vitamin B6

Why social anxiety, introversion and loneliness can be lethal and a simple nutritional solution

January 10, 2020 By Trudy Scott 40 Comments

It was an honor to be selected as one of fifteen participants for The Future of Health presentations at Mindshare in August 2019. I presented this to my peers in the integrative health and nutrition space but it’s applicable to everyone and I’d like to share it with you today.

Here is my video presentation: Why social anxiety, introversion and loneliness can be lethal and a simple nutritional solution (click below to watch the video)

Here are some additional reading resources on much of what I cover in my 5 minute presentation:

Pyroluria is a social anxiety condition that is not well recognized in the medical community. It responds really well to a few key nutrients, with zinc and vitamin B6 forming the foundation. I cover this in this blog post: Pyroluria, high mauve, pyrrole disorder, malvaria, elevated kryptopyrroles and social anxiety.
Here is a link to the Pyroluria Questionnaire from my book The Antianxiety Food Solution (which has an entire chapter on the topic). I created this questionnaire using the work of Carl Pfeiffer and Joan Mathews-Larson, modifying it based on feedback I receive from my clients.
I discuss how I first discovered the pyroluria-introversion connection here – Am I an anxious introvert because of low zinc and vitamin B6? My response to Huffington Post blog. I wrote this in response to the Huffington Post article, “23 Signs You’re Secretly An Introvert”, by Carolyn Gregoire.
Here is the webmd loneliness article with this quote: “Loneliness has the same impact on mortality as smoking 15 cigarettes a day, making it even more dangerous than obesity” ~ Douglas Nemecek, MD, chief medical officer for behavioral health, Cigna
And this loneliness paper, Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review
In this blog I write about how Increased sociability improves vagus nerve function: the role of social anxiety, pyroluria and low zinc

This is the the amazing and inspiring group of speakers who I shared the stage with:

Amie Apigan – Why Attachment is the New Field of Medicine
Lauryn Lax – Eating Healthy is Killing You
Jess Sherman – Raising Resilient Kids in a Complex World: Will we Rise to the Challenge
Terry Wahls – Creating an Epidemic of Health – My Radical Path
Susanne Bennett – The Kimchi Revolution: How an Ancient Food Can Transform the Future of Health
Razi Berry – Love is Medicine
Kaylea Boutwell – I’ve Got Your Back: Novel Pain Therapies Transforming Spinal Care Outcomes
Dana Cohen – Hydration: 8 Glasses a Day is not the Way!
Elisa Song – Breathing Life into Your Kids
Joel Sprechman – Creating 1M Super Poopers & Evolving Crohn’s Colitis
Katy Kimball – My Plan to Empty Your Waiting Rooms (the Real Root Cause of Poor Health)
Heather Paulson – Why Choose? Using the Best of Both Worlds to Experience Health with Cancer
James Maskell – Group Visits: How Functional Medicine Reaches the Vulnerable
Mehgan Walker – Life, Liberty and the Pursuit of Chronic Disease: Why Chasing Happiness is Making us Sick

(do let me know if you’d like me to share any of these presentations in the follow-up blog)

Mindshare 2019 green room — Here are some of us in the backstage “green room” and getting ready to go on stage!

We each had a maximum of 5 minutes to present and were not allowed slides or notes. The last time I had memorized my talks and had them timed was 15 years ago when I was in Toastmasters. Before that it was when I was in school. I wasn’t even sure if I could do it when I entered my proposal to speak. When practicing the day before I was still unsure I could manage. Because of my Lyme disease, my memory and word recall isn’t as great as it used to be.

If you pay close attention and you’ll notice the spot where I almost freeze – everything just went out of my head! I simply breathed in calmly, made an attempt to look like I had paused and was fortunate that most of the ending came back to me! Whew!

I’d love to hear what you think of my message and if it resonates with you or a loved one. Feel free to share your pyroluria score and how you score on the introvert questionnaire.

Please also share if you’ve seen the benefits of no social anxiety, introversion and/or loneliness (or much less) when on the pyroluria protocol.

Increased sociability improves vagus nerve function: the role of social anxiety, pyroluria and low zinc

December 13, 2019 By Trudy Scott 42 Comments

With the objective of taking a deeper dive into some of the favorite topics of the recent Anxiety Summit: Gut-Brain Axis, today’s blog is about the vagus nerve since Dr. Navaz Habib’s interview, Vagus Nerve Activation to Reduce Anxiety, was voted one of the favorites. I’m focusing on one tool that improves vagus nerve function that we didn’t have time to get into in great detail – and that is how increased sociability helps. It’s all good and well to recommend getting out and hanging out with more people but if you have the social anxiety condition called pyroluria it’s really challenging, hard work and very stressful. Added stress makes pyroluria worse so it becomes a vicious cycle.

Let’s start with the research that supports the connection between the vagus nerve and increased anxiety and mood problems. In the interview with Dr Navaz, we discussed this paper: Vagus Nerve as Modulator of the Brain–Gut Axis in Psychiatric and Inflammatory Disorders which states that “vagus nerve stimulation is a promising add-on treatment for treatment-refractory depression, posttraumatic stress disorder, and inflammatory bowel disease” and how stimulation of vagal fibers that go from the gut to the brain (afferent fibers) influences neurotransmitter production and “play crucial roles in major psychiatric conditions, such as mood and anxiety disorders.” The gut bacteria play a major role too, “partly by affecting the activity of the vagus nerve.”

In our interview we end with very practical ways to activate your vagus nerve

Deep breathing exercises (mentioned in the above paper, together with yoga and meditation) and cold showers (which makes you breathe harder)
Gargling and using the gag reflex
Humming, chanting and singing (I used these approaches for my vagus nerve issue after my terrifying plane ride. GABA also helped with the voice/throat spasms I experienced – more here on that)
Auricular acupuncture (which is also very effective for addictions)
And finally, social interaction or increased sociability, which I want to cover today

The research on the vagus nerve and being more social

Let’s look at the research on the vagus nerve or vagal tone and being more social. This paper, Upward spirals of the heart: autonomic flexibility, as indexed by vagal tone, reciprocally and prospectively predicts positive emotions and social connectedness, reports that that vagal tone and connectedness or being more social is a two-way street i.e. it’s reciprocal

“…increases in connectedness and positive emotions predicted increases in vagal tone” and
“Adults who possessed higher initial levels of vagal tone increased in connectedness and positive emotions more rapidly than others”

In summary, the more social and happy you are, the healthier your vagus nerve is and a healthier vagus nerve leads to feeling more connected and happy.

This study was done with adults in a community-dwelling setting over 9 weeks: “adults were asked to monitor and report their positive emotions and the degree to which they felt socially connected each day.”

Address pyroluria in those who have social anxiety

Pyroluria, the social anxiety condition, was not part of the study because it’s under-recognized as a factor in anxiety. I’d like to propose that we address pyroluria in those who have social anxiety in order to further improve social connectedness and their vagus nerve function.

Many folks with pyroluria put on a brave face in social settings and even “extrovert” which is extremely stressful. The added stress makes pyroluria worse (zinc and vitamin B6 are dumped in much higher amounts) so it becomes a vicious cycle.

Others, who are not willing to even show up because of their severe social anxiety, are not getting that social interaction and connectedness that is so crucial for improved vagus nerve function and better overall health.

Here is the pyroluria questionnaire and the pyroluria/introvert connection.

Connecting the dots further we have

research that reports that vagus nerve stimulation has potential in autism treatment and we know pyroluria and social issues are common in autism
one of the key nutrients for pyroluria, zinc, plays a role in vagus nerve function
another key nutrient in pyroluria is vitamin B6 and it plays a role in reducing inflammation
according to the vagus nerve study above, the vagus nerve “plays important roles in the relationship between the gut, the brain, and inflammation”
both zinc and vitamin B6 are needed for neurotransmitter production, so increasing both GABA and serotonin will further improve mood and reduce anxiety
and finally, the more social and happy you are, the healthier your vagus nerve is and a healthier vagus nerve leads to feeling more connected and happy

By addressing the social anxiety called pyroluria with a foundation of zinc and vitamin B6, we can increase sociability and thereby improve vagus nerve function.

UPDATE 5/7/2020:

Social isolation during the coronavirus pandemic – other vagus nerve exercises

This blog is very applicable now during the coronavirus pandemic. I’ve made an update because I feel we need to start thinking about the longer-term adverse impacts of social isolation and work on other ways to improve vagus nerve function during isolation or quarantine.

This can include any or all of the ways mentioned above: deep breathing exercises, yoga, meditation, cold showers, gargling/gag reflex, humming/chanting/singing and/or auricular acupuncture.

Do you find you have better vagus nerve function when you are more sociable? What of these vagus nerve exercises have you been doing and found helpful during isolation? Do you have any other favorite approaches like using essential oils or anything else?

Vagus nerve stimulation to treat respiratory symptoms associated with COVID-19

This paper reports benefits in 2 patients with coronavirus – Use of non-invasive vagus nerve stimulation to treat respiratory symptoms associated with COVID-19: A theoretical hypothesis and early clinical experience

Both patients reported clinically meaningful benefits from nVNS therapy [non-invasive vagus nerve stimulation].
In Case 1, the patient used nVNS to expedite symptomatic recovery at home after hospital discharge and was able to discontinue use of opioid and cough suppressant medications.
In Case 2, the patient experienced immediate and consistent relief from symptoms of chest tightness and shortness of breath, as well as an improved ability to clear his lungs.

The authors also share that “vagus nerve stimulation has been demonstrated to block production of cytokines in sepsis and other medical conditions.”

With this virus being novel and with everyone learning we are still appreciative of small case reports like this and hope to see bigger studies done. Until then there is other evidence of the overall importance of the vagus nerve in helping to regulate lung infection and immunity.

The nVNS therapy mentioned in the COVID-19 paper is an external device that delivers “a proprietary signal through the skin to either the right or the left branches of the vagus nerve in the neck.” It’s not something I’ve used personally or had clients use so please share if you’ve had success with this device or a similar device.

Loving social isolation and thriving during coronavirus

On the flip side we also need to consider that there are some individuals who are loving social isolation and thriving emotionally. I share some feedback from folks in my community:

Elissa: “As an introvert, my mental health has never been better ☺️. Loving isolation life.”
Drew: “Loving it in many ways. Dreading the hedonism starting up again…”
Tiffany: “My anxiety levels have decreased and I have decreased my anxiety meds! I think it’s because the demand to produce has decreased. I can actually move at my own speed in this world. I’m fortunate, though. My heart goes out to those people in medical fields. I really miss some things, like time with my dad, but we have made some adjustments, like driveway picnics.”
Katie: “I was praying for relief from the busyness. Definitely didn’t have this in mind and my heart hurts for those who are impacted. It has been a beautiful time of rest and restoration for my body and soul.”
Wendy: “My life is usually slow paced and introverted. Now it’s more so and I’m finding the less I do in a day, the better I sleep. I’m actually dreading getting back to “normal” with all the pressures put on us by extroverts. Yes I have sympathy for people suffering mentally by isolation, but for the first time I feel like my type of lifestyle is socially acceptable. I’m tired of life expectations being dictated by the extrovert half of the population.”

I appreciate these folks for sharing their valuable perspectives about thriving in these times. It reinforces how unique we all are.

If you’re struggling with social isolation…

How are you feeling and what are you most looking forward to doing once social isolation recommendations are relaxed?
I’m guessing you don’t have pyroluria but please share if you do?

If you are thriving in social isolation…

Would you consider yourself an introvert /a contented introvert?
Have you got pyroluria and has addressing it nutritionally in the past allowed you to be more sociable or at least less anxious when you are in crowds?
How are you feeling during social isolation and what do you love the most right now?
What are you not looking forward to once social isolation recommendations are relaxed?
And how do you plan to go back to the old “normal” or don’t you?

Please comment below and let us know where you are with social isolation during this pandemic – struggling or thriving? And what vagus nerve exercises are you using right now? Have you used an external device with success?

