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5-HTP

The role of low serotonin, low vitamin B6 and low iron in anxiety and panic attacks

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Low serotonin can cause anxiety and panic attacks. Because vitamin B6 and iron are required raw materials for making serotonin, we know that low levels of these two nutrients often contribute to anxiety and panic attacks.

We have some pretty recent research supporting all this: Low serum concentrations of vitamin B6 and iron are related to panic attack and hyperventilation attack

Reduced serotonin level is known as one of the causes of panic attacks and hyperventilation attacks ….

In the serotonin synthesis system of the brain, vitamin B6 is a coenzyme for tryptophan hydroxylase, which is involved in the conversion of tryptophan into 5-hydroxytryptophan and iron serves as a cofactor for aromatic L-amino acid decarboxylase involved in the formation of serotonin from 5-hydroxytryptophan. Therefore, a reduction in vitamin B6 and iron levels can suppress the progression of the serotonin synthesis.

The study authors measured serum levels of vitamins B2, B6, and B12 and iron in 21 premenopausal women who had been admitted to the emergency room with panic attacks.

The results were compared with lab values from 20 volunteers, also premenopausal women, and this is what they reported:

We found that both vitamin B6 and iron levels were significantly lower in the panic attack/hyperventilation attack group than in the volunteer group. There was no significant difference in the serum levels of vitamins B2 or B12.

These results suggest that low serum concentrations of vitamin B6 and iron are involved in panic attacks and hyperventilation attacks.

This certainly confirms what I see with my clients. When I’m working with someone with anxiety, we always assess for low serotonin, low iron and low vitamin B6 levels, and when we address low levels we almost always see improvements – both in the reduction of anxiety and panic attacks. We’ll often see a mood boost too, sleep improvements and a reduction in carb cravings.

Here are some additional factors to consider:

  • Vitamin B6 can be challenging to measure in serum so I like to also use the pyroluria questionnaire and poor dream recall as a clue. The authors mention that serum pyridoxal 5-phosphate (PLP) is often used as an indication of B6 status, however they opted to use pyridoxal (PAL) after conversion from PLP.
  • Supplementing with vitamin B6 can often lead to some improvements in a few weeks with many folks who have pyroluria reporting feeling less anxious and more social within a week.
  • There is the potential for vitamin B6 toxicity. I have yet to see any signs of toxicity in my clients, but I have also not ever recommended more than 500mg/day. However, there are some individuals who have issues with very small amounts of vitamin B6. Unfortunately, I do not know why this happens.
  • Testing ferritin levels are an excellent way to assess iron levels and iron should never be supplemented unless iron is low. Dr. Izabella Wentz, shares in her book Hashimoto’s Protocol and blog that the optimal ferritin level for thyroid function is between 90-110 ng/m. Addressing low iron levels can take awhile to see a shift in labs.
  • Because zinc and magnesium are also cofactors for making serotonin, low levels may also need to be addressed. I would have loved to see these included in this study,
  • As always, we assess for low serotonin levels using the amino acid questionnaire and start on tryptophan or 5-HTP right away, based on doing trials – so we can see anxiety reduction and relief from panic attacks right away, while the other changes are starting to provide the raw materials for serotonin production.

Keep in mind that low serotonin and low iron and/or low vitamin B6 – although very common with anxiety and panic attacks – are not the only root cause and many other factors may also need to be addressed.

We’d love to hear if addressing low iron and/or low vitamin B6 levels have helped you? Did you use tryptophan and/or 5-HTP at the same time?

If you’re a practitioner, are often do you see low iron and/or low vitamin B6 in your anxious clients/patients?

How do I taper tryptophan without withdrawal symptoms: a tight band around my head, brain zaps and agitated free-floating anxiety?

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I have not had any clients experience the need to taper or slowly wean their tryptophan dose or report tapering side-effects similar to those they experienced when tapering off an antidepressant. However, I recently had someone ask this question on the blog (and then had someone else ask a similar question) so I’m sharing these questions and my responses in the hope of gleaning some additional information (and educating you if this applies to you). I never say never and am always learning. I’m also very interested to know how common this is and what some of the underlying factors could be.

Here is the question that was asked by Lara (we’ll call her Lara) and slightly paraphrased for clarity:

I’ve been taking 1500 mg of tryptophan for 3 months, and it has helped a lot with sleep and depression. I dropped to 1000 mg about a week ago then 500mg just to see how I’d do without it. I didn’t think it was numbing my feelings, but I am experiencing a return of feeling good.

