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Anxiety: when to use GABA and tryptophan and how much to use

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When you have anxiety it can be confusing trying to figure out the root cause. I like to start by assessing for low GABA and low serotonin because when you address these with targeted individual amino acids you typically see results right away and feel hopeful (and now have time to look for other root causes like gluten issues, high cortisol, gut issues, dietary changes etc).

But there may still be some confusion about when to use GABA and when to use tryptophan and how much of each of these amino acids to use.

I’d like to share a question I received on this blog: I am on 5-HTP for anxiety and I am wondering about trying tryptophan instead and my response so you have a clearer understanding of this:

I have started with Source Naturals GABA Calm 125 mg, 2 on awakening and two in mid-afternoon, and 2 GABA Relaxer at bedtime. It has taken some anxiety edge away from me, but I still feel some anxiety on and off, not so severe as before. I used to feel very anxious on awakening. I want to improve more.

Today, I ordered Lidtke L-trytophan 500mg and am expecting to receive it in a week. I plan to take 2 Gaba Calm on awakening and 2 in mid-afternoon, then add one 500mg Trytophan mid-afternoon and one 500 mg trytophan at bed time.

Is this a good plan? Or shall I have 2 GABA Calm on awakening, 2 trytophan mid-afternoon and 2 trytophan at bedtime.

It’s an excellent question and this is my feedback (with some additional information here for this blog post)

Firstly I’m so pleased to hear the GABA products has taken some of the anxiety edge away.

I would expect this when someone has the low GABA type of anxiety and hear this all the time despite the fact I continue to be asked the blood brain barrier question and does GABA really work as a supplement.

There is also no specific formula to be followed because each person is different and when I’m working with someone we’re figuring out what is working and why and adjusting accordingly. If something is working we continue with that until no additional benefits are seen.

Ask yourself what low GABA anxiety symptoms (this is the physical anxiety) have improved with the GABA and how much (rate each one before – out of 10; and what are they now – out of 10).

From your question it sounds like they could improve more – so if we were working together I’d continue to increase GABA before adding something new. I’d do this until the low GABA symptoms are resolved or until no additional benefits are observed.

Remember when it comes to brain chemical imbalances and anxiety we have 3 anxiety types

  1. Low GABA anxiety type (physical anxiety, more stiff and tense muscles)
  2. Low serotonin anxiety type (mental anxiety, ruminations, negative self-talk, worry)
  3. Low blood sugar anxiety type (physical anxiety, but more shaky)

You need to figure out which type of anxiety you are experiencing and address that. It can be different for each person but it’s not uncommon to experience all of the above.

Once that has been done and we have the ideal amount of GABA and no more low GABA anxiety symptoms I’d then check what low serotonin symptoms my client has (these are the busy mind, ruminations type or worry anxiety).

If she does have some of these symptoms, we pick one or two symptoms and do a trial with 1 x 500mg tryptophan opened on to the tongue (or less if she’s super sensitive). She rates the symptoms out of 10 before the tryptophan trial and then after the trial. Depending on how she responds on the trial, we’ll decide if she needs 1 or 2 x 500mg mid-afternoon and evening. The bedtime dose also depends on how bad the insomnia is. We continue to increase as needed based on symptoms until she has no more low serotonin type symptoms or until no additional benefits are observed.

All the while we are starting to make other changes – like diet, eating for blood sugar balance (this and using glutamine helps with the low blood sugar anxiety type), no caffeine, no sugar, looking for high cortisol, no gluten, looking at gut health and for other nutritional deficiencies.

Here are some links to additional resources related to the above:

I’d love to hear your feedback – do you/did you have the low GABA type of anxiety or the low serotonin type of anxiety or the low blood sugar type of anxiety or all three?

And feel free to share the before rating (from 1 to 10) and the after rating (from 1 to 10) once you’re taking the corresponding amino acid.

 

GABA takes some of the anxiety edge away and now I want to add tryptophan: how do I do this?

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GABA and tryptophan are both calming amino acids with GABA helping more with physical anxiety, tension-in-the-body type of anxiety and tryptophan with anxiety-in-the-head, worrying and ruminations. Many of my clients do really well with both but I like to have them use one at a time to really make sure they are seeing all the benefits before adding the next one.

I recently received this excellent question on one of the blogs about serotonin support: she’s doing better on the GABA and now wants to add tryptophan:        

I have started with Source Naturals Gaba Calm 125 mg, 2 on awakening and two in mid afternoon, and 2 Gaba Relaxer at bedtime. It has taken some anxiety edge away from me, but I still feel some anxiety on and off, not so severe as before. I used to feel very anxious on awakening. I want to improve more. to-day, I ordered Lidtke L-trytophan 500mg and am expecting to receive it in a week. I plan to take 2 Gaba Calm on awakening and 2 in mid afternoon, then add one 500mg trytophan mid afternoon and one 500 mg trytophan at bed time. Is this a good plan? or shall I have 2 Gaba Calm on awakening, 2 trytophan mid afternoon and 2 trytophan bedtime?

I love getting questions on the blog and make sure each one gets answered. However I can’t ever offer specific advice via the blog – you have to be a client for me to be able to do that. But because this is an excellent question I’d like to share some of what I shared with her in the hope it will help you (or your patients/clients) too.

First off I am so pleased to hear the Source Naturals GABA Calm and Country Life GABA Relaxer (a very nice combination of GABA, glycine, taurine, inositol, niacinamide and vitamin B6) has taken some of the anxiety edge away for her!

Here is my answer for her – about what I’d do next if I was working with her one-on-one:

There is also no specific formula to be followed because each person is different and when I’m working with someone we’re figuring out what is working and why and adjusting accordingly. If something is working we continue with that until no more benefits are seen.

I would say this – ask yourself what low GABA anxiety symptoms (this is the physical anxiety) have improved with the GABA and how much (rate each one before – out of 10; and what are they now – out of 10). From your question it sounds like they could improve more – so if we were working together I’d continue to increase GABA before adding something new.

Then once that has been done and we have the ideal amount I’d then check what low serotonin symptoms my client has (these are the busy mind, ruminations type or worry anxiety). If she does have some of these symptoms, pick or two and do a trial with 1 x 500mg tryptophan opened on to the tongue (or less if she’s super sensitive). She rates the symptoms out of 10 before the tryptophan trial and then after the trial. Depending on how she responds on the trial, we’ll decide if she needs 1 or 2 each time. The bedtime dose also depends on how bad the insomnia is. We continue to increase as needed based on symptoms.

All the while we are starting to make other changes – like diet, eating for blood sugar balance, no caffeine, no sugar, looking for high cortisol, no gluten, looking at gut health and for other nutritional deficiencies.

I hope this helps you and makes sense. In summary these are the guidelines I use:

  • It’s best to do one amino acid at a time when starting out
  • Make sure you’ve increased an amino acid so you can experience it’s full benefits before adding another one
  • Start all amino acids based on your unique needs – the best way to determine this is to do a trial first
  • Adjust accordingly while keeping a log of symptoms (with before and after ratings) and supplement amounts

Here are some links to additional resources related to the above:

I’d love to hear your feedback on your low GABA and/or low serotonin symptoms and the before rating (from 1 to 10) and the after rating (from 1 to 10) once you’re taking the related amino acid.

And please let me know if it’s helpful to read a real life question and my response.

I am on 5-HTP for anxiety and I am wondering about trying tryptophan instead

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Both 5-HTP and tryptophan help to boost serotonin levels so you can feel happy, calm, sleep well and not crave carbs. I typically have my clients who have low serotonin symptoms start with a trial of tryptophan because it I see such excellent results with this amino acid. That being said, some people simply do better on one versus the other and you may do better with 5-HTP. If you have low serotonin symptoms and are using either of these amino acids and not getting the expected results, it’s worth considering a change.

Here is a question I recently received on the blog. It’s something I’m commonly asked about and something I deal with often when working one-on-one with clients:

I am on 5-HTP (400 mg) [for anxiety]. I am wondering about trying tryptophan instead. What is the best (safest) way to make the switch? What is the starting dose you usually suggest? I am tapering off SSRIs so I know my serotonin reserves are low.

Here are some of the reasons you may want to consider switching and doing a trial of tryptophan

  • the 5-HTP is not working as you would expect for your anxiety or depression, or other low serotonin symptoms like PMS, insomnia, afternoon and evening carb cravings, negative self-talk, perfectionism, worry in the head and ruminations, and even anger issues or irritability (here is the complete questionnaire)
  • the 5-HTP is causing digestive issues
  • you have done an adrenal saliva test and discovered you have high cortisol. If you feel wired-tired I like to use tryptophan because 5-HTP has been shown to raise cortisol levels

Depending on how severe your symptoms are I would have you slowly replace one with the other, keeping in mind that 50mg 5-HTP is roughly equivalent to 500mg tryptophan.

In this particular case she was taking 400 mg 5-HTP and was surprised to hear that she may now need 2000 mg tryptophan, saying “that seems like a lot!”

Here is my feedback:

2000mg tryptophan isn’t too much if you have low serotonin symptoms and need it. If we were working together I would have her start with a trial of 500mg which is the typical starting amount and increase based on her response. If 500mg helps some symptoms but doesn’t give complete resolution of symptoms then I’d have her try 1000mg and monitor symptoms, and then go up to 1500mg and even 2000mg.

She may respond better to tryptophan and may only need 500mg or 1000mg or she may in fact need the full 2000mg.

She is currently taking an SSRI, so I would assume her doctor already knows she has been using 5-HTP and knows her plans to switch, giving approval and monitoring for possible serotonin syndrome. She would also take the tryptophan at least 6 hours from the SSRI.

Here is additional information on SSRI tapering while using amino acids.

Obviously a similar approach could be used to switch from tryptophan to 5-HTP.

I also only ever recommend the Lidtke brand of tryptophan. You can find this and the other amino acids I use with my clients here.  

Have you switched from 5-HTP to tryptophan and seen added benefits?

Have you switched from tryptophan to 5-HTP and seen added benefits?

If you’re a practitioner please share if you’ve used this approach successfully.

Sleep improvement: Oral intake of GABA and Apocynum venetum leaf extract

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sleep-improvement

I’ve blogged about the Sleep promoting effects of combined GABA and 5-HTP. There is another combination of nutrients that has been shown to help with sleep: GABA and the herb Apocynum venetum leaf extract.

In this 2015 paper: The Improvement of Sleep by Oral Intake of GABA and Apocynum venetum Leaf Extract

The electroencephalogram (EEG) test revealed that oral administration of GABA (100 mg) and [Apocynum venetum Leaf Extract] AVLE (50 mg) had beneficial effects on sleep.

In this study they found that GABA helps people to fall asleep quickly and Apocynum venetum Leaf Extract induces deep sleep, and that they work well when taken together.

The authors conclude that both GABA and Apocynum venetum leaf extract:

can be regarded as safe and appropriate for daily intake in order to improve the quality of sleep.

Earlier this year I heard Dr. Peter Bongiorno present at the Integrative Healthcare Symposium and one of the herbs he covered was Apocynum venetum leaf extract for depression. Since this was new to me, I invited him to share about this herb on the recent Anxiety Summit: Serotonin and anxiety: tryptophan, 5-HTP, serotonin syndrome and medication tapers

I also briefly mentioned the above GABA/Apocynum venetum leaf extract study in my talk on the recent Anxiety Summit – GABA: Blood brain barrier controversy, concerns, best forms and how to do a trial for eliminating anxiety

I find that many of my clients with anxiety also have sleep problems and GABA is often helpful if their sleep issues are related to low GABA levels, often manifesting as physical tension.

One of the signs of low serotonin, in addition to anxiety and worry, is insomnia and I find tryptophan (and sometimes 5-HTP) to be very helpful for many clients too. I’ll often have someone use both GABA and tryptophan (or GABA and 5-HTP) and the combination seems to be a good one.

I have not yet used Apocynum venetum leaf extract alone with clients or in combination with GABA and look forward to learning more. Have you have tried it alone or in combination with GABA? Have you used it with clients?

Tryptophan for PMS: premenstrual dysphoria, mood swings, tension, and irritability

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pms

In a study published in 1999, A placebo-controlled clinical trial of L-tryptophan in premenstrual dysphoria, tryptophan was found to reduce symptoms of PMS when used in the luteal phase or second half of the cycle (i.e. after ovulation):

37 patients with premenstrual dysphoric disorder were treated with L-tryptophan 6 g per day, and 34 were given placebo. The treatments were administered under double-blind conditions for 17 days, from the time of ovulation to the third day of menstruation, during three consecutive menstrual cycles.

They looked at dysphoria, which is defined as a state of unease or generalized dissatisfaction with life, plus mood swings, tension (and anxiety), and irritability and they found a 34.5% reduction of symptoms with tryptophan compared to 10.4% with placebo.

The paper concludes:

that these results suggest that increasing serotonin synthesis during the late luteal phase of the menstrual cycle has a beneficial effect in patients with premenstrual dysphoric disorder.

Let me share what I see with the women with PMS that I work with:

  • This is very typical when I’m working with someone with PMS and anxiety and other mood symptoms. It typically takes 2 to 3 cycles for an amino acid like tryptophan to have an impact on PMS itself. But it does typically start to work right away on the less severe anxiety and mood symptoms that may also be a factor during the rest of the month.
  • I don’t start with 6g per day of the tryptophan but rather have each person do the amino acid questionnaire, review the precautions and do a trial of tryptophan, increasing as needed to find the optimal amount for their needs (you can read more about this here on anxiety and the amino acid overview
  • We often find that adding GABA helps too, as this supports progesterone production
  • Many anxious women I work with also have pyroluria or signs of low zinc and low vitamin B6 and adding these nutrients, together with evening primrose oil, provide additional hormonal support (and help with the social anxiety).
  • Other factors to consider with PMS: low total cholesterol (as cholesterol is needed to make hormones), gluten issues, adrenal function and blood sugar control, gut health and the microbiome, and liver support
  • And finally, we can’t forget diet and need to switch to eating a real whole foods diet free from sugar, gluten and caffeine. Coffee and chocolate in the second half of the cycle can be especially problematic for many women

Together with the tryptophan and the above approaches (if needed as we are all so different), it’s not unreasonable to get the reduction of symptoms from 34.5% (as seen with the tryptophan) down to 100%. It breaks my heart when I hear women think they have to live with PMS symptoms when they don’t have to!

Have you used tryptophan for PMS? Do you take it all month or just in the 2nd half of your cycle? What about other changes that have helped: GABA or liver support or quitting caffeine? Or something else?  Please share.

 

Tryptophan for anxiety, sleep and mood: in Put Anxiety Behind You

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put-anxiety-behind-you

Tryptophan is an amino acid I use with clients all the time. If you have the low serotonin symptoms of anxiety, worry, depression, insomnia, PMS, TMJ, anger issues, winter blues and afternoon/evening cravings, tryptophan can provide relief very quickly, provided you use a quality tryptophan product and find the right amount for your unique needs. I do a trial of each amino acid with my clients.

Dr. Peter Bongiorno, ND, a doctor of naturopathic medicine, also uses tryptophan with his patients. Here is an excerpt on tryptophan from his newest book Put Anxiety Behind You: The Complete Drug-Free Program:

Tryptophan (sometimes referred to as L-tryptophan) is a naturally derived amino acid that serves as a precursor to the neurotransmitter serotonin, which is needed to help you stay asleep. Low levels of tryptophan contribute to generalized anxiety and panic attacks. Back in the early 1990s, a laboratory I was associated with at Yale University performed “tryptophan depletion studies” and which volunteers who were already prone to anxiety were put on a tryptophan-free diet. Within days, these people were extremely anxious, panicky and unstable – and they had lots of trouble staying asleep.

I usually give people 500 – 1,000 mg of tryptophan at bedtime, but I may dose up to 2,500 mg. Take tryptophan at bedtime with a slice of simple carbohydrate (like an apple slice) – the carbohydrate will increase insulin levels and insulin will promote tryptophan absorption in the brain. In my clinic I use a supplement called Tryptophan Calmplete, which includes B vitamins.

Although most conventional psychiatrists are afraid to mix natural medicines like tryptophan with conventional medications studies suggest that they can be safely combined. One eight-week randomized controlled trial of thirty patients with major depression combined 20 mg of Prozac (an SSRI medication) with 2,000 mg of tryptophan as daily treatment for major depressive disorder. This study demonstrated that combining tryptophan and an SSRI improved mood and helped patients stay asleep.

If you look up tryptophan on websites like WebMD, they are going to tell you that tryptophan is unsafe. The reason for this is because in the early 1990s there was an incident of Eosinophilia Myalgia Syndrome, a condition contracted by thirty people who most unfortunately got sick (and some died) after ingesting tryptophan supplements. This tragic event occurred because the company making the supplement had no quality controls, and allowed the introduction of bacteria. These deaths had nothing to do with tryptophan itself. My sense is that the folks behind conventional websites WebMD, who should be doing their homework, let these ideas persist on purpose. The drug companies who advertise with these websites then benefit from continuing the misinformation. I have taken tryptophan myself, have used it with family members and countless patients with absolutely no problem save for the side benefit of better sleep and mood.

This book is an excellent resource for anxiety, where addressing nutritional imbalances with a supplement such as tryptophan is part of the bigger picture of addressing sleep, doing thought work and mind-body work, balancing hormones and blood sugar, exercising, adopting a healthy real foods diet, and making sure you have a healthy digestive system.

He uses the analogy of a stool – when one of the legs or supports is weak, your health suffers.

put-anxiety-behind-you-fig1

I’m a research-geek and love to be able to look at the studies so my only negative comment about the book is that all the studies mentioned in the text are not listed in the references and studies that are listed in the references are not numbered so they can be easily found in the text.

His other book Holistic Solutions for Anxiety and Depression: Combining Natural Remedies with Conventional Care is also excellent and is geared to therapists and other practitioners. You can read my review of that book here.

I had the pleasure of interviewing Dr. Bongiorno on The Anxiety Summit (season 3) – our topic: Serotonin and Anxiety, Happiness, Digestion and our Hormones. And I’m excited to share that he’ll be speaking on Season 4 of the Anxiety Summit. We’ll be taking a deeper dive into serotonin and tryptophan.

I also had the pleasure of meeting Dr. Bongiorno in person and hearing him present at the New York City Integrative Healthcare Symposium earlier this year.  

peter-trudy

Dr. Bongiorno is co-director of Inner Source Natural Health and Acupuncture in New York City. President of the New York Association of Naturopathic Physicians, he is a contributor to numerous blogs and online magazines, including DrOz.com and Sharecare.com, and is regularly interviewed as a natural medicine expert on national television and radio.

Dr. Bongiorno has been kind enough to offer a copy of Put Anxiety Behind You: The Complete Drug-Free Program as a giveaway. We’ll do a drawing and select one lucky reader and announce the winner next Friday. If you’d like to be entered in to the drawing simply comment below and share:

  • why you’d like to win the book
  • if you’ve used tryptophan and what results you saw/see
  • which section you’re most excited about reading and why (just go to the Amazon preview via this link and check out the table of contents and sections of the book)
  • which holistic approaches you already use personally or if you’re a practitioner, what you have used with your anxious patients/clients

5/12/16 UPDATE: Thanks for participating and commenting – the winner is Liz. We’ll contact you to get a mailing address and get a copy of the book to you! Enjoy it! 

If you missed out I encourage you to still check out the table of contents (with the look inside Amazon feature) and get the book if it feels like a fit for you. Check out the comments below to be inspired further.

Please share your feedback (and questions you may have) in the comments section below.