worrying

How to alleviate the fear and anxiety associated with choking and vomiting in Avoidant Restrictive Food Intake Disorder (ARFID)

May 27, 2022 By Trudy Scott 14 Comments

According to The National Eating Disorders Association /NEDA, “Avoidant Restrictive Food Intake Disorder (ARFID) is a new diagnosis in the DSM-5, and was previously referred to as “Selective Eating Disorder.” ARFID is similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size, or fears of fatness.”

As you can read on this page:

“Many children with ARFID also have a co-occurring anxiety disorder, and they are also at high risk for other psychiatric disorders”
There are also “fears of choking or vomiting” and
There is a “dramatic restriction in types or amount of food eaten” and they will often “only eat certain textures of food”

What we seldom see addressed is the biochemical causes of anxiety and fears which can show up as phobias and ongoing worrying and obsessing about ingesting certain foods. These are all typical low serotonin symptoms.

With low serotonin (you can see all the symptoms here) we use the amino acids tryptophan or 5-HTP to raise serotonin and alleviate these symptoms (often within a few minutes).

However, what do we do when a child (or adult) with ARFID has low serotonin and is too terrified to even consider a trial of tryptophan or 5-HTP? This may be because of fear of choking or vomiting and/or because of an aversion to the taste/texture and/or the fact that they are being offered something new that is not on their “safe foods” list.

There is a similar issue with low GABA which can show up as physical anxiety and tummy issues like “constipation, abdominal pain, upset stomach.” Intrusive thoughts are a common sign of low GABA too and this can manifest as a debilitating fear of choking and dying.

There is the same issue with not being able to have the individual use sublingual GABA as a supplement in order to alleviate these symptoms.

It’s for this reason, we have to be creative and find other ways to support serotonin and GABA.

Other ways to boost serotonin and GABA

The traditional ways that tryptophan/5-HTP and GABA are used is opened onto the tongue or swallowed or chewed. However, there are other ways to boost serotonin and GABA in these kids with ARFID, without further adding to their distress:

Experiment with using tryptophan or 5-HTP topically. I’m not aware of a commercial topical product but I recently mixed 500mg tryptophan powder (only tryptophan with no fillers) into a base cream (I used Primal Derma beef tallow) and used it topically with success.
Experiment in a similar way with using GABA topically. It could be made at home too (with a GABA only powder) or a product such as Somnium GABA cream is an excellent option (I have used this product with success). I suspect the liposomal GABA/theanine products may also work topically (but have yet to experiment with this option).
If tolerated, GABA powder swished in the mouth but not swallowed, may be an option once some of the anxiety and fears have been reduced. GABA powder doesn’t taste bad (it’s slightly sweet) and mixes well in water. By swishing some in the mouth it can help reduce the fear of choking and esophageal spasms (if they are present). It may also help with the sensation of a lump-in-the-throat (called globus pharyngeus) that some kids with ARFID describe.
Liquid zinc (zinc sulfate) tastes like water when zinc levels are low and may be tolerated. This 2021 paper, Macro- and Micronutrient Intake in Children with Avoidant/Restrictive Food Intake Disorder, lists low vitamin B1, vitamin B2, vitamin C, vitamin K, zinc, iron, and potassium in kids with ARFID. Zinc, iron and the B vitamins are all needed to make serotonin and GABA, and low zinc can reduce appetite. It’s also possible these children had low levels of some of these nutrients beforehand and that this contributed to their fears and restrictive eating.
Magnesium spray or other forms of topical magnesium creams can be used. Magnesium itself is calming and is a cofactor for making serotonin and GABA. An Epsom salts bath also provides magnesium and a warm bath with Epsom salts and an essential oil such as lavender is very calming.

Other less direct but equally effective approaches to include are:

gentle yoga (it supports GABA production and is calming)
swinging on an outdoor swing (reduces stress, cortisol and anxiety)
full spectrum light therapy (boosts serotonin)
vagus nerve support “This modern world can lead to overstimulation of the nervous system and you can become desensitized to chronic stress. Over time, this can lead to low vagal tone, which has been linked to a variety of mental and physical health issues.”
full spectrum infrared sauna (low heat and of short duration to simulate light exercise)
a weighted blanket is calming and improves mood and sleep and
essential oils such as orange (topically or diffused) can help with fear and anxiety.

