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Sundowning in Alzheimer’s and dementia: melatonin/tryptophan for the agitation, restlessness, anxiety, disturbed sleep and aggression

March 3, 2023 By Trudy Scott 8 Comments

sundowning in alzheimer's and dementia

The terms “sundown syndrome” or “sundowning” are used to describe a wide range of neuropsychiatric symptoms occurring in individuals with dementia in the late afternoon, evening, or night. These symptoms include confusion, restlessness, anxiety, agitation, aggression, pacing, wandering, screaming, yelling, and hallucinations. The treatment of sundown syndrome is challenging, and pharmacological therapies are not particularly effective.

This definition is from a very encouraging case study published as a letter to the editor of the Journal of the American Geriatrics Society – Melatonin for Sundown Syndrome and Delirium in Dementia: Is It Effective?

This case study is very typical in terms of symptoms and a pharmacological approach:

An 81-year-old man with Alzheimer’s disease diagnosed 4 years previously was admitted to the elderly department because of behavioral disturbances, sleep disorders, and wandering. His wife said that his cognitive and functional impairments had gradually worsened over the past 4 years and that, in the last 6 months, her husband had become verbally aggressive, agitated, and restless; wandered; and paced. He did not sleep for long and had difficulty falling asleep. The symptoms increased in the late afternoon and at night. He had no hallucinations or delusions. One month before admission, delirium was suspected, and his general practitioner prescribed haloperidol, but it was not effective.

During admission, sundown syndrome was diagnosed, and he received pharmacological and nonpharmacological interventions for behavioral and sleep disturbances, but none was effective, and some aggravated symptoms. The pharmacological interventions consisted of benzodiazepines, antipsychotics, cholinesterase inhibitors, mood stabilizers, and antidepressants, all given in an optimal dosing schedule.

Melatonin led to much improved symptoms within a few hours

None of the medications were effective and some made his symptoms worse. This case study is atypical in that his doctors were open to the use of melatonin. This led to much improved symptoms within a few hours and complete resolution in 2 weeks with a second dose:

After extensive review of his history, the effect of past treatments, and the published literature, melatonin was started at a dose of 2 mg at 8:00 p.m. for sleep disorders. Not only did his sleep quality improve within a week, but there was also significant improvement in his behavior within 2 hours of initiation of melatonin. A therapeutic trial with an additional dose of 2 mg given at 3:00 p.m. was started, and his symptoms gradually improved over the subsequent 2 weeks (NPI score 20). No behavioral changes were observed in the 2-month follow-up.

These results are powerful and mirror what a number of other studies are showing, for sundowning and to also slow “down the progression of cognitive impairment”). We also see melatonin working clinically for this population.

I share this case study so if you are a carer or have a parent or loved one with Alzheimer’s or dementia, you have a resource to share with the medical team. There is growing awareness of this research and some neurologists are prescribing melatonin with success. Typically 0.5 mg to 5 mg melatonin is used once or twice a day.

My hope is that this becomes the standard of care instead of prescribing psychiatric medications which the authors acknowledge are not particularly effective. And they don’t get to the root cause that is triggering these symptoms: low melatonin and low serotonin (more on low serotonin below).

Melatonin and anxiety

Melatonin also improves sleep quality and reduces anxiety after a TBI (traumatic brain injury). I blogged about a study that used timed-release melatonin here. The study participants used 2 mg of timed-release/prolonged-release melatonin for 4 weeks. This improved sleep quality and melatonin was also associated with a small decrease in self-reported anxiety.

As outlined in this paper, Melatonin as a Potential Approach to Anxiety Treatment, “melatonin’s benefit in anxiety may reside in its sympatholytic action, interaction with the renin-angiotensin and glucocorticoid systems, modulation of interneuronal signaling and its extraordinary antioxidant and radical scavenging nature.”

The serotonin connection and using tryptophan or 5-HTP

Keep in mind the strong serotonin connection: these sundowning symptoms start late afternoon and evening (hence the name sundowning) and serotonin is a precursor to melatonin production.

I look forward to seeing research on the use of tryptophan or 5-HTP for sundowning symptoms too. Until then, based on the above, and the fact that many of these symptoms are classic signs of low serotonin, I feel comfortable recommending either of these amino acids.

As always, we start low, use afternoon and evening doses and increase based on symptom resolution. The typical adult dose of tryptophan is 500 mg and 50 mg of 5-HTP. I recommend starting with 100 mg tryptophan and 10mg of 5-HTP. The amino acid precautions are always reviewed. I would not recommend either tryptophan or 5-HTP if the individual is currently prescribed an antidepressant, unless you are working with a knowledgeable practitioner and always with the approval and monitoring of the prescribing doctor. This is because of the possibility of serotonin syndrome.

Dr. Dale Bredesen recommends tryptophan and melatonin

Dr. Dale Bredesen is the author of The End of Alzheimer’s (my Amazon link) and a number of other books on Alzheimer’s. He is an authority on Alzheimer’s and recommends both tryptophan and melatonin. In this paper, Reversal of cognitive decline: A novel therapeutic program, he reports the use of 0.5 mg melatonin and 500 mg tryptophan used (3 x week) for sleep issues.

Interestingly and surprisingly, he doesn’t mention sundowning in his books or papers. However, if you are new to his work, I encourage you to look into his functional medicine approach, which is extensive and offers results and hope for many.