I’ve been on antidepressants before and I am feeling the same withdrawal effects as when I weaned off meds. This is exactly why I chose to not go back to pharmaceuticals. It was difficult to wean off. How do I taper tryptophan without experiencing withdrawal symptoms? Thank you for your valuable knowledge.

These are the kinds of questions I’d ask a client in this situation:

  • Was the 1500mg helping and which low serotonin symptoms were eased?
  • How did this change when you reduced to 1000mg and then reduced to 500mg? i.e. did the low serotonin symptoms come back?
  • Which antidepressant are you comparing these affects to? And how long ago did you wean off the antidepressant?
  • Which brand of tryptophan you are using? (I find Lidtke is the best quality)

Keep in mind that we always want to be sure it’s not a one-off situation. In order to be sure someone is observing mild adverse effects from a supplement I’ll often have my client stop it and then add it back to make sure. And sometimes more than once.

In this instance repeating the process may be a good idea i.e. going back to 1000mg and then 1500mg and then reducing again, carefully documenting in a food mood supplement log.

It turns out that Lara was using the Lidtke tryptophan and she was seeing wonderful benefits for her low serotonin symptoms with none of the typical SSRI side-effects:

the 1500mg before bed with a small carb helped me get to sleep and stay asleep. It also helped with anxiety and depression during day. I tend to be a worrier, have social anxiety, and get stuck with negative thoughts about myself and others. And have very little interest in life.

I was on Zoloft from 2005 – 2009. Got off of that and did Lexapro for only 6 months in 2012. The Zoloft was life changing for me but I did not like the side effects and being on an antidepressant for the rest of my life.

The tryptophan is superior to these SSRIs [selective serotonin reuptake inhibitors] – no sexual side effects, no weight gain, or anhedonia [inability to feel pleasure in normally pleasurable activities].

She describes how she reduced the tryptophan and how her withdrawal symptoms were similar to those she experienced when tapering off her SSRIs in the past:

The withdrawal effects were felt when dropping from 1500mg to 1000mg, to 500mg, then zero over 2 days and they lasted about 3 days. By the 4th day I was no longer feeling bad.

The symptoms are hard to explain – it felt like a tight band around my head, also brain zaps (this is a common SSRI withdrawal symptom many describe feeling in their head).

The worst of it was a deep agitated free-floating anxiety like you’re walking along the edge of a cliff and there’s a physical pain in your gut. Fortunately, it was only present from waking up till around 2pm.

These are questions I’d ask or wonder about

As I mentioned in the introduction, I have not had any clients experience the need to taper or slowly wean their tryptophan dose or report tapering side-effects similar to those they experienced when tapering off an antidepressant. But if this is an issue some individuals experience I’d like to know about it

I’d also like to know how long the tapering side-effects of tryptophan last and how severe the symptoms are. In Lara’s case the symptoms were pretty severe but fortunately they only lasted 3 days which is very much shorter than SSRI tapers.

There could be confounding factors and here are additional questions I’d ask or wonder about if a client experienced similar adverse tapering effects. These are questions you could ask yourself if you have experienced this when stopping tryptophan abruptly:

  • Could the prior use of SSRI prescriptions be a factor? (but I have worked with many clients with prior use of SSRIs and not have tryptophan tapering issues)
  • What else has changed in terms of stress, diet, hidden gluten exposure, or even the something like a recent introduction of collagen (which may deplete serotonin levels in susceptible folks)?
  • Are there hormonal changes that could affect serotonin levels – like in a woman with PMS or perimenopausal or menopausal symptoms? (again, I’ve worked with many women of all ages and haven’t observed this to be an issue)
  • If you are prone to the winter blues and reduced winter serotonin, could stopping the tryptophan in the winter play a role? (I have had clients have SSRI tapering issues in winter because of being prone to the winter blues and choose to work with their doctors on their SSRI taper in the spring and summer for this reason)
  • Could this also be an issue with summer blues in hot states like Arizona?
  • Could any of these play a role: a recent medical procedure, a course of antibiotics (especially fluoroquinolones) or antifungals, poor gut health, a new infection, decreased immunity or increased inflammation?
  • Could low levels of these nutrients play a role: vitamin B6, ferritin, magnesium and zinc?
  • Would using high doses of vitamin C during the “taper” help reduce some of the symptoms? (this works well as an antidote when you take tryptophan and don’t need it and want to negate some of the negative effects, so may help in this situation)

Stopped tryptophan and felt very angry and down

The other question I had about tryptophan weaning is this one from someone who shared that she had suggested tryptophan for a friend. This friend was

experiencing a lot of ruminating and anxiety. She responded beautifully and felt great. About a year later, she tried to stop taking it, and said she felt very angry and down. Is there a weaning process for the tryptophan?

