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Mitochondrial disruption and systemic benzodiazepine side effects/tapering issues: pain, fatigue, brain fog, insomnia and anxiety

By Trudy Scott 19 Comments

mitochondrial disruption

A recent article published on Naturopathic Doctor News & Review, Mitochondrial Disruption Explains Systemic Benzodiazepine Side Effects, reports on new research that identifies a possible mechanism for wide-ranging side effects of these antianxiety medications. In addition to side-effects there can also be persistent withdrawal symptoms that continue after they have been tapered:

Benzodiazepines impair mitochondrial signaling across multiple systems in the body, not just GABA receptors in the brain. Mitochondria play a central role in regulating cell energy metabolism, hormone synthesis, oxidative stress balance, and immune response.

Disrupting these pathways has systemic consequences that explain the wide range of symptoms patients report during chronic use and withdrawal.

These findings offer a cellular mechanism for persistent fatigue, pain syndromes, cognitive impairment, and inflammatory symptoms that may continue after tapering.

Many medications impact the mitochondria but this new research has identified a new possible mechanism: tryptophan-rich sensory proteins (HsTSPO1) and reactive oxygen species.

In this blog I share more about HsTSPO1 and this new research, additional symptoms of benzodiazepine withdrawal, what we already know about mitochondria and anxiety, other medications and environmental toxicants that affect the mitochondria, and some key nutrients for mitochondrial support.

Benzodiazepines bind to tryptophan-rich sensory proteins (HsTSPO1)

This article from Virginia Commonwealth University, Researchers may have solved decades-old mystery behind benzodiazepine side effects, discusses the new study and HsTSPO1:

Benzodiazepines produce their therapeutic effect by binding with GABAA receptors in the brain; however, the drug has an equally strong affinity to human mitochondrial tryptophan-rich sensory proteins (HsTSPO1), located on the outer membrane of mitochondria in cells.

This type of protein is linked to several neurodegenerative diseases, including Alzheimer’s, and researchers have suspected that HsTSPO1 may be involved in certain side effects of benzodiazepine drugs.

And “when valium and other benzodiazepines bind to HsTSPO1, they inhibit the protein’s ability to manage ROS (reactive oxygen species) levels in our cells … this both reduces the production and the neutralization of ROS.

This may help explain why such medications cause side effects over time

And the authors propose this: “The new insights into HsTSPO1’s function could help pharmaceutical companies develop improved benzodiazepines.”

I have a better idea and propose we create more awareness about how these and other medications affect the mitochondria. I believe all medications should include a warning about these mitochondrial effects, and that mitochondrial support should be included when these medications are prescribed and then tapered.

This may include a combination of the same nutrients used for neurodegenerative disorders caused by mitochondrial dysfunction – CoQ10, B-vitamins/NADH, L-carnitine, vitamin D, and alpha-lipoic acid. And should also include infrared sauna, red light therapy and other detox approaches.

Ideally, this awareness will increase the use of the amino acids GABA, tryptophan, 5-HTP and DPA (d-phenylalanine), and other nutritional approaches instead of long-term benzodiazepine prescriptions for anxiety, pain and sleep issues. More on that below.

Some of the many other symptoms of benzodiazepine withdrawal

This paper from 1994, The benzodiazepine withdrawal syndrome describes some of the many symptoms:

Physiological dependence on benzodiazepines is accompanied by a withdrawal syndrome which is typically characterized by sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremor, sweating, difficulty in concentration, dry wretching and nausea, some weight loss, palpitations, headache, muscular pain and stiffness and a host of perceptual changes.

The mechanism is not addressed in the paper but in the light of this new research, it’s possible that tryptophan-rich sensory proteins, increased reactive oxygen species and mitochondrial dysfunction are factors.

Brain mitochondria: anxiety and fear

I first addressed mitochondrial dysfunction during the 2019 Anxiety Summit: Gut-Brain Axis. One of my guest experts, Tara Hunkin, NTP, CGP, RWP shared these highlights from this review paper – Anxiety and Brain Mitochondria: A Bidirectional Crosstalk:

  • Despite the established link between mitochondrial dysfunction and various psychiatric disorders, the contribution of mitochondria in anxiety disorders has not been extensively addressed.
  • Mitochondria are emerging as modulators of anxiety-related behavior, as evidenced both in animal and human studies.
  • There is a bidirectional link between mitochondria and anxiety. Mitochondrial, energy metabolism, and oxidative stress alterations are observed in high anxiety; conversely, changes in mitochondrial function can lead to heightened anxiety.

More recent research, published in 2024, The Emerging Role of Brain Mitochondria in Fear and Anxiety, supports this and proposes “a model in which mitochondrial function is critical for regulating the neural circuits that underpin fear and anxiety behaviors, highlighting how mitochondrial dysfunction can lead to their pathological manifestations.”

The new HsTSPO1 research builds on this research, identifying a possible mechanism and further supporting the oxidative stress connection.

On a side note, I’m really intrigued to learn more about these tryptophan-rich sensory proteins!

Other medications and environmental toxicants that impact the mitochondria

Keep in mind that it’s not only benzodiazepines that impact the mitochondria.

This 2023 paper, Drug-induced mitochondrial toxicity: Risks of developing glucose handling impairments, explores the correlation between potential mitochondrial dysfunction caused by selected medications, specifically looking at their effects on insulin signalling and glucose handling:

Drug classes such as statins, anti-diabetics, anti-epileptics, NSAIDs, anti-depressants, and certain antibiotics have been identified to induce mitochondrial toxicity.

This 2022 paper, Environmental Chemical Exposures and Mitochondrial Dysfunction: a Review of Recent Literature, states this:

Classes of environmental toxicants such as polycyclic aromatic hydrocarbons, air pollutants, heavy metals, endocrine-disrupting compounds, pesticides, and nanomaterials can damage the mitochondria in varied ways, with changes in mtDNA copy number and measures of oxidative damage the most commonly measured in human populations.

Amino acids and nutritional support: instead of benzos and before/during tapering

As I mentioned above, this awareness will hopefully increase the use of the amino acids GABA, tryptophan, 5-HTP and DPA (d-phenylalanine), and other nutritional approaches instead of long-term benzodiazepine prescriptions for anxiety, pain and sleep issues.

When it comes to tapering, it’s best to be nutritionally stable BEFORE starting to taper. This means eating real whole food that includes quality animal protein, healthy fats, fermented foods and organic vegetables and fruit; eating for blood sugar control; quitting sugar, gluten, alcohol and caffeine; addressing gut and adrenal health; addressing pyroluria and key nutritional deficiencies like low zinc, low iron, low vitamin D and more. This is all covered in my book.

Addressing neurotransmitter imbalances with amino acids before and during the tapering helps immensely too.  And so does mitochondrial support.

And a reminder: tapering should always be done very very very slowly and under medical supervision with the prescribing doctor.

Additional resources when you are new to using GABA, tryptophan and other amino acids as supplements

As always, I use the symptoms questionnaire to figure out if low serotonin or low GABA or other neurotransmitter imbalances may be an issue.

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 on your own so you are knowledgeable. And be sure to share it with the practitioner/health team you or your loved one is working with.

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control (this is covered in an entire chapter too), sugar cravings, anxiety and mood issues.

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 acids that I use with my individual clients and those in my group programs.

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), a good place to get help is the GABA QuickStart Program (if you have low GABA symptoms). This is a paid online/virtual group program where you get my guidance and community support.

If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. This is also a paid online/virtual program with an opportunity to interact with me and other practitioners who are also using the amino acids.

Wrapping up and your feedback

Are you aware that benzodiazepines and many other medications can play a role in mitochondrial disruption? And that this mitochondrial disruption is likely a factor when it comes to systemic benzodiazepine side effects and tapering issues such as pain, fatigue, brain fog, insomnia and anxiety (and more)?

Have you considered or used mitochondrial support when tapering one of the benzodiazepines and has this approach helped?

And has it helped to be nutritionally stable BEFORE tapering and using amino acids to help with tapering? What changes did you make and which amino acids helped?

If you’re a practitioner is this a topic you discuss and address with your clients/patients?

Please do share in the comments below.

Are adrenal issues causing your anxiety? Highlights from the book: Adrenal Transformation Protocol by Izabella Wentz PharmD

By Trudy Scott 8 Comments

adrenal transformation protocol

This is a guest post from my friend and colleague, Dr. Izabella Wentz, who just came out with her latest book, Adrenal Transformation Protocol (my Amazon link). The book is focused on healing your adrenals, and in it she shares specific strategies to support anxiety. Izabella shares a few of the many strategies with you here in this guest post.

You’ll notice that we share many common approaches:

  • Addressing low blood sugar (much more on that below)
  • Caffeine intake: Izabella recommends reducing caffeine but I have found many folks in my community need to quit altogether. I have noticed that those with panic disorders experience 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.
  • Gluten elimination: Interestingly, I have found in my clinical experience and research that there is a connection between gluten and anxiety, social phobia, depression, and even schizophrenia.
  • Using herbal adaptogens, addressing nutrient deficiencies, and even pyroluria which can deplete key nutrients needed for adrenal health (especially when under high amounts of stress).

All of her approaches focus on adrenal health specifically and she has now taken over 3000 people on an adrenal healing journey. And 86% of them reported that their anxiety improved after going through her protocol.

By Dr. Izabella Wentz. PharmD

Stress is at the root cause of many chronic health issues, and very well may be at the root of your anxiety, too. Chronic stress can put a burden on our adrenal glands, resulting in an excess of stress hormones like cortisol. The body’s repeated exposure to cortisol can result in increased blood sugar levels, increased heart rate, and increased blood pressure, all of which can lead to feelings of anxiety.

The adrenals are two small glands, located on top of each kidney, that release hormones such as cortisol and adrenaline. Adrenal dysfunction generally occurs when your hypothalamic-pituitary-adrenal (HPA) axis is unable to effectively manage your stress response. The HPA axis describes the interactive feedback loop that takes place among these three endocrine, or hormone-producing, glands. If the communication among these three breaks down, your adrenals and their ability to produce important essential hormones can be jeopardized.

Overactive adrenals can leave you feeling like you’re constantly in “fight or flight” mode. First, your body releases high levels of stress chemicals like adrenaline and cortisol. To ensure you’re ready to defend yourself or run, these chemicals spike your blood sugar, as well as increase heart rate, blood pressure, and insulin levels – making you feel anxious, stressed and wide awake at night.

Chronic stress is one of the most common causes of adrenal dysfunction. Our bodies are well-equipped to respond to acute stressors (like being chased by a bear or getting out of the way of an oncoming car), where we experience activation of the fight-or-flight response, followed by a return to the rest-and-digest state.

However, many of us today face a never-ending presence of stressful, yet non-life-threatening, situations that can lead to the constant activation of the stress response.

With enough chronic stress, the HPA axis becomes overwhelmed and desensitized to the usual feedback loop, and stops sending messages to the adrenals to produce more hormones or less hormones, no matter what’s happening.[1]

Other common causes of adrenal dysfunction include sleep deprivation, blood sugar dysregulation, and chronic inflammation (which are all forms of stress on the body).

Symptoms of poor adrenal function may include the following:

  • Feeling overwhelmed
  • Feeling anxious
  • Feeling tired despite adequate sleep
  • Trouble falling asleep or trouble staying asleep
  • Difficulty getting up in the morning
  • Dependency on caffeine
  • Cravings for salty foods (a.k.a. the “I just ate a whole bag of chips” syndrome)
  • Cravings for sweet foods
  • Increased effort required for everyday activities
  • Intolerance to exercise
  • Low blood pressure
  • Feeling faint/dizzy when getting up quickly
  • Easily startled
  • Mental fog or trouble concentrating
  • Alternating diarrhea/constipation
  • Low blood sugar (often presenting as feeling angry when hungry or, as I like to call it, “hangry”)
  • Decreased sex drive
  • Decreased ability to handle stress
  • Longer healing time
  • Mild depression
  • Less enjoyment in life
  • Feeling worse after skipping meals
  • Increased premenstrual syndrome (PMS)
  • Reduced ability to make decisions
  • Reduced productivity
  • Poor memory

If you have three or more of these symptoms, and if these symptoms developed after experiencing a period of acute or chronic stress, sleep deprivation, an infection, or toxic exposure, chances are that you have adrenal dysfunction.

The anxiety adrenal connection

Anxiety is a hallmark symptom of adrenal dysfunction. When the adrenals are compromised, your resilience to stress starts to go down, and you might start to feel more anxious.

Of course, anxiety and adrenal dysfunction run on a two-way street. Chronic stress and anxiety can tax the adrenals, and weakened adrenals can contribute to feelings of anxiety.[2]

There’s another connection here that I’d like to highlight, and that is the thyroid. The thyroid is impacted by adrenal function, and anxiety can also be connected to thyroid conditions. In fact, I’ve noticed that up to 50 percent of my clients with anxiety have Hashimoto’s, an autoimmune thyroid condition.

A 2004 study found an association between the presence of a mood or anxiety disorder, and the presence of anti-TPO antibodies (indicating Hashimoto’s).[3] It also noted that a slight reduction in thyroid hormone secretion (such as that found in subclinical hypothyroidism) may affect mood as well. Therefore, it’s also possible that the anxiety you are feeling is related to your thyroid.

Anxiety solutions: Use the ABC’s

One of the first places to start is with the ABCs of adrenal health – adaptogens, B vitamins, and vitamin C.

Adaptogens both tone down overactive systems and boost underactive systems in the body, and are thought to help normalize the HPA axis. Examples of adaptogenic herbs that may increase the body’s ability to resist stress include: ashwagandha, astragalus, reishi mushroom, dang shen, eleuthero, ginseng, jiaogulan, licorice, maca, schisandra, spikenard, and suma.

Ashwagandha in particular is helpful for stress and anxiety, and it can also support thyroid health. Research supports that ashwagandha may offer antidepressant, antioxidant, anti-inflammatory and neuroprotective benefits.[4] It also may reduce anxiety, improve sleep, and even help address sexual dysfunction in women.[5]

Rhodiola is another favorite for stress support, mood support, and improved sleep. Sometimes referred to as golden root, rhodiola focuses on our nervous system health. Izabella has found it to be helpful for those with depressed cortisol levels (which can happen in later stages of adrenal dysfunction).

One of the main chemicals in rhodiola is salidroside, found to have neuroprotective effects that reduce the impact of stress on the immune system and the neuro-endocrine system.[6] Studies have found an anti-fatigue effect along with cognitive function improvements, such as memory improvements (during stressful conditions), and it’s also been shown to diminish depressive symptoms.[7]

B vitamins and vitamin C tend to be depleted during times of stress and high cortisol production. In particular, deficiencies in pantothenic acid and biotin (vitamins in the “B” family), have been linked to decreased adrenal function in animals and humans.[8]

Vitamin C is an important antioxidant that helps support the adrenals, mitochondria, collagen production, and immune function.[9] It’s also needed for the production of cortisol.

Supplementing with the ABCs is a really good place to start if you’re experiencing anxiety or adrenal dysfunction.

Balancing blood sugar

One of the most important strategies to reduce your anxiety involves addressing blood sugar issues. Blood sugar swings can put us on an emotional rollercoaster.

After consuming carbohydrate-rich foods, some people find their blood sugar goes up too high, too quickly.