Ginger, pressure-point wrist-bands, the horizon and vitamin B6 for sea-sickness

July 5, 2019 By Trudy Scott 18 Comments

We had an amazing day snorkeling on the Great Barrier Reef earlier this week. As you know, I always like to keep it real. I was not very happy on the 2.5 hour boat trip to the Great Barrier Reef. It was supposedly calm, but it felt very rough to me (look at the horizon behind the boat!)

I’ve always suffered from various degrees of motion sickness and this day was no exception. However, I was able to keep it together and not throw up by using pressure point wrist bands, ginger tea and ginger tablets, sitting where I could feel the sea air blowing on me and by looking at the horizon pretty much the entire time. As someone with pyroluria, my vitamin B6 status is good too and this always helps with nausea prevention.

pressure point wrist band — Here is a close-up picture of the pressure-point wrist bands, with the pressure “button” placed two finger widths from the wrist joint. It’s important to put these on before the motion starts.

The tour company, Adrenalin Dive, offered these excellent TravaCalm Natural ginger tablets to everyone. These were new to me and I took 2 shortly after we left Townsville.

tulsi tea — I also sipped Organic India Tulsi Ginger tea for the entire journey, in both directions. I always carry ginger tea with me.

Next for me is vestibular neuro-rehab with a functional neurologist to hopefully sort out this motion sickness thing once and for all!

The good news is that it was so much calmer once we got to the reef and I felt 100% when snorkeling. I’m in awe of the beauty of this place: the amazing blues, the colorful coral and fish, together with spending hours in the ocean!

I think we need a new term similar to forest bathing called “reef bathing” as I’m sure the physiological benefits are similar – a combination of calming, lowered blood pressure and heart rate, lowered cortisol and even boosting serotonin (we could not stop smiling!) and endorphins (the feeling of pure joy is still with us).

Since I’m on holiday, I’ll share more with the supporting research about vitamin B6, ginger and pressure point wrist-bands in an updated version of this blog.

Until then feel free to share what works for you if you’re prone to motion sickness.

Pectus excavatum and pyroluria: is there a connection?

June 7, 2019 By Trudy Scott 23 Comments

I recently received a question about the possible connection between pectus excavatum and pyroluria, a social anxiety condition. In layman’s terms, pectus excavatum is a depression or indentation in the chest wall and is related to problems with connective tissue. This Medscape article describes it as follows:

Pectus excavatum, also known as sunken or funnel chest, is a congenital chest wall deformity in which several ribs and the sternum grow abnormally, producing a concave, or caved-in, appearance in the anterior chest wall.

It’s not something I’m familiar with other than seeing someone with this condition at the beach once (I share some pictures below) and when doing the research for this blog.

The question was posed in relation to a blog on Joint hypermobility / Ehlers-Danlos Syndrome, a connective tissue disorder that does seem to be common in those with pyroluria.

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

There are also connective tissue symptoms with pyroluria with the following commonly a factor: joints popping, cracking, or aching; pain or discomfort between the shoulder blades; and/or cartilage problems. This is often due to low levels of zinc. Here is the entire pyroluria questionnaire.

Addressing low levels of the mineral zinc and vitamin B6, together with some other nutrients and stress management, are key to addressing pyroluria symptoms. The social anxiety can typically be lifted in a week and the joint and pain problems often ease in 1 to 2 months.

So now that I’ve set things up with an overview of pyroluria and EDS and the connective tissue problems, let me share what I uncovered about pectus excavatum and why I feel there is very likely a connection with pyroluria.

Pectus excavatum and low zinc – impacting connective tissue and psychological impairment

According to this 2012 paper, Pectus excavatum: history, hypotheses and treatment options

Pectus excavatum (PE) … is the most common chest wall deformity, representing 90% of all cases. Depending on the severity of PE, deviations of thoracic organs and spine deformities are known. Although PE in most instances has little or no influence on the function of the inner organs, the cosmetic appearance of the patients leads to psychological impairment which requires therapy.

In the above paper, they write about one of the hypotheses: weak cartilage through metabolism dysfunction. They report decreased levels of zinc in the pectus excavatum patients, suggesting “the lack of zinc in the diet results in a lower metabolic activity of chondrocytes.” Chondrocytes are cells found in cartilage connective tissue. In summary, one hypothesis is that low dietary zinc affects cartilage connective tissue in some individuals with pectus excavatum.

