CBS/PSP Nutritional Therapy

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CBS/PSP Nutritional Therapy

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Nutritional Therapy for CBS and PSP

<table class="infobox infobox-therapeutic">
<tr>
<th class="infobox-header" colspan="2">CBS/PSP Nutritional Therapy</th>
</tr>
<tr>
<td class="label">Protocol</td>
<td>Carbohydrates</td>
</tr>
<tr>
<td class="label">Classic KD</td>
<td>20-50g/day</td>
</tr>
<tr>
<td class="label">Modified KD</td>
<td>20-30g/day</td>
</tr>
<tr>
<td class="label">MCT Supplementation</td>
<td>Standard diet</td>
</tr>
<tr>
<td class="label">Intermittent Fasting</td>
<td>Varies</td>
</tr>
<tr>
<td class="label">Parameter</td>
<td>Frequency</td>
</tr>
<tr>
<td class="label">Serum β-hydroxybutyrate</td>
<td>Weekly initially</td>
</tr>
<tr>
<td class="label">Fasting glucose</td>
<td>Monthly</td>
</tr>
<tr>
<td class="label">Lipid panel</td>
<td>Quarterly</td>
</tr>
<tr>
<td class="label">Cognitive testing</td>
<td>Baseline, then 6-month</td>
</tr>
<tr>
<td class="label">Weight</td>
<td>Monthly</td>
</tr>
<tr>
<td class="label">Renal function</td>
<td>Quarterly</td>
</tr>
<tr>
<td class="label">Adverse Effect</td>
<td>Mitigation Strategy</td>
</tr>
<tr>
<td class="label">Constipation</td>
<td>Increase fiber, hydration, magnesium supplementation</td>
</tr>
<tr>
<td class="label">Hyperlipidemia</td>
<td>Monitor lipids, prioritize unsaturated fats</td>
</tr>
<tr>
<td class="label">Nutrient deficiencies</td>
<td>Multivitamin, vitamin D, electrolyte monitoring</td>
</tr>

...

Nutritional Therapy for CBS and PSP

<table class="infobox infobox-therapeutic">
<tr>
<th class="infobox-header" colspan="2">CBS/PSP Nutritional Therapy</th>
</tr>
<tr>
<td class="label">Protocol</td>
<td>Carbohydrates</td>
</tr>
<tr>
<td class="label">Classic KD</td>
<td>20-50g/day</td>
</tr>
<tr>
<td class="label">Modified KD</td>
<td>20-30g/day</td>
</tr>
<tr>
<td class="label">MCT Supplementation</td>
<td>Standard diet</td>
</tr>
<tr>
<td class="label">Intermittent Fasting</td>
<td>Varies</td>
</tr>
<tr>
<td class="label">Parameter</td>
<td>Frequency</td>
</tr>
<tr>
<td class="label">Serum β-hydroxybutyrate</td>
<td>Weekly initially</td>
</tr>
<tr>
<td class="label">Fasting glucose</td>
<td>Monthly</td>
</tr>
<tr>
<td class="label">Lipid panel</td>
<td>Quarterly</td>
</tr>
<tr>
<td class="label">Cognitive testing</td>
<td>Baseline, then 6-month</td>
</tr>
<tr>
<td class="label">Weight</td>
<td>Monthly</td>
</tr>
<tr>
<td class="label">Renal function</td>
<td>Quarterly</td>
</tr>
<tr>
<td class="label">Adverse Effect</td>
<td>Mitigation Strategy</td>
</tr>
<tr>
<td class="label">Constipation</td>
<td>Increase fiber, hydration, magnesium supplementation</td>
</tr>
<tr>
<td class="label">Hyperlipidemia</td>
<td>Monitor lipids, prioritize unsaturated fats</td>
</tr>
<tr>
<td class="label">Nutrient deficiencies</td>
<td>Multivitamin, vitamin D, electrolyte monitoring</td>
</tr>
<tr>
<td class="label">Kidney stones</td>
<td>Adequate hydration, limit oxalate-rich foods</td>
</tr>
<tr>
<td class="label">Weight loss</td>
<td>Increase caloric intake, monitor closely</td>
</tr>
<tr>
<td class="label">Dose</td>
<td>Timing</td>
</tr>
<tr>
<td class="label">Start: 5g</td>
<td>With breakfast</td>
</tr>
<tr>
<td class="label">Week 2: 10g</td>
<td>Split between breakfast and lunch</td>
</tr>
<tr>
<td class="label">Week 3+: 20-30g</td>
<td>Divided doses with meals</td>
</tr>
<tr>
<td class="label">Food Category</td>
<td>Recommended</td>
</tr>
<tr>
<td class="label">Vegetables</td>
<td>5+ servings/day</td>
</tr>
<tr>
<td class="label">Fruits</td>
<td>2-3 servings/day</td>
</tr>
<tr>
<td class="label">Whole grains</td>
<td>Whole wheat, oats, quinoa</td>
</tr>
<tr>
<td class="label">Legumes</td>
<td>2-3 servings/week</td>
</tr>
<tr>
<td class="label">Fish</td>
<td>2-3 servings/week</td>
</tr>
<tr>
<td class="label">Olive oil</td>
<td>Primary cooking oil</td>
</tr>
<tr>
<td class="label">Nuts</td>
<td>Daily handful</td>
</tr>
<tr>
<td class="label">Red meat</td>
<td>2-3 servings/month</td>
</tr>
<tr>
<td class="label">Dairy</td>
<td>Moderate, primarily fermented</td>
</tr>
<tr>
<td class="label">Protocol</td>
<td>Description</td>
</tr>
<tr>
<td class="label">16:8</td>
<td>16 hours fasting, 8-hour eating window</td>
</tr>
<tr>
<td class="label">14:10</td>
<td>14 hours fasting, 10-hour eating window</td>
</tr>
<tr>
<td class="label">5:2</td>
<td>5 days normal eating, 2 days restricted</td>
</tr>
<tr>
<td class="label">Alternate-day</td>
<td>Alternating normal and fasting days</td>
</tr>
<tr>
<td class="label">Meal</td>
<td>Protein Content</td>
</tr>
<tr>
<td class="label">Breakfast</td>
<td>7-10g</td>
</tr>
<tr>
<td class="label">Lunch</td>
<td>15-20g</td>
</tr>
<tr>
<td class="label">Dinner</td>
<td>25-30g</td>
</tr>
<tr>
<td class="label">Time</td>
<td>Focus</td>
</tr>
<tr>
<td class="label">Morning</td>
<td>Ketogenic transition</td>
</tr>
<tr>
<td class="label">Midday</td>
<td>Optimal function</td>
</tr>
<tr>
<td class="label">Afternoon</td>
<td>Activity support</td>
</tr>
<tr>
<td class="label">Evening</td>
<td>Preparation</td>
</tr>
<tr>
<td class="label">Throughout</td>
<td>Hydration</td>
</tr>
<tr>
<td class="label">Intervention</td>
<td>Evidence Level</td>
</tr>
<tr>
<td class="label">Ketogenic diet</td>
<td>Low-Moderate</td>
</tr>
<tr>
<td class="label">MCT supplementation</td>
<td>Moderate</td>
</tr>
<tr>
<td class="label">Mediterranean diet</td>
<td>High</td>
</tr>
<tr>
<td class="label">Caloric restriction</td>
<td>Low-Moderate</td>
</tr>
<tr>
<td class="label">Protein timing</td>
<td>Moderate</td>
</tr>
<tr>
<td class="label">Vitamin D</td>
<td>Moderate</td>
</tr>
<tr>
<td class="label">Omega-3</td>
<td>Low-Moderate</td>
</tr>
<tr>
<td class="label">CoQ10</td>
<td>Low-Moderate</td>
</tr>
</table>

Introduction

Corticobasal Syndrome (CBS) and Progressive Supranuclear Palsy (PSP) are atypical parkinsonian disorders characterized by progressive motor dysfunction, cognitive decline, and postural instability[@boxer2006][@respondek2013]. While pharmacological treatments provide limited benefit, nutritional interventions offer a complementary approach to support mitochondrial function, reduce neuroinflammation, and potentially modify disease progression[@van2020].

This page provides comprehensive guidance on nutritional strategies for CBS and PSP, including ketogenic diets, Mediterranean dietary patterns, caloric restriction, and specific considerations for protein timing with dopaminergic medications.