This leads to a rapid, sometimes excessive release of insulin (a hormone that regulates blood sugar levels). These insulin surges can cause low blood sugar, which can cause unpleasant symptoms such as anxiety, nervousness, lightheadedness, fatigue, excessive hunger, and “hanger”.[10]

You can balance your blood sugar by reducing your intake of carbohydrates, and increasing your protein and fat intake. A low-carb or ketogenic diet (a low-carb diet where the body breaks down fats for fuel instead of relying on carbohydrates) could be beneficial for some.

Starting the day off by having a breakfast that is filled with good fats (for example, avocado or coconut milk), as well as a good source of protein, while limiting your intake of sugars (even from fruit). Some options include eggs with avocados, burger patties, or protein and fat-based smoothies. In addition to a good breakfast, eating frequent protein and fat-containing meals and snacks, help to balance your blood sugar throughout the day.

Eat on a schedule to avoid getting “Hangry”

It’s ideal to eat every two to three hours, and avoid high carbohydrate foods, to support balanced blood sugar. This will also help with energy levels, feelings of anxiety, and “hanger”. A typical day would look like this:

  • Start the day with an energizing Adrenal Kick Start (recipe is in the book), followed by a blood-sugar-balancing breakfast smoothie.
  • A mid-morning snack/caffeine-free latte/tea/green juice to help with blood sugar, hunger, hormones, and energy levels.
  • A nourishing and balancing midday lunch.
  • Another snack/caffeine-free latte/tea/green juice two to three hours later.
  • An easy-to-digest dinner is scheduled for the early evening to set up for restful sleep.
  • An optional after dinner snack or tea, to support restful sleep through stable blood sugar levels at night.

Reduce (and ideally eliminate) caffeine

If you’re currently drinking coffee, soda, green tea, or black tea, removing or reducing your intake of caffeine can be helpful for an immediate reduction in anxiety, and is supportive over time to your adrenals.

Some people who are slow metabolizers of caffeine and do not clear it effectively out of their body may not be able to have any caffeine at all – not even chocolate! Others who are fast metabolizers and are able to clear caffeine more quickly from their bodies, may be able to tolerate more daily caffeine without it impacting their anxiety levels.

Regardless of your genes and metabolism of caffeine, the weaker your adrenals and the more unbalanced your blood sugar levels are, the more likely you are to experience anxiety from caffeine. This is because caffeine forces more glucose to be produced by the liver, sending the body on a blood sugar rollercoaster that can trigger anxiety.

If you’re thinking about reducing your caffeine intake, do it gradually over time, instead of quitting cold-turkey, which can cause withdrawal symptoms such as headaches, fatigue and even vomiting.

There are ways to improve energy levels and sleep before trying to get off caffeine, such as supporting your mitochondria and tuning into the circadian rhythm.

[Trudy’s note: be sure to read my comment above about the need to eliminate caffeine altogether in many instances]

Address low magnesium

Research suggests that a magnesium deficiency may be associated with anxiety. Several studies have found that feelings of fear and panic can be greatly reduced with an increased magnesium intake.[11] It has even been shown to have a positive effect on both post-traumatic anxiety and premenstrual anxiety, as well.[12]

Even more interesting, is the understanding that magnesium also controls the hypothalamic-pituitary-adrenocortical (HPA) axis, which is the hub of the body’s stress response system.[13] This could provide some explanation as to why a magnesium deficiency could lead to increased stress and anxiety when the HPA axis is out of balance. Other signs of a magnesium deficiency include headaches, insomnia, constipation, and menstrual cramps.

A magnesium supplement throughout the day may help, or at bedtime if you have insomnia or a racing mind when you’re trying to fall asleep. The citrate version is best if you tend to be constipated (magnesium citrate has stool softening effects), and I recommend the glycinate version if you tend to have normal bowel movements or diarrhea. Keep in mind that, for some people, magnesium glycinate can worsen anxiety symptoms. If you notice that your anxiety increases after taking magnesium glycinate, try switching to magnesium citrate.

Remove reactive foods

The most common food reactions responsible for anxiety symptoms are due to gluten, dairy, soy, grains (especially corn), sugar, caffeine (as discussed above), and surprisingly to some, nuts.[14]

Doing targeted food sensitivity testing, or simply a trial of eliminating the suspect foods for a period of time (with an elimination diet), can help you uncover your food triggers.

If anxiety is not resolved using the strategies above, there are many advanced strategies for anxiety support, and the book provides plenty of information and options for testing.

Address copper toxicity

A toxic buildup of copper may be at the root of anxiety, racing thoughts, mood swings, fatigue, and insomnia.[15] High-copper foods include shellfish, oysters, nuts, seeds, and chocolate. We can also absorb copper from our water and metal pipes and products. Certain medications (oral contraceptives, antacids, copper-rich multivitamins), excess estrogen, copper IUDs, and zinc deficiency can increase our exposure. Many people with adrenal dysfunction have a congested liver, so that is likely one reason copper toxicity is a common root cause.

Reducing copper containing foods, and increase zinc containing foods (non-organ meats, eggs, poultry).

Balance thyroid hormones

Having an excess amount of thyroid hormone can make us extremely anxious, irritable and on edge. This is commonly attributed to Graves’ disease, but can also occur in Hashimoto’s. The ideal TSH for most people is between 0.5-2 μIU/mL. Levels that are too high or too low indicate an imbalance of thyroid hormone levels and have been associated with various symptoms, including anxiety. Work with your doctor to test your thyroid and adjust medication if needed.

Address female hormone imbalances

Estrogen dominance and/or low progesterone may lead to many symptoms like irritability, mood lability, depression, and mood swings.[16] If tests reveal low progesterone, supplementing with oral or topical bioidentical progesterone might just be the chill pill you need.

Address gut infections

An imbalance of gut bacteria can contribute to mood issues. There are also certain overgrowths and gut infections that can impact anxiety levels. For example, overgrowth of Streptococcus bacteria has been associated with obsessive-compulsive disorder.[17] The book includes recommendations for further testing that can help you determine if you have an overgrowth or infection.

Address iron toxicity/overload

A buildup of too much iron can cause irritability and depression.[18] Ferritin levels above 200 ng/dL in women (300 ng/mL in men) can indicate iron toxicity or overload. The book offers several different options for treatment.

Address mold toxicity

There is a big connection between mood issues and mold exposure.[19] If your symptoms appeared or increased after moving into a new home, there’s a good chance your anxiety may be connected to mold exposure.

Address common nutrient deficiencies

Nutrient deficiencies are common in those with adrenal issues, and could be contributing to feelings of anxiety. Address these important nutrients for mood support: omega-3 fatty acids, folate (vitamin B9), iron, vitamin B12, and vitamin D.

Address the social anxiety condition called pyroluria

Symptoms of social anxiety have been associated with pyroluria, which is a condition where there are too many pyrrole molecules in your body.[20] These molecules can deplete your system of essential nutrients that play an important role in mood and adrenal health.

[Trudy’s note: I’m really pleased to see pyroluria mentioned in this book, because it’s not often acknowledged as a condition. I also appreciate the reference, in the pyroluria section, to my work and book, The Antianxiety Food Solution.]

Adrenal Transformation Protocol – for anxiety

Adrenal Transformation Protocol (my Amazon link) provides comprehensive support for the many potential stressors the body can experience, so that you can heal anxiety using a whole body, root-cause approach.

When we address the root causes of adrenal fatigue and anxiety, like blood sugar imbalances, food sensitivities, and nutrient deficiencies, we can increase our resilience and reduce feelings of anxiety!

Adrenal dysfunction often begins after a stressful period in our lives. When the body puts cortisol front and center, rebuilding and repairing go on the backburner, and we can end up with a host of symptoms including fatigue, brain fog, and anxiety.

While most people can bounce back from small stressors, some of us can get caught up in a stress cycle that ends up affecting our physiology. When we are caught in this stress cycle, it throws our hormonal systems out of balance, and leads to us being stuck in “fight or flight” mode. Prolonged “fight or flight” mode eventually leads to burnout, and often contributes to anxiety.

Through years of research, patient study, and work with thousands of clients, my signature protocol has been shown to reverse symptoms of adrenal fatigue. It provides a foundation for optimal health, and can even be one of the keys to resolving anxiety.

In both my own work and Izabella’s, we have found that addressing the adrenals often results in the complete resolution of chronic stress symptoms!

Izabella has experienced multiple bouts of adrenal fatigue and has struggled with anxiety. She realized that her body was responding to the various stress triggers in her environment, and decided to send it safety signals instead, to put it into a healing and rebuilding state. The protocol worked so well for her that she piloted it as a program with a small group in 2020. Despite all of the things that happened in 2020, people reported that the program helped them rebalance their stress response.

Over 3000 people have now completed this protocol, with incredible results, and it’s all in her new book, Adrenal Transformation Protocol (my Amazon link). The book outlines a simple four-week plan to help you recover your adrenal function and resolve symptoms like fatigue, brain fog, depression, and anxiety. The protocol is designed to help you feel calm, strong, excited about life, and brilliant once more!

In addition to reduced brain fog, reduced fatigue, and better sleep, participants reported incredible results in mood – 86 percent reported reduced anxiety and 80 percent reported reduced feelings of nervousness.

Adrenal dysfunction can be a root cause of anxiety. If you’re still experiencing anxiety symptoms and feel like you’ve tried everything, but haven’t yet addressed your adrenal health, I’d highly recommend Adrenal Transformation Protocol (my Amazon link)!

Feel free to share your feedback once you’ve read the book.

Also, let us know if any of the above approaches have helped you address your adrenal issues?

If you have questions and other feedback please share it here too.

[1] Cook SB. Current Controversy: Does Adrenal Fatigue Exist?. Natural Medicine Journal. 2017;9(10).[2] Faravelli C, Lo Sauro C, Lelli L, et al. The role of life events and HPA axis in anxiety disorders: a review. Curr Pharm Des. 2012;18(35):5663-5674. doi:10.2174/138161212803530907

[3] Carta M, Loviselli A, Hardoy M et al. The link between thyroid autoimmunity (antithyroid peroxidase autoantibodies) with anxiety and mood disorders in the community: A field of interest for public health in the future. BMC Psychiatry. 2004;4(1). doi:10.1186/1471-244x-4-25.

