Women's health

Paroxysmal laryngospasm with low GABA physical-tension-type-anxiety: Is GABA powder rubbed on the inside of the cheek a solution?

March 4, 2022 By Trudy Scott 42 Comments

One type of reactive airway obstruction is paroxysmal laryngospasm, which is a rare laryngeal disease in adults. In this condition, the throat is completely closed due to some form of hypersensitivity or a protective laryngeal reflex causing a transient, complete inability to breathe. Paroxysmal laryngospasm onset in patients is often characterized by a sudden and complete inability to breathe, along with voice loss or hoarseness and stridor. Paroxysmal laryngospasm usually lasts from several seconds to several minutes and may be accompanied by obvious causes such as upper respiratory tract infection, emotional agitation or tension, and/or severe coughing.

I shared something similar on Facebook and the fact that this had just happened to me when drinking lemon water and starting to talk too quickly after my last sip. I choked on the lemon water and my vocal cords went into a spasm. I could not breathe and I had a violent coughing fit. It was a terrifying experience! A few dabs of GABA powder inside my cheek helped relax my vocal cords – which are muscles – immediately. I could breathe right away.

I’ve been researching this condition for some time now because I figured out this same solution for a family member who has had this happen about 6 times in the last few years.

The response on Facebook was surprisingly high and I now wonder how common this condition is with those who experience low GABA physical-tension-type-anxiety and if oral GABA powder is a viable solution for more individuals.

The 2020 paper on paroxysmal laryngospasm

The above description comes from this 2020 paper – Paroxysmal Laryngospasm: A Rare Condition That Respiratory Physicians Must Distinguish from Other Diseases with a Chief Complaint of Dyspnea

Let’s review a few terms from the paper:

According to Merriam-Webster, a paroxysm is a fit or attack.
Laryngospasm “(luh-RING-go-spaz-um) is a transient and reversible spasm of the vocal cords that temporarily makes it difficult to speak or breathe”, according to Mayo Clinic
Mayo Clinic describes dyspnea as follows: “Shortness of breath – known medically as dyspnea – is often described as an intense tightening in the chest, air hunger, difficulty breathing, breathlessness or a feeling of suffocation.”
According to Medscape, stridor is “an abnormal high-pitched sound produced by turbulent airflow through a partially obstructed airway.”) It’s particularly distressing to hear.

So essentially the title of this paper could be translated to something like this: An attack of temporary spasms of the vocal cord that causes difficulty breathing (0ften with a distressing sound of suffocating). I would go as far to say: A terrifying attack ….

One of the objectives of the paper is to create more awareness on “how to identify and address paroxysmal laryngospasm from the perspective of respiratory physicians.” The authors share that otolaryngologists (head and neck surgeons) and anesthesiologists (it happens frequently when undergoing anesthesia) are experts in managing paroxysmal laryngospasm.

They also state it’s rare and generally happens when an individual has gastroesophageal reflux disease (GERD), and share how antireflux therapy i.e. PPIs (proton pump inhibitors) are frequently an effective treatment. My input on this: if it is caused by GERD, address why the GERD is happening and avoid PPIs if possible since they contribute to nutritional deficiencies and osteoporosis.

Hysterical stridor in adult females who are anxious and/or depressed

There is no mention of GABA or addressing spasms in the vocal cords and other muscles in this paper. However, the authors do discuss hysterical stridor as being different from paroxysmal laryngospasm, stating “it has a strong demographic pattern of occurring in young adult females, lasting for minutes to hours, frequently requiring sedation or anxiolytics for treatment, and persisting for years.”

They also share this about hysterical stridor:

Psychological assessment usually reveals multiple sources of life stress, compulsive personality traits, depression, anxiety, maladjustment, or a history of psychosomatic comorbidity. Other psychotherapy interventions, such as antianxiety therapy, depression therapy, sedation therapy, speech therapy, and behavioral therapy, are usually effective.

(note: I’m not thrilled by the term hysterical stridor. The diagnosis of hysteria goes back to the 1880s.)

I’m proposing oral GABA powder be researched as another viable option to address the low GABA anxiety symptoms, the hysterical stridor and the paroxysmal laryngospasm.

Is paroxysmal laryngospasm/hysterical stridor really that rare?

I do wonder if these conditions are really that rare. When I shared my experience on Facebook I had a reasonably big response from people saying it’s happened to them a few times, with some saying it has been happening all their lives. Here are a few of the many examples:

Anita shared this: “I have experienced laryngospasm. The experience is a spasmodic tightening of the airway triggered by ‘swallowing wrong’ for me. I have never experienced laryngospasm aside from that. I do have low GABA symptoms of physical tension and have had intrusive thoughts in the past, stress eating, but have never used ‘wine to relax’ as I am a ‘teetotaler.’ The episodes I’ve experienced have always resolved on their own within a minute or so. Scary feeling – that is for sure! I plan to keep GABA powder on hand now just in case of a future episode.”
Megan shared this: “I have Laryngospasm. I have total throat closure. It feels like forever but I suppose it’s up to 50 seconds. I’ve had it since I was a child and my mum has it too. Food is probably my main trigger, crumbly or syrup type things, a bad cold or even just swallowing wrong. I had a look at the list and I have quite a lot of the low GABA symptoms. I have generalized anxiety, feeling worried/fearful, panic attacks (but they are under control with Zoloft), tense stiff muscles, feeling stressed and burnt out, intrusive and unwanted thoughts and acrophobia.”

One woman felt she had experienced paroxysmal laryngospasm and she had been told it was a panic attack. A few people mentioned a similar condition called vocal cord disorder (often exercised- induced). Many said they had received no diagnosis or help from their doctor.

Interestingly, there are not many papers on “paroxysmal laryngospasm” or “hysterical stridor” so the research and presumably awareness too, seems to be lacking.

Why did I consider GABA for paroxysmal laryngospasm?

You may wonder why I considered GABA when this happened to me. I’ve personally used GABA with success over the years for spasms in my back muscles, rectal muscle spasms/proctalgia fugax, and vagus nerve and coughing/throat spasm episodes. With the additional knowledge I’ve now gained I suspect the latter was a form of laryngospasm.

I’ve also shared how GABA helps ease globus pharyngeus (a lump-in-the-throat sensation that is associated with anxiety and something I experienced in my late 30s).

I’m prone to low GABA physical-tension-type anxiety and have always done really well with oral sublingual GABA.

And of course, when you look at the low GABA symptoms all this makes perfect sense. GABA helps with muscle spasms and provides pain relief when muscles are tight. The vocal cords are muscles and the larynx itself contains many muscles.

In case you’re new to GABA, it is a calming amino acid, used as a supplement, to ease low GABA levels. With low GABA you’ll experience physical-tension and stiff-and-tense-muscles type of anxiety, panic attacks and insomnia. You may feel the need to self-medicate to calm down, often with alcohol but sometimes with carbs and sugary foods.

What GABA did I use and how did I use it?

I dumped some GABA powder on the palm of my hand (with the help of a family member who rushed to my aid). I wet my finger with saliva, dabbed it in the GABA powder and rubbed it on the inside of my cheek. I did this a few times.

I don’t know exactly how much I used in total but estimate it to be around 200 mg GABA. I stopped rubbing it on the inside of my cheek as soon as I felt the muscles relaxing and I was able to breathe easily again. It felt like forever but it probably only lasted 30-60 seconds. I’d assume a more intense paroxysmal laryngospasm may require more GABA.

It was really encouraging how quickly GABA relaxed the muscles and stopped the laryngospasm. It’s also taken away the fear about it happening again.

Resources if you are new to using GABA as a supplement

If you are new to using the the amino acid GABA as a supplement, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see the low GABA and other low neurotransmitter symptoms)

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

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

If you don’t feel comfortable reading my book, doing the low GABA symptoms questionnaire and doing trials of GABA on your own, you can get guidance from me in the GABA Quickstart Program.

If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. It’s an opportunity to interact with me and other practitioners who are also using the amino acids.

Have you experienced paroxysmal laryngospasm? And do you have the low GABA physical-tension-type-anxiety symptoms? What else is a trigger for you?

If you’ve already been using GABA with success, have you noticed a reduction in the paroxysmal laryngospasm episodes?

Have you ever used GABA in the way I did to stop an episode quickly?

Have you received a diagnosis and if yes, what diagnosis?

If you’re a practitioner please share what you have seen?

Feel free to ask your questions here too.

Around my period I definitely feel the need for extra tryptophan if I’ve had some extra heavy emotional stuff come up that I need to process

December 10, 2021 By Trudy Scott 6 Comments

Many women find that they need additional nutritional support i.e. tryptophan for serotonin support (and often GABA too) around their periods. Today’s case study highlights the hormonal shifts that may lead to a situation where it appears tryptophan doesn’t work, then it does work, and then sometimes it doesn’t work as expected. The variable results and the need to switch between lower and higher doses on an ongoing basis can occur with PMS (premenstrual syndrome) PMDD (premenstrual dysphoric disorder, a severe, sometimes disabling extension of premenstrual syndrome). The variable results can also be more pronounced while recovering from trauma.

This case study is a follow-on from a blog I recently published: Tryptophan doesn’t work, then it does and then it doesn’t: could it be hormonal shifts, dietary factors and/or parasites?

Here is Kimberley’s feedback on the Facebook post that discussed these variable results. She shared how her hormonal shifts led to a need for additional tryptophan and 5-HTP:

Around my period I definitely feel the need for extra tryptophan. My PMDD symptoms have decreased since I started using tryptophan/5-HTP, but sometimes I need a bit more if I’ve had some extra heavy emotional stuff come up that I need to process (since that always happens with my period!).

I thanked her for sharing and said how happy I was for her. I also asked what symptoms have decreased and how much? I also asked how much tryptophan and 5-HTP she uses before her period and then around her period?

I was also curious if she just experimented with different doses until she figured it out or had she heard me talk about the PMDD tryptophan study: A placebo-controlled clinical trial of L-tryptophan in premenstrual dysphoria. In this study tryptophan was found to reduce symptoms of PMS when used in the luteal phase or second half of the cycle (i.e. after ovulation).

Her low serotonin symptoms have decreased as much as 75-80 percent

Kimberley confirmed that she had read the above study and related blog post – Tryptophan for PMS: premenstrual dysphoria, mood swings, tension, and irritability – and more about her symptoms:

I had read the blog you referenced, which is one of the reasons I tried tryptophan in the first place.

I was experiencing a lot of emotional distress, feelings of downright despair that left me miserable both during my period and ovulation (half the month, every month, which was truly awful). Those have definitely decreased, sometimes as much as 75-80 percent, other times they’re worse and I feel like I need more support.

I usually take 1x Lidtke 5-HTP (50mg) mid-afternoon and 1x Lidtke Tryptophan (500mg) at bedtime, but yesterday I increased to 2x Lidtke Tryptophan and do feel an improvement in my mood this morning.

I experimented to get the right dose of both amino acids, initially increasing to the maximum you recommend, and then slowly decreasing to what I’m taking now when I found I didn’t feel well when I took too much.

I just reread the blog you linked above and realized I should be using GABA every day to support progesterone (instead of just as needed for anxiety). Thanks for the reminder!

I love that after reading the blog she was inspired and motivated to experiment with different doses when she is/was feeling so bad. I encouraged her to continue trialing different doses at various times of the month especially in the second half of the month. I also reminded her that some folks do better with tryptophan and some do better with 5-HTP when it comes to low serotonin symptoms. And to continue to look at why serotonin is low and address that. Low GABA (related to low progesterone) can cause increased anxiety at this time and is a common issue with PMS/PMDD.

(You can see the entire list of low serotonin and low GABA symptoms here.)

She plans to continue experimenting with tryptophan and 5-HTP and may also try switching over to just 5-HTP and see if that changes anything. It’s unlikely that she would benefit from much higher doses of either as she shared “I don’t seem to be able to take more than 2 caps of either one without getting uncomfortable symptoms, though.”

Exercise and yoga for her low serotonin and PMDD

She did share how much exercise helps her mood, why she isn’t able to exercise as much:

The biggest thing I know to do to address low serotonin is add more exercise into my life, but this has been hard lately because I’ve had a couple of different viruses recently that left my exercise intolerance worse than it had been. I’m trying to support my mitochondria right now and add light exercise back in slowly.

Exercise is a wonderful way to raise serotonin levels and aerobic exercise has been shown to reduce the symptoms of PMS too. Yoga may be an option while she is recovering. In one study, yoga was found to be beneficial for PMS: “Alpha-brain waves production due to regular yoga practice are directly related with state of peace, creativity, mood elevation, relaxation, and release of serotonin, thus leading yoga practitioners feel more relaxed.”

Trauma: cortisol, serotonin, dopamine and estradiol

Kimberley also shared how how trauma plays into her situation:

I think some of the reasons for my health issues, low neurotransmitters, etc., are trauma related and I’ve been working through Dr. Aimie Apigian’s programs for that. But that’s another story.

I respect Dr. Aimie Apigian’s work in trauma and somatic experiencing and acknowledge this aspect must be addressed too. I love that Dr. Aimie brings this together with a functional medicine approach, looking at biology/biochemistry too. Recent trauma research confirms that there are major biochemical mechanisms involved in PTSD (post-traumatic stress disorder). These can include impacts to cortisol, serotonin and dopamine levels. And women are more vulnerable to these effects.

A 2021 paper, Estradiol, stress reactivity, and daily affective experiences in trauma-exposed women discusses high cortisol and more severe symptoms around their periods when estradiol (one of the estrogens) is low. As I mentioned above, estrogen and serotonin are closely related. The authors state this:“For women who are cycling, it may be useful to understand how the menstrual cycle affects their symptoms. When you can explain what’s happening biologically, it often becomes less threatening.”

Yoga may provide added psychological benefits as she works through her past trauma too.

Kimberly gave me permission to share her story and this is always something I appreciate so others in my community can learn from these types of experiences. If needed, I hope this her story gives you confidence to experiment with different doses and combinations around your period.

She also benefits from the comments from others on Facebook and the comments here on the blog, our back and forth, and this blog post.

She promised to keep me posted on how she goes and I’ll be sure to share when I hear back from her.

Resources if you are new to using tryptophan, 5-HTP and GABA and the amino acids as supplements

If you are new to using the amino acids as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see the low GABA symptoms here) and a brief overview here, Anxiety and targeted individual amino acid supplements: a summary.

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

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

Have you found you need additional tryptophan/5-HTP or GABA around your period? How have you experimented and how does it help you?

If you’re a practitioner, have you seen this with clients or patients?

Do you also feel better with exercise and/or yoga?

And are/were your variable results more pronounced while recovering from trauma?

Feel free to ask your questions here too.

Pesticide warehouse fire and spill: environmental effects, detoxification and long-term impacts for anxiety and physical health

August 13, 2021 By Trudy Scott 6 Comments

pasticide warehouse and fire spill — The toxic green river/lagoon with poisoned/dead fish piling up (Credit: Drone Fundi)

One month ago, during the political riots in South Africa, a warehouse in Cornubia was burned down causing a slew of pesticides, insecticides and fungicides to be spilled into the nearby river and ocean, and burned into the atmosphere. This happened in a semi-industrial area bordering on residential areas such as Umhlanga Rocks and Sunningdale, and the informal settlement Blackburn. My sister and her family live in Umhlanga Rocks and we frantically communicated (during the riots and after the spill), trying to figure out what was going on, with me offering insights on how to help them mitigate some of the short-term toxic health effects. These included practical steps to avoid the toxic air and water, and some nutritional approaches to start supporting detoxification.

While this blog is specific to the situation in South Africa, something like this could happen near you one day. For this reason, I’m sharing what I have learned and what I already know about environmental toxins so you are aware of the short-term and long-term impacts for anxiety, mood and physical health.

Much of the nutritional support and detoxification recommendations are also applicable if you are dealing with smoke from forest fires too, like much of the western states of the US and Canada right now, and some countries like France and Greece in the EU.

The South African civil unrest and riots that led to the pesticide fire and spill

This article describes the civil unrest and explains how “South Africa suffered an insurrection attempt with two provinces, KwaZulu-Natal and Gauteng disabled, and national fuel and food supply lines disrupted.” It is thought that twelve masterminds planned and executed it on social media and then lost control after the looting started.

The pesticide warehouse in Cornubia, KwaZulu-Natal, was leased by United Phosphorus Limited (UPL) and was burned down as a direct result of this rioting and looting.

Queen Nandi Drive Durban — One of hundreds of burning buildings: Queen Nandi Drive, Durban (Credit: Kierran Allen Photography)

The Cornubia warehouse was one of many hundreds of factories, stores and warehouses that were burned down, all contributing to a toxic soup in the atmosphere.

Wildlife photographer, Kierran Allen, captures the above scene and many other shocking images. Check them out on his Facebook page and here.

The pesticide warehouse fire and spill

The UPL product list is long and includes 124 herbicides, 43 fungicides, 52 insecticides and various other chemicals. I looked through some of the categories and found atrazine, paraquat, glyphosate, chlorpyrifos and many more.

As of today, 30 days after the initial fire, the company has not disclosed which products were part of the fire and spill (more on this below).

As a result of the warehouse fire and spill, the Ohlanga river and Umhlanga lagoon turned a strange green-blue and thousands and thousands of fish were killed. The beaches and sea water became toxic too. Koi fish in a nearby neighborhood pond died. Surfers reported burning skin while surfing at Umdloti, 12 km north of the lagoon mouth.

Individuals in the community reported headaches, burning skin and eyes, asthma, nose and throat problems, and coughing. I also saw a report of “oily black goop floating on my pool surface” and getting on the paws of their cats and dogs.

Drone Fundi published an excellent 3-minute aerial video on their Facebook page and gave me permission to snag a screenshot of the dead fish image for this blog.

umhlanga river — The toxic green-blue river/lagoon with poisoned/dead fish piling up (Credit: Drone Fundi)

Excellent coverage by environmental journalist, Tony Carnie

Environmental journalist, Tony Carnie, has provided the most comprehensive coverage in a number of excellent articles on The Daily Maverick blog:

On July 20th, 2021: New health warnings issued in Durban over toxic fumes stemming from chemical blaze

The Indian multinational pesticide company United Phosphorus Limited has belatedly advised people to double down on health and safety precautions in the wake of the arson attack and massive fire at a chemicals warehouse at Cornubia, north of Durban.

On August 12, 2021: ‘Lift the cloud of secrecy over Durban toxic chemicals explosion,’ MPs and community leaders demand

It has been exactly a month since a massive cloud of toxic chemical fumes engulfed residential areas over large parts of Durban for 12 days – but government officials and the Indian-owned UPL agrochemicals giant are still refusing to release a full inventory of the quantity and type of poisons to the public.

Red flags about the fire and spill that concern me

As I read the media articles, the company press releases and reached out to the company, a number of concerning red flags started showing up:

UPL hired a risk management company to do the press releases and respond to enquiries. I did correspond with them and although very responsive they didn’t initially provide details of what pesticides were involved and then offered a partial list
The first press release on July 17, 2021 mentioned a warehouse storing “plant protection products.” I had never heard this term before and had to look it up – they are pesticides and other chemicals like insecticides and fungicides. It took a good few days for this to make it into media reports
UPL consulted with Dr. Gerhard Verdoorn and shared this in a press releases on July 19, 2021:

He was provided with a list of the crop solution products stored in the warehouse, and was requested to provide guidance on the possible health implications posed by the release of these products into the environment.

In his view, there is a minimal risk of any long-term effects to the health of people exposed to smoke from the warehouse. However, exposure in the short term to some of the chemicals contained in the crop solution products may result in dermal, eye and respiratory irritation.

This does not mention that Dr. Verdoorn is an industry spokesperson and I have concerns that they continue to downplay the severity and possible long-term impacts.

This same press release did mention some of the chemicals that were in the fire:

Some of the herbicides, such as chloroacetamides (for example, acetochlor, S-metalochlor), phenoxycarboxylic acids (2,4-D, MCPA and benzoic acids, or dicamba) may not have burned out completely. Two pyrethroids – alpha-cypermethrin and lambda-cyhalothrin – which are dermal, eye and respiratory tract irritants may have been present in the smoke.

One of my first thoughts was why is this warehouse located so close to residential areas and why don’t they have safety measures in place
30 days later there is no disclosure of what pesticides and how much (The Daily Maverick blog reports this). One article mentioned they don’t want to provoke anxiety in the community by sharing the list. Not knowing causes anxiety and concerns.
30 days later there is no expert commentary on long term potential impacts (I share more on this below) and long term mitigation/cleanup and detoxification approaches for the community

After watching movies like Erin Brockovich, Dark Waters (the true story of Dupont and Teflon) and Rainmaker, red flags like this need to be documented. I’m more than happy to take all this back if and when things change.

I share all this for the residents of this area who are being impacted right now, and so you can get an idea of red flags to look out for if you encounter something like this in your neighborhood one day.

Update August 17th: The list of chemicals

According to this Daily Maverick article, Here it is: The toxic stockpile of chemicals in torched United Phosphorus Limited Durban warehouse

*More than 26 000 kilograms of Masta 900, an insecticide containing the “very potent neurotoxin” methomyl for which “contact with skin, inhalation of dust or spray, or swallowing may be fatal.”

*Another 1 800 litres of methamidophos, also a “very potent neurotoxin”.

*More than 40 000 litres of products using the herbicide paraquat which poses “high risk for all life forms”.

*Over 19 000 kilograms of Terbufos, another “very toxic” chemical presenting “high risk to all forms of life”.

*More than 600 000 kilograms of products containing tebuthiuron, a chemical classified as “very toxic to aquatic life … with long lasting effects” sold under a variety of brand names including Lava 800 and Limpopo SC.

*More than 160 000 kilograms of potassium hydroxide and 100 000 kilograms of ammonia hydroxide, both intermediate products used in manufacturing that are “extremely caustic” chemicals that burn skin on contact.

*More than 3 000 kilograms of Cyprex, a “highly active herbicide” containing halosulfuron-methyl, a product that “may damage the unborn child”, according to the European Chemicals Agency.

*More than 500 000 litres of Triclon, a product containing triclopyr butotyl and classified as “flammable, harmful and environmentally hazardous” and that “may cause lung damage if swallowed”.

*More than 30 000 litres of MSMA 720, also known as monosodium methylarsonate which has been shown to have “limited evidence of a carcinogenic effect”, and over time converts to inorganic arsenic in soil with the potential to contaminate water sources.

*More than 30 000 kilograms of oxamyl-based insecticides, including products Bandito and Oxadate, that also present “high risk for all life forms”.

*Almost 11 000 kilograms of Tenazole, containing “extremely flammable” fungicide terbuconazole.

*More than 1 000 litres of Colloso, a fungicide containing the active ingredient carbendazim which “may cause heritable genetic damage”, “may impair fertility”, and “may cause harm to unborn child”.

Practical solutions for short-term immediate exposure

As soon as I learned what had happened I started reading everything in the local media, contacted UPL, looked up the products they carry and immediately shared Dr. Elisa Song’s 2018 blog with my sister and friends: How to Detoxify When Air Pollution is High. Dr. Song published this resource for keeping children and families safe and healthy through the tragedy of the 2018 California fire season.

I knew her advice on “Optimizing Indoor Air Quality” would be perfect for the toxic pesticide situation too:

keep doors and windows closed at all times
have separate outdoor clothes and shoes
vacuum daily and use a HEPA filter
bring plants inside to help improve air quality
use your air conditioner as another way to clean the air and
diffuse essential oils.

My additions were as follows:

don’t hang clothes on the washing line
keep your pets inside and wipe them down after they go outside
ideally go somewhere away from the situation
definitely don’t go to the source to see what is happening as exposure will likely be much higher.

I also reached out to colleagues for specific information relating to a pesticide spill and certified Toxicity and Detox Specialist, Sinclair Kennally, very kindly did a write up specially for this situation. In her blog post, Environmental Toxin Exposure: what to do when disasters hit, she shares wonderful advice on:

daily best practices during the disaster
DIY strategies to reduce toxic exposure when supplies are scarce
herbs that can be used for first aid in a pinch
most important supplements for recovery afterwards
using activated charcoal or zeolite on laundry loads
making your own air filter pet care (using apple cider vinegar and bentonite clay/activated charcoal)
emergency essentials (especially water).

Detoxification solutions, and respiratory and immune health

Dr. Song’s detox advice on the same blog on “Supporting Respiratory and Immune Health” is very applicable for a pesticide spill such as this and for forest fires (and other environmental pollution): “Daily epsom salt baths to support detoxification and enhance magnesium and glutathione levels,” liposomal glutathione, extra magnesium and essential oils to support detoxification, immune and respiratory health. She mentions citrus and lavender essential oils which offer the added benefit of being calming and helping with sleep too (more on that below).

On Sinclair’s blog she empahsizes “Toxin excretion is the most crucial stage of any disaster” and she discusses sauna, binders, mobilizers and support for detox pathways in great detail.

The stores were all closed because of the looting so I gathered some additional resources in case folks didn’t have certain things on hand:

N-Acetyl Cysteine/NAC – improves glutathione levels, is a powerful antioxidant, “acts directly as a scavenger of free radicals” and is a mucolytic (clears mucus and relieves breathing difficulties)
Rooibos tea – is neuroprotective and it’s “cell-protective activity …is connected with the ability of reducing glycaemia, inflammation as well as oxidative stress.” It also eases anxiety and supports healthy cortisol levels
Apple cider vinegar (preferably organic with the mother) – “could be promising for attenuation of liver cell damages induced by several toxins through its powerful antioxidant properties” due to its major constituents of flavonoids and polyphenols.
Broccoli sprouts or extract – “the sulforaphane may be exerting its protective actions by activating a signaling molecule, NRF2, that elevates the capacity of cells to adapt to and survive a broad range of environmental toxins.” The authors go on to say it’s a “frugal, simple and safe means that can be taken by individuals to possibly reduce some of the long-term health risks associated with air pollution.” A simple way to get some of these benefits is to make your own homemade broccoli sprouts (easy and lots of fun to nurture them and watch them grow!) and to consume them daily!
Vitamin D3 – “vitamin D is a significant factor in detoxification and protection against environmental toxins” (used based on vitamin D levels i.e. always test first)

Sleep, stress/anxiety, pyroluria and immunity

Sinclair starts with a reminder to “be gentle and kind with yourself and others” and Dr. Song also mentions the importance of managing stress: “Psychological stress IS a toxin and fills up our inflammation bucket as much as any physical toxin.” Dr. Song recommends some wonderful kid’s books and breathing/meditation apps.

Of course, I wholeheartedly support their sage advice. I also recommend increasing tryptophan or 5-HTP, and GABA, as needed, if you are already using these amino acid supplements. You’ll increase tryptophan or 5-HTP for the worry-type low serotonin anxiety and/or GABA for the physical-tension low GABA anxiety.

Supporting serotonin and GABA levels also help with sleep issues and GABA also supports a good immune system.

We know these chemicals can have a direct impact on neurotransmitter levels. One example is the insecticide fipronil impacting GABA levels. In this blog I share how the main mechanism of action is by targeting the gamma-aminobutyric acid (GABA) receptor and that recent research points to increased anxiety, aggressive behavior, memory problems and even Alzheimer’s disease in animal studies.

Another example is the herbicide glyphosate, which affects gut microbiota, causing anxiety and depression-like behaviors in mice, very likely via alterations in GABA and serotonin levels.

I also recommend bumping up your pyroluria supplements because zinc and vitamin B6 are depleted by added stress and worry.

Potential long term impacts on mental and physical health

This paper, Environmental Exposures and Depression: Biological Mechanisms and Epidemiological Evidence shares that pesticides are “quickly absorbed through the skin, mucous membranes, gastrointestinal and respiratory tracts, and the placenta” and can cause depression via various mechanisms:

Inhibiting the enzyme acetylcholinesterase (AChE), which results in decreased degradation of the neurotransmitter acetylcholine
Interference with the serotonergic and dopaminergic systems

Depression may also be caused by DNA methylation in specific genes, “increased oxidative stress, astrocyte dysfunction, and impaired hippocampal neurotransmission.” Prenatal exposure also increases the risk of depression.

This chapter, Psychiatric Effects of Organic Chemical Exposure, from the book, Effects of Persistent and Bioactive Organic Pollutants on Human Health, states that:

Clinicians should remain aware that psychiatric symptoms can arise from toxic chemicals in diverse situations including terrorist attacks with chemical agents, mass chemical disasters in industrial or community settings, individual chemical accidents, and intentional solvent inhalation. Emerging evidence also indicates that prenatal exposure to organic compounds adversely affects neurodevelopment in humans and may be associated with later risk of mental illness.

Other chapters in this book cover cancer, diabetes, heart disease, obesity, thyroid function, women’s and men’s reproductive health, bone and joint health, immunity, respiratory illnesses, cognitive function and Parkinson’s disease.

All this is why we need to know what products were part of the fire and spill.

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

If you are new to using the amino acids tryptophan/5-HTP or GABA as supplements and want to know more in case you need them in a future situation, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see all the low serotonin symptoms here) and a brief overview here, Anxiety and targeted individual amino acid supplements: a summary.

If you suspect low serotonin or low levels of any of the neurotransmitters and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids so you are knowledgeable. It also covers all the basics of a healthy diet that Dr. Song recommends.

With much appreciation to Dr. Song, Sinclair for their helpful resources, the journalists, advocates and photographers, and to all the researchers.

Have you (or a loved one) experienced a pesticide or other environmental spill/disaster (or excessive smoke from a forest fire) and have these detox approaches and anxiety/sleep recommendations helped (or are they helping right now)?

Do you have any additional tips to share?

Feel free to post any questions here too.

Timing/combinations of tryptophan and 5-HTP for anxiety, depression and bad sleep (premenstrual dysphoric disorder/PMDD)

August 6, 2021 By Trudy Scott 28 Comments

Naomi asked these questions about tryptophan timing, using it in the morning and her PMDD (premenstrual dysphoric disorder) symptoms of anxiety, depression and bad sleep:

I heard your talk on the Biology of Trauma summit, thank you it was great. When’s the best time to take tryptophan? I want to try it for PMDD depression & anxiety along with accompanied bad/little sleep.

I’ve read it needs to be taken on an empty stomach. If I take it in the mornings will it make me drowsy for the day? I struggle with having an empty stomach in the evenings as I often need to eat something close to bedtime to have the energy to sleep through.

I thanked Naomi for her kind words and shared that tryptophan is best used mid-afternoon and evening when serotonin levels take a downwards dip. And tryptophan (and the other amino acids) must always be taken on an empty stomach/away from protein. I also shared how she may want to experiment with also using 5-HTP at various times in the day and in different combinations (more on that below).

Regarding the evening dose, tryptophan can be used between dinner and a bedtime snack if a snack is necessary for blood sugar stability (for improving sleep).

I shared this blog as an additional resource for her – Tryptophan for PMS: premenstrual dysphoria, mood swings, tension, and irritability

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).

I’ve seen both tryptophan and 5-HTP improve symptoms in 2-3 cycles (often in conjunction with GABA) and other steps I outline in the above blog. I don’t typically have clients only use it after ovulation but this is one way a trial could be approached.

Using a combination of tryptophan and 5-HTP

Regarding Naomi’s question about taking tryptophan in the morning and her concern about it making her drowsy during the day, this is my feedback about possibly experimenting with also using 5-HTP at various times in the day and in different combinations:

Many folks do not need serotonin support earlier in the day since it goes down at the end of the day but there are some women who do
If you are someone who does need serotonin support earlier in the day, you may do very well with tryptophan i.e. it may not make you sleepy
If you are someone who does need serotonin support earlier in the day, you may find that tryptophan does make you sleepy and you do better with 5-HTP earlier in the day. In this case, you would use 5-HTP in the morning (as needed, possibly on waking and/or mid-morning) and tryptophan in the afternoon and evening.

And just to add to the mix of variations, keep in mind that some folks do better on 5-HTP (at any time of the day) and some folks with high cortisol find 5-HTP too stimulating.

The way to figure out which amino acid and which combination works best for you is to do a trial of the various combinations and keep a careful log of your responses.

I really do recommend my book when you are new to the amino acids

I also reminded her that when you are new to the amino acids I really do recommend my book “The Antianxiety Food Solution” so you understand exactly how to use them. There is an entire chapter on the amino acids.

I also cover other anxiety nutrition solutions like gluten/sugar/caffeine removal (all important for anxiety, depression and sleep), blood sugar control (often a factor in not being able to sleep through the night and daytime anxiety), gut health (affects mood and can also affect sleep), pyroluria (the zinc, vitamin B6 and evening primrose oil are key for hormone health). I reminded her that it’s the amino acids and diet we must work on.

If you’ve been reading my blog posts and following me for awhile, you know I speak on many summits. I see these interviews as a great introduction for folks new to the amino acids but cannot possibly cover everything in 45-60 minutes.

Additional information on PMDD and low serotonin

Here is additional information on PMDD and low serotonin – Premenstrual Dysphoric Disorder: Epidemiology and Treatment:

It is possible that women with PMDD are more sensitive to [the] effects of estrogens on serotonergic function. Women with PMDD or PMS exhibit specific serotonin abnormalities that are particularly apparent in the late luteal phase [or second half of the cycle] when estrogen levels have declined. These include a deficiency in whole blood serotonin, blunted serotonin production in response to l-tryptophan challenge and, and aggravated premenstrual symptoms during tryptophan depletion.

Be aware that the authors recommend antidepressants as the first-line treatment for PMDD and unfortunately do not mention using tryptophan, GABA or a dietary approach.

I always use this approach when serotonin is low

Keep in mind that this discussion about tryptophan and 5-HTP timing and combinations is not necessarily only applicable for PMDD or PMS but can be used across the board when serotonin support is needed. I always use this approach when serotonin is low i.e. someone has worry-type ruminating anxiety, depression, afternoon and evening cravings, irritability, anger issues.

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

If you are new to using the amino acids tryptophan/5-HTP or GABA as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see all the low serotonin symptoms here) and a brief overview here, Anxiety and targeted individual amino acid supplements: a summary.

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

Have you (or a loved one) been diagnosed with PMDD, PMS or have low serotonin symptoms?

Has tryptophan or 5-HTP helped and what combination and what timing has worked best for you?

Feel free to post any questions here too.

Swings are fun for teens, college students and adults! And they reduce stress/anxiety, and improve mood, memory and PMS symptoms

June 18, 2021 By Trudy Scott 21 Comments

Earlier this month I met up with a dear childhood friend for a walk and catch-up and we both rediscovered the joy of swings. I always suggest a walk or hike or swim when meeting with friends and colleagues, and this time was no different except that I really wanted to go somewhere with a swing!

The reason that I wanted to find a swing set was because I had just read an article about swings and teen girls needing a better place to hang out. I love the outdoors and love to play, laugh and have fun, and I couldn’t resist it once I started looking at the research. I discovered all the wonderful benefits of improved mood, reduced anxiety and stress, improved cognition and memory, reduced PMS symptoms, improved social relationships and reduced pain.

