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SMILES diet depression trial: reduced depression and anxiety

By Trudy Scott 16 Comments

The SMILES trial, A randomised controlled trial of dietary improvement for adults with major depression was recently published BMC Medicine. It is the first randomized controlled trial to test whether dietary improvement can actually treat depression. Yes, we’re using dietary improvement and treat in the same sentence!

The objective was to determine if “structured dietary support, focusing on improving diet quality using a modified Mediterranean diet model” would have an impact on mood. The outcome is very exciting:

‘SMILES’ was a 12-week, parallel-group, single blind, randomised controlled trial of an adjunctive dietary intervention in the treatment of moderate to severe depression. The intervention consisted of seven individual nutritional consulting sessions delivered by a clinical dietician. The control condition comprised a social support protocol to the same visit schedule and length.

The results indicate that dietary improvement may provide an efficacious and accessible treatment strategy for the management of this highly prevalent mental disorder, the benefits of which could extend to the management of common co-morbidities.

These encouraging results were seen in participants who switched from a junk food diet to a real foods diet. Of the 67 who were enrolled in the study, the majority were using some form of therapy: psychotherapy and medications combined or psychotherapy only or medication only. There were 31 in the diet support group and 25 in the social support control group. Participants had to have been eating this diet in order to be accepted into the study:

a poor (low) intake of dietary fibre, lean proteins and fruit and vegetables, and a high intake of sweets, processed meats and salty snacks.

The dietary approach followed by participants in the study intervention group was the ‘ModiMedDiet’ which is based on the Australian Dietary guidelines and the Dietary Guidelines for Adults in Greece.

The primary focus was on increasing diet quality by supporting the consumption of the following 12 key food groups (recommended servings in brackets): whole grains (5–8 servings per day); vegetables (6 per day); fruit (3 per day), legumes (3–4 per week); low-fat and unsweetened dairy foods (2–3 per day); raw and unsalted nuts (1 per day); fish (at least 2 per week); lean red meats (3–4 per week), chicken (2–3 per week); eggs (up to 6 per week); and olive oil (3 tablespoons per day), whilst reducing intake of ‘extras’ foods, such as sweets, refined cereals, fried food, fast-food, processed meats and sugary drinks (no more than 3 per week). Red or white wine consumption beyond 2 standard drinks per day and all other alcohol (e.g. spirits, beer) were included within the ‘extras’ food group. Individuals were advised to select red wine preferably and only drink with meals.

The dietary composition of the ModiMedDiet was as follows: protein 18% of total energy; fat 40%; carbohydrates 37%; alcohol 2%; fibre/other 3%.

Here are the reasons I’m excited about this research:

  • It’s the first randomized controlled diet depression study and ONE THIRD of the dietary intervention group saw improvements in their depression symptoms.  This was just diet alone and switching from processed/junk food to real food with no specific dietary restrictions!
  • Participants also reported improvements in anxiety symptoms.
  • The authors even addressed the cost factor, stating it was more affordable to eat this way ($112 per week vs $138 per week).
  • The authors address the fact that the dietary intervention group was able to make these dietary changes “despite the fatigue and lack of motivation” that we so commonly see with depression.
  • I’m optimistic about it paving the way for making dietary approaches part of the standard of treatment for mental health conditions. The paper suggests the addition of “clinical dieticians to multidisciplinary mental health teams.”  I’d like to add that these dieticians, together with nutritionists and health coaches would need to be well versed in functional medicine approaches.
  • According to an article on ABC, one participant continued the Mediterranean diet after finishing the study and is now doing a diploma in health science. How inspiring is this? When we get results like this we want to share them with everyone!  

These are very encouraging results and we applaud the positive results of this SMILES study which are truly groundbreaking.

Let’s also be aware of where we are headed with future research and how we can improve on the trial diet.  The researchers conclude with this comment about future research:

The scaling up of interventions and identification of the pathways that mediate the impact of dietary improvement on depressive illness are also key imperatives

Professor Jacka recently shared this paper on how personalized dietary interventions successfully lower post-meal glucose i.e. how certain foods can affect two people quite differently because of our unique gut bacteria. She said that she wants to do a similar personalized nutrition study for depression if they are successful in obtaining NHMRC funding.

Here are some questions I’ve been asked about this SMILES trial (and I’m sharing here in case you have similar questions):

  • why did only one-third of the study intervention group see improvements?
  • why was wheat and other grains included?
  • why was low fat dairy and lean meats emphasized?
  • why was there no mention of grass-fed meat, wild fish, healthy fats like butter and coconut oil, pastured eggs or chickens or quality organic fruits and vegetables?

The ideal dietary approach for anxiety, depression and any health condition is always one that high quality, is personalized and takes into account biochemical individuality. With the removal of gluten, grains and the inclusion of the other dietary changes mentioned above, plus addressing all nutritional imbalances I expect we will see more than one-third of the dietary group experiencing improvements in depression in future trials.  

I truly appreciate the work of Professor Felice Jacka and her team and look forward to seeing more studies like the SMILES trial, using a personalized approach and quality foods that include grass-fed red meat and wild fish, plus pastured eggs or chickens, and healthy fats; and organic produce as a baseline. 

And then future trials that also look at the impacts of these dietary changes on anxiety and depression: gluten and/or grain removal;  removal of high histamine foods and high oxalate foods;  a low FODMAPs diet; the specific carbohydrate diet/SCD; a Paleo diet and so on – all based on biochemical individuality. We know these diets works in clinical practice and now we just need the research to back this up.  In part 2 of the blog, I share some incredibly inspiring diet-depression and diet-anxiety Paleo success stories.

In summary:

  • a simple change like switching from junk to real food can have a major impact on your depression and anxiety – ONE THIRD of the dietary intervention group saw improvements in their depression symptoms and many also saw reduced anxiety. This is profound! 
  • you may need to make additional dietary changes (gluten-free, grain-free, low FODMAPs i.e. avoiding or adding certain foods based on your biochemical individuality) and always add healthy fats and focus on quality
  • you may also need to address brain chemical imbalances with amino acids supplements, address gut health, adrenal issues, low zinc, low vitamin B6, low vitamin D etc. too

Are you encouraged by this research?

And have you made similar dietary changes to those done in the SMILES trial and seen a reduction in your anxiety and depression?

Have you removed gluten or grains and made additional dietary changes, and added supplements and seen even more benefits?

Note: to avoid confusion I’ve used the Australia spelling of “randomised” and “fibre” in the quoted sections and the US spelling “randomized” elsewhere in the blog.

The Evolution of Psychiatry: integrative psychiatry, anxiety and the thyroid

By Trudy Scott 2 Comments

James Maskell is the founder of The Functional Forum and this month the theme was The Evolution of Psychiatry. It was such a great episode so I’m sharing it with you here today.

The first presentation was by Janet Settle, MD and Will Van Derveer, MD. They took the stage and presented on the fundamentals of integrative psychiatry, covering root cause-based psychiatry. Together with Scott Shannon, MD, they are also now offering their “Psychiatry Masterclass” training program to other doctors.

This presentation included:

  • The foundations of truly effective, root-cause focused mental health system
  • Typical unresolved physiological dysfunctions that manifest as mental illness
  • Concrete steps for creating the mental health centers of the future

Here is a sampling of what they covered. Isn’t it wonderful to see a slide titled “Integrative Psychiatry Model” and with physiologic root causes listed?

The section on child abuse, trauma and psychospiritual root causes was enlightening:

They cover MDMA- and ketamine-assisted psychotherapy and I look forward to learning more from them about these approaches. However, until I learn more I’m wary of these approaches because of the side-effects. Based on the work I do with targeted individual amino acids I would use them before even considering MDMA or ketamine.

You can watch the entire video presentation here:

 

Next up was Thyroid Pharmacist, Dr. Izabella Wentz, returning to the Functional Forum stage for her first keynote. Dr. Izabella is a dear friend and one of my favorite thyroid experts and she covered the connections between thyroid health and depression and anxiety, looking at proven protocols to address the underlying causes.   Her presentation is titled “The Misdiagnosis Machine: How Thyroid Problems Mimic the Symptoms of Mental Illness.”

