I’m using ox bile (as a supplement) to help counter the effects of dietary oxalates very likely caused by my bile issues and poor fat digestion.
I started with 125 mg ox bile with lunch and dinner and now I’m up to 250 mg at lunch and 375 mg at dinner. Many ox bile products are 500 mg but I decided to start low and go slow and also use an ox bile only product rather than ox bile combined with digestive enzymes.
I don’t know exactly what my liver or gallbladder issues are but suspect low bile production and/or sluggish bile flow.
I have an issue with dietary oxalates and using ox bile confirms my suspicions because I can feel it helping further with symptom reduction (foot and eye pain, and restless legs at night). Because of improved fat digestion, I’m encouraged it’s going to help with longer term bone health (I was recently diagnosed with osteoporosis), immunity, hormone balance and heart health too. I expect better absorption of healthy fats like omega-3 fatty acids, evening primrose oil and fat-soluble vitamins A, E, D and K (and D and K are so important for bone health).
Of course, all this means less oxalate absorption and a reduced impact of the sharp damaging crystals found in medium/high oxalate foods. Oxalates also bind to minerals like zinc, magnesium, and calcium so those mineral deficiencies should shift too.
Read on for a background on oxalate crystal disease, the research on conjugated bile acid replacement therapy (or ox bile supplementation) and oxalate/fat digestion mechanisms, and more about signs of bile issues and solutions. I also share what else I do to mitigate oxalate issues and improve fat digestion, and the ox bile product I am using.
Ox bile increases fat absorption and reduces oxalate absorption
This paper, Conjugated bile acid replacement therapy reduces urinary oxalate excretion in short bowel syndrome, explains that “Soluble oxalate is hyper absorbed by the colon leading to hyperoxaluria and an increased risk for renal calcium oxalate stones and deposits” (and other pain issues – more on that below).
Using ox bile as a supplement (or replacement) with meals “increases fat absorption and thereby decreases calcium fatty acid soap formation and oxalate hyperabsorption.” What does this mean? When fat absorption is improved with ox bile supplements there is more calcium left to bind to excess oxalates in the gut and get rid of them in the stool i.e. less oxalates are absorbed.
I encourage you to read the above paper for a better understanding of the mechanisms.
I do appreciate this team of researchers who have highlighted this approach to help with oxalate issues. Keep in mind I’m experimenting and extrapolating from this single case study of someone with short bowel syndrome and based on what I already know about bile/fat digestion, my own oxalate issues and symptoms of poor bile production/flow (see below).
I don’t have short bowel syndrome but there are a few related studies like this one from the same department, so I feel comfortable experimenting and tracking.
Other pain issues and my pain symptoms caused by dietary oxalates
Keep in mind that the increased absorption of oxalates also causes issues like joint and soft tissue pain, anxiety, restless legs, insomnia, bladder issues, vulvodynia, eye-poking (in autism), thyroid problems, osteoporosis, damage to the heart etc. even when there are no kidney stones. This is not recognized in kidney stone research but is seen extensively in clinical practice.
In 2012 I made the connection between oxalate intake and my excruciating foot pain – a combination of hot-burning-coals-pain and shards-of-glass-pain. The pain has always been worse at night and at its worst I was unable to sleep with severe restless legs. A few years later, I noticed my left eye being affected too, with scratchy discomfort and mild pain. There is also a goopy kind of discharge from the inner part of my eye and burning/redness crystal-like teariness on the outer parts of my eyes.
You can read more about my oxalate story and oxalate crystal disease on this blog – Oxalate crystal disease, dietary oxalates and pain: the research & questions.
It’s more than only ox bile replacement to help with oxalate issues
I say that ox bile helps further because this is a journey I’m on and there are many nutritional approaches that have been helping me over the years. My symptoms have reduced as I do eat mostly low oxalate with some medium oxalate vegetables from time to time, and occasional chocolate or carob (which are high oxalate).
I continue to finesse my use of calcium citrate at bedtime when my symptoms do flare. I am fortunate that I am able to eat cheese so this is another source of calcium for me.
I have pyroluria so I have long used vitamin B6 which is recognized to be helpful for some with oxalate issues. I suspect this may have prevented dumping when I first switched to low oxalate eating.
