Concussion

Concussion Supplement Protocol

A concussion involves damage to the brain caused by acute trauma. The brain is actually a gelatinous consistency and is easily disrupted by acceleration forces that can occur in blows, whiplashes, and falls. It involves inflammation and damaged brain tissue.

  • Headache or “pressure” in the head.
  • Nausea or vomiting.
  • Balance problems or dizziness, or double or blurry vision.
  • Bothered by light or noise.
  • Feeling sluggish, hazy, foggy, or groggy.
  • Confusion, or concentration or memory problems.
  • Just not “feeling right,” “feeling down” or emotional changes.

Nutrition for concussion involves targeting the inflammation and promoting the healing of the tissues. Healing can be slow, incomplete, and frustrating.

I have put together a list that research has found can be helpful in speeding up and improving healing. The supplements include Magnesium threonate, Resveratrol, Turmeric, Vitamin D3, Vitamin C, and others.

Go to my Fullscript Dispensary store to see the list and find pecific dosing, additional information, and ordering information. There is also a discount on all orders. Just create your account by clicking below. Then go to Recommendations – Protocols – Concussion.

Dr. Michels FullScript Dispensary – us.fullscript.com/welcome/JordanMichels

Bone and Joint Healing

The structure of our body is made of Connective tissue. It is the primary protein of connective tissue is collagen which like other proteins is made within cells by forming chains of amino acids. Connective tissue is an important component of skin, muscle, tendons, ligaments, cartilage and bones as well as many other tissues. Collagen is formed by three chains that form a triple helix in a rope like fashion. Collagen fibrils are given increased strength by being bound together with sulfur bonds. In bone tissue the collagen matrix becomes mineralized with calcium crystals.

Connective tissues can become damaged due to age, injury, inflammation, surgery, autoimmune disease. With age the tissue repair mechanisms of our cells become slowed.

Synovial joints are surrounded by tissues that contain lubrication fluids. One of the primary lubricants is hyaluronic acid.

Nutritionally, there are several nutritional strategies to aid the repair and maintenance of bones and joints.

  1. Raw materials for healing such as: Glucosamine, Chondroitin, MSM, Collagen, Sulfur, Collagen and hyaluronic acid.
    • Glucosamine is an important component of cartilage. It is made in the body by combining the sugar glucose with the amino-acid glutamine. Cartilage is a strong rubbery lubricating material found in joints. Injuries can damage cartilage. It also tends to breakdown with age. Many natural repair processes including cartilage slow down with age and disease. Studies show oral glucosamine helps with many types of joint pain, reduces inflammation, and promotes healing of joints.
    • Chondroitin is made in the body by polymerizing Glucosamine into larger chains. Oral Chondroitin has similar properties as glucosamine. But it appears the combination works the best.
    • MSM – stands for Methylsulfonylmethane. It is naturally found in certain plants and is derived from DMSO. It functions as an anti-oxidant and as a source of sulfur which gives collagen its strength by bonding strands of collagen together. Collagen is the main structural protein of the body including bones, cartilage, muscles, tendons and skin.
    • Collagen – cannot be absorbed without being broken down first. Still it will provide all the amino acids needs for the body to manufacture new collagen.
  1. Nutrients to support healing metabolism involved in healing processes such as trace minerals and vitamins such as: Manganese, Selenium, Zinc, Copper, and Niacin, and SamE.
  2. Reduce inflammation such as Turmeric and Boswellia. See additional information on the Inflammation protocol post.

 

Below are a few specific supplements that can achieve these goals. Specific dosing, additional information and ordering information (and a discount on all orders) can be found at my FullScript Dispensory. Just create your account by clicking below. Then go to Recommendations – Protocols – Joint Health and Repair.

Dr. Michels FullScript Dispensory – us.fullscript.com/welcome/JordanMichels

  • ArthroSoothe: gives joints nutritional support for repair, lubrication, free movement, and healthy function. Contains vitamins, minerals, herbs and nutrients to support healing, lubrication, and reduce inflammation. This is a combination formula with nutrients in all three above categories.
  • Glucosamine, Chondroitin, and MSM capsules.
  • Whole Body Collagen: Collagen Peptides powder. Mixes easily. Pleasant mild taste.
  • Bioactive Collagen Complex: Bone & Joint Support: Contains collagen, vitamins, minerals, and nutrients to support joint healing, lubrication.
  • SamE – (S-adenosyl-L-methionine): It is naturally found in the body and seems to promote healing of cartilage and reduces inflammation. Studies show reduced pain and improved joint function. If you have bipolar disease or take antidepressants check with your doctor.

Paleo Diet and Supplementation

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Paleo diet is a simple concept. It is a shift of one’s diet to approximate the diet that humans ate during their evolution. In other words, it is an effort to eat the foods we are most adapted to eat. Evolution takes hundreds of thousands of years to evolve major adaptations to dietary changes. Although, humans have a remarkably flexible digestive system and metabolism any long-term shifts in diet away may push this flexibility to its limits resulting in disease and decreased well-being.

The great thing is that you can’t really do it wrong. It is a set of principles that one can easily incorporate to any degree you like. If you like the diet you can get more serious about it. The Paleo principles can also easily be adapted to a low carb, weight loss or Keto diet. It can also be adapted to a low lectin diet (see Dr. Gundry’s work) by eliminating all nightshades, grains, legumes and animals fed with these foods).

One paleo principle that needs special mention is that the Paleolithic diet was extremely varied. It is a hunter/gatherer diet there was minimal food storage and no refrigeration. The diet was very dependent on seasonal availability and exploiting many micro environments and their plants and animals. This variety of foods resulted in avoiding the toxins and increasing the nutrients that can result from our over-reliance on a handful of species (such as wheat and soy).

Grains and Starches: Grains were not domesticated until about 10,000 years ago, thus are somewhat foreign to the evolutionary diet. Starches are composed of glucose (sugar) molecules.  Thus, generally they easily convert to sugars stressing our sugar based metabolic pathways. This can lead to blood sugar issues and diabetes. These starches and sugars can also provide too much food to yeasts and certain bacteria, throwing our flora out of balance and thereby causing lots of digestive issues and having far reaching effects on the brain and immune system. Generally, the Paleo diet is noted for reduced levels of easily converted (low glycemic) starches and especially grains (especially wheat). Grains were not domesticated till maybe 10,000 years ago. In addition to the starches grains also contain many compounds that can cause issues such as lectins (chemicals plants produce especially is seeds and skins to deter animals from eating them). Most root vegetables contain starches with low glycemic index due to being high in fiber and having starch molecules resistant to our enzymes (resistant starches – see fiber below). Thus, root vegetables are often a preferred form of starch. White potatoes are not ideal but acceptable occasionally in moderation (potato starch is too readily broken down). Some better starches are yam, cassava root or four, plantain, squash, onion, beets and carrots.

Flour: Some of the common flours that can be used instead of wheat or grain fours are cassava (ground yucca root), tapioca (yucca starch), arrowroot, coconut four (fiber), chestnut flour, and nut flours (especially almond and hazelnut).

Fruit: Fruit in excess have lots of sugars and can cause many of the same issues as in starches above. Fruits were a great calorie source in season and have some nutrients and antioxidants and fiber (see below). However, many modern fruits have been selected for size and increased sweetness. Small fruits are more nutrient dense. Brightly colored fruits are higher in antioxidants. Most berries are a better choice than large sweeter fruits. Other fruits can certainly be used in moderation. Fruit and vegetable based powders are an easy and tasty way to supplement (see below).

Sugars: Natural sugars were only found in small amounts in the Paleolithic diet. Refined sugars and artificial sweeteners are avoided. Small amounts of honey, maple syrups, dates and other dried fruit can be used in small amounts. Stevia is a good non-caloric sweetener. Erythritol and Xylitol can be used. They are natural sugar alcohols that the body can’t absorb or metabolize so they do not affect blood sugar. Similarly, the bacteria and yeasts that cause cavities and harmful biofilms in the gut can’t eat these sugars so they have an inhibitory effect on these problems.

Proteins: The main protein sources of the paleolithic diet was animals fed on grasses and wild foods. This resulted in high levels of Omega 3 oils and low levels of omega 6 oils. When this ratio gets reversed it pushes the body to increased inflammation. The omega 3s have many important functions in hormones, the cell membrane and the nervous system particularly. Eggs and dairy products should also be grass-fed. The amount of protein eaten by our paleolithic ancestors probably varied considerably at different times and locations. But generally, fish, eggs, poultry, and red meat was a vital part of most paleolithic diets. Insects and reptiles were often an important component of the diet. Most of us will forgo these foods. But cricket powder is highly nutritious, low on the food chain, and available on Amazon.

No Paleolithic groups were vegetarian or vegan and it not easy to maintain a satisfactory diet as a vegan. Eggs are a concentrated, nutritious source of protein. Dairy (see below) and protein powders made from these are available. Eggs and dairy should be grass-fed. Also, in the suggestions below is a mushroom fermented pea protein that would be a good source of plant protein for those wanting to reduce animal-based proteins.

Nuts were an important part of the paleolithic diet. They generally are a great source of minerals, protein and fats. The best nuts are filberts, almonds walnuts, macadamia, cashews, pistachios and pine nuts. Sunflower seeds, sesame seeds, chia seeds, flax seeds, pumpkin seeds can all be used. These can be eaten raw. Digestibility can be increased and lectins decreased by sprouting or soaking followed by low temperature roasting.

Vegetables: The Paleolithic diet consisted of lots of green matter. The modern diet has much less vegetable matter and diversity. These greens supply vitamins, minerals, trace minerals anti-oxidants and many other compounds needed by the body.The Paleo diet was very high in vegetables. Fruit and vegetable based powders are an easy and tasty way to supplement (see below).

Legumes like grains were not probably eaten in quantity until 10,000 years ago. Like grains, they are full of anti-nutrients such as lectins. They can be eaten in small amounts of these antinutrients are reduced by pressure cooking, soaking, fermentation, etc., but only if tolerated.

Fats – MCT’s and Omega 3s: Polyunsaturated fats coming from grains and seeds were rare in the Paleolithic diet. These polyunsaturated fats can easily go rancid in the body causing many problems such as free radicals and toxic waste. The exception was omega 3 fats produced by grass and algae, and concentrated in cold water fish and to some degree in grass fed animal products (see proteins above). Mono-unsaturated fats are found in nuts, avocado and olive oils and are generally beneficial. Saturated fats also found in meat and dairy are generally healthy and a good source of energy. Confusion remains as the medical establishment taught for years that saturated fats caused heart disease. They do not. One group of fats needs special mention, Medium chain fatty acids (MCTs). These are especially found in coconuts. They are considered the healthiest fat as they are so easily converted into energy, including in the brain (which requires a huge amount of our total energy). Vegetable oils (other than olive, avocado, hazelnut and coconut) should generally be avoided.

Dairy: Dairy would have been a rare find in Paleolithic times. Yet, dairy in moderate amounts is acceptable in the forms of grass-fed animals’ butter and cream and fermented foods such as yogurt and kefir and small amounts of cheese. Do not use cow products if sensitive. Milk and Lactose containing dairy should be avoided.

Fiber and resistant starches from fruit, vegetables and roots would have been a much bigger part of the diet in Paleolithic times. These fibers slow the absorption of sugars into the blood and feed beneficial bacteria in the gut. These bacteria are essential to prevent the wrong bacteria and yeast from growing and play an important role in digestion, the immune system and the nervous system. Resistant starches are resistant to the enzymes of digestion. These starches are converted to sugars much more slowly minimizing the above problems. Fiber and resistant starches feed beneficial bacterial improving digestion, microflora, regularity and reducing small intestinal bacterial overgrowth (SIBO). For this resistant they are often referred to prebiotics, and in the long run may be more important than probiotics (good bacteria cultures). Resistant starches are common in many root vegetables, such as yam and cassava. Glucomannan is one such starch found in Konjac root.

Protein and Meal Bars: These can be a great way of eating right, on the run with high quaity protein, fats and fiber and keeping carbs to a minimum.

Vegetables: The Paleolithic diet consisted of lots of green matter. The modern diet has much less vegetable matter and diversity. These greens supply vitamins, minerals, trace minerals anti-oxidants and many other compounds needed by the body.

Modern indulgences consistent with the paleo diet. Dark chocolate, coffee, tea, mate and red wine in moderation have many antioxidants.

Avoid: Over refined foods, artificial sweeteners, polyunsaturated vegetable oils (see fats above).

Lifestyle factors:

  • Intermittent fasting: Food was not available every time we were hungry. We evolved to primarily utilize fat burning metabolism except in the short periods after meals. Eating whenever we are hungry or bored creates a lazy metabolism that predisposes us to obesity, diabetes, and metabolic syndrome (causing high blood pressure, high blood fats, and high blood sugar and increase cardiovascular disease risk).
  • Interval training: This is the occasional short bursts of extreme exercise pushing our anaerobic metabolism to the extreme. It is part of the paleolithic lifestyle as it was necessary for hunting or when being chased by predators. This type of exercise has long term positive metabolic effects.

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Supplements to help with the Paleo diet: 

Sign-up for Dr. Michels FullScript Dispensary:
https://us.fullscript.com/welcome/jordanmichels

This will allow you to set up an account, see pricing and order.

Once in the store navigate to the Catalog, then to Categories.
Then you should see the four categories right below where it says Dr. Michels Fullscript Store Categories.
Click on the Paleo-Friendly and you will see all the  products listed below.
Links for the products below will work if your fullscript account is set-up and logged in.

  Protein and Meal Powders

  • Pure PaleoMeal Vanilla: Good tasting meal replacement with complete bovine protein, MCTs, fiber, vitamins and minerals.
  • Pure PaleoMeal Chocolate: Good tasting meal replacement with complete bovine protein, MCTs, fiber, vitamins and minerals.
  • KTO-360™ Powder: Good tasting meal replacement. features collagen protein, MCTs, avocado oil, butter and fiber.
  • Mycopure Golden Mild: Plant based protein (rice and pea) fermented with shitake. with mushroom extracts, minerals and turmeric.
  • Mycopure Chocolate: Plant based protein (rice and pea) fermented with shitake. with mushroom extracts and minerals.
  • Whole Body Collagen: Collagen for bone, joint and skin.
  • WheyBasics: Highly purified, undenatured whey protein per serving in a great-tasting, naturally flavored formula.
  • Egg White Protein – Chocolate: 100% derived from egg albumen, and is produced from a superior extraction process allowing for easy mixability and digestion.
  • Egg White Protein – Vanilla: 100% derived from egg albumen, and is produced from a superior extraction process allowing for easy mixability and digestion.

Medium Chain Fatty Acids

  • MCT Colada: Emulsified tasty MCT oil. Easily dispersed, easily absorbed. Pineapple coconut flavor.
  • MCT Liquid: Pure MCT oil.
  • KTO-C8 Chewables 60t: Tasty chewy treats with 500 mg. caprylic acid. Watermelon/Strawberry flavor. very low carb.
  • KTO-C8 Liquid: Pure Caprylic Acid (a MCT)

Omega 3 Fatty Acids

Fibers

  • PaleoFiber Unflavored powder: Twelve type of hypo-allergenic not irritating fibers.
  • PaleoFiber® RS: Resistant starch powder from green banana and potato starch.
  • Glucomannan 575mg Capsules: Soluble bulking fiber can aid in weight management, constipation, digestion.
  • Glucomannan Powder: Soluble bulking fiber can aid in weight management, constipation, digestion.

Protein Bars, Meal Bars and Fiber Bars

  • Chocolate Mint Fiber Bar: Delicious, high fiber bar containing a generous 14 g of dietary fiber per serving, prebiotics, no sugar.
  • Ketogenic Coconut Hemp Chocolate Bar: Low carb chocolate with hemp and pumpkin seed protein, almond and sunflower butter and coconut.
  • Cocommune Bar: Chocolate Coconut Bar with prebiotic fibers an no added sugar.
  • EssentiaBar Double Dark Chocolate: Delicious bar optimizing the intake of proteins, fats, carbohydrates, and micronutrients with whey and rice protein, omega 3 and prebiotics.
  • NRG Meal Bar: Chocolate coated bar with whey protein, L-carnitine, coenzyme Q10 (ubidecarenone) and vitamin E.
  • P.B. Meal Bar: Chooclate/Peanut butter bar with whey and pumpkin seed protein.
  • Pure PaleoBar: A great-tasting chocolate flavored nutrition bar which features a true Paleo profile, with bone broth protein isolate, hemp protein, and pumpkin seed and coconut oil.

Fruit and Vegetable Powders

  • PaleoGreens – Lemon/Lime: A great tasting food made with over 90% organic ingredients, vegetable, fruit, and berry and grass juices.
  • PaleoGreens – Unflavored: A great tasting food made with over 90% organic ingredients, vegetable, fruit, and berry and grass juices.
  • Paleo Reds – Strawberry: Great tasting fruit powder. Over a dozen fruits and vegetables and their phytonutrients from the red/purple group, 80% organic and antioxidant rich.