Low GABA in Alzheimer’s disease and dementia

This paper, Implications of GABAergic Neurotransmission in Alzheimer’s Disease, shares that “of the two major types of synapses in the central nervous system (CNS): glutamatergic and GABAergic, which provide excitatory and inhibitory outputs respectively, abundant data implicate an impaired glutamatergic system during disease progression.” 

The amino acid GABA may also help anxiety, disturbed sleep and restlessness. And it’s common to have both low serotonin and low GABA.

This case study illustrates how using the amino acid GABA can help ease the anxiety often experienced in those with Alzheimer’s disease.

It’s too entrenched in our thinking that there is nothing to be done

It saddens me that it’s too entrenched in our thinking that there is nothing to be done. Unfortunately, many family members and medical professionals consider sundowning a normal part of the disease progression and question whether it’s worth doing anything.

My feedback is this: please don’t discount the power of the amino acids, melatonin and other nutritional approaches to offer some relief and improved quality of life for the patient. And when they are calmer, less aggressive and sleeping better it’s so much easier for the caregivers too.

Resources if you are new to using tryptophan or GABA as supplements

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

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

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

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

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

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

Have you used melatonin to help with sundowning symptoms with your loved one and if yes how much helps?

Was melatonin prescribed or did you research it and bring the information to the doctor?

Have you used melatonin to help with sundowning symptoms in your clients/patients? What ranges have you seen to help?

Have you also found tryptophan, 5-HTP and/or GABA to help?

If you have questions and other feedback please share it here too.

Filed Under: Alzheimer's disease, Anxiety, serotonin, Tryptophan Tagged With: 5-HTP, aggression, agitation, alzheimer's, anxiety, confusion, dementia, disturbed sleep, Dr. Dale Bredesen, GABA, GABA Quickstart online program; and Balancing Neurotransmitters: the Fundamentals program for practitioners, melatonin, pacing, restlessness, serotonin, sundown syndrome, Sundowning, tryptophan, wandering, yelling

GABA and Silexan (an oral lavender product) for anxiety, panic attacks, agoraphobia, insomnia and stressful events like travel/social events

February 24, 2023 By Trudy Scott 29 Comments

gaba and silexan

When sharing a study on the benefits of Silexan, a proprietary formulation of oral lavender essential oil (used as a supplement), I received this feedback from Kat. She uses both Silexan and GABA with success, depending on the situation:

I used Silexan (CalmAid) here in the USA, for 7 weeks and had wonderful results!!

I was having daily constant panic attacks… agoraphobia and insomnia. They put me on several SSRIs to which I had severe reactions to. The Silexan saved me! I was able to get my life back. I used it nightly and it helped tremendously with sleep and anxiety. I heard about it through The Carlat Report Psych podcast and website after a desperate search to find something to help.

It’s a product that I highly recommend to everyone I know who suffers with anxiety. I now use it only as needed. There are no side effects except a perfume burp but that’s tolerable for me! It can be stopped without any withdrawal effects.

And this is how she responded when I asked if she had previously done a trial of GABA or tryptophan and how Silexan compared to the amino acids.

I use the GABA during times where the panic is increasing (GABA Calm 1/2 tablet, sublingually).

I use the Silexan when I have something stressful planned like travel, social events etc. Silexan works so well without any side effects and can be stopped without any withdrawal effects.

The GABA is an immediate effect vs the Silexan which is slower acting but lasts throughout the day.

What wonderful results for Kat. I thanked her for sharing and voiced my concern with CalmAid and some of the other products that contain Silexan: they contain canola oil. I just wish they stopped making this with canola oil! I share more about this below and another product option that doesn’t use canola oil.

GABA or Silexan? Kat’s sweet spot, serotonin and pyroluria

If you’re wondering where you should start – GABA or Silexan? If you’ve been following my work or even starting to use GABA, you’ll know I always start clients with GABA when they have low GABA symptoms of physical anxiety and tension.

I agree with Kat – it’s very typical for GABA to provide immediate results. I did also share with her that in order to get longer lasting effects GABA does need to be used 3-4 x day, between meals. This means that, for her, GABA may offer similar results to Silexan by slowly building up her GABA levels.

However, Kat has found the sweet spot she needs by using this combination so I would stick with this approach.

If she did decide to stop using Silexan in the future, tryptophan may be needed too – for low serotonin worry-type anxiety symptoms. She did mention that she doesn’t currently use tryptophan and Silexan also affects serotonin levels.  

I do love that Kat plans for stressful events and uses Silexan in these situations. She does mention needing it for social events so I’d suggest looking into pyroluria too. More here on this social anxiety condition and how zinc, vitamin B6 and other key nutrients can help.

Kat’s dietary changes, no caffeine, no sugar and cravings?

I also asked if she has also made dietary changes and quit caffeine, alcohol and sugar. Kat shared that she doesn’t drink any caffeine and hasn’t since 2015. Good for her – caffeine is a major anxiety trigger. She does recognize that her anxiety gets worse when she’s eating a lot of processed foods/gluten/dairy/soy and she limits these.

I said it’s best to avoid these trigger foods altogether. This is often easier said than done! The amino acids help so much to break the addiction and eliminate the need to use willpower: GABA for stress-eating, tryptophan or 5-HTP if her cravings happen mostly in the afternoon and evening, and DPA if comfort foods are her reward. More on the amino acids and cravings here.

I thanked Kat for sharing her wonderful results and asked for permission to share as a blog.  I always appreciate being able to do this so I can continue to educate and inspire. This also shows how there is no-one size fits all.

Silexan research on anxiety and insomnia

This is the study I shared on Facebook – Prescription of Silexan Is Associated with Less Frequent General Practitioner Repeat Consultations Due to Disturbed Sleep Compared to Benzodiazepine Receptor Agonists: A Retrospective Database Analysis

The prescription of Silexan to adult patients consulting general practitioners (GPs) for disturbed sleep results in less frequent repeat consultations than Z-drugs (including zolpidem, zopiclone, and zaleplon).

This may support Silexan’s role as an efficacious, self-enabling, well-tolerated, and sustained treatment option.

Because Silexan is a proven anxiolytic, its impact in improving undiagnosed anxiety disorders may have had a lasting effect for certain patients.

As explained in this same paper, “Silexan is an active substance with an essential oil produced from Lavandula angustifolia flowers.” It’s a proprietary lavender oil that complies with and exceeds the European Pharmacopoeia quality definition for the monograph lavender oil. “Several studies have shown positive effects of Silexan on symptoms of subsyndromal/mild anxiety or GAD [generalized anxiety disorder] compared to conventional treatment or placebo groups.”

Silexan and other oral lavender products

The proprietary product of Silexan, with 80mg of Lavandula angustifolia essential oil, is found in a number of products:

  • Nature’s Way CalmAid ® (this is the product Kat used/uses)
  • Integrative Therapeutics Lavela ™
  • Seremind ® (in Australia)

This supplement, NFH Lavender SAP, does not use the proprietary Silexan but does contain 80mg of organic lavender (Lavandula angustifolia) essential oil. This product is my preference since it contains olive oil and not canola oil like the others mentioned above.

All of the above are available in my online supplement store (for US purchases only). Nature’s Way CalmAid ® is also available on iherb.

Dosing recommendations for adults is 1 softgel once or twice daily with a full glass of water. There is a caution not to use while pregnant, nursing, or for children under 12 years of age.

GABA for anxiety, insomnia, sugar cravings, sensorimotor skills and immunity

I share case studies and research about GABA all the time so I’ll just share links to some of the past GABA blogs in case you’re new to GABA (a calming amino acid and neurotransmitter):

  • GABA for ending sugar cravings (and anxiety and insomnia)
  • GABA is a life saver for anxiety, theanine helps at night (insomnia) and 5-HTP makes a significant difference in lessening daily pain
  • GABA and theanine for easing anxiety, improving sleep and supporting immunity
  • Half a crushed GABA Calm for my autistic child: sleep, anxiety and sensorimotor skills (writing, horse riding and swimming) improve

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

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

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

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

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

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

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

Have you found that an oral lavender product such as Silexan (used as a supplement) helps with your anxiety, panic attacks and/or sleep?

Have you used the NFH Lavender SAP product with similar success to other Silexan products?

Do you also use the amino acid GABA (sublingually) and in what situations do you use GABA vs oral lavender?

How much of each do you use?

If you have other questions and feedback please share them here too.

Filed Under: Anxiety, GABA, Insomnia Tagged With: Agoraphobia, anxiety, essential oil supplement, GABA, GABA Calm, lavender, Nature’s Way CalmAid, NFH Lavender SAP, oral lavender, panic attacks, pyroluria, resources if you are new to the amino acids; the GABA Quickstart online program; and Balancing Neurotransmitters: the Fundamentals program for practitioners, serotonin, Silexan, sleep, social events, stressful events, sugar cravings, travel

GABA Calm is a game changer for husband’s sound and tactile hypersensitivity, significant coordination problems and his anxiety

February 10, 2023 By Trudy Scott 20 Comments

gaba calm

My husband is low in GABA and he had significant coordination problems and sensory sensitivity ….. until GABA Calm. 3 tablets per day work great. If he has none, he gets hyper sensitive again and starts tripping over things in the house.

He has always struggled with anxiety and sound / tactile hypersensitivity. Alongside that he often tripped over things. He made great progress when he started using The Listening Program. I wonder if this sound therapy raises GABA and that was why it helped him (although it only partially helped with anxiety)?

When he stopped The Listening Program then his symptoms came back.

He started taking GABA Calm as I saw it in your blogs years ago. Then he found that he didn’t need to do the Listening Program any more.

GABA Calm is a game changer for him.

Denise shared this feedback about her husband’s great results on a blog post about GABA Calm helping with anxiety and sensorimotor skills in an autistic child.

I thanked her for sharing these wonderful results her husband is experiencing.  I am inspired to share this feedback as a blog to give others hope. And also because this illustrates the diversity of how GABA can help i.e. it works for adults and children, males and females, and there is different dosing according to each person’s unique needs.

Music therapy: calming effect and GABA mechanisms

This study, Emotional Inhibitory Effect of Music Therapy on Anxiety Neurosis Based on Neural Content Analysis in Hippocampus, reports that music therapy has a calming effect by adjusting the glutamate/GABA balance. This is likely why Denise’s husband found The Listening Program to be helpful in certain ways – glutamate is the main excitatory neurotransmitter and GABA is the main calming neurotransmitter.

GABA, the GABA Calm supplement, hypersensitivity and sensorimotor difficulties (research)

GABA (gamma-aminobutyric acid) is your main inhibitory neurotransmitter and the amino acid GABA can be used as a supplement to raise GABA levels and ease physical anxiety symptoms, help with insomnia, stress eating, intrusive thoughts and stiff/tense muscles.

