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Vitamin C causes oxalate formation resulting in pain, anxiety, and insomnia (when there is a defect in ascorbic acid or oxalate metabolism)?

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vitamin c and oxalate

Supplemental vitamin C has many exceptional health benefits and causes no issues for a large majority of individuals. However if you have dietary oxalate issues, doses of vitamin C above 100mg to 250mg per day may be problematic and trigger pain, anxiety, insomnia, bladder issues and more. This blog, Coronavirus and vitamin C for immune support: new pain or more severe pain due to oxalate issues?, is part 1 of the series  which sets the scene and is a fact-finding article. Part 2, Oxalate crystal disease, dietary oxalates and pain: the research & questions (part 2), covers the research behind oxalate crystal disease.

Today we look at some of the research on vitamin C/ascorbic acid being a possible trigger for the formation of oxalates in certain instances. This paper, No contribution of ascorbic acid to renal calcium oxalate stones, has a good summary:

Even though a certain part of oxalate in the urine derives from metabolized ascorbic acid, the intake of high doses of vitamin C does not increase the risk of calcium oxalate kidney stones due to physiological regulatory factor: gastrointestinal absorption as well as renal tubular reabsorption of ascorbic acid are saturable processes, and the metabolic transformation of ascorbic acid to oxalate is limited as well.

But in the large-scale Harvard Prospective Health Professional Follow-Up Study, those groups in the highest quintile of vitamin C intake (> 1,500 mg/day) had a lower risk of kidney stones than the groups in the lowest quintiles.

This paper does however have this precaution:

Recurrent stone formers and patients with renal failure who have a defect in ascorbic acid or oxalate metabolism should restrict daily vitamin C intakes to approximately 100 mg.

My proposed interpretation of this

I’d like to propose an interpretation of this, based on what we know about oxalates. These are the individuals who should restrict daily vitamin C intakes to approximately 100 mg per day (or up to around 250mg per day – more on the range below):

1) If you are someone who is a recurrent stone former or is in renal failure with a defect in ascorbic acid or oxalate metabolism

2) If you are someone with dietary oxalate issues i.e. you have similar symptoms when consuming vitamin C as you do when consuming high oxalate foods. Could we consider that you be classified as having “a defect in ascorbic acid or oxalate metabolism?” I would say yes.

I’ve added #2 above because we need to keep in mind that many individuals who have issues with dietary oxalates are not necessarily stone formers and nor do they have renal failure.

Research is also lacking in this area as you can read in Oxalate crystal disease, dietary oxalates and pain: the research & questions (part 2).

An omission of the 100mg per day restriction

I would like to point out that the study mentioned above was referred to in an article on Dr. Andrew Saul’s site but for some reason the section about the 100mg daily restriction was omitted from the article. It may have something to do with the fact that the author firmly believes that no-one has oxalate issues with any dose of vitamin C. In fact, he even jokingly makes this comment in the article:

Is some clown still trying to tell you that vitamin C is somehow dangerous? Or that you shouldn’t take more than 200 mg/day?

If you are someone who does experience pain when consuming vitamin C (like I do), I’m pretty sure you don’t find this comment amusing.

Vitamin C intake leading to pain, anxiety, insomnia, low mood and bladder issues

Here is some additional feedback from a question I posted on Facebook. This is the question I posted:

I’ve been sharing here about vitamin C being an issue for some folks who have oxalate issues and seeing an increase in pain. I’d love to hear if you upped your vitamin C intake for immune support and saw your mood take a dive or your anxiety increase or your sleep get worse? Vitamin C typically helps because it’s a cofactor for making neurotransmitters like serotonin and GABA and tyrosine but too much of a good thing is not good! Did you also have increased or new pain (as well as anxiety, low mood and insomnia)?

Here are some of the responses from folks who shared about pain, anxiety, insomnia, low mood and bladder issues:

  • Fay shared this: “Yes increased pain, insomnia and anxiety with increased C and mouth sores to boot. Taking liposomal C and Ester C to boost antioxidants for health reasons and pain in elbows and knees. Not sleeping well at all either.”
  • Lica shared this: “Yes increased anxiety…never thought of it before…felt a bug coming on and took c for a few days…yup anxiety.”
  • Nicola shared this: “Increase in body pain, burning bladder, sleep affected and low mood ( not something I usually suffer with). I was taking liposomal C then increased the dose and also added Ester C as I had symptoms of covid. I was taking 1-2g a day of liposomal previously as a preventative and increased to 4g plus 4g of Ester. Only did it for a couple of days. Stopped three days ago and pain is starting to subside but no sleep last night. So I will continue with a break for now and add a very low dose again perhaps of Ester C and see how I go.”

