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SSRI/antidepressant impact on the microbiome, discontinuation syndrome and safe tapering

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ssri antidepressant impact

Antidepressants can have an antibiotic effect, causing dysbiosis and impacting serotonin, GABA and dopamine production. This can cause psychiatric symptoms and even suicidal thoughts or behaviors. Various SSRI (selective serotonin reuptake inhibitors) and SNRI (serotonin norepinephrine reuptake inhibitors) have more of an effect than others. And the top known side effects for SSRIs are gut symptoms: nausea, diarrhea and vomiting.

These medications are seldom prescribed with informed consent and can cause severe psychological, cognitive, physical and neurological withdrawal side effects (also known as discontinuation syndrome). A functional medicine and nutritional approach using 5-HTP, GABA, theanine and glycine can often be used to smooth the taper process.

Dr. Achina Stein addresses all this in her interview, SSRI Impact on the Microbiome and Safe SSRI Tapering, on The Anxiety Summit 5: Gut-Brain Axis, which will be airing online Nov 8-14, 2021.

achina stein and trudy scott

We cover the following:

  • Antibiotic effect of antidepressants: dysbiosis and impacts on serotonin/GABA/dopamine
  • Withdrawal/discontinuation syndrome symptoms of SSRIs and benzodiazepines
  • 5-HTP, GABA, theanine and glycine to smooth the taper process

Here are a few snippets from our interview.

We start with a discussion on the antibiotic effect of antidepressants and a review of this paper – Serotonin Reuptake Inhibitors and the Gut Microbiome: Significance of the Gut Microbiome in Relation to Mechanism of Action, Treatment Response, Side Effects, and Tachyphylaxis.

Dr. Stein comments on this study sharing how SSRIs affect the gut and microbiome in many different ways:

  • “This paper is important. It’s one of several papers that talk about how the SSRIs or serotonin reuptake inhibitors affect the gastrointestinal tract. And as you know, the gastrointestinal tract is really full of serotonin.
  • SSRIs, as well as other psychotropic medications, actually exert an antibiotic effect, which can have a direct consequence in disrupting the integrity and stability of the gut microbiome.
  • And the ones that are most likely to do that are Sertraline, fluoxetine, and paroxetine in that order. And it’s followed by fluvoxamine, escitalopram, and citalopram, having the least impact.
  • What they’re noticing is that this antibiotic effect actually results in dysbiosis.
  • The top known side effects for SSRIs are gut symptoms: nausea, diarrhea, vomiting.
  • We know that the gut microbiome has a significant effect on emotions, behaviors, and metabolic changes.
  • And it’s involved in the metabolism of drugs, and this combination is what really causes psychiatric symptoms and even suicidal thoughts or behaviors.”

She also talks about the bidirectional gut-brain connection/communication, the microbiome and short-chain fatty acids (which are a common theme you’ll hear throughout the summit):

  • “There is this huge connection between the gut microbiome and the brain.
  • And there’s also other indirect communication pathways because we’ve always wondered, well, how does this happen that the gut is connected to the brain?
  • So the other pathways which are more indirect are the hypothalamic-pituitary-adrenal axis.
  • And there’s also an immune-mediated connection where there’s a communication between short-chain fatty acids and microglia in the brain.
  • So short-chain fatty acids are the main metabolites produced by the microbiota in the large intestine through bacterial fermentation of indigestible polysaccharides, which are dietary fiber and resistant starch. And they possess neuroactive properties. So they influence the communication between these short-chain fatty acids between the gut and the microglia of the brain.
  • And it’s a bidirectional communication too.”

And we talk about tachyphylaxis or the poop-out effect of antidepressants.

The discussion on the SSRI (selective serotonin reuptake inhibitors) and SNRI (serotonin norepinephrine reuptake inhibitors) discontinuation syndrome (or withdrawal symptoms) is eye-opening and sobering, Here are just a few of the many psychological symptoms that she says patients may experience when tapering:

I’m just going to read them off because I think it’s important for people to know: mood swings, unstable moods, hypomania, hyperarousal, anxiety, medication-induced agitation – which is described as being caffeinated – impulsive behavior, aggression, irritability, crying spells, lowered mood or depression.

Dr. Stein also shares the many cognitive, physical and neurological side effects, and how she works with her patients with a functional medicine and nutritional approach to try and mitigate the side effects. She likes to use 5-HTP, GABA, theanine and glycine to smooth the taper process.

We also have a lengthy discussion about informed consent and the fact that it’s not happening and should be.

We do a deep dive into all this and much more.

The interviews that dove-tail well with this topic are as follows:

  • My interviews, GABA & Tryptophan: Gut-Anxiety Connections and Glutamine, DPA and Tyrosine for Anxiety and Sugar Cravings. The amino acids help during the  tapering process and help you make the dietary changes.
  • Thiamine Deficiency in Anxiety and Gut Health (Part 1 and 2) with Chandler Marrs. She talks about how medications can deplete thiamine. Could this contribute to some of the severe discontinuation syndrome symptoms we see?
  • Anxiety, Gut-Brain Communication and Diet with David Perlmutter, MD, FACN, ABIHM. This one gives you an excellent overview of the gut-brain communication and fermented foods, short-chain fatty acids and histone deacetylases (HDACs).
  • Gut-Brain Axis and Mental Health with Peter Bongiorno, ND, LAc. This is also a great overview on the mental health impacts of the microbiome. He goes deep into serotonin and GABA production mechanisms.