This could possibly be related to the above and you could pose similar questions but based on on what I see with clients I feel this is more of a matter of stopping the tryptophan too soon while she still had low serotonin – especially if the ruminating and anxiety came back. Feeling angry and down are classic signs of low serotonin.

The questions asked were specifically about tryptophan but they could also possibly apply to some individuals who stop 5-HTP abruptly.

I’d love to hear if you’ve experienced anything like this with either tryptophan or 5-HTP and if yes please share your answers to some of the above questions.

Right now, I’m afraid I don’t have an answer for you on how to taper tryptophan without these withdrawal symptoms: a tight band around the head, brain zaps and agitated free-floating anxiety. Right now, I’m not sure how big an issue this is. If it is common, I’m hoping some of the feedback I receive may provide some answers.

Amyotrophic lateral sclerosis/ALS: ketogenic diet, GABA, 5-HTP and environmental toxins

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(Image from ABC: The Enemy Within – Australian Story)

I recently watched a documentary on the life and work of Justin Yerbury, a basket-ball player turned scientist who has motor neuron disease (also referred to as ALS) and is seeking a cure. It was aired on ABC and called The Enemy Within – Australian Story

When Justin Yerbury’s family members began to die from motor neurone disease he made a life-changing decision.

He turned his back on a professional basketball career and enrolled in a science degree. Almost 20 years later, he is an internationally recognised expert on the disease, leading the way in the search for a treatment.

Recently, however, Justin’s work took on a terrible urgency as he too developed symptoms of MND.

As Australian Story filmed with Justin and his family, his condition deteriorated dramatically, requiring difficult decisions to enable him to continue his search for a cure.

Having met Justin in 2017, Professor Stephen Hawking recorded the introduction to this story shortly before his death from motor neurone disease.

(the Australian spellings are neurone instead of neuron and recognised instead of recognized)

I felt very moved by his story and work and felt compelled to reach out to Dr. Yerbury to share what I have learned about this condition in the last few years. I know of a number of practitioners who work with individuals with this condition and even some colleagues with family members who have been diagnosed with this condition. I have also had enough queries that it’s time for a blog post on the topic so you are informed too.

What is Amyotrophic lateral sclerosis (ALS) and motor neuron disease (MND)?

Let’s start with the fact sheet on Amyotrophic lateral sclerosis from the NIH (National Institute of Neurological Disorders and Stroke). They describe ALS as follows:

Amyotrophic lateral sclerosis (ALS) is a group of rare neurological diseases that mainly involve the nerve cells (neurons) responsible for controlling voluntary muscle movement. Voluntary muscles produce movements like chewing, walking, and talking. The disease is progressive, meaning the symptoms get worse over time. Currently, there is no cure for ALS and no effective treatment to halt, or reverse, the progression of the disease.

ALS belongs to a wider group of disorders known as motor neuron diseases, which are caused by gradual deterioration (degeneration) and death of motor neurons. Motor neurons are nerve cells that extend from the brain to the spinal cord and to muscles throughout the body. These motor neurons initiate and provide vital communication links between the brain and the voluntary muscles.

I encourage you to watch the 30 minute program if you want to learn more about this condition and Dr. Yerbury’s work (they call it MND rather than ALS in the documentary.)

You may also be familiar with the life and story of Professor Stephen Hawking – he had ALS or motor neuron disease.

Ketogenic diet for ALS?

Here is some of the information I sent to Dr. Yerbury, explaining my work as a nutritionist working with women with anxiety using nutritional psychiatry approaches. Many of these nutritional psychiatry approaches – such as the SMILES study – have been spear-headed in Australia by Professor Felice Jacka.

