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World Benzodiazepine Awareness Day 2017: Awareness and Anxiety Nutrition Solutions

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Awareness and nutrition solutions

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

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

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

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

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

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

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

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

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

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

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

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

Tryptophan and melatonin make a big difference but why do I still wake at 4am?

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waking-up-early

I get many questions on the blog about problems with sleep: not able to fall asleep, not waking rested and waking in the early hours and not being able to go back to sleep. By far the most common question is “Why do I still wake at 4am and can’t go back to sleep?”

So let me share one of the typical questions I receive and my feedback in the hope that something you read here may help you or someone you’re working with. Here is the question:

I purchased Lidtke l-Tryptophan and time release melatonin and notice a big difference in my sleep. Instead of waking up every two hours I’m sleeping better but still wake up at 4 am and can’t get back to sleep. GABA hasn’t helped. What can I take to get back to sleep and what are your thoughts on Seriphos Phosphorylated Serine? I think my anxiety has to do with my adrenals because I wake up in a sweat and am way past menopause.

Since she is seeing a big difference with tryptophan and timed-release melatonin, low serotonin is the likely root cause of her insomnia or at least one of the root causes. We always want to capitalize on what is already working. Too many people don’t see expected results with 1 x 500mg tryptophan at bedtime and 1mg timed-release melatonin and start looking for other solutions when the answer may be right in front of them.

Here are the steps I’d follow with a client with similar sleep challenges:

  • Try more tryptophan, increasing it slowly over the course of a few weeks in the hope that it more will provide more serotonin support. This is what I call an amino acid trial where you rate and log your improvements as you incrementally increase – with the goal of finding an optimal amount for your needs. We all have different needs and post menopause it’s not uncommon for women to experience anxiety, depression and insomnia related to low serotonin and fluctuating sex hormones. We also always want to capitalize on what is already working.
  • Also, to add to what’s working, add tryptophan mid-afternoon if it’s not already in place. When someone scores high on the low serotonin questionnaire the typical timing of tryptophan is mid-afternoon and an hour before bed (always away from protein). Serotonin levels start to decline mid-afternoon hence the benefits of a mid-afternoon dose. Start low and increase slowly.
  • I would also suggest trying the tryptophan opened up (at both times) to see if this makes a difference.
  • Taking a tryptophan at the 4am waking can help you go back to sleep so this is worth trying. For some people 500mg at 4am is too much and using 125mg or 250mg works well. You determine the amount based on how you feel when you do get up. If you were able to go back to sleep easily buy wake groggy then it’s too much.
  • Some people are reporting better results with Lidtke Tryptophan Complete (which has all the co-factor nutrients) so this may be worth trialing too. I’d start by adding to what is already in place.
  • If we get benefits with any of the above by are not quite there then I would suggest additional timed-release melatonin until sleep improves.

This is always done slowly and methodically over the course of a few weeks. I always have my clients carefully log what they try and what is working and not working.

Other factors we’d make sure are addressed:

  • What GABA was used, was it trialed (starting low and increased) and was it used sublingually?
  • Is high cortisol at night a factor? Doing an adrenal saliva test will provide the answer. If it is then the Interplexus Seriphos is the best for lowering it. It’s best to take 1-3 x Seriphos about 2-3 hours before the high cortisol.  [UPDATE: INTERPLEXUS SERIPHOS WAS REFORMULATED IN 2016 – PLEASE SEE BELOW FOR MORE ON THIS]
  • Is gut health a factor? Look into SIBO, gluten sensitivity, other food sensitivities, dysbiosis and parasites (which are often active in the early hours and can cause night sweats)
  • Is there a sex hormone imbalance? Even with someone way past menopause, the night sweats mean this should be ruled out. The addition of amino acids starts to balance the hormones but more support may be needed.  
  • Is any caffeine (even decaf) still being consumed?
  • Is blood sugar stable? Make sure to have breakfast with animal protein and healthy fats and the same at each meal and for snacks. Consider a trial of glutamine during the day and just before bed for added blood sugar stability
  • Are medications a factor? Current medications or prior use of benzodiazepines or SSRIs can affect sleep even long after they have been tapered.
  • Is sleep apnea a factor?

We also address all the usual sleep hygiene factors: dark room, cool room, quiet room, no cell phone or clock radio on the bedside table, no late night computer use and getting some early morning light.

Many essential oils can provide added benefits when diffused at night or mixed with a carrier oil and used topically. One lovely combination I share on the Essential Oils Revolution 2 (happening now) is lavender, roman chamomile and neroli which helps both insomnia and anxiety.

There can be many other possible root causes of insomnia: autoimmunity, Lyme disease, pain, past trauma or grief and even genetic polymorphisms, all covered on the recent Sleep Success Summit.

Have you used tryptophan or other amino acids like GABA (for the more physical tension) and melatonin to reduce or eliminate early morning waking episodes?

If you’re a practitioner, have you helped your clients/patients with this methodical approach?

What else has helped you?

Update August 27, 2016 : INTERPLEXUS SERIPHOS HAS BEEN REFORMULATED -I am doing research to find suitable alternatives. For now, feel free to read through the comments below for discussions about this.  Once I have some useful information I’ll create a new blog post. 

Update November 18, 2016: Here are some possible alternatives to Seriphos

Update January 20, 2017: The Original Formula of Seriphos has been reintroduced you can read more about this here