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Vulvodynia: oxalates, GABA, tryptophan and physical therapy

February 10, 2017 By Trudy Scott 39 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Has physical therapy with a pelvic floor specialist helped?

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

Have any other treatments helped you?

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

Please share questions or feedback below.

 

Filed Under: Amino Acids, Women's health Tagged With: anxiety, benzodiazepine, depression, GABA, gabapentin, oxalates, pain, physical therapy, SSRI, tryptophan, vulvodynia

Why I recommend GABA for anxiety instead of phenibut

November 25, 2016 By Trudy Scott 64 Comments

gaba-instead-of-phanibut

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • more about phenibut
  • gabapentin (which also has issues and withdrawal symptoms can to mimic some of the same withdrawal symptoms associated with benzodiazepine and alcohol withdrawal)
  • the blood-brain barrier GABA concerns that many people raise (and one of the reasons many practitioners say they like phenibut)
  • some possible mechanisms as to how GABA does work to ease anxiety and worry
  • good forms of GABA and how best to use GABA
  • how to do a GABA trial to find your ideal dose (you can find some of this information here and in my book The Antianxiety Food Solution)
  • feedback from people who have used GABA with success (you can also find some of that positive feedback here)
  • and what to use if you don’t have access to GABA supplements

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

Filed Under: GABA Tagged With: anxiety, depression, GABA, gabapentin, phenibut, post-traumatic stress, the anxiety summit

Vagus nerve rehab with GABA, breathing, humming, gargling and key nutrients

March 25, 2016 By Trudy Scott 202 Comments

vagus-nerve

I’ve got an issue going on with my vagus nerve at the moment and the throat spasms have been affecting my voice and ability to speak for any length of time. It’s also causing this persistent dry cough, despite not feeling sick or having any respiratory symptoms. It’s much worse later in the day and gets particularly bad after about 30 minutes of talking.

I’ve been working with the very talented PT/nutritionist Joe Tatta for the last week and I am seeing much improvement already. I’m also learning so much on vagus nerve rehab.

Joe is a Musculoskeletal Pain Expert and you may recall our wonderful interview on the last Anxiety Summit on pain and anxiety.

Let me give you some of the back story. Just over a week ago I posted this message in a private facebook group of integrative practitioners/colleagues:

I’d love some help for me please. I have this ongoing spasmodic dry cough that starts as soon as I talk and gets worse later in the day. As you can imagine it’s affecting my day to day meetings, seeing clients and doing interviews, not to mention being highly irritating!

I don’t feel sick at all and have no congestion. It started after my NYC trip and a really frightening flight over the Colorado mountains!

We had the most awful turbulence and it felt like wings on the plane were going to break. People were screaming and the parents behind us were reassuring their kids saying it’s ok, it’s just like a roller coaster ride. I was sitting next to a 6’4’’ young man who had just completed training in the Coast Guard. He was also terrified and said they had taught him how to survive a boat going down but not how to survive a plane going down.

I believe my immune system got suppressed big time! The day after I got home I got the flu for the first time in 30+ years and I felt pretty grim for a day and then recovered nicely over the next 4-5 days. The flu was over 10 days ago but this stupid cough continues!

One night I could not sleep due to the coughing and decided to try and relax my airways with GABA. I know how effective GABA is for stiff and tense muscles so why not try it for the throat spasms I was having? I am now able to have a reasonable conversation for say 15-30 mins if I take 500mg GABA opened on to my tongue. Viola! a new use for GABA – pretty cool!

I must be low in GABA because I’m able to take upwards of 5 (and sometime more) doses of 500mg a day and not feel too wiped out. That’s a lot of GABA for me – 125mg to 250mg used to be enough for the anxiety I once experienced! I did have a bit of my old early morning waking with anxiety (that I used to have in my late 30s) that week of the flu but that’s now gone.

I’m also using a homeopathic called Boiron Drosera. I’ve never had asthma and don’t have much experience with it but from what I’m reading it sounds like the“cough-variant” of asthma!?

I’m asking here because I’m intrigued by this whole scary flight/depressed immunity/GABA for the spasms thing and wonder if anyone here has any insights?

Joe Tatta responded in about 30 minutes with this message:

Sounds like you have a vagus nerve problem. Potentially loss of parasympathetics. You can read some in this article but there is much more…

Here is the article he shared: Arnold’s nerve cough reflex: evidence for chronic cough as a sensory vagal neuropathy

Arnold’s nerve ear-cough reflex is recognised to occur uncommonly in patients with chronic cough. In these patients, mechanical stimulation of the external auditory meatus can activate the auricular branch of the vagus nerve (Arnold’s nerve) and evoke reflex cough. This is an example of hypersensitivity of vagal afferent nerves, and there is now an increasing recognition that many cases of refractory or idiopathic cough may be due to a sensory neuropathy of the vagus nerve.

The paper presents two cases where the cough was successfully treated with gabapentin. Gabapentin (also known as Neurontin) affects GABA levels and this why I get such great results with GABA.

Gabapentin is drug that is primarily used to treat seizures and neuropathic pain. It is also used for restless leg syndrome and hot flashes, and off-label for anxiety, insomnia, fibromyalgia and bipolar disorder. I’d love to see GABA being studied and used for these conditions especially because gabapentin can cause withdrawal syndrome: Withdrawal symptoms after gabapentin discontinuation and an increased risk of suicidal thoughts.

Joe offered to meet with me via skype and I learned that the neuro-rehab is key. I’ve been doing breathing exercises and humming every hour on the hour for the last week i.e. about 10 times a day. When I hum it’s the “happy birthday” song and I have to think of a specific birthday. I hum and smile and think about my baby sister’s 7th birthday party 37 years ago. I had just come back from Australia and I have such great memories of it! We chatted about it at the weekend and had a good laugh.

I continue to use the GABA as needed, and am also taking GPC (GlyceroPhosphoCholine) and Acetyl-L-carnitine, both of which are acetylcholine precursors for nerve rehabilitation.

Because I’ve had so many questions about what is going on with me and what I’m doing, I have decided to start this blog post and I’ll continue to add to it. I’ve been documenting what has been happening as I go through this rehab because I’m finding it so fascinating.

Stay tuned for all the details:

  • More on the vagus nerve and why it’s so important
  • Why the very scary plane ride triggered this issue I’m having
  • How GABA works to stop the spasms in 5-10 seconds (I have a video to share)
  • Exactly what exercises I’m doing for the rehab and why you need to build up and not do gargling exercises on day one
  • More details about the nutrients: GPC and acetyl-l-carnitine
  • And an interview with Joe Tatta to share his expertise (I’m the patient/client here and am in learning mode)

I wouldn’t suggest trying any of this yourself until I share more because from what I’ve learned so far, you need to slowly built up to certain of the exercises.

Updates 4/1/16:

Here is the first video (taken 3/16/16) where I share the story of the scary plane ride and my flu and the start of the throat spasms.  You can hear how my voice sounds and how quickly 500mg GABA relaxes the spasms in my throat/neck.  I share what I learned from Joe Tatta about it being connected the vagus nerve. 

 

Here is the second video (also taken 3/16/16) where I demonstrate the 3-6-6 second breathing exercise and the happy birthday song humming exercise. I have to think of an actual birthday. I hum and think of my baby sister’s birthday (you can see those photos above).  Be warned, I am what I call “musically challenged!”

Here is the third video (taken late evening 3/16/16) where you can hear how bad my voice and throat gets later in the day.

 

Here is the video taken at Heavenly ski resort on 3/27/16.  You can see me doing my humming exercises in between skiing on this beautiful mountain and how I needed GABA after a strenuous ski run.  And I summarize what has been working for me so far.  I hope you enjoy the stunning scenery too!  I feel so fortunate that we can hop in the car and visit such an amazing place like this on the weekend! It’s about 90 minutes up the hill from where we live.  

 

And here is the final video in this series (taken yesterday 3/31/16). I demonstrate the exercises I am currently doing: 3-6-6 second breathing, humming (which has improved), the yawning and the tongue massage of the roof of my mouth.  I also talk about GPC and acetyl-l-carnitine. 

 

You can probably see and hear that I am much improved and have not needed much GABA for the last two days now.  In the last week I have interviewed Dr. Josh Axe for his “Eat Dirt” book and Dr. Kelly Brogan for her “A Mind of Your Own” book.  And Dr. David Brady has interviewed me for his June Fibrofix Summit and Dr. Eric Zielinski interviewed me for his August Essential Oils 2 Summit.  For each interview I did my exercises right beforehand and took 500mg GABA half way through the interview.  

GABA for vagus nerve
I had 2 x 500mg GABA on hand for my interviews – opened and ready to use!

Update: 4/8/16

I continue to improve and have not needed GABA for 4 days and only have a very mild hint of the throat feeling late evening.  

Two days ago I added an essential oil called Parasympathetic. It contains clove and lemon and I’ll share more in a future post.  Right now I can share that I used too much the first day and had the very dry mouth I experienced with too much GPC and acetyl-l-carnitine.

Update: 4/22/16

A quick update to let you know that my dry spasmodic cough has completely gone.  I  have not had any symptoms for a week and I have stopped the vagus nerve rehab exercises, GPC,  acetyl-l-carnitine, the essential oil called Parasympathetic and GABA.  

I so appreciate all the caring and concerned comments, feedback and ideas for me!  And boy, am I grateful for Joe and his expertise!

I will still be interviewing Joe so he can share the theory and address questions so please post questions you may have. 

If any of this resonates with you or if you have any other questions I’d love to hear back from you.

Please post them in the comments section below.

 

Filed Under: GABA Tagged With: anxious, breathing, GABA, gabapentin, humming, Joe Tatta, scary, spasms, vagus nerve, voice

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