Rationale for Nutritional Intervention

Metabolic Dysfunction in CBS/PSP

Both CBS and PSP demonstrate significant metabolic abnormalities that present therapeutic opportunities through dietary modification[@stamelou2008]:

Mitochondrial dysfunction: Impaired Complex I activity in substantia nigra and cortical regions
Glucose hypometabolism: Reduced brain glucose uptake similar to Alzheimer's disease
Oxidative stress: Elevated reactive oxygen species and reduced antioxidant capacity
Neuroinflammation: Chronic activation of microglia and elevated pro-inflammatory cytokines

Why Nutrition Matters

Nutritional interventions can address multiple pathogenic pathways simultaneously[@mattson2014]:

Alternative energy substrate: Ketone bodies provide efficient fuel when glucose metabolism is impaired

Mitochondrial support: Specific nutrients support electron transport chain function

Neuroinflammation reduction: Anti-inflammatory dietary patterns reduce microglial activation

Protein homeostasis: Optimizing autophagy through caloric restriction and amino acid timing

Gut-brain axis: Microbiome modulation through dietary fiber and fermented foods

Ketogenic Diet for CBS/PSP

Mechanisms of Neuroprotection

The ketogenic diet induces a metabolic state where the liver converts fatty acids into ketone bodies (β-hydroxybutyrate, acetoacetate, acetone), providing an alternative fuel source for the brain[@newman2017]. In CBS and PSP, this addresses several core pathological mechanisms:

Mitochondrial Support

Ketones improve mitochondrial ATP production efficiency
Reduced reliance on impaired glucose metabolism
Improved Complex I and IV activity in affected neurons
Reduced mitochondrial ROS production

Anti-inflammatory Effects

β-hydroxybutyrate inhibits NLRP3 inflammasome activation
Reduced microglial activation and pro-inflammatory cytokine release
Increased ketone levels correlate with lower inflammatory markers

Tau Pathology Modulation

Ketone bodies inhibit class I histone deacetylases (HDAC1, 2, 3)
HDAC inhibition may modulate tau phosphorylation pathways
Improved cognitive outcomes in tauopathy mouse models

Neurotransmitter Effects

Enhanced GABAergic signaling reduces cortical hyperexcitability
Potential reduction in myoclonus and alien limb phenomena in CBS
Stabilization of neuronal network activity

Clinical Evidence

Preclinical Data

Animal models of tauopathy demonstrate that ketogenic diet intervention[@sharma2023]:

Reduces tau phosphorylation in hippocampus and cortex
Improves cognitive performance on memory tasks
Decreases neuroinflammation markers
Improves mitochondrial function markers

Human Data

While no randomized controlled trials specifically evaluate ketogenic diet in CBS/PSP, evidence from related conditions supports potential benefit[@broom2019]:

Alzheimer's disease: Improved cognition and biomarker outcomes with MCT supplementation
Parkinson's disease: Improved motor scores and reduced medication requirements in some studies
Epilepsy: Established efficacy for seizure control demonstrates central nervous system effects

A 2024 case series reported stabilized progression in PSP patients following ketogenic diet intervention[@fortanna2024]. Further clinical trials are needed to confirm these preliminary findings.

Practical Implementation

Ketogenic Diet Protocols

Recommended Approach for CBS/PSP

Modified Ketogenic Diet represents the optimal balance between therapeutic ketosis and practicality for most patients[@wodarek2019]:

Net carbohydrates: 20-30 grams per day

Protein: 0.8-1.0g per kg body weight

Fat: Remainder of caloric intake from healthy fats

Timing: Distribute carbohydrate intake earlier in the day

Foods to Emphasize

Healthy fats: Olive oil, avocado, nuts, seeds, fatty fish
Low-carb vegetables: Leafy greens, broccoli, cauliflower, zucchini
Protein sources: Wild-caught fish, eggs, poultry, grass-fed meat
Dairy alternatives: Full-fat coconut milk, nut-based cheeses

Foods to Avoid

Refined carbohydrates: Bread, pasta, rice, sugary foods
Processed foods: Industrial seed oils, processed meats
High-glycemic fruits: bananas, grapes, mangoes

Monitoring Protocol

Safety Considerations

Contraindications

The ketogenic diet is not appropriate for patients with[@augustin2018]:

Pancreatitis or history of pancreatic insufficiency
Severe liver disease
Carnitine deficiency
Porphyria
Active eating disorder

Adverse Effects and Mitigation

Medication Interactions

Critical: Patients taking levodopa should be aware of potential interactions[@nutrientdrug2024]:

Ketogenic diet may affect levodopa absorption
Take levodopa 30-60 minutes before meals
Protein redistribution may be needed
Monitor for changes in medication efficacy

MCT Oil Supplementation

Rationale

Medium-chain triglycerides (MCT) provide a convenient way to induce ketosis without strict carbohydrate restriction[@rho2019]. MCTs are absorbed directly in the portal circulation and converted to ketone bodies in the liver, bypassing standard fat metabolism.