GABA Calm is one of many different GABA supplements that I recommend to my clients. This particular one is a sublingual/chewable offered as a 125mg dose, which is where I have most of my clients start. Denise’s husband finds that 3 GABA Calm used throughout the day are enough for his needs. These alleviate his anxiety and also stop his sound and tactile hypersensitivity, and significant coordination problems such as tripping.

This paper reports that“Sensory over-responsivity (SOR), extreme sensitivity to or avoidance of sensory stimuli (e.g., scratchy fabrics, loud sounds)… is present in 5–15% of the general population and is even more common (rates over 50%) in individuals with both genetic and environmentally-based psychiatric and neurodevelopmental disorders such as anxiety, attention deficit hyperactivity disorder, early life adversity, and autism spectrum disorder (ASD).”

The authors discuss altered thalamic sensory gating and an excitatory (glutamate) / inhibitory (GABA) neurochemical imbalance in ASD youth. Most of the research on sensory issues and GABA has been done in ASD children but it clearly applies to adults with anxiety too.

I highlight the motor issues with GABA/glutamate imbalances in the above GABA sensorimotor skills blog. This research is also looking at ASD populations but these mechanisms may account for her husband’s significant coordination problems/tripping.

You can read the current list of low GABA symptoms here. This list will be updated with sound and tactile hypersensitivity, and coordination problems/tripping (and a few others like asthma and laryngospasm).

An occupational therapist who is training as a nutritional therapist

Denise is an occupational therapist (OT) who is training as a nutritional therapist so she can recommend supplements for the kids she works with, alongside the other therapies she uses as an OT.   I love this. I’m a big believer in using everything we have at our disposal and am a huge advocate of OT.  I would love to see more OTs and other practitioners using the amino acids and nutritional therapy.

Denise shared that she actually started her journey in nutritional therapy 20 years ago due to the impact she was seeing in diet and autism. She took a very long break and had her own children and has now restarted her training. She shared this:

I plan to integrate nutritional advice into my work with families. As I am currently a NT student I haven’t been able to advise families even regarding the GABA Oolong tea [more on that below]. I am excited to qualify as I see various sensory, motor and attention issues that can be easily treated through nutritional adjustments and supplements.

Denise is already using the amino acids personally and with her family, sharing: “I love using aminos e.g. 5-HTP and L-theanine for myself and my daughters and GABA for my husband, tyrosine occasionally for my son.”

She has my book “The Antianxiety Food Solution”, a great resource that is practical and fully referenced, for both consumers and practitioners.

I encouraged her to also look into the amino acid training I offer for practitioners once she has completed her training as a nutritional therapist, so she can confidently use them with her clients too.

Having her in the program is also an opportunity for me and others in the group to learn from Denise about her expertise on integrating amino acids, nutrition and OT.

Her feedback on GABA oolong tea or GABA Calm for children with autism?

She also commented that she loved reading the GABA Oolong research – GABA Oolong tea in children with autism: improvements in sensorimotor skills, autism profiles, anxiety and sleep (new research)

I asked for her feedback and if she has kids in her practice, see any benefits when drinking this GABA Oolong tea. And what their responses are to the taste. Since she is still a student she can’t yet advise families regarding the GABA Oolong tea but she did say this:

To be honest I think the Source Naturals GABA Calm sublingual will be easier to tolerate for lots of children compared with tea.

As fascinating as the GABA Oolong tea research is, I feel the same way and  I really appreciate this feedback from an OT. I have actually received similar feedback from a number of other practitioners too. Stay tuned as I continue to gather feedback.

Autism: diet, GABA and working with an OT

It’s amazing that 20 years ago Denise was seeing the impact of diet in kids with autism. If you would like to learn more, this blog – Nutritional and Dietary Intervention for Autism Spectrum Disorder – summarizes a 2018 study and offers many insights into to the progress since then.

As I mentioned above, her husband’s success with 3 GABA Calm illustrates the diversity of how GABA can help i.e. adults and children, males and females, and different dosing according to each person’s unique needs.

This is the blog Denise commented on – Half a crushed GABA Calm for my autistic child: sleep, anxiety and sensorimotor skills (writing, horse riding and swimming) improve.

In the above blog, I share Vic’s feedback about just half a GABA Calm improving her daughter’s sleep, social skills and sensorimotor skills such as pen and pencil use, horse riding and swimming. Her daughter is also working with an OT and getting those added benefits too.

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

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

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

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

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

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

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

Have you or a family member had GABA help with sound and tactile hypersensitivity, coordination problems and anxiety?

Which GABA product and how much?

And is the GABA product used sublingually or the capsule opened?

Are you an OT using amino acids and nutritional approaches with your clients, in addition to other approaches?

Do you find music therapy to be calming, in a similar way to the calming effects of GABA?

If you have other questions and feedback please share them here too.