Dr. Izabella shares the symptoms of the autoimmune attack on the thyroid gland. As well as fatigue, weight gain, gut issues and apathy, you can experience mood symptoms such as anxiety, OCD-like symptoms and mood swings.

You can watch the entire video presentation here (and listen for a mention of my name and how commonly I see anxiety with clients with thyroid symptoms):

 

If you enjoyed Dr. Izabella’s presentation you don’t want to miss her upcoming documentary called The Thyroid Secret. I’m thrilled to have been invited to contribute on my expertise on anxiety and how this ties back to thyroid health. You can read more about it and find a few snippets from my interview here.

 

Dr. Izabella also has a new book that will be released next month: Hashimoto’s Protocol: A 90-Day Plan for Reversing Thyroid Symptoms and Getting Your Life Back. I have a review copy and it’s brilliant! I’ll be sharing more via a book review and interview with Dr. Izabella, taking a deep dive into infections and Hashimoto’s, so stay tuned for that.

I hope you’ve enjoyed these two presentations! For me, hearing presentations like these gives me so much optimism for the future of mental health!

I’d love to hear what has inspired you?

If you’re a practitioner and would like to attend a live Functional Forum meeting in the future or tune in online, you can register here to be notified. James and his team also offer excellent practice resources for functional medicine practitioners. We appreciate him for what he is doing for functional medicine via the Functional Forum!

 

 

Interview: Heal Your Pain Now + the fear-pain connection

By Trudy Scott 5 Comments

If you struggle with chronic pain from an injury, autoimmune disease, fibromyalgia, joint pain, arthritis, anxiety, depression or have tried everything without success, Heal Your Pain Now provides natural solutions to eliminate pain and return you to a life worth living.

I recently had the pleasure of interviewing Dr. Joe Tatta, physical therapist and nutritionist, author of this wonderful new book and a dear friend!

You can watch the interview here:

 

And here is a summary from our great interview:

What is chronic pain – it’s about protection. Acute pain like an ankle sprain tells you to rest and heal; chronic pain – persists beyond 3 months and is less about protection and more about the brain being in a hyper-sensitive state.

The human body has innate ability to heal i.e. the body has a natural anti-inflammatory process and tissue will heal in 3 months. After those 3 months it becomes less about the actual tissue and more about what is going on centrally in the brain and nervous system.

Central sensitization or the hyper-sensitive brain: we have a neural signature specific to you and your pain experience.

It’s based on what you believe about pain, are told about pain, your memories, your emotions, input from body (such as tightness), your thoughts, touch and sound.

With central sensitization pathways light up in the brain causing pain and in some instances those pathways never quiet down. The more we can be educated about pain the faster we can release this central sensitization and the pain.

An example: You and I had backpain – my life: mom is a nurse, my backpain comes and goes, I can move a little, I go to work, do some chores and basic exercise; in your life your grandmother had really bad back pain, was in a wheelchair and said back pain is the worst pain you could ever have. This may make your pain persist. Fear causes pain to persist over a long period of time.

Fear and pain: it can be actual fear or perceived; fight or flight – muscles tense around the spinal column; blood is shunted away from the spinal muscles because you’re getting ready to run or fight; when it’s persistent there is no blood flow and no healthy nutrients going to the spinal muscles; cortisol levels become elevated – they are inflammatory and very powerful at laying down memory patterns (which can make pain persist).

When you lessen fear you promote relaxation and in general pain disappears very fast.

When you hear all this the brain repatterns – you’re doing a mini cognitive behavior session just listening to and watching the video of us interacting! (I love this!)

Myth: chronic pain has to be chronic – no! Replace the word chronic with persistent because language is really important for creating these pain memories.

Myth: imaging studies like xrays and MRIs are correlated with pain. Often we see intense pain with normal xrays, sometimes no pain with awful rays.

There is also the emotional aspect – when someone in a white coat holds up that xray and says you have this issue it can start that fear response and the pain can be worse.

This fear pain connection is fascinating and I asked if it common knowledge

  • The average physician only receives 4 hours of pain science education in 12 -16 years of education – most of what they learn focused on medications, injections and surgery. We currently have a biomedical model (xray and injection or surgery, injections or medications) but we are moving to a biopsychosocial model (movement, nutrition, mindset, the brain)
  • The book has 40 pages of evidence based research (if you’re a practitioner and would like access to the papers let me know in the comments and Dr. Joe can get them to you)
  • I suggest using the book to educate yourself and your doctor

Medications prescribed for pain: Opioids (oxycontin, codeine, morphine) #1 drug prescribed for pain. CDC and NIH: You should not prescribe opioids as first line of treatment for chronic pain. They are highly addictive – 3 million addicted to them; 2 million die each year; opioid-induced hyperalgesia – the more you take the more pain sensitivity you have and the more medication is needed.

Side effects: constipation caused by opioids and you’re prescribed medications for the constipation; called OIC (opioid induced constipation) – changes the microbiome, fecal matter is bound up, you get leaky gut, inflammation starts in gut and there are impacts on neurotransmitter production like GABA and serotonin (and then increased anxiety and depression).

Other medications used are SSRIs – depression looks very similar to pain in the brain – when you heal the gut you can balance serotonin

Gabapentin and NSAIDs and benzodiazepines are also prescribed.

The book covers ALL pain – any chronic (or persistent) pain that has been around for 3 months or longer

Nutrition: diet is the #1 way to reduce inflammation – food is medicine approach; 100% whole food (if it comes in a box or a can or is made by man it has no place in your diet especially if you have chronic pain); farm-raised beef, wild fish, fruit and vegetables, healthy fats i.e. a modified Mediterranean diet.

Then use a gut-healing protocol for removing inflammation and addressing autoimmunity – remove gluten, dairy and sugar. In 3-7 days people see their pain decrease from 8/10 to 2/10.

“I don’t think I have arthritis and I don’t think I need this Aleve – I think it was the gluten I was eating”

If you slip a little and have some gluten then you realize you can’t even have any and you’re educating yourself that food is medicine. It’s very powerful

With gut healing, if you have autoimmunity take out eggs and GMOs (soy and corn) too; there is more clinical evidence around nightshades – if you can heal the gut you can often tolerate small amounts.

The ketogenic diet is last phase: 65% – 75% fat, 5% carbs (from fibrous vegetables) and the rest is protein. It’s awesome to regulate blood sugar, helps central sensitization (we know because those with seizures do really well on a ketogenic diet). With seizures glutamate is high and GABA low and the ketogenic diet helps balance out these in your brain and calms the nervous system and decreases pain; upregulates ATP (energy molecule) which helps with pain. Brain fogs goes away.

The ketogenic diet is not for someone with type 1 diabetes, who is pregnant or in acute adrenal fatigue

Do a trial of 3-4 weeks and cycle into ketosis every 4-6 months.

Intermittent fasting tricks body into thinking body is starving.

A big plane flies over at the 41 minute mark! Enjoy the laugh with us!

With intermittent fasting do a 14-16 hour fast overnight, say 6pm to 9am the next day

Mini-fasts: protein shake in the morning or evening – the meal is smaller; or use bone broth – healing for gut and collagen for your joints!

Supplements: omega-3s (2000 to 4000mg); curcumin (in oil – really important to help absorption); vitamin D 5000-10,000 IU; some kind of proteolytic enzymes; GABA for pain and anxiety and central sensitization.

If this feels overwhelming and you feel you need more support (in addition to reading the book) Dr. Joe does have a group program

It’s called Heal your Pain Heal your Life  – 6 week process, a Facebook group group, Q and A calls, and social support (which is huge if you have pain and can’t get out of house, or if others can’t relate to your pain, plus for the community support)

Movement, sedentary syndrome, sit rise test: movement is medicine and has to be in your life in some form. Even 5 minutes twice a day can help. It sends signal to your brain “I can move a bit and I’m safe”, you build confidence and fear decreases, releases endorphins, quiets down the nervous system

Sit rise test – cross your legs and lower yourself down to the floor without your hands and then stand back up. It indicates a long life-expectancy; they are not sure why – cardio effects? Balance? It tests strength and vitality; if you can’t do it – practice each day. Third world cultures sit on the floor to communicate – when you move joints in full range it lubricates them.