Signs of low quality bile from Anne Louse Gittleman
These are from her book, The New Fat Flush Plan:
- Queasiness after a fatty meal (impaired bile flow)
- Light-colored or floating stools (lack of bile output)
- Nausea/motion sickness (not enough bile)
- Dry skin and hair (lack of essential fatty acids)
- Constipation (inadequate bile for lubrication)
- Constant feeling of fullness
- Inability to lose weight
- Pain under the right rib cage (reflective pain from the gallbladder)
- Hemorrhoids (congested liver)
- Varicose veins (pressure from constipation due to thickened bile)
- Pain between the shoulder blades (reflective pain from the gallbladder)
- Bloating or gas
- Headache over the eyes (gallbladder meridian passes over this region)
- Bitter taste in the mouth after meals (sign of bile regurgitation)
- History of prescription or recreational drug use (need for more liver and gallbladder support)
- Sensitivities to chemicals
- Easily intoxicated (need for more liver and gallbladder support)
- Fibromyalgia (sign of liver and gallbladder overload)
- Hypothyroidism (sign of deficient bile to stimulate active thyroid hormone in fat cells)
I’m adding these signs/related issues/conditions:
- Fatigue
- Itchy skin
- SIBO/small intestinal bacterial overgrowth
- Osteoporosis
- History of gallbladder attacks or gallstones
- Oxalate issues
In my Anxiety Summit interview with Anne Louise Gittleman she explains what bile is and why it’s so important (read here if you’re new to this).
What I’ve already done to improve my bile production/quality
Here is a quick summary of the advice Anne Louise Gittleman offers, with a note of what I’ve done. I share this to illustrate that I didn’t jump straight to ox bile supplementation/replacement:
- Elimination of food allergies (I’ve done this)
- Addressing low levels of hydrochloric acid or stomach acid (this is not an issue for me)
- Controlling stress (this is ongoing)
- Adding bitter greens to the diet (I do this as much as I can, avoiding medium/high oxalate bitter greens)
- Hot lemon water in the morning (a favorite of the original Fat Flush Plan and something I’ve done for years)
- Adding non-GMO lecithin from soy and sunflowers to your morning smoothie (I don’t do this)
- Using a bile building formula that contains choline, taurine, beet root, inositol and methionine, and pancreatic lipase (I use taurine but can’t use beet root because it’s high oxalate; I did a 2 month trial of a lipase only supplement with no changes; I will likely experiment with choline, methionine and inositol in the near future)
- Using castor oil packs (I plan to do this in the near future)
These are some of the other approaches that can also help:
- Digestive bitters (it does help me and I continue to use it but it’s not enough)
- Toxin removal (I’ve experienced the harmful effects of acute environmental toxin exposure and my daily use of taurine helped. I blogged about this here.)
- Ongoing detox with infrared sauna (I use a Therasage portable sauna)
- Ox bile supplementation/replacement (I chose to use ox bile to be sure it was a bile issue I was dealing with and I did many other interventions first.)
My observations when using ox bile supplementation
I have not had any severe pain flares and have not needed to use extra calcium citrate in the night. The other profound change was a dramatic increase in energy. A few months ago I thought my Lyme was flaring again as I was so exhausted in the afternoons. This exhaustion has dissipated.
In terms of digestive symptoms, I notice less queasiness after a fatty meal like roast chicken with the skin on or a fatty lamb slow cooker stew. The constant feeling of fullness, gas and bloating has improved too. I suspect ox bile is helping with SIBO because it’s antimicrobial. But I can’t be sure since I started berberine 6 months ago and noticed it reduced methane gas production.
I have yet to test out motion sickness on a boat trip but I haven’t been using wristbands in the car and have been fine. I had been having some unusual/new skin itchiness a few months ago and this has now resolved. I do have sensitivities to chemicals but I haven’t noticed any change yet.
I used my stool color as a gauge to whether the ox bile was working – as I increased the dose I noticed it got darker and I have no more floaters. My bowel movements are much easier (more lubrication) and I feel the urge to go more than before.
It will be interesting to see if longer term this helps with improving my bone density. It makes no sense that I have osteoporosis given I’ve been physically active all my life. I highly suspect my bile issues have been a factor since childhood and then got worse during perimenopause Research shows “Gallbladder emptying time is longer during the perimenopausal period.” Unfortunately kidney stones and oxalate issues ramp up in menopause so it’s the perfect storm. I will be discussing all this with my endocrinologist/bone density doctor and ideally do some testing to figure out what the bile issues are (the pancreatic elastase test was fine).
I do track carefully and only make one change at a time so I typically know what improvements I can attribute to what changes.
Ox bile product options
Allergy Research has an Ox Bile 125 mg product and a 500 mg product. 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, Nutricology has an Ox Bile 125 mg product and a 500 mg product. This is the brand I happen to be using. It can be purchased on iherb (use this link to save 5%).
In conclusion
I’d like to give a shout out to my colleagues… I first learned about oxalates from my dear friend Julie Matthews. Hearing her present at a conference helped me make the connection to my feet pain issues. She introduced me to Susan Owens, oxalate guru and researcher, and the TLO/Trying Low Oxalate group, and now I communicate regularly with them, the TLO moderators and members. And I met Sally K. Norton a few years ago. She is the author of this excellent book, Toxic Superfoods: How Oxalate Overload Is Making You Sick (my Amazon link).
Unfortunately no-one discusses the use of ox bile replacement/supplementation for those of us with oxalate issues and bile issues, and I suspect it’s an under-appreciated tool for those of us who continue to struggle. Hopefully this research and my results starts a discussion on the topic and further interest.
Sally K. Norton does mention a connection in her book: “The immune system has a method for shielding surrounding tissues from oxalate crystals; entrapping them with extruded DNA called a neutrophil extracellular trap (NET). These NETs forming around oxalates may contribute to gallstones and gallbladder “sludge”. If this is the case in my situation, then my lifelong issues with bile were likely made worse by my intake of medium- and high-oxalate foods.
I do hope that me sharing my personal experiments and healing journey helps you or someone you know. Honestly, I could write a book on oxalates and what I’ve learned over the last few years. There is so much to all this and even though it’s a “pain” to be affected like this it is fascinating. I do feel thankful to have dietary and nutritional “solutions.”
The next step for me is looking into and addressing my endogenous oxalate production i.e. oxalates that are produced internally vs oxalates that are ingested. Stay tuned for an update on this.
Do you have oxalate issues together with gallbladder/bile issues/fat digestion issues and how has ox bile supplementation helped you?
Has ox bile helped you with low bile production or sluggish bile – even if you don’t have oxalate issues?
If you’re a practitioner have you used ox bile with your clients or patients?
Feel free to share and ask your questions below.
what are you thoughts/experience/advice on TUDCA ?
Jane
I’ve been learning is that TUDCA is best used in conjunction with ox bile (see Sandra’s question)
Have you been using it with success?
I managed to figure all this out as well. Had severe arthritis in my elbows and connected it to oxelates. I tried ox bile and it helped. One extra tip from me. Get some goats milk and make some kefir. Goats kefir has no lactose and no dodgy protein. This was the final piece of the puzzle for me
Stu
Great to hear you found help with ox bile (and presumably reducing oxalate too)? Love the addition of goat kefir for the calcium benefits and for probiotics!
I’d love to hear how quickly you saw improvements in the elbow arthritis with these changes? and how the severety changed?
Hi Trudy.
I am supposing that if bile is ok and also a good idea if you have had your gall bladder removed. Please comment.
Thank you for all your helpful information so far.
I have always had an inability to absorb vitamin A, suffer from itches especially in the summer which I think is brachioradial in origin since I also have neck issues esp axial. My daughter has the same brachioradial summer itch, has neck issues and is also autistic ( she has 2 kids on the spectrum – Asperger’s) and following lower oxalates. We were watching Julie Matthews and that’s how I came across you. We are in New Zealand.
I have heard that taking vit D is also a cause of brachioradial issues and I have been taking it for years for bone and immune health. I am introducing a low oxalate diet due to otherwise unexplainable muscle and ligament pain.
My reason for asking about the gall bladder is because my brother has had his out and I suspect this would be a good idea for him as well as low oxalates.
My 16 yo grandson also has had surgical removal if some large bowel re cancer so I am thinking about him too.
So much to think about right?
I look forward to your comments.
Leigh Manson
Leigh
If I had a client with itches, issues with fat soluble vitamins such as A and D, possible oxalate issues and a family history of gallbladder issues I’d be looking into liver/gallbladder and bile issues.
I am aware brachioradial pruritus is a nerve issue that causes itching but you may find this paper of interest – itching and the liver/bile/opioids/serotonin and more https://www.journal-of-hepatology.eu/article/S0168-8278(05)00612-4/fulltext
Ox bile is often recommended after gallbladder removal and can be used when you do still have a gallbladder but have issues with bile quality/production/flow.
Be sure to discuss supplementation with your functional medicine doctor. It’s also invaluable to get a gallbladder ultrasound to know if there is sludge or gallstones. I feel they should be routine annual procedures especially for women over 40.
I initially tried bile supplements to try to resolve ongoing digestion/elimination issues – in the end it did not help (gallbladder removed long ago after which issues started to build over time – eventually found to be gluten intolerant as well). I have tried several things – hydrochloric acid, bile acid, and digestive enzymes and most did nothing, some created more problems (gas, increased diarrhea, etc).
I finally found Dr Tennant’s digestive/bile acid/hydrochloric acid supplement 3 in 1, and it certainly works where others did’nt (esp the ones with rice hull, rice bran, etc which are a trigger for me, or absorbic acid which is also a trigger). I am thinking these three together are causing many digestive issues these days in many people (family I’m noticing too).
Starting to wonder if our cooked foods are a big instigator since we kill all the enzymes when cooking food – may be the trigger for gluten intolerance as well? Not being able to digest the more difficult things including oxalates? Interesting to say the least.
Lynn
Thanks for sharing and glad you found the combo that works for you.
I agree with you on the fillers – rice, corn and cellulose. And vitamin C is especially an issue for those with oxalate issues but also when it’s made from corn.
There are pros and cons to cooked foods vs raw foods but I don’t know how much this plays into gluten and oxalate issues. Something to ponder for sure. I see bigger issues as leaky gut, the microbiome, stress and low stomach acid/low bile production.
I would love to find a low oxalate bitters.
Also, is there a downside to trying ox bile ?and I’ve heard someone mention in another post to take after you eat ???
Cheryl
I’ve learned that herbs in tincture form are all lower in oxalate than dried herbs so presume a bitters tincture is low oxalate. Mine has not bothered me yet. Some larger doses of some herbal liquids (such as milk thistle) have been fine too whereas milk thistle in a capsule bothers me.
Downside to ox bile is too much can cause digestive pain and diarrhea and play a role in leaky gut. My bottle says to take with a fatty meal and that’s been working well for me.
I learned recently I have an oxolate problem after trying carnivore. I had oxolate dumping for 2-3 weeks. So glad I learned about as I was having issues with my ankles,feet . Avoiding high oxolate foods has helped so much. Would love to learn more about this.
Denise
So glad you made the connection between medium/high oxalate foods and ankle/feet issues. Be sure to read the other oxalate blogs here on my site (search for oxalates) and the TLO facebook group is a great resource. Also Sally K. Norton’s book is excellent (I share a link in this blog)
Datis Kharrazian mentioned that taking ox bile can stop your ability to make it yourself naturally. Do you have any information on this?
N
I have not found any evidence that supports this and would love a study link if you happen to have it.
I believe my high oxalate issues are from going on a paleo diet and eating a lot of high oxalate foods as a result. I have leaky gut & SIBO, and suspect the leaky gut lead to high blood oxalates. I was also going through menopause at the time.
My doctor prescribed ox bile, which I was taking for quite some time. He said it was for elimination issues. It helped for a while with that problem and then it stopped helping. I didn’t realize it was also for oxalate absorption until I read your blog post.
My bile tends to be above normal or the high side of normal. My doctor believes I likely have Gilberts Syndrome. I stopped taking ox bile a couple of months ago because the whites of my eyes were yellow. Now that I’m not taking ox bile, the yellow is gone, but I have noticed more hip pain, which is primarily where my oxalate issues are concentrated. I was also taking B6 for awhile, but now my doc has me on a B complex supplement.
Joelle
There is a connection between Gilbert’s Syndrome and gallbladder issues. I think you mean bilirubin tends to be above normal or the high side of normal?
Vitamin B6 does help many who have oxalate issues and with ox bile it’s a matter of finding the sweet spot. Best to discuss all this with your functional medicine doctor.
And feel free to share which high oxalates foods you were consuming on the Paleo diet – I know green smoothies, chia seeds and nuts/nut flours are common culprits
I suspect I have an Oxalates intolerance as when I was drinking green smoothies every day packed with spinach, Swiss chard, chia, banana and pineapple for a couple years, I have had severe pain in my left foot and ankle, along with itchy rashes periodically. The last few months I have not been drinking the smoothies each day, and the foot pain and rashes have disappeared.
I had my gallbladder removed shortly after I had my daughter, 36 years ago, and have always been slender. I have never take any type of ox bile or enzymes, but do take vit D and K, B Complex (Mercola) supplements.
Recently I’ve been reading your blogs and am fascinated by all that I am learning. Also have read Sally Norton’s book. Wondering if you are familiar with Dr. Brooke Goldner’s raw food protocol?
Mary
Glad you’ve made the oxalate connection and found relief on a lower oxalate diet. sally’s book is great
I’m not familiar with Dr. Brooke Goldner’s raw food protocol
I have taken TUDCA from time to time which was recommended by a Functional Med practitioner in the past. I did used to take pancreatic enzymes with contained ox bile. I now see that TUDCA is only one of four bile acids and it may be better to use ox bile for the four depending on what you are using it for.
According to a result of the ZOE health study tests I had done I do not handle fats well. Not sure if they come to this conclusion from the gut bacteria or the blood glucose response to the very sweet and greasy test cookies they give you to eat. I think I will now get some ox bile.
Sandra
That is correct about TUDCA and what I’ve been learning is that TUDCA is best used in conjunction with ox bile for this reason. I’m curious how TUDCA has helped you in the past?
I’m not familiar with Zoe testing but love that their focus is individualized nutrition and postprandial metabolism. The site states they measure “blood fat levels after eating food” ie the test cookie. Can you share what exactly the results were about not being able to handle fats and if your functional medicine practitioner ordered this test?
Be sure to discuss ox bile supplementation with your functional medicine practitioner
Can you recommend a brand for ox bile? Thanks!
Kristin
This blog is my personal story so I didn’t recommend a product but I’m happy to share which one I’m using – Nutricology Ox Bile 125mg.
Be sure to discuss supplementation with your functional medicine doctor
Trudy, I was just putting my own puzzle together when your email came through yesterday. It was a godsend in its timing and validation as to what I was figuring out for myself. As another CN, I have histamine issues and a sluggish gallbladder. I had just began a low dose ox bile (again after not taking it for years) and recent labs showed that I wasn’t absorbing the fats. I knew I had to increase the ox bile but it was amazing to me just how much a sluggish gallbladder affects your nutrient levels and the symptoms it presents. Thanks for your timely post.
Vicki
Hello to a fellow CN! Glad to hear this blog has been helpful. It’s quite amazing the impact a sluggish gallbladder can have!
Feel free to share which lab shows fat absorption issues and which symptoms you resonate with. And how has ox bile helped in the past and how much/which product? Are you doing the same this time around? Are oxalates an issue too?
I’d appreciate hearing from you – what do you know about histamine/gallbladder issues?
Trudy I have no gallbladder. I have been using ox bile for years. I have developed histamine and oxalate issues. Now when I use ox bile I get ringing in my ears which I think histamine levels go up . I think it also jacks up the oxalates then causes yeast infection I can never get rid of. It’s a vicious circle. I have a pretty good diet and exercise. Not over weight. Any suggestions for a different brand .
Sue
I’m not aware of histamine issues being more severe with an ox bile supplement but do wonder about leaky gut – too much ox bile can cause this. Feel free to share which brand and how much ox bile and how had it been helping before.
Trudy, thank you! You are always on the cutting edge and I also appreciate your honesty in sharing your own process. I’m intrigued by this post, as while I don’t have oxalate issues, I do indeed have the big liver and gall bladder issues (the oxalate connections are revelatory though!). My question is why I’ve not tolerated ox bile, TUDCA, taurine, things like that? You say you did low dose to begin, and also did other things first (I love the helpful lists). Reasons for doing it that way? Maybe those details could help me understand how I might be able to use this womderful substance. Thanks so much!!