I encourage you to register and tune in if you have:

  • Anxiety & feel overwhelmed & stressed by little things
  • Panic attacks &/or obsessive thoughts or behaviors
  • Social anxiety/pyroluria
  • Phobias or fears (flying, spiders or even driving on a highway)

And also if you suffer from…

  • Food sensitivities, IBS/SIBO, parasites or gallbladder issues
  • Constipation, diarrhea, bloating, gas, pain & other digestive issues
  • Leaky gut, a leaky blood-brain barrier or vagus nerve issues

Join us if you are also an emotional eater with intense sugar cravings (and know you suffer from low blood sugar), experience insomnia, low mood, PMS, poor focus and/or low motivation.

This is THE online event to learn about the powerful individual amino acids – GABA, theanine, tryptophan, 5-HTP, glutamine, DPA and tyrosine – to quickly ease anxiety and help with gut symptoms while you are dealing with other root causes which take longer to address. (They also help with cravings as with this example, and sleep and immunity).

anxiety summit 5

With research-based anxiety nutritional solutions and practical steps, you can determine your root causes, ease your anxiety and prevent it from coming back so you can feel on top of the world again!

If you are a practitioner, please join us too and find advanced solutions for your clients or patients too!

You’ve heard me say the Anxiety Summit has been called “a bouquet of hope!”  My wish for you is that this summit is your bouquet of hope!

I hope you’ll join me and these incredible speakers, be enlightened and find YOUR solutions!

Here’s to no more anxiety and you feeling on top of the world again!

Register now

 

How have antidepressants impacted your gut and digestion?

Have you experienced discontinuation syndrome when tapering from an SSRI or SNRI or benzodiazepines? And have diet and the amino acids helped smooth the taper process?

Feel free to post your questions here too.

Fatigue, sleep disorders, depression, anxiety, fibromyalgia and cardiac troubles as the expression of a classic mild thiamine deficiency

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coffee sugar thiamine

Fatigue, sleep disorders, depression, anxiety, fibromyalgia and cardiac troubles are some of the symptoms we see as the expression of a classic mild thiamine deficiency. Thiamine deficiency is very under-rated and under-recognized, and can have far reaching ramifications. And a magnesium deficiency and high dose magnesium can actually cause a thiamine deficiency. There are also many other causes of thiamine deficiency that may not be on your radar: a high carb/processed food/sugar diet, coffee, tea, alcohol, genetics, environmental toxins, medications, celiac disease, leaky gut, bariatric surgery and malabsorption.

It’s for this reason that I invited Chandler Marrs, PhD to speak on the Anxiety Summit 5: Gut-Brain Axis. We had so much to cover and it ended up being so long, that we split it into part 1 and part 2.

chandler marrs

This is what we cover in Thiamine Deficiency in Anxiety and Gut Health (Part 1)

  • Excessive carbs, alcohol, medications and genetics as causes of low B1/thiamine
  • Dysbiosis, dysmotility, constipation, anxiety, depression, panic attacks, low energy
  • Psychiatric and digestive effects: research, history and other symptoms

This is what we cover in Thiamine Deficiency in Anxiety and Gut Health (Part 2)

  • The mitochondria, dysautonomia and POTS
  • Other symptoms: hyperemesis, exercise intolerance, muscle pain, neuropathy
  • Thiamine supplementation – forms, dosing and paradoxical reactions

Thiamine deficiency is under-rated and under-recognized

We start with why it’s an under-rated and under-recognized deficiency and Dr. Marrs shares that the assumption is that deficiency is not common and even when you test it looks like you are not deficient:

  • “The assumption is that there is no such thing [as a thiamine deficiency] and that it’s rare unless you are a chronic alcoholic. And even then, it’s missed 80% of the time. Or you have a severe injury or illness that depletes thiamine rapidly.
  • The presumption is that we’ve solved it, and it’s rare, and it only happens in countries where food availability is problematic.
  • The reality is that the chemistry of our foods, the chemistry of our environment, the medications that we take all combine and accrue to not only deplete the available thiamine on the basis of intake but to increase the need and to damage a lot of the enzymes involved in the processing of thiamine.
  • So a lot of folks are functionally deficient in that even though by definition they meet the daily requirement and they may, based upon lab testing, show up as being sufficient and not frankly deficient.
  • And so, I think that we just have taken our eye off of the ball with regard to this particular nutrient.”

Magnesium deficiency (and high dose magnesium) can actually cause a thiamine deficiency

Dr. Marrs also shares how a magnesium deficiency (which is very common) can actually cause a thiamine deficiency:

  • “One of the things that’s interesting is it requires magnesium to activate thiamine into its active form.
  • If someone is thiamine sufficient and magnesium deficient, then they are actually functionally deficient in thiamine because you cannot take the free thiamine and activate it into thiamine pyrophosphate.
  • So magnesium deficiency itself can cause thiamine deficiency. And there’s a good percentage of the population that doesn’t get enough magnesium.”

And she also shares how when taking high dose magnesium it’s so crucial to also be addressing low thiamine in order to prevent them becoming more thiamine deficient:

  • “Now, the flip side of that is really interesting. And I think this is important for your audience, in particular, is that magnesium supplementation, when someone has a problem with thiamine, will actually shut down thiamine processing and mitochondrial processing at one of the enzymes. Because if you don’t have thiamine with magnesium, then the enzyme α-ketoglutarate dehydrogenase kind of shuts the whole sequence down.
  • So if you are giving someone high dose magnesium, which is common to supplement, and not tackling the thiamine as well, you risk them becoming more thiamine deficient and reducing ATP output, energy output even further. So everything has to be in balance to some extent or another.” 

I can think of one situation where this could be common. You use high dose magnesium due to constipation. Low thiamine may be one of the underlying causes of your constipation and now high dose magnesium is going to make the low thiamine situation worse.

Up to 30% of psychiatric patients have a thiamine deficiency

We talk about how up to 30% of psychiatric patients have a thiamine deficiency but that there hasn’t been enough work on psychiatric disorders which Dr. Marrs says “is strange given the fact that some of the strongest symptoms involve brain function and the most dangerous or some of the more dangerous damage is relative to areas of the brain.”

I share some quotes from a 2019 paper that does actually look at the psychiatric aspects – Neurological, Psychiatric, and Biochemical Aspects of Thiamine Deficiency in Children and Adults:

  • “The brain is highly vulnerable to thiamine deficiency due to its heavy reliance on mitochondrial ATP production. This is more evident during rapid growth, i.e., perinatal and children.
  • Thiamine deficiency contributes to a number of conditions spanning from mild neurological and psychiatric symptoms, confusion, reduced memory, sleep disturbances, and severe encephalopathy, ataxia, congestive heart failure, muscle atrophy, and even death.”

This paper also looks at the beneficial effect of thiamine supplementation in autism spectrum disorder (ASD) and other neurological conditions.

Below, I share some additional studies that we didn’t talk about in the interview but add value to the topic.

Fatigue, sleep disorders, depression, anxiety, fibromyalgia and cardiac troubles as the expression of a classic mild thiamine deficiency

This paper, High-dose thiamine improves the symptoms of fibromyalgia, states that “It is our opinion that fatigue, sleep disorders, depression, anxiety and cardiac troubles are the expressions of a classic mild thiamine deficiency.”

The authors share 3 cases where thiamine/vitamin B1 improved symptoms in all areas for all these women:

  • Patient 1: Female, 58 years old, weight 59 kg. From 1998, the patient began to have widespread pain accompanied by severe fatigue, depression, anxiety, irritability, sleep disorders, trouble concentrating, dry skin, general sickness, continuous headache, intolerance to low temperatures and, more recently, episodes of tachycardia and extrasystolia [alteration in heart rhythm].
  • Patient 2: Female, 37 years old, weight 74 kg. From 1999, the patient has had widespread pain and all the symptoms described for patient 1, with the only exception being that of cardiac symptoms.
  • Patient 3: Female, 60 years old, weight 65 kg. From 2006, the patient began to have widespread pain, fatigue, depression, anxiety, sleep disorders. Trouble concentrating.

As you can see the symptoms can be very varied and this is what makes it challenging to identify low thiamine as being the issue.

Thiamine deficiency after bariatric surgery

Here one case study where thiamine deficiency occurred after bariatric surgery: Wernicke’s encephalopathy mimicking multiple sclerosis in a young female patient post-bariatric gastric sleeve surgery:

We describe a case of Wernicke’s encephalopathy secondary to thiamine (B1) deficiency in a patient status post-bariatric sleeve gastrectomy.

The presenting symptoms of new-onset weakness, diplopia [double-vision], and confusion in a young female patient raised suspicion for multiple sclerosis (MS), but given a history of bariatric surgery, thiamine levels were checked, revealing significant Vitamin B1 (thiamine) deficiency.

This case highlights the importance of thorough history taking, as a misdiagnosis of MS in this case could have resulted in irreversible neurological deterioration and hematological and infectious consequences associated with the inappropriate administration of disease-modifying therapies.

Bariatric surgery is one of many causes of thiamine deficiency.

Some of the other many causes of thiamine deficiency

Other causes of thiamine deficiency include factors that may not be on your radar: a high carb/processed food/sugar diet (and even consistent smaller amounts of “healthy” sweeteners), coffee and tea consumption, alcohol consumption (excessive consumption and even moderate consumption i.e. social drinking), genetics (we talk about specific genes in the interview), environmental toxins, certain medications, celiac disease, leaky gut and malabsorption etc.

We do a deep dive into all this in the two interviews (and much more).

chandler marrs interview
(As you can see, when I do interviews I take notes throughout for a few reasons: writing consolidates the information into my brain and it allows me to make notes for follow-up questions. It also helps the video editing process later.)

Interviews that dove-tail well with this topic are these ones:

  • Michael Collins – Sugar/Fructose Addiction: Anxiety, ADHD and Aggression (because sugar and carbs lead to low thiamine)
  • My interviews, Glutamine, DPA and Tyrosine for Anxiety and Sugar Cravings and GABA & Tryptophan: Gut-Anxiety Connections (because the amino acids help you quit sugar/carbs, coffee and alcohol easily)
  • Tara Hunkin, NTP, CGP, RWP – Mitochondrial Dysfunction in Anxiety (because low thiamine adversely affects the mitochondria)

I encourage you to register and tune in if you have:

  • Anxiety & feel overwhelmed & stressed by little things
  • Panic attacks &/or obsessive thoughts or behaviors
  • Social anxiety/pyroluria
  • Phobias or fears (flying, spiders or even driving on a highway)

And also if you suffer from…

  • Food sensitivities, IBS/SIBO, parasites or gallbladder issues
  • Constipation, diarrhea, bloating, gas, pain & other digestive issues
  • Leaky gut, a leaky blood-brain barrier or vagus nerve issues

Join us if you are also an emotional eater with intense sugar cravings (and know you suffer from low blood sugar), experience insomnia, low mood, PMS, poor focus and/or low motivation.

This is THE online event to learn about the powerful individual amino acids – GABA, theanine, tryptophan, 5-HTP, glutamine, DPA and tyrosine – to quickly ease anxiety and help with gut symptoms while you are dealing with other root causes which take longer to address. (They also help with cravings as with this example, and sleep and immunity).

anxiety summit 5

With research-based anxiety nutritional solutions and practical steps, you can determine your root causes, ease your anxiety and prevent it from coming back so you can feel on top of the world again!

If you are a practitioner, please join us too and find advanced solutions for your clients or patients too!

You’ve heard me say the Anxiety Summit has been called “a bouquet of hope!” My wish for you is that this summit is your bouquet of hope!

I hope you’ll join me and these incredible speakers, be enlightened and find YOUR solutions!

Here’s to no more anxiety and you feeling on top of the world again!

Register now

 

Please share if these thiamine deficiency symptoms are new to you.

Also let us know if you’ve benefited from thiamine in the past or are currently using some form of thiamine – and how helped/is helping.

Have you seen this correlation between low magnesium and low thiamine OR taking high doses of magnesium and low thiamine symptoms?

Feel free to post your questions here too.

“A demonic urge to eat sugar and all things sweet”: glutamine opened onto the tongue stops the urge every time!

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sugar urge and glutamine

In my interview, Glutamine, DPA & Tyrosine for Anxiety & Sugar Cravings, on the Anxiety Summit 5: Gut-Brain Axis, I share the story of a client of mine who described her sugar cravings as an “almost demonic urge  to eat sugar and all things sweet.”

Before working with me she had been trying to control her blood sugar levels by eating the right foods at the right times i.e. healthy fats and quality protein (especially at breakfast). But this wasn’t enough to eliminate her sweet cravings. She would make and eat sweet treats all day long, using “healthier” sweeteners like monk fruit and maple syrup.

The solution was using 500mg of glutamine opened onto her tongue. I had the same conversation  that  I have with all my clients who would obviously rather eat something sweet than open a glutamine capsule onto  their tongue: “If you have an intense craving for something sweet, tell yourself that  you’re  going to  indulge, but also humor your nutritionist and take the glutamine anyway. You may be surprised to find your urge completely disappears.”

She did that and it worked –  it stopped her demonic urge to eat something sweet every time and very quickly!

As a reminder here are the signs of low blood sugar –

Anxiety and mood:

  • Nervous, anxious, panic attacks
  • Irritable, shaky, headachey – especially if you go too long between meals
  • Lightheaded if meals are missed
  • Agitated, easily upset
  • Eating relieves fatigue

Sugar cravings:

  • Crave sugar, starch or alcohol any time during the day
  • Very intense cravings for sweets/sugar

I also share an excerpt from this March 2021 paper, The role of glutamine in supporting gut health and neuropsychiatric factors, highlighting the role of glutamine in gut health and depression/anxiety, and the gut-brain connection:

Glutamine can positively affect gut health by supporting the gut microbiome, gut mucosal wall integrity, and by modulating inflammatory responses.

As modulated by the vagus nerve, via the enteric nervous system, the gut-brain connection can impact the brain’s neurochemical environment.

Poor gut health can disrupt the balance of neurotransmitters, which can result in neuropsychiatric based conditions such as depression [and anxiety].

Glutamine supplementation may provide significant adjunctive nutritional support in cases of depression [and anxiety] by promoting proper gut health.

anxiety summit 5

Here are all the topics I cover in my interview:

  • Sugar addiction: impacts on the microbiome, tryptophan metabolism, zinc & B vitamins
  • Glutamine for intense sugar cravings, anxiety & support of the microbiome/mucosa
  • DPA for comfort/reward cravings, pain & acute stress
  • Tyrosine for focus & calm energy

Dr. Aimie Apigian, MD, kindly interviewed me. She is also a guest expert on the summit so be sure to tune into her excellent interview too: The Biology of Trauma and the Freeze Response.

I encourage you to register and tune in if you have:

  • Anxiety & feel overwhelmed & stressed by little things
  • Panic attacks &/or obsessive thoughts or behaviors
  • Social anxiety/pyroluria
  • Phobias or fears (flying, spiders or even driving on a highway)

And also if you suffer from…

  • Food sensitivities, IBS/SIBO, parasites or gallbladder issues
  • Constipation, diarrhea, bloating, gas, pain & other digestive issues
  • Leaky gut, a leaky blood-brain barrier or vagus nerve issues

Join us if you are also an emotional eater with intense sugar cravings (and know you suffer from low blood sugar), experience insomnia, low mood, PMS, poor focus and/or low motivation.

This is THE online event to learn about the powerful individual amino acids – GABA, theanine, tryptophan, 5-HTP, glutamine, DPA and tyrosine – to quickly ease anxiety and help with gut symptoms while you are dealing with other root causes which take longer to address. (They also help with cravings as with this example, and sleep and immunity).

anxiety summit 5

With research-based anxiety nutritional solutions and practical steps, you can determine your root causes, ease your anxiety and prevent it from coming back so you can feel on top of the world again!

If you are a practitioner, please join us too and find advanced solutions for your clients or patients too!

You’ve heard me say the Anxiety Summit has been called “a bouquet of hope!”  My wish for you is that this summit is your bouquet of hope!

I hope you’ll join me and these incredible speakers, be enlightened and find YOUR solutions!

Here’s to no more anxiety and you feeling on top of the world again!

Register now

Please share if glutamine has helped you with low blood sugar symptoms such as an intense desire for something sweet.

Feel free to post your questions here too.

Fermented foods (like sauerkraut) and the bidirectional relationship between anxiety/depression and gut function

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fermented foods

Today’s blog is to whet your appetite (pun intended) with some snippets from my interview – Anxiety: Gut-Brain Communication & Diet – with Dr. David Perlmutter, author of Grain Brain and Brain Wash. In this interview we talk about fermented foods (like sauerkraut) and a study that highlights mechanisms underlying the  bidirectional relationship between anxiety/depression and gut function.

With anxiety at an all-time high and the ever-evolving research on the gut-brain connections we are relaunching the Anxiety Summit 5: Gut-Brain Axis summit on November 8-14, 2021. This interview is featured during the summit and is meaty (you’d expect nothing less from Dr. Perlmutter.)

The two-way connection between the gut and brain is powerful and needs to be explored and addressed if you have anxiety. Diet, fermented foods, reducing inflammation, addressing leaky gut (or intestinal permeability) and neurotransmitter support with amino acids are some of the ways that make a difference.

For the summit relaunch we have 4 incredible new guest expert interviews on sugar addiction, thiamine deficiency, trauma and the freeze response and safe tapering of SSRIs. And I have a new deep dive interview on glutamine, DPA and tyrosine for anxiety and sugar cravings/addiction. I’m excited to share it all with you!

For now, save the date and look out for the registration link in a few weeks. We’re in edit mode for the videos and transcripts, and getting all the backend setup done.

This is the first question I ask Dr. Perlmutter: I’d like to start with the microbiome and the fact that there is a bidirectional relationship between mental health and gut function. There’s a paper titled, Fermented foods, the gut and mental health: a mechanistic overview with implications for depression and anxiety published online late 2018 in The Journal of Nutritional Neuroscience. It highlights this important bidirectional relationship and the role of fermented foods. Can you share a little bit more about this and why this is important?

Before I share Dr. Perlmutter’s response, let me share a few quotes from the abstract of the paper:

  • Mental disorders including depression and anxiety are often comorbid with gut problems, suggesting a bidirectional relationship between mental health and gut function.
  • Several mechanisms might explain this comorbidity, such as inflammation and immune activation; intestinal permeability; perturbations in the hypothalamic-pituitary-adrenal axis; neurotransmitter/neuropeptide dysregulation; dietary deficiencies; and disturbed gut microbiome composition.
  • The potential of modulating the microbiome-gut-brain axis, and subsequently mental health, through the use of functional foods, is an emerging and novel topic of interest.
  • Fermented foods are considered functional foods due to their reputed health benefits.

The paper goes on to discuss food fermentation and summarizes how these foods “act biologically in the gastrointestinal tract and have the ability to modify the gut microbiota, influence translocation of endotoxins and subsequent immune activation, and promote host nutrition.” They are exploring their theoretical potential to improve symptoms of depression and anxiety in humans, saying more research is needed.

Dr. Perlmutter highlights various section of the paper and starts by sharing more about fermented foods and that we’ve been actively fermenting for thousands of years:

I think it’s first instructive to recognize that we’ve been actively fermenting foods for thousands of years as humans as a technique to preserve them, and allow us to travel with a food source. But beyond that, our ancestors prior to that would eat fermented foods. Fermentation is actually what happens to food when it’s left outside and is exposed to bacteria and begins the process of, dare I say, rotting. I don’t want that to be off putting to people who are going to hear the later part of our discussion dealing with eating fermented foods, because we have wonderful fermented foods that we eat these days.

He goes on to elaborate on what the paper terms functional foods. What this means is that these fermented foods have far-reaching health benefits for optimal health and for making us resistant to disease (i.e. improving our immunity):

The point is that the process of fermentation is basically a process of enrichment of food sources with bacteria. And what a notion that is, where we’re looking at the idea of eating a food that’s teeming with bugs, with germs, if you will. I say it that way, because it has such a negative connotation, but it really is what we want to do. These bacteria are involved in so many processes that deal with our health, and nurture our health, and our resistance to disease.

Some common examples of fermented foods are kimchi, sauerkraut, kefir (dairy kefir and water kefir), kombucha, and yogurt. Keep in mind, you can ferment many different vegetables. One of my favorites is cauliflower.

The paper also mentions inflammation as one possible mechanism for the bidirectional relationship between anxiety/depression and gut function, and Dr. Perlmutter discusses this in great detail, in the context of chronic health conditions. And he ties it all back to the microbiome:

From my perspective, of course, that has to do with the functionality of the brain, the way the brain remains healthy, and disease-free moving forward. And there are multiple mechanisms that relate to what’s going on in the gut to the brain. When we think of disease processes, most of what we are concerned about is the notion of inflammation, at least, in terms of a mechanism that relates to so many of the chronic degenerative conditions of the brain; be it Alzheimer’s, Parkinson’s, or even a non-chronic degenerative condition, which is autism is not necessarily considered to be progressive, but nonetheless at its heart, is in fact an inflammatory disorder.

So beyond that, of course, all of the chronic degenerative conditions that plague our planet, including heart disease, cancer, diabetes, the autoimmune conditions are at their very core, primarily inflammatory.

And let me be very clear that chronic degenerative conditions are ranked by the World Health Organization as the number one cause of death on planet Earth.

So we have to pay attention to anything that’s involved in the regulation of inflammation in the human body. And front and center right now in terms of gaining the spotlight, is the health of the gut bacteria, as well as its metabolites and it’s gene expression, collectively, we call that the microbiome.

The paper mentions intestinal permeability as another mechanism. Dr. Perlmutter covers the importance of the gut lining integrity and why it’s so important when it comes to anxiety, depression and the chronic diseases he mentions:

So we realize that the gut bacteria have a very important function, and that is to maintain the integrity of the gut lining.

And why would I, as a neurologist, give a hoot about the integrity of the gut lining? Quite categorically it’s because that is where inflammation in the body, in the long term, has its genesis. So, meaning we’ve got to have a strong gatekeeper at the lining of the gut to keep various gut-related proteins and other chemicals from making their way into the rest of the body, and challenging the immune system, upregulating the production of inflammatory chemicals that then do damage.

Dr. Perlmutter ends by discussing neurotransmitter dysregulation (also mentioned in the paper):

We know that our gut bacteria are involved in the manufacture of various neurochemicals, various neurotransmitters, serotonin, for example, dopamine, norepinephrine, epinephrine, [GABA], etcetera, that are primarily manufactured in the gut.

As a matter of fact, when it comes to serotonin, which certainly gains the spotlight; 90% is manufactured in the gut, another 9% is manufactured in the blood platelets, meaning that only 1% is actually manufactured in the brain, though, we call it a brain transmitter, a neurotransmitter. That said, the availability of the precursor for serotonin; the amino acid tryptophan, the availability of that even to the brain, is in fact controlled to a significant degree by actions of the gut microbes.

He wraps up by bringing in the microbiome, inflammation, chronic health conditions, anxiety and depression, and our lifestyle choices and diet (which includes foods such as fermented vegetables):

If we simply recognize that our gut bacteria are playing a massive role in regulating inflammation in the body, that’s enough, because our mission for the prevention of chronic degenerative conditions in the brain and out of the brain is controlling inflammation.

And it’s through the lens of the microbiome that we realize the detrimental or effectiveness of our food choices, and other lifestyle choices that can act to increase or balance inflammation. So it becomes extremely important.

The paper does discuss perturbations in the hypothalamic-pituitary-adrenal axis but we didn’t get into this during this interview. However, we do cover this in Dr. Peter Bongiorno’s interview on the summit.

Some of the recent research on specific fermented foods and mental health

Here is some of the recent research on specific fermented foods and mental health, where some or all of the above mechanisms may be a factor:

Some simple changes you can make

Here are some simple changes that be incorporated when you have anxiety or depression:

  • Include fermented foods and beverages in the diet (ideally on a daily basis). If you decide to include sauerkraut, you can make it yourself or buy it from the store. If you buy it ready-made, always make sure it’s raw and found in the refrigerated section. Vinegar should not feature on the label but do look for salt as this is used in the fermentation process. In the example I share above, the added ginger helps with digestion even further and is very delicious!
  • Eat a real whole foods diet with quality animal protein, healthy fats and organic vegetables and fruit (there is much research supporting dietary changes for improving mood and easing anxiety i.e. nutritional psychiatry)
  • Avoid inflammatory foods like gluten, sugar, processed foods/fast foods and foods that you have a sensitivity to
  • Address intestinal permeability if necessary (glutamine is my go-to nutrient for this and I take a deep dive into this amino acid in one of the new interviews on the summit)
  • Use targeted individual amino acids such as GABA to boost GABA (for physical anxiety symptoms) and tryptophan or 5-HTP to boost serotonin (for worry-type anxiety). You can do this while you are addressing underlying gut issues and making dietary changes. Keep in mind that these amino acids help you quit sugar, gluten and junk food at the same time as easing anxiety!

Resources if you are new to using the amino acids as supplements

If you are new to using the amino acids as supplements and want to know more, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution and a brief overview here, Anxiety and targeted individual amino acid supplements: a summary.

If you suspect low neurotransmitters and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids so you are knowledgeable.

Do join us on the summit relaunch of Anxiety Summit 5: Gut-Brain Axis summit on November 8-14, 2021. Registration details coming soon.

And if you’d like to learn more about Dr. Perlmutter’s book, Brain Wash: Detox Your Mind for Clearer Thinking, Deeper Relationships, and Lasting Happiness (written with his son Dr. Austin Perlmutter), here is my review. In our interview on the summit, he shares about disconnection syndrome (and loneliness) and how our decision-making abilities have been compromised.

Are fermented foods and beverages included in your diet (and your family’s diet) on a daily basis? And what are your favorites?

Do you make your own fermented vegetables?

Have you observed mood and/or digestive improvements since including fermented foods in your diet?

If you are a practitioner, do you recommend fermented foods and discuss this bidirectional communication between the gut and the brain with your clients/patients?

Feel free to post your questions too.

I need help with my Diet Coke addiction – when I stop, my fatigue, brain fog, anxiety/depression increase big time!

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diet coke addiction

A woman asked for help on the blog, wanting desperately to quit her long-time Diet Coke addiction. This woman knows her addiction is detrimental to her health and she gets withdrawal symptoms when she tries to quit – fatigue, brain fog, anxiety and depression increase big time! And yet she can’t quit. This is not unusual. I share my feedback on the brain chemical imbalances that can drive addictions and how to figure out which amino acids (or more than one) may help her quit easily. This means she doesn’t have to go cold turkey and then fail yet again. Using the amino acids means there is no willpower required and no feelings of deprivation, and it’s addressing an underlying neurotransmitter imbalance i.e. a root cause.

Here is her question:

I need help with my Diet Coke addiction. I have been using it for 35 years and I am too appalled to tell you how much I drink.

I have tried to quit many times and ended up in utter failure. A friend mentioned that phenylalanine may be a booster for my dopamine.

