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The individual amino acids glutamine, GABA, tryptophan (or 5-HTP), DPA and tyrosine are powerful for eliminating sugar cravings, often within 5 minutes

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The individual amino acids glutamine, GABA, tryptophan (or 5-HTP), DPA and tyrosine are powerful for eliminating sugar cravings, often within 5 minutes. It seems that this wonderful benefit – over and above the anxiety-reducing and mood-boosting benefits – is often overlooked or poorly understood.

I recently posted this on Facebook: GABA for ending sugar cravings (and anxiety and insomnia) and I’m writing this blog today because it’s clear there is some confusion about this cravings aspect.

Let me first recap Melissa’s experience with Source Naturals GABA Calm during her family holiday trip (the link above has all the details):

I’m glad I bought it before travelling home for Christmas – I was cool as a cucumber at the airport and was much calmer when visiting family and friends compared to last year! I notice a general calmness and am sleeping well.

As well as the calming benefits of GABA, Melissa found this unexpected reduction in cravings for sweets, chocolates, truffles and ice cream after about a week of taking it:

I didn’t even realize this until I was grocery shopping and out of habit walked towards the ice cream – I stopped and realized I didn’t want ice cream. So I walked toward the chocolate – same reaction. For once in my life, I was not craving sweets. I made truffles for a NYE party and only ate two. But what is really shocking is that the leftovers are still in my refrigerator two days later and I haven’t touched them.

This is a very typical response that I see with my clients and when I shared the above blog, others on Facebook shared similar experiences and surprise about the connections. Kim found it fascinating and very timely saying:

I ran out of GABA a month ago. Not only has my anxiety been very difficult to manage but literally I haven’t been able to stop eating. Sugary, high carb, total junk has consumed my thoughts. I never realized the correlation.

April also seemed surprised to learn that GABA was also actually helping with her sugar cravings too:

I think my sugar cravings are down (not looking for something sweet every night after dinner, maybe I treat myself to once a week and not overindulge when I do) and when I think about it, I’ve lost a bit of weight as a result. Most of all it helps me sleep and reduces tension in my neck.

In the above examples, due to low GABA levels in these women, GABA was helped with both the anxiety and the stress-eating, leading to a calming effect and reduced sugar cravings. If you have low blood sugar cravings then glutamine is the amino acid to use; low serotonin cravings then tryptophan or 5-HTP will help; low endorphin cravings then DPA will do the trick; and low catecholamines then tyrosine is the amino acid to use.

The best way to figure it which neurotransmitter deficiency is affecting your sugar cravings is to do the amino acid mood questionnaire and also review this list for further clarification:

  1. If you have to eat sugar when you haven’t eaten in awhile it’s likely low blood sugar and glutamine on the tongue stops the sugar desire almost immediately and also helps with the low blood sugar symptoms of shakiness and irritability
  2. If you stress-eat your sugar cravings are likely due to low GABA, and GABA will stop the stress-eating and calm you down
  3. If you eat sugar or carbs to feel happy (and especially from late afternoon into the evening) then your sugar cravings are likely due to low serotonin, and tryptophan (or 5-HTP) stops the cravings and boosts mood and reduces anxiety
  4. If you are a comfort-eater then it’s likely due to low endorphins and DPA will stop that feeling of “I deserve-it” kind of reward-eating or comfort-eating and also give you a hug-like mood boost
  5. If you eat sugar for an energy boost or to give your focus then it’s likely due to low catecholamines and tyrosine will stop those cravings and give you a mood and energy boost, and help with mental clarity

It’s not uncommon for my anxious clients to have issues in all these areas and I have them address low blood sugar and each neurotransmitter deficiency one by one (for 2 through 5) and very methodically so they know exactly which areas are problematic for them.

When it comes to low blood sugar, addressing adrenal health is also key. And as always, we need to be making dietary changes, fixing gut health, addressing other deficiencies, removing toxins and more, using a complete functional medicine approach.

However, using the amino acids in a targeted way like this gets you results quickly while you’re figuring out everything else.

You may say “what exactly do you mean by quickly”?   When opened onto the tongue and used with the trial method, based on your unique needs, if you have low levels, you can expect to notice effects in as quickly as 5 minutes and sometimes up to 15 minutes in some cases! This is why I like to refer to them as the amazing amino acids! They truly are amazing for eliminating cravings, reducing anxiety and improving mood and even sleep – provided they are needed.