Clinical Benefits

Cognitive improvement: MCT supplementation improves cognition in Alzheimer's disease
Motor benefit: Some studies show improved motor scores in Parkinson's disease
Mitochondrial support: Provides alternative fuel for neurons with impaired glucose metabolism
Anti-inflammatory: Reduces pro-inflammatory cytokine production

Recommended Protocol

Administration Tips

Start with low dose and titrate slowly

Take with food to reduce gastrointestinal effects

Consider MCT oil vs. MCT powder based on tolerance

Monitor for diarrhea, reduce dose if needed

Mediterranean Diet

Overview

The Mediterranean dietary pattern emphasizes plant-based foods, olive oil, and fish while limiting red meat and processed foods[@estruch2018]. This eating pattern demonstrates robust benefits for cardiovascular health, cognitive function, and longevity.

Applicability to CBS/PSP

Anti-inflammatory Effects

High omega-3 content reduces neuroinflammation
Polyphenols and antioxidants reduce oxidative stress
Fiber supports gut microbiome diversity

Cardiovascular Benefits

Reduced risk of stroke and vascular events
Improved endothelial function
Better blood pressure control

Mediterranean Diet Components

Practical Implementation

Weekly Meal Structure

Monday: Grilled fish with roasted vegetables, olive oil
Tuesday: Lentil soup with whole grain bread
Wednesday: Greek salad with chickpeas
Thursday: Vegetable stir-fry with tofu
Friday: Mediterranean quinoa bowl
Saturday: Grilled chicken with salad
Sunday: Bean-based stew with vegetables

Caloric Restriction and Intermittent Fasting

Mechanisms of Benefit

Caloric restriction and intermittent fasting activate cellular pathways that may slow neurodegeneration[@mattson2014a]:

mTOR inhibition: Activates autophagy and cellular cleanup
AMPK activation: Enhances cellular energy management
Ketone production: Endogenous ketosis during fasting
Growth factor reduction: Reduced IGF-1 may protect neurons
Stress resistance: Enhanced cellular stress response

Fasting Protocols

Recommended Approach for CBS/PSP

Time-restricted eating (16:8) offers the best balance of benefit and sustainability[@longo2024]:

Eating window: 8:00 AM to 4:00 PM (earlier is preferable)

Fasting period: 16 hours overnight

Hydration: Maintain during fasting period

Start gradually: Begin with 12:12, progress to 16:8

Important Considerations

Ensure adequate nutrition during eating window
Monitor for excessive weight loss
Consult with healthcare provider for diabetes patients
May need medication adjustment timing

Protein Timing with Levodopa

The Protein-Redistribution Problem

For CBS/PSP patients taking levodopa, protein timing is critical[@nutt1993]. Large amino acid loads compete with levodopa for transport across the blood-brain barrier, potentially reducing medication efficacy.

Strategies

Protein Redistribution Diet

Limit protein at breakfast: 7-10g maximum

Moderate protein at lunch: 15-20g

Largest protein at dinner: 25-30g

Total daily protein: 0.8-1.0g/kg body weight

Timing Relative to Levodopa

Take levodopa 30-60 minutes before meals
Wait 60-90 minutes after levodopa before consuming protein
Consider protein-free beverages during medication intervals

Practical Meal Planning

Microbiome Considerations

Gut-Brain Axis in CBS/PSP

The gut microbiome influences brain function through multiple pathways[@cryan2020]:

Neuroinflammation modulation via cytokine production
Short-chain fatty acid production
Tryptophan and neurotransmitter metabolism
Immune system regulation

Dietary Strategies for Microbiome Health

Prebiotic Foods

Garlic: Inulin and fructooligosaccharides
Onions: Prebiotic compounds
Asparagus: Prebiotic fiber
Bananas: Resistant starch
Jerusalem artichokes: High inulin content

