dopamine

Psychiatric Complications of Primary Hyperparathyroidism and Mild Hypercalcemia: anxiety, depression, anger, irritability, delusions and impaired cognition

July 7, 2023 By Trudy Scott 38 Comments

In samples of patients undergoing parathyroidectomy for primary hyperparathyroidism (PHPT), these disturbances have been identified at a rate of 43.1%–53.0% for anxiety, 33.0%–62.1% for depression, 22.0% for thoughts of death or suicide, 51.9% for anger and irritability, 5.0%–20.0% for hallucinations and delusions, and 37.3%–46.5% for impaired cognition.

In fact, it has been noted that there are more neuropsychiatric phenomena in PHPT than is often recognized and that these symptoms are easily missed, particularly in the elderly population.

This excerpt is from, Psychiatric Complications of Primary Hyperparathyroidism and Mild Hypercalcemia, published in Psychiatry Online.

I’ve recently been reading as much as I can about this condition, for personal and professional reasons. As soon as I learn about something new I go digging to see if there is an anxiety connection. And I must say I was very surprised to read these stats. It’s not something I’ve heard discussed or taught at mental health conferences.

The authors also state this about the condition:

The incidence of primary hyperparathyroidism (PHPT) is about 21 cases per 100,000 person-years, and the disorder is usually caused by a solitary parathyroid adenoma. PHPT has traditionally been recognized by its characteristic symptoms, including urolithiasis (“stones”); osteopenia and osteoporosis (“bones”); abdominal cramping, nausea, and peptic ulceration (“moans”); and depression, anxiety, cognitive dysfunction, insomnia, confusion, and personality changes (“psychiatric overtones”).

How do changes in serum calcium levels contribute to mental health and cognitive symptoms?

It’s always helpful to understand the mechanism and it was the first thought that went through my mind – how does hyperparathyroidism and changes in serum calcium levels cause these mental health and cognitive symptoms? The authors share this:

Although the pathogenesis [or cause] of psychiatric symptoms in primary hyperparathyroidism remains unclear, calcium is thought to figure prominently in determining changes in monoamine metabolism in the central nervous system(CNS), thereby modifying neurotransmission and resulting in alterations in mood and cognition.

I went digging and found this paper – Acute psychosis secondary to suspected hyperparathyroidism: A case report and literature review.

The authors also state that the mechanism isn’t known for certain. And although they are referring specifically to psychosis, the explanation could be applied to other symptoms too: “It is thought that the changes in serum calcium level slow down nerve function and neurotransmission rate, inducing psychosis (and other symptoms like anxiety, depression, anger, irritability and suicidal thoughts).

Understanding this possible mechanism helps us find a temporary solution for these symptoms until the hyperparathyroidism is addressed with surgery i.e. using amino acids as supplements.

Using amino acids to ease symptoms while you are seeking the root cause/s

If you’ve been following my work and have read my book The Antianxiety Food Solution, you’ll be familiar with using targeted amino acids as supplements to support low levels of neurotransmitters. These provide quick relief of symptoms (in a day or less) while you are seeking the root cause.

If we look at the above symptoms:

Anxiety can be a sign of low serotonin (worry type of anxiety) and/or low GABA (physical type of anxiety) – and tryptophan/5-HTP and/or GABA help ease symptoms.
Depression can be a sign of low serotonin (negativity), low dopamine (curl-up-in-bed depression) an/or low endorphins (weepy depression) – and tryptophan/5-HTP, tyrosine and/or DPA help ease symptoms.
Irritability and anger are common with low serotonin – and tryptophan/5-HTP helps to ease symptoms.
Low GABA can also be involved with anger and rage
Cognitive issues can be caused by low dopamine and low GABA – and tyrosine and/or GABA help ease symptoms

(You can find the symptoms questionnaire here. As always, amino acids are used based on symptom clusters and dosed according to your unique needs.)

If you find you have been using the amino acids long term and have explored all the possible root causes described in my book and summarized here, it may be worth investigating primary hyperthyroidism especially if you’re menopausal.

Case: “I had to have a parathyroid gland removed a few years ago… I literally felt better from the moment I came round from the surgery”

We always want to find the root cause when we have various symptoms. With this condition, it’s common to observe very quick resolution of symptoms after parathyroid surgery to remove the adenoma/s. Someone in our community shared this:

I had to have a parathyroid gland removed a few years ago … I literally felt better from the moment I came round from the surgery. It’s a miserable disease. I thought I was going to die! Lots of people get so low that they don’t feel like they can go on.

Bone pain was awful. Fatigue, depression etc.

I had had some dental issues around that time. One of my teeth crumbled. My Vitamin D went down to 9 so I am sure that was a large part of the puzzle.

I was actually diagnosed fairly quickly but was retested many times. I self-referred to a surgeon that was in-network in the end as my insurance wouldn’t cover various surgeons that my doctor wanted me to go too.

I had had breast cancer a few years ago and so had had weekly blood tests and, when I went back and looked, my calcium had been high for years. So important to read our own results.

The surgery was so easy.

What an amazing outcome for this woman and I appreciate her for sharing so we all get to learn and benefit from her journey. And yes, I agree, we need to advocate for ourselves and ask for and keep copies of all our labs. And get educated and ask questions. It’s really unfortunate that high calcium and hyperparathyroidism is so often missed.

Not everyone has all the listed symptoms of primary hyperparathyroidism. This woman did experience fatigue, depression and bone pain. She did not experience anxiety and didn’t have kidney stones. I do suspect dietary oxalate issues (without kidney stones) can be an issue for some folks because of the calcium disruption.

