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

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sjogren's syndrome

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, 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)

Here is one more resource for you: The Autoimmune Masterclass which airs online this weekend It’s a similar format to online 7-day summits but runs for 2 days instead and is no-cost to attend during these two days.

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?

Additional Anxiety Resources
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Sleeping through the night for the first time in many years: a trial and error approach to find the ideal tryptophan product

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If you have trouble sleeping through the night (or even have anxiety or panic attacks), finding the nutritional/biochemical root causes and addressing them is going to provide relief but it’s not always straightforward to find your root cause or causes (there are often more than one). Also, what works for you today may not work for you in 2 years time and may not work for your friend who has similar symptoms. You have to be a detective yourself and/or work with a health professional who can put all the puzzle pieces together.

I recently read a Facebook comment where someone was really frustrated about all the trial and error work that may be involved:

I’m just so tired of all this trial and error work trying to figure out why I’m anxious and depressed can’t sleep more than 4 hours a night. It’s been going on way too long I just want answers and a solution to all this. Enough already!

While I feel for this woman, I do acknowledge that it can sometimes be challenging to put all the puzzle pieces together. Other times we are able to figure things out very quickly. I’d like to share some feedback from Lorraine on the tryptophan-PMS-anxiety blog to illustrate how one small change made a big difference for her and it was a matter of trial and error.

Lorraine shares her great results with this Tryptophan Complete tweak for her insomnia:

Trudy, after listening to your talks about Lidtke Tryptophan I decided to give the Tryptophan Complete a try. I’ve taken one capsule each on the last two nights instead of two of the Tryptophan 500mg caps. Both nights I slept straight through all night and had a hard time waking up in the morning. I’ve struggled with insomnia for many, many years. The 500mg Lidtke Tryptophan supplements were helping but I was still waking up during the night. For me to sleep all night is almost miraculous.

I’ve been also taking Progesterone (low on testing), Magnesium, L-Theanine and Melatonin.

I recently added phosphatidylserine, and Holy Basil because saliva testing showed high cortisol at bedtime and off the charts high in the morning. I’m hoping to start eliminating some of those other supplements now that I’m sleeping so well.

I want to thank you for the Anxiety Summits and your book and updates on Facebook and newsletters. I have learned so much from you!

I’ve blogged about which product to use for boosting serotonin: Tryptophan 500mg or Tryptophan Complete (by Lidtke)?. I share this

  • I like to have my clients do a trial of the amino acidsso they can find the ideal dose for their needs and right now I still feel this would still be the best approach to take – using 500mg tryptophan. Once you have figured out you do well with tryptophan-only product and have your dose, then consider reducing it slightly after about 2-3 weeks and adding in additional Tryptophan Complete.
  • The other option is this: if you don’t get the expected results with Tryptophan 500mg, then try the Tryptophan Complete. You may need the other ingredients for it to work well for you.

Lorraine chose to do the latter – switching to Tryptophan Complete – since she didn’t get ideal results with Tryptophan 500mg and it worked for her. I will add that even though she slept straight through all night, I don’t like that she had a hard time waking up in the morning and when that happens, I recommend less tryptophan. It’s very possible that the ideal combination would be 1 x Tryptophan 500mg and 1 x Tryptophan Complete (my first suggestion).

Here is my quick commentary on the other products she’s using for her insomnia:

  • Progesterone and theanine: Testing progesterone levels are important before using progesterone. Both theanine and GABA support GABA production and when GABA is low, we often see low progesterone. With both low GABA and low progesterone, sleep and anxiety can be worse.
  • Magnesium: This mineral is commonly low and is needed to make both serotonin and GABA.
  • Melatonin: This is made in the body when there is sufficient serotonin and may not be needed long-term once she has good levels of serotonin (which the tryptophan product/s are helping her make).
  • Phosphatidylserine and holy basil: High cortisol is a common root cause of both insomnia and anxiety and saliva testing is an excellent way to confirm this. Phosphatidylserine can be used to lower high cortisol although I have found even better results with a phosphorylated serine product called Seriphos. Holy basil or tulsi is an adaptogenic herbal product that provides adrenal support helping with sleep problems and easing anxiety and stress.

In Lorraine’s case, her insomnia was caused by low serotonin (hence the need for tryptophan, melatonin and magnesium), low GABA/low progesterone (hence the need for progesterone, theanine and magnesium) and high cortisol (hence the need for phosphatidylserine and holy basil).

She shares she’s hoping to start eliminating some of these other supplements now that she’s sleeping so well. So, this would be another trial and error approach, stopping and/or reducing one at a time and seeing how she does. Or she may well find she needs to continue with everything for some time.

As you can see, for Lorraine it was a matter of trial and error to find her solution, but it was well worth it to get the “miraculous results” she experienced: sleeping though the night for the first time in many years!

Some of these products may work for you but it’s going to be a matter of trial and error to find your root cause/s and solution.

In case they are relevant for you, these products mentioned in this blog can all be found in my online Fullscript store:

I’d love to hear how you’ve used a trial and error approach either on your own or with the help of your practitioner to find the nutritional solution for your insomnia and/or anxiety?

If you’re a practitioner, please do share an example of how you’ve used this approach with a client or patient.

If you’ve had frustrations with this trial and error approach, please share them too.

Feel free to post your questions here too.

Additional Anxiety Resources
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I have chronic insomnia and I started getting headaches with GABA, 5-HTP and melatonin

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A combination of GABA (gamma-aminobutyric acid) and 5-HTP (5-hydroxytryptophan) can often improve sleep duration more than the use of either of these two amino acids alone. I blogged about this and the supporting research published in 2016.

Eve asked this question about her chronic sleep problems and headaches that she suspects are being triggered by the supplements:

I have chronic insomnia and I have been using 100mg 5-HTP, 250mg GABA and 1mg melatonin during the night for a week but the second day I used them I started getting a headache. Do you have idea what happened and can you please help me?

I shared this feedback about each person having unique needs and that I trial one amino acid at a time to find the ideal dose and then once we have a good baseline with good results and no adverse effects, we add the next one if needed. With 3 new supplements being started at once, we don’t know which one may be helping and which one (or more) is causing headaches.

A reminder I give all my clients is NOT to push through with the amino acids when you are experiencing any adverse effects. Headaches are more common with tyrosine rather than 5-HTP or GABA but too much of any one of the amino acids may cause a headache and with some folks, even a small amount can cause a headache especially if it’s not needed. At the first sign of a headache my advice is to stop the latest supplement added and see how you do. If 3 where started at one time, as in this situation, stop all 3 and add them back one at a time, watching for headaches and benefits.

Eve didn’t say which GABA product she was using. Source Naturals GABA Calm is the one I most often recommend, and the small amount of tyrosine could be causing her headaches. If this is the case, a switch to a GABA-only product or a GABA-theanine product may be what is needed.

It’s always important to also review the amino acid precautions before use. If you have migraines, tyrosine may make them worse.

But I do want to also add that some folks cannot tolerate 500mg tyrosine at all and yet they do just fine with the 25mg of tyrosine in the GABA Calm product (and sometimes up to 75mg of tyrosine when three GABA Calm lozenges are needed at once).

It’s also good to be aware that some folks do better on tryptophan versus 5-HTP so if it is the 5-HTP that is the problem I’d consider a trial of tryptophan. The best way to do that is to replace the 5-HTP with tryptophan (and I recommend Lidtke 500mg tryptophan).

You want to also look carefully at each of the products in case there are fillers that could be causing the headaches.

If it turns out that none of these are working i.e. the problem with sleep isn’t because of low serotonin and low GABA, then we ask these questions and address them:

  • is there a gut issue i.e. is there candida, parasites and/or dysbiosis?
  • is night-time cortisol high?
  • is gluten or other grains an issue? or was there accidental gluten exposure?
  • is caffeine or alcohol consumption a problem?
  • is there EMF and WiFi exposure?
  • are there medication side-effects?
  • has there been mold exposure or some other environmental trigger?

Have you had issues when trialing amino acids for sleep or anxiety and then figured out what the problem was?

Gut bacteria, pain and anxiety connections: Klebsiella and ankylosing spondylitis

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We know about the gut-brain connection where the health of our microbiome impacts how anxious or depressed we feel, but we often forget that there is a gut-pain connection too and how addressing dysbiosis and bad bacteria in the gut can have far-reaching benefits.

An old work friend recently reached out asking for help for her husband who had been diagnosed with ankylosing spondylitis, ulcerative colitis and gluten sensitivity, and was not seeing results with conventional treatment. I did some digging for them and a colleague mentioned that they had addressed Klebsiella when they discovered that her husband had genes predisposing him to ankylosing spondylitis. Read on to see what I’ve learned.

Klebsiella as a precursor to ankylosing spondylitis

The paper shared with me: The relationship between Klebsiella infection and ankylosing spondylitis, discusses the HLA-B27 gene and the Klebsiella connection:

Klebsiella-reactive arthritis is the precursor stage occurring in the early and active phases of ankylosing spondylitis.

Let’s learn more about Klebsiella, ankylosing spondylitis, the anxiety connection and prevalence, the role of neuro-inflammation and genes, the problems of a high carb diet and the role the amino acids GABA, tryptophan and DPA play in pain and anxiety relief and being able to quit the carbs easily, plus provide sleep support.

In case you’re not familiar with Klebsiella, this excellent FX Medicine article describes it as follows:

Klebsiella pneumoniae (KP) is a type of gram-negative rod-shaped bacteria that can cause different types of infections ranging from pneumonia (lung), blood infections (septicaemia), wound or surgical infections, urinary tract infections, small intestinal bowel overgrowth (SIBO), ankylosing spondylitis, Crohn’s disease, ulcerative colitis and meningitis (brain).

Ankylosing spondylitis is an inflammatory disease of the spine

In case you’re not familiar with the condition ankylosing spondylitis (pronounced like this) the Mayo Clinic site provides this summary:

Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the vertebrae in your spine to fuse. This fusing makes the spine less flexible and can result in a hunched-forward posture. If ribs are affected, it can be difficult to breathe deeply.

Ankylosing spondylitis affects men more often than women. Signs and symptoms typically begin in early adulthood. Inflammation also can occur in other parts of your body – most commonly, your eyes.

They say there is no cure and the treatments include pain medications and physical therapy to ease symptoms (and surgery in some cases).

I’m all for physical therapy but you’ll notice there is no mention of gut health or Klebsiella. This is why we have to keep searching for root causes – and work with a functional medicine practitioner – no matter what the health condition, be it ankylosing spondylitis or anything else.

Prevalence of anxiety in ankylosing spondylitis

As with most physical conditions there is a connection with anxiety. This paper: Prevalence of psychological disorders, sleep disturbance and stressful life events and their relationships with disease parameters in Chinese patients with ankylosing spondylitis reports that

AS [ankylosing spondylitis] patients had more severe psychological disorders, sleep disturbance, and stressful life events.

Prevalence of anxiety, depression, and sleep disturbance was 31.6%, 59.3%, and 31.0% respectively.

We have to ask ourselves if we have anxiety, depression and insomnia because of the pain being experienced or because of one or more of the root causes that contribute to both pain and anxiety.

Microbiota disturbance, neuro-inflammation, and anxiety

Often the research focuses on the former but we know that there is Evidence for interplay among antibacterial-induced gut microbiota disturbance, neuro-inflammation, and anxiety in mice. In this 2018 animal study treatment with lactobacilli suppresses this neuro-inflammation.

Ankylosing spondylitis, Crohn’s disease, genes and a high carb diet

The above FX Medicine article shares the connection between ankylosing spondylitis, Crohn’s disease and ulcerative colitis, as well as the genetic susceptibility, together with the problems of a high carb diet:

Genetically susceptible people, such as those who have the HLA-B27 allelotypes and consume a high starch/carbohydrate diet, can trigger a growth in Klebsiella in the bowel, the starch becoming a main food supply for the Klebsiella.

The amino acids for pain, carb addition, anxiety and insomnia

The amino acids come into the picture again, helping to ease the pain, provide precursors for neurotransmitter production until the microbiome is balanced, and eliminate carbohydrate cravings so they can be given up without willpower.

As always figuring out your own imbalance and doing an amino acid trial is key. Here is a summary of how they may help in this instance, assuming you have low levels of GABA, serotonin and/or endorphins:

  • GABA helps with stress eating of carbs, eases physical anxiety, eases some pain.
  • Tryptophan helps with afternoon and evening carb cravings, eases mental worry-type anxiety and depression, and also eases some pain. Both GABA and tryptophan help with insomnia.
  • DPA boosts endorphins providing acupuncture-like pain relief and provides the emotional comfort that starchy treats often do.

The FX Medicine article has treatment and prevention tips for you to share with your functional medicine doctor, who will be able to run a functional stool test such as the GI-MAP offered by Diagnostic Solutions Lab.

Just because there are these gut bacteria, pain, anxiety, Klebsiella and ankylosing spondylitis connections, it doesn’t necessarily mean everyone with ankylosing spondylitis has Klebsiella or that everyone who has Klebsiella will go on to develop ankylosing spondylitis (as stated above) or even that everyone with ankylosing spondylitis will have anxiety. I’m simply connecting some dots so you can start to think outside the box.

I’d love to hear what has worked for you or a loved one with ankylosing spondylitis and/or if you’ve seen elevated Klebsiella on your stool test or have the genetic predisposition?

Have the amino acids and a low-carb diet helped the healing process and eased some of your anxiety while addressing the underlying Klebsiella infection?

The amino acids GABA and tryptophan can help to relieve anxiety in children: an interview with Dr. Nicole Beurkens

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Using individual amino acids such as GABA and tryptophan can have an incredible impact on children with anxiety, easing anxiety very quickly. I don’t often write or talk about using amino acids with children and since many of you have asked for more resources for children, today I’m sharing an interview I recently did on this topic on The Better Behavior Show. This is a podcast hosted by my colleague and good friend Dr. Nicole Beurkens.

I share specifics on how Amino acids can help to relieve anxiety in children, together with some case studies.

Dr. Nicole sums up the power of the amino acids beautifully – and this is exactly why my clients love them so much – they take the edge off quickly, provide results and help with overwhelm:

I think that the fact that these [amino acids] can work quickly is really helpful. And as you said, it helps to take the edge off, it helps to reduce the symptoms so then we can more effectively address all of the underlying things. Because often, I’ll have parents say, “Oh, you want me to change the diet and do all these things, I just feel so overwhelmed, my kid is having so many issues, I don’t know how we’re going to do any of that.” And then when you can use things like targeted aminos to help take the edge off the symptoms for the parent and the child, it makes all of that other stuff more doable, I think.

Here are some snippets from one of the stories I share – the wonderful results I had with a 11-year old girl who had been adopted, was diagnosed with reactive attachment disorder and had explosive anger issues. This young girl:

….also had insomnia, so she was not sleeping well at all. She was very fatigued in the day, had really bad anxiety about going to school and loved colored candies and she was a big bread eater.

This family didn’t have much money to spend so I really had to find an affordable solution with the biggest benefits. She was anemic so we addressed that with iron supplements and getting her eating quality grass-fed red meat again and we figured out that gluten was an issue so she went gluten-free and this made a big difference with the outbursts.

The other factor was to figure out if low serotonin was a factor and address this. The big clues were the anger, the insomnia, the anxiety and the sugary cravings:

I was talking to her about the fact that she loved candies and she loved bread, and I said — how would you feel about giving it up? She was fuming with me. She was in a swivel chair and she turned her back to me and she didn’t want to talk about it.

I offered her a 100mg chewable tryptophan to see if it would help with her sugar cravings and the fact that she was furious with me:

“How about trying this amino acid, it’s called tryptophan and it’s chewable and it doesn’t taste bad… and then we’ll talk a little bit later. Don’t worry about what I said earlier.” So I gave her 100mg of chewable tryptophan.

She chewed the tryptophan and within 5 minutes, she turned around, smiled at me and said, “I think I can do it, I’m ready to do it.”

She was calm and smiling, and ready to give up the candies and bread and other gluten-containing products. These 3 interventions – addressing her low iron levels, having her go gluten-free and supplementing with tryptophan – completely turned this little girl’s life around.

Here is the link to the entire transcript of our interview: Amino acids can help to relieve anxiety in children. You can also find the audio interview at this same link or by going directly to iTunes – simply search for “The Better Behavior Show.”

Do listen in and/or read the transcript and learn more about:

  • how I do a trial of the amino acids (this allows for quick results in 5-10 minutes)
  • how I’ve worked with non-verbal children
  • a simple trick for using the unpleasant tasting tryptophan sublingually
  • what low GABA anxiety looks like in a child
  • why ADHD symptoms in children may actually be anxiety (I share another success story in this section)
  • why I use GABA Calm with children and adults (Dr. Nicole uses this GABA product too and loves that it’s sublingual and tastes great)
  • times you may consider using tyrosine or DPA
  • and much more

It was a pleasure to be on the show of someone whose work I deeply respect. Dr. Nicole is a unique combination of clinical psychologist, nutritionist, and special education teacher, and shares these resources for help with improving your child’s behavior naturally: her book Life Will Get Better, blog, and the Better Behavior Naturally Parent Program.  and tune in to my interview and some of the other excellent interviews.

If you’d like to learn more about these supplements, look at my supplements blog here

There is also a “Liquid and powder options for children” section on this blog – with other products you may find useful for children.

I’d also like offer a caution about the 100mg chewable tryptophan This chewable form is both good and bad. It’s good because it’s a nice 100mg of tryptophan per tablet, is chewable, tastes good and is suitable for children and “pixie dust” individuals who need a very small amount and for when doing the initial trial. The bad aspect is that it does contain sugar and is quite sweet. Because you are continually consuming something sweet you may end up over-consuming them if sugar addiction is your issue. I’ve seen the same with children who want to eat them like candy. So, what I do most of the time is use the chewable tryptophan for the trial and then switch to the 500mg tryptophan after that. We did that with the 11-year old with anger issues, anxiety and candy cravings.

One more thing: Lidtke is the only brand of tryptophan I use and recommend because of its quality. I forgot to mention that in our interview.

Have you benefited from using any of the amino acids and then found they also help your child/children?