I really appreciate these women sharing their experiences so we can all learn!

What is the upper limit of vitamin C for individuals with dietary oxalate issues?

I’m sure you’re wondering about the various dosages mentioned: the study mentions 100mg per day,  Dr. Andrew Saul’s clown comment says 200mg per day and Susan Owen’s TLO Facebook group recommends no more than 250mg per day. You’ll need to figure out what the upper dose of vitamin C you can tolerate – by trial and error.

The big disconnect is always the mention of kidney stones

This is one of many similar studies on the topic of ascorbic acid/vitamin C and oxalates. There are also many studies and articles stating that vitamin C does NOT play a role in the formation of oxalates and cause kidney stones. The big disconnect is always the mention of kidney stones. The missing piece – in the research and in many articles – is that you can have issues with dietary oxalates AND vitamin C when there is no kidney disease/no kidney stones.

I have a number of additional oxalate blog posts planned so please let me know what else you want to hear about.

Here are the 2 previous blog posts on this topic of oxalates, vitamin C and pain:

Please also share your vitamin C oxalate story and how you figured it out (and if you react in a similar way to dietary oxalates).

Let us know what your ideal dose is (and which dose caused issues) and what form of vitamin C and product name you use/used. Feel free to share if you also have a history of kidney stones.

Feel free to post your questions here too.

This Is Your Brain on Food by Uma Naidoo, MD (video interview and review)

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brain on food

Dr. Uma Naidoo has a wonderful new book called This Is Your Brain on Food: An Indispensable Guide to the Surprising Foods that Fight Depression, Anxiety, PTSD, OCD, ADHD, and More (my Amazon link)

Her big bold message is this “Until we solve nutritional problems, no amount of medication and psychotherapy is going to be able to stem the tide of mental issues in our society.”  This is something I wholeheartedly agree with!

I had the wonderful opportunity to interview Dr. Naidoo and we talked about the benefits of fermented foods and social anxiety, vitamin D and anxiety, dietary sources of polyphenols for ADHD and much more:

51 women with type 2 diabetes and vitamin D deficiency were randomly allocated to receive one oral pearl of 50,000 IU vitamin D3 (26 women) or a placebo (25 women) fortnightly for 16 weeks

Anxiety score changes were significantly lower in vitamin D group than the controls

Dietary polyphenols… have antioxidant capacities as well as immunoregulatory effects and, therefore, appear appropriate in ADHD therapy.

  • Dr. Naidoo recommends these sources of polyphenols: berries and other fruit, vegetables, extra virgin olive oil.
  • I’m fascinated by the fact that polyphenols “act as a low-dose toxin that trains the body to mount an immune response in a process called hormesis” (there are many geeky gems like this in the book)
  • Dr. Naidoo shares the story of her 36 year old patient with severe anxiety. He was a binge eater and also had a history of alcohol abuse. Vitamin B1 (250mg) was every effective for him…“In animal studies, thiamine appears to reduce stress-like responses because it protects the hippocampus”
  • We talk about chamomile tea and how it helps with sleep. There are some cautions if you’re on a blood thinner prescription or going to have surgery. Pregnant women should also avoid it.
  • Dr. Naidoo shares a delicious Golden Milk recipe with tips on how to use turmeric (one her favorite spices and inspired by her grandmother’s cooking) with black pepper. You’ll find this in the recipes section.
  • Dr Naidoo also shares one of her favorite comfort foods – a yummy lentil soup recipe called dal in south Indian cuisines. It’s a great source of fiber, plant-based protein and is very affordable. And really healthy when cooked with vegetables and spices like mustard seeds, ginger, garlic and turmeric. She shares a tip to improve the flavors – making tadka (listen to the interview below, enjoy and be inspired!)

 

It’s a wonderful book that I highly recommend if:

  • you are new to nutritional psychiatry and the power of food
  • you are a seasoned foodie and want to geek out on mechanisms and the science
  • you want to learn about foods and nutrients (all science-based) specifically for depression, anxiety, PTSD, OCD, ADHD and insomnia
  • you are a practitioner and want to learn and share a wonderful book with your patients or clients

I read it cover to cover and picked up so many gems. I also loved reading about her memories of cooking with her Pinetown granny (Pinetown is just outside Durban where we both happened to grow up)!

