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Trichotillomania: NAC, GABA, tryptophan, inositol and zinc?

By Trudy Scott 44 Comments

 

This recent paper reports on a case study with NAC – Trichotillomania: a good response to treatment with N-acetylcysteine

Trichotillomania is considered a behavioral disorder and is characterized by the recurring habit of pulling one’s hair, resulting in secondary alopecia. It affects 1% of the adult population, and 2 to 4.4% of psychiatric patients meet the diagnostic criteria. It can occur at any age and is more prevalent in adolescents and females. Its occurrence in childhood is not uncommon and tends to have a more favorable clinical course.

The scalp, eyebrows and eyelashes are the most commonly affected sites. Glutamate modulating agents, such as N-acetylcysteine, have been shown to be a promising treatment. N-acetylcysteine acts by reducing oxidative stress and normalizing glutaminergic transmission. In this paper, we report a case of trichotillomania with an excellent response to N-acetylcysteine.

In this case report an 11 year-old male student had been pulling his hair out for 6 months. He had a relationship problem with this father and also suffered from asthma and dermatitis. He was started on NAC:

Treatment with N-acetylcysteine was initiated ​​(1200 mg/day for three months). The patient’s outlook improved dramatically, but complete remission was not achieved. We chose to increase the dosage to 1800 mg/day, which resulted in almost complete regrowth.

[From: Trichotillomania: a good response to treatment with N-acetylcysteine]

In this paper from 2009, N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study, it is reported that

  • Fifty individuals with trichotillomania (45 women and 5 men) received 1200-2400 mg/day of N-acetylcysteine or placebo over a 12-week period.
  • 56% percent of patients experienced “much or very much improved” hair-pulling symptoms with N-acetylcysteine use compared with 16% using the placebo, and the improvements were first noted after 9 weeks of supplementation.
  • Those in the N-acetylcysteine group did not experience any adverse events.

As you can see, the results with NAC are excellent but it can take 9 weeks and more before results are seen. For this reason, I would always also assess for low serotonin and low GABA and do trials of tryptophan or 5-HTP for low serotonin and GABA for low GABA. With any compulsive and obsessive behaviors I always consider inositol too and we may add this once the ideal dose of tryptophan has been found.

What is my rationale for recommending GABA, tryptophan, 5-HTP and/or inositol?

  • Since NAC works on reducing oxidative stress and normalizing glutaminergic transmission, GABA may help too and will certainly help to ease any physical anxiety that is being experienced
  • “Recommended first-line therapy for this psychiatric condition is administration of SSRIs” even though their efficacy is not yet proven in children – for this reason I’d recommend tryptophan or 5-HTP
  • Also “according to the psychiatric definition, these patients pull their hair because the act is gratifying and reduces tension, anger, depression and anxiety” (these are all signs of low serotonin and another reason to consider tryptophan or 5-HTP)
  • Because they offer relief right away, within 1-5 minutes

A complete nutritional and functional medicine work-up would be part of the plan too – to address the asthma and dermatitis (in the first paper above) and any other symptoms the person is experiencing and may be a contributing factor.

I’d expect the 56% of improved patients (in the second study above) to go to a much higher percent with all of the above approaches.

When I shared these papers on Facebook I was asked this question from someone who pulls out her eyelashes:

I pull my mascara off what is left of my eyelashes every night. I try my hardest not to do it but I find it impossible once I’ve touched my lashes. I’m about to start taking GABA and I was thinking about taking NAC. Would it be a bad idea to take both these amino acids?

This is my feedback: I always like to do one thing at a time and (as mentioned above) I would do the amino acid questionnaire and a trial of tryptophan and GABA first if the scores are high, and then look at adding NAC. If there are still some obsessive tendencies I would consider adding inositol. I am not aware of any issues with using all of these nutrients at once.

Someone else asked this:

Wouldn’t you deal with the psychological cause of it too – at the same time?

My response: Yes absolutely – if there is a psychological cause. But be aware that sometimes it’s purely nutritional or biochemical.

Another person shared that she only exhibits these behaviors when she’s stressed. Of course, the nutrients mentioned above, plus dietary changes, adrenal support, improving gut health and everything that I educate about, are important for reducing stress.

I also received some success stories. Here is one of them:

I’ve struggled with trichotillomania and dermatillomania (skin picking) for years and years. I underwent hypnosis that was extremely effective. When I added in zinc (after reading your book) the urge is almost completely gone. Thank you!

Keep in mind that zinc is a co-factor for making serotonin and GABA, is important for overall adrenal support and stress reduction, is needed for glutathione production and works as an antioxidant. I’d actually love to see these studies repeated with zinc alone.

And then I received this message from someone else:

I’m messaging you my answer about NAC because it’s slightly embarrassing I’ve always had terrible acne and always have picked at it obsessively and could not stop until I was given some supplements for PCOS which happened to contain NAC. To my surprise I lost the compulsion to pick at my skin, something I had never thought possible!

How wonderful for both of them! I always appreciate feedback like this and have to say nothing is too embarrassing to share (especially if it helps someone else).

Have you used NAC with success – with trichotillomania or dermatillomania (skin-picking) or even nail-biting? Or some other compulsive behavior?

What about GABA or inositol or tryptophan or zinc (or something else) for the same purpose and/or for additional emotional and stress-reducing support?

The best food-mood-nutrient topics of 2017

By Trudy Scott Leave a Comment

As we move into 2018, it’s time to recap and share the best of 2017 – from both blog posts and facebook posts. Hopefully these topics have helped you move forward as you address your anxiety symptoms and will help you (and your clients/patients if you’re a practitioner) take even bigger leaps as you move into 2018!

Most popular blog posts

Here are the most popular blog posts of 2017, based on comments and questions. If you have already read one of these and found it interesting at the time of publication, it’s worth a re-read for all the valuable comments/questions and my feedback.

Collagen and gelatin lower serotonin: does this increase your anxiety and depression?

I see everyone raving about gelatin and collagen – and rightly so – they have amazing health benefits. However, no-one is addressing the fact that gelatin is actually used in tryptophan-depletion studies to lower serotonin.

Some people get more anxious and depressed when consuming collagen, some do just fine and some even use it to lower their serotonin. Many need to use it with added tryptophan. I recently made some additional updates to this blog and have more to add so stay tuned for more on this topic.

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

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

My Kid is Not Crazy and PANS/PANDAS awareness day 2017

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) occurs when strep triggers a misdirected immune response results in inflammation on a child’s brain. In turn, the child quickly begins to exhibit life changing symptoms such as OCD, anxiety, tics, personality changes, decline in math and handwriting abilities, sensory sensitivities, restrictive eating, and more.

Anxiety, compulsive thinking, counting behaviors: gluten, tryptophan and inositol

Today I’m going to share my feedback on a question I received on how to approach working with a child with anxiety, compulsive thinking and counting behaviors in the hope it can help you or someone you know (or are working with if you’re a practitioner)

DPA for weepiness, pain and comfort and reward eating

This amino acid is a favorite with so many of my clients because it helps with [weepiness, pain and comfort and reward eating] by boosting your endorphins and when you chew a capsule you feel like you just got a big hug.

How to Beat Anxiety and Resolve Panic Attacks with Targeted Amino Acids: Wellness Mama podcast

I share my wonderful interview with Katie, the “Wellness Mama”. We talk about my favorite topic: How to Beat Anxiety and Resolve Panic Attacks with Targeted Amino Acids, with some extra questions about pregnancy and nursing that I’m not often asked about.

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

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

I share that sublingual is best, do a trial and start low, my favorite GABA products and when it works and when it doesn’t.

Tryptophan for the worry-in-your-head and ruminating type of anxiety

I’m going to review some tryptophan products for the worry-in-your-head and ruminating type of anxiety… Lidtke is the only brand of tryptophan that I recommend simply because I see it work so well and because of quality issues with tryptophan in the past.

I also share when to use tryptophan and when to use GABA, and tryptophan for PMS.

GABA: an amino acid supplement for neurotransmitter support and anxiety relief

I recently attended the first international meeting of International Society for Nutritional Psychiatry Research and was honored and thrilled to present my poster – GABA: an amino acid supplement for neurotransmitter support and anxiety relief Because you were not able to be there, here are the contents of my poster word for word.

