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Perimenopause and menopause: low GABA, pyroluria and the adrenals

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As you go into perimenopause and menopause you don’t have to settle for increased anxiety, dull moods, depression, a foggy brain, a flabby belly, night sweats, insomnia, fatigue, low libido, weight gain and the bone loss that so “common” and “accepted” with getting older.

There are natural, effective and easy-to-implement solutions to balance your hormones at any age!

My perimenopausal symptoms hit with a vengeance in my late 30s. The stress that I was experiencing at work, together with all the hormone changes and what I call my “perfect storm” of gluten issues, heavy metals, low GABA, low serotonin, low zinc, adrenal issues, vegetarian diet, candida, pyroluria and leaky gut, all worked together to cause my anxiety and panic attacks.

I didn’t settle and as soon as I used GABA and tryptophan the anxiety and panic attacks stopped and I could take a step back and work on all the other underlying issues, without all the overwhelm.

I share my story in my interview on the Perimenopause Summit with summit host Dr. Michelle Sands, and go into great detail about how to use the amino acids in the most effective way to ease anxiety, worry, fear, negative self-talk, ruminations and overwhelm.

I also share a study about tryptophan easing PMS symptoms in just 3 cycles, as well as some of my other tips for PMS symptom relief (think liver support).

I also talk about a topic that no-one is addressing and yet there is such a simple solution for this excruciatingly painful condition called proctalgia fugax. You may not have heard this term but if you have you know it! In the medical literature it is described as “a condition that leads to rectal spasms and sharp fleeting pain in the lower rectum or anus.” Sublingual GABA works miracles in a few minutes).

My interview – Amino Acid Therapy for Anxiety

  • Problems with commonly prescribed anti-anxiety meds
  • How food affects mood
  • Right and wrong way to use amino acid therapy

Unfortunately, hormone and women’s health issues are incredibly misdiagnosed and misunderstood, leaving many women feeling hopeless, broken and stuck.

Dr. Michelle gets all this because she was also there, in her 20s with irregular and absent periods, mood swings, joint pain, infertility, low libido, digestive issues and insomnia. She was told her ovaries had failed and to manage her symptoms for the rest of her life with birth control pills, antidepressants and other medications. So, she found a better way — a natural way to help her body heal itself — and she’s here to teach you how to do the very same, no matter whether you’re in your 20s or decades older!

The pyroluria perimenopause connection

There are little known connections between pyroluria (a social anxiety condition) and perimenopause.

The nutrients, zinc, vitamin B6 and evening primrose oil, eliminate the social anxiety symptoms and have a direct tie in to perimenopause because these same nutrients:

  • are needed to make neurotransmitters like GABA and serotonin
  • are also are needed to make our sex hormones (and help so much with PMS and perimenopausal hormone imbalance)

In my interview with Dr. Michelle I also share how I discovered I had pyroluria before I even knew what pyroluria was. I was in perimenopause and had terrible PMS. I read Ann Louise Gittleman’s wonderful book Before the Change: Taking Charge of Your Perimenopause (my Amazon link), and she recommended zinc, vitamin B6, and evening primrose oil for PMS symptoms. Once I started taking these nutrients I had fewer hormonal issues and they helped so much with my social anxiety.

A few years later when I was working with clients with pyroluria and I looked at the pyroluria questionnaire I thought: “that looks like me, maybe I’ve got this too!” I did the urine test and I discovered that I have pyroluria.

In my interview I talk about :

  • the pyroluria-introvert connection and why I believe there is a nutritional aspect to introversion and it’s not purely a personality trait
  • the pyroluria-Lyme connection and how Klinghardt feels that Lyme Disease cannot be treated until the underlying pyroluria is addressed

Be sure to also tune in to Ann Louise Gittleman’s interview. Her discussion about zinc and copper is a perfect complement to my interview.

Ann Louise Gittleman, PhD, CNS: Is Perimenopause a Mineral Imbalance?

  • Do you have toxic levels of this mineral (copper)?
  • Best way to test mineral imbalance
  • Overcoming nutrient and mineral imbalance

Adrenal health is so important during perimenopause

Adrenal health is so important during perimenopause. This is covered in this interview – Adrenals are a Perimenopausal Gal’s Bestie with Marcelle Pick MSN, OB-GYN, NP. She covers the following:

  • Role of the adrenal glands in hormone balance
  • Causes and consequences of adrenal burnout
  • Caring for your adrenals.

