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benzodiazapines

GABA and theanine for sedation, anxiety, and cognition in preoperative surgical patients (a randomized controlled study)

By Trudy Scott 7 Comments

amino acids for sedation

L-theanine is a unique amino acid found in green tea. It prevents stress, produces anxiolysis, modulates alpha activity, and provides beneficial effects on mental state, including sleep quality.

Gamma-aminobutyric acid (GABA) is a non-proteinogenic amino acid and a phytochemical that is the main inhibitory neurotransmitter in the mammalian brain. It is beneficial in anxiety and stress regulation.

This overview of theanine and GABA come from this paper, Comparison of the effects of two amino acids, Gamma-aminobutyric acid (GABA) and L-theanine, on sedation, anxiety, and cognition in preoperative surgical patients – A randomized controlled study, a very promising paper published in May this year.

This novel study was planned to study and compare the effects of L-theanine and GABA on anxiety, sedation, and cognition in preoperative patients posted for major elective surgeries under general anesthesia.

The conclusion is that: “GABA and L-theanine result in effective preoperative anxiolysis with minimal sedation and improvement of cognitive skills.”

In other words, both these amino acids are calming before a surgical procedure, don’t cause too much drowsiness and improve cognition.

There are a number of reasons why I feel this study is so promising: anxiety before surgery is very common; laryngospasms (or vocal cord spasms) during surgery are potentially life threatening and clinically we see GABA to be helpful outside of the surgical setting; and any research confirming the calming benefits of GABA (and other amino acids like theanine) supports what we see clinically and furthers the field. This is especially the case when it’s a randomized controlled study such as this one. More on all this below.

The study information and benzodiazepine comparison with GABA/theanine

It was a small study with a “total of 168 patients aged between 18 and 55 years .. who were randomly divided into three groups that received either oral L-theanine, oral GABA, or oral alprazolam 0.25 mg. The anxiety score, sedation score, and psychomotor and cognitive performance scores were noted 60 minutes before and after the administration of the drugs” and amino acids.

Alprazolam is an antianxiety medication known as a benzodiazepine which impairs “psychomotor performance and cause excessive sedation.” I’ve blogged extensively about many of the  known issues with benzodiazepines.

Because of this it’s worth noting that the authors share this exciting information: “To our knowledge, our study is the first comparative study that compares GABA with L-theanine and alprazolam.”

This in itself is very encouraging but more so because the outcome “showed that oral L-theanine, oral GABA, and oral alprazolam were equally effective in producing anxiolysis.”

How much GABA and theanine was used in the study? And what is optimal?

The authors had the study participants use 500 mg GABA and 200 mg of theanine. Both were used as capsules and swallowed. If you’ve been following my work, you’re aware that I find sublingual (or powder or liposomal or topical) use of GABA to be more effective than swallowing a capsule. For this reason it’s possible that using a lower dose sublingually may be as effective or possibly even more effective.

As always, dosing of GABA (and other amino acids such as theanine) is individualized to the unique needs of the person. Ideally, the person has figured out their optimal dose for easing anxiety in their day to day life before going in for surgery. They may find that a higher dose is needed the weeks leading up to surgery and the day of surgery.

You can read the entire study here: Comparison of the effects of two amino acids, Gamma-aminobutyric acid (GABA) and L-theanine, on sedation, anxiety, and cognition in preoperative surgical patients – A randomized controlled study

Laryngospasms during anesthetic – could GABA help prevent this?

Laryngospasm is a life threatening complication during the perioperative period (time of surgery) with an incidence of 0.78-5% depending on the surgical type, patient age, pre-existing conditions and anesthetic technique.”

It is described as “the sustained closure of the vocal cords resulting in the partial or complete loss of the patient’s airway. Although described in the conscious state and associated with silent reflux, laryngospasm is a problematic reflex which occurs often under general anaesthesia.”

The authors state that “a clear management plan is required to avoid significant morbidity and even mortality.” They do discuss the use of magnesium “due to both an increased depth of anaesthetic and muscle relaxation” and the authors state that this “agent may have a role to play in the future prevention of laryngospasm, but more studies are needed.”

Clinically we see GABA to be helpful for the prevention of laryngospasms outside of a surgical setting (I blogged about this here) and it’s intriguing to consider that the use of GABA before surgery may actually help prevent or reduce the severity of this complication. I look forward to future research on this application of GABA.

Until then it may be worth discussing with your surgeon and anesthetist. I have a family member who is susceptible to laryngospasms and GABA powder rubbed on the inside of his cheek during an episode, stops the spasm and stridor (abnormal high-pitched sound) in a matter of 30 seconds. Prior to a recent surgical procedure, he discussed this with his surgeon and anesthetist. We were both pleasantly surprised that they were both interested and open to having him take GABA with him into surgery.

GABA for anxiety, stress, muscle spasms and pain too

I shared this excerpt in a recent blog but it’s worth sharing again: a number of studies have shown that “GABA is implicated in a large number of diseases including anxiety and stress disorders, pain, musculoskeletal disorders, sleep disorders, depression, addiction and withdrawal syndromes.”

Let’s consider GABA (and theanine) during the often stressful and anxiety-provoking periods leading up to surgery and on the day of surgery. It’s likely to help with muscle spasms, pain reduction and sleep too.

A few GABA product options  – a sublingual, a powder and a cream

gaba calm
gaba pure poder
somnium gaba cream

The authors had the study participants use 500 mg GABA, swallowed. As I mentioned above, using a lower dose sublingually may be as effective or possibly even more effective. Also, dosing of GABA (and other amino acids) is individualized to the unique needs of the person.

One product I use and recommend is Source Naturals GABA Calm lozenges. It’s a good low dose of 125 mg and is convenient and effective because it’s a sublingual lozenge.

Now GABA Powder is another product I use and recommend. It does need to be measured out to provide a 125 mg typical starting dose. I have clients use a handy mini measuring spoon like this one (my Amazon link) and share more about how to measure out GABA powder on this blog).

For Source Naturals GABA Calm lozenges and Now GABA Powder:

Somnium GABA Cream is another option that could be considered especially for children and those with special needs. It is available in the US and elsewhere with international shipping. Read more about the product and who else may benefit from using a cream, and grab my coupon code to save 15%.

Additional resources when you are new to using GABA and other amino acids as supplements

As always, I use the symptoms questionnaire to figure out if low low GABA or other neurotransmitter imbalances may be an issue.

If you suspect low levels of any of the neurotransmitters and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids on your own so you are knowledgeable. And be sure to share it with the practitioner/health team you or your loved one is working with.

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control (this is covered in an entire chapter too), sugar cravings, anxiety and mood issues.

The book doesn’t include product names (per the publisher’s request) so this blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the amino acids that I use with my individual clients and those in my group programs.

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), a good place to get help is the GABA QuickStart Program (if you have low GABA symptoms). This is a paid online/virtual group program where you get my guidance and community support.

If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. This is also a paid online/virtual program with an opportunity to interact with me and other practitioners who are also using the amino acids.

Wrapping up and your feedback

I’d love to hear from you – does any of this resonate with you? Do you feel increasingly anxious before surgery and other medical procedures and is GABA and/or theanine part of your calming repertoire?

And have either helped you when experiencing a laryngospasm?

Have you ever discussed either of these two amino acids with your surgeon or anesthetist prior to surgery and were they open?

If you’re a practitioner do you recommend GABA and theanine to your anxious clients/patients and as a surgeon or anesthetist would you consider these amino acids in the future (especially in patients more prone to laryngospasm)?

Feel free to share and ask your questions below.

Rebound insomnia after tapering a benzodiazepine: will taking GABA or any other natural supplement interfere with healing?

By Trudy Scott 16 Comments

rebound insomnia after tapering

This question was posted on one of the GABA blog posts by Fran, asking about about using GABA for insomnia shortly after having tapered a benzodiazepine she had used for 15 years:

I am a senior who took benzodiazepines (clonazepam) on advice of my doctor for sleep because of chronic fatigue for 15 years. Last year I weaned myself off the medication and it has been just over 10 months. No one tells you that when you stop taking them you go into a rebound insomnia phase and it can last a long time. The doctor still won’t admit that!

I joined benzo buddies, a group I found out about on your site and found much encouragement from the posts of many brave and determined people. One post mentioned that the drug actually overrides your GABA receptors so when you stop taking it they have to heal to become active again. My question is: Will taking GABA or any other natural supplement interfere with that healing. The writer of the post feels taking nothing is best for the brain to return to normal and that only time will do that.

I said I was sorry to hear about her struggles with her benzodiazepine prescription. Sadly it’s all too common and it’s seldom that folks are cautioned about the rebound insomnia and other issues seen with benzodiazepines.

I love benzo buddies and other benzo support groups and often recommend that clients join one of these groups for the community support aspect. I am really happy that Fran found encouragement.

However, I  respectfully disagree with their message that GABA supplements or other supplements should not be used and that you should just wait for time to heal. We want to use everything at our disposal in order to heal as quickly as possible. And quality sleep is imperative for healing.

Also many of the most severely affected folks are part of these support groups, so it may well be all that they know, hence the advice they dispense.

Many do get relief with GABA during and post benzo taper and it won’t affect long-term healing (with a very low dose)

It is true that GABA receptors can be affected by benzodiazepines but despite this, many of my clients and others in my community do get relief from GABA during this period. Since we are all unique, some folks may have an issue, so we always do a trial with GABA if someone has rebound insomnia (and other low GABA symptoms of physical tension/anxiety, stiff and tense muscles, stress eating etc).

When someone can’t tolerate GABA they will know very quickly – typically in 1-2 days. If you can’t tolerate GABA it may feel the same as someone who takes GABA and doesn’t need it (i.e. GABA isn’t low) or when someone takes too much. This could make you feel light-headed, dizzy, feel a flush and/or feel too tired. You may even feel more anxious. Vitamin C is a wonderful antidote to all this and these short-term adverse reactions won’t interfere with long-term healing.

