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Depression

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

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anxiety in black community

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

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

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

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

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

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

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

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

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

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

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

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

Nelson Mandela Quote
from the Nelson Mandela facebook page

Here are some resources geared specifically to Black mental health

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

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

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

This is the power of nutritional psychiatry:

Although the growth in scientific research related to nutrition in psychiatry may be recent, it is now at a stage where it can no longer be ignored. In light of this, we aim to provide a platform to move towards a new integrated paradigm in psychiatry whereby nutritional considerations (both educational and prescriptive) can be considered “mainstream”.

The International Society for Nutritional Psychiatry Research/ISNPR made the above statement via a letter published in 2015 in World Psychiatry, the official journal of the World Psychiatric Association –   “International Society for Nutritional Psychiatry Research consensus position statement: nutritional medicine in modern psychiatry.” You can read more about this here.

This recent paper, Nutritional Psychiatry: Towards Improving Mental Health by What You Eat, further adds to the discussion, providing an “overview of the emerging field of nutritional psychiatry, exploring the scientific evidence exemplifying the importance of a well-balanced diet for mental health.”

I recently heard integrative psychiatrist Dr. Kelly Brogan, share this on The Trauma and MindBody Super Conference:“it’s best to address trauma when your nervous system has physiologically improved.” She always starts with addressing physiology: diet, gluten issues, the gut and microbiome, blood sugar stability, micronutrient deficiencies such as low B12, low thyroid and other contributing physiological root causes.

By incorporating nutritional psychiatry and functional medicine approaches we can provide additional healing support for the depression, anxiety, current trauma and intergenerational trauma caused by racism and inequalities.

Updates 7/7/20:

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

 Here are some of them:

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

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

I am not an authority on Black mental health, racism or intergenerational trauma. As I look into the research, read articles and listen to podcasts, I acknowledge that I’ve been learning a great deal. And I know I still have much to learn.

I am, however, an authority on food and using a nutritional approach for anxiety. Real whole nutrient-dense food is the foundation and always will be – for every single human regardless of race.  We do, however, need more programs and studies that are specific for people of color. 

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

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

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

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

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

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

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

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

IMMH highlights: mold, oxalates, anxiety, panic attacks and depersonalization

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IMMH highlights

Today I’m sharing some highlights from three different presentations at the recent IMMH/Integrative Medicine for Mental Health Conference – on mold and the connection to oxalate issues, as well as a major trigger of anxiety, panic attacks, depression and depersonalization.

Matthew Pratt-Hyatt, PhD: “The Hidden Threats of Mycotoxins.”

Matthew Pratt-Hyatt, PhD presented on “The Hidden Threats of Mycotoxins.” He shared medically significant mycotoxins and that ochratoxin affects the kidneys and my first thought was: “I wonder if this plays a role in oxalate issues?”

I asked Dr. Pratt-Hyatt after his presentation and he said yes, the mycotoxins produce oxalates and then dietary oxalates can be the tipping point. He wasn’t aware of any research on the mycotoxin-oxalate connection but sees the connection on the Great Plains MycoTOX lab test and Organic Acids test

Matthew Pratt-Hyatt

Matthew Pratt-Hyatt

Matthew Pratt-Hyatt

Matthew Pratt-Hyatt

Dr. Neil Nathan: “Mold Toxicity as an Unrecognized Cause of Mental Health issues.”

One of my favorite presentations was the one delivered by Dr. Neil Nathan on “Mold Toxicity.” He defines mold toxicity and how it can directly trigger anxiety, panic attacks, depression, depersonalization and hallucinations, as well as some of the common complications which can exacerbate mental health symptoms. These include mast cell activation, multiple chemical sensitivities, secondary porphyrias, methylation dysfunction and pyroluria.

I do appreciate the fact that he addressed that there can be PTSD caused by physicians when someone knows they are sick – especially with mold toxicity – and yet they do not feel heard or validated. This can even lead to their families being less supportive.

Dr. Nathan is a brilliant and compassionate practitioner, and the author of the excellent book – Toxic: Heal Your Body from Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivities, and Chronic Environmental Illness (my Amazon link)

Neil Nathan

Neil Nathan

Neil Nathan

Neil Nathan

Neil Nathan

Dr. Kurt Woeller: “Metabolic Products in Mental Health – How Fungal, Bacterial, Mitochondrial and Other Compounds Influence the Brain.”

Dr. Kurt Woeller shared more about oxalates and mold in his presentation: “Metabolic Products in Mental Health.” I really like the Oxalate Metabolism diagram that shows the role of low vitamin B6, dietary oxalates including ascorbic acid, collagen and gelatin, mold, yeast and genetics in someone with high oxalates.

On a side note, low serotonin is often a factor with collagen and gelatin but it can be a source of oxalates.

He mentions various health problems associated with high oxalates – pain issues are common and so is fatigue and behavioral issues. Dr. Woeller works primarily with children but I have seen anxiety and depression in adults with oxalate issues too.   If mold is one of the triggers then the mental health issues can be further impacted.

 

In case you missed the previous two IMMH blogs:

What wasn’t discussed were some of the other mechanisms that may be causing the increased anxiety – such as the impacts of toxic mold on neurotransmitters and low levels of zinc.

Have you been exposed to toxic mold and was this a trigger for your anxiety, panic attacks and other mood issues?

Did GABA, tryptophan and zinc (and other nutritional support approaches) help ease some of the anxiety symptoms while you were remediating your home and detoxing from the mold toxicity?

Do you have oxalate issues and have you ruled out the fact that toxic mold may be a trigger? I personally have oxalate issues (I share more about this here) and plan to do the MycoTOX test to learn more. I’ll keep you posted on what I find.

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 triggered by toxic mold? 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).

When using GABA for anxiety does tolerance increase and which amino acid to use for a low mood?

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gaba and tolerence

Today I’m sharing some great questions I’ve received about GABA and serotonin support for anxiety and low mood, and my feedback to give you some ideas on what to look for as you use the amino acids for your own issues (or with clients/patients if you’re a practitioner).

I cover possible reasons for ongoing low GABA levels, long-term use of the amino acids, low mood associated with menopause, problems with mainly sugar- and gluten-free, the role of the adrenals and thyroid, the amino acids I’d start with for low mood, how lithium orotate may help, how to know if collagen is causing a low mood and making you more anxious, and some resources for you.

GABA tolerance has increased

Gaba has been a lifesaver for my anxiety! I also use taurine sometimes for anxiety too, and that has helped too. Right now, I take 1000 mg [of taurine]. As for GABA (I now take 1000 mg of that also) I have noticed that my tolerance for it has increased.

Here is my feedback: I’m really pleased GABA and taurine are helping ease your anxiety. I have not seen tolerance to be a factor with my clients using GABA and I’m not aware of any research on this topic. I would look into what could be depleting GABA at a faster rate so you seem to need more and more.

This could be caused by:

  • increased stress which lowers zinc and increases cortisol
  • poor gut health and dysbiosis (there is a bacteria in the gut that may consume GABA – it’s called gabavorous)
  • low zinc and low B6 (which are needed to make GABA and other neurotransmitters)
  • toxin exposure (we’re now seeing that GABA has a protective effect – this blog covers have GABA is protective of the thyroid after fluoride exposure)
  • thyroid problems (the amino acids are less effective in this instance)

Keep in mind that long-term use of the amino acids is not the plan. Once the diet is addressed and the other underlying biochemistry, nutrient deficiencies, toxins etc. are addressed they should no longer be needed. At most, an occasional “top-up” may be needed.

Low mood associated with menopause

Which amino acids would you recommend for low mood associated with menopause? No panic attacks but a crashing low mood for 24hrs or more before slight recovery, a few easy days and then the cycle begins again. Diet is mainly sugar- and gluten-free. Any suggestions would be appreciated, thank you

Here is my feedback: When I hear “diet is mainly sugar- and gluten-free” with mood swings I always look into gluten exposure and blood sugar dips. Keeping a food mood log is an easy first step to see if the low mood is tied to what is being eaten and when.

I would recommend the complete removal of gluten and sugar. Gluten can trigger depression, anxiety, OCD and lead to many psychiatric symptoms. Blood sugar swings can cause both depression and anxiety. The amino acids make it easy to quite sugar and gluten – no willpower required and no feelings of deprivation. Do the questionnaire and do a trial of the amino acids that apply. Based on the above symptoms I’d suspect tryptophan and tyrosine may help and are always a good first step while everything else is being figured out.

I would also look at adrenal function as they take up the slack in menopause and rule out Hashimoto’s thyroiditis and Graves (as you can get mood swings with both as the thyroid levels shift).

Low lithium can also cause mood swings too and lithium orotate can help to keep an even mood, allowing the amino acids to be more effective.

Finally, I’d want to know if collagen, gelatin or bone broths have recently been added to your diet and are being consumed in an on-an-off pattern that correlates with the low mood. Certain susceptible individuals find that it lowers serotonin and increases depression and anxiety, and causes insomnia.

Next steps are a full workup looking at sex hormones, low zinc, low B6, low magnesium, the gut, EMFs, sleep and other dietary factors like salicylates, histamine, glutamates etc. We look at all the possible 60+ nutritional and biochemical root causes and address them or rule them out.

It’s also important to have a good support system in place for those very low days – friends and family members, being part of a community and even keeping a mental health support line number close at hand.

And of course, I always say this: get out in nature, get some exercise, hug someone and have a good laugh.

Resources for you

  • My book The Antianxiety Food Solution (my Amazon affiliate link) has an entire chapter on the amino acids GABA, tryptophan, tyrosine, and DPA (and how to use them), a chapter on blood sugar balancing and glutamine and a chapter on gluten issues (and much more). Read it and become a savvy health-advocate for yourself. Become someone who is well-informed about the amino acids, the precautions and nuances, and all the nutritional approaches for anxiety-relief. Share a copy with your doctor and point out the references.
  • If figuring it out alone or reading my book feels overwhelming to you, or you’re afraid to use the amino acids on your own, my home-study Amazing Aminos for Anxiety program walks you through a step-by step approach on how to figure out which symptoms are tied to which neurotransmitter deficiency, and how to trial each respective amino acid. Stay tuned for a special upcoming launch with live Q and A calls so you can get your questions answered. (If you have recently purchased the homestudy ONLY version we will be contacting you to invite you to participate.)
  • Here is a blog to read if you’re new to GABA: GABA for the physical-tension and stiff-and-tense-muscles type of anxiety
  • Here is a blog to read if you’re new to tryptophan: Tryptophan for the worry-in-your-head and ruminating type of anxiety (it’s a blog about low serotonin anxiety but applies to low-serotonin low mood too)
  • Here is a blog to read if you’re new to tyrosine: Tyrosine for focus, motivation, energy, a good mood and possibly even anxiety
  • You can find the amino acids in my supplement store here.

Can you relate to either of these questions? And are you good at playing a detective to figure out why something may not be working as expected?

What has worked for your anxiety and/or low moods?

Feel free to post questions in the comments too.

And let me know if you’re interested in the homestudy program with live Q and A calls. (If you have recently purchased the homestudy ONLY version we will be contacting you to invite you to participate.)

Delayed IgG food sensitivities: depression and anxiety due to inflammation, leaky gut, leaky blood brain barrier and low serotonin

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It’s really encouraging and exciting to see a major study confirming what we’ve known about IgG food sensitivities or IgG food reactivity for years, and also reporting a link to irritable bowel syndrome (IBS) and depression. The paper, published in May this year, The Food-Specific Serum IgG Reactivity in Major Depressive Disorder Patients, Irritable Bowel Syndrome Patients and Healthy Controls states

There is an increasing amount of evidence which links the pathogenesis of irritable bowel syndrome (IBS) with food IgG hyperreactivity. Some authors have suggested that food IgG hyperreactivity could be also involved in the pathophysiology of major depressive disorder (MDD).

The following diagram and excerpt illustrates the gut-immune-inflammatory-brain model for depression that is associated with food IgG hyperreactivity or sensitivity.

The gut-immune-inflammatory-brain model for Major Depressive Disorder associated with food IgG hyperreactivity. According to the hypothesis proposed in our previous work, we present a possible mechanism underlying the MDD [major depressive disorder] development, suggesting that the interplay between genetic and environmental factors may lead to disruption of tight junctions, the loss of their integrity and both gut and BBB [blood brain barrier] permeability. Undigested food compounds, which would normally break down in the gut, translocate into the blood circulation, and trough epitopes combine with food IgG antibodies to form immune complexes. This, in turn, provokes an abnormal response and triggers immune-inflammatory cascade. Uncontrolled release of the proinflammatory mediators may contribute to low-grade systemic inflammation and low-grade neuroinflammation, which, via pathological processes in CNS [central nervous system], i.e., changes in neurotransmitter metabolism, neurogenesis, glutamate excitotoxicity, may in consequence induce and then maintain and prolong depression.

[diagram and excerpt from The Food-Specific Serum IgG Reactivity in Major Depressive Disorder Patients, Irritable Bowel Syndrome Patients and Healthy Controls]

I wrote my book, The Antianxiety Food Solution, in 2011 and there wasn’t research on the gut-immune-inflammatory-brain model, but I do write extensively about delayed IgG food sensitivities (as well as other types of food issues). If you don’t have my book I’m including some of the highlights related to this (and I encourage you to pick up a copy too!). If you do have my book I hope this next section encourages you to go back and read chapter 4 again (and even check out the other books I mention below).

I write about how with delayed food reactions, it may take a few hours to several days before symptoms appear, which can make it difficult to identify the offending food or foods. In these reactions, the body responds by creating a type of antibody known as IgG (immunoglobulin G).

I also write about how food sensitivities can have effects beyond physiological symptoms, including creating imbalances in key chemicals in the brain, which can cause anxiety, phobias, depression, irritability, and mood swings. When food sensitivities have these effects, they are sometimes termed “brain allergies” or “cerebral allergies.” Dr. Carl Pfeiffer wrote extensively about this and used these terms in his wonderful book, Nutrition and Mental Illness, way back in 1987. (This book is a quick read and is one of my favorite older books on the subject of mental health and biochemical imbalances.)

I also reference the work of my colleague and friend, clinical nutritionist Liz Lipski. In her 2004 book, the 3rd edition of Digestive Wellness she shares that

24 percent of American adults claim they have delayed food and environmental reactions.

She feels that these sensitivities are often the result of leaky gut syndrome, a condition characterized by damage to the microvilli lining the intestinal walls. This allows undigested food particles to travel across the intestinal wall and into the blood, where the immune system responds to them as foreign, harmful substances and creates antibodies to neutralize them.

All this sounds very similar to what the new study is reporting doesn’t it? I’d prefer it not to take so long for the knowledge from as far back as 1987 to get into mainstream journals but it’s the world we live in and we can just appreciate that we are moving forward and in the right direction!

The 2018 paper mentioned above concludes the following:

Our findings suggest more common food-specific serum IgG hyperreactivity among patients with IBS and MDD [major depressive disorder], which may be one of the mechanisms leading to the development of immune activation and low-grade inflammation observed in these disorders.

They do support an elimination diet for IBS but not for depression:

There is no causal relationship which could confirm clinical utility of an elimination diet in patients with depression

I do love research, but this really bothers me as it’s just common-sense and we do have some case studies supporting the use of elimination diets. In this case study the patient’s “treatment-resistant” depression improved considerably with an elimination diet, with similar results in another case study where a gluten-free elimination diet improved both anxiety and depression and everyday functioning.

In the meantime, we’ll continue to rely on the wisdom of practitioners like Dr. Pfeiffer and Liz Lipski, and all the clinical evidence showing how an elimination diet does help with both depression and anxiety. Just read some of the success stories on this blog – Paleo and grain free diets: anxiety and depression success stories.

Other mechanisms: nutrient malabsorption and serotonin production

There are other mechanisms that I also cover in my book – nutrient malabsorption and a more direct impact on serotonin production.

One possible mechanism is indirect effects of gastrointestinal damage due to eating problem foods, resulting in nutrient malabsorption. In a 2009 double blind placebo-controlled study:

65 celiac patients aged 45-64 years on a strict gluten-free diet for several years [and showing signs of low folate, low vitamin B12 and low vitamin B6] were randomized to a daily dose of 0.8 mg folic acid,0.5 mg cyanocobalamin and 3 mg pyridoxine or placebo for 6 months

I doubt folic acid or this form of B12 would be used today but even with these forms at these low doses, the study participants showed homocysteine in a good range and reported improvement in general well-being – after just 6 months of supplementation.

Another possible mechanism is the fact that gluten sensitivity and the resulting damage to the gut can limit the availability of tryptophan and therefore lead to decreases in levels of serotonin. Research published in 2005, Gluten-free diet may alleviate depressive and behavioural symptoms in adolescents with coeliac disease: a prospective follow-up case-series study, reports that:

serotonergic dysfunction due to impaired availability of tryptophan may play a role in vulnerability to depressive and behavioral disorders among adolescents with untreated coeliac disease

In addition to removing the foods that are causing the sensitivities, you need to heal the gut and boost serotonin levels with a targeted individual amino acid like tryptophan.

Give the link between anxiety and depression, all of the above could apply if you have anxiety too.

Have you had IgG food sensitivity testing and found that an elimination diet helped reduce your depression or anxiety symptoms?

Kate Spade: suicide, hormonal imbalance, antidepressants as a trigger and the stigma of mental health

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Photo by Paul Keleher (originally posted to Flickr as kate spade) [CC BY 2.0], via Wikimedia Commons
Kate Spade, a well-known American fashion icon and handbag designer, died by suicide last week at the age of 55. I’m always torn in situations like this…just share the news story with my sympathies in order to respect the family or use this as an opportunity to learn from and prevent others from suffering the same fate. This time I’m doing the latter – with the risk of appearing insensitive – because there are red flags here and I feel so strongly that we all need to learn from this in order to move mental health forward. I’m hoping her husband and family would approve.

In the announcement about Kate Spade’s suicide in the New York Times, Mr. Spade said:

that though his wife had suffered from anxiety at points during their relationship and marriage, her serious bouts of depression only began about six years ago, at the age of 49.

Kate suffered from depression and anxiety for many years. She was actively seeking help and working closely with her doctors to treat her disease, one that takes far too many lives. We were in touch with her the night before and she sounded happy. There was no indication and no warning that she would do this. It was a complete shock. And it clearly wasn’t her. There were personal demons she was battling.

My heart goes out to Kate Spade’s husband, young daughter and loved ones. Her suicide is just so sad but as I said I have a fair bit to say about this….

 

Hormone imbalance triggering anxiety and depression?

According to the reports, Kate’s “serious bouts of depression only began about six years ago, at the age of 49, but she had suffered “from depression and anxiety for many years”.

Perimenopause and menopause is a classic time for women to experience worsening anxiety and depression and can be driven by fluctuating hormones, especially low estrogen. In this study, Depression and the menopause: why antidepressants are not enough? the authors share that

Postmenopausal depression is more severe, has a more insidious course, is more resistant to conventional antidepressants in comparison with premenopausal women and has better outcomes when antidepressants are combined with HT (hormone therapy).

Addressing hormone imbalance as one possible root cause can eliminate the anxiety and depression. Some of my favorite resources for hormone balance are these books: The Hormone Secret and Cooking for Hormone Balance.

 

Low levels of neurotransmitters like serotonin, catecholamines and GABA?

Directly connected to hormonal imbalance is brain chemistry imbalance. Addressing low levels of neurotransmitters like serotonin, the catecholamines and GABA provide results quickly when they are used in a targeted way based on individual needs:

  • Low serotonin is an issue when estrogen levels are declining and the amino acid tryptophan can have profound benefits if low serotonin is one of the root causes, leading to depression, worry, fear, overwhelm and sleep issues.
  • Low catecholamines can cause the “I just want to say in bed” depression and low motivation, together with fatigue and poor focus. The amino acid tyrosine can help to eliminate some of this and also provides thyroid support.  Poor thyroid health can also be a root cause of depression.
  • We see low GABA levels when progesterone is low and if this is one of the root causes, it can result in increased physical anxiety and insomnia. The amino acid GABA, opened on to the tongue, can provide calming results within minutes.

I can totally relate to the hormonal aspect as I suffered from PMS for years and my anxiety issues and panic attacks started in my late 30s and I had a really low spell as I was going through menopause.  Both GABA and tryptophan turned things around very quickly for me as they do for my clients.

 

The role of diet and nutritional psychiatry?

There is so much new science behind the role of a real foods traditional diet for alleviating both depression and anxiety. The SMILES study, published by Prof Felice Jacka early 2017, was the first randomized controlled diet depression study and ONE THIRD of the dietary intervention group saw improvements in their depression symptoms.  This was just diet alone and switching from processed and junk food to real food with no specific dietary restrictions.

There is also much clinical evidence supporting how diet can have an impact. Holly, suffered from with severe depression and anxiety changed her diet and shared this with me:

Over the course of a year and a half, I was given 10 different psychiatric diagnoses and cycled through 10 different medications. I discovered the healing power of diet completely by accident, and it changed my life. I now live with no diagnoses and no symptoms.

I started with the Whole30 (strict paleo), then went paleo, dabbled with a ketogenic approach, and now I eat a modified paleo diet, with some rice and goat dairy.

This has been termed nutritional psychiatry and you can read more diet-depression and diet-anxiety success stories here.

Keep in mind that your prescribing psychiatrist may not yet be on board with this or up to date on the newest research. Just last week someone told me what happened when they discussed nutritional psychiatry with their doctor and showed them my book The Antianxiety Food Solution (my Amazon link). He said: “Good luck with that!”

 

Could the antidepressant medication have triggered her suicide?

The statement from Kate’s husband says “She was actively seeking help for depression and anxiety over the last 5 years, seeing a doctor on a regular basis and taking medication for both depression and anxiety.”  Could the antidepressant medication have triggered her suicide or played some part?

We will never know with Kate but this is always my first thought when I learn of a suicide and when we hear of homicides in the news. One of my colleagues shared this when her suicide was first announced: “I was wondering if she was under psych care and what role meds might have played in this tragedy.”

This paper is one of many papers reporting similar antidepressant suicide and violence risks, and concludes that:

Antidepressants double the occurrence of events in adult healthy volunteers that can lead to suicide and violence

Kelly Brogan MD – Holistic Psychiatrist​ no longer prescribes psychiatric medications because we don’t know who will experience this side-effect. She writes this about a Swedish study and antidepressants and increased suicides

As antidepressant prescriptions increased 270% over 15 years, suicide rates also increased. Strikingly, more than half of the young women who committed suicide (52%) were prescribed antidepressants within a year of committing suicide. And antidepressants were detected in 41% of the women who committed suicide, showing that they were under the influence of antidepressants at the time of death. 

 

What if you are taking an antidepressant and seeing benefits?

When I posted some of this on Facebook earlier in the week someone who is on an antidepressant and benefiting shared her frustration that we are blaming suicide on medications.

There are many who do benefit but there are two issues I have:

  1. Even if someone is doing well on an antidepressant, benzodiazepine or other psychiatric medication I feel we need informed consent about the side-effects and training for the individual and family on what to look out for as things can change. The can occur when meds are changed, doses are increased or decreased, new meds are added, one or more are stopped abruptly or too quickly (called discontinuation syndrome). Many doctors also need to be educated and to acknowledge that suicide and homicide are very real side-effects of these meds.
  2. We don’t know who will be adversely impacted, which is why consent/knowledge about this is so important.

When we rent ski equipment or go bungee jumping we sign an informed consent form, acknowledging the possible risks of death. Why is this not happening with these medications? I just want individuals to be going into this with eyes wide-open so they don’t say “why didn’t anyone tell us this?”

If someone is currently seeing benefits from antidepressants (or benzodiazepines) I make sure they know ALL the risks and encourage them to continue to look for root the causes and address these (never stopping medications abruptly and never without the prescribing doctor’s permission).