And shares these gems:

  • Prior to menopause about 15% of our sex hormones are produced by our adrenals and after menopause it’s 30% – this is why adrenal health is so important!
  • When you are stressed the adrenals will make cortisol at the expense of estrogen and progesterone

She also talks about how we handle stress impact the adrenals and why it’s so important to work on lifestyle changes. One great example she shares is this: “are we a perfectionist and do we expect too much of ourselves?”

I’d like to add to this and say that the first step is recognizing that you are a perfectionist and reminding you that perfectionism is a classic sign of low serotonin. That way you can consider using the amino acids tryptophan or 5-HTP to say goodbye to perfectionism and ease some of your stress.

I talk all about low serotonin in my interview but want to help you make this connection as you listen to Dr. Marcelle’s and my interviews.

Dr. Marcelle also discusses what to eat, some of her favorite adaptogenic herbs for the adrenals, exercise advice (and why to do less when you are healing your adrenals) and the effects of childhood trauma.

REGISTER HERE

Do let us know if any of this resonates with you and feel free to post questions in the comments below.

I have issues with perimenopausal anxiety a couple of weeks per month and don’t want to turn to SSRIs.

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My challenges with anxiety have been hormonal. I’ve had issues with both postpartum anxiety and now perimenopausal anxiety a couple of weeks per month as I’m approaching menopause. I don’t want to turn to SSRIs but some days are pretty miserable and most other days I feel fine. Any info you have to share regarding this topic or any natural solutions would be of great interest.

When I’m working with a client who reports symptoms like this we start with serotonin and GABA support; determine if they have low zinc, low vitamin B6 and low iron. I also always ask the question: are you on the birth control pill (now or in even in the past).

I’ve blogged about much of this in the past so I’m going to share snippets and blogs for further reading.

Serotonin support with tryptophan for immediate worry-type anxiety relief

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).

This is very typical when I’m working with someone with both PMS (premenstrual syndrome) and perimenopausal anxiety, depression, irritability and mood swings. It typically takes 2 to 3 cycles for an amino acid like tryptophan to have an impact on the cyclical nature of your perimenopausal symptoms.

However, tryptophan does typically start to work right away on the less severe anxiety and mood symptoms assuming you find the ideal dose for your needs. I use the trial method to help my clients figure this out.

When you boost serotonin you also reduce the worry-in-your-head and ruminating type of anxiety, and end to panic attacks and phobias, a boost of confidence, no more depression and negativity, imposter syndrome that is no more, an end to your anger issues and irritability, an improvement in sleep and no more afternoon/evening cravings for something sweet.

You can read more about tryptophan here: Tryptophan for the worry-in-your-head and ruminating type of anxiety

GABA support for relief from tension-type anxiety

During perimenopause progesterone is often low and when it is low, we can expect GABA to be low too. Research confirms low GABA and high glutamate-glutamine in premenstrual dysphoric disorder (PMDD) and that shifting hormones may lead to dysregulation of GABA which contributes to HPA axis dysfunction. The HPA (hypothalamic pituitary adrenal) axis is your stress response system and when it’s not functioning well you are more susceptible to the effects of stress and more likely to feel depressed and anxious.

If your GABA levels are low you will feel increased physical tension and insomnia. The amino acid GABA, opened on to the tongue, can provide calming results within minutes.

Dee likes the instant calm and compares how it worked as well as Xanax had worked for her in the past:

I have taken Xanax in the past for panic attacks. My functional medicine doctor suggested this product as I wanted a natural product. 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.

Low zinc, low vitamin B6 and/or low iron?

Low iron/ferritin is common if you’re still having a period and it’s one of the important -cofactors for making serotonin, thyroid hormones and the sex hormones. Low iron, together with low vitamin B6 plays a role in anxiety and panic attacks. In one study premenopausal women who had been admitted to the emergency room with panic attacks were found to have both low iron and low vitamin B6. I have an entire blog post on this topic here

The other key co-factor for making serotonin is zinc. You’ll want to look into and address pyroluria if you feel more anxious in social situations like family gatherings, going to church events or community picnics, or even while doing business networking or in work meetings. The key nutrients for pyroluria are zinc and vitamin B6 and both help with PMS and perimenopausal anxiety, and hormone balance.

Are you on the birth control pill?

I recently reviewed Beyond the Pill A 30-Day Program to Balance Your Hormones, Reclaim Your Body, and Reverse the Dangerous Side Effects of the Birth Control Pill by Dr. Jolene Brighten.

If you currently on the pill or have been in the recent past read the above review and get the book to give you an excellent understanding of what may be going on with your body.

Dr. Jolene shares that mood disruption is common and mentions a study in the Journal of the American Medical Association which reports the following:

women who began the pill were more likely to be prescribed an antidepressant – which means it contributes to a bit more than moodiness

She writes in great detail about Post–birth control syndrome (PBCS) which is “is a constellation of symptoms women experience when they discontinue hormonal birth control.” She has found the symptoms of PBCS typically occur in the first 4-6 months after stopping the pill. As well as mood swings and anxiety, you may also experience heavy bleeding or no period, acne, headaches, infertility, pill-induced PCOS (polycystic ovarian syndrome), hypothyroidism, gut issues and even autoimmune symptoms.

You also want to reduce your stress levels. Here are some ideas for you:

All the above is a great starting point. You also want to consider adrenal support if needed; and support liver health, together with dietary changes, addressing gut health and thyroid health, getting toxins out of your life and figuring out whatever your own root causes may be.

Here is the link to the amino acids and pyroluria supplements I use with my clients.

Have you found that any of the above has helped you with your PMS or perimenopausal anxiety?

Do you have any stress-relief tips to share with other women who find themselves so stressed out at this age?

Feel free to post questions here too.

Beyond the Pill by Dr. Jolene Brighten – my book review

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I really wish this book – Beyond the Pill A 30-Day Program to Balance Your Hormones, Reclaim Your Body, and Reverse the Dangerous Side Effects of the Birth Control Pill by Dr. Jolene Brighten – was available when I was in my 30s and on the pill.

Dr. Jolene mentions a study in the Journal of the American Medical Association which reports the following:

women who began the pill were more likely to be prescribed an antidepressant – which means it contributes to a bit more than moodiness.

This was not a small study and included over one million women.

Symptoms caused by the pill and the damage it does to your body

This book, Beyond the Pill, provides a comprehensive list of symptoms caused by the pill:

  • hormonal confusion: missing or irregular periods, light or heavy periods, short cycles, infertility, headaches
  • digestive problems: leaky gut, gut dysbiosis, inflammatory bowel disease
  • energy reduction: fatigue, adrenal and thyroid dysfunction
  • skin issues: hair loss, dry skin
  • mood disruption: depression, anxiety
  • lady part disturbance: low libido (Oh, hell no!), vaginal dryness, chronic infection, pain with sex
  • vitamin, mineral, and antioxidant depletion (such as folate, B12, and magnesium) (I’ll add vitamin B6 to this list too – it is mentioned elsewhere in the book)

The pill does further damage to your body and also:

  • intensifies the risk of blood clots, which lead to strokes
  • increases the risk of breast, cervical, and liver cancers
  • increases the risk of diabetes
  • raises the risk of heart attacks
  • triggers autoimmune disease

Truth-bombs about how the pill works

She shares plenty of truth-bombs about how the pill works – like these gems:

As long as you’re on the pill, your brain and ovaries aren’t talking, which can seriously affect all your hormones.

When you take that week of placebo pills, you’re not actually getting a period because you never ovulated. Instead, this is what is called a withdrawal bleed (I did not know this!)

Post–birth control syndrome (PBCS)

I first became aware of Dr. Jolene’s brilliance in this area when she started writing about Post–birth control syndrome (PBCS) a few years ago. PBCS is “is a constellation of symptoms women experience when they discontinue hormonal birth control.” She has found the symptoms of PBCS – hormonal irregularities like no period or heavy bleeding, acne, mood swings and anxiety, headaches, infertility, pill-induced PCOS (polycystic ovarian syndrome), hypothyroidism, gut issues and even autoimmune symptoms – typically occur in the first 4-6 months after stopping the pill. To make it easy for you the PBCS symptoms are all laid out in a handy quiz in the book.

She has found these symptoms won’t go away without taking the necessary steps that include detox, gut repair, healing the thyroid and adrenals, addressing metabolic health or blood sugar control, boosting mood, improving libido and addressing nutritional deficiencies that the pill has caused. This is all covered in the book as a 30-day program to balance your hormones, reclaim your body, and reverse the dangerous side effects of the birth control pill.

I really appreciate that Dr. Jolene shares this:

I want you to know I’m not anti-pill. Nope. I’m pro–informed consent, which means doctors giving you all the information you need to consent to taking birth control.

This book will help you understand what those hormonal symptoms mean, how the pill is affecting your body, and what to do if you either need to stay on it or are ready to get off it.

Addressing low vitamin B6, low serotonin and low GABA

Here are a few of the nutritional supporting approaches she covers (all supported by research) that are very applicable for support for anxiety specifically and relevant to what you’ve been learning from me: addressing low vitamin B6, low serotonin and low GABA.

