everywomanover29

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GABA oral rinse reduces burning mouth pain

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Burning Mouth Syndrome (BMS) is a chronic pain condition characterized by persistent burning in the mouth. It affects mostly females, especially postmenopausal women, and conventional approaches are often not very successful. You’ll often see articles and papers with the terms ‘refractory’ and ‘unknown etiology’/unknown causes.

Medications like SRNIs and benzodiazepines

Some studies report limited success with medications like venlafaxine/Effexor, an SRNI and topical and oral use of benzodiazepines such as clonazepam/Klonopin. In this paper, Refractory burning mouth syndrome: clinical and paraclinical evaluation, comorbidities, treatment and outcome, 8 participants saw their pain diminish by half within 3 months.

Another paper, The Effect of Clonazepam Mouthwash on the Symptomatology of Burning Mouth Syndrome: An Open Pilot Study, reports success with a benzodiazepine mouthwash in half the participants.

Other than the poor quality of life and having to continue to live with pain, the bigger concern is the side-effects of medications like these, plus concerns with tolerance and then issues with withdrawal.

New oral GABA research for burning mouth

It’s for this reason that I’m excited about the recent research, γ-Aminobutyric acid (GABA) oral rinse reduces capsaicin-induced burning mouth pain sensation: An experimental quantitative sensory testing study in healthy subjects, that finds that both and men and women experienced immediate benefits when using GABA for burning mouth pain.

The burning mouth pain was caused by the application of capsaicin to the tongues of thirty healthy males and females. Capsaicin is the compound that makes chili peppers hot. (I find it interesting that capsaicin was the compound used to cause the burning mouth sensation because this same compound is used in topical creams and patches to ease pain.)  

The study concludes as follows:

Capsaicin-induced burning tongue pain and decreases in WDT (warm detection) and HPT (heat pain) can be ameliorated by rinsing the mouth with lidocaine and GABA solutions.

Rinsing the mouth with an oral GABA containing solution ameliorated burning pain and increased heat sensitivity produced by application of capsaicin to the tongue. This finding suggests that GABA can act as a local analgesic agent in the oral cavity.

Lidocaine, a numbing medication, was part of the GABA solution in this study, but because it has side-effects that may include anxiety, I recommend a trial of a GABA-only solution to ease the burning mouth pain.

Using a GABA-only oral solution

Using a GABA-only oral solution makes sense given that the likely mechanism of action of topical benzodiazepines in burning mouth pain is via local action on peripheral GABAA receptors found in the nerve fibers of the tongue.

This is also very feasible based on how effective GABA is for other pain such as proctalgia fugax/rectal spasms, and the visceral pain and muscle tension in your gut caused by the bloating symptoms of SIBO (small intestinal bacterial overgrowth) and muscular back pain after a fall.  

How much GABA will help?

As with any use of GABA and the other amino acids, how much will help depends on each person’s unique biochemistry and needs at the time. In the same way I do a trial of GABA with my anxiety clients to determine how much would help, I do the same with burning mouth pain (and other pain situations).

I recommend a trial of a GABA-only product and starting low with 100 to 200mg of GABA swished held in the mouth with some water for a few minutes. This can be used three or four times a day in between meals and with the mg increased slowly based on results.  You can find the GABA supplements I recommend here.

GABA is an amino acid that is recognized for calming physical anxiety and tension and since anxiety (and depression) is very common in those with burning mouth pain, the GABA is going to provide calming benefits too.  

As with any health condition, finding the underlying root causes using a comprehensive functional medicine approach is key. One such root cause may be low GABA and using oral GABA is going to address this one and provide some relief while other root causes are identified and addressed.  

These other root causes can be very varied as explained in the paper Burning Mouth Syndrome. They can include: age-related reduction in estrogen and progesterone levels, lower cortisol, diabetes mellitus and hypothyroidism, allergic reactions to foods, additives and even metals in the mouth, autoimmune connective tissue disorders, nutritional deficiencies (B1, B2, B6, B12. folate, and/or zinc), smoking and candida, and medication side-effects as mentioned above.

Have you experienced burning mouth pain and seen relief with GABA or other nutritional approaches?

If you’re a practitioner, is burning mouth pain common in your postmenopausal clients or patients and what approaches have you found most successful? Have you found GABA to be helpful?