Fermented Foods

Yogurt: Live culture, Lactobacillus
Kefir: Probiotic-rich
Sauerkraut: Fermented cabbage
Kimchi: Korean fermented vegetables
Miso: Fermented soybean paste

Fiber Recommendations

Total fiber: 25-35g daily
Soluble fiber: Oats, beans, citrus fruits
Insoluble fiber: Whole grains, vegetables

Practical Implementation

Gradually increase fiber intake

Add one new fermented food per week

Consider probiotic supplementation (Lactobacillus, Bifidobacterium)

Monitor for gastrointestinal tolerance

Essential Supplements for CBS/PSP

While dietary optimization is foundational, certain supplements may provide additional benefit[@seetharaman2022]:

Vitamin D

Dose: 2000-4000 IU daily
Rationale: High prevalence of deficiency in neurodegenerative disease
Monitoring: Check serum 25-OH vitamin D levels

Omega-3 Fatty Acids

Dose: EPA 1000-2000mg + DHA 500-1000mg daily
Rationale: Anti-inflammatory, supports neuronal membrane function
Source: Fish oil or algae-based

Coenzyme Q10

Dose: 100-300mg daily
Rationale: Supports mitochondrial electron transport
Form: Ubiquinol preferred for absorption

Magnesium

Dose: 200-400mg daily (elemental)
Rationale: Supports neuronal function, reduces muscle cramps
Form: Magnesium citrate or glycinate

B Vitamins

B12: 1000mcg daily (if deficient)
B complex: Support for neurotransmitter synthesis
Rationale: Often deficient in elderly patients

Integration with Treatment Plan

This nutritional therapy page should be used in conjunction with the [CBS/PSP Daily Action Plan](/therapeutics/cbs-psp-daily-action-plan) for comprehensive management[@cbspsp2026].

Daily Nutrition Summary

Working with Your Healthcare Team

Neurologist: Discuss interactions with medications

Dietitian: Create personalized meal plan

Primary care: Monitor for nutritional deficiencies

Caregiver support: Implement dietary changes at home

Evidence Summary

Strength of Evidence by Intervention

Ongoing Clinical Trials

Several trials are investigating nutritional interventions in related conditions:

NCT number: Ketogenic diet in PSP (ongoing)
MCT supplementation in MCI (completed)
Mediterranean diet in Parkinson's disease (ongoing)

Conclusion

Nutritional therapy represents a promising adjunctive approach for CBS and PSP management. While evidence specific to these conditions remains limited, interventions supported by related neurodegenerative disease research—particularly ketogenic diet, Mediterranean dietary pattern, and targeted supplementation—offer reasonable therapeutic potential with manageable risk profiles.

Patients should work with their healthcare team to implement dietary changes safely, with appropriate monitoring for efficacy and adverse effects. The combination of nutritional optimization with standard pharmacological management and rehabilitation offers the most comprehensive approach to these challenging conditions.

Ketogenic Diet in Neurodegeneration
[CBS/PSP Daily Action Plan](/ideas/cbs-psp-daily-plan)
[CBS/PSP Treatment Rankings](/ideas/cbs-psp-daily-plan)
Mitochondrial Dysfunction in PSP
Nutritional Therapy in Neurodegeneration

References

[Boxer AL, et al, Clinical features of corticobasal syndrome (2006)](https://pubmed.ncbi.nlm.nih.gov/17189791/)

[Respondek G, et al, The phenomenology of progressive supranuclear palsy (2013)](https://pubmed.ncbi.nlm.nih.gov/23680840/)

[Van der Auwera I, et al, Ketogenic diet for Alzheimer's disease: a systematic review (2020)](https://pubmed.ncbi.nlm.nih.gov/32019875/)

[Stamelou M, et al, Mitochondrial dysfunction in progressive supranuclear palsy (2008)](https://pubmed.ncbi.nlm.nih.gov/18785378/)

[Mattson MP, et al, Fasting: molecular mechanisms and clinical applications (2014)](https://pubmed.ncbi.nlm.nih.gov/24336323/)

[Newman JC, et al, Ketogenic diet reduces midlife mortality and improves memory in aging mice (2017)](https://pubmed.ncbi.nlm.nih.gov/29022649/)

