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Anxiety and globus pharyngeus (lump in the throat): GABA to the rescue?

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globus pharyngeus and gaba

Low levels of GABA, a calming neurotransmitter can lead to anxiety, fears and panic attacks. With low GABA, the anxiety is a physical kind of anxiety with muscle tension or muscle spasms.  Today you’ll read how low GABA may be one possible root cause of globus pharyngeus, which you may have experienced as a rather scary golf-ball-like lump or constriction in the throat.

Let me describe globus pharyngeus and then I’ll share my story with globus pharyngeus, why low GABA may be a factor (and supplemental sublingual GABA to the rescue) and other possible root causes that should be considered.

This 2015 paper, Globus pharyngeus: an update for general practice, defines it as follows:

Globus pharyngeus or globus sensation is the painless sensation of a lump in the throat and may be described as a foreign body sensation, a tightening or choking feeling.

Globus means globe or sphere and it can actually feel like you have a golf-ball sized object in your throat.

You may have experienced it without even knowing the medical name. Only a few of my clients and those in my community have ever heard the term. I also only learned about the name many years after my episode.

What is very surprising is that, according to the above paper, up to 45% of the population have experienced it.

My story with globus pharyngeus

I’m one of the 45% and for me it was a terrifying experience.  As you may know, I experienced anxiety, PMS, fears and panic attacks in my late 30s and early 40s (it’s why I do this work).

Fortunately I only had one episode. It truly felt like I had a golf-ball in my throat and was horrifying. I knew I needed to swallow so I could get rid of this obstruction but at the same time I was terrified to swallow in case it got stuck and choked and killed me.

I remember going to the mirror to try and see this golf-ball sized object in my throat. I was so surprised that I couldn’t see anything.

Looking back, I suspect the addition of GABA Calm to my protocol prevented further episodes. I was also using progesterone cream at the time and this promotes GABA production too.

I’ve had many clients report that looking back they also realized their episodes stopped once they addressed their low GABA levels.

I was also under a great deal of stress at the time: work stress (long hours and my adrenals were a mess) and physical stress (due to amalgam removal, gluten issues, perimenopausal changes and much more).

Globus pharyngeus and GABA

The fact that the throat or pharynx “is a muscular tube that runs from the back of your nose down into your neck” is one reason for considering a muscle spasm and low GABA as a root cause.

The amino acid GABA, when used sublingually, eases muscle spasms within 15 seconds to 2 minutes. Some examples where we see this:

If you’re in the midst of an episode it’s impossible to open a capsule of GABA into your mouth. Until a client knows how much they can tolerate we start with 100-125 mg and increased based on the trial.  Taking the powder and dabbing it with a wet finger and putting the finger to the inside cheek a few times is the best way for quick relief.

A product that is GABA-only in a capsule such as Enzymatic Therapy GABA or ProThera 500mg GABA are my choices for in-the moment relief (more on these in my supplement store here).

Source Naturals GABA Calm is my most popular GABA product and is my choice for everyday use.

Of course, I recommend this approach to doing nothing. The authors state: “simple reassurance may be all that is required” or “Advise patients to resist the urge to dry swallow.” We can do better.

Once your GABA levels are sufficient, it’s less likely to happen unless you’re under a great deal of stress and/or there are psychological factors at play:

There is increased reporting of stressful life events prior to development of symptoms and research suggests that as many as 96% of patients with globus sensation report an exacerbation of symptoms during times of emotional intensity.

During times of added stress, folks may experience other “physical symptoms such as palpitations, poor sleep, and feelings of panic.”

Other root causes and possible solutions

The above paper does also list other root causes and solutions that would need to be investigated if GABA doesn’t help or possibly in conjunction with GABA support: tonsil issues, hiatus hernia, reflux in 23 -68% of individuals (I would look for the root cause rather than using a proton pump inhibitor/PPI), sinusitis, post-nasal drip, goitre, an actual foreign body, high consumption of alcohol/caffeine/tobacco and cancer (which they state is rare).

Interestingly, speech and language therapy has been shown to improve globus pharyngeus in two studies, possibly due to the reassurance experienced.

The paper concludes as follows:

Finally the link between anxiety and globus sensation must be considered. Evidence supports the use of cognitive behavioural therapy, but very little evidence exists for the use of anxiolytics or antidepressants.

I’ll add to this: the link between low GABA and globus sensation must also be considered, especially if you experience the physical type of low GABA anxiety. GABA to the rescue!

Based on the research, low serotonin, vagus nerve function, thyroid health and h/pylori may also be factors. I suspect food sensitivities play a role. And pyroluria too, because of the additional loss of zinc and vitamin B6 which is needed for GABA production. I’ll leave all this for a follow-up blog.

Have you experienced a globus sensation episode? And what did it feel like?

Did you get a diagnosis or is the term new to you?

Has GABA helped … in the moment or if you look back on your use of GABA for anxiety?

Did you discover other root causes and solutions? Please do share.

Please share if  you have pyroluria and your episodes were triggered by a very stressful event

And feel free to post your questions.

If you’re a practitioner I’d love to hear your feedback too.

Oxalate crystal disease, dietary oxalates and pain: the research & questions

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oxalate crystal disease

This blog post came out of my quest for finding a medical explanation/term for my own pain caused by dietary oxalates and a desire to gain a better understanding for my clients who experience similar pain. It’s been on my writing list for some time and I’ve been gathering articles and research but the current coronavirus pandemic and recommendations for high vitamin C intake had me concerned enough to blog about it and ask for feedback from my community.

This is the blog, Coronavirus and vitamin C for immune support: new pain or more severe pain due to oxalate issues?, where I pose the question about recent increased intake of vitamin C or the addition of large doses for immune support and increased pain: joint pain, eye pain, foot pain, vulvodyndia, bladder issues, insomnia, gut pain, kidney pain, changes in thyroid health/labs, bone pain etc?  The feedback on this blog and on Facebook has been huge and confirms the connection.  Thank you if you’ve already contributed to the discussion!