We also start with a very small dose – I typically have someone start with 25mg GABA and go up from there – and only use sublingual GABA. For some very sensitive folks we will start even lower as in this example where Syd gets sleep and body anxiety benefits with just 1.5 mg to 3 mg GABA.

Other nutrients that may also help with insomnia

We may also use other nutrients to help with sleep support and rebound anxiety (which is also common) and other symptoms, all based on each person’s unique needs. These may include tryptophan or 5-HTP if serotonin is also low (this can affect sleep and cause worry/ruminating type anxiety), melatonin if that is low (either sublingual or timed-release) and Seriphos if cortisol is high too. We may also combine GABA with theanine (research shows the combination may help some folks).

A full functional medicine and nutritional workup is recommended in order to be as nutritionally stable as possible. Ideally this happens before tapering starts but even if it’s done after the fact it can help with healing and symptom relief. Addressing histamine imbalances is one factor to consider as this can impact sleep (more on that below).

This is an important question that many folks ask so I appreciate her asking so I could share it as a blog post for others in a similar situation.

I am waiting to hear back about what happened when she did use GABA and how much she used. She mentioned that she did take GABA for a time at first but it only worked for a while. I find that during the taper and post taper, GABA needs can fluctuate as healing starts to take place. I have clients adjust up and down as needed.

More on benzodiazepine withdrawal and histamine issues

These medications have the most debilitating withdrawal reactions in all of medicine and Valium blocks DAO/impacts histamine levels:

Benzodiazepines (Xanax, Klonopin, Ativan, Valium, Librium, and others) as well as Z-drugs (Ambien, Lunesta and others), which are similar, have the most debilitating withdrawal reactions in all of medicine.

This happens in regular, everyday people who are taking the medications exactly as their doctor prescribed. It also happens to people on what they think are “low doses” and is not just a “high dose” problem.

Many people doing a benzodiazepine taper are often switched to Valium which is a DAO [diamine oxidase blocker (or histamine liberator)] and this further prevents histamine from being removed from the body [and can lead to increased anxiety].

Dyes are also triggers…the pink Xanax can be problematic.

GABA is as effective as benzodiazepines (which should only be prescribed for short-term use)

Many folks who have used benzos in the past, find GABA to be as effective. Another woman in my community, Dee, shared that she had taken Xanax in the past for panic attacks and her functional medicine doctor suggested GABA Calm as she wanted a natural product. This is her encouraging feedback: “I was amazed how it works just like the Xanax did – instant calm feeling within 10 mins of taking 2 capsules. I use them as needed when I am having heightened stress and anxiety.”

Ideally we want to use GABA instead of one of the benzodiazepines – which are all too commonly prescribed for anxiety, insomnia and pain – in order to avoid tolerance issues, dependence and withdrawal/tapering issues. The fact that they are used long term – like 15 years for Fran – further compounds the issues. Even a few months can be problematic for some folks. It’s important to be aware that this class of medication is intended for short-term use  i.e. 2-4 weeks only.

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

If you are new to using GABA and any of other the amino acids as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see all the symptoms of neurotransmitter imbalances, including low GABA).

If you suspect low levels of any of the neurotransmitters and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids on your own so you are knowledgeable. And be sure to share it with the practitioner/health team you or your loved one is working with.

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control, sugar cravings, self-medicating with alcohol and more.

The book doesn’t include product names (per the publisher’s request) so this blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the amino acids that I use with my individual clients and those in my group programs. You can find them all in my online store.

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), a good place to get help is the GABA QuickStart Program (if you have low GABA symptoms). This is a paid online/virtual group program where you get my guidance and community support.

If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. This is also a paid online/virtual program with an opportunity to interact with me and other practitioners who are also using the amino acids.

Have you used GABA with success while tapering a benzodiazepine or shortly after tapering is complete?

Have you used other nutrients to help while tapering or post taper? If yes, which ones?

Did you find that GABA was not helpful? (which product and how much did you use?)

If you have questions please share them here too.

The benzodiazepine valium blocks DAO and impacts histamine levels: wisdom from Yasmina Ykelenstam and a tribute to her brilliance

By Trudy Scott 72 Comments

The benzodiazepine valium blocks DAO and impacts histamine levels and may actually increase anxiety via this mechanism. I learned all this in an interview I conducted with my amazing colleague Yasmina Ykelenstam.

Sadly Yasmina lost her battle to a rare and aggressive type of breast cancer this week. She had triple negative breast cancer which has a minimal survival rate of no longer than just a few months. She lived with it for over 2 years, outliving all odds. She had just turned 43.

It is with great sadness and reflection that I write this post as tribute to Yasmina who was as bold as she was brilliant.

Yasmina is well known as the Low Histamine Chef and for an abundance of histamine intolerance resources and recipes on Healing Histamine.

We only met in person on one occasion in 2017 and spent an evening and wonderful lunch together. Her warmth, passion and caring shone through and I felt I already knew this kind and smart woman. I had been following her work online after an interview with Dr. Ben Lynch on season 2 of the Anxiety Summit – Biochemical and genetic predispositions: COMT, GAD & MAOA – where he raved about her work.

I reached out to Yasmina and was so thrilled to have the opportunity to interview her for season 3 of the Anxiety Summit – Histamine-containing Foods: their Role in Anxiety, Depression and Schizophrenia

As a tribute to Yasmina and so her brilliance continues to shine I’m sharing some of the highlights from our interview, where she shared that:

  • Histamine is the gluten of the intolerance world
  • Histamine is a neurotransmitter and plays a role in mood disorders
  • Histamine can cause symptoms of anxiety: Increased heart rate and blood pressure, shortness of breath and gasping for air, pounding heart, dizziness and feeling faint

In case you’re new to histamine intolerance this paper provides a quick overview: Histamine and histamine intolerance

Histamine intolerance results from a disequilibrium of accumulated histamine and the capacity for histamine degradation. Histamine is a biogenic amine that occurs to various degrees in many foods. In healthy persons, dietary histamine can be rapidly detoxified by amine oxidases, whereas persons with low amine oxidase activity are at risk of histamine toxicity. Diamine oxidase (DAO) is the main enzyme for the metabolism of ingested histamine.

This new research shows how a low histamine diet has benefits: Histamine-reduced diet and increase of serum diamine oxidase correlating to diet compliance in histamine intolerance

In our interview we had a lengthy discussion on benzodiazapines and the histamine connection. It was both fascinating and very concerning:

Many people doing a benzodiazepine taper are often switched to Valium which is a DAO [diamine oxidase blocker (or histamine liberator)] and this further prevents histamine from being removed from the body.

Dye are also triggers…the pink Xanax can be problematic 

Here is the transcript from the benzodiazepine section of our interview, with a few tweaks to give it context. I start by asking Yasmina to talk about histamine interactions with psychiatric medications.

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

Yasmina Ykelenstam: Well, I recommend that people go to a wonderful website and it is called histaminintoleranz.ch. It’s German, but it’s translated into English. That’s H‑I‑S‑T‑A‑M‑I‑N‑I‑N‑T‑O‑L‑E‑R‑A‑N‑Z.ch. And they have a very, very long list of medications on there that interact with diamine oxidase or histamine liberators. The one that I just wanted to mention very quickly because it’s relevant to anxiety – and that one is diazepam [you can find this listed on the above site on this page.]

Diazepam (or Valium) is a medicine, as I said, that I used when I was a child – for a couple of days. And it’s a tranquilizer, a benzodiazepine. One of the most commonly prescribed benzodiazepines in the world is Valium.

I don’t know if it still is, but when the UN would send out emergency packs to people, Valium was included in there. That’s how widespread its use is. It’s a diamine oxidase blocker. So it blocks the enzyme responsible for degrading histamine in the body. So people who are dealing with anxiety symptoms that are perhaps caused by histamine issues would not do very well potentially with Valium / diazepam because it would further prevent histamine from being removed from the body.

I was on Valium / diazepam for many, many years after it was first prescribed to me and I did not know that. And it was the medicine, it was the tranquilizer that I chose to use to taper from another benzo. I was on Xanax at the time and I had been told that Xanax is harder to withdraw from than crack. So I should switch to another benzodiazepine that had a longer half-life – how long it stays in the body – so that it would make it easier for me to withdraw. And Valium / diazepam was the one that I chose and I think that’s when my body started giving me the message of “Hurry up; just finish this; just cut, cut, cut; get this out of the body because it’s not doing you any good.”

But there is a very, very long list of medications on that German site and interestingly, there are a number of antihistamines in the list of medications that block diamine oxidase and also the other histamine-degrading enzyme. Cimetidine, C‑I‑M‑E‑T‑I‑D‑I‑N-E – I think it is a second-generation antihistamine. It is still prescribed today. It was being prescribed to many people by a doctor in London.

I have another doctor: Dr. Seneviratne in London. He is an immunologist with mast cell focus. He’s excellent. But there was another doctor who was supposedly a mast cell person who was prescribing cimetidine to people. I had to send a message to him saying please stop doing this because it’s probably not very good for them. Also, we were talking about diphenhydramine and that is an HNMT blocker, which is the other histamine‑degrading enzyme.

Trudy Scott: Okay. So I want to just recap here. So we’ve got these meds that block the DAO enzyme, which in turn prevents you from releasing histamine and preventing histamine from being removed from the body.

Yasmina Ykelenstam: Exactly. Yeah, and what’s odd is diphenhydramine is obviously Benadryl, which is one of the most commonly prescribed antihistamines in the United States.

Trudy Scott: A lot of people are on diphenhydramine. You’re right, yeah.

Yasmina Ykelenstam: There are many different mechanisms of action for degrading histamine and for getting it out of the body. So it might not be the end of the world if you’re taking one medication that affects the DAO enzyme but doesn’t affect the HNMT enzyme. And obviously, there’s the liver and there’s different methods of dealing with things in the body. So it’s not the end of the world, but still it’s something you might not want to do and should definitely discuss with your doctor.

Trudy Scott: Yes, and being aware of this. Now I wanted to just go back to the benzodiazepines because I was not aware of this connection to Valium diazepam, and that being a DAO blocker. So is it only the Valium and the other benzodiazepines are not, or is it all benzodiazepines?

Yasmina Ykelenstam: Okay, let me try to remember. Haloperidol is an antipsychotic, isn’t it? (It’s on the list)

Trudy Scott: Yes, that’s correct.

Yasmina Ykelenstam: I am not aware of any others offhand and I’m just trying to take a quick look at the list now that I have it in front of me. But no, I don’t believe so because I looked them up because having taken all of them, and I mean, really all of them, I have taken every benzodiazepine ever made in the last 30 years. And no, I think it was just the diazepam, but as I said, it is one of the most commonly prescribed.

Trudy Scott: And it’s really important for me to mention this because I am dead against all benzodiazepines because of their addictive/dependent nature and the side effects and when you’re trying to taper off they cause all these problems. I’ve interviewed a number of people on this topic. In Season 1 of the Anxiety Summit, I interviewed Dr. Catherine Pittman who talked about the Benzobuddies.org group and how so many individuals battle getting off benzodiazepines.

Yasmina Ykelenstam: Oh, I was a member.

Trudy Scott: You were?

Yasmina Ykelenstam: I was a member there (at benzobuddies.org) at one point.

Trudy Scott: Oh, you were? Yeah, it’s a very big issue and problematic drug. But why I’m saying this is because Professor Ashton, who’s an expert on tapering, talks about switching to Valium. So this could be problematic.

Yasmina Ykelenstam: Well, if you could reach out to these communities, that would be fantastic because I did spend some time after, figuring out what was going on, trying to contact people and trying to let them know of this link because there were a lot of people that were in these communities that were suffering from protracted withdrawals. And by this point, I had my suspicions that the protracted withdrawals were actually a histamine response and that the reason that they were experiencing this was just that the original issue was never dealt with. And that was that it might be an underlying histamine issue that initially had them diagnosed with the anxiety disorder and then they were taking these meds. And so when you take the medication away, you’re still left with the existing condition but it isn’t being addressed.

Trudy Scott: Yes, and maybe some of them had done the switch to Valium, which was making things worse.

Yasmina Ykelenstam: Exactly.

Trudy Scott: Very interesting.

Yasmina Ykelenstam: The reason I switched to Valium was because I was following Dr. Ashton’s protocol from benzo.org.uk. I was advised against coming off my medication and I was told that there was no safe withdrawal protocol. I brought them a copy of the Ashton protocol and I was laughed out of the office, but I chose to do it on my own anyway and I’m very grateful to her research.

Trudy Scott: Yes, she’s done amazing research. I’m so appreciative to learn of this component and I’m on a mission to educate people about the benzodiazepines and this is just another aspect that we need to be considering. I will certainly reach out to some of these groups and people hearing this on this Summit, is going to bring awareness to this aspect. All of this is fantastic.

Yasmina Ykelenstam: The other brief thing is that, of course, the dyes are also triggers. And this is why a lot of us, when we’re prescribed psychiatric meds, end up with a new set of symptoms because of the coloring that is actually on the tablets. I was unable to take the pink Xanax, but I was able to take the white Xanax, and my doctor never understood it. He said, “I don’t understand how higher doses of Xanax make you feel worse, but the lower ones works for you.” And I kept telling him, “But I’m taking the same dose at the end of the day, so I don’t understand either.”

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

Here is the link to the entire audio so you can get a better understanding of histamine intolerance.

I’d love to hear your benzodiazepine and histamine intolerance experiences – both good and bad

It would remiss of me to omit something that is seldom discussed: the link between benzodiazepine use and increased cancer risk. In our interview Yasmina shared this “I have taken every benzodiazepine ever made in the last 30 years.”

Yasmina was always very open about her healing journey and I suspect she asked herself this question and would be ok with me making this possible connection in the hope it may help someone who is considering a starting a benzodiazepine prescription or someone contemplating doing a benzodiazepine taper.

I hope this has been helpful if you’re currently taking a benzodiazepine, are considering taking one, have taken one in the past, have issues with high histamine foods, are taking one of the other medications on the list, and/or have had issues with the colors in medications.

With much appreciation to Yasmina! We loved her and thank her for sharing so freely and wisely and we love that her wisdom will live on! Rest in peace.  My deepest sympathies to her family and others who were close to her.

Note added later on 9/14/18 after this blog was published:

As soon as I heard the sad news about Yasmina I wrote this blog as a tribute to her. Then a few hours before it was due to be published I heard her family had not yet made the announcement public and hadn’t yet shared the news with her community.  At the last minute I removed the tribute sections out of respect for them. When I woke I saw the announcement on her Facebook page and reinstated my tribute.

I’ll be doing further updates to share some of what was said about continuing her legacy and anything more I learn.

GABA oral rinse reduces burning mouth pain

By Trudy Scott 47 Comments

Burning Mouth Syndrome (BMS) is a chronic pain condition characterized by persistent burning in the mouth. It affects mostly females, especially postmenopausal women, and conventional approaches are often not very successful. You’ll often see articles and papers with the terms ‘refractory’ and ‘unknown etiology’/unknown causes.

Medications like SRNIs and benzodiazepines

Some studies report limited success with medications like venlafaxine/Effexor, an SRNI and topical and oral use of benzodiazepines such as clonazepam/Klonopin. In this paper, Refractory burning mouth syndrome: clinical and paraclinical evaluation, comorbidities, treatment and outcome, 8 participants saw their pain diminish by half within 3 months.

Another paper, The Effect of Clonazepam Mouthwash on the Symptomatology of Burning Mouth Syndrome: An Open Pilot Study, reports success with a benzodiazepine mouthwash in half the participants.

Other than the poor quality of life and having to continue to live with pain, the bigger concern is the side-effects of medications like these, plus concerns with tolerance and then issues with withdrawal.

New oral GABA research for burning mouth

It’s for this reason that I’m excited about the recent research, γ-Aminobutyric acid (GABA) oral rinse reduces capsaicin-induced burning mouth pain sensation: An experimental quantitative sensory testing study in healthy subjects, that finds that both and men and women experienced immediate benefits when using GABA for burning mouth pain.

The burning mouth pain was caused by the application of capsaicin to the tongues of thirty healthy males and females. Capsaicin is the compound that makes chili peppers hot. (I find it interesting that capsaicin was the compound used to cause the burning mouth sensation because this same compound is used in topical creams and patches to ease pain.)

The study concludes as follows:

Capsaicin-induced burning tongue pain and decreases in WDT (warm detection) and HPT (heat pain) can be ameliorated by rinsing the mouth with lidocaine and GABA solutions.

Rinsing the mouth with an oral GABA containing solution ameliorated burning pain and increased heat sensitivity produced by application of capsaicin to the tongue. This finding suggests that GABA can act as a local analgesic agent in the oral cavity.

Lidocaine, a numbing medication, was part of the GABA solution in this study, but because it has side-effects that may include anxiety, I recommend a trial of a GABA-only solution to ease the burning mouth pain.

Using a GABA-only oral solution

Using a GABA-only oral solution makes sense given that the likely mechanism of action of topical benzodiazepines in burning mouth pain is via local action on peripheral GABAA receptors found in the nerve fibers of the tongue.

This is also very feasible based on how effective GABA is for other pain such as proctalgia fugax/rectal spasms, and the visceral pain and muscle tension in your gut caused by the bloating symptoms of SIBO (small intestinal bacterial overgrowth) and muscular back pain after a fall.

How much GABA will help?

As with any use of GABA and the other amino acids, how much will help depends on each person’s unique biochemistry and needs at the time. In the same way I do a trial of GABA with my anxiety clients to determine how much would help, I do the same with burning mouth pain (and other pain situations).

I recommend a trial of a GABA-only product and starting low with 100 to 200mg of GABA swished held in the mouth with some water for a few minutes. This can be used three or four times a day in between meals and with the mg increased slowly based on results.  You can find the GABA supplements I recommend here.

GABA is an amino acid that is recognized for calming physical anxiety and tension and since anxiety (and depression) is very common in those with burning mouth pain, the GABA is going to provide calming benefits too.

As with any health condition, finding the underlying root causes using a comprehensive functional medicine approach is key. One such root cause may be low GABA and using oral GABA is going to address this one and provide some relief while other root causes are identified and addressed.

These other root causes can be very varied as explained in the paper Burning Mouth Syndrome. They can include: age-related reduction in estrogen and progesterone levels, lower cortisol, diabetes mellitus and hypothyroidism, allergic reactions to foods, additives and even metals in the mouth, autoimmune connective tissue disorders, nutritional deficiencies (B1, B2, B6, B12. folate, and/or zinc), smoking and candida, and medication side-effects as mentioned above.

Have you experienced burning mouth pain and seen relief with GABA or other nutritional approaches?

If you’re a practitioner, is burning mouth pain common in your postmenopausal clients or patients and what approaches have you found most successful? Have you found GABA to be helpful?

If you are still suffering with burning mouth please share the following when you comment:

  • Your age (it seems to be more prevalent in women 59 and older)
  • If you have anxiety and/or depression now and have been prone to either in the past
  • How you score on the low GABA questionnaire and which symptoms you relate to? This will provide a clue that low GABA may be an issue and the oral GABA rinse is more likely to help
  • How you score on the low serotonin questionnaire (same link as GABA questionnaire above) and which symptoms you relate to? SSRIs have been shown to help in some cases and we know tryptophan/5-HTP help with pain so serotonin support may help too. Perhaps a tryptophan or 5-HTP rinse is worth a trial too?
  • How long it’s been an issue, what approaches you’ve tried and which approaches have helped (even if they only helped a short while or helped the pain a little)
  • Current and past medications (burning mouth is caused by certain medications)

I’d love to gather a list of all this so we can help you and more women who suffer with these awful symptoms.