When I stop, my fatigue, brain fog, anxiety/depression increase big time. I know this drink is literally killing my health and I am desperate for some answers, suggestions….or a miracle.

What supplements do you recommend for helping me quit this devil of a habit? Thank you for ALL you do!” 

Here is my response …. when it comes to using amino acids to help break the addiction, pretty much everything I write about in relation to sugar addiction or cravings would likely also apply to quitting Diet Coke.

What emotions are driving the addiction?

She needs to figure out what emotions are driving her addiction and use the respective amino acid supplement/s (one or more of them) to help break the addiction and improve the mood symptoms at the same time.

These are the questions I review with my clients who have a Diet Coke addiction (or other diet soda or regular soda addiction):

  1. If you have to drink it when you haven’t eaten in awhile it’s likely low blood sugar. Glutamine on the tongue stops the desire almost immediately and also helps with the low blood sugar symptoms of shakiness and irritability
  2. If you stress-drink, your cravings are likely due to low GABA, and GABA will stop the stress-drinking and calm you down too
  3. If you drink it to feel happy (and especially from late afternoon into the evening) then your cravings are likely due to low serotonin, and tryptophan (or 5-HTP) stops the cravings and boosts mood and reduces anxiety
  4. If you drink it for comfort or a reward comfort then it’s likely due to low endorphins and DPA (d-phenylalanine) will stop that feeling of “I deserve-it” and also give you a hug-like mood boost
  5. If you drink it for an energy boost or to give you focus then it’s likely due to low catecholamines and tyrosine will stop those cravings and give you a mood and energy boost, and also help with mental clarity

Based on her question above, she mentions that “my fatigue, brain fog, anxiety/depression increase big time” when she stops. The fatigue, brain fog and depression is a big clue that #5 above will likely apply. She asks about using phenylalanine for dopamine support (dopamine is one of the catecholamines). I prefer tyrosine to l-phenylalanine for boosting levels.

The fact that anxiety also increases when she stops is a clue that #2 or #3 may apply too, and possibly #1. It’s not unusual for someone to have imbalances in multiple areas.

If this is the case, I  always recommend doing a trial of one at a time, so it’s easy to see the benefits.

It’s not the same neurotransmitter imbalance that shows up in each person

It’s also not the same neurotransmitter imbalance that shows up in each person with a Diet Coke (or other soda addiction). When I shared this on Facebook and asked what was the driving emotion behind their “self-medication” with Diet Coke this is feedback I received from two women:

  • “I had been drinking almost 6 per day for decades. I believe it was comforting.” In this instance, addressing low endorphins with DPA (#4) would have helped. Comfort or reward or treat is a common emotional driver for all addictions.
  • “I noticed I would drink Diet Coke when I felt anxious (1 or 2 times a day).” In this instance #2 or #3 would have helped i.e. GABA support if it was physical anxiety and/or tryptophan or 5-HTP for low serotonin if it was worry-type anxiety.

The caffeine addiction and the artificial sweetener Aspartame

Keep in mind, with Diet Coke, there is the caffeine addiction and the artificial sweetener Aspartame that also make it challenging to quit. Tyrosine and addressing low catecholamines (#5 above) and vitamin C can help with the caffeine addiction and quitting so headaches are minimized.

The amino acids can help with the imbalances created by aspartame. This paper, Direct and indirect cellular effects of aspartame on the brain, proposes that “excessive aspartame ingestion might be involved in the pathogenesis of certain mental disorders and also in compromised learning and emotional functioning.”  This excerpt from the abstract is relevant to this discussion:

Aspartame is composed of phenylalanine (50%), aspartic acid (40%) and methanol (10%). Phenylalanine plays an important role in neurotransmitter regulation, whereas aspartic acid is also thought to play a role as an excitatory neurotransmitter in the central nervous system. Glutamate, asparagines and glutamine are formed from their precursor, aspartic acid. Methanol, which forms 10% of the broken down product, is converted in the body to formate, which can either be excreted or can give rise to formaldehyde, diketopiperazine (a carcinogen) and a number of other highly toxic derivatives. Previously, it has been reported that consumption of aspartame could cause neurological and behavioural disturbances in sensitive individuals. Headaches, insomnia and seizures are also some of the neurological effects that have been encountered, and these may be accredited to changes in regional brain concentrations of catecholamines, which include norepinephrine, epinephrine and dopamine.

This further supports the need for catecholamine support with tyrsosine (#5 above) and GABA support with the amino acid GABA (#2 above).

Recognizing it’s an issue is a big first step

I acknowledge her for recognizing it’s an issue – that is a big first step! I did also ask her to share how much she was consuming each day because there is no judgement here and we acknowledge it’s an addiction. I’ll report back when I hear from her and will also share which amino acid/s helped her break the addiction.

As always, it’s not only about the amino acids and a comprehensive healing approach is always part of the picture. The amino acids make it easy to get started and then other underlying issues can be addressed: other nutritional deficiencies, dysbiosis, fatty liver, metabolic syndrome and so on. You can see some of the many studies below.

Of course, it’s important to be eating a real whole foods diet with quality animal protein, healthy fats, organic vegetables and fruit, no caffeine, no gluten, no sugar, fermented foods and herbs.

Reconsider your diet soda consumption if you’re on the fence

If you are on the fence about giving up your diet soda consumption here are a few additional papers that will hopefully make you reconsider:

Facts like this help you recognize it’s an issue but even when we have these facts, we often simply cannot quit. This is where the amino acids are so powerful because they work with no willpower required and no feelings of deprivation. And using them addresses the underlying neurotransmitter imbalance/root cause that led to the initial addiction or “self-medication”. They also help address the neurotransmitter deficiencies that are often made worse by diet soda consumption.