We do have a few professional differences of opinion that I feel I should mention:

  • I am not in favor of canola oil and I’d switch out the recipes that call for canola oil with olive oil
  • I have a difficult time extrapolating high-fat diets in rat studies to concerns about saturated fat consumption in humans (given the nature of the rat chow in many of these studies)
  • I’m more concerned with portion-size of carbs than I am with portion-size of healthy fats (and typically recommend full-fat coconut milk, and chicken and turkey with skin-on)
  • I find grass-red meat to be beneficial for my clients with anxiety and mood issues
  • Many of my anxious clients cannot tolerate any caffeine and I consider 14 alcoholic drinks a week for men and 7 alcoholic drinks a week for women to be excessive
  • I prefer stove-top and oven cooking to using a microwave.

This is the official book blurb:

Did you know that blueberries can help you cope with the aftereffects of trauma? That salami can cause depression, or that boosting Vitamin D intake can help treat anxiety?

When it comes to diet, most people’s concerns involve weight loss, fitness, cardiac health, and longevity. But what we eat affects more than our bodies; it also affects our brains. And recent studies have shown that diet can have a profound impact on mental health conditions ranging from ADHD to depression, anxiety, sleep disorders, OCD, dementia and beyond.

A triple threat in the food space, Dr. Uma Naidoo is a board-certified psychiatrist, nutrition specialist, and professionally trained chef. In This Is Your Brain on Food, she draws on cutting-edge research to explain the many ways in which food contributes to our mental health, and shows how a sound diet can help treat and prevent a wide range of psychological and cognitive health issues.

Packed with fascinating science, actionable nutritional recommendations, and delicious, brain-healthy recipes, This Is Your Brain on Food is the go-to guide to optimizing your mental health with food.

Uma Naidoo, MD is board-certified psychiatrist (Harvard Medical School), professional chef (Cambridge School of Culinary Arts), and nutrition specialist (Cornell University). She is currently the Director of Nutritional and Lifestyle Psychiatry at Massachusetts General Hospital (MGH), where she consults on nutritional interventions for the psychiatrically and medically ill; Director of Nutritional Psychiatry at the Massachusetts General Hospital Academy; and has a private practice in Newton, MA. She also teaches at The Cambridge School of Culinary Arts.

Dr. Naidoo speaks frequently at conferences at Harvard, for Goop audiences, the New York City Jewish Community Center (JCC), and Ivy Boston. She blogs for Harvard Health and Psychology Today and completed a unique video cooking series for the MGH Academy which teaches Nutritional Psychiatry using culinary techniques in the kitchen.

You can get your copy of This Is Your Brain on Food here (my Amazon link) and find additional information about Dr. Naidoo here and the book here.

Let us know what you think in the comments below and be sure to leave Dr. Naidoo a review once you read your copy!

Feel free to post your questions here too.

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.

Hydroxychloroquine and chloroquine (antimalarial drugs): quinism and the risk of sudden and lasting neuropsychiatric effects

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Hydroxychloroquine

The Quinism Foundation, a nonprofit charitable organization “promotes and supports education and research on quinism, the family of medical disorders caused by poisoning by mefloquine, tafenoquine, chloroquine, and related quinoline drugs.”

Executive Director of the foundation, Dr. Remington Nevin, MD, MPH, DrPH, is a Johns-Hopkins trained psychiatric epidemiologist and drug safety expert and former U.S. Army public health physician. He has published extensively on the subject.

The foundation share the symptoms of chronic quinoline encephalopathy, also known as neuropsychiatric quinism:

The term “quinism” may seem new, but the symptoms of poisoning by mefloquine (previously marketed as Lariam®), tafenoquine (marketed as Krintafel® and Arakoda™), chloroquine (marketed as Aralen®), and related quinoline drugs are all too familiar: Tinnitus. Dizziness. Vertigo. Paresthesias. Visual disturbances. Gastroesophageal and intestinal problems. Nightmares. Insomnia. Sleep apnea. Anxiety. Agoraphobia. Paranoia. Cognitive dysfunction. Depression. Personality change. Suicidal thoughts.

These symptoms are not “side effects,” they are symptoms of poisoning by a class of drug that is neurotoxic and that injures the brain and brainstem. This poisoning causes a disease, and this disease has a name: Chronic quinoline encephalopathy — also known as quinism.

In March they published this press release: The Quinism Foundation Warns of Dangers from Use of Antimalarial Quinolines Against COVID‑19. Here are some highlights:

  • A risk of sudden and lasting neuropsychiatric effects from the use of antimalarial quinolines against COVID‑19, the disease caused by the novel coronavirus
  • In susceptible individuals, these drugs act as idiosyncratic neurotoxicants, potentially causing irreversible brain and brainstem dysfunction, even when used at relatively low doses

What is concerning is lasting neuropsychiatric effects and the fact that even low doses can cause irreversible effects. The Foundation “has urged policy makers, physicians, and members of the public to be alert to such effects.”

Dr. Nevin states that “these are not safe drugs” and “While it may be tempting to attribute anxiety, depression, paranoia, or other mental health symptoms to the psychological effects of the COVID‑19 pandemic, these symptoms may be an early warning sign of idiosyncratic neurotoxicity, and must be taken seriously.” 

You can read the entire March 2020 press release here. It contains a link to U.S. Food and Drug Administration’s MedWatch program for reporting adverse effects.

Another press release published late July also cautions the use of tafenoquine against COVID-19 which The Qunism Foundation states “is a neurotoxic quinoline antimalarial drug with a similar adverse effect profile to mefloquine.”

New COVID-19 research on chloroquine and hydroxychloroquine

It’s encouraging to see that new research published on COVID-19 and these medications also highlights the possibility of neuropsychiatric side effects (even through the authors state it’s considered uncommon): Psychiatric Aspects of Chloroquine and Hydroxychloroquine Treatment in the Wake of COVID-19: Psychopharmacological Interactions and Neuropsychiatric Sequelae

…neuropsychiatric side effects are very uncommon but possible, and include a potentially prolonged phenomenon of “psychosis following chloroquine.” Hydroxychloroquine has less information available about its neuropsychiatric side effects than chloroquine, with psychosis literature limited to several case reports

Case reports on psychiatric symptoms induced by hydroxychloroquine

Here is one of these case reports: Psychiatric symptoms induced by hydroxychloroquine.  A 36-year-old woman was diagnosed with Systemic Lupus Erythematosus (SLE) and antiphospholipid syndrome, and was treated with prednisone 10 mg and hydroxychloroquine 200 mg every 24 hours. Her arthritis improved but

One month after initiation of treatment, the patient began with generalized anxiety, suicidal ideation and the appearance of auditory and kinaesthetic [tactile] hallucinations.

She had similar adverse effects 5 years later  when hydroxychloroquine (without prednisone) was prescribed following an outbreak of cutaneous SLE

A week later, the patient was admitted to the Department of Psychiatry because of suicidal ideation, self-harm and kinaesthetic and auditory hallucinations, which improved after withdrawal of hydroxychloroquine and treatment in a psychiatric setting. 

Since then, the patient has not been taking hydroxychloroquine and has had no further episodes of kinaesthetic [tactile] or auditory hallucinations.

Here are two other case reports: Hydroxychloroquine-induced acute psychosis in a systemic lupus erythematosus female and Hydroxychloraquine-induced acute psychotic disorder in a female patient with rheumatoid arthritis: a case report.

Risk factors for susceptibility

This review article from 2018, Neuropsychiatric clinical manifestations in elderly patients treated with hydroxychloroquine: A review article mentions that these adverse events can range from less severe nervousness to “actual psychosis and suicidal tendencies.” 

It also lists possible risk factors that may make certain individuals more susceptible:

co-exposure to interacting drugs, alcohol intake, familial history of psychiatric diseases, female gender, and the concomitant use of low-dose glucocorticoids [such as prednisone]. 

Malaria drug causes brain damage that mimics PTSD

I first learned of this neuropsychiatric connection a number of years ago when I read about the “case of a service member diagnosed with post-traumatic stress disorder but found instead to have brain damage caused by a malaria drug.” You can read about this here – Malaria drug causes brain damage that mimics PTSD: case study.

A few years ago I also blogged about the anti-malaria medication mefloquine and how it was known to contribute to neuropsychiatric symptoms in susceptible individuals: PTSD from 3 tours in Afghanistan: Can GABA help with the anxiety?

My concerns about long-term prophylactic use and lack of awareness

My concerns are long-term prophylactic use. There are a number of clinical trials planned or in progress for long-term use in healthcare workers. If they are stressed, anxious, depressed and exhausted because of the COVID-19 work they have been doing, they may incorrectly attribute some of their symptoms to all that rather than the medication side-effects. And if they do get COVID-19, they may confuse the neurological and psychiatric effects of COVID-19 with those of chloroquine or hydroxychloroquine.

What also concerns me is the lack of awareness. None of the advocates of this class of medications mentions quinism, the possible neuropsychiatric side-effects and long-term risks, or who may be susceptible.

I would be very happy if chloroquine or hydroxychloroquine is found to be a solution (or part of a solution) for COVID-19 – alone or in combination with zinc – for certain individuals.

But I believe we do need to be very aware about side-effects as serious as these. I’d also like to see education for healthcare providers and the consumer, as well as informed consent for the consumer.

Similar concerns with other medications

In the past I’ve written about similar concerns with other medications such as benzodiazepines, SSRIs and fluoroquinolone antibiotics:

Your feedback and questions so we can all learn

I encourage you to keep all this in mind as you navigate what you hear in the news, read on social media and/or read in the research on hydroxychloroquine.

Keep all this in mind too if you have future plans to travel to a malaria area for a vacation in the future (wouldn’t we love that – a trip!?).

Have you used chloroquine or hydroxychloroquine for COVID-19 and experienced psychiatric side-effects? Or know someone who has?

Have you used antimalarial medications in the past and experienced psychiatric side-effects? Was this a short-course or long-term prophylactic use?

Have you used these medications for lupus or rheumatoid arthritis with success and without psychiatric side-effects? Or have you experienced adverse effects and had to stop?

If you have had adverse psychiatric effects please share which medication, dosage and frequency? Also do you have any of the predisposing risk factors: alcohol intake at the time, history of psychiatric diseases (you or family members), are female, and were also prescribed low-dose glucocorticoids such as prednisone, and/or other medications (and which ones)?

Feel free to post your questions here too.

Depression, anxiety and intergenerational trauma due to racism in the Black community

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anxiety in black community

I feel sickened by George Floyd’s death and the police brutality we all witnessed. I stand by Black Lives Matter and an end to racism, social injustice and inequalities. In the light of current events in the USA and around the world, today’s article highlights the prevalence of mental health in the Black community, the biological impacts of trauma, racism and intergenerational trauma, some reasons why mental health services are not being used, the impacts of racism on physical health and some resources geared to Black mental health.

In this recent article by Columbia University Department of Psychiatry, Addressing Mental Health in the Black Community, we learn the following:

Research suggests that the adult Black community is 20% more likely to experience serious mental health problems, such as Major Depressive Disorder or Generalized Anxiety Disorder.

Additionally, Black emerging adults (ages 18-25) also experience higher rates of mental health problems and lower rates of mental health service utilization compared to White emerging adults, and older Black adults.

What shocked me was reading this statistic: “the Black community comprises approximately 40% of the homeless population, 50% of the prison population, and 45% of children in the foster care system.” All of this puts the Black community is at more risk for mental health issues.

The article also highlights the biological impacts of trauma“through enslavement, oppression, colonialism, racism, and segregation” and shares that “intergenerational trauma may be passed down biologically from one generation to the next.”

Some of the factors that may lead to mental health services not being used amongst the Black community are lack of trust, lack of finances and fear:

Lack of trust in the medical system due to historical abuses of Black people in the guise of health care, less access to adequate insurance, culturally responsive mental health providers, financial burden, and past history with discrimination in the mental health system.

I encourage you to read the entire article at this link.

This paper, Transgenerational Consequences of Racial Discrimination for African American Health goes further into the intergenerational effects of racism on both psychological and physical health: immune health, heart health, obesity, diabetes and so on. The paper concludes as follows:

without addressing the harmful consequences of racial discrimination, improving the health of African Americans as well as other marginalized groups, will remain inadequately addressed.

This inspiring quote is from Nelson Mandela from his autobiography, Long Walk to Freedom  (1994) and no-one says it better than him. It is a message of hope!

Nelson Mandela Quote
from the Nelson Mandela facebook page

Here are some resources geared specifically to Black mental health

With regards to nutritional support for anxiety, depression and PTSD, everything that I write about in terms of nutritional psychiatry applies. My book, The Antianxiety Food Solution, covers the foundations of diet and how to use amino acids. This recent blog, The psychological trauma of coronavirus – nutritional support for doctors, nurses and their loved ones could easily be adapted to be: The psychological trauma of racism – nutritional support for the Black Community.

I am very aware that when it comes to working with a functional medicine practitioner or a nutritionist, and purchasing supplements/doing special diets may be a major stumbling block for many Blacks with financial hardships. This needs to become the standard of care so everyone has access to resources like these.

Until then finding access to real whole foods is a powerful first step.  In the SMILES diet depression trial,  the first randomized controlled diet depression study, ONE THIRD of the dietary intervention group saw improvements in their depression and anxiety symptoms. This was simply by switching from processed/junk food to real food with no specific dietary restrictions.

