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Tryptophan supplementation for anorexia?

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tryptophan and anorexia

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.

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 times 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

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 psychology and medication. Our approach included addressing low serotonin with tryptophan or 5-HTP, addressing low zinc, 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.

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.

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

Have you (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?

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overthinking

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.

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.

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.

The Antianxiety Food Solution by Trudy Scott

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antianxiety food solution

The Antianxiety Food Solution

– How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood and End Cravings
by Trudy Scott, CN (published by New Harbinger, 2011)

It’s remarkable how much the foods we eat can impact our brain chemistry and emotions. What and when we eat can make the difference between feeling anxious and staying calm and in control. But most of us don’t realize how much our diets influence our moods, thoughts, and feelings until we make a change. In this book, you’ll find four unique antianxiety diets designed to help you address nutritional deficiencies that may be at the root of your anxiety and enjoy the many foods that foster increased emotional balance.

This easy-to-use guide helps you choose the best plan for you and incorporates effective anxiety-busting foods and nutrients. You’ll soon be on the path to freeing yourself from anxiety—and enjoying an improved overall mood, better sleep, fewer cravings, and optimal health—the natural way!

In The Antianxiety Food Solution, you’ll discover:

  • How to assess your diet for anxiety-causing and anxiety-calming foods and nutrients
  • Foods and nutrients that balance your brain chemistry
  • Which anxiety-triggering foods and drinks you may need to avoid
  • Easy lifestyle changes that reduce anxiety and increase happiness

Buy your copy

 

Buy the book from Amazon
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Endorsements

This book “fills an important gap in the popular literature on anxiety. It provides clear, helpful guidelines for utilizing nutrition to overcome anxiety.Edmund Bourne, PhD, author of The Anxiety and Phobia Workbook
A great book with plenty of practical advice backed by science.Daniel G. Amen, MD, author of Change Your Brain, Change Your Life
Every one of the millions now suffering from anxiety has a new friend in Trudy Scott, whose book offers them a nutritional lifeline.  Replete with specific and practical suggestions, this book is backed up by research and clinical expertise.Julia Ross, MA, MFT, author of The Mood Cure and The Diet Cure
This book is a must-read if you have anxiety and want to treat the underlying causes and heal, rather than having to rely on medications. Adjust your brain chemistry with the right nutrients and you can reclaim your brain and your life!Hyla Cass, MD, author of 8 Weeks to Vibrant Health
This book is a real tour-de-force in complementary mental health literature and should be on the shelves of every anxiety sufferer. It’s a user-friendly and balanced book about foods and nutrients that can reduce anxiety, and it is also refreshingly original.Jonathan Prousky, MSc, ND, professor of clinical nutrition at the Canadian College of Naturopathic Medicine and author of Anxiety: Orthomolecular Diagnosis and Treatment
As a nutrition and fitness expert and the mother of a child with an emotional disorder, I find this book invaluable. It is one I will use myself and recommend to both clients and colleagues.JJ Virgin, CNS, CHFS, nutrition and fitness expert, author of Six Weeks to Sleeveless and Sexy, and cohost of TLC’s Freaky Eaters
A leader in the field of food and mental health, Trudy Scott supplements the core themes of food and gut health with chapters on amino acids, pyroluria, and lifestyle changes. Trudy aptly emphasizes that readers should try to find the root cause of their health problems.Lawrence E. Cormier, MD, holistic psychiatrist in Denver, CO
This book may be the key you’ve been looking for. It does an excellent job of explaining the science behind anxiety and then bringing it to a practical level, providing a nutritional and integrative approach to anxiety.Elizabeth Lipski, PhD, CCN, director of doctoral studies at Hawthorn University in Whitethorn, CA, and author of Digestive Wellness
Trudy Scott’s work communicates something I tell my patients every day: there is a powerful connection between what we eat and how we feel.Mike Dow, PsyD, cohost of TLC’s Freaky Eaters
I recommend this book not only to those who suffer from anxiety, but to their health care providers as well.Karla Maree, certified nutrition consultant, neuronutrient therapist, and director of nutritional therapy at Recovery Systems Clinic
A comprehensive book providing the nation with much-needed formulas for overcoming anxiety and restoring stable emotions!Joan Mathews-Larson, PhD, LADC, founder of the Health Recovery Center in Minneapolis, MN, and author of Depression-Free, Naturally
This book offers a wealth of useful information for those who would like to try dietary and other lifestyle changes in order to improve their mental health. It is also a valuable resource for clinicians interested in broadening their approach to the treatment of anxiety.Felice N. Jacka, PhD, research fellow at the University of Melbourne in Australia
Full of practical tips for restoring balance to your body and mind. I highly recommend it.Mark Atkinson, MD, author of The Mind-Body Bible
The Antianxiety Food Solution is one of the most comprehensive guides to nutritional healing for anxiety.Elizabeth Large, ND
Trudy Scott is an expert on the relationship between food and mood, an often neglected area. This book provides clearly presented practical information, which I believe to be important adjunctive help in the treatment of anxiety, depression, and serious mental illness.Katherine Falk, MD, psychiatrist in New York, NY
An easy-to-read book that should help many people with anxiety.Michael B. Schachter, MD, CNS, board-certified psychiatrist
 

Buy the book from Amazon
Buy the Kindle from Amazon
Buy the book in German

 

Reviews from readers

I can “recommend it for practitioners who have patients/clients who want to improve their affect, increase energy levels (who doesn’t!), suffer from anxiety, poor memory or sleep issues. Pass on this book to them and ask them to read it through cover to cover. It’s got a wealth of tips and resources linking behaviour with nutrition, and does it gracefully and with much self-insight.

I’ve read many books on the subject of psychology and biochemical links, and this is definitely one of the best written. It’s aimed at the intelligent reader who may have a little knowledge of nutrition, as well as practitioners and those who use patient centred approaches within their practice.

Donald Scott, Osteopath & Naturopath, Natural Therapy Centre, Kilmacolm, Inverclyde, United Kingdom

I cried my way thru this book ~ out of JOY~ for finally finding a very helpful book! I have been on a journey for 10 years trying to navigate issues with depression, stress, anxiety, insomnia and other fun things. I’ve been to doctors, psychologists, psychiatrists and counselors. I’ve been put on medication which after many years of that left me suicidal, overweight, depressed and very angry. It is VERY frustrating trying to navigate doctors, testing and information out there that could help you. This summer I read several books that addressed depression from a dietary and nutrition standpoint. This one was the best in my opinion. It’s not too long, easy to read and understand, and well organized. And it agreed with several things I had read in other books ~ such as the use of amino acids, vitamins and issues with gluten and sugar to address depression, etc. There’s many good ‘life stories’ in it too which help you relate. Thanks Trudy Scott!

Kathy Masterson, Amazon review

Book reviews

Table of contents

Introduction

My Story
Anxiety Statistics and Facts
Causes of Anxiety
What Is a Natural Approach and Why Use It?
Overview of the Book

Chapter 1: Figure Out Your Optimum Antianxiety Diet

The Antianxiety Food Solution Diets

Antianxiety Food Solution Diet 1: Gluten Free
Antianxiety Food Solution Diet 2: Gluten Free and Dairy Free
Antianxiety Food Solution Diet 3: Grain Free and Dairy Free
Antianxiety Food Solution Diet 4: Traditional Foods

Foods to Include

Eat Real, Whole, Good-Quality Foods
Eat Frequently Enough
Eat Quality Animal Protein

Red Meat
Poultry and Eggs
Fish and Other Seafood

Eat Nonstarchy Fresh Vegetables
Eat Fresh Fruit
Eat Good Fats
Keep Hydrated
Eat Legumes
Eat Starchy Fresh Vegetables
Eat Gluten-Free Whole Grains
Consume Dairy
Eat Whole Grains That Contain Gluten

Foods to Avoid

Avoid Empty Foods
Other Foods You May Need to Avoid

Eat Bonus Foods
Recipe and Food Resources
Wrapping Up

Chapter 2: Avoid Sugar and Control Blood Sugar Swings

The Harmful Effects of Sugar and Sweeteners
Sugars and Sweeteners Defined
Where Sugar Is Found
Artificial Sweeteners
What to Use Instead of Unhealthy Sugars and Artificial Sweeteners
Control Blood Sugar Swings

Benefits of Controlling Blood Sugar Swings
Simple Dietary Changes to Help Control Blood Sugar Swings
Supplements

How Quickly You Can Expect Improvements
If You Have a Sugar or Carb Addiction and Can’t Quit

Chapter 3. Avoid Caffeine, Alcohol, and Nicotine

Coffee and Caffeine

Caffeine and Anxiety
Other Reasons to Consider Giving Up Caffeine
How to Quit Caffeine and What to Drink Instead
If You Do Want to Drink Coffee

Alcohol

Nutritional Deficiencies Due to Alcohol Consumption
Alcohol and Low Blood Sugar
Alcohol Sensitivity
How to Quit Alcohol

Nicotine

Nicotine and Anxiety
How to Quit Smoking

How Quickly You Can Expect Improvements

Chapter 4. Address Problems with Gluten and Other Foods

Why Food May Be Affecting Your Mood
True Food Allergies
Food Sensitivities or Delayed Food Reactions
Problems with Gluten

Gluten, Anxiety, and Other Mood Problems
Gluten and the Digestive System

Testing for Gluten Sensitivities

Two-Week Gluten Elimination-Challenge Trial
Lab Tests for Gluten Sensitivity

Salivary Antigliadin Antibodies
IgG Antibodies for Gluten-Containing Grains
Elevated Thyroid Antibodies

Testing for Celiac Disease

Alternatives to Grains That Contain Gluten
If Gluten Isn’t a Problem
Problems with Dairy Consumption
Problems with Other Foods
Problems with All Grains and Starchy Vegetables
Using Amino Acids to Reduce Cravings
Allergies and Anxiety Due to Low Blood Histamine
How Quickly You Can Expect Improvements

Chapter 5. Improve Your Digestion

The Digestive Process

Why Good Digestion and Absorption Are Important
Using Your Stool as a Clue to Your Digestive Function

Eating Guidelines for Good Digestion

Eat Foods That Promote Good Digestion and Skip Poor-Quality Food
Change Your Eating Habits

Causes of Poor Digestion and How to Improve Your Digestion

Low Levels of Stomach Acid or Pancreatic Enzymes

Testing for Low Stomach Acid and Pancreatic Enzymes
How to Correct Low Stomach Acid or Low Pancreatic Enzymes

Large Intestine Issues
Bacterial Imbalance or Parasites
Candida Overgrowth

Testing for Bacterial Imbalance, Parasites, and Candida
Controlling Candida and Increasing Beneficial Bacteria

Foods and Nutrients for Healing a Damaged Digestive System
Liver or Gallbladder Problems
How Quickly You Can Expect Improvements

Chapter 6. Balance Brain Chemistry with Amino Acids

GABA

Steps to Raise GABA Levels

Serotonin

Steps to Raise Serotonin Levels

Catecholamines

Steps to Raise Catecholamine Levels

Endorphins

Steps to Raise Endorphin Levels

Testing for Levels of Amino Acids
Drug of Choice
Guidelines for Supplementing with Amino Acids
Amino Acid Precautions
How Quickly You Can Expect Improvements

Chapter 7. Address Pyroluria or Low Levels of Zinc and Vitamin B6

Prevalence of Pyroluria and Co-occurring Disorders
Testing for Pyroluria

Pyroluria Urine Test
Zinc Taste Test
Vitamin B6 Testing
Fatty Acid Testing
Comprehensive Metabolic Profile

Zinc, Vitamin B6, and Fatty Acids for Pyroluria

Zinc Supplementation
Food Sources of Zinc
Vitamin B6 Supplementation
Food Sources of Vitamin B6
Fatty Acids for Pyroluria
Other Nutrients for Pyroluria

How Quickly You Can Expect Improvements

Chapter 8. Other Nutrients, Hormone Imbalances, Toxins, Medications, and Lifestyle Changes

Basic Supplements

Multivitamin and Multimineral with B Vitamins
Iron
Vitamin C

Individual Nutrients for Anxiety

Extra B Vitamins
Magnesium and Calcium
Vitamin D
Omega-3s and Omega-6s
Theanine and Lactium

Hormone Imbalances

Adrenal Dysfunction
Thyroid Dysfunction
Sex Hormone Imbalances in Women

Reduce Your Exposure to Toxins

Toxins in the Home
Heavy Metals

Understand the Effects of Medications

Make Important Lifestyle Changes

Do Some Exercise, Preferably Outdoors
Get Enough Sleep
Consider Therapy and Support Groups
Set Aside Time for Relaxation

Take Up Yoga, Tai Chi, Qigong, or Meditation
Take a Real Vacation Every Year
Try Guided Imagery
Other Techniques That May Help