Filed Under: Anxiety, GABA, Men's health Tagged With: adults, amino acids, anxiety, autism, children, coordination problems, diet, female, GABA, GABA Calm, GABA Oolong tea, husband, hypersensitivity, male, music, occupational therapist, sensorimotor, sensory sensitivity, sound, sound and tactile hypersensitivity, tactile, the GABA Quickstart online program; and Balancing Neurotransmitters: the Fundamentals program for practitioners, The Listening Program, tripping

A case of enterobiasis presenting as post-traumatic-stress-disorder / PTSD (i.e. a common and parasitic pinworm infection)

February 3, 2023 By Trudy Scott 11 Comments

case of enterobiasis

Enterobiasis (oxyuriasis) is a common infection in humans caused by Enterobius vermicularis (E. vermicularis), a human intestinal helminth. Because of the easy way of its transmission among people, it has an extremely high prevalence in overcrowded conditions, such as nurseries and primary schools. Oxyuriasis’s symptoms are extremely diverse in children, ranging from nausea, diarrhea, insomnia, irritability, recurrent cellulitis, loss of appetite, nightmares and endometritis.

Here we report a curious case of oxyuriasis in the settings of a refugee camp in Greece. The patient was a 10-year old Syrian female, who presented with unusual and vague symptoms like insomnia and irritability. Given the violent background of the Syrian warzone that the patient had escaped, she was firstly diagnosed with post traumatic stress disorder (PTSD) before eventually getting correctly diagnosed with enterobiasis.

This infection is the first documented case of enterobiasis in the settings of a refugee camp and can highlight the unsanitary living conditions that refugees have to endure in those camps.

The above is the abstract from a 2017 paper: A case of enterobiasis presenting as post-traumatic-stress-disorder (PTSD): a curious case of the infection with predominant mental health symptoms, presenting for the first time in the settings of a refugee camp

In addition to her symptoms of insomnia and irritability, she had a decreased appetite and mild abdominal (tummy) pain. She was also experiencing nausea and vomiting and had a slightly raised body temperature (subfebrile). She was severely malnourished and had lost 3kg/6.6lbs in 5 days.

Because of the violent nature of her situation she was initially seen by a psychologist but her symptoms worsened in a few days. When this young girl complained about itching in the perianal area (around her anus), the clinic reassessed her and scars around the anal area from the scratches.

They then confirmed enterobiasis/pinworm after using a piece of clear adhesive tape “to collect a specimen from the perianal surface of the girl, for three consecutive mornings … A microscopic examination showed the presence of oval shaped eggs, which is typical for the specific helminth [parasitic worm].”

She was treated with “two doses of albendazole, with each dose two weeks apart, in order to avoid reinfection …. And after a 3 month follow-up period, the patient remains asymptomatic without any signs of recurrence.”

An overview of pinworm infections, symptoms, tape test and treatment approaches

This WebMD article offers an overview of pinworm infections, the symptoms, the tape test and treatment approaches.

As you’ll read it’s not only a problem in refugee camps – it’s “very common in elementary school-aged children” and it’s the most common kind of worm infection in the United States. “Most of the time, pinworm infections don’t cause serious problems.” However, when one child (or adult) gets a pinworm infection it can easily be spread to the entire family.  The Syrian refugee paper mentions the whole family was tested.

Systemic infection: female health issues and gut health

The WebMD authors also state, “in rare cases, and especially if you have a lot of them, the pinworms can travel from the anal area up the vagina to the uterus, fallopian tubes, and around the pelvic organs. This can cause inflammation of the vagina (vulvovaginitis).”

I first learned about these serious systemic issues in women from naturopathic doctor Rachel Arthur at a conference in Australia. Contrary to the WedMD article, she believes this is not rare and more common than you’d expect, contributing to hormonal imbalances and even infertility.

The research confirms the impacts of pinworm on the gut, with reports of pinworm associated with appendicitis, pinworm in the liver, pinworms contributing to dysbiosis and pinworm being a factor in inflammatory bowel disease.

The WebMD article doesn’t mention the mental health symptoms and mechanisms but you can read more about that (and my interview with Dr. Jay Davidson) below.

Annual deworming and concerns about drug resistance?

I’m not going to get into anti-parasitic medications and herbal alternatives in this blog post – Dr. Jay talks about mimosa pudica seeds and Dr. Rachel recommends chondroitin sulfate – but do I want to mention that there are many public policy papers calling for annual deworming procedures for everyone. It’s also mentioned in the above Syrian refugee paper, as is hand-washing for prevention.

And many folks recall annual deworming concoctions as a child and did/do the same with their children.

There is, however, the concern about antiparasitic drug resistance similar to what is being seen with antibiotics and antiviral drugs.

If you are new to parasites and their impacts on mood issues, anxiety and insomnia and more

If you are new to parasites, here are some insights from an interview I did with Dr. Jay Davidson on The Anxiety Summit 5: Gut Brain Axis. The topic of our interview is – Parasites, Anxiety and TUDCA for Your Liver. He shares this:

The Greek meaning of parasite is one that sits at another’s table. So essentially think of a parasite as it’s taking things from you. It’s taking nutrients, it’s taking key things that your body needs and literally off of you, not to the point that it’s killing you because then you’re not a good host to give a good environment. So it’s basically just kind of sucking you dry.

We discussed symptoms individuals may experience: mood issues, anxiety and insomnia (especially around full moon). He shared that with insomnia “the big issue that I see is restless sleep where you toss, you turn, you wake often. You can’t just be relaxed when you sleep. Parasites get active when you go to bed. The more active they are within your body and the more you’re trying to calm down, the more your body is getting stressed out. This is where teeth grinding happens when you sleep.

This is very typical and likely the kinds of insomnia symptoms this young refugee girl experienced too. Pinworm is more active at night so the itching around her anus and the need to scratch would have affected her sleep too. This is a classic sign of pinworm.