Benzodiazepine horror story on The Mental Wellness Summit 2

By Trudy Scott 28 Comments

The Mental Wellness Summit 2 aired online September 25 – October 2, 2017

Whether challenged by depression, anxiety, stress, addiction or another mental health challenge, every single person is impacted and affected – you, your family, friends, neighbors and coworkers -either directly or indirectly every single day.

This Mental Wellness Summit 2 will provided the information you need to:

  • Overcome the silence, isolation and fear of your struggle
  • Transcend outdated, prescription-based healthcare systems
  • Find holistic practitioners and natural solutions for your pain
  • Implement expert practices, tools and tips into your daily routine

My interview covered the dangers of benzodiazepines and why GABA is a more effective option for anxiety.

Here are some snippets from my interview where I discuss benzodiazepines which are

  • a class of psychoactive drugs / tranquillizers with sedative, sleep-inducing, anti-anxiety, anticonvulsant, and muscle relaxant properties
  • they target the GABAA receptor and enhance the effect of the neurotransmitter GABA
  • the common Brand name/drug name are: Xanax/ Alprazolam, Klonopin/Clonazepam, Valium/ Diazepam, Ativan/ Lorazapam

These medications are commonly prescribed for:

  • Anxiety, social anxiety, panic, pain/dental pain, insomnia, fear of flying, Lyme disease, ER visits for back/neck spasms
  • Children with autism
  • IBS
  • pre-surgery anxiety
  • ICU patients needing ventilation
  • during chemotherapy for cancer treatments – for anxiety, nausea and anticipatory nausea

I share this true benzodiazepine horror story:

Been totally disabled by benzos for over 3 years. I have been off meds for 17.5 months and the impact of these meds makes any anxiety I ever felt a cake walk. Please run from the poison.

When I turned 21 I went to the doctor for dizziness and they put me on xanax. I started to feel anxious and they then added Zoloft. That was the start of a long journey. I was shifted from one anti-depressant to another. At 34 I was told I was treatment resistant and they added lamotrigine. Then my world crashed at age 37. I have been on xanax, then klonopin, then Ativan, then back to xanax, then valium to taper. I had also been given ambien to sleep in early 30s.

I tapered off meds over a period of a year. I was on 1.5 mg xanax and tapered off valium as prescribed. I have tried many supplements but I react poorly to all of them. I get very agitated and revved up.

I have locked shoulder muscles, neck, jaw; I have internal vibrations, I get bad headaches, jelly legs, distorted vision like floaters and squiggles and fireworks, my teeth all feel like they will fall out but they are not loose, it feels like adrenaline or cortisol rushes through the body. Sometimes my arms go numb. I am pretty tortured every day. These meds are truly causing chemical warfare on some of us. 

This is one of the many reasons I do this work – so more people don’t end up in this situation and so everyone knows about the dangers of benzodiazepines and that there are nutritional solutions for anxiety. One of them is the amino acid GABA and I discuss this in the latter half of the interview.

World Benzodiazepine Awareness Day 2017: Awareness and Anxiety Nutrition Solutions

By Trudy Scott 14 Comments

World Benzodiazepine Awareness Day 2017 was celebrated earlier this week on July 11th. The organization recommends that everyone should watch and share this short informative video: The risks of taking benzodiazepines (Klonopin, Xanax, Ativan) as prescribed. It could save your life or the life of someone you know.

This is what W-BAD shares about benzodiazepines and Z-drugs that are used as prescribed:

Benzodiazepines (Xanax, Klonopin, Ativan, Valium, Librium, and others) as well as Z-drugs (Ambien, Lunesta and others), which are similar, have the most debilitating withdrawal reactions in all of medicine.

This happens in regular, everyday people who are taking the medications exactly as their doctor prescribed. It also happens to people on what they think are “low doses” and is not just a “high dose” problem. This happens because the prescribing guidelines for this class of drug recommend short-term use only (less than 2-4 weeks), yet doctors are prescribing them for much longer. Even worse, these unsuspecting patients are given no warning (or informed consent) by their doctor about these risks and dangers before taking the prescription past the recommended timeline. The patients think the drugs are “safe” because they are prescribed when they are actually quite dangerous medications that are capable of inflicting sometimes severe and life-threatening withdrawal syndromes which are known, for some people, to persist for many years.

W-BAD shares these stats about how common it is to see physical dependence, adverse effects, and withdrawal:

Experts and studies estimate that as many as 60% of people taking benzodiazepines for more than the recommended 2-4 week time period will develop physical dependence, adverse effects, and withdrawal

60% is actually a conservative percentage, as some other sources indicate that “50-80% of people regularly taking benzodiazepines (even in ‘low dose’) for longer than a few months will develop a physical tolerance to the drug and become dependent, resulting in difficulty stopping benzodiazepines because of withdrawal symptoms”.

30% of long-term users will experience severe withdrawal or adverse effects which may include seizures, hallucinations, psychosis, akathisia, and sometimes suicide or death (people are especially at risk for severe withdrawal if they over-rapidly taper or cold-turkey their benzodiazepine/Z-drug).

The tapers to discontinue these medications, once you’ve taken them past 2-4 weeks and depending on dose, can last many months or years. I see this all the time in my practice.

About 10-15% of people who withdraw will develop a protracted withdrawal syndrome which can potentially persist for many years (there are anecdotal reports of it persisting up to five, seven, and even ten years post-cessation.). Others, even after a slow, gradual reduction of the benzodiazepine or Z-drug will experience withdrawal that lasts for up to 18 months post-cessation.

Physical dependence is a physical condition, a state of adaptation in the body caused by chronic use of a tolerance forming drug, in which abrupt or gradual drug withdrawal causes withdrawal.

When someone becomes physically dependent to benzodiazepines (or Z-drugs), they are also at risk for developing tolerance. With benzodiazepines/Z-drugs, specifically, when the receptors in the brain become adapted or accustomed to the action of the original dose of BZ, more of the drug is needed in order for the desired therapeutic effect (or the original effect at the original dose) to be achieved. This means that the drug loses its effectiveness and the person taking it can begin to experience withdrawal symptoms while still taking the prescribed dose of the drug.

It’s very unfortunate that some of the very same symptoms that are trying to be addressed by these medications are now amplified or seen for the first time:

Some common symptoms of tolerance include increasing anxiety, panic attacks, development of agoraphobia for the first time, interdose withdrawal (withdrawal symptoms emerging in between doses), as well as a plethora of other physical/neurological/psychological symptoms.

Visit the website World Benzodiazepine Awareness Day to learn more and to get involved:

By spreading the word about taken-as-prescribed benzodiazepine risks, harms, and dangers, W-BAD (World Benzodiazepine Awareness Day) hopes to bring awareness to the general public and the medical community about this problem before more people are needlessly harmed. Please help share this video with everyone you know and, together, we can prevent more victims of iatrogenic (caused by medicine) dependence, withdrawal, and injury from prescribed benzodiazepines and Z-drugs.

There are some heartbreaking stories on the Facebook page (an excellent resource) :

W-BAD acknowledges Professor Malcolm H. Lader for guiding them in providing information that appears throughout the website and in handout materials. Prof. Lader first described benzodiazepine withdrawal syndrome as a potential brain injury in the scientific literature, and also campaigned around the world to get everyone from politicians to royalty to listen.

Here is some guidance with slow tapering protocols from W-BAD (and never stop cold-turkey).

For additional resources this is the blog post I published last year: World Benzodiazepine Awareness Day – say NO to Benzodiazepines for anxiety!

Awareness and nutrition solutions

I do love that this awareness is being created. It is so needed for those who are prescribed these medications and currently taking them, for anyone who may consider a future prescription, and for everyone in the medical profession, as well as all integrative and functional medicine practitioners and nutritionists.

All this awareness creates the perfect opportunity to offers nutrition solutions too, so we can address:

  • the initial root cause/s of your anxiety which led to your prescription of this medication to start with
  • the anxiety you now experience even through you were prescribed these medications for something else (such as pain)
  • your current biochemistry and nutritional status to facilitate an easier taper from the benzodiazepine with the least withdrawal effects
  • your current biochemistry and nutritional status so you don’t get anxiety in the future, once you have completed the taper

And if you are considering a benzodiazepine prescription in the future you are now informed about the dangers and have nutritional resources too.

When I am working with someone who has been prescribed a benzodiazepine, I get them nutritionally stable BEFORE they even consider a benzodiazepine taper.

I use amino acids like GABA and tryptophan, melatonin and niacinamide to make the taper easier and so we can balance brain chemistry before tapering and then during the taper (all under the supervision of the prescribing doctor and using the Ashton taper protocol).

Dr. Jonathan Prousky, talks about his success with benzodiazepine tapers on a prior Anxiety Summit interview – using melatonin, niacinamide, Neurapas Balance, rhodiola and GABA.

There is also a big focus on diet (real food/often a Paleo diet, no additives, organic, healthy fats, no gluten, no sugar, no caffeine, quality grass-fed/wild protein), addressing high cortisol if needed, addressing low zinc, low iron, low vitamin B6, low B12 and looking at gut health. Lifestyle and stress reduction is important and we look at and address all possible 60+ underlying factors/causes.

This is all covered in detail in my book “The Antianxiety Food Solution” (on amazon here) The basics plus advanced topics (like fluoroquinolone antibiotic issues when on benzodiazepines and more) are also addressed on the Anxiety Summits.

I feel very strongly about providing this nutritional support and sharing how helpful it is because organizations like W-BAD and Benzobuddies.org (as much as love them) advocate for no nutrient support suggesting it won’t help or could make symptoms worse. I will admit that some people who are tapering are very sensitive and in these situations very very tiny amounts (as small as a pinch in some instances) of some of the nutrients may be a better option, always only doing one thing at a time to make sure it’s helping and not making symptoms worse, and doing functional medicine tests. Using essential oils, light therapy, gentle detox, Heartmath and yoga are wonderful to start with, in conjunction with all the diet changes.

Please share your benzodiazepine story and what has helped you taper more easily and recover.

If you’re a practitioner please share what approaches you have used to help your clients or patients taper more easily.