Aria
I like to start by giving the body the ability to heal and do it’s own things with as few interventions as possible which I why I started with the basic ways to support my liver and bile production/quality. I then chose to do low dose ox bile to confirm it was in fact bile I was having an issue with a not something else. I’m still not sure if it’s a production (quantity) or quality issue or even something else (like bile duct or valve issue).
Feel free to share how you’ve not tolerated ox bile, TUDCA or taurine.
And thanks for your kind words
Thank you–good info. I don’t even remember the issues that I had. I seem to have become a mast cell person–hard to tolerate many supplements. Various weird symptoms with many, from increased adrenaline to itching to depression to irritability to all kinds of things. Thanks again for all the helpful info, replies and caring!
unsure about taking calcium as a supplement because i’ve had several kidney stones. also have osteoporosis, so should supplement with calcium for that. but really interested in NOT having more stones.
thanks!
Elizabeth
It’s best to discuss with your functional medicine practitioner as I know mainstream medicine advises no supplemental calcium for folks who’ve had kidney stones. This makes no sense to me given the benefits when someone has oxalate issues contributing to the kidney stones. And when someone has osteoporosis.
This is fascinating information, Trudy!
I have severe Osteoporosis, GAD, no gallbladder, plus issues with digesting fat. Osteoporosis does run in my family, but I am only 64 and have lost 5 inches in height.
I went to Mayo last Fall and they ran every test possible and could not figure out why I have such severe Osteoporosis at such a “young” age. One thought I had was that the SSRI’s I have taken for many, many years caused my Osteoporosis to be worse. The doctors did not agree with me.
I am going to try a low dose of Ox Bile and see if this helps with fat digestion and, perhaps, my GAD and Osteoporosis. I should probably try a no/low oxalate diet, as well.
I would appreciate any thoughts you could share with me regarding my issues – if you believe they could be related to high oxalates and/or not having a gallbladder.
Thank you!
Pam
Pam
Glad to hear you find it fascinating. As I’ve been diving into the research and connections I’m more and more fascinated
You are spot on with the SSRI and osteoporosis connection and it’s really unforgivable that the doctors at Mayo dismissed your concerns. There is plenty of evidence supporting this with this 2022 paper being a good overview – The use of antidepressants is linked to bone loss: A systematic review and metanalysis https://pubmed.ncbi.nlm.nih.gov/36267210/
May I ask which SSRI and how long you were on it for?
And yes these are all commonly correlated – known fat digestion issues, osteoporosis and past gallbladder issues, and oxalate issues in menopause is common too. May I ask what led to your gallbladder removal and at what age? Do keep us posted if you decide to trial ox bile (and be sure to work with your practitioner) and switch to low oxalate diet (I have my clients start by reducing high oxalate foods and going slow).
If GAD refers to generalized anxiety disorder be sure to check out my book “The Antianxiety Food Solution” for info on dietary changes (like gluten-free, sugar-free, caffeine-free) and the amino acids GABA and tryptophan. More here https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/
Trudy, thank you for sharing all this information! I very much appreciate it!
I had my gallbladder removed 19 years ago, so my understanding is that my bile now goes directly into my stomach?
I know I have issues with fat digestion. I have been taking lipase for a couple of years, now, but do not believe it is doing the trick.
Is Ox Bile supplementation something that works for those who do not have gallbladders?
Thank you!
Pam
Pam
After gallbladder removal bile goes from the liver directly into the small intestine but because there is no gallbladder the amount can’t be controlled based on intake of fat. Using an ox bile supplement gets around this and is often worth considering when there are fat digestion issues. Other approaches to improve bile quality (covered in the blog) can be helpful too. Be sure to discuss with your practitioner and please keep us posted.
Feel free to share about your gallbladder removal too
Thank you, Trudy!
Pam
Thank you for your response, Trudy, about the correlation between taking SSRI’s and bone loss. I very much appreciate the article you provided regarding this issue, also! I have lost 5 inches over the past six years, due to spinal compression fractures.
In response to your questions, I have been on SSRI’s since Prozac first came out. I am 64. That’s a long time to be on them! I have Obsessive Compulsive Disorder and this creates quite a lot of anxiety for me, to the point of not being able to function at times. Thus, the SSRI’s.