Today I’ll share an overview of oxalates, my pain issues with dietary oxalates, a deeper dive into the condition called oxalate crystal disease (with some of my insights and questions), and the autism and atherosclerosis research. It’s by no means a comprehensive blog on all things oxalates but rather a way to try and connect some dots and pose some questions for going deeper.

The next blog will address my vitamin C/oxalate/pain story and the research on vitamin C, oxalates and pain, together with questions.

Oxalates defined and food sources

Before we review oxalate crystal disease, let’s define calcium oxalates. Julie Matthews, my good friend and colleague and an oxalate expert shares this in her blog, Oxalates: Their Influence on Chronic Disease

Oxalates present in our body as sharp crystals or crystalline structures with jagged edges that cause pain, irritation, and distress. They can bind with certain minerals; particularly calcium and magnesium, as well as iron and copper

You’ll find many different lists of low, medium and high oxalate foods. When I started eating low oxalate I found Susan Owen’s site simple and very helpful. I then joined the Trying Low Oxalates Facebook group for support and feedback.

In summary, these are the common medium-oxalate and high-oxalate foods that many folks have problems with: nuts, nut-butters and nut-flour (something to watch when eating Paleo or GAPS), wheat, chocolate, kiwi fruit (very high – see the raphides image below), star fruit (also very high), beets, potatoes, legumes, berries, spinach and soy.

You can see why these needle shaped calcium oxalate crystals found in kiwi fruit could inflict pain. This is just one example – there are many different shapes of calcium oxalate crystals.

raphides purified from kiwifruit
Raphides purified from kiwifruit. Raphides, needle shaped calcium oxalate crystals, were collected from kiwifruit homogenate through heavy media separation using a dense CsCl solution. (A) The SEM image of purified raphides (x400). Shared from: Synergistic Defensive Function of Raphides and Protease through the Needle Effect via Creative Commons.

My oxalate story: severe foot pain and eye pain

I personally had severe dietary oxalate issues in 2012 which manifested as excruciating foot pain. It was a combination of hot-burning-coals-pain and shards-of-glass-pain. It was just after my book, The Antianxiety Solution (my Amazon link), came out. Due to my book tours and events, I would be on my feet all day presenting, often for 3 full consecutive days, so I figured that must be the reason. When I travelled, I took a blender and made smoothies with berries, ate plenty of healthy nuts as my snacks and took kale chips with me to make sure I was getting my greens. Kiwi fruit was a favorite of mine!

I was eating a high oxalate diet and had no idea until I heard Julie present at an Integrative Medicine for Mental Health Conference on dietary oxalates and autism. A light-bulb went off and then I worked with her to learn about oxalates and figure out if it was in fact because of oxalates and sure enough, as soon as I removed high and medium oxalate foods the pain resolved. Note: the advice is NOT to remove all high and medium oxalate foods at once because dumping can occur. I was fortunate that this didn’t happen with me, possibly because of the vitamin B6 I was already taking as part of the pyroluria protocol.

When I eat a low oxalate diet I do really well. However, more recently dietary oxalates have been causing me eye pain when I have a treat like eggplant or carob. It starts out as a kind of scratchy discomfort and mild pain and then gets worse and worse. I also have a goopy kind of discharge from the inner part of my eye and burning/redness crystal-like teariness on the outer parts of my eyes.  I recently had one very severe incident where the eye pain in my left eye was agonizing for about 2 hours. I was beside myself and tried GABA, DPA and tryptophan for an attempt at pain relief – with no success. When I took 500mg of vitamin B6 the pain eased immediately.

The theory is that oxalates cause issues where you have a weakness. I injured my left eye walking into a low tree-branch while rock-climbing 15 years ago, so I suspect this is why my left eye is more severely affected.

Oxalate crystal disease

The condition “oxalate crystal disease” is the closest explanation I’ve found that explains the pain I’ve experienced and makes the most sense, other than the fact that all the studies mention kidney disease and yet I don’t have kidney disease and have never had kidney stones. I’ve also never had a problem with my estimated Glomerular Filtration Rate (eGFR). In case eGFR is new to you it measures how well your kidneys filter the wastes from your blood and is the best overall measure of kidney function/damage.

This paper, Update on oxalate crystal disease, summarizes it:

Oxalate arthropathy is a rare cause of arthritis characterized by deposition of calcium oxalate crystals within synovial fluid. This condition typically occurs in patients with underlying primary or secondary hyperoxaluria. Primary hyperoxaluria constitutes a group of genetic disorders resulting in endogenous overproduction of oxalate, whereas secondary hyperoxaluria results from gastrointestinal disorders associated with fat malabsorption and increased absorption of dietary oxalate. In both conditions, oxalate crystals can deposit in the kidney leading to renal failure. Since oxalate is primarily renally eliminated, it accumulates throughout the body in renal failure, a state termed oxalosis. Affected organs can include bones, joints, heart, eyes, and skin. Since patients can present with renal failure and oxalosis before the underlying diagnosis of hyperoxaluria has been made, it is important to consider hyperoxaluria in patients who present with unexplained soft tissue crystal deposition. The best treatment of oxalosis is prevention. If patients present with advanced disease, treatment of oxalate arthritis consists of symptom management and control of the underlying disease process.

Let me break this down because I’ve had to look up terminology and read and re-read papers in order to get a better understanding of things:

#1 Oxalate arthropathy is a rare cause of arthritis characterized by deposition of calcium oxalate crystals within synovial fluid.

Oxalate arthropathy is a disease of the joints caused by oxalates depositing in the synovial fluid of the joints.  The paper states it is a rare cause of arthritis, but I suspect it is much more common given what we’re seeing clinically.

Also, because all the research connects oxalate crystal disease with kidney disease, it may be overlooked when there is no kidney disease (more on that below).

Synovial fluid is the fluid between the joints that acts as a lubricant and nutrient source.

#2 This condition typically occurs in patients with underlying primary or secondary hyperoxaluria.

Hyperoxaluria occurs when you have “too much oxalate in your urine.”

#3 Primary hyperoxaluria constitutes a group of genetic disorders resulting in endogenous overproduction of oxalate and… secondary hyperoxaluria results from gastrointestinal disorders associated with fat malabsorption and increased absorption of dietary oxalate.

Primary hyperoxaluria is genetic and results in endogenous or internal overproduction of oxalate, causing too much oxalate in the urine.

The secondary hyperoxaluria description mentions “gastrointestinal disorders associated with fat malabsorption and increased absorption of dietary oxalate.”  There are a number of other factors which I’ll address in a future blog.

According to this paper and others, secondary hyperoxaluria also results in too much oxalate in the urine.

#4 In both conditions, oxalate crystals can deposit in the kidney leading to renal failure. Since oxalate is primarily renally eliminated, it accumulates throughout the body in renal failure, a state termed oxalosis.

Affected organs can include bones, joints, heart, eyes, and skin.

Mayo clinic states oxalosis occurs if your kidneys fail. “Because your body can no longer eliminate the extra oxalate, it starts accumulating — first in your blood, then in your eyes, bones, skin, muscles, blood vessels, heart and other organs.”

My comment is that in some instances, oxalates accumulate in various parts of the body without kidney failure. I share more about this aspect and what we see clinically below, plus an autism and atherosclerosis study.

This paper, Oxalate crystal deposition disease, also mentions the following: “osteopathy, acute and chronic arthropathy with chondrocalcinosis, synovial calcification, and miliary skin calcium oxalate deposits and vascular calcifications that affect mainly the hands and feet.” The paper is focused on primary hyperoxaluria (and does also discuss the kidney involvement) but I’m including it because of the conditions listed. You may have received one of these diagnoses and not linked it back to dietary oxalates and/or vitamin C intake possibly playing a role.

The authors do report “systemic life-threatening cardiovascular, neurologic, and hematologic manifestations”, saying they are rare.

Calcium oxalates: anxiety, sleep, headaches, fatigue and other symptoms

Calcium oxalate crystals can also be found in the thyroid, and ear, leading to hearing loss under some circumstances.

Julie Matthews, in her blog, Oxalates: Their Influence on Chronic Disease, also shares that

Clinical studies and anecdotal experience indicate that oxidative stress, mitochondrial disruption and damage, and nutrient depletions, trigger widely varied symptoms including fatigue and inflammatory cascades, joint pain or pain anywhere in the body. Chronic low energy is very common because of a reduction in ATP in the mitochondria. Oxalates could be a hidden source of headaches, urinary pain, genital irritation, joint, muscle, intestinal or eye pain.

Other common oxalate-caused symptoms may include mood conditions, anxiety, sleep problems, weakness, or burning feet. Indicators can be digestive, respiratory, or even bedwetting for children.

What the researchers are saying – always kidney disease

I’ve reached out to a number of researchers, practitioners and labs and they all state that oxalate crystal disease only happens with kidney disease/kidney stones. This is what one researcher shared with me: “Plasma oxalate concentrations only elevate enough to cause systemic disease when there is significant kidney disease (typically GFR <20-30). I have never seen a significantly elevated plasma oxalate without chronic kidney disease.”

Could this be the case because they are kidney specialists and therefore only seeing patients who already have kidney disease?

The good news is that a number of them are intrigued and interested in learning more.

Oxalate crystals in autism and atherosclerosis without kidney issues

However, based on my own experience and according to many in this community and other communities like the Trying Low Oxalates Facebook group, pain issues related to dietary oxalate intake may occur without kidney issues/kidney stones, and often does.

These papers offer some support for what I suspect we are seeing clinically – systemic oxalate deposits can occur deposits without kidney stones or renal failure:

Children with ASD [autism spectrum disorder] demonstrated 3-fold greater plasma oxalate levels … and 2.5-fold greater urinary oxalate concentrations. Despite significant hyperoxaluria no evidence of kidney stone disease…was observed

calcium oxalate crystals were observed within atherosclerotic plaques in the coronary arteries. Similar deposits were seen in the thyroid gland and other organs but not in the kidneys. None of the patients had chronic renal failure…. We suggest the phrase “atherosclerotic oxalosis” to describe this finding.

These are the disconnects I’m seeing in the research and questions I have:

  • Oxalate crystal disease is reported to be rare and it only happens with kidney disease/kidney stones – could it be more common than reported? As Julie states: “New science and clinical experience reveal concerns about oxalates that far exceed traditional kidney stone pathology.”
  • Should we be calling it hyperoxaluria. “too much oxalate in your urine” if the kidney is not involved? Or do we need to expand the definition of hyperoxaluria to include too much oxalate in other tissues outside the kidney and urine?
  • Could oxalate crystal disease with no kidney disease be a new syndrome that has yet to be widely and clearly identified in the research?

I mean no disrespect to the study authors and researchers by sharing my insights and questions here and in the section above.  I appreciate the work they do and the opportunity to learn from them.

Searching through the literature on this has been extremely challenging because studies always refer to the kidney. It may well be that there is a perfectly logical explanation for much of this and someone has already gone through the research and has answers to all my questions.  I am very willing to be enlightened so please do share if you’ve come across a good explanation.

Either way, please share your insights based on what I’ve shared in this blog and in relation to your experiences with pain caused by dietary oxalates and/or pain caused by vitamin C intake. I will be sharing this blog and the comments with the researchers and practitioners who are open to all this.

Social anxiety caused by pyroluria: oxytocin, the vagus nerve, pectus excavatum and Ehlers-Danlos Syndrome

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social anxiety pyroluria

Pyroluria is associated with a type of anxiety characterized by social anxiety, avoidance of crowds, a feeling of inner tension, and bouts of depression. If you have pyroluria you may experience varying degrees of anxiety or fear, often starting in childhood, and you usually manage to cover it up and push through. You may build your life around one person, become more of a loner over time, have difficulty handling stress or change, and have heightened anxiety symptoms when under more stress.

It’s not well-recognized in the medical profession and has long been considered a genetic condition. More recently some practitioners have been proposing that it may be triggered by environmental toxins and that it’s not only genetic. Either way, symptoms can start to resolve within a week when low levels of zinc and vitamin B6, together with some other nutrients are addressed. Stress management is key. This can be emotional stress and the stress of toxin exposure, infections like Lyme disease, mold toxicity and even low blood sugar and gluten issues.