I’ve recently being looking at the growing research base on the ketogenic diet and mental health and when I saw his story on ABC my first thought was – I wonder if there is research on ketogenic diets and ALS/MND? After a very quick search I found these papers:

there are strong epidemiologic data showing that malnutrition is a common symptom of amyotrophic lateral sclerosis both in humans and in mice and may contribute to disease progression. There is also epidemiologic evidence that increased dietary fat and cholesterol intake might reduce the risk of amyotrophic lateral sclerosis and the rate disease progression. Finally, data from animal studies strongly suggest that increasing dietary intake of fat ameliorates disease progression. However, determining whether amyotrophic lateral sclerosis patients should be treated with a high-fat or ketogenic diet can be based only on randomized double-blind placebo-controlled interventional trials.

Metabolism-based therapy [which includes the ketogenic diet] has been used successfully in the treatment of seizures but study of its use in other neurodegenerative disorders [such as Alzheimer’s disease, Parkinson’s disease and ALS] is growing.

A gluten-free diet?

We must always consider gluten with every chronic health condition. There is a case report of celiac disease with neurologic manifestations misdiagnosed as amyotrophic lateral sclerosis:

he was diagnosed as having CD, and a gluten-free diet was immediately begun. At a 4-month follow-up, his weight and the quality of his stool had improved gradually, and the neurological manifestations had not progressed.

Another study reports that in certain cases, ALS may be associated with autoimmunity and gluten sensitivity, with elevated transglutaminase 6 antibodies in the serum of 23 patients.

GABA and 5-HTP: the Deanna Protocol

Awhile back I was contacted by someone in my community about the Deanna Protocol for ALS because it uses amino acids GABA and 5-HTP and other nutrients like niacin and CoQ10:

It is determined that the substances in the DP™ Plan provide energy to cells that are dying and in doing so keeps them alive.  This is very important because when nerve cells die, they release glutamate which kills the contiguous cells.  If too many cells are dying then we cannot supply enough energy to keep up with the rate of death of the cells.  When the DP™ Plan​ is taken in sufficient quantities, it will support the nerves that are challenged by glutamate.

As you may already know I use targeted individual amino acids such as GABA and tryptophan/5-HTP with clients so I am very familiar with their therapeutic benefits for anxiety and I am fascinated they also ease symptoms in ALS.

There is an animal study supporting this approach: Metabolic therapy with Deanna Protocol supplementation delays disease progression and extends survival in amyotrophic lateral sclerosis (ALS) mouse model.

Anxiety and depression

There is also research indicating that psychiatric symptoms often precede an ALS diagnosis:

neuropsychiatric conditions are overrepresented in amyotrophic lateral sclerosis (ALS) patient kindreds and psychiatric symptoms may precede the onset of motor symptoms…. A diagnosis of depression was significantly associated with a first record of ALS ≥5 years later, in keeping with growing evidence for major depressive disorder as an early marker of cerebral neurodegeneration.

This doesn’t mean if you have anxiety or depression that ALS or another neurodegenerative disorder is in your future, because we can address so many of the root causes before we get to that diagnosis. Many of the nutrients in the Deanna Protocol will help both the person with ALS and the caregivers who also suffer psychological distress.

Environmental toxins and ALS

We recently spent 3 days at Shell Harbour just south of the Wollongong area and we loved it!

Lovely Red Sands Beach, NSW

As beautiful as it was I couldn’t help but be concerned about the toxins being released into the air from the steel production plants. Dr. Yerbury lives in the area and is conducting his research at the University of Wollongong. I know toxins play a role in many diseases and wondered about an ALS connection. I found this paper: Association of Environmental Toxins With Amyotrophic Lateral Sclerosis

Pollution in Wollongong

I also shared that I’m a total research geek and pretty passionate about the power of nutrition, lifestyle and environmental factors because this was how I was able to eliminate my own anxiety and panic attacks.

You can learn more about Dr. Yerbury and his publications here. We appreciate the work him and his research team are doing and thank him for sharing his story.

It would be wonderful if some of this information can help Dr. Yerbury and even be considered for future research by his very passionate research team. I also hope this information will be helpful for you or a loved one suffering with ALS or MND.

GABA, 5-HTP and melatonin isn’t working anymore for my insomnia and tryptophan gives me a migraine – what should I do?

