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.
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?
Trudy is right to caution the all-too-ready assumption that since there MUST be a psychological cause of this symptom. To Trudy’s mention of nutritional/biochemical causes that need to be addressed, I’d add the likelihood of genetic contribution, and the important need to always consider the possibility of inflammatory and infectious causes of any new agitational brain symptom; and this IS a brain symptom and brain function gone awry.
To the psychiatric notion that SSRIs are the first line of resort, I’d irreverently remind us all that this is a fairly ubiquitous, and often marginally effective, psychiatric reflex.
To Trudy I’d like to ask, given that the dose range of NAC in several studies is pretty consistent (1200 to 2400 mg a day), how do you achieve the very high doses of Inositol (described in many studies as high as 16-20 gms/day, when most inositol capsules Ive seen contain 500 to 1000 mg, and the amount of inositol powder to achieve 16 to 20 grams a day is a pretty noxious amount. can you direct us to much more practical, concentrated forms of Inositol?
Thank You Trudy,
Dr John
Dr John
Thanks for weighing in on psychological causes and SSRIs. And thanks for adding the inflammatory and infectious causes. As you can see I mentioned a full functional and nutritional workup should be done but omitted to specifically mention theses ones but they are as key as the ones I did mention. I’d love to hear what inflammatory and infectious causes you’ve seen to play a role? with inflammation: gluten and food sensitivities, environmental issues?; with infections: PANDAs, Lyme, toxoplasmosis?
Great question about inositol – I have yet to come across a more concentrated form and when higher amounts are needed I find mixing it in water and drinking through the day is the best approach.
I’m curious about your genetic comment – have you seen this run in families? and could it be that the same nutritional deficiency/predisposition to a nutritional deficiency/infection etc is being passed down to the children?
Trudy
Thank you. I haven’t found either, but someone ought to compound, a more concentrated form of Inositol, given the number of grams per day that have been reported required to control more severe OCD type symptoms. (Again I caution against the DSM/Psychiatric instinct to mistake a SYMPTOM for a DISEASE, and to treat the symptom without doing the truly medical step of identifying and treating the etiology and pathophysiolgy underlying the disease. For example, kids with PANS/PANDAS usually have intense concentration problems from an inflamed, neurotransmitter flooded brain, but that shouldnt be called “ADHD”, and treating it with typical ADHD stimulants often makes it worse: because it isn’t ADHD in the first place, and its etiology and neurophysiology is infection and inflammation driven. Similarly PANDAS kids given SSRIs for “OCD” characteristically get WORSE more often than better according to the few most knowledgeable neurologists.)
As for infections, remember that Bartonella is emerging as a very potent cause, in adolescents, of an agitational encephalopathy of the PANDAS variety, or with symptoms identical to the Strep driven PANDAS, including severe agitation, severe repetition compulsions and other obsessive compulsive symptoms.
I mentioned heredity because there is a very high incidence of “OCD” (I hate using those DSM labels) in the children of parents with a history of trichotilomania. And a higher incidence at least of “Chronic Fatigue Syndrome” and perhaps inflammatory brain illnesses in general, in people (like perhaps this kid) with history of Atopic allergies and Atopic dermatitis. And you’re likely right to suspect that hereditary flaws in neurotransmitter metabolism tie in with and are an integral part of the clinical symptoms of this family of diseases.
Thanks Trudy,
Dr John
Thanks Dr. John! Good point on Bartonella and of course any infection contributing to PANDAS type symptoms as covered in this blog https://www.everywomanover29.com/blog/kid-not-crazy-panspandas-awareness-day-2017/
And even gluten issues. There is no research on gluten and trichotillomania but we know gluten issues can impact serotonin and contribute to obsessive behaviors https://www.everywomanover29.com/blog/integrative-medicine-approach-pediatric-ocd-anxiety/
As always, as a nutritionist, I start with the simple changes like the diet and nutrients and lifestyle, and then refer out for further testing and treatment (via say a Lyme doctor) if changes are not being seen.
