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nutritional psychiatry

Tryptophan supplementation for anorexia?

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tryptophan and anorexia

This blog post highlights the potential importance of tryptophan supplementation in improving therapeutics in anorexia (and other eating disorders) and some of my insights about the 2017 anorexia-tryptophan study. I also share the high incidence of eating disorders, overlaps with anxiety and the case for tryptophan supplementation given the many low serotonin symptoms (anxiety, obsessive thoughts/behaviors, perfectionism, negative-self-talk, low self-esteem and depression) we see with anorexia and other eating disorders.

According to The National Eating Disorders Association (NEDA), eating disorders are

serious but treatable mental and physical illnesses that can affect people of all genders, ages, races, religions, ethnicities, sexual orientations, body shapes, and weights. National surveys estimate that 20 million women and 10 million men in America will have an eating disorder at some point in their lives.

While no one knows for sure what causes eating disorders, a growing consensus suggests that it is a range of biological, psychological, and sociocultural factors.

While NEDA does acknowledge that some of the causative factors may be biological, unfortunately there is no mention of nutritional psychiatry or tryptophan on the site. You’ll see this to be the case in the majority of conventional treatment centers.

The 2017 paper on tryptophan potential for anorexia

The paper, Improving therapeutics in anorexia nervosa with tryptophan, does acknowledge that the “growing body of evidence suggests that our diet is an important contributing factor in the development, management and prevention of a number of psychiatric illnesses.”

It discusses what we know about tryptophan being “the sole precursor” of serotonin, a neurotransmitter and that when used as a supplement it has therapeutic benefits when serotonin is low.

The author proposes that excessive dieting and food restriction decrease brain tryptophan and serotonin and propose the “potential importance of tryptophan supplementation in improving therapeutics in anorexia patients” (together with psychotherapy).

Given that anorexia has the “highest lethality of all psychiatric illnesses” and that there are currently “no FDA approved pharmacological treatments available” for anorexia, the urgency for implementing nutritional psychiatry approaches is high. The authors also share that the antidepressants and antipsychotics which are commonly used to treat the co-occurring anxiety, depression, OCD and psychosis are not very effective.

The author mentions a paper that used 250 mg tryptophan twice a day times a day but based on my work with individuals with anxiety, we know an individualized approach is best.  A typical starting dose of tryptophan is 500mg used once or twice a day and I use the trial approach to determine the ideal dose for each person.

Incidence of anorexia and eating disorders in general

Here are a few select anorexia and eating disorder statistics from NEDA. I find much of this alarming and in some cases surprising (like the high incidence of males who are affected):

  • 40% to 60% of elementary school girls (ages 6-12) are concerned about their weight
  • 2% to 13% of adolescent girls meet the criteria for eating disorders
  • Males represent 25% of individuals with anorexia (they are at a higher risk of dying because they are often diagnosed later since many people assume males don’t have eating disorders)
  • Male athletes, especially those competing in sports that emphasize diet, appearance, size and weight, are at risk. In weight-class sports (wrestling, rowing, horse racing) and aesthetic sports (bodybuilding, gymnastics, swimming, diving) about 33% of male athletes are affected. In female athletes in weight class and aesthetic sports, disordered eating occurs at estimates of up to 62%.
  • In one study of ultra-Orthodox and Syrian Jewish communities in Brooklyn, 1 out of 19 girls was diagnosed with an eating disorder, which is a rate about 50 percent higher than the general U.S. population.
  • Despite similar rates of eating disorders among non-Hispanic Whites, Hispanics, African-Americans, and Asians in the United States, people of color are significantly less likely to receive help for their eating issues.
  • Elevated rates of binge-eating and purging by vomiting or laxative abuse was found for both males and females who identified as gay, lesbian, bisexual, or “mostly heterosexual” in comparison to their heterosexual peers.
[You can find the actual stats and studies quoted above at the NEDA stats link.]

 

Prevalence of anxiety and making the case for low serotonin

The prevalence of anxiety is high in those with eating disorders (which is one of the reasons for this particular blog):

  • Anxiety is also diagnosed in 48-51% of people with anorexia nervosa, 54-81% of people with bulimia nervosa, and 55-65% of people with binge eating disorder
  • Two-thirds of people with anorexia also showed signs of an anxiety disorder several years before the start of their eating disorder.

In one study, after dietary treatment (called refeeding), plasma tryptophan levels normalized in patients with anorexia:

Disturbance in serotonin function has been described as central to the psychobiology of this disorder 

Plasma TRP normalizes during the course of refeeding, supporting the hypothesis that serotonin function is disturbed in patients with anorexia nervosa.

We also see a large number of low serotonin symptoms in those with eating disorders:

  • Childhood obsessive-compulsive traits, such as perfectionism, having to follow the rules, and concern about mistakes, were much more common in women who developed eating disorders than women who didn’t.
  • Binge eating disorder patients … also had significantly higher levels of negative affect, and lower self-esteem
  • In a study of women with eating disorders, 94% of the participants had a co-occurring mood disorder
[You can find the actual stats and studies quoted above at the NEDA stats link.]

There are all classic low serotonin symptoms: obsessive thoughts/behaviors, perfectionism, negative-self-talk, low self-esteem and depression.

This further supports the rationale for tryptophan supplementation and is another reason for this blog. I have extensive experience in the use of tryptophan and 5-HTP and believe they should be part of all eating disorder programs.

There is one big difference in that typically we see afternoon and evening sugar and carb cravings with low serotonin-type anxiety. Whereas with anorexia, the low self-esteem, obsessive thinking and body dysmorphia (feeling shame or disgust with parts of their body or appearance) may prevent someone acting on these cravings. However, if there are sugar and carb cravings (and bingeing), this is the time they will typically occur.

Here are two recent blog posts that share case studies where tryptophan was used with success:

Anorexia and other eating disorders require a multidisciplinary team

I don’t currently work with clients with anorexia as it requires a multidisciplinary team. I did, however, work with a few clients with anorexia when I worked at Recovery Systems over 10 years ago. They had a therapist, nutritionist and doctor on their team and a nutritional approach led to more improvements than they had experienced at prior in-house eating disorder clinics where they had received psychological support only or psychology and medication. Our approach included addressing low serotonin with tryptophan or 5-HTP, addressing low zinc, addressing the gut/microbiome, low B vitamins, low omega-3 fatty acids and more (based on the unique needs of the client).

I now refer eating disorder clients to Dr. James Greenbatt, MD, an eating disorder specialist and integrative psychiatrist. He has a wonderful book on the topic: Answers to Anorexia – a Breakthrough Nutritional Treatment That is Saving Lives, with the second edition coming out soon. In the first edition he does address neurotransmitter deficiencies but we differ in our approach.  He doesn’t use individual amino acids like tryptophan or 5-HTP and prefers to use a blend of amino acids based on a blood or urinary amino acid test.

In this article, New Approaches to Treating Anorexia, Dr. Greenblatt covers the multidisciplinary aspect, current treatment options, the limited medical options and the need for targeted nutrition therapy. Although this article doesn’t address tryptophan and low serotonin, he does discuss the key role of zinc, B vitamins and omega-3 fatty acids.

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

If you are new to using the amino acids tryptophan/5-HTP, GABA or  tyrosine as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see the low serotonin symptoms here) and a brief overview here, Anxiety and targeted individual amino acid supplements: a summary.

If you suspect low serotonin or 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 so you are knowledgeable. And be sure to share it with the team you or your loved one is working with.

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 acid products that I use with my individual clients and those in my group programs.

Have you (or a loved one) been diagnosed with anorexia or another eating disorder?

Did you see the most success with an approach that included nutritional psychiatry and serotonin support with tryptophan or 5-HTP?

What else has helped?

Feel free to post any questions here too.

Swings are fun for teens, college students and adults! And they reduce stress/anxiety, and improve mood, memory and PMS symptoms

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swings for anxiety

Earlier this month I met up with a dear childhood friend for a walk and catch-up and we both rediscovered the joy of swings. I always suggest a walk or hike or swim when meeting with friends and colleagues, and this time was no different except that I really wanted to go somewhere with a swing!

The reason that I wanted to find a swing set was because I had just read an article about swings and teen girls needing a better place to hang out. I love the outdoors and love to play, laugh and have fun, and I couldn’t resist it once I started looking at the research. I discovered all the wonderful benefits of improved mood, reduced anxiety and stress, improved cognition and memory, reduced PMS symptoms, improved social relationships and reduced pain.

These pictures are us swinging and catching up – we laughed and laughed and had such fun!  It’s hard to believe we’ve been friends for close to 50 years and it always feels like we were never apart when we do get together.

swings

Our swing experience made it extra special this time! You can see the pure joy on our faces!

Teen girls needing a better public space to hang out

The recent Bloomberg article I had read, Teen Girls Need Better Public Spaces to Hang Out shares this:

Making space for girls means rethinking which age groups need to swing and climb, how to encourage physical activity (and not just playing a sport), and how to make a safe, sheltered place for outdoor conversation.

And this about movement:

While lack of activity among teens is a major public health issue, many girls are looking for more creative, less competitive ways of moving their bodies.

It features really cool images of swings called “Swing Time.” They are designed by Höweler + Yoon Architecture and deliver “the kind of fun, physical outdoor experience with room for face-to-face conversation that many teen girls are looking for.”

As I mentioned above, I was immediately intrigued because I love the idea of outdoor play and social interaction in a safe place for young girls.

Beth Jones, a Mindset and Wellness Coach who works with teen girls and their moms incorporating movement, play and nutrition, posted the Bloomberg article on Facebook saying:

I love this idea so much. I used to love going to the playground in my teens to swing, hang out, just have a space for me. There’s a reason why my business logo has a girl on a swing. That swinging and twisting are also so great for the vestibular system and can help calm anxiety (the back and forth swinging). Maybe they should bring back some swings to middle and high schools.

I’m familiar with the use of swings in occupational therapy to address sensory processing disorders in children. But I was also very interested to know if there was any research on the health benefits of swings for teens and adults. I went searching and was very pleased with what I found, hence this blog post.

Before we get into the research I’d like to extend a big thanks to Beth Jones for the inspiration for all this! Now the research …..

PMS symptoms improved: mood, stress, anxiety, social relationships, pain and memory

This small study, Vestibular stimulation for management of premenstrual syndrome found the following benefits after 2 months of using the swing in females 18-30 years of age:

  • Depression and stress scores decreased
  • Anxiety scores decreased (although it was not statistically significant)
  • Serum cortisol levels decreased.
  • Social relationships improved
  • Systolic blood pressure decreased (there was no change in diastolic blood pressure and pulse rate)
  • Pain levels decreased
  • Spatial and verbal memory improved

These are amazing benefits using something as simple as a swing. I feel we could safely extrapolate to younger teen girls and even women above 30 years of age too.

Swings for stress management in college students

Vestibular stimulation using swings is the specialty of Dr. Mukkadan, Founder and Research Director of Little Flower Medical Research Centre in India. Together with his team, he published the above PMS paper and this paper on Vestibular Stimulation for Stress Management in Students.

They recommend “placement of swings in college campuses … which may be a simple approach to alleviate stress among college students.”

This is such a simple and yet powerful (and also fun!) intervention especially given the huge rise in anxiety and mental health issues in students. It would be a perfect approach to use in conjunction with amino acid supplements and nutritional psychiatry for these students.

According to another study published by his team, college students will also see improved spatial and verbal memory.

What about swings for teen boys and all adults too?

Once I saw the images in the Bloomberg article, and after reading the research, and after playing on swings again after all these years, my thinking started expanding. I believe everyone could benefit from using a swing.

I certainly wanted to swing right away (hence the walk and swing meet up with my friend a few weeks ago) and now seek out swings when I go for walks. I would love to see an area set aside in parks for teen girls (and boys too) and as Beth says, in middle and high schools too. And how about a designated area in parks for adults who want to swing too?

There are now parks with Liberty swings for children and adults in wheelchairs. The vestibular benefits of rocking chairs are helping veterans dealing with substance abuse and mood issues. I also see an application for stress reduction in the workplace. The opportunities are endless.

Here are some of my recommendations:

  • Seek out swings in parks. Give it a try to see how you feel and how much you enjoy it!
  • Advocate for swings in your communities, middle schools, high schools, colleges and place of business.
  • Get a rocking chair for yourself and/or older family members
  • Get a swing for your backyard (suitable for teens and adults). I’m looking into options for my backyard and will share more once I find some suitable options.

When did you last go for a swing as an adult? How much fun was it!?

If it’s been some time, does this – my pictures and the research – inspire you to want to look for a swing and have a go again?

Does your teen or college student seek out outdoor play like swings and see benefits?

If you are an OT/occupational therapist or exercise physiologist or other health professional using vestibular therapy with swings please do share so we can all learn.

Feel free to post any questions here too.

Rage, anxiety, cravings & insomnia in 11-year old girl with RAD/reactive attachment disorder: chewable tryptophan turns things around

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rad and tryptophan

Today I’m sharing the case of an 11-year-old girl who had huge rage issues, was angry much of the time, suffered from terrible anxiety, had crazy sugar cravings (for bread and colored candies) and had dreadful insomnia. Because of the insomnia she was also very fatigued and this likely drove some of her cravings and irritability too. She was adopted and had been diagnosed with RAD (reactive attachment disorder). During our first session, chewable tryptophan turns things around quickly – she smiles and is willing to make changes and quit the sugar and gluten. We also address low iron levels and with these 4 nutritional interventions this child’s behavior improves dramatically.

This book chapter, Reactive Attachment Disorder, states how The Diagnostic and Statistical Manual 5th Edition (DSM-5) classifies reactive attachment disorder as follows:

a trauma- and stressor-related condition of early childhood caused by social neglect or maltreatment. Affected children have difficulty forming emotional attachments to others, show a decreased ability to experience positive emotion, cannot seek or accept physical or emotional closeness, and may react violently when held, cuddled, or comforted. Behaviorally, affected children are unpredictable, difficult to console, and difficult to discipline. Moods fluctuate erratically, and children may seem to live in a “flight, fight, or freeze” mode. Most have a strong desire to control their environment and make their own decisions. Spontaneous changes in the child’s routine, attempts to discipline the child, or even unsolicited invitations of comfort may elicit rage, violence, or self-injurious behavior.

Reactive attachment disorder/RAD and low serotonin

There is no research on tryptophan helping to address RAD symptoms or trauma, but based on her low serotonin symptoms, a trial of tryptophan was the first thing I considered.

There is, however, evidence to indicate the role of low serotonin in RAD, as indicated by a study where antidepressants were successfully used. The authors mention how:

The absence of responsive and consistent caretaking can subject the developing brain to an inordinate amount of physiological stress, leading to increased cortisol production and consequential inefficiencies in the serotonin and the growth-hormone releasing systems.

Although not specific to RAD, another paper looking at trauma states that:

Serotonin and dopamine levels were found to be abnormal in the presence of PTSD.

As the field of nutritional psychiatry grows, I expect to see more and more research supporting the use of tryptophan and other amino acids for those suffering from symptoms like this. Symptoms that are caused by imbalances that are triggered by the trauma in their lives.

We know that therapy, EFT, EMDR and other approaches are crucial for trauma recovery (this family had already done some of this work) but we must start to incorporate nutritional support too.

The case study

Here are the details of this case study and the nutritional interventions. As I mentioned above, because of her severe rage episodes, a trial of tryptophan was the first thing I considered:

She was referred to me by a friend. The family didn’t have much money. And so, we had to really try and figure out a few simple interventions that we could use that were going to be effective.

This young girl had been adopted. She was diagnosed with reactive attachment disorder and her anger issues were just phenomenal. The mom had to physically put her body around her and hold her down when she was having one of her fits because she was worried that she was going to hurt herself and hurt other people.

She also had anxiety, huge cravings for colored candies and insomnia. She was so fatigued because she wasn’t sleeping well.

So sitting in my office with this young girl and her mom, we started to talk about the sweets and the candies and the need to give up the candies. She was fuming with me. She was sitting in a swivel chair. She turned her back on me and didn’t want to talk about having to give up candy at all.

I said, “Look, let’s not even talk about that, but would you take this chewable tryptophan here? And we’ll talk about it in a second.” I gave her 100 mg of the chewable tryptophan and continued discussing things with her mom.  She had no idea what it was going to do or how it would make her feel.

Within five minutes she turned her chair back, looked at me and she said, smilingly, “Yes, let’s do it. I can give up the candy.” She was smiling and she was happy.

So long story short, with this young girl, we started her on [chewable] tryptophan [and it turned things around quickly].

Chewable tryptophan – when I use it and when I don’t

I typically use 500mg Lidtke tryptophan for the adult clients I work with and prefer this company’s product because it is really high quality. It really does work better than many other tryptophan products on the market.

Lidtke also makes a chewable 100mg tryptophan which is also high quality, and the product I used with this young girl. Here are some benefits of this 100mg product:

  • It’s useful for doing the initial trial in order to figure out if tryptophan is going to help with low serotonin symptoms in children – because it’s a lower dose.
  • It’s especially useful for children for ongoing use (typically midafternoon and evening) because it’s a lower dose.
  • It’s also useful for adults who are “pixie dust” folks and do better with a lower dose of supplements in general or respond more severely to medications/alcohol/chemicals. We may start with a trial of the 100mg chewable and increase from there, also typically midafternoon and evening.

I don’t use the chewable 100mg tryptophan under these circumstances:

  • When the child (or adult) finds that 5 x100mg works for them at each time they need it. In this instance it’s best to switch to a 500mg tryptophan. Using it swallowed may work or it may need to be opened onto the tongue.
  • When the child (or adult) starts to consume the chewables like candy. They are sweet and do taste good and I’ve seen this happen. Because you are continually consuming something sweet you may end up over-consuming them if sugar addiction is one of your issues. You may also end up taking too much tryptophan.

If the chewable tryptophan is not available where you live, using a small amount of a powdered tryptophan or opening a capsule of the 500mg tryptophan is an option. Since it tastes bitter it can be mixed with mashed banana or inositol. (You can find all the Lidtke products in my online supplement store. The link is in the resources section below.)

Gluten and candies were also a huge issue, and she had low iron

There was more to her issues than only low serotonin:

Gluten was also a huge issue, so we got her off gluten and the candies. The tryptophan helped with this” (i.e. it made it easy to break the addiction and not feel deprived).

Tryptophan also helped her sleep. And it helped with the severe rage issues.

Obviously the gluten was contributing to the rage issues as well.

Her iron and ferritin levels were really low (possibly as a result of her gluten issues). So we added an iron supplement, and animal protein/red meat.

So with just four interventions – the gluten, the animal protein, getting her iron levels up and the tryptophan – this kid was just a new kid.

Here are some articles that are related to the above:

Keep in mind there is not a one-size-fits-all and these 4 simple nutritional interventions – tryptophan, gluten removal, adding red meat and addressing low iron – happened to be the combination that worked for this young girl.

Resources if you are new to using tryptophan as a supplement

If you are new to using the amino acid tryptophan as a supplement, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution and a brief overview here, Anxiety and targeted individual amino acid supplements: a summary.

If you suspect low serotonin symptoms 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 so you are knowledgeable.

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 Lidtke chewable tryptophan 100mg, Lidtke tryptophan 500mg and other products that I use with my individual clients and those in my group programs.

We use an amino acid like tryptophan for quick relief of symptoms, like I did in this instance. Then we focus on the foundations like diet – like no gluten and red meat in this instance – and address all other imbalances, like her low iron. If cortisol was high we would have addressed that.

This case deserves it’s own blog post

In case you’re wondering, I first shared this case study in my interview, “Calming Anxiety, Aggression and OCD with Amino Acids and Food”, on The Unlocking ADHD and Autism Summit (it starts next week and airs online May 31 – June 6, 2021.) Due to the interest in this case and the use of chewable tryptophan, I felt it deserved a deeper dive and its own blog post with links to some of the research and some practical information about the chewable tryptophan.

Have you used this chewable tryptophan product with success – personally, with your child or with a patient/client?

Have you found that addressing serotonin with tryptophan (or 5-HTP) helps resolve symptoms in a child diagnosed with RAD or a child with rage issues? What about helping with sleep problems, easing anxiety and stopping cravings too?

Have you addressed low iron levels and seen improvements with the removal of gluten too.

Feel free to post your questions here too.

 

[The above statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.]

Huge rise in anxiety in college students (and other mental health issues): amino acid supplements and nutritional psychiatry as a solution.

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anxiety in college students

Is your son or daughter finding college/university overwhelming? Is he or she battling with new or worsening anxiety, worrying about results, has fears about success or fitting in, lying awake imagining the worst outcomes or maybe feeling like a perfectionist and getting stuck? Perhaps they have poor self-confidence, feel like an imposter and may even have panic attacks.  These signs and symptoms are all common with the low serotonin-type of worry-in-the-head anxiety, which may also include PMS (premenstrual syndrome), obsessive tendencies and anger issues.

They may also be experiencing the low GABA type of tension-anxiety, where they lie awake at night stiff and tense and self-medicate with too much sugar, carbs, junk food and/or alcohol (and maybe even pot and other drugs). There may be intrusive thoughts too and panic attacks also triggered by low GABA.

What about focus issues/ADHD and low motivation, no ability to follow-through on tasks and projects, procrastination and missing deadlines? These are all classic signs of low catecholamine, which also includes low energy, and feeling depressed/sad/low/flat. Your son or daughter may just want to crawl up in their dorm bed and not do anything or may spend hours doing mindless activities like binge watching Netflix or scrolling mindlessly through social media.

All of these signs and symptoms point to low levels of neurotransmitters or brain chemicals: low serotonin, low GABA and low dopamine. We need the right raw materials to make these neurotransmitters and the majority of college cafeterias are not providing nutrient-dense foods and/or foods that are unique for each person’s biochemistry (more on this below).

The huge rise in anxiety and other mental health issues in college students

It’s no wonder that we are seeing a huge rise in anxiety and other mental health issues in college students. Way too many students are dropping out and so many are struggling unnecessarily.

This 2019 Harvard blog post shares some alarming stats:

Anxiety in college is very common. According to the American College Health Association Fall 2018 National College Health Assessment, 63% of college students in the US felt overwhelming anxiety in the past year. In the same survey, 23% reported being diagnosed or treated by a mental health professional for anxiety in the past year.

This article in Nature earlier this year, The problem is greater than it’s ever been’: US universities urged to invest in mental-health resources, highlights points from US National Academies of Sciences, Engineering, and Medicine report:

  • 68% of university presidents listed student mental health as one of their most pressing issues
  • the dropout rate for students with diagnosed mental-health problems ranges from 43% to as high as 86%
  • The students who said that they had more trouble with anxiety or depression after the lockdown also reported greater alcohol use

It states that faculty members should “receive formal training to address and support student well-being” and “students should learn about mental-health issues as part of their introductory training.” They also say “Hiring more counsellors could be an important step, but counsellors alone can’t turn the tide.” I agree with all this but recommend adding nutritional psychiatry awareness, training and resources too.

Poor diet and nutritional deficiencies are a major contributing factor even though it’s seldom discussed. The good news is that there are relatively simple solutions – amino acids as supplements for quick relief and diet as the foundation – but it does take work.

Using amino acids as supplements for quick relief

Amino acids, used as supplements, are a quick way to offer immediate relief of symptoms:  tryptophan or 5-HTP (for the low serotonin worry-type anxiety), GABA (for the tension-type anxiety) and tyrosine (for the low dopamine poor-focus and low symptoms). Here are some examples:

  • A 23-year-old female college student, adopted and exposed to alcohol while in the womb, has some learning struggles. She doesn’t want to miss a day of taking 5-HTP, because she says that “it keeps her on her toes,” which she says means that it “keeps me focused,” when studying.
  • Tyrosine helped a young man who was learning new software: “Within an hour the stress just melted away!”, alleviating his anxiety and panic attacks and creating a feeling of calm focus.
  • A newly qualified nutritionist shared how she suffered badly from imposter syndrome at the end of her nutrition degree and she felt socially awkward in so many outings and situations. Her anxiety and stress were through the roof and her sleep was poor. She said these wonderful results: “What really tipped the balance was the supplementation of tyrosine, tryptophan & GABA.”

If you are new to the amino acids, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution and additional information on Anxiety and targeted individual amino acid supplements: a summary

This lists The Antianxiety Food Solution Amino Acid and Pyroluria Supplements that I use with my individual clients and those in my group programs.

We use the amino acids for quick relief of symptoms and then focus on the foundations like diet and address other imbalances.

Diet as the foundation for students i.e. nutritional psychiatry

I first blogged about nutritional psychiatry in 2015 when the ISNPR position statement was published in World Psychiatry, the official journal of the World Psychiatric Association. This 2019 paper, Nutritional psychiatry: Towards improving mental health by what you eat provides an overview of the emerging field of nutritional psychiatry:

Does it matter what we eat for our mental health? Accumulating data suggests that this may indeed be the case and that diet and nutrition are not only critical for human physiology and body composition, but also have significant effects on mood and mental wellbeing. While the determining factors of mental health are complex, increasing evidence indicates a strong association between a poor diet and the exacerbation of mood disorders, including anxiety and depression, as well as other neuropsychiatric conditions.

The 2017 SMILES Trial is the first randomized controlled diet depression study and ONE THIRD of the dietary intervention group saw improvements in their depression symptoms.  This was just diet alone and switching from processed/junk food to real food with no specific dietary restrictions. Participants also reported improvements in anxiety symptoms. And the authors even addressed the cost factor, stating it was more affordable to eat this way.

Research supports this connection in college students. This is one of a growing number of studies, Eating behavior and relationships with stress, anxiety, depression and insomnia in university students, that concludes that:

unhealthy eating patterns are common in university populations and are related to anxiety, stress, and depression. Educational interventions to reduce unhealthy food consumption in university students can also result in psychological health improvements and/or vice versa.

Unfortunately, as students get more anxious and depressed their food choices get worse (especially for male students) and it becomes a vicious cycle. This paper, Examining the Role of Anxiety and Depression in Dietary Choices among College Students, reports:

Overall, a decrease in total caloric intake and an increase in sugar consumption were found as self-reported symptoms of anxiety and depression increased. In addition, there were sex differences in the relationship between depression and food choices. Men consumed more saturated fat as well as less fruits and vegetables as self-reported symptoms of depression increased. Results suggest symptoms of depression are a greater risk factor for poor nutrition in male college students than females.

It’s time for colleges/universities to recognize all this and teach about nutritional psychiatry. My book, The Antianxiety Food Solution is an excellent starting point for students, parents and educators (together with other blogs on this site).

Checking out cafeterias and cooking options

When looking at colleges are you also looking at what the cafeteria offers and if they cater for special diets (like gluten-free, dairy-free, Paleo etc) and/or offer real whole food, organic vegetables and fruit, grass-fed meat, wild fish and fermented foods?

Can students use a slow cooker, blender, Instant Pot or electric frying pan in their dorms?

Is there a dorm kitchen and can they take their own pots and pans (so non-stick pans can be avoided) and any of the above appliances?

Are there nearby living options that include a kitchen and a store with quality food for purchase?

I feel colleges/universities should be rated on all of the above in addition to everything else.

It all starts at home before they leave for college

Having a good college cafeteria and dorm kitchens is one step in the right direction, but these young adults also need to understand the impact of a breakfast of bagels and coffee or not having breakfast or the fact that gluten may trigger a panic attack and make them sad. They need to know how to shop and cook if there is a shared dorm kitchen or apartment. And they need to make the right choices when they do eat in the cafeteria or nearby restaurants (assuming good options are available). This all starts at home with you before they leave for college.

Katie shares this about her daughter who plans to use the college cafeteria for some meals and also cook in the apartment kitchen on weekends:

My daughter was just saying today how glad she is that she doesn’t have to figure out [the connection between increased anxiety, fatigue, brain fog, sadness and what they are eating] while learning how to live on her own and go to college. I changed how I ate 8 years ago for my PCOS and about 3 years ago she decided to give it a try after feeling so horrible but seeing my change. I’m so proud of her for embracing a healthier lifestyle in her teen years when everyone around her is subsisting off energy drinks and vending machine food. It makes me think that if we offer them a little education, they’ll make good choices for themselves.

This mom can also feel proud that she led by example for her daughter (and I appreciate them for letting me share here).

But I believe the colleges need to play a role in this too. They are providing food and this is a perfect educational opportunity that will serve their students (and future generations), solve the mental health crisis they are struggling with and prevent drop-outs (which is having an impact on their bottom-line).

Do you believe colleges/universities should be rated on all of the above in addition to everything else? What have you done to check out cafeterias and cooking options for your daughter or son?

Has your son or daughter benefited from any of the amino acids or eating real whole food (and according to their own needs?

Do you work in a college and are you seeing this rise in anxiety and depression? If yes, how do we get these changes implemented?

How do we educate students once they are at college (other than making sure campus food is excellent):

  • a lifestyle/diet/anxiety app with resources and tracking?
  • online training with a nutritionist/coach and access to an online forum and live Q&As?
  • one-on-one campus nutrition coaches?
  • make nutritional psychiatry part of the curriculum?
  • produce a documentary following the lives of students on campus and showing the transformation they experience?

Feel free to post your questions and ideas here too.

[The above statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.]

I was called a vulture for preying on sensitive people in a social anxiety group – because I mentioned pyroluria and a nutritional solution

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I was called a vulture

Earlier this week I was called a vulture for preying on sensitive people in a social anxiety group because I mentioned pyroluria and a nutritional solution in response to someone asking for help. I shared much of this on Facebook and the response has been huge – supportive, understanding and encouraging, and also something many of you have also faced and can relate to. I’m publishing it as a blog post too because I feel there are many takeaways and lessons we can all learn from this.

The person asking for help posted this:

I’m seriously stuck. I’ve been battling social anxiety disorder my whole life. I feel like my social skills have gotten worse during 2020-2021. Is anyone the same way? And If possible can anyone give me some good advice?

I posted this in response to the request for advice:

Look into pyroluria and the nutrient protocol – life-changing for me (and my clients – disclaimer: I’m a nutritionist)

And this is the response from someone else in the group:

So not medicine. I think as a nutritionist you shouldn’t be advising people to avoid actual medical help. Foods can’t help but most depression and anxiety isn’t stress based. It’s a biological chemical imbalance. Food won’t help it in the long run. As someone who’s had bipolar, depression, anxiety, social anxiety, insomnia and possible schizo. I have known people to get seriously ill from people that couldn’t manage to be actual doctors. I’ve lost a friend due to them being advised to stop meds and take some herb. Please unless you are actually here because you have social anxiety and such. Could you please leave and stop acting like a vulture over the sensitive people.

I get that it can be tough to grasp that nutrition and nutrients could be a solution for social anxiety but even with a response like this I will continue to share my message.

This was my response:

Correct, not medicine … nutrition. I had social anxiety and panic attacks and diet (gluten-free, caffeine-free, sugar-free etc) and nutrients like zinc, vitamin B6, GABA, tryptophan and more solved my anxiety. I’m passionate about creating awareness because I’ve seen “nutritional psychiatry” work for 100s of thousands of folks.

Please be open-minded … and google “nutritional psychiatry”, “gut-brain”, “pyroluria social anxiety” and “gluten schizophrenia” … you will be pleasantly surprised. It’s going to take some time for all this to be part of mainstream psychiatry but it’s in the research and awareness and acceptance is growing.

I’m sorry about your loss but I would never advise anyone to stop taking their meds. For folks who want to explore this approach we always work in conjunction with their prescribing doctor.

It’s also not very nice calling someone a vulture but I understand that the idea that food and nutrients could be so powerful when it comes to anxiety and mental health can be tough when you first hear about it.

Why I’m sharing this – it’s not for sympathy or to call this person out

I’m not sharing this here for sympathy.

I’m not sharing this to call out this person who called me a vulture or to judge or shame them.

I’m sharing it to illustrate the challenge we have with getting this message out.

I’m sharing it in case you’ve tried to tell a loved one or friend or colleague about the power of anxiety nutrition solutions and have had push-back.

I’m sharing here so we remember to have empathy for someone who doesn’t yet know or understand what we have learned and experienced (no matter what they say or how they say it or even if they have even been preyed on in the past so a comment like this may be justified in their mind).

I’m sharing here because I truly believe in the power of planting seeds of knowledge.

I’m sharing here because I believe everyone deserves to feel their absolute best every single day.

I’m sharing here because everyone struggling with anxiety and social anxiety deserves to know about the growing field of “nutritional psychiatry” in mainstream medicine.

This is why I’m sharing here and why I’ll continue to share nutritional solutions in groups where folks are asking for help for social anxiety, anxiety and panic attacks (and other conditions where pyroluria and neurotransmitter imbalances are common, and there is a role for diet and nutrients).

Why the disconnect and the possible role of neurotransmitter imbalances

I’m hoping all this can help you as you reach out and offer support to someone in an online group. And also help you as you share what you have learned or experienced personally when it comes to nutritional solutions for social anxiety/anxiety – with loved ones, community members, friends and colleagues who are sometimes less than receptive.

I suspect one big disconnect is comprehending that lifestyle/diet/nutrients could help with anxiety and mental health challenges. Heart disease, diabetes, high blood pressure and cancer are more recognized as being lifestyle conditions even dietary and lifestyle changes are not always implemented.

I also often hear this: “my anxiety or social anxiety or panic attacks are so severe (or so complex) there is no way nutrients and nutrition could help! I need medications for sure.”

If someone has nutritional deficiencies or neurotransmitter imbalances, that may also be playing a role in how they respond. For example, low serotonin can make you feel hopeless, fearful, negative, overwhelmed and even angry. This is in addition to feeling anxious and not sleeping well, so you’re more likely to be cranky and irritable.

Links to resources for you to share

Here are links if you need some resources to share or in case you’re new to some of this:

Tamara’s wonderful feedback about gluten and vitamin D

This was Tamara Underwood’s response to my vulture post and her powerful feedback about gluten and vitamin D:

That was a thoughtful response Trudy. I think when people have complex health issues, they think the solution needs to be complex. I had no idea how powerful nutrients could be until it solved my own health issues. Often, it is returning to basics and using foundational support in a targeted way.

I’ve had chronic migraines (3-4 a week) since I was a toddler. Tried every medication, label and off label, to manage them for 40+ years. Removing gluten was life changing. I’ve been migraine free for 8 years now.

Also, about 10yrs ago, I experienced a very dark, unexplained depression for nearly a year. Of course drugs and therapy are the first line treatments. Not sure why I was opposed to starting there but thankful. My Vit D was 4.1. I felt so radically better within a week of starting repletion that I went back to school for my MS in Clinical Nutrition.

I think about how different life might be now, 10 yrs later, had I not pushed for testing. Psych meds wouldn’t have improved my Vit D so I would have been prescribed all the variations and combos and told how complex my case was when it didn’t help. [One study supporting an association between low vitamin D and depression]

There are just so many toxicities, deficiencies, and imbalances worth exploring if your mental wellness suffers. I’m passionate about this subject and a big fan of yours Trudy.

I’m thrilled that going gluten free and addressing low vitamin D solved her migraines and depression. It’s so wonderful to hear Tamara was inspired to go back to school to study nutrition. She now does this work helping professionals (firefighters, EMTS etc.) who shoulder a greater burden of stress and trauma. Check out Underwood Functional Wellness. I appreciate her for allowing me to share here.

I plan to update this blog with more of the wonderful insights from my community on Facebook but folks are still actively engaging and I need to get permission to share here. Stay tuned for more.  You can also join the discussion on the Facebook post here.

Until then, feel free to post your insights, thoughts, experiences (and questions if you have them) in the comments below.

Let us know how nutritional approaches have helped your anxiety and/or other health issues?

What made you open to this approach and were you initially skeptical?

And let us know if you continue to share your success and plant seeds even when you get negative feedback – and why? And do you have resources you like to share?

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.