Because the pill depletes vitamin B6, she recommends up to 100mg per day for PMS and mood-related symptoms, and symptoms of PBCS. (I know vitamin B6 is controversial and she does acknowledge this).

Dr Jolene identifies the concerning and far-reaching effects of the pill on serotonin: “studies have shown that women on the pill don’t metabolize tryptophan normally” affecting both serotonin and melatonin production, reducing kynurenic acid and raising high-sensitivity C-reactive protein (hs-CRP), a marker of inflammation and immune system activation, and shifting the “tryptophan pathway… toward quinolinic acid production, which is inflammatory and harmful to the brain.”

I would have loved to see more about tryptophan and 5-HTP and even vitamin B6 (given that it is crucial for the conversion of tryptophan away from quinolinic acid) in this section of the book. Using tryptophan as a supplement is only briefly mentioned and 50-100mg 5-HTP is only recommended for serotonin-related cravings. As you may know from my work using targeted trials of the amino acid tryptophan and/or 5-HTP offers very quick anxiety relief and  support for PMS within 3 cycles. Fortunately, you can fill in the gaps and use what I teach about these amino acids in conjunction with everything else in the book.

I do love that she adds to our knowledge base with other tips, sharing that the botanicals “passionflower and skullcap support healthy serotonin production by reducing quinolinic acid production.” This was new to me and I’m intrigued.

I love what she writes about progesterone inducing “a sense of calm and a deep sense of love and connection by stimulating gamma-aminobutyric acid (GABA) receptors.”  Theanine and taurine (a precursor of GABA) are recommended and taurine is also part of her detox and adrenal protocols which I love.

However, I use GABA itself extensively in my work and find it to be more effective than theanine or taurine for the anxiety symptoms – it’s a firm favorite for the majority of my anxious clients. Again, you can fill in the gaps and check out what I share about GABA for very quick anxiety relief and PMS support.

 

My other favorite sections: libido and orgasms, and liver detox

Some of my other favorite sections include the libido section and her wonderful information about orgasms – she shares the myriad of health benefits of orgasms and recommends once-weekly orgasms but need I say more than this comment from Dr. Jolene:

Women can have four different types of orgasm throughout the month because of the hormonal changes we experience. Dude, this is a serious reason to consider ending that pill pack.

I couldn’t resist including this advice for anxiety and insomnia:

Trouble with anxiety? Have sex. Trouble with insomnia? Have sex. When you have an orgasm and release oxytocin, it relaxes you, calms your mind, and enables you to get a good night’s sleep. Besides oxytocin, your body releases vasopressin during orgasm, a hormone that often accompanies the release of melatonin.

If you do have low libido Dr. Jolene has this covered.

I also love the liver detox chapter and so will you. You’ll learn that the pill can cause benign liver tumors and can contribute to gallstones and gallbladder disease. She also shares this about the synthetic estrogen in birth control pills and the liver/libido connection:

There is some concern that long-term exposure to the synthetic estrogen in birth control pills actually alters your liver genes to make higher levels of SHBG (sex hormone binding globulin) for the rest of your life. Unfortunately, SHBG also binds up your testosterone. The result is a libido that’s nonexistent.

She also has you covered on how to detox as part of this wonderfully comprehensive hormone balancing program.

The official book blurb

Out of the 100 million women – almost 11 million in the United States alone – who are on the pill, roughly 60 percent take it for non-contraceptive reasons like painful periods, endometriosis, PCOS, and acne. While the birth control pill is widely prescribed as a quick-fix solution to a variety of women’s health conditions, taking it can also result in other more serious and dangerous health consequences.

Did you know that women on the pill are more likely to be prescribed an antidepressant? That they are at significantly increased risk for autoimmune disease, heart attack, thyroid and adrenal disorders, and even breast and cervical cancer? That the pill can even cause vaginal dryness, unexplained hair loss, flagging libido, extreme fatigue, and chronic infection.

As if women didn’t have enough to worry about, that little pill we’re taking to manage our symptoms is only making things worse.

This book is perfect for you if

  • You’re a woman in your child-bearing years and are currently on the pill, considering the pill, have been on the pill in the past and had issues, and even did well on the pill in the past
  • You’re a woman like me and past the birth control age and yet are intrigued to get a better understanding of how you may have been affected by the pill in the past and also want a better understanding of your body and hormonal health going forward
  • You have a daughter or grand-daughter or niece or friend you can gift a copy to
  • You are a practitioner who works with women
  • You are a curious male with women in your life and would like to understand them better so you can continue to have the healthiest relationship possible.

I’m already recommending this book and will continue to recommend it going forward!

