vitamin B6

Tryptophan and DPA (d-phenylalanine) for cravings and sleep issues (and a concern about 5-HTP and nightmares)

June 21, 2024 By Trudy Scott 19 Comments

Thank you for all your work! I saw your talk in the Super Trauma conference and immediately went and read your book. I suspect I am low in all 3 neurotransmitters, and have noticed the biggest difference in supplementing with DPA (d-phenylalanine). I started taking all 3 supplements by swallowing and switched to taking them sublingually after I got used to the idea.

My question is about tryptophan in particular. I struggle with nightmares already so I am a bit wary of trying 5-HTP. I tried taking mid afternoon and before bed but it made me way too tired in the afternoon. Is it okay to just double the dose right before bed? How safe are these amino acids in higher doses? I was also wanting to add an evening dose of DPA to help with cravings. Thanks again!

I get many questions like this on the blog about using either 5-HTP with DPA or tryptophan with DPA together, for helping to improve sleep and ease sugar cravings. So today I’m sharing one of these questions and my insights in case you have a similar question. This will also give you the opportunity to ask questions you may have related to using these amino acids together and gain an understanding on how to tweak the amino acids for optimal results.

Read on for my response to the above question from Amanda. I also share more about 5-HTP and nightmares (and why she may also decide to use this amino acid too), vitamin B6 and nightmares, pyroluria, and how to figure out if your cravings are due to low endorphins or low serotonin (or a combination).

Should she add an evening dose of DPA?

It’s wonderful to hear that DPA is helping with Amanda’s comfort cravings/emotional eating and other low endorphin symptoms. As a reminder these include:

Heightened sensitivity to emotional pain
Heightened sensitivity to physical pain
Crying or tearing up easily
Eating to soothe your mood, or comfort eating
Really, really loving certain foods, behaviors, drugs, or alcohol
Craving a reward or numbing treat
PMS (premenstrual syndrome) or PMDD (premenstrual dysphoric disorder) *

(bookmark this symptoms questionnaire because it’s updated as new research is published and has more symptoms listed that what is included in my book)

And in case you’re new to DPA (d-phenylalanine), it is an amino acid that prevents the breakdowns of endorphins so we have more of these feel-good neurotransmitters.

I’m really glad she figured out it’s more effective when opened and used on the tongue rather than swallowing it. I share more about this here – How best to use the amino acid DPA for easing heart-ache, weepiness, comfort eating and a compulsive desire for food. It really can mean the difference between no results and great results.

Amanda asks about adding an evening dose of DPA to help with endorphin-related cravings too and also using tryptophan only at night. Keep in mind that afternoon and evening cravings are typically related to low serotonin and it’s best to trial one amino acid at a time so you know which is working for which symptom. If we were working together, I’d recommend figuring out her serotonin support first and then layering in an extra DPA (or possibly two) at night if it’s still needed.

In case you’re curious, I discussed low serotonin, low endorphins and low GABA in my interview at the Trauma Super Conference so she is also using GABA. Using this one sublingually is key and it helps with easing physical tension and stress eating.

What could her serotonin support look like?

Since tryptophan used mid afternoon and before bed made her way too tired in the afternoon she could consider a lower dose of tryptophan (midafternoon and evening) or could just trial one tryptophan after dinner to help with sleep and reduce after dinner cravings.

For some folks this is enough. If not, after a few days of tracking symptoms, she could increase to one tryptophan after dinner and another at bedtime or two tryptophan at bedtime if her symptoms are not down 2/10 or 3/10.

Her concern about 5-HTP and nightmares

Some folks do better on 5-HTP and some on tryptophan and she is getting results with tryptophan so doesn’t really have to worry about 5-HTP at this stage. However, I do want to address Amanda’s concern about 5-HTP and nightmares, because in the future she may want to consider 5-HTP.

She may find she does in fact need some serotonin support earlier in the day and 5-HTP in the afternoon may be the answer for her i.e. 5-HTP midafternoon and tryptophan in the early evening and/or at bedtime. It’s not unusual that we mix and match these two amino acids.

I’ve not had any clients report nightmares with 5-HTP, so I was surprised to hear this feedback on a Facebook thread, where a number of folks stopped using it for this reason. However, most folks on the same Facebook thread shared that 5-HTP works very well for them and does not cause nightmares. There is also research that supports the use of 5-HTP for night terrors. I suspect it may have to do with low vitamin B6 which we know contributes to poor dream recall and/or nightmares.

I share more about 5-HTP and nightmares here. And vitamin B6 and dream recall here.

I posed this question in the 5-HTP/nightmares blog: “Could it be that folks who get nightmares with 5-HTP, happen to also have pyroluria? Or perhaps they simply have low vitamin B6?” I have all my anxious clients supplement with vitamin B6 and/or P5P and this may be why nightmares with 5-HTP was news to me.

Vitamin B6 for neurotransmitter production and pyroluria

Since she does already struggle with nightmares, I’m not surprised she is concerned. However nightmares are a clue that someone may have low vitamin B6. This is typically picked up when I have clients do the pyroluria questionnaire on the intake form. Addressing low vitamin B6 is also important because it’s a cofactor for making the neurotransmitters and helps with hormone balancing.

I reminded her to read the pyroluria chapter in my book too. It includes the above questionnaire and detailed information on vitamin B6, zinc and evening primrose oil (all needed to address this condition that leads to feelings of being socially anxious).

How safe are these amino acids in higher amounts?

I share the top of the range for dosing all the amino acids in my book. This is typically 1500 mg tryptophan twice a day, 150 mg 5-HTP twice a day and 1500 mg DPA three times a day. Occasionally I have had clients need higher doses. The clue is symptom relief. We start low, monitor symptoms and adjust up as needed, and then down if no additional benefits are observed.

Using extra DPA at night for cravings?

As I mentioned above, I’d recommend figuring out serotonin support first (tryptophan only or a combination of 5-HTP and tryptophan) and then layering in an extra DPA (or possibly two) in the evening if it’s still needed for comfort cravings.

For some folks it’s very easy to identify comfort cravings (low endorphins) from worry/low mood cravings (low serotonin):

If you eat sugar or carbs to feel happy (and especially from late afternoon into the evening) then your sugar cravings are likely due to low serotonin, and tryptophan (or 5-HTP) stops the cravings and boosts mood and reduces anxious feelings
If you are a comfort-eater then it’s likely due to low endorphins and DPA will stop that feeling of “I deserve-it” kind of reward-eating or comfort-eating and also give you a hug-like mood boost

If it’s not easy to figure out the only way to know for sure is to do a trial of tryptophan and then do a trial of DPA and observe before and after feelings and the need to self-medicate with whatever the sugary treat is. Amanda may need one or the other at various times and she may even need both at certain times.

DPA and tryptophan product options

I recommend Lidtke EndorphiGen (which is DPA) and Lidtke Tryptophan 500mg. You can purchase these from my online store (Fullscript – only available to US customers – use this link to set up an account).

If you’re not in the US, these products are available via iherb: Doctor’s Best D-Phenylalanine (or DPA) and Life Extension Tryptophan 500mg (use this link to save 5%).

Additional resources when you are new to using amino acids as supplements

As always, I use the symptoms questionnaire to figure out if low endorphins or low serotonin or other neurotransmitter imbalances may be an issue.

If you suspect low levels of any of the neurotransmitters 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 on your own so you are knowledgeable. And be sure to share it with the practitioner/health team you or your loved one is working with.

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control (this is covered in an entire chapter too), sugar cravings, anxiety and mood issues.

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 amino acids that I use with my individual clients and those in my group programs.

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), if you need serotonin support, the Serotonin QuickStart Program is a good place to start. This is a paid online/virtual group program where you get my guidance on using tryptophan and 5-HTP safely, and community support during 5 LIVE Q&A calls. You can sign up to be notified when the next live launch of this program is happening. We take a deep dive into product options including Lidtke products and others if you’re not able to access Lidtke.

Low GABA can also affect sleep and cause stress eating. If you also have low GABA symptoms, the next step to get help is the GABA QuickStart Program. This is also a paid online/virtual group program where you get my guidance and community support. Another option is the budget-friendly GABA QuickStart Homestudy program.

If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. This is also a paid online/virtual program with an opportunity to interact with me and other practitioners who are also using the amino acids.

Wrapping up and your feedback

I’m thrilled Amanda is seeing these benefits with DPA, tryptophan and GABA and is fine-tuning her results even further. I appreciate her asking her questions on the blog so I can share and we all can learn.

Now I’d love to hear from you – does any of this resonate with you? If yes, which combination has worked best for you for emotional eating and sleep issues?

Is 5-HTP or tryptophan better for you and is vitamin B6 part of your supplement list.

If you’re a practitioner have you seen this combination work well with clients/patients?

Feel free to share and ask your questions below.

Vitamin B6 and magnesium on neurobehavioral status of autism spectrum disorder with hyperactivity and irritability (research)

May 24, 2024 By Trudy Scott 7 Comments

Today I’m sharing new research that supports some of the original findings about vitamin B6 and magnesium published by autism biomedical pioneer Bernie Rimland.

Despite the small population size, this study demonstrated neurobehavioural improvement among children with ASD [autism spectrum disorder] with hyperactivity and irritability. Consequently, it can be expected that future studies conducted on a larger scale might help to establish the beneficial role of Vitamin B6 and Magnesium as a complementary treatment for autism with hyperactivity and irritability.

The above comes from the conclusion of this 2021 paper, Vitamin B6 and Magnesium on Neurobehavioral Status of Autism Spectrum Disorder: A Randomized, Double-Blind, Placebo Controlled Study.

There were 50 children in the study, with a random assignment of 27 to the study group (vitamin B6 and magnesium) and 23 to the control group (placebo). All the children were autism patients from a pediatric autism and neurodevelopmental disorder outpatient clinic in India.

One of the primary aims over the 3 month study period was to investigate “any improvement among the six domains of ASD: general observation, cognition, emotion, social behavior, communication, and sensory deficits.”

Read on for learning more about the study outcomes, and dosing and forms of magnesium and vitamin B6 (and how this compares to P5P). I also share more about autism biomedical pioneer Bernie Rimland’s earlier research and the autism/B6/pyroluria connections. And end with some of the many possible mechanisms, GABA and vitamin B6, and other applications for vitamin B6.

More about the study outcomes

The improvement observed in the study/intervention group was 81% compared to only 47% in the placebo group.
Both the study group and control group had a mixture of patients rated as having mild, low moderate, high moderate and severe symptoms of ASD. At the conclusion of the study, there were fewer patients in high moderate and severe categories.
There was “an overall improvement in the symptoms of autism along with improvements in specific domains e.g. Emotion and Cognition.” The Emotion domain includes hyperactivity, aggressiveness, emotional lability (or instability) and stress.

Dosing varied by age and forms of magnesium and vitamin B6

The dosage of magnesium and vitamin B6 for the 27 children in the intervention/study group was pre-determined by the age of the subjects: “Patients aged 2-3 years received 50 mg Magnesium and 25mg Vitamin B6 daily, aged 4-8 years received 100 mg Magnesium and 50mg Vitamin B6 daily, and patients aged 9-12 years were given 200 mg Magnesium and 100mg Vitamin B6 daily.”

Patients in both groups received Risperidone for hyperactivity and irritability.

The form of magnesium used in the study was glycinate and the form of vitamin B6 was pyridoxine.

Vitamin B6 and magnesium research by autism biomedical pioneer Bernie Rimland

The authors share that of the many autism studies with nutrients, studies using vitamin B6 and magnesium “given by parents to ASD children have been observed to produce improvement for about 30 years.”

As I mentioned above, this new research builds on some of the original findings about vitamin B6 and magnesium published by autism biomedical pioneer Bernie Rimland. The study authors share this: “Rimland found significant improvement with the use of high doses of pyridoxine, however high doses of pyridoxine showed side effects which could be negated by co-administering magnesium.”

This 1988 paper by B. Rimland is referenced: Controversies in the treatment of autistic children: vitamin and drug therapy, and states that “Among the biomedical treatments, the use of high-dosage vitamin B6 and magnesium received the highest ratings”

Also referenced is this vitamin B6 paper, co-authored by B. Rimland and published 46 years ago: The effect of high doses of vitamin B6 on autistic children: a double-blind crossover study. It states that “Behavior was rated as deteriorating significantly during the B6 withdrawal.”

Vitamin B6, autism and pyroluria

My experience when it comes to vitamin B6 and P5P is primarily with the many individuals in my community who have pyroluria or suspect they do based on their symptoms (here is the pyroluria symptoms questionnaire). This is about 80% of the anxious folks in my community.

I share this because pyroluria is common in autism spectrum disorder:

children with learning disorders and behavioral disorders: 25% (Abram Hoffer)
autism spectrum disorders: 46% (Woody McGinnis)

(more on prevalence and associated conditions here)

And this study found emotional instability – a key aspect of pyroluria and autism – improved with vitamin B6 and magnesium.

For adults with pyroluria, vitamin B6 is used in the range of 100 mg to 500 mg, starting low and increasing as needed. We use dream recall and increased ability to socialize without feeling anxious as a clue that the correct dose is being used.

Keep in mind that 25 mg P5P (pyridoxal-5-phosphate) or the active form of vitamin B6 is approximately equivalent to 100 mg pyridoxine.

I have found that some folks do better on one form of vitamin B6 than the other i.e. not everyone needs P5P and some folks do better with a combination of P5P and pyridoxine. As with all supplements there is no one–size fits all and so the protocol and form of vitamin B6 used in this study group really only serves as a guideline.

The possible mechanisms

The authors mention this as one possible mechanism under these circumstances: “Magnesium inhibits the excitatory channel glutamate N-methyl-D-aspartate (NMDA) and reduces hyperactivity – a part of the emotional domain.” They also mention the fact that “magnesium increases presynaptic releases” enhancing “both short term and long term synaptic facilitation and long-term potentiation, improving learning and other memory functions.”

I’m adding these as possible mechanisms to consider too:

Vitamin B6 is a potent anti inflammatory compound
Vitamin B6 and magnesium are co-factors needed to make serotonin (which is calming and helps with emotional stability) and dopamine (which helps with focus and motivation)
“GABA is formed from glutamate via the addition of glutamate decarboxylase and vitamin B6”
Vitamin B6 offers neuroprotection in situations of excess glutamate release (together with vitamin B12 and B2)
Vitamin B6 is key (together with zinc, evening primrose oil and others) for addressing social anxiety/pyroluria which is common in autism (as mentioned above)
Vitamin B6 and magnesium improve hormonal health
Oxalate issues are common in autism, leading to depleted levels of vitamin B6 and magnesium. Supplementation can help counter some of the adverse effects.

Also vitamin B6 (and other B vitamins) and magnesium are depleted by sugar, stress, dysbiosis, food allergies, certain medications and caffeine. And it’s common to find deficiencies of both.

A comprehensive dietary and functional medicine / biomedical approach, targeted individual amino acids such as GABA and tryptophan, in addition to vitamin B6 and magnesium is imperative in ASD.

Many other applications for vitamin B6

It’s wonderful to be able to share yet another application for vitamin B6, which, in some circles, is receiving an unfavorable reputation about causing toxicity.

Here are a few other related vitamin B6 blog posts that may be of interest:

Because of the role of vitamin B6 when it comes to calming GABA, it’s worth sharing this blog too – Half a crushed GABA Calm for my autistic child: sleep, anxiety and sensorimotor skills (writing, horse riding and swimming) improve. Both vitamin B6 and GABA are commonly beneficial.

And sometimes, vitamin B6 on it’s own provides results – Anxiety and vomit phobia in an 8-year-old: within a week of starting vitamin B6 she made a complete turnaround.

Additional resources when you are new to using amino acids as supplements

As always, I use the symptoms questionnaire to figure out if low GABA or other neurotransmitter imbalances may be an issue.

There is also an entire chapter on pyroluria and in-depth sections on vitamin B6 and zinc.

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), a good place to get help is the GABA QuickStart Program (if you have low GABA symptoms too). This is a paid online/virtual group program where you get my guidance and community support.

Wrapping up and your feedback

I’d love to hear from you – have you had success with vitamin B6 and magnesium – personally or with your child? How much has helped and which products? (feel free to share the diagnosis and what symptoms have improved)

Have dietary changes and/or addressing pyroluria helped too?

If you’re a practitioner have you seen these nutrients to help in situations like this?

I’m also curious to hear if you’re familiar with the vitamin B6 and magnesium research and work done by Bernie Rimland?

Feel free to share and ask your questions below.

Anxiety and vomit phobia in an 8-year-old: within a week of starting vitamin B6 she made a complete turnaround

December 1, 2023 By Trudy Scott 15 Comments

Debbie, a mom in the community, shared this wonderful feedback about how vitamin B6 helped her daughter with terrible anxiety and a phobia of vomit:

My youngest (who is 8 now) started exhibiting terrible anxiety about a year ago, specifically around the phobia of vomit. Her anxiety is mostly about other people throwing up. But her anxiety became so strong it was preventing her from going to school or even staying in her classroom, kept her from eating (because her anxiety hurt her tummy) and even from wanting to do extracurricular activities that she previously loved but now was afraid to attend in case a child might throw up there.

We started her on weekly therapy sessions, and I started her on GABA and tryptophan. While the amino acids helped a little, it wasn’t enough to calm the thoughts that plagued her all day at school and home. Most days I still couldn’t get her out of the car for school.

Through your website and some other research, I decided to try supplementing her with vitamin B6. Within a week of her starting B6 she made a complete turnaround. The anxiety would still come when a kid at school would say their tummy hurt, but she was able to calm herself down within minutes and talk through the worry.

We still have some low days (especially if we haven’t taken her supplements in a few days) but overall, she’s a new kid. Even the school asked what we are doing differently to get her to be calm again.

It’s wonderful to hear that within a week of starting vitamin B6 she made a complete turnaround.

This blog addresses some of the possible mechanisms (possible serotonin and GABA support, and addressing pyroluria), how much vitamin B6 she had her daughter use and optimal dosing, plus other factors like a good multi or B complex.

Some of the possible causes and mechanisms: serotonin and/or GABA support

According to the Child Mind Institute, “Emetophobia, or the severe fear of vomiting or seeing others vomit, is surprisingly common. Kids who already tend to be anxious are more likely to develop it. It leads to fear of things they associate with vomiting. Often it starts with avoiding places where they (or someone else) threw up, or places that remind them of it.”

They discuss therapy and medications as solutions whereas I am discussing nutritional solutions that address the root causes. In this case: addressing low vitamin B6 and its impact on serotonin and/or GABA.

This letter, Vitamin B6: A new approach to lowering anxiety, and depression?, published in 2022, mention a few studies concluding that vitamin B6 supplements “significantly reduce feelings of stress, anxiety, and depression.” It does this via an impact on serotonin and GABA production and this results in the calming of the nervous system.

This 2022 paper, High-dose Vitamin B6 supplementation reduces anxiety and strengthens visual surround suppression, also discusses a GABA mechanism: vitamin B6 supplementation “increases inhibitory GABAergic neural influences, which is consistent with its known role in the synthesis of GABA.” (100 mg/day of vitamin B6 was used by the adult participants)

In this blog post you can read about the role of low vitamin B6 and iron in low serotonin, leading to anxiety and panic attacks.

How much vitamin B6 to use and is pyroluria a factor?

Debbie was not sure how much vitamin B6 to give her daughter:

The struggle I still have is knowing how much to dose her. There’s conflicting info out there as to how much is too much for kids. Right now I’m giving her Carlson liquid B6. I give her between 2-3 drops, which, if I’m doing the math correctly, is about 4-6 mg. She seems to be doing alright on that as long as we don’t miss a day. When we do miss, her anxiety becomes immediately irrational again. If you have any insight on dosing, please let me know. Thanks for all you do!

I shared this feedback with her: With phobia of vomiting I immediately think of the social anxiety condition pyroluria and the additional need for zinc, vitamin B6 and evening primrose oil.

This supports the fact that vitamin B6 helps her daughter and that missed days and increased stress means the anxiety returns.

With kids anxiety can often show up as tummy issues and nausea. And “emetophobics are particularly vulnerable to somatic symptoms, especially gastrointestinal symptoms such as nausea. Nausea, as an anxiety symptom, may be misinterpreted as an imminent episode of vomiting causing further symptoms in a vicious circle.” (from this paper about an 8 year old boy with emetophobia)

Debbie mentions her daughter gets a sore tummy when anxious. If she also feels nauseous on her bad days, that would be another clue to consider pyroluria. A common symptom is morning nausea and addressing pyroluria helps kids who experience this and also helps prevent vomiting. The nutrients for pyroluria are also key for neurotransmitter production (as mentioned above).

I shared that I’ve used 10 – 25mg of vitamin B6 in children this age who have pyroluria (plus the other pyroluria supplements and stress reduction).

Good dream recall with no nightmares is a good gauge of vitamin B6 status and a clue that enough is being used and easy enough to ask children and/or observe nightmares.

There are not many papers on the use of vitamin B6 in children. This study, Use of Nutritional Supplements Based on L-Theanine and Vitamin B6 in Children with Tourette Syndrome, with Anxiety Disorders: A Pilot Study used 2.8mg of vitamin B6 but they were also using theanine.

Supportive solutions: a child’s multi with B vitamins and other underlying factors

When an individual B vitamin like vitamin B6 is used, it’s always advised to use a B complex or a good multivitamin that contains all the B vitamins with sufficient amounts. For children I like a product like Klaire Labs Vitaspectrum ® Powder. This product may actually provide enough vitamin B6 in a situation like this – 1 scoop provides 15 mg of vitamin B6 – or it could be used with extra vitamin B6.

It goes without saying that all dietary and other nutritional factors, gut health, blood sugar handling, sleep, toxins, infections etc. may need to be addressed too.

I would also want to do further exploration into why vitamin B6 may be low, other than pyroluria – such as dysbiosis, inflammation, malabsorption, autoimmunity, low dietary intake, leaky gut, high sugar intake, gluten sensitivity or celiac disease and alcohol use disorder (in adults).

Why didn’t GABA or tryptophan help?