I’m a climber, skier, mountain biker, windsurfer and have had many injuries and worked with wonderful physical therapist and yet I have learned so much from Dr. Joe and this book! I will use it for prevention of injuries and pain and for the next time I am injured and in pain.

Dr. Joe ended by saying

Keep moving forward, we’re going to change the pain paradigm and give people their lives back!

This is the book summary:

In Heal Your Pain Now, Dr. Joe Tatta teaches you how to regain control of your life by breaking the cycle of persistent pain. Following Dr. Tatta’s program, you learn the role of the brain in pain–and how to use your brain to STOP your pain; how nutrition can eliminate the inflammation in your body, which is exacerbating your pain; and how to overcome Sedentary Syndrome and choose the best movement strategy. Dr. Tatta provides quizzes, self-assessments, meal plans, shopping lists, recipes, and exercises to support you throughout the program.

As I mentioned in the interview I really appreciate the very unique perspective Dr. Joe brings to healing from pain. His expertise from the physical therapy and movement world is so beautifully meshed with the power of nutrition! He covers the foundational information for eating an anti-inflammatory diet, an excellent gut healing protocol, healing supplements and with much fascinating reading on intermittent fasting and the ketogenic diet.

Dr. Joe explains these concepts brilliantly: the brain in pain, central sensitization, myths around pain and the biospychosocial model of pain. With the work that I do with anxious women like you (and men too), the pain connection to fear is very relevant; and the fact that stress, anxiety, post-traumatic stress disorder (PTSD), or depression are danger signals that can actually make the pain worse depending on how “sensitive” your nervous system has become.

Also, since many of the same pain medications are also often prescribed for anxiety, this book is a wonderful resource for someone with both pain and anxiety. But best of all, this book offers real solutions for everyone suffering from any kind of pain, and a solid understanding of the mechanisms.

I’m sure you’d like access to what we talked about during the interview:

 

Please let us know which parts of this really resonated with you and what you’re looking forward to implementing for your pain.

 

Vulvodynia: oxalates, GABA, tryptophan and physical therapy

By Trudy Scott 41 Comments

On a recent webinar with Julie Matthews, I shared how healthy foods that are high in oxalates caused me excruciating foot pain: Oxalates and leaky gut for Anxiety.

We also mentioned how oxalates can be a factor in vulvodynia and someone asked this question on the blog:

I just listened to the webinar talking about oxalates. I was shocked and delighted to hear the mention of the connection between high oxalates and vulvodynia. My friend has suffered with this for 18 months with little improvement. She has painful feet so I am wondering if there is indeed a connection for her situation. Could you please explain a bit more of the vulvodynia/ oxalates connection? I would like to give my friend the information.

Before I share the resources I offered her for her friend, let me share this about vulvodynia:

Vulvodynia is defined as chronic vulvar burning, stinging, rawness, soreness or pain in the absence of objective clinical or laboratory findings to explain these symptoms. Vulvodynia is a chronic pain syndrome affecting up to 18% of the female population and is generally regarded as an underdiagnosed difficult to treat gynecological disorder.

There is still much we have to learn about vulvodynia and the causes are multifactorial:

The etiology [cause] of vulvodynia is still enigmatic and is probably multifactorial-including physiological concerns (eg, pelvic floor muscle dysfunction, neuropathic pain, and psychosocial) and sexual issues (eg, anxiety and sexual dysfunction). Although it is a common syndrome, most patients are neither correctly diagnosed nor treated. A diagnosis of vulvodynia is based upon patient history and lack of physical findings upon careful examination. No clinical or histological findings are present to aid in diagnosis. Most treatment options for vulvodynia are neither well studied nor have an evidence base, relying instead upon expert opinion, care provider experience, and use of data from other pain syndromes. However, many patients show marked improvement after physical therapy for the pelvic floor, medications for neuropathic pain, and psychosexual therapy.