This much-needed solution-based and heavily referenced book released January 29. It’s ground-breaking information and I’m thrilled to be sharing it with you!

Grab your copy of Beyond the Pill (my Amazon link) and find additional information here.

I now recognize that post–birth control syndrome (PBCS) was part the perfect storm that contributed to my anxiety and panic attacks in my late 30s (and a whole host of other symptoms). Personally, I found the entire book fascinating reading, and wish I’d had access to this material while I was in the midst of trying to figure things out.

Fortunately, GABA and tryptophan helped immensely with my anxiety and PMS (together with everything else I did) and I eventually discovered FAM (Fertility Awareness Method). But wish I’d know about this safer option when I was younger. Dr. Jolene is a big fan of FAM and covers it extensively in the book, sharing what I found to be true: it works even if it seems scary at first AND you get to learn so much about your body.

Please feel free to share your experiences with the birth control pill (both good and bad), why it was prescribed and what you learn from this book that can help others in your situation. Feel free to post questions here too.

How GABA eases agonizing rectal pain and spasms in under 2 minutes

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Proctalgia fugax is described as a condition that leads to rectal spasms and sharp fleeting pain in the lower rectum or anus. In some people it can be more than fleeting and is often described as excruciating and agonizing.  

This paper describing proctalgia fugax shares how this pain can

recur over weeks, is localized to the anus or lower rectum, and can last from seconds to several minutes with no pain between episodes. There is no diurnal variation. There are numerous precipitants [preceding factors] including sexual activity, stress, constipation, defecation and menstruation, although the condition can occur without a trigger.

Although the cause of proctalgia fugax is unclear, spasm of the anal sphincter is commonly implicated. The condition may be more likely to occur after sclerotherapy for hemorrhoids and vaginal hysterectomy. There are also associations with other functional pathologies, such as irritable bowel syndrome and anxiety.

My story

I have experienced this awful anal sphincter spasm and pain myself so I want to shine some light on this condition and offer the simplest and most effective solution: oral and sublingual GABA. It works to completely eliminate the pain in 1-2 minutes! And it can also be used to prevent a full-on spasm if you catch it in advance. More about this below.

Let me first share my story so you can relate to the pain. I started to experience this a few years ago. It was right after my aunt died from rectal cancer and my immediate thought was that I was dying of cancer. That’s how bad the pain was. It’s like nothing I’ve ever experienced and I’ve had some pretty bad pain experiences: shingles, a tick bite headache, ice-pick headaches from a neck injury and poking my eye on a tree-branch while hiking.

For me, since it initially used to happen during the night, it felt like I was in bad dream and was lying somewhere injured and in agony. I would half wake-up moaning in pain, not quite grasping how the pain I was feeling could be so bad. Then I would come fully awake and feel the need to bear down (as in needing to have a bowel movement) but this would actually make it worse.

How do others describe the pain?

When I shared this paper on facebook one woman said her rectal pain and spasms last 20-30 minutes and is bad a childbirth.

Someone else shared that her husband “complained of feeling like a knitting needle was being driven through his anus.”

What do I think my triggers are?

I have not had sclerotherapy for hemorrhoids or a vaginal hysterectomy. I do have a history of anxiety and panic attacks (in my late 30s) and do have IBS/SIBO right now and I suspect that both low GABA and IBS/SIBO are my biggest root causes. I no longer have any anxiety but since I respond so well to GABA I assume my GABA levels are not optimal (likely due to the SIBO). I suspect exposure to hidden sources of gluten could also be a factor, and this could also affect my GABA levels.

Medications or heating pads as a solution?

I didn’t ever consider the conventional approaches which include: botox, benzodiazepines, SSRIs, Gabapentin, lidocaine, oral diltiazem, topical glyceryl nitrate, nerve blocks or salbutamol.

A warm bath has been reported to help but I was looking for a 1-2 minute fix (and less if possible). Once you’ve experienced this pain you’ll understand that you not imagine running a bath in the midst of a spasm and waiting to get in it.

Heating pads do also work but can take 20 minutes to take effect and that is simply too long for most people.

The first solution for in-the-moment relief (takes 2 to 12 minutes)

After the first episode I started searching online and because I didn’t know it was called proctalgia fugax I searched for “rectal cramp”, “rectal spasm”, “anal cramp” and came across forums with hundreds of women asking about it and describing their pain.

