Trudy Scott Anxiety Nutrition Solutions & Every Woman Over 29

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

August 13, 2021 By Trudy Scott 6 Comments

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

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

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

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

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

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

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

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

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

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

The pesticide warehouse fire and spill

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

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

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

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

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

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

Excellent coverage by environmental journalist, Tony Carnie

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

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

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

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

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

Red flags about the fire and spill that concern me

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

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

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

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

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

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

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

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

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

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

Update August 17th: The list of chemicals

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

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

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

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

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

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

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

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

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

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

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

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

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

Practical solutions for short-term immediate exposure

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

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

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

My additions were as follows:

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

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

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

Detoxification solutions, and respiratory and immune health

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

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

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

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

Sleep, stress/anxiety, pyroluria and immunity

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

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

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

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

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

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

Potential long term impacts on mental and physical health

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

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

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

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

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

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

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

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

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

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

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.

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.

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 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.

What if overthinking, fear, anxiety and worry (caused by low serotonin) is holding you back instead of low motivation/low dopamine?

July 2, 2021 By Trudy Scott 50 Comments

One of the first things that comes to mind when someone is stuck and not able to get things done is low motivation caused by low catecholamines/low dopamine. But what if overthinking, fear, anxiety and worry (caused by low serotonin) is holding you back instead? The following case may help you figure it out if any of this applies to you.

William asked this question on one of the tyrosine blogs, justifiably thinking he may need tyrosine to get unstuck:

Excellent article. I may try tyrosine. I have anxiety and shut down when I am about to start something or my mind overthinks and I shut down with worry. I have problems sleeping. I take a group of things…GABA, glycine, 5-HTP but still wake at 3am.

Anyway I always have GOOD intentions of doing things when I wake in the morning….then it goes downhill. I was not always like this but got worse with STRESS from work and now I FIGHT myself to actually do something I used to LOVE to do. Makes me MAD!

I actually am AFRAID just thinking about taking Tyrosine {Not funny}

I FEAR so much it becomes stupid. I think of doing things and SHUT DOWN with worry.

I want my life back…life is too short to suffer knowing HELP is so close. What do you think? Love your articles…

I think this is a great question many others in my community may relate to so I’ve decided to do this as a blog post with his question and a longer response.

I thanked him for his kind words, saying I can’t offer advice via the blog but can share that we need to be careful with tyrosine when someone has sleep issues or anxiety. I also offered some brief thoughts which I’ll elaborate on here so you can understand my thinking as I work with someone.

Is it low motivation caused by low catecholamines/low dopamine?

The first thing that comes to mind when someone is stuck and not able to get things done is low catecholamines and low dopamine. The classic signs are lack of motivation, fatigue, poor focus and feeling depressed, often using sugary foods or drinks for an energy pick-up (especially in the afternoon).

William may feel that he has low motivation and needs tyrosine because he can’t get things done or he starts something and can’t complete it.

His intentions are good but he has to push himself or as he says “fight myself” to get things done. Because of this he feels tyrosine may be the next amino acid he should trial.

Why I would investigate and address low serotonin

William says he has anxiety and also has trouble sleeping. This could be related to low serotonin and/or low GABA.

However when someone has anxiety and insomnia and I hear the following words/phrases, I immediately think low serotonin should be investigated and addressed:

“My mind overthinks”
“I shut down with worry”
“I actually am AFRAID just thinking about taking Tyrosine”
“I fear so much”

All of the above can hold you back and look like low motivation when it is actually worry and fear that is holding you back.

Typically, with low serotonin, you could also second-guess things you do, experience negative self-talk, have a lack of confidence when doing things, get stuck because of perfectionism and may even feel like an imposter. You may also be very controlling and want to do it all yourself and not be willing to delegate – this can hold you back too.

All this and anything else on the list of low serotonin symptoms would further suggest we need to address this first.

Finding the ideal serotonin support for his needs

He is currently taking GABA, glycine and 5-HTP but still wakes at 3am. And he is still anxious.

I would work to optimize 5-HTP dosing (increasing every few days to see if more helps) or switch to tryptophan if the increased dose isn’t helping. Some folks do better one one versus the other and 5-HTP can raise cortisol in some instances causing a wired-tired feeling.

I’d do the same with GABA once the ideal dose of 5-HTP or tryptophan is found. This helps improve sleep and reduce anxiety too.

And I’d look into high cortisol in case this is causing his 3am awakenings.

Once he has ideal serotonin support for his needs, the overthinking will stop, the worry will go away and his fears will vanish – and he will be able to complete things he starts.

Being well rested because of a great night’s sleep is going to help a great deal too.

There may be a need for tyrosine now or later

I may be wrong and there may in fact be a need for tyrosine now. These cases illustrate tyrosine helping when it didn’t seem it would:

There may also be a need for tyrosine later and a trial will provide the answers.

Right now William is “AFRAID just thinking about taking Tyrosine” but once his serotonin levels are ideal he should no longer have this fear.

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 and a brief overview here, Anxiety and targeted individual amino acid supplements: a summary.

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 so you are knowledgeable.

As with all individual amino acids we use them for quick relief of symptoms. And we also always focus on the foundations like diet, the gut, adrenals and stress levels.

We appreciate William for asking this question so we all get to learn. Hopefully he’ll jump on and add to the discussion and share his results later.

Can you relate to his lack of motivation showing up as fear, worry and overthinking instead and holding you back?

What about these other low serotonin symptoms keeping you stuck: second-guessing, negative self-talk, lack of confidence, perfectionism, imposter syndrome and controlling?

Has using tryptophan or 5-HTP allowed you to get past some of this so you can get things done?

Did you also have to address low dopamine and actual low motivation, poor focus and fatigue with tyrosine?

Feel free to post any questions here too.

Alice in Wonderland Syndrome – is there a pyroluria connection?

June 25, 2021 By Trudy Scott 48 Comments

I first learned about Alice in Wonderland Syndrome (AIWS) during one of the Anxiety Summits. I’m surprised at how many queries I get about this syndrome and the fact that everyone who has reached out also has the social anxiety condition called pyroluria or suspects they have it.

This 2017 paper, Alice in Wonderland Syndrome: A real life version of Lewis Carroll’s novel, describes it as follows:

Alice in Wonderland Syndrome was originally coined by Dr. John Todd in 1955. The syndrome is named after the sensations experienced by the character Alice in Lewis Carroll’s novel Alice’s Adventures in Wonderland. Alice in Wonderland Syndrome consists of metamorphopsia (seeing something in a distorted fashion), bizarre distortions of their body image, and bizarre perceptual distortions of form, size, movement or color. Additionally, patients with Alice in Wonderland Syndrome can experience auditory hallucinations and changes in their perception of time. Currently, there is no known specific cause of Alice in Wonderland Syndrome. However, theories point to infections such as the Epstein-Barr virus, medications such as topiramate and associated migraines.

You can read about all the types of visual and non-visual distortions in this paper: Alice in Wonderland syndrome – A systematic review. This paper also includes a list of conditions in which Alice in Wonderland syndrome has been described in the literature, with infections and migraines being very common. The authors also feel that what we see in the published literature may only be the tip of the iceberg:

Since 1955, no more than 169 case descriptions of AIWS have been published. The literature indicates that this may be only the tip of the iceberg, with many individual symptoms of AIWS being experienced (albeit occasionally and only fleetingly) by up to 30% of adolescents in the general population.

The published case numbers have increased slightly (this paper was published in 2016) and it’s reported that many of the 30% of adolescents with AIWS experience non-clinical symptoms i.e. they are not severe enough to need treatment.

I still find “up to 30% of adolescents in the general population” to be very surprising for a syndrome which was once considered very rare and is frequently misdiagnosed.

Read on to hear from some folks in my community who have reached out and described their AIWS episodes. They all have pyroluria and I’d love to know if there is a possible connection.

Everything either looks really far away but massive or really close up but tiny

Sallie, a mom in my community, shared about her son and what he experienced in the comments section of the pyroluria prevalence and associated conditions blog. During his episodes, everything either looks really far away but massive or really close up but tiny:

I believe he has Alice in Wonderland syndrome. I have taken him to GP’s, pediatricians, optometrists, opthamologists and no one knew what was wrong. I spent about 6 months researching the possibilities myself and came across AIWS. When I showed him some of the journal articles, he was so relieved to finally have an answer. Since then, I have had a gut feeling that pyroluria and AIWS may be linked somehow.

She believes his AIWS may have been triggered by an infection when he was around 6 years of age. He developed sudden onset of vomiting, fever and delirium:

Still to this day, he distinctly remembers this night and recalls (like it was yesterday) not being able to stop looking at his hands because they were changing size and how far away/close up they were.

Once he was old enough to articulate what he was experiencing, he was able to tell me he feels weird, like he needs to go to a pitch-black room and lie down. Sometimes it coincides with a headache.

Everything suddenly appears as if far away then everything either looks really far away but massive or really close up but tiny. He feels dizzy while this happens also. Stress definitely increases the number of AIWS episodes.

Infections are reported as one (of possibly many) root causes of AIWS: “Reported causes include infection (especially with Epstein Barr virus), migraine, epilepsy, depression, and toxic and febrile delirium.”

Infections are common mental health triggers. Strep as a trigger for PANDAS/PANS is a classic example. I blog about Bartonella and sudden-onset adolescent schizophrenia here.

He has pyroluria and stress increases the number of episodes he experiences. My question is this: is there a link between the dumping of zinc and vitamin B6 during these times of stress and episodes of AIWS?

The feeling of being extremely small somatically (or physically), like how you feel when in a football stadium

Mike is a 21 year old male and thinks he may very well have pyroluria based on the questions. He also shares this in the blog comments about his AIWS experiences:

I have experienced sensations similar to Alice in Wonderland Syndrome throughout my life, more so during periods of stress. The feeling of being extremely small somatically (or physically), like how you feel when in a football stadium.

Again, he has pyroluria and his symptoms are worse during periods of stress. Keep in mind that stress makes pyroluria symptoms more intense too.

She usually experiences objects/people smaller than what they are but her more pronounced symptoms are sound distortions

Brenda, another mom in the community, shared this about her daughter’s dreams and PMS on the pyroluria questionnaire blog:

I’m quite certain that my 17 year old daughter has pyroluria. I counted 23 symptoms that she definitely exhibits. Her dream recall is so poor that she insists she doesn’t dream at all. I’m going to start her on zinc, B6 and evening primrose oil right away. Her PMS/premenstrual syndrome is so severe that I had decided to see a gyno to discuss birth control pills. Of course I won’t after listening to your interview with Karla Maree (on the Anxiety Summit).

She also asked if I was familiar with Alice in Wonderland Syndrome and if so do I think it may be connected to pyroluria? She shares this about her daughter’s AIWS experiences:

My daughter has experienced occasional Lilliputian (trivial or small) hallucinations since childhood. She usually experiences objects/people smaller than what they are but her more pronounced symptoms are sound distortions. She hears voices/noises (real, not imagined) much louder than they are in reality.

She does not have migraines, has never had mononucleosis or any of the other conditions listed as possible causes of Alice in Wonderland Syndrome. That’s why I’m thinking it may be caused by nutritional deficiencies.

This was my introduction to this syndrome and I appreciate her for asking the question. I did some reading of the research and the word “hallucination” got me thinking that a pyroluria connection was possible. The original work by Dr. Carl Pfeiffer with pyroluria was with individuals with schizophrenia.

However, the second paper mentioned above does state that “AIWS is characterized by perceptual distortions rather than hallucinations or illusions and therefore needs to be distinguished from schizophrenia spectrum and other psychotic disorders.”

We clearly have much to learn and I’m still curious to find out how often these two conditions do overlap – pyroluria/social anxiety and Alice in Wonderland Syndrome.

Resources if you are new to pyroluria

Pyroluria is a social anxiety condition and the physical and emotional symptoms are caused by deficiencies of vitamin B₆ and zinc. When you experience high levels of stress, vitamin B₆ and zinc will be further depleted, so you may notice worsening symptoms and more anxiety. Here is the symptoms questionnaire and additional resources if you are new to pyroluria:

Pyroluria questionnaire (from my book, The Antianxiety Food Solution):
Pyroluria prevalence and associated conditions
Social anxiety caused by pyroluria: oxytocin, the vagus nerve, pectus excavatum and Ehlers-Danlos Syndrome
My book, The Antianxiety Food Solution, has an entire chapter on pyroluria

Have you (or a family member) had episodes of Alice in Wonderland Syndrome? And do episodes coincide with times of added stress?

Do you also suspect pyroluria and has the pyroluria protocol or other nutritional interventions helped to reduce or stop the episodes?

I’d love to also hear anything else you’re willing to share: age at onset, age AIWS stopped, do you suspect an infection as the trigger (or a medication or toxins or something else?), do others in the family have AIWS episodes and how would you describe your AIWS episodes?

Feel free to post any questions here too.