depression

Irukandji syndrome: severe pain, nausea, breathing difficulties and a feeling of impending doom (impact on serotonin and other neurotransmitters?)

December 30, 2022 By Trudy Scott 14 Comments

Irukandji syndrome is in the news again. In addition to the jellyfish sting causing severe pain, nausea and breathing difficulties, the research states there is a feeling of impending doom after you’re stung. I’m sharing this current news from Australia and a recent study because I’m curious about the mechanisms and short- and long-term impacts on serotonin and other neurotransmitters, likely affecting anxiety, depression, pain and insomnia. And I’d like to help create awareness since there is not 100% consensus on what to do right away after a sting and less awareness in the medical community than I feel comfortable with.

From the ABC article published this week in Australia: “Another child has been flown to Hervey Bay Hospital with a suspected Irukandji sting after swimming in a creek off Wathumba Road on K’gari (Fraser Island) in Queensland, Australia on Wednesday afternoon.

The key points of the article:

“Three young girls and a boy have been flown to hospital with suspected Irukandji stings in the past two days
The jellyfish stings can cause severe pain, nausea and breathing difficulties
A Toxicologist is calling for more research into their movements and physiology”

The yahoo news article expanded on the symptoms: “They have this severe body pain, often low back pain, nausea, vomiting, and this feeling of impending doom that sort of lays over the top of this whole thing.”

I found the latter interesting as impending doom is a classic sign of low serotonin. So I went digging into the research. I was enlightened and surprised by what I found.

Raising awareness on this worldwide increasing threat

This 2022 paper, Raising Awareness on the Clinical and Forensic Aspects of Jellyfish Stings: A Worldwide Increasing Threat is eye-opening and concerning and also mentions the impending doom symptom.

Irukandji syndrome is a severe illness produced by the envenomation i.e. injection of venom, of some species of small jellyfish from the Cubozoa class, known as box jellyfish.

It consists of a clinical picture dominated by systemic symptoms similar to a catecholamine surge, including hypertension, tachycardia, intense pain, and muscle cramping, eventually leading to pulmonary edema, shock and cerebral hemorrhage.

Also listed are symptoms of anxiety, restlessness, headache, localized sweating and impending doom. A feeling of impending doom is a classic symptom of low serotonin.

With regards to Irukandji syndrome it’s becoming a worldwide problem: “The first cases described happened in the northern Australian territories. However, similar disorders have been observed all over the tropical waters, including Thailand, the Caribbean, Florida, and Hawaii.”

The good news is that the authors state “Irukandji syndrome is typically not deadly, especially if supportive care is given early” and “not all encounters with species capable of producing Irukandji syndrome result in this clinical state.” They also share that typically the severe pain only lasts a few hours but do mention one case where “pain recurred up to a year later.” I discuss possible longer term effects below.

As you read the paper, be aware there are many types of jellyfish with many different mechanisms. Cubozoa includes the deadliest jellyfish species and includes Carukia barnesi and Chironex fleckeri. (commonly known as the Australian box jelly). It’s the Carukia barnesi that causes Irukandji syndrome.

The images in the above paper are graphic so be warned.

There is not 100% consensus on what to do right away

What is also really concerning is that there is not 100% consensus on what to do right away. This 2017 paper, Cubozoan Sting-Site Seawater Rinse, Scraping, and Ice Can Increase Venom Load: Upending Current First Aid Recommendations, published by Hawaiian researchers, found the “best outcomes occurred with the use of venom-inhibiting technologies (Sting No More® products)” and they state not to use a sea water rinse. They also found vinegar and heat treatment were less effective with certain types of jellyfish.

And yet the tentative recommendation from the above 2022 paper is to use vinegar, heat, sea water, and careful removal of remaining tentacles with tweezers quickly because only “about 1% of nematocysts (stinging cells) discharge upon initial contact.” They do suggest using Sting No More® before removing tentacles in order to deactivate the nematocysts.

I’m not sharing any of the above as conclusive in all situations but more to illustrate what both papers state: further research is needed in different places of the world, as different jellyfish species seem to react differently to the treatments.

There is also less awareness in the medical community than I feel comfortable with hence my desire to share this so you are more aware if you or a family member is stung by a jellyfish.

Are there possible long-term impacts on anxiety, depression, pain and insomnia? (and the potential role of amino acids)

Just like we have long-term impacts on anxiety, depression, pain and insomnia with Lyme disease and other infections like Bartonella – due to effects on serotonin, GABA and other neurotransmitters – do we need to consider these long term impacts after a jellyfish sting too?

I have to wonder if there are also longer term impacts given the trauma of the situation and the many medications that are needed to save your life: nitroglycerin, opioids, benzodiazepines and others.

If mood, anxiety, pain and sleep issues persist after the acute recovery phase (which can take up to 3 months and more) and there are other signs of low serotonin, GABA, dopamine and endorphins, it’s important to consider the use of targeted amino acids. I recommend tryptophan or 5-HTP for low serotonin symptoms (worry type of anxiety, insomnia and low mood), GABA for low GABA symptoms (physical anxiety and tension), tyrosine for low dopamine symptoms (depressed with low energy and poor focus) and DPA for low endorphin symptoms (pain and weepiness).

It would be wonderful to see research in this area.

Is there a possible role for GABA right after the sting too?

Given there is “hypertension, tachycardia, intense pain, and muscle cramping”, would the amino acid GABA help?

With Irukandji syndrome, “there have been reports of blood pressures as high as 300/180 mmHg” (normal is 120/80 mmHg). In one study, 80mg GABA was found to reduce mild hypertension and it’s possible that a higher dose of GABA may help right after the sting. It may also help to alleviate pain and muscle tension/muscle cramping too.

It would be wonderful to see research on GABA use right after the sting too.

Resources if you are new to using amino acids as supplements

If you are new to using GABA or any of the other amino acids as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see all the symptoms of neurotransmitter imbalances, including low GABA and low serotonin).

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, sugar cravings, self-medicating with alcohol and more.

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. You can find them all in my online store.

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.

I do hope these 4 young Australian children are doing well after having been stung.

Have you or a family member been stung by a jellyfish? Where did it happen and what type of jellyfish? What symptoms did you experience? What was the treatment and what was recovery like?

Have you or your family member had any long-term lingering symptoms of anxiety, depression, pain and insomnia? Have the amino acids or other solutions helped?

If you’re a practitioner have you seen long-term lingering symptoms of anxiety, depression, pain and insomnia in your clients/patients who have had a jellyfish sting?

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

GABA is not the same as gabapentin. GABA (gamma-aminobutyric acid) is an amino acid supplement; gabapentin is a prescription medication

December 23, 2022 By Trudy Scott 53 Comments

One common question I hear from folks who are new to my work is this: “is GABA the same as gabapentin?” Quite frankly it has always surprised me to get this question since they are different words – why would you think they are the same? But I’d carefully explain the difference, educate the person and move on. A few months ago I shared a blog post on how the amino acid GABA was effective for an 11 year old with ADHD, irritability, anxiety and tantrums and someone asked this question again: “GABA sold at health store or prescription Gabapentin?”

I decided it was finally time to ask why she thought they may be the same thing. I first explained what GABA is (an amino acid supplement), shared some links to products and said “no, not prescription Gabapentin – I’m curious why you’d think that?”

She replied that “some people refer to GABA the same as Gabapentin” and thanked me for the clarification.

I appreciate her response but it did still concern me that the amino acid GABA is lumped together with prescription gabapentin. My next step was a facebook post sharing the above dialogue and asking my community there for feedback: “Have you heard GABA and gabapentin used interchangeably? Did you think they were the same thing at one stage?”

The response was enlightening, hence this blog post to provide clarification if you’re not sure either or if you know exactly what GABA is but have had confused conversations with your practitioner, family members, friends and/or colleagues. And to also get your feedback on this topic.

GABA is not the same as gabapentin. GABA (gamma-aminobutyric acid) is an amino acid supplement and neurotransmitter; gabapentin is a prescription medication. They are often used interchangeably (as you’ll read below) and should not be!

GABA and gabapentin is used interchangeably by a variety of practitioners

Here are some of the many responses showing how GABA and gabapentin is used interchangeably by a variety of practitioners:

Jennifer shared this: Yes in the vet world, gabapentin is often called gaba. Not surprising since western medicine likes to pretend that supplements don’t exist. I didn’t know GABA existed as a supplement for many years. I always explain what it is when I talk about it, to make sure there’s no confusion.

Val shared this: I was just at the dentist and I shared that I take Gaba to help me sleep. She said “Gabapentin?” I said “no I don’t take a synthetic medication, instead I take Gaba which is an amino acid.” It’s good to share with all who are willing to listen.

Katie shared this: I have never heard them used interchangeably but, whenever I talk about GABA, I say “GABA otc amino acid, not gabapentin the prescription” to be extra clear and educational.

Heather said: I was wondering this earlier in the week. My husband’s [nurse practitioner] suggested gabapentin temporarily for a back injury but she used the term “gaba”. I quickly got clarification. Hopefully she won’t do that again. But I understand it. Her field is all pain management.

Theresa shared this: Nurses who don’t know medicine often do that. I’ve found that [gaba] is listed in my med list when they don’t seem to know the difference.

Laura shared this: I always knew that they were different but I have had psychiatrists use them interchangeably.

Bonnie shared this: I mentioned GABA to my dad’s nurse and she got all upset, thinking I meant Gabapentin. At the time I didn’t know it was two different things. Dad was in the hospital and I suggested gaba to calm him. She said, no, no, no! I didn’t realize we were speaking of two different things.

Lisa shared this: When I told my primary doctor [an MD] that I was taking Gaba instead of prescription drugs she asked “gabapentin?” I said “no, Gaba which is a supplement”. She looked confused.

Lindy shared this: It’s a common assumption. I think some GPs (general practitioners) shorten gapapentin to gaba.

Jane shared this: “Yes – I am very careful to say the “supplement GABA.” I mentioned it to an Anesthesiologist when I had surgery. I normally don’t tell the medical profession my supplements – they have no idea what they are. I do specify the “supplement GABA” to holistic providers – I don’t want any misunderstanding. I was on Gabapentin and Lyrica for a long time. Horrific medications with severe consequences

If you relate to any of this feedback, keep sharing in order to educate, explain the difference and clarify to make sure there is no confusion.

What is GABA?

If you are new to the amino acid GABA, it’s a supplement that is used to raise low GABA (the neurotransmitter) levels and ease the physical-tension and stiff-and-tense-muscles type of anxiety.

The other symptoms we see with low GABA are panic attacks, physical tension in certain settings like public speaking or driving, and the need to self-medicate to calm down, often with alcohol but sometimes with carbs and sugary foods. Insomnia can also be due to low GABA and you’ll experience physical tension (rather than the ruminating thoughts which is the low serotonin type of insomnia – although it’s not uncommon to experience both). GABA also helps with muscle spasms and pain relief when muscles are tight.

You can read this blog, GABA for the physical-tension and stiff-and-tense-muscles type of anxiety for my biggest takeaways for using GABA effectively. I also share a number of GABA products and some feedback from folks who have experienced the benefits. One example is this:

I have used GABA (several brands, just open a capsule and sprinkle a small amount under the tongue) for years now, with calming results within minutes.

With regards to the question about GABA being available in health stores: there are amino acid supplements that are available over the counter at a health store and also via my online health store here (these are products I have vetted and use with clients).

Here is the blog I referred to above: GABA for children: ADHD, focus issues, irritability, anxiety and tantrums. My blog is a wealth of information when it comes to GABA so be sure to use the search feature.

What is gabapentin?

Per the Cleveland Clinic site:

Gabapentin is a prescription medication known as a gamma aminobutyric acid (GABA) analogue. GABA reduces the excitability of nerve cells (neurons) in the brain, which play a role in seizures and the transmission of pain signals. Gabapentin mirrors the effects of GABA calming excited neurons. Gabapentin is in a class of medications called anticonvulsants.

It’s been approved for seizures and nerve pain caused by shingles, however, off-label use is common when it comes to other types of pain, anxiety and depression. This paper, Outpatient Off-Label Gabapentin Use for Psychiatric Indications Among U.S. Adults, 2011-2016 warns of

risks associated with gabapentin combined with central nervous system depressant (CNS-D) drugs, which are commonly prescribed in psychiatric treatment….Over 6 years, 58.4% of off-label gabapentin visits listed one or more concomitant CNS-D medications, most frequently antidepressants (24.3%), opioids (22.9%), and benzodiazepines (17.3%).

The above Cleveland Clinic site lists some brand names – Horizant®, Gralise® and Neurontin® – but it is known by many different names in other countries. You can look it up in your country here.

You’ll also see all the side effects and the fact that dependence and withdrawal is downplayed despite the growing evidence that these are very real issues. More on that below.

There are many issues with gabapentin dependence and withdrawal

This blog post is really about terminology and the interchangeable use of GABA and gabapentin, but if you’re new to gabapentin, it’s important to be aware that there are many issues with dependence and withdrawal (often similar to benzodiazepines):

Withdrawal symptoms after gabapentin discontinuation

On day 3 of hospitalization, she developed restlessness, disorientation, confusion, agitation, and anxiety. She was presumed to be suffering from ethanol withdrawal and was treated with benzodiazepines but had no improvement in symptoms. During days 4 and 5, the patient became increasingly confused, agitated, and anxious, with complaints of headache, light sensitivity, and increasing nervousness. On day 5, gabapentin was reinitiated, and the patient’s confusion and agitation improved that evening. The next morning, the patient was calm, alert, and cooperative.

Akathisia induced by gabapentin withdrawal

To our knowledge, this is the first reported cases of akathisia induced by gabapentin withdrawal. Available case reports suggest that gabapentin withdrawal can occur at doses ranging from 400-8000 mg/day. Patients experienced symptoms similar to those that develop with benzodiazepine withdrawal and were taking gabapentin for as little as 3 weeks to as long as 5 years.

Gabapentin dependence and withdrawal requiring an 18-month taper in a patient with alcohol use disorder: a case report

This case highlights the need for patient-centered slow tapers in patients with severe gabapentin dependence and withdrawal.

The withdrawal took 18 months.

There is one case report of macular edema after gabapentin use and gabapentinoid (pregabalin/Lyrica) more so than gabapentin/Neurontin) prescriptions increased risk of suicidal behavior and unintentional overdose.

This 2017 paper, Gabapentin and pregabalin: do the benefits outweigh the harms? summarizes as follows: “Prescribers should be aware of the very limited clinical evidence for use of gabapentin and pregabalin outside their licensed indications, as well as their capacity to do harm.”

The amino acid GABA has none of these issues.

Why it may be confusing for practitioners

Other than the fact that gabapentin is described as a GABA analogue, I can see why it may be confusing for practitioners who don’t yet know about my work and the amino acid GABA.

The fact that GABA is an amino acid supplement and also a neurotransmitter may also be contributing to some of the confusion.

The other fact that I believe is adding to the confusion is because of how gabapentin is often referred to in the research. Let’s take this 2020 paper as an example: γ-Aminobutyric Acid and Derivatives Reduce the Incidence of Acute Pain after Herpes Zoster – A Systematic Review and Meta-analysis

It has γ-aminobutyric acid and derivatives in the paper title and as part of the aim, is mentioned in the results and elsewhere too:

The aim of the present study was to investigate the effectiveness of GABA and its derivatives in reducing acute pain incidence in patients having HZ.
The results showed that the treatment with GABA and its derivatives significantly reduced the number of patients with acute zoster pain.
There is no guideline for using and dosing GABA and its derivatives to prevent acute HZ pain.

And elsewhere they refer to GABA-like compounds:

The optimal dosage of GABA-like compounds is still to be determined.
Nevertheless, the presently available data indicate that the application of GABA-like compounds in this respect is very promising.

The entire review is about gabapentin/neurontin and is not about the amino acid GABA at all, even though the search terms used for this paper included: gamma-aminobutyric acid and gaba.

This is just one example of many such papers. I know what the amino acid GABA is and I was initially confused when reading the title and abstract, and even when reading the full paper (initially hopeful the paper would also be discussing the amino acid GABA).