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Today I’m addressing a great question I received on a recent tryptophan blog about insomnia and the use of the amino acids GABA and 5-HTP in a combination product together with melatonin, and what the next steps should be when you are not getting the expected results. And if continuing with tryptophan is a good idea when it seems to be causing a migraine and isn’t leading to a whole night’s sleep. Here is the question:

I have suffered from insomnia for most of my life. I just got your book and am loving it! Thank you for all that you do. My symptoms seem to be high for both low GABA and low serotonin [here is the questionnaire].

I also believe I have a blood sugar problem, so I’m starting to follow your suggestions for that.

I’ve been taking a supplement for sleep that has both GABA and 5-HTP in it, along with melatonin. It worked for a year, however it just recently stopped working.

I thought maybe I should try tryptophan. After taking only 220 mg per night, along with 5 mg of melatonin, I was able to sleep, but not through the entire night. However, the next day I woke up with a horrible headache/migraine. I know it was the tryptophan because I did a trial and tried a night without it and then again with it and the nights I took it, sure enough, the migraine would return.

I must add that I had bloodwork done and tested low for melatonin, which is why I was adding the melatonin into my protocol.

My question is: do I continue with a higher dose of GABA, 5-HTP and melatonin, since it worked for a year i.e. do I up the dosage of the supplement I’ve been taking? Or do I continue trying different doses of tryptophan?

I shared this response in my comment (with some additions for this blog post).

Always first address the nutritional foundational aspects

Firstly, I was glad to hear she is loving my book The Antianxiety Food Solution (my Amazon link) and implementing dietary changes. This is so foundational to any protocol for both anxiety and insomnia. Too often, someone hears me talking about the amazing amino acids and forgets the nutritional basics of real whole food, quality animal protein (like wild fish, pastured eggs and chicken, grass-fed red meat), organic veggies and fruit, healthy fats (like olive oil, coconut oil and butter), fermented foods and broths, and no gluten, caffeine or sugar.

I don’t ever have clients push through

With regards to her trial of tryptophan I shared that I don’t ever have clients push through on a product that is causing any adverse effects, and especially when it’s a migraine. She was smart and trialed the tryptophan twice to make sure it was the tryptophan that caused the migraine and not something else.

Capitalize on what has worked and increase one at a time

With regards to the GABA, 5-HTP and melatonin I shared that I always like to capitalize on what has worked in the past (or is currently working) and would rather increase the 5-HTP and/or melatonin and/or GABA one at a time.

Notice that I said increase these products one at a time. She is taking a combination product so it’s impossible for her to do this. Maybe her GABA levels are now good (because her progesterone levels have improved due to be on a regular zinc supplement or because she has been doing regular yoga sessions) and maybe she needs more serotonin support (because her estrogen levels are off because of recent exposure to xenoestrogens in plastics).

Even though is research showing that a combination product containing GABA and 5-HTP improved sleep and sleep duration more than the use of either of the two amino acids alone, based on her feedback, if we were working together I would have her do each of the GABA, 5-HTP and melatonin separately. This way it’s easy to mix and match and increase one and possibly lower the other, until the ideal combination is found for her unique needs at this time in her life.

She may even find she only needs GABA or only needs 5-HTP or only melatonin. She may also find she needs sublingual melatonin for helping her fall asleep and timed-release melatonin for helping her stay asleep.

She mentions the amino acid questionnaire so it sounds like she is clear on her symptoms: low GABA physical anxiety affecting her sleep and low serotonin mental worry-type of anxiety affecting her sleep. So as she trials the individual amino acids she can see how she does symptom-wise in order to find the ideal amount.

Other factors to consider with insomnia

It’s often straight-forward with the amino acids and the great thing is that one you have the correct combination you will see results in a few days to a few weeks. But There are other factors we may need to consider with insomnia:

  • Keep in mind that 5-HTP can raise cortisol and low blood sugar can indicate adrenal issues so looking at high cortisol as a factor in the sleep problems would be something to consider. A 4-collection saliva test will measure this and my favorite product for lowering high cortisol is Seriphos. Other nutrients for adrenal support may be needed too.
  • Just addressing low blood sugar can often improve insomnia. Eating to support blood sugar swings, early morning sunlight and no blue light after dark can make a world of difference.
  • Other sleep factors we always want to consider: sex hormone imbalances, parasites (they are more active at night and can keep you awake and play a role in high cortisol), accidental gluten exposure, SIBO (small intestinal bacterial overgrowth), candida, sleep apnea and mouth breathing, EMFs (WiFi in the home, commuting with the iphone on, a new cordless phone etc.) and medication side-effects (benzodiazepines are a common one).