Once serotonin and GABA levels have improved with some of the above measures, and more and more of the fear of choking and vomiting dissipates and food texture and taste aversion is reduced, the amino acids can then hopefully be introduced in the ways they are typically used (more on that below). This will further speed up the anxiety and fear reduction, allowing more and more foods to be slowly introduced.

If you are new to Avoidant Restrictive Food Intake Disorder (ARFID)

Be sure to read more about ARFID on The National Eating Disorders Association /NEDA site: diagnostic criteria, risk factors, warning signs and symptoms (behavioral and psychological, and physical).

As with all eating disorders, the risk factors for ARFID involve a range of biological, psychological, and sociocultural issues. These factors may interact differently in different people, which means two people with the same eating disorder can have very diverse perspectives, experiences, and symptoms.

Resources if you are new to using tryptophan/5-HTP and GABA as supplements

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

If you suspect low levels of GABA or 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 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, blood sugar control, sugar cravings, self-medicating with alcohol and more.

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), a good place to get help is the GABA QuickStart Program. This is a paid online/virtual group program where you get my guidance and community support. There are many moms in the program who are having much success with their kids.

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.

If you feel comfortable doing so, please share more about the ARFID struggles of your son or daughter in order to help more parents understand this disorder – their age, how long they have struggled, their fears and their safe food list.

Do let us know if you have found success with any of these approaches with your loved one with ARFID (or yourself)? And what other approaches have also helped?

If you are a practitioner are you seeing results with approaches like these with your ARFID clients/patients?

If you have questions please share them here too.

Teen with anxiety, low self-esteem and insomnia: how to do a one-off trial of tryptophan to figure out if she has low serotonin

August 20, 2021 By Trudy Scott 23 Comments

A mom asks for advice for her teenage daughter who has anxiety, low self-esteem issues, insomnia, experiences negativity and has phobias. She wants to know if serotonin support may help and where to start. I share my feedback confirming that these are low serotonin symptoms and that I would do a trial of tryptophan. I go deeper in this blog and also go into detail about how I would do a one-off trial (or evaluation) of tryptophan if I was working with this family. I also share why I’d look into low GABA, seasonal allergies and the birth control pill. And I discuss the importance of being proactive given the increasing suicide and self-harm in this age-group, with the pandemic compounding the increase.

Here is the question that Maria asked about her daughter:

My 13-year-old teen has always suffered from insomnia, sometimes light, sometimes a bit heavier, depending on the period. She has suffered from asthma from a young age, even if this issue has improved enormously, it is sometimes present, specially during spring time as she is allergic to different plants. She would suffer from sugar cravings in the past as we were trying to change her diet. Things are going better in this respect as well; however, negativity, phobias, low self esteem and anxiety are always present for her.

Are these signs of low serotonin? How could we help her feel better? Should serotonin pills be applied directly? Would this make the system dependent on it? If amino acids should be supplemented, how should we do this, considering her age?

I responded that yes, negativity, phobias, low self esteem and anxiety (the worry type) are signs of low serotonin. Insomnia can also be caused by low serotonin especially if her daughter is lying awake, overthinking and worrying about things.

I shared that the body does not get dependent on the amino acids and I’d consider a trial of tryptophan to address her symptoms.

Doing a one-off trial/evaluation of tryptophan based on her symptoms

If I was working with this family, I would help this mom figure out for sure if her daughter has low serotonin by reviewing the low serotonin symptom list with her, and helping her rate them on a scale of 1-10 with 10 being the worst.

This can often be challenging for a 13-year old: giving the symptoms a severity rating and being able to identify exactly how she feels. Her ratings may also be reflective of where she is in her cycle at the time and may fluctuate more in the month if her cycle is not yet regular. Working together with mom we can hopefully figure this out. If not, we do the best we can with the information we have.

The next step is picking one or two symptoms that are easy to measure the day we do the initial trial or evaluation. For this young girl I’d pick anxiety/worry and negativity and ask her some questions that would help us assess before and after results of the one-off trial /evaluation of tryptophan:

For anxiety and worry she may say it’s also a 9 and give me this example: “I’m really worried about performing in the concert – I keep thinking about it all day long and at night.”
For negativity she may say it’s a 9 and give me this example: “I really don’t think I’m good enough to be in the dance class.”