Observe the mention of psychological impairment. Could the low zinc be playing a role in this too? I address this below.

Pectus excavatum and Ehlers-Danlos, plus dental crowding

This paper, Pectus Excavatum and Heritable Disorders of the Connective Tissue, make the connective tissue and Ehlers-Danlos connection:

It seems clear that several patients affected by pectus excavatum display a typical association with connective tissue disorders, which may span from mild form like simple laxity without morbidity associated, to more severe forms such as MFS and Ehlers-Danlos syndrome

This paper also mentions “Highly arched palate with dental crowding” which is common in pyroluria and seems to be related to low levels of zinc.

The image below illustrates a moderate/severe form of pectus excavatum.

Vitamin B6 and high homocysteine

With regards to vitamin B6, one of the other key nutrients needed for pyroluria, one paper, Pectus carinatum repair in an adolescent with hyperhomocysteinaemia: Anaesthetic implications reports a case of a 14-year-old boy with high homocysteine. his level was 18.5 μmol/l (normal levels are within 7–10 μmol/l). He was treated with folic acid, Vitamin B6 and B12 supplements. Is this common in all cases of chest wall deformities? I don’t know but it would interesting to find out.

Pectus excavatum: social anxiety and depression

There are some older studies that report mental health symptoms, including social anxiety are common. In this 1999 paper, Funnel chest. Psychological and psychosomatic aspects in children, youngsters, and young adults, they report these reactions in children older than 11:

embarassment reactions, social anxiety, feelings of stigma, limited capacity for work, orientation towards failure, reduced tolerance of frustration and temptation, limited capacity for communication and even markedly depressive reactions are observed.

It’s understandable that the physical manifestations of this condition would lead to some of these feelings but I have to question how much of this could also be related to low zinc and low vitamin B6. Both nutrients are needed for easing pyroluria/social anxiety symptoms and making neurotransmitters such as serotonin.

Other than trying to make some connections with the research, when this question was asked on facebook, a number of people said they (or a family member) has both pyroluria and pectus excavatum.

If you do have pectus excavatum and pyroluria, getting on the pyroluria protocol will:

ease some of the social anxiety and depressive symptoms
very likely lead to less pain and discomfort
very possibly prevent further connective tissue issues
feasibly prevent pectus excavatum in future children or perhaps reduce the severity in the instance where zinc is a factor (this one is a long shot that I feel is worth further research)

I’d love to gather more information and am looking for feedback so please do share your symptoms and experiences in the comments. Let us know if you or your child or other family member has pectus excavatum and any of the following:

A score 15 or more on the pyroluria questionnaire and/or suffer from social anxiety
Have low zinc
Have low B6 (poor dream recall or nightmares is a clue)
Have high homocysteine i.e. above 10 μmol/l
Ehlers-Danlos syndrome or joint hypermobility
Dental crowding

Resources for you

My book The Antianxiety Food Solution (my Amazon affiliate link) has an entire chapter on pyroluria. Read it and become a savvy health-advocate for yourself. Share a copy with your doctor and point out the references.
Here is a blog if you’re new to pyroluria and the associated conditions.
Here is the pyroluria questionnaire.
You can find the pyroluria products in my supplement store here.

I have issues with perimenopausal anxiety a couple of weeks per month and don’t want to turn to SSRIs.

March 8, 2019 By Trudy Scott 10 Comments

My challenges with anxiety have been hormonal. I’ve had issues with both postpartum anxiety and now perimenopausal anxiety a couple of weeks per month as I’m approaching menopause. I don’t want to turn to SSRIs but some days are pretty miserable and most other days I feel fine. Any info you have to share regarding this topic or any natural solutions would be of great interest.

When I’m working with a client who reports symptoms like this we start with serotonin and GABA support; determine if they have low zinc, low vitamin B6 and low iron. I also always ask the question: are you on the birth control pill (now or in even in the past).

I’ve blogged about much of this in the past so I’m going to share snippets and blogs for further reading.