Last year I wrote a series of blog posts on each of the above-mentioned amino acids. If you missed them you may find them helpful for getting a better understanding, even though they are not specific about sugar cravings:

Have you found any of the amino acids to help you eliminate your cravings for sweets, chocolate, ice-cream and other high-carb foods? Were you pleasantly surprised to experience this lovely benefit when you were initially looking for anxiety-relief?

If you’re a practitioner, do you see similar cravings benefits with your anxious clients/patients?

Feel free to ask your questions and share challenges you’ve had too.

More kids are showing up in ERs with anxiety, depression and other common mental health problems: why isn’t nutritional psychiatry part of the discussion?

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This article on NBC news, More kids are showing up in ERs (Emergency Rooms) with mental health crises, reports large increases across the country.

Dr. Anna Abrams, a pediatrician and researcher at Children’s National Medical Center in Washington, finds the numbers both shocking and disheartening.

In the 5-year period from 2012 to 2016, when looking at ER mental health admissions in 45 children’s hospitals, they found the following increases:

  • 48 % in white children
  • 64% in non-Hispanic black children
  • 77% increase in Hispanic children

with about a 55 % increase overall.

Dr. Abrams and her colleagues presented these findings at the American Academy of Pediatrics conference in earlier this month.

Other than the very large increases, there is something else to be concerned about: the researchers say they aren’t sure why we are seeing these increases, speculating it “could be due to the scarcity of mental health professionals who can help children” and “People are also talking more openly about depression, anxiety and other common mental health problems and that may make parents feel more comfortable about seeking help for their children.”

While these are very valid reasons, we really do need to be incorporating nutritional psychiatry (a term coined in 2015) and functional medicine (Dr. Mark Hyman is one of the leaders in functional medicine) into these discussions, studies and conferences. Other than poor diets and nutritional deficiencies we need to be considering stress, exposure to toxins, poor gut health and increasing Wifi exposure, to name a few.

If we look at diet alone, there is so much recent research supporting the connection between diet and mental health. Here are two of many new studies:

Despite some contradictory results, overall there was support for an association between healthy dietary patterns or consumption of a high-quality diet and lower levels of depression or better mental health. Similarly, there was a relationship between unhealthy diet and consumption of low-quality diet and depression or poor mental health.

These data suggest that Iranian adolescent females eating a pro-inflammatory diet…had greater odds of having at least moderate depressive symptoms.

And here are just a few other factors to consider:

How do we get this nutritional psychiatry research and case studies into the hands of those who can change actually policy and the way mental health is addressed? I believe it has to be a grass-roots effort from the bottom up and I have these suggestions:

  • share this blog and the research with your doctor and/or allied health practitioner
  • reach out to study authors, journalists and legislators and share research and success stories like the above, and your own personal results
  • if you’re a practitioner, write blogs like this sharing the good results you see with your clients and patients – with researchers, journalists and legislators
  • share in forums and on social media, and with your neighbors, friends and family
  • comment on blogs like this – with success stories in your family or with clients – so more people get to see what really is working

Every little bit helps! I’d love to hear your ideas too.

Nutritional and Dietary Intervention for Autism Spectrum Disorder – a new study

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The research confirms how effective nutritional psychiatry is for anxiety and depression (the SMILEs diet depression trial) so when a 12 month randomized trial reports the benefits of nutrition for autism spectrum disorder (ASD) we celebrate this too. Many of the same mechanisms that contribute to anxiety, can also play a role when it comes to ASD – such as food sensitivities, poor gut health, heavy metals, fatty acid imbalances and so on. Also, many children with ASD experience anxiety – 34 to 47% depending on whether you ask a parent of a teacher. Many adults with autism and Asperger’s syndrome also experience anxiety and overwhelm too. In one study 50% of adults with ASD experienced social anxiety.

This paper was published in March this year: Comprehensive Nutritional and Dietary Intervention for Autism Spectrum Disorder-A Randomized, Controlled 12-Month Trial and was

a randomized, controlled, single-blind 12-month treatment study of a comprehensive nutritional and dietary intervention.

Treatment began with a special vitamin/mineral supplement, and additional treatments were added sequentially, including essential fatty acids, Epsom salt baths, carnitine, digestive enzymes, and a healthy gluten-free, casein-free, soy-free (HGCSF) diet.

