osteoporosis

The marketing of Risperdal and how atypical antipsychotics became a multi-billion-dollar industry – a shockingly eye-opening article!

August 22, 2025 By Trudy Scott 2 Comments

Even though I’m very aware this happens, this shockingly eye-opening article by Lydia Green is the best explanation I’ve heard….

I didn’t set out to shape the field of psychiatry. I was just a copywriter working in pharmaceutical advertising. But over time, I found myself at the center of a campaign that would help transform how mental illness—and its treatment—are understood in the U.S. This is the story of how we marketed one drug, Risperdal, and how that effort helped turn atypical antipsychotics into a multi-billion-dollar industry.

If you’ve ever wondered how this powerful class of drugs ended up being prescribed for everything from adolescent mood swings to agitated nursing home patients, you’re not alone. The rise of atypical antipsychotics was a business and marketing phenomenon—driven in part by a wave of pharmaceutical mergers in the 1990s. First introduced for schizophrenia, atypical antipsychotics were promoted as more effective and safer than older drugs like Haldol or Thorazine.

While journalists and regulators have addressed this issue, I want to share my memories of marketing Risperdal—the first widely prescribed atypical antipsychotic. This is the story of how we promoted Risperdal not just as a medication, but as a revolution in psychiatric care. It’s also the story of how we redefined schizophrenia, rewrote the safety narrative of antipsychotics, and helped drive one of the most successful (and concerning) pharmaceutical launches in history.

It was also my first realization of the immense power marketers have to shape their version of the truth—and how I eventually came to question the very system I helped build.

This is an excerpt from the excellent article recently published on the Mad in America site. We all need to be aware what happened with this medication and is still happening. It’s so wrong and is just heart-breaking to think how individuals and their families were manipulated and impacted. Unfortunately it’s very likely also happening with many other block-buster medications too – like Ozempic (for weight-loss), Evenity (for osteoporosis) and more.

In this blog, I share stories from social workers and psychologists who were working in the field at time, the overprescribing of atypical antipsychotics to children and teens in the mid-1990s and now, and the powerful effects of tryptophan, GABA, other nutrients and diet for anxiety, agitation, rage and sleep issues in autism, dementia and ADHD.

You can read the full article here – Confessions of an Ad Writer: How I Helped Turn Atypical Antipsychotics into a Billion-Dollar Industry.

Be sure to read some of the many comments from individuals and families who bore the brunt of this. It’s heartbreaking.

Stories from individuals who were working in the trenches at the time

I shared this article on Facebook and here is some of the feedback I received from the community. Laura Ann’s response:

Thank you for sharing this article. I can remember when I was fresh out of my grad social work program and was working in child psychiatry at the University of Maryland, our docs were pushing this drug for young children with ADHD and conduct disorder. Unbelievable! These companies and their executives should be criminally prosecuted.

We tend to think of these scandals as something that happened but aren’t currently happening. I think we will be reading similar articles about GLP-1’s.

I appreciate her for sharing what she was seeing as a social worker at the time. This is so sad and so wrong. I agree that these companies should be prosecuted. Instead they pay massive fines which are part of their marketing and just-doing-business budget, and continue as before.

Unfortunately Laura Ann is spot on, as much of this continues with Risperdal and other psychiatric meds and it’s already happening with GLP-1s. I share more on this below.

Elizabeth Mary’s response:

Just reading your post gave me chills and made my stomach turn. I worked with folks with developmental disabilities during this time period, I had for years! I watched as the antipsychotics and various psych meds infiltrated the group homes and joined a team of co-workers to fight it. We lost. It was disgusting. And I had no idea all this was happening in the background

My heart breaks for these individuals and their families. Bravo to her for trying to fight it and I appreciate her for sharing what she saw happening.

And this feedback from someone else in the community:

This drug was pushed on individuals with ASD (autism spectrum disorder)! Probably still is! Very sad!

I am a retired psychologist who worked primarily with individuals with developmental disabilities. I saw it all the time. The “medical model” was used a lot, meaning many saw psychiatrists and/or PCPs (primary care providers) who prescribed these meds. It has a long history.

Overprescribing of atypical antipsychotics and other psychiatric medications to children and teens – then and now

As mentioned above, I’ve been aware for some time that there is overprescribing of psychiatric medications to children and teens. In one of my interviews on an Anxiety Summit, “Psychiatric Medications in Children and Teens” with Dr. Nicole Beurkens, we discuss these results from this 2019 paper, Current Pattern of Psychiatric Comorbidity and Psychotropic Drug Prescription in Child and Adolescent Patients:

Our study indicates that the rate of presentation to child and adolescent psychiatry outpatient clinics is increasing, and rates of diagnosis and initiation of psychiatry drugs are high among the presented children.
The prevalence of ADHD shows an increase in males and females in our country, and psychiatric polypharmacy (multiple medications) has reached significant rates.

Keep in mind that Lydia Green shared her marketing work began in the mid-1990s, about 25 years before the above paper was published.

Unfortunately not much has changed. This 2025 paper from Swedish authors reports that the “number of prescriptions to children aged 5-17 years has increased” and that “most prescribed drugs were risperidone [Risperdal] and aripiprazole.”

This 2025 paper report that in a group of Australian children with intellectual disability, autism spectrum disorder and cerebral palsy, “risperidone was the most prescribed antipsychotic medication” and it was often prescribed off-label.

Similar increases in antipsychotic prescriptions are also reported in children and teens in Israel in 2025. The list of papers goes on and on and there are similar papers for dementia and other conditions.

There are versions of this story about a lot of diseases: osteoporosis is another one

Melissa’s response to the Risperdal article was this: “Makes you wonder about therapies they are pushing today.” It’s creating awareness which is what we need and she is asking a great question. Yes – there are many versions of this story about other medications.

Here is a perfect quote from this 2009 article: How A Bone Disease Grew To Fit The Prescription

There’s a powerful economic incentive for pharmaceutical firms to expand the boundaries of the use of different therapies. So whether you consider treatments for osteoporosis or treatments for depression or treatments for high cholesterol — in all of these settings — pharmaceutical firms stand to benefit if the therapies for these diseases are broadly used, even if they’re used among people who have very mild forms of these diseases.

In this same article, Caleb Alexander, a pharmaco-epidemiologist at the University of Chicago, is writing about the marketing of osteoporosis medications and says “the dynamic is well understood.” But all this applies equally to the marketing of all medications i.e. “There are versions of this story about a lot of diseases.”

Dubious marketing by the makers of Ozempic and Wegovy (GLP-1s for weight loss)

This is happening right now for GLP-1s. There were already reports in 2023 about dubious marketing by Novo Nordisk, the makers of Ozempic and Wegovy:

In Great Britain, the company has paid within three years a total of around 21.7 million pounds (24.7 million euros) to experts and organisations including important opinion leaders who have since touted semaglutide as a “game changer” in obesity in a campaign described as an “orchestrated PR campaign.

Sadly I expect their marketing campaigns to run unchecked and get more and more sophisticated, with unsuspecting consumers being taken advantage of and harmed.

Families are not aware of the powerful effects of tryptophan, GABA, other nutrients and diet

My goal is to try and change this lack of awareness so families and individuals can explore other options when they are faced with decisions about some of these medications.

Instead of using antipsychotics for a family member with dementia or Alzheimer’s who is experiencing agitation, aggression and anxiety, consider tryptophan and melatonin, and GABA:

Instead of using antipsychotics, explore the use of 5-HTP/tryptophan and/or GABA for kids with ADHD:

Instead of antipsychotics and other psychotropic medications in autism, explore tryptophan and GABA:

This is by no means a conclusive approach to addressing these symptoms in dementia/Alzheimer’s, ADHD and autism. We also need to consider and address diet, other nutritional imbalances, infections, gut health, toxins and much more.

Additional resources when you are new to using GABA and tryptophan as supplements

As always, I use the symptoms questionnaire to figure out if low GABA or low serotonin or other neurotransmitter imbalances may be an issue.

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 (this is covered in an entire chapter too), sugar cravings, anxiety and mood issues.

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.

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. You can sign up to be notified when the next live launch is happening.

If you need serotonin support, the Serotonin QuickStart Program is a good place to get help. This is also a paid online/virtual group program where you get my guidance on using tryptophan and 5-HTP safely, and community support during 5 LIVE Q&A calls. You can sign up to be notified when the next live launch of this program is happening.

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.

Wrapping up and your feedback

I appreciate Lydia for sharing this and enlightening us, and Mad in Arica for inviting her to do the article. And I appreciate community members for sharing and allowing me to share on this blog

Have you or a family member been the victim of the overprescribing of atypical antipsychotics ?

Have you seen this overprescribing of atypical antipsychotics happening in the work you do as a social worker, psychologist, doctor or other health professional?

Are you surprised to learn about similar strategies being used for marketing osteoporosis and GLP-1 medications?

Feel free to share and ask your questions below.

Osteoporosis: two of my favorite self-help books by R. Keith McCormick DC (and some of my own story)

August 16, 2024 By Trudy Scott 3 Comments

In May 2023 I posted this on Facebook and it never made it on to the blog so here goes …. osteoporosis and two of my favorite self-help books by R. Keith McCormick DC:

Earlier this week I read this book, The Whole-Body Approach to Osteoporosis: How to Improve Bone Strength and Reduce Your Fracture Risk by R. Keith McCormick DC, and wow, I’m very impressed and learned a ton.

It actually consolidates and builds on what I learned from him at the in-depth and excellent interviews with him on the Osteoporosis Summit, hosted by my friend and colleague, Margie Bissinger, MS, PT, CHC (thanks Margie! – I’ve ordered his newest book too).

I really love how Dr. McCormicks walks us through him being a detective with clients (the cases are excellent). And his information and interpretation on advanced bone health tests (like CTX, P1NP), other basic blood work (CRP, homocysteine, fibrinogen, vitamin D etc.) and functional testing (celiac/gluten sensitivity labs) he does is invaluable.

I’m curious to see what updates he’s made (if any) in his newest book, Great Bones: Taking Control of Your Osteoporosis. Does he now prefer MK-4 to MK-7 (forms of vitamin K), if he addresses the tricky calcium-oxalate issues (I’m trying to figure this one out too) and if he also discusses Trabecular Bone Score (TBS) which can be included in the DXA.

I do like that he discusses prevention too – for younger women and men! He was in his 40s when he started to have osteoporotic fractures.

I’m in my early 60s and don’t have osteopenia or osteoporosis but I want to be proactive and do comprehensive testing. I do have concerns due to my dietary oxalate issues and calcium homeostasis as a result of this.

Read about both books below and more on my own osteoporosis story (yes, I do have osteoporosis after all!) and probable root causes.

The Whole-Body Approach to Osteoporosis

Here is the official blurb for this book:

No pill will cure you of osteoporosis. While medication can sometimes help, it won’t fully address the underlying causes of your osteoporosis or osteopenia. To restore bone health, you’ll need a targeted program combining the best bone-building strategies from traditional and holistic medicine. The Whole-Body Approach to Osteoporosis distills these complex strategies into a whole-body plan you can begin today to dramatically improve your bone strength and overall vitality.

This comprehensive guide includes information on:

- What to eat for stronger bones
- Choosing bone-building supplements and osteoporosis medications
- Foods and medications that may be contributing to bone loss
- Signs and symptoms that can help you monitor your bone health
- How lab tests can help you personalize your plan

It was published in 2009, and I found it to be eye-opening and a wonderful introduction to the comprehensive functional medicine, nutritional and lifestyle approach that needs to be considered when addressing bone health. It’s written for the layperson but is meaty enough for practitioners new to the mechanisms of bone building and bone breakdown, osteoporosis medication and the impacts of environmental toxins.

As I mentioned above, his information and interpretation on advanced bone health tests (like CTX, P1NP), and other labs that are important for bone health (CRP, homocysteine, fibrinogen, vitamin D etc.) is invaluable. He also covers the basics that I cover in my book/work – like eating real food, digestive health and celiac/gluten sensitivity.

It comes highly recommended and you can find it in bookstores and on Amazon here (my Amazon link).

Great Bones: Taking Control of Your Osteoporosis

Here is the official blurb for this book:

Dr. McCormick knows what potential dangers lurk for women and men who don’t understand the life cycle of bone, who don’t realize the role nutrition plays in bone health, who don’t know what can happen to bone even when they think they’re doing “everything right.”

In his mission to help readers — women and men, athletes and nonathletes, primary care physicians and specialists — Dr. McCormick explains not just the fundamentals of osteoporosis but also the pathophysiology of bone loss and what it takes to regain skeletal health.

If you’re a patient suffering from bone loss, Dr. McCormick helps you take control of your osteoporosis; if you’re a doctor, he lays out the most up-to date science so you can best serve your patients. Great Bones is a book everyone can use to achieve better skeletal health well into their 70s, 80s, and beyond.

This one was published in 2023 and is a hefty 714 pages (vs 200 pages for his first book). This book takes everything in his first book to the next level. And while it is more geared to practitioners it is easy enough to follow for the health-savvy layperson.

Every time I pick it up to search for something I learn so much more. Here are a few eye-opening gems:

Test CTX early morning and avoid biotin and collagen for 48 hours beforehand (I also heard him say this on the osteoporosis summits)
“Butyric acid can increase bone formation by lowering osteoclastic formation” (bone break down) “and stimulating the deposition of calcium into the collagen matrix”
“High concentration of lead are found in the cement lines – where mineralized bone meets non-mineralized collagen and where zinc concentration is highest” (and more information on how lead adversely affects our bones)
“Post-menopausal women excrete eight times more urinary zinc than women with normal bone density”

With regards to my questions I had before getting this book – he does use both forms of vitamin K (MK-4 and MK-7) and he also discusses Trabecular Bone Score (TBS) which is an add-on for the DXA and a good indicator of bone texture and quality.

Unfortunately he doesn’t address the tricky calcium-oxalate issues that I’m trying to figure out, other than a very brief mention on one page.

I’m eagerly waiting for a kindle version to come out so I can more easily search for advanced topics. My index is full of my scribbles as I find some topics buried within other topics, like some of the TBS information.

This book is also highly recommended and you can find it on Amazon here (my Amazon link).

My osteoporosis story (some of it anyway)

When I posted about these books in May 2023, I was planning to be proactive and do comprehensive testing to get a good baseline in my early 60s. After reading these books and two others, I had my first DXA in July that included a TBS and testing of my left forearm. I was shocked to find out I have osteoporosis, despite the fact I have exercised my entire life – running (road and trails), playing tennis and then squash, rock-climbing, doing weights to train for climbing, backpacking with heavy packs, mountain biking, skiing and wind-surfing.

Because of this I’m really passionate about getting the message out about testing early (for women and men) and being informed and proactive. Dr. McCormick suggests women do their first DXA at 50 and men at 55 (and earlier if they’ve had a fracture).

Given my many possible root causes, I now wonder if I should have tested myself at 40 years of age? As I mentioned above, my dietary oxalate issues and the disruption of calcium homeostasis is likely a major factor. I’ve added these as contributing factors too: my long-term gut issues (since childhood), gluten sensitivity, SIBO, my history and propensity for anxiety and panic attacks, my past exposure to toxic lead (in my 20s I worked in an oil refinery and was exposed to jet fuel at a small airport), the fact that I have pyroluria (the zinc and vitamin B6 connections – I’ll be publishing a blog post on this and osteoporosis) and my liver/bile issues (which play into the oxalate issues).

Dr. McCormick says this at the start of Great Bones … “you need to understand the causes” and I do so now I can work on all of this. I love that he also says: “In this book what you will find is hope – within realistic physiological limitations – that you can improve your bone health.”

Dr. Kim Millman’s healthier bones course

With these books and other reading I’m doing, I now have the knowledge and tools. I’ve seen some improvements in the last year and I’m ready to jump in and do further testing and additional adjustments to actually reverse my bone loss.

But I need more so I’ve just signed up to do Dr. Kim Millman, MD’s online Restore & Rebuild: 100 Days to Healthier Bones program. Dr. Millman was also a speaker on Margie’s osteoporosis summit and if you are also looking for support and expert guidance via an online program, this one is a no-brainer. There is also an opportunity to ask your questions. It’s really short notice and if you can’t make this cohort, I’ll share my feedback in case you make the 2025 class.

Dr. Millman shared this in one of her interviews with Margie: “I think that the most important thing to understand is that it is possible to reverse bone loss and drastically reduce your risk of fractures naturally. And in my 15 years of evaluating and treating the root causes of bone loss, my patients do not break bones, and they don’t feel fragile anymore. Their fear fades. They don’t feel vulnerable, and they return to living their most active lives and doing the things they love.”

Hearing this gives me even more hope and I’m excited!

And in case you’re wondering, I’m still glad I’ve read both these books and have them to refer back to again and again. Both are heavily referenced too and I love to look at the research.

Wrapping up and your feedback

Now I’d love to hear from you – do you have osteoporosis and have you read either of these books and have any gems to share?

Do you have another favorite book on bone health?

Have you done Dr. Millman’s program?

What age were you diagnosed with osteopenia or osteoporosis and were you surprised?

Have you been able to reverse your bone loss and drastically reduce your risk of fractures naturally?

What root causes do you feel play a role for you?

If you’re a practitioner working with clients/patients with osteopenia or osteoporosis I’d love your insights

Feel free to share and ask your questions below.

Berberine in perimenopause and menopause: improving mood, calming the anxious mind, and improving heart health, blood sugar and bone health

May 10, 2024 By Trudy Scott 15 Comments

… Berberine, an isoquinoline alkaloid derived from plants of the generis Berberis, has been recognized as being capable of decreasing oxidative stress, LDL, triglycerides, and insulin resistance and of improving the mood. This review describes the cellular and clinical effects associated with the use of berberine, which suggest that this molecule could be an effective natural supplement to ensure a smooth peri- and postmenopausal transition.

The above is from a paper published in 2015, Potential benefits of berberine in the management of perimenopausal syndrome.

These are just a few of the many benefits of berberine. Other research reports impacts on the microbiome, benefits for bone density and kidney health – all very relevant in perimenopause and menopause.

I feel that berberine may be a nutrient to consider, in addition to dietary changes, stress reduction and lifestyle changes, and targeted individual amino acids. Read on to discover some of the mechanisms and the benefits of using a comprehensive approach, and feedback from folks in the community who are using berberine with success.

Impacts on oxidative stress, blood sugar/insulin resistance, lipids and heart health, and mood

I encourage you to read the full paper in order to get an overview of the impacts on oxidative stress, blood sugar/insulin resistance, lipids and heart health, and mood. Here is a very high level summary:

Estrogen deficiency, increased cardiovascular risk, an “overproduction of reactive oxygen species (ROS)” and reduced nitric oxide (NO) which are important contributing factors when it comes to “menopause-related endothelial dysfunction, atherosclerosis, hypertension, cardiovascular, and renal diseases.” Berberine counters this via various mechanisms.
Type 2 diabetes is higher amongst menopausal women, causing high blood sugar and insulin resistance. This paper shares a study that found berberine “significantly lowered fasting blood glucose (FBG), hemoglobin A1c, triglycerides, and insulin levels in patients with Type 2 diabetes as well as metformin and rosiglitazone.” One way berberine does this is via “increased insulin receptor (InsR) messenger RNA and protein expression.”
“inactivity of LDL receptor (LDLR)” in liver cells leads to higher levels of oxidized LDL, a risk factor for “endothelial dysfunction and atherosclerosis.” One mechanism is that berberine improves LDLR expression and has lipid-lowering activity.
When it comes to mood issues, the increased oxidative stress, immune dysfunction and inflammation play a role because of “interactions between neurotransmitters, neuropeptides, oxidative and nitrosative stress, and cytokines.” Higher levels of inflammatory markers such as interleukin-6 (IL-6), C-reactive protein, interleukin-1-beta (IL-1β), and TNFα “can enter the brain and may cause alterations of the metabolism of serotonin and dopamine.” Berberine helps to counter this inflammatory cascade and “inhibits the expression of MAO” , increasing norepinephrine, serotonin, and dopamine – and improving mood and presumably reducing anxiety too.

Berberine benefits menopause — From: Potential benefits of berberine in the management of perimenopausal syndrome

Feedback from folks in the community

When I shared this research on Facebook I received much in the way of positive results.

Susan shared this: “A functional medicine doctor suggested I take it with every meal. My A1C was not bad, (5.3) but my last level was 4.8. This was over the course of about 1 year.”

Becky shared this: “I used it for about 6 months along with diet changes to drop my A1C. Have been holding steady since with dietary measures alone. I didn’t realize berberine also helped lower LDL. Mine is slightly elevated. Not enough that my traditional MD has called me on it, but I’ve adjusted my diet again and hearing this about berberine I think I’ll try going back on it.”

Liz shared this: “I had gained some caregiver weight so started on berberine twice a day and it was helpful. However my Doc quickly had me switch over to [a combination product with berberine, chromium and alpha lipoic acid] and it’s fabulous! Twice a day and I feel great, my carb cravings are at bay and my bloodwork and overall health has vastly improved in just a few months.”

Marcy shared this: “Yes!! My son had been steadily gaining weight from binge eating and medications. In October 2022 his triglycerides were through the roof and I was so worried about his health. I put him on 500 mg of Berberine twice a day. Fast forward to today, he has lost approximately 50 pounds and his triglycerides are normal. There were other factors that may have contributed to the weight loss such as therapy and more structured eating times, but I absolutely believe the Berberine supported all this!” (this was also a combination product with berberine and a small amount of alpha lipoic acid and grape seed extract)

Marcia shared this: “I’ve used Berberine for appetite suppression, which it seems to help with, though not enough for me to lose any weight. But it did also actually lift my mood, which I was not expecting.”

Berberine: the microbiota, the gut-brain connection and anxiety

The number of studies on berberine is impressive and growing by the day. It’s not discussed in the above paper, but this paper, Effects of Berberine on the Gastrointestinal Microbiota states this: “The mechanism underlying the role of berberine in lipid‐lowering and insulin resistance is incompletely understood, but one of the possible mechanisms is related to its effect on the gastrointestinal microbiota.” Given what we know about the gut-brain connection, this is another likely mechanism for mood and anxiety benefits.

In another paper, Berberine ameliorates ovariectomy-induced anxiety-like behaviors by enrichment in equol generating gut microbiota, the authors propose that the use of berberine “modulates the gut microbiota, stimulates equol production, and improves anxiety-like symptoms” … “suggesting a direct link between gut microbiota modulation and estrogen deficiency-induced anxiety.”

Berberine: osteoporosis and the kidneys

An osteoporosis study shows that berberine regulates “the estrogen and thyroid hormone signaling pathways to treat osteoporosis in a multi-target, multi-pathway, and multi-system manner.”

And berberine used in conjunction with calcium carbonate and vitamin D, helps to prevent drug-induced bone loss too: “berberine inhibits bone resorption and improves bone formation to prevent glucocorticoid-induced osteoporosis.” I’d be considering vitamin K and other approaches like working towards optimal homocysteine, addressing food sensitivities, addressing possible oxalate and gallbladder issues too. The latter are more common during and after perimenopause.

Interestingly berberine also improves kidney health. One study reports that berberine “significantly ameliorated chronic kidney disease by altering the composition of the gut microbiota and inhibiting the production of gut-derived uremic toxins.”

A comprehensive approach that includes amino acids

As I mentioned above, I feel that berberine may be a nutrient to consider, in addition to dietary changes, stress reduction and lifestyle changes, and targeted individual amino acids. Berberine is relatively new to me and not covered in my book “The Antianxiety Food Solution” but it’s a great resource for the rest.

Here are are few blog posts specific to amino acids in perimenopause and menopause:

The good news is that the amino acids provide immediate relief while the berberine is slower-acting and starting to have an impact.

Product recommendation: Thorne Berberine

There are many good berberine products available. I did some reading and research and landed on Thorne Berberine.

It is available from my online store (Fullscript – only available to US customers – use this link to set up an account) and it’s available via iherb (use this link to save 5%).

If you’re new to berberine, be sure to discuss the research and if it may be something to consider with your practitioner.

Additional resources when you are new to using amino acids as supplements

As always, I use the symptoms questionnaire to figure out if low GABA or other neurotransmitter imbalances may be an issue.

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 too). This is a paid online/virtual group program where you get my guidance and community support.

Wrapping up and your feedback

I do always appreciate feedback from the community and being able to share it on the blog.

Now I’d love to hear from you – have you used berberine with success? How much have you used, which product and how has it helped?

Were you aware of all these benefits?

Have you also used amino acids and dietary approaches as you start to see hormonal shifts?

If you’re a practitioner do you berberine with your clients/patients?

And please let me know if it’s helpful that I’m now including product recommendations and where to get them.

Feel free to share and ask your questions below.

Collagen causes anxiety and sleep problems for some people. I would never have connected the dots but apparently I am one of those people.

March 1, 2024 By Trudy Scott 13 Comments

Thank you for solving my sleeping problem! I would never have connected the dots regarding collagen causing anxiety and sleep problems for some people, but apparently I am one of those people.

Although I would fall asleep instantly at bedtime, I would wake up 3 or 4 hours later and while my body was tired, my mind was wide awake and I was unable to go back to sleep for at least 2 or 3 hours. I would think about all the things I needed to do and the challenges I was having. These things would not bother me as much in the day. No matter what I tried – like praying and listening to calming music, I could not shut off my anxious thoughts.

Then it occurred to me that when I go out of town to visit my family, I sleep better. After hearing Trudy’s collagen presentation on the Osteoporosis Summit, I connected the dots! For the last 6 months, I have been putting about 10 grams of Vital Protein collagen in my coffee each morning. I don’t take the collagen with me when I travel. So I stopped using it and lo and behold, I am sleeping the best sleep I have slept in a long time! I even look forward to going to sleep.

So I thank you Trudy from the bottom of my heart for enlightening me. And Margie, I thank you for the wonderful Summit you put together with so much great information. I would still be sleep deprived if it wasn’t for you both!

I was so pleased to receive this lovely thank you email from Merrilyn (sent to me and summit host Margie Bissinger) and said how happy I am for her. I asked if I could share her feedback as a new blog so we can enlighten others who may have similar issues and because it’s an opportunity to share some of sleep/collagen research that supports a possible mechanism. She kindly said yes and answered my questions:

How long had you been using collagen and how long after starting it did the sleep issues start?
And how quickly after stopping the collagen did your sleep improve?
Did you consider using tryptophan or 5-HTP so you could continue to use the collagen? And are you prone to low serotonin?

Read on for some background on the serotonin-lowering effects for some folks who consume collagen, Merrilyn’s responses to my questions, my insights, some of the research, and the tryptophan and 5-HTP products I recommend.

The original collagen/gelatin serotonin-lowering blog/research from 2017

I first addressed this potential cause for anxiety, mood and sleep issues in a blog in 2017 – Collagen and gelatin lower serotonin: does this increase your anxiety and depression?

Margie invited me to share this information and some of the research with those who are using it or planning to use it for osteoporosis. I’m so glad I accepted because clearly there are still folks who are not aware of the potential serotonin-lowering effects of collagen. And I’m sharing Merrilyn’s results via this new blog in case it’s also new to you.

Briefly, collagen and gelatin are used in tryptophan-depletion studies to lower serotonin levels. It does this because neither collagen or gelatin contain tryptophan. Some people seem to be adversely impacted by acute tryptophan depletion/ATD caused by collagen or gelatin consumption while others are not.

If this is all new to you, I encourage you to read the original blog and search for “collagen” to find other information on this topic on my site.

How long had you been using collagen and how long after starting it did the sleep issues start?

I asked how long she’d been using collagen and how long after starting it did she notice problems with her sleep. This wasn’t clear to her and many folks like Marrilyn unfortunately don’t connect the dots right away.

I started Vital Proteins collagen on July 1, 2023. I did mark that down because as I add supplements to my diet, I try to make notes and only do one at a time in case they cause a problem. I did note that I was not consistent with taking it daily and I was only taking 5 to 10 grams daily ( in my cup of coffee!).

I have always had a bit of a problem with waking up at night, but normally go right back to sleep. I can’t remember exactly when the sleeping problems worsened and I never connected them to collagen.

Seems like over time, the sleeping and waking up with ruminating thoughts was getting worse. I had started trying Tylenol PM or Advil PM, only taking 1/2 of one with one plain Tylenol or Advil to help me sleep and relieve any muscle tension from exercise. That did not always help. Taking a whole PM was better, but I felt groggy the next day. I don’t need any now that I have stopped the collagen.

How quickly after stopping the collagen did your sleep improve?

When the cause of waking in the night is due to low serotonin, it’s common to notice improvements very quickly after stopping collagen. This was the case with Merrilyn:

I would say my sleep improved immediately after stopping it. I realized that on the days I was out of town and didn’t take the collagen, I slept better. … but I attributed it to the fact that it is cooler there and my 6 year old grandson wears me out by the evening. I do not take the collagen with me and I had not connected this to the sleep pattern.

I returned home after one trip and started the collagen that next morning and the sleepless nights started again. I can’t remember when I listened to your talk, but I am guessing around January 18th, because I noted that I stopped after that day and according to my Fitbit and my memory, I slept great the night of January 19th and other than one night, I have slept well since.

I do want to commend Merrilyn for keeping a log of new supplements and sleep patterns. It’s something I recommend for all my clients.

Did you consider using tryptophan or 5-HTP so you could continue to use the collagen and are you prone to low serotonin?

I also asked if she considered using tryptophan or 5-HTP (some folks do better on one vs the other) so she could continue to use the collagen – she had not considered this. And I wanted to know if she has been prone to low serotonin or suspects low serotonin currently.

I do believe I am prone to low serotonin based on the little I have read in your book. I have thought about using tryptophan with the collagen and might later. For now, I just want to enjoy sleeping and focus on improving my diet.

I also have evenings when I crave sugar. I can do without it during the day, but evenings are worse. Something else to work on.

She’s referring to the low serotonin symptoms questionnaire in the amino acid chapter of my book, The Antianxiety Food Solution. It’s also on the blog here.

A big clue is the insomnia and anxiety caused by consumption of collagen, and also the evening cravings. There are cravings with all the neurotransmitter imbalances, with afternoon/evening cravings common with low serotonin.

It is possible Merrilyn’s anxiety and insomnia effects are for reasons other than low serotonin: glutamate, oxalate, arginine or a histamine reaction are all possible with collagen intake). Doing a trial of tryptophan or 5-HTP while consuming collagen would confirm a serotonin connection.

Osteoporosis, allergies, serotonin and coffee

Merrilyn also shared that she is in her early 70s and besides osteoporosis and allergies, is generally healthy and takes no prescription drugs. Interestingly, research finds there may be a role for 5-HTP (and presumably tryptophan) for allergies and asthma, so this may be another clue for her.

Of course, reducing her cravings – tryptophan and/or 5-HTP make it easy – will also improve her nutrient status of zinc, magnesium, iron, vitamin B6 and other B vitamins etc. all of which are key when it comes to osteoporosis.

Quitting coffee altogether will likely prevent any waking in the night – yes, even just one cup a day can make a difference – and also help improve the status of many of these nutrients. This is often the least favorite change my clients make but Merrilyn will read about all this in the caffeine chapter in my book and may find tyrosine helps her do so.

Research: Daytime tryptophan depletion altered night-time sleep

A paper published in 2002, Mid-morning tryptophan depletion delays REM sleep onset in healthy subjects, reports the following:

Rapid daytime tryptophan depletion in healthy volunteers significantly decreased plasma tryptophan levels during the day and the evening, followed by alterations in the characteristics of night-time sleep, including increased sleep fragmentation, REM sleep latency, and REM density during first sleep episode.

In this randomized double-blind cross-over study, participants received “a tryptophan-free mixture of amino acids at 10:30 am…. resulting in a 77% decrease and 41% decrease of serum tryptophan at 3:30 pm. and 9:30 pm.” Keep in mind that collagen is a blend of certain amino acids and is tryptophan-free.

The authors discuss the fact that serotonin is involved in sleep regulation but interestingly the mood of study participants was not affected.

Even more interesting is another study that found collagen used before bedtime improved sleep and cognitive function in physically active males. It’s possible it’s doing this because it is lowering serotonin that is too high.

Tryptophan and 5-HTP product options

Products I recommend include Lidtke 500 mg Tryptophan, and Pure Encapsulations 50 mg 5-HTP. You can purchase these from my online store (Fullscript – only available to US customers – use this link to set up an account).

If you’re not in the US, Doctor’s Best L-Tryptophan 500mg and Source Naturals 50 mg 5-HTP are products I recommend on iherb (use this link to save 5%).

Additional resources when you are new to using tryptophan or 5-HTP and other amino acids as supplements

We use the symptoms questionnaire to figure out if low serotonin or other neurotransmitter imbalances may be an issue for you.

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 too). This is a paid online/virtual group program where you get my guidance and community support.

Have you made the connection between your collagen consumption and anxiety/insomnia (or other low serotonin symptoms)?

Did you end up simply stopping collagen or have you successfully used it with tryptophan or 5-HTP?

If you’re a practitioner do you see this with your clients/patients who are prone to low serotonin?

And please let me know if it’s helpful that I’m now including product recommendations and where to get them?

Feel free to share and ask your questions below.

I have osteoporosis – within a week of starting collagen I experienced profound insomnia, was much more anxious and had tons of worrying thoughts

August 18, 2023 By Trudy Scott 10 Comments

Nancy shares her unpleasant experience when using collagen for her osteoporosis and asks how she can use tryptophan and possibly add the collagen back:

I have osteoporosis and recently started taking a collagen peptide product (Fortibone). At the same time, I started taking a bone support formula containing calcium, magnesium, vitamin D, vitamin K2, boron, etc.

Within a week I began experiencing such PROFOUND insomnia. I felt like I was wide awake and could not drift off till 4 am each morning. Also, when I laid down at night, I was much more anxious than I normally am and had tons of worrying thoughts flitting thru my mind.

Within a couple weeks of the insomnia starting, I thankfully caught your talk about collagen and folks who are susceptible to it, at the 2023 Osteoporosis Summit. The puzzle pieces clicked together; I’m a MAO-A. I immediately stopped the collagen and the bone support supplement.

I understand supplementing with tryptophan may be the fix for being able to reintroduce the collagen.

I appreciate her for sharing her experience on one of my collagen blogs and thanked her, saying how glad I was that she heard my interview about this.

Collagen and gelatin lower serotonin in susceptible individuals

Intake of collagen (and gelatin) can lower serotonin in susceptible individuals and cause these symptoms she experienced. I first blogged about this in 2017 but it’s still not common knowledge even amongst practitioners and companies selling collagen products.

The good news is that awareness is growing. Dr. R. Keith McCormick does mention the serotonin-collagen connection in his excellent book Great Bones – Taking Control of Your Osteoporosis (my Amazon link). He does not, however, offer tryptophan as a solution.

If this is new to you, this blog post describes why it happens (i.e. collagen does not contain any tryptophan), lists many of the tryptophan depletion studies and who may be more susceptible to this effect – Collagen and gelatin lower serotonin: does this increase your anxiety and depression?

Here is a more recent blog on the topic too: Collagen causes increased anxiety, low mood, irritability, insomnia, gut issues and an itchy skin: some questions and my answers

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

Could supplementing with tryptophan be the fix for being able to reintroduce the collagen?

Nancy said “I understand supplementing with tryptophan may be the fix for being able to reintroduce the collagen.” Hearing her symptoms – profound insomnia, increased anxiety and worrying thoughts flitting through her mind – led me to the same conclusion, especially since they all started soon after starting collagen.

We know she has the MAOA (monoamine oxidase A) genetic polymorphism – this does make her more susceptible to the serotonin-lowering effects of collagen. Other factors that may make her more susceptible (explained in the 2017 blog above) are current or prior depression and/or OCD (obsessive compulsive disorder) or family history of these conditions and being a smoker. In addition to a MAOA defect is having a 5-HTTLPR genetic polymorphism.

To confirm the likely low serotonin connection, it would have been helpful to know if she also experienced other low serotonin symptoms: panic attacks and phobias, lack of confidence, depression, negativity, imposter syndrome, PMS, irritability, anger issues and afternoon/evening cravings.

It would also be helpful to know if her symptoms resolved when she stopped using the collagen.

But the best way to confirm is to do a trial of tryptophan and observe if these symptoms resolve when using collagen.

How to use tryptophan in a situation like this?

She asked these specific questions about using tryptophan:

I bought the Lidtke brand which is a 500 mg. capsule. How do I dose this? I realize you said to trial dose it but:

1) what time of day is best to take it?

2) is it taken on an empty stomach or can it be taken with food?

3) should I start taking the tryptophan BEFORE restarting the collagen and be watching for the night time anxiety/insomnia symptoms to reappear?

4) if the insomnia, anxiety do reappear, how much do I titrate up and is there a max dose of tryptophan? If I’m taking more than one capsule a day, should they be taken at one time or divided throughout the day?

Tryptophan is always taken midafternoon and evening on an empty stomach/away from protein and increased until there is symptom resolution.

For clients in a similar situation who have stopped the collagen but still have insomnia, anxiety and worry symptoms, I have them start on tryptophan before adding back collagen and adjust the tryptophan dose up if needed once collagen is reintroduced.

If symptoms resolved when the collagen was stopped, tryptophan would be trialed as soon as symptoms show up when collagen is reintroduced.

With tryptophan, 500 mg is a typical starting dose but less may work in a situation like this. I’ve had clients use up to 1500 mg tryptophan 2 x day. It’s really individualized with no one-size fits all.

I did mention my book, The Antianxiety Food Solution, as an excellent resource for Nancy. There is an entire chapter on the amino acids and how to use them. I recommend everyone read it before using any of the amino acids as supplements.

Resources if you are new to using amino acids as supplements

If you are new to using 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, low serotonin, low dopamine, low blood sugar and low endorphins).

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, (as I mentioned above) 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, anxiety and mood issues.

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 too). This is a paid online/virtual group program where you get my guidance and community support.

Thanks to Nancy for sharing her experience with collagen and asking this question.

Have you used collagen for bone health/osteoporosis or for other reasons? And have you experienced insomnia, and increased anxiety and worrying?

Were your symptoms due to low serotonin and did tryptophan allow you to continue with collagen or add it back if you stopped it?

Or were your symptoms caused by oxalates in collagen, a histamine reaction and/or a glutamate reaction?

Has Fortibone led to improvements in your bone health? If yes, how long have you been using it and which collagen product (a number of products contain Fortibone)?

If you have questions and feedback please share them here too.

Psychiatric Complications of Primary Hyperparathyroidism and Mild Hypercalcemia: anxiety, depression, anger, irritability, delusions and impaired cognition

July 7, 2023 By Trudy Scott 38 Comments

In samples of patients undergoing parathyroidectomy for primary hyperparathyroidism (PHPT), these disturbances have been identified at a rate of 43.1%–53.0% for anxiety, 33.0%–62.1% for depression, 22.0% for thoughts of death or suicide, 51.9% for anger and irritability, 5.0%–20.0% for hallucinations and delusions, and 37.3%–46.5% for impaired cognition.

In fact, it has been noted that there are more neuropsychiatric phenomena in PHPT than is often recognized and that these symptoms are easily missed, particularly in the elderly population.

This excerpt is from, Psychiatric Complications of Primary Hyperparathyroidism and Mild Hypercalcemia, published in Psychiatry Online.

I’ve recently been reading as much as I can about this condition, for personal and professional reasons. As soon as I learn about something new I go digging to see if there is an anxiety connection. And I must say I was very surprised to read these stats. It’s not something I’ve heard discussed or taught at mental health conferences.

The authors also state this about the condition:

The incidence of primary hyperparathyroidism (PHPT) is about 21 cases per 100,000 person-years, and the disorder is usually caused by a solitary parathyroid adenoma. PHPT has traditionally been recognized by its characteristic symptoms, including urolithiasis (“stones”); osteopenia and osteoporosis (“bones”); abdominal cramping, nausea, and peptic ulceration (“moans”); and depression, anxiety, cognitive dysfunction, insomnia, confusion, and personality changes (“psychiatric overtones”).

How do changes in serum calcium levels contribute to mental health and cognitive symptoms?

It’s always helpful to understand the mechanism and it was the first thought that went through my mind – how does hyperparathyroidism and changes in serum calcium levels cause these mental health and cognitive symptoms? The authors share this:

Although the pathogenesis [or cause] of psychiatric symptoms in primary hyperparathyroidism remains unclear, calcium is thought to figure prominently in determining changes in monoamine metabolism in the central nervous system(CNS), thereby modifying neurotransmission and resulting in alterations in mood and cognition.

I went digging and found this paper – Acute psychosis secondary to suspected hyperparathyroidism: A case report and literature review.

The authors also state that the mechanism isn’t known for certain. And although they are referring specifically to psychosis, the explanation could be applied to other symptoms too: “It is thought that the changes in serum calcium level slow down nerve function and neurotransmission rate, inducing psychosis (and other symptoms like anxiety, depression, anger, irritability and suicidal thoughts).

Understanding this possible mechanism helps us find a temporary solution for these symptoms until the hyperparathyroidism is addressed with surgery i.e. using amino acids as supplements.

Using amino acids to ease symptoms while you are seeking the root cause/s

If you’ve been following my work and have read my book The Antianxiety Food Solution, you’ll be familiar with using targeted amino acids as supplements to support low levels of neurotransmitters. These provide quick relief of symptoms (in a day or less) while you are seeking the root cause.

If we look at the above symptoms:

Anxiety can be a sign of low serotonin (worry type of anxiety) and/or low GABA (physical type of anxiety) – and tryptophan/5-HTP and/or GABA help ease symptoms.
Depression can be a sign of low serotonin (negativity), low dopamine (curl-up-in-bed depression) an/or low endorphins (weepy depression) – and tryptophan/5-HTP, tyrosine and/or DPA help ease symptoms.
Irritability and anger are common with low serotonin – and tryptophan/5-HTP helps to ease symptoms.
Low GABA can also be involved with anger and rage
Cognitive issues can be caused by low dopamine and low GABA – and tyrosine and/or GABA help ease symptoms

(You can find the symptoms questionnaire here. As always, amino acids are used based on symptom clusters and dosed according to your unique needs.)

If you find you have been using the amino acids long term and have explored all the possible root causes described in my book and summarized here, it may be worth investigating primary hyperthyroidism especially if you’re menopausal.

Case: “I had to have a parathyroid gland removed a few years ago… I literally felt better from the moment I came round from the surgery”

We always want to find the root cause when we have various symptoms. With this condition, it’s common to observe very quick resolution of symptoms after parathyroid surgery to remove the adenoma/s. Someone in our community shared this:

I had to have a parathyroid gland removed a few years ago … I literally felt better from the moment I came round from the surgery. It’s a miserable disease. I thought I was going to die! Lots of people get so low that they don’t feel like they can go on.

Bone pain was awful. Fatigue, depression etc.

I had had some dental issues around that time. One of my teeth crumbled. My Vitamin D went down to 9 so I am sure that was a large part of the puzzle.

I was actually diagnosed fairly quickly but was retested many times. I self-referred to a surgeon that was in-network in the end as my insurance wouldn’t cover various surgeons that my doctor wanted me to go too.

I had had breast cancer a few years ago and so had had weekly blood tests and, when I went back and looked, my calcium had been high for years. So important to read our own results.

The surgery was so easy.

What an amazing outcome for this woman and I appreciate her for sharing so we all get to learn and benefit from her journey. And yes, I agree, we need to advocate for ourselves and ask for and keep copies of all our labs. And get educated and ask questions. It’s really unfortunate that high calcium and hyperparathyroidism is so often missed.

Not everyone has all the listed symptoms of primary hyperparathyroidism. This woman did experience fatigue, depression and bone pain. She did not experience anxiety and didn’t have kidney stones. I do suspect dietary oxalate issues (without kidney stones) can be an issue for some folks because of the calcium disruption.

Some reasons why hyperparathyroidism is underdiagnosed

In the last few months I have learned that primary hyperparathyroidism is underdiagnosed. PTH (parathyroid hormone) is not routinely tested and I believe that it should be. Also, as you read above, elevated calcium levels are often ignored or brushed off as being a non-issue. And to complicate things further calcium is not always elevated. Hyperparathyroidism is also underdiagnosed and undertreated in the elderly.

For many women (and men) the discovery happens after they are diagnosed with osteoporosis and then calcium and PTH are tested, and/or past elevated calcium levels are “discovered.” If the hyperparathyroidism diagnosis happens first then osteoporosis screening is not always done and I believe it should be. And don’t get me started on when I believe osteoporosis screening should start (at 45 and not 65 or 70 years old) and issues with DEXA screening (more to come on this).

The good news is that primary hyperparathyroidism is a well-established cause of secondary osteoporosis which starts to resolve after the surgery too.

I’m still very much in learning mode

Primary hyperparathyroidism only recently appeared on my radar as a result of the 2023 osteoporosis summit, hosted by my friend and colleague, Margie Bissinger, Physical Therapist and osteoporosis coach. Dr. Deva Boone was a speaker on this condition on the summit and her site is a wealth of information. I appreciate them both.

As I mentioned above, I am also amazed it’s not something I’ve heard about at mental health or integrative health conferences and when doing continuing education.

I will admit I’m no expert and I’m still very much in learning mode – for myself and for you and this community. But, as you know, I like to share what I learn. As I continue to learn, I plan to share additional perspectives and the osteoporosis/menopause and oxalate links.

I am also in the process of creating a hyperparathyroidism questionnaire to use with my clients. Not everyone has all the above symptoms and not all the papers and resources list all the symptoms covered here today. For example, fatigue is listed on many sites but not in the above two papers and very few sites emphasize the mental health symptoms.

I’m also learning there are clues to look for – like forearm results on the DEXA scan and a good TBS/trabecular bone score has some significance. Stay tuned.

Resources if you are new to using amino acids as supplements

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, anxiety and mood issues.

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 too). This is a paid online/virtual group program where you get my guidance and community support.

If you’ve been diagnosed with hyperparathyroidism (or a family member has been) you can likely relate to much of this. Please share your/their journey. I’d love to hear how long it took for a diagnosis and treatment and what symptoms resolved after surgery, and how quickly.

Did you find the amino acids helped anxiety, mood and cognition symptoms in the short term, and then were no longer needed after surgery?

If you’re new to hyperparathyroidism, feel free to ask your questions and share what you’d like to hear more about in the follow-up blog.

If you are a practitioner, is primary hyperparathyroidism on your radar and do you recommend PTH testing in addition to calcium testing? Have you found the amino acids to be a good short-term solution for your clients/patients?

And if hyperparathyroidism is your area of expertise, feel free to add to the discussion.

Feel free to post your feedback here in the comments.