But no-one really had a solution and many had seen their doctors without much success. The best solution that many people use is 30-60 seconds of finger pressure (with the finger wrapped in toilet paper) in the anal sphincter during a spasm. Sometimes this is needed for up to 2-3 mins and sometimes doing this 2 or 3 times a few minutes apart is needed. Think about how you put pressure on a calf muscle spasm to stop the cramps. This works well but the agony can last for the entire 2 to 12 minutes (depending on how many times it has to be done).  Adding a small amount of arnica cream onto the toilet paper seems to helps too.  

How common is it?

It took more searching and reading and then I discovered what it was called. Once I found a name for it and started looking into I was surprised to see how common it is:

The prevalence of proctalgia fugax in the general population may be as high as 8%–18%. Many patients present to primary health care physicians and often do not require further consultation because the symptoms are fleeting. This condition is more common among women than among men, and usually affects patients between 30 and 60 years of age.

Although it’s more common among women I worked with a male client who experienced this. During one of his episodes, the pain was SO bad he actually passed out and hit his head on the bathroom floor.

The best solution for almost-immediate relief (takes 1 minute)

I know that GABA works amazing well for physical anxiety and stiff and tense muscles and I decided to try GABA in the midst of a spasm. It worked amazingly well and within 1 minute the terrible pain started to ease. It does need to be taken sublingually and I have found that 250mg to 500mg opened onto my tongue works best for me.

Each person would need to find the ideal amount for their needs but at night this should be a reasonable amount. During the day this could be too much and make you sleepy or too relaxed.

I’ve also used a combination of sublingual GABA and theanine with similar results.

I know GABA isn’t readily available everywhere so I did an experiment with taurine and found I needed more (at least 1000 mg) and it did take longer (2-3 minutes) to get relief, but it did work.

THE immediate solution for preventing the spasm

But I have now gotten to the point where I can nip it in the bud and prevent the spasm altogether – by taking sublingual GABA at the very first hint of an ache or twinge. I’ve been fortunate that when this does happen (about once a month and sometimes every 2 months) it’s around 8-11pm.

The long-term solutions for getting to the root cause/s?

We always want to get to the root cause of an issue and that is the next step. I reached out to the practitioners in my community to ask them how they help their clients and patients with this and what approaches they have used to end the spasm and pain. I will be sharing some of their solutions and how to get to some of the root causes in part 2.

UPDATE: Here is part 2 – How to address rectal spasms with GABA, pelvic floor work, gluten removal and squats

I’d love your feedback!

I’d love your feedback so I can learn what works, so we can all learn from each other and so others get answers quicker than I did.

Have you ever experienced this rectal pain and spasms? And what has worked for you?

I’d love to know if it is more common after sclerotherapy for hemorrhoids and vaginal hysterectomy? Have you had either? Or any surgery in the abdominal area?

Do you also have IBS/SIBO?  What about celiac disease or gluten sensitivity?

Do you currently have anxiety or mood issues or have a history of anxiety or mood issues?  How many low GABA and low serotonin symptoms do you have – here is the questionnaire  (a paper from 1965 mentions that patients with proctalgia fugax have been described as irritable, perfectionistic, meticulous, obsessional, tense, and anxious)

If you’ve tried GABA or these other approaches (or decide to try them) please come back and share.  Too many people don’t know about this and it needs to change!

Menopause: insulin, cortisol, and oxytocin (an interview with Dr. Anna Cabeca)

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What should a healthy menopause look like and what does an unhealthy hormonal imbalance leads? And what is the significance of insulin, cortisol, and oxytocin?

Dr. Brian Mowll, host of the upcoming Diabetes Summit, interviews Dr. Anna Cabeca on the topic of menopause and metabolic health. Dr. Anna is a board certified gynecologist and obstetrician as well as board certified in anti-aging and regenerative medicine. She is an expert in functional medicine and an expert in women’s health.

She starts with an overview of what menopause should look like and what an unhealthy hormonal imbalance leads to:

Hormonally, what does menopause look like? Yes, we’re going to age. And we’re going to have wrinkles and laugh lines and smile lines and things like that. But that’s awesome. We should be waking up rested, going to sleep on schedule without difficulty and have the sense of peace within us that we’ve become able to enjoy the life that we’ve worked so hard to create and also be able to educate, inspire, and instruct those around us and the generations that follow us. So those are the ideals in menopause.

However, with our environment and toxicities and unhealthy aging and unhealthy hormonal imbalance, what happens is we tend to get overweight, difficulty with weight loss. We tend to have increases in our blood sugar, increases of heart disease. What that feels like, too, is hot flashes, mood swings, itchy skin, night sweats and irritability. The monster within us can come out!