Resources if you are new to using GABA and other amino acids as supplements

I appreciate these women for sharing their interactions with practitioners so we can all be enlightened.

Have you heard GABA and gabapentin used interchangeably? Did you think they were the same thing at one stage?

How do you refer to GABA and gabapentin in order to avoid confusion?

If you’ve been prescribed gabapentin what was/is it prescribed for? And did you/do you also have a prescription for an antidepressant, opioid or benzodiazepine?

Have you had/do you have any issues using gabapentin?

Have you had success using the amino acid GABA? If yes, what for?

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

GABA supplementation may offer a new approach for the prevention and treatment of asthma (and it helps anxiety, ADHD and insomnia)

December 16, 2022 By Trudy Scott 12 Comments

If you’re already taking the amino acid GABA for physical anxiety, have you noticed if it’s also helping to ease your asthma symptoms too? This may sound surprising but research shows GABA may reduce inflammation and spasms and help with asthma symptoms via these mechanisms. What’s encouraging is the fact that GABA supplementation also helps with anxiety, obesity, ADHD and insomnia which commonly occur with asthma and can be associated with inflammation too. It’s so important to be addressing the root causes of asthma because of the many neuropsychiatric side-effects of asthma medications. This blog addresses all of these topics.

We’ll start with the research first. In this study, Effect of gamma-aminobutyric acid treatment on plasma substance P and calcitonin gene-related peptide levels in children with asthma, of 75 children with asthma, 36 children were in the GABA treatment group and received oral GABA (25-30 mg/kg per day) in addition to standard asthma medications.

The authors propose that airway inflammation may be a factor in asthma and GABA helps because it reduces SP (substance P) and CGRP (calcitonin gene-related peptide), easing neurogenic inflammation and tracheal spasms.

The conclusion of the study is that oral GABA:

can significantly decrease plasma levels of SP and CGRP in children suffering from acute asthma.

It may offer a new approach for the prevention and treatment of asthma.

(this is my best translation from the Chinese paper).

Dosing of GABA for asthma

The children in the study group received oral GABA of 25-30 mg/kg per day. For a 100 lb /45 kg child this would equate to 1125 mg -1350 mg of GABA per day.

As I always share, I don’t recommend using GABA based on the weight of the person and I consider this a high dose. For adults, 125 mg GABA is a good starting dose with 125 mg often used 2-4 times a day. For a child, ¼ to ⅓ this dose is typically good to start with. All that said, many adults and children with asthma and anxiety need higher doses than what they initially start with.

It’s also worth noting that the oral dose of GABA was swallowed so it’s possible (and very likely) that more was needed than if it was used sublingually or with the capsule opened or a powder or a liposomal form.

GABA is seldom recommended for asthma – more recent research supports this approach

This is not new research – the paper was published in 2013 – but I seldom see it discussed or hear about practitioners recommending GABA for asthma.

A more recent paper, Neuroimmune Pathophysiology in Asthma (published in 2021) supports this and discusses the role of neurotransmitters (including GABA and serotonin) and neuropeptides (including SP, CGRP and others) in asthma. The authors suggest “that regulating the effects of neurotransmitters and neuropeptides represents a potential novel approach for the treatment of asthma.”

Why we need to consider GABA – the neuropsychiatric side effects of asthma medications

Exploring the use of GABA and these approaches is especially important given the neuropsychiatric side effects of asthma medications. In this study (published in March this year), Neuropsychiatric adverse drug reactions induced by montelukast impair the quality of life in children with asthma

Neuropsychiatric ADRs (adverse drug reactions) were reported in 78 (62.4%) of 125 patients, who recovered when the drug was discontinued.

These were children of 3-18 years taking montelukast for the first time. The good news is that they recovered when the drug was stopped.

The bad news is there is no information on how many kids who have been prescribed this class of medication are subsequently prescribed psychiatric medications.

This concern needs to be considered for all asthma medications: there are similar adverse effects with antihistamine and inhaled corticosteroid medications.

GABA helps with other conditions where spasms are common

The study results are very encouraging and support what I see clinically with asthma and other conditions where spasms are common. These include

GABA helps with all of the above and the non-allergic comorbidities seen with asthma.

Asthma in children and non-allergic comorbidities (obesity, depression and anxiety, ADHD and insomnia)

As stated in this paper, Paediatric asthma and non-allergic comorbidities: A review of current risk and proposed mechanisms “It is increasingly recognized that children with asthma are at a higher risk of other non-allergic concurrent diseases than the non-asthma population.” These include obesity, depression and anxiety, neurodevelopmental disorders (such as ADHD), sleep disorders and autoimmune diseases.

This paper looks at mechanisms and inflammation is a common theme except when it comes to anxiety and depression. Given that this paper was published this year and all that we now know about nutritional psychiatry and neuroinflammation and anxiety, it’s clearly lacking in this aspect.

Clinically, we see how GABA can help with obesity (and cravings or stress-eating), depression and anxiety, ADHD and insomnia, as illustrated by these case studies:

I see similar comorbidities (the occurrence of more than one disorder at the same time) in adults and GABA can be used safely with adults and children.

Asthma from a functional medicine approach

There is clearly more to asthma than only GABA. This this article on natural remedies for asthma covers diet (eat real good quality food and avoid junk food), nutrients like vitamin D, zinc and others, and allergens – and all this needs to be investigated and addressed with a functional medicine approach.