I am not sure how well they work, because I find my OCD to be aggravated by what’s going on in my life – I have been on several SSRI’s over the years, the most recent being Escitalopram. 20 mg seemed to help keep me on a even keel over the past 7 years or so, depending on what was going on in my life. I did try to stay off it for a year, trying Ashwaganda, but couldn’t do this by myself and had no one to guide me.
My Psych Nurse Practitioner decide I should try a different SSRI when my OCD got out of control in 2023. Problem there was that she took me completely off the Escitalopram over two weeks and started the new SSRI at the lowest dose possible, throwing me into a deep depression. She would only increase it a tiny bit at 2 week intervals. (I discovered she hadn’t handled things correctly when I ended up finding a new practitioner – a Psych PA).
The Psych PA put me back on 20 mg of Escitalopram and I became functional again- all of this occurred over a 10 week period. Now I take 30 mg of Escitalopram (she started this during the winter months), but I am wanting to go back to 20 mg. She has told me I can take Ashwaganda with the drugs I take, just watch for Serotonin Syndrome symptoms – she didn’t have any idea what dosage I could take of Ashwaganda. Once again, I am recognizing that myOCD is out of control due to situations occurring in my life right now.
I would very much like to consult with you on what to do, but do not know how to go about this, or if you are taking new patients. Please let me know.
Thank you so much!
P.S. I had my gallbladder removed around age 45 after horrible pain that began (including in my left shoulder blade area) after consuming a lot of cheese and olives for a snack. I was told removal of the gallbladder was the answer. I have since learned differently.
Pam
Pam
Gosh sorry to hear about your multiple prescriptions and being taken off these meds with no taper.
Apologies for the late response but I somehow missed this. I have a long waiting list and you can sign up here https://www.everywomanover29.com/blog/services/ In the meantime I encourage you to read my book and start to make dietary changes. Many folks feel comfortable experimenting with amino acids that don’t interact with SSRIs.
Thank you so much for your reply, Trudy!
Pam
Pam – You’re welcome!
I’d love to share some of your story via the blog so we can help create awareness for others. May I do so using your first name only?
Great info, thank you! I’m curious how you determined that you do not have low stomach acid? I’m thinking it’s similar for me that my issue has always been bile related, not stomach acid.
Also, I recently watched a video on YouTube that said that it’s best to take Oxbile 1-2 hours after a meal so that stomach acid can do its work first and then the Oxbile can do its job to neutralize the stomach acid before everything moves from the stomach to the intestines etc.
I’m going to try taking ox bile after a meal, along with taking Tudca and digestive enzymes during a meal.
I’ve had gallstones for over 20 years, and recently suddenly developed reaction symptoms to all medium-high-oxalate foods. I also recently developed Hypercalciuria, and recently found out that I have a large stone lodged in the Cystic Duct of my gallbladder. HIDA scan showed that my gallbladder is now not functioning at all.
My theory is that this blockage and lack of gallbladder function is causing my oxalate issues due to decreased bile. I’m hoping that supplementing with Ox bile and Tudca will help, especially if I need to have my gallbladder removed.
B
I figured my stomach acid is ok based on a few things: I’ve trialed apple cider vinegar and betain Hcl and not seen a difference, and lab markers for total protein and globulin have been right in the middle of optimal.
I have not common across any science regarding the timing of ox bile supps but have read/heard before a meal, with a meal and after a meal. I chose with my meal and it’s working well for me. I may experiment with other timing down the road.
I have seen some research that ox bile helps to dissolve gallstones but because of the risk and severity with blockage it’s important to work with a practitioner and have them order regular ultrasounds and monitor. Be sure to discuss the suspected oxalate issues with them too
Hi Trudy, thanks so much for your reply. I tried Tudca with a meal and Oxbile an hour after, and I experience some throat hoarseness and upper left abdominal pain in the stomach area. That lead me to read about what bile can do to the stomach lining, and now I’m a bit concerned about taking it. I wish there was a way for it to go straight to the small intestine.
Hi Trudy,
I have short bowel syndrome after emergency surgery about 4 years ago. Prior to surgery I was about 240lbs and had several hernia repairs so I have tried to keep my weight down. I have been taking berberine for about 6 months now and just started taking ox bile because of my on going digestion issues. I only started the ox bile a few days ago and wasn’t sure if I can take it together with berberine? More than anything else I was intrigued by the foot pain and the oxalate relation you talked about. I have had ongoing foot pain that has gotten so much better since I stopped eating gluten and started following a low fodmap diet. I used to eat a lot of raw spinach prior to that. Sorry for rambling but I had no idea how much these things were connected and I’m noticing a difference now that I’m taking the ox bile too but I’m not sure if I ok to take the berberine.
