Today I’m sharing the case of an 11-year-old girl who had huge rage issues, was angry much of the time, suffered from terrible anxiety, had crazy sugar cravings (for bread and colored candies) and had dreadful insomnia. Because of the insomnia she was also very fatigued and this likely drove some of her cravings and irritability too. She was adopted and had been diagnosed with RAD (reactive attachment disorder). During our first session, chewable tryptophan turns things around quickly – she smiles and is willing to make changes and quit the sugar and gluten. We also address low iron levels and with these 4 nutritional interventions this child’s behavior improves dramatically.
This book chapter, Reactive Attachment Disorder, states how The Diagnostic and Statistical Manual 5th Edition (DSM-5) classifies reactive attachment disorder as follows:
a trauma- and stressor-related condition of early childhood caused by social neglect or maltreatment. Affected children have difficulty forming emotional attachments to others, show a decreased ability to experience positive emotion, cannot seek or accept physical or emotional closeness, and may react violently when held, cuddled, or comforted. Behaviorally, affected children are unpredictable, difficult to console, and difficult to discipline. Moods fluctuate erratically, and children may seem to live in a “flight, fight, or freeze” mode. Most have a strong desire to control their environment and make their own decisions. Spontaneous changes in the child’s routine, attempts to discipline the child, or even unsolicited invitations of comfort may elicit rage, violence, or self-injurious behavior.
Reactive attachment disorder/RAD and low serotonin
There is no research on tryptophan helping to address RAD symptoms or trauma, but based on her low serotonin symptoms, a trial of tryptophan was the first thing I considered.
There is, however, evidence to indicate the role of low serotonin in RAD, as indicated by a study where antidepressants were successfully used. The authors mention how:
The absence of responsive and consistent caretaking can subject the developing brain to an inordinate amount of physiological stress, leading to increased cortisol production and consequential inefficiencies in the serotonin and the growth-hormone releasing systems.
Although not specific to RAD, another paper looking at trauma states that:
Serotonin and dopamine levels were found to be abnormal in the presence of PTSD.
As the field of nutritional psychiatry grows, I expect to see more and more research supporting the use of tryptophan and other amino acids for those suffering from symptoms like this. Symptoms that are caused by imbalances that are triggered by the trauma in their lives.
We know that therapy, EFT, EMDR and other approaches are crucial for trauma recovery (this family had already done some of this work) but we must start to incorporate nutritional support too.
The case study
Here are the details of this case study and the nutritional interventions. As I mentioned above, because of her severe rage episodes, a trial of tryptophan was the first thing I considered:
She was referred to me by a friend. The family didn’t have much money. And so, we had to really try and figure out a few simple interventions that we could use that were going to be effective.
This young girl had been adopted. She was diagnosed with reactive attachment disorder and her anger issues were just phenomenal. The mom had to physically put her body around her and hold her down when she was having one of her fits because she was worried that she was going to hurt herself and hurt other people.
She also had anxiety, huge cravings for colored candies and insomnia. She was so fatigued because she wasn’t sleeping well.
So sitting in my office with this young girl and her mom, we started to talk about the sweets and the candies and the need to give up the candies. She was fuming with me. She was sitting in a swivel chair. She turned her back on me and didn’t want to talk about having to give up candy at all.
I said, “Look, let’s not even talk about that, but would you take this chewable tryptophan here? And we’ll talk about it in a second.” I gave her 100 mg of the chewable tryptophan and continued discussing things with her mom. She had no idea what it was going to do or how it would make her feel.
Within five minutes she turned her chair back, looked at me and she said, smilingly, “Yes, let’s do it. I can give up the candy.” She was smiling and she was happy.
So long story short, with this young girl, we started her on [chewable] tryptophan [and it turned things around quickly].
Chewable tryptophan – when I use it and when I don’t
I typically use 500mg Lidtke tryptophan for the adult clients I work with and prefer this company’s product because it is really high quality. It really does work better than many other tryptophan products on the market.
Lidtke also makes a chewable 100mg tryptophan which is also high quality, and the product I used with this young girl. Here are some benefits of this 100mg product:
- It’s useful for doing the initial trial in order to figure out if tryptophan is going to help with low serotonin symptoms in children – because it’s a lower dose.
- It’s especially useful for children for ongoing use (typically midafternoon and evening) because it’s a lower dose.
- It’s also useful for adults who are “pixie dust” folks and do better with a lower dose of supplements in general or respond more severely to medications/alcohol/chemicals. We may start with a trial of the 100mg chewable and increase from there, also typically midafternoon and evening.
I don’t use the chewable 100mg tryptophan under these circumstances:
- When the child (or adult) finds that 5 x100mg works for them at each time they need it. In this instance it’s best to switch to a 500mg tryptophan. Using it swallowed may work or it may need to be opened onto the tongue.
- When the child (or adult) starts to consume the chewables like candy. They are sweet and do taste good and I’ve seen this happen. Because you are continually consuming something sweet you may end up over-consuming them if sugar addiction is one of your issues. You may also end up taking too much tryptophan.
If the chewable tryptophan is not available where you live, using a small amount of a powdered tryptophan or opening a capsule of the 500mg tryptophan is an option. Since it tastes bitter it can be mixed with mashed banana or inositol. (You can find all the Lidtke products in my online supplement store. The link is in the resources section below.)
Gluten and candies were also a huge issue, and she had low iron
There was more to her issues than only low serotonin:
Gluten was also a huge issue, so we got her off gluten and the candies. The tryptophan helped with this” (i.e. it made it easy to break the addiction and not feel deprived).
Tryptophan also helped her sleep. And it helped with the severe rage issues.
Obviously the gluten was contributing to the rage issues as well.
Her iron and ferritin levels were really low (possibly as a result of her gluten issues). So we added an iron supplement, and animal protein/red meat.
So with just four interventions – the gluten, the animal protein, getting her iron levels up and the tryptophan – this kid was just a new kid.
Here are some articles that are related to the above:
- The role of low serotonin, low vitamin B6 and low iron in anxiety and panic attacks
- Integrative Medicine Approach to Pediatric Obsessive-Compulsive Disorder and Anxiety I write about a study where gluten was found to be the cause of a childhood case of obsessive-compulsive disorder (OCD)
- Tryptophan for my teenager: she laughs and smiles, her OCD and anxiety has lessened, and she is more goal oriented and focused on school.
Keep in mind there is not a one-size-fits-all and these 4 simple nutritional interventions – tryptophan, gluten removal, adding red meat and addressing low iron – happened to be the combination that worked for this young girl.
Resources if you are new to using tryptophan as a supplement
If you are new to using the amino acid tryptophan as a supplement, 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 serotonin symptoms 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.
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 Lidtke chewable tryptophan 100mg, Lidtke tryptophan 500mg and other products that I use with my individual clients and those in my group programs.
We use an amino acid like tryptophan for quick relief of symptoms, like I did in this instance. Then we focus on the foundations like diet – like no gluten and red meat in this instance – and address all other imbalances, like her low iron. If cortisol was high we would have addressed that.
This case deserves it’s own blog post
In case you’re wondering, I first shared this case study in my interview, “Calming Anxiety, Aggression and OCD with Amino Acids and Food”, on the ADHD and Autism Summit in May 2021. Due to the interest in this case and the use of chewable tryptophan, I felt it deserved a deeper dive and its own blog post with links to some of the research and some practical information about the chewable tryptophan.
Have you used this chewable tryptophan product with success – personally, with your child or with a patient/client?
Have you found that addressing serotonin with tryptophan (or 5-HTP) helps resolve symptoms in a child diagnosed with RAD or a child with rage issues? What about helping with sleep problems, easing anxiety and stopping cravings too?
Have you addressed low iron levels and seen improvements with the removal of gluten too.
Feel free to post your questions here too.