Getting Back to the Basics – Start at the Beginning

You have the urge to pull. You can resist the urge, but it can take a lot of effort to do so. If you give in, you may or may not like what you feel after you pull (exhilaration, pleasure), but you probably don’t like how you feel (guilt, shame, despair) or the end result of pulling (i.e., bald spots, thinning or non-existent hair, eyebrows or eyelashes, etc.). You feel out of control and powerless to change it.

This is a typical scenario and when it comes down to it, we have to start at the beginning – with the urge to pull. If we can eliminate the urge to pull, we can eliminate everything that comes after it.

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Food Allegies and Trich

We have covered a number of ways that different environmental and genetic factors could adversely affect trichotillomania in this blog. This post will focus on another common biological cause for neurotransmitter imbalance that can exacerbate or cause trichotillomania, and that is food allergies or food hypersensitivities.

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Can Skimping on Sleep Make Trichotillomania Worse?

As you read through the numerous articles and research on this blog you will quickly see that we have found that imbalances with certain neurotransmitters (which are brain chemicals that control most of the body’s functions) can lead to a great many disorders, including trichotillomania and the urge to pull, depression, anxiety, compulsive and/or obsessive thoughts and behaviors, food cravings, binging behavior, addictions, migraines and many others, including sleep disturbances. Therefore, it would not be surprising to find a relationship between these seemingly varied imbalances.

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Trichotillomania and Food Cravings

Many people that suffer from trichotillomania also experience other symptoms of neurotransmitter imbalance, which can include any of the following:

In particular, we have been seeing a lot of people suffering from trichotillomania that also have insatiable cravings for sweets and/or simple carbohydrates, including breads, cookies, candy, chips, pastries and similar foods. Most people that have this combination of sugar cravings and trichotillomania don’t realize they are connected, and they often feel helpless on both accounts. However, I am here to tell you that not only are they related, they can both be resolved using the same techniques.

Balanced Amino Acid Therapy

Both the urge to pull and cravings for sugar and sweets are regulated by your brain chemistry. The chemical messengers responsible for this regulation are called neurotransmitters, which include serotonin and dopamine. Imbalances in your neurotransmitter function will cause miscommunication, which often leads to symptoms including the urge to pull, cravings and any number of the conditions listed above. However, restoring proper neurotransmitter balance will improve communication and alleviate these conditions.

One of the keys to establishing proper neurotransmitter function is the employment of balanced amino acid therapy. This means that a health care professional trained in the proper use of amino acids will help you determine exactly the right mix of amino acids and cofactors you need in order to establish optimal neurotransmitter function. Once this occurs, not only will your urge to pull disappear, your cravings will also be substantially reduced or eliminated altogether. This occurs because you are addressing the root cause of your problems, and by digging down to the root, you can manage a whole host of symptoms due to neurotransmitter imbalance.

The Importance of Using Balanced Amino Acids

I have been many emails asking how to achieve proper neurotransmitter balance using amino acid therapy. It seems that many people are attempting to take their own mixture of amino acids in an attempt to alleviate their urges to pull. This trial-and-error method is bound to fail in most cases and can lead to greater imbalances. This is because taking amino acids that are not properly balanced for each individual will cause depletion of competing systems over time.

Amino Acid Synthesis

I believe the reason for so much confusion comes from the fact that the synthesis of monoamine neurotransmitters, including serotonin, dopamine, norepinephrine and epinephrine, seems so straightforward:

From an intuitive standpoint, taking 5-HTP would seem to be the perfect way to increase serotonin and taking L-tyrosine or L-dopa would seem the ideal way to increase levels of dopamine. Unfortunately, this is one instance where the simple answer doesn’t play out in practice.

Synthesis Interactions

A thorough review of peer-reviewed literature shows several interactions occur in the actual synthesis of neurotransmitters from amino acids:

As you can see, giving only 5-HTP, L-dopa, L-tyrosine or L-tryptophan can deplete the monoamine neurotransmitters along with their amino acids, making the overall situation worse. Based on this data, the odds of a person obtaining the correct balance of amino acids to achieve proper neurotransmitter function are virtually zero. Once more, the probability of a person using trial-and-error to try and establish proper neurotransmitter function causing further imbalance is incredibly high. This highlights the need for professional guidance in regards to establishing the optimal amino acid dosing for each person.

Professional Guidance

Although resolving this situation isn’t as easy as it seems, a solution does exist. The science of amino acid therapy has grown by leaps and bounds over the past six years, due in large part to the work of Marty Hinz, MD and his staff at NeuroResearch, Inc. Dr. Hinz’s work has shown that with proper training, achieving optimal neurotransmitter function is possible using properly balanced amino acid therapy along with functional testing as needed. We have been using this approach for almost a decade with tremendous success and can help you achieve the resolution you are looking for.

A Novel Way to Improve Trichotillomania

We talk a lot about using amino acid therapy to help correct underlying neurotransmitter imbalances to help people overcome trichotillomania and other disorders related to neurotransmitter imbalance, such as depression, anxiety, OCD, ADD/ADHD, migraines, obesity, fibromyalgia and insomnia. However, recent research has shown that you may be able to fine-tune your neurotransmitter levels by using the right combination of probiotics.

Probiotics – good for your (brain) health

Probiotics are the “good” bacteria that normally reside in your gut. It is known that if  these bacteria become imbalanced in some way (due to illness, improper diet or toxin exposure), a condition called “dysbiosis” results, which can have many dire consequences including decreased immunity, improper immune function, food allergies, inflammation, indigestion and numerous other physical disorders. However, until recently it was not known that these bacteria can also generate neurotransmitters that can also affect your brain, impacting your mental and emotional states.

Researchers at Texas Tech University Health Sciences Center found that the following bacteria can produce neurotransmitters in the gut:

This could mean that the microbial balance in your gut could be a key player in improving and maintaining your neurotransmitter levels, and therefore alleviating the urge to pull. It also provides more scientific evidence for something that we routinely see in the clinic – that many people with gastrointestinal disorders develop or have one or more disorders related to neurotransmitter imbalance and that correctly the underlying gastrointestinal disorder is imperative to long-term recovery. Think of it like this – the gastrointestinal disorder (like IBS, Crohn’s disease, food allergies or Celiac’s disease) is like a hole in a bucket, causing neurotransmitter levels to decline (or become imbalanced). In order to fill the bucket back up (using amino acid therapy) over time, you have to first fix the whole.

Certain gastrointestinal disorders create neurotransmitter imbalances through inflammatory, immune or genetic influences. This research provides another potential way to explain, and address, the resulting neurotransmitter dysfunction. Obviously, more research needs to be done to define just how this can be useful in real life, but for now, it seems logical that anyone that suffers from trich or other disorders associated with neurotransmitter imbalance must heal any underlying gut issues while restoring proper neurotransmitter balance using amino acid therapy to achieve long term success.

Amino Acid Therapy and Trichotillomania

Amino acid therapy can be very effective at restoring proper neurotransmitter function and alleviating the insatiable urge to pull that some many people with trichotillomania experience. There are really two ways in which amino acids are used for people with trichotillomania. The first is to use n-acetyl cysteine, or NAC, which has been shown in clinical trials to reduce the urge to pull in about 56% of people that use NAC (see our post entitled N-acetylcysteine and Treatment of Trichotillomania for more information). NAC is thought to work by increasing the concentration of glutamate (an excitatory neurotransmitter) in a part of the brain that reduces compulsive behavior and hair pulling. Glutamate works in conjunction with GABA (an inhibitory neurotransmitter) to control many functions in the body. Thus, NAC provides a safe and moderately effective strategy to use amino acid therapy to decrease the urge to pull associated with trichotillomania.

However, we have found that a more effective way to implement amino acid therapy in regards to trichotillomania is to address the serotonin/dopamine system.  By providing the brain the proper proportion of the necessary amino acid precursors and cofactors necessary to achieve optimal serotonin and dopamine function we have had an 86% success rate with eliminating the urge to pull, as opposed to just reducing the urge to pull.

This increased success rate is attributed to the fact that dopamine exhibits control over the release of glutamate and GABA in certain parts of the brain. Therefore, the imbalance between glutamate and GABA that leads to trichotillomania in most people is likely to be caused by an imbalance with dopamine and serotonin (as they are farther upstream). By optimizing serotonin and dopamine function, all the systems downstream, including glutamate and GABA normalize as well. When this happens, the urge to pull disappears.

Another key distinction between using NAC or this balanced amino acid approach is the ability to remain symptom free once the amino acid(s) have been discontinued. With NAC, the urge to pull often returns once the supplement is discontinued (this provides further evidence that NAC may not be addressing the root cause of the imbalance). However, with balanced amino acid therapy we have found that once optimized neurotransmitter function is established and maintained for a period of time, most people can reduce or eliminate the amino acids and remain symptom free utilizing dietary and lifestyle factors to maintain optimal neurotransmitter status.  This means that it is very likely you won’t have to take these supplements forever and you can remain trichotillomania-free. This occurs because we are addressing the underlying root imbalance that seems to lead to the urge to pull for most people with trichotillomania. By correctly the underlying neurotransmitter imbalance with balanced amino acid therapy you effectively eliminate the problem, which allows you to stop pulling your hair out.

Other Disorders Associated with Neurotransmitter Imbalance

Many people that come into the office are often amazed to hear that a number of their symptoms can be caused by neurotransmitter imbalance. A recent client came in suffering from trich. During her initial interview, she also told me that she suffered from constant anxiety, intermittent depression, sleep problems and insomnia in addition to restless legs every time she laid down. I told her this all made perfect sense and she just stared at me. “How could this possibly make sense?”  she asked. I went on to tell her how neurotransmitter imbalances in the brain can manifest themselves in all sorts of ways including:

Most of the time, a person exhibits more than just one symptom of neurotransmitter imbalance, they just don’t make the connection that their symptoms are related.

“I wouldn’t have believed it if I wasn’t living it.
This is a miracle.”

As I explained this, I could see a light bulb go off in my clients head as her stare turned to an expectant grin, “Does this mean that I can address all of those problems using amino acid therapy?” To which I answered, “It most certainly does. As we continue to rebalance your neurotransmitter levels and restore optimal functioning, the symptoms associated with imbalance will disappear.”

She left the office with a new-found hope. That hope turned into amazement and disbelief as her symptoms began to disappear one by one. Now, she is living a life without the burden of constant anxiety or sleep problems; she no longer has restless legs and she is no longer pulling. “I wouldn’t have believed it if I wasn’t living it. This is a miracle.”

I replied, “It’s not a miracle – it’s better living through science.” Using a targeted approach incorporating amino acid therapy will help improve the status and function of your neurotransmitter levels. When this happens, the symptoms associated with the imbalances disappear, and you can get on with your life.

The Real Effect of Amino Acid Therapy

I speak a lot about amino acid therapy and how it modifies neurotransmitter levels in the brain which helps people eliminate the urge to pull.  This is a convenient way to think about the problem and the solution: low or imbalanced levels of certain neurotransmitters cause the urge to pull and correctly those underlying imbalances fixes the problem. However, what we are really doing is a little more complicated than that. This blog post is a little bit more ‘heady’ than most, but will provide a more in-depth explanation of the change we elicit for those of you interested in more of the science of amino acid therapy.

The problem – imbalanced neurotransmitter levels

Neurotransmitters are chemical messengers; when neurotransmitter levels are too low or imbalanced, the messages get garbled and symptoms of disease or disorders develop, like trich. We correct this by restoring proper neurotransmitter balance by providing the body with the nutrients it needs to make the necessary neurotransmitters. However, it isn’t quite as simple as giving the body the nutrients and having it ‘make’ the necessary neurotransmitters.

The primary determinant of neurotransmitter levels in the body is the functional status of molecules called transporters. Transporters, which are molecules in the cell walls, facilitate the movement of neurotransmitters in and out of the cells, including the neurons. Neurotransmitters cannot cross the walls of the neurons on their own as they are water-soluble and the cell walls are made of fat. Water and oil (fat) do not mix. The transporters remedy this by escorting the neurotransmitters in and out of the neurons.

When there is damage to the neurons, a signal is sent throughout the body to all the transporters that encodes them to alter the flow or neurotransmitters in a way to try and compensate for the problem. When the damage is minor, the transporters can compensate for neurotransmitter imbalances by utilizing nutrients from a healthy diet. However, when significant damage occurs, properly balanced amino acid therapy needs to be used to correct the problem.

The solution – Organic Cation Transporter Optimization

A special transporter called the ‘organic cation transporter (OCT)’ is primarily responsible for the transport of serotonin and the catecholamines (dopamine, norepinephrine, and epinephrine) as well as their amino acid precursors. These transporters are found throughout the body in many tissues, including the kidneys, gut, liver as well as the brain and function similarly in all tissues throughout the body. This means that if we affect change to the OCTs with amino acids it affects all the OCTs throughout the entire body.

When we run a ‘neurotransmitter test’ what we are really doing is determining the functional status of these OCTs in the kidneys in relation to a given amount of amino acids. By giving the body properly balanced amino acid therapy we can define the exact amounts of neurotransmitters and amino acids needed to restore proper functioning of the OCTs in the kidneys. However, because this also affects the OCTs in all the other tissues, including the brain in exactly the same way, testing the urinary excretion of neurotransmitters while taking an exact amount of balanced amino acids allows us to restore proper functioning within the brain. This restores the flow of electricity in the neurons and leads to the relief of disease symptoms – in this case – eliminating the urge to pull.

So what we are really doing is using amino acid therapy to help optimize the function of the OCTs in the neurons to facilitate proper signaling. This is akin to unscrambling the messages so that the brain gets the proper signals. When the signals are no longer crossed, you get your life back under (your) control.

If this post is too much science for you, don’t worry. Amino acid therapy works whether or not you understand why it works. It’s wonderful that way.

Beyond NAC – Addressing the Cause

In a previous post we discussed the studies that have been done regarding the use of N-acetylcysteine (NAC) in the treatment of trichotillomania (N-acetylcysteine and Treatment of Trichotillomania).  It is known that NAC increases the concentration of glutamate (an excitatory neurotransmitter) concentration in an area of the brain called the nucleus accumbens that can reduce the incidence of compulsive behaviors and hair pulling (1-4). The most prominent study showed that this reduced hair pulling in 56% of people taking 1200-2400 mg/day of NAC (1). However, there may be a more direct way to influence one’s neurotransmitter balance and affect a greater, more lasting change in hair pulling as well as other addictive or compulsive behaviors.

NAC has a direct effect on the glutamate concentrations in the brain (nucleus accumbens). This seem to restore reduce hair pulling in about half the people taking NAC (1). However, one would assume that discontinuation of NAC would also lead to a return in hair pulling because a lasting effect would be expected only if administration of NAC addressed the cause of neurotransmitter imbalance in the brain.

In a previous post, we discussed the priority of neurotransmitter systems in the body (Neurotransmitter Systems Priority). Research has indicated that the serotonin/catecholamine system exhibits primary control over many systems in the body. The catecholamines include dopamine, norepinephrine and epinephrine. This is also true of the nucleus accumbens, where dopamine-powered neurons exhibit control over the release of neurotransmitters from the nucleus accumbens (5). Therefore, the cause of imbalance in this area of the brain is more likely due to an imbalance in the serotonin/catecholamine systems somewhere upstream of the nucleus accumbens. Addressing the cause should restore proper glutamate/GABA balance in the nucleus accumbens and therefore, lead to a reduction in hair pulling. This is in fact, exactly what we have observed in clinical cases.

Once we restore proper serotonin and catecholamine (dopamine, norepinephrine and epinephrine) function using balanced amino acid therapy, people notice a marked decrease and most often elimination of hair pulling. Based on the observations noted above, balancing the primary neurotransmitter system (i.e., serotonin/catecholamine system), the secondary systems (such as glutamate/GABA)) also rebalance. Addressing neurotransmitter imbalances in this manner has the benefit of addressing the cause rather than the end effect of neurotransmitter imbalance, allowing for the possibility of continued relief from symptoms, such as hair pulling, once proper neurotransmitter status has been restored. We have observed this with clinical cases as well, where people suffering from trichotillomania achieve the elimination of the urge to pull with balanced amino acid therapy and are able to reduce and discontinue amino acid therapy over time without the return of symptoms.

In rare cases, we must augment balanced amino acid therapy with NAC to achieve complete relief of symptoms. It is thought in these cases that permanent damage may be present that inhibits proper neurotransmitter function. These people will most likely need continued amino acid therapy, including NAC, to achieve long-term relief; however, they can be free from the urge to pull doing so.

In summary, it has been our experience that properly addressing the primary serotonin/catecholamine neurotransmitter system facilitates changes in secondary and downstream neurotransmitter systems (such as glutamate/GABA) to produce more dramatic and lasting changes in reducing and eliminating the urge to pull in people with trichotillomania.

References

1. http://yale.tsocd.org/wp-content/uploads/2010/03/Trich-and-NAC-PDF.pdf
2. Coric V, Taskiran S, Pittenger C, Wasylink S, Mathalon DH, Valentine G, Saksa J, Wu-Y-T, Gueorguieva R, Sanacora G, Malison RT, Krystal JH. Riluzole augmentation in treatment-resistant obsessive-copulsive disorder: an open-label trial. Biol Psychiatry. 2005;58(5):424-428.
3. Odlaug BL, Grant JE. N-acetyl cysteine treatment of grooming disorders. J Clin Psychopharmacol. 2007;27(2):227-229.
4. Coric V, Kelmendi B, Pittenger C, Wasylink S, Bloch MH, Green J. Beneficial effects of the antiglutamatergic agent riluzole in a patient diagnosed with trichotillomania. J Clin Psychiatry. 2007;68(1):170-171.
5. http://en.wikipedia.org/wiki/Nucleus_accumbens

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