There are many possible biological or biomedical or metabolic causes of depression and anxiety and many of these can play a factor in suicide.  Here is a list of just some of them:

My concern is that none of these – the medications or poor diet and nutritional deficiencies – are ever discussed when someone does commit suicide or goes on a violent or homicidal rampage.

 

The stigma of mental health and the fear of seeking help

There are reports that “Kate Spade felt unable to seek help or discuss her mental health because she feared this might damage the brand she created.”  This is a huge issue and if it was true for her or if anyone with a mental health condition feels like this, this has to change!

As Dr. Mark Hyman MD​ said this when I interviewed him last year before the launch of his Broken Brain docu-series

I began to realize that the body was driving a lot of this brain dysfunction, and that if you fix the body, a lot of the brain disorders would get better, that it wasn’t a primarily a mental problem, but it was a physical problem.

Our interview and full transcript is here and we cover the gamut in 12 minutes: the gut and microbiome, nutritional deficiencies, food sensitivities, heavy metals, other environmental toxins and medications.

We don’t hide the fact that we have a broken leg so why do we have to hide it when we have a broken brain? If we can start to acknowledge that mental health issues so often have this physical aspect (and often it’s 100% physical) then hopefully we can end this crazy stigma.

And even if there is also trauma or lifestyle factors that make someone depressed or anxious – so be it. Stop the stigma and shame. Why do we have to put on a brave face and pretend all is well. It has to stop so people can ask for help.

Last but not least, I feel we need to offer practical nutritional psychiatry resources to the family who have been traumatized by the loss of a loved one to suicide.  We know the amino acids and B vitamins help individuals recover from psychological stress after a natural disaster and these same nutrients can help the family in the midst of their sorrow.

I am aware it’s a very delicate subject and I’m sure this will rub some people the wrong way but I believe we all need to be talking about this and not tip-toeing around it.

I really feel this all needed to be said today. I hope this helps you or a loved one.

Rest in peace Kate Spade.

I wake in the middle of the night with a jolt of fear, feelings of dread or feeling depressed

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Waking in the night feeling anxious and with a jolt of fear, having a panic attack, experiencing feelings of impending doom, with a pounding heart and even feeling depressed is a common issue I see with clients and it’s a common question that I’m often asked on my blog and on Facebook.

Here is a typical question you may relate to:

I usually wake between 5-6 am and have this overwhelming feeling of dread and start thinking of all the things I have to get done. And then I can’t fall back asleep. What is this?

Or this one:

Does anyone have severe depression when waking up in the middle of the night, but never during the day or before falling asleep. It doesn’t go away until after I’m fully awake and upright in the morning.

Low serotonin?

Serotonin is known to dip later in the day and at night and we know low serotonin can cause depression and insomnia/waking in the night, so my first thought would be to assess for low serotonin and address this if it is the case. I use the questionnaire and trial method.

I always start with tryptophan, but may switch to 5-HTP if that’s not working as expected as some people do better on one versus the other. We add melatonin if the tryptophan or 5-HTP isn’t quite enough to help with the waking.

There are many possible causes of low serotonin so over the course of the next few months these will be addressed too, on a case by case basis. Some of the causes in include: a poor diet, low stomach acid, malabsorption, low zinc, low B6, low iron, low magnesium, dysbiosis and/or parasites and/or candida, the birth control pill, MTHFR defects (with this defect expressing) etc.

Low GABA?

Low GABA levels may be a factor too as this can contribute to insomnia and waking, especially when there is physical tension. New research reports GABA’s involvement in unwanted thoughts and it’s a common factor in my community and clients. Again, I use the questionnaire and trial method to find the ideal amount of GABA for each person.

High cortisol?

High cortisol in the night can also be a factor and I suspect this when someone says they wake with a jolt of fear or feels what they describe as an adrenalin rush. Saliva testing can confirm cortisol levels and Seriphos is the best product I’ve found to lower high cortisol. Addressing low blood sugar and finding the root cause of the adrenal issues are also key. General adrenal support with B vitamins and adaptogenic herbs are often needed too.

Hormone imbalances and/or PMS?

Here is another typical question you may relate to:

I’ve had the worst week regards 3am panic attacks, lurid dreams and wake up aching. It always feels like the end of the world and yet I get up and stagger out to do my morning routines and all is right with the world (apart from physical aches and pains). I have often had bouts of this. It’s a week to go until my period.

If the anxiety or panic attacks are cyclical and tied to your menstrual cycle I will still start with a trial of tryptophan which has been shown to help PMS, tension, depression and mood swings. Serotonin support also helps with fibromyalgia-type aches and pains.

A trial of GABA is often needed too and can help with alleviating the panic attacks, waking and some of the aches. Other factors like a gluten sensitivities, adrenal issues and high oxalates may also play a role in physical aches.

Lurid dreams clues me into the possibility of low vitamin B6, which is an important co-factor for making both GABA and serotonin, as well as being important for alleviating PMS symptoms and the social anxiety condition called pyroluria. The pyroluria protocol, with vitamin B6, zinc and evening primrose oil, helps both the social anxiety as well as PMS symptoms and insomnia.

Address the basics

You may be looking for the perfect supplement to help and while the amino acids come pretty close to being that, it goes without saying that you want to always address the basics. This means making sure you are eating a real whole food diet with quality animal protein and getting that animal protein at breakfast in order to balance blood sugar. The following needs to be eliminated too: caffeine, gluten and sugar. Some individuals do even better on a ketogenic diet.

Looking at sleep hygiene factors fall under the basics too: a dark, cool and quiet room, no PC or iPhone late at night, no iPhone or other EMF sources close by, sunlight exposure in the early morning etc.

And we mustn’t forget stress reduction, exercise and nature.

Address other bigger issues

Medication side-effects must always be considered. Here are a few examples:

Hashimoto’s thyroiditis must also always be considered especially when there are fluctuations in mood, anxiety and sleep. These fluctuations in mood and anxiety can happen at any time of the day and not necessarily in the night.

If the insomnia and middle of the night anxiety and depression persists we continue to dig and look at dietary histamine and oxalate issues, SIBO, parasites and other digestive issues.

If we are still not seeing all the expected results then a referral for Lyme disease, mold toxicity, sleep apnea, TBI (traumatic brain injury) and heavy metals may be needed.  Current or past  trauma and support for PTSD must also be considered – this can be therapy-based and nutritional support.

My checklist

My checklist when I start when working with someone with issues similar to the above. This will be tweaked based on each person’s own biochemistry and where they are in terms of diet, supplements and lifestyle:

  • Low serotonin? Do a tryptophan or 5-HTP trial
  • Low melatonin? If tryptophan or 5-HTP trial isn’t quite enough then add melatonin
  • Low GABA? Do a GABA trial
  • Low blood sugar? Add quality protein at breakfast, plus glutamine
  • High cortisol? Support the adrenals and use Seriphos or something else to lower the high cortisol
  • PMS/sex hormone imbalances or Hashimoto’s? Address with diet, nutrients and hormone support as needed
  • Low magnesium, low zinc, low B6, low iron? Assess for these deficiencies and address them
  • Gut health issues like leaky gut, dysbiosis, candida, parasites, SIBO? Address these issues
  • Histamine, oxalate or other dietary issues? Address these issues
  • Medication side-effects? Figure out which one is an issue and work with the doctor to taper if needed and address why the medication was initially prescribed.
  • If the issue persists – a referral for Lyme disease, mold, sleep apnea and/or heavy metals etc

As you can see there are many overlaps with some of the 60+ root causes of anxiety.

Here is additional information on tryptophan for low serotonin, GABA for low GABA and glutamine for low blood sugar, plus the list of supplements I use with clients.

As always, if the amino acids are new to you, review the precautions and be smart about using them. My book The Antianxiety Food Solution (Amazon affiliate link) has an entire chapter on the amino acids, plus chapters on diet, gut health, caffeine, blood sugar and more.

We’d love to hear which of the above approaches have helped with your insomnia and waking with a jolt of fear or dread or pounding heart.