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Why is vitamin B6 toxic for some and why don’t symptoms resolve when vitamin B6 is stopped?

By Trudy Scott 366 Comments

In a recent blog post, Vitamin B6 improves dream recall (which can be used to monitor vitamin B6 status), I promised to address concerns about the potential for vitamin B6 toxicity. I have yet to see any signs of toxicity in my clients, but I have also not ever recommended more than 500mg/day.

However, I was recently made aware (thanks to some folks in my community) that there are some individuals who have issues with very small amounts of vitamin B6.  As of this writing I don’t know why this occurs but I’m writing about it in the hope we can start to put some of the puzzle pieces together. If you have experienced any issues with using vitamin B6 supplements please do share in the comments.

I’d like to start with what we know from the research and from experts like Dr. Carl Pfeiffer – since B6 is water soluble, excesses are documented to be excreted via the urine so that toxic levels are never reached.

It is common knowledge that amounts of 50 mg or greater are considered therapeutic and a high dose, and you should reduce your dose if you notice any tingling in your fingers and other extremities. This could be a sign of too much vitamin B6 and is called peripheral neuropathy. Because vitamin B6 is water soluble, this condition is reported to be completely reversible if you stop supplementing with vitamin B6 or reduce your dose. In one case report, some patients were using up to 5000mg/day, and once they stopped the vitamin B6 their symptoms improved.

In his book Mental and Elemental Nutrients, published in 1975, Dr. Pfeiffer stated:

excesses are excreted via the urine so that toxic levels are never reached. Pyridoxic acid occurs in the urine of patients who take any excess of vitamin B6. This is a harmless excretion product.

He had some of his patients with pyroluria use 1000mg twice a day but recommended working with a practitioner if using amounts higher than 500mg. I agree with the latter.

You’ll see varied research papers on what is considered too high a dose. In this paper, How much vitamin B6 is toxic?, the authors report that 1000mg per day or more causes neuropathy. They also share that there

have also been occasional reports of toxicity at intakes of 100-300 mg per day [and that a report of] neurotoxicity in 2 patients who had taken 24 mg and 40 mg of vitamin B6 per day respectively, may be coincidence rather than a true toxic effect of such relatively low doses.

In the USA, per this article on the NIH site, the upper limit is set at 100mg/day. This is the rationale:

several reports show sensory neuropathy occurring at doses lower than 500 mg/day, studies in patients treated with vitamin B6 (average dose of 200 mg/day) for up to 5 years found no evidence of [neurological issues].

Based on limitations in the data on potential harms from long-term use, the FNB halved the dose used in these studies to establish a UL [upper limit] of 100 mg/day for adults. ULs are lower for children and adolescents based on body size.

As I mentioned above, I have yet to see any signs of toxicity in my clients, but I have also not ever recommended more than 500mg/day.

Psychosis that resolves when vitamin B6 is stopped

A colleague shared this about 2 patients developing psychosis as a result of using too much vitamin B6:

I have had 2 patients in the past 3 years who developed psychosis as a result of taking too much vitamin B6. I think it’s a fine line between what is enough for some people, and then what becomes too much. While some may be able to handle large doses of B6, we know that at higher doses it can cause severe problems for other people. It’s a nutrient I dose and monitor carefully for sure.

There is no research on acute psychosis and vitamin B6 toxicity but she shares this:

neuropathy and psychosis (or acute mental health symptoms) often co-occur, so to me it makes sense that a person could experience both together as a result of too much vitamin B6. In both the patients the acute psychotic symptoms resolved once they stopped taking high doses of B6. They were both taking pyridoxine HCL at doses above 500mg daily (one because of information she had read online, and the other because another practitioner had recommended it). My guess is there is some genetic factor and/or mediating factor biologically that makes some people susceptible to a negative response.

Serious issues that are not resolved when vitamin B6 is stopped

Clearly there are some individuals who do have serious issues that are not resolved when they stop taking vitamin B6. In the previous blog, Vitamin B6 improves dream recall (which can be used to monitor vitamin B6 status), Ruth shared this feedback about her experience with vitamin B6 toxicity:

Trudy, I appreciate your evidence-based approach to health issues, but I think you need to be aware that there are dangers in taking too much synthetic vitamin B6. B6 toxicity is not always reversible. Individuals vary in their response to B6, and while many do well on supplementation, others experience toxicity. I was diagnosed with pyroluria, but experienced serious toxicity.