These pictures are us swinging and catching up – we laughed and laughed and had such fun! It’s hard to believe we’ve been friends for close to 50 years and it always feels like we were never apart when we do get together.

Our swing experience made it extra special this time! You can see the pure joy on our faces!

Teen girls needing a better public space to hang out

The recent Bloomberg article I had read, Teen Girls Need Better Public Spaces to Hang Out shares this:

Making space for girls means rethinking which age groups need to swing and climb, how to encourage physical activity (and not just playing a sport), and how to make a safe, sheltered place for outdoor conversation.

And this about movement:

While lack of activity among teens is a major public health issue, many girls are looking for more creative, less competitive ways of moving their bodies.

It features really cool images of swings called “Swing Time.” They are designed by Höweler + Yoon Architecture and deliver “the kind of fun, physical outdoor experience with room for face-to-face conversation that many teen girls are looking for.”

As I mentioned above, I was immediately intrigued because I love the idea of outdoor play and social interaction in a safe place for young girls.

Beth Jones, a Mindset and Wellness Coach who works with teen girls and their moms incorporating movement, play and nutrition, posted the Bloomberg article on Facebook saying:

I love this idea so much. I used to love going to the playground in my teens to swing, hang out, just have a space for me. There’s a reason why my business logo has a girl on a swing. That swinging and twisting are also so great for the vestibular system and can help calm anxiety (the back and forth swinging). Maybe they should bring back some swings to middle and high schools.

I’m familiar with the use of swings in occupational therapy to address sensory processing disorders in children. But I was also very interested to know if there was any research on the health benefits of swings for teens and adults. I went searching and was very pleased with what I found, hence this blog post.

Before we get into the research I’d like to extend a big thanks to Beth Jones for the inspiration for all this! Now the research …..

PMS symptoms improved: mood, stress, anxiety, social relationships, pain and memory

This small study, Vestibular stimulation for management of premenstrual syndrome found the following benefits after 2 months of using the swing in females 18-30 years of age:

Depression and stress scores decreased
Anxiety scores decreased (although it was not statistically significant)
Serum cortisol levels decreased.
Social relationships improved
Systolic blood pressure decreased (there was no change in diastolic blood pressure and pulse rate)
Pain levels decreased
Spatial and verbal memory improved

These are amazing benefits using something as simple as a swing. I feel we could safely extrapolate to younger teen girls and even women above 30 years of age too.

Swings for stress management in college students

Vestibular stimulation using swings is the specialty of Dr. Mukkadan, Founder and Research Director of Little Flower Medical Research Centre in India. Together with his team, he published the above PMS paper and this paper on Vestibular Stimulation for Stress Management in Students.

They recommend “placement of swings in college campuses … which may be a simple approach to alleviate stress among college students.”

This is such a simple and yet powerful (and also fun!) intervention especially given the huge rise in anxiety and mental health issues in students. It would be a perfect approach to use in conjunction with amino acid supplements and nutritional psychiatry for these students.

According to another study published by his team, college students will also see improved spatial and verbal memory.

What about swings for teen boys and all adults too?

Once I saw the images in the Bloomberg article, and after reading the research, and after playing on swings again after all these years, my thinking started expanding. I believe everyone could benefit from using a swing.

I certainly wanted to swing right away (hence the walk and swing meet up with my friend a few weeks ago) and now seek out swings when I go for walks. I would love to see an area set aside in parks for teen girls (and boys too) and as Beth says, in middle and high schools too. And how about a designated area in parks for adults who want to swing too?

There are now parks with Liberty swings for children and adults in wheelchairs. The vestibular benefits of rocking chairs are helping veterans dealing with substance abuse and mood issues. I also see an application for stress reduction in the workplace. The opportunities are endless.

Here are some of my recommendations:

Seek out swings in parks. Give it a try to see how you feel and how much you enjoy it!
Advocate for swings in your communities, middle schools, high schools, colleges and place of business.
Get a rocking chair for yourself and/or older family members
Get a swing for your backyard (suitable for teens and adults). I’m looking into options for my backyard and will share more once I find some suitable options.

When did you last go for a swing as an adult? How much fun was it!?

If it’s been some time, does this – my pictures and the research – inspire you to want to look for a swing and have a go again?

Does your teen or college student seek out outdoor play like swings and see benefits?

If you are an OT/occupational therapist or exercise physiologist or other health professional using vestibular therapy with swings please do share so we can all learn.

Feel free to post any questions here too.

Imposter syndrome and neurotransmitter support: I feel like the person I’m supposed to become

February 26, 2021 By Trudy Scott 9 Comments

imposter syndrome and neurotransmitter support

A newly qualified nutritionist posted wonderful feedback on a blog post on imposter syndrome and low serotonin with tryptophan as one possible solution. She shared how neurotransmitter support with tryptophan, tyrosine and GABA was her solution, eliminating her imposter syndrome and social awkwardness in 2 weeks. Here is the feedback Yo shared on the blog:

Thanks for your work on neurotransmitters, Trudy. I am a fan. I had suffered BADLY from imposter syndrome at the end of my nutrition degree and I felt socially awkward in so many outings and situations. My anxiety and stress were through the roof! VERY bad sleep, stressed and my digestion was very poor.

Fast forward to a year later after addressing my sleep (no. 1 priority); stress levels; diet; loads of minerals; vitamin supplementation – my health started to shift for the better, but I still had the imposter syndrome hanging over my head.

What really tipped the balance was the supplementation of tyrosine, tryptophan & GABA. The imposter syndrome seemed to have vanished within two weeks. And it was in your blogs that had pointed out clues to the amino acids I was needing to supplement.

I feel like the person I’m supposed to become and I can’t thank you enough for the amazing work you’ve been doing. I will definitely be following your journey, learning more about these neurotransmitters, and sharing this information so that others can benefit from it. Thank you, thank you!