We would typically not connect social anxiety/pyroluria with low oxytocin, vagus nerve function or connective tissue disorders but if you read on you’ll see there are some interesting connections.

Oxytocin, social anxiety and zinc

Research has found that oxytocin levels correlate strongly with levels of social anxiety. A paper published in the Journal of Psychiatric Research looked at how variations in the oxytocin receptor (OXTR) gene is associated with an increased risk of anxiety, stress and depression in individuals with a history of exposure to early life stress. Supporting low levels of oxytocin can ease the threats of social interactions.

What is interesting is that zinc, a key nutrient for pyroluria, is needed for binding oxytocin to its receptor. You can read more about all this here: Oxytocin, social anxiety, pyroluria and autism

Sociability improves vagus nerve function and thriving at home alone

Increased sociability helps improve vagus nerve function. It’s all good and well to recommend getting out and hanging out with more people but if you have pyroluria it’s really challenging. It’s also hard work, very stressful and the added stress makes your pyroluria symptoms worse so it becomes a vicious cycle.

You can read all about this here: Increased sociability improves vagus nerve function: the role of social anxiety, pyroluria and low zinc. There is an updated section on social isolation during coronavirus and how some people are thriving being home alone.

Pectus excavatum and Ehlers-Danlos Syndrome

Pectus excavatum is an indentation in the chest wall and is related to problems with connective tissue. When it comes to pyroluria and pectus excavatum, this is what we see in common: social anxiety and depression, low zinc and low vitamin B6, dental crowding and sometimes Ehlers-Danlos Syndrome (EDS). I write more about this here: Pectus excavatum and pyroluria: is there a connection?.

I’ve written an entire blog on Joint hypermobility / Ehlers-Danlos Syndrome and pyroluria. Anxiety, depression, attention deficit (and hyperactivity) disorder, autism spectrum disorders, and obsessive-compulsive personality disorders are all common with EDS. Many folks with EDS report better less social anxiety, improved mood and often improved physical symptoms/reduced pain on the pyroluria protocol of zinc, vitamin B6, evening primrose oil and a good copper-free multi.

Resources for you

Please do share if you have pyroluria or score high on the questionnaire and have seen improvements in your social anxiety and any physical symptoms.

Depression, anxiety and intergenerational trauma due to racism in the Black community

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anxiety in black community

I feel sickened by George Floyd’s death and the police brutality we all witnessed. I stand by Black Lives Matter and an end to racism, social injustice and inequalities. In the light of current events in the USA and around the world, today’s article highlights the prevalence of mental health in the Black community, the biological impacts of trauma, racism and intergenerational trauma, some reasons why mental health services are not being used, the impacts of racism on physical health and some resources geared to Black mental health.

In this recent article by Columbia University Department of Psychiatry, Addressing Mental Health in the Black Community, we learn the following:

Research suggests that the adult Black community is 20% more likely to experience serious mental health problems, such as Major Depressive Disorder or Generalized Anxiety Disorder.

Additionally, Black emerging adults (ages 18-25) also experience higher rates of mental health problems and lower rates of mental health service utilization compared to White emerging adults, and older Black adults.

What shocked me was reading this statistic: “the Black community comprises approximately 40% of the homeless population, 50% of the prison population, and 45% of children in the foster care system.” All of this puts the Black community is at more risk for mental health issues.

The article also highlights the biological impacts of trauma“through enslavement, oppression, colonialism, racism, and segregation” and shares that “intergenerational trauma may be passed down biologically from one generation to the next.”

Some of the factors that may lead to mental health services not being used amongst the Black community are lack of trust, lack of finances and fear:

Lack of trust in the medical system due to historical abuses of Black people in the guise of health care, less access to adequate insurance, culturally responsive mental health providers, financial burden, and past history with discrimination in the mental health system.

I encourage you to read the entire article at this link.

This paper, Transgenerational Consequences of Racial Discrimination for African American Health goes further into the intergenerational effects of racism on both psychological and physical health: immune health, heart health, obesity, diabetes and so on. The paper concludes as follows:

without addressing the harmful consequences of racial discrimination, improving the health of African Americans as well as other marginalized groups, will remain inadequately addressed.

This inspiring quote is from Nelson Mandela from his autobiography, Long Walk to Freedom  (1994) and no-one says it better than him. It is a message of hope!

Nelson Mandela Quote
from the Nelson Mandela facebook page

Here are some resources geared specifically to Black mental health

With regards to nutritional support for anxiety, depression and PTSD, everything that I write about in terms of nutritional psychiatry applies. My book, The Antianxiety Food Solution, covers the foundations of diet and how to use amino acids. This recent blog, The psychological trauma of coronavirus – nutritional support for doctors, nurses and their loved ones could easily be adapted to be: The psychological trauma of racism – nutritional support for the Black Community.

I am very aware that when it comes to working with a functional medicine practitioner or a nutritionist, and purchasing supplements/doing special diets may be a major stumbling block for many Blacks with financial hardships. This needs to become the standard of care so everyone has access to resources like these.

Until then finding access to real whole foods is a powerful first step.  In the SMILES diet depression trial,  the first randomized controlled diet depression study, ONE THIRD of the dietary intervention group saw improvements in their depression and anxiety symptoms. This was simply by switching from processed/junk food to real food with no specific dietary restrictions.

By doing this we can start to slowly heal some of the depression, anxiety, current trauma and intergenerational trauma caused by racism and inequalities.

Updates 7/7/20:

The above SMILES Diet Depression study doesn’t mention race. There are, however, many studies that didn’t make it into the blog because I felt compelled to publish something quickly.

 Here are some of them:

China, Ghana, India, Mexico, the Russian Federation, and South Africa…examine the relationship between demographic and lifestyle characteristics and depression….. Increased fruit and vegetable intake appeared to co-occur with significantly lower rates of depression, suggesting diet as a modifiable factor for addressing depression burden.

Among overweight/obese women, improvement in health-related quality of life related to physical health, a significant decrease in depressive score, and a reduction in waist circumference were noted.