Here is the year-long protocol for the study participants:

Day 0: Vitamin/Mineral supplementation begins.
Day 30: Essential Fatty Acid supplementation begins.
Day 60: Epsom salt baths begin.
Day 90: Carnitine Supplementation begins.
Day 180: Digestive Enzyme supplementation begins.
Day 210: Healthy, casein-free, gluten-free diet begins.
Day 365: Final assessment of autism severity and overall functioning status. Final blood draw and urine collection.

And these are the guidelines for the dietary changes for the study participants:

  1. Adequate intake of a variety of vegetables (including leafy greens) and fruit (preferably whole fruit).
  2. Adequate protein quality and intake.
  3. Adequate, but not excessive, caloric intake.
  4. Minimal consumption of “junk” foods and replacement with healthy snacks.
  5. Healthy, gluten-free, casein-free, and soy-free (HGCSF).
  6. Avoidance of artificial flavors, colors, and preservatives.

Parents of participants reported that the vitamin/mineral supplements, essential fatty acids, and HGCSF diet were the most beneficial. And when asked at the end of the study which treatments they planned to continue at the conclusion of the study, over 85% of parents said the vitamin/mineral supplement and the essential fatty acids were the most likely to be continued, 70% planned to continue the Epsom salt baths, 63% planned to continue the healthy HGCSF diet, and 44% planned to continue using the carnitine and digestive enzymes.

I’m really pleased that they mentioned the following limitation because we really do need to address the nutritional needs of each person:

all participants received all treatments, whereas probably only a subset are likely to benefit from any single intervention (for example, only participants with low carnitine are likely to benefit from carnitine supplementation)…. future studies could try to determine which treatments were most beneficial, using the results of this study to guide those future studies.

Despite the above study limitation, the treatment group saw the following improvements:

  • Improved nonverbal intellectual ability
  • Significantly greater improvement in autismsymptoms and developmental age
  • Significantly greater increases in EPA, DHA, carnitine, and vitamins A, B2, B5, B6, B12, folic acid, and coenzyme Q10

Many of the study participants saw improved communication skills as well as improved daily living skills and social skills – all of which can lead to reduced anxiety and social anxiety, and improved overall happiness.

The authors do mention that the combination of all of the above treatments is feasible for most families and that there were minimal adverse effects. They conclude that:

The positive results of this study suggest that a comprehensive nutritional and dietary intervention is effective at improving nutritional status, non-verbal IQ, autism symptoms, and other symptoms in most individuals with ASD [both children and adults].

Julie Matthews, one of the nutritionists supporting the study

My good friend and colleague, Julie Matthews, was one of the nutritionists supporting the study and is one of the co-authors on the paper. I’m so proud of her contribution to this research which further supports prior studies and the work she does clinically.

Julie is the author of Nourishing Hope for Autism: Nutrition and Diet Guide for Healing Our Children and the founder of the Bioindividual Nutrition Institute. She is hosting the Nourishing Hope for Autism Summit running July 30 to August 30 and she interviews lead researcher, James Adams, PhD, Director of the Autism/Asperger’s Research Program at Arizona State University. The interview is titled “The Scientific Evidence Linking Nutrition and Autism Improvement” so be sure to tune in if you’d like more information on this study and other dietary and nutritional interventions for ASD. (You can register here).

 

Shamus diagnosed with moderate to severe autism at age 2

Julie shares Shamus’ success story on her Nourishing Hope blog. He was diagnosed with moderate to severe autism at age 2.

When they began him on nutritional and biomedical protocols, his parents had no expectation of improved speech or ever “mainstreaming” their son. They just wanted him to sleep so they could cope with him being autistic.

Within 3 days of starting a gluten and casein-free (GFCF) diet his projectile vomiting stopped and his meltdowns reduced from 20 per day to just 3. The next step was the GAPS diet (Gut and Psychology Syndrome) which included broths and fermented foods, and did lead to worsening symptoms for a short time. Later on overgrowth of the harmful bacteria Clostridium difficile was addressed and other biomedical/nutritional interventions were included.

Today at age 10, Shamus shows no signs of autism and has been classified as “fully recovered!” He’s in a mainstream classroom at school, his teachers love him and he has a great group of friends. Shamus is great at team sports, and exhibits no problems in the classroom whatsoever.

I’m horrified that the doctor told this mom that she was over-anxious, had post-natal depression and needed to take an antidepressant (but that’s another entire blog post).

 

Both children and adults benefit from dietary changes

I find it very encouraging that the study participants were both children and adults with autism spectrum disorder and their ages ranged from 3 years to 58 years. Julie shares this inspiring and hopeful comment in the press release:

The study also shows that no matter the age of the individual with autism, diet and nutrition intervention can help. It’s never too late to be nourishing hope!

I agree, it’s never too late to make changes. This wonderful success story about an older gentleman with autism is just one example. Carolyn Gammicchia, mom/wife/autism advocate/ disability activist, shared the following on Facebook shortly after the study was published:

I have spoken to many people across the country who implemented this in older individuals, one man was 51 from TX who had been institutionalized and had not spoken. He was in very poor health when a wonderful lady took him in and somehow got my number and called me. She had seen a presentation I had done about five years ago about this and she weaned him off multiple medications, cleaned up his diet (went GFCFSF i.e. gluten-free, casein-free and soy-free) and supplemented with vitamins and minerals, plus exercise. He started speaking, lost 50 lbs, and is able to work now. It works!

Diet reduces anxiety and depression and helps with bipolar and schizoaffective disorder too

I mentioned nutritional psychiatry at the start so here are a few blog posts that highlight how diet reduces anxiety and depression and helps with bipolar and schizoaffective disorder too.

Going back to the study limitation – what this all means is finding the right combination of dietary and nutritional interventions for each person. There is no one-size fits all and bioindividualized nutrition is key – for ASD, anxiety, depression and any other condition.

We’d love to hear what dietary interventions you’ve used with success with a loved one with autism or Asperger’s syndrome.  Have these changes also reduced anxiety and improved other mood symptoms?

If you’re a practitioner, feel free to share a success story about one of your clients/patients with ASD.

Do also share some tips that you have found make this dietary transition easier and some challenges you have faced. Feel free to post your questions too.

Ketogenic diet: reductions in auditory hallucinations and delusions, better mood and energy, and weight loss

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Two schizoaffective patients of Dr. Chris Palmer, a psychiatrist from Harvard’s McLean Hospital in Belmont, Massachusetts, tried a ketogenic diet for weight loss. As well as losing weight, they experienced reductions in auditory hallucinations and delusions, had a better mood and had more energy.

Here is additional information about these remarkable results, published late last year in this letter to the editor – Ketogenic diet in the treatment of schizoaffective disorder: Two case studies.

The male patient: lost weight, reductions in auditory hallucinations and delusions, better mood and energy

The male patient, diagnosed with schizoaffective disorder, with a prior psychiatric history of attention deficit hyperactivity disorder and major depression, experienced “dramatic” reductions in auditory hallucinations and delusions, as well as better mood and energy on the ketogenic diet. He also lost weight, losing 104 pounds over the course of a year.

He weighed 322 lb and wanted to lose weight by following a ketogenic diet, typically consisting of coffee with medium chain triglyceride (MCT) oil and butter (“bulletproof coffee”), eggs, meat, fish, poultry, spinach, kale, and olive oil. Within 3 weeks, he had lost 15 lb, but also noted a dramatic reduction in his auditory hallucinations and delusions, and improvement in his mood, energy, and ability to concentrate. For the past year, he has largely remained on this ketogenic diet and has lost 104 lb.

His functioning has improved and he has become more independent:

He completed a certification course, successfully participates in an online college program, has friends, began dating, and moved from his father’s home into an independent apartment.

The female patient: lost weight, resolution of her delusions

After four weeks on the ketogenic diet, the female patient, also diagnosed with schizoaffective disorder, and with a prior psychiatric history of major depression and anorexia nervosa, had resolution of her delusions and lost ten pounds:

she wanted to lose weight, and went on a ketogenic diet, consisting mostly of coffee, eggs, poultry, and lettuce. Within 4 weeks, she lost 10 lb and noted that her delusions were no longer present, and that her mood and energy were much better. After 4 months, she lost a total of 30 lb and her PANSS score decreased to 70 [down from 107]

In both instances their symptoms returned when they stopped the diet, but then improved again when back on the ketogenic diet.

In case you’re not familiar with the ketogenic diet here is a quick summary:

The ketogenic diet is a high-fat / low carbohydrate [and low protein] diet that has been used since the 1920’s to treat childhood epilepsy, with some studies suggesting that over 50% of patients experience significant reductions in seizure frequency. The ketogenic diet results in ketone bodies, instead of glucose, being used as the primary energy source in the brain.

There simply is no psychiatric medication available with the power to accomplish these results

I had the pleasure of meeting Dr. Georgia Ede, MD  last year at the ISNPR conference. She is a Harvard-trained psychiatrist and nutrition consultant practicing at Smith College, and writes about these two schizoaffective cases in her article – Low-Carbohydrate Diet Superior to Antipsychotic Medications:

These outcomes are truly remarkable: improvement by dozens of points on the PANSS, significant weight loss, and better quality of life. There simply is no psychiatric medication available with the power to accomplish these results.

I agree with Dr. Ede especially when we look at the medications these patients had trialed. These medication trials for the male patient: methylphenidate, amphetamine salts, dextroamphetamine, bupropion, sertraline, paroxetine, buspirone, lamotrigine, lorazepam, clonazepam, gabapentin, haloperidol, perphenazine, aripiprazole, olanzapine, quetiapine, and clozapine. The female patient had a similarly long list of medication trials and she also received 23 electroconvulsive therapy treatments. For both of them, positive and negative symptoms persisted.

I do still have questions about the ketogenic diet

The research in epilepsy is extensive and the research in mental health is growing. I am really impressed with the results, but I do still have questions about the ketogenic diet. Perhaps you have some similar questions and concerns. Here goes…

  1. If this particular nutritional psychiatry approach works so well for severe mental health disorders such as schizophrenia and psychosis, how will it work for less severe conditions like anxiety and panic attacks? Are these severe cases like the “canaries in the coal-mine” paving the way and teaching us about the benefits of this way of eating?
  2. Should you use a ketogenic dietary approach as the first approach or consider it as a last resort once the other dietary approaches have been implemented and you’re not seeing full symptom resolution? In other words, should you start with a real whole foods diet, then implement a gluten-free diet, then a grain-free diet, then remove dairy (if it’s an issue), then incorporate low FODMAPs if needed and only then implement a ketogenic diet? (low oxalate, low salicylate and low histamine would be incorporated as needed earlier in the process, based on each person’s unique needs).  If we look only at schizoaffective disorder,  there is growing evidence of the role of gluten  in some individuals with this paper “suggesting that an antigliadin IgG positive population of schizophrenia could be a distinct subgroup.” This 2 person pilot study reports the benefits of a gluten-free diet: “this potential mechanism is exciting and may provide improvement for up to one-fourth of patients (antibody-positive) who suffer from this devastating disorder.”
  3. How do we clearly define a ketogenic diet and communicate this definition to practitioners and to those who choose to implement this way of eating on their own? I’ve had feedback from many people who tell me they have been on a ketogenic diet (and it’s worked well for them or maybe it hasn’t worked so well for them), only to discover they are not really eating a true ketogenic diet. How do we simplify this way of eating and make it easy for individuals to understand and then stay in ketosis?
  4. How do we create a ketogenic diet that is nutrient dense and also offers the benefits seen in this research. I have major concerns about long-term nutritional deficiencies with a diet of coffee, eggs, poultry, and lettuce (as eaten by the female patient in this case study). It should ideally include plenty of leafy greens, non-starchy vegetables like broccoli, cauliflower, asparagus etc. and healthy fats like avocado, grass-fed butter and coconut oil, together with fermented vegetables and bone broths. I’m also not convinced that coffee should be part of the ketogenic diet, especially if coffee increases your anxiety and affects your sleep.

  1. How do we help individuals make the switch to this way of low carb eating and help them maintain so they don’t feel deprived and are not relying on willpower alone? As you can see from these 2 cases, the diet can be challenging to sustain and slip ups are common. If you are eating enough health fats (and it’s a lot more than you’re used to eating), this typically helps with cravings. If you still have cravings and feel you are deprived and missing out on treats, the targeted individual amino acids offer powerful results: tryptophan (for afternoon cravings), GABA (for stress eating), DPA (for comfort eating), tyrosine (when there is low motivation) and glutamine (for low blood sugar cravings).
  2. Is the ketogenic diet the next big fad or weight-loss trend as we’re hearing in the media? Based on the above research it truly does have impressive therapeutic benefits beyond only weight-loss. So can we see similar benefits with a modified ketogenic diet, using intermittent fasting and/or cycling in and out of ketosis, and even adding in a ‘feasting day’ of carbs?
  3. Who shouldn’t adopt a ketogenic diet? For example: those with the APOE4 gene, women with adrenal and hormone issues, and individuals with thyroid issues and no gallbladder? The question then becomes this: of those suffering with anxiety and depression or another mental health disorder, who doesn’t have one of these issues? And how do we address the keto rash, constipation, fat malabsorption, fatigue, mineral deficiencies and other issues some people experience on a ketogenic diet?

Right now, this is my thinking: as with any nutritional or functional medicine approach, I would say there is no one-size-fits all for who should implement a ketogenic diet (we need to consider the unique biochemistry of each person) and there is no one set ketogenic diet (it will need to be customized for each person).

I’m hoping to get answers to many of these questions on the upcoming Keto Edge Summit (May 7-13, 2018), hosted by ketogenic diet expert, Dr. David Jockers. If you have similar questions, be sure to tune in too.  I’m going to reach out to Dr. Jockers for an interview too.

I’m also hoping to do my own interview with Dr. Palmer to discuss his interest in the ketogenic diet for mental health, to learn more about these cases and other patients he’s seen success with. Feel free to post your questions for Dr. Palmer (and Dr. Jockers) here and I’ll be sure to get them addressed.  We certainly appreciate Dr. Palmer for sharing these results so we can all learn, and also appreciate his patients for being willing to share their stories.

Please do share if you’ve adopted a ketogenic diet and the benefits you have experienced, and if you experienced any issues. Be sure to share what a typical day’s diet looks like for you.

World Benzodiazepine Awareness Day 2017: Awareness and Anxiety Nutrition Solutions

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World Benzodiazepine Awareness Day 2017 was celebrated earlier this week on July 11th. The organization recommends that everyone should watch and share this short informative video: The risks of taking benzodiazepines (Klonopin, Xanax, Ativan) as prescribed. It could save your life or the life of someone you know.

This is what W-BAD shares about benzodiazepines and Z-drugs that are used as prescribed:

Benzodiazepines (Xanax, Klonopin, Ativan, Valium, Librium, and others) as well as Z-drugs (Ambien, Lunesta and others), which are similar, have the most debilitating withdrawal reactions in all of medicine.

This happens in regular, everyday people who are taking the medications exactly as their doctor prescribed. It also happens to people on what they think are “low doses” and is not just a “high dose” problem. This happens because the prescribing guidelines for this class of drug recommend short-term use only (less than 2-4 weeks), yet doctors are prescribing them for much longer. Even worse, these unsuspecting patients are given no warning (or informed consent) by their doctor about these risks and dangers before taking the prescription past the recommended timeline. The patients think the drugs are “safe” because they are prescribed when they are actually quite dangerous medications that are capable of inflicting sometimes severe and life-threatening withdrawal syndromes which are known, for some people, to persist for many years.

W-BAD shares these stats about how common it is to see physical dependence, adverse effects, and withdrawal:

Experts and studies estimate that as many as 60% of people taking benzodiazepines for more than the recommended 2-4 week time period will develop physical dependence, adverse effects, and withdrawal

60% is actually a conservative percentage, as some other sources indicate that “50-80% of people regularly taking benzodiazepines (even in ‘low dose’) for longer than a few months will develop a physical tolerance to the drug and become dependent, resulting in difficulty stopping benzodiazepines because of withdrawal symptoms”.

30% of long-term users will experience severe withdrawal or adverse effects which may include seizures, hallucinations, psychosis, akathisia, and sometimes suicide or death (people are especially at risk for severe withdrawal if they over-rapidly taper or cold-turkey their benzodiazepine/Z-drug).

The tapers to discontinue these medications, once you’ve taken them past 2-4 weeks and depending on dose, can last many months or years. I see this all the time in my practice.

About 10-15% of people who withdraw will develop a protracted withdrawal syndrome which can potentially persist for many years (there are anecdotal reports of it persisting up to five, seven, and even ten years post-cessation.). Others, even after a slow, gradual reduction of the benzodiazepine or Z-drug will experience withdrawal that lasts for up to 18 months post-cessation.

Physical dependence is a physical condition, a state of adaptation in the body caused by chronic use of a tolerance forming drug, in which abrupt or gradual drug withdrawal causes withdrawal.

When someone becomes physically dependent to benzodiazepines (or Z-drugs), they are also at risk for developing tolerance. With benzodiazepines/Z-drugs, specifically, when the receptors in the brain become adapted or accustomed to the action of the original dose of BZ, more of the drug is needed in order for the desired therapeutic effect (or the original effect at the original dose) to be achieved. This means that the drug loses its effectiveness and the person taking it can begin to experience withdrawal symptoms while still taking the prescribed dose of the drug.

It’s very unfortunate that some of the very same symptoms that are trying to be addressed by these medications are now amplified or seen for the first time:

Some common symptoms of tolerance include increasing anxiety, panic attacks, development of agoraphobia for the first time, interdose withdrawal (withdrawal symptoms emerging in between doses), as well as a plethora of other physical/neurological/psychological symptoms.

Visit the website World Benzodiazepine Awareness Day to learn more and to get involved:

By spreading the word about taken-as-prescribed benzodiazepine risks, harms, and dangers, W-BAD (World Benzodiazepine Awareness Day) hopes to bring awareness to the general public and the medical community about this problem before more people are needlessly harmed. Please help share this video with everyone you know and, together, we can prevent more victims of iatrogenic (caused by medicine) dependence, withdrawal, and injury from prescribed benzodiazepines and Z-drugs.

There are some heartbreaking stories on the Facebook page (an excellent resource) :

W-BAD acknowledges Professor Malcolm H. Lader for guiding them in providing information that appears throughout the website and in handout materials. Prof. Lader first described benzodiazepine withdrawal syndrome as a potential brain injury in the scientific literature, and also campaigned around the world to get everyone from politicians to royalty to listen.

Here is some guidance with slow tapering protocols from W-BAD (and never stop cold-turkey).

For additional resources this is the blog post I published last year: World Benzodiazepine Awareness Day – say NO to Benzodiazepines for anxiety!

Awareness and nutrition solutions

I do love that this awareness is being created. It is so needed for those who are prescribed these medications and currently taking them, for anyone who may consider a future prescription, and for everyone in the medical profession, as well as all integrative and functional medicine practitioners and nutritionists.

All this awareness creates the perfect opportunity to offers nutrition solutions too, so we can address:

  • the initial root cause/s of your anxiety which led to your prescription of this medication to start with
  • the anxiety you now experience even through you were prescribed these medications for something else (such as pain)
  • your current biochemistry and nutritional status to facilitate an easier taper from the benzodiazepine with the least withdrawal effects
  • your current biochemistry and nutritional status so you don’t get anxiety in the future, once you have completed the taper

And if you are considering a benzodiazepine prescription in the future you are now informed about the dangers and have nutritional resources too.

When I am working with someone who has been prescribed a benzodiazepine, I get them nutritionally stable BEFORE they even consider a benzodiazepine taper.

I use amino acids like GABA and tryptophan, melatonin and niacinamide to make the taper easier and so we can balance brain chemistry before tapering and then during the taper (all under the supervision of the prescribing doctor and using the Ashton taper protocol).

Dr. Jonathan Prousky, talks about his success with benzodiazepine tapers on a prior Anxiety Summit interview – using melatonin, niacinamide, Neurapas Balance, rhodiola and GABA.

There is also a big focus on diet (real food/often a Paleo diet, no additives, organic, healthy fats, no gluten, no sugar, no caffeine, quality grass-fed/wild protein), addressing high cortisol if needed, addressing low zinc, low iron, low vitamin B6, low B12 and looking at gut health. Lifestyle and stress reduction is important and we look at and address all possible 60+ underlying factors/causes.

This is all covered in detail in my book “The Antianxiety Food Solution” (on amazon here) The basics plus advanced topics (like fluoroquinolone antibiotic issues when on benzodiazepines and more) are also addressed on the Anxiety Summits.

I feel very strongly about providing this nutritional support and sharing how helpful it is because organizations like W-BAD and Benzobuddies.org (as much as love them) advocate for no nutrient support suggesting it won’t help or could make symptoms worse. I will admit that some people who are tapering are very sensitive and in these situations very very tiny amounts (as small as a pinch in some instances) of some of the nutrients may be a better option, always only doing one thing at a time to make sure it’s helping and not making symptoms worse, and doing functional medicine tests. Using essential oils, light therapy, gentle detox, Heartmath and yoga are wonderful to start with, in conjunction with all the diet changes.

Please share your benzodiazepine story and what has helped you taper more easily and recover.

If you’re a practitioner please share what approaches you have used to help your clients or patients taper more easily.

SMILES diet depression trial: reduced depression and anxiety

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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.