Parting Words

Appendices

  1. Sue’s Story
  2. Food, Mood, Energy, Cravings, and Sleep Log

Resources

Internet Resources for Healthy Eating and Living
Lab Tests
Recommended Reading

Nutritional Healing
Food, Cooking, and Cookbooks

References

A selection of quotes and facts from each chapter

Here are a selection of quotes and facts from each chapter of the book:

Introduction

“There’s a reason why I’m so passionate about working with people with anxiety and why I’m writing this book. I’ve had my own personal journey with anxiety…”

Chapter 1: Figure Out Your Optimum Antianxiety Diet

There are 4 antianxiety diets but “Eating real, whole, good-quality food is the foundation of this book and any program to prevent and alleviate mental health issues such as anxiety….”

Chapter 2: Avoid Sugar and Control Blood Sugar Swings

“Sugar and alcohol may contribute to elevated levels of lactate in the blood, which can cause anxiety and panic attacks”

Chapter 3: Avoid Caffeine, Alcohol, and Nicotine

In a study, “…those with panic disorders experienced increases in symptoms such as nervousness, fear, nausea, heart palpitations, and tremors after consuming caffeine and said the effects were similar to how they felt during a panic attack…”

Chapter 4: Address Problems with Gluten and Other Foods

“Clinical experience and specific studies support the connection between gluten and anxiety, social phobia, depression, and even schizophrenia”

Chapter 5: Improve Your Digestion

“…people with digestive complaints such IBS, food allergies and sensitivities, small intestinal bacterial overgrowth and ulcerative colitis frequently suffer from anxiety and…depression.”

Chapter 6: Balance Brain Chemistry with Amino Acids

“GABA plays a major role in anxiety, and serotonin plays a role in at least some types of anxiety…. The great thing about supplementing with amino acids is that you’ll get immediate feedback: positive effects, adverse effects, or no changes at all.”

Chapter 7: Address Pyroluria or Low Levels of Zinc and Vitamin B6

“Low levels of zinc and vitamin B6 are frequently associated with a type of anxiety characterized by social anxiety, avoidance of crowds, a feeling of inner tension, and bouts of depression”

Chapter 8: Other Nutrients, Hormone Imbalances, Toxins, Medications, & Lifestyle Changes

“Mild to moderate deficiency of vitamin C may be associated with increased nervousness and anxiety… Supplemental magnesium together with vitamin B6 was shown to alleviate anxiety-related premenstrual symptoms, as well as breast tenderness and menstrual weight gain…”

As you can see, there are many factors that can affect how anxious you feel and since we are all biochemically unique it’s important to figure out and address what may be triggering your anxiety, mood issues and associated cravings.
 

Buy the book from Amazon
Buy the Kindle from Amazon
Buy the book in German

 

Once you’ve read your copy (or listened to the audio version) I would love to hear back from you on how my book has helped you and/or family members – either here in the comments below or via an Amazon review or a review on another platform.

Feel free to post your questions too.

5-HTP and/or tryptophan to help with increased anxiety, panic attacks and depression caused by spring allergies

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5-htp, tryptophan, and spring allergies

Many of my clients experience increased anxiety, more severe panic attacks and worse depression when their spring allergies are flaring up. Do they feel like this simply because they feel so bad physically or could there be some underlying biochemistry that triggers their worsening mental health symptoms? I explain below how low serotonin is one possible root cause that can be addressed nutritionally with tryptophan and/or 5-HTP. Other factors to consider are the impact on the adrenals and GABA levels.

Today’s blog is inspired by Unten, who is part of my Facebook community. She asked this question:

I find that always during spring my anxiety and panic attacks get much worse when there’s lots of pollen and dust and other allergens in the air (at least here in Finland)…could this be true and not just “in my head”?

And then someone else responded saying:

I have noticed the same for me as well here in the USA.

My response to both of them is that it is not just in your head. There is plenty of research supporting this connection and we see it clinically too.

