A.Some natural ways to increase norepinephrine levels will involve some form of stress to the body, since this neurotransmitter kicks in during stress. Great examples of would be cold exposure, fasting and exercise.
Cryotherapy is an effective way to boost norepinephrine and was found to be beneficial for managing MS. Read the details here.
Fasting (short-term, intermittent fasting) also increases norepinephrine levels [1] and can help improve MS. More details here.
Exercise is another great way to bring your norepinephrine levels up [2].
B. Amino Acid Therapy
The amino acids tyrosine and phenylalanine are the precursors of norepinephrine (as well as dopamine), thus eating foods rich in these amino acids or taking supplements can help.
Phenylalanine
Foods : Phenylalanine is an essential amino acid found in the brain and blood plasma that can convert to tyrosine, which in turn is used to make dopamine and norepinephrine. Best sources of phenylalanine are protein rich foods like meats (especially chicken, turkey, duck, wild game), eggs, fish and seafood, dairy (especially cottage cheese and ricotta) beans, legumes, banana, chocolate, coffee, some seeds and nuts [3]. Banana peels contain significant amounts of norepinephrine and dopamine [23]. Phenylalanine is particularly helpful for managing fatigue and pain.
Supplements : phenylalanine is available in three forms: DL, D, and L Phenylalanine. L-Phenylalanine form is mostly used to form tyrosine. D-phenylalanine is the mirror form of L-phenylalanine and is created in laboratory (phenylalanine from foods is in L form). DL is a combination of D, and L Phenylalanine. Cautions: phenylalanine can cause anxiety and heart palpitations, especially in high doses. Should not be used if you are pregnant or you are breastfeeding, or if you have high blood pressure. It can also interact with certain antidepressants ( MAOIs and SSRIs).
Tyrosine
Raising tyrosine levels is a better, more effective way to boost norepinephrine and dopamine levels. According to research, the brain concentration of tyrosine can be raised with diet (even after a single meal with higher protein (tyrosine rich) meal). Furthermore, studies found that raising the brain tyrosine concentration stimulates the production of norepinephrine, epinephrine (adrenaline) and dopamine. An extra reason to take tyrosine and not phenylalanine: stress can interfere with the conversion of phenylalanine to tyrosine; in this case supplementation with phenylalanine could not boost the levels of norepinephrine or dopamine [4]. Other studies also found that norepinenephrine, dopamine and serotonin levels can be increased with dietary changes [5].
Food sources of tyrosine: meats (duck, chicken, turkey, wild game), dairy products (cottage cheese and ricotta), almonds, avocados, banana.
Supplements : Acetyl-l-tyrosine has greater bioavailability than other forms of tyrosine. Overall, tyrosine is better tolerated than phenylalanine. Cautions: Like phenylalanine, this supplement should not be taken in higher than recommended dosage as it may cause anxiety, irritability and heart palpitations. Tyrosine can interfere with MAOIs antidepressants, and thyroid hormone medications.
Acetyl-L-carnitine (ALCAR)
Acetyl-L-carnitine (ALCAR) is another amino acid that help increase the levels of norepinephrine and serotonin. It can be taken in supplement form, although exercise and fasting can naturally increase ALCAR [6] .
C. Other supplements
Phosphatidylserine [7] and the cofactors (involved in the production of norepinephrine) should also be considered : B vitamins (B6,B3 and B9), biopterin (a form of folic acid), iron, copper and vitamin C.
All supplements that raise dopamine levels may help boost norepinephrine levels because dopamine is the precursor of norepinephrine. Read this article about ways to raise dopamine levels naturally or with meds. Also consider the cofactors involved in the conversion dopamine to norepinephrine- the most important ones being cooper and vitamin C.
D. Herbs
Some herbs that increase the levels of norepinephrine (human and animal studies) include curcumin [8] , mucuna pruriens [ 9] , green tea extracts [10] , ginkgo biloba [11] or resveratrol [12]. Some herbs stimulate the immune system, while other herbs are immuno supressive (note: prescription drugs are immunosuppressants). Another classification would take into consideration different immune system cells involved in autoimmunity (TH1, TH2, TH17, TH9 etc) and see which herbs can improve the autoimmune reaction- more research is needed in this field.
2 Prescription Drugs that Boost Norepinenphrine
I will cover here only two classes of prescription meds – those that specifically work by increasing norepinephrine levels : NARIs (noradrenaline reuptake inhibitors- example: reboxetine, atomoxetine and SNRIs (serotonin and noradrenaline reuptake inhibitors: duloxetine, venlafaxine, desvenlafaxine)
Some of these drugs had been researched for MS in several studies, and showed mixed results. For example atomoxetine did not help recover from MS (animal models) nor improved cognitive function in Alzheimer’s disease ( human studies). The researchers believe that NARIs don’t work when the norepinephrine producing neurons are damaged (as it happens in MS). Other drugs that are synthetic precursors of norepinephrine (desipramine, L-DOPS) did show some benefits [12].
Norepinephrine does not cross the blood brain barrier, thus you need NARIs and SNDRIs to enhance the norepinephrine levels in the brain. However, intravenous norepinephrine is used in extreme cases of low blood pressure- in emergency situations (shock). Be aware of the side effects of these drugs. Duloxetine and venlafaxine are on the FDA watch list for serious side effects, along with other 7 antidepressants [23].
3. Coffee, alcohol, nicotine, and cannabis
Perhaps this would be a good time to cover some controversial topics: coffee, alcohol, nicotine, and cannabis (marijuana).
The bad: it appears that one of the key reasons why these substances are abused is because they raise the norepinephrine levels (although the levels of this neurotransmitter fluctuates due to various factors). Noradrenergic (norepinephrine system) signaling is modulated soon after these substances are used, may be affected by chronic use, can rebound during withdrawal and are also influenced by chronic stress [13].
The good : there is a lot of research going on that covers their health benefits. While some studies found conflicting results, these are the general trends : coffee consumption may be protective against MS [14] .The occasional glass of red wine appears to be OK as well [15].
Nicotine patches and gums are currently researched for various brain conditions (in animal model of MS [16] , human studies in Parkinson’s [17], Alzheimer’s [18] , ADHD [19] , cases of mild cognitive impairment [20]. Keep in mind that the health benefits come from nicotine in patch and gum form. Cigarette smoking are clearly linked with MS development and progression, thus should be completely avoided.
Prescription drug Sativex is approved in several countries for managing MS. It is a formulated extract of the cannabis sativa plant (marijuana) that contains the principal cannabinoids THC and CBD [22].