[4] Lopresti AL, Smith SJ, Malvi H, Kodgule R. An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled study. Medicine (Baltimore). 2019;98(37):e17186. doi:10.1097/MD.0000000000017186

[5] Dongre S, Langade D, Bhattacharyya S. Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Improving Sexual Function in Women: A Pilot Study. Biomed Res Int. 2015;2015:284154. doi:10.1155/2015/284154

[6]  Lee Y, Jung JC, Jang S, et al. Anti-Inflammatory and Neuroprotective Effects of Constituents Isolated from Rhodiola rosea. Evid Based Complement Alternat Med. 2013;2013:514049. doi:10.1155/2013/514049

[7] Cropley M, Banks AP, Boyle J. The Effects of Rhodiola rosea L. Extract on Anxiety, Stress, Cognition and Other Mood Symptoms. Phytother Res. 2015;29(12):1934-1939. doi:10.1002/ptr.5486

[8] Pan L, Jaroenporn S, Yamamoto T, et al. Effects of pantothenic acid supplement on secretion of steroids by the adrenal cortex in female rats. Reprod Med Biol. 2011;11(2):101-104. Published 2011 Dec

[9] Valdés F. Vitamina C [Vitamin C]. Actas Dermosifiliogr. 2006;97(9):557-568. doi:10.1016/s0001-7310(06)73466-4

[10] Mathew P, Thoppil D. Hypoglycemia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 23, 2022.

[11] Boyle NB, Lawton C, Dye L. The Effects of Magnesium Supplementation on Subjective Anxiety and Stress—A Systematic Review. Nutrients. 2017 May; 9(5): 429. doi:10.3390/nu9050429.

[12] Fromm L, Heath DL, Vink R, Nimmo AJ. Magnesium attenuates post-traumatic depression/anxiety following diffuse traumatic brain injury in rats. J Am Coll Nutr. 2004;23(5):529S-533S. doi:10.1080/07315724.2004.10719396

[13] Sartori SB, Whittle N, Hetzenauer A, Singewald N. Magnesium deficiency induces anxiety and HPA axis dysregulation: modulation by therapeutic drug treatment. Neuropharmacology. 2012;62(1):304-312. doi:10.1016/j.neuropharm.2011.07.027

[14] Vatn MH. Food intolerance and psychosomatic experience. Scand J Work Environ Health. 1997;23 Suppl 3:75-78.

[15] Russo AJ. Decreased zinc and increased copper in individuals with anxiety. Nutr Metab Insights. 2011;4:1-5. Published 2011 Feb 7. doi:10.4137/NMI.S6349

[16] Glick ID, Bennett SE. Psychiatric complications of progesterone and oral contraceptives. J Clin Psychopharmacol. 1981;1(6):350-367. doi:10.1097/00004714-198111000-00003

[17] Mell LK, Davis RL, Owens D. Association between streptococcal infection and obsessive-compulsive disorder, Tourette’s syndrome, and tic disorder. Pediatrics. 2005;116(1):56-60. doi:10.1542/peds.2004-2058

[18] Cutler P. Iron overload and psychiatric illness. Can J Psychiatry. 1994;39(1):8-11. doi:10.1177/070674379403900104

[19] Harding CF, Pytte CL, Page KG, et al. Mold inhalation causes innate immune activation, neural, cognitive and emotional dysfunction. Brain Behav Immun. 2020;87:218-228. doi:10.1016/j.bbi.2019.11.006

[20] Mensah A. Mood instability: Pyrrole disorder underlying cause bipolar, DMDD. Mensah Medical. https://www.mensahmedical.com/pyroluria-pyrrole-disorder/. Published July 12, 2016. Accessed February 8, 2023.

Trigeminal neuralgia and anxiety: GABA, tryptophan, St. John’s Wort, acupuncture, DPA, gluten, herpes and Lyme disease

By Trudy Scott 30 Comments

trigeminal neuralgia and anxiety

I get a surprisingly high number of questions about trigeminal neuralgia asking if there is a role for the amino acids GABA or tryptophan to help ease some of the nerve and associated face pain. It’s surprising because trigeminal neuralgia is considered a rare neurological disorder.

Nerve pain is not my area of expertise (anxiety is), and because anxiety and depression is common in this population, there are very likely similar underlying causes (more on that below). The targeted individual amino acids that we use for anxiety, also help to ease pain, so I’m sharing some of what I know in case it helps you or a loved one.

Read on to learn more about this condition and GABA, tryptophan, DPA, acupuncture, St. John’s Wort, Lyme disease, herpes and B vitamins.

About trigeminal neuralgia and the incidence

The NIH fact sheet defines trigeminal neuralgia (TN) as

a chronic pain condition that affects the trigeminal or 5th cranial nerve, one of the most widely distributed nerves in the head. TN is a form of neuropathic pain (pain associated with nerve injury or nerve lesion.) The typical or “classic” form of the disorder (called “Type 1” or TN1) causes extreme, sporadic, sudden burning or shock-like facial pain that lasts anywhere from a few seconds to as long as two minutes per episode.  These attacks can occur in quick succession, in volleys lasting as long as two hours.  The “atypical” form of the disorder (called “Type 2” or TN2), is characterized by constant aching, burning, stabbing pain of somewhat lower intensity than Type 1.  Both forms of pain may occur in the same person, sometimes at the same time. The intensity of pain can be physically and mentally incapacitating.