Some reasons why hyperparathyroidism is underdiagnosed

In the last few months I have learned that primary hyperparathyroidism is underdiagnosed. PTH (parathyroid hormone) is not routinely tested and I believe that it should be. Also, as you read above, elevated calcium levels are often ignored or brushed off as being a non-issue. And to complicate things further calcium is not always elevated. Hyperparathyroidism is also underdiagnosed and undertreated in the elderly.

For many women (and men) the discovery happens after they are diagnosed with osteoporosis and then calcium and PTH are tested, and/or past elevated calcium levels are “discovered.” If the hyperparathyroidism diagnosis happens first then osteoporosis screening is not always done and I believe it should be. And don’t get me started on when I believe osteoporosis screening should start (at 45 and not 65 or 70 years old) and issues with DEXA screening (more to come on this).

The good news is that primary hyperparathyroidism is a well-established cause of secondary osteoporosis which starts to resolve after the surgery too.

I’m still very much in learning mode

Primary hyperparathyroidism only recently appeared on my radar as a result of the 2023 osteoporosis summit, hosted by my friend and colleague, Margie Bissinger, Physical Therapist and osteoporosis coach. Dr. Deva Boone was a speaker on this condition on the summit and her site is a wealth of information. I appreciate them both.

As I mentioned above, I am also amazed it’s not something I’ve heard about at mental health or integrative health conferences and when doing continuing education.

I will admit I’m no expert and I’m still very much in learning mode – for myself and for you and this community. But, as you know, I like to share what I learn. As I continue to learn, I plan to share additional perspectives and the osteoporosis/menopause and oxalate links.

I am also in the process of creating a hyperparathyroidism questionnaire to use with my clients. Not everyone has all the above symptoms and not all the papers and resources list all the symptoms covered here today. For example, fatigue is listed on many sites but not in the above two papers and very few sites emphasize the mental health symptoms.

I’m also learning there are clues to look for – like forearm results on the DEXA scan and a good TBS/trabecular bone score has some significance. Stay tuned.

Resources if you are new to using amino acids as supplements

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

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

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

The book doesn’t include product names (per the publisher’s request) so this blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the amino acids that I use with my individual clients and those in my group programs. You can find them all in my online store.

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

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’ve been diagnosed with hyperparathyroidism (or a family member has been) you can likely relate to much of this. Please share your/their journey. I’d love to hear how long it took for a diagnosis and treatment and what symptoms resolved after surgery, and how quickly.

Did you find the amino acids helped anxiety, mood and cognition symptoms in the short term, and then were no longer needed after surgery?

If you’re new to hyperparathyroidism, feel free to ask your questions and share what you’d like to hear more about in the follow-up blog.

If you are a practitioner, is primary hyperparathyroidism on your radar and do you recommend PTH testing in addition to calcium testing? Have you found the amino acids to be a good short-term solution for your clients/patients?

And if hyperparathyroidism is your area of expertise, feel free to add to the discussion.

Feel free to post your feedback here in the comments.

Dysphoric Milk Ejection Reflex (D-MER) is an abrupt emotional “drop” that occurs in some women just before milk release

June 23, 2023 By Trudy Scott 4 Comments

Dysphoric Milk Ejection Reflex (D-MER) is an abrupt emotional “drop” that occurs in some women just before milk release and continues for not more than a few minutes. The brief negative feelings range in severity from wistfulness to self-loathing, and appear to have a physiological cause.

The authors suggest that an abrupt drop in dopamine may occur when milk release is triggered, resulting in a real or relative brief dopamine deficit for affected women.

Clinicians can support women with D-MER in several ways; often, simply knowing that it is a recognized phenomenon makes the condition tolerable. Further study is needed.

The above abstract is from this paper published in 2011 – Dysphoric milk ejection reflex: A case report.

Alia Heise (AH) is co-author of this paper and coined the term D-MER. She is sharing her breastfeeding and D-MER experiences as the case.

Many women who are struggling with these feelings don’t ask for help and when they do they are often dismissed. The authors share it’s “a breastfeeding problem for which affected mothers seem only rarely to seek or receive help.” I’m sharing this case and more about D-MER for these reasons and because troubled mothers often stop breastfeeding.

Read on to learn about the dopamine hypothesis and how Rhodiola helped Alia.

Feedback from struggling moms

The authors share this description from a struggling mom:

If you read Harry Potter they talk about the creatures that suck the soul out of you and when they are around it makes you cold and you start to focus on negative things and fall into this abyss of negative thoughts – that is how D-MER was for me at times.

Someone in my community shared this when I posted the case on Facebook:

I experienced an extreme emotional response. I would describe it as a wave of huge anxiety… almost suicidal at times but only during letdown (it lasted only a couple of minutes if that, but it was so severe.)

I started noticing it when I would pump. After I researched it I figured out there was a name for it and a reason. I never could find anyone to help me… I remember mentioning it to my doctor and she had never heard of it. I just suffered through and so my breastfeeding/pumping journey ended at 6 months.

I appreciate Alie and the authors for helping to create awareness and these moms for sharing their experiences. Hopefully this information will mean fewer moms struggle alone with D-MER and more awareness amongst practitioners.

I share some highlights below but be sure to read the entire paper here – Dysphoric milk ejection reflex: A case report.

The spectrum of D-MER symptoms and a drop in dopamine hypothesized as the cause

Here is the spectrum of D-MER symptoms (as listed in the above paper):

Depression, wistfulness, homesickness, apprehension, hopelessness, hollowness in stomach (first 3 months)
Anxiety, dread, panic, irritability (6 to 12 months)
Anger, tension, agitation, paranoia (until weaning)

A drop in dopamine is hypothesized as the cause in susceptible mothers (also from the above paper):

Based on AH’s experiences, and until more is known, it is the authors’ very humble hypothesis that a drop in dopamine either facilitates or parallels each oxytocin spike in lactating human mothers, and that it is this dopamine drop that results in D-MER in susceptible mothers.

What adds value to Alia’s dopamine hypothesis is that bupropion, a dopamine reuptake inhibitor (i.e. a medication that increases dopamine), reduced her symptoms in a day and eliminated her symptoms in 5 days. She did, however, have to stop the medication due to side effects.

Rhodiola prevents the breakdown of dopamine, increasing it’s availability

Alia then learned about a herb called Rhodiola rosea that “is a monoamine oxidase inhibitor that prevents the breakdown of dopamine, increasing its availability.”

When she used Rhodiola her symptoms became much milder and when she missed taking Rhodiola her D-MER symptoms were worse. She didn’t notice any changes in her milk supply.

I will add that Alia used Rhodiola when her daughter was 14 months old and her D-MER symptoms were “somewhat reduced, but still extremely troublesome.” I have to wonder if she may have needed to use a higher dose when her daughter was a new-born and Alie’s symptoms were more severe.

Safety of Rhodiola when breastfeeding

The authors quote Sheila Humphrey, author of The Nursing Mother’s Herbal (my Amazon link) who groups Rhodiola with several other “tonic herbs” for which “there are no anecdotes, as yet, to suggest that they will affect breastfeeding babies.”

Dr Aviva Romm, MD, calls Rhodiola “The Spirit Calming, Anti-Anxiety Adaptogen” in this article about adaptogenic herbs

Rhodiola extract helps promote a calm emotional state and supports strong mental performance, optimal immune function, and hormonal balance. It is a key adaptogen for reducing anxiety. It improves mental and physical stamina, improves sleep, and reduces stress, “burn out,” and irritability.

She says to avoid Rhodiola if you have bipolar disorder and during pregnancy (due to lack of safety data), but considers it safe while breastfeeding.

But, as always, when it comes to nursing, I have clients work with their practitioner.

Future research on tyrosine and theanine during breastfeeding, and prevention

I would also love to see future research on the safety of tyrosine and theanine (and all amino acids) being used during breastfeeding, as another option for moms with D-MER.

Tyrosine is well-recognized as an amino acid that helps to boost dopamine levels and improve a low mood and may help ease some of the D-MER symptoms. Some individuals report how tyrosine also alleviates their anxiety and panic attacks and creates a feeling of calm focus.

Theanine, also an amino acid, supports GABA, dopamine and serotonin and I feel has a potential application in D-MER. There may well be a role for tryptophan (for serotonin support and the depression/self-loathing/anger/agitation/panic symptoms of D-MER) and GABA (for GABA support and the anxiety/tension symptoms of D-MER).

They may also help with postpartum anxiety, depression, OCD and intrusive thoughts.

I’d also like to see future research look at possible correlations between D-MER and low neurotransmitters before pregnancy/nursing. And if these women saw benefits with amino acids. Addressing low levels of neurotransmitters and the dietary factors I address in my book, The Antianxiety Food Solution, may help prevent this or at least reduce the severity of symptoms.

Resources if you are new to using amino acids as supplements

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

Have you experienced D-MER and were you advised to use Rhodiola? And if yes, how did it help? What else helped?

Or did you get no help from your medical team?

Do you feel there is a possible correlation between your D-MER symptoms and low neurotransmitter symptoms you experienced before pregnancy/nursing? If yes, which amino acids helped you before you were pregnant?

If you are a practitioner, are you familiar with D-MER and have you seen Rhodiola help?

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

A 12 year old’s Diet Coke consumption and obsession with collecting the cans: can tryptophan and tyrosine help him quit with ease?

March 24, 2023 By Trudy Scott 14 Comments

A concerned mother, Rebble, posted a request for help for her 12 year old son who has suddenly started drinking Diet Coke and obsessively collecting the cans. I explain about the biochemistry of addiction and obsession. If your child, another loved one or even you, are hooked on Diet Coke, this blog offers practical solutions in the way of amino acids to balance brain chemistry and make quitting no longer about willpower. I share why I’d consider starting with the amino acid supplement tryptophan for serotonin support and the amino acid supplement tyrosine for dopamine support. And then looking into low blood sugar. I also share some of the many harmful effects of soda/diet soda and some practical tips for her as she encourages her son to make changes.

Here are her questions and what she has already tried to help him quit:

To my horror, my 12yo son has just started buying/consuming Coke and principally Diet Coke regularly from our village shop. He has got obsessed about collecting the cans, some of which are from his friends’ consumption but more and more from his. He used to hate these drinks but now peer pressure has kicked in and he wants to consume what his friends (who live on the stuff and a horrendous amount of sugar) consume.

I’ve pointed out the ingredients, that they are toxic to his brain. He doesn’t care.

I’ve shown him a brilliant video clip of Renaldo removing coca cola bottles from the press table and promoting water instead (with good effect).

Yet still he keeps buying the stuff.

I’ve made it known with the shopkeeper that I don’t approve of my children buying caffeinated sugary drinks full of neurotoxic ingredients but he doesn’t wish to police my children (though he did give me a refund on the 8 cans he had just sold my son!) which I understand.

Do you have a short summary of why it’s so bad, for children in particular? Either something I could show my children, their friends and/or the shopkeeper?

