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5-HTP

5-HTP can raise salivary cortisol: does this cause a “wired-tired” feeling?

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5-htp salivary

Are you aware that 5-HTP – an amino acid supplement that supports serotonin levels – can raise cortisol levels and leave you feeling “wired-tired”? You may be able to relate to this if you’ve ever used 5-HTP to help with anxiety and insomnia and ended up feeling more anxious and more wide-awake despite your exhaustion and need for sleep. You feel “wired-tired” and it’s not pleasant at all.

Both 5-HTP and tryptophan, used as supplements, help to boost serotonin levels so you can feel happy, calm, sleep well and not crave carbs in the afternoon/evening. They also help with panic attacks and phobias, lack of confidence, depression, negativity, imposter syndrome, PMS, irritability, anger issues, pain/fibromyalgia, TMJ and anger. I typically have my clients with low serotonin symptoms start with a trial of tryptophan because I see such excellent results with this amino acid. That being said, some people simply do better on one versus the other and you may do better with 5-HTP.

However there is one big caveat with 5-HTP. I don’t recommend 5-HTP when a client has elevated cortisol levels because we know that it can raise cortisol levels in certain individuals. This can leave you feeling agitated, cranky, as well as wired and yet tired at the same time.

In this 2002 study, L-5-hydroxytryptophan induced increase in salivary cortisol in panic disorder patients and healthy volunteers

Salivary cortisol levels were measured in 24 panic disorder patients and 24 healthy volunteers, following ingestion of 200 mg L-5-hydroxytryptophan or placebo.

The experiment was carried out in the afternoon, “when basal cortisol secretion is more stable.” The first saliva sample was obtained at 1pm and the subjects ingested the 200mg 5-HTP at 2pm. Additional saliva samples were obtained at 2:30pm, 3:00pm and 3:30pm.

They report the following:

A significant rise in cortisol was observed in both patients and controls following ingestion of L-5-hydroxytryptophan. No such effects were seen in the placebo condition.

Here are a few additional comments and my thoughts:

  • This study was done to find evidence for “serotonin receptor hypersensitivity in panic disorder” and not specifically to test for the effects of 5-HTP on cortisol levels but it serves this purpose rather nicely (and it’s one of many similar studies, some of which measure plasma cortisol levels)
  • Keep in mind 200mg of 5-HTP is a large starting dose. It’s typical to start with 50mg so may be a factor to consider
  • In this study they did not assess cortisol levels beyond the 1.5 hours from ingestion of the 5-HTP. It would have been useful to see when levels started to go down
  • We would want to consider the ramifications of using 5-HTP for weeks (whether it’s 50 or 200mg). What impact would that have on cortisol and the adrenals? (I am not aware of a study like this having been done)
  • I’m also not aware of a study being done with 50mg but if you feel worse and feel “wired-tired” with 5-HTP and switch to tryptophan (the equivalent starting dose is 500mg) and your anxiety and other low serotonin symptoms resolve then you have found your solution
  • You may be wondering: “could I use 5-HTP to raise my low cortisol levels”? Theoretically yes and possibly very short-term. But I would question the timing since 5-HTP and tryptophan are best dosed mid-afternoon and later. This is when we would expect our cortisol levels to be on the downward slope as we end our day. I’d also want to nourish the adrenals with B vitamins and herbal adaptogen and remove the trigger/s that are leading to low cortisol.

If you suspect low serotonin symptoms and are new to using the amino acids and do not have my book I highly recommend getting it and reading it before jumping in to taking supplements: The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings.

There is a complete chapter on the amino acids and one for pyroluria, plus information on real whole food, sugar and blood sugar, gluten, digestion and much more.  If you’re not a reader there is now also an audible version.

Here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution and additional information on Anxiety and targeted individual amino acid supplements: a summary

Please also read and follow these Amino Acid Precautions.

This lists The Antianxiety Food Solution Amino Acid and Pyroluria Supplements that I use with my individual clients and those in my group programs.

Have you used 5-HTP with success? Or have you used it and felt “wired-tired”? Have you correlated the success or failure of your 5-HTP use with your salivary cortisol levels?

If you switched from 5-HTP to tryptophan did you have success with that?

If you’re a practitioner is this something you see with your clients/patients and take into consideration?

Feel free to post your questions here too.

Botox injections (cosmetic or non-cosmetic): are they a root cause of anxiety and panic attacks?

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botox injections

New research shows Botox injections are being considered for severe depression and bipolar disorder because it stops frowning and this lack of frowning has a positive impact on neurotransmitters and mood. I recently posted this on Facebook and asked this question:

I’m curious if you have had Botox injections or would consider it (for cosmetic reasons) or perhaps for migraines, dystonia, proctalgia fugax or depression/bipolar?

If you have had Botox injections are you happy with the result or did you have any adverse effects like increased anxiety, panic attacks or anything else?

The response was varied with most folks saying they would never consider using Botox for cosmetic reasons, some folks saying they used Botox for cosmetic reasons and had issues and some folks saying they’ve used Botox for cosmetic reasons and love it, and others who have used Botox for non-cosmetic reasons.

All the practitioners who commented have concerns about Botox saying results are mixed with some of their clients having severe reactions and some doing fine. As I looked further into this topic I’ve gained additional insights and my biggest concern for you, and my community, is that Botox can lead to very severe anxiety and panic attacks.

I encourage you to keep an open mind about my Botox concerns if you have chronic anxiety that is not resolving and it started (or got worse) after receiving Botox injections, or if  you’re considering Botox injections.

Anxiety, panic attacks, inability to handle stress, body shaking

I gained my biggest insights from the Botox Dysport (Side Effects) Support group. Someone suggested I look into this group and I requested an invite to join so I could learn more. So many of the members of this support group  report anxiety, panic attacks, inability to handle stress, body shaking and problems connecting socially.  This is what one member shared:

…just joining the dots, I’ve been unwell for a few years since getting Botox but didn’t put it together until having it last week and going into panic attacks / ER.

Since then extreme anxiety and I’ve ended up in a mental health facility on benzodiazepines (ativan/valium). Reactions / withdrawal has been severe, have started to put it all together whilst reading through this page.

I’m realising that my decline, immune system failure (chronic epstein barr) fatigue, loss of motivation, loss of appetite, shaking in my body, muscle atrophy, anxiety, no motivation to connect socially, can’t handle any stress, can’t relax, tinnitus, breathing trouble and the list goes on is from botox…. scared to say the least as doesn’t seem to be a solution, I was worried to get Botox originally and obviously am eating myself up with regret, thought I would share if anyone has a similar story.

There are many similar posts to this one and it’s heart-breaking, especially because they say they are not being heard by their doctors.

I had a short online conversation with one of the moderators and she shared they suspect Botox is impacting the hypothalamic-pituitary-adrenal (HPA) axis leading to high cortisol and causing their anxiety symptoms. Many of the members find relief with Seriphos, which is a phosphorylated serine product I’ve had great success with. Here is my blog post on Seriphos for anxiety and insomnia related to high cortisol.

I asked if any of the members find GABA or serotonin support helpful and for some GABA helps ease the physical tension and for other members tryptophan or 5-HTP helps ease the worry type of anxiety. However for others, the amino acids seem to have a paradoxical effect and make symptoms worse.

I’ve never been in favor of Botox for cosmetic reasons simply because I’m not a fan of putting foreign objects/toxins into the body and because I believe in aging gracefully with confidence. I do find that many women feel the need for cosmetic Botox injections and other ways to try and look younger (such as breast implants and hair dye) because of low self-esteem and lack of confidence caused by low serotonin.

Botox for non-cosmetic purposes

Botox is also used for non-cosmetic purposes. Some of my neurologist colleagues also have concerns about cosmetic use and will only use Botox injections for the following:

  • severe cases of dystonia
  • migraines (to relax forehead muscles)
  • proctalgia fugax /rectal spasms

Botox may also be used for multiple sclerosis (MS) symptoms, pelvic pain and bladder issues, for TMJ, after a stroke and for chronic anal fissures in colitis (sphincter spasms can prevent anal fissures from healing).