Resources if you are new to using the amino acids as supplements

If you are new to using the amino acids as supplements and want to know more, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution and a brief overview here, Anxiety and targeted individual amino acid supplements: a summary.

If you suspect low neurotransmitters and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids so you are knowledgeable.

What advice do you have if you have been through this yourself and what has helped you?

What do you drink now instead of your diet soda?

If you are a practitioner, how do you help your patients/clients with this kind of addiction?

Feel free to post your questions too.

The Essential Oils Apothecary – Advanced Strategies and Protocols for Chronic Disease and Conditions by Eric Zielinski and Sabrina Ann Zielinski

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This wonderful new book was just released this week. It covers the basics and their recipes are wonderful as always. I really appreciate that Dr. Z and Mama Z include chapters on insomnia, stress and anxiety, depression and substance abuse. Even though I already know about and use essential oils, I picked up plenty of gems. I do love that they include the research too.

Here are a few highlights that resonated with me:

  • A new essential oil that I learned about is Bitter Orange. I love all the citrus essential oils and learn that this one “is used in Ayurvedic medicine as an aid to meditation and can be extremely helpful in easing stress and anxiety” … and that a “study from Iranian researchers found that when patients were given bitter orange prior to a minor operation, they felt more relaxed, with much less anxiety.”
  • Being reminded about Thyme essential oil for stress relief and anxiety support. I found this statement worth remembering and fascinating: “Like many essential oils, thyme oil works by stimulating smell receptors in the nose, which then transmit messages through the nervous system to the emotion-controlling limbic system in the brain.”
  • Learning about a study where “Japanese investigators evaluated the anti-stress benefit of aromatherapeutic hand massages in healthy women in their twenties.” I see a huge application for this in children, hospitalized loved ones and elderly parents too.
  • I love ginger and I was intrigued to learn about Plai root essential oil, a cousin to ginger and similar to eucalyptus “with additional spicy notes.” They share that a study with healthy male volunteers found  that plai improved mood “by easing the negative emotions and enhancing positive emotions, especially feelings of pleasure and contentment.” They also share that plai essential oil pairs well with rosemary, a favorite of mine for mood and anxiety support.
  • I was not aware that black pepper essential oil can “reduce cravings for cigarettes, alcohol, or marijuana. Black pepper oil can also help you fight withdrawal symptoms and keep you calm throughout….by elevating levels of the feel-good neurotransmitter serotonin in your brain.” They share a fun recipe for Quit Sticks to help folks quit these addictions.
  • The list of essential oils that are rich in linalool, “known for its calming, sedative, anticonvulsant, and anxiolytic (anti­anxiety) properties. Chemically, it is a monoterpenoid—a major compound found in essential oils – and is widely used as an antimicrobial agent and a fragrance.” The list includes Rosewood (82.3 to 90.3 percent), Coriander seed (59.0 to 87.5 percent), Magnolia leaf or flower (78.9 percent / 69.9 percent), Bergamot mint (24.9 to 55.2 percent), Neroli (31.4 to 54.3 percent), Lavender (25.0 to 45.0 percent) and many others.

I’ve highlighted some gems related to insomnia, stress and anxiety, depression and substance abuse but there are also sections on the following: chronic fatigue, fibromyalgia, low libido, Alzheimer’s and dementia, bone and joint disorders, cancer support, cardiovascular disease, chronic respiratory disease, diabetes and obesity, fatty liver, inflammatory bowel disease, Parkinson’s disease and epilepsy.

Here is the official blurb:

Soothing practices, healing rituals, and 100+ practical recipes for applying essential oils to the treatment and symptom management of chronic illness–by the bestselling author of The Healing Power of Essential Oils and his wife, Mama Z!

More and more people living with a chronic condition–from insomnia, hypertension, and fibromyalgia to migraines, insulin resistance, and even the effects of chemotherapy–are reaching for essential oils as a complementary therapy to treat their symptoms. Whether you apply them topically, infuse them in liquid, or diffuse them in the air, essential oils are proven to penetrate the skin and work on the body’s physiology gently and quickly.

Dr. Eric Zielinski, author of the bestselling primer on using essential oils for general health, The Healing Power of Essential Oils, and his wife, Sabrina, affectionately called Mama Z, now bring their masterful and authoritative knowledge to the complexities of chronic illness. The Essential Oil Apothecary shares more than 100 research-backed and easy-to-prepare formulations, from an Immune Boosting Blend to an Anxiety-Busting Body Oil, to help with symptoms of twenty-five common chronic conditions, including fatigue, pain, anxiety, and addiction. It also offers two life-changing tools: an essential home makeover to remove toxins that may be making you sicker, and self-care rituals (including Mama Z’s beauty rituals) that help you feel better when navigating any chronic illness.

Dr. and Mama Z’s evidence-based and holistic approach will help you experience the power of essential oils against chronic illness and build a lifetime of healthy habits and supportive lifestyle actions.

I see this as a book you’ll refer to again and again (like I refer to their first book “The Healing Power of Essential Oils”). I recommend it for essential oils beginners and for individuals (including practitioners) who are already using essential oils.

Use this link to order your copy and claim additional bonus digital content.   Or purchase from your favorite local bookstore or from Amazon (my link) and then use this link to claim your bonus content.

Let us know what gems you pick up when you read it!