The incidence of new cases is approximately 12 per 100,000 people per year and women are impacted more than men.

A number of studies show anxiety, depression and insomnia are common when someone has trigeminal neuralgia. The question is this – is the pain causing the anxiety, depression and insomnia OR are there common underlying physiological causes for both. It’s likely a combination of both especially when it comes to idiopathic trigeminal neuralgia i.e. when there is no known cause. Known causes include head injury, multiple sclerosis, dental procedures, tumors and cysts.

By using some of the approaches outlined below, we may see pain relief and improved mood, less severe anxiety and better sleep.

When to consider GABA and serotonin support

There is no research on either GABA or tryptophan/5-HTP helping with symptoms of trigeminal neuralgia, however medications that work on both GABA and serotonin are typically prescribed for trigeminal nerve pain. For this reason I would consider a trial of GABA and/or tryptophan (or 5-HTP if other low GABA physical anxiety symptoms and low serotonin worry-type anxiety symptoms are also present. You can find the symptoms list here.

There is research-based and clinical evidence that GABA and serotonin support help with other types of pain:

Both help with the anxiety, low mood and insomnia that is often present with pain conditions like this.

St. John’s Wort for nerve pain and mood

In one case report, Hypericum perforatum (St. John’s Wort) as a possible therapeutic alternative for the management of trigeminal neuralgia (TN), a 53-year-old Hispanic female patient with a history of trigeminal neuralgia used an over-the-counter preparation of St. John’s Wort and found it relieved her pain completely.

St. John’s Wort is a herb that is primarily “used for depression but also is used for rheumatism, gastroenteritis, headache and neuralgias. ” This case report is one of many studies on this herb and trigeminal neuralgia and other neuralgias (nerve pain).

It has anti-inflammatory and antioxidant effects and also supports serotonin and GABA production which further supports the above recommendations to trial the amino acids.  GABA and tryptophan would also be safe options if St. John’s Wort can’t be used as in the case of blood thinners, the birth control pill and other medications

Pain relief with endorphin support: acupuncture and DPA

Acupuncture offers pain relief via endorphin boosting and can be an option for the treatment of  trigeminal neuralgia, also offering relief for the “secondary myofascial pain associated with it.”

DPA (d-phenylalanine) is an endorphin-boosting amino acid that may also offer some pain relief. It can also be used to wean off prescription pain medication and improve sleep.

Other research-based pain-relief approaches for trigeminal neuralgia

Physical therapy, chiropractic care, using a custom dental appliance, and addressing myofacial pain may offer relief or be part of the solution.

There are some less recognized approaches too:

All of the above can also improve mood and insomnia and reduce anxiety too.

Other factors to consider: B vitamins, Lyme disease, herpes and gluten

As with any condition, a full functional medicine work up should be done to rule out and/or address gluten issues, low vitamin B6/B1/B12, and even herpes zoster and Lyme disease as a root cause (or contributing factor).

Current approaches and emerging interventions – disappointing for a 2021 paper

I was excited to read the title of this paper, Trigeminal Neuralgia: Current Approaches and Emerging Interventions, published late this year. The authors share that it “summarizes over 150 years of collective clinical experience in the medical and surgical treatment of trigeminal neuralgia.”

What is disappointing is there is no mention of any of the approaches listed in this blog. It’s published by neurosurgeons so it is understandable that they would say: “The first-line treatment remains anticonvulsant medical therapy. Patients who fail this have a range of surgical options available to them.”

Medications and/or surgical options may work well for you but if not, you need to know there are other options. You may also be looking for a medication-free or non-invasive approach.

Keep in mind that this is what you’ll be offered unless you work with a functional medicine practitioner.

I do agree with and am encouraged by these statements:

  • What is increasingly clear is that there is no catch-all medical intervention that is effective for all patients with trigeminal neuralgia, likely reflective of the fact that it is likely a heterogenous group of disorders that jointly manifests in facial pain.
  • Ultimately, elucidation of the molecular mechanisms underlying trigeminal neuralgia will pave the way for novel, more effective and less invasive therapies.

Complementary approaches: NIH fact sheet

What is encouraging is that the NIH fact sheet I link to above, does mention low-impact exercise, yoga, creative visualization, aromatherapy and meditation.

Other than the standard medications (carbamazepine, oxcarbazepine, topiramate, gabapentin, pregabalin, clonazepam, phenytoin, lamotrigine and valproic acid and tricyclic antidepressants such as amitriptyline or nortriptyline) and surgical options they do also mention acupuncture, chiropractic, biofeedback and nutrients.

Botox is listed too but I have concerns about this approach.

This blog is not intended to be a comprehensive approach for pain relief for trigeminal neuralgia but rather some options you can consider and explore with your practitioner – especially when you also have anxiety, depression and insomnia too.

Resources if you are new to using tryptophan/5-HTP, GABA and DPA as supplements

If you are new to using the amino acids as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see the low serotonin, low GABA and low endorphin symptoms) 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. 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.

Has any of the above approaches helped you or your loved one? If not, what has helped you?