I would love to see safer approaches for non-cosmetic Botox injections being researched and explored by practitioners. For example:

Botox for mental health – we can do better with nutritional psychiatry

At the beginning of this blog I mentioned the new research that shows Botox injections are being considered for severe depression and bipolar disorder because it stops frowning. This lack of frowning has a positive impact on neurotransmitters and mood.

A study published in 2018, Clinical analysis of 86 botulism cases caused by cosmetic injection of botulinum toxin (BoNT), reports that botulism is a severe side effect of Botox injections with symptoms including: “headache, dizziness, insomnia, fatigue, blurred vision, eye opening difficulty, slurred speech, dysphagia [difficulty swallowing], constipation, and anxiety.”

The authors report these symptoms occur in the first 36 days after the Botox injections and that all symptoms resolved after botulinum antitoxin serum injections.

This conclusion clearly doesn’t address why there are so many folks in the Botox Dysport (Side Effects) Support group continue to experience long-term severe symptoms.

We also have research reporting a possible connection between Botox injections and thyroid autoimmunity.

I feel we can do better especially with what we know about nutritional psychiatry, the use of targeted individual amino acids, nutrients like lithium orotate, the gut-brain connections and everything covered in my book The Antianxiety Food Solution (my Amazon link) and on this blog.

A note of appreciation

I’d like to end with a note of appreciation to everyone who commented on my Facebook post, to the members of Botox Dysport (Side Effects) Support group on facebook (with over 5700 members as of this writing).

I’d also like to thank Diane Kazer for asking bold questions about Botox injections as part of her Non-Toxic Beauty Revolution summit. It starts next week – tune in to learn more about Botox, Breast Implant Illness, toxins in your cosmetics and so much more. In my interview we also talk extensively about the low serotonin/low self-esteem connections which I feel is a big missing piece for helping women who feel the desire or need to use cosmetic Botox in order to feel good and love themselves.

Diane writes about Botox here: Is Botox Safe? Top 3 Concerns & What to do if you’ve had it, sharing a brief history of botox, what she has uncovered about toxicity issues and possible detox solutions.

She also created this list of 58 Botox Illness Symptoms which she gave me permission to share here. She compiled this list from 1000+ people who have had Botox injections.

58 botox illness symptoms

Because of Diane asking questions and this initial research I’ve done, I’m adding a question about past history of Botox injections to my client intake form and will be gathering more information from my community of anxious women to see if there are patterns as to why some folks have such bad reactions.

I do feel we need to be asking if Botox injections (cosmetic or non-cosmetic) are a possible root cause of anxiety and panic attacks because they are adding to the toxic burden in susceptible folks.

But I do acknowledge it’s challenging to unwind all the contributing factors because it depends on what is going on with each person, such as their gut health, other medications (benzodiazepines themselves can be problematic), past trauma, infections, poor adrenal health, low GABA, low serotonin, poor detox capacity, low bile production, genetics etc. Unfortunately there is no way to know in advance who will be harmed and if Botox is the tipping point.

Please comment below if you’ve had Botox injections and had adverse reactions or have benefited from them with no adverse reactions. And if you have not had Botox would you ever consider it? Feel free to post your questions too.

Imposter syndrome and low serotonin: is tryptophan the solution?

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imposter syndrome

No-one is talking about the biochemical and low serotonin aspect of imposter syndrome and the role tryptophan plays. This really does need to be part of the discussion and part of the solution.

In case you aren’t familiar with the term imposter syndrome, many of my clients who appear to have very successful careers will say to me … “I feel like I’m an imposter. They’re going to catch me out at what I’m doing. I’m not really as good as everyone thinks I am.” Perhaps you can relate to this? You just don’t feel that you’re good enough – you’re faking it until you make it and putting on a brave face.