Serotonin support with tryptophan for immediate worry-type anxiety relief

In a study published in 1999, A placebo-controlled clinical trial of L-tryptophan in premenstrual dysphoria, tryptophan was found to reduce symptoms of PMS when used in the luteal phase or second half of the cycle (i.e. after ovulation).

This is very typical when I’m working with someone with both PMS (premenstrual syndrome) and perimenopausal anxiety, depression, irritability and mood swings. It typically takes 2 to 3 cycles for an amino acid like tryptophan to have an impact on the cyclical nature of your perimenopausal symptoms.

However, tryptophan does typically start to work right away on the less severe anxiety and mood symptoms assuming you find the ideal dose for your needs. I use the trial method to help my clients figure this out.

When you boost serotonin you also reduce the worry-in-your-head and ruminating type of anxiety, and end to panic attacks and phobias, a boost of confidence, no more depression and negativity, imposter syndrome that is no more, an end to your anger issues and irritability, an improvement in sleep and no more afternoon/evening cravings for something sweet.

You can read more about tryptophan here: Tryptophan for the worry-in-your-head and ruminating type of anxiety

GABA support for relief from tension-type anxiety

During perimenopause progesterone is often low and when it is low, we can expect GABA to be low too. Research confirms low GABA and high glutamate-glutamine in premenstrual dysphoric disorder (PMDD) and that shifting hormones may lead to dysregulation of GABA which contributes to HPA axis dysfunction. The HPA (hypothalamic pituitary adrenal) axis is your stress response system and when it’s not functioning well you are more susceptible to the effects of stress and more likely to feel depressed and anxious.

If your GABA levels are low you will feel increased physical tension and insomnia. The amino acid GABA, opened on to the tongue, can provide calming results within minutes.

Dee likes the instant calm and compares how it worked as well as Xanax had worked for her in the past:

I have taken Xanax in the past for panic attacks. My functional medicine doctor suggested this product as I wanted a natural product. I was amazed how it works just like the Xanax did – instant calm feeling within 10 mins of taking 2 capsules. I use them as needed when I am having heightened stress and anxiety.

Low zinc, low vitamin B6 and/or low iron?

Low iron/ferritin is common if you’re still having a period and it’s one of the important -cofactors for making serotonin, thyroid hormones and the sex hormones. Low iron, together with low vitamin B6 plays a role in anxiety and panic attacks. In one study premenopausal women who had been admitted to the emergency room with panic attacks were found to have both low iron and low vitamin B6. I have an entire blog post on this topic here

The other key co-factor for making serotonin is zinc. You’ll want to look into and address pyroluria if you feel more anxious in social situations like family gatherings, going to church events or community picnics, or even while doing business networking or in work meetings. The key nutrients for pyroluria are zinc and vitamin B6 and both help with PMS and perimenopausal anxiety, and hormone balance.

Are you on the birth control pill?

I recently reviewed Beyond the Pill A 30-Day Program to Balance Your Hormones, Reclaim Your Body, and Reverse the Dangerous Side Effects of the Birth Control Pill by Dr. Jolene Brighten.

If you currently on the pill or have been in the recent past read the above review and get the book to give you an excellent understanding of what may be going on with your body.

Dr. Jolene shares that mood disruption is common and mentions a study in the Journal of the American Medical Association which reports the following:

women who began the pill were more likely to be prescribed an antidepressant – which means it contributes to a bit more than moodiness

She writes in great detail about Post–birth control syndrome (PBCS) which is “is a constellation of symptoms women experience when they discontinue hormonal birth control.” She has found the symptoms of PBCS typically occur in the first 4-6 months after stopping the pill. As well as mood swings and anxiety, you may also experience heavy bleeding or no period, acne, headaches, infertility, pill-induced PCOS (polycystic ovarian syndrome), hypothyroidism, gut issues and even autoimmune symptoms.

You also want to reduce your stress levels. Here are some ideas for you:

Get into nature and experience the incredible benefits of forest bathing
Do some bird-watching in your backyard or at a nearby park: People living in neighborhoods with more birds, shrubs and trees are less likely to suffer from depression, anxiety and stress
Get outside and start bouldering or go and “play” in a climbing gym: A growing body of research suggests that bouldering, a form of rock climbing, can help build muscle and endurance while reducing stress

All the above is a great starting point. You also want to consider adrenal support if needed; and support liver health, together with dietary changes, addressing gut health and thyroid health, getting toxins out of your life and figuring out whatever your own root causes may be.