Is it the caffeine that makes it addictive?

My son does exhibit some challenging behaviors (e.g. torturous noise at home, not able to sit still without fidgeting with things at meals, etc.) but seems to be able to turn this on / off at will. I don’t think he does this at other people’s homes or at school. I can’t say they are necessarily linked to the drinks as they precede the start of him consuming them but I’m certain the drinks cannot help.

This is tough but I’m glad Rebble is horrified and working to do something about it. Sadly many parents have no idea how harmful these drinks are for pre-teens and teens.

She mentions his challenging behaviors preceded his diet soda drinking. It’s common that we see someone self-medicating with sugar and/or artificial sweeteners. And it’s likely that that peer pressure was the tipping point for him and then once she started he was well and truly addicted.

This is the feedback I shared for her and my observations on where to start: when I hear obsessed, peer pressure and challenging behaviors, I immediately think neurotransmitter or brain chemicals imbalances and would look into low serotonin and possibly low dopamine because of his inability to sit still. Low blood sugar may also be an issue.

What emotions are driving his addiction and obsession?

With an addiction you need to figure out what emotions are driving the addiction and use the respective amino acid supplement/s (one or more of them) to help break the addiction and improve the mood/behavioral symptoms at the same time.

These are the questions I review with my clients who have a Diet Coke addiction, or other diet soda or regular soda addiction (or even alcohol or carb addiction):

If you drink it to feel happy (and especially from late afternoon into the evening) then your cravings are likely due to low serotonin, and tryptophan (or 5-HTP) stops the cravings and boosts mood and reduces anxiety.
If you drink it for an energy boost or to give you focus then it’s likely due to low catecholamines and tyrosine will stop those cravings and give you a mood and energy boost, and also help with mental clarity.
If you have to drink it when you haven’t eaten in awhile it’s likely low blood sugar. Glutamine on the tongue stops the desire almost immediately and also helps with the low blood sugar symptoms of shakiness and irritability.
If you stress-drink, your cravings are likely due to low GABA, and GABA will stop the stress-drinking and calm you down too.
If you drink it for comfort or a reward then it’s likely due to low endorphins and DPA (d-phenylalanine) will stop that feeling of “I deserve-it” and also give you a hug-like mood boost.

Ideally mom would have him complete the amino acids symptoms questionnaire in order to figure out which areas are issues for her son.

This is where I would start

I don’t have all this information but based on mom’s feedback this is where I would start: serotonin support, dopamine support and address low blood sugar.

We do know he is obsessed with collecting the cans. Obsession and cravings for a sweet taste is a clear sign of low serotonin i.e. a big clue that #1 may apply to her son and that he may benefit by using tryptophan or 5-HTP.

We do also know he is “not able to sit still without fidgeting with things at meals.” The Diet Cokes may be helping him focus and this is a big clue that #2 and low dopamine may also apply to her son, and that he may benefit from tyrosine. Keep in mind tyrosine also helps to break the caffeine addiction too.

I’m not sure what his “torturous noise at home” could be related to but it may be a clue to #3 i.e. low blood sugar and irritability. It may also be a symptom of rage or anger, also a sign of low serotonin and #1.

I would also look at his diet and make sure he is eating for blood sugar stability (quality protein for breakfast with healthy fats, healthy fats/protein at each meal and healthy snacks). And address everything else I cover in my book – gluten, microbiome etc.

It’s not unusual for someone to have imbalances in multiple areas. If this is the case, I always recommend doing a trial of one amino acid at a time, so it’s easy to see the benefits.

Role models, the harmful effects of soda/diet soda and other things I’d try with this young man

On one hand, you could be surprised that the Renaldo press conference clip removing the Cokes (watch it here) didn’t make enough of an impression because having a sporting hero as a role model is powerful. BUT on the other hand, based on what I know about soda/diet soda.caffeine and addiction, role models are unfortunately just not enough for some folks.

I shared these other things I’d try:

1) Have someone other than mom tell him about the harmful effects of diet sodas – a respected teacher, favorite uncle or nutritionist.

2) Appeal to things that may make him think twice about it like acne and not being fit enough to play his favorite sport. Concerns about weight gain or not being able to get into his desired university (because of impacts on his academic grades) may be a driver too. It’s doubtful that he’d be concerned with tooth decay, adrenal dysfunction, diabetes, heart disease, inflammation, increased risk of osteoporosis or increased anxiety/depression and insomnia.

3) Suggest that he does a school project on the topic so he understands the many harmful effects and facts (the research confirms that adolescents lack knowledge regarding health risks of soda and diet soda consumption. The project could hail Renaldo as a hero and he could get his buddies to help.

4) Help him find something else he likes to drink. Fruit juice isn’t a good option but fizzy fermented drinks are and so is fruit-infused water.

5) Be sure the rest of the family is setting an example at home and when you go out

6) Keep planting the seeds with love and encouragement

However, none of the above or flat-out saying he cannot buy diet sodas will work if there is the addiction aspect and unbalanced brain chemistry.

Keep in mind there is a continuum with sugar/carb/artificial sweeteners/caffeine addiction i.e. some kids (and adults) can quit sugar/carbs/artificial sweeteners/caffeine more easily and others need some nutritional support and some need much more support for balancing brain chemistry with amino acids. If there are also behavioral issues/signs that’s the clue they likely need the amino acid support.

Once he has the facts and understands the harm he also has to be willing to make the changes to break the addiction if it’s severe. I have parents gently recommend a month trial to see if it will work. “No diet soda forever” is too much for a pre-teen/teen (and adults too) to grasp and be ok with especially when they are addicted.

Rebble posed her question on a blog about Diet Coke addiction: I need help with my Diet Coke addiction – when I stop, my fatigue, brain fog, anxiety/depression increase big time!

Be sure to read the above blog for further insights.

I appreciate her for reaching out and hope this additional information helps her son and helps you too.

Resources if you are new to using tryptophan or GABA as supplements

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

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control, sugar cravings, anxiety and mood issues (which include rage/anger/irritability/self-harm).

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

Has one of the amino acids helped with your preteen’s soda or diet soda addiction? Which one/s helped?

What helped your preteen be open to the idea of using the amino acids to quit?

What else helped?

Has any of the above helped you too? Or your clients/patients?

If you have questions and other feedback please share it here too.

Around my period I definitely feel the need for extra tryptophan if I’ve had some extra heavy emotional stuff come up that I need to process

December 10, 2021 By Trudy Scott 6 Comments

Many women find that they need additional nutritional support i.e. tryptophan for serotonin support (and often GABA too) around their periods. Today’s case study highlights the hormonal shifts that may lead to a situation where it appears tryptophan doesn’t work, then it does work, and then sometimes it doesn’t work as expected. The variable results and the need to switch between lower and higher doses on an ongoing basis can occur with PMS (premenstrual syndrome) PMDD (premenstrual dysphoric disorder, a severe, sometimes disabling extension of premenstrual syndrome). The variable results can also be more pronounced while recovering from trauma.

This case study is a follow-on from a blog I recently published: Tryptophan doesn’t work, then it does and then it doesn’t: could it be hormonal shifts, dietary factors and/or parasites?

Here is Kimberley’s feedback on the Facebook post that discussed these variable results. She shared how her hormonal shifts led to a need for additional tryptophan and 5-HTP:

Around my period I definitely feel the need for extra tryptophan. My PMDD symptoms have decreased since I started using tryptophan/5-HTP, but sometimes I need a bit more if I’ve had some extra heavy emotional stuff come up that I need to process (since that always happens with my period!).

I thanked her for sharing and said how happy I was for her. I also asked what symptoms have decreased and how much? I also asked how much tryptophan and 5-HTP she uses before her period and then around her period?

I was also curious if she just experimented with different doses until she figured it out or had she heard me talk about the PMDD tryptophan study: A placebo-controlled clinical trial of L-tryptophan in premenstrual dysphoria. In this study tryptophan was found to reduce symptoms of PMS when used in the luteal phase or second half of the cycle (i.e. after ovulation).

Her low serotonin symptoms have decreased as much as 75-80 percent

Kimberley confirmed that she had read the above study and related blog post – Tryptophan for PMS: premenstrual dysphoria, mood swings, tension, and irritability – and more about her symptoms:

I had read the blog you referenced, which is one of the reasons I tried tryptophan in the first place.

I was experiencing a lot of emotional distress, feelings of downright despair that left me miserable both during my period and ovulation (half the month, every month, which was truly awful). Those have definitely decreased, sometimes as much as 75-80 percent, other times they’re worse and I feel like I need more support.

I usually take 1x Lidtke 5-HTP (50mg) mid-afternoon and 1x Lidtke Tryptophan (500mg) at bedtime, but yesterday I increased to 2x Lidtke Tryptophan and do feel an improvement in my mood this morning.

I experimented to get the right dose of both amino acids, initially increasing to the maximum you recommend, and then slowly decreasing to what I’m taking now when I found I didn’t feel well when I took too much.

I just reread the blog you linked above and realized I should be using GABA every day to support progesterone (instead of just as needed for anxiety). Thanks for the reminder!

I love that after reading the blog she was inspired and motivated to experiment with different doses when she is/was feeling so bad. I encouraged her to continue trialing different doses at various times of the month especially in the second half of the month. I also reminded her that some folks do better with tryptophan and some do better with 5-HTP when it comes to low serotonin symptoms. And to continue to look at why serotonin is low and address that. Low GABA (related to low progesterone) can cause increased anxiety at this time and is a common issue with PMS/PMDD.

(You can see the entire list of low serotonin and low GABA symptoms here.)

She plans to continue experimenting with tryptophan and 5-HTP and may also try switching over to just 5-HTP and see if that changes anything. It’s unlikely that she would benefit from much higher doses of either as she shared “I don’t seem to be able to take more than 2 caps of either one without getting uncomfortable symptoms, though.”

Exercise and yoga for her low serotonin and PMDD

She did share how much exercise helps her mood, why she isn’t able to exercise as much:

The biggest thing I know to do to address low serotonin is add more exercise into my life, but this has been hard lately because I’ve had a couple of different viruses recently that left my exercise intolerance worse than it had been. I’m trying to support my mitochondria right now and add light exercise back in slowly.

Exercise is a wonderful way to raise serotonin levels and aerobic exercise has been shown to reduce the symptoms of PMS too. Yoga may be an option while she is recovering. In one study, yoga was found to be beneficial for PMS: “Alpha-brain waves production due to regular yoga practice are directly related with state of peace, creativity, mood elevation, relaxation, and release of serotonin, thus leading yoga practitioners feel more relaxed.”

Trauma: cortisol, serotonin, dopamine and estradiol

Kimberley also shared how how trauma plays into her situation:

I think some of the reasons for my health issues, low neurotransmitters, etc., are trauma related and I’ve been working through Dr. Aimie Apigian’s programs for that. But that’s another story.