I can relate to all this personally. I had a very successful corporate job in my late 30s and I started to feel sure I was useless and that I was going to lose my job. Then the dreadful perimenopausal symptoms and anxiety and panic attacks started. And then I figured out it was low serotonin and hormone imbalances (and a number of other root causes that factored in to all this – I list many typical root causes below).

Valerie Young’s excellent book, The Secret Thoughts of Successful Women: Why Capable People Suffer from the Impostor Syndrome and How to Thrive in Spite of It, [my Amazon link] has created the awareness we need and offers so much in terms of recognizing the way imposter syndrome mani­fests in our lives. She shares these examples which you may also resonate with:

From the high-achieving Ph.D. candidate convinced she’s only been admitted to the program because of a clerical error to the senior executive who worries others will find out she’s in way over her head, a shocking number of accomplished women in all ca­reer paths and at every level feel as though they are faking it – impostors in their own lives and careers.

This article in Harvard Business Review, Overcoming Imposter Syndrome, states

Imposter syndrome can be defined as a collection of feelings of inadequacy that persist despite evident success. ‘Imposters’ suffer from chronic self-doubt and a sense of intellectual fraudulence that override any feelings of success or external proof of their competence.

The article mentions phrases such as “I must not fail”, “I feel like a fake” and “it’s all down to luck”, offering these tools: recognise the imposter feelings, reframe, talk about how you feel, be kind to yourself, visualize success and seek support.

This is all great advice but it’s hard work when you’re already struggling. And what if there was a simple solution that involved addressing low serotonin with an amino acid supplement such as tryptophan or 5-HTP?

How you will feel if your serotonin is low

If your serotonin is low you WILL feel like this: plenty of self-doubt, lack of confidence and negative self talk. It’s common to feel anxious and inadequate, have ruminating thoughts, do lots of reprocessing and overthinking, and be a perfectionist (you may get stuck because of the perfectionism and overthinking things). This often occurs together with carb cravings (especially late afternoon and evening), PMS/perimenopausal/menopausal symptoms. Insomnia is common and this is when much of the ruminations and negative self-talk occurs.

There is a very simple solution. Figure out if low serotonin is the issue and address it with tryptophan or 5-HTP.  Using co-factors like zinc, vitamin B6, iron, magnesium, and diet and lifestyle changes may be necessary too.

Why is serotonin low (and address the root causes)

You also need to figure out why serotonin is low and address this. Low serotonin may be caused by many factors such as:

  • dysbiosis and a messed up microbiome (we make so much serotonin in the gut)
  • stress and the adrenals (cortisol affects your sex hormone production)
  • the birth control pill (which lowers zinc and vitamin B6, both of which are needed for serotonin production)
  • gluten issues (leading to low serotonin and other nutritional deficiencies)
  • not consuming enough quality animal protein (amino acids are the building blocks of our neurotransmitters, and grass fed red meat provides zinc, iron and omega-3s – all needed to make serotonin)
  • low stomach acid (meaning you can’t digest the protein you’re consuming)
  • sex hormone imbalances (serotonin and estrogen are very closely linked)
  • liver issues (affecting how you process xenoestrogens)
  • low bile production (so you’re not digesting the healthy fats you’re eating)
  • statins (leading to cholesterol that is too low)
  • not getting enough exercise, sunshine or nature
  • mold exposure
  • heavy metal toxicity
  • Lyme disease and other co-infections
  • and more

I’ve poured through the research on imposter syndrome and there is no mention of serotonin. A few articles – like this one in Forbes, Why You Need To Understand The Neuroscience Of Imposter Syndrome – mention serotonin but not tryptophan (or 5-HTP) or any of the above approaches for raising serotonin (other than exercise).

However, clinically we see all the signs of imposter syndrome disappear once low serotonin is addressed.

Imposter syndrome and low serotonin? Have you made the connection and can you relate?

Please comment below if imposter syndrome resonates with you so we can all learn from each other. I’d love to hear:

  • how imposter syndrome shows up in your life and how you’d describe it to your best friend?
  • when do you feel like this – at work, all the time (work and home life) or only certain situations?
  • are these new feelings and if yes when did they start?  or have you always felt like this?
  • what type of job do you have? or are you an entrepreneur?
  • have you sought help for imposter syndrome and what has helped?
  • are you surprised to learn there is a biochemical aspect and nutritional solutions?
  • what other low serotonin symptoms do you have?
  • have you used tryptophan (or 5-HTP) for other low serotonin symptoms (like anxiety, ruminations, insomnia etc) and then realized that imposter syndrome is not longer an issue for you?
  • have you figured out and addressed some of the root causes of your low serotonin?

(if you feel more comfortable sharing some of this anonymously feel free to use a nickname when commenting – I’m aware that there is a stigma to admitting this in the corporate world)

Feel free to post your questions too.

GABA & Tryptophan: The Gut-Anxiety Connections with Trudy Scott on The Anxiety Summit 5

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gaba and tryptophan

One of my three interviews on The Anxiety Summit 5: Gut-Brain Axis airs on day 1 of the summit. The topic is: GABA & Tryptophan: The Gut-Anxiety Connections. In this interview, I’m interviewed by my colleague and friend Dr. Nicole Beurkens, PhD,  and you’ll learn about:

  • Low serotonin: fear, overwhelm, gut motility & anorexia
  • Low GABA: physical tension, gut & rectal pain, burning mouth
  • Blood brain barrier, phenibut, candida & CBD

I start with some background on why a summit on the gut-brain axis, what we don’t know about the incidence of anxiety and the huge increase we are seeing. The big message is that we have growing awareness but no real solutions. This goal of this summit is to create awareness around gut issues as a possible root cause and the growing research in nutritional psychiatry – AND to provide solutions!

We cover some of the basics in case you  don’t know anything about GABA and tryptophan. If you’ve been following my work you’re likely going to be familiar with this section.

trudy scott as5

I cover plenty of new research throughout the interview and we start with 5-HTP as it relates to both gut health and anxiety.  We discuss this 2019 paper: Effects of Serotonin and Slow-Release 5-Hydroxytryptophan on Gastrointestinal Motility in a Mouse Model of Depression:

  • Administration of 5-HTP SR [slow release] to mice restored [serotonin] to the ENS [enteric nervous system] and normalized GI motility and growth of the enteric epithelium.
  • 5-HTP SR [slow release] might be used to treat patients with intestinal dysfunction associated with low levels of 5-HT [serotonin].

This paper doesn’t mention anxiety or depression but we know that serotonin support with 5-HTP or tryptophan addressed this aspect too.  And given this, it’s very possible that we could extrapolate some of this research to tryptophan.

We cover motility issues at length in the SIBO (small intestinal bacterial overgrowth) interviews with Dr. Alison Siebecker and Shivan Sarna – SIBO: Anxiety, Testing, Probiotics and Fecal Transplants (Part 1 and 2). We also talk about the fear and overwhelm factor when starting a new protocol in that interview and in this interview of mine – and how addressing low serotonin helps so much.

We also talk about one of my favorite topics: GABA and the controversial blood-brain-barrier question and point you back to the discussion I have with Dr. Datis Kharrazian in his interview: Fix the Brain to Fix the Gut. Be sure to tune in to that one.

I also share some research on low serotonin and gut health in anorexia; interesting anti-candida properties of serotonin; how CBD can make tryptophan more effective (be sure to tune in to Dr. Hyla Cass’ interview for more on this: Endocannabinoid System and Your Gut); new GABA studies; the phenibut FDA ban; and updates on some possible reasons why one or more of the amino acids don’t work as well as expected when you do the questionnaire, you have all the symptoms, you review the precautions and a do a trial.

I mentioned this is one of 3 interviews I do on the summit. My other 2 interviews cover:

  • How Collagen Can Cause Anxiety and Insomnia
  • Simple Solutions for Anxiety and Gut Health

I’ll share highlights from these ones in another email/blog.

anxiety summit

Please join us and listen to my interviews and all the others on The Anxiety Summit 5: Gut-Brain Axis.