I am not an authority on Black mental health and don’t pretend to be. I am, however, an authority of food and mental health. Real whole nutrient-dense food is the foundation and always will be – for every single human regardless of race.  We do, however, need more studies that are specific for people of color. 

This needs to be a public health initiative where we address the food security issues. According to this paper, Food Insecurity and Maternal Mental Health Among African American Single Mothers Living With HIV/AIDS in the Alabama Black Belt, “Food insecurity places low-income African American women at risk of depression.”  This is one of many similar such studies.  

Together with this we need to address racism. This paper, Experiences of Racial and Ethnic Discrimination Are Associated with Food Insecurity and Poor Health, sums up with this:

Public health interventions intended to improve food security and health may be only partially effective without simultaneously addressing racism and discrimination

If you have information on non-profit organizations, community gardens, community kitchens and other resources for supporting Black communities when it comes to nutritional supplements, food insecurity and food deserts, and eating real foods please share in the comments.

For now check out and be inspired by Ron Finley, the Gangsta Gardener – and his amazing community garden and gardening masterclasses: 

Ron envisions a world where gardening is gangsta, where cool kids know their nutrition and where communities embrace the act of growing, knowing and sharing the best of the earth’s fresh-grown food. 

Determined to change South Central Los Angeles from food desert to food forest, he wants his actions to be educational, inspiring, and nutritious. He wants kids to grow up with the option of healthy food, instead of fried, fattening staples. He wants to sweep up and transform his street, his hood, the city of LA and communities everywhere.

Please also share your experiences supporting mental health in Black communities. And if you’ve been subject to racism and felt the mental and physical effects please share too. We’re here to support you and learn how we can do better.

Dr. Datis Kharrazian’s GABA Challenge for a leaky blood brain barrier is a theory and we still have much to learn

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gaba challenge theory

I highly respect Dr. Datis Kharrazian and his work and had the pleasure of interviewing him last November on the Anxiety Summit 5: Gut-Brain Axis. During our preparations I asked if we could talk about his GABA challenge for a leaky blood brain barrier and he graciously agreed.

I wanted to address this topic in our interview because two of the most common questions I get asked are these:

  • “How can GABA work if it can’t cross the blood brain barrier?” and
  • “If GABA works does this mean I have a leaky blood brain barrier?”

We had such a great conversation on the topic I’ve decided to pull this part of the transcript into a blog so I can share it here with you and use the blog link to share it more widely as I’m asked these questions on social media and elsewhere.

You will learn how Dr. Kharrazian came up with the GABA Challenge, what his thoughts are today, his reservations with GABA and my excellent results with low doses of sublingual GABA. I also share some links to success stories, some of the research and how to figure out if GABA is for you.

Here it is, word for word.

Trudy: So while we’re talking about the leaky blood brain barrier, I want to just talk briefly about GABA and the GABA challenge that you have proposed as a tool for testing for a leaky blood brain barrier. And as you know, I use GABA extensively with clients with the low GABA physical type of anxiety.

I’ve always been a huge fan of you and your work but we do have a professional difference of opinion in this area. And I’ve never actually been a proponent of using the GABA challenge, and I’ve been pretty vocal about it. So I’m really glad that we had a discussion about this in the Facebook group of your neuroinflammation training, and you shared some insights because I was asking some questions about this.

I’d love you to just share some of what we talked about in that discussion. Because if we don’t talk about it, my community is going to say, “Hey, why didn’t you talk to Dr. Kharrazian about this?”

Dr. Kharrazian: Sure, no problem. I don’t think we have this big a disagreement. I think we just have different ways of looking at what’s out there and what we are observing as people working with people, patients who have anxiety.

So ultimately, we have a bunch of theory right now and a bunch of potential models, but we don’t have any clear studies to show what’s really happening. So, one of the things that I proposed in my book before… you understand, I was working with brain patients for over 20 years now….before we had S100 B readily available for many years, it was only in research; you couldn’t get it from conventional labs, even though research was showing it. And the blood brain permeability test was not available either. These have really become more available the past five years and prior to that, we didn’t really have a great test to evaluate if the blood brain barrier was breached.

In an effort to work with what’s out there, what we could do, one of the things that I was doing was doing a test that we called the GABA challenge test. It was really based on the lactulose mannitol test. So the lactulose mannitol test is a well-established test in gastroenterology where they measure leaky gut. So, in that test what the person does is they consume a monosaccharide and a disaccharide, lactulose and mannitol. Lactulose is a disaccharide, it’s very large, and mannitol is very small. And if mannitol doesn’t get absorbed, then there’s a malabsorption issue. And if lactose, which is very large; that should not get through the tight junctions of the gut, gets absorbed in a post urine test, after they drink it, then it shows they have leaky gut. So the whole premise of when you find particle sizes too large to cross, can be a clue to an indication of permeability.

So the GABA challenge that I write about in my book, Why Isn’t My Brain Working? (my Amazon link) was really a way for us to have patients consume GABA. If you look at the molecular weight of GABA, the Dalton size, it’s several hundred Daltons. Several hundred Daltons cannot cross the blood brain barrier. So the concept was, well if someone is taking GABA and they have an effect, then there’s a potential for it to cross the blood brain barrier. And it was kind of following the theory of the lactulose mannitol test. So there’s patients out there who take GABA and nothing happens and some patients take it and go, “It was amazing. Best thing ever. It finally helped me sleep,” or, “Helped reduce anxiety for me.” So, one of the theories was that maybe for some of these people, their blood brain barrier is breached.

Now I know we talked and there is actually the possibility of other pathways that can impact GABA, maybe directly to the gut itself, through the vagus, so I don’t discount those possibilities because we still don’t know. I mean, ultimately, there’d have to be a study designed where they look at it. And it would have to be an animal study, there’s no way you can get an IRB for human studies to check if it’s crossing the brain. It’s some really advanced isotope tracing techniques and I just don’t think the level of dyes they would have to consume to look at the gut and the brain is peripheral and separate… it wouldn’t be possible. So the real answer is, we don’t know.