This paper, Changes in Severity of Allergy and Anxiety Symptoms Are Positively Correlated in Patients with Recurrent Mood Disorders Who Are Exposed to Seasonal Peaks of Aeroallergens, confirmed a significant positive association between allergy scores and anxiety scores and reports some possible mechanisms:

  1. The psychological effects of being ill, as well as impairments of sleep secondary to nasal obstruction or inflammation may affect mood.
  2. Cytokines may lead to a mood disturbance via the expression of the enzyme indoleamine-2,3-dioxygenase, which shifts the synthesis of tryptophan from serotonin to kynurenine. The resultant acute tryptophan depletion results in decreased brain serotonin, which may contribute to both depression and anxiety.
  3. Cytokines released during allergic inflammation may affect the brain directly, via nerves, surrounding tissue, or via regions that do not have a blood brain barrier, such as the circumventricular organs.
  4. Cytokines may also be involved in changes in the hypothalamic-pituitary-adrenal (HPA) axis… A sustained increase in activity in the HPA axis is associated with severe anxiety.
  5. Cytokines might lead to a physiological change in GABAA receptor functioning

I’ll discuss some possible solutions below.

Tryptophan and/or 5-HTP for low serotonin support if needed

The second bullet above is a good reason to consider serotonin support with tryptophan or 5-HTP.  If you have anxiety or panic attacks (and other low serotonin symptoms), we always want to figure out if low serotonin is a possible cause and address it, regardless of the circumstances/trigger (seasonal allergies in this instance).

Here are some useful blogs related to low serotonin and the amino acids:

Christine’s increased depression due to seasonal allergies improves a few days after starting 5-HTP and tryptophan

When I posted the above possible mechanisms on Facebook, Christine thanked me and shared her surprise:

I had no idea! This explains my increased depression lately. I didn’t know there was a correlation, but it makes complete sense now.  I’m in the Midwest. I’ve always had issues in March and April because of my seasonal allergies.

When I asked if she has used tryptophan or 5-HTP and bumped up the dose when she is suffering during seasonal allergies, she responded:

I just learned about both of these [amino acids]. I just bought your book and I am starting to use them. I don’t know if they take a while to start working?

I responded saying the amino acids work very quickly if they are needed and serotonin is low. It was not surprising to me that Christine shared her great results a few days later:

I’ve been using 5-HTP and tryptophan. I’m feeling so much better now. Thank you!

If your anxiety or depression is caused by low serotonin, you can expect to feel some relief right away provided you find the ideal dose for your unique needs. For some it’s a solution right away and for others it can take some adjusting up and down and trialing with 5-HTP and/or tryptophan to find the right combination.

Adrenal support and/or Seriphos if needed

The fourth bullet under the possible mechanisms above, is a good reason to also consider adrenal support: herbal adaptogens such a rhodiola and licorice, B vitamins, extra pantothenic acid and vitamin C. I also recommend using something like Seriphos to lower high cortisol if needed.  Another option is Relora®, a combination of Magnolia officinalis and Phellodendron amurense which lowers cortisol and reduces stress and anxiety.

Low GABA support if needed

The fifth bullet above is a good reason to consider GABA support with GABA or theanine if you have the low GABA type of physical tension that is made worse during your seasonal allergies. Just like with low serotonin we always want to figure out if low GABA is a possible cause of the anxiety and address it, even if it’s being made worse because of seasonal allergies.

You can see all the low GABA symptoms here and GABA products I use with my clients here on the supplements blog.

Address all root cause of anxiety/depression and the seasonal allergies

As always, it’s not only the low serotonin and/or high cortisol we need to address. We must always do a full functional workup looking at diet, nutritional deficiencies, digestion, all hormones, toxins and infections (and so on) so we can address all possible root causes.

Of course, identifying and addressing the root causes of the seasonal allergies is important too. This blog, Hay Fever: 9 Natural Ways to Treat Seasonal Allergy Symptoms by Dr. Josh Axe, outlines many dietary and lifestyle changes that can have a big impact. You’ll notice that much of this is foundational to my work.

Stress reduction is key and serotonin/GABA support help so much in this regard. So does zinc which is needed for both the production of serotonin and GABA, and enhanced immunity.

The blog also states that quercetin helps with seasonal allergies because it “stops the production and release of histamine.” Interestingly, quercetin also protects  against stress-induced anxiety and depression in animal studies (here is a link to one such study).

Thanks to these folks for asking good questions and for allowing me to share here.

My first take-away is not to ever tolerate not feeling your best (if that’s confusing – you deserve to feel your best always!) and always ask questions and look for connections.  My second take-away is to encourage you and others in my community to be empowered and take action. So kudos to Christine for jumping and purchasing my book, The Antianxiety Food Solution, reading it and being smart about using the amino acids.

Have you found that higher doses of tryptophan or 5-HTP helps with reducing the more severe anxiety, the depression/low mood and/or the increased panic attacks you experience during allergy season?

What about other low serotonin symptoms such as insomnia, cravings and PMS? Are they worse during allergy season?

Have you found addressing low GABA anxiety with higher doses of GABA helps when you have seasonal allergies?

Have you tested your cortisol levels during allergy season and found that adrenal support helps too? Keep in mind it will take longer to see results if this is the case.

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

5-HTP for a calm brain, and a racing mind at night: questions and answers

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5-HTP q and a

5-HTP is an amino acid, made from the seeds of an African plant, Griffonia simplicifolia, and used as a supplement to ease low serotonin symptoms. With low levels of serotonin you’ll experience the worry-type of anxiety with ruminations, obsessing, panic attacks, insomnia (often lying awake worrying). This type of anxiety is different from the low GABA physical/tension type anxiety. Other low serotonin symptoms include low mood/depression, late afternoon and evening carbohydrate cravings, pain, digestive/IBS symptoms, PMS, irritability, rage and anger, TMJ, low confidence, imposter syndrome and perfectionism.

When I share my low serotonin blogs on Facebook I receive so many great questions about 5-HTP. Today I’m going to share some of these questions and my answers so you can get the benefits too.

Gail asks why 5-HTP stopped working for her when it had been working so amazingly well:

I took 5-HTP and it worked amazingly….for about 6 months. Then it did nothing. Any idea why?

I took 100 mg per day. It’s hard to explain, but it calmed my brain down. I wasn’t so quick to blurt things out during the day and at night I was able to sleep because my mind wasn’t racing. Nothing else changed at that time. That was a few years ago, I think I’ll buy more and try again

I would guess that something did shift around the 6 month mark and would try and identify what it was so you know for the future. It could have been accidental gluten exposure (from the diet or even cosmetics), hormonal shifts (perimenopause or menopause), adding collagen or gelatin on a regular basis (this can lower serotonin in susceptible folks) and/or changes in thyroid health.

If you have pyroluria and were exposed to major stresses (life stresses or toxic mold etc.) you’d lose vitamin B6 and this could affect serotonin production. The addition of the birth control pill and antidepressants can also deplete vitamin B6. I share some possible reasons for low serotonin on this blog on imposter syndrome (as mentioned above, imposter syndrome is a common sign of low serotonin).

With these wonderful benefits Gail experienced, trialing 5-HTP again is worth considering. Because 5-HTP works so quickly she’ll feel that sense of calm right away and she won’t blurt things out during the day (possibly caused by lack of confidence and/or irritability and/or anger?). Also, her mind won’t race at night, she’ll fall asleep quickly and will stay asleep, waking rested, calm, happy, confident and optimistic.

And in future if something like this happens again, I’d try to identify the cause and bump up 5-HTP temporarily.

Wendy asks about headaches as an adverse effect:

What do you recommend if 5-HTP gives you headaches?

Headaches are not a common adverse effect with 5-HTP (compared to the amino acid tyrosine which is recognized to cause headaches and migraines in susceptible folks).

Even if you are seeing benefits – for the worry-type anxiety and other low serotonin symptoms – with 5-HTP you don’t ever want to push through with something like headaches and continue to take it. I have clients use less 5-HTP and observe if they still see the benefits with no headaches.

We also make sure low serotonin is the issue. If it’s not then any amount of 5-HTP will either do nothing or cause adverse effects. If the issue is low serotonin then I have clients do a trial of  tryptophan.

If the 5-HTP is being used to ease low mood/depression caused by low catecholamine or low endorphins depression then neither 5-HTP or tryptophan is going to help and may cause adverse effects. And tyrosine and/or DPA are better choices.

Gerry asks this question after my interview on Your Best Sleep Ever Summit:

Great talk Trudy. When you want to increase serotonin, do you take both 5-HTP & tryptophan or just one or the other?

They can be used alone or both can be used together. I like to have clients add one new amino acid supplement at a time so we know what is working before confounding things with another one. I typically start with tryptophan for low serotonin support simply because I have such good results with it and because 5-HTP can raise cortisol in some folks.

We start with tryptophan mid-afternoon and evening (after doing a trial earlier in the day to make sure it helps).  If tryptophan causes adverse effects or doesn’t work then we do a trial of 5-HTP and then use it afternoon and evening (when serotonin levels tend to drop).