The next part of their discussion is fascinating and rather unexpected. Dr. Brian asks Dr. Anna about the main hormonal players in menopause and this is what she shares:  

As a gynecologist, you would think the major players would be estrogen, progesterone, and even testosterone. However, the major players when it comes to a healthy menopause are insulin, cortisol, and oxytocin. I run menopause programs specifically to get these major hormones in balance. And then we can fine tune the minor hormones.

But unless we’re getting the concepts that relate to increasing our body’s ability to have insulin sensitivity and, regarding cortisol, to have reset our cortisol, our natural circadian rhythm, we’re not going to get hormonal balance at all. And we’ll continue to struggle with the inflammation, the weight gain, the mood swings, [the anxiety and insomnia], the night sweats….  

Actually, insulin and cortisol have a bigger role than estrogen, progesterone, and testosterone although those are important and DHEA as well which I will replace very frequently. But insulin and cortisol are key to healthy menopause.  

And so cortisol is our natural anti-inflammatory. But also, we know that when we excrete high spikes of cortisol, that’s going to affect glucose production. So whether cortisol is too high or too low, we’re going to have an issue with glucose production and metabolism and increasing hemoglobin A1c and inflammation. So from both those areas, we’re going affect our inflammatory pathways.

Dr. Anna also covers some of the following in the interview:

  • Issues she sees with ketogenic diets and eating low carbohydrate diets (this one is for women in particular – she feels it throws off our neurotransmitters)
  • Why to test for pH and how to do it
  • Simple ways to boost oxytocin
  • Nutritional support for the adrenals

As I mentioned above, these are a few snippets from the upcoming Diabetes Summit.

In case you’re thinking “I don’t have diabetes, I don’t need to tune in to this one”, or “I’m not menopausal” or “I’m a guy” here are few points to consider:

  • If you’re a woman and experience stress this would be applicable whether or not you have diabetes or are in menopause (addressing this could help prevent diabetes and make menopause a breeze)
  • If you’re a man and experience stress this topic is also relevant, whether or not you have diabetes – just remove the words “menopause” and “women” and focus on the information about insulin, cortisol and oxytocin

So do consider tuning in to this one and other interviews in the summit!

If you do have diabetes or pre-diabetes then tuning in to the summit is a must! According to a 2015 study, nearly half the US population had diabetes or pre-diabetes.  Add to that all the Americans who are overweight, obese, or have insulin resistance and other blood sugar imbalances, that number likely climbs above 75%! Unfortunately it’s not just in the US.  Diabetes has become a global epidemic, predicted to get much worse in the next 20 years.

Clearly we need to do something different.  Change often starts with information and inspiration.  Learning the root causes of the problem and real solutions to correct those causes can motivate action.

That’s why I’m excited about this upcoming online Diabetes Summit.  My friend and diabetes expert, Dr. Brian Mowll, is hosting this life-changing event for the fourth year, and this year’s event looks amazing.

I’m really pleased to be a speaker on this summit too. I cover the anxiety diabetes connection and how GABA helps reduce anxiety and how research shows it’s a promising treatment for diabetes. Read more here.

You can register for this online event here.

 

Vulvodynia: oxalates, GABA, tryptophan and physical therapy

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On a recent webinar with Julie Matthews, I shared how healthy foods that are high in oxalates caused me excruciating foot pain: Oxalates and leaky gut for Anxiety.

We also mentioned how oxalates can be a factor in vulvodynia and someone asked this question on the blog:

I just listened to the webinar talking about oxalates. I was shocked and delighted to hear the mention of the connection between high oxalates and vulvodynia. My friend has suffered with this for 18 months with little improvement. She has painful feet so I am wondering if there is indeed a connection for her situation. Could you please explain a bit more of the vulvodynia/ oxalates connection? I would like to give my friend the information.

Before I share the resources I offered her for her friend, let me share this about vulvodynia:

Vulvodynia is defined as chronic vulvar burning, stinging, rawness, soreness or pain in the absence of objective clinical or laboratory findings to explain these symptoms. Vulvodynia is a chronic pain syndrome affecting up to 18% of the female population and is generally regarded as an underdiagnosed difficult to treat gynecological disorder.

There is still much we have to learn about vulvodynia and the causes are multifactorial:

The etiology [cause] of vulvodynia is still enigmatic and is probably multifactorial-including physiological concerns (eg, pelvic floor muscle dysfunction, neuropathic pain, and psychosocial) and sexual issues (eg, anxiety and sexual dysfunction). Although it is a common syndrome, most patients are neither correctly diagnosed nor treated. A diagnosis of vulvodynia is based upon patient history and lack of physical findings upon careful examination. No clinical or histological findings are present to aid in diagnosis. Most treatment options for vulvodynia are neither well studied nor have an evidence base, relying instead upon expert opinion, care provider experience, and use of data from other pain syndromes. However, many patients show marked improvement after physical therapy for the pelvic floor, medications for neuropathic pain, and psychosexual therapy.