I really appreciate questions like this being posted on the blog so others like you also get to benefit. This question also demonstrates just how our needs for certain nutrients can change over time and how we may to keep adjusting what we are doing.

In case you have questions about specific products that I use with clients, here is my supplements blog and more information on GABA for the physical type of anxiety and 5-HTP/tryptophan for the worry-type of anxiety.

Can you relate to this scenario? Feel free to ask your questions about sleep, GABA, 5-HTP, tryptophan and melatonin and share your experiences with these products and how they have helped you or if you’ve had issues with any of them.

Midday bright light therapy for bipolar depression

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A recent study from Northwestern University and published in The American Journal of Psychiatry: Adjunctive Bright Light Therapy for Bipolar Depression: A Randomized Double-Blind Placebo-Controlled Trial has found that midday daily exposure to 7,000 lux bright white light for 6 weeks, significantly decreased symptoms of depression and increased functioning in people with bipolar disorder.

The press release issued by Northwestern University reports as follows

Previous studies found morning bright light therapy reduced symptoms of depression in patients with Seasonal Affective Disorder (SAD.). But patients with bipolar disorder can experience side effects such as mania or mixed symptoms from this type of depression treatment. This study implemented a novel midday light therapy intervention in an effort to provide relief for bipolar depression and avoid those side effects.

Compared to dim placebo light, study participants assigned to bright white light between noon and 2:30 p.m. for six weeks experienced a significantly higher remission rate (minimal depression and return to normal functioning). More than 68 percent of patients who received midday bright light achieved a normal level of mood, compared to 22.2 percent of patients who received the placebo light.

Images used with permission from Northwestern University

How the 7,000 lux bright light therapy was used

Here are the details of how the 7,000 lux bright light therapy was used in the study:

The light therapy patients were instructed to place the light box about one foot from their face for 15-minute sessions to start.

Every week, they increased their exposure to the light therapy by 15-minute increments until they reached a dose of 60 minutes per day or experienced a significant change in their mood.

Study lead author Dr. Dorothy Sit shares that starting low and slowly increasing the treatment made it more tolerable. None of the study participants experienced side effects, likely because the treatment was customized for each patient:

No one experienced mania or hypomania, a condition that includes a period of elation, euphoria, irritability, agitation, rapid speech, racing thoughts, a lack of focus and risk-taking behaviors.

A noticeable mood improvement with bright light therapy was also noticed as quickly as four weeks, which is similar to other light therapy research for non-seasonal depression and depression during pregnancy.

How do you do this in the middle of a work day?

You may have concerns about doing this at midday as this facebook follower voiced:

I guess if your bipolar depression is so debilitating that you cannot hold a job, then this is worth trying.

But 60 minutes!! What working person has 60 minutes in the middle of their workday?

It’s very doable because there are very nice desk versions that could easily be used at work (without anyone knowing – if privacy is a concern) or at a home-office desk for your convenience. I share some examples in this blog – Winter blues or SAD: light therapy.

I have tried lights in the morning but found that it caused agitation

I also received this feedback about increased agitation:

I have tried lights in the morning but found that it caused agitation. Over time my tolerance went down so that I could only use for less than 5 minutes. I haven’t ever tried midday light though. I’m not bipolar but I have depression which is generally worse in the winter. Exercise helps.

It may be worth trying midday light therapy if morning light therapy causes agitation or other adverse effects.

The press release mentions that light therapy is typically used in the morning to help reset circadian rhythms and the authors are unclear why midday light therapy worked for these patients with bipolar disorder. They plan to investigate further. If it is working via the same mechanism i.e. by resetting circadian rhythms, then it may well work at this time for other individuals too.

It may also be that your depression (and/or anxiety) is not caused by low serotonin but by something else instead – such as low catecholamines, poor thyroid health, gluten issues, poor diet and so on.

Using light therapy and tryptophan (or 5-HTP)

I have also found that some people do well on a combination of light therapy and tryptophan (or 5-HTP). One of my clients had many low serotonin symptoms and did better mood-wise and with reduced anxiety, on a small amount of tryptophan but still needed additional serotonin support. Additional tryptophan was too much for him and increased his day-time sleepiness, but using a small amount of tryptophan together with light therapy was the ideal balance for him.