If tryptophan is working in the afternoon and evening, and additional support for worry or ruminations or panic or anxiety is needed earlier in the day, we may consider 5-HTP which can often also help improve focus. We may also consider tryptophan earlier in the day too.

It’s very individualized and we may mix and match to find the ideal combination and dosing based on trials and symptom resolution. It’s important to be aware that some folks do better on 5-HTP and some do better on tryptophan.

Here are some useful blogs related to low serotonin and the amino acids:

As always, it’s not only the low serotonin we need to address. 5-HTP offers quick relief but we must always do a full functional workup looking at diet, nutritional deficiencies, digestion, all hormones, toxins and infections (and so on) so we can address all possible root causes – and why serotonin is low in the first place.

Thanks to these folks for asking good questions and for allowing me to share here.

What questions do you have about 5-HTP?

Which low serotonin symptoms can you relate to and has 5-HTP or tryptophan helped? Or have you found success with a combination.

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

Night eating syndrome: is low serotonin a root cause and is tryptophan a solution?

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night eating syndrome

According to this paper, Circadian Rhythm Profiles in Women with Night Eating Syndrome, “Patients with night eating syndrome (NES) – first described in 1955 – demonstrate a phase delay in the circadian pattern of food intake, manifested by evening hyperphagia, nocturnal awakenings with food intake, and morning anorexia.”

I would start by asking this question: is low serotonin a root cause and is tryptophan a possible solution? I’ll share why below and where to start in order to find a solution.

Before I do that let me explain the terminology used in the above quote: Circadian means it happens every 24 hours, hyperphagia is obsessive food-seeking behavior, nocturnal awakenings are waking in the night and anorexia refers to restricted eating in the morning.

There is no research supporting the use of serotonin support with either tryptophan or 5-HTP for night eating syndrome but I would still start here for the following reasons:

  • this behavior happens in the evening and at night and it’s well recognized that serotonin levels are lower later in the day and at night
  • carbohydrate cravings and addictions occur with low serotonin and cravings are most intense later in the day (typically afternoon and evening)
  • obsessive behaviors are common with low serotonin
  • insomnia or night-time waking is a common symptom with low serotonin
  • doing a trial with either of these amino acids will very quickly confirm if low serotonin is a contributing factor or will rule it out

I would also have my client look at other low serotonin symptoms which would help confirm that low serotonin may be a factor for them: worry-type of anxiety, ruminations, PMS, irritability, rage or anger, TMJ, panic attacks, perfectionism, depression, low self-esteem and so on. You can see all the low serotonin symptoms here.

We typically start with a trial of tryptophan simply because so many of my clients do so well with it. The other reason is that 5-HTP can raise cortisol and cause a wired-tired feeling. That being said, some folks do better on one vs the other so if tryptophan doesn’t help then we trial 5-HTP.  You can see the products I use with my clients here on the supplements blog.

I would love to see tryptophan or 5-HTP being more extensively – because it works so effectively and quickly, and is addressing the root cause – but also because there is research that does support the serotonin connection to night eating syndrome:

  • Night eating syndome has been associated with “depression, emotional eating, sleep problems, and food addiction as well as with being overweight or with having obesity (especially as people age)” – all low serotonin symptoms.
  • Night eating patients are “responsive to selective serotonin reuptake inhibitor treatment” (antidepressant/SSRI treatment)
  • Bright light therapy may help with night eating because of it’s “serotonergic antidepressant mechanisms of action.” Night eating syndrome also shares features with seasonal affective disorder (SAD) and it’s not uncommon to experience both. The winter blues or SAD is common with low serotonin. I write more about SAD and bright light here.

I’d also consider low blood sugar as a contributing factor. We would need to rule out the use of the sleep medication Ambien/Zolpidem which has been shown to cause amnesia and sleep related eating disorders which resolves when the medication is stopped.

As always, it’s not only the low serotonin we need to address. Tryptophan or 5-HTP offer quick relief but we must always do a full functional workup looking at diet, nutritional deficiencies, digestion, all hormones, toxins and infections (and so on) so we can address all possible root causes – and why serotonin is low in the first place.

I share some possible reasons for low serotonin on this blog on imposter syndrome. Imposter syndrome is another common sign of low serotonin.

Have you been diagnosed with night eating syndrome or do you feel you possibly fit the profile? Does it happen every night and what foods are you drawn to? Which low serotonin symptoms can you relate to and has tryptophan or 5-HTP helped? What about light therapy? And was an  antidepressant prescribed?

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