This is the power of nutritional psychiatry:

Although the growth in scientific research related to nutrition in psychiatry may be recent, it is now at a stage where it can no longer be ignored. In light of this, we aim to provide a platform to move towards a new integrated paradigm in psychiatry whereby nutritional considerations (both educational and prescriptive) can be considered “mainstream”.

The International Society for Nutritional Psychiatry Research/ISNPR made the above statement via a letter published in 2015 in World Psychiatry, the official journal of the World Psychiatric Association –   “International Society for Nutritional Psychiatry Research consensus position statement: nutritional medicine in modern psychiatry.” You can read more about this here.

This recent paper, Nutritional Psychiatry: Towards Improving Mental Health by What You Eat, further adds to the discussion, providing an “overview of the emerging field of nutritional psychiatry, exploring the scientific evidence exemplifying the importance of a well-balanced diet for mental health.”

I recently heard integrative psychiatrist Dr. Kelly Brogan, share this on The Trauma and MindBody Super Conference:“it’s best to address trauma when your nervous system has physiologically improved.” She always starts with addressing physiology: diet, gluten issues, the gut and microbiome, blood sugar stability, micronutrient deficiencies such as low B12, low thyroid and other contributing physiological root causes.

By incorporating nutritional psychiatry and functional medicine approaches we can provide additional healing support for the depression, anxiety, current trauma and intergenerational trauma caused by racism and inequalities.

Updates 7/7/20:

The above SMILES Diet Depression study doesn’t mention race. There are, however, many studies that didn’t make it into the blog because I felt compelled to publish something quickly.

 Here are some of them:

China, Ghana, India, Mexico, the Russian Federation, and South Africa…examine the relationship between demographic and lifestyle characteristics and depression….. Increased fruit and vegetable intake appeared to co-occur with significantly lower rates of depression, suggesting diet as a modifiable factor for addressing depression burden.

Among overweight/obese women, improvement in health-related quality of life related to physical health, a significant decrease in depressive score, and a reduction in waist circumference were noted.

I am not an authority on Black mental health, racism or intergenerational trauma. As I look into the research, read articles and listen to podcasts, I acknowledge that I’ve been learning a great deal. And I know I still have much to learn.

I am, however, an authority on food and using a nutritional approach for anxiety. Real whole nutrient-dense food is the foundation and always will be – for every single human regardless of race.  We do, however, need more programs and studies that are specific for people of color. 

This needs to be a public health initiative where we also address the food security issues. According to this paper, Food Insecurity and Maternal Mental Health Among African American Single Mothers Living With HIV/AIDS in the Alabama Black Belt, “Food insecurity places low-income African American women at risk of depression.”  This is one of many similar such studies.  

Together with this we need to address racism. This paper, Experiences of Racial and Ethnic Discrimination Are Associated with Food Insecurity and Poor Health, sums up with this:

Public health interventions intended to improve food security and health may be only partially effective without simultaneously addressing racism and discrimination

If you have information on non-profit organizations, community gardens, community kitchens and other resources for supporting Black communities when it comes to nutritional supplements, food insecurity and food deserts, and eating real foods please share in the comments.

For now check out and be inspired by Ron Finley, the Gangsta Gardener – and his amazing community garden and gardening masterclasses: 

Ron envisions a world where gardening is gangsta, where cool kids know their nutrition and where communities embrace the act of growing, knowing and sharing the best of the earth’s fresh-grown food. 

Determined to change South Central Los Angeles from food desert to food forest, he wants his actions to be educational, inspiring, and nutritious. He wants kids to grow up with the option of healthy food, instead of fried, fattening staples. He wants to sweep up and transform his street, his hood, the city of LA and communities everywhere.

Please also share your experiences supporting mental health in Black communities. And if you’ve been subject to racism and felt the mental and physical effects please share too. We’re here to support you and learn how we can do better.

The vagus nerve impacts mood, anxiety, immune response, digestion and heart rate

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vagus nerve impacts

The vagus nerve forms a bi-directional “super-highway” between your brain and the majority of your internal organs. Unless your vagus nerve is in good shape and activates readily when it is supposed to, the communication between your brain and the body will be disrupted.

This modern world can lead to overstimulation of the nervous system and you can become desensitized to chronic stress. Over time, this can lead to low vagal tone, which has been linked to a variety of mental and physical health issues, including chronic inflammation, poor gut function, neurodegeneration, autoimmunity and cancer.

And we know this to be true: you cannot FULLY heal leaky gut, microbiome function or brain issues WITHOUT optimizing your vagus function.