You’ll notice that oxalates and other dietary approaches are not mentioned. There are actually 2 studies that state there is NO connection between dietary oxlalates and vulvodynia. This is the first one: Influence of dietary oxalates on the risk of adult-onset vulvodynia. The second paper: Urinary oxalate excretion and its role in vulvar pain syndrome concludes that:

Urinary oxalates may be nonspecific irritants that aggravate vulvodynia; however, the role of oxalates as instigators is doubtful.

In this paper: Vulvar vestibulitis-a complex clinical entity, a low oxalate diet and calcium citrate did help:

Successful outcomes were achieved in 14.3% of patients using a low oxalate diet and calcium citrate supplementation

The Vulval Pain Society is a wealth of information on vulvodynvia and they have this information on the low oxalate diet, saying it helps many women and it worth trying:

A diet low in oxalate salts has been suggested as a treatment for women who experience unexplained vulval pain or vulvodynia… it is widely used in the United States as a treatment for vulvodynia. The diet may be supplemented with the use of oral calcium citrate.

There are few doctors in the UK who are aware of or routinely use this treatment. Many specialist doctors who run vulval clinics in this country [the UK] are skeptical about the treatment, as much of the evidence has not been published in the medical literature and the treatment is not of proven value. A diet low in oxalate with or without calcium citrate may, however, benefit some women with vulval pain and this is certainly an option for some women to try.

The vulvar pain is often described as a “burning” or “cutting” or “sharp” kind of pain. You’ll see medications recommended for the neuropathic pain in many of the studies and on the Vulval Pain society site.

It does concern me that so many women are prescribed SSRIs and medications like gabapentin and benzodiazepines when there are the safer and more effective options of the amino acids such as tryptophan and GABA.   When dosed correctly these individual amino acids help with some of the pain and anxiety right away while other root causes are addressed.

For my clients, I recommend targeted individual amino acids instead of the medications. I recommend a trial of tryptophan instead of an antidepressant, assuming they score low on the serotonin section of the amino acid questionnaire.

Research shows there is serotonin involvement with vulvodynia. In this study of women with PVD (provoked vestibulodynia i.e. pain in the entrance of the vagina, common with vulvodynia):

Polymorphism in the serotonin receptor gene, 5HT-2A, has been associated with other chronic pain disorders such as fibromyalgia…. The results [of this study] indicate a contribution of alterations in the serotonergic system to the patho-genesis of PVD and gives further evidence of PVD being a general pain disorder similar to other chronic pain disorders.

I also recommend a trial of GABA instead of gabapentin or one of the benzodiazepines, assuming they score low on the GABA section of the amino acid questionnaire.

Tryptophan and GABA can help with both the pain, and the anxiety and depression that is commonly seen with vulvodynia and other pelvic floor conditions – right away while other root causes are addressed.

Since acupuncture is often reported to be helpful, I also consider a trial of DPA for endorphin boosting and hence some pain reduction too.

Physical therapy is often extremely beneficial and frequently overlooked, so finding a good pelvic floor PT to be part of your healing team is key too.

When responding to the blog question I commented that “your friend is fortunate to have you looking out for her”. Using some or all of the above approaches I would expect her to find some relief of the vulva pain, the foot pain and experience reduced anxiety and depression (assuming these are her root causes).

Please note that this is not an exhaustive list of contributing factors for vulvoldynia – other factors could include candida, infections such as HPV, IBS/SIBO, and trauma and sexual abuse. My colleague, Jessica Drummond, nutritionist and physical therapist, and an expert on female pelvic pain, writes about immunity, dysbiosis, gluten and other food sensitivities, cortisol and sex hormone imbalances in this article: Vulvovaginal Pain and The Immune System: Practical Steps for Vulvovaginal Pain Relief. A full functional workup is required and your root cause can be different from someone else’s root cause.

I’d also like to add that although dietary oxalates cause excruciating pain in my feet, I’m so fortunate, in that I do not have vulvodynia.

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

We use the symptoms questionnaire to figure out if low serotonin or other neurotransmitter imbalances may be an issue for you.

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 importance of quality animal protein and healthy fats is also covered.

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 too). 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.

Have you had success with a low oxalate diet and calcium citrate for vulvodynia? And other pain (in the feet or hips or elsewhere in the body)?

Has physical therapy with a pelvic floor specialist helped?

Have you found tryptophan, GABA or DPA to help with the pain and the anxiety and/or depression too?

Have any other treatments helped you?

If you’re a practitioner what approaches have helped your clients/patients?

Please share questions or feedback below.

Share your diet-depression success story: SMILES study looking for your input

By Trudy Scott 18 Comments

Professor Felice Jacka, nutritional psychiatry researcher and founder of ISNPR/International Society for Nutritional Psychiatry Research posted this exciting news and important request on the ISNPR facebook page:

The SMILES RCT, which is the first randomised controlled trial to test whether dietary improvement can actually treat depression, has now been accepted for publication in BMC Medicine (publication date 31st January).

As part of the media campaign, we will be needing to identify people who are willing to be interviewed. If there is anyone who has personally experienced a benefit from improving their diet, would you please volunteer for this purpose?

It’s a very important role, as the media coverage for SMILES will be limited if we can’t provide personal, first-person experiences to journalists. Clearly – for the sake of the field – it will be important to generate extensive media in order for clinicians and the general public to understand the implications and possibilities that arise from the RCT. Your help is enormously appreciated!

You can read more about this SMILES RCT here and the Anxiety Summit interview with Felice Jacka here: The Research – Food to prevent and treat anxiety and depression?.

Although anxiety was looked at in the study, Felice shared this regarding the type of interviewees they are looking for:

  • We really need to keep a focus on the topic of the RCT, which is depression
  • And to also keep it to those who improved the quality of their diet i.e. moving from a processed food diet, to one high in plant foods and healthy fats and healthy proteins
  • Not a particular type of diet (e.g. not paleo, not gluten free).

If you’ve personally benefited from changing your diet in this way and you’d like to help by sharing your story with the media please comment on the blog (or send an email to support [at] everywomanover29.com) with details of your story and willingness to be interviewed, plus your location. Be sure to let us know how best to contact you.

Right now we’ll just be calling on those who meet the above criteria for the media interviews.

BUT if you’ve benefited from any other changes to your diet – for either anxiety or depression – feel free to share anyway, so we can inspire others to do the same.

Here is my story:

For me it was anxiety and panic attacks that resolved when I made dietary and other nutritional and lifestyle changes.   I had been eating a vegetarian diet for a few years and I suspect the non-organic/GMO processed soy products (soy milk, soy yogurt, soy “butter” etc) were a big issue for me and damaged my gut.  When I added back quality animal protein (grass-fed red meat, wild fish, pastured eggs and chicken), switched to organic produce, added healthy fats and removed gluten my mood improved dramatically.  Now I eat a combination of a Paleo/SCD /low FODMAPS/low oxalate diet. 

During the severe anxiety and panic attacks I also needed additional support in the way of the targeted amino acids GABA (this was a life-saver and stopped the panic attacks in a few days) and tryptophan, plus zinc, vitamin B6, evening primrose oil, a good multi and B complex and adrenal support.  I still continue with some of these basic nutrients today.

My health issues have been complex as I’ve also had to deal with heavy metals, poor gut health and much more so I had what I call “a perfect storm” and yet diet has had such a huge impact for me!

Thanks for sharing your story! I’ll be sharing more as soon as the paper is actually published. Stay tuned for an interview with Felice too! 

And  big congrats to Felice and her team on this ground-breaking research!

UPDATE January 30, 2017: Here is the link to the research – A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial)

 

Why I recommend GABA for anxiety instead of phenibut

By Trudy Scott 68 Comments

gaba-instead-of-phanibut

I have concerns with phenibut and I don’t feel anyone should be using it. It is widely used in Russia as a medication for anxiety and it’s only available by prescription in that country. It’s available over-the-counter in the USA, Australia and the UK and it’s very effective for anxiety and insomnia. It’s for this reason that many anxious individuals really love it and practitioners recommend it.

Here is some information about phenibut from this 2001 paper – Phenibut (beta-phenyl-GABA): a tranquilizer and nootropic drug:

Phenibut (beta-phenyl-gamma-aminobutyric acid HCl) is a neuropsychotropic drug that was discovered and introduced into clinical practice in Russia in the 1960s. It has anxiolytic and nootropic (cognition enhancing) effects. It acts as a GABA-mimetic, primarily at GABA(B) and, to some extent, at GABA(A) receptors. It also stimulates dopamine receptors and antagonizes beta-phenethylamine (PEA), a putative endogenous anxiogenic. The psychopharmacological activity of phenibut is similar to that of baclofen, a p-Cl-derivative of phenibut.

Phenibut is widely used in Russia to relieve tension, anxiety, and fear, to improve sleep in psychosomatic or neurotic patients; as well as a pre- or post-operative medication. It is also used in the therapy of disorders characterized by asthenia [abnormal physical weakness or lack of energy] and depression, as well as in post-traumatic stress, stuttering and vestibular disorders.

One of the reasons phenibut seems to work so well is because it is so similar to benzodiazepines. The above paper goes on to state:

Comparison of phenibut with piracetam and diazepam reveals similarities and differences in their pharmacological and clinical effects.

There is research showing that physical dependence can develop, including tolerance and withdrawal, and adverse symptoms can be similar to benzodiazepines: Phenibut Dependence

We present a case of a patient who used phenibut to self-medicate anxiety, insomnia and cravings for alcohol. While phenibut was helpful initially, the patient developed dependence including tolerance, significant withdrawal symptoms within 3-4 h of last use and failure to fulfil his roles at work and at home. He finally sought medical assistance in our addictions clinic. We have gradually, over the course of 9 weeks, substituted phenibut with baclofen, which has similar pharmacological properties, and then successfully tapered the patient off baclofen. This required approximately 10 mg of baclofen for each gram of phenibut.

I talk about my concerns about phenibut and cover the best forms of GABA in my Anxiety Summit season 4 presentation – GABA: Blood Brain Barrier Controversy Concerns, Best Forms and How to Do a Trial for Eliminating Anxiety, and share what other practitioners share:

…practitioners will say well they use it cautiously. They only use it if really needed. And some practitioners will say they pulse. So they’ll have a client or a patient take it for a certain number of days and then stop for a certain number of days.

I just think let’s err on the side of caution and let’s not even go there. Let’s use these other nutrients [like GABA].

Why mess with something when you’ve got something else that can be used. I’ve had practitioners say to me “Well, phenibut works so well. That’s why I use it. GABA doesn’t seem to work as well.” And maybe it’s because they are not doing it sublingually. So if you’ve been using phenibut or you’re a practitioner I’d love to hear from you if you switch your patients or your clients to GABA and have them open up the capsules. Let us know if you’re finding better results with that method rather than having them swallow the GABA capsules.

During this same GABA presentation on the Anxiety Summit I share some of my other concerns about phenibut:

It’s used in high doses for performance enhancement and what really horrified me is that there are these dedicated forums with information on how to taper safely. So there are these forums that talk about phenibut like it’s a drug and tell people how they can safely go this high [on the phenibut] and if they get these [bad] effects, what they need to do and how they can taper. When I read all that I was just horrified.

Why mess with something like phenibut when we’ve got GABA that does work so well when used in the right way (sublingually appears to be most effective) and when trialed to find the ideal targeted dose for your particular needs.

If you’d like a refresher or want to learn more about the following topics, be sure to listen (or re-listen if you tuned in during the summit) to my season 4 Anxiety Summit presentation on GABA:

Please share your phenibut and GABA experiences so we can all learn.