Dr. Axe does mention stress and anxiety being a trigger: “It’s well-known that stress increases the severity and frequency of asthmatic attacks because it hinders immune function and raises inflammation.” He mentions stress-reduction techniques and breathing. I say let’s add GABA to the mix too.

Resources if you are new to using GABA and other amino acids as supplements

Has GABA helped ease your physical anxiety and asthma symptoms too?

What about obesity/cravings, ADHD and insomnia as well?

Have you or one of your children been adversely impacted by asthma medications? If yes please share which medications and what symptoms were experienced.

What functional medicine and nutritional approaches have helped your asthma symptoms?

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

Does 5-HTP (an amino acid) cause nightmares or does it help prevent nightmares (and also support low serotonin symptoms)?

October 7, 2022 By Trudy Scott 24 Comments

How do you do with using the amino acid 5-HTP for supporting your low serotonin symptoms of anxiety, worry, ruminating, fears, depression and insomnia? Does it help or does it cause nightmares? On a recent Facebook thread someone shared that 5-HTP causes really bad nightmares, so she had to stop using it. A few others posted saying 5-HTP also caused them nightmares. I’ve not had any clients report nightmares, so I was surprised to hear this feedback. However, most folks on the same Facebook thread shared that 5-HTP works very well for them and does not cause nightmares. There is also research that supports the use of 5-HTP for night terrors. I suspect it may have to do with low vitamin B6 and share more on that below.

Here is her experience with 5-HTP and nightmares and some of my feedback:

I don’t know how anyone takes 5-HTP. The horrific nightmares I got from taking it made me stop 50 mg. I tried 3 times thinking it was a fluke and it happened every time. Too scary for me.

My first try was suggested from my Naturopath, Metagenics SeroSyn. 200 mg. First morning waking up I had a nightmare so bad I can’t even share it. I also woke up feeling unable to wake up, drugged almost. So I waited, did more research and googled 5-HTP and nightmares just to see if there was a connection. I found it. I read to lower the dosage. So I went to Pure Encapsulations 50 mg. Same thing happened. I tried 2 more times, same thing happened. When I researched, I found so many people talking about “vivid dreams” and after my last attempt the dream was so real I thought my son was in my home when I woke up and had to process reality from my dream. That did it for me. Now I’m terrified of it. Just my own experience. I did get help from depression though! But I cannot go through one evil for another. Now I’m stuck looking for help and answers.

I thanked her for sharing and agreed it does help to do a few experiments to be sure it was the 5-HTP. I also shared that I would not consider the Metagenics SeroSyn a good 5-HTP to test because of all the other ingredients. But it also happened with Pure Encapsulations 50 mg 5-HTP – that was a good test to confirm.

I also shared that some folks do better on 5-HTP and some on tryptophan so if 5-HTP did help with low serotonin symptoms then I’d consider a trial of tryptophan especially since she did say using the 5-HTP helped with her depression.

We would also look for other ways to support serotonin – saffron, turmeric, St. John’s Wort, theanine (it supports GABA, serotonin and dopamine) and of course diet (real whole food, quality animal protein, no gluten/sugar/caffeine, fermented foods, organic vegetables and fruit, healthy fats etc), gut health and more.

I’d also look into and address low zinc and low vitamin B6 as both are needed to make serotonin and the other neurotransmitters. More on low vitamin B6, pyroluria and nightmares below.

Here is some of the feedback from other folks who also had issues with 5-HTP:

5-HTP didn’t mix well with my body either. Taken at night, horrible dreams, and 50mg Pure Encapsulations formula in the morning made me feel so dark, spaced out and terrible nausea.
I appreciate this post. I had nightmares from a magnesium supplement that included 5-HTP! Now I know I’m not alone.

And here is some of the feedback from folks who do well with 5-HTP (the majority of those who responded):

I take 100 mg of 5-HTP in the morning (Natural Factors) and about 350 mg of tryptophan before bed (Lidtke). It works well for me. No nightmares although I do dream a lot. Mostly noticed improvement in mood and ruminating thoughts. Also taking Sam-e which also helps.
I take chewable natural factors Tranquil Sleep. It contains other ingredients (like theanine) as well but it’s really easy to dose. If I take 2 it’s too much. I get weird dreams and a headache. So 1 1/2 it is.
5-htp helped me so much! But I had to take it in the morning. 250mg was perfect for me. I was using this for my debilitating anxiety which would keep me in flight or fight all day and I would ruminate. Really helped me along with therapy. I no longer need it.
I’ve just started taking 50mg 5-HTP at night. It’s a micronized version I buy from a compounding chemist in Australia. No negative side effects so far.
Grateful for the reminder … I did great on 5-htp myself. Have had all dose amounts, given at different times too. I deal with chronic pain and trauma/stress.
My sister gets anxiety on 5-HTP but it helps me so much! I have not tracked regular consumption compared to my sleep (I get too much REM without it and wake up exhausted). I also no longer need it as a daily and can take it as needed. I take 200mg, forget the brand but it’s a single ingredient.
I take 50 mg of 5-HTP from Seeking Health and do very well on it. It has helped me with depression, worry, fear, more energy and motivation and no nightmares.
I take the Now brand, 100mg at bedtime along with the same brand of L theanine. No nightmares and I’ve been doing this for about 5 years.
I use 50mg Seeking Health 5-HTP and I love it. It gives me energy and motivation, helps with intrusive thoughts and anxiety. I’ve used the Jarrow brand in the past without results. No nightmares. P5P, on the other hand, I cannot take. It gives me such clear, vivid nightmares I would wake up crying. Never again.