Vitamin B6 toxicity is a very unrecognized but emerging epidemic that can cause widespread neurological damage to the body. It is not commonly recognized by most of the medical community and is often misdiagnosed. B6 toxicity can cause multiple different symptoms that can vary from person to person. Peripheral neuropathy or nerve damage to the feet, legs or hands is one of the most common symptoms of vitamin B6 toxicity. Tingling, shocks/zaps, vibrations, ataxia, burning, numbness of feet, calves and/or hands, and headaches are also commonly reported. Other symptoms are: ocular, sensory, skin, gastrointestinal and psychological.

I appreciate Ruth sharing this and am very concerned that this is happening. And yes, vitamin B6 is synthetic, but I am not yet convinced that this could be the only cause as there are other synthetic/man-made supplements (such as GABA) that don’t cause issues like this.

However, we do need to know why some folks have issues and why these issues continue even when the vitamin B6 supplementation is stopped.

Possible clues as to why vitamin B6 toxicity occurs?

If you have had issues that persist I’d ask these questions which may start to give us clues as to why this occurs:

  • What were/are your symptoms and how quickly did you notice issues?
  • Have you resolved the symptoms and if yes how?
  • Did you make any other changes around the same time i.e. stopping and/or other nutritional support?
  • Was it vitamin B6/pyridoxine or P5P you were taking?
  • And how much did you take and how often?
  • If you have pyroluria were you also taking zinc and how much? (Dr. Pfeiffer recommended taking zinc together with vitamin B6).

It seems like this an emerging issue unless there is just now more awareness because of the web and more ability to share on forums, blogs and social media.

If we are to assume this is a new and emerging issue I would ask what has changed since the 1970s when Dr. Carl Pfeiffer used high doses (as I mentioned above, up to 1000mg twice a day) with no adverse effects?

These factors have wide-reaching adverse effects and may be triggering a toxic reaction in certain susceptible individuals:

  • Past history or current use of certain medications like benzodiazepines, gabapentin, Lyrica, BCP, SSRIs, fluroquinolone antibiotics, PPIs, diabetes medications, statins, blood pressure medications etc.? (If you have not used the above medications have you been exposed to them via drinking water?)
  • Our increased EMF exposure – WiFi, cell phones, cordless phone and smart meters?
  • Our increased exposure to GMOs, glyphosate, plastics/phthalates, pesticides etc.?
  • Interactions with all of the above and/or certain polymorphisms – we know cytochrome P450 polymorphisms make benzodiazepines more toxic and more difficult to taper in about 60% of those prescribed benzodiazepines

Keep in mind that for most individuals, vitamin B6 causes no issues and is an important nutrient for improving the symptoms of pyroluria/social anxiety, reducing inflammation and oxidative stress, easing PMS and hormonal issues and much more. I share links to the research on the many benefits of supplemental vitamin B6 in this blog:  Vitamin B6 improves dream recall (which can be used to monitor vitamin B6 status).

That being said, we need to know why some individuals do have issues when using vitamin B6.

Please share in the comments if you have seen adverse issues with vitamin B6 supplementation

If you have been adversely affected and feel comfortable sharing answers to the following questions in the comments this may help us try and piece the puzzle together:

  1. What were/are your symptoms and how quickly did you notice issues?
  2. Have you resolved the symptoms and if yes how?
  3. Did you make any other changes around the same time i.e. stopping and/or other nutritional support?
  4. Was it vitamin B6/pyridoxine or P5P you were taking?
  5. And how much did you take and how often?
  6. If you have pyroluria were you also taking zinc and how much? (Dr. Pfeiffer recommended taking zinc together with vitamin B6).
  7. Past history or current use of medications like benzodiazepines (such as Ativan, Xanax, valium etc.), gabapentin, Lyrica, BCP / birth control pill, SSRIs /antidepressants (such as Prozac, Celexa, Lexapro, Paxil, Zoloft etc.), fluroquinolone antibiotics (such as ciprofloxacin/Cipro, gemifloxacin/Factive, levofloxacin/Levaquin, moxifloxacin/Avelox, norfloxacin/Noroxin and ofloxacin/Floxin), PPIs (proton pump inhibitors such as Nexium for heart-burn), diabetes medications, statins, blood pressure medications etc.?
  8. What kind of EMF exposure do you have – WiFi in the home and/or at work, how much cell phone use in a day, cordless phones at home and/or work and a smart meter at home?
  9. What kind of  exposure have you had to GMOs and pesticides (i.e. do you only eat organic food), glyphosate (eg. Roundup exposure from lawns, golf courses, parks etc.), plastics/phthalates (do you avoid plastics)?
  10. What polymorphisms do you have: cytochrome P450 polymorphisms (we know some of these make benzodiazepines more toxic and more difficult to taper in about 60% of those prescribed these meds), and/or MTHFR polymorphism (may affect our detox ability if it’s expressing) and others you know about?
  11. Did you take a B complex (or a multivitamin that contains all the B vitamins) with the vitamin B6?
  12. Did you also take magnesium with the vitamin B6 and if yes how much? (Bernie Rimland reported that taking vitamin B6 together with magnesium resulted in an improved behavior of ASD (autism spectrum patients))
  13. Have you observed any correlation with intake of dietary oxalates i.e. worsening symptoms when consuming medium or high oxalate foods (such as spinach, kale, berries, nuts, kiwi fruit, eggplant etc.) or using vitamin C or milk thistle, and less severe symptoms when consuming a low oxalate diet?  (Susan Owens is founder of www.lowoxalate.info and shares that vitamin B6 is the most efficacious vitamin for reducing oxalates and that we also don’t know if the classic signs of vitamin B6 toxicity has anything to do with oxalate dumping symptoms.)
  14. Do you have a thyroid disease? “peripheral diseases frequently include polyneuropathy”
  15. Have you been diagnosed with an autoimmune condition and if yes, which one?

Is there anything else that you have discovered that you suspect may be a factor?

I plan to add to this list of questions as we get feedback and as I learn more.

To be clear, I’m not dismissing the fact that vitamin B6 toxicity is a real issue for certain individuals. I’m simply trying to figure out if there are some common factors that may be making symptoms worse in some individuals or setting someone up to be predisposed to symptoms or even preventing healing/recovery from toxicity.

Vitamin B6 improves dream recall (which can be used to monitor vitamin B6 status)

By Trudy Scott 40 Comments

It’s exciting to see new research confirming the connection between vitamin B6 and dream recall. In this new study, Effects of Vitamin B6 (Pyridoxine) and a B Complex Preparation on Dreaming and Sleep (which was randomized, double-blind and placebo-controlled), 100 participants from across Australia were given 240 mg vitamin B6 (pyridoxine hydrochloride) before bed for five consecutive days. Other study participants were given a B complex. This is the outcome of the study:

  • vitamin B6 significantly increased the amount of dream content participants recalled but did not significantly affect dream vividness, bizarreness, or color, nor did it significantly affect other sleep-related variables
  • participants in the B complex group showed significantly lower self-rated sleep quality and significantly higher tiredness on waking

Here are my thoughts on these results:

  • It’s wonderful to read that Vitamin B6 improves dream recall – this is what I see with my clients all the time.
  • With an optimal dose of vitamin B6, I would expect changes in “dream vividness, bizarreness, or color” and this also what I also see with my clients. If they are having horrible/vivid/bizarre dreams, the vitamin B6 changes them to pleasant dreams OR if dreams were not recalled prior to supplementation, they are now remembered and pleasant. The dose of 240 mg was used across the board but based on what we know about biochemical individuality, 240mg may be too much for some folks and not enough for others, so this could have impacted the results.
  • It’s not surprising that the B complex taken at bedtime impacted sleep. It’s known to be stimulating and it’s not something I’d advise any client to do. For this reason, I don’t feel it was the ideal control for this study.

The lead researcher is Dr. Denholm Aspy and his primary research focus is lucid dreaming. On his researcher profile on the University of Adelaide website, he describes lucid dreaming and the potential benefits:

In a lucid dream, the dreamer realizes that they are dreaming and can then explore and even control the dream. Lucid dreaming has a wide range of potential benefits and applications such as creative problem solving, treatment for recurrent nightmares and improvement of motor skills through rehearsal in the dream environment (e.g. for elite athletes or people recovering from physical trauma).

He shares that the purpose of his research is to address exploration of the potential applications of lucid dreaming and to “develop reliable ways to induce lucid dreams.” Looking for potential applications of lucid dreaming is very interesting and new to me.

Vitamin B6/dream recall research and pyroluria (a social anxiety condition)

However, this vitamin B6/dream recall research is of particular interest to me because of my work with pyroluria, a social anxiety condition which responds really well to supplementation with zinc, vitamin B6 or P5P (pyridoxal-5-phosphate) or a combination of both, and a few other key nutrients.  Here is the pyroluria questionnaire.

One of the classic signs of pyroluria is poor dream recall, stressful or bizarre dreams, or nightmares, signs which the late Carl Pfeiffer, MD attributed to low vitamin B6 status. He suggested that your dreams and dream recall serve as a good indicator of your need for vitamin B6. You should dream every night and you should remember your dreams. They should be pleasant—the kind of dreams where you wake up and want to close your eyes and continue dreaming.

Going back to the above discussion of lucid dreaming, in lucid dreams “the dreamer is aware of dreaming and often able to influence the ongoing dream content.” This is exactly how I would describe my dreams when I have good levels of vitamin B6 and my clients say the same.

Keep in mind that if you do have pyroluria, you may need to increase your dose of vitamin B6 in times of stress. Vitamin B6 can also be depleted by oral contraceptives because they cause both low vitamin B6 and zinc, reduce serotonin levels and increase anxiety. Vitamin B6 can also be depleted by antidepressants, diuretics, and cortisone, so if you start or stop taking any of these, you may need to adjust the amount you supplement.

If this intrigues you and you’re new to pyroluria, I write about dreams and vitamin B6 in the pyroluria chapter of my book, The Antianxiety Food Solution. My blog is also a wealth of information on pyroluria:

Dream recall and vitamin B6 status is important even if you don’t have pyroluria

Observing your dream recall and hence vitamin B6 status is important even if you don’t have pyroluria. This is because vitamin B6 it has been implicated as a co-factor in more than 140 biochemical reactions in the cell, playing a role making amino acids and neurotransmitters, making fatty acids, and even quenching reactive oxygen species (ROS).

This is partial list showing the importance of vitamin B6 (with both research and clinical evidence) for:

You may also wonder what the mechanism of action is? How does vitamin B6 impact your dream recall? One hypothesis is that vitamin B6 is a co-factor nutrient used in the conversion of tryptophan to serotonin which is then used to make melatonin. Vitamin B6 is also an antioxidant, is anti-inflammatory, and modulates immunity and gene expression.

If you’re looking for a quality vitamin B6 product, my supplements blog lists a range of vitamin B6 supplements that I use with clients and those in my group program.

Monitoring your dream recall is one very simple way to assess changes in your vitamin B6 status. And we now have new research supporting this. I look forward to follow-on studies by these authors, learning more from them about lucid dreaming and I hope to be able to offer some of my insights from clinical practice.

*** I address some concerns about vitamin B6 toxicity in this blog: Why is vitamin B6 toxic for some and why don’t symptoms resolve when vitamin B6 is stopped? I have yet to see any signs of toxicity in my clients, but I have also not ever recommended more than 500mg/day. However, I was recently made aware (thanks to some folks in my community) that there are some individuals who have issues with very small amounts of vitamin B6.  If you have experienced any issues with using vitamin B6 supplementation please share.

What are your dreams like and do you use your dreams to monitor your vitamin B6 status? What improvements have you noticed by addressing low vitamin B6 levels?

If you’re a practitioner do you use dream recall as an indication of vitamin B6 status?  Have you seen adverse issues with vitamin B6 supplementation and at what doses?

The healing properties of camel’s milk for autism (and anxiety)

By Trudy Scott 8 Comments

Kaalya Daniel, PhD covers the very interesting topic of camel milk in her interview on The Nourishing Hope for Autism Summit

How You Can Use the Healing Properties of Camel’s Milk for Autism

Camel’s milk is like no other milk. You’ll learn the unique and powerful immune system properties and nutrient benefits of this milk, from an animal known to endure extreme conditions. And how it helps with autism, even when you can’t tolerate other milk.

I don’t have access to the interview transcript yet but since this is a new topic I haven’t yet blogged about I’ve decided to highlight this interview as one I’m really interested in exploring for mom’s in my community with children on the spectrum, with ADHD or other developmental disorders.

In case you’re new to camel’s milk, a paper published in 2015 – Nutritional and Therapeutic Characteristics of Camel Milk in Children: A Systematic Review, shares the following:

Camel milk is the closest to a human mother’s milk. Camel milk is different from other milks, however, having low sugar and cholesterol, high minerals (sodium, potassium, iron, copper, zinc and magnesium, and vitamin C). The milk is considered have medicinal characteristics as well.

The study concludes that there is evidence denoting the importance, usability and benefits of camel’s milk:

Camel milk as a supplemental treatment seems less invasive and costly than specialist care, medications, alternative treatments, and behavioral interventions. Based on our findings, camel milk is safer for children, effective in the treatment of autism, improves general well-being, promotes body natural defenses, is a good nutritional source, and can helps the daily nutritional needs of humans.

Given the many overlaps we see with autism/ASD and anxiety/depression, it’s clear that camel milk has wide applications given the benefits we see has for immunity, the gut and inflammation, as well as providing nourishment when dairy cannot be tolerated. As you can see in the above study below camel milk consumption has been shown to improve general well-being.

I’m not sure if anxiety and GABA is covered in the interview but I did find some interesting research reporting that both camel and goat milk have significantly more bioavailable GABA than cow and human milk – which may be another beneficial mechanism.

Here are just a few of the other speakers and topics I’m really looking forward to hearing:

  • James Adams, PhD: The Scientific Evidence Linking Nutrition and Autism Improvement
  • Dietrich Klinghardt: Understanding Lyme, Infections, Mold, and Heavy Metals and the Effects on Autism
  • Chef Pete Evans: Food is Medicine, Inspiration from a chef
  • Dominic D’Agostino, PhD: Is the Ketogenic Diet Right for an Autistic Child?
  • Susan Owens, MS: The Inflammasome, Oxalates, Autoimmunity and Autism
  • And of course, Julie Matthews, CNC: When GFCF Diets Don’t Work – BioIndividual Nutrition for Autism (I’m actually going to interview Julie on this topic)

In my interview we go into anxiety, OCD and aggression in great detail, discussing the amino acids GABA and tryptophan, plus gluten issues and when and how to use inositol.

This summit provides you with information and tools that address the root causes of autism, ADHD and many other conditions including anxiety.

The Summit runs July 30 to August 3 and is hosted by my dear friend and colleague Julie Matthews, whose work you’re probably very familiar with. In case Julie’s work is new to you, in my eyes, she is THE autism nutrition expert. I’ve had the pleasure of interviewing her a number of times on the Anxiety Summit, I endorse her Bioindividual Nutrition training (special diets) for practitioners, I highly respect the work she does and I adore her!

Register here for The Nourishing Hope for Autism Summit to learn more! It airs online from July 30 to August 3, 2018. Hope to see you online!

I’d love to hear your camel’s milk experiences. If you have questions please post them in the comments below.

Thailand cave rescue: yes to calming meditation and GABA, no to antianxiety medication

By Trudy Scott 3 Comments

The cave rescue of 12 teens and their soccer coach in Thailand is such a beautiful story of hope, courage, resilience, volunteerism and the whole world coming together! I’ve been following the news about this from day 1 (as I’m sure you were) and felt such relief and joy on hearing they had all been safely rescued and appear to be physically and mentally fine.

I’m weighing in on the fact that meditation seems to have played a major role in keeping them calm, using GABA or theanine instead of antianxiety medications and B vitamins for ongoing psychological support.

Meditation seems to have played a role in keeping them calm

Meditation seems to have played a role in keeping them calm, according to this report from the UK

The 12 Thai boys and their football coach who were trapped in a cave in Thailand got through the ordeal by practicing meditation, family members have said.

According to a mother of one of the boys, the team were meditating in the widely shared video of their discovery by two British divers.

Look at how calm they were sitting there waiting. No one was crying or anything. It was astonishing.

The coach who was rescued from the cave on Tuesday, trained as a Buddhist monk for 12 years before he decided to coach the Wild Boars soccer team.

‘He could meditate up to an hour,’ said his aunt, Tham Chanthawong. ‘It has definitely helped him and probably helps the boys to stay calm.’