When you register now you’ll get access to there 3 interviews right away:

  • Fix the Brain to Fix the Gut – Datis Kharrazian, DHSc, DC, MS, FACN, CNS
  • MTHFR, B12 Genes and Anxiety – Carolyn Ledowsky, ND
  • Why Bile is the Key to Anxiety & Hormone Havoc – Ann Louise Gittleman, PhD, CNS

anxiety summit 5 speakers

If you have already signed up for the summit, I hope you enjoy these interview highlights.

If you have yet to sign up, please do come and join us and learn.

Register for the Anxiety Summit 5

 

If you’re considering purchasing the summit to keep for your learning library, you have a number of options that include:

  • Online only or flash drive or both
  • A PDF or printed transcripts of all the interviews
  • The Best of Anxiety-Gut interviews from previous Anxiety Summits
  • GABA Quickstart Program (a group program with me on how to actually use GABA for your physical anxiety, with a private Facebook group and live Q & A call)
Purchase options

 

If you’d like to give feedback or ask a question, please post in the comments section at the bottom.

I’d love to hear from you once you’ve listened in to this interview and the others.

I have chronic insomnia and I started getting headaches with GABA, 5-HTP and melatonin

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A combination of GABA (gamma-aminobutyric acid) and 5-HTP (5-hydroxytryptophan) can often improve sleep duration more than the use of either of these two amino acids alone. I blogged about this and the supporting research published in 2016.

Eve asked this question about her chronic sleep problems and headaches that she suspects are being triggered by the supplements:

I have chronic insomnia and I have been using 100mg 5-HTP, 250mg GABA and 1mg melatonin during the night for a week but the second day I used them I started getting a headache. Do you have idea what happened and can you please help me?

I shared this feedback about each person having unique needs and that I trial one amino acid at a time to find the ideal dose and then once we have a good baseline with good results and no adverse effects, we add the next one if needed. With 3 new supplements being started at once, we don’t know which one may be helping and which one (or more) is causing headaches.

A reminder I give all my clients is NOT to push through with the amino acids when you are experiencing any adverse effects. Headaches are more common with tyrosine rather than 5-HTP or GABA but too much of any one of the amino acids may cause a headache and with some folks, even a small amount can cause a headache especially if it’s not needed. At the first sign of a headache my advice is to stop the latest supplement added and see how you do. If 3 where started at one time, as in this situation, stop all 3 and add them back one at a time, watching for headaches and benefits.

Eve didn’t say which GABA product she was using. Source Naturals GABA Calm is the one I most often recommend, and the small amount of tyrosine could be causing her headaches. If this is the case, a switch to a GABA-only product or a GABA-theanine product may be what is needed.

It’s always important to also review the amino acid precautions before use. If you have migraines, tyrosine may make them worse.

But I do want to also add that some folks cannot tolerate 500mg tyrosine at all and yet they do just fine with the 25mg of tyrosine in the GABA Calm product (and sometimes up to 75mg of tyrosine when three GABA Calm lozenges are needed at once).

It’s also good to be aware that some folks do better on tryptophan versus 5-HTP so if it is the 5-HTP that is the problem I’d consider a trial of tryptophan. The best way to do that is to replace the 5-HTP with tryptophan (and I recommend Lidtke 500mg tryptophan).

You want to also look carefully at each of the products in case there are fillers that could be causing the headaches.

If it turns out that none of these are working i.e. the problem with sleep isn’t because of low serotonin and low GABA, then we ask these questions and address them:

  • is there a gut issue i.e. is there candida, parasites and/or dysbiosis?
  • is night-time cortisol high?
  • is gluten or other grains an issue? or was there accidental gluten exposure?
  • is caffeine or alcohol consumption a problem?
  • is there EMF and WiFi exposure?
  • are there medication side-effects?
  • has there been mold exposure or some other environmental trigger?

Have you had issues when trialing amino acids for sleep or anxiety and then figured out what the problem was?

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?