I thanked Yo for her kind words and for sharing this wonderful outcome. I always say we all deserve to feel our absolute best so I love that she says “I feel like the person I’m supposed to become”!

Read on for my commentary on her specific work addressing her neurotransmitter imbalances with targeted amino acids, and questions I still have about the amino acid trials she did. I also define imposter syndrome in case you’re new to it and more on the low serotonin aspect of imposter syndrome. You’ll also find additional resources if you need guidance using amino acids like tryptophan/5-HTP and GABA.

Addressing neurotransmitter imbalances with targeted amino acids

I also congratulated her on doing the foundational work first. As she discovered, even with all that in place, we often still have to address neurotransmitter imbalances with targeted amino acids too. With regards to imposter syndrome and the amino acids she used:

Using tryptophan to address low serotonin eases worry, rumination, anxiety, negative self-talk, self-doubt and and not feeling capable – all of which we’d typically associate with imposter syndrome
Using tyrosine to address low dopamine results in more motivation and better focus so you are more likely to finish tasks (and therefore feel more confident and capable). Many folks report a feeling of calm focus with tyrosine too
Using GABA to address low GABA eases physical tension and overwhelm and helps stop unwanted thoughts.

A 2-week turnaround is fabulous and means she found the right combination of amino acids and ideal doses for her unique needs right away. I’ve seen results like this in 2 weeks but doing a new amino acid trial each week would usually take at least 3 weeks. I suspect her results were so fast because of the foundational work that was in place.

I typically start with amino acids trials on day one of working with someone, while we are working on diet, sleep, stress – this would have led to her feeling like the person she was meant to become much sooner and would have helped with sleep, stress and dietary changes too. Her approach worked but it took longer to get results.

Questions I still have about the amino acid trials

I have these questions I posed to Yo and hope to hear back as I feel these answers may be helpful as you navigate your own challenges with imposter syndrome:

Did she do a trial of one amino acid at a time (my preferred approach so you know exactly what effects each one has)?
Or did she start taking all 3 amino acids at once and why?
What doses were ideal for her unique needs and how quickly did she find the ideal doses
Is she continuing with a maintenance dose?
Also, since she mentioned social awkwardness I have to wonder if the pyroluria protocol would be of added value (if any of the social awkwardness still remains)? This protocol helps to make neurotransmitters.

I’ll report back once I get Yo’s feedback.

If you’re new to imposter syndrome

If you’re new to imposter syndrome, here is a definition from Intellectual Self-doubt and How to Get Out of It:

People with imposter syndrome often feel like they are not as capable or adequate as others perceive or evaluate them to be. The signs and symptoms are feelings of phoniness, self-doubt, and inability to take credit for one’s accomplishments. It is a form of intellectual self-doubt. Those with imposter syndrome are often intelligent and high achievers – like many academics, pharmacists, and professional students. On one hand, imposter syndrome provides motivation to persevere. On the other hand, you over prepare and overwork.

This author shares a link to the Clance Imposter Scale. This is a self-assessment of imposter syndrome, developed by Dr. Pauline Rose Clance and Dr. Suzanne Imes (who worked together and coined the term “Impostor Phenomenon”.).

This paper reports that

Imposter syndrome is common among early career nurse researchers and often has a considerable impact on those affected. It can cause various problems, including anxiety, self-doubt and feelings of inadequacy, and therefore has significant potential to adversely affect personal and professional development.

Imposter syndrome and low serotonin as a root cause

You can also read more about imposter syndrome on my previous blog post on this topic – Imposter syndrome and low serotonin: is tryptophan the solution? and the Harvard Business review definition:

Imposter syndrome can be defined as a collection of feelings of inadequacy that persist despite evident success. ‘Imposters’ suffer from chronic self-doubt and a sense of intellectual fraudulence that override any feelings of success or external proof of their competence.

The numbers of papers on imposter syndrome are increasing but there is still no mention of biochemistry or neurotransmitters so these amino acid success stories are adding to the body of knowledge. (I would love to get them published as case studies so if you can help please do let me know.)

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

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

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

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

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

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), and you need serotonin support, the Serotonin QuickStart Program is a good place to get help. This is a paid online/virtual group program where you get my guidance on using tryptophan and 5-HTP safely, and community support during 5 LIVE Q&A calls. You can sign up to be notified when the next live launch of this program is happening.

The next way to get help is the GABA QuickStart Program (if you have low GABA symptoms too). This is a paid online/virtual group program where you get my guidance and community support. Another option is the budget-friendly GABA QuickStart Homestudy Program.

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

Wrapping up and your feedback

I love hearing life-changing stories like this and I am sharing it here to inspire and offer hope! I also love that Yo is such a fan now and wants to pay it forward by sharing this information with clients so I also shared my amino acid practitioner training with her.

Now I’d love your feedback …

Is imposter syndrome new to you? And is this concept of addressing imposter syndrome with amino acids new to you? We would appreciate hearing:

#1 How you describe your imposter syndrome and how it impacts your life
#2 How you score on the Clance Imposter Scale (and which aspects bother you the most)
#3 What symptoms you have on the Amino Acid Questionnaire in the low serotonin, low catecholamine and low GABA sections.

If you already know about imposter syndrome and have found a solution with the amino acids please do share your success story so we can all learn from each other, as well as inspire and offer hope. We would appreciate hearing:

#A How you described your imposter syndrome and how it impacted your life
#B How you scored on the Clance Imposter Scale before and after using amino acids (and which aspects bothered you the most)
#C What symptoms you had on the Amino Acid Questionnaire in the low serotonin, low catecholamine and low GABA sections (before and after using the amino acids)
#D Which amino acids were most helpful and how much of each amino acid helped you
#E If you’ve also had CBT (cognitive behavior therapy) and how it helped too

If you feel more comfortable sharing some of this anonymously feel free to use a nickname or your initials only when commenting – I’m aware that there is a stigma to admitting this in the corporate world, as a health professional and as an entrepreneur.

Feel free to post your questions and feedback in the comments below.