Here is the video of their lovely smiling calm faces when they were first found.

 

In this paper, Meditation Programs for Psychological Stress and Well-Being, they report that

Meditation programs, in particular mindfulness programs, reduce multiple negative dimensions of psychological stress [such as anxiety, depression, stress, distress, well-being, positive mood, attention]

Meditation has also been shown to improve dopamine and serotonin transporter binding, which appears to have reduced fatigue and improved mood in this study, likely because there are higher levels of these neurotransmitters available.

In a study done with young adults, Effects of mindfulness meditation on serum cortisol of medical students, meditation lowered cortisol levels, suggesting reduced feelings of stress.

Meditation and GABA/theanine instead of antianxiety medications

It was clearly an extremely difficult rescue and the Australian doctor, Adelaide anaesthetist Dr Richard Harris, risked his life to go into the cave and stayed with the boys and their coach for several days. He assessed their health and made sure they were ready for the rescue.

He used his medical expertise and rescue diving experience to decide to have each of them use antianxiety medication for the arduous 8-hour plus rescue (I suspect it was Dr. Harris’ decision). It was confirmed by Thai Prime Minister Prayuth Chan-ocha – to help calm their nerves – and it’s likely they were given a benzodiazepine, hopefully only the one time.

Even though very short term acute situations like this, is actually the intended use of benzodiazepines, it concerns me that these young boys were medicated, especially since adverse paradoxical reactions can be caused by benzodiazepines and are difficult to predict and diagnose.

The following adverse reactions can occur: “unanticipated restlessness and agitated episode,” sometimes aggression, hostility, and rage, as well as “an increased state of anxiety.” An adverse reaction during the actual rescue would have been very serious.

There were also reports of elevated white blood cells (WBC) and signs of a lung infection in some of the boys, and one boy had low blood pressure. These are all be side-effects of benzodiazepines. It’s difficult to know what caused any of this – was the medication, the rescue itself and the fact that were under water or spending all that time in the cave?

My intention is not to be critical of the medical decisions that were made in these very dire circumstances. I’ve done caving or spelunking as it was called in England and it’s pretty scary being underground and in the dark, wading through running water – and we were safely in control of things!

I’m sharing about benzodiazepines simply to raise awareness about other options and some of the many risks. And we haven’t even explored the fact that long-term use of benzodiazepines do more harm than good. More than a week to 2 weeks is considered too long, and for some this is even too long.

I really do look forward to the day when benzodiazepines are not the first approach but rather that:

  • meditation is recognized as being as effective, if not a more effective calming approach (I suspect the mediation benefits these boys had been experiencing would likely have carried them through the rescue)
  • the amino acids GABA or theanine are recognized for the calming benefits they offer (especially since the “mechanism of benzodiazepine action is through the gamma-aminobutyric acid [or GABA] receptors.”

B vitamins and other nutrition solutions after psychological stress

Thailand’s Department of Mental Health shared that

People who endure such an intense and dangerous event can go on to suffer lasting anxiety, depression and other symptoms of post-traumatic stress disorder.

I was so pleased to hear that the boys and their coach are being given B vitamins. There is evidence-based research on the psychological benefits of B vitamins after a trauma (like an earthquake or flood), thanks to my colleagues Julia Rucklidge, PhD and Bonnie Kaplan PhD​.

I do hope the B vitamins are continued and is offered to worried family members and all the wonderful rescuers who must be exhausted and stressed too.

Hopefully the boys will also continue to meditate with their soccer coach and share some of the benefits they experienced with family and friends.

How did you feel when you heard the rescue was over? Good news gives us such feel-good warm emotions doesn’t it!?

Do you meditate and have you used calming GABA or theanine?

Let us know if you have questions too.

Melatonin improves sleep quality and reduces anxiety after a TBI (traumatic brain injury)

By Trudy Scott 11 Comments

New research shows that melatonin improves sleep quality and reduces anxiety after a TBI (traumatic brain injury). The study, Efficacy of melatonin for sleep disturbance following traumatic brain injury: a randomised controlled trial was completed in Australia and used a prolonged-release (also called timed-release) melatonin product.