What conventional treatment have you had and did it help? Were you offered any of the above non-medication and non-surgical treatment approaches?

If you’re a practitioner, has any of this helped? Please share your treatment approaches too.

Feel free to ask your questions here too.

Thailand cave rescue: yes to calming meditation and GABA, no to antianxiety medication

By Trudy Scott 3 Comments

The cave rescue of 12 teens and their soccer coach in Thailand is such a beautiful story of hope, courage, resilience, volunteerism and the whole world coming together! I’ve been following the news about this from day 1 (as I’m sure you were) and felt such relief and joy on hearing they had all been safely rescued and appear to be physically and mentally fine.

I’m weighing in on the fact that meditation seems to have played a major role in keeping them calm, using GABA or theanine instead of antianxiety medications and B vitamins for ongoing psychological support.

Meditation seems to have played a role in keeping them calm

Meditation seems to have played a role in keeping them calm, according to this report from the UK

The 12 Thai boys and their football coach who were trapped in a cave in Thailand got through the ordeal by practicing meditation, family members have said.

According to a mother of one of the boys, the team were meditating in the widely shared video of their discovery by two British divers.

Look at how calm they were sitting there waiting. No one was crying or anything. It was astonishing.

The coach who was rescued from the cave on Tuesday, trained as a Buddhist monk for 12 years before he decided to coach the Wild Boars soccer team.

‘He could meditate up to an hour,’ said his aunt, Tham Chanthawong. ‘It has definitely helped him and probably helps the boys to stay calm.’

Here is the video of their lovely smiling calm faces when they were first found.

 

In this paper, Meditation Programs for Psychological Stress and Well-Being, they report that

Meditation programs, in particular mindfulness programs, reduce multiple negative dimensions of psychological stress [such as anxiety, depression, stress, distress, well-being, positive mood, attention]

Meditation has also been shown to improve dopamine and serotonin transporter binding, which appears to have reduced fatigue and improved mood in this study, likely because there are higher levels of these neurotransmitters available.

In a study done with young adults, Effects of mindfulness meditation on serum cortisol of medical students, meditation lowered cortisol levels, suggesting reduced feelings of stress.

Meditation and GABA/theanine instead of antianxiety medications

It was clearly an extremely difficult rescue and the Australian doctor, Adelaide anaesthetist Dr Richard Harris, risked his life to go into the cave and stayed with the boys and their coach for several days. He assessed their health and made sure they were ready for the rescue.

He used his medical expertise and rescue diving experience to decide to have each of them use antianxiety medication for the arduous 8-hour plus rescue (I suspect it was Dr. Harris’ decision). It was confirmed by Thai Prime Minister Prayuth Chan-ocha – to help calm their nerves – and it’s likely they were given a benzodiazepine, hopefully only the one time.

Even though very short term acute situations like this, is actually the intended use of benzodiazepines, it concerns me that these young boys were medicated, especially since adverse paradoxical reactions can be caused by benzodiazepines and are difficult to predict and diagnose.

The following adverse reactions can occur: “unanticipated restlessness and agitated episode,” sometimes aggression, hostility, and rage, as well as “an increased state of anxiety.” An adverse reaction during the actual rescue would have been very serious.

There were also reports of elevated white blood cells (WBC) and signs of a lung infection in some of the boys, and one boy had low blood pressure. These are all be side-effects of benzodiazepines. It’s difficult to know what caused any of this – was the medication, the rescue itself and the fact that were under water or spending all that time in the cave?

My intention is not to be critical of the medical decisions that were made in these very dire circumstances. I’ve done caving or spelunking as it was called in England and it’s pretty scary being underground and in the dark, wading through running water – and we were safely in control of things!

I’m sharing about benzodiazepines simply to raise awareness about other options and some of the many risks. And we haven’t even explored the fact that long-term use of benzodiazepines do more harm than good. More than a week to 2 weeks is considered too long, and for some this is even too long.

I really do look forward to the day when benzodiazepines are not the first approach but rather that:

  • meditation is recognized as being as effective, if not a more effective calming approach (I suspect the mediation benefits these boys had been experiencing would likely have carried them through the rescue)
  • the amino acids GABA or theanine are recognized for the calming benefits they offer (especially since the “mechanism of benzodiazepine action is through the gamma-aminobutyric acid [or GABA] receptors.”

B vitamins and other nutrition solutions after psychological stress

Thailand’s Department of Mental Health shared that

People who endure such an intense and dangerous event can go on to suffer lasting anxiety, depression and other symptoms of post-traumatic stress disorder.

I was so pleased to hear that the boys and their coach are being given B vitamins. There is evidence-based research on the psychological benefits of B vitamins after a trauma (like an earthquake or flood), thanks to my colleagues Julia Rucklidge, PhD and Bonnie Kaplan PhD​.

I do hope the B vitamins are continued and is offered to worried family members and all the wonderful rescuers who must be exhausted and stressed too.

Hopefully the boys will also continue to meditate with their soccer coach and share some of the benefits they experienced with family and friends.

How did you feel when you heard the rescue was over? Good news gives us such feel-good warm emotions doesn’t it!?

Do you meditate and have you used calming GABA or theanine?

Let us know if you have questions too.