For me, I still am always suspicious if someone takes GABA and they have a reaction. I always want to go and check the blood brain barrier. And it’s not 100%, I mean, I can tell you without question, there’s people who take GABA, you do a blood brain barrier test, they feel benefit from it, but their blood brain barrier doesn’t have any markers to show permeability.

So it’s not hard for me to consider the possibility that there’s some exogenous pathways too. But at the same time, it’s also really hard to look at the molecular weight of GABA and look at what can cross a healthy blood brain barrier. This Dalton size, we’re talking nanoparticles to a huge, huge particle. So I don’t know but I think we’ll just have to see what happens. And ultimately, if you feel better with GABA, that’s great. If it’s not harmful to you, and if you feel like taking it, that’s great.

I like to also use things like Valerian root, passion flower, and hops because those compounds cross the blood brain barrier. They cross the blood brain barrier and they bind to GABA receptors.

So, the other thing too with actually using GABA you always have the potential for your neurotransmitter receptor sites to down regulate. And this is seen all the time too, patients take GABA and they feel great and then they have to increase their dose and they don’t get the effect as they first did. And they increase the dose and finally, they just don’t get much of an effect from it. And that’s potentially due to receptor site down regulation, which is not as common if you take agonists like Valerian root or passion flower, or hops. These things bind to GABA receptors. So I did a review in my book, where I went over all the literature of the different GABA compounds, which have been published in the literature.

But I’m not going to deny the possibility that there is a potential exogenous source but I also can’t let go the possibility that the blood brain barrier is permeable. So I’m still waiting.

Trudy: Yes, I think it’s great because the fact that you write about that and you taught about that, and you teach about it. It got me looking into the research further and it got me more curious; and it’s good, it’s good to have a healthy discussion and a healthy debate, and be open to possibilities. I’m very open to having my mind changed if something comes up.

I just see GABA works so well with my clients and we use very, very small amounts. I know with your GABA challenge, it’s… what is the amount, its 1,500 milligrams, I think or 1,500 to 2,000? So I’ll start my clients on 125 milligrams of GABA sublingually and get results. I have not noticed the effect that they need more and more, and more. So that’s interesting that you say that. But yeah, it’s good, I’m glad that we’ve had this discussion.

And the other thing that you did say in the online discussion, you said, if someone has a response to taking oral GABA, in other words, taking a GABA supplement does help them, you would want to test for the blood brain barrier permeability, just to see what’s going on. And I like that you say we can track. I’ve actually been in discussions with Cyrex and said, “Hey, why don’t we monitor people who are doing the Cyrex test and have a response to GABA, either therapeutically for the anxiety or with your challenge?” We may start to see some patterns, which I think would be very interesting.

Dr. Kharrazian: Yes, the best we can do with the data in that scenario is just the correlation statistical analysis. But it still wouldn’t answer it.

Trudy: No, I know. But maybe that will trigger someone to want to do a study. So, the good news is we’re seeing more and more research on GABA in the literature. So, it’s exciting. Well, thank you for discussing that with me.

You can read more from our very enlightening interview here: Fix the Brain to Fix the Gut. Dr Kharrazian covers the impact of brain injury and impaired vagal activity (as well as motility and breakdown of the blood brain barrier), how to activate your neurons, using polyphenols for neuroinflammation and butyrate for leaky gut/brain.

These blogs have additional information on GABA and some of the many possible mechanisms:

Here are some blogs with feedback from folks who have benefited from using sublingual GABA for dental anxiety, ADHD/focus issues and Lyme anxiety:

The best way for you to figure out if you will benefit from GABA is to use the trial method. Do the low GABA questionnaire and do a trial of GABA (used sublingually), starting low and increasing until you find the right amount to ease anxiety and improve sleep. You can find the GABA products I recommend on my supplements blog.

Please do share if you’ve benefited from using GABA or if you use it with success with your clients or patients.

Coronavirus and vitamin C for immune support: new pain or more severe pain due to oxalate issues?

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coronavirus pain vitamin c

I have concerns regarding the use of high doses of oral vitamin C for boosting immunity – for a subset of susceptible individuals who have dietary oxalate issues. This is directly related to the many recommendations that have been and are being made in relation to the coronavirus pandemic, but it applies beyond the pandemic for anyone who has dietary oxalate issues.  My concerns relate to high doses of vitamin C making existing pain symptoms worse or even causing new pain symptoms in someone who is not aware they may have oxalate problems. This may include joint pain, vulvodynia, bladder pain, painful urination, eye pain, headaches, foot pain, stomach pain, general body pain, deep bone pain etc. All this can manifest as fatigue, irritability, anxiety, low mood and insomnia.

I’ve been promising to blog about this topic for over a month and have gathered enough information for a short book! I figured a good place to start is to share feedback I’ve received so far and ask for your feedback so we can learn and heal, educate and inform others going through this, as well as offer insights to researchers and doctors who are not aware of this issue (and sometimes say “based on biology it’s not possible”).

In the coming weeks, if there is enough interest, I’ll share additional information on mechanisms, what the research says and what the research says is not possible, labs, types of oxalate issues (there are many), the possible causes (there are also many) and long-term impacts beyond pain (for the thyroid, mitochondria, heart and more), the solutions, additional resources and  feedback from experts (of which there are very few – as of now I’ve been reading everything published by Susan Owens, Julie Matthews, Great Plains Labs and research published by kidney specialists).

Until then I’m humbly asking for your feedback. If you have no idea what oxalates are or are taking vitamin C with no issues, then please don’t worry. Things will become clearer as you read this blog and read follow-on blogs. I feel it’s really important to get this initial blog out rather than waiting until I have everything written up perfectly.

I’ve also been hearing feedback from folks who have now recovered from coronavirus or are still recovering, with many reporting lingering pain and fatigue. I am concerned some of that pain may be related to high doses of oral vitamin C or IV (intravenous) vitamin C leading to oxalate issues they may not be aware of.

My request to you – please share your vitamin C oxalate story

This is what I posted on facebook and I’ll simply share it again here: I’m looking for oxalate vitamin C stories to share with folks who don’t believe or are not aware that high dose vitamin C causes issues for those with dietary oxalate issues.

1) What symptoms do you experience?

2) How quickly do you notice symptoms after taking vitamin C?

3) What form of C have you tried? (ascorbic acid or Ester C or whole food sources of C like camu camu/amla/goji berry/acerola cherry/rosehips/kakadu plum/acai berry/ maqui berry or liposomal or something else). Please also share the brand and source of vitamin C if you know

4) How much vitamin C do you use and is this more than you usually take or are you/were you taking this for the first time?

5) How long did it take to get back to normal/no pain/no symptoms once you stopped taking vitamin C?

NOTE – ONLY VITAMIN C: for questions 2) through 5) – in order to be sure the new symptoms are due to vitamin C and not something else – the addition of vitamin C must be the only change made and then stopping vitamin C must also be the only change made. I have clients keep a log too and repeat the “test” if they are not sure. This can be likened to a gluten elimination trial but in reverse. Repeating the “test”also depends on the symptom severity.

6) Does/did anything help to counter the adverse effects (like calcium citrate, vitamin B6, NAC, MSM, biotin, bile support, Epsom salts baths or anything else)?

7) How long have oxalates been an issue for you and are you eating low oxalate? Or is this all new to you?

8) Would you equate the effects of vitamin C to eating high oxalate foods like spinach, raspberries, nuts and seeds, kiwi fruit, figs, turmeric, chocolate, wheat, white potato, soy, beets etc (less severe/same symptoms/more severe)?

I’m also adding these new questions based on some of the research I’ve been doing:

9) Are you aware of any kidney issues and if you get regular blood work done do you track and take note of your estimated Glomerular Filtration Rate (eGFR)?  What have you observed in terms of values? (In case eGFR is new to you it measures how well your kidneys filter the wastes from your blood and is the best overall measure of kidney function. It helps determine if you have any kidney damage.)  Have you ever been told you have kidney issues and have other kidney lab markers out of range?

10) What are your results on the Great Plains Lab organic acids test (OAT) for the following: Oxalic acid, Glycolic acid (glycolate), Glyceric acid (glycerate), Arabinose (a yeast/candida marker) Ascorbic acid (ascorbate, vitamin C), Pyridoxic acid (marker of vitamin B6 status), Furandicarboxylic acid and hydroxy-methylfuroic acid (markers for fungi such as Aspergillus), and markers of bacterial imbalance?

11) Do you have pyroluria (based on a urine test) or have more than 15 symptoms from the the pyroluria questionnaire and/or are susceptible to low vitamin B6 (poor dream recall and/or nightmares) and low zinc (and therefore high copper)?

12) How do you score on symptoms of low serotonin, low GABA, low endorphins and low catecholamines? (here is that questionnaire). Is your anxiety, low mood, cravings or sleep worse when you are dealing with your other oxalate symptoms/pain?

13) Do you have any genetic markers that indicate a susceptibility for oxalate issues?

14) Do you have celiac disease, gluten sensitivity, leaky gut, liver issues, gall stones, no gallbladder, poor bile production, fat malabsorption, mold toxicity issues, low pancreatic enzymes, candida, high iron/ferritin?

15) What are your results on a mold toxicity test such as the Great Plains MycoTOX profile? and/or do you live in a moldy home/worked in a moldy environment or have in the recent past?

16) What are you results on a stool test (and which stool test)?

17) Do you have high mercury, high lead or high levels of other metals?

18) What is your vitamin D level (now if you happen to know it and/or typical levels in the past) and did you start to take extra vitamin D during this pandemic too? If you are taking extra vitamin D how much extra? And does your vitamin D supplement also contain vitamin K1 and vitamin K2?

19) Do you have any other out-of-range (functional levels) markers on blood work or other lab tests?

I will come back and add references and the rationale for posing these questions.

Also, feel free to comment with a nickname to keep your health information private.

Josefin’s story: painful “fat tissue” around elbows, knees and hips, and an irritated bladder

I share some of the Facebook feedback below, but first, here are Josefin’s comments on my coronavirus blog. Josefin thanked me for not ignoring the oxalate problems that might come with higher doses of vitamin C, saying she has “experienced them first-hand and it is not something to take lightly.”

I asked her to share what happens when she eats medium and high oxalate foods (like spinach, nuts, kiwi fruit, chocolate etc). She shared this:

I gradually decreased my oxalate content in food as recommended in the TLO-group. During that year I experienced periods with a lot of the typical dumping-signs like sandy stools, pain in body and especially in joints and muscles, sand in eyes, bladder pain, peeing a lot, cravings for oxalate foods and a temporary relief in the dumping symptoms when I ate some higher oxalate foods.

I also realized that the painful “fat tissue” that I had all over the body (but mainly around elbows, knees and hips) for 10 years was really deposited oxalates with mostly fluid around it, since I lost it more and more while I dumped and had more pain there also when I dumped. Now the deposits are all gone.

I did want to know if the adverse symptoms she experienced with vitamin C were the same as when eating foods high in oxalates, and she confirmed they were:

Many of the symptoms of dumping were the same as I had previously experienced a few days to weeks after trying to do bowel flushes with vitamin C.

Josefin has been on a low oxalate diet for 3 years and has found the most vitamin C she can tolerate is 200-250mg of vitamin C per day. More about that in her own words:

Now after being on a low oxalate diet for 3 years (carnivore the last year) I have tried taking vitamin C very many times and come to the conclusion that about 200-250 mg per day is what I can take. If I take more I will get a gradual increase of that painful fat-tissue that will start after a few days to weeks depending on how much vitamin C I take. I will also get more of a flu feeling and irritated bladder.

When I stop taking the vitamin C I will within a day or two get all my typical dumping symptoms and they will continue for days to weeks depending on how much I have taken. Symptoms severity also depends on how much I have been taking.

It turns out she gets similar reactions with various forms of vitamin C: “ascorbic acid, calcium ascorbate, multimineral buffered ascorbate and also liposomal vitamin C from Quicksilver Scientific”.

Syd’s story: cystitis, along with a crashed brain

Syd shared this on the Facebook post:

I get symptoms from taking high dose Vitamin C within about 45 minutes. It shows up as cystitis, mostly, along with a crashed brain.

She did confirm that when taking vitamin C (possibly the ascorbic acid form) the symptoms mimic her symptoms when eating high oxalate foods. She also wants to try liposomal vitamin C and camu camu to figure out if she gets the same reactions:

I have the very same response to high oxalate foods. I used to think it was a bladder infection, but I tested four times and every time the test was negative. I’m having a response at the moment. I (stupidly) started eating protein bars that have nuts in them and after eating about four of them across several days, I have the cystitis symptoms.

I’m staring at some liposomal Vit C in the fridge that I’ve been wanting to try at a low dose. Same with some camu camu. I need the cystitis symptoms to abate first.

Virginia, Cathi and Melissa and their pain stories

Virginia also offered feedback on Facebook on her experiences with vitamin C, and again they are similar to when she eats high oxalate foods:

I took a pack of Vit C 1000mg (ascorbic acid) at night last week, next morning I noticed oxalate dumping. Took calcium citrate and it was gone within a day and yes the reaction is similar to eating high oxalate foods

On another Facebook thread my question got Cathi wondering if vitamin C was a factor in her worsening arthritis:

Hmmmmmm this has me thinking. I started Vitamin C crystals 1000mg a day – small spoonful in water. It is sour and not awful. Then, a couple of months ago the arthritis deposits in my right hand fingers got much worse and my right wrist has given me so much grief I have had to reduce my yoga. And I got a weird cyst or something on the inside of my right wrist. I wonder…. Gonna stop it and see if it makes a difference!!! Thank you as I was totally stumped and I hope this is the answer!!!!

On this same thread, Melissa shared that noticed severe joint and muscle pain within 2 or 3 days of starting vitamin C:

When the COVID stuff started, I started taking vitamin C as a preventative measure to keep my immune system strong. Within two or three days, I had system joint and muscle pain everywhere. I could hardly move! I stopped the vitamin C and it cleared up in 3 or 4 days. I’ve never had kidney stones, but my brother has, so maybe it’s a genetic predisposition? I do have a history of on & off systemic joint pain since my early 20’s.

I never thought I had oxalate issues but now I’m wondering if it might be related to my random systemic joint pain. 

I was taking between 1,000 to 3,000 mg per day. The label says Solaray timed release vitamin c (ascorbic acid), acerola cherry and rose hips.

Thanks to these folks, everyone who has already contributed on other blogs, all the Facebook feedback (and to you if you provide feedback today).

My hesitation – I don’t have all the answers and we are in the midst of a pandemic where vitamin C is so important

I planned to include this in part 2 but I’m adding this section now because a few hours after publication there are already so many comments and questions. I did hesitate about publishing this blog when I don’t have all the answers and because we’re in the midst of a pandemic where vitamin C has been shown to be very important.

There is plenty of research on the benefits of vitamin C and it’s widely used with much success during serious illness and for sepsis. This paper, An Update on Current Therapeutic Drugs Treating COVID-19, published just last month, discusses vitamin C (ascorbic acid) as a supporting agent, playing a role as a potent antioxidant, with benefits for immune health and as an antiviral against flu viruses.

It also discusses an IV vitamin C coronavirus trial and high dosages currently being used in various hospitals for this virus. The authors do also say “no major side effects” which is what we are typically told about vitamin C.

The Orthomolecular Medicine News Service have issued a number of valuable press releases on vitamin C specific to coronavirus but they are steadfast in their conviction that there are no issues with vitamin C, saying it doesn’t cause kidney stones.

For the majority (I think) there will be no major side-effects but for those with oxalate issues high doses of vitamin C are clearly problematic.

One caveat is that there may be a place for short-term high-dose use during a healing crisis, even for someone with dietary oxalate issues. Unfortunately I don’t have an answer for this aspect yet and I’m hoping a vitamin C expert will contribute to the discussion or I’ll discover some research about this.

And let’s not forget this study published in 1994, The clinical effects of vitamin C supplementation in elderly hospitalised patients with acute respiratory infections, where 200mg of supplemental vitamin C per day resulted in an 80% decrease in deaths among severely ill, hospitalized respiratory disease patients.

This topic is near and dear to my heart and folks have oxalate issues now so I decided to go ahead and publish this information. I’m looking for a solution for my community who are already aware they have oxalate issues (many of you have already reached out to me so thank you) and for myself too. I’ll share details of my oxalate story (my pain is in my feet and my eyes) and my vitamin C experiment in a future blog (I used food based vitamin C and 100-200mg/day and it didn’t go well).

As I mentioned above, I’m also concerned there are many people who don’t know they have oxalate issues and may end up with issues because of all the well-meaning vitamin C advice that is being shared during this pandemic.

I may have bitten off more than I can handle with this topic – I’m learning voraciously and it’s like drinking from a fire-hose! But I’m doing what I often do … I learn by teaching and asking for your feedback and questions, and I’m open about the fact that I’m not an expert and don’t have all the answers.

**** Some cautions *****
Please discuss your situation with your doctor and other health practitioners before stopping or reducing vitamin C based on what you’re reading here.

If you are completely new to the topic of oxalates, this is sound advice from Susan Owens on getting started: “work your way gradually into a completely low oxalate diet.” You can learn more on getting started here. Susan runs the Trying Low Oxalate Group (TLO) on facebook and they are extremely helpful.  I will be sharing additional resources/studies/practitioner feedback etc. but this will get you started.

A reminder that pain can have many root causes other than dietary oxalate issues (or in addition to oxalate issues): gluten issues, nightshades, low GABA, low serotonin, low endorphins, Lyme disease (bartonella can cause foot pain), fibromyalgia, low B12, heavy metals, mold toxicity, autoimmune conditions etc.

******************

Feel free to comment below – share your feedback and ask your questions. And do let me know if you’re interested in learning more about this topic and additional blog posts.

If you’re a practitioner who works with individuals with dietary oxalate issues I’d love to hear from you too.