With regards to anxiety and mood issues and possible mechanisms, Dr. Jay shares how parasites contribute to neurotransmitter imbalances:

Parasites will eat the protein you eat and not allow your body to break down that protein into amino acids. That’s why amino acid therapy can be so beneficial symptomatically and change people’s lives, because they’re getting these amino acids that they’re not getting when they have parasites.

When we digest protein, the amino acids are needed to help us make neurotransmitters. With his amino acid comments, he is making reference to my work with the amino acid tryptophan to support your low serotonin worry-type of anxiety symptoms and the amino acid GABA to support your low GABA physical-anxiety type symptoms. They are wonderful for quick relief of anxiety and mood symptoms, and even help sleep problems too. But as he says “you always want to make sure to go to the underlying cause to remove the parasitic infection.”

Other symptoms of parasitic infection that we discuss at length: restless legs and calf cramping, diarrhea, bowel urgency, SIBO (small intestinal bacterial overgrowth), vertical wrinkles above your mouth, nail-biting, food sensitivities, bed-wetting and night sweats. These are all symptoms that we need to look for and then consider stool testing and/or the sticky tape test/clear adhesive tape test for pinworm (as mentioned in the Syrian refugee paper and WebMD article above).

If you missed this interview and/or summit, you can find the purchase link on the above blog and here.

Tryptophan is not working (possibly because of parasites) and toxoplasma gondii (and GABA/anxiety)

Here is some additional reading on parasites on my site and in the literature:

  • Tryptophan doesn’t work, then it does and then it doesn’t: could it be hormonal shifts, dietary factors and/or parasites? As I share here, if you have a very pronounced shift in symptoms for 4-5 days around a full moon each month – more severe insomnia, more anxious, more depressed – I would want to check for parasites (as well as hormonal impacts and everything else covered on this blog).
  • Toxoplasma gondii: schizophrenia, bipolar disorder, OCD and unresolved anxiety? As I share in this blog, toxoplasma gondii is a microscopic parasite that infects cats and can be found in the soil – research shows it may be a factor in schizophrenia, bipolar disorder and OCD in susceptible individuals. Could toxoplasma gondii could be one of the root causes of unresolved anxiety? I believe so and feel it’s under-rated.
  • In this study, Toxoplasma gondii Infections Alter GABAergic Synapses and Signaling in the Central Nervous System, the authors share that “toxoplasma interferes with GABA signaling in the brain …playing a role in seizures and other neurological complications seen in Toxoplasma-infected individuals.” This particular parasite disrupts the workings of the glutamic acid decarboxylase 67 enzyme (GAD67), used to make GABA from glutamate, and very likely contributes to increased anxiety symptoms too.

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

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

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

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

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

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

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

If you or a family member have had a pinworm infection, what symptoms did you experience and was the entire family affected?

Have you had hormonal and/or pelvic issues and/or gut issues as a result of systemic infection with pinworm?

How have other parasitic infections impacted your health?

How familiar are you with the fact that pinworm and other parasites can affect your mood, anxiety and sleep, as well as cause gut issues?

If you’re interested in learning more about testing and herbal protocols please let me know. If you’d like to share what has worked for you please do share too.

If you have other questions and feedback please share them here too.

Filed Under: Anxiety, Gut health, Insomnia, Parasites, PTSD/Trauma Tagged With: amino acids, anxiety, diarrhea, Enterobiasis, female health, GABA, insomnia, irritability, itching anal area, loss of appetite, mental health, mood, nausea, Nightmares, parasite, parasitic, pinworm, post-traumatic-stress-disorder, PTSD, Syrian, tape, the GABA Quickstart online program; and Balancing Neurotransmitters: the Fundamentals program for practitioners, toxoplasma gondii, tryptophan

My 6 year old was having panic attacks getting out of the car for Kindergarten: GABA has completely relieved him of his fears

January 27, 2023 By Trudy Scott 12 Comments

gaba for fears

My 6 year old son was having panic attacks getting out of the car going to Kindergarten and taking two GABA Calm has completely relieved him of his fears. He has been going for 3 straight weeks in a row.

I thought it may be low serotonin since this happened last winter as well but I gave him 5-HTP for a couple months and it didn’t seem to affect him and his anxiety. We had to have him repeat Kinder this year.

But wow, the GABA has been fabulous and Kindergarten is in full swing because of your help.

This is from Lisa, a mom in the community. I never get tired of getting feedback like this – how wonderful for this young boy and his family. She shared this very positive outcome on one of the GABA blogs, asking this question (which I address below):

Quick question…does the GABA have to be taken on an empty stomach to work? We try to give it as soon as he is awake and wait to eat for 15-20 mins but sometimes it’s not possible.

The timing of GABA and tracking symptoms

I share that GABA is best taken on an empty stomach and ideally 30 minutes away from protein-containing food. But I also say that the way she is having him use it is clearly working for him. In a situation like this it’s simple enough to track the outcome on days they do wait 15-20 mins and on days when it’s not possible to wait the 15-20 mins (and make a note of how close to food he does take GABA). How is his anxiety, fears and panic attacks in these two situations?

Lisa shared that GABA works well in both instances:

We will keep doing the no food for 15-20 minutes after taking it because it is obviously working. We’ve only had it happen where he eats after about 5 mins and it seems to still do the job.