I use Inositol powder 1 tsp to sweeten my spearmint tea (I have PCOS) or I add it 1 tsp to a berry and plain non sweetened yogurt smoothie as a sweetener instead of using sugar. I love that I have a sweetener option that also helps my hyperinsulinemia as well as my anxiety and skin picking. I currently use 8 grams a day.
S
I love this lovely way of using inositol powder and your great results! thanks for sharing! I’d love to hear if this 8g is enough for helping your anxiety and skin-picking or if you also use any of the other nutrients?
Also to my just posted comments about various hereditary predispositions possibly involved here, I should add that PANS/PANDAS knowledgeable neurologists etc have found a higher incidence of PANDAS in families with a history of “OCD” and in kids with a prior history of “OCD” themselves. Of course that “prior OCD’ may simply have been a milder form of a more explosive PANS/PANDAS emergence later on. The true pathophysiology underlying some DSM Psychiatric labels is likely to be marginally appreciated at the present time, given the instinct to define a symptom as a disease, and then to mobilize a med to subdue the symptom. Leaves out a very important part of the thought process.
thanks Trudy,
Dr John
Thanks for sharing this too Dr. John
Where would I find the amino acid questionare? I’m a 38 year old woman who’s struggled with TTM for over 25 years and if this could help I’d be so happy:)
Amy
Here is the questionnaire https://www.everywomanover29.com/blog/amino-acids-mood-questionnaire-from-the-antianxiety-food-solution/ Do keep us posted on how things go with you
This is wonderful! I have two children , one with trichotillomania, both have skin issues, one identified ADD, the other identified as ADHD, combined type. Youngest —I was told he was a “ strep carrier “ and I have suspected PANDA since I first read about it. Both have comorbidities, and struggle ! There’s more, but too much to put here. One is allergic to sulfa, and NAC somehow inflamed that. My question is how to find a dr who will treat without just putting them on antidepressants, anti anxiety. etc drugs.
Patricia
These are the types of practitioners who would be able to able to help: functional medicine doctor, naturopath, nutritionist and ideally someone with expertise in PANDAS and mental health. Educating yourself on all this is a great first step and making dietary changes can be powerful too of course. I’ve had great results kids with ADD/ADHD with no gluten or dairy, often a GAPS-type diet, quality protein at breakfast, looking at low iron, low zinc and the amino acids. Here is an example of a child with ADHD who improved on GABA https://www.everywomanover29.com/blog/gaba-children-adhd-focus-issues-irritability-anxiety-tantrums/
Hello Dr. John and Trudy,
I have a terrible problem with a busy brain and negative ruminating thoughts that will not stop. For the past two years I have also had terrible anxiety and insomnia. Even when I do not sleep I am not tired. I have worked with 3 naturopaths and a functional Med MD. We have done much to look for root cause and addressed many of the things that you mention. Yet I am not much better.
I am taking many supplements including some herbs and 5-HTP (I have tried GABA AND tryptophan without success)and have resorted to klonopin and trazodone which no longer help much with sleep. I also am taking Lamictal. My ND is now suggesting Phenibut for sleep. I do not want to use phenibut. I am already taking meds that I have tried VERY hard to avoid. I feel desperate. I weaned off of Lexapro 2.5 years ago and have never been the same since. My father had classic “bipolar” disorder. I feel desperate.
Do you think NAC would help me with the busy brain? Do you have other suggestions?
Margaret
I always go back to checking things off one by one – this is a good list of factors to consider https://www.everywomanover29.com/blog/60-nutritional-biochemical-causes-of-anxiety/
Based on the success I see with clients this more or less the order I go in: amino acids, diet (like no gluten, blood sugar control etc), high cortisol, gut health (SIBO is often not considered and can cause anxiety and insmonia, also parasites, candida), zinc/B6, then melatonin, inositol, lithium orotate and only then would I trial NAC if there were obsessive behaviors.