Natural Supplements Before and During Acute Viral Infections

Lonicera japonica (honeysuckle)

 

How to Decrease the Risk of Getting Sick and Minimize Complications of Acute Viral Conditions:

Acute viral infections can be dangerous in themselves and by creating over zealous immune responses. Respiratory infections of course can affect our breathing and cause pneumonia. But they can also cause damage to many other organs. This information is for educational purposes and is not meant as treatment or diagnosis. If you have serious symptoms consult with a physician.

There are four major ways supplements and herbs can help with acute viral infections.  Following are some the supplements that may have the biggest protective effects. The supplements are listed into four categories.

These four categories are listed as separate protocols in my “Full Script” store. Listed in each category are some excellent products containing the ingredients or herbs in the lists below. At the end of the lists below are some additional notes on some of these supplements and herbs. These lists and the notes will be updated as I find out more information, as research progresses and as I have time to make additional notes.

Dr. Michels Full Script Dispensary:

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A. Immune system optimization (before infection).

Firstly, are the supplements that can help generally improve the effectiveness of the immune system. This can help prior to infection for several reasons. One example is by improving the “innate” immune system. This can destroy infected cells before a virus can get established which can prevent infection or decrease severity (many viral infections are dose dependent).

  • Vitamin C
  • Vitamin D3
  • Zinc
  • Selenium
  • Copper
  • Melatonin
  • Elderberry
  • Medicinal mushrooms

B. Antiviral Supplements.

Secondly, there are many supplements and herbs that have direct effects on stopping the virus from being able to infect cells or by preventing their ability to replicate within the cells. They can do this by binding to viral structures or by block enzymes needed for entering cells or replicating. The ones listed in bold are also good due to other mechanisms or have other general benefits for health. The ones listed in bold are also useful for more than one category or have general health benefits. They can be used before a possible infection. All of them can be used after infection.

  • Vitamin C
  • Zinc
  • Copper
  • Glutathione
  • Quercetin
  • Andrographis
  • Licorice
  • Lonicera
  • Scutellaria

C. Calming the Immune System

Thirdly, there are many supplements that may decrease the risk of an immune overreaction such as the cytokine storm that can wreak more damage than the infection itself. The ones listed in bold are also useful for more than one category or have general health benefits. They can be used before a possible infection. All of them can be used after infection.

  • Vitamin C
  • Vitamin D3
  • Melatonin
  • Astaxanthin
  • Elderberry
  • Turmeric
  • Glutathione
  • N-Acetyl Cysteine (NAC)
  • Ashwagandha
  • Artemisia annua

D. Protecting the Body

Lastly, there are many supplements that may help protect tissues and organs from the oxidative and other damaging effects of infection and inflammation. The ones listed in bold are also useful for more than one category or have general health benefits. They can be used before a possible infection. All of them can be used after infection.Vitamin C

  • Melatonin
  • Astaxanthin
  • Nicotinamide Riboside
  • Boswellia

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Notes and Supplements:

Most of these supplements can be found in the products listed on my Full Script Webstore. They are organized in the same functional categories as they are above. Sometimes several products containing the same supplements are listed to allow for preference (such as powder or capsule). All supplements should be checked for safety if pregnant and for any interactions with medications. Dosages suggested below are for adults and may need to be adjusted for children.

To go to the store:
https://us.fullscript.com/welcome/jordanmichels

This will allow you to set up an account, see pricing and order.

Once in the store navigate to the Catalog, then to Categories.
Then you should see the four categories right below where it says Dr. Michels Fullscript Store Categories (A, B, C, and D).
Click on the desired category and you will see all the suggested products Dr. Michels has recommended for that group.
Links for the products below will work if your account is set-up and logged in.

 

  • Vitamin C (A,B,C,D): Is the only nutrient that is all four categories above. For category A the suggested dose is 1-4 grams daily. For Category B-D I would recommend 5-10 grams as mineral ascorbates such as C+ BioFiz Powder (with bioflavonoids)or Bufffered Vitamin C Capsules. Too much can cause diarrhea (it helps to split the dose into 2-4 times to increase absorption and decrease digestive issues). To increase vitamin C absorption more add a liposomal vitamin C product one teaspoon 2-4 times a day. For acute illness use both ascorbates and liposomal to maximize.
  • Vitamin D3 (A,C): Acts as a hormone in the body. Vitamin D status as determined by blood test has a strong correlation to outcome of many viral diseases. 5,000-10,000 i.u. per day is a reasonable dose to take in the absence of a blood test. It can be adjusted accordingly when a blood test is available. Get some sunshine when weather and season allow to build up stores. Consider a boost of 50,000 i.u. at onset of symptoms. Avilable in 5,000 i.u. D3 capsules or 10,000 i.u. D3 capsules.
  • Zinc (A,B): is especially active in categories A and B. Dose best not exceed 30 mg (Zinc Supreme). Zinc lozenges may be particularly useful as the zinc will directly contact the tissues of the throat. However, make sure you add up the mg. of zinc taken in lozenges so as not to exceed 30 mg. daily total.
  • Copper(A,B): Zinc supplementation can cause a copper deficiency. Also, copper has anti-viral properties of its own. Suggested dose is 2 mg. per day (Copper Citrate).
  • Selenium (A): Is a common deficiency. Recommended dose is 200 mcg. per day.
  • Elderberry (A,C):: is a traditional supplement for strengthening and balancing the immune system. Several studies have shown benefits for decreasing length and severity of respiratory viral illnesses. There was a concern that it might aggravate the “cytokine storm”. Current thinking is that is not a problem. Elderberry is an ingredient in the general immune strengthening supplements Immunotone Plus and ImmunoBerry Liquid (great for kids). It is also available as Elderberry Liquid.
  • Medicinal Mushrooms: M/R/S Mushrooms is a blend of Maitake, Reishi and Shitake mushrooms. Take as directed. Mushrooms are also in Immunotone Plus.
  • Melatonin (A,C,D):: is usually thought of a sleep aid. But it is an important antioxidant and plays a role in immune function. As a general supplement 0.5-3 mg is generally good (if it leaves you drowsy in the morning decrease dose). When sick dosage can be 10-40 mg. per day divided into 2 doses. Melatonin Liposomal Spray offers good absorption and adjustable dosing.
  • Quercetin (B):: It makes sense to take this preventatively as well as if you develop symptoms, as it is safe and many benefits. It is an anti-viral. It is one of naturally occurring bioflavonoids. There is a small amount is the C+ BioFizz (along with some other bioflavonoids). And it is available separately in the Quercetin Plus, which has been formulated for improved absorption (quercetin is generally poorly absorbed).
  • Glutathione (B,C): The most potent antioxidant the body produces. It is also important in the function of the innate immune system. It is easily destroyed by the digestive process. Liposomal Glutathione bypasses digestion and is directly absorbed through the mucosa.
  • N-Acetyl Cysteine (NAC)  (B, C) is an amino acid that is a precursor to glutathione.
  • Anti-Viral Herbs (B):: Andrographis, Licorice, Lonicera, and Scutellaria all have anti-viral properties. If one has viral symptoms or been diagnosed consider using them in combination. Essential Defense is a herbal combination with Lonicera and Licorice as well as many other herbs. Andrographis is available as Andrographis (capsules). Licorice is available as Licorice Plus (with Ashwagandha). Scutellaria is available as Scullcap Herb (capsules).  These can all be taken as directed on the label.
  • Turmeric (C): Contains the active ingredient curcumin. It is widely used for its safe and effective anti-inflammatory properties. It is available in Turmeric capsules. Dosage is 1-2 caps. 2-3 x per day, or in a emulsified liquid form (better absorption) Turmero Active (micronized). Dosage is 1 tea. 1-2 x per day.
  • Ashwagandha (C): It is available as Ashwandha (capsules)
  • Artimesia annua (C):Also know as sweet wormwood seems to help calm the excess inflammation and excess cytokines. It is available as Artimesia. Use as directed on bottle.
  • Boswellia (D): Also known as Frankincense is available as an extract Boswellia AKBA. Take as directed.
  • Nicotinamide Riboside (D): is a precursor to NAD+ an intracellular energy currency and may help prevent cell death in stressed cells. It is available as Nicotinamide Riboside. Take 100 mg once or twice daily.