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Archives for September 2019

The Anxiety Summit, Dr. Perlmutter, the fear center of the brain and the joy of fresh flowers

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trudy and flowers

These lovely flowers are all from our garden and I have my wonderful mom-in-law to thank for this arrangement which I used for a very special interview this week with Dr. David Perlmutter (more on this below) for season 5 of The Anxiety Summit. I have my mom-in-law, Althea, to thank for all the flowers in all the interviews.

As you know, I love nature and flowers and because of this it feels really special to be able to say that The Anxiety Summit has been dubbed “a bouquet of hope.” Someone in one of the past seasons shared this anonymously and then sent me a lovely letter afterwards saying it was her.

Unfortunately, we were in the middle of packing to move and her letter was misplaced so I still don’t have a name and person to thank. If you’re reading this now, please please let me know it was you so I can thank you.

I’m sure you don’t need a study to convince you why you enjoy flowers so much but here goes anyway because – you know me – I love to geek out on the research.

In a study, Effect of olfactory stimulation by fresh rose flowers on autonomic nervous activity, 19 female university and graduate students (21 to 26 years old) reported an increase in physiological and psychological relaxation when smelling fresh roses. The study reported that the aroma of the fresh flowers led to

  • a significant increase in parasympathetic nervous activities
  • an increase in “comfortable” and “natural” feelings.

I’m not one bit surprised at these results! Are you? I would expect there to be an effect on our endorphins too because we feel so wonderful when we get a bunch of flowers from our loved one!

Dr. Perlmutter – Anxiety: Gut-Brain Communication & Diet

As I said above, I had the distinct pleasure of interviewing Dr. David Perlmutter for The Anxiety Summit this week (notice the flower arrangement in the background).

dr. perlmutter interview

You likely know Dr. Perlmutter as the author of Grain Brain, The Surprising Truth About Wheat, Carbs and Sugar, with over 1 million copies in print. What a wonderful interview we had. He’s smart, articulate, funny, geeky and practical at the same time, and an all around lovely person. I can’t wait to share this and all the incredible interviews I have done for The Anxiety Summit 5: Gut-Brain Axis.

In my interview with Dr David Brady on this summit he mentions how Dr. Perlmutter has championed the whole gut-brain connection. We all appreciate him for this work and with him being a trailblazer and leader in this, having him as a speaker on this summit could not have been more perfect. This is our topic and the talking points we cover

Anxiety: Gut-Brain Communication & Diet

  • Fermented foods, prebiotics, gut integrity and anxiety
  • SCFAs/short chain fatty acids, HDACs and serotonin production
  • Inflammation/cortisol and the amygdala/prefrontal cortex connection

Here is a snippet from our interview which went deep into the research, the mechanisms and biochemistry, and then brought it all back to practical interventions :

Both inflammation and stress can enhance anxiety. Well, what is anxiety? Anxiety is a physiological reaction to real of more commonly a perceived stress – in other words, a threat. There is no real threat there but the body perceives a situation that is not necessarily threatening as being threatening. So the body goes into this anxiety response for no good reason….

What we understand is that inflammation and cortisol actually tend to reduce the availability or the functionality of a connection between two parts of the brain. One of them, called the amygdala, is the fear center, and the other is the prefrontal cortex which is an area of the brain that tends to calm things down. It says to the amygdala: “Hey, cool, we’re glad you’re around but this isn’t one of those times you need to get excited.” It’s the adult in the room, if you will.

Inflammation and cortisol/stress breaks this key connection between the amygdala and the prefrontal cortex and these are one possible mechanism that leads to anxiety. We go on to discuss solutions such as diet, nature, and sleep.

I could have brought up flowers and talked more about nature at this point but we still had so much to cover.

Earlier in the interview went in depth into dietary aspects like delicious fermented foods and prebiotics such as garlic, onions, leeks and cauliflower. Prebiotics are fuel for short-chain fatty acids like butyrate, acetate and propionate, which are involved in the integrity of the gut lining, protect from intestinal inflammation. They are also involved in the manufacture of calming neurotransmitters, so here we have some of the stress/cortisol aspect covered.

Please join us and listen to the entire interview on The Anxiety Summit 5: Gut-Brain Axis.

anxiety summit

Resources from Dr. Perlmutter

Now I get to share some of his wonderful work. You can find him online at DrPerlmutter.com and he has these new releases coming up:

  • Alzheimer’s – The Science of Prevention documentary is airing online October 9-20. You can watch the trailer and register here
  • He is the editor of the upcoming collection The Microbiome and the Brain that will be authored by top experts in the field and will be published in 2019 by CRC Press – written for both practitioners and researchers. This is so exciting and perfectly supports what we cover in this summit.
  • His new book Brain Wash, which is proudly co-written with his son Austin Perlmutter, MD will be published in January 2020. He does share a few gems from the book in our interview.

I’ll be tuning into the Alzheimer’s documentary and sharing snippets, and will review both of his new books so stay tuned for that.

Are you excited to hear my interview with Dr. Perlmutter? Which areas are of most interest to you?

And do you love flowers as much as I do? What are you favorites and how do you enjoy them?

If you have found any of the Anxiety Summits to be “a bouquet of hope” in your healing journey please tell us why and how you’re doing now.

If you’d like to give feedback or ask a question, please post in the comments below.

 

GABA, Rescue Remedy & essential oils for eliminating dental anxiety

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dental anxiety

Have you used GABA to help with the anxiety you experience when going to the dentist or with one of your children who are fearful during a dental visit? I recently shared a comment on Facebook about how delighted I was with some of the feedback from Integrative Medicine for Mental Health attendees for my recent GABA presentation. I had a mom, Katie, respond and share how happy she was that GABA helped her 8 year old son on a trip to the dentist. She shared this:

My 8 year old has some anxiety, OCD-like tendencies, and sensory processing issues. Going to the dentist is extremely difficult. They recommended full sedation, which I refused. Instead, I brought his GABA, Rescue Remedy, and essential oils. He got 2 cavities filled like a champ!

I had forgotten the GABA at first and he was struggling. I stopped the dentist, gave my son a GABA lozenge to dissolve in his mouth, and within 30 seconds he was calm. The dentist was SO impressed. It really does work! I’m so grateful I learned about it from you!

GABA really does work this quickly – 30 seconds is not unusual – and this effectively and I was thrilled for this mom and her son.

A few other moms asked about which GABA product Katie used for her son, which one I recommend, and can GABA be used with children.

I like GABA Calm for kids and adults for the physical type of tension anxiety. When using with a child we want to start low and slowly increase. I’ll have the mom start them on one quarter (or sometimes less) of the GABA Calm product (which contains 125mg of GABA) and increase based on the trial and how their symptoms improve.

kal gaba

Katie used a 25mg GABA product by Kal, pictured here. I really like that it’s a nice low amount and that it uses what they call ActivMelt™ technology, so it melts in the mouth. Using GABA this way or sublingually or opening a capsule of a GABA-only product and holding it in the mouth is the most effective way to use GABA.

Depending on sensitivity issues you may need to test it out and consider some of the other ingredients if you notice tummy upset or something else.

Rescue Remedy and an essential oil blend

Katie also shared this about the Rescue Remedy and essential oil blend she used when they arrived (before giving him GABA):

The Rescue Remedy was very helpful. We use it on the whole family. For oils, I used a blend called Tranquility from Butterfly Express.

I had him inhale the oil plus applied it behind his ears and on the carotid artery on his neck. The dental assistant commented on how good that oil works because she felt really relaxed and calm.

I find GABA to be more effective so start there but many moms like Katie, find Rescue Remedy, a Bach Flower remedy, to help. I remember using Rescue myself, many years ago before I had discovered GABA.

The Tranquility blend contains: Blue Tansy, Geranium, Chamomile German, Lavender Officinalis, Palmarosa, Patchouli, Orange Sweet, Tangerine, and Ylang Complete. I’m not familiar with this company but the essential oils in this blend are wonderful.

Both of these – the oils and Rescue remedy – helped initially but it seems it was the GABA that gave him the most effective calming relief.

Thank you Katie for sharing on Facebook and giving me permission to share your son’s GABA dentist story here. Well done for getting your dentist on board with both the essential oils and GABA.

Anxiety nutritional solutions resources for dentists

Going to the dentist can be stressful at the best of times and downright terrifying in some instances and I want kids and adults alike to know they have options like this.

Now, let’s get my book, The Antianxiety Food Solution, into the hands of all dentists so they can help their anxious and fearful patients with GABA and other nutritional approaches!

And let’s also talk to the dentist about diffusing calming essential oils in the treatment and/or waiting rooms or at least encouraging their patients to bring their own blends.

Keep in mind that serotonin support with tryptophan or 5-HTP should also be considered if there is a phobia and fear that is so intense, the child won’t even go to the dentist. Katie mentions her son has OCD-like tendencies too and serotonin support helps with these symptoms as does a gluten-free diet in many children (as illustrated by this case study).

Have any of the above helped your dental anxiety? Or helped with anxiety your children have experienced going to the dentist?

More about my IMMH GABA presentation

In case you’re curious and missed my other emails and blogs about on my Integrative Medicine for Mental Health presentation, the topic was “GABA for anxiety, ADHD, autism, addictions & insomnia: New research and practical applications” and here is some of the lovely feedback I received:

  • I am a GABA believer!
  • Trudy Scott could be a keynote with all the data she contributes.
  • Would have given Trudy Scott an “excellent” rating if she had gotten her slides in on time.

Oh dear on that last one but I will own being late delivering the slides. But I had 3 spider bites on my finger, then my laptop was ruined by water on the plane and then I sprained my ankle (GABA helped her too). And believe it or not, the backup box of the printed presentation was not delivered to the hotel! You really can’t make this stuff up!

I really loved having this opportunity to educate enthusiastic and knowledge-hungry integrative practitioners on the wonderful benefits of GABA and the other amino acids!

It’s a great conference. In fact, it’s the best conference on integrative medicine for mental health!

As a practitioner, do you want to learn more about how to incorporate GABA and the other targeted individual amino acids, tryptophan/5-HTP, DPA, glutamine and tyrosine, into your work to help your clients/patients with sleep issues and anxiety? I invite you to check out my new online practitioner training here: Balancing Neurotransmitters – The Fundamentals. I’m extending the $100 discount offered at IMMH (use coupon code immh2019).

How high to go on GABA for sleep issues and what are the negative effects of too much tyrosine?

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gaba and sleep issues

How high to go on GABA for sleep issues and what are the negative effects of too much tyrosine?

Today I’m sharing a great question I received about sleep issues – how high to go on GABA and what are the negative effects of too much tyrosine – together with my feedback because it’s not always a simple answer.

Here is the question about sleep, GABA and tyrosine:

I find I need more than the 500mg of sublingual Gaba Calm for sleep even with 200mg theanine. What dose can I go up to. Took a while to work up to that dose. I want to get away from sleeping tablets. Also what are the negative effects of too much tyrosine that comes with this product?

GABA Calm contains both GABA (125mg) and tyrosine (25mg) and it’s one of my most recommended products for anxiety. It sometimes works for insomnia and sometimes it doesn’t.

GABA and feeling stiff and tense with insomnia and anxiety

As you may know, with sleep issues caused by low GABA levels you’ll often lie awake with feelings of physical tension and stiff muscles rather than the ruminating thoughts which is the low serotonin type of insomnia – although it’s not uncommon to experience both. You may also have the stiff-and-tense type of anxiety, panic attacks and the need to self-medicate to calm down, often with alcohol but sometimes with carbs and sugary foods. By using the amino acid GABA you can raise your GABA levels and ease many of these symptoms.

Tyrosine can be stimulating and can be calming

Tyrosine is a considered a stimulating amino acid that is the precursor for making catecholamines (one of the neurotransmitters) like dopamine, epinephrine and norepinephrine. Boosting these neurotransmitters provides focus, increased energy and more motivation, and can also alleviate some forms of “curl-up-in-bed” depression.

Conversely tyrosine can also provide a sort of calm focus for some folks.

How much GABA and how much tyrosine?

Keeping all the above in mind, here is my feedback: 500mg of GABA is a large dose when starting out and is typically too high for most people, causing a light-headed feeling and sometimes a niacin-like flush. For this reason, it was good to hear that she worked up to that dose of GABA, found in 4 of the GABA Calm tablets i.e. 125mg of GABA for each one.

When my clients get up to multiple GABA Calm tablets I will often have them switch to a GABA-only product or a GABA/theanine product (opened up onto the tongue and held there for 2 minutes or longer) as the tyrosine can be stimulating. Some folks do fine on a small amount of tyrosine in the evening so 1-2 GABA Calm may be fine but more than that and it can be too much and may need to be avoided.

Taking 4 x GABA Calm tablets also provide a hefty dose of sugar alcohols which could cause diarrhea.

As far as using higher amounts of GABA, I have clients increase as long as they are seeing added benefits. I have had some clients go up to 1000-2000mg but more than this is rare. Theanine can often also be increased up to around 1000mg.

Here are some clues to look out for:

  • too tired in the day → too much GABA or too much theanine?
  • too tired in the day → too little GABA or too little theanine causing disturbed sleep?
  • too tired in the day → not enough tyrosine?
  • not able to sleep well → too little GABA or theanine?
  • not able to sleep well → too much tyrosine (at night or even mid-afternoon)?
  • calm energy → just enough tyrosine
  • sleep well → just enough GABA and/or theanine

There is research supporting that a GABA/theanine combination can improve sleep and that a GABA/5-HTP combination can too. There is no research on GABA Calm and insomnia but in practice it works for some people at night and not for others.

I’m sure you can agree with me that it’s not always simple and there can never be one size fits all. This doesn’t work: “Since you have insomnia take 2 GABA Calm and I’ll see you in a month” or even “This 250mg GABA with 100mg theanine will sort out your sleep issues in no time.”

It’s always a matter of figuring out what your own unique needs are.

Looking for other root causes of your insomnia

If my clients are not seeing incremental benefits as they increase the GABA and/or theanine (and stop the tyrosine) they go back down to their lower dose and we start looking for other root causes for their insomnia.

These root causes can range from low serotonin to high cortisol, also gut issues like SIBO, parasites (which are more active at night) or gluten issues. Too much caffeine (even if consumed in the morning and even a single cup of coffee!) and low blood sugar must always be ruled out too. Some sleep medications can actually make sleep worse especially benzodiazepines. And side-effects of all medications need to be looked at and also the possible effects of EMFs/WiFi.

Have you found that using the trial method with GABA and/or theanine has enabled you to find the ideal amount to take for your insomnia or anxiety? Where did you start and how high did you need to go and how much did this approach help?

Did the removal of tyrosine make a difference or make you more tired in the day?

Were there other factors at play as root causes of your insomnia or anxiety?

As a practitioner, do you want to learn more about how to incorporate GABA and theanine and the other targeted individual amino acids, tryptophan/5-HTP, DPA, glutamine and tyrosine, into your work to help your clients/patients with sleep issues and anxiety? I invite you to check out my new online practitioner training here: Balancing Neurotransmitters – The Fundamentals. I’m extending the $100 discount offered at IMMH for a few weeks (use coupon code immh2019).

Psychedelics: is MDMA assisted therapy effective and safe?

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psychedelics

Dr. Dan Engle, MD, did one of the keynote presentations at the recent IMMH conference. The topic was “Psychiatry Meets Psychedelics: Treating Psycho-Emotional Conditions with Ayahuasca, Psilocybin and more.”

psychedelics

This was not about recreational use of psychedelics but rather Psychedelic Assisted Psychotherapy or PAP, which is “professionally supervised use of ketamine, MDMA, psilocybin, LSD and ibogaine as part of elaborated psychotherapy programs.” Dr. Engle also talked about peyote, cannabis, ayahuasca, San Pedro and DMT.

psychedelics

psychedelics

I had the pleasure of meeting Dr. Engle the day before during the speaker panel we were both part of and shared that I was coming to his presentation because I have a curious mind and love to learn but to be honest “I’m not yet sure if I’m on board with pyschedelics because I’m concerned about the adverse effects AND that too many folks will rush into this approach before exhausting all other nutritional and functional medicine options.” He appreciated my honesty, saying the fact that I was going to come to his talk was a great first step.

psychedelics

He highlighted the epidemics of suicide (22-23/day in veterans), anxiety and depression in youth (40% increase in teens and 200% increase in suicide in girls 10-14 years old, and a 50% increase in boys, opioids (115 overdoses/day and a 400% increase from 1999-206) and loneliness (where rates have doubled since the 1980s).

This is all very horrifying and calls for drastic interventions. Is Psychedelic Assisted Psychotherapy the solution and is it safe and effective?

Let’s take MDMA as one example. In case you’re new to the term, MDMA is the abbreviation for 3,4-Methyl​enedioxy​methamphetamine. This 2018 article, Is psychiatry ready for medical MDMA? shares this:

Advocates for MDMA-assisted psychotherapy have been at pains to distinguish the street drug ecstasy from MDMA, the medicine. Ecstasy can contain a range of substances as well as varying doses of MDMA.

psychedelics

Dr. Engle shared some of the psychedelic science, with impressive results for MDMA.

The study by Mithoefer in 2010 reported that 83% of patients with severe treatment-resistant PTSD saw their symptoms resolve after 2-3 sessions of MDMA assisted therapy. These are very encouraging results, however the patients were described as having treatment-resistant PTSD as a result of not seeing resolution of their symptoms with either psychotherapy or psychopharmacology (i.e. medications). They had not been offered a functional medicine/nutritional approach. This is all good and well if there were no adverse reactions with the MDMA assisted therapy.

According to the above paper: There were no drug-related serious adverse events, adverse neurocognitive effects or clinically significant blood pressure increases.

However, what wasn’t mentioned in Dr. Engle’s presentation is that some studies do show adverse effects of MDMA. For me, this is an area of concern as far as psychedelic use goes, and I would have liked to hear more about what kinds of problems we need to be aware of.

This 2014 paper: The potential dangers of using MDMA for psychotherapy lists a number of very concerning potential dangers:

  • Early studies from the 1980s noted that MDMA was an entactogen, engendering feelings of love and warmth. However, negative experiences can also occur with MDMA since it is not selective in the thoughts or emotions it releases. This unpredictability in the psychological material released is similar to another serotonergic drug, LSD.
  • Acute MDMA has powerful neurohormonal effects, increasing cortisol, oxytocin, testosterone, and other hormone levels. The release of oxytocin may facilitate psychotherapy, whereas cortisol may increase stress and be counterproductive.
  • MDMA administration is followed by a period of neurochemical recovery, when low serotonin levels are often accompanied by lethargy and depression.
  • MDMA could increase the likelihood of suicide in those individuals with strong post-recovery feelings of depression.
  • Regular usage can also lead to serotonergic neurotoxicity, memory problems, and other psychobiological problems.
  • Proponents of MDMA-assisted therapy state that it should only be used for reactive disorders (such as PTSD) since it can exacerbate distress in those with a prior psychiatric history.

The author ends by saying: My own position is that it will always be far safer to undertake psychotherapy without using co-drugs. In selected cases MDMA might provide an initial boost, but it also has far too many potentially damaging effects for safe general usage.

There are many practitioners who, like me, are not yet on board with Psychedelic Assisted Psychotherapy, because adverse effects appear to be under-reported and not discussed. A more recent 2018 paper calls for more research about the safety of MDMA assisted therapy: an immediate need for more research directly examining its safe usage in the therapeutic context.

Hopefully the phase 3 MDMA trial Dr. Engle mentioned on this slide will provide further insights about potential safety issues.

psychedelics

Dr. Engle did also share this interesting slide: Active/Lethal Dose Ratio and Dependence Potential of Psychoactive Drugs, Drugs and Society, US Public Policy, 2006. It’s apparently from this paper published by Gable, RS (I’ll confirm once I find out). You can see MDMA on the far right indicating a rather high potential for acute lethality (bottom scale), with a moderate/low risk for dependence (the scale on the left).

Dr. Engle stopped by my booth after his presentation to see if he’d been able to change my mind. I shared my concerns about the potential risks. I also said that it would be helpful to see a study comparing MDMA assisted therapy with a functional medicine/nutritional approach. I also said I’ll keep reading and learning and will keep an open mind but right now I’m still very much on the fence. This approach does seem to be very effective but I have concerns about safety.

I blogged about some of my concerns last year: MDMA-Assisted Psychotherapy for Treating Chronic PTSD: Why I feel we can do better and the role of nutrition and amino acids like GABA

I agree there is an immense need for successful treatment approaches, but jumping to MDMA from psychotherapy and/or psychiatric medications is skipping out the entire nutritional and biochemical step which is SO powerful and doesn’t have the above adverse effects. I’m concerned too many who have not seen benefits from therapy or medications are seeing MDMA as THE solution and are going to be harmed even further.

One other big reason is that I’m very much on the fence is that I see so much success with the nutritional approach that I use with clients.

In addition to psychotherapy, there are also so many nutritional and biochemical factors we can consider when it comes to PTSD. These don’t have any of the above harmful effects seen with MDMA.

Here are a few to consider:

I feel it is these kinds of interventions that should be considered for PTSD, rather than subjecting individuals who are already suffering to treatments that have adverse reactions AND are not addressing underlying nutritional deficiencies of low GABA, low serotonin, out of balance endocannabinoid system, dysbiosis and overall health, to name a few of the many possible underlying biochemical factors.

Real whole food, exercise, GABA, tryptophan, zinc, berries, probiotics etc. wouldn’t even feature on a chart such as the one above! They are effective approaches and they are safe!

In case you missed the previous IMMH blogs:

Have you been part of a Psychedelic Assisted Psychotherapy program with MDMA or one of the other psychedelics? What benefits did you experience? Did you have any adverse effects?

Would you consider Psychedelic Assisted Psychotherapy with MDMA or one of the other psychedelics?

Have you see benefits and/or adverse effects with your patients or clients?

As a practitioner, do you want to learn more about how to incorporate GABA and the other targeted individual amino acids, tryptophan/5-HTP, DPA, glutamine and tyrosine, into your work to help your clients/patients with anxiety and PTSD? I invite you to check out my new online practitioner training here: Balancing Neurotransmitters – The Fundamentals. I’m extending the $100 discount offered at IMMH for a few weeks (use coupon code immh2019).