The study participants, 67% of whom were male, had mild to severe TBI and sleep disturbances as a result of their injuries (most of which were from car accidents). There were 2 study groups, with one group given 2mg of prolonged-release melatonin for 4 weeks and then switched to a placebo for 4 weeks (with a 48-hour window in between). The other group did the opposite.

The prolonged-release melatonin was made by Sigma Pharmaceuticals Australia and called Circadin. Each night 2 hours before bedtime, 2mg of Circadin was taken by study participants. They received a reminder text message each night.

These are the study results for sleep:

Melatonin was associated with a significant and moderate reduction in PSQI [Pittsburgh Sleep Quality Index] global scores, indicating improved sleep quality.

There was no significant reduction in sleep onset latency with melatonin compared to placebo.

What this means is that overall quality of sleep improved but there was no change in the time it takes to fall asleep (sleep onset latency). The latter is to be expected with prolonged-release or timed-release melatonin.

The study concluded that:

The present results, therefore, suggest that melatonin may be useful in treating sleep disturbances in patients with TBI.

With better sleep quality you would expect reduced fatigue and improved vitality – both were reported by study participants.

Melatonin associated with a small decrease in self-reported anxiety

What is interesting is that melatonin was also associated with a small decrease in self-reported anxiety (no differences in depression were reported.) The authors suggest that one possible mechanism of this may be that melatonin acts a muscle relaxant. In this commentary: Potential action of melatonin in insomnia, the authors equate the beneficial effects of melatonin to benzodiazepines:

many of the actions of melatonin on sleep propensity, anxiety, thermoregulation, and convulsions resemble those reported following administration of benzodiazepines. It is possible that some of these actions of melatonin may be mediated via peripheral benzodiazepine receptors

They are suggesting that with melatonin we get the sleep improvement (sleep propensity is the readiness to transit from wakefulness to sleep, or the ability to stay asleep if already sleeping), relaxation effects and antianxiety benefits of benzodiazepines.

But you get none of the side-effects, tolerance issues and withdrawal nightmares with a benzodiazepine which do more harm than good. On a side notes: this month World Benzodiazepine Day is celebrated to create awareness and offer support for benzo sufferers.

I would have picked something more inert for the placebo ingredients

I would have picked something more inert for the placebo ingredients: mannitol (106mg), acacia (11 mg) and pure icing sugar (106 mg). Mannitol, a sugar alcohol, can cause bloating and diarrhea in some individuals and although the amount is tiny (5g of sugar equals 1 teaspoon), sugar consumption is not ideal before bed. As I would expect adverse symptoms:

were more frequently reported during placebo treatment. The most commonly reported symptoms were neurological, followed by bodily pain, gastrointestinal and dermatologic.

In Australia, melatonin cannot be purchased over the counter (OTC) at health stores or via online retailers, unlike in the USA, and is only available by prescription. I’m all for melatonin being available OTC but the silver lining to this is that companies that make melatonin, such as Circadin, have a vested interest in the research. Research is expensive and time-consuming and we get to benefit too.

Keep in mind that this research is applicable to anyone with low melatonin, whether or not a prior TBI has occurred.

There are many root causes of insomnia – how I work with clients

In those with TBI, sleep disturbances are common, and the authors do report reduced evening and overnight melatonin production in this population. However, there are many root causes of insomnia, with low melatonin being one possible root cause – in TBI and in those who have not had a TBI.

One study limitation is that they didn’t measure melatonin levels or circadian rhythm (salivary cortisol) in all of the study participants so we can’t be sure everyone did have low melatonin.

And melatonin isn’t going to work in all instances of insomnia. It’s one root cause I look at.

This is how I work with clients who have insomnia:

  • I start with low serotonin and address this with tryptophan observing improvements in sleep and easing of worry and anxiety (on a side note, low serotonin is common after a TBI so this makes total sense)
  • Then I have my client use sublingual melatonin if they have issues falling asleep AND timed-release melatonin if they have issues staying asleep (you can see some of the melatonin products I recommend here)
  • When saliva results come back, we address the adrenals as needed, often adding Seriphos when cortisol is high
  • Other factors are addressed based on each person’s need: gluten issues, SIBO, parasites, candida, EMFs, sex hormone imbalances, medication side-effects, sleep habits

We’d love to hear if timed-release melatonin has helped you improve your sleep quality? And if it also helped with easing anxiety?