Thank you for listening and inspiring me.
Danielle
Glad to hear you’re making these connections and doing better! Gluten is inflammatory and high oxalate and of course spinach is very high oxalate.
I personally take berberine and ox bile together and am not aware of any reason not to. Keep us posted on your progress with ox bile and how much works for you
Sure, Trudy, you can share my story via the blog. 🙂
Pam
Thank you – I’ll post a link here when I do
Pam, I am very interested in learning more about your experience with Ashwaganda. My 14 year old daughter struggles with OCD, anxiety and depression. I am considering discussing the possibility of using Ashwaganda with her family practitioner, as I’d like to avoid prescription medications.
Julie
I have clients do the symptoms questionnaire https://www.everywomanover29.com/blog/amino-acids-mood-questionnaire-from-the-antianxiety-food-solution/ to help decide where to start. With OCD, anxiety and depression I typically start with tryptophan first and we also consider inositol too, and then GABA and sometimes DPA.
We’re also looking at diet as gluten is often a factor, as are low blood sugar issues. Quality animal protein esp at breakfast is key. I share more about the amino acids and dietary approaches in my book “The Antianxiety Food Solution” https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/
And there are many blogs on the above topics – feel free to use the search feature on the blog
Ashwagandha is a wonderful herbal adaptogen but would not be my first choice for a teen. I believe Pam is using it because she is already taking a SSRI
I am so grateful for your feedback, Trudy! Thank you! I did purchase a copy of your book. She has Celiec disease, so she has been gluten free for several years. I do worry about blood sugar dips, as she doesn’t eat as much protein as she should. Her digestive issues may play into this. I am trying to work with our regular family practitioner. He tested her zinc, which was normal. She struggles with a low vitamin d level, and B6 was elevated with her latest lab work, although we had been supplementing up to that point. After reading some of your literature, I am beginning to wonder if an adrenal issue is part of all of this.
Julie
Vitamin D is needed for serotonin production so addressing this in addition to using tryptophan or 5-HTP is often helpful. Have you had her use either of these amino acids yet?
Digestive issues can lead to low neurotransmitters. With blood sugar issues we do consider the adrenals. But keep in mind zinc testing is notoriously inaccurate (I wrote about this in the pyroluria chapter of my book – glad you have a copy!) and elevated B6 can be misleading.
Hopefully a full iron panel (with ferritin) was done as this can often be an issue in celiac disease and mood issues
Thank you so much for this feedback, Trudy! I am so appreciative!! As far as the amino acids mentioned go; she has not taken either of these, and she has not had a FULL iron panel done. I will be adding this to my “laundry list”. I hadn’t considered the relationship between mood and these levels.
There are so many components to all of this! I often find myself wondering if this is all stemming from the digestive issues….You really start to wonder where it all begins!
Julie
Gut health is often a factor and can be a root cause but the amino acids give relief while we are figuring out root causes and addressing them
Julie and Trudy,
My son has Asperger’s Syndrome and GAD, along with mild OCD. When he was a teenager, I determined, after a lot of research, that he had Leaky Gut Syndrome. Also, he was addicted to milk, which I believe led to some of his problems (casein). I read a book called Enzymes for Autism and started my son on specific digestive enzymes based on his symptoms. What a difference this made in his behavior and attitude – he was much more agreeable. After three or so years, he chose to stop taking them. He is now 39 and has learned many coping mechanisms with his issues, as well as taking SSRI’s. Trudy, I am wondering what you believe about digestive enzymes for some of these issues.
Pam
Pam
Absolutely and wonderful that they helped. As you found there are specific enzymes that help with dairy and gluten and even salicylates/phenols etc and are known to help with symptoms kids and adults with autism/Asperger’s experience. I’m curious to hear which enzymes you used and what behavior changes you noticed.
I’m not familiar with this book but I’m going to check it out so thanks for sharing.
As I’m sure you know, the amino acids are often helpful in this population too – to help with anxiety, social anxiety, focus, motivation, confidence and mood issues etc.