Both tryptophan and 5-HTP can raise serotonin but I like to start with tryptophan. I typically start with 100mg Lidtke chewable tryptophan in children/teens so I’d have her chew one tablet and then check back in the next 2 to 5 minutes (or maybe a little longer for some folks).

This is the kind of feedback I’m looking for:

With regards to anxiety and worry she may say: “Gosh, I completely stopped thinking about the concert. I’m not worrying about it at all. Now that you ask I’m thinking about it again but I think my worry/anxiety is about a 5 now.”
With regards to negativity she may say: “I think I feel better about being in the dance class. I think I can do it. My negativity feels like it’s a 5 or 6”

Since this teen responded so well, I’d have her start taking tryptophan midafternoon and evening (away from protein) and we’d increase if needed, each week, and based on her symptoms.

I have everyone keep a food mood and supplements log and mom could help her do this too.

GABA, seasonal allergies and the birth control pill

I also always assess low GABA when someone is anxious (especially if she also has physical anxiety, tension, stiff muscles) and has insomnia. We’d do the same one-off trial with a product like GABA Calm (or similar) once we’ve established a good dose of tryptophan for easing her symptoms.

This mom also mentioned Spring time allergies so I also shared this blog with her: 5-HTP and/or tryptophan to help with increased anxiety, panic attacks and depression caused by spring allergies. Depending on the season, her daughter may score higher on some of the low serotonin symptoms.

I’d also want to know if her daughter is on a birth control pill (often prescribed at this age for acne) because it can contribute to anxiety and depression.

Being proactive is wise given the rise in suicide and self-harm in this age group

Being proactive about addressing low serotonin symptoms quickly is wise given the rise in suicide and self-harm in this age group. This 2021 Italian study discusses the role of emotional dysregulation when it comes to and self-injurious thoughts and behaviours in high-school students:

Overall, 11.1% of adolescents reported self-harming behaviours without suicide ideation or attempts, 6.4% declared having thought to suicide without acting a suicide attempt or self-harm, 1.4% declared having attempted suicide and really thought to take away their life.

Unfortunately, the pandemic has also made things worse for many adolescents. This study reports that Canadian adolescents appear to be experiencing “higher rates of self-harm thoughts and behaviours relative to before the pandemic.”

It’s important to keep in mind that pre-teens and teens may not be willing to admit that they are engaging in self-harm like cutting or burning, or thinking about taking their lives.

Resources if you are new to using the amino acids as supplements

If you are new to using the amino acids tryptophan/5-HTP or GABA as supplements and want to know more in case you need them in a future situation, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see all the low serotonin and low GABA symptoms here) and a brief overview here, Anxiety and targeted individual amino acid supplements: a summary.

If you suspect low serotonin or 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 so you are knowledgeable.

It also covers all the basics of a healthy diet. It’s a comprehensive approach – amino acids AND diet. I’d also want to know what her diet is like right now – gluten-free, sugar-free, caffeine-free, eating protein at breakfast for blood sugar control, real whole foods, grass-fed red meat, wild fish, fermented foods etc?

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 acid products that I use with my individual clients and those in my group programs.

Thanks to this mom for asking the question and allowing me to use it as a teaching tool for my community. Let’s get her daughter and all teens feeling their best again.

Can you relate to the question this mom asked? Does it sound similar to what your daughter is experiencing right now or a client/patient?

Do you do a one-off trial /evaluation like this to find out if serotonin support is needed? Or have you done this in the past with your daughter, family member or yourself?

What are the before and after questions (and symptom ratings) and did tryptophan help?

Feel free to post any questions here too.

Huge rise in anxiety in college students (and other mental health issues): amino acid supplements and nutritional psychiatry as a solution.

May 21, 2021 By Trudy Scott 17 Comments

Is your son or daughter finding college/university overwhelming? Is he or she battling with new or worsening anxiety, worrying about results, has fears about success or fitting in, lying awake imagining the worst outcomes or maybe feeling like a perfectionist and getting stuck? Perhaps they have poor self-confidence, feel like an imposter and may even have panic attacks. These signs and symptoms are all common with the low serotonin-type of worry-in-the-head anxiety, which may also include PMS (premenstrual syndrome), obsessive tendencies and anger issues.

They may also be experiencing the low GABA type of tension-anxiety, where they lie awake at night stiff and tense and self-medicate with too much sugar, carbs, junk food and/or alcohol (and maybe even pot and other drugs). There may be intrusive thoughts too and panic attacks also triggered by low GABA.

What about focus issues/ADHD and low motivation, no ability to follow-through on tasks and projects, procrastination and missing deadlines? These are all classic signs of low catecholamine, which also includes low energy, and feeling depressed/sad/low/flat. Your son or daughter may just want to crawl up in their dorm bed and not do anything or may spend hours doing mindless activities like binge watching Netflix or scrolling mindlessly through social media.

All of these signs and symptoms point to low levels of neurotransmitters or brain chemicals: low serotonin, low GABA and low dopamine. We need the right raw materials to make these neurotransmitters and the majority of college cafeterias are not providing nutrient-dense foods and/or foods that are unique for each person’s biochemistry (more on this below).

The huge rise in anxiety and other mental health issues in college students

It’s no wonder that we are seeing a huge rise in anxiety and other mental health issues in college students. Way too many students are dropping out and so many are struggling unnecessarily.

This 2019 Harvard blog post shares some alarming stats:

Anxiety in college is very common. According to the American College Health Association Fall 2018 National College Health Assessment, 63% of college students in the US felt overwhelming anxiety in the past year. In the same survey, 23% reported being diagnosed or treated by a mental health professional for anxiety in the past year.

This article in Nature earlier this year, The problem is greater than it’s ever been’: US universities urged to invest in mental-health resources, highlights points from US National Academies of Sciences, Engineering, and Medicine report:

68% of university presidents listed student mental health as one of their most pressing issues
the dropout rate for students with diagnosed mental-health problems ranges from 43% to as high as 86%
The students who said that they had more trouble with anxiety or depression after the lockdown also reported greater alcohol use

It states that faculty members should “receive formal training to address and support student well-being” and “students should learn about mental-health issues as part of their introductory training.” They also say “Hiring more counsellors could be an important step, but counsellors alone can’t turn the tide.” I agree with all this but recommend adding nutritional psychiatry awareness, training and resources too.

Poor diet and nutritional deficiencies are a major contributing factor even though it’s seldom discussed. The good news is that there are relatively simple solutions – amino acids as supplements for quick relief and diet as the foundation – but it does take work.

Using amino acids as supplements for quick relief

Amino acids, used as supplements, are a quick way to offer immediate relief of symptoms: tryptophan or 5-HTP (for the low serotonin worry-type anxiety), GABA (for the tension-type anxiety) and tyrosine (for the low dopamine poor-focus and low symptoms). Here are some examples:

A 23-year-old female college student, adopted and exposed to alcohol while in the womb, has some learning struggles. She doesn’t want to miss a day of taking 5-HTP, because she says that “it keeps her on her toes,” which she says means that it “keeps me focused,” when studying.
Tyrosine helped a young man who was learning new software: “Within an hour the stress just melted away!”, alleviating his anxiety and panic attacks and creating a feeling of calm focus.
A newly qualified nutritionist shared how she suffered badly from imposter syndrome at the end of her nutrition degree and she felt socially awkward in so many outings and situations. Her anxiety and stress were through the roof and her sleep was poor. She said these wonderful results: “What really tipped the balance was the supplementation of tyrosine, tryptophan & GABA.”

If you are new to the amino acids, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution and additional information on Anxiety and targeted individual amino acid supplements: a summary

This lists The Antianxiety Food Solution Amino Acid and Pyroluria Supplements that I use with my individual clients and those in my group programs.

We use the amino acids for quick relief of symptoms and then focus on the foundations like diet and address other imbalances.

Diet as the foundation for students i.e. nutritional psychiatry

I first blogged about nutritional psychiatry in 2015 when the ISNPR position statement was published in World Psychiatry, the official journal of the World Psychiatric Association. This 2019 paper, Nutritional psychiatry: Towards improving mental health by what you eat provides an overview of the emerging field of nutritional psychiatry:

Does it matter what we eat for our mental health? Accumulating data suggests that this may indeed be the case and that diet and nutrition are not only critical for human physiology and body composition, but also have significant effects on mood and mental wellbeing. While the determining factors of mental health are complex, increasing evidence indicates a strong association between a poor diet and the exacerbation of mood disorders, including anxiety and depression, as well as other neuropsychiatric conditions.

The 2017 SMILES Trial is the first randomized controlled diet depression study and ONE THIRD of the dietary intervention group saw improvements in their depression symptoms. This was just diet alone and switching from processed/junk food to real food with no specific dietary restrictions. Participants also reported improvements in anxiety symptoms. And the authors even addressed the cost factor, stating it was more affordable to eat this way.

Research supports this connection in college students. This is one of a growing number of studies, Eating behavior and relationships with stress, anxiety, depression and insomnia in university students, that concludes that:

unhealthy eating patterns are common in university populations and are related to anxiety, stress, and depression. Educational interventions to reduce unhealthy food consumption in university students can also result in psychological health improvements and/or vice versa.

Unfortunately, as students get more anxious and depressed their food choices get worse (especially for male students) and it becomes a vicious cycle. This paper, Examining the Role of Anxiety and Depression in Dietary Choices among College Students, reports:

Overall, a decrease in total caloric intake and an increase in sugar consumption were found as self-reported symptoms of anxiety and depression increased. In addition, there were sex differences in the relationship between depression and food choices. Men consumed more saturated fat as well as less fruits and vegetables as self-reported symptoms of depression increased. Results suggest symptoms of depression are a greater risk factor for poor nutrition in male college students than females.

It’s time for colleges/universities to recognize all this and teach about nutritional psychiatry. My book, The Antianxiety Food Solution is an excellent starting point for students, parents and educators (together with other blogs on this site).

Checking out cafeterias and cooking options

When looking at colleges are you also looking at what the cafeteria offers and if they cater for special diets (like gluten-free, dairy-free, Paleo etc) and/or offer real whole food, organic vegetables and fruit, grass-fed meat, wild fish and fermented foods?

Can students use a slow cooker, blender, Instant Pot or electric frying pan in their dorms?

Is there a dorm kitchen and can they take their own pots and pans (so non-stick pans can be avoided) and any of the above appliances?

Are there nearby living options that include a kitchen and a store with quality food for purchase?

I feel colleges/universities should be rated on all of the above in addition to everything else.

It all starts at home before they leave for college

Having a good college cafeteria and dorm kitchens is one step in the right direction, but these young adults also need to understand the impact of a breakfast of bagels and coffee or not having breakfast or the fact that gluten may trigger a panic attack and make them sad. They need to know how to shop and cook if there is a shared dorm kitchen or apartment. And they need to make the right choices when they do eat in the cafeteria or nearby restaurants (assuming good options are available). This all starts at home with you before they leave for college.

Katie shares this about her daughter who plans to use the college cafeteria for some meals and also cook in the apartment kitchen on weekends:

My daughter was just saying today how glad she is that she doesn’t have to figure out [the connection between increased anxiety, fatigue, brain fog, sadness and what they are eating] while learning how to live on her own and go to college. I changed how I ate 8 years ago for my PCOS and about 3 years ago she decided to give it a try after feeling so horrible but seeing my change. I’m so proud of her for embracing a healthier lifestyle in her teen years when everyone around her is subsisting off energy drinks and vending machine food. It makes me think that if we offer them a little education, they’ll make good choices for themselves.

This mom can also feel proud that she led by example for her daughter (and I appreciate them for letting me share here).

But I believe the colleges need to play a role in this too. They are providing food and this is a perfect educational opportunity that will serve their students (and future generations), solve the mental health crisis they are struggling with and prevent drop-outs (which is having an impact on their bottom-line).

Do you believe colleges/universities should be rated on all of the above in addition to everything else? What have you done to check out cafeterias and cooking options for your daughter or son?

Has your son or daughter benefited from any of the amino acids or eating real whole food (and according to their own needs?

Do you work in a college and are you seeing this rise in anxiety and depression? If yes, how do we get these changes implemented?

How do we educate students once they are at college (other than making sure campus food is excellent):

a lifestyle/diet/anxiety app with resources and tracking?
online training with a nutritionist/coach and access to an online forum and live Q&As?
one-on-one campus nutrition coaches?
make nutritional psychiatry part of the curriculum?
produce a documentary following the lives of students on campus and showing the transformation they experience?

Feel free to post your questions and ideas here too.