You’ll notice that oxalates and other dietary approaches are not mentioned. There are actually 2 studies that state there is NO connection between dietary oxlalates and vulvodynia. This is the first one: Influence of dietary oxalates on the risk of adult-onset vulvodynia. The second paper: Urinary oxalate excretion and its role in vulvar pain syndrome concludes that:

Urinary oxalates may be nonspecific irritants that aggravate vulvodynia; however, the role of oxalates as instigators is doubtful.

In this paper: Vulvar vestibulitis-a complex clinical entity, a low oxalate diet and calcium citrate did help:

Successful outcomes were achieved in 14.3% of patients using a low oxalate diet and calcium citrate supplementation

The Vulval Pain Society is a wealth of information on vulvodynvia and they have this information on the low oxalate diet, saying it helps many women and it worth trying:

A diet low in oxalate salts has been suggested as a treatment for women who experience unexplained vulval pain or vulvodynia… it is widely used in the United States as a treatment for vulvodynia. The diet may be supplemented with the use of oral calcium citrate.

There are few doctors in the UK who are aware of or routinely use this treatment. Many specialist doctors who run vulval clinics in this country [the UK] are skeptical about the treatment, as much of the evidence has not been published in the medical literature and the treatment is not of proven value. A diet low in oxalate with or without calcium citrate may, however, benefit some women with vulval pain and this is certainly an option for some women to try.

The vulvar pain is often described as a “burning” or “cutting” or “sharp” kind of pain. You’ll see medications recommended for the neuropathic pain in many of the studies and on the Vulval Pain society site.

It does concern me that so many women are prescribed SSRIs and medications like gabapentin and benzodiazepines when there are the safer and more effective options of the amino acids such as tryptophan and GABA.   When dosed correctly these individual amino acids help with some of the pain and anxiety right away while other root causes are addressed. 

For my clients, I recommend targeted individual amino acids instead of the medications. I recommend a trial of tryptophan instead of an antidepressant, assuming they score low on the serotonin section of the amino acid questionnaire.

Research shows there is serotonin involvement with vulvodynia. In this study of women with PVD (provoked vestibulodynia i.e. pain in the entrance of the vagina, common with vulvodynia):

Polymorphism in the serotonin receptor gene, 5HT-2A, has been associated with other chronic pain disorders such as fibromyalgia…. The results [of this study] indicate a contribution of alterations in the serotonergic system to the patho-genesis of PVD and gives further evidence of PVD being a general pain disorder similar to other chronic pain disorders.

I also recommend a trial of GABA instead of gabapentin or one of the benzodiazepines, assuming they score low on the GABA section of the amino acid questionnaire.

Tryptophan and GABA can help with both the pain, and the anxiety and depression that is commonly seen with vulvodynia and other pelvic floor conditions – right away while other root causes are addressed.

Since acupuncture is often reported to be helpful, I also consider a trial of DPA for endorphin boosting and hence some pain reduction too.

Physical therapy is often extremely beneficial and frequently overlooked, so finding a good pelvic floor PT to be part of your healing team is key too.

When responding to the blog question I commented that “your friend is fortunate to have you looking out for her”. Using some or all of the above approaches I would expect her to find some relief of the vulva pain, the foot pain and experience reduced anxiety and depression (assuming these are her root causes).

Please note that this is not an exhaustive list of contributing factors for vulvoldynia – other factors could include candida, infections such as HPV, IBS/SIBO, and trauma and sexual abuse. My colleague, Jessica Drummond, nutritionist and physical therapist, and an expert on female pelvic pain, writes about immunity, dysbiosis, gluten and other food sensitivities, cortisol and sex hormone imbalances in this article: Vulvovaginal Pain and The Immune System: Practical Steps for Vulvovaginal Pain Relief. A full functional workup is required and your root cause can be different from someone else’s root cause.

I’d also like to add that although dietary oxalates cause excruciating pain in my feet, I’m so fortunate, in that I do not have vulvodynia.

Have you had success with a low oxalate diet and calcium citrate for vulvodynia? And other pain (in the feet or hips or elsewhere in the body)?

Has physical therapy with a pelvic floor specialist helped?

Have you found tryptophan, GABA or DPA to help with the pain and the anxiety and/or depression too?

Have any other treatments helped you?

If you’re a practitioner what approaches have helped your clients/patients?

Please share questions or feedback below.