Host of the Mind, Body & The Vagus Nerve Connection Summit, Eva Detko, PhD, MSc, BA (Hons), mIAHT, shares the above wisdom about the vagus nerve. I’ll add this: this overstimulation of the nervous system is especially high right now during this coronavirus pandemic.

In my interview, Balancing Neurotransmitters to Optimize Vagus Function, we start with a review paper that reports how the vagus nerve is intricately connected with anxiety and mood (and immunity).

I share from Vagus Nerve as Modulator of the Brain–Gut Axis in Psychiatric and Inflammatory Disorders:

  • The vagus nerve represents the main component of the parasympathetic nervous system, which oversees a vast array of crucial bodily functions, including control of mood, immune response, digestion, and heart rate.
  • It establishes one of the connections between the brain and the gastrointestinal tract and sends information about the state of the inner organs to the brain via afferent fibers.

The review article goes on to state how the vagus nerve is an attractive tool for treating psychiatric and gastrointestinal disorders: “There is preliminary evidence that vagus nerve stimulation is a promising add-on treatment for treatment-refractory depression, posttraumatic stress disorder, and inflammatory bowel disease.”

And as we all know when we hear the term treatment-refractory depression, it means we haven’t got to the root cause of it. It just means that medications haven’t worked for it.

So this allows us to extrapolate and say, well, there’s other lifestyle and dietary, and nutritional approaches that we could use. But they’re saying that stimulating the vagus nerve, activating it, can actually help in this area. And with my work in anxiety, whenever I see depression, I feel like I can replace that with anxiety (because of similar underlying causes). The other thing that they say is that there’s this impact on inflammation: “Treatments that target the vagus nerve increase the vagal tone and inhibit cytokine production.”

And we know that when we’ve got inflammation going on in the body, that’s going to contribute to mood disorders: “Stimulation of vagal efferent fibers in the gut influences neurotransmitters (like serotonin and dopamine, and GABA) that play a crucial role in major psychiatric disorders.”

So the conclusion is that vagal tone is correlated with the capacity to regulate stress responses and can be influenced by breathing. Its increase through meditation and yoga is likely to contribute to resilience, and the mitigation of mood and anxiety symptoms. And we know from other research, and we know from just doing it, that using meditation and yoga is going to affect anxiety levels. We’ve seen research showing that yoga and meditation raises GABA levels, which is one of the neurotransmitters that helps us feel calm.  But now we’re also seeing from the research that good vagal tone has an impact as well.

So it’s really exciting to see that there’s many different ways that we can use to approach someone who does have anxiety issues.

I also talk about a very interesting study that brings the connections between GABA and the vagus nerve together very nicely. As I’m talking I see Eva nodding in agreement as I cover this. I wanted to share this study to add another mechanism as to how GABA may work, given so many people don’t believe it can because of the blood brain barrier.

This was an animal study done in 2011 and it’s titled: Ingestion of Lactobacillus Strain Regulates Emotional Behavior and Central GABA Receptor Expression in a Mouse via the Vagus Nerve. You may have had other people in the summit talking about this. I can see you nodding there. Let me just bring it back to this discussion because I’ve got something to add about this. But what they found is this – Lactobacillus rhamnosus increased GABA in the hippocampus. It reduced cortisol levels, which was caused by the increased stress, and it reduced anxiety and the depression in the animals.

When they severed the vagus nerve in some of the mice in the study they found that these neurochemical and behavioral effects were not found. So as soon as the vagus nerve was severed, the effects of the Lactobacillus rhamnosus, which was increasing GABA levels, was not reducing the anxiety and it was not reducing those cortisone levels.

The biggest question that I get about GABA is: “How could GABA possibly work if it can’t cross the blood brain barrier?”  Maybe this is one way that is having an impact on anxiety. We know that we’ve got a lot of GABA receptors in our peripheral tissue. We’ve got GABA receptors in our muscles, which probably is the reason why we feel it when we’ve got this physical tension, or we’ve got the spasms. We’ve got GABA receptors in our pancreas. We’ve got GABA receptors in our endocrine system.

But maybe this vagus nerve connection and the fact that when it’s severed we’re not getting those effects, maybe this is another way that GABA is having an impact on anxiety.

Making the vagus nerve connection to serotonin, I share some interesting new research on SSRIs/antidepressants and the vagus nerve: Oral Selective Serotonin Reuptake Inhibitors Activate Vagus Nerve Dependent Gut-brain Signalling.

SSRIs like Zoloft or Paxil or Prozac are often prescribed for anxiety, depression, autism and dementia. And there’s a whole host of issues that we have with SSRIs where you’ll have serious withdrawal symptoms in some people.