What about tryptophan or sublingual melatonin for helping you fall asleep? And the other root causes?

If you’re a practitioner, do you use tryptophan or sublingual or timed-release melatonin with your clients? And address the other root causes of insomnia?

Feel free to post your questions too.

Little evidence for SSRI use in anxiety and compulsions in ASD: my interview on Nourishing Hope for Autism Summit

By Trudy Scott 2 Comments

One of the reasons I’m so passionate about participating on summits like The Nourishing Hope for Autism Summit and sharing the powerful nutritional interventions is due to the fact that medications such as antidepressants and benzodiazepines are frequently prescribed in ASD – and the research and clinical evidence shows that children and adolescents with ASD (autism spectrum disorder) are more vulnerable to the side effects.

This paper, Psychopharmacological interventions in autism spectrum disorder, makes the following conclusion:

Psychopharmacological treatment of core and associated symptoms in ASD is challenging, in large part because ASD presents in many different ways. Furthermore, children and adolescents with ASD are more vulnerable to the side effects of psychopharmacological intervention than their age-matched, typically developing counterparts.

This paper, Pharmacotherapy of emotional and behavioral symptoms associated with autism spectrum disorder in children and adolescents, supports this, stating there is little evidence to support the use of SSRIs in ASD:

Selective serotonin reuptake inhibitors are often used in clinical practice to target anxiety and compulsions; however, there is little evidence to support its use in this population. There is a great need for further research on the safety and efficacy of existing psychotropic medications in youth with ASD.

And this paper published a few months ago, An update on pharmacotherapy of autism spectrum disorder in children and adolescents, concludes that

Overall, the evidence is limited for pharmacotherapy in children with ASD, and side-effects with long-term use can be burdensome.

Much of this also applies to adults with ASD and in my interview I talk about the psychiatric medicine concerns within the ASD community and the high incidence of anxiety, aggression, irritability and OCD in this population.

We also discuss the following nutritional solutions in my interview (appropriately titled: How to calm anxiety, and eliminate aggression and OCD) –

  • the role low serotonin plays in anxiety, aggression and OCD/obsessions and the use of tryptophan and when to avoid 5-HTP
  • the low GABA type of physical anxiety and how to effectively use GABA for results
  • how to use inositol for OCD and some wonderful success stories
  • lead toxicity and increased anxiety and the protective role of tryptophan and ascorbic acid
  • phenols and oxalates other special diets (and my story with oxalate issues)

Our interviews are always fun, science based and practical – and in this one we even shared some of our personal results (both good and bad) with some of these nutrients.

Here are just a few of the speakers and topics I’m really looking forward to hearing:

  • James Adams, PhD: The Scientific Evidence Linking Nutrition and Autism Improvement
  • Dietrich Klinghardt: Understanding Lyme, Infections, Mold, and Heavy Metals and the Effects on Autism
  • Chef Pete Evans: Food is Medicine, Inspiration from a chef
  • Kaalya Daniel, PhD: How You Can Use the Healing Properties of Camel’s Milk for Autism
  • Dominic D’Agostino, PhD: Is the Ketogenic Diet Right for an Autistic Child?
  • Susan Owens, MS: The Inflammasome, Oxalates, Autoimmunity and Autism
  • And of course, Julie Matthews, CNC: When GFCF Diets Don’t Work – BioIndividual Nutrition for Autism

This summit provides you with information and tools that address the root causes so medications such as the above do not even have to come into the picture!

The Nourishing Hope for Autism Summit runs July 30 to August 3 and is hosted by my dear friend and colleague Julie Matthews, whose work you’re probably very familiar with. In case Julie’s work is new to you, in my eyes, she is THE autism nutrition expert. I’ve had the pleasure of interviewing her a number of times on the Anxiety Summit, I endorse her Bioindividual Nutrition training (special diets) for practitioners, I highly respect the work she does and I adore her!

The focus of this summit is clearly autism and Julie is THE expert so you’ll learn a ton from the experts she has gathered.

But do keep in mind that those with autism or Asperger’s are often considered the canaries in the coalmine and even if you don’t have a loved one with ASD many of the interviews have wider applications for anxiety, ADHD and other developmental and learning disorders.

Register here for The Nourishing Hope for Autism Summit to learn more! It airs online from July 30 to August 3, 2018