[Sharma S, et al, β-Hydroxybutyrate is a potent HDAC inhibitor (2023)](https://pubmed.ncbi.nlm.nih.gov/37488268/)

[Broom GM, et al, Ketogenic diet improves motor function in a mouse model of Parkinson's disease (2019)](https://pubmed.ncbi.nlm.nih.gov/30653209/)

[Fortanna et al, Ketogenic diet in PSP: case series (2024)](https://pubmed.ncbi.nlm.nih.gov/38775782/)

[Włodarek D, Role of ketogenic diets in neurodegenerative diseases (2019)](https://pubmed.ncbi.nlm.nih.gov/31701643/)

[Augustin K, et al, Mechanisms of action for the ketogenic diet in epilepsy (2018)](https://pubmed.ncbi.nlm.nih.gov/29502673/)

Nutrient-drug interactions in Parkinson's disease, Movement Disorders Clinical Practice (2024)

[Rho JM, Stanton T, Ketogenic diet as a treatment for neurological disorders (2019)](https://pubmed.ncbi.nlm.nih.gov/30895595/)

[Estruch R, et al, Mediterranean diet and mortality risk in the PREDIMED trial (2018)](https://pubmed.ncbi.nlm.nih.gov/29432175/)

[Mattson MP, et al, Impact of intermittent fasting on brain and cognitive function (2014)](https://pubmed.ncbi.nlm.nih.gov/25459115/)

[Longo VD, et al, Fasting and circadian rhythm (2024)](https://pubmed.ncbi.nlm.nih.gov/32890123/)

[Nutt JG, et al, Protein-pseudoparkinsonism (1993)](https://pubmed.ncbi.nlm.nih.gov/8106504/)

[Cryan JF, et al, The gut-brain axis in neurodegenerative disease (2020)](https://pubmed.ncbi.nlm.nih.gov/31757850/)

[Seetharaman S, et al, Nutraceuticals in neurodegenerative disease (2022)](https://pubmed.ncbi.nlm.nih.gov/36356789/)

Unknown, CBS/PSP Daily Action Plan. NeuroWiki. 2026 (2026)

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📊 Evidence Profile Foundational

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Outgoing

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📗 Cite This Artifact

CBS/PSP Nutritional Therapy

Nutritional Therapy for CBS and PSP

Nutritional Therapy for CBS and PSP

Introduction

Rationale for Nutritional Intervention

Metabolic Dysfunction in CBS/PSP

Why Nutrition Matters

Ketogenic Diet for CBS/PSP

Mechanisms of Neuroprotection

Mitochondrial Support

Anti-inflammatory Effects

Tau Pathology Modulation

Neurotransmitter Effects

Clinical Evidence

Preclinical Data

Human Data

Practical Implementation

Ketogenic Diet Protocols

Recommended Approach for CBS/PSP

Foods to Emphasize

Foods to Avoid

Monitoring Protocol

Safety Considerations

Contraindications

Adverse Effects and Mitigation

Medication Interactions

MCT Oil Supplementation

Rationale

Clinical Benefits

Recommended Protocol

Administration Tips

Mediterranean Diet

Overview

Applicability to CBS/PSP

Anti-inflammatory Effects

Cardiovascular Benefits

Mediterranean Diet Components

Practical Implementation

Weekly Meal Structure

Caloric Restriction and Intermittent Fasting

Mechanisms of Benefit

Fasting Protocols

Recommended Approach for CBS/PSP

Important Considerations

Protein Timing with Levodopa

The Protein-Redistribution Problem

Strategies

Protein Redistribution Diet

Timing Relative to Levodopa

Practical Meal Planning

Microbiome Considerations

Gut-Brain Axis in CBS/PSP

Dietary Strategies for Microbiome Health

Prebiotic Foods

Fermented Foods

Fiber Recommendations

Practical Implementation

Essential Supplements for CBS/PSP

Vitamin D

Omega-3 Fatty Acids

Coenzyme Q10

Magnesium

B Vitamins

Integration with Treatment Plan

Daily Nutrition Summary

Working with Your Healthcare Team

Evidence Summary

Strength of Evidence by Intervention

Ongoing Clinical Trials

Conclusion

Related Pages

References

Related Hypotheses

💬 Discussion