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Could a daily moisturizer help to lower markers of inflammation and reduce anxiety, panic, PTSD, phobias and social anxiety?

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Could using a good quality moisturizer on a daily basis help to lower markers of inflammation (proinflammatory markers) and actually help reduce anxiety, panic, PTSD, phobias, social anxiety and other mental health symptoms, plus other chronic health conditions at the same time? Based on a new pilot study, I’m going out on a limb and saying this may well pan out to be true. And there is certainly no harm in making this a daily self-care routine until further research confirms this, certainly because of the other benefits of using a moisturizer.

New study: a skin moisturizer reduces markers of inflammation

Let’s take a look at this new study which reports how using a skin moisturizer actually reduces markers of inflammation in the body: Topical Applications of an Emollient Reduce Circulating Pro-Inflammatory Cytokine Levels in Chronically Aged Humans: A Pilot Clinical Study

Emollients are moisturizers that help keep the skin moist and supple by reducing water loss from the epidermis, the outer layer of the skin.

The study set out to mirror an animal study where skin problems in older/aged mice was tied to elevated markers of inflammation called cytokines. When epidermal function/skin health in the mice was improved, the circulating cytokine levels were reduced:

Thirty‐three aged humans were treated twice‐daily for 30 days, with ≈3 ml of an emollient, previously shown to improve epidermal [i.e. skin] function

Changes in epidermal function and levels of three key, age‐related, plasma cytokines (IL‐1β, IL‐6 and TNFα) were measured at baseline and after treatment.

Circulating levels of proinflammatory cytokines in the body, IL‐1β, IL‐6 and TNFα, were higher in the older adults before the use of the emollient. After topical use, i.e, using the cream on their skin twice a day for 30 days:

circulating levels of IL‐1β and IL‐6 normalized, while TNFα levels declined substantially.

The authors suggest larger clinical trials to confirm this connection between high levels of proinflammatory cytokines and chronic inflammatory disorders and to show how improving skin health by moisturizing may prevent chronic inflammatory disorders such as heart disease, type II diabetes, osteoporosis and Alzheimer’s disease in older adults.

The University of California explains the mechanism:

Our skin starts to deteriorate around age 50 with changes to epidermal pH, hydration, and the permeability barrier, which keeps water in and bacteria and other potential pathogens out. A loss of moisture and breaks in the permeability barrier cause the skin to release inflammatory cytokines. Ordinarily, these cytokines help to repair defects in the barrier, but in aging skin the barrier can’t be fixed as easily, so the inflammatory signals continue to be released, eventually reaching the blood.

This article and the study authors are suggesting this is an issue to be addressed with older adults and with respect to the above chronic diseases, but there is enough research on the role of inflammation on anxiety and other mental health conditions at any age, that this study had me perk up and take notice. Also, if you’re young and not moisturizing or living in a dry climate or have other factors contributing to inflammation (more on that below), could this be happening too? I believe it’s highly likely.

The role of inflammation on anxiety and other mental health conditions

Here is one of the many anxiety-inflammation studies: Inflammation in Fear- and Anxiety-Based Disorders: PTSD, GAD, and Beyond, reporting that:

heightened concentrations of inflammatory signals, including cytokines and C-reactive protein, have been described in posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic disorder (PD), and phobias (agoraphobia, social phobia), etc.

And concludes that:

targeting inflammation may serve as a potential therapeutic target for treating these fear- and anxiety-based disorders in the future

Inflammation plays a role in depression too. This paper, Role of Inflammation in Depression and Treatment Implications reports that:

Numerous studies (including meta-analyses) have found elevated peripheral and central inflammatory cytokines and acute phase proteins in depression.

The ongoing inflammation affects neurotransmitters and makes antidepressants less effective:

Chronic exposure to increased inflammation is thought to drive changes in neurotransmitters and neurocircuits that lead to depressive symptoms and that may also interfere with or circumvent the efficacy of antidepressants.

Many approaches for reducing cytokines and inflammation

I do want to address the one statement in the emollient study where they say that “approaches that reduce circulating cytokines are not yet available.” There are, in fact, many approaches for reducing cytokines and inflammation.

In one study vitamin D supplementation improved mood, reduced anxiety and lowered markers of inflammation (CRP and IL-10) in female diabetics who had low levels of vitamin D.

In another study looking at anxiety in women with PCOS (polycystic ovary syndrome), probiotics and selenium improved their mental health and hormonal profiles, lowered markers of inflammation and reduced oxidative stress.

This paper lists a number of underling root causes that cause systemic inflammation and depression: psychosocial or life stressors, poor diet, physical inactivity, obesity, smoking, altered gut permeability (i.e. leaky gut), atopy (a genetic tendency to allergies – this could include gluten sensitivity), poor dental health, sleep issues and vitamin D deficiency.

Of course, these factors may also play a role in anxiety and using a functional medicine and nutritional approach, you can reduce the inflammation and eliminate the anxiety/depression. It’s a matter of finding your root cause/s and addressing them.

Research is also finding that GABA, one of the main calming neurotransmitters, may also have a possible role in “neuroimmune interaction, being involved in the modulation of immune cell activity associated with different systemic and enteric inflammatory conditions.”

Low zinc and low vitamin B6 are also factors in inflammation, and addressing low levels reduces inflammation and eases anxiety such as pyroluria (a social anxiety condition) and low GABA and low serotonin anxiety because zinc and vitamin B6 are co-factors for making these brain chemicals.

The benefit of touch and a boost of oxytocin

I’d like to mention other benefits of using a daily moisturizer – the benefits of touch, massage and a boost of oxytocin:

  • Hand massage and therapeutic touch has been shown to decrease anxiety and make the elderly in a nursing home feel more comforted. If you’re a caregiver to a parent, make daily moisturizing part of your routine.
  • Swedish massage reduces anxiety in ICU patients and improves vital signs.
  • Touch increases the release of oxytocin improving well-being and may also have “applications in neuropsychiatric disorders especially those characterized by persistent fear, repetitive behavior, reduced trust and avoidance of social interactions.”

Adding skin moisturizing to your daily self-care routine

I feel very comfortable saying you now we have a new tool – daily skin moisturizing – to add to your toolbox to help lower your markers of inflammation and reduce anxiety, panic, PTSD, phobias and social anxiety. Let’s use everything at your disposal to heal and feel your absolute best.

It’s something most women (and a few men) are already doing, and this information can give you more reason to continue to do it.

It’s a lovely self-care routine if you’ve not been doing it for some time or have never regularly used a moisturizer. This information can be an incentive to add it back to your daily routine or start doing it.

The biggest problem I see with moisturizing is using toxic chemicals and less than ideal creams on your skin so I reached out to colleagues and my community on Facebook to get input on their favorite home-made and store-bought moisturizers:

In the meanwhile, feel free to share your favorites and what your moisturizing self-care routine is like, and if you get regular massages and use moisturizing creams with love ones. Simply comment below.

Additional Anxiety Resources
Click on each image to learn more

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.

Delayed IgG food sensitivities: depression and anxiety due to inflammation, leaky gut, leaky blood brain barrier and low serotonin

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It’s really encouraging and exciting to see a major study confirming what we’ve known about IgG food sensitivities or IgG food reactivity for years, and also reporting a link to irritable bowel syndrome (IBS) and depression. The paper, published in May this year, The Food-Specific Serum IgG Reactivity in Major Depressive Disorder Patients, Irritable Bowel Syndrome Patients and Healthy Controls states

There is an increasing amount of evidence which links the pathogenesis of irritable bowel syndrome (IBS) with food IgG hyperreactivity. Some authors have suggested that food IgG hyperreactivity could be also involved in the pathophysiology of major depressive disorder (MDD).

The following diagram and excerpt illustrates the gut-immune-inflammatory-brain model for depression that is associated with food IgG hyperreactivity or sensitivity.

The gut-immune-inflammatory-brain model for Major Depressive Disorder associated with food IgG hyperreactivity. According to the hypothesis proposed in our previous work, we present a possible mechanism underlying the MDD [major depressive disorder] development, suggesting that the interplay between genetic and environmental factors may lead to disruption of tight junctions, the loss of their integrity and both gut and BBB [blood brain barrier] permeability. Undigested food compounds, which would normally break down in the gut, translocate into the blood circulation, and trough epitopes combine with food IgG antibodies to form immune complexes. This, in turn, provokes an abnormal response and triggers immune-inflammatory cascade. Uncontrolled release of the proinflammatory mediators may contribute to low-grade systemic inflammation and low-grade neuroinflammation, which, via pathological processes in CNS [central nervous system], i.e., changes in neurotransmitter metabolism, neurogenesis, glutamate excitotoxicity, may in consequence induce and then maintain and prolong depression.

[diagram and excerpt from The Food-Specific Serum IgG Reactivity in Major Depressive Disorder Patients, Irritable Bowel Syndrome Patients and Healthy Controls]

I wrote my book, The Antianxiety Food Solution, in 2011 and there wasn’t research on the gut-immune-inflammatory-brain model, but I do write extensively about delayed IgG food sensitivities (as well as other types of food issues). If you don’t have my book I’m including some of the highlights related to this (and I encourage you to pick up a copy too!). If you do have my book I hope this next section encourages you to go back and read chapter 4 again (and even check out the other books I mention below).

I write about how with delayed food reactions, it may take a few hours to several days before symptoms appear, which can make it difficult to identify the offending food or foods. In these reactions, the body responds by creating a type of antibody known as IgG (immunoglobulin G).

I also write about how food sensitivities can have effects beyond physiological symptoms, including creating imbalances in key chemicals in the brain, which can cause anxiety, phobias, depression, irritability, and mood swings. When food sensitivities have these effects, they are sometimes termed “brain allergies” or “cerebral allergies.” Dr. Carl Pfeiffer wrote extensively about this and used these terms in his wonderful book, Nutrition and Mental Illness, way back in 1987. (This book is a quick read and is one of my favorite older books on the subject of mental health and biochemical imbalances.)

I also reference the work of my colleague and friend, clinical nutritionist Liz Lipski. In her 2004 book, the 3rd edition of Digestive Wellness she shares that

24 percent of American adults claim they have delayed food and environmental reactions.

She feels that these sensitivities are often the result of leaky gut syndrome, a condition characterized by damage to the microvilli lining the intestinal walls. This allows undigested food particles to travel across the intestinal wall and into the blood, where the immune system responds to them as foreign, harmful substances and creates antibodies to neutralize them.

All this sounds very similar to what the new study is reporting doesn’t it? I’d prefer it not to take so long for the knowledge from as far back as 1987 to get into mainstream journals but it’s the world we live in and we can just appreciate that we are moving forward and in the right direction!

The 2018 paper mentioned above concludes the following:

Our findings suggest more common food-specific serum IgG hyperreactivity among patients with IBS and MDD [major depressive disorder], which may be one of the mechanisms leading to the development of immune activation and low-grade inflammation observed in these disorders.

They do support an elimination diet for IBS but not for depression:

There is no causal relationship which could confirm clinical utility of an elimination diet in patients with depression

I do love research, but this really bothers me as it’s just common-sense and we do have some case studies supporting the use of elimination diets. In this case study the patient’s “treatment-resistant” depression improved considerably with an elimination diet, with similar results in another case study where a gluten-free elimination diet improved both anxiety and depression and everyday functioning.

In the meantime, we’ll continue to rely on the wisdom of practitioners like Dr. Pfeiffer and Liz Lipski, and all the clinical evidence showing how an elimination diet does help with both depression and anxiety. Just read some of the success stories on this blog – Paleo and grain free diets: anxiety and depression success stories.

Other mechanisms: nutrient malabsorption and serotonin production

There are other mechanisms that I also cover in my book – nutrient malabsorption and a more direct impact on serotonin production.

One possible mechanism is indirect effects of gastrointestinal damage due to eating problem foods, resulting in nutrient malabsorption. In a 2009 double blind placebo-controlled study:

65 celiac patients aged 45-64 years on a strict gluten-free diet for several years [and showing signs of low folate, low vitamin B12 and low vitamin B6] were randomized to a daily dose of 0.8 mg folic acid,0.5 mg cyanocobalamin and 3 mg pyridoxine or placebo for 6 months

I doubt folic acid or this form of B12 would be used today but even with these forms at these low doses, the study participants showed homocysteine in a good range and reported improvement in general well-being – after just 6 months of supplementation.

Another possible mechanism is the fact that gluten sensitivity and the resulting damage to the gut can limit the availability of tryptophan and therefore lead to decreases in levels of serotonin. Research published in 2005, Gluten-free diet may alleviate depressive and behavioural symptoms in adolescents with coeliac disease: a prospective follow-up case-series study, reports that:

serotonergic dysfunction due to impaired availability of tryptophan may play a role in vulnerability to depressive and behavioral disorders among adolescents with untreated coeliac disease

In addition to removing the foods that are causing the sensitivities, you need to heal the gut and boost serotonin levels with a targeted individual amino acid like tryptophan.

Give the link between anxiety and depression, all of the above could apply if you have anxiety too.

Have you had IgG food sensitivity testing and found that an elimination diet helped reduce your depression or anxiety symptoms?

Amyotrophic lateral sclerosis/ALS: ketogenic diet, GABA, 5-HTP and environmental toxins

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(Image from ABC: The Enemy Within – Australian Story)

I recently watched a documentary on the life and work of Justin Yerbury, a basket-ball player turned scientist who has motor neuron disease (also referred to as ALS) and is seeking a cure. It was aired on ABC and called The Enemy Within – Australian Story

When Justin Yerbury’s family members began to die from motor neurone disease he made a life-changing decision.

He turned his back on a professional basketball career and enrolled in a science degree. Almost 20 years later, he is an internationally recognised expert on the disease, leading the way in the search for a treatment.

Recently, however, Justin’s work took on a terrible urgency as he too developed symptoms of MND.

As Australian Story filmed with Justin and his family, his condition deteriorated dramatically, requiring difficult decisions to enable him to continue his search for a cure.

Having met Justin in 2017, Professor Stephen Hawking recorded the introduction to this story shortly before his death from motor neurone disease.

(the Australian spellings are neurone instead of neuron and recognised instead of recognized)

I felt very moved by his story and work and felt compelled to reach out to Dr. Yerbury to share what I have learned about this condition in the last few years. I know of a number of practitioners who work with individuals with this condition and even some colleagues with family members who have been diagnosed with this condition. I have also had enough queries that it’s time for a blog post on the topic so you are informed too.

What is Amyotrophic lateral sclerosis (ALS) and motor neuron disease (MND)?

Let’s start with the fact sheet on Amyotrophic lateral sclerosis from the NIH (National Institute of Neurological Disorders and Stroke). They describe ALS as follows:

Amyotrophic lateral sclerosis (ALS) is a group of rare neurological diseases that mainly involve the nerve cells (neurons) responsible for controlling voluntary muscle movement. Voluntary muscles produce movements like chewing, walking, and talking. The disease is progressive, meaning the symptoms get worse over time. Currently, there is no cure for ALS and no effective treatment to halt, or reverse, the progression of the disease.

ALS belongs to a wider group of disorders known as motor neuron diseases, which are caused by gradual deterioration (degeneration) and death of motor neurons. Motor neurons are nerve cells that extend from the brain to the spinal cord and to muscles throughout the body. These motor neurons initiate and provide vital communication links between the brain and the voluntary muscles.

I encourage you to watch the 30 minute program if you want to learn more about this condition and Dr. Yerbury’s work (they call it MND rather than ALS in the documentary.)

You may also be familiar with the life and story of Professor Stephen Hawking – he had ALS or motor neuron disease.

Ketogenic diet for ALS?

Here is some of the information I sent to Dr. Yerbury, explaining my work as a nutritionist working with women with anxiety using nutritional psychiatry approaches. Many of these nutritional psychiatry approaches – such as the SMILES study – have been spear-headed in Australia by Professor Felice Jacka.

I’ve recently being looking at the growing research base on the ketogenic diet and mental health and when I saw his story on ABC my first thought was – I wonder if there is research on ketogenic diets and ALS/MND? After a very quick search I found these papers:

there are strong epidemiologic data showing that malnutrition is a common symptom of amyotrophic lateral sclerosis both in humans and in mice and may contribute to disease progression. There is also epidemiologic evidence that increased dietary fat and cholesterol intake might reduce the risk of amyotrophic lateral sclerosis and the rate disease progression. Finally, data from animal studies strongly suggest that increasing dietary intake of fat ameliorates disease progression. However, determining whether amyotrophic lateral sclerosis patients should be treated with a high-fat or ketogenic diet can be based only on randomized double-blind placebo-controlled interventional trials.

Metabolism-based therapy [which includes the ketogenic diet] has been used successfully in the treatment of seizures but study of its use in other neurodegenerative disorders [such as Alzheimer’s disease, Parkinson’s disease and ALS] is growing.

A gluten-free diet?

We must always consider gluten with every chronic health condition. There is a case report of celiac disease with neurologic manifestations misdiagnosed as amyotrophic lateral sclerosis:

he was diagnosed as having CD, and a gluten-free diet was immediately begun. At a 4-month follow-up, his weight and the quality of his stool had improved gradually, and the neurological manifestations had not progressed.

Another study reports that in certain cases, ALS may be associated with autoimmunity and gluten sensitivity, with elevated transglutaminase 6 antibodies in the serum of 23 patients.

GABA and 5-HTP: the Deanna Protocol

Awhile back I was contacted by someone in my community about the Deanna Protocol for ALS because it uses amino acids GABA and 5-HTP and other nutrients like niacin and CoQ10:

It is determined that the substances in the DP™ Plan provide energy to cells that are dying and in doing so keeps them alive.  This is very important because when nerve cells die, they release glutamate which kills the contiguous cells.  If too many cells are dying then we cannot supply enough energy to keep up with the rate of death of the cells.  When the DP™ Plan​ is taken in sufficient quantities, it will support the nerves that are challenged by glutamate.

As you may already know I use targeted individual amino acids such as GABA and tryptophan/5-HTP with clients so I am very familiar with their therapeutic benefits for anxiety and I am fascinated they also ease symptoms in ALS.

There is an animal study supporting this approach: Metabolic therapy with Deanna Protocol supplementation delays disease progression and extends survival in amyotrophic lateral sclerosis (ALS) mouse model.

Anxiety and depression

There is also research indicating that psychiatric symptoms often precede an ALS diagnosis:

neuropsychiatric conditions are overrepresented in amyotrophic lateral sclerosis (ALS) patient kindreds and psychiatric symptoms may precede the onset of motor symptoms…. A diagnosis of depression was significantly associated with a first record of ALS ≥5 years later, in keeping with growing evidence for major depressive disorder as an early marker of cerebral neurodegeneration.

This doesn’t mean if you have anxiety or depression that ALS or another neurodegenerative disorder is in your future, because we can address so many of the root causes before we get to that diagnosis. Many of the nutrients in the Deanna Protocol will help both the person with ALS and the caregivers who also suffer psychological distress.

Environmental toxins and ALS

We recently spent 3 days at Shell Harbour just south of the Wollongong area and we loved it!

Lovely Red Sands Beach, NSW

As beautiful as it was I couldn’t help but be concerned about the toxins being released into the air from the steel production plants. Dr. Yerbury lives in the area and is conducting his research at the University of Wollongong. I know toxins play a role in many diseases and wondered about an ALS connection. I found this paper: Association of Environmental Toxins With Amyotrophic Lateral Sclerosis

Pollution in Wollongong

I also shared that I’m a total research geek and pretty passionate about the power of nutrition, lifestyle and environmental factors because this was how I was able to eliminate my own anxiety and panic attacks.

You can learn more about Dr. Yerbury and his publications here. We appreciate the work him and his research team are doing and thank him for sharing his story.

It would be wonderful if some of this information can help Dr. Yerbury and even be considered for future research by his very passionate research team. I also hope this information will be helpful for you or a loved one suffering with ALS or MND.

Time magazine: ketamine is NOT the solution for treatment resistant depression!

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Seen at LAX airport en route back to Australia – this cover of Time magazine:

The Anti Antidepressant. Depression affects 16 million Americans. One third don’t respond to treatment. A surprising new drug may change that.

It’s scary to think that ketamine and ketamine-like drugs are being considered the solution to “treatment resistant depression”. I’ve never liked this term and in my opinion, what it really means is that the root cause of the depression has not been found. To me it looks like the mainstream medical mental health community is desperate!

It really is time to get all the well-researched nutritional psychiatry approaches to the forefront! They do work! The timing of this article is even more interesting since I was returning from the first international meeting of the International Society for Nutritional Psychiatry Research in Bethesda, MD.

Lead food mood researcher Professor Felice Jacka presented her SMILES paper where dietary changes from a junk food diet to a real whole foods diet reduced depression in 30% of the participants.

Microbiome researcher Professor John Cryan discussed the gut brain connection. This paper: Recent developments in understanding the role of the gut microbiota in brain health and disease, was published just last week:

recent preclinical and clinical evidence suggest that targeting the microbiota through prebiotic, probiotic, or dietary interventions may be an effective “psychobiotic” strategy for treating symptoms in mood, neurodevelopmental disorders, and neurodegenerative diseases

And research on sulforaphane for psychosis, and depression and anxiety was presented: Sulforaphane produces antidepressant- and anxiolytic-like effects in adult mice

these findings demonstrated that SFN [sulforaphane] has antidepressant- and anxiolytic-like activities in stressed mice model of depression, which likely occurs by inhibiting the hypothalamic-pituitary-adrenal (HPA) axis and inflammatory response to stress. These data support further exploration for developing SFN [sulforaphane] as a novel agent to treat depression and anxiety disorders.

I presented on the benefits of a gluten-free/grain free/Paleo diet for certain individuals for depression and anxiety, and did a poster presentation on GABA for eliminating anxiety. 

As you can see from the TIME Magazine article the only approaches that have been considered (and have failed) are medications in various different combinations:

Every week, when Ian Hanley sits down with his therapist, he goes through a list of depression treatments he’s been researching online. The best-known treatments at the top of the list–half a dozen antidepressants and known combinations of those drugs–are all crossed out….

Most diagnoses do not come with 20-plus medicines approved by the Food and Drug Administration to treat it–and yet with depression, more options don’t always mean better outcomes. Ever since the first antidepressants were introduced 60 years ago, doctors have had patients like Hanley–people who don’t seem to get better even after they’ve worked their way through the lengthy list of available drugs. About 30% of all people with depression don’t respond adequately to the available treatments. That’s a dismal failure rate for a class of drugs designed to improve a person’s basic ability to function.

According to this article in Time magazine:

The biggest development has been the rediscovery of a promising, yet fraught, drug called ketamine. It’s best known as a psychedelic club drug that makes people hallucinate, but it may also have the ability to ease depression–and fast. In a race to shape the next generation of antidepressants, Johnson & Johnson and Allergan are fast-tracking new medicines inspired by ketamine.

I encourage you to read the entire article and take note of the following: the side-effects seen with medications over the years and the fact that doctors “don’t know the consequences and potential side effects of taking tiny doses of ketamine over and over again”; “she tried nearly everything” (you’ll read this in all the articles advocating for ketamine but unfortunately they are only referring to medications); the ketamine effects are temporary and cost $15,000 per year (and are not covered by insurance); and ketamine “is thought to stimulate an opioid receptor in the brain” and is already known to be addictive.  

When I shared this image and article on my Facebook page I discovered that is a pretty divided topic with a number of people feeling really strongly about the fact that this approach needs to be researched further and considered.  I acknowledge their concern for the individuals who have not found a solution for their depression. BUT my question is this: have all the dietary and nutritional approaches been considered and looked into with these people who have not responded to antidepressants? 

I strongly believe that ketamine is NOT the solution and that nutritional psychiatry is!

Have you used this ketamine approach personally or with patients?

Would you consider using ketamine personally if the antidepressants didn’t work for you? Or would you be more willing to work with a functional medicine or functional nutrition practitioner to find your true root causes and address them with diet, nutrients and a functional medicine approach?

How to address rectal spasms with GABA, pelvic floor work, gluten removal and squats

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Last week I wrote about proctalgia fugax, a condition that leads to rectal spasms and sharp fleeting pain in the lower rectum or anus, often described as excruciating and agonizing. Proctalgia fugax actually means anal pain of unknown cause but I am seriously questioning this definition because as you’ll see below there are a number of possible root causes!

I have experienced this horrible pain and was not willing to use medications. Instead, because I could find no other solutions, I experimented with sublingual GABA during an episode and then figured out how to prevent a spasm at the first hint of pain.  You can read all the details on this blog: How GABA eases agonizing rectal pain and spasms in under 2 minutes

I promised to share part 2 with some root causes and other solutions but this article has grown because of all the wonderful feedback on the above blog. I’ve gathered some of it here as additional resources.

What is the pain like?

Here are some additional descriptions of the pain (sharing here so others can relate and feel comforted that this is not something weird):

  • horrible, shooting pain up the lower rectum/spine area
  • I have had this issue since I was about 45 (I’m now 60) at least a few times per year. It lasts usually 15 to 30 minutes and is extremely painful.
  • I have had this pretty much all my life. More common with my period and the spasm lasts for close to 1/2 hour or so. Very deep aching pain.
  • It stops me in my tracks. The pain is so bad sometimes I can’t breathe. It’s scary.

For some people the fear of having a spasm when out and about is extremely traumatic:

It seems no one in the mainstream medical field is concerned about it. It may be physically harmless but I know many people on other forums who live in constant fear of an attack – especially publicly. It is far from psychologically harmless.

I loved all the feedback: pleased to find out there is a name for it and feel comforted to know you’re not alone. Many have been worried and embarrassed to ask for help. And across the board you are all very interested in experimenting with GABA (or theanine or taurine) to see if it helps reduce or eliminate the spasms in the moment.

This GABA approach is a good one because it helps ease the pain and spasms and because stress is a common underlying factor.

Positive feedback about GABA helping

I am pleased to get some positive feedback that GABA is helping:

I used to get these right before my period – hormonally related for me. Interestingly, I have been taking Pharmagaba to help me sleep better and to help me relax…noticed that I haven’t had one of these “butt cramps” as I call them, in months.

And this wonderful result from someone else:

There were times I literally had to sleep in the tub for 5 hours at a time and keep refilling it hot water. Most excruciating pain I’ve ever had and I’ve birthed a child naturally! I’m taking GABA for other reasons and after reading this (facebook post), I realize I haven’t had this since!

Concerns about using GABA

A few of you had concerns about using GABA – for example: GABA causes palpitations for me but I will seriously consider trying it.

I wouldn’t use GABA if it causes palpitations or I would at least experiment with super small amounts. I mentioned I’ve used up to 500mg – for many people this is too much and even 100mg may help. Taurine may be an option too. If you can’t tolerate GABA or taurine the next section covers some other options and how to address some of the possible root causes.

And someone shared that when she took GABA in the past for anxiety it really seemed to make her more anxious:

Since I did not have the expected result for anxiety, I wonder if it would not be the best choice for me in this situation either . . . I would like to use something which works quickly, so the sublingual option would have been appealing. I have used l-theanine with good results (for anxiety) and have never tried taurine before.

I would not recommend GABA for someone who gets more anxious with it. When something does work, like theanine, I’d go with that approach. Or I would consider a very small dose of GABA and build up slowly.

There are some common patterns

When looking at common patterns many who responded on the GABA blog:

Medications for relief

Many find relief with medications but side-effects always need to be considered and it makes the most sense to get to the root causes and address them. Here are some mentioned:

Addressing tight pelvic floor muscles and stress

We always want to get to the root causes of an issue and that is the most logical step. I reached out to the practitioners in my community to ask them how they help their clients and patients with this and what approaches they have used to end the spasm and pain. My colleague, Jessica Drummond, nutritionist and physical therapist, and an expert on female pelvic pain and women’s health, shares this advice:

For women with proctalgia fugax, the acute rectal spasm can come at any time unexpectedly. Usually, this is a sign that your pelvic floor muscles are tight and need to be relaxed. Avoid doing Kegel exercises, and see a physical therapist who is a pelvic floor specialist in order to release the muscles of your pelvic floor.

Additionally, it’s important to be sure that you’re finding time each day to fully relax, breathe deeply, and receive support from your family or friends. Often women with pelvic floor muscle spasm feel stressed or a lack of safety in their lives and bodies. So, working with a skilled professional to address your stress is key.

Lorraine shared these wonderful results with her pelvic floor therapy (on the GABA blog) and how much it’s been helping her:

Anxiety or stressful times was a huge trigger (I am still pretty type A) and I finally learned one reason among many that stress triggers it. My naturopathic doctor sent me to see the ‘guru’ in pelvic floor therapy–Caroline Allen in Ottawa. I suffered for years with anxiety and did not realize that I was still constantly holding my tummy in as an old habit to stress even now that I have overcome my anxiety disorder. She taught me how to relax the core which was a challenge at first and required much conscious thought–those muscles had many years of training to stay tight. I was also breathing incorrectly and she showed me that when our breathing is incorrect, our diaphragm is tight and then it pulls up and tightens the entire pelvic floor. I can often prevent or significantly decrease the severity of an attack by reminding myself to relax certain key muscles and breathing into the pelvic floor.

Gluten sensitivity, other food sensitivities and functional imbalances

Jessica also shares what can worsen pelvic floor function:

You may have nutrient deficiencies or [gluten or other] food sensitivities that can worsen your pelvic floor muscle function. And, if you have IBS or constipation that should be addressed by a nutrition professional who specializes in digestive or pelvic health.

Here is some of the feedback I received on the GABA blog, observing links to gluten sensitivity, other food sensitivities and functional imbalances:

  • Gluten sensitivity
    • I found that once I eliminated gluten from my diet, this almost eliminated the problem.
  • Other food sensitivities – keeping a food-stress-spasm log will help you figure this out
    • We have found a sensitivity to corn, coconut, and nightshades and eating these brings on an attack. I suspect gluten as well but don’t always get an attack the way corn will
    • Food too high in phytic acid is a huge trigger for me…I avoid nuts like the plague
    • I do have gluten intolerance, and have been gluten free since 2009. I also stay away from dairy, all grains, and eggs. Recently I went off of all nightshades and on a lectin free diet. I haven’t seen any difference yet, and it has been over a month, but then again I haven’t had a spasm lately either. Not sure if that is a coincidence or not.
    • I have discovered that the following foods bring it on the next day: gluten, onions, citrus, especially orange juice, and black tea. Staying away from these foods has made a huge difference, but I still get episodes, which makes me think there’s another trigger I haven’t discovered
  • Any functional imbalance
    • I’ve recently been seeing a new naturopathic doctor who addressed SIBO, hormone imbalance as well as a stubborn parasite. My attacks most often occurred in correlation with constipation, digestive upset and ovulation pain (I had low zinc and low progesterone). Addressing all three factors has helped.

Other possible factors that should be considered: low magnesium, low potassium, low serotonin, low vitamin D, low zinc and dehydration, and look at drug-induced nutrient depletions from the BCP, fluroquinolones and proton pump inhibitors.

Jessica provides a comprehensive overview in this article: Physical Therapy and Nutrition: A Powerful Combination To Heal Pelvic Pain. It’s written for health professionals but is an excellent overview for anyone.

Some other possible solutions

I received so much wonderful feedback on the GABA blog that I’ve gathered these other possible solutions into a list:

  • Skullcap and valerian for mild symptoms
  • Designs for Health Gastromend, a product that is healing for entire GI tract helps in 15 minutes. Drinking Aloe juice may be helping
  • Sitting on the toilet and pushing down like with a bowel movement [this doesn’t feel good when I do it] or sitting on my foot to apply upward pressure before the spasm gets to deep will generally shorten the duration. I have found that stretching and holding the stretch for a few minutes will ease the intensity and duration of the spasm.
  • Nothing seems to help me except for a really hot heating pad. It usually takes about 20 minutes or a little longer for the spasms to go away

Squats, reflexology and downward dog for immediate relief

I also received these solutions that provide immediate relief while you’re figuring out and addressing the bigger root causes:

  • My gastroenterogist recommended going into a deep squat when the spasm starts. I tried and it worked!
  • I rub the inner ankle area (above the bone) in an upward motion – both sides. I rub as hard as I can. It takes a few minutes of rubbing but the pain reduces almost immediately. I went to a foot reflexologist and she said that this area relates to the rectum. [I found this reflexology chart and assume you rub the area marked “Rectum and Anus”]
  • Downward dog yoga pose

I appreciate all the wonderful feedback on the GABA blog and the opportunity to share this so more of us get answers more quickly! Too often we think it’s just us but I encourage seeking solutions no matter what weird quirks we think we have!

I have one more article to share on the topic so stay tuned for part 3 with an exercise that strengthens the pelvic area and reverses rectal spasms.  

Feel free to share what’s worked for you, what your possible triggers are and if GABA or any of these approaches resonate with you.