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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 (including details of how to set up an account in my new online store with Fullscript, plus a special offer).

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.

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’ve recently switched to using Fullscript for the fulfillment of the professional grade supplements I use with my one on one clients and with those in my group programs. You order through Fullscript and they ship directly to you.

We’re offering a one-time discount of 20% off all purchases until the end of September. You will need to set up an account with Fullscript. Details are at the end of the supplements blog. If you already have an account with Fullscript and have already made a purchase I hope you simply enjoy this content about GABA.

If you had an account with Emerson/Wellevate, apologies for any confusion but we’re recommending everyone transitions over to Fullscript. Look out for a separate email from me on this.

Stay tuned for more updates and product reviews from now through the end of September. I’ll be sending a product review email each Wednesday.

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.

How GABA eases agonizing rectal pain and spasms in under 2 minutes

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Proctalgia fugax is described as a condition that leads to rectal spasms and sharp fleeting pain in the lower rectum or anus. In some people it can be more than fleeting and is often described as excruciating and agonizing.  

This paper describing proctalgia fugax shares how this pain can

recur over weeks, is localized to the anus or lower rectum, and can last from seconds to several minutes with no pain between episodes. There is no diurnal variation. There are numerous precipitants [preceding factors] including sexual activity, stress, constipation, defecation and menstruation, although the condition can occur without a trigger.

Although the cause of proctalgia fugax is unclear, spasm of the anal sphincter is commonly implicated. The condition may be more likely to occur after sclerotherapy for hemorrhoids and vaginal hysterectomy. There are also associations with other functional pathologies, such as irritable bowel syndrome and anxiety.

My story

I have experienced this awful anal sphincter spasm and pain myself so I want to shine some light on this condition and offer the simplest and most effective solution: oral and sublingual GABA. It works to completely eliminate the pain in 1-2 minutes! And it can also be used to prevent a full-on spasm if you catch it in advance. More about this below.

Let me first share my story so you can relate to the pain. I started to experience this a few years ago. It was right after my aunt died from rectal cancer and my immediate thought was that I was dying of cancer. That’s how bad the pain was. It’s like nothing I’ve ever experienced and I’ve had some pretty bad pain experiences: shingles, a tick bite headache, ice-pick headaches from a neck injury and poking my eye on a tree-branch while hiking.

For me, since it initially used to happen during the night, it felt like I was in bad dream and was lying somewhere injured and in agony. I would half wake-up moaning in pain, not quite grasping how the pain I was feeling could be so bad. Then I would come fully awake and feel the need to bear down (as in needing to have a bowel movement) but this would actually make it worse.

How do others describe the pain?

When I shared this paper on facebook one woman said her rectal pain and spasms last 20-30 minutes and is bad a childbirth.

Someone else shared that her husband “complained of feeling like a knitting needle was being driven through his anus.”

What do I think my triggers are?

I have not had sclerotherapy for hemorrhoids or a vaginal hysterectomy. I do have a history of anxiety and panic attacks (in my late 30s) and do have IBS/SIBO right now and I suspect that both low GABA and IBS/SIBO are my biggest root causes. I no longer have any anxiety but since I respond so well to GABA I assume my GABA levels are not optimal (likely due to the SIBO). I suspect exposure to hidden sources of gluten could also be a factor, and this could also affect my GABA levels.

Medications or heating pads as a solution?

I didn’t ever consider the conventional approaches which include: botox, benzodiazepines, SSRIs, Gabapentin, lidocaine, oral diltiazem, topical glyceryl nitrate, nerve blocks or salbutamol.

A warm bath has been reported to help but I was looking for a 1-2 minute fix (and less if possible). Once you’ve experienced this pain you’ll understand that you not imagine running a bath in the midst of a spasm and waiting to get in it.

Heating pads do also work but can take 20 minutes to take effect and that is simply too long for most people.

The first solution for in-the-moment relief (takes 2 to 12 minutes)

After the first episode I started searching online and because I didn’t know it was called proctalgia fugax I searched for “rectal cramp”, “rectal spasm”, “anal cramp” and came across forums with hundreds of women asking about it and describing their pain.

But no-one really had a solution and many had seen their doctors without much success. The best solution I could piece together was the use of 30-60 seconds of finger pressure (with the finger wrapped in toilet paper) in the anal sphincter during a spasm. Sometimes this is needed for up to 2-3 mins and sometimes doing this 2 or 3 times a few minutes apart is needed. Think about how you put pressure on a calf muscle spasm to stop the cramps. This works well but the agony lasts for the entire 2 to 12 minutes (depending on how many times it has to be done). Refining it by adding a small amount of arnica cream onto the toilet paper helps too.  

How common is it?

It took more searching and reading and then I discovered what it was called. Once I found a name for it and started looking into I was surprised to see how common it is:

The prevalence of proctalgia fugax in the general population may be as high as 8%–18%. Many patients present to primary health care physicians and often do not require further consultation because the symptoms are fleeting. This condition is more common among women than among men, and usually affects patients between 30 and 60 years of age.

Although it’s more common among women I worked with a male client who experienced this. The pain was SO bad he actually passed out and hit his head on the bathroom floor.

The best solution for almost-immediate relief (takes 1 minute)

I know that GABA works amazing well for physical anxiety and stiff and tense muscles and I decided to try GABA in the midst of a spasm. It worked amazingly well and within 1 minute the terrible pain started to ease. It does need to be taken sublingually and I have found that 250mg to 500mg opened onto my tongue works best for me.

Each person would need to find the ideal amount for their needs but at night this should be a reasonable amount. During the day this could be too much and make you sleepy or too relaxed.

I’ve also used a combination of sublingual GABA and theanine with similar results.

I know GABA isn’t readily available everywhere so I did an experiment with taurine and found I needed more (at least 1000 mg) and it did take longer (2-3 minutes) to get relief, but it did work.

THE immediate solution for preventing the spasm

But I have now gotten to the point where I can nip it in the bud and prevent the spasm altogether – by taking sublingual GABA at the very first hint of an ache or twinge. I’ve been fortunate that when this does happen (about once a month and sometimes every 2 months) it’s around 8-11pm.

The long-term solutions for getting to the root cause/s?

We always want to get to the root cause of an issue and that is the next 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. I will be sharing some of their solutions and how to get to some of the root causes in part 2.

I’d love your feedback!

I’d love your feedback so I can learn what works, so we can all learn from each other and so others get answers quicker than I did.

Have you ever experienced this rectal pain and spasms? And what has worked for you?

I’d love to know if it is more common after sclerotherapy for hemorrhoids and vaginal hysterectomy? Have you had either? Or any surgery in the abdominal area?

Do you also have IBS/SIBO?  What about celiac disease or gluten sensitivity?

Do you currently have anxiety or mood issues or have a history of anxiety or mood issues?  How many low GABA and low serotonin symptoms do you have – here is the questionnaire  (a paper from 1965 mentions that patients with proctalgia fugax have been described as irritable, perfectionistic, meticulous, obsessional, tense, and anxious)

If you’ve tried GABA or these other approaches (or decide to try them) please come back and share.  Too many people don’t know about this and it needs to change!

Vulvodynia: oxalates, GABA, tryptophan and physical therapy

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On a recent webinar with Julie Matthews, I shared how healthy foods that are high in oxalates caused me excruciating foot pain: Oxalates and leaky gut for Anxiety.

We also mentioned how oxalates can be a factor in vulvodynia and someone asked this question on the blog:

I just listened to the webinar talking about oxalates. I was shocked and delighted to hear the mention of the connection between high oxalates and vulvodynia. My friend has suffered with this for 18 months with little improvement. She has painful feet so I am wondering if there is indeed a connection for her situation. Could you please explain a bit more of the vulvodynia/ oxalates connection? I would like to give my friend the information.

Before I share the resources I offered her for her friend, let me share this about vulvodynia:

Vulvodynia is defined as chronic vulvar burning, stinging, rawness, soreness or pain in the absence of objective clinical or laboratory findings to explain these symptoms. Vulvodynia is a chronic pain syndrome affecting up to 18% of the female population and is generally regarded as an underdiagnosed difficult to treat gynecological disorder.

There is still much we have to learn about vulvodynia and the causes are multifactorial:

The etiology [cause] of vulvodynia is still enigmatic and is probably multifactorial-including physiological concerns (eg, pelvic floor muscle dysfunction, neuropathic pain, and psychosocial) and sexual issues (eg, anxiety and sexual dysfunction). Although it is a common syndrome, most patients are neither correctly diagnosed nor treated. A diagnosis of vulvodynia is based upon patient history and lack of physical findings upon careful examination. No clinical or histological findings are present to aid in diagnosis. Most treatment options for vulvodynia are neither well studied nor have an evidence base, relying instead upon expert opinion, care provider experience, and use of data from other pain syndromes. However, many patients show marked improvement after physical therapy for the pelvic floor, medications for neuropathic pain, and psychosexual therapy.

You’ll notice that oxalates and other dietary approaches are not mentioned. There are actually 2 studies that state there is NO connection between dietary oxlalates and vulvodynia. This is the first one: Influence of dietary oxalates on the risk of adult-onset vulvodynia. The second paper: Urinary oxalate excretion and its role in vulvar pain syndrome concludes that:

Urinary oxalates may be nonspecific irritants that aggravate vulvodynia; however, the role of oxalates as instigators is doubtful.

In this paper: Vulvar vestibulitis-a complex clinical entity, a low oxalate diet and calcium citrate did help:

Successful outcomes were achieved in 14.3% of patients using a low oxalate diet and calcium citrate supplementation

The Vulval Pain Society is a wealth of information on vulvodynvia and they have this information on the low oxalate diet, saying it helps many women and it worth trying:

A diet low in oxalate salts has been suggested as a treatment for women who experience unexplained vulval pain or vulvodynia… it is widely used in the United States as a treatment for vulvodynia. The diet may be supplemented with the use of oral calcium citrate.

There are few doctors in the UK who are aware of or routinely use this treatment. Many specialist doctors who run vulval clinics in this country [the UK] are skeptical about the treatment, as much of the evidence has not been published in the medical literature and the treatment is not of proven value. A diet low in oxalate with or without calcium citrate may, however, benefit some women with vulval pain and this is certainly an option for some women to try.

The vulvar pain is often described as a “burning” or “cutting” or “sharp” kind of pain. You’ll see medications recommended for the neuropathic pain in many of the studies and on the Vulval Pain society site.

It does concern me that so many women are prescribed SSRIs and medications like gabapentin and benzodiazepines when there are the safer and more effective options of the amino acids such as tryptophan and GABA.   When dosed correctly these individual amino acids help with some of the pain and anxiety right away while other root causes are addressed. 

For my clients, I recommend targeted individual amino acids instead of the medications. I recommend a trial of tryptophan instead of an antidepressant, assuming they score low on the serotonin section of the amino acid questionnaire.

Research shows there is serotonin involvement with vulvodynia. In this study of women with PVD (provoked vestibulodynia i.e. pain in the entrance of the vagina, common with vulvodynia):

Polymorphism in the serotonin receptor gene, 5HT-2A, has been associated with other chronic pain disorders such as fibromyalgia…. The results [of this study] indicate a contribution of alterations in the serotonergic system to the patho-genesis of PVD and gives further evidence of PVD being a general pain disorder similar to other chronic pain disorders.

I also recommend a trial of GABA instead of gabapentin or one of the benzodiazepines, assuming they score low on the GABA section of the amino acid questionnaire.

Tryptophan and GABA can help with both the pain, and the anxiety and depression that is commonly seen with vulvodynia and other pelvic floor conditions – right away while other root causes are addressed.

Since acupuncture is often reported to be helpful, I also consider a trial of DPA for endorphin boosting and hence some pain reduction too.

Physical therapy is often extremely beneficial and frequently overlooked, so finding a good pelvic floor PT to be part of your healing team is key too.

When responding to the blog question I commented that “your friend is fortunate to have you looking out for her”. Using some or all of the above approaches I would expect her to find some relief of the vulva pain, the foot pain and experience reduced anxiety and depression (assuming these are her root causes).

Please note that this is not an exhaustive list of contributing factors for vulvoldynia – other factors could include candida, infections such as HPV, IBS/SIBO, and trauma and sexual abuse. My colleague, Jessica Drummond, nutritionist and physical therapist, and an expert on female pelvic pain, writes about immunity, dysbiosis, gluten and other food sensitivities, cortisol and sex hormone imbalances in this article: Vulvovaginal Pain and The Immune System: Practical Steps for Vulvovaginal Pain Relief. A full functional workup is required and your root cause can be different from someone else’s root cause.

I’d also like to add that although dietary oxalates cause excruciating pain in my feet, I’m so fortunate, in that I do not have vulvodynia.

Have you had success with a low oxalate diet and calcium citrate for vulvodynia? And other pain (in the feet or hips or elsewhere in the body)?

Has physical therapy with a pelvic floor specialist helped?

Have you found tryptophan, GABA or DPA to help with the pain and the anxiety and/or depression too?

Have any other treatments helped you?

If you’re a practitioner what approaches have helped your clients/patients?

Please share questions or feedback below.