Here is the link to the amino acids and pyroluria supplements I use with my clients.

Have you found that any of the above has helped you with your PMS or perimenopausal anxiety?

Do you have any stress-relief tips to share with other women who find themselves so stressed out at this age?

Feel free to post questions here too.

The role of low serotonin, low vitamin B6 and low iron in anxiety and panic attacks

December 7, 2018 By Trudy Scott 17 Comments

Low serotonin can cause anxiety and panic attacks. Because vitamin B6 and iron are required raw materials for making serotonin, we know that low levels of these two nutrients often contribute to anxiety and panic attacks.

We have some pretty recent research supporting all this: Low serum concentrations of vitamin B6 and iron are related to panic attack and hyperventilation attack

Reduced serotonin level is known as one of the causes of panic attacks and hyperventilation attacks ….

In the serotonin synthesis system of the brain, vitamin B6 is a coenzyme for tryptophan hydroxylase, which is involved in the conversion of tryptophan into 5-hydroxytryptophan and iron serves as a cofactor for aromatic L-amino acid decarboxylase involved in the formation of serotonin from 5-hydroxytryptophan. Therefore, a reduction in vitamin B6 and iron levels can suppress the progression of the serotonin synthesis.

The study authors measured serum levels of vitamins B2, B6, and B12 and iron in 21 premenopausal women who had been admitted to the emergency room with panic attacks.

The results were compared with lab values from 20 volunteers, also premenopausal women, and this is what they reported:

We found that both vitamin B6 and iron levels were significantly lower in the panic attack/hyperventilation attack group than in the volunteer group. There was no significant difference in the serum levels of vitamins B2 or B12.

These results suggest that low serum concentrations of vitamin B6 and iron are involved in panic attacks and hyperventilation attacks.

This certainly confirms what I see with my clients. When I’m working with someone with anxiety, we always assess for low serotonin, low iron and low vitamin B6 levels, and when we address low levels we almost always see improvements – both in the reduction of anxiety and panic attacks. We’ll often see a mood boost too, sleep improvements and a reduction in carb cravings.

Here are some additional factors to consider:

Vitamin B6 can be challenging to measure in serum so I like to also use the pyroluria questionnaire and poor dream recall as a clue. The authors mention that serum pyridoxal 5-phosphate (PLP) is often used as an indication of B6 status, however they opted to use pyridoxal (PAL) after conversion from PLP.
Supplementing with vitamin B6 can often lead to some improvements in a few weeks with many folks who have pyroluria reporting feeling less anxious and more social within a week.
There is the potential for vitamin B6 toxicity. I have yet to see any signs of toxicity in my clients, but I have also not ever recommended more than 500mg/day. However, there are some individuals who have issues with very small amounts of vitamin B6. Unfortunately, I do not know why this happens.
Testing ferritin levels are an excellent way to assess iron levels and iron should never be supplemented unless iron is low. Dr. Izabella Wentz, shares in her book Hashimoto’s Protocol and blog that the optimal ferritin level for thyroid function is between 90-110 ng/m. Addressing low iron levels can take awhile to see a shift in labs.
Because zinc and magnesium are also cofactors for making serotonin, low levels may also need to be addressed. I would have loved to see these included in this study,
As always, we assess for low serotonin levels using the amino acid questionnaire and start on tryptophan or 5-HTP right away, based on doing trials – so we can see anxiety reduction and relief from panic attacks right away, while the other changes are starting to provide the raw materials for serotonin production.

Keep in mind that low serotonin and low iron and/or low vitamin B6 – although very common with anxiety and panic attacks – are not the only root cause and many other factors may also need to be addressed.

We’d love to hear if addressing low iron and/or low vitamin B6 levels have helped you? Did you use tryptophan and/or 5-HTP at the same time?

If you’re a practitioner, are often do you see low iron and/or low vitamin B6 in your anxious clients/patients?