Debbie is well versed in amino acids, having used GABA for her PCOS (polycystic ovarian syndrome). It helped ease her lifelong anxiety, wean off anxiety medication, ovulate each month and stop her PCOS meds. She helped her older daughter with GABA too – she calls them her “happy pills.” And Debbie used tryptophan with success when collagen caused her to have panic attacks again. You can read her story on this blog.

I can’t be sure why GABA or tryptophan didn’t help her younger daughter. It’s where I would have started too, but we are all unique and what works for Debbie and her older daughter just didn’t work for her younger daughter.

It’s possible that a higher dose of GABA or tryptophan may have worked better, or other GABA or tryptophan products, or theanine or 5-HTP or inositol may have been an option.

It’s wonderful that vitamin B6 did work and I appreciate Debbie for sharing and allowing me to share as a blog. I love that the school also asked what they are doing differently to get her daughter to be calm again.

Additional resources when you are new to using amino acids or the pyroluria nutrients as supplements

We use the symptoms questionnaire to figure out if low GABA or low serotonin or low endorphins or low dopamine or low blood sugar may be an issue with vomit phobia.

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control, sugar cravings, anxiety and mood issues.

As mentioned above, I would start with GABA and tryptophan (like Debbie did) and then start looking for other approaches that may help.

There is also an entire chapter on pyroluria where vitamin B6, zinc and evening primrose oil is addressed in detail.

This includes the products mentioned in this blog: Carlson 100mg B6 and Klaire Labs Vitaspectrum® Powder.

Does any of this resonate with you?

If yes, has vitamin B6 helped your child (or you) with anxiety and vomit phobia?

And is pyroluria also a factor that is being addressed?

Have either tryptophan or GABA or Klaire Labs Vitaspectrum® Powder helped too (alone or in conjunction with vitamin B6)?

Feel free to share and ask your questions below.

Side stitch when running or exercising: the anxiety/stress connection (and the pyroluria protocol of zinc and vitamin B6 as a solution?)

August 4, 2023 By Trudy Scott 21 Comments

If you get a painful side stitch when running or doing other exercise or experienced a side stitch when you were a kid, you may be as intrigued as I was to learn there is new research that points to an anxiety/stress connection. This cross-sectional observational study was done involving an anonymous survey of one hundred sixty-eight male and female adults who were running at least 10 miles/16 km per week.

The conclusion of this study, Thorn in Your Side or Thorn in Your Head? Anxiety and Stress as Correlates of Exercise-Related Transient Abdominal Pain, is as follows: “anxiety and stress are associated with the presence of ETAP.” A runner’s side stitch is referred to as ETAP i.e. exercise-related transient abdominal pain. The authors mention the fact that this is the first study to reveal this anxiety/stress connection. This is relevant given the numerous recent studies looking for a cause and no definitive solutions.

This research is also really intriguing to me given what Dr. Carl Pfeiffer MD, PhD, identified 50+ years ago in the 1970s i.e. side stitches are common in those with pyroluria/social anxiety. What’s important is the fact that the pyroluria nutrient protocol eases social anxiety and prevents side stitches in my clients. You’ll read feedback from individuals in the community who resonate with this research and the pyroluria connections. I share more about pyroluria below in case it’s new to you and a possible cause of the side stitch pain.

My feedback and feedback from others in the community

I have pyroluria and always got a left side stitch as a kid, in my teens when running and playing squash and in my 20s/30s when running. And then they stopped (and the social anxiety and related symptoms resolved) when I addressed my pyroluria with zinc, B6 and EPO, and a copper-free multi that contains manganese. I see these kinds of results with my clients all the time so a light-bulb went off when I read this new research .

I shared this research and the anxiety/stress/pyroluria connection on Facebook and asked: did you/do you get side stitches when running/exercising? Here is some of the feedback I received, where the pyroluria protocol did help.

Kameka shared this: “I had side stitches as a kid and as an adult. Running was the main exercise that caused it and it was usually the left side. Now that you mention it, I haven’t had them since I started supplementing for pyroluria. Also, my social anxiety is sooo much better as well!”

She did the symptoms questionnaire and the pyroluria urine test (which can give false negative results) and confirmed she takes vitamin B6, zinc, magnesium, and primrose oil.

Bec shared this: “I hated PE at high school for that reason. While everyone was running, I was suffering from side stitches (I think it was my right side) and having breaks. I have pyroluria with lots of symptoms. I do well with zinc and P5P.”

Not everyone reported an improvement with the protocol but many folks resonated with the side stitch/pyroluria connections:

Megan said: “Couldn’t run as a kid. A stitch every time. I can’t recall which side, never really paid too much attention. Looking at the pyroluria symptoms, I think I may have always had it.”

Janie exclaimed: “Oh, boy, did I!” (while distance running). She finds it hard to remember but thinks it may have been on her right side. She also shared that “tests for zinc come back normal, but I have many of the [pyroluria] symptoms, especially the less common ones. I scored high. I always want breakfast but all the other questions fit me like a glove, like pieces of a puzzle with my photo on the box.

My lack of dream recall is another sign. I take 25 mg of methylated B6, but still no dreams. The question regarding being seated in the middle of a restaurant…THAT IS ME!! My throat will feel like it’s closing up, so much tension.”

I explained that most zinc testing is not accurate and that we increase until we get symptom resolution. I also referred her to the pyroluria chapter in my book.

Susie shared this: “Yes I always got side stitches so I gave up running. I suspected pyroluria but not sure if I have it.”

Leah said “I’d say my daughter and I both [had side stitches] more when we were younger. Both socially anxious and pyroluria. Less exercising now too.”

Information if you’re new to pyroluria

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

Also on the list of symptoms is this one: “Upper abdominal pain on your left side under the ribs or, as a child, having a stitch in your side as you ran.”

