social anxiety

Why social anxiety, introversion and loneliness can be lethal and a simple nutritional solution

January 10, 2020 By Trudy Scott 40 Comments

It was an honor to be selected as one of fifteen participants for The Future of Health presentations at Mindshare in August 2019. I presented this to my peers in the integrative health and nutrition space but it’s applicable to everyone and I’d like to share it with you today.

Here is my video presentation: Why social anxiety, introversion and loneliness can be lethal and a simple nutritional solution (click below to watch the video)

Here are some additional reading resources on much of what I cover in my 5 minute presentation:

Pyroluria is a social anxiety condition that is not well recognized in the medical community. It responds really well to a few key nutrients, with zinc and vitamin B6 forming the foundation. I cover this in this blog post: Pyroluria, high mauve, pyrrole disorder, malvaria, elevated kryptopyrroles and social anxiety.
Here is a link to the Pyroluria Questionnaire from my book The Antianxiety Food Solution (which has an entire chapter on the topic). I created this questionnaire using the work of Carl Pfeiffer and Joan Mathews-Larson, modifying it based on feedback I receive from my clients.
I discuss how I first discovered the pyroluria-introversion connection here – Am I an anxious introvert because of low zinc and vitamin B6? My response to Huffington Post blog. I wrote this in response to the Huffington Post article, “23 Signs You’re Secretly An Introvert”, by Carolyn Gregoire.
Here is the webmd loneliness article with this quote: “Loneliness has the same impact on mortality as smoking 15 cigarettes a day, making it even more dangerous than obesity” ~ Douglas Nemecek, MD, chief medical officer for behavioral health, Cigna
And this loneliness paper, Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review
In this blog I write about how Increased sociability improves vagus nerve function: the role of social anxiety, pyroluria and low zinc

This is the the amazing and inspiring group of speakers who I shared the stage with:

Amie Apigan – Why Attachment is the New Field of Medicine
Lauryn Lax – Eating Healthy is Killing You
Jess Sherman – Raising Resilient Kids in a Complex World: Will we Rise to the Challenge
Terry Wahls – Creating an Epidemic of Health – My Radical Path
Susanne Bennett – The Kimchi Revolution: How an Ancient Food Can Transform the Future of Health
Razi Berry – Love is Medicine
Kaylea Boutwell – I’ve Got Your Back: Novel Pain Therapies Transforming Spinal Care Outcomes
Dana Cohen – Hydration: 8 Glasses a Day is not the Way!
Elisa Song – Breathing Life into Your Kids
Joel Sprechman – Creating 1M Super Poopers & Evolving Crohn’s Colitis
Katy Kimball – My Plan to Empty Your Waiting Rooms (the Real Root Cause of Poor Health)
Heather Paulson – Why Choose? Using the Best of Both Worlds to Experience Health with Cancer
James Maskell – Group Visits: How Functional Medicine Reaches the Vulnerable
Mehgan Walker – Life, Liberty and the Pursuit of Chronic Disease: Why Chasing Happiness is Making us Sick

(do let me know if you’d like me to share any of these presentations in the follow-up blog)

Mindshare 2019 green room — Here are some of us in the backstage “green room” and getting ready to go on stage!

We each had a maximum of 5 minutes to present and were not allowed slides or notes. The last time I had memorized my talks and had them timed was 15 years ago when I was in Toastmasters. Before that it was when I was in school. I wasn’t even sure if I could do it when I entered my proposal to speak. When practicing the day before I was still unsure I could manage. Because of my Lyme disease, my memory and word recall isn’t as great as it used to be.

If you pay close attention and you’ll notice the spot where I almost freeze – everything just went out of my head! I simply breathed in calmly, made an attempt to look like I had paused and was fortunate that most of the ending came back to me! Whew!

I’d love to hear what you think of my message and if it resonates with you or a loved one. Feel free to share your pyroluria score and how you score on the introvert questionnaire.

Please also share if you’ve seen the benefits of no social anxiety, introversion and/or loneliness (or much less) when on the pyroluria protocol.

Increased sociability improves vagus nerve function: the role of social anxiety, pyroluria and low zinc

December 13, 2019 By Trudy Scott 43 Comments

With the objective of taking a deeper dive into some of the favorite topics of the recent Anxiety Summit: Gut-Brain Axis, today’s blog is about the vagus nerve since Dr. Navaz Habib’s interview, Vagus Nerve Activation to Reduce Anxiety, was voted one of the favorites. I’m focusing on one tool that improves vagus nerve function that we didn’t have time to get into in great detail – and that is how increased sociability helps. It’s all good and well to recommend getting out and hanging out with more people but if you have the social anxiety condition called pyroluria it’s really challenging, hard work and very stressful. Added stress makes pyroluria worse so it becomes a vicious cycle.

Let’s start with the research that supports the connection between the vagus nerve and increased anxiety and mood problems. In the interview with Dr Navaz, we discussed this paper: Vagus Nerve as Modulator of the Brain–Gut Axis in Psychiatric and Inflammatory Disorders which states that “vagus nerve stimulation is a promising add-on treatment for treatment-refractory depression, posttraumatic stress disorder, and inflammatory bowel disease” and how stimulation of vagal fibers that go from the gut to the brain (afferent fibers) influences neurotransmitter production and “play crucial roles in major psychiatric conditions, such as mood and anxiety disorders.” The gut bacteria play a major role too, “partly by affecting the activity of the vagus nerve.”

In our interview we end with very practical ways to activate your vagus nerve

Deep breathing exercises (mentioned in the above paper, together with yoga and meditation) and cold showers (which makes you breathe harder)
Gargling and using the gag reflex
Humming, chanting and singing (I used these approaches for my vagus nerve issue after my terrifying plane ride. GABA also helped with the voice/throat spasms I experienced – more here on that)
Auricular acupuncture (which is also very effective for addictions)
And finally, social interaction or increased sociability, which I want to cover today

The research on the vagus nerve and being more social

Let’s look at the research on the vagus nerve or vagal tone and being more social. This paper, Upward spirals of the heart: autonomic flexibility, as indexed by vagal tone, reciprocally and prospectively predicts positive emotions and social connectedness, reports that that vagal tone and connectedness or being more social is a two-way street i.e. it’s reciprocal

“…increases in connectedness and positive emotions predicted increases in vagal tone” and
“Adults who possessed higher initial levels of vagal tone increased in connectedness and positive emotions more rapidly than others”

In summary, the more social and happy you are, the healthier your vagus nerve is and a healthier vagus nerve leads to feeling more connected and happy.

This study was done with adults in a community-dwelling setting over 9 weeks: “adults were asked to monitor and report their positive emotions and the degree to which they felt socially connected each day.”

Address pyroluria in those who have social anxiety

Pyroluria, the social anxiety condition, was not part of the study because it’s under-recognized as a factor in anxiety. I’d like to propose that we address pyroluria in those who have social anxiety in order to further improve social connectedness and their vagus nerve function.

Many folks with pyroluria put on a brave face in social settings and even “extrovert” which is extremely stressful. The added stress makes pyroluria worse (zinc and vitamin B6 are dumped in much higher amounts) so it becomes a vicious cycle.

Others, who are not willing to even show up because of their severe social anxiety, are not getting that social interaction and connectedness that is so crucial for improved vagus nerve function and better overall health.

Here is the pyroluria questionnaire and the pyroluria/introvert connection.

Connecting the dots further we have

research that reports that vagus nerve stimulation has potential in autism treatment and we know pyroluria and social issues are common in autism
one of the key nutrients for pyroluria, zinc, plays a role in vagus nerve function
another key nutrient in pyroluria is vitamin B6 and it plays a role in reducing inflammation
according to the vagus nerve study above, the vagus nerve “plays important roles in the relationship between the gut, the brain, and inflammation”
both zinc and vitamin B6 are needed for neurotransmitter production, so increasing both GABA and serotonin will further improve mood and reduce anxiety
and finally, the more social and happy you are, the healthier your vagus nerve is and a healthier vagus nerve leads to feeling more connected and happy

By addressing the social anxiety called pyroluria with a foundation of zinc and vitamin B6, we can increase sociability and thereby improve vagus nerve function.

UPDATE 5/7/2020:

Social isolation during the coronavirus pandemic – other vagus nerve exercises

This blog is very applicable now during the coronavirus pandemic. I’ve made an update because I feel we need to start thinking about the longer-term adverse impacts of social isolation and work on other ways to improve vagus nerve function during isolation or quarantine.

This can include any or all of the ways mentioned above: deep breathing exercises, yoga, meditation, cold showers, gargling/gag reflex, humming/chanting/singing and/or auricular acupuncture.

Do you find you have better vagus nerve function when you are more sociable? What of these vagus nerve exercises have you been doing and found helpful during isolation? Do you have any other favorite approaches like using essential oils or anything else?

Vagus nerve stimulation to treat respiratory symptoms associated with COVID-19

This paper reports benefits in 2 patients with coronavirus – Use of non-invasive vagus nerve stimulation to treat respiratory symptoms associated with COVID-19: A theoretical hypothesis and early clinical experience

Both patients reported clinically meaningful benefits from nVNS therapy [non-invasive vagus nerve stimulation].
In Case 1, the patient used nVNS to expedite symptomatic recovery at home after hospital discharge and was able to discontinue use of opioid and cough suppressant medications.
In Case 2, the patient experienced immediate and consistent relief from symptoms of chest tightness and shortness of breath, as well as an improved ability to clear his lungs.

The authors also share that “vagus nerve stimulation has been demonstrated to block production of cytokines in sepsis and other medical conditions.”

With this virus being novel and with everyone learning we are still appreciative of small case reports like this and hope to see bigger studies done. Until then there is other evidence of the overall importance of the vagus nerve in helping to regulate lung infection and immunity.

The nVNS therapy mentioned in the COVID-19 paper is an external device that delivers “a proprietary signal through the skin to either the right or the left branches of the vagus nerve in the neck.” It’s not something I’ve used personally or had clients use so please share if you’ve had success with this device or a similar device.

Loving social isolation and thriving during coronavirus

On the flip side we also need to consider that there are some individuals who are loving social isolation and thriving emotionally. I share some feedback from folks in my community:

Elissa: “As an introvert, my mental health has never been better ☺️. Loving isolation life.”
Drew: “Loving it in many ways. Dreading the hedonism starting up again…”
Tiffany: “My anxiety levels have decreased and I have decreased my anxiety meds! I think it’s because the demand to produce has decreased. I can actually move at my own speed in this world. I’m fortunate, though. My heart goes out to those people in medical fields. I really miss some things, like time with my dad, but we have made some adjustments, like driveway picnics.”
Katie: “I was praying for relief from the busyness. Definitely didn’t have this in mind and my heart hurts for those who are impacted. It has been a beautiful time of rest and restoration for my body and soul.”
Wendy: “My life is usually slow paced and introverted. Now it’s more so and I’m finding the less I do in a day, the better I sleep. I’m actually dreading getting back to “normal” with all the pressures put on us by extroverts. Yes I have sympathy for people suffering mentally by isolation, but for the first time I feel like my type of lifestyle is socially acceptable. I’m tired of life expectations being dictated by the extrovert half of the population.”

I appreciate these folks for sharing their valuable perspectives about thriving in these times. It reinforces how unique we all are.

If you’re struggling with social isolation…

How are you feeling and what are you most looking forward to doing once social isolation recommendations are relaxed?
I’m guessing you don’t have pyroluria but please share if you do?

If you are thriving in social isolation…

Would you consider yourself an introvert /a contented introvert?
Have you got pyroluria and has addressing it nutritionally in the past allowed you to be more sociable or at least less anxious when you are in crowds?
How are you feeling during social isolation and what do you love the most right now?
What are you not looking forward to once social isolation recommendations are relaxed?
And how do you plan to go back to the old “normal” or don’t you?

Please comment below and let us know where you are with social isolation during this pandemic – struggling or thriving? And what vagus nerve exercises are you using right now? Have you used an external device with success?

Buddy Bench for introverted adults with social anxiety, shyness and feelings of overwhelm?

July 26, 2019 By Trudy Scott 6 Comments

Buddy Benches or Friendship Benches are being used in many countries around the world in schools to help children who feel lonely or are shy or anxious. I propose we do something similar for introverted adults with social anxiety, shyness and feelings of overwhelm or intimidation when they attend conferences.

This BBC article, How ‘Buddy Benches’ are making playtime less lonely shares this about how they are helping children fit in more:

The school playground can be a lonely place for a child if they haven’t got anyone to play with. But a special type of bench is helping pupils make friends.

The idea is simple – if a child feels lonely, they can go to the bench as a signal that they need someone to play with. Another child will see them, go and talk to them and include them in their games.

Also from the BBC article, we learn that Buddy Bench Ireland is taking it a step further and trying to do something different with them, using the bench to engender empathy and as

a reminder for children of things like communication, mutual support and opening up about feelings

Other objectives of these Buddy Benches in schools is:

reducing social isolation
improving mental wellbeing
end bullying

I propose we take these Buddy Benches – that work so well with children – to another level and set them up at conferences for adults too. I believe they could work very well for introverts (who make up around 50% of the population) with social anxiety and/or anyone feeling overwhelmed and/or intimidated and/or shy.

I get kickback when I talk about introverts feeling socially anxious but it’s common as you can see by these comments from introverted individuals

It isn’t always a comfortable place to be when I must be in a crowd.
The hardest aspect of living life as in introvert is we all live in an extroverted world. School pushes kids to do group projects, that are just awkward and when you don’t do well in it you’re doing something wrong or something is wrong with you. The moment I step out of the door I am no longer me, I am a character that has to put on a show in order to succeed in the work place.
Sometimes I can communicate with friends well and sometimes I fake it really badly. I always wonder if people can see past my half smile and fake laugh. It’s painful to be honest. But there are times when I don’t mind so much.

One big question is this: would adults use one or would they feel more self-conscious than children? Would they worry more about what others will think if they sit down at an empty bench waiting for someone to join them, essentially saying “I’m shy” or “I’m anxious” or “I’m an introvert” or “I feel intimidated”?

In the BBC article they address this stigma and worry aspect:

But do children actually use the bench? And are they worried about how it makes them look?

“They don’t see it as stigmatised,” says Sinead McGilloway, director of the Centre for Mental Health and Community Research at Maynooth University, who led a study of 117 pupils at three schools which have benches.

Forty per cent of the children she questioned said they had used the bench, and 90% said if they saw someone else sitting on it they would talk to them.

I have these questions for you about using a Buddy Bench at a business or health conference:

1) How likely are you to use a Buddy Bench as an adult diagnosed with social anxiety and/or know you have the social anxiety condition called pyroluria and you’re working to address your symptoms with nutrients but are not quite there yet.

2) How likely are you to use a Buddy Bench as an adult who identifies with being an introvert and are easily overwhelmed at the networking and mingling aspects that comes when you attend a conference?

3) How likely are you to use a Buddy Bench as an adult who feels shy and/or easily overwhelmed and/or intimidated in new settings with large groups of people you don’t know?

4) How likely are you to be the “Big Buddy” (I just made this term up because it makes me think of Big Brother or Big Sister) and go up to someone sitting on a designated Buddy Bench in order to offer moral support, conversation, connection, encouragement and kindness?

Of course, I love the idea of these Buddy Benches and would have used one for support and connection in the past. I have pyroluria and used to have dreadful social anxiety (and considered myself an introvert). But now that I’m on the pyroluria protocol I feel like a social butterfly and I am very relaxed at big group events. I would definitely go and buddy-up with someone looking for support.

And let’s not forget that Buddy Benches are just one part of the solution – for both children and adults – and we don’t want to forget food, nutrients and functional medicine:

While you’re figuring out the role of diet, gut health, adrenal/thyroid health, toxin exposure etc, a good place to start is to assess for and address low GABA and low serotonin with the amino acids GABA and tryptophan. This provides quick nutritional support for worry, fear, anxiety, tension, overwhelm, lack of confidence and feelings of intimidation.
My next step would be to assess for and address pyroluria with zinc and B6 (and other key nutrients) to help ease and often eliminate the social anxiety completely. Believe it or not, there is a strong connection between pyroluria and introversion and many of my clients and folks in my community no longer feel introverted when they address their pyroluria. I write about this in another blog: Am I an anxious introvert because of low zinc and vitamin B6?

Feel free to comment and let us know what you think about Buddy Benches for adults. Do you have other ideas as to where these adult Buddy Benches could be used?

Let us know if you’ve seen these Buddy Benches work successfully with children and what ideas we could take away to get similar results for adults using them.

And do share if a nutritional approach or if addressing pyroluria has eased your social anxiety, and maybe got you wondering if you are an introvert after all.

Feel free to post your questions too.

Can food and nutrients really help me if I have very severe anxiety and/or panic attacks and I’m using medications?

June 21, 2019 By Trudy Scott 8 Comments

As I prepare for “The Anxiety Summit 5: Gut-Brain Axis” (airing in November 2019) I have been going through interviews from the first Anxiety Summit in 2014 and would like to share something that I addressed in my opening interview as a good recap for you as you are on your healing journey with anxiety (or in case this comes up again in the future) – you truly can eliminate anxiety entirely!

This is a question I am often asked: “Can I really eliminate anxiety using food, nutrients (and a functional medicine approach) if I have very severe anxiety and/or panic attacks and I’m using medications?”

Way too many folks don’t believe it’s possible but yes, you can! You can completely eliminate full blown anxiety, panic attacks, social anxiety (where you cannot go out to social event or go and feel so anxious), phobias like fear of spiders or agoraphobia (where you cannot get out of the house), and even obsessive-compulsive disorder (OCD).

Many folks believe their anxiety is much too severe and that food and nutrients couldn’t possibly help. I’m here to tell you this is just not true.

It’s not uncommon for well-known thought leaders to perpetuate this myth, implying anxiety and fears never go away.

Ali Brown, entrepreneurial guru for women, and one of my amazing business mentors, created a program to help businesswomen overcome their fears. She shared this in the program information: “Let’s not forget women’s darkest best friends: anxiety and worry” and admitted “I still have to fight it. I come from a long line of worriers.”

I say no, you don’t have to fight it. Just because you come from a long line of worriers doesn’t necessarily mean that you have to put up with it and live with it. There is something you can do to eliminate the anxiety, worries and fears.

Seth Godin, author and thought leader, says this: “When fear shows up, understand that it never goes away. Dance with it instead.”

While I really enjoy the dance suggestion – it’s fun and the joy of dancing and the exercise may help – however I really do disagree with the fact that he says fear never goes away.

In season 1 interviewed Julia Ross, MA, my mentor and author of The Mood Cure (my Amazon link), on using amino acids for anxiety and she summed it up perfectly:

On a scale from zero to 10, zero is not an unrealistic goal when it comes to anxiety. It’s really the human potential and GABA and tryptophan give us access to it.

I’m going to repeat this because I think it’s really worth repeating. Zero is not an unrealistic goal when it comes to anxiety. Bravo Julia – I totally agree with this and I want you to know this!

It starts with doing trials of GABA and tryptophan, and using food and nutrients, and finding all the root causes and addressing them.

I really want you to know this, remember this, and don’t stop looking for the answer and the root causes. It may be food changes that you need to make. It may be breakfast that you need to eat. It may be low serotonin or low GABA. It may be foods that are problems for you like gluten or dairy. It may be additives in the foods that you’re eating. It may be toxins in your environment. There are many possible root causes, and you may have one or many root causes that are causing your anxiety.

Addressing these root causes with food and nutrients (and a functional medicine approach you can completely eliminate your anxiety even if you have very severe anxiety and/or panic attacks and you’re using medications.

Resources for you

My book The Antianxiety Food Solution (my Amazon affiliate link) covers the 9 steps I use with clients. Read it and become a savvy health-advocate for yourself. Share a copy with your doctor and point out the references.
Here is a blog on: How to do an amino acid trial for anxiety
You can find GABA and tryptophan and other nutrients in my supplement store here
Here is a blog on: 60+ Nutritional & Biochemical Causes of Anxiety

Do you believe your anxiety is much too severe for food and nutrients to be of help?

Or did you believe this and started looking at nutritional and biochemical root causes anyway and found solutions and anxiety resolution?

Pectus excavatum and pyroluria: is there a connection?

June 7, 2019 By Trudy Scott 23 Comments

I recently received a question about the possible connection between pectus excavatum and pyroluria, a social anxiety condition. In layman’s terms, pectus excavatum is a depression or indentation in the chest wall and is related to problems with connective tissue. This Medscape article describes it as follows:

Pectus excavatum, also known as sunken or funnel chest, is a congenital chest wall deformity in which several ribs and the sternum grow abnormally, producing a concave, or caved-in, appearance in the anterior chest wall.

It’s not something I’m familiar with other than seeing someone with this condition at the beach once (I share some pictures below) and when doing the research for this blog.

The question was posed in relation to a blog on Joint hypermobility / Ehlers-Danlos Syndrome, a connective tissue disorder that does seem to be common in those with pyroluria.

In case you’re new to pyroluria, it is a genetic condition that is frequently associated with a type of anxiety characterized by social anxiety, avoidance of crowds, a feeling of inner tension, and bouts of depression. People with this problem experience varying degrees of anxiety or fear, often starting in childhood, but they usually manage to cover it up and push through. They tend to build their life around one person, become more of a loner over time, have difficulty handling stress or change, and have heightened anxiety symptoms when under more stress. You can read more about it here.

There are also connective tissue symptoms with pyroluria with the following commonly a factor: joints popping, cracking, or aching; pain or discomfort between the shoulder blades; and/or cartilage problems. This is often due to low levels of zinc. Here is the entire pyroluria questionnaire.

Addressing low levels of the mineral zinc and vitamin B6, together with some other nutrients and stress management, are key to addressing pyroluria symptoms. The social anxiety can typically be lifted in a week and the joint and pain problems often ease in 1 to 2 months.

So now that I’ve set things up with an overview of pyroluria and EDS and the connective tissue problems, let me share what I uncovered about pectus excavatum and why I feel there is very likely a connection with pyroluria.

Pectus excavatum and low zinc – impacting connective tissue and psychological impairment

According to this 2012 paper, Pectus excavatum: history, hypotheses and treatment options

Pectus excavatum (PE) … is the most common chest wall deformity, representing 90% of all cases. Depending on the severity of PE, deviations of thoracic organs and spine deformities are known. Although PE in most instances has little or no influence on the function of the inner organs, the cosmetic appearance of the patients leads to psychological impairment which requires therapy.

In the above paper, they write about one of the hypotheses: weak cartilage through metabolism dysfunction. They report decreased levels of zinc in the pectus excavatum patients, suggesting “the lack of zinc in the diet results in a lower metabolic activity of chondrocytes.” Chondrocytes are cells found in cartilage connective tissue. In summary, one hypothesis is that low dietary zinc affects cartilage connective tissue in some individuals with pectus excavatum.

Observe the mention of psychological impairment. Could the low zinc be playing a role in this too? I address this below.

Pectus excavatum and Ehlers-Danlos, plus dental crowding

This paper, Pectus Excavatum and Heritable Disorders of the Connective Tissue, make the connective tissue and Ehlers-Danlos connection:

It seems clear that several patients affected by pectus excavatum display a typical association with connective tissue disorders, which may span from mild form like simple laxity without morbidity associated, to more severe forms such as MFS and Ehlers-Danlos syndrome

This paper also mentions “Highly arched palate with dental crowding” which is common in pyroluria and seems to be related to low levels of zinc.

The image below illustrates a moderate/severe form of pectus excavatum.

Vitamin B6 and high homocysteine

With regards to vitamin B6, one of the other key nutrients needed for pyroluria, one paper, Pectus carinatum repair in an adolescent with hyperhomocysteinaemia: Anaesthetic implications reports a case of a 14-year-old boy with high homocysteine. his level was 18.5 μmol/l (normal levels are within 7–10 μmol/l). He was treated with folic acid, Vitamin B6 and B12 supplements. Is this common in all cases of chest wall deformities? I don’t know but it would interesting to find out.

Pectus excavatum: social anxiety and depression

There are some older studies that report mental health symptoms, including social anxiety are common. In this 1999 paper, Funnel chest. Psychological and psychosomatic aspects in children, youngsters, and young adults, they report these reactions in children older than 11:

embarassment reactions, social anxiety, feelings of stigma, limited capacity for work, orientation towards failure, reduced tolerance of frustration and temptation, limited capacity for communication and even markedly depressive reactions are observed.

It’s understandable that the physical manifestations of this condition would lead to some of these feelings but I have to question how much of this could also be related to low zinc and low vitamin B6. Both nutrients are needed for easing pyroluria/social anxiety symptoms and making neurotransmitters such as serotonin.

Other than trying to make some connections with the research, when this question was asked on facebook, a number of people said they (or a family member) has both pyroluria and pectus excavatum.

If you do have pectus excavatum and pyroluria, getting on the pyroluria protocol will:

ease some of the social anxiety and depressive symptoms
very likely lead to less pain and discomfort
very possibly prevent further connective tissue issues
feasibly prevent pectus excavatum in future children or perhaps reduce the severity in the instance where zinc is a factor (this one is a long shot that I feel is worth further research)

I’d love to gather more information and am looking for feedback so please do share your symptoms and experiences in the comments. Let us know if you or your child or other family member has pectus excavatum and any of the following:

A score 15 or more on the pyroluria questionnaire and/or suffer from social anxiety
Have low zinc
Have low B6 (poor dream recall or nightmares is a clue)
Have high homocysteine i.e. above 10 μmol/l
Ehlers-Danlos syndrome or joint hypermobility
Dental crowding

Resources for you

My book The Antianxiety Food Solution (my Amazon affiliate link) has an entire chapter on pyroluria. Read it and become a savvy health-advocate for yourself. Share a copy with your doctor and point out the references.
Here is a blog if you’re new to pyroluria and the associated conditions.
Here is the pyroluria questionnaire.
You can find the pyroluria products in my supplement store here.

Sjogren’s syndrome: tryptophan and GABA for anxiety, and moisturizing for dry skin and inflammation?

May 10, 2019 By Trudy Scott 33 Comments

A few weeks ago I blogged about a new pilot study about the use of a skin moisturizer twice a day reduced inflammation in older adults. I use the inflammation research to question if this may be applicable and helpful for you if you suffer from anxiety, extrapolating that it may well be given the added benefits of touch and an oxytocin boost.

I received a number of great questions about how to apply this information and have decided to share a question from someone with both Sjogren’s syndrome and anxiety, in order to illustrate how I’d work with someone like this.

Here is the question I received:

I would like to know how much of one’s body needs to be moisturized, and if it is also necessary to be done twice per day? Such a simple but effective way to help with anxiety. Will be slathering a lot more in the future! I have Sjogren’s so everything is dry – skin, mouth, eyes, hair. I have been trying to keep my face much “moister” and I am sure my wrinkles have lessened. I find rice bran oil is also quite good.

I’m going to address her moisturizing question below and share more about anxiety in Sjogren’s syndrome and some nutritional solutions, but first let me explain what Sjogren’s syndrome is.

An overview of Sjogren’s syndrome

Let me explain what Sjogren’s (SHOW-grins) is in case you’re not familiar with this condition. It’s an autoimmune condition and is described as follows on the Mayo Clinic site:

often accompanies other immune system disorders, such as rheumatoid arthritis and lupus. In Sjogren’s syndrome, the mucous membranes and moisture-secreting glands of your eyes and mouth are usually affected first — resulting in decreased tears and saliva.

Although you can develop Sjogren’s syndrome at any age, most people are older than 40 at the time of diagnosis. The condition is much more common in women.

The site goes on to say that other than dry eyes and mouth, some people experience joint pain and stiffness, swollen salivary glands, skin rashes or dry skin, vaginal dryness, persistent dry cough and prolonged fatigue. It’s worth a read to learn more about complications like more dental cavities, yeast infections, vision issues, problems in the lungs, kidneys or liver, the risk of lymphoma and peripheral neuropathy.

My feedback about moisturizing

In the study, moisturizing was done twice a day. I’m not sure how much of the body needs to be moisturized but if everything is dry, I’d want to moisturize as much as possible.

Given that chronic inflammation is a major factor in Sjogren’s and other autoimmune conditions like systemic lupus erythematosus, it’s feasible to expect similar benefits in terms of reduced inflammation. Hopefully we’ll see research on autoimmune conditions in the future.

When it comes to anxiety, I do want to make it clear that I was and still am extrapolating from the research on inflammation and measuring reduced anxiety was not part of the study. Moisturizing may or may not help with anxiety and I certainly wouldn’t only use this intervention.

Anxiety in Sjogren’s – low serotonin and GABA?

You may not be aware that anxiety/depression is very common in Sjogren’s. In one study they

found 33.8% patients with anxiety, and 36.9% had depression, which were significantly higher than controls.

I use a comprehensive nutritional and lifestyle approach to help my clients ease their anxiety and as I mention above, I would not only rely on moisturizing.

I would use the serotonin questionnaire to determine if low serotonin is contributing to the anxiety (the worry-in-the head and rumination type of anxiety) and do a trial of tryptophan or 5-HTP.

Interestingly, a number of studies suggest the involvement of the serotonin system in the development of Sjogren’s, with one study reporting

Significantly lower platelet levels of serotonin in Sjogren’s patients as compared to healthy controls.

They didn’t find a correlation between the levels of serotonin and how severe the Sjogren’s symptoms were, which falls in line with what we know about biochemical individuality and why doing a trial of tryptophan or 5-HTP (to find your ideal dose) is the best approach for serotonin support.

I would use also the GABA questionnaire to determine if low GABA (physical tension type of anxiety) is a factor, and do a trial of GABA.

If you recall, in the Mayo Clinic description above, stiffness is a common symptom of Sjogren’s and GABA eases stiffness.

I haven’t found any research on GABA in Sjogren’s, but one case study reports that a patient experiencing athetoid movements (a movement dysfunction, characterized by involuntary writhing movements), reported symptom improvement with hydroxychloroquine (which can have severe psychiatric effects in susceptible individuals), pilocarpine, gabapentin, and clonazepam. The latter two medications work on the GABA system.

You can find the tryptophan and GABA products I use with my clients here.

Poor sociability in Sjogrens – could this be related to pyroluria?

A study published earlier this year is reportedly the first study to conclude that patients with Sjogren’s score “high on neuroticism and anxiety and low on sociability.”

If social anxiety is a concern, I’d have her do the pyroluria questionnaire and address this if needed.

If you recall, in the Mayo Clinic description above, joint pain and dental cavities are common symptoms. These are also very common with pyroluria, so using a nutritional approach helps ease the social anxiety, and improves joint issues and mouth health.

The other factor that makes me suspect pyroluria may be common in Sjogren’s is that it’s considered a systemic connective tissue disorder, together with systemic lupus erythematosus and rheumatoid arthritis. You can read more about pyroluria and connective tissue disorders on the pyroluria prevalence blog and the Ehlers Danlos/joint hypermobility blog.

Poor mouth health is also common with histapenia/low histamine so I’d want to look into this too.

You can find the pyroluria supplements I use with my clients here.

Sjogren’s and the Autoimmune-Paleo diet

Since Sjogren’s is an autoimmune condition, following an Autoimmune-Paleo (AIP) diet is key too. Here are some books that are well-worth making part of your library, even though they are not specific to Sjogren’s syndrome they offer support for autoimmune conditions (and many individuals often have more than one autoimmune disease)

Hashimoto’s Protocol by Dr. Izabella Wentz (Hashimoto’s is an autoimmune thyroid condition)
Hashimoto’s Food Pharmacology, a recipe book by Dr. Izabella Wentz (both on Hashimoto’s but applicable to any autoimmune condition)
Cooking for Hormone Balance: a recipe book by Magdalena Wszelaki (she has AIP recipes)
The Autoimmune Solution Cookbook by Amy Myers MD

I haven’t dived into the research on all the other autoimmune conditions and the above connections (low serotonin, low GABA and pyroluria) but it’s highly likely similar connections exist. So, if you have any autoimmune condition and anxiety this could all apply for you too.

If you have been diagnosed with Sjogren’s syndrome please share if GABA and tryptophan have helped ease your anxiety, and if the pyroluria protocol has helped you with social anxiety?

And let us know if moisturizing is helping your dry skin and possibly reducing inflammation and anxiety too?