We are all unique and there is clearly no one-size fits all.

Low vitamin B6 can cause nightmares or poor dream recall

It’s well recognized that low vitamin B6 can cause nightmares or poor dream recall. In this study, Effects of Vitamin B6 (Pyridoxine) and a B Complex Preparation on Dreaming and Sleep (which was randomized, double-blind and placebo-controlled), 100 participants from across Australia were given 240 mg vitamin B6 (pyridoxine hydrochloride) before bed for five consecutive days. Other study participants were given a B complex. This is the outcome of the study:

vitamin B6 significantly increased the amount of dream content participants recalled but did not significantly affect dream vividness, bizarreness, or color, nor did it significantly affect other sleep-related variables
participants in the B complex group showed significantly lower self-rated sleep quality and significantly higher tiredness on waking

This vitamin B6/dream recall research is of particular interest to me because of my work with pyroluria, a social anxiety condition which responds really well to supplementation with zinc, vitamin B6 or P5P (pyridoxal-5-phosphate) or a combination of both, and a few other key nutrients. Here is the pyroluria questionnaire.

One of the classic signs of pyroluria is poor dream recall, stressful or bizarre dreams, or nightmares, signs which the late Carl Pfeiffer, MD attributed to low vitamin B6 status. He suggested that your dreams and dream recall serve as a good indicator of your need for vitamin B6. You should dream every night and you should remember your dreams. They should be pleasant – the kind of dreams where you wake up and want to close your eyes and continue dreaming.

Could it be that folks who get nightmares with 5-HTP, happen to also have pyroluria? Or perhaps they simply have low vitamin B6 status? I have all my anxious clients supplement with vitamin B6 and/or P5P and this may be why nightmares with 5-HTP was news to me.

5-HTP can increase cortisol – does this affect nightmares?

There is research and clinical evidence supporting that, for some individuals, 5-HTP can raise cortisol. I’ve blogged about this here:

This is not always the case. Someone in the same Facebook thread shared this: “My cortisol measured above the reference range, but 5-HTP is the only thing I’ve found that’s helping me sleep recently.”

I’m not aware of a high cortisol-nightmare connection but it’s possible. In one study, nightmares triggered high cortisol the next morning, but I donut this has relevance in this situation.

5-HTP induces long-term improvement of sleep terrors in children

There clearly is a subset of folks who don’t do well with 5-HTP and yet there is evidence that it can actually improve sleep terrors. In a small open label clinical trial of 45 children, it was found that 5-HTP was able to “modulate the arousal level in children and to induce a long-term improvement of sleep terrors” (in the majority of children in the trial). There were 34 male and 11 female children ranging in age from 3.2-10.6 years.

After the first visit, L -5-HTP was administered (2 mg/kg per day) at bedtime to 31 randomly selected patients for a single period of 20 consecutive days. After 1 month of treatment, 29/31 (93.5%) of patients showed a positive response. In the comparison group without drug therapy, after 1 month, the episodes disappeared only in four children (28.6%) while ten children (71.4%) showed the persistence of episodes with the same frequency as before. After 6 months, 26/31 (83.9%) of children treated with L -5HTP were sleep terror-free, while in five children (16.1%) sleep terror episodes persisted. Of the children in the comparison group, ten (71.4%) continued to show sleep terrors at 6-month follow-up.

If we assume a 10-year-old weighs, 70lb or close to 32kg, they would have been given 60mg 5-HTP (i.e. 2 mg/kg).

Typical adult dosing of 5-HTP is 50mg twice a day, mid-afternoon and evening. For a 10-year-old we may start with a quarter of this dose i.e. 12.5mg or 25mg 5-HTP twice a day, for a total of 25mg or 50mg a day – which is close to what was used in this study.

You can read more about this in the paper here: L -5-Hydroxytryptophan treatment of sleep terrors in children

Resources if you are new to using 5-HTP and other amino acids as supplements

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

How do you do with 5-HTP for low mood, worry-type of low serotonin anxiety, cravings, PMS, negative self-talk, anger/rage/irritability, insomnia, ruminating thoughts, winter blues etc? Does it help?

Or does it give you nightmares that are bad enough that you have had to stop?

Please share how much you used? And if tryptophan or other serotonin support helped instead?

Did the addition of vitamin B6 or P5P help prevent the nightmares when using 5-HTP?

And do you have pyroluria or suspect you may have it? Do you have high cortisol?

If you’re a practitioner I’d love to hear your experiences with 5-HTP and nightmares.

If you have questions please share them here too.

GABA is a life saver for anxiety, theanine helps at night (insomnia) and 5-HTP makes a significant difference in lessening daily pain

September 16, 2022 By Trudy Scott 16 Comments

Joie has Sjogren’s, Hashimoto’s, fibromyalgia & collagenous colitis (all diagnosed after severe mold exposure) and shared how GABA is a life saver for her anxiety, how theanine helps at night with her insomnia and how 5-HTP makes a significant difference in lessening her daily pain. Here is her wonderful feedback in her own words (my feedback for her follows):

I was diagnosed with Sjogrens several years ago. I also have Hashimoto’s, Fibromyalgia & Collagenous Colitis. All of these happened after a severe mold exposure which destroyed my pituitary, and caused Exocrine Pancreatic Insufficiency (EPI). I have to take human growth hormone injections daily, as my pituitary isn’t working, digestive enzymes for the EPI, and have experienced the anxiety and depression you’ve written about.