I’d also be concerned about the medications (prior and current) possibly contributing to the anxiety and insomnia and agree with you – I would not want to add phenibut into the mix.
Hello Margaret –
I have every symptom/issue that you list. I have been working with an ND also, who has identified very elevated adrenaline and very low serotonin in my case. She also identified that I was taking methylated B vitamins, which promote the generation of adrenaline and speed up the break down rate of serotonin, so I have stopped taking all methylated B vitamins. Please note that ever since I stopped these vitamins, I have experienced what Dr Ben Lynch and Dr Amy Yasko refer to as “methyl detox” – which is awful and includes the general feeling of having the flu and never improving, plus high anxiety, low grade fever, all over body and muscle pain, and their suggestion of taking niacin really does not appear to help. Research shows that methylfolate has an 8 week half life, which is a pretty long period of time.
My ND has suggested that I take Phenibut, which she referes to as a Gaba precursor. My Gaba is low but not as low as the serotonin. When I take Lorazapam, which acts on Gaba receptors, I mostly experience a relief in the tight back and tight abdomen muscles which makes me feel like it is easier to breathe. But adrenaline can power right through the Lorazapam, so I generally do not get any sleeping benefit from lorazapam. Also, whenever I take lorazapam/ativan, it has a boomerang effect – the next day I generally feel worse – more aggitated, more anxiety, etc.
I am curious as to why you are hesitant to take Phenibut?
I’m not sure if I marked the box to be notified with replies to my inquiry.
Can you please make sure I am notified of any replies. Thank you
Margaret.
Hello,
I have done much of what you have listed above and I continue to work with my doctor. However my main question was not answered….
Would taking NAC help with my busy brain and possibly insomnia?
Thank you
Margaret
Trudy, I am a hypnotherapist and holistic nutrition coach. I have found that hypnosis is an amazing and successful treatment for trichotillomania in children and adolescents. I must say that when I have seen these clients I also review their specific nutritional needs. Since reading your article I went back to review my notes and found that I recommended zinc with all of these patients, and discussed one or more of the amino’s GABA, Tryptophan or Tyrosine with all of them as well. I hold the belief that hypnotherapy is the reason for their recovery but now wonder if it would work so well without the added supplementation and nutrition coaching.
I wish I had known about this stuff when I was younger. Maybe I could’ve saved my cousin’s life somehow. She had trichotillomania as an adolescent in the late 70’s early 80’s. I remember my parents telling me that she had pulled out all of her eyelashes. My aunt and uncle attributed it to her problems in school and anxiety. She died in 2007 at age 40. We were the same age. She self medicated with alcohol and drugs and it eventually killed her. I think her liver shut down. I’ve done some genetic testing and found out I have alpha 1 anti-trypsin deficiency as well as mutations involving COMT and MTHFR. I’m also looking into a possible form of Porphyria. I went into menopause at age 46. I have 3 daughters that each have their own problems involving anxiety, mood disorders, hormonal imbalance. I had to take progesterone suppositories during each pregnancy for the first 3 months yet my Dr never followed up with it nor did he investigate as to why my progesterone was low in the first place. I didn’t think about asking either. My first born was my 5th pregnancy at age 25. I started getting migraines after having my second child and they just progressed and got worse after my 3rd daughter, peaking in 2013. I had 3 severe migraines that year and each time it was the same month I got a period. The last one being Aug 2013 in which I had a seizure, still not sure to this day. I went to the emergency room and they just said it was a migraine/abdominal pain. They were wrong. I went thru hell after that. Severe depression, anxiety, paranoia, chronic fatigue, couldn’t eat much at all due to pain in my abdomen, mostly on the left side. I developed a histamine intolerance or it just became more noticeable and mast cell activation. I normally weigh 115 at 5′ 2″, but I went down to 98 lbs and had muscle wasting. I felt anorexic. Couldn’t think, had short term memory loss, no motivation at all, insomnia, my days and nights were flipped. I don’t know if it was one specific thing that caused this to happen or a combination of things, like the perfect storm. It felt like all my endocrine glands had shut down at once or at least the PTA axis. My endocrinologist said she was going to refer me to a specialist at a teaching hospital because she couldn’t figure it out. I have yet to see that happen. She kept putting me on 4 month follow up visits without any kind of treatment except for prescribing Fosomax for osteoporosis, which I couldn’t even tolerate orally. I have fought for 4 years to get my health and mind back pretty much on my own and I’m still trying to put my life back together. What scares me is that my daughters, especially my oldest who is 23, are having problems already and I don’t want them to go thru what I’ve gone thru. I’ve tried to get them help but regular Dr’s just put them on the pill, ssri’s or adhd meds. They don’t look for or treat the actual causes.