I respect Dr. Aimie Apigian’s work in trauma and somatic experiencing and acknowledge this aspect must be addressed too. I love that Dr. Aimie brings this together with a functional medicine approach, looking at biology/biochemistry too. Recent trauma research confirms that there are major biochemical mechanisms involved in PTSD (post-traumatic stress disorder). These can include impacts to cortisol, serotonin and dopamine levels. And women are more vulnerable to these effects.

A 2021 paper, Estradiol, stress reactivity, and daily affective experiences in trauma-exposed women discusses high cortisol and more severe symptoms around their periods when estradiol (one of the estrogens) is low. As I mentioned above, estrogen and serotonin are closely related. The authors state this:“For women who are cycling, it may be useful to understand how the menstrual cycle affects their symptoms. When you can explain what’s happening biologically, it often becomes less threatening.”

Yoga may provide added psychological benefits as she works through her past trauma too.

Kimberly gave me permission to share her story and this is always something I appreciate so others in my community can learn from these types of experiences. If needed, I hope this her story gives you confidence to experiment with different doses and combinations around your period.

She also benefits from the comments from others on Facebook and the comments here on the blog, our back and forth, and this blog post.

She promised to keep me posted on how she goes and I’ll be sure to share when I hear back from her.

Resources if you are new to using tryptophan, 5-HTP and GABA and the amino acids 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 the low GABA symptoms here) and a brief overview here, Anxiety and targeted individual amino acid supplements: a summary.

If you suspect low GABA 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. And be sure to share it with the team you or your loved one is working with.

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

Have you found you need additional tryptophan/5-HTP or GABA around your period? How have you experimented and how does it help you?

If you’re a practitioner, have you seen this with clients or patients?

Do you also feel better with exercise and/or yoga?

And are/were your variable results more pronounced while recovering from trauma?

Feel free to ask your questions here too.

SSRI/antidepressant impact on the microbiome, discontinuation syndrome and safe tapering

October 16, 2021 By Trudy Scott 2 Comments

Antidepressants can have an antibiotic effect, causing dysbiosis and impacting serotonin, GABA and dopamine production. This can cause psychiatric symptoms and even suicidal thoughts or behaviors. Various SSRI (selective serotonin reuptake inhibitors) and SNRI (serotonin norepinephrine reuptake inhibitors) have more of an effect than others. And the top known side effects for SSRIs are gut symptoms: nausea, diarrhea and vomiting.

These medications are seldom prescribed with informed consent and can cause severe psychological, cognitive, physical and neurological withdrawal side effects (also known as discontinuation syndrome). A functional medicine and nutritional approach using 5-HTP, GABA, theanine and glycine can often be used to smooth the taper process.

Dr. Achina Stein addresses all this in her interview, SSRI Impact on the Microbiome and Safe SSRI Tapering, on The Anxiety Summit 5: Gut-Brain Axis.

We cover the following:

Antibiotic effect of antidepressants: dysbiosis and impacts on serotonin/GABA/dopamine
Withdrawal/discontinuation syndrome symptoms of SSRIs and benzodiazepines
5-HTP, GABA, theanine and glycine to smooth the taper process

Here are a few snippets from our interview.

We start with a discussion on the antibiotic effect of antidepressants and a review of this paper – Serotonin Reuptake Inhibitors and the Gut Microbiome: Significance of the Gut Microbiome in Relation to Mechanism of Action, Treatment Response, Side Effects, and Tachyphylaxis.

Dr. Stein comments on this study sharing how SSRIs affect the gut and microbiome in many different ways:

“This paper is important. It’s one of several papers that talk about how the SSRIs or serotonin reuptake inhibitors affect the gastrointestinal tract. And as you know, the gastrointestinal tract is really full of serotonin.
SSRIs, as well as other psychotropic medications, actually exert an antibiotic effect, which can have a direct consequence in disrupting the integrity and stability of the gut microbiome.
And the ones that are most likely to do that are Sertraline, fluoxetine, and paroxetine in that order. And it’s followed by fluvoxamine, escitalopram, and citalopram, having the least impact.
What they’re noticing is that this antibiotic effect actually results in dysbiosis.
The top known side effects for SSRIs are gut symptoms: nausea, diarrhea, vomiting.
We know that the gut microbiome has a significant effect on emotions, behaviors, and metabolic changes.
And it’s involved in the metabolism of drugs, and this combination is what really causes psychiatric symptoms and even suicidal thoughts or behaviors.”

She also talks about the bidirectional gut-brain connection/communication, the microbiome and short-chain fatty acids (which are a common theme you’ll hear throughout the summit):

“There is this huge connection between the gut microbiome and the brain.
And there’s also other indirect communication pathways because we’ve always wondered, well, how does this happen that the gut is connected to the brain?
So the other pathways which are more indirect are the hypothalamic-pituitary-adrenal axis.
And there’s also an immune-mediated connection where there’s a communication between short-chain fatty acids and microglia in the brain.
So short-chain fatty acids are the main metabolites produced by the microbiota in the large intestine through bacterial fermentation of indigestible polysaccharides, which are dietary fiber and resistant starch. And they possess neuroactive properties. So they influence the communication between these short-chain fatty acids between the gut and the microglia of the brain.
And it’s a bidirectional communication too.”

And we talk about tachyphylaxis or the poop-out effect of antidepressants.

The discussion on the SSRI (selective serotonin reuptake inhibitors) and SNRI (serotonin norepinephrine reuptake inhibitors) discontinuation syndrome (or withdrawal symptoms) is eye-opening and sobering, Here are just a few of the many psychological symptoms that she says patients may experience when tapering:

I’m just going to read them off because I think it’s important for people to know: mood swings, unstable moods, hypomania, hyperarousal, anxiety, medication-induced agitation – which is described as being caffeinated – impulsive behavior, aggression, irritability, crying spells, lowered mood or depression.

Dr. Stein also shares the many cognitive, physical and neurological side effects, and how she works with her patients with a functional medicine and nutritional approach to try and mitigate the side effects. She likes to use 5-HTP, GABA, theanine and glycine to smooth the taper process.

We also have a lengthy discussion about informed consent and the fact that it’s not happening and should be.

We do a deep dive into all this and much more.

The interviews that dove-tail well with this topic are as follows:

My interviews, GABA & Tryptophan: Gut-Anxiety Connections and Glutamine, DPA and Tyrosine for Anxiety and Sugar Cravings. The amino acids help during the tapering process and help you make the dietary changes.
Thiamine Deficiency in Anxiety and Gut Health (Part 1 and 2) with Chandler Marrs. She talks about how medications can deplete thiamine. Could this contribute to some of the severe discontinuation syndrome symptoms we see?
Anxiety, Gut-Brain Communication and Diet with David Perlmutter, MD, FACN, ABIHM. This one gives you an excellent overview of the gut-brain communication and fermented foods, short-chain fatty acids and histone deacetylases (HDACs).
Gut-Brain Axis and Mental Health with Peter Bongiorno, ND, LAc. This is also a great overview on the mental health impacts of the microbiome. He goes deep into serotonin and GABA production mechanisms.

I encourage you to tune in if you have:

Anxiety & feel overwhelmed & stressed by little things
Panic attacks &/or obsessive thoughts or behaviors
Social anxiety/pyroluria
Phobias or fears (flying, spiders or even driving on a highway)

And also if you suffer from…

Food sensitivities, IBS/SIBO, parasites or gallbladder issues
Constipation, diarrhea, bloating, gas, pain & other digestive issues
Leaky gut, a leaky blood-brain barrier or vagus nerve issues

Join us if you are also an emotional eater with intense sugar cravings (and know you suffer from low blood sugar), experience insomnia, low mood, PMS, poor focus and/or low motivation.

This is THE online event to learn about the powerful individual amino acids – GABA, theanine, tryptophan, 5-HTP, glutamine, DPA and tyrosine – to quickly ease anxiety and help with gut symptoms while you are dealing with other root causes which take longer to address. (They also help with cravings as with this example, and sleep and immunity).

With research-based anxiety nutritional solutions and practical steps, you can determine your root causes, ease your anxiety and prevent it from coming back so you can feel on top of the world again!

If you are a practitioner, please join us too and find advanced solutions for your clients or patients too!

You’ve heard me say the Anxiety Summit has been called “a bouquet of hope!” My wish for you is that this summit is your bouquet of hope!

I hope you’ll join me and these incredible speakers, be enlightened and find YOUR solutions!

Here’s to no more anxiety and you feeling on top of the world again!

Learn more/purchase now

How have antidepressants impacted your gut and digestion?

Have you experienced discontinuation syndrome when tapering from an SSRI or SNRI or benzodiazepines? And have diet and the amino acids helped smooth the taper process?

Feel free to post your questions here too.

I need help with my Diet Coke addiction – when I stop, my fatigue, brain fog, anxiety/depression increase big time!

September 10, 2021 By Trudy Scott 42 Comments

A woman asked for help on the blog, wanting desperately to quit her long-time Diet Coke addiction. This woman knows her addiction is detrimental to her health and she gets withdrawal symptoms when she tries to quit – fatigue, brain fog, anxiety and depression increase big time! And yet she can’t quit. This is not unusual. I share my feedback on the brain chemical imbalances that can drive addictions and how to figure out which amino acids (or more than one) may help her quit easily. This means she doesn’t have to go cold turkey and then fail yet again. Using the amino acids means there is no willpower required and no feelings of deprivation, and it’s addressing an underlying neurotransmitter imbalance i.e. a root cause.

Here is her question:

I need help with my Diet Coke addiction. I have been using it for 35 years and I am too appalled to tell you how much I drink.

I have tried to quit many times and ended up in utter failure. A friend mentioned that phenylalanine may be a booster for my dopamine.

When I stop, my fatigue, brain fog, anxiety/depression increase big time. I know this drink is literally killing my health and I am desperate for some answers, suggestions….or a miracle.

What supplements do you recommend for helping me quit this devil of a habit? Thank you for ALL you do!”

Here is my response …. when it comes to using amino acids to help break the addiction, pretty much everything I write about in relation to sugar addiction or cravings would likely also apply to quitting Diet Coke.

What emotions are driving the addiction?

She needs to figure out what emotions are driving her addiction and use the respective amino acid supplement/s (one or more of them) to help break the addiction and improve the mood symptoms at the same time.

These are the questions I review with my clients who have a Diet Coke addiction (or other diet soda or regular soda addiction):

If you have to drink it when you haven’t eaten in awhile it’s likely low blood sugar. Glutamine on the tongue stops the desire almost immediately and also helps with the low blood sugar symptoms of shakiness and irritability
If you stress-drink, your cravings are likely due to low GABA, and GABA will stop the stress-drinking and calm you down too
If you drink it to feel happy (and especially from late afternoon into the evening) then your cravings are likely due to low serotonin, and tryptophan (or 5-HTP) stops the cravings and boosts mood and reduces anxiety
If you drink it for comfort or a reward comfort then it’s likely due to low endorphins and DPA (d-phenylalanine) will stop that feeling of “I deserve-it” and also give you a hug-like mood boost
If you drink it for an energy boost or to give you focus then it’s likely due to low catecholamines and tyrosine will stop those cravings and give you a mood and energy boost, and also help with mental clarity

Based on her question above, she mentions that “my fatigue, brain fog, anxiety/depression increase big time” when she stops. The fatigue, brain fog and depression is a big clue that #5 above will likely apply. She asks about using phenylalanine for dopamine support (dopamine is one of the catecholamines). I prefer tyrosine to l-phenylalanine for boosting levels.

The fact that anxiety also increases when she stops is a clue that #2 or #3 may apply too, and possibly #1. It’s not unusual for someone to have imbalances in multiple areas.

If this is the case, I always recommend doing a trial of one at a time, so it’s easy to see the benefits.

It’s not the same neurotransmitter imbalance that shows up in each person

It’s also not the same neurotransmitter imbalance that shows up in each person with a Diet Coke (or other soda addiction). When I shared this on Facebook and asked what was the driving emotion behind their “self-medication” with Diet Coke this is feedback I received from two women:

“I had been drinking almost 6 per day for decades. I believe it was comforting.” In this instance, addressing low endorphins with DPA (#4) would have helped. Comfort or reward or treat is a common emotional driver for all addictions.
“I noticed I would drink Diet Coke when I felt anxious (1 or 2 times a day).” In this instance #2 or #3 would have helped i.e. GABA support if it was physical anxiety and/or tryptophan or 5-HTP for low serotonin if it was worry-type anxiety.

The caffeine addiction and the artificial sweetener Aspartame

Keep in mind, with Diet Coke, there is the caffeine addiction and the artificial sweetener Aspartame that also make it challenging to quit. Tyrosine and addressing low catecholamines (#5 above) and vitamin C can help with the caffeine addiction and quitting so headaches are minimized.

The amino acids can help with the imbalances created by aspartame. This paper, Direct and indirect cellular effects of aspartame on the brain, proposes that “excessive aspartame ingestion might be involved in the pathogenesis of certain mental disorders and also in compromised learning and emotional functioning.” This excerpt from the abstract is relevant to this discussion:

Aspartame is composed of phenylalanine (50%), aspartic acid (40%) and methanol (10%). Phenylalanine plays an important role in neurotransmitter regulation, whereas aspartic acid is also thought to play a role as an excitatory neurotransmitter in the central nervous system. Glutamate, asparagines and glutamine are formed from their precursor, aspartic acid. Methanol, which forms 10% of the broken down product, is converted in the body to formate, which can either be excreted or can give rise to formaldehyde, diketopiperazine (a carcinogen) and a number of other highly toxic derivatives. Previously, it has been reported that consumption of aspartame could cause neurological and behavioural disturbances in sensitive individuals. Headaches, insomnia and seizures are also some of the neurological effects that have been encountered, and these may be accredited to changes in regional brain concentrations of catecholamines, which include norepinephrine, epinephrine and dopamine.

This further supports the need for catecholamine support with tyrsosine (#5 above) and GABA support with the amino acid GABA (#2 above).

Recognizing it’s an issue is a big first step

I acknowledge her for recognizing it’s an issue – that is a big first step! I did also ask her to share how much she was consuming each day because there is no judgement here and we acknowledge it’s an addiction. I’ll report back when I hear from her and will also share which amino acid/s helped her break the addiction.

As always, it’s not only about the amino acids and a comprehensive healing approach is always part of the picture. The amino acids make it easy to get started and then other underlying issues can be addressed: other nutritional deficiencies, dysbiosis, fatty liver, metabolic syndrome and so on. You can see some of the many studies below.

Of course, it’s important to be eating a real whole foods diet with quality animal protein, healthy fats, organic vegetables and fruit, no caffeine, no gluten, no sugar, fermented foods and herbs.

Reconsider your diet soda consumption if you’re on the fence

If you are on the fence about giving up your diet soda consumption here are a few additional papers that will hopefully make you reconsider:

Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA) – “Although these observational data cannot establish causality, consumption of diet soda at least daily was associated with significantly greater risks of select incident metabolic syndrome components and type 2 diabetes.”
Altered processing of sweet taste in the brain of diet soda drinkers – “there are alterations in reward processing of sweet taste in individuals who regularly consume diet soda.” This has widespread ramifications for driving the need for sugar/carbs and all things sweet
A comparative study of the effect of diet and soda carbonated drinks on the histology of the cerebellum of adult female albino Wistar rats – “These results suggest that diet soda has adverse effect on the cerebellum of adult female albino Wistar rats,” with “shrunken and degenerated Purkinje cells with hypertrophied dendrites.” Purkinje cells are involved in the release of GABA.
Soft drinks consumption and nonalcoholic fatty liver disease – “the aspartame sweetener and caramel colorant which are rich in advanced glycation end products … potentially increase insulin resistance and inflammation”

Facts like this help you recognize it’s an issue but even when we have these facts, we often simply cannot quit. This is where the amino acids are so powerful because they work with no willpower required and no feelings of deprivation. And using them addresses the underlying neurotransmitter imbalance/root cause that led to the initial addiction or “self-medication”. They also help address the neurotransmitter deficiencies that are often made worse by diet soda consumption.

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

If you are new to using the amino acids as supplements and want to know more, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution and a brief overview here, Anxiety and targeted individual amino acid supplements: a summary.

If you suspect low 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.

What advice do you have if you have been through this yourself and what has helped you?

What do you drink now instead of your diet soda?

If you are a practitioner, how do you help your patients/clients with this kind of addiction?

Feel free to post your questions too.