Trudy Scott Anxiety Nutrition Solutions & Every Woman Over 29

Wean off prescription pain medication, improve sleep and reduce emotional eating with DPA (an endorphin-boosting amino acid)

September 3, 2021 By Trudy Scott 19 Comments

A question about using the amino acid DPA (d-phenylalanine) to help wean off prescription pain medication was posted on the blog. She was also hoping it would help ease her pain while she was weaning and improve her poor sleep too. I share my feedback on DPA for weaning, timing of vitamin C, additional information for sleep support and using DPA for emotional eating too. Concerns about oxalates and pain are mentioned and the importance of a comprehensive approach.

Here is the question that was posted:

Hi Trudy, I am trying to get off prescription pain medication and have read that DPA really helps – do you have any knowledge and/or experience with this?

There is a very popular opiate withdrawal support website that recommends DPA 500mg 3x/daily. Since amino acids need to be taken away from food and other amino acids, I feel like it could be very easy to make the DPA go to waste if not taken at exactly the right time every day.

The insomnia is the worst part of opiate withdrawal for me – days can go by with only 20-45 minutes of sleep. I have a little one to care for and the stress of no sleep just makes me want to give up.

No sleep worsens my physical pain as I toss and turn for hours on end. It isn’t a surprise that then causes terrible emotional distress.

One more question…since Vitamin C does help withdrawal does it affect/break down DPA? I take a liposomal version multiple times a day.

Here is my response: Yes, DPA (d-phenylalanine) does help with withdrawal from prescription pain medication and I’ve used it for this purpose with great success with many clients. It does need to be used away from protein and the dosing can vary for each person.

A starting dose of DPA is 500mg and it can be used 3- 4 x day to start, and we increase from there based on the unique need of each person. We typically adjust the DPA up as the prescription medication is tapered very slowly, and under the guidance of the prescribing physician.

I share more about her vitamin C and insomnia questions below.

If you are new to DPA and endorphin support

DPA/d-phenylalanine is an amino acid used as a supplement.

DPA destroys the enzyme that breaks down/inhibits endorphins and in essence raises endorphin levels. Endorphins are feel-good chemicals that you experience with an endorphin rush when you go for a run or when someone gives you a big hug, when you show kindness to someone or an individual does something nice for you.

Taking the amino acid, DPA, as a supplement helps to raise your endorphins and helps when you feel weepy and overly emotional and reduces the need to self-medicate with treats as a reward or for comfort (more on that below). This amino acid is a favorite with so many of my clients and community because it makes them feel so lovely.

In addition to helping with emotional pain, DPA also helps with easing physical pain. And for this reason it can be used to help get off prescription pain medications.

In summary, these are the signs of low endorphins:

Heightened sensitivity to emotional pain
Heightened sensitivity to physical pain
Crying or tearing up easily
Eating to soothe your mood, or comfort eating
Really, really loving certain foods, behaviors, drugs, or alcohol
Craving a reward or numbing treat

DPA and endorphin support for pain: the research

Here is one paper, which discusses how DPA inhibits or breaks down enkephalins (endorphins are closely related compounds) and as a result helps with depression and pain, and acts as an anti-inflammatory: “proven to be beneficial in many human patients with chronic, intractable pain.” The authors also state that a compound such as DPA “may alleviate other conditions associated with decreased endorphin levels such as opiate withdrawal symptoms.”

This paper discusses beta-endorphins and the reward mechanism and how they can induce euphoria, reduce pain and ease addictions and distress: “Long known for its analgesic effect, the opioid beta-endorphin is now shown to induce euphoria, and to have rewarding and reinforcing properties.”

I would love to see DPA used instead of pain meds when possible or used in conjunction with prescription pain medications when they are needed.

I am also very curious to know which opiate withdrawal support website is recommending DPA. I’m so pleased to hear this because it helps so much – for physical pain relief and for weaning off pain medications.

Is DPA the same as DLPA?

DLPA (dl-phenylalanine), although similar sounding, is not the same as DPA and only offers about half as much endorphin support. It also provides dopamine/catecholamine support (i.e. focus, motivation, mood, energy) and this aspect means DLPA has the same precautions as tyrosine. It also means DLPA can affect sleep if used from midafternoon onwards.

I seldom have clients use DLPA and prefer DPA for endorphin support and tyrosine for dopamine/catecholamine support if needed.

Keep in mind, the amino acid DPA, is not the same as the omega-3 fatty acid called docosapentaenoic acid and also abbreviated as DPA.

The brand of DPA that I recommend for my clients

The brand I recommend for my clients is Lidtke Endorphigen. You can read about it and the other supplements I recommend on the supplements blog here.

My recommendation has always been to chew the DPA capsule for the best effects and to get results quickly (in 2-5 minutes). Instead of chewing the whole capsule I now recommend opening the capsule into your mouth. You can read more about using DPA and some client feedback here.

I’ve used Endorphigen personally too and it’s always with me as part of my travel first-aid kit. I write about using DPA, GABA and acupuncture for pain relief after my back injury and I had DPA, GABA and arnica on hand when I sprained my ankle while hiking in Red Rocks.

Benefits include reduction of emotional/comfort eating too

As I mentioned above, with DPA there is the bonus benefit of endorphin support to help end emotional/comfort eating where you are seeking treats as a reward i.e it helps with physical pain and emotional pain.

You may relate to this if you are someone who would say or think “I just LOVE chocolate-chip cookies!” or “PLEEEEASE don’t make me give up my treats, it’s all I have left after I gave up my coffee and wine! I deserve something nice!”

This emotional attachment to sweet treats and reward-eating is very common with low endorphins.

Using vitamin C with the amino acids and watching for oxalate pain adverse effects

She is correct, vitamin C is best used away from the amino acids so as not to reduce the beneficial effects.

I do caution clients to find the right amount of vitamin C as too much can increase pain in individuals with dietary oxalate issues. I write about oxalate crystal disease here and vitamin C and oxalates here. Both can aggravate insomnia too and increase anxiety.

Address low serotonin, low GABA and/or high cortisol for sleep too

With sleep issues we may also look into supporting low serotonin with tryptophan or 5-HTP, and/or low GABA levels with GABA and/or theanine. These amino acids can also help with reducing pain in some instances.

Opioids have an endocrine effect via impacts on the hypothalamic-pituitary-gonadal axis, affecting sex hormones levels and cortisol levels. Endocrine dysfunction can adversely impact sleep and make anxiety worse, and needs to be addressed. GABA and serotonin support can help with some of the sex hormone imbalances and Seriphos helps when cortisol is too high.

A comprehensive approach is key

Of course, a comprehensive approach is key, so it’s important to remove inflammatory foods (gluten, maybe all grains, sugar, caffeine, unhealthy fats etc), add fish oil if omega-3s are low and include anti-inflammatory nutrients such as turmeric.

And we always want to figure out the root cause of the pain and address it. Also, ruling out if dietary oxalates (and vitamin C) are an issue is important and often overlooked.

I’m a big fan of working with a physical therapist and acupuncturist too.

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

If you are new to using the amino acids, DPA, tryptophan or GABA, as supplements and want to know more, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution and a brief overview here, Anxiety and targeted individual amino acid supplements: a summary.

If you suspect low endorphins, low serotonin or low GABA levels 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.

Can you relate to any of this? Has DPA helped your pain and/or helped you withdraw from prescription pain meds? And did you even know this was an option?

Did it also help you sleep and make you less anxious/worried because of the reduction in pain?

What about less emotional eating when using DPA/Endorphigen?

Feel free to post your questions too.

Teen with anxiety, low self-esteem and insomnia: how to do a one-off trial of tryptophan to figure out if she has low serotonin

August 20, 2021 By Trudy Scott 23 Comments

A mom asks for advice for her teenage daughter who has anxiety, low self-esteem issues, insomnia, experiences negativity and has phobias. She wants to know if serotonin support may help and where to start. I share my feedback confirming that these are low serotonin symptoms and that I would do a trial of tryptophan. I go deeper in this blog and also go into detail about how I would do a one-off trial (or evaluation) of tryptophan if I was working with this family. I also share why I’d look into low GABA, seasonal allergies and the birth control pill. And I discuss the importance of being proactive given the increasing suicide and self-harm in this age-group, with the pandemic compounding the increase.

Here is the question that Maria asked about her daughter:

My 13-year-old teen has always suffered from insomnia, sometimes light, sometimes a bit heavier, depending on the period. She has suffered from asthma from a young age, even if this issue has improved enormously, it is sometimes present, specially during spring time as she is allergic to different plants. She would suffer from sugar cravings in the past as we were trying to change her diet. Things are going better in this respect as well; however, negativity, phobias, low self esteem and anxiety are always present for her.

Are these signs of low serotonin? How could we help her feel better? Should serotonin pills be applied directly? Would this make the system dependent on it? If amino acids should be supplemented, how should we do this, considering her age?

I responded that yes, negativity, phobias, low self esteem and anxiety (the worry type) are signs of low serotonin. Insomnia can also be caused by low serotonin especially if her daughter is lying awake, overthinking and worrying about things.

I shared that the body does not get dependent on the amino acids and I’d consider a trial of tryptophan to address her symptoms.

Doing a one-off trial/evaluation of tryptophan based on her symptoms

If I was working with this family, I would help this mom figure out for sure if her daughter has low serotonin by reviewing the low serotonin symptom list with her, and helping her rate them on a scale of 1-10 with 10 being the worst.

This can often be challenging for a 13-year old: giving the symptoms a severity rating and being able to identify exactly how she feels. Her ratings may also be reflective of where she is in her cycle at the time and may fluctuate more in the month if her cycle is not yet regular. Working together with mom we can hopefully figure this out. If not, we do the best we can with the information we have.

The next step is picking one or two symptoms that are easy to measure the day we do the initial trial or evaluation. For this young girl I’d pick anxiety/worry and negativity and ask her some questions that would help us assess before and after results of the one-off trial /evaluation of tryptophan:

For anxiety and worry she may say it’s also a 9 and give me this example: “I’m really worried about performing in the concert – I keep thinking about it all day long and at night.”
For negativity she may say it’s a 9 and give me this example: “I really don’t think I’m good enough to be in the dance class.”

Both tryptophan and 5-HTP can raise serotonin but I like to start with tryptophan. I typically start with 100mg Lidtke chewable tryptophan in children/teens so I’d have her chew one tablet and then check back in the next 2 to 5 minutes (or maybe a little longer for some folks).

This is the kind of feedback I’m looking for:

With regards to anxiety and worry she may say: “Gosh, I completely stopped thinking about the concert. I’m not worrying about it at all. Now that you ask I’m thinking about it again but I think my worry/anxiety is about a 5 now.”
With regards to negativity she may say: “I think I feel better about being in the dance class. I think I can do it. My negativity feels like it’s a 5 or 6”

Since this teen responded so well, I’d have her start taking tryptophan midafternoon and evening (away from protein) and we’d increase if needed, each week, and based on her symptoms.

I have everyone keep a food mood and supplements log and mom could help her do this too.

GABA, seasonal allergies and the birth control pill

I also always assess low GABA when someone is anxious (especially if she also has physical anxiety, tension, stiff muscles) and has insomnia. We’d do the same one-off trial with a product like GABA Calm (or similar) once we’ve established a good dose of tryptophan for easing her symptoms.

This mom also mentioned Spring time allergies so I also shared this blog with her: 5-HTP and/or tryptophan to help with increased anxiety, panic attacks and depression caused by spring allergies. Depending on the season, her daughter may score higher on some of the low serotonin symptoms.

I’d also want to know if her daughter is on a birth control pill (often prescribed at this age for acne) because it can contribute to anxiety and depression.

Being proactive is wise given the rise in suicide and self-harm in this age group

Being proactive about addressing low serotonin symptoms quickly is wise given the rise in suicide and self-harm in this age group. This 2021 Italian study discusses the role of emotional dysregulation when it comes to and self-injurious thoughts and behaviours in high-school students:

Overall, 11.1% of adolescents reported self-harming behaviours without suicide ideation or attempts, 6.4% declared having thought to suicide without acting a suicide attempt or self-harm, 1.4% declared having attempted suicide and really thought to take away their life.

Unfortunately, the pandemic has also made things worse for many adolescents. This study reports that Canadian adolescents appear to be experiencing “higher rates of self-harm thoughts and behaviours relative to before the pandemic.”

It’s important to keep in mind that pre-teens and teens may not be willing to admit that they are engaging in self-harm like cutting or burning, or thinking about taking their lives.

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 and low GABA 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. It’s a comprehensive approach – amino acids AND diet. I’d also want to know what her diet is like right now – gluten-free, sugar-free, caffeine-free, eating protein at breakfast for blood sugar control, real whole foods, grass-fed red meat, wild fish, fermented foods etc?

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.

Thanks to this mom for asking the question and allowing me to use it as a teaching tool for my community. Let’s get her daughter and all teens feeling their best again.

Can you relate to the question this mom asked? Does it sound similar to what your daughter is experiencing right now or a client/patient?

Do you do a one-off trial /evaluation like this to find out if serotonin support is needed? Or have you done this in the past with your daughter, family member or yourself?

What are the before and after questions (and symptom ratings) and did tryptophan help?

Feel free to post any 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.

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.

Twisties, nervousness and demons at the Olympics: Outpouring of love and support for Simone Biles for taking care of her mental health

July 30, 2021 By Trudy Scott 10 Comments

Simone Biles at a training session at the Rio 2016 Summer Olympic Games (Salty View / Shutterstock.com)

There has been an incredible outpouring of love and support for gymnast Simone Biles, as she withdrew from the 2020 Olympics Women’s Team final on Tuesday and All-Around Individual Final on Wednesday. This was due to the twisties, nervousness and mental demons. I’ve decided to gather some of this admiration into a blog post as a testament to Simone who I adore and respect even more than I did before today. I want this to be all about the love and support, but in order to tie it all together, I share more on the twisties (and anxiety), being vulnerable and taking care of yourself, nutritional psychiatry, using amino acids and mental health advocacy below.

Before we get into all that, here is an ET video that explains some of the backstory leading up to this:

Simone shares that she feels good physically but emotionally, her feelings vary by the day. She also talks about the stress of the Olympics and being the star gymnast and that she feels she has the weight of the world on her shoulders.

You’ll also see and hear the love and support she gets from her team members and fellow gymnasts. Two-time Olympian, Aly Raisman, says this about Simone: “She is human too and sometimes people forget that. She is doing the best she can.”

The love and support continued to show up all over social media (and is still showing up)! What follows are some of my favorite posts and mentions.

The love and support – Simone Biles already won

Women Hold Up Half The Sky, a community that empowers women to find their voice and celebrates women in their diversity, shared this powerful post when Simone withdrew:

“Simone Biles already won” and how she has “shattered records to become the world’s most decorated gymnast, has four moves named for her and fought on behalf of abuse survivors.”

Simone is one of many young female gymnasts who were sexually abused by disgraced former USA Gymnastics doctor Larry Nassar. This article in Elle covers her story and goal to be an advocate for other young girls.

We are just as proud of you today as yesterday

Jen Hatmaker, New York Times bestselling author of “Simple and Free” posts this lovely uplifting message, ending with:

I’ll tell you what, Simone Biles, the only thing withdrawing from the team competition told me is that absolutely nothing is more important than your mental health, and rather than push through until you had an utter breakdown emotionally or physically, you had the strength of character to step down. The watching, expectant eyes of the whole world are a heavy burden none of us understand.

Your IG caption on July 7th said: “Whatever is good for your soul, do that.” And you did. Well done.

Because this life is a long game, little sister. No matter what everyone is telling you, this is NOT your one moment. It sure isn’t. Most of your moments are ahead of you in fact, and you get to choose how you want to live them.

We are just as proud of you today as yesterday, and we will be proud of you for all your tomorrows. Catch your breath, girl. You are already a champion.

I wholeheartedly agree, nothing is more important than her metal health. Too often we put on a brave face and push through. Simone didn’t and for that we are super-proud of her – for her own physical and mental health, and for being a role model to girls and women around the world.

Simone Biles and Naomi Osaka are the role models I want for my girls

Diary of a Mom, mother, intersectional advocate, believer in the power of community, posted this beautiful message about strength, bravery, vulnerability and Simone and Naomi being role models for her daughters:

I have long admired Simone Biles, but I am now officially in awe of this young woman.

We knew she was strong. We knew she was brave. But, by god, the courage and resolve that she has shown in the last two days are just BEYOND.

To stand firmly in one’s own humanity and to say, from that incredibly vulnerable place, “My safety comes first,” should not have to be a radical act, but it is. Oh, how it is. In the world in which we live (and far more so in the rarified air of elite competition), it is not just radical, it’s revolutionary.

Simone Biles and Naomi Osaka are the role models I want for my girls. Women who know their worth. Who declare and own and defend their *inherent* value – not based on what they can do but on who they are. Women who achieve incredible things not despite their perfectly human limitations but precisely *because* they are willing to acknowledge and respect them.

Yes, these are the role models I want for my girls.

Bravo, Simone.

#GOAT

I applaud this strong woman and amazing athlete

Mary Kay Irving, Therapist/Care Coordinator at Boulder Community Health and Owner at Boulder Center for Health and Nutrition, shares this message.

I applaud this strong woman and amazing athlete for prioritizing her own needs….i.e.. mental health needs. #destigmatizementalhealth #mentalhealthawareness

I also applaud Simone and support her decision to take care of her mental health needs no matter how hard it must have been for her!

Simone is an absolute legend!

My friend and colleague Dr. Jessica Drummond, a functional nutrition and integrative women’s health expert, and founder of Integrative Women’s Health Institute, says Simone is an absolute legend:

Simone is an absolute legend. The fact that she landed this AT ALL is AMAZING. I was a gymnast for 13 years. You have to be able to just “feel it” in the air or you literally crash because there’s no awareness of where the floor/ apparatus is. Literally anyone else would have had a serious physical injury from this challenge to her nervous system in mid-air… especially with the amount of pure power that Simone throws around.

This is so great for people, especially our youth athletes, to see

Another friend and colleague, Beth Jones who is a Female/Teen Athlete Wellness & Mindset Coach, posts this.

I’m grateful for athletes like Simone Biles and Naomi Osaka who are coming forward (and professionals as well) to normalize mental health as a key piece of sports training and recovery.

I could not agree more.

In this post, Beth also shares Simone’s press release video where she fully advocates for her mental health and personal performance, keeping the team dynamic in mind, and also sets a wonderful example for young athletes

Sometimes you need to hear it from the GOAT’s mouth.

My understanding is that she hasn’t made a final decision regarding continuing competition in the individual event finals. She has an amazing support staff around her, including mental health specialists, who can help her make the best decision for her. I also wanted to share this video – it’s her interview explaining the decision in her own words.

She is fully advocating for her mental health and personal performance, while also keeping the team dynamic in mind. This is so great for people, especially our youth athletes, to see – there are not a lot of athletes who will speak candidly in this way.

I’m glad that athlete mental health is finally getting some of the recognition it deserves – think about how much stress and frustration not being scored on your achievements (link in comments) must have been for her on top of everything else.

The mindset that mental “injury” creates absolutely ties into, not only performance but injury prevention. The level of skill that all Olympic athletes are competing at is so high and second-guessing or not being fully focused leads to injury.

Thank you for finding your voice and staying true to yourself.

Tyler Gordon, a 14-year old artist who seeks to inspire through the stories of heroes in his work, tweeted this sweet message with his painting of Simone:

Dear Ms. @Simone_Biles Thank you for finding your voice and staying true to yourself. I know it was hard, scary, and you probably felt alone. But you powered through and are still the peoples champion!

This young man is kind-hearted and has talent! You can actually watch him painting Simone here.

Unfortunately, there have been way too many negative comments. I believe these are people who don’t understand mental health. You don’t have to have broken your back to have compassion for someone who has but there are still too many people who can’t understand mental health or have empathy until they have experienced it or see a loved one experiencing it. I’m hopeful all this media attention will help create more awareness, compassion and kindness.

The twisties and how stress and anxiety can play a role

In case you are new to this term (like I was until this week), this article explains what the twisties are – Simone Biles Mentioned Having ‘the Twisties’ – Here’s What That Means, and Why It Can Be Dangerous in Gymnastics:

The twisties is an informal term used to refer to a certain kind of mental block that a gymnast can experience as they are in the air during a twisting skill. When someone gets the twisties, there is a disconnect between the brain and body, Jamie Shapiro, PhD, a certified mental performance coach who is the co-director of the Masters in Sport and Performance Psychology program at the University of Denver

In this same article, Dr. Shapiro, a former gymnast herself, shares how this loss of control can have both physical and mental implications:

Physically, the twisties can make a gymnast unable to perform the skills as they were previously able to.

Mentally, that inability to perform the skills can cause anxiety, exacerbating the mental block.

Allie Wagener, PhD, a licensed psychologist who specializes in sport and performance psychology at Premier Sports Psychology and is also a former gymnast shares how dangerous this can be in terms of injuring yourself when “you don’t know where you are in the air and you don’t know how to land.” It’s also terrifying for the gymnast and that worry and fear about it happening again can make things worse.

I wanted to understand more about the “twisties” in gymnastics and asked Jessica Drummond how similar are they to the yips, which happen in golf or baseball, and which I know are closely tied to increased anxiety/stress. The stress/anxiety can be a trigger and then having the yips make your anxiety and fears worse. Jessica confirmed this about the twisties:

Yes, it’s sort of a loop that can get stuck – get lost in the air (cognitive, proprioceptive, vestibular) –> realize how dangerous that is/ was/ could be –> fear –> stress –> exacerbates the original brain-based issue.

I encourage you to read the entire article to see how stress and anxiety, racing/negative/distracted thoughts, fear of failure, high expectations and even focal dystonia (involuntary muscle spasms) can play a role.

The experts also mention a number of possible techniques to help (like progression, focusing on a different skill, using simple cue words to “keep you focused on the skill rather than the fear”), speaking with a sports psychologist and taking a break.

There is no mention of “nutritional psychiatry” as a possible solution (and I share more on this below).

What Simone has shared – I’m a little bit more nervous

Right now, we don’t know exactly why Simone experienced the twisties or if any of the above apply to her, but we do know some of what she has shared with the media up until now.

In this article Simone said she wasn’t physically injured but fighting some mental demons and had experienced a little injury to her pride. She said that “after the performance I did I just didn’t want to go on,” saying it was all in her head. Simone also emphasized the need to protect her body and mind, saying “I have to focus on my mental health and not jeopardize my health and well-being.”

An article in Women’s Health Magazine reports her comments at a press conference after the USA team won the Silver medal. Simone shared how she just doesn’t trust herself as much as she used to, wasn’t having as much fun as usual and admitted that “I’m a little bit more nervous when I do gymnastics.”

It was here that she announced that she had the twisties.

Around this time USA Gymnastics announced Simone had withdrawn to focus on her mental health. They also offered their support:

We wholeheartedly support Simone’s decision and applaud her bravery in prioritizing her well-being. Her courage shows, yet again, why she is a role model for so many.

A place for “nutritional psychiatry” and “anxiety nutrition solutions”

My hope is that more and more “nutritional psychiatry” and “anxiety nutrition solutions” (like the use of GABA, tryptophan and other amino acids) will make it into the world of professional (and recreational) sports. I’d like to see this embraced by athletic coaches, registered dieticians and psychologists working with athletes, and hopefully some of the athletes themselves.

Research shows that elite young athletes have high psychological demands:

Elite young athletes have to cope with multiple psychological demands such as training volume, mental and physical fatigue, spatial separation of family and friends or time management problems may lead to reduced mental and physical recovery.

The paper concludes that:

Future research should focus on sports medical and sports psychiatric interventional approaches with the goal to prevent anxiety and depression as well as teaching coping strategies to young athletes.

I recently blogged about how the amino acid tyrosine erased severe performance anxiety in a female musician – to such an extent that she had no more shaking, sweating, panic attacks or passing out. Much of this could be applied to an athletic performance where low dopamine is a factor.

This recent blog resonated with many in my community: What if overthinking, fear, anxiety and worry (caused by low serotonin) is holding you back instead of low motivation/low dopamine? Much of this could also apply to athletes with the twisties or yips with low serotonin as a root cause.

My book, The Antianxiety Food Solution, is a great place to start with the foundations of eating to reduce anxiety (real whole food, no gluten, no caffeine, no sugar, eating for blood sugar control and gut health) and more advanced interventions (like using the amino acids GABA, tryptophan, 5-HTP, tyrosine, DPA and glutamine for balancing brain chemistry, and addressing low zinc and vitamin B6 for pyroluria/social anxiety.)

All this is clearly very needed, and the research and awareness are growing in leaps and bounds, but as Beth Jones, Female/Teen Athlete Wellness & Mindset Coach, shares, what an amazing shift it would be if we could add more “nutritional psychiatry” into the sports psych training:

Coming from 20 years working in sports med with athletes, I keep coming back to wishing there was a degree that combined sports psychology & nutrition (functional & fueling). I started looking into the more mental aspects of performance and healing and then also bringing in more nutrition aligned with healing needs about 15 years ago, but it was all on my own.

What I’ve been learning from you has given me some new tools to share, but you’re right in that they are not well known. I know our US Olympic Committee has amazing health professionals in all areas that work as a team approach for our athletes, but I wonder how many of the RDs are actually having conversations with the mental health team and collaborating taking all of the athlete-specific nuances into consideration.

I know my own therapist suggested that I not pursue sports psych because of the lack of support among therapists out there, but what an amazing shift it would be if we could add more nutritional psychiatry into the sports psych training? Trying to forge a path in this area on my own, but it’s a lot of bush-whacking and little progress.

Beth raises some excellent points and as I said above, hopefully more and more of the “anxiety nutrition solutions” and “nutritional psychiatry” will make it into professional and recreational sports.

It’s ok to say you’re not ok mentally

Simone has noticed and embraced the love and support she’s been receiving. She tweeted this:

The outpouring [of] love & support I’ve received has made me realize I’m more than my accomplishments and gymnastics which, I never truly believed before

She is way more than her accomplishments and gymnastics.

Naomi Osaka penned an article in Time magazine with this title: ‘It’s O.K. Not to Be O.K.’ She wrote this shortly after she withdrew from the French Open to tend to her own mental health. Naomi’s openness has inspired Simone to speak out.

When athletes like Simone and Naomi prioritize their own mental health and are public about it, they are paving the way for it being ok to say you’re not ok mentally. Through their honesty and vulnerability, they have become role models and mental health advocates, and we applaud them for that.

But most of all we applaud them both for taking care of their mental health!

What love and support can you share for Simone and Naomi? Feel free to post in the comments.

Does this motivate and inspire you to be more open about your own anxiety and mental health challenges (if you have not been open yet)?

If you’re an athlete (professional or recreational), does any of this resonate with you and have the amino acids or diet helped you with your anxiety?

If you work with athletes (professional or recreational), I’d love to hear if this resonates with you and if you’re using nutritional psychiatry approaches with them to help ease their anxiety?

If you have connections to athletes (professional or recreational), or coaches, dieticians or psychologists who work with athletes, please share this blog and my work, so we can get nutritional psychiatry resources and anxiety nutrition solutions into their hands and help more athletes.

Tryptophan supplementation for anorexia?

July 9, 2021 By Trudy Scott 27 Comments

This blog post highlights the potential importance of tryptophan supplementation in improving therapeutics in anorexia (and other eating disorders) and some of my insights about the 2017 anorexia-tryptophan study. I also share the high incidence of eating disorders, overlaps with anxiety and the case for tryptophan supplementation given the many low serotonin symptoms (anxiety, obsessive thoughts/behaviors, perfectionism, negative-self-talk, low self-esteem and depression) we see with anorexia and other eating disorders. And the importance of a comprehensive nutritional approach.

I’ve updated the original blog with newer research on low zinc and iron with males with eating disorders – and how this ties in with serotonin production and also pyroluria (read on below).

According to The National Eating Disorders Association (NEDA), eating disorders are

serious but treatable mental and physical illnesses that can affect people of all genders, ages, races, religions, ethnicities, sexual orientations, body shapes, and weights. National surveys estimate that 20 million women and 10 million men in America will have an eating disorder at some point in their lives.

While no one knows for sure what causes eating disorders, a growing consensus suggests that it is a range of biological, psychological, and sociocultural factors.

While NEDA does acknowledge that some of the causative factors may be biological, unfortunately there is no mention of nutritional psychiatry or tryptophan on the site. You’ll see this to be the case in the majority of conventional treatment centers.

The 2017 paper on tryptophan potential for anorexia

The paper, Improving therapeutics in anorexia nervosa with tryptophan, does acknowledge that the “growing body of evidence suggests that our diet is an important contributing factor in the development, management and prevention of a number of psychiatric illnesses.”

It discusses what we know about tryptophan being “the sole precursor” of serotonin, a neurotransmitter and that when used as a supplement it has therapeutic benefits when serotonin is low.

The author proposes that excessive dieting and food restriction decrease brain tryptophan and serotonin and propose the “potential importance of tryptophan supplementation in improving therapeutics in anorexia patients” (together with psychotherapy).

Given that anorexia has the “highest lethality of all psychiatric illnesses” and that there are currently “no FDA approved pharmacological treatments available” for anorexia, the urgency for implementing nutritional psychiatry approaches is high. The authors also share that the antidepressants and antipsychotics which are commonly used to treat the co-occurring anxiety, depression, OCD and psychosis are not very effective.

The author mentions a paper that used 250 mg tryptophan twice a day but based on my work with individuals with anxiety, we know an individualized approach is best. A typical starting dose of tryptophan is 500mg used once or twice a day and I use the trial approach to determine the ideal dose for each person.

Incidence of anorexia and eating disorders in general

Here are a few select anorexia and eating disorder statistics from NEDA. I find much of this alarming and in some cases surprising (like the high incidence of males who are affected):

40% to 60% of elementary school girls (ages 6-12) are concerned about their weight
2% to 13% of adolescent girls meet the criteria for eating disorders
Males represent 25% of individuals with anorexia (they are at a higher risk of dying because they are often diagnosed later since many people assume males don’t have eating disorders)
Male athletes, especially those competing in sports that emphasize diet, appearance, size and weight, are at risk. In weight-class sports (wrestling, rowing, horse racing) and aesthetic sports (bodybuilding, gymnastics, swimming, diving) about 33% of male athletes are affected. In female athletes in weight class and aesthetic sports, disordered eating occurs at estimates of up to 62%.
In one study of ultra-Orthodox and Syrian Jewish communities in Brooklyn, 1 out of 19 girls was diagnosed with an eating disorder, which is a rate about 50 percent higher than the general U.S. population.
Despite similar rates of eating disorders among non-Hispanic Whites, Hispanics, African-Americans, and Asians in the United States, people of color are significantly less likely to receive help for their eating issues.
Elevated rates of binge-eating and purging by vomiting or laxative abuse was found for both males and females who identified as gay, lesbian, bisexual, or “mostly heterosexual” in comparison to their heterosexual peers.

[You can find the actual stats and studies quoted above at the NEDA stats link.]

Prevalence of anxiety and making the case for low serotonin

The prevalence of anxiety is high in those with eating disorders (which is one of the reasons for this particular blog):

Anxiety is also diagnosed in 48-51% of people with anorexia nervosa, 54-81% of people with bulimia nervosa, and 55-65% of people with binge eating disorder
Two-thirds of people with anorexia also showed signs of an anxiety disorder several years before the start of their eating disorder.

In one study, after dietary treatment (called refeeding), plasma tryptophan levels normalized in patients with anorexia:

Disturbance in serotonin function has been described as central to the psychobiology of this disorder

Plasma TRP normalizes during the course of refeeding, supporting the hypothesis that serotonin function is disturbed in patients with anorexia nervosa.

We also see a large number of low serotonin symptoms in those with eating disorders:

Childhood obsessive-compulsive traits, such as perfectionism, having to follow the rules, and concern about mistakes, were much more common in women who developed eating disorders than women who didn’t.
Binge eating disorder patients … also had significantly higher levels of negative affect, and lower self-esteem
In a study of women with eating disorders, 94% of the participants had a co-occurring mood disorder

[You can find the actual stats and studies quoted above at the NEDA stats link.]

There are all classic low serotonin symptoms: obsessive thoughts/behaviors, perfectionism, negative-self-talk, low self-esteem and depression.

This further supports the rationale for tryptophan supplementation and is another reason for this blog. I have extensive experience in the use of tryptophan and 5-HTP and believe they should be part of all eating disorder programs.

There is one big difference in that typically we see afternoon and evening sugar and carb cravings with low serotonin-type anxiety. Whereas with anorexia, the low self-esteem, obsessive thinking and body dysmorphia (feeling shame or disgust with parts of their body or appearance) may prevent someone acting on these cravings. However, if there are sugar and carb cravings (and bingeing), this is the time they will typically occur.

Here are two recent blog posts that share case studies where tryptophan was used with success:

Anorexia and other eating disorders require a multidisciplinary team and a targeted nutritional approach

I don’t currently work with clients with anorexia as it requires a multidisciplinary team. I did, however, work with a few clients with anorexia when I worked at Recovery Systems over 10 years ago. They had a therapist, nutritionist and doctor on their team and a nutritional approach led to more improvements than they had experienced at prior in-house eating disorder clinics where they had received psychological support only or psychological support and medication. Our approach included addressing low serotonin with tryptophan or 5-HTP, addressing low zinc and low iron, low vitamin D, addressing the gut/microbiome, low B vitamins, low omega-3 fatty acids and more (based on the unique needs of the client).

I now refer eating disorder clients to Dr. James Greenbatt, MD, an eating disorder specialist and integrative psychiatrist. He has a wonderful book on the topic: Answers to Anorexia – a Breakthrough Nutritional Treatment That is Saving Lives, with the second edition coming out soon. In the first edition he does address neurotransmitter deficiencies but we differ in our approach. He doesn’t use individual amino acids like tryptophan or 5-HTP and prefers to use a blend of amino acids based on a blood or urinary amino acid test.

In this article, New Approaches to Treating Anorexia, Dr. Greenblatt covers the multidisciplinary aspect, current treatment options, the limited medical options and the need for targeted nutrition therapy. Although this article doesn’t address tryptophan and low serotonin, he does discuss the key role of zinc, B vitamins and omega-3 fatty acids.

UPDATE: October 10, 2024

Given that most of the eating disorder research is conducted primarily in females, it’s encouraging to share the results of this 2022 paper, Sex differences and associations between zinc deficiency and anemia among hospitalized adolescents and young adults with eating disorders, which reports that “zinc deficiency is equally severe and anemia is more common in hospitalized males with eating disorders compared to females.”

Liquid zinc sulfate tastes like water when zinc levels are low. I saw those with anorexia being willing to drink it when I worked in Julia Ross’ Clinic, so it’s a relatively easy way to start to increase zinc levels and improve appetite. Zinc and iron both help increase serotonin production, and zinc is key for pyroluria/social anxiety which is common in this population.

Also, with pyroluria, morning nausea negatively affects appetite so it’s often helpful to address this in conjunction with using amino acids. Vitamin B6 is part of the pyroluria protocol and is another serotonin co-factor. Evening primrose oil, also part of the pyroluria protocol, improves zinc absorption. This is all covered in the pyroluria chapter in my book.

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

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

Have you (or a loved one) been diagnosed with anorexia or another eating disorder?

Did you see the most success with an approach that included nutritional psychiatry and serotonin support with tryptophan or 5-HTP?

What else has helped?

Feel free to post any questions here too.