This sounds like a great plan. If they can, I would also do a trial waiting the full 30 minutes and see how he does on those days. She may find with the longer duration he only needs one GABA Calm.

It may also be that because GABA is being used in a sublingual manner like this, it can be used closer to food. Perhaps a trial right after food is worthwhile. I’m sure it will reduce some of the early morning stress and rush getting ready for Kindergarten.

I also confirmed with her that he is using the Source Naturals GABA Calm product. This is the sublingual product (with just 125mg of GABA and a few other ingredients) that I have so much success with. You can read more about it here – Source Naturals GABA Calm™: Why I recommend it for anxiety.

The school is in shock at how well carpooling is going for him

I love that the school is now in shock and that this mom went with her instinct and pulled him out of school the first year his fears showed up:

We just got a call from the school today and they are in shock at how well carpooling is going for him. They wanted to know what I was doing, ha! He had been a star student so they were shocked when he started to have meltdowns and panic attacks, running away and into traffic about 3 months into school. We deal with a bit of ADHD at home (it’s manageable with the diet) but anxiety is what most see on the outside.

We are repeating Kindergarten because half way through last year he started to panic getting out of the car. The previous school wanted to grab him out of the car and have me drive off. They said he would calm down better without me. What? Just what I want to do is traumatize my child at the start of his academic life. I pulled him and we waited since he was on the younger side and put him in a fabulous charter school this year.

The GABA has taken all those fears out and has been a huge bridge for him to get to school.

I do hope Lisa told the school exactly what he’s doing with GABA and how quickly it’s helped him. So many children are struggling with anxiety and mental health issues and could do with nutritional support like GABA and some of the dietary changes he had made before using GABA (more on that below).

5-HTP didn’t help and why a switch to tryptophan may have helped

You’ll notice she mentioned that 5-HTP had not helped the previous year:

I thought it may be low serotonin since this happened last winter as well but I gave him 5-HTP for a couple months and it didn’t seem to affect him and his anxiety.

Fear and panic attacks are common with low serotonin so it’s good that she did a trial of 5-HTP. Here are some of my insights:

  • I would not have someone use 5-HTP for a couple of months – the amino acids work quickly so a week or possibly two should be enough to decide whether to continue or stop
  • You always want to increase until you find the ideal dose. I’m not sure how Lisa approached this aspect.
  • When there are low serotonin symptoms and 5-HTP doesn’t work, we switch to tryptophan. 5-HTP works well for some and tryptophan works better for others. You can see all the low serotonin symptoms here

It’s possible her son may still benefit from additional serotonin support. Or it may be that the GABA is all he needs. With ADHD it may be worth investigating tyrosine too.

Dietary changes: gluten, dairy, phenols and high histamine foods

It’s important to always address the foundational diet so I checked with Lisa about dietary changes. This is key to not needing long-term GABA supplementation (once other causes of low GABA are addressed – such as Lyme disease, phthalates, aspartame, gut health etc). She shared this about his diet:

He has always been gluten free and dairy free (only goats milk as a baby). We follow the Feingold Diet and try to stay away from high histamine foods as it causes his anger and anxiety to be worse.

It’s great she has made these foundational dietary changes with gluten and dairy – both can exacerbate mood issues. The Feingold diet eliminates phenols. Both phenols and high histamine foods can be problematic for many children too, as she reports.

All these dietary factors are so key but even then additional neurotransmitter support is often needed and in this instance it’s GABA that he clearly needs. Because of his issue with histamines it’s possible he may not have tolerated pharmaGABA (a fermented GABA) so GABA Calm was a good first choice for the initial trial.

Pyroluria testing – why I often don’t use this urine test

I know he has some imbalances so we need to do an OAT test and pyroluria test (I have pyroluria so I know he is bound to have it). Money is the issue at the moment so the GABA chewables have been a true lifesaver. I can’t thank you enough!

I let her know that I don’t often have clients do the urine test for pyroluria because of the false negatives. He’s doing really well but children with pyroluria are really good at masking and pushing through (and so are adults, as I’m sure Lisa already knows). The pyroluria protocol (zinc, vitamin B6 and evening primrose oil) provide raw materials for neurotransmitter production and can help with ADHD symptoms too. We simply do a trial of the protocol when symptoms exist and determine if they are helping.

I love her comment: “the GABA chewables have been a true lifesaver.” This and the outcome for this 6 year old is the reason I love the amino acids.  They offer incredible results and relief from anxiety, fears and panic attacks, while you are working through testing (like the OAT and others) and other contributing root causes.

I said her feedback is really inspiring and I’d love to share it as a blog post for other families. She kindly responded with this:

You can definitely write up a blog post about it. If I can help other families going through the same thing it was all worth it. If you have any other questions don’t hesitate to ask. Thank you again for sharing all your knowledge.

I appreciate her willingness to post their success and her permission to share as a blog post.

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

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

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

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

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

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

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

Have one of your children experienced similar results with GABA offering relief for anxiety, fears and panic attacks? Which GABA product helped your child and how much helped?

When using sublingual or chewable GABA products like GABA Calm, have you found the timing in relation to foods being important?

What dietary changes has your child also made and how have they helped?

If you have questions and feedback please share them here too.

Filed Under: Anxiety, Children/Teens, GABA Tagged With: 5-HTP, 6 year old, amino acids, anxiety, Balancing Neurotransmitters: the Fundamentals program, dietary changes, empty stomach, fears, GABA, GABA Calm, GABA Quickstart online program, Kindergarten, panic attacks, practitioners, pyroluria, school, serotonin, Timing, tracking, tryptophan

Coconut Macaroon Mini Muffin recipe (low oxalate)

January 20, 2023 By Trudy Scott 18 Comments

coconut macaroon mini muffin

If you have dietary oxalate issues (pain, anxiety, insomnia, restless legs, hearing loss, eye issues, unresolved thyroid issues, bladder issues and more) and yet really miss the occasional muffin this Coconut Macaroon Mini Muffin recipe is a delicious low oxalate option. I see way too many so-called healthy gluten-free recipes that use almond flour and it’s concerning given that almonds are high oxalate foods. If you’re new to the dietary oxalate issues you can read more about this below. I’m finding it to be underappreciated as an issue especially in menopausal women when symptoms seem to be more severe in susceptible individuals. I have also found that using almond flour in baking affects your zinc/copper balance, increasing copper and hence causing more anxiety and even panic attacks.

If you don’t have dietary oxalate issues, you can certainly enjoy this recipe too. The addition of flaked coconut does make it similar to macaroons.

Coconut Macaroon Mini Muffin recipe (a low oxalate option)

Ingredients

1/2 cup melted butter
1/2 cup coconut sugar
4 eggs
1/2 teaspoon vanilla
1/2 cup sifted coconut flour
2 cups coconut flakes

Method

Melt the butter over low heat and add the coconut sugar. Once it’s cooled add the eggs and vanilla. Stir in the coconut flour and coconut flakes.

Spoon the mixture into a greased mini muffin pan. Bake at 375 degrees F/ 190 degrees C for 18 – 20 minutes. The muffins don’t rise at all but will start to turn golden brown. Remove and cool on a cooking rack. Makes 12 mini muffins.

Eat warm or when cooled. Serve with butter and/or cream and/or coconut butter. For a little added sweetness a small amount of raw honey can be spread on a muffin too.

coconut macaroon muffins
coconut macaroon muffins

I adapted this recipe from the Coconut Butter Cookies recipe in “Cooking with Coconut Flour” by Bruce Fife ND. I pretty much always do this when I cook – adapt recipes to my needs and likes – and always reduce the sugar. In this instance, I halved the sugar and used coconut sugar.

The original recipe does have a reduced sugar option suggesting using ½ cup of sugar and adding ¼ teaspoon stevia. I’d find this too sweet.

I decided to cook them in mini muffin pans instead of making cookies on a baking tray but you could always try this option. Use the same temperature and cooking time per the original recipe.

They were a little dry (next time I’ll use a little extra butter in the recipe) but eating them with butter and/or cream made them delicious. I tried both – I always like to include some healthy fats. If dairy isn’t tolerated, coconut cream could be substituted. I suspect coconut oil could be substituted for the melted butter but have not tried it.

cooking with coconut flour

Here is “Cooking with Coconut Flour” by Bruce Fife ND. You can find it on Amazon here (my link). I’ve baked a number of recipes from this book and I’m impressed. I really appreciate that it’s all coconut flour recipes with no almond flour or other gluten-free flours used.

It’s ideal to keep baked goods – especially the ones shown on the cover of this book – to a minimum. But for an occasional treat this recipe book is excellent.

If you’re new to dietary oxalates as a possible issue

This blog post is a helpful one to start with if you’re new to dietary oxalates and the issues they can cause: Oxalate crystal disease, dietary oxalates and pain: the research & questions

These are the common medium-oxalate and high-oxalate foods that many folks have problems with: nuts, nut-butters and nut-flour (especially baking with almond flour and something to watch when eating Paleo or GAPS), wheat, chocolate, kiwi fruit (very high – see the raphides image on the above blog), star fruit (also very high), beets, potatoes, sweet potatoes, legumes, raspberries, spinach and soy.

In the above blog post, I share an overview of oxalates, my pain issues with dietary oxalates (severe foot pain and eye pain), and deeper dive into the condition called oxalate crystal disease (with some of my insights and questions).

The big take-aways are that calcium oxalate crystals are sharp and can cause far reaching harm beyond pain – such as unresolved anxiety, thyroid issues, neurological symptoms, eye issues, hearing loss, bladder issues, headaches, fatigue, insomnia, restless legs, autism symptoms and more. You can have issues with dietary oxalates and not have kidney disease/kidney stones, although there is very little research supporting the latter.

You may find these oxalate blogs helpful too:

  • Increased kidney stones in postmenopausal women with lower estradiol levels. What about increased dietary oxalate issues too?
  • Waking in the night due to environmental toxins: impacts on the liver, gallbladder and fat digestion (making oxalate issues worse)
  • Butternut Bake recipe (a low oxalate alternative to Potato Bake)

What dietary oxalates issues have you experienced and has a low oxalate diet helped you?

Do let us know if you make this recipe and enjoy it.

Feel free to share a favorite recipe of something you’ve adapted to be low or even medium oxalate.

If you have questions and feedback please share them here too.

Filed Under: Anxiety, Oxalates, Recipes Tagged With: almond flour, anxiety, bladder issues, coconut, coconut flour, Coconut Macaroon Mini Muffin recipe, copper, dietary oxalate issues, eye issues, gluten-free recipes, hearing loss, insomnia, Low oxalate, menopausal, oxalate, pain, panic attacks, restless legs, unresolved thyroid issues, zinc

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