The GABA has been a life saver for me (for my anxiety), and I share this with all I know who experience anxiety. I also use L-theanine at night because of insomnia. The 5-HTP has helped somewhat for sleep. L-tryptophan didn’t seem to make a difference. However the 5-HTP has made a significant difference in lessening my daily pain levels, which I am most grateful for.

Unfortunately, I am also taking Klonopin and Gabapentin, both of which I have tried to get off of but keep finding myself back on both in order to have greater than 5 hours of sleep at night. Even with these, I often awaken after 4-6 hours and take 1-2 chewable GABA which allows me to go back to sleep and get 2-4 more hours of sleep.

She shared this on the blog, Sjogren’s syndrome: tryptophan and GABA for anxiety, and moisturizing for dry skin and inflammation?, where I write about the prevalence of anxiety and depression in this autoimmune condition, and the fact that serotonin and GABA are often low.

I shared how sorry I was to hear how mold has impacted her but that it was wonderful to hear the GABA has been a lifesaver for you in terms of anxiety (and when waking in the night) and that theanine helps her sleep. It’s wonderful that 5-HTP helps ease her daily pain (here is fibromyalgia research on 5-HTP) and helps somewhat with her sleep issues.

Has she increased the amino acids to the optimal doses for her unique needs?

My question for her was this: “how much of each of these amino acids are you using and have you increased them to the optimal doses for your unique needs?” I asked this because many folks don’t do this and we always want to capitalize on what is working.

Here are some examples that relate to Joie:

When 5-HTP helps with pain relief we also do afternoon and bedtime trials to see if it can improve sleep further. And we always explore some of the reasons why serotonin may be low and address those too. You can read more on that here: what causes low serotonin

I shared that tryptophan doesn’t work for everyone and some do better with 5-HTP, but I do also consider melatonin when sleep is an issue, especially timed release to prevent waking in the night.

Since GABA is a lifesaver for her in terms of her anxiety and also helps when she wakes, trialing higher doses at bedtime may prevent the early morning waking. The same could be said for trialing a higher dose of theanine and using both GABA and theanine together at night (a 2019 study shows the combination decreases sleep latency and improves NREM sleep).

High cortisol, rebound sleep issues with meds and/or poor fat digestion?

If she has already done the above, I’d explore high cortisol and do a 5-collection an adrenal saliva test). When cortisol is high during the night, the use of Seriphos can be a game-changer for many.

Unfortunately both Klonopin and Gabapentin (especially the former) can cause rebound insomnia even when they seem to be helping in the short-term.

I also mentioned that my recent blog post many be helpful since she mentions exocrine pancreatic insufficiency, which could affect sleep by impacting her fat digestion – Waking in the night due to environmental toxins: impacts on the liver, gallbladder and fat digestion (making oxalate issues worse). This has relevance whether or not oxalates are an issue.

Autoimmune-Paleo (AIP) diet, pyroluria and moisturizing for reducing inflammation

It goes without saying that since Sjogren’s, Hashimoto’s and even Collagenous Colitis are autoimmune conditions, following an Autoimmune-Paleo (AIP) diet is key too. I have links to some AIP resources on the above Sjogren’s blog post.

In this blog I also mention pyroluria which may be relevant for someone with Collagenous Colitis and is crucial to address when there has been toxic mold exposure or other chronic issues like Lyme disease or MCAS. More on this here.

And you can also read about the value of moisturizing for reducing inflammation.

I thanked her and said I plan to share her results and my response as a new blog as I feel it will help others and give hope!

Resources if you are new to using amino acids as supplements

Has GABA helped with your anxiety and insomnia? What about theanine? And 5-HTP for your pain? Or melatonin for sleep?

Have you used taurine with success for fat digestion? Or Seriphos for high cortisol?

What else has helped you with symptoms like these ones?

If you have questions please share them here too.

Waking in the night due to environmental toxins: impacts on the liver, gallbladder and fat digestion (making oxalate issues worse)

September 9, 2022 By Trudy Scott 37 Comments

Today I’m sharing how waking in the night may be caused by oxalate issues that are made more severe because of home cleaning products, environmental toxins and fragrances/phthalates. It can happen because of the additional detoxification work required and adverse impacts on your liver and gallbladder. This can impact bile production so fat digestion is impaired. And when you have impaired fat digestion this can contribute to more severe oxalate issues because more oxalates are absorbed in the gut. This can lead to increased pain, worsening sleep and/or waking in the night, increased anxiety, fatigue, depression, more severe bladder symptoms, eye problems etc.

Using extra calcium citrate in the night can help in the short term. But improving fat digestion (with lipase, ox bile, taurine, a lipotropic formula, digestive bitters etc.) and supporting the liver/gallbladder is key because it gets to the root of the problem. And of course, avoid the chemical exposure. Sometimes this can’t be done – which is the case when you are traveling – so you have to do your best to reduce exposure.

This is actually my story. I’m traveling in South Africa at the moment and had a flare of my old oxalate issues, with increased foot pain at night, so much so that it was waking me at 3am in the morning. I’d be awake from 3-5am feeling agitated and restless and waiting for the extra calcium citrate to work. I’m a hot mess when I don’t get a solid 8-9 hours sleep so I had to figure out what the issue was and fix it quickly. It was a somewhat convoluted journey (more on that below) but eventually I landed on taurine as the solution and it’s been wonderful to get my solid sleep with no waking in the night!

I do eat a fair amount of fat – plenty of butter on my steamed veggies, olive oil, coconut oil, avocados, the fat from grass-fed meat, chicken skin, full fat cheese and eggs – and didn’t want to cut back.

So when taurine came to the rescue I was thrilled and still am!

I took 500mg before bed the first day and woke briefly twice but went right back to sleep. The second day I took 500mg taurine mid-morning, 500mg taurine mid-afternoon and 500mg before bed (all away from food). That night I woke briefly once and went right back to sleep. The third day I did the same and slept solidly through the night. My goal had been to increase to 3000mg per day but I’ll stick with 1500mg as long as this continues.

There were a few clues that indicated a need for liver-gallbladder support: the 3am waking is classic for liver issues; and my stool had become pale despite nothing else changing.

Impaired fat digestion leads to an increase in oxalate absorption

As mentioned above, when you have impaired fat digestion this can contribute to more severe oxalate issues because more oxalates are absorbed in the gut. This paper, Fat malabsorption induced by gastrointestinal lipase inhibitor leads to an increase in urinary oxalate excretion, summarizes the mechanism well:

Unabsorbed bile acids and fatty acids may react with calcium in the intestinal lumen, forming “soaps” that limit the amount of free calcium binding with oxalate, with a consequent increase in intestinal oxalate absorption leading to hyperoxaluria

In the above study, it’s orlistat (Xenical®), a gastrointestinal lipase inhibitor rather than environmental toxins and bile issues, that causes the increase in oxalates. I share it because it has a helpful explanation of the mechanism.

I share more about my issues with dietary oxalates here – Oxalate crystal disease, dietary oxalates and pain: the research & questions. My main issues in the past have been foot pain and eye pain, with downstream impacts on sleep. This blog has links to a number of other dietary oxalate blogs if this topic is new to you.

Bile production and detoxification

You may recall my wonderful interview with Ann Louise Gittleman on The Anxiety Summit 5: Gut-Brain Axis. The topic was: Why Bile is the Key to Anxiety & Hormone Havoc. I’ll add sleep to that too.

She covered the role of bile in PMS, estrogen imbalance and thyroid health; and importantly, how it’s involved in the removal of toxins from the body:

Bile is the dumping ground for hormones like estrogen. It’s the dumping ground for heavy metals that create anxiety like mercury, as well as too much aluminum and lead. And it’s the dumping ground, also, for a bunch of chemicals. So you got to keep the bile flowing. You have to keep it decongested. You have to thin it out.

She mentions simple tools to improve bile production: bitters (already part of my routine), lemon and water in the morning (also part of my daily routine), coffee (I can’t drink coffee as it makes me anxious), grapefruit and watercress. She also discusses key nutrients for bile production and quality: choline, inositol, methionine and taurine.

I could not find any lipotropic formula with choline, inositol, methionine (they all had rice flour). And I could not find any products that contained only lipase or ox bile.

While I was looking for something to improve my bile production, I did try a milk thistle extract (for overall liver support) and a liver-gallbladder herbal tincture but both made things worse. So I did some reading on taurine, found a nice taurine only 500mg product and haven’t looked back. Read on for some of the mechanisms.

Taurine and bile acid conjugation and detoxification

Metabolic actions of the amino acid taurine include: “bile acid conjugation, detoxification, membrane stabilization, osmoregulation, and modulation of cellular calcium levels.”

This paper, The Continuing Importance of Bile Acids in Liver and Intestinal Disease, explains the significance of bile acid conjugation with taurine:

After biosynthesis from cholesterol and before excretion from the hepatocyte, bile acid molecules are conjugated with glycine or taurine, which converts a weak acid to a strong acid. As a result, conjugated bile acids are fully ionized at the range of pH values present in the small intestine.

Taurine works on GABA receptors and is a GABA alternative

What is really interesting is that taurine works on GABA receptors and has a synergistic effect with GABA. I suspect this played a role for me too.

In this editorial, Taurine and GABA neurotransmitter receptors, a relationship with therapeutic potential?, the authors share the following::

“Taurine exerts its neuronal inhibitory effect through the activation of GABAA receptors (GABAAR) but with less affinity than the specific agonists of each receptor.
GABA and taurine act synergistically in extra-synaptic GABA receptors.
Some experiments suggest that taurine activates GABAB receptors with high affinity”

In countries where over-the-counter GABA is not available (like the UK, Australia and New Zealand), I will recommend taurine as an option. I don’t find it to be as effective as GABA but it is slightly calming.

You may need to course-correct from time to time

I share this story to illustrate that things can be going well in terms of sleep, pain, anxiety, depression and so on, and then something can happen and you have to course-correct.

I also often hear from folks in my community saying: “GABA and/or tryptophan was working perfectly to help me sleep and all of a sudden it’s no longer working. What is going on?” A situation like this shows how something else can change and it has nothing to do with the amino acids no longer working.

I do already use GABA, tryptophan (more on these below), melatonin and magnesium at bedtime and continued taking these supplements but I had to fix the root cause – the fat digestion issue.

I will add this: even if you don’t have dietary oxalate issues, this approach may be worth considering if you have no gallbladder, have fat digestion issues, are exposed to environmental toxins, have liver issues and wake in the night.

Resources if you are new to using amino acids as supplements

Have you experienced any adverse symptoms when exposed to environmental toxins? And has this made your oxalate issues worse or affected your fat digestion?

Have you used taurine with success? How much helps you?

Have other liver or gallbladder approaches also helped?

If you have questions please share them here too.

Read all posts in this series: