Trichotillomania Cures

I am often asked if our approach ‘cures’ trