insomnia

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

September 9, 2022 By Trudy Scott 37 Comments

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

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

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

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

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

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

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

Impaired fat digestion leads to an increase in oxalate absorption

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

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

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

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

Bile production and detoxification

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

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

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

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

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

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

Taurine and bile acid conjugation and detoxification

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

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

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

Taurine works on GABA receptors and is a GABA alternative

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

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

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

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

You may need to course-correct from time to time

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

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

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

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

Resources if you are new to using amino acids as supplements

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

If you suspect low levels of any of the neurotransmitters and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids on your own so you are knowledgeable. And be sure to share it with the practitioner/health team you or your loved one is working with.

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control, sugar cravings, self-medicating with alcohol and more.

The book doesn’t include product names (per the publisher’s request) so this blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the amino acids that I use with my individual clients and those in my group programs. You can find them all in my online store.

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), a good place to get help is the GABA QuickStart Program (if you have low GABA symptoms). This is a paid online/virtual group program where you get my guidance and community support.

If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. This is also a paid online/virtual program with an opportunity to interact with me and other practitioners who are also using the amino acids.

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

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

Have other liver or gallbladder approaches also helped?

If you have questions please share them here too.

Read all posts in this series:

Collagen causes increased anxiety, low mood, irritability, insomnia, gut issues and an itchy skin: some questions and my answers

September 2, 2022 By Trudy Scott 37 Comments

Today we have some feedback from folks on some of the negative impacts they experienced when consuming collagen. I’m sharing their questions and the feedback I gave them in the hope this will help you too. Not everyone experiences unpleasant symptoms when consuming collagen but those who are susceptible may experience the following: increased anxiety or new anxiety, feeling low, inability to sleep or worsening sleep, tension, irritability, gut issues, itchy skin, frequent urination, a bad mood, worsening psoriasis, blepharitis, panic attacks and a disrupted menstrual cycle.

The causes of these symptoms can be due to the serotonin-lowering effects of collagen, the dietary oxalate impact, a histamine reaction and/or a glutamate reaction to collagen.

Beth shares how she feels low and anxious after using marine collagen for five days:

Have just recently begun receiving your emails. I read the above article and wanted to let you know of my experience. I started taking Vital Proteins marine collagen to see if it would improve sun damage to my skin. I took one scoop for about five days. On the fifth day I felt very low. So low that it made me somewhat anxious. As I have trouble with anxiety I stopped it immediately. Felt better the next day. The container lists 19 amino acids including tryptophan but the amount of it is zero mg. I hadn’t noticed that when I started taking it. After reading your article I’m fairly sure that that is why I felt depressed.

I shared this: for individuals who have observed a mood dip or increase in anxiety since using collagen or gelatin, I suggest they stop using collagen/gelatin and see how they feel, then add it back and see how they feel (sometimes more than once if they are not certain).

If they do see a correlation, look at the low serotonin symptoms and do a trial of tryptophan or 5-HTP (after checking the precautions) to see if this improves their low mood and reduces their anxiety when using collagen/gelatin. This confirms if their symptoms are due to the serotonin-lowering effects and allows them to continue using it for the benefits it provides.

Be sure to read the above collagen/serotonin blog for some of the research on what makes some folks more susceptible to the serotonin-lowering effects: a current depression/anxiety or history of depression/anxiety (even a family history), prior use of antidepressants, OCD / obsessive compulsive disorder, MAOA and/or 5-HTTLPR (the serotonin transporter gene) polymorphisms, smokers or former smokers, and women polydrug ecstasy users. This is not a conclusive list.

It’s interesting that she mentions her product has tryptophan listed with zero mg. When I looked online I didn’t see it listed on the product at all. Maybe it’s a change they have made to the label.

I also shared that when you are new to the amino acids (and other anxiety nutrition solutions like real whole food, quality animal protein, fermented foods, organic produce, health fats, gluten/sugar/caffeine removal, blood sugar control, gut health, pyroluria etc) my book “The Antianxiety Food Solution” is a great place to start.

The above question and the following questions come from the popular blog, Collagen and gelatin lower serotonin: does this increase your anxiety and depression?

How long after stopping bone broth does it take for this anxious feeling to leave?

Diane asks about bone broth and collagen and how it causes extreme anxiety and sleep problems:

I just finished your book and have to say how awesome it is ! A wealth of information. As I am struggling with many of the issues, I do have a question on bone broth and collagen. I have definitely noticed extreme anxiety and inability to sleep with bone broth and collagen supplement.(plus spring allergies are at play as well) I even tried a piece of Turkey with my bone broth this week to see if that helped. I have such gut issues I was really hoping to use bone broth. Anyway, my question is how long after stopping bone broth does it take for this anxious feeling to leave? Days or weeks? I want it cleared out before I try adding tryptophan with the broth.

I thanked her for the great feedback on my book. It’s wonderful to have the foundational stuff in place and she’s getting that from my book.

I don’t have an answer on how long symptoms can last as it’s very individualized. Typically if the effects are caused by serotonin being lowered, using either tryptophan or 5-HTP can result in significantly less anxiety and better sleep in a few days, provided the optimal dose is used.

Keep in mind that spring allergies can often make things worse and more tryptophan or 5-HTP may be needed during the allergy period. The dose would then need to be reduced once allergy season has passed. I blog about spring allergies and increased anxiety here.

My advice would be to use the tryptophan or 5-HTP to resolve the anxiety and insomnia and then once resolved, consider adding back the collagen and monitoring how she is doing. At this time she may need to bump up her tryptophan or 5-HTP yet again.

Is it a histamine reaction rather than low serotonin? (or an oxalate or glutamate reaction?)

Kelly believes her symptoms may be a histamine reaction and not caused by low serotonin:

If you become anxious, tense, irritable, can’t sleep AND have some issues with itchy skin, frequent urination, worsened gut issues, etc., then it’s a histamine problem from the collagen/glycine, and not serotonin at all.

I shared that these symptoms could actually be both since low serotonin can also cause anxiety, tension, irritability and insomnia. But I agree the itchy skin, frequent urination, worsened gut issues are a big clue it’s a histamine issue too or perhaps only a histamine issue. Gut issues would happen with both low serotonin and histamine.

I’d start with a trial of tryptophan or 5-HTP because if it is low serotonin you will know very quickly. You can see what symptoms resolve and by how much.

Challenges with dietary oxalates could cause all the symptoms she experiences. So it’s a matter of figuring it out for each person. If you already know you have histamine or oxalate issues it’s also relatively easy to figure out by simply stopping the collagen and/or adding the counter-measures you typically use – like quercetin for histamine reactions and calcium citrate for oxalate issues.

It’s possible that some of these symptoms are a glutamate reaction too – like anxiety, tension, irritability and insomnia – and the amino acid GABA may help in this instance.

A bad mood, insomnia, psoriasis, blepharitis, panic attacks, hormone imbalance – oxalates or serotonin-lowering effects?

Em shares how she had a really bad mood, full blown insomnia, worsening psoriasis, blepharitis, panic attacks and disrupted menstrual cycle:

I am soooo glad I found this article. I started taking Oslo Skin Labs collagen (Verisol, so it is considered good quality) half way through December 2021. Looking back, that is when the problems started. I started sleeping restlessly and it got really bad in January. Full blown insomnia. My psoriasis got much worse, the blepharitis too. I have severe Endometriosis and was worried that if these other inflammation issues (psoriasis causes skin inflammation and blepharitis causes eye inflammation) were worse then maybe my endo was worse also since that can’t be checked on the outside.

Besides the inflammation symptoms I was experiencing extremely bad moods, feeling tense to the point of bordering on panic attacks and also a disrupted menstrual cycle.

I have been on Amitriptyline for 1,5 years and it worked wonders on my mood and sleep and I just couldn’t figure out why it wasn’t working any more. Then I realized that the only thing I changed was adding collagen to my diet in my fruit/vegetable smoothie ( I don’t drink coffee). So I started Googeling and found your article and stopped the collagen immediately. Have stopped for 2 days now and already my eyes are less red and inflamed. Pfew! It’s crazy and also scary how serious the side effects of collagen have been.

Do you think that besides the tryptophan lowering side effect that also the histamine might have played a part in my case? I don’t dare try the collagen with tryptophan supplement as the potential side effects are too serious to play around with. But I’m very bummed out about missing out on the skin and hair benefits.

Would love to hear your thoughts. I follow a vegetarian diet by the way and eat super healthy.

With Em I’d suspect an oxalate issue first because of the worsening psoriasis, blepharitis and endometriosis. She is also a vegetarian and this diet is often high in dietary oxalates. I write about oxalates and pain here.

However, with the “bad moods, feeling tense to the point of bordering on panic attacks and also a disrupted menstrual cycle”, I’d also suspect a serotonin-lowering impact. As mentioned above, a history of mood issues and antidepressant use can be a predisposing factor. She would need to work with her prescribing doctor if she wanted to use tryptophan or 5-HTP because Amitriptyline has the potential to cause serotonin syndrome.

It’s also possible that her symptoms are caused in part by a histamine or glutamate reaction too.

With appreciation for helping to create awareness about these issues with collagen

I have much appreciation for each of these women for asking these questions and sharing their symptoms so we can all learn. There is not much awareness about collagen being problematic for some susceptible folks and it’s a very rude awakening when you start using something for the health benefits and have a bad reaction. Hopefully their stories and others like this will help create more awareness.

The good news is that once you identify your cause/s and address them as above, you can often continue to consume collagen.

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

Have you experienced any adverse symptoms when using collagen? Please share the symptoms so we can all learn from each other .

And were you able to figure out if it was due to low serotonin, a histamine or glutamate reaction or because of dietary oxalates?

If it was low serotonin, has tryptophan or 5-HTP helped so you can continue to use collagen?

If you have questions please share them here too.

Rebound insomnia after tapering a benzodiazepine: will taking GABA or any other natural supplement interfere with healing?

August 26, 2022 By Trudy Scott 16 Comments

This question was posted on one of the GABA blog posts by Fran, asking about about using GABA for insomnia shortly after having tapered a benzodiazepine she had used for 15 years:

I am a senior who took benzodiazepines (clonazepam) on advice of my doctor for sleep because of chronic fatigue for 15 years. Last year I weaned myself off the medication and it has been just over 10 months. No one tells you that when you stop taking them you go into a rebound insomnia phase and it can last a long time. The doctor still won’t admit that!

I joined benzo buddies, a group I found out about on your site and found much encouragement from the posts of many brave and determined people. One post mentioned that the drug actually overrides your GABA receptors so when you stop taking it they have to heal to become active again. My question is: Will taking GABA or any other natural supplement interfere with that healing. The writer of the post feels taking nothing is best for the brain to return to normal and that only time will do that.

I said I was sorry to hear about her struggles with her benzodiazepine prescription. Sadly it’s all too common and it’s seldom that folks are cautioned about the rebound insomnia and other issues seen with benzodiazepines.

I love benzo buddies and other benzo support groups and often recommend that clients join one of these groups for the community support aspect. I am really happy that Fran found encouragement.

However, I respectfully disagree with their message that GABA supplements or other supplements should not be used and that you should just wait for time to heal. We want to use everything at our disposal in order to heal as quickly as possible. And quality sleep is imperative for healing.

Also many of the most severely affected folks are part of these support groups, so it may well be all that they know, hence the advice they dispense.

Many do get relief with GABA during and post benzo taper and it won’t affect long-term healing (with a very low dose)

It is true that GABA receptors can be affected by benzodiazepines but despite this, many of my clients and others in my community do get relief from GABA during this period. Since we are all unique, some folks may have an issue, so we always do a trial with GABA if someone has rebound insomnia (and other low GABA symptoms of physical tension/anxiety, stiff and tense muscles, stress eating etc).

When someone can’t tolerate GABA they will know very quickly – typically in 1-2 days. If you can’t tolerate GABA it may feel the same as someone who takes GABA and doesn’t need it (i.e. GABA isn’t low) or when someone takes too much. This could make you feel light-headed, dizzy, feel a flush and/or feel too tired. You may even feel more anxious. Vitamin C is a wonderful antidote to all this and these short-term adverse reactions won’t interfere with long-term healing.

We also start with a very small dose – I typically have someone start with 25mg GABA and go up from there – and only use sublingual GABA. For some very sensitive folks we will start even lower as in this example where Syd gets sleep and body anxiety benefits with just 1.5 mg to 3 mg GABA.

Other nutrients that may also help with insomnia

We may also use other nutrients to help with sleep support and rebound anxiety (which is also common) and other symptoms, all based on each person’s unique needs. These may include tryptophan or 5-HTP if serotonin is also low (this can affect sleep and cause worry/ruminating type anxiety), melatonin if that is low (either sublingual or timed-release) and Seriphos if cortisol is high too. We may also combine GABA with theanine (research shows the combination may help some folks).

A full functional medicine and nutritional workup is recommended in order to be as nutritionally stable as possible. Ideally this happens before tapering starts but even if it’s done after the fact it can help with healing and symptom relief. Addressing histamine imbalances is one factor to consider as this can impact sleep (more on that below).

This is an important question that many folks ask so I appreciate her asking so I could share it as a blog post for others in a similar situation.

I am waiting to hear back about what happened when she did use GABA and how much she used. She mentioned that she did take GABA for a time at first but it only worked for a while. I find that during the taper and post taper, GABA needs can fluctuate as healing starts to take place. I have clients adjust up and down as needed.

More on benzodiazepine withdrawal and histamine issues

These medications have the most debilitating withdrawal reactions in all of medicine and Valium blocks DAO/impacts histamine levels:

World Benzodiazepine Awareness Day 2017: Awareness and Anxiety Nutrition Solutions

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.

The benzodiazepine valium blocks DAO and impacts histamine levels: wisdom from Yasmina Ykelenstam and a tribute to her brilliance

Many people doing a benzodiazepine taper are often switched to Valium which is a DAO [diamine oxidase blocker (or histamine liberator)] and this further prevents histamine from being removed from the body [and can lead to increased anxiety].

Dyes are also triggers…the pink Xanax can be problematic.

GABA is as effective as benzodiazepines (which should only be prescribed for short-term use)

Many folks who have used benzos in the past, find GABA to be as effective. Another woman in my community, Dee, shared that she had taken Xanax in the past for panic attacks and her functional medicine doctor suggested GABA Calm as she wanted a natural product. This is her encouraging feedback: “I was amazed how it works just like the Xanax did – instant calm feeling within 10 mins of taking 2 capsules. I use them as needed when I am having heightened stress and anxiety.”

Ideally we want to use GABA instead of one of the benzodiazepines – which are all too commonly prescribed for anxiety, insomnia and pain – in order to avoid tolerance issues, dependence and withdrawal/tapering issues. The fact that they are used long term – like 15 years for Fran – further compounds the issues. Even a few months can be problematic for some folks. It’s important to be aware that this class of medication is intended for short-term use i.e. 2-4 weeks only.

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

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

Have you used GABA with success while tapering a benzodiazepine or shortly after tapering is complete?

Have you used other nutrients to help while tapering or post taper? If yes, which ones?

Did you find that GABA was not helpful? (which product and how much did you use?)

If you have questions please share them here too.

Low lithium questionnaire and how we use lithium orotate with the amino acids

August 19, 2022 By Trudy Scott 44 Comments

This is the low lithium questionnaire that I use with new clients in order for us to figure out if a trial of low dose lithium, in the form of lithium orotate, may be helpful. The hallmark of low lithium is a rollercoaster of emotions. Keep in mind that this is just one of 12 questionnaires that I have my clients complete. Many of the following symptoms can have multiple causes, the labs may relate to other deficiencies and the conditions have other root causes. This questionnaire simply provides additional evidence that lithium orotate may help.

We typically do a lithium orotate trial, starting with 5 mg once a day, and going up to 10 mg twice a day. We do this after we have started trialing the respective amino acids for low serotonin, low GABA, low endorphins, low catecholamines and low blood sugar. A big clue that lithium orotate may be helpful (when many of the symptoms below are checked off) is when the amino acids for low serotonin (tryptophan or 5-HTP), low GABA (GABA or theanine), low endorphins (DPA or DLPA), low catecholamines (tyrosine or DLPA) and low blood sugar (glutamine) are not as effective as expected (based on the amino acids mood/neurotransmitter questionnaire).

Low lithium questionnaire

Symptoms
Mood swings (a rollercoaster of emotions)
Addictions and/or cravings
Depressed
Low self-esteem
Boredom
Easily distracted
Rebellious, disruptive behavior and/or aggressiveness
Irritability
Restless/internal anxiety (similar to low serotonin worry/ruminating anxiety)
Restless/external anxiety (similar to low GABA physical anxiety)
Anxiety ups and downs (fluctuations)
Melancholic pessimism
Suicidal thoughts
Disorganized with planning difficulties
Focus issues/ADHD
Insomnia
Procrastination and/or no initiative
Jack of all trades, master of none
Impulsive and/or lacking tact
Poor insight
Risky behavior
Cognitive issues
Migraines or cluster headaches

Effectiveness of amino acids
The amino acids for low serotonin, low GABA, low endorphins, low catecholamines and low blood sugar are not as effective as expected (based on the amino acids mood/neurotransmitter questionnaire)

Labs
Low white blood cell count
Low red blood cell count
Anemia
Low platelet count

Conditions
Anorexia nervosa
Heart disease (heart arrhythmias, history of heart attack)
Raised blood sugar or diabetes
Kleptomania
Alcoholism
Alzheimer’s disease
Fibromyalgia
Bipolar II
Gout
Hyperthyroidism
Nearsightedness or glaucoma
Herpes infections (current or prone to them)

If you are new to low dose lithium / lithium orotate

As I share in this blog, Upping my tryptophan and lithium orotate have been absolutely profound for me: I’ve been depression free and anxiety free for over a year, I’ve used lithium orotate with many clients and use it when folks have mood swings and anxiety ups and downs. It’s harder for the amino acids to work when there is a moving goal post and lithium orotate evens things out.

You can read Katrin’s wonderful results: “Upping my tryptophan dose and also including and upping the dose of lithium orotate has been absolutely profound for me. I’m off my SSRI/antidepressant (which I was off and on for a number of years). I’ve been depression/anxiety free for over a year. So fantastic.”

The above blog also includes additional information on the differences between low dose lithium / lithium orotate and prescription lithium carbonate. The latter is used at much higher doses and does have side-effects.

One of the many ways lithium works is via the impact on neurotransmitter production. This paper, Potential Mechanisms of Action of Lithium in Bipolar Disorder, states this: “At a neuronal level, lithium reduces excitatory (dopamine and glutamate) but increases inhibitory (GABA) neurotransmission.” It also increases protective proteins such as BDNF (brain-derived neurotrophic factor), helps reduce oxidative stress and is neuroprotective. This paper is referring to lithium carbonate and not lithium orotate but until we have more research on lithium orotate, I feel comfortable extrapolating, given what I’ve seen clinically with lithium orotate.

I’ve also blogged about low dose or microdose lithium here: Microdose lithium formulation is capable of halting signs of advanced Alzheimer’s and improving cognition. In a study published in 2020, “a team of researchers has shown that, when given in a formulation that facilitates passage to the brain, lithium in doses up to 400 times lower than what is currently being prescribed for mood disorders is capable of both halting signs of advanced Alzheimer’s pathology and of recovering lost cognitive abilities.” In this study, they used lithium citrate in similar doses as the lithium orotate i.e 3.2 mg to 6.4 mg NP03 based on 70kg of body weight (which is around 154.3 lbs).

Resources if you are new to using the amino acids as supplements (and where to get lithium orotate)

You can find the amino acid products I use and a number of different lithium orotate products in my online Fullscript store.

Do you resonate with any of the above and have you used lithium orotate with success?

Was the rollercoaster of emotions and fluctuating anxiety a hallmark for you before using lithium orotate?

If you’re a practitioner, do you use lithium orotate with your clients or patients?

If you have questions please share them here too.

Increased kidney stones in postmenopausal women with lower estradiol levels. What about increased dietary oxalate issues too?

June 3, 2022 By Trudy Scott 20 Comments

Epidemiological data reveal that the overall risk for kidney stones disease is lower for women compared to age-matched men. However, the beneficial effect for the female sex is lost upon menopause, a time corresponding to the onset of fall in estrogen levels.

The above is from a 2013 paper, Serum estradiol and testosterone levels in kidney stones disease with and without calcium oxalate components in naturally postmenopausal women.

The aim of this study was to look at serum estradiol and testosterone levels of naturally postmenopausal women who had kidney stones.

It was a small study with 113 naturally postmenopausal women with newly diagnosed kidney stones (some with calcium oxalate stones and some with non-calcium oxalate stones) and 84 controls, all around 52 to 62 years of age.

The results were as follows:

Serum estradiol (E2) was significantly lower in kidney stones patients compared to controls (21.1 vs. 31.1 pg/ml)
Serum testosterone (T) levels did not significantly differ among the groups.

The authors came to the conclusion that “Naturally postmenopausal women with higher remaining estradiol levels appear less likely to suffer from kidney calcium oxalate stones.

These findings support the hypothesis that higher postmenopausal endogenous [produced by the body] estrogens may protect against kidney stones with ageing.”

This is very encouraging research because it means we can do something about it (more on that below).

My question is this: What about increased dietary oxalate issues in this age group? And can there be similar issues in perimenopausal women too? This study only looked at kidney stones but I propose that there is a connection and that declining estradiol is the common factor. I also propose that providing estrogen support may help to counter both issues – kidney stones and/or dietary oxalate issues with no kidney stones, especially with the clinical observations and feedback I have had (more on that below).

Now this may not be the case for all women and is clearly not the only factor when it comes to kidney stones and dietary oxalate issues. But I do feel it needs to be part of the discussion. In menopause, osteoporosis and heart disease are on our radar but kidney stones and dietary oxalate issues are not.

Dr. Felice Gersch talks about estrogen and calcium in bone health and osteoporosis

I really thought I was onto something after hearing Dr. Felice Gersh, MD (a integrative gynecologist who focuses on women’s health and menopause) talk about estrogen and calcium in bone health/osteoporosis on The Osteoporosis Summit earlier this year. This is some of what she shared:

Estrogen affects everything! So estrogen is involved in the development of bone, but it’s even more complex. For example, estrogen allows the proper absorption of calcium, so that you get proper absorption of calcium from food in the gastrointestinal tract. That involves having proper estrogen levels. And having proper estrogen levels allows the reabsorption of calcium in the kidneys so that you don’t excrete a lot of calcium that you shouldn’t be excreting.

As soon as I heard calcium and the kidneys, the light bulbs went off and I started looking for some research. I didn’t expect there to be much because a higher incidence of kidney stones in menopause and the estrogen connection is not something I’ve heard discussed by menopause experts. However, the above study was one of many. Here are a few more studies that support this connection:

Estrogen replacement increased the citrate and calcium excretion rates in postmenopausal women with recurrent urolithiasis (urolithiasis is kidney stone disease)
Etiological role of estrogen status in renal stone formation

Interestingly this 2021 paper, Association between sex hormones and kidney stones: analysis of the National Health and Nutrition Examination Survey, reports that there is “no independent association between sex hormones (testosterone and estradiol) and history of kidney stones in either males or females.” This conclusion may be related to the fact that there are fewer studies that include women. I look forward to future research in this area and until then we use the other research and what we see clinically.

How common are dietary oxalate issues in my community of perimenopausal and menopausal women?

I posted the 2013 study and this question on Facebook to see how common an issue it is:

If you have dietary oxalate issues (with or without kidney stones) I’m curious if there is a hormonal connection and specifically if things got worse for you in perimenopause, and got really bad in menopause (as estrogen declines even further). This has certainly been the case for me.

Here is some of the feedback I’ve received on this post and related posts:

Cynthia shared this: “Really interesting! I definitely had oxalate issues (perimenopause) provoked by ruptured appendix/SBO/abscesses and fistula formation (13 day hospitalization)….I had to remove all oxalates and go full carnivore for 9 months….I’m still oxalate sensitive and had not been before…. I will definitely be sharing this with my communities….there are SO many middle aged women with oxalate issues”

Kirsten shared this: “Interesting to know. At the age of 49 (I am now 51), for the first time in my life I developed kidney stones – probably the most painful experience of my life. I eliminated vitamin C supplements and some oxalates (I had a daily dose of “green juice” that I was consuming as well that I no longer take) however I never understood the relationship between estrogen and their development. I am not post menopausal as of yet -but definitely experiencing symptoms common in peri-menopause… Perimenopausal symptoms include – anxiety (the worrying type) which is at its worst around the time I menstruate (taking 5-HTP which helps but doesn’t completely resolve), night sweats, hypoglycemia, HPA dysfunction (which could be a result of perimeno as well as its own issue – or both). If I don’t keep my stress levels in check, everything becomes exacerbated – meditation helps too.”

Leah shared this: I developed oxalate issues after menopause (I’m in my 60s) and didn’t realize what is was until I read your post about it during the early days of the pandemic when people were overdosing on vitamin C (at least you were trying to figure out if there was a connection at the time). With more research, I discovered a product called Kidney Cop that I still take (though I never get stones, only skin issues on my face). I also switched to liposomal vitamin C and amla and cut back on the offensive [high oxalate] foods for me. I do also experience a similar effect when I use collagen powder with peptides (skin issues). When I switched to a powder that didn’t contain peptides but has collagen types 1-5 in it, I had no issues. I don’t know if this is oxalate-related or not, but the skin issue is the same (clear fluid-filled bumps around my mouth and chin only).”

A number of women in the Facebook group Trying Low Oxlaates have shared comments like this: “I was never bothered by oxalate issues before menopause” and “I can tell you that my oxalate problems became far worse – along with everything else, pyroluria, copper toxicity etc – in perimenopause.”

Personally, my severe dietary oxalate issues started in 2012, when I was 52, and it manifested as excruciating foot pain. It was a combination of hot-burning-coals-pain and shards-of-glass-pain. Later it affected my left eye and more recently it impacted my sleep in a big way. I eat low oxalate and use vitamin B6 and calcium citrate (carefully timed) to keep symptoms away. My next plan is to see if addressing my low estrogen will help even more (more on that below).

Approaches to support declining estrogen levels in perimenopause and menopause

Briefly, here is a summary for supporting declining estrogen levels in perimenopause and menopause:

Diet and lifestyle including exercise and stress-reduction
Amino acid support as needed (GABA supports progesterone and tryptophan supports estrogen) and the pyroluria protocol of zinc, vitamin B6 and evening primrose oil (more on this here)
Adrenal support
Essential oils such as geranium and rose otto and clary sage and other oils to help with anxiety and stress
Liver and kidney support
Avoiding environmental toxins, especially xenoestrogens (plastics, fragrances, pesticides etc) which bind to estrogen receptor sites
Maca – the research on Femmenessence Maca-Pause for bone and cardio health is very encouraging and I suspect there may be benefits for dietary oxalate issues and kidney stones too (when there is a low estrogen trigger). I will be trying this approach and I’ll report back on what I find.
Other herbal approaches for hormonal support: Black cohosh, red clover, dong quai (which, interestingly, are reno-protective too)
Bioidentical hormone replacement therapy

This section deserves an entire blog post and is important to address over and above the mood issues, increased anxiety, compromised sleep, low libido, vaginal issues and hot flashes – because of the impacts for heart health, cognitive decline and bone health.

Kidney stones and dietary oxalate issues in men

This 2016 paper addresses kidney stones in males and makes the testosterone connection for men under 60 years of age: Possible role of elevated serum testosterone in pathogenesis of renal stone formation

Urolithiasis [kidney stones] occurs with greater frequency in males with incidences three times higher compared to females indicating some role played by androgens. Stone formation in renal tissues before puberty is similar between males and females, whereas greater frequency is seen in the third to the fourth decade of life when the levels of serum testosterone are also the highest in males.

With advancing age, the probability for stone formation also decreases as consistent with the decline in serum testosterone levels with more than 20% of healthy men over 60 years of age presenting with serum levels of hormone below the range for young men.

This paper does also support the menopausal estrogen connection I’ve mentioned above: “With females, the frequency for stone formation is considered more compared with premenopausal postulated mainly due to low estrogen levels.”

There is so mention of dietary oxalate issues but we do see this clinically.

My other resources on oxalates if this is new to you

This blog, Oxalate crystal disease, dietary oxalates and pain: the research & questions, came out of my quest for finding a medical explanation/term for my own pain caused by dietary oxalates and a desire to gain a better understanding for my clients who experience similar pain.

You can read an overview of oxalates, my pain issues with dietary oxalates, a deeper dive into the condition called oxalate crystal disease (with some of my insights and questions), and the autism and atherosclerosis research.

As I mentioned above, my severe dietary oxalate issues started in 2012 (when I was 52) and it manifested as excruciating foot pain. It was a combination of hot-burning-coals-pain and shards-of-glass-pain. Later it affected my left eye.

You can also read how oxalates can contribute to anxiety, sleep issues (this has been a more recent issue for me), headaches, fatigue and other symptoms.

When I did the research for this older blog I didn’t come across any studies related to menopause and estrogen levels.

I published this blog, Coronavirus and vitamin C for immune support: new pain or more severe pain due to oxalate issues?, to help folks identify the increase in different types of pain they were seeing as a result of using high dose vitamin C. This could be joint pain, eye pain, foot pain, vulvodynia, bladder issues, insomnia, gut pain, kidney pain, changes in thyroid health/labs, bone pain etc.

This blog, Vitamin C causes oxalate formation resulting in pain, anxiety, and insomnia (when there is a defect in ascorbic acid or oxalate metabolism)? is part 2 and reviews some of the research on vitamin C/ascorbic acid being a possible trigger for the formation of oxalates in certain instances.

I do mention the big disconnect that we see in this research is always the mention of kidney stones. The missing piece – in the research and in many articles – is that you can have issues with dietary oxalates when there is no kidney disease/no kidney stones. I propose similar logic for dietary oxalate issues in perimenopause and menopause with declining estrogen levels i.e. dietary oxalate issues with or without kidney stones.

If you’re in perimenopause or menopause have approaches for supporting estrogen (estradiol) made your dietary oxalate issues and/or kidney stones less severe? Please share what has helped and if you have both – dietary oxalate issues and kidney stones/kidney disease.

If you’re a younger woman and have dietary oxalate issues and kidney stones/kidney disease, have you noticed any hormonal connections?

If this doesn’t affect you personally, have you seen the benefits of supporting estrogen with your perimenopausal/menopausal female clients/patients who have dietary oxalate issues and kidney stones/kidney disease?

If you’re male and have had dietary oxalate issues and/or kidney stones have you found they get less severe as you get older and testosterone declines?

If you have questions please share them here too.

PharmaGABA vs GABA when you have histamine issues/MCAS: does pharmaGABA ease physical anxiety or make things worse?

April 15, 2022 By Trudy Scott 34 Comments

If you have histamine issues or MCAS (mast cell activation syndrome) and the low GABA type of physical anxiety (with muscle tension, insomnia and stress eating), you may well want to consider which type of GABA product you use. It may be wise to avoid or use caution with the type of GABA that is produced via fermentation and could actually make your symptoms worse and cause a histamine reaction.

PharmaGABA and GABA (gamma-aminobutyric acid) are the two forms of commercially available GABA products. PharmaGABA is produced via industrial fermentation of the amino acid glutamic acid (glutamate) using Lactobacillus hilgardii. This is the same beneficial bacteria that is used to ferment foods like kimchi, the well-known Korean vegetable fermented product.

However, GABA is not fermented and is a manufactured product. It’s the form I typically have clients start with simply because it’s been around longer than pharmaGABA and I’ve had such excellent results with it.

I’ve also had reliable feedback from folks who have used both, that GABA works best for them. That said, some folks do find that pharmaGABA works better for their needs and I recognize that there is no one-size-fits-all.

How probable is it that someone could have a histamine reaction to pharmaGABA?

It was only recently that I became aware of the possibility that someone could have a histamine reaction to pharmaGABA. Someone asked the question in my GABA Quickstart online group program and I posed the question to folks on Facebook. Today I’m sharing some of that feedback and asking you to please contribute to the discussion so we can all learn.

Based on what I’ve learned so far I believe it’s very feasible and also probable for many individuals who have histamine issues to have a bad response to pharmaGABA. Keep in mind, histamine triggers are not the same across the board, and it’s possible that some individuals may not react initially and may only react as more and more is used. Or they may not not react at all.

Today’s blog is to shine light on the matter because it’s not something I’ve heard about or seen documented in the research or company product specifications or warnings.

PharmaGABA wasn’t tolerated by Calina’s daughter: she had increased ADHD, agitation, rages, tics and was argumentative and very emotional

Calina shared this about her daughter’s reaction to pharmaGABA and asked about a GABA product that isn’t fermented:

My daughter has high histamine and did not tolerate the pharmaGABA at all. She has increased ADHD, agitation, rages, constantly starts arguments, tics and is very emotional. She has the same reactions with fermented foods (like sauerkraut).

Calina shared that she is 20 and was diagnosed with MCAS at 2 years old:

It improved some for many years, but she’s always been very short attention span, anxiety, OCD, ODD, and learning differences.

Her daughter has a number of more recent factors that are likely compounding things for her:

In 2017 after a mold exposure, dog bite, mosquito bites that left bullseye rashes, all of those symptoms intensified to the extreme.

She used to eat sauerkraut daily but became intolerant. She’s always had problems with all fermented foods and supplements.

I suspect her daughter does have a histamine reaction to pharmaGABA. The clue for me is that her reactions to pharmaGABA are the same as when she consumes fermented foods.

And the symptoms are more severe and more varied than what we see when too much GABA or too much pharmaGABA is used. With too much of either we see increased anxiety and/or more sleepiness and/or feeling flushed. Flushing is common with histamine issues/MCAS and it can be challenging to figure out cause and effect, but this mom and daughter have been dealing with this for a long time and are more likely able to identify what is causing what.

If her daughter has low GABA anxiety physical type symptoms (with insomnia, spinning/focus issues, intrusive thoughts, panic attacks, stiff and tense muscles) I would recommend a GABA-only product, with manufactured GABA instead of fermented pharmaGABA.

PharmaGABA didn’t work for Bren and caused a migraine the next day

A common sign of histamine intolerance/MCAS is migraines so it’s possible that pharmaGABA could trigger a migraine in someone with histamine issues.

Bren shared this on my Facebook post:

Ah now I think I understand why Jarrow’s GABA Soothe not only didn’t work nearly as well for me as GABA Calm, but I also had a migraine the next day. Thanks so much for that information.

When I asked if she has histamine issues and if a migraine is a typical histamine reaction for her she shared that is really only just learning about histamine issues:

Until recently I would have said no and have only had the vaguest idea of what that might mean. But I have been struggling to get off Seroquel, which is the reason I started taking GABA, and I recently found out that Seroquel is a potent anti-histamine. So when you posted about people having histamine issues with the pharmaGABA, which seemed to have caused my migraine, I put 2 and 2 together. I may have it all wrong, but if so it is quite a coincidence.

In Bren’s case it’s a bit more challenging to tease out since this is new to her, she doesn’t eat sauerkraut because she doesn’t like them, but she feels there may be other foods that are affecting her.

This Jarrow GABA Soothe product also contains theanine and Ashwagandha extract so it’s hard to know if it was the pharmaGABA itself. In this instance confirming her reaction with a pharmaGABA only product would be better.

Quetiapine, sold under the brand name Seroquel, is an atypical antipsychotic medication and Bren started to make the connections when she saw my question and because she had read about Seroquel being a histamine-blocking medication.

I share her example because you may not know if you have histamine issues but you may have had a less than pleasant reaction. This will hopefully give you some things to think about.

Product labeling of pharmaGABA can be confusing

You may have noticed this product, Jarrow GABA Soothe, has GABA on the front of the bottle and strangely has “Gamma-amino butyric acid (GABA) (PharmaGABA)” on the product label.

This label makes no sense at all and is contributing to consumer and practitioner confusion.

Unfortunately this kind of labeling is not unusual and variations of this is common with many products.

GABA is used interchangeably with pharmaGABA all the time. In fact, I do it here on the blog and did it in my book. Maybe we are going to find we need to be specific.

Is the flush reaction from too much GABA or because of a histamine reaction?

The biggest issue I see with GABA and pharmaGABA is using too high a dose to start. This causes a temporary and uncomfortable tingling niacin-like flush sensation (in the brain and body).

One challenging aspect is figuring out if the flush reaction is from too much pharmaGABA, or if it’s due to a histamine reaction.

I’d suggest lowering the pharmaGABA dose and looking at all the adverse symptoms. For example, the symptoms of increased ADHD, agitation, rages, tics, being more argumentative and very emotional experienced by Calina’s daughter would not be attributed to too much pharmaGABA but to a histamine reaction (especially when correlated with her similar reactions to high histamine foods.)

If you’re new to histamine issues and MCAS

If you’re new to histamine issues and MCAS (mast cell activation syndrome), Dr. Jill Carnahan has an excellent overview here – Mast Cell Activation Syndrome: Here’s What You Need to Know When Histamine Goes Haywire.

Mast cell activation syndrome is an immune disorder. It’s just one type of mast cell activation disease.

What sets MCAS apart from other mast cell activation diseases is that it isn’t caused by an abnormally large amount of mast cells, and it isn’t a result of pathogen infection. Instead, when you have MCAS, you have a normal amount of mast cells, but they’re overactive and malfunctioning.

When your body is exposed to what it thinks is a threat, these overactive mast cells start to go haywire and secrete massive amounts of chemical mediators stored in the cytoplasm of your cells—degranulation. What’s meant to be a positive, protective response from your mast cells instead triggers both local and systemic negative effects.

When chemical messengers are released into your body, they set off an alarm that triggers an immune system response. And when this response becomes chronic—the chemical messengers are set off too much, too often—the result is mast cell activation syndrome.

In this instance, because pharmaGABA is fermented (and is likely high in histamine for this reason), it’s perceived to be a threat and causes adverse symptoms.

Over the next few months I’ll be sharing additional information about histamine issues and MCAS because of the symptoms of anxiety, insomnia, brain fog, depression and racing heart. Stress is a big trigger and teasing out the role and interplay of neurotransmitter support with GABA and tryptophan is of value.

Resources if you are new to using GABA or pharmaGABA as supplement

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

I actually write about pharmaGABA briefly because it was new at the time and I had some clients who were seeing success with GABA, also trial pharmaGABA. The results were not as good as when they used GABA, so I continued to use GABA.

If you don’t feel comfortable reading my book and figuring things out on your own (doing the symptoms questionnaire and doing respective trials), you can get guidance from me in the GABA Quickstart Program (online/virtual).

If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. It’s an opportunity to interact with me and other practitioners who are also using the amino acids.

If you have histamine issues or have been diagnosed with MCAS:

Have you found you can’t tolerate pharmaGABA and do better with GABA for easing physical anxiety, insomnia and/or stress eating?
Are your histamine reactions to pharmaGABA similar to when you eat fermented foods and other high histamine foods?
Please share which pharmaGABA product you used and how much you used
Please share the reactions and the foods that trigger similar reactions so we can build an informal database with the feedback

If you have experienced reactions to pharmaGABA but do well with GABA, do you now have plans to look into the possibility of histamine issues/MCAS? Please share which pharmaGABA product you used and how much you used.

If you’re a practitioner, have you observed these effects with your patients and/or clients and is it something you caution them about?

Feel free to ask your questions here too.