If you are still suffering with burning mouth please share the following when you comment:

  • Your age (it seems to be more prevalent in women 59 and older)
  • If you have anxiety and/or depression now and have been prone to either in the past
  • How you score on the low GABA questionnaire and which symptoms you relate to? This will provide a clue that low GABA may be an issue and the oral GABA rinse is more likely to help
  • How you score on the low serotonin questionnaire (same link as GABA questionnaire above) and which symptoms you relate to? SSRIs have been shown to help in some cases and we know tryptophan/5-HTP help with pain so serotonin support may help too. Perhaps a tryptophan or 5-HTP rinse is worth a trial too?
  • How long it’s been an issue, what approaches you’ve tried and which approaches have helped (even if they only helped a short while or helped the pain a little)
  • Current and past medications (burning mouth is caused by certain medications)

I’d love to gather a list of all this so we can help you and more women who suffer with these awful symptoms.

How much GABA should I use and which GABA product is best?

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The most common question I get about GABA (gamma-amino butyric acid) is the one about the blood-brain barrier and does it even work (it certainly does – read here for information on this one).

The next most common question I get about GABA is this one:

How much GABA should I use and which GABA product is best?

This exact question was actually asked of me a number of times last week after I published: Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth (SIBO). In this blog I share about my trials of using sublingual GABA for the visceral pain and muscle tension in my gut caused by the bloating symptoms of SIBO.

There is no simple answer! It requires a blog post to provide a good answer because we are all unique, have different needs and these needs can even differ at different times depending on the issue and what is going on in our lives at the moment.

Let’s first do a quick recap of GABA (gamma-amino butyric acid) in case this is new to you. GABA is a calming amino acid that can be used as a supplement to raise GABA levels (GABA is also a neurotransmitter. It’s one of the amino acids I use most frequently with my anxious clients (together with tryptophan). GABA helps with the physical anxiety and tension, as well as panic attacks. New research shows it also helps with inhibition of unwanted thoughts and may also offer gut protection after alcohol consumption. It also helps with stiff and tense muscles and muscle pain and spasms.

How I have benefited from GABA

Here is a quick summary of how I’ve benefited from GABA supplements. I use this information to inform my use of GABA to help with the visceral pain I now experience due to my SIBO (more on that below).

If you have never used GABA or if you’ve used it once or twice, reading this should give you a clue as to why there is no one answer and how we need to use a trial approach to figure out what is best for each situation.

This also illustrates that there is no one size fits all for everyone and even for the same person under different situations.

  1. The anxiety and panic attacks I experienced 15 years ago:
    1. I used 1-2 GABA Calm three times a day and a combination GABA product at night. GABA Calm contains 125mg GABA and the GABA product contains 200mg GABA. My anxiety eased and my panic attacks stopped in a few days, giving me immediate relief and hope while I started to address all the other root causes like gluten sensitivity, adrenal issues, low zinc, gut health, low vitamin B6 and more
    2. The doses of GABA I used for my anxiety and panic attacks are typical amounts my clients benefit from and I would not have someone start on 500mg.
    3. If someone is a “pixie-dust” person and very sensitive I’d have them start with a pinch/dab or ¼ of 125 mg GABA Calm.
  1. The “ice-pick” headaches on the top of the skull that I discovered were caused by neck spasms:
    1. Physical therapy, high doses of GABA and high doses of magnesium were essential.
    2. Because of the low doses of GABA I had used for my anxiety years before this, I started with low doses of GABA increasing slowly from 200mg up to 1000mg GABA. This higher amount worked for me at this time for this injury.
  1. Throat spasms and the loss of my voice due to vagus nerve issues caused by a terrifying plane ride:
    1. Based on my prior ice-pick headache experience I now knew I could tolerate higher doses and started with 500mg GABA and used more as needed.
    2. I must have been really low in GABA because I was actually able to use upwards of 5 (and sometime more) doses of 500mg a day and not feel too wiped out, even during the day.
    3. That’s a lot of GABA for me – as I mentioned above 125mg to 250mg used to be enough for the anxiety I experienced 15 years ago.
    4. I write more about all this here: Vagus nerve rehab with GABA, breathing, humming, gargling and key nutrients (with videos to demonstrate immediate effects when using GABA sublingually)
  1. Rectal spasms/proctalgia fugax. These seem to be related to SIBO/IBS and I still experience these from time to time.
    1. I have found that 250mg to 500mg GABA opened onto my tongue works best for me for this particular muscle spasm.
    2. Again, it eases the spasms and pain in a few minutes. I write more about this here: How GABA eases agonizing rectal pain and spasms in under 2 minutes
  1. A back injury in August causing severe muscle spasms and pain.
    1. Again, based on my previous experiences using GABA, right after my fall I started taking 1000mg of GABA powder every few hours (held in my mouth for 1-2 minutes) and then reduced it to 2 or 3 times a day as needed.
    2. I share more in this blog: Acupuncture boosts GABA to reduce back pain and oral GABA further reduces the pain
    3. In the above blog you can also read some research about the mechanism of how GABA supplements ease inflammation and tracheal spasms associated with asthma.
  1. Visceral pain caused by SIBO.
    1. My SIBO is really well-controlled with diet but I’ve been having pain, bloating and insomnia while doing this herbal SIBO protocol. I suspect the cellulose in one of the herbal products is causing this bloating and pain after dinner. It was getting so bad it was keeping me awake (this is typical when I am accidently exposed to problematic foods and get a flare-up).
    2. SIBO patients can have visceral hypersensitivity where their pain can be due to the pressure of the gas that is produced and the muscles in the digestive system actually contracting against this pressure.
    3. It got me thinking about how effective GABA is for relieving muscle tension and how much it’s helped me in the past. I also use GABA with my clients all the time for relief of their physical anxiety and stiff and tense muscles. There are GABA receptors all over the gut and I recently discovered that GABA is important for motility.
    4. Over the last 2 weeks I’ve trialed 300mg GABA (opened on to the tongue) a few times to ease the pain and pressure and it’s been amazing at how much it’s helped and how quickly it’s eased the pain. I’ve used it as soon as I notice the bloating starting and it GABA helps me sleep too (as does the tryptophan I’ve also added). I suspect I could safely double this dose in the evening and may do this if the lower dose isn’t enough some evenings. I’ve also used it some days the next morning when I wake with the bloated ache in my belly.

How much should I use and which GABA product is best?

I have a blog post listing the products I use with clients: The Antianxiety Food Solution Amino Acid and Pyroluria Supplements

Always read the precautions (there is a link on the above blog) and do the amino acid questionnaire (the link is also on the above blog) before starting a trial. I also recommend reading the amino acids chapter in my book The Antianxiety Food Solution so you are a well-informed savvy consumer.

If you’re doing a trial for anxiety and panic attacks:

  • If you can use tyrosine the Source Naturals GABA Calm product is the one I use with most of my anxious clients.
  • The other GABA products listed on the supplements blog need to be opened onto the tongue and started with a low dose (100-200mg is a good starting dose) and increase based on symptom relief. More can often be used at night, especially if sleep is also an issue – sometimes up to 500mg.

If you have SIBO/IBS and are doing a trial for visceral pain:

  • I’d suggest NOT starting with the Source Naturals GABA Calm because the sugar alcohols can be problematic for some individuals. Or if you do, be aware that it may not help and may make things worse in the short-term. Personally, I have not found this product to be an issue with my SIBO and I have very few clients report an issue.
  • The other GABA products listed on the supplements blog need to be opened onto the tongue and started with a low dose and increased based on symptom relief.
  • For a client totally new to GABA I’d start with 100-200mg in the evening and also increase slowly over a few weeks based on symptom relief, up to 500-1000mg.
  • For early morning belly pain I’d start a client on 100-200mg because too much in the day can make you feel tired.    

If you have other pain issues:

  • For a client totally new to GABA I’d start with 100-200mg in the evening and increase slowly over a few weeks based on symptom relief, up to 500-1000mg.  Depending on the pain more may often be needed and higher doses can often be tolerated during the day.
  • Keep in mind that pain can have any many root causes and it may be more than low just GABA or may not be due to low GABA at all. Other factors to consider include but are not limited to: low serotonin, low magnesium, low endorphins, inflammation, structural damage, low omega-3s, gluten issues, Lyme disease etc.  Physical therapy and acupuncture are wonderful approaches to include too.

As you can see from my experiences above it’s a matter of doing trials to find the ideal amount for you for your particular situation.  

If you’ve used GABA supplements for anxiety, visceral pain or other muscles spasms I’d love to hear from you.

This GABA-pain connection is not well recognized and I’d love to have more people know about this as a possible option. The more we share our experiences the more we all learn.

If you plan a trial similar to any of the above I’d also love to hear your questions and feedback.

GABA for the physical-tension and stiff-and-tense-muscles type of anxiety

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Today I’m going to review some GABA products for the physical-tension and stiff-and-tense-muscles type of anxiety, and share some additional resources for you.

The other symptoms we see with low GABA are panic attacks, physical tension in certain settings like public speaking or driving, and the need to self-medicate to calm down, often with alcohol but sometimes with carbs and sugary foods. Insomnia can also be due to low GABA and you’ll experience physical tension (rather than the ruminating thoughts which is the low serotonin type of insomnia – although it’s not uncommon to experience both). GABA also helps with muscle spasms and pain relief when muscles are tight.

The biggest take-aways with GABA:

  • Sublingual is best. I find that GABA works best when used sublingually and this is one reason I like Source Naturals GABA Calm so much. If this is not an option (it does contain sugar alcohols that some clients can’t or won’t use and does contain tyrosine which as some contraindications) then opening a capsule of a GABA-only or a GABA-theanine combination are my next choices when working with someone.
  • Start very low and increase as needed. I have found 125mg to be a good starting dose but some pixie dust clients do well on a dab or pinch
  • Do a trial to determine if the anxiety in in fact due to low GABA. I always do this with clients before starting any amino acid. Be sure to read how to do an amino acid trial – it has the low GABA questionnaire, the precautions and information on how to use targeted individual amino acids.

Here are some of the actual GABA products I recommend and use with clients:

  • Source Naturals GABA Calm. This is a pleasant-tasting sublingual product that is my most popular and most effective form of GABA I use with my clients. It contains 125 mg GABA and some glycine, taurine and magnesium, and a small amount of tyrosine to counter the calming effects. You can see the lozenges in the picture above.
  • Nutritional Fundamentals for Health GABA-T SAP: gamma-Aminobutyric acid (GABA) 300 mg, l-Theanine 150 mg. This is pleasant-tasting when opened on to the tongue and works very well when GABA Calm can’t be used.  I find best results when it is used opened on to the tongue and I really like that it’s a low dose of GABA. Some of my clients do well with half a capsule. You can see an opened capsule in the picture above.
  • Enzymatic Therapy GABA: gamma-Aminobutyric acid (GABA) 250 mg. This is also pleasant-tasting when opened on to the tongue and works very well when GABA Calm can’t be used.  As with all GABA products, I find best results when it is used opened on to the tongue.
  • ProThera 500mg GABA: gamma-aminobutyric acid (GABA) 500 mg.  You will likely need to open this up and start with less than a full capsule during the day and increase as needed based on the trial. A full capsule may be fine at night for some individuals and more than one works in some situations. 

There are a number of other great GABA products. When I reached out on Facebook for feedback I heard from one mom who likes Kirkman Labs GABA with Niacinamide and Inositol for her son who is on the spectrum, and someone else shared she likes Thorne PharmaGABA better than GABA products.

A few people shared this feedback when using GABA: one person felt too tired, someone else felt a niacin-type flush and someone else got an electric shock feeling in her brain. How you respond depends on the dose and with GABA and the other amino acids there is no one recommended dose for anyone. It’s very individualized which is why I have clients do a trial and start low. GABA helps many people tapering from benzodiazepines but some people are so sensitive that even a pinch is too much.

One person asked how to get GABA from food as she is fearful of taking medications and supplements. I always recommend a real whole foods diet with quality animal protein and organic produce, together with health fats and fermented veggies – so this is a great foundation. It may not be enough and when there is fear and phobias I immediately think of low serotonin and would determine if this is a factor an address this first. I covered low serotonin and tryptophan in the product review last week.

Here are some additional GABA resources for you:

Source Naturals GABA Calm™: Why I recommend it for anxiety

It’s a great product to use with children. Trish Soderstrom shared how she used this product with her daughter’s Lyme anxiety.

We’ve used Source Naturals GABA Calm sublinguals with good results. I learned about GABA helping anxiety and because I was treating my young daughter I purchased this because it was easy for her to take.But there may still be some confusion about when to use GABA and when to use tryptophan and how much of each of these amino acids to use.

GABA is calming for me, doesn’t work for my daughter’s anxiety and makes my son sleepy

I have used GABA (several brands, just open capsule and sprinkle small amount under tongue) for years now, with calming results within minutes. It was recommended to me by 2 family members, both bi-polar, who were tested by Dr. Amen. I have also used it with my children (now adults); my daughter says it doesn’t work for her. (She has anxiety issues and occasional panic attacks, and Rescue Remedy helps her.) It does work to calm my 3 sons, but one says it makes him sleepy, and lasts into the next day, so he won’t take it.

GABA for children: ADHD, focus issues, irritability, anxiety and tantrums

My daughter hasn’t been diagnosed with ADHD but has a lot of ADHD qualities. We were having a huge amount of behavior problems as she is getting older (she’s 11). I did some research and went to the health food store and bought a bottle. At this point I was mentally exhausted from all the fighting and drama at home and at school. I was desperate and didn’t want to put her on any hard medication.

She has had amazing behavior at school and at home since giving it to her. She’s almost like different child. GABA has truly changed our life. She’s been taking it for almost 2 months.

The blog has many other posts on GABA and serotonin and simply use the “search” function to find them.

This blog post is part of the series of amino acid product reviews:

The resources in this blog and my other articles are intended to be used in conjunction with my book: The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings. If you do not have my book I highly recommend getting it and reading it before jumping in and taking the amino acid supplements:

There is a complete chapter on the amino acids and one for pyroluria, plus information on real whole food, sugar and blood sugar, gluten, digestion and much more.

You can find the GABA products and the others I recommend here on this blog: The Antianxiety Food Solution Amino Acid and Pyroluria Supplements

 

I’d love to hear what GABA product has worked for you and how it’s helped?

If you have questions please post them below or on the supplements blog

GABA and tryptophan for pain and anxiety in Parkinson’s disease?

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Last week I blogged about my recent back injury and how acupuncture boosts GABA to reduce back pain and how oral GABA further reduces the pain. Both these interventions have helped me so much and I’m doing so much better.

I love the feedback I receive in the blog comments and the great questions – which get to help the person asking the question and everyone else reading the blog and comments. So thank you if you comment!

I received this lovely feedback about GABA and anxiety, and a question about Parkinson’s disease (on the above blog) and want to share it and my response here so you and families with a loved one with Parkinson’s disease will also have access to this information:

I have loved reading your articles for a long time and listen to you whenever you are on a summit. I have learned a lot. GABA definitely helps me to relax, reduce my monkey mind and sleep better.

My mom has Parkinson’s disease and is very stiff and tight. She hurts often, especially her back. She also has afternoon anxiety, some call it “sundowners”. Can she take GABA with carbidopa-levidopa and blood pressure meds? She needs some kind of help!

Thank you in advance for any suggestions you might have to give her any quality of life as right now it is not good and the doctors offer no suggestions beyond possibly more prescriptions.

I responded saying how glad I was to hear GABA helps her to relax, reduces her monkey mind and also helps her to sleep better and how sorry I was to hear about her mom’s stiffness, pain and anxiety.

I posted this regarding the stiffness and back pain: share this paper with your doctor and get his/her approval to do a trial of GABA – Parkinson’s Disease and Neurodegeneration: GABA-Collapse Hypothesis:

the original description of Parkinson’s disease (PD) as due to the selective damage of dopaminergic neurons in the mesencephalon should be updated into the concept of a severe multisystemic neurodegenerative disorder of the nervous system, whose clinical symptoms reflect the localization and progression of the most advanced GABA pathology. A future and more complete therapeutic approach to PD should be aimed first at slowing (or stopping) the progression of Ca(2+)/GABA functional decline.

I have worked with a few people with Parkinson’s disease and GABA has been very helpful for the stiffness and pain, the physical anxiety, easing some of their tremors and helping with insomnia. I always do a trial so we know how much the individual will need.

For someone on blood pressure medication I’d start with a GABA-only product or GABA-theanine product rather than GABA Calm which does contain tyrosine.

I posted this regarding the “sundowners” question: I’d share this with your doctor and get the approval to do a trial of tryptophan – Sundown Syndrome in Persons with Dementia: An Update

sundown syndrome is characterized by the emergence or increment of neuropsychiatric symptoms such as agitation, confusion, anxiety, and aggressiveness in late afternoon, in the evening, or at night.

Although this paper refers to dementia, these symptoms also happen to be classic low serotonin symptoms that typically respond really well to tryptophan. The paper mentions melatonin as an intervention but since tryptophan converts to melatonin I’d start with tryptophan (based on doing a trial) and then consider adding melatonin too if needed.

I shared a few more resources on Parkinson’s disease:

I also shared this amazing and inspiring video created by physical therapist Anicea Gunlock, on how using music while gait training can be beneficial for those suffering from Parkinsons’s disease

You read more about this music approach Anicea Gunlock used with her patient here.

The amino acids GABA and tryptophan can often be used in conjunction with all of the above approaches and often provide immediate relief for anxiety, pain, agitation and insomnia while some of the other root causes are being addressed.

I’ve recently updated the Antianxiety Food Solution Amino Acid and Pyroluria Supplements blog with some of my favorite GABA and tryptophan products mentioned above. You’ll also see the amino acid questionnaire and amino acid precautions on this blog.

Instead of only considering the amino acids for someone whose primary issue is anxiety, I’d like you to start thinking about using the amino acids for anyone who has a medical diagnosis – such as autism, cancer, ALS, Parkinson’s disease, MS, Alzheimer’s disease or anything else – and who also happens to suffer from anxiety.

Have you used GABA or tryptophan to ease stiff and tense muscles and pain in your Parksinson’s disease, for a family member or for a patient/client?

And have you used tryptophan for the low serotonin worry-type of anxiety, agitation and insomnia?

Acupuncture boosts GABA to reduce back pain and oral GABA further reduces the pain

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I fell and injured my back last week but I am doing much better already. I’m going to be sharing a series of articles on post what I’m doing to ease the pain and heal – acupuncture and cupping being two of the approaches. As well as heat (with a hot water bottle), I’m also using a long list of nutrients such as:

  • high-dose fish oil and curcumin (as anti-inflammatories)
  • relaxing magnesium
  • arnica for bruising
  • GABA for relaxing my muscles and helping with the acute pain, and for easing the fear and anxiety (initially I was very fearful I had a serious back injury) and
  • DPA (d-phenylalanine) for the endorphin-boosting pain-relief

Today I’m going to share some research on GABA and how it helps with pain reduction and muscle tension, and how the acupuncture actually boosts GABA (as well as endorphins) to reduce pain.

Based on the examination I have soft tissue bruising around the lumbar area (L3 to L5). Sitting had been impossible until 2 days ago and even now I have to alternate between sitting and standing. I also twisted my ankle in the fall so initially standing was even challenging!  

I had one acupuncture and cupping session last Saturday and will be having another one this coming Saturday. I felt some immediate relief after this session and my back has been getting better and better each day.

Oral sublingual GABA for the acute pain and muscle relaxation

In the interim, between acupuncture/cupping sessions I felt I needed relaxing support for my stiff and spasming back muscles so I immediately started using high doses of GABA for the acute pain. And it’s been working amazingly well.

Right after the fall I was taking 1g of GABA powder every few hours (held in my mouth for 1-2 minutes) and now I only need to take it 2 or 3 times a day as needed. This is the dose I started with only because I know this dose works for me for the rectal spasms I sometimes experience. I always have clients do a trial and start low and increase slowly based on need and response. The starting dose is typically 125mg as found in GABA Calm but I suspect this is likely too low if you are someone needing pain relief.

With the oral sublingual GABA I feel relief from the pain within 5 minutes and it lasts a few hours.

My pain level was 10/10 and is now down to 2/10 most of the time with a few times during the day when it is 4/10. I’m walking, standing, able to turn over in bed and sleep through the night, and able to get off the bed without assistance. I can now also put on my yoga pants, socks and shoes myself – these were impossible tasks in the first 5 days after my fall!

Acupuncture boosts GABA and downregulates substance P and CGRP

I have not been able to find research on oral GABA for easing pain but do have some research to share. In this first paper, Effect of electroacupuncture on thermal pain threshold and expression of calcitonin-gene related peptide, substance P and γ-aminobutyric acid in the cervical dorsal root ganglion of rats with incisional neck pain the authors state that it is known that acupuncture therapy effectively reduces post-surgical pain, but its mechanism of action remains unclear. The aim of the study was to investigate:

whether expression of γ-aminobutyric acid (GABA) and the neuropeptides substance P (SP) and calcitonin gene-related peptide (CGRP) in the primary sensory neurons of cervical dorsal root ganglia (DRG) are involved in electroacupuncture (EA)-induced analgesia [pain reduction]in a rat model of incisional neck pain.

The conclusion is as follows: acupuncture increases the pain threshold i.e. it reduces pain and the mechanism is likely related to

downregulation of pronociceptive mediators SP/CGRP and upregulation of the inhibitory transmitter GABA in the primary sensory neurons of cervical DRGs

In case you’re not familiar with the terms substance P (SP) and calcitonin gene-related peptide (CGRP) I’m going to explain what they are, how they are connected to pain and why downregulation helps with pain reduction.

What is substance P (SP)?

Founders and Directors of Neuroplastix, Marla Golden, DO and Michael Moskowitz, MD share this about substance-P (SP), the main pain neurotransmitter:

It has five basic functions in the body. They are pain, inflammation, anxiety, depression and nausea. Even though these seem like negative experiences, they are important for survival. Problems arise with excessive production and release of Substance-P.

They share a very descriptive video that:

depicts a nerve injury causing a massive release of Substance-P, up to 5 times greater than in acute pain. This diffuses out to three to five times more local area. This is a major way that the pain map expands in persistent pain and keeps the pain going.

Be sure to watch the video on this page.

What is calcitonin gene-related peptide (CGRP)?

Calcitonin gene-related peptide (CGRP) is relatively new marker for pain as this recent review paper discusses – Calcitonin gene-related peptide and pain: a systematic review

The present review revealed the association between measured CGRP levels and somatic, visceral, neuropathic and inflammatory pain. These data suggest that CGRP may act as a neuromodulator in non-headache pain conditions. However, more studies are needed to fully understand the role of CGRP in nociceptive processing and therapy of chronic pain.

Oral GABA lowers substance P and CGRP in asthmatic children

As I mentioned there is no research on the effects of oral GABA on pain reduction so I’m going to extrapolate from this study on asthma – Effect of gamma-aminobutyric acid treatment on plasma substance P and calcitonin gene-related peptide levels in children with asthma.

In this study of 75 children with asthma, 36 children were in the GABA treatment group and received oral GABA (25-30 mg/kg per day) in addition to standard asthma medications. For a 100 lb /45 kg child this would equate to 1125-1350mg of GABA per day.

The conclusion of the study is that oral GABA

can significantly decrease plasma levels of SP and CGRP in children suffering from acute asthma.

The authors propose that airway inflammation may be a factor in asthma and since GABA reduces SP and CGRP, eases neurogenic inflammation and tracheal spasms, it may offer a new approach for the prevention and treatment of asthma (this is my best translation from the Chinese paper).

In summary, oral GABA, used sublingually has helped me tremendously with the acute pain of my muscle injury, and it helped ease the anxiety and fear I felt right after the incident.

As you read above, I am using more than just the GABA, but because it works so quickly I saw benefits right away and had hope while all the other approaches are starting to slowly help too. I just love that I get to experience this first-hand and share it with you – although I would have preferred not falling and that initial severe pain!

I also have a good history of GABA helping me so this was a clue for me to try it now. It was my life-saver when I first experienced my terrible anxiety and panic attacks and helped me tremendously within a few days.  I also did very well with GABA when I used it for throat spasms during  my vagus nerve issue after that scary plane ride, and another incidence when I was getting terrible ice-pick type headaches that turned out to be a jammed neck issue.   I really am a GABA girl aren’t I!?

I have used high doses of GABA like this with one client who had a back and neck injury after a construction accident. It also helped him tremendously.

Have you used high doses of GABA for muscle injuries and seen improvements like this? Or do you use this approach with your clients/patients?

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

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

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

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

What is the pain like?

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

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

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

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

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

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

Positive feedback about GABA helping

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

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

And this wonderful result from someone else:

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

Concerns about using GABA

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

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

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

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

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

There are some common patterns

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

Medications for relief

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

Addressing tight pelvic floor muscles and stress

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

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

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

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

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

Gluten sensitivity, other food sensitivities and functional imbalances

Jessica also shares what can worsen pelvic floor function:

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

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

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

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

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

Some other possible solutions

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

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

Squats, reflexology and downward dog for immediate relief

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

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

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

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

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