Thank you for your response, Trudy! All easier said than done as far as finding the specialists, but I am determined to get to the root of this for my children’s sake!
Dear Trudy,
I am thankful to have found your article. I have a 17 year old daughter who has had trich since the age of 8. She also suffers depression, anxiety and PTSD.
She has seen psychologists over the years to help her deal with these conditions and her stressors. She has been through a difficult time through a messy divorce since the age of 6.
I have her taking the following:
High dose Practitioner only B supplement
Magnesium
Calcium with Vitamin D
Picamillon (increases GABA in the brain and has B3 in it to help it cross the brain barrier)
The picamillon has improved her depression and anxiety greatly where she can actually relax more and cope far better with her day and school work load. It has also assisted with her insomnia. I had her taking NAC for the past year but with no change to the trich whatsoever, therefore has stopped taking it. I was wondering what dosage of zinc you recommend. Considering the Picamillon has helped so much in regards to her depression and anxiety I am hesitant to put her on zinc as well as say tryptophan that may increase serotonin. Picamillon helps increase serotonin.
I am not a professional nutritionist however I have been studying everything I can find relating to the endocrine system, adrenal function and hormones that are not at their optimal function after my daughter suffering prolonged ongoing stressors. Hence the hair pulling.
I would so appreciate advice in relation to what else could possibly help with the compulsive component that contributes to the hair pulling when suffering heightened anxiety. And the doses. I am interested to try zinc next but unsure of what dose would be recommended.
Her standard medical tests have all come back ok with the exception of high testosterone which has since regulated itself. We live in Australia and not a lot of help or knowledge here about trich.
Kind Regards and thank you in advance for your reply!
Christy
I can’t offer specific advice via the blog but here is some general feedback. I don’t have experience with Picamilon so can’t comment specifically on this but would use the approach I outline in this blog post, starting with tryptophan and inositol. I always start with a trial to assess how someone responds. I use zinc sulfate taste test for assessing zinc status plus alk phos <70, plus other factors like pyroluria, low appetite, poor sense of smell, white flecks on the nails etc.
I had been suffering from trichotillomania and excoriation disorder (dermatillomania) for 15 years. I have been prescribed high doses of escitalopram, sertraline, desvenlafaxine and even clomipramine and a combination of the last two, but the pulling and skin-picking didn’t stop. I have attended full sessions of CBT and HRT and my therapist says it is neurobiological. I have tried NAC up to 2400 mg/day and supplemented it with 5HTP and zinc but it did not help. When my psychiatrist put me on naltrexone 100 mg/day and concomitantly added pimozide 4 mg/day, the pulling and even the skin-picking stopped completely within just 2 days of starting treatment.
Ray
Thanks for sharing. I’m gald glad you’re found a resolution. It’s an interesting combination. I like to help my clients continue to seek root causes and address those. Since pimozide works on high dopamine we’d look at addressing that. When naltrexone works we look at immune dysfunction and endorphin support like DPA.
Dear Trudy,
I am so happy I came across your blog, thank for all the information. My daughter has suffered with Trich since she was 7, now 21 and the Trich is at its worst. We tried CBT, HRT, Accupuncturist, and Hypnosis before giving in SSRI’s( Escitalopram, Sertraline). They did not help with the Trich nor with her anxietiy. She has been off of SSRIs since March this year and started taking 1200mg of NAC a day and CBD Oil. It really has not made a big difference, the urges to pull are still there.
She took the amino acid questionnaire and she had 8 of the Low Gab and 11 of the Low Serotonin symptoms. Can you please recommend what she should take. We are desperate.
Thank you in advance.
Hello – Just offering up some ideas from my experience. My anxiety and depression started from medical malpractice, so my path to health recovery has gone up and down. Intake of the standard American Diet and or certain multivitamins can, in some people, provide us with too much folic acid. Folic acid interferes with something called biopterin in our bodies, which is instrumental in the production of our neurotranmsmitters. Take a look at the enriched foods your daughter may be consuming and offer up substitutes to keep the intake of folic acid low. Choosing gluten free bread and pasta is a good place to start. What happens in some people is the folic acid intake overwhelms the intake of real folate from leafy green veggies, and we do not get the true benefit from Real folate. Folic acid also can mask the results of a serum B12 blood test, making it appear falsely high. Vitamin B12 contributes much to our well being, and even if she is eating foods high in B12 such as meat and shellfish, she may not be getting the benefit from it as B12 takes a complicated path and there are many places where it may not get processed. Consider a trial of Vitamin B12 shots to see if this is helpful. My B12 deficiency was identified by a urinary methylmalonic acid test. Low vitamin B12 can create a multitude of symptoms, including nervous type actions such as hair pulling.
Hi Sally,
Thank you for sharing your experience, I appreciate all the great suggestions.
Hi Trudy, I have owned your book for a couple years and although we have worked with several Naturopathic experts to treat our 17 year old son who has had extremely severe OCD, PANS, Pyroluria, etc for more 4 and a half years, apart from initially having success with 18 grams of Inositol it stopped working after 2 months. We have tried every possible anxiety/OCD/PANS supplement to treat his condition always under the guidance of experts who have been the best in their field and knowledge and paid for numerous tests. We have been promised by so many natural health professionals that they will heal him, and after thousands and thousands of dollars, we are heartbroken that my poor, beautiful, kind natured son’s symptoms have only become even more severe every week though 2020. It is just not fair! Just when we think OCD can’t get more severe, it does and now it is yet at a new severe level more than ever before. For 2020, he has been attempting to do Year 10 schooling online as he can no longer go to school, but for the last few months, even that now is no longer an option. He is housebound and now can’t do very basic normal functions of living. He is totally stuck, repeating things over and over. We decided to try one last thing, GAPS (Gut and Psychology Syndrome) as one final effort before we resort to SSRI’s, but he has continued to get even worse for the last 3 and a half months on GAPS. My sons life and ours has been totally destroyed! We have tried natural medicine and tried again and again with different natural health professionals, but nothing works. Our family is totally heart broken. We didn’t want to resort to anti-depressants and know the dangers but there is no hope on the path we are on. We are desperate and need help from someone who can get to the bottom of this mess. We live in Adelaide, South Australia and plead with you to please help us work out what to do. Please help us Trudy. You are our only hope!
Lisa
I am sorry to heat how your son is struggling. When inositol works that’s a clue that serotonin support will likely help so I would consider a trial of tryptophan and then 5-HTP if that doesn’t work. And possibly consider cycling inositol or going over 18g. Have you trialed NAC, GABA and zinc? Did you hear Dr. Elisa Song on the Anxiety Summit 6? She is my go-to person for PANDAS/PANS
Hi Lisa
My daughter is now r3 and she has been suffering from autoimmune encephalitis since age 10 and trichotillomania since age 13. Main symptoms of AE has been OCD, rage, irritation and mood swings from anxiety to depression. But OCD has been the main issue. Trich has been mistakenly categorized under OCD because of her picking split ends or odd hairs but it is definitely NOT. We now know that her trich is a result of some childhood traumas that she kept inside and she is pulling her hair to soothe herself when she faces conditions that resemble and remind her traumas.
We wasted years with so called specialists dealing with symptoms rather than the underlying cause. No treatment or medicine helped us. If anything they made it worst. IVIG could have helped if diagnosed earlier but it didn’t help at the age 22. So we had to go for the last resort, plasmapheresis. It is a complete reset of the immune system. Almost all immunoglobulins are taken out together with all the amino acids in the plasma. Yes, she will be skating on a thin ice for the rest of her life because she no longer has the archive or capacity of a regular immune system. So we will need to protect her from all viruses, cuts and bruises. But her OCD was almost completely gone within weeks of the last plasma exchange session. Her rage and irritation were gone within days. Mood swings are still there sometimes but not as often or bad as before.
Trich is still a problem but we started EMDR treatment to get down to the bottom of her traumas. I am also trying to support her psychological treatment with Trudy’s supplement suggestions. We were already taking NAC for the past seven weeks. Now we added L-tryptophan, GABA and Inositol. We’ll keep the fingers crossed and let you know guys how it goes.
Many thanks to Trudy. God bless her!
Sam
Thanks for sharing this with Lisa. I have never heard of using plasmapheresis for treatment of OCD, rage, mood swings and irritation – amazing results. I do hope the EMDR continues to help and you also have added success with the amino acids. I assume the amino acids was something you added after the plasmapheresis? I’m curious why you had not considered doing them before too?
Please keep us posted on how your daughter continues to do
Apologies for the delay in your comment approval and my response. We had a computer glitch where a large number of comments were hidden from view in a spam folder. It mostly affected new folks who were commenting for the first time but it’s hopefully resolved now.
Lisa,
We found the AIP Paleo Diet without starchy carbs and sugars (including honey and fruit juices) significantly reduced my daughter’s PANDAS/PANS symptoms. After an initial course of antibiotics for strep/PANDAS, we removed both inflammatory foods (AIP Paleo) and the food sources for the pathogenic gut microbes (starches and sugars) that were causing her dysbiosis/PANS. After her OCD was under control, we were able to add back additional Paleo compliant foods. Note that even now, 8 years later, if she has refined sugar for two or three days, her OCD returns. Note also that some folks have problems with GAPS because fermented foods are high in natural sources of glutamate. My daughter was already on a significant amount of supplemental GABA when we shifted from GFCF to AIP Paleo/SCD, so her glutamate was under control. See here for the association of OCD and glutamate. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205262/
Wendy
Thanks so much for sharing this information for Lisa! And how wonderful that you found a solution for your daughter’s OCD.
To clarify – no honey and fruit juice when on the AIP Paleo diet initially? Were you able to identify which pathogenic bacteria were feeding on the carbs/sugars? And was candida/yeast also a factor? It’s interesting that 8 years later refined sugar triggers OCD symptoms again. Have you considered that some residual dysbiosis/yeast may still remain?
Thanks too for sharing about the link between fermented foods and natural sources of glutamate and the fact that supplemental GABA helped keep things under control. Sadly too many folks give them up because they don’t know GABA can help counter the effects.
Apologies for the delay in your comment approval and my response. We had a computer glitch where a large number of comments were hidden from view in a spam folder. It mostly affected new folks who were commenting for the first time but it’s hopefully resolved now.
Hello Trudi
I’m 33 years old and have been suffering from skin picking since I was 4 and trich since I was 17. At 24 I was diagnosed with ADHD (inattentive). I recently started taking 10mg of dexadrine to help with concentration at work. Unfortunately dexadrine is making my BFRD’s worse, but improving my concentration. I’ve tried 3 months of a ketogenic diet, it defiantly helped but the lifestyle change was difficult to manage. NAC has done nothing for me. We’re all looking for a silver bullet.
Any advise would be appreciated.
Luke
Luke
I always start with addressing low serotonin with tryptophan or 5-HTP and low GABA with GABA. BFRD’s are often driven by anxiety.
The best way to determine if someone may have low GABA/serotonin is to look at the low GABA/serotonin symptoms, rate them on a scale of 1-10 with 10 being worst, do a trial of the respective amino acid and rate the symptoms again right afterwards (in the next 2 to 30 minutes). Here are the symptoms https://www.everywomanover29.com/blog/amino-acids-mood-questionnaire-from-the-antianxiety-food-solution/
Both can often help with ADHD
– ADHD: 5-HTP melts have been a miracle for one of my adopted kids https://www.everywomanover29.com/blog/adhd-5-htp-melts-have-been-a-miracle-for-one-of-my-adopted-kids/
– GABA for children: ADHD, focus issues, irritability, anxiety and tantrums https://www.everywomanover29.com/blog/gaba-children-adhd-focus-issues-irritability-anxiety-tantrums/
The amino acids can be taken for a few months but ideally we work on underlying reasons why neurotransmitters are low.
If you are new to the amino acids (and other anxiety nutrition solutions like gluten/sugar/caffeine removal, blood sugar control, gut health, pyroluria etc) my book “The Antianxiety Food Solution” is a great place to start. More here https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/ Much of this can help with ADHD too.
I have been using NOW brand inositol for years and it totally saved me from behavioral therapy (where gloves, put bandaids on your eyebrows, and other crazy stuff my trich doctor suggested. I switched brands, got a mad stomach ache and switched back. I take as much as I can throughout the day, spooning it into anything. It tastes like nothing to me.
Angela
Thanks for sharing – this is wonderful to hear! And yes inositol has a very plain taste although some folks find it slightly sweet. I’m sure other blog readers would love to hear how much helps you and which brand didn’t work.
I’m also curious to hear some of the other “crazy stuff” your trich doctor suggested that didn’t help. I’m hoping you’ve shared your inositol success with him/her?
What about using inositol together with an SSRI?
Hello,
Can you please explain how glutaminergic transmission influences trichotillomania ?
Trich
It’s excitatory and causes anxiety and agitation which leads to trichotillomania and/or other uncomfortable behaviors
Hi Trudy . My friend recommend I follow you and I’m very interested in your posts. My daughter is suffering with newly found trichatillomania. I’m interested in your post about it and the use of NAC and GABA. She is 11 years old. Just started her periods for first time and about to move to senior school in September. Lots happening for her. She already deals with very severe food allergies which we manage daily and is quite an anxious child over health matters. Are you able to say whether NAC or GABA is safe in children with food allergies? And is there a starting dose for this age group? I have personally taken both however I do not want to cause any undue reactions for her.
Much appreciated! (We are in the UK).
Thanks
Mandy
Both are generally safe with allergies but it really depends on what type of allergies.
We use 150 lbs for adult dosing and a child who is 75lbs uses half the dose to start. But even this can vary.
When you are new to the amino acids, my book “The Antianxiety Food Solution” is an excellent resource. More here https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/ It’s a comprehensive approach that includes diet, gut health, adrenals and more.
hello! i’m Ioanna and i’m 27 years old. My trich started when i was 14. i shaved my head 8 years later, stopped it for 2,5 years but since 2020 i’m helpless. i’ve tried NAC but as soon as i get used to it it’s nothing. i’ve read your questionnaire and i pretty sure my serotonin is very low.. suicidal thoughts for sure, not good sleep although many hours and my mood SUCKS. i am pessimistic so bad and feel like nothings gonna change. also i’m also 40 pounds more than i should..
the question is how to start with them? i mean.. can i combine inositol and GABA or 5-HTP , or NAC and 5-HTP.. ? please help me 🙁
Ioanna
I have clients pick one amino acid and trial it before adding the next one – that way we know what is working. We layer in additional amino acids as needed and often use them all. Based on the symptoms you describe, starting with tryptophan would make sense.
You can look at all the symptoms here https://www.everywomanover29.com/blog/amino-acids-mood-questionnaire-from-the-antianxiety-food-solution/
My book “The Antianxiety Food Solution” https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/ is a great resource to get started with using the amino acids and making dietary changes for long-term support of neurotransmitters.