In the study, the researchers proposed that SSRIs were having an effect on serotonin and it was the vagus nerve that was now communicating to the brain leading to increased serotonin levels. Similar to the GABA study, when they severed the vagus nerve of the mice, they did not see the same benefits from the SSRI.

My thinking is this: could we possibly extrapolate and say the amino acid tryptophan may have similar effects?

We won’t hold our breath for a similar tryptophan study but we can learn from this paper and possible mechanisms.

I also share how I use GABA and tryptophan with clients so if you’re new to using targeted individual amino acids you’ll learn more about this too.

As you know, my work is primarily using the neurotransmitters precursors (such as the amino acids) and using dietary changes, but we don’t want to forget about other approaches like vagus nerve support.

If we can improve vagus function, then we’re going to get even better benefits.

I share some of my favorite vagus nerve exercises. One of them – social interaction – has been challenging lately but cold showers are very do-able.

Let me share some aspects on the importance of social interaction for improving vagal tone.

Research shows that the more social interactions you have, the more it improves vagal tone. And then that improved vagal tone, improves your mood and makes you more social (and has ramifications for so many other areas as you’ll learn on the summit).

However if you have a condition called pyroluria (social anxiety, preferring one-to-one connections rather than being in large groups, not liking small talk, early morning nausea, not really big on animal protein – I go into it in depth during the interview if it’s new to you), getting out and being social can be very challenging when you are forcing yourself and putting on a brave face:

It’s a very stressful situation in doing that, and then it makes your pyroluria worse so your social anxiety gets worse. So when you have pyroluria and you have a stressful situation, you end up dumping high levels of zinc and B6. So it makes things worse.

If you do go out, it’s either very stressful or you just don’t even do it. So my contribution to the discussion is: let’s address pyroluria and that’s going to in turn allow people to get out and socialize without feeling uncomfortable, without feeling awkward, without having to stress, without feeling absolutely exhausted afterwards, and it’s going to help improve vagal tone.

Eva sums up with this important aspect:

What people need to know is that social connection is good for your vagus nerve only if it’s perceived positively by you internally. So if you’re in a situation where you’re forcing yourself to interact with other people, you’re actually not going to have a positive knock-on effect on your vagus nerve because it’s going to be the opposite. You’re going to stimulate the sympathetic nervous system response because you’re there, as you described, completely uncomfortable and basically stress out. So those social connections need to be positive.

Here are some interviews I look forward to tuning into:

  • Niki Gratrix, BA, Dip ION: Connecting the Vagus Nerve, Emotions and Gut Function
  • Ben Lynch, ND: Epigenetics of Chronic Stress
  • Bridgit Danner, LAc, FDNP: How Mold Toxicity Damages Your Nervous System
  • Jay Davidson, DC, PScD: Impact of Infections on Mitochondrial and Vagus Function
  • Kimm Sun, CNM: Impact of Birth Trauma Across Lifetime
  • Eva Detko, PhD, MSc, BA (Hons): Impact of Perfectionism on Heart Rate Variability
  • Misa Hopkins: Vagus Nerve Session of the Day – Vagus Nerve Sound Healing

I don’t go into the immune connection in my interview because it was recorded before the coronavirus pandemic started but keep this in mind as you tune in: you cannot have a well-functioning immune system without a healthy nervous system, and vice-versa!

vagus nerve summit

Click here to join me on The Mind, Body & The Vagus Nerve Connection Summit

This event will provide you with all the information you need to:

  • Understand the vagus nerve’s complexity
  • Know the importance of high vagal tone
  • Measure your vagal tone
  • Recognize symptoms and root causes of vagus nerve dysfunction
  • Optimize gut-brain communication
  • Address emotional trauma and chronic stress
  • Improve your relationships to increase vagal tone
  • Strengthen vagus function with physical approaches

And when you register today, you’ll gain INSTANT access to the following free gifts, including my summit interview video and transcript!

vagus nerve summit bonuses

  • Symptoms and Root Causes of Vagus Nerve Dysfunction Navaz Habib, DC, AFMCP
  • Balancing Neurotransmitters to Optimize Vagus Function Trudy Scott, CN
  • EFT, Polyvagal Theory and the Mind-Body Connection Craig Weiner, DC
  • Vagus Nerve 101 eGuide from Eva Detko, PhD, MSc, BA (Hons), mIAHT

To your continued learning and healing – and good vagus nerve function!

Click here to join me on The Mind, Body & The Vagus Nerve Connection Summit