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

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

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

Migraines, Anxiety and Antiphospholipid Syndrome: on the Chronic Headache & Migraine Summit

The autoimmune condition called Antiphospholipid Syndrome (APS) is one of many possible contributing factors for both migraines and anxiety.

Cognitive impairment, strokes and livedo reticularis is common.

GABA protects against hypothyroidism caused by fluoride and reduces anxiety

To the best of our knowledge, this is the first study to establish the therapeutic efficacy of GABA as a natural antioxidant in inducing thyroprotection against fluoride-induced toxicity.

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

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

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

Anxiety: when to use GABA and tryptophan and how much to use

When you have anxiety it can be confusing trying to figure out the root cause. I like to start by assessing for low GABA and low serotonin because when you address these with targeted individual amino acids you typically see results right away and feel hopeful (and now have time to look for other root causes like gluten issues, high cortisol, gut issues, dietary changes etc).

But there may still be some confusion about when to use GABA and when to use tryptophan and how much of each of these amino acids to use.

Vulvodynia: oxalates, GABA, tryptophan and physical therapy

I just listened to the webinar talking about oxalates. I was shocked and delighted to hear the mention of the connection between high oxalates and vulvodynia.

Research shows there is serotonin involvement with vulvodynia and SSRIs are often prescribed, as are benzodiazepines. My recommendation is trials of tryptophan and/or GABA.

Seriphos Original Formula is back: the best product for anxiety and insomnia caused by high cortisol

If you have high nighttime cortisol (as measured by an adrenal saliva test) it can cause insomnia and anxiety. Using 1-3 x Seriphos about 1-3 hours before the high cortisol is the best way I know for lowering the high cortisol and providing relief.

The product was reformulated and didn’t work like it used to and then the original formula was brought back.

GABA takes some of the anxiety edge away and now I want to add tryptophan: how do I do this?

I would say this – ask yourself what low GABA anxiety symptoms (this is the physical anxiety) have improved with the GABA and how much (rate each one before – out of 10; and what are they now – out of 10). From your question it sounds like they could improve more – so if we were working together I’d continue to increase GABA before adding something new.

The most popular facebook posts

And here are some of the most popular Facebook posts on TrudyScottAntianxietyFoodSolution (based on comments and shares). Many of these link to other sources like the research or other blogs with additional information. Most of them have a great back and forth discussion on the Facebook post so feel free to join in there.

Canola oil linked to worsened memory and learning ability in Alzheimer’s

Canola oil is one of the most widely consumed vegetable oils in the world, yet surprisingly little is known about its effects on health. Now, a new study published online December 7 in the journal Scientific Reports by researchers at the Lewis Katz School of Medicine at Temple University (LKSOM) associates the consumption of canola oil in the diet with worsened memory, worsened learning ability and weight gain in mice which model Alzheimer’s disease. The study is the first to suggest that canola oil is more harmful than healthful for the brain.

Canola oil is not something I’ve ever recommended and I’m really glad to see this research. You have to read labels because it’s in a lot of salad dressings and processed foods!

Nestle to buy vitamin maker Atrium Innovations for $2.3 billion

The following brands are now owned by Nestle: Garden of Life, Douglas Laboratories, Pure Encapsulations.

This is not good! Other than the fact that the formulations will likely be changed, there is much to be said about Nestle and their ethics.

The Big Vitamin D Mistake

This could lead to a recommendation of 1000 IU for children <1 year on enriched formula and 1500 IU for breastfed children older than 6 months, 3000 IU for children >1 year of age, and around 8000 IU for young adults and thereafter. Actions are urgently needed to protect the global population from vitamin D deficiency.

Do you use a zinc supplement every day?

1) how much and what form? and with or without copper?
2) how did you decide to add zinc (or was it recommended by a practitioner)
3) how did you assess your zinc status (alk phos? zinc challenge/tally? mood symptoms? white flecks on nails? poor digestion? pyroluria questionnaire? blood work? other?)
4) how it helps you? (less anxious? more social? less depressed? less cravings? better digestion? better skin? less aches/pains? better blood sugar control? less PMS/hormone symptoms? better adrenal health? better immunity? other?)

Scary new information about benzodiazepine deaths

The five most frequently occurring drugs found in decedents were ethyl alcohol (5,318), benzodiazepines (5,167, including 1,851 alprazolam occurrences), cocaine (2,882), cannabinoids (2,292), and morphine (2,040).

With teen mental health deteriorating over five years, there’s a likely culprit

In a new paper published in Clinical Psychological Science, my colleagues and I found that the increases in depression, suicide attempts and suicide appeared among teens from every background – more privileged and less privileged, across all races and ethnicities and in every region of the country. All told, our analysis found that the generation of teens I call “iGen” – those born after 1995 – is much more likely to experience mental health issues than their millennial predecessors.

What happened so that so many more teens, in such a short period of time, would feel depressed, attempt suicide and commit suicide? After scouring several large surveys of teens for clues, I found that all of the possibilities traced back to a major change in teens’ lives: the sudden ascendance of the smartphone.

Gabapentin and pregabalin are as problematic as benzodiazepines

Crippling toll of the new valium that’s ruining the lives of MILLIONS

Can you relate to the term high-functioning anxiety?

Busy and in control. High-achieving and perfectionistic. Driven by details and order in a desperate attempt to calm racing thoughts, worry, and the fear that invade every ounce of the mind and body. An over-thinker with a tendency to perseverate, dwell, and stew on everything.

I used to be like this before the panic attacks and it’s a big clue that it’s time to do something about it but too often we push and push and push and then it gets really bad. I would love to be able to reach women (and men) at this stage before it gets really bad!

Great article about squatting and the benefits

How often do you squat? and do you use a device like the Squatty Potty?

Screen time might boost depression, suicide behaviors in teens

A new study finds that teens, especially girls, who spend several hours per day on phones and tablets are more likely to be depressed and have suicide-related outcomes.

When it comes to cravings, addiction and appetite we have this research supporting the use of glutamine

– Glutamine and glutamatergic metabolism is a factor in cravings and alcohol dependence
– A combination of tyrosine, lecithin, glutamine and 5-HTP helped withdrawal syndromes and mental symptoms in detoxified heroin addicts
– Glutamine has been shown to decrease secretion of ghrelin, the hormone that impacts appetite regulation. High levels of ghrelin appear to make high-calorie foods look more appealing.

Why the vaginal mesh scandal could be ‘bigger than thalidomide’

More than 92,000 women had vaginal mesh implants between 2007 and 2015 in England, and about one in 11 is said to have complications. More than 800 of these women are now taking legal action against the NHS and mesh manufacturers.

Please be aware of the dangers of vaginal mesh (and other procedures that use mesh) – it’s something I’ve always warned my clients about and it needs to become common knowledge

Do you take probiotics on a daily basis and do they help? Have you had to stop taking probiotics because of any adverse effects?

Melatonin–estrogen interactions in breast cancer

Individualized protocols in Dr. Nalini Chilkov’s OutSmart Cancer system include melatonin at 10-20mg at bedtime (to match nature’s cycling of melatonin…not for sleep issues) . MANY breast cancer patients have low or aberrant melatonin patterns.

The anti antidepressant. Depression affects 16 million Americans.

One third don’t respond to treatment. A surprising new drug may change that: ketamine.

I’m quite surprised how many women who are smart and savvy when it comes to eating and natural health continue to color their hair (or straighten or perm or treat).

I’m curious if you are one of those people ? And if yes why? Do you know the risks or would you just prefer not to know?

Excellent article on toxic sunscreen ingredients

I have always avoided conventional sunscreens and teach my clients about this but wish more people were aware of these issues. It’s not just sunscreens either…so many skin care products, makeup, hair products and household products have ingredients that are endocrine disrupters, cause DNA and oxidative damage and affect our health – both physically and mentally! What sunscreen do you use?

My favorite protein powder

I love this one because _______. I use it in these ways ______, _______, ________.

Right now my favorite protein powder is a pea protein (made by Nuzest). I love this one because it’s gluten-free, dairy and soy free, GMO-free and is pea only (no other ingredients!). I just found out it’s also available in USA and other countries.

My favorite healthy protein bar

I love it because _______ AND/OR I tried ______ and don’t like it because ________. My clients are always looking for protein bars for a quick healthy snack but so many are loaded with sugar OR don’t have enough protein and fat OR are full of processed soy OR contain a ton of nuts OR aren’t gluten-free.

Thank you for being such a huge part of this community, for sharing your stories and successes and for offering words of encouragement to others in the community. Thank you too, for asking your questions. Keep the questions coming – they keep me on my toes and help me to learn too!

I’d love to hear how the above topics have helped you and what topics you’d like me to cover in 2018, plus which areas you’d like me to take an even deeper dive into.

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

By Trudy Scott 61 Comments

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

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

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

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

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

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

How I have benefited from GABA

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

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

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

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

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

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

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

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

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

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

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

If you have other pain issues:

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

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

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

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

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

Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth (SIBO)

By Trudy Scott 15 Comments

Despite the fact that this paper was published in 2014, it’s still very relevant and I’m just behind in sharing it via a blog post: Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth

Patients with small intestine bacterial overgrowth (SIBO) have chronic intestinal and extraintestinal symptomatology which adversely affects their quality of life. Present treatment of SIBO is limited to oral antibiotics with variable success. A growing number of patients are interested in using complementary and alternative therapies for their gastrointestinal health. The objective was to determine the remission rate of SIBO using either the antibiotic rifaximin or herbals in a tertiary care referral gastroenterology practice.

I’ve also decided to post this study now because I’ve been dealing with chronic SIBO for some time and am in the middle of doing the Metagenics herbal protocol (more information on that below).

SIBO symptoms and conditions

Here is a summary of some of the chronic intestinal symptoms: Abdominal bloating (gas), belching, flatulence, abdominal pain, cramps, constipation and/or diarrhea, heartburn (reflux or GERD), nausea and food sensitivities.

Here is a summary of some of the extraintestinal (outside the intestinal system) symptoms and conditions that have been linked to SIBO and/or dysbiosis: disorders of mood and behavior (including anxiety), diabetes, obesity, cardiovascular disease, rosacea, restless legs syndrome, pain, anemia, interstitial cystitis, and other pelvic conditions such as vulvodynia and proctalgia fugax (rectal spasms), chronic prostatitis and polyneuropathy.

During season 3 of The Anxiety Summit, I interviewed Dr. Allison Siebecker on Small Intestinal Bacterial Overgrowth and Anxiety. We talked about the SIBO Questionnaire I use with my clients and she gave me permission to share my modified version. You can find this SIBO questionnaire here. Please check out Dr. Siebecker’s site siboinfo.com for a wealth of information about SIBO.

The herbal treatments in this study

In this study, one hundred and four patients who tested positive for newly diagnosed SIBO by lactulose breath testing were offered either 1200mg rifaximin a day or one of two herbal treatments for 4 weeks. Lactulose breath testing was done again at the end of the treatment.

These are the two herbal treatments that were offered:  

Dysbiocide and FC Cidal (both by Biotics Research): take 2 capsules twice daily of each of these products

or

Candibactin-AR and Candibactin-BR (both by Metagenics): take 2 capsules twice daily of each of these products

The ingredients in each of the products
(from the paper: Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth)

Study conclusion

The study concluded that these herbal therapies are at least as effective as rifaximin for resolution of SIBO. It also states that the herbal products also appear to be as effective as triple antibiotic therapy in patients who don’t respond to rifaximin.

Adverse effects

With regards to adverse effects, they were reported as follows: in the rifaximin treated patients there was 1 case of anaphylaxis, 2 cases of hives, 2 cases of diarrhea and 1 case of Clostridium difficile; in the herbal group only one case of diarrhea was reported.

A comment about bioindividuality

You’ll notice that the only herb that is in both sets of herbal protocols is Red Thyme Oil or thymus vulgaris and yet both herbal protocols offer a solution. I’ve heard Dr. Siebecker share that of all the different approaches for SIBO (including the elemental diet), at least one approach works for everyone. So, if you’ve tried an approach and it hasn’t worked, don’t give up and move on to the next approach. This points to bioindividuality, and there being no one size fits all approach.

Dr. Siebecker lists the above combination herbal protocols together with the herbal protocol her and team use on her site, which, again, is different from the above: 1-3 of the following herbs x 4 weeks per course, at highest levels suggested on product labels.

  • Allicin from Garlic (the highest potency formula is Allimed)
  • Oregano
  • Berberine- found in Goldenseal, Oregon Grape, Barberry, Coptis, Phellodendron
  • Neem
  • Cinnamon

My protocol and experience

As I mention above, I also decided to post this study because I’ve been dealing with chronic SIBO for some time and am in the middle of doing the Metagenics herbal protocol. I’m 14 days into a 28-day protocol.

I’m actually doing 1 capsule of Candibactin-AR, 3 times a day away from food and 2 capsules of Candibactin-BR, twice a day, and about 10 minutes before food. I landed on this protocol, so I would have enough of each for a 4-week protocol.

When I started on the products I immediately observed the typical SIBO bloating and almost quit but quickly figured out it was from the microcrystalline cellulose and hypromellose in the Candibactin-BR.

It turns out that these are soluble fibers (dispersible in water) and are more easily fermented than insoluble fibers. This fermentation in the small intestine can trigger IBS/SIBO symptoms. Adding 2 capsules of a product with cellulase (an enzyme that breaks down cellulose) has helped.

Pain, gas and GABA

I also remembered that Dr. Siebecker shared on the SIBO SOS I summit about how SIBO patients can have visceral hypersensitivity where their pain can be due to the pressure of the gas that is produced and the muscles in the digestive system actually contracting against this pressure. It got me thinking about how effective GABA is for relieving muscle tension. I use GABA with my clients all the time for relief of their physical anxiety and stiff and tense muscles. And GABA helps me and many others with proctalgia fugax (rectal spasms)  which seems to be related to IBS/SIBO.

Over the last week I’ve tried sublingual GABA a few times to ease the pain and pressure and it’s been amazing. I’ve used it as soon as I notice the bloating starting AND even the next morning when I wake with the bloated ache in my belly.  I’ve been using the NFH GABA-T SAP opened on to my tongue. This product contains 300mg GABA and 150mg of theanine.  

I’m going to keep this in mind in case of a future flare up of my IBS/SIBO if I’m accidentally exposed to a food I can’t tolerate – assuming this protocol doesn’t clear it up for me. I suspect, as Dr. Siebecker reports, and based on the fact that I have chronic SIBO, that I’ll need a few more rounds anyway.

There is research supporting why this works: there are GABA receptors all over the gut and GABA is important for motility. (Stay tuned for a detailed blog post on this topic).

As well as the initial bloating and pain, I’ve also experienced some die-off symptoms like brain-fog and feeling blah, together with some sleep issues a few nights. The GABA helps with this and so does the tryptophan that I’ve also added.

If you’ve used GABA for this purpose or medications like Gabapentin or others to achieve similar results, I’d love to hear from you.

I’ll share more as I progress through the protocol. I’m also going to be speaking on SIBO SOS summit (the 3rd one) hosted by Dr. Allison Siebecker and Shivan Sarno. I will share more about my SIBO journey then, as well as all my results with this herbal protocol and any other challenges I face along the way.

Please also share if you’ve had success with any of the above herbal protocols or other approaches for your SIBO.

And feel free to post any questions below.

30 Experts Share Their Best Advice for Brain Health by Jordan Fallis

By Trudy Scott 4 Comments

Jordan Fallis of Optimal Living Dynamics reached out to some of his favorite cutting-edge health practitioners and researchers and asked them one question:

What is the one piece of advice you would offer to people who want to improve and optimize their brain health?

I was thrilled to be one of the people he reached out to. This is my response:

This a tough question and I can think of many things such as eating sardines or other oily fish for the omega-3 benefits; eating pumpkin seeds as a great source of zinc and tryptophan (both great for anxiety and depression); dumping the bread and cookies due to the inflammatory effects of gluten on the brain and body; and eating grass-fed red meat as a great source of zinc, omega-3s and iron, all of which are needed for brain health. 

But if I had to pick only one piece of advice, I would say to optimize gut health because of the very strong gut-brain connection. This means healing a leaky gut with an amino acid like glutamine; improving the microbiome by eating fermented foods like sauerkraut; improving protein digestion with enzymes; cooking and eating quality food at home; chewing our food slowly, and addressing issues like candida, parasites, small intestinal bacterial overgrowth and dysbiosis.

In addition to the above, I always trial the use of targeted individual amino acids such as calming GABA, mood-boosting tryptophan and DPA, and addressing nutritional deficiencies with nutrients like zinc, vitamin B6, iron, magnesium and so on. You may need to also address Lyme disease, mold, heavy metals and many of the other possible biochemical causes of anxiety and depression.

Here are some snippets from a few of my favorite quotes:

  • Kelly Brogan: the brain “does not understand modern chemicals, processed foods, and industrial pollutants. It also doesn’t understand chronic stress, poor sleep, minimal movement, and indoor living”
  • Hyla Cass: “don’t follow a low-fat diet! Make sure to get sufficient fats and protein. Avoid trans fats, but eat healthy fats like omega 3’s found in fatty fish, and medium chain triglycerides from coconut oil”
  • Sayer Ji: “Turmeric is one of the most remarkable neuroprotective and neurorestorative agents yet identified”
  • Max Lugavere: “…there’s simply nothing like exercise for the brain.”
  • Gwen Olson: “Do your own due diligence before taking any pharmaceuticals. Put the name of the drug into a search engine followed by the words ‘controversy’ and ‘side effects’”
  • James Greenblatt: “As vitamins and minerals serve as co-factors in almost every enzymatic reaction in the brain, it is important to assess for adequate nutrient levels regularly to ensure that you are optimizing brain health”

You can read all the inspiring and valuable responses on Jordan’s blog: 30 Experts Share Their Best Advice for Brain Health. You’ll see some common themes: stress, the gut, exercise, real food, sleep and nutrients.

When I asked Jordan how he knew of me and my work he shared this:

I found you through Sean Croxton’s Depression Sessions. When that first came out, I was in the middle of my journey, trying to restore my own mental health. It was great timing. So I immediately purchased it and watched all the videos for more solutions.

I already knew about pyroluria, as I had read Dr. William Walsh’s book Nutrient Power at that time. But it was great to see you talk about it and bring it to light! And I believe I was taking just regular B6 before your talk. So then I switched to P-5-P. I continue to take P-5-P and zinc picolinate regularly.

I’m so thankful I’m feeling better and have my life back, so I’m going to work really hard to share everything that helped me. I just feel like I need to do that 🙂

I really appreciate that Jordan wants to share everything that has helped him and this article is a perfect way to do this.

Here are some additional resources for you on pyroluria, the social anxiety condition he mentions above:

I hope you enjoy these resources from me, Jordan and all the experts he reached out to!

I’d love to hear what you have found to be the best brain advice you have received and implemented?  

 

GABA helps with inhibition of unwanted thoughts

By Trudy Scott 74 Comments

There is plenty of research and clinical evidence showing that low serotonin promotes worry and ruminating thoughts and we know that using tryptophan (or 5-HTP) can help with easing these worries and unwanted thoughts i.e. the worry-in-the-head type of anxiety.

The calming supplement GABA has long been recognized to help ease the more physical type of anxiety where you feel body tension and may have stiff and tense muscles.

Over the last year I’ve been getting feedback from women in my community saying that oral GABA supplements also helps some of the head symptoms too and now we have some new research supporting the possible mechanism of this – Scientists identify mechanism that helps us inhibit unwanted thoughts:

We are sometimes confronted with reminders of unwanted thoughts – thoughts about unpleasant memories, images or worries. When this happens, the thought may be retrieved, making us think about it again even though we prefer not to. While being reminded in this way may not be a problem when our thoughts are positive, if the topic was unpleasant or traumatic, our thoughts may be very negative, worrying or ruminating about what happened, taking us back to the event.

Scientists have identified a key chemical within the ‘memory’ region of the brain that allows us to suppress unwanted thoughts, helping explain why people who suffer from disorders such as anxiety, post-traumatic stress disorder (PTSD), depression, and schizophrenia often experience persistent intrusive thoughts when these circuits go awry.

Professor Anderson, Dr. Schmitz and colleagues showed that the ability to inhibit unwanted thoughts relies on a neurotransmitter – a chemical within the brain that allows messages to pass between nerve cells – known as GABA.

GABA is the main ‘inhibitory’ neurotransmitter in the brain, and its release by one nerve cell can suppress activity in other cells to which it is connected.

Anderson and colleagues discovered that GABA concentrations within the hippocampus – a key area of the brain involved in memory – predict people’s ability to block the retrieval process and prevent thoughts and memories from returning.

The study is looking at GABA concentrations within the hippocampus and there is no mention of the use of GABA supplementation to enhance this process:

While the study does not examine any immediate treatments, Professor Anderson believes it could offer a new approach to tackling intrusive thoughts in these disorders.

Ideally the next step will be to study the use of oral GABA supplementation.

Here is the study abstract: Hippocampal GABA enables inhibitory control over unwanted thoughts

UPDATE Jan 28, 2022:

This 2021 paper, Astroglia and Obsessive Compulsive Disorder, supports the low GABA mechanism when it comes to obsessive compulsive disorder/OCD which is characterized by persistent intrusive thoughts (obsessions) and repetitive behaviors (compulsions).

The researcher shares the most prominent theory regarding the underlying mechanisms of OCD and persistent intrusive thoughts (and compulsions):

an increased excitation to inhibition (E/I) ratio due to increased glutamatergic excitation or reduced GABAergic inhibition.

And states that, in astrocytes (a subtype of glial cells), both the glutamate transporter GLT1 and GABA transporter GAT-3 are critical for regulating this balance.   

Feedback on GABA helping with overactive brain and perseveration

When I shared this research on facebook two people commented on how the Source Naturals GABA Calm product I recommend helps them with this aspect of anxiety.

Tiffany shares how Source Naturals GABA Calm helps calm her overactive brain:

I have definitely noticed that sublingual GABA Calm that you suggest helps calm my overactive brain.

Dawn shares how this same GABA product has helped her a lot:

I have an old TBI [traumatic brain injury] and the physiology of PTSD, from childhood trauma, so a double whammy. This sublingual lozenge makes a big difference in my day if I start to get anxious, or begin to perseverate on something that really isn’t all that important.

Perseverate is not a word I use very much and in case you’re not familiar with this term, the Oxford dictionary defines it as follows: “repeat or prolong an action, thought, or utterance after the stimulus that prompted it has ceased.” It’s also defined as: “the tendency of an idea to stick in your mind or recur, or getting stuck on something mentally and not being able to shift gears.” In psychiatry it’s “the persistent and pathological repetition of a verbal or motor response, often seen in organic brain disease and schizophrenia.”

Updating the GABA questionnaire and GABA blog

I’m using this research and feedback to make an update of the low GABA section on the amino acid questionnaire:

  • Do you have intrusive thoughts, perseverate or have an overactive brain? Or do you have unwanted thoughts – thoughts about unpleasant memories, images or worries?

I’ve also updated this recent blog post – Anxiety, compulsive thinking, counting behaviors: gluten, tryptophan and inositol where I to share my feedback on a question I received on how to approach working with a child with anxiety, compulsive thinking and counting behaviors. I mentioned GABA as a possibility but with her symptoms and this new research, a GABA trial would definitely be something to pursue.

Resources if you are new to using GABA as a supplement

If you are new to using the the amino acid GABA as a supplement, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see the low GABA and other low neurotransmitter symptoms) and a brief overview here: Anxiety and targeted individual amino acid supplements: a summary.

If you suspect low levels of GABA and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids so you are knowledgeable. And be sure to share it with the team you or your loved one is working with.

The book doesn’t include product names (per the publisher’s request) so this blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the GABA products that I use with my individual clients and those in my group programs.

I’d love your feedback

  • Do you resonate with any of this and have you seen this benefit when using GABA, in addition to the relief of physical anxiety?
  • If you’ve also observed improvements in your ruminating thoughts when using tryptophan, I’d love you to try and share how GABA helps and how tryptophan helps i.e. how you feel before and after with each supplement?
  • Also, if you are also using tryptophan and/or 5-HTP how do you know if it’s these amino acids or the GABA that is helping?
  • I’m really looking for the differences you observe as you support low GABA vs low serotonin?  Are they clear or are they blurred?
  • If you’re a practitioner what feedback do you get from your clients/patients about low GABA vs low serotonin?

As I mention above I would love to see follow-on research showing that sublingual GABA supplements can actually shift this. Sharing what we see clinically will be very helpful so your feedback is valuable and appreciated.

Feel free to ask your questions here too.