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Metal-on-metal hip replacement and cobalt toxicity: anxious, tearful, lowered self-esteem, social withdrawal and poor sleep

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I’m always on the look-out for out-of-the-box root causes for anxiety, insomnia and low mood and the role of targeted amino acids like GABA, tryptophan and tyrosine in easing symptoms clients and boy was I surprised to learn about the connection between metal-on-metal hip replacements and mental health symptoms.

I first learned about this in the new Netflix documentary called The Bleeding Edge which is an “eye-opening look at the fast-growing medical device industry” and “reveals how the rush to innovate can lead to devastating consequences for patients.”

With metal-on-metal hip replacements it’s the cobalt and chromium in the metal-on-metal hip replacements that are causing toxicity in many individuals. In the Guardian article The Bleeding Edge: behind the terrifying new Netflix documentary we hear about Stephen Tower, an orthopedic doctor who shared his story in the documentary:

He had developed a tremor and was having a hard time thinking when he decided to scrawl all over the walls and ceiling of a hotel room during a medical conference, eventually using soap as ink.

Tower, his friends and family knew he was in the throes of mental health crisis, but no one was sure why. So, Tower studied himself until he found the answer in a blood and urine sample: his levels of cobalt, a metal used in rechargeable batteries, were more than a hundred times higher than normal.

Tower thought it might be related to his metal-on-metal hip replacement and had it redone. On the operating table, his surgeon found metal sludge seeping from the device before it was removed.

Dr. Tower shares that within a month of having his hip replacement redone his recovery was remarkable – he could think again, and his psychiatric symptoms resolved.

The sad thing is that he actually admits that he would never have believed this could be possible without having had experienced it himself. We see this all too often in the medical profession.

But he is now enlightened and of course he’s passionate about sharing what he experienced and has started documenting similar adverse experiences in his patients. He says the EPA and FDA should be studying this and reporting it and so they should be.

I was curious to find out how serious an issue this was and how long it’s been an issue because surely we’d be hearing more about it.

A paper published in 2017: Neuropsychiatric symptoms following metal-on-metal implant failure with cobalt and chromium toxicity reports depression and short term memory problems, as well as “disorientation in place, problems with tests of concentration and word finding difficulties.”

The paper includes feedback from some of the study participants. This is what two of them shared about their mood, sleep and anxiety post-hip replacement:

Ms. X … persistent anxieties about the need for future surgery and a feeling she must always be cautious about protecting her hip, tearfulness, lability of mood, lowered self-esteem – “I used to be very active and now I feel a mess”, guilt about being a burden on her husband, a fear about the effects of ions on her body and poor concentration.

Mrs. Z … complained of poor sleep with early morning wakening, low mood and emotional lability, social withdrawal, poor appetite, forgetfulness and a tendency to repeat herself reported by relatives, her frustration at being unable to do day to day activities such as cleaning, she felt she was a burden to relatives, and complained of anhedonia [or an inability to feel pleasure in normally pleasurable activities]. She was disorientated in person, was unable to perform serial sevens and was able to register, but not able to retain any elements of a new name and address on cognitive testing.

The study authors state that “in order preserve neurocognitive function implant removal conceivably should be as soon as possible after toxicity is detected.”

They admit it’s a small sample and that some of the depression and anxiety may be typical after a surgery HOWEVER once I looked at how long metal-on-metal cobalt toxicity has been an issue I feel we really need to take this very very seriously. Here are just a few of the studies from 2017 going back to 2011:

Cobalt can be responsible for local toxicity (including metallosis, hypersensitivity reaction, and benign tumor) or systemic toxicity (including cardiomyopathy, polycythemia, hypothyroidism, and neurological disorders).

  • Systemic toxicity related to metal hip prostheses (published 2014) This systematic review states toxicity is rare but reported cases of cardiotoxicity, thyroid toxicity, peripheral neuropathy, hearing loss, cognitive decline and visual impairment.

Prosthetic hip-associated cobalt toxicity (PHACT) is gaining recognition due to the use of metal-on-metal total hip replacements

And then we have this study reporting toxicity issues as far back as 1999:

Our findings suggest that in total hip replacements using metal-metal pairings, metal ions of the alloys are released. This release may lead to significantly elevated metal concentrations in biological fluids. Long-term studies are needed to determine the risk of metal-metal implants as a potential cause of cobalt and chromium toxicity.

You may wonder how this toxicity problem has been ignored and swept under the rug for so long. If you watch the documentary, you’ll soon see that the medical devices industry is far more powerful than the pharmaceutical industry and has its own set of rules for medical device approval. It’s basically the wild west and the FDA is doing nothing about it (even though it is acknowledged to be a problem)!

I’m not suggesting we shouldn’t be doing hip replacements – they are amazing surgical innovations that give many people their mobility and lives back – but instead I suggest we consider the following:

  • Know what you’re getting into before you embark on a major medical procedure
  • Understand that the testing for medical devices is very inadequate
  • Ask questions and get detailed information about the medical device: what materials are being used, how long it’s been around, any known adverse effects etc.
  • Search for information using terms like “horror stories metal-on metal hip replacement” and “law suits metal-on metal replacement”
  • Have a plan in place should you start to notice adverse symptoms after a hip replacement (or other major procedure). You may even want a medical directive in case you become cognitively incapacitated

I have no expertise on what the safest type of hip replacement is and will find an expert for a part 2 of the blog. If you know of someone please do share in the comments.

How do we address the cobalt and chromium toxicity?

  • Tower, the orthopedic doctor in The Bleeding Edge documentary found his symptoms resolved once the metal-on-metal hip replacement was removed. The research seems to support this approach too
  • A 2-person case study supports the use of N-acetyl-cysteine (NAC) for reducing blood levels
  • An in vivo (test tube) study found astaxanthin “mitigated cobalt cytotoxicity … by modulating oxidative stress”

How do we address the anxiety, insomnia and associated mood issues?

I recommend using the above amino acids short-term to ease symptoms before the hip revision surgery is done and for as long afterwards as they are needed. And, as always, base the use of the amino acids on trials per the amino acid questionnaire.

Also, work with a thyroid expert for thyroid support which will also help the mood and cognitive issues. And work with a heart specialist to rule out any damage to the heart.

If you’ve had a metal-on-metal hip replacement in the past and have chronic anxiety or cognitive issues (that started or got worse after the surgery), then I encourage you to look into cobalt toxicity as a possible root cause or contributory root cause.

Please feel free to share your experiences with this surgery – both good and bad – so we can all learn. And if the amino acids have helped ease anxiety and mood symptoms and helped you sleep while going through this.

And do let us know what you think about the Netflix documentary The Bleeding Edge.

Using amino acids for anxiety and depression: does the right dose ever change or need a tweak?

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If you are using targeted individual amino acids for anxiety and/or depression and doing well on them, you’ll likely get to the point when you’re asking questions like how to discontinue them and does the right dose ever change or need a tweak, especially after some stressful life events. Amy posted this question in the comments section of the blog on using tyrosine to create a sense of calm energy (paraphrased and formatting for ease of reading)

Trudy you are a God send! I stumbled upon your work after following Julia Ross. I have depression and anxiety. I’m currently taking:

1000 mg tyrosine 2x daily

500 mg glutamine morning, 1000mg mid-morning and afternoon

500mg DPA (Endorphigen) 3 x daily (previously I was using DLPA but your recommended DPA was so much better and less stimulating)

50 mg 5-HTP afternoon and

1500mg tryptophan at night

I used the amino acids to treat what used to be referred to as “atypical” depression: loss of motivation, tiredness, lethargic, intense carb craving, feelings of guilt and hopelessness. I would become paralyzed with depression, barely able to get through the days. When I was younger I treated these episodes with antidepressants but as I got older could no longer tolerate the side effects. I’m also still on birth control pills at the age of 46 and believe I may be in perimenopause but can’t stop the pills for medical reasons.

Tyrosine gave me my energy back, glutamine cut the carb cravings. DPA and True Calm work wonders for my anxiety.

I watch my sugar intake and always consume lots of animal protein. I’m so grateful for this solution.

After trialing this seems to be the right combo. I always get confused when is it time to discontinue supplements? Do you stop or slowly reduce or taper?

Does the “right” dose ever change? I’ve been on this combo about 2 months. I’ve felt great but some anxiety/panic creeping back up …. wondering if supplements need a tweak or is this just the result of some stressful life events. Advice appreciated!

I was really pleased to hear the wonderful results she was having and glad that she had trialed the amino acids to find the correct amount for her unique needs and situation. I don’t see this happening often enough and it really is the most effective way to get results. It’s what I do with all my clients – methodical, step-by-step trialing of each amino acid, one at a time and carefully documenting results (both good and bad) in order to find the optimal dose of each one.

When and how to discontinue the amino acids?

To answer her question about when and how to discontinue this is my feedback:

Once you are feeling back to your old self with no more anxiety, panic attacks or depression, you may choose to stop everything at once, but I prefer to slowly lower the amount of one amino acid at a time and add back if your symptoms come back. They don’t need to be “tapered” but doing it this way it helps with preventing your original anxiety and depression symptoms going back to really bad in one big swoop and having to start all over again.

I will add that I have had feedback from someone saying when she stopped tryptophan abruptly she felt the same withdrawal effects as when she weaned off meds but based on my experience this is very rare.

After posting her question Amy made some adjustments – taking less of all of them. As I mentioned above I find it better to lower the amount of one amino acid at a time – kind of reverse of the trialing method you use when starting the amino acids. Also, since she mentioned she felt anxiety/panic creeping back up, I would have expected her to increase some of the calming amino acids.

Does the right dose ever change or need a tweak?

And to answer Amy’s other question: does the right dose ever change or need a tweak?

Yes, the “right dose” can change based on stressful life events especially if you have pyroluria – stressful life events can cause you to dump more zinc and vitamin B6 affecting serotonin and GABA production and increasing the social anxiety.

Amy does mention that she’s on the birth control pill and this depletes zinc and vitamin B6 and hence serotonin) and has an impact on the microbiome – so this may well be playing a role in the need to tweak doses.

There are many other factors that could lead to the need to adjust the amino acids (or other supplement protocols):

  • hormonal changes like PMS, perimenopause or menopause
  • something contributing to leaky gut like adding back gluten or accidental exposure to gluten
  • antibiotics (affecting the microbiome and serotonin/GABA levels)
  • artificial sweeteners (because of their effect on the microbiome and hormones)
  • starting on other medications (since many cause nutritional depletions)
  • adding in a new food like collagen/gelatin (for some people collagen and gelatin may lower serotonin levels)
  • running a marathon (it likely depletes zinc and may ramp up cortisol)
  • a formulation changing completely without you knowing (one example is Seriphos – used to lower high cortisol – where the core ingredient changed completely and the labeling stayed the same)
  • a product changing from using gelatin to cellulose capsules (this may be problematic if you have SIBO)
  • you move into a new home and get mold exposure
  • you get a new dog or cat and start using Frontline Plus for fleas (fipronil, the active ingredient, targets GABA receptors and recent research points to increased anxiety, aggressive behavior, memory problems)
  • you have started using a sauna (depletion of zinc and other minerals, as well as stirring up toxins)
  • your need for serotonin support increases as you head into winter-time (some low serotonin folks are more susceptible to the winter blues)
  • a recent course of fluoroquinolone antibiotics (impacts on magnesium and GABA levels and the mitochondria)
  • you may no longer need them

This is not a complete list of reasons that could impact you but this will give you an idea of what to start to think about.

Hopefully this shows how important it is to monitor how you’re doing and adjust as needed (either up or down) and think about what is changing in your life.

If you’d like to read about the amino acids products Amy uses – the same ones I recommend and use with clients – you can find them listed on my supplements blog.

We appreciate Amy for allowing me to share her results and posting these questions which are a great learning opportunity for you.  She shared this with me:

I hope my “story” is helpful. Keep doing this important work! I work in the behavior health field. My colleagues think this is radical thinking and continue to only support the medical model. I’ve done a lot of my own research and trial and error. I wish there were more-open minded clinicians.

Hopefully with success stories like this, all the nutritional psychiatry research and behavioral health practitioners like Amy who have experienced it first hand and/or with clients/patients and family, we’ll change how mental health care is approached.

Do success stories like this lead you to be more open-minded about anxiety nutrition solutions? Have they worked for you?

And have you found the ideal dose of amino acids and then needed to adjust them up or down based on any of the above? How methodical were you in doing your adjustments?

CBD oil resolves anxiety and insomnia in young girl with PTSD caused by sexual abuse

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There is growing evidence that cannabidiol (also called CBD) is effective for many individuals suffering from anxiety and sleep issues.

A case study published in 2016, Effectiveness of Cannabidiol Oil for Pediatric Anxiety and Insomnia as Part of Posttraumatic Stress Disorder, reports that cannabidiol oil was effective for reducing the anxiety and improving the sleep of a young girl who was experiencing these problems due to posttraumatic stress disorder (PTSD).

She had been sexually abused at the age of three and the medication (Clonidine) had not helped and had caused side major effects (hallucinations).

In the discussion the authors state the following:

Cannabidiol oil, an increasingly popular treatment of anxiety and sleep issues, has been documented as being an effective alternative to pharmaceutical medications.

This case study provides clinical data that support the use of cannabidiol oil as a safe treatment for reducing anxiety and improving sleep in a young girl with posttraumatic stress disorder.

Prior to the prescribing of the CBD a functional medicine workup included ruling out thyroid dysfunction and low levels of iron and vitamin D deficiency. The following helped initially but were not sufficient to reduce all her symptoms: 1 -5mg/night of melatonin, 3g inositol 3 times a day, 500 mg/day of fish oil/EPA, 300mg magnesium/day. She also had psychotherapy sessions for 3 years.

Once it was decided to trial CBD she was given 25 mg at bedtime, and 6-12 mg of CBD sublingual spray during the day as needed for her anxiety: A gradual increase in sleep quality and quantity and a decrease in her anxiety were noted. After 5 months, the patient was sleeping in her own room most nights and handling the new school year with no difficulties. No side effects were observed from taking the CBD oil.

In this case study, the CBD was from industrial hemp, providing the medicinal benefits of CBD without the “high” of the THC.

I am very much in favor of CBD rather than THC because of the high risk of psychosis, schizophrenia and increased anxiety with THC. Dr. Hyla Cass and I share our concerns in this Anxiety Summit interview: Marijuana and anxiety: Panacea or Pandora’s Box?

The authors of this case report provide a very thorough overview of the mechanism of action of CBD via the two cannabinoid receptors in the body, CB1 and CB2:

  • CBD has an indirect effect on the CB1 receptors by stopping the enzymatic breakdown of anandamide, allowing it to stay in the system longer and provide medical benefits. The CB1 receptors are located mainly in the brain and modulate neurotransmitter release in a manner that prevents excessive neuronal activity (thus calming and decreasing anxiety), as well as reduces pain, reduces inflammation, regulates movement and posture control, and regulates sensory perception, memory, and cognitive function.
  • CBD has a mild effect on the CB2 receptors, which are located in the periphery in lymphoid tissue. CBD helps to mediate the release of cytokines from the immune cells in a manner that helps to reduce inflammation and pain

They explain other mechanisms that include “stimulation of vanilloid pain receptors (TRPV-1 receptor)”, “activating adenosine receptors” to reduce anxiety, “a potentially new third cannabinoid receptor GPR55”, and “directly activating the 5-HT1A serotonin receptor.”

I find the latter mechanism very interesting – activation of the serotonin receptor – given the work I do with supporting my clients who have low serotonin and do well with targeted supplementation with tryptophan and 5-HTP. As well as anxiety and insomnia, this young girl was also impulsive and disobedient, had aggressive outbursts at school and was self-destructive, and had low self-esteem and suicidal ideation. These symptoms are all classic signs of low serotonin.

I’d have loved to see how she would have done on a trial of tryptophan instead of 25mg of diphenhydramine (Benadryl), which acts in a similar way to SSRI antidepressants. Interestingly, diphenhydramine was the medication that led to the development of fluoxetine (Prozac) and high doses can mimic serotonin syndrome. Diphenhydramine also has side-effects that include “drowsiness, dizziness, constipation, stomach upset, blurred vision, or dry mouth/nose/throat.”

Based on my experience with tryptophan and 5-HTP – and all her low serotonin symptoms, I’d definitely consider this a better choice for a young girl like this, especially because we see results so quickly, often within a week and sometimes up to 2 or 3 weeks rather than the 5 months it took to completely resolve her sleep issues and anxiety.

Since low GABA can also lead to physical anxiety and insomnia, and with new research suggesting CBD also acts on GABAA receptors a trial of GABA may also have led to quicker results.

Aimée Gould Shunney, ND, summarizes this perfectly in the module on “Stress, Adrenal Health, and Cannabidiol: The ECS-HPA Connection” in the Integrative Cannabis course

CBD impacts the serotonin receptors, in particular the 5-HT1A receptors which has a lot to do with depression [and anxiety]. It impacts the GABA receptors, the dopamine receptors, the glutamine receptors. It also impacts different receptors that effect the inflammatory environment in the body like TRPV-1 and PPAR. There are so many different ways both within the ECS [endocannabinoid system] at the cannabinoid receptors and outside at these other receptors that CBD can help create balance and calm within the HPA axis. In short, CBD balances the system that keeps you balanced.

In summary, doing trials of tryptophan (or 5-HTP) and GABA, together with CBD oil, seems like an ideal approach to consider. I recommend doing this together with dietary changes that support serotonin production, like real whole quality food, quality protein, healthy fats, fermented foods, foods high in zinc, exercise, time in nature etc. so long-term use isn’t needed – for the CBD oil and the amino acids.

I’m excited about this emerging use of CBD oil, all the recent research, and using it in conjunction with dietary and lifestyle changes, and the amino acids and other nutritional approaches.

You can read more about the GABA and tryptophan products I use with clients here.

The two CBD products I’ve had the best results with are Elixinol (read here on using Elixinol for benzodiazepine tapers) and CV Sciences +CBD Oil.

Please share if you’ve used CBD oil or CBD supplements with good results.

We’d also love to hear if using CBD in conjunction with tryptophan (or 5-HTP) and GABA has improved your symptoms even more than just using the amino acids alone, or if the amino acids alone provided relief.

How do I taper tryptophan without withdrawal symptoms: a tight band around my head, brain zaps and agitated free-floating anxiety?

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I have not had any clients experience the need to taper or slowly wean their tryptophan dose or report tapering side-effects similar to those they experienced when tapering off an antidepressant. However, I recently had someone ask this question on the blog (and then had someone else ask a similar question) so I’m sharing these questions and my responses in the hope of gleaning some additional information (and educating you if this applies to you). I never say never and am always learning. I’m also very interested to know how common this is and what some of the underlying factors could be.

Here is the question that was asked by Lara (we’ll call her Lara) and slightly paraphrased for clarity:

I’ve been taking 1500 mg of tryptophan for 3 months, and it has helped a lot with sleep and depression. I dropped to 1000 mg about a week ago then 500mg just to see how I’d do without it. I didn’t think it was numbing my feelings, but I am experiencing a return of feeling good.

I’ve been on antidepressants before and I am feeling the same withdrawal effects as when I weaned off meds. This is exactly why I chose to not go back to pharmaceuticals. It was difficult to wean off. How do I taper tryptophan without experiencing withdrawal symptoms? Thank you for your valuable knowledge.

These are the kinds of questions I’d ask a client in this situation:

  • Was the 1500mg helping and which low serotonin symptoms were eased?
  • How did this change when you reduced to 1000mg and then reduced to 500mg? i.e. did the low serotonin symptoms come back?
  • Which antidepressant are you comparing these affects to? And how long ago did you wean off the antidepressant?
  • Which brand of tryptophan you are using? (I find Lidtke is the best quality)

Keep in mind that we always want to be sure it’s not a one-off situation. In order to be sure someone is observing mild adverse effects from a supplement I’ll often have my client stop it and then add it back to make sure. And sometimes more than once.

In this instance repeating the process may be a good idea i.e. going back to 1000mg and then 1500mg and then reducing again, carefully documenting in a food mood supplement log.

It turns out that Lara was using the Lidtke tryptophan and she was seeing wonderful benefits for her low serotonin symptoms with none of the typical SSRI side-effects:

the 1500mg before bed with a small carb helped me get to sleep and stay asleep. It also helped with anxiety and depression during day. I tend to be a worrier, have social anxiety, and get stuck with negative thoughts about myself and others. And have very little interest in life.

I was on Zoloft from 2005 – 2009. Got off of that and did Lexapro for only 6 months in 2012. The Zoloft was life changing for me but I did not like the side effects and being on an antidepressant for the rest of my life.

The tryptophan is superior to these SSRIs [selective serotonin reuptake inhibitors] – no sexual side effects, no weight gain, or anhedonia [inability to feel pleasure in normally pleasurable activities].

She describes how she reduced the tryptophan and how her withdrawal symptoms were similar to those she experienced when tapering off her SSRIs in the past:

The withdrawal effects were felt when dropping from 1500mg to 1000mg, to 500mg, then zero over 2 days and they lasted about 3 days. By the 4th day I was no longer feeling bad.

The symptoms are hard to explain – it felt like a tight band around my head, also brain zaps (this is a common SSRI withdrawal symptom many describe feeling in their head).

The worst of it was a deep agitated free-floating anxiety like you’re walking along the edge of a cliff and there’s a physical pain in your gut. Fortunately, it was only present from waking up till around 2pm.

These are questions I’d ask or wonder about

As I mentioned in the introduction, I have not had any clients experience the need to taper or slowly wean their tryptophan dose or report tapering side-effects similar to those they experienced when tapering off an antidepressant. But if this is an issue some individuals experience I’d like to know about it

I’d also like to know how long the tapering side-effects of tryptophan last and how severe the symptoms are. In Lara’s case the symptoms were pretty severe but fortunately they only lasted 3 days which is very much shorter than SSRI tapers.

There could be confounding factors and here are additional questions I’d ask or wonder about if a client experienced similar adverse tapering effects. These are questions you could ask yourself if you have experienced this when stopping tryptophan abruptly:

  • Could the prior use of SSRI prescriptions be a factor? (but I have worked with many clients with prior use of SSRIs and not have tryptophan tapering issues)
  • What else has changed in terms of stress, diet, hidden gluten exposure, or even the something like a recent introduction of collagen (which may deplete serotonin levels in susceptible folks)?
  • Are there hormonal changes that could affect serotonin levels – like in a woman with PMS or perimenopausal or menopausal symptoms? (again, I’ve worked with many women of all ages and haven’t observed this to be an issue)
  • If you are prone to the winter blues and reduced winter serotonin, could stopping the tryptophan in the winter play a role? (I have had clients have SSRI tapering issues in winter because of being prone to the winter blues and choose to work with their doctors on their SSRI taper in the spring and summer for this reason)
  • Could this also be an issue with summer blues in hot states like Arizona?
  • Could any of these play a role: a recent medical procedure, a course of antibiotics (especially fluoroquinolones) or antifungals, poor gut health, a new infection, decreased immunity or increased inflammation?
  • Could low levels of these nutrients play a role: vitamin B6, ferritin, magnesium and zinc?
  • Would using high doses of vitamin C during the “taper” help reduce some of the symptoms? (this works well as an antidote when you take tryptophan and don’t need it and want to negate some of the negative effects, so may help in this situation)

Stopped tryptophan and felt very angry and down

The other question I had about tryptophan weaning is this one from someone who shared that she had suggested tryptophan for a friend. This friend was

experiencing a lot of ruminating and anxiety. She responded beautifully and felt great. About a year later, she tried to stop taking it, and said she felt very angry and down. Is there a weaning process for the tryptophan?

This could possibly be related to the above and you could pose similar questions but based on on what I see with clients I feel this is more of a matter of stopping the tryptophan too soon while she still had low serotonin – especially if the ruminating and anxiety came back. Feeling angry and down are classic signs of low serotonin.

The questions asked were specifically about tryptophan but they could also possibly apply to some individuals who stop 5-HTP abruptly.

I’d love to hear if you’ve experienced anything like this with either tryptophan or 5-HTP and if yes please share your answers to some of the above questions.

Right now, I’m afraid I don’t have an answer for you on how to taper tryptophan without these withdrawal symptoms: a tight band around the head, brain zaps and agitated free-floating anxiety. Right now, I’m not sure how big an issue this is. If it is common, I’m hoping some of the feedback I receive may provide some answers.

Vitamin B6 improves dream recall (which can be used to monitor vitamin B6 status)

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It’s exciting to see new research confirming the connection between vitamin B6 and dream recall. In this new study, Effects of Vitamin B6 (Pyridoxine) and a B Complex Preparation on Dreaming and Sleep (which was randomized, double-blind and placebo-controlled), 100 participants from across Australia were given 240 mg vitamin B6 (pyridoxine hydrochloride) before bed for five consecutive days. Other study participants were given a B complex. This is the outcome of the study:

  • vitamin B6 significantly increased the amount of dream content participants recalled but did not significantly affect dream vividness, bizarreness, or color, nor did it significantly affect other sleep-related variables
  • participants in the B complex group showed significantly lower self-rated sleep quality and significantly higher tiredness on waking

Here are my thoughts on these results:

  • It’s wonderful to read that Vitamin B6 improves dream recall – this is what I see with my clients all the time.
  • With an optimal dose of vitamin B6, I would expect changes in “dream vividness, bizarreness, or color” and this also what I also see with my clients. If they are having horrible/vivid/bizarre dreams, the vitamin B6 changes them to pleasant dreams OR if dreams were not recalled prior to supplementation, they are now remembered and pleasant. The dose of 240 mg was used across the board but based on what we know about biochemical individuality, 240mg may be too much for some folks and not enough for others, so this could have impacted the results.
  • It’s not surprising that the B complex taken at bedtime impacted sleep. It’s known to be stimulating and it’s not something I’d advise any client to do. For this reason, I don’t feel it was the ideal control for this study.

The lead researcher is Dr. Denholm Aspy and his primary research focus is lucid dreaming. On his researcher profile on the University of Adelaide website, he describes lucid dreaming and the potential benefits:

In a lucid dream, the dreamer realizes that they are dreaming and can then explore and even control the dream. Lucid dreaming has a wide range of potential benefits and applications such as creative problem solving, treatment for recurrent nightmares and improvement of motor skills through rehearsal in the dream environment (e.g. for elite athletes or people recovering from physical trauma).

He shares that the purpose of his research is to address exploration of the potential applications of lucid dreaming and to “develop reliable ways to induce lucid dreams.” Looking for potential applications of lucid dreaming is very interesting and new to me.

Vitamin B6/dream recall research and pyroluria (a social anxiety condition)

However, this vitamin B6/dream recall research is of particular interest to me because of my work with pyroluria, a social anxiety condition which responds really well to supplementation with zinc, vitamin B6 or P5P (pyridoxal-5-phosphate) or a combination of both, and a few other key nutrients.  Here is the pyroluria questionnaire.

One of the classic signs of pyroluria is poor dream recall, stressful or bizarre dreams, or nightmares, signs which the late Carl Pfeiffer, MD attributed to low vitamin B6 status. He suggested that your dreams and dream recall serve as a good indicator of your need for vitamin B6. You should dream every night and you should remember your dreams. They should be pleasant—the kind of dreams where you wake up and want to close your eyes and continue dreaming.

Going back to the above discussion of lucid dreaming, in lucid dreams “the dreamer is aware of dreaming and often able to influence the ongoing dream content.” This is exactly how I would describe my dreams when I have good levels of vitamin B6 and my clients say the same.

Keep in mind that if you do have pyroluria, you may need to increase your dose of vitamin B6 in times of stress. Vitamin B6 can also be depleted by oral contraceptives because they cause both low vitamin B6 and zinc, reduce serotonin levels and increase anxiety. Vitamin B6 can also be depleted by antidepressants, diuretics, and cortisone, so if you start or stop taking any of these, you may need to adjust the amount you supplement.

If this intrigues you and you’re new to pyroluria, I write about dreams and vitamin B6 in the pyroluria chapter of my book, The Antianxiety Food Solution. My blog is also a wealth of information on pyroluria:

Dream recall and vitamin B6 status is important even if you don’t have pyroluria

Observing your dream recall and hence vitamin B6 status is important even if you don’t have pyroluria. This is because vitamin B6 it has been implicated as a co-factor in more than 140 biochemical reactions in the cell, playing a role making amino acids and neurotransmitters, making fatty acids, and even quenching reactive oxygen species (ROS).

This is partial list showing the importance of vitamin B6 (with both research and clinical evidence) for:

You may also wonder what the mechanism of action is? How does vitamin B6 impact your dream recall? One hypothesis is that vitamin B6 is a co-factor nutrient used in the conversion of tryptophan to serotonin which is then used to make melatonin. Vitamin B6 is also an antioxidant, is anti-inflammatory, and modulates immunity and gene expression.

If you’re looking for a quality vitamin B6 product, my supplements blog lists a range of vitamin B6 supplements that I use with clients and those in my group program.

Monitoring your dream recall is one very simple way to assess changes in your vitamin B6 status. And we now have new research supporting this. I look forward to follow-on studies by these authors, learning more from them about lucid dreaming and I hope to be able to offer some of my insights from clinical practice.

*** I address some concerns about vitamin B6 toxicity in this blog: Why is vitamin B6 toxic for some and why don’t symptoms resolve when vitamin B6 is stopped? I have yet to see any signs of toxicity in my clients, but I have also not ever recommended more than 500mg/day. However, I was recently made aware (thanks to some folks in my community) that there are some individuals who have issues with very small amounts of vitamin B6.  If you have experienced any issues with using vitamin B6 supplementation please share.

What are your dreams like and do you use your dreams to monitor your vitamin B6 status? What improvements have you noticed by addressing low vitamin B6 levels?

If you’re a practitioner do you use dream recall as an indication of vitamin B6 status?  Have you seen adverse issues with vitamin B6 supplementation and at what doses?

Delayed IgG food sensitivities: depression and anxiety due to inflammation, leaky gut, leaky blood brain barrier and low serotonin

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It’s really encouraging and exciting to see a major study confirming what we’ve known about IgG food sensitivities or IgG food reactivity for years, and also reporting a link to irritable bowel syndrome (IBS) and depression. The paper, published in May this year, The Food-Specific Serum IgG Reactivity in Major Depressive Disorder Patients, Irritable Bowel Syndrome Patients and Healthy Controls states

There is an increasing amount of evidence which links the pathogenesis of irritable bowel syndrome (IBS) with food IgG hyperreactivity. Some authors have suggested that food IgG hyperreactivity could be also involved in the pathophysiology of major depressive disorder (MDD).

The following diagram and excerpt illustrates the gut-immune-inflammatory-brain model for depression that is associated with food IgG hyperreactivity or sensitivity.

The gut-immune-inflammatory-brain model for Major Depressive Disorder associated with food IgG hyperreactivity. According to the hypothesis proposed in our previous work, we present a possible mechanism underlying the MDD [major depressive disorder] development, suggesting that the interplay between genetic and environmental factors may lead to disruption of tight junctions, the loss of their integrity and both gut and BBB [blood brain barrier] permeability. Undigested food compounds, which would normally break down in the gut, translocate into the blood circulation, and trough epitopes combine with food IgG antibodies to form immune complexes. This, in turn, provokes an abnormal response and triggers immune-inflammatory cascade. Uncontrolled release of the proinflammatory mediators may contribute to low-grade systemic inflammation and low-grade neuroinflammation, which, via pathological processes in CNS [central nervous system], i.e., changes in neurotransmitter metabolism, neurogenesis, glutamate excitotoxicity, may in consequence induce and then maintain and prolong depression.

[diagram and excerpt from The Food-Specific Serum IgG Reactivity in Major Depressive Disorder Patients, Irritable Bowel Syndrome Patients and Healthy Controls]

I wrote my book, The Antianxiety Food Solution, in 2011 and there wasn’t research on the gut-immune-inflammatory-brain model, but I do write extensively about delayed IgG food sensitivities (as well as other types of food issues). If you don’t have my book I’m including some of the highlights related to this (and I encourage you to pick up a copy too!). If you do have my book I hope this next section encourages you to go back and read chapter 4 again (and even check out the other books I mention below).

I write about how with delayed food reactions, it may take a few hours to several days before symptoms appear, which can make it difficult to identify the offending food or foods. In these reactions, the body responds by creating a type of antibody known as IgG (immunoglobulin G).

I also write about how food sensitivities can have effects beyond physiological symptoms, including creating imbalances in key chemicals in the brain, which can cause anxiety, phobias, depression, irritability, and mood swings. When food sensitivities have these effects, they are sometimes termed “brain allergies” or “cerebral allergies.” Dr. Carl Pfeiffer wrote extensively about this and used these terms in his wonderful book, Nutrition and Mental Illness, way back in 1987. (This book is a quick read and is one of my favorite older books on the subject of mental health and biochemical imbalances.)

I also reference the work of my colleague and friend, clinical nutritionist Liz Lipski. In her 2004 book, the 3rd edition of Digestive Wellness she shares that

24 percent of American adults claim they have delayed food and environmental reactions.

She feels that these sensitivities are often the result of leaky gut syndrome, a condition characterized by damage to the microvilli lining the intestinal walls. This allows undigested food particles to travel across the intestinal wall and into the blood, where the immune system responds to them as foreign, harmful substances and creates antibodies to neutralize them.

All this sounds very similar to what the new study is reporting doesn’t it? I’d prefer it not to take so long for the knowledge from as far back as 1987 to get into mainstream journals but it’s the world we live in and we can just appreciate that we are moving forward and in the right direction!

The 2018 paper mentioned above concludes the following:

Our findings suggest more common food-specific serum IgG hyperreactivity among patients with IBS and MDD [major depressive disorder], which may be one of the mechanisms leading to the development of immune activation and low-grade inflammation observed in these disorders.

They do support an elimination diet for IBS but not for depression:

There is no causal relationship which could confirm clinical utility of an elimination diet in patients with depression

I do love research, but this really bothers me as it’s just common-sense and we do have some case studies supporting the use of elimination diets. In this case study the patient’s “treatment-resistant” depression improved considerably with an elimination diet, with similar results in another case study where a gluten-free elimination diet improved both anxiety and depression and everyday functioning.

In the meantime, we’ll continue to rely on the wisdom of practitioners like Dr. Pfeiffer and Liz Lipski, and all the clinical evidence showing how an elimination diet does help with both depression and anxiety. Just read some of the success stories on this blog – Paleo and grain free diets: anxiety and depression success stories.

Other mechanisms: nutrient malabsorption and serotonin production

There are other mechanisms that I also cover in my book – nutrient malabsorption and a more direct impact on serotonin production.

One possible mechanism is indirect effects of gastrointestinal damage due to eating problem foods, resulting in nutrient malabsorption. In a 2009 double blind placebo-controlled study:

65 celiac patients aged 45-64 years on a strict gluten-free diet for several years [and showing signs of low folate, low vitamin B12 and low vitamin B6] were randomized to a daily dose of 0.8 mg folic acid,0.5 mg cyanocobalamin and 3 mg pyridoxine or placebo for 6 months

I doubt folic acid or this form of B12 would be used today but even with these forms at these low doses, the study participants showed homocysteine in a good range and reported improvement in general well-being – after just 6 months of supplementation.

Another possible mechanism is the fact that gluten sensitivity and the resulting damage to the gut can limit the availability of tryptophan and therefore lead to decreases in levels of serotonin. Research published in 2005, Gluten-free diet may alleviate depressive and behavioural symptoms in adolescents with coeliac disease: a prospective follow-up case-series study, reports that:

serotonergic dysfunction due to impaired availability of tryptophan may play a role in vulnerability to depressive and behavioral disorders among adolescents with untreated coeliac disease

In addition to removing the foods that are causing the sensitivities, you need to heal the gut and boost serotonin levels with a targeted individual amino acid like tryptophan.

Give the link between anxiety and depression, all of the above could apply if you have anxiety too.

Have you had IgG food sensitivity testing and found that an elimination diet helped reduce your depression or anxiety symptoms?