Addressing low levels of the mineral zinc and vitamin B6, together with some other nutrients and stress management, are key to addressing these symptoms.

Here is the complete symptoms questionnaire on the blog. This questionnaire can also be found in the pyroluria chapter in my book, The Antianxiety Food Solution. You’ll find the detailed supplement protocol and additional information on how to assess for low zinc and low vitamin B6 in this chapter too.

You can read more about the prevalence and associated conditions here. It’s most often considered a genetic condition but is possibly environmentally triggered too.

There are many pyroluria blog posts where I cover various aspects such as the importance of addressing pyroluria for recovery from MCAS and Lyme, pyroluria and Ehlers Danlos Syndrome, pyroluria and intrusive thoughts and many more. I encourage you to use the search feature on the blog.

A possible cause of the side stitch in pyroluria

Here is an excerpt from a paper published in 1974 by Dr. Pfeiffer and colleagues, Treatment of Pyroluric Schizophrenia Malvaria With Large Doses of Pyridoxine and zinc, describing why the side pain probably occurs:

This 15-year-old upper middle-class patient (now 19 after studying for four years) represents a case of nutrient deficiency in which vitamins (specifically B6) and the trace minerals manganese and zinc were inadequate for the development of normal knee joints and normal brain function.

The deficiency was sufficiently severe at its peak to cause prolonged psychosis, atypical seizures, arthritis, amenorrhea, constipation, and splenic pain. The pain is probably due to hemolytic crisis in which red cell fragments engorge the Kupfer cells of the spleen and liver, extend the capsule, and cause pain. The double deficiency is produced by the formation of KP [kryptopyrroles] which combines with pyridoxal and zinc.

Based on the above and other publications by Dr. Pfeiffer, when the stitch happens on the left side, my understanding is that the pain is in the spleen. And when it happens on the right side, the pain is in the liver area. Most individuals with pyroluria say they felt/feel their side stitch on the left side. Either way it appears to be caused by low zinc, low vitamin B6 and the other nutrients needed by those with pyroluria. And resolved when on the pyroluria protocol.

I would love to see these ETAP researchers take their anxiety/stress research one step further and identify how common pyroluria is in runners who get side stitches and if the pyroluria protocol prevents the side stitches.

My book as a resource and pyroluria supplements

As mentioned above, there is an entire chapter on pyroluria in 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 addressing these deficiencies. And be sure to share it with the practitioner/health team you or your loved one is working with.

Keep in mind that these nutrients are cofactors for making neurotransmitters and are a key part of my protocol when working with individual amino acids.

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 pyroluria supplements and amino acids that I use with my individual clients and those in my group programs. You can find them all in my online store.

Thanks to everyone who contributed to the discussion on Facebook. Now I would love to hear from you so I can approach the authors with their feedback and yours too.

Did you get a side stitch as a kid and did it affect your ability to take part in school sports?

Do you still get a side stitch when running or doing other exercises? If yes, does it hold you back and with which exercise?

Did/does the side stitch occur on the left or right side?

And do you have pyroluria? (based on the symptoms questionnaire and/or pyroluria urine test)?

Does the pyroluria protocol prevent your painful side stitches? And had you made the connection to pyroluria/anxiety/stress?

Are you seeing a similar pattern with your kid/s? (pyroluria, side stitch and the protocol helps them too)

If you have questions and feedback please share them here too.

“A catatonic woman awakened after 20 years. Her story may change psychiatry.” (Her schizophrenia was an untreated autoimmune disease)

June 16, 2023 By Trudy Scott 8 Comments

Today I’m sharing some highlights from a recent eye-opening article in the Washington Post: A catatonic woman awakened after 20 years. Her story may change psychiatry

Before she became a patient, April had been an outgoing, straight-A student majoring in accounting at the University of Maryland Eastern Shore. But after a traumatic event when she was 21, April suddenly developed psychosis and became lost in a constant state of visual and auditory hallucinations. The former high school valedictorian could no longer communicate, bathe or take care of herself.

April was diagnosed with a severe form of schizophrenia

April was hospitalized, medicated and eventually institutionalized. It got to the point where she no longer recognized her family and she became catatonic, “unmoving, unblinking and unknowing of where or who she was.”

Twenty years after April’s original diagnosis it was discovered that she has an autoimmune condition. Dr. Sander Markx is director of precision psychiatry at Columbia University and I have so much admiration for his dedication to the field and the fact that he facilitated this testing and discovery so long after meeting April, when he was a student:

Markx and his colleagues discovered that although April’s illness was clinically indistinguishable from schizophrenia, she also had lupus, an underlying and treatable autoimmune condition that was attacking her brain.

After months of targeted treatments – and more than two decades trapped in her mind – April woke up.

April’s transformation is truly heartwarming and it’s wonderful that the doctors plan to do similar testing and offer similar treatments for others living with schizophrenia who are in mental health institutions in New York State.

Researchers in other countries are making similar connections and it’s really exciting to read that they are recognizing that “underlying autoimmune and inflammatory processes may be more common in patients with a variety of psychiatric syndromes than previously believed.”

We can and should be doing better when looking for root causes

I believe we can and should be doing better when it comes to looking for root causes. Many individuals may have an autoimmune/inflammatory condition and many may have other root cause/s. If I was on an advisory panel these would be my recommendations:

Use this powerful outcome to really turn psychiatry on its head and screen for lupus and other autoimmune conditions in every single person with schizophrenia. Dr. Markx “believes highly sensitive and inexpensive blood tests to detect different antibodies should become part of the standard screening protocol for psychosis.”
Do the same for every single person with mental illnesses and illnesses with a behavioral aspect – including anxiety, depression, bipolar, OCD/obsessive compulsive disorder. ADD/ADHD, autism/ASD (autism spectrum disorders), developmental disorders and neurological disorders.
Go beyond autoimmune screening and do a comprehensive functional medicine and nutritional deficiency assessment for every single person, including low serotonin, low GABA, low vitamin D, low zinc, low vitamin B6, hormone imbalances (sex hormones, adrenals, thyroid health), gut health, liver health etc. This includes testing for infections (such as Lyme and strep), looking at toxin exposure (phthalates, mold, heavy metals) and medication side effects.

If you’re new to the concept of root causes and functional medicine/nutritional testing these two blogs will be helpful. They are specific to anxiety because I work with anxious individuals but much of it can also be applied to other mental health and even physical health conditions (like rheumatoid arthritis and say multiple sclerosis):

Functional medicine and nutrition for maintaining symptom resolution in the long term

As you read in the article, April received “short, but powerful “pulses” of intravenous steroids for five days, plus a single dose of cyclophosphamide, a heavy-duty immunosuppressive drug typically used in chemotherapy and borrowed from the field of oncology. She was also treated with rituximab, a drug initially developed for lymphoma.”

Incredibly, she recovered completely and was eventually discharged from the psychiatric hospital and has been living in a rehab center for 3 years. Unfortunately “she has recently regressed because she was not receiving adequate maintenance care.”

I see the next step for April and others like her, is maintaining resolution of symptoms in the long term. This is where functional medicine and nutrition shines.

The ISNPR shared this about Nutritional psychiatry in 2015 in a letter published in World Psychiatry, the official journal of the World Psychiatric Association:

In addition to dietary modification, we recognize that nutrient-based (nutraceutical) prescription has the potential to assist in the management of mental disorders at the individual and population level.

In other words, diet and nutrient-based approaches need to be included for mental health treatment and for prevention. One of many examples is the ketogenic diet which has been shown to reduce auditory hallucinations and delusions in those with schizophrenia. Another is the low carb diet helping to reduce bizarre intrusive thoughts. And the SMILES trial was the first randomized controlled trial to show that dietary improvement can actually treat depression.

Specific nutrients can be very powerful too. One example is a case where a woman in my community experienced a drastic reduction in intrusive thoughts, anxiety and fears (and better sleep) with GABA, tryptophan, 5-HTP and the pyroluria protocol (zinc, vitamin B6 and evening primrose oil). More on the blog. Intrusive thoughts can be alleviated with a similar combination of nutrients and by addressing hormonal imbalances too.

These blogs/research illustrate a few of the many root causes of schizophrenia and psychosis other than lupus:

When it comes to autoimmunity in general I refer you to the work of Dr. Tom O’Bryan, Dr. Izabella Wentz, Dr. Terry Wahls, Dr. Amy Myers and others who teach about using functional medicine and diet for reversing a number of different autoimmune conditions.

The above approaches can all be explored and used when individuals are initially diagnosed too. But keep in mind that there is no one size fits all and it’s a matter of finding the root causes for each person.

We are moving in the right direction and there is hope but…

We are moving in this direction, awareness is growing and there is hope. But I know we can get there sooner.

What Dr. Markx and his colleagues have discovered and shared with the world will hopefully help us get there much more quickly.

(You can read the whole story here and a similar transformation experienced by Devine Cruz.)

I’m thrilled for April and Devine and their families, and appreciate them sharing these stories with the world. Let’s hope their stories do change psychiatry!

Resources if you are new to using amino acids as supplements

If you are new to using amino acids as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see all the symptoms of neurotransmitter imbalances, including low GABA, low serotonin and low endorphins).

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control, sugar cravings, anxiety and mood issues.

Does this heartwarming story give you hope for psychiatry?

What do you feel we should be doing to advance nutritional psychiatry even more quickly?

Can you or a family member relate to this and what did you discover in terms of testing and nutritional support/functional medicine?

Feel free to post your feedback and questions here in the comments.

Half a crushed GABA Calm for my autistic child: sleep, anxiety and sensorimotor skills (writing, horse riding and swimming) improve

January 6, 2023 By Trudy Scott 28 Comments

The inhibitory neurotransmitter GABA (gamma-aminobutyric acid) and the main excitatory neurotransmitter glutamate released by neurons in the cerebellum play an important role in sensory processing in autism. Research shows GABA to be low and glutamate to be elevated in autism spectrum disorders. While we don’t have any research supporting the amino acid GABA (used as a supplement) to raise GABA levels (and counter high glutamate levels) in autism, we do have much clinical evidence i.e. GABA can have a major impact on sensorimotor skills, as well as improving sleep, anxiety and social interaction. Today I’m sharing feedback from a mom whose autistic child is experiencing these benefits. Here is Vic’s feedback in her own words:

I use half a GABA tablet crushed in liquid for my autistic child (the Source Naturals you recommend) and it definitely helps. A whole GABA tablet and we see increased waking in the night but half seems perfect.

I’m using GABA in combination with 5-HTP. GABA was added after 5-HTP because it didn’t feel enough on its own and sleep and anxiety definitely improved at that point. We tried L–tryptophan first without success.

Sleep and sensorimotor skills have improved since weaning off an SSRI and onto the above combination as her willingness to engage with social interaction. We are also working on OT (occupational therapy) and retained reflexes and so improvements may be from that too.

Oh also supplementing b6, but not zinc as she refused it due to taste (which from reading means she probably doesn’t need it)

On a personal note there’s no way I’d manage to get her to drink [GABA Oolong] tea with her taste sensitivities – same reason I’m crushing rather than sublingual so practically speaking Source Naturals GABA is much easier than copying what they did in the study.

Vic is referring to the GABA Oolong tea study – GABA Oolong tea in children with autism: improvements in sensorimotor skills, autism profiles, anxiety and sleep (new research).

This very small (nine children) recent study found “significant improvement in manual dexterity and some large individual improvements in balance, sensory responsivity, DSM-5 criteria and cortisol levels with GABA tea.” They ingested the equivalent of 39.2 mg GABA for the day.

Sensorimotor skills that have improved: pen and pencil use, horse riding and swimming

I was thrilled to see her wonderful feedback in the comments section of the above blog and shared my delight, asking her which sensorimotor skills have improved. Vic shared this:

Sensorimotor wise, the biggest improvement I’ve noticed is her pen and pencil use – she’s actually being able to write and draw what she wants better than she was and she’s less avoidant of it in general. Her hand/eye referencing is noticeably better and her pressure control with a writing implement.

Her balance and core strength is improving (OT feel core strength generally doesn’t come properly until those internal senses are functioning) – her horse riding instructor commented on the change in how she is able to hold herself on a horse – especially when the horse got an unexpected itch the other week and she could simply adjust her body without conscious effort. Before she would have wobbled if a horse had done that.

She’s now teaching herself to swim as she has a better sense of body awareness to coordinate her limbs to all be doing what she wants.

So yeah mostly vestibular, proprioception and interoception are all working better!

As you’ll read below, research does show that GABA plays a role in sensorimotor difficulties in autism.

Some of my feedback on the GABA product and dosing, and adding it after 5-HTP

In case you’re not familiar with the Source Naturals GABA Calm product, it’s a sublingual tablet that contains 125 mg GABA (and some other ingredients). It’s typically used as a sublingual i.e. held in the mouth and dissolved, but this mom has figured out that crushing it and mixing it in liquid works best for her daughter.

To see these results with only 62 mg GABA is impressive. But as I’ve shared before, dosage does depend on your unique needs and there can be a large variation in dosing. As mentioned above, in the GABA Oolong autism study, the equivalent of 39.2 mg GABA was used daily.

That said, I did say I’d consider exploring a GABA only product at night if there are still some low GABA symptoms that remain. This could also be mixed in water.

Given that her daughter is doing occupational therapy too and also using 5-HTP and vitamin B6 (since low serotonin and pyroluria/social anxiety is common in autism) it can be challenging to tease out how much has improved with GABA alone. Vic did add GABA after having started 5-HTP and this is the best way to know what is helping which symptoms i.e. using a layered approach.

It’s also good that she figured out 5-HTP was beneficial when tryptophan wasn’t. It’s not unusual that some folks do better on one vs the other.

GABA does play a role sensorimotor difficulties in autism – the research

As reported in this 2016 paper, The Role of Sensorimotor Difficulties in Autism Spectrum Conditions:

In addition to difficulties in social communication, current diagnostic criteria for autism spectrum conditions also incorporate sensorimotor difficulties, repetitive motor movements, and atypical reactivity to sensory input.

GABA does play a role in sensorimotor difficulties as reported in this same paper. Here are some of the highlights:

The inhibitory neurotransmitter GABA (gamma-aminobutyric acid) and the main excitatory neurotransmitter glutamate released by [neurons in the cerebellum] play an important role in sensory discrimination in autism. GABA is known to decrease the firing of neurons , thereby reducing and inhibiting sensory feedback.
GABAergic functioning has been implicated in tactile reactivity.
Reductions in GABAergic system have been discovered in brain tissue: with significant reductions in GABA_A receptors, 63% reduction in comparison to controls, and a reduction by 61% of the glutamic acid decarboxylase protein (the enzyme responsible for converting glutamate into GABA).
Increased glutamate levels (excitatory neurotransmitter) in blood and platelets have been found in autism subjects, suggesting impaired conversion of glutamate to GABA, consequently increasing the excitatory state of the brain.

In the section on future directions, the authors conclude that addressing the deficiency of the inhibitory neurotransmitter GABA in the cerebellum of those with autism, “could have a global impact on sensorimotor planning, cognitive and social development.” They recommend a non-evasive GABA substitute such as oolong tea.

Elsewhere in the paper, they mention the amino acid l-theanine which “blocks the binding of l-glutamic acid to glutamate receptors in the brain, thereby perhaps aiding the improvement in motor activity by increasing inhibition of movement.”

I’d like to propose that the amino acid GABA is the subject of future research, given what we see clinically.

Resources if you are new to using amino acids as supplements

If you are new to using GABA or any of the other amino acids as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see all the symptoms of neurotransmitter imbalances, including low GABA and low serotonin).

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control, sugar cravings, self-medicating with alcohol and more.

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), a good place to get help is the GABA QuickStart Program (if you have low GABA symptoms). This is a paid online/virtual group program where you get my guidance and community support.

Another option is the budget-friendly GABA QuickStart Homestudy program.

If you also need serotonin support, the Serotonin QuickStart Program is a good place to get help. This is also a paid online/virtual group program where you get my guidance on using tryptophan and 5-HTP safely, and community support during 5 LIVE Q&A calls. You can sign up to be notified when the next live launch of this program is happening.

Wrapping up and your feedback

I’m so happy for this young girl and she and her family must be thrilled with her results. I really do appreciate Vic for sharing this outcome – it’s so inspiring and also motivating if you are a parent.

Have you used the amino acid GABA personally or with clients/patients and observed improvements in sensorimotor skills? How much and what benefits have you seen? Which product have you used? Please do share if the diagnosis is autism spectrum disorder or something else.

Have you also seen improvements with anxiety, sleep and social skills when using the amino acid GABA?

Feel free to post your questions and feedback in the comments below.