Have you used light therapy with success – for the winter blues or depression or bipolar disorder? Or even for anxiety?

Have you ever used it at midday or at other times?

And have you used light therapy in conjunction with tryptophan or 5-HTP?

Anxiety, compulsive thinking, counting behaviors: gluten, tryptophan and inositol

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Today I’m going to share my feedback on a question I received on how to approach working with a child with anxiety, compulsive thinking and counting behaviors in the hope it can help you or someone you know (or are working with if you’re a practitioner). Here is the question:

Regarding anxiety and compulsive thinking/OCD counting behaviors in a 12 year old, have you experienced (or heard through client sharing) a correlation with certain foods or inflammatory compounds? In a younger person, I am trying figure out the triggers if there is low production of certain neurotransmitters driving the symptoms. This child in particular has had a long history of allergies and terrible asthma (requiring nebulizer treatments) so I’ve long suspected food sensitivities as a driver for systemic inflammation but am trying to connect the dots for her parent. The counting seems to be a distraction of sorts for her – I assume following a triggering thought. This parent is very new to integrative therapies so treating with an amino acid is going to *feel* like she’s not doing enough as parent. Standard talk therapy has not helped.

This is how I responded and it’s how I would start to work with a parent with a child with these types of issues.

After looking at the basics to make sure the child is eating real whole food with no additives, is not consuming any caffeine and is getting quality animal protein at breakfast (to keep blood sugar stable and reduce anxiety), I always consider gluten and even dairy and other food intolerances. I write about the success of a gluten-free diet with a 7 year old boy in this blog: Integrative Medicine Approach to Pediatric Obsessive-Compulsive Disorder and Anxiety. He saw a “marked reduction of OCD symptoms and anxiety along with marked improvement of social behavior and school work.”

OCD and counting behaviors are classic low serotonin symptoms and her anxiety could be the low-serotonin worrying type or the low GABA type which is more physical anxiety. I’d have them do the amino acid questionnaire

I’d start with a trial of tryptophan – using 100mg of Lidtke Chewable Tryptophan – to help with the OCD, counting and worry-type anxiety. If it helps, I’d have her use it twice a day mid-afternoon and evening, increasing it over the course of a few weeks to find the ideal amount for symptom relief (and keeping a food mood log to record doses and symptoms).

Some people do really well with tryptophan, others do better with 5-HTP for low serotonin symptoms, so doing a trial with 25mg of 5-HTP would be an option if the tryptophan doesn’t help as expected.  

I would carefully review the precautions with the mom as tryptophan and 5-HTP can sometimes be an issue with asthma and may need to be lowered or discontinued.

Inositol can be added if additional nutritional support is needed for the OCD and counting behaviors and may even be needed to replace the tryptophan or 5-HTP if either one triggers asthma. The maximum dose in the research is 18g of inositol per day and I start at 2g once a day and increase slowly over a few weeks to find the ideal dose. Here is feedback from one mom on how inositol alone helped her son with migraines, stress, anxiety and OCD

Once we’ve figured out nutritional support for the low serotonin symptoms then we’d address low GABA if needed, using sublingual GABA. [Update Nov 17, 2017: I mentioned GABA as a possibility but with her symptoms and the new GABA research on intrusive thoughts, a GABA trial would definitely be something to pursue]

I found this comment to be rather unusual: “treating with an amino acid is going to *feel* like she’s not doing enough as parent.” The parents I work with are thrilled to discover how powerful the amino acids are and how quickly they provide amazing results.

These other factors would also be addressed: possible high cortisol, gut health and any of the other possible contributing root causes. I also always keep Lyme disease, heavy metals and PANDAS on the list as possible areas to refer out for if symptoms are not resolving with the above approaches.

Here are links to the amino acid questionnaire, the precautions and the supplements:

  • I have my clients complete the Amino Acids Mood Questionnaire from The Antianxiety Food Solution and check off their symptoms in each of the sections. The rating uses scale of 1-10 with 10 being worst.
  • I also have my clients review the Amino Acids Precautions and we figure out which amino acids they can and can’t use
  • These are some of the supplements I use with my clients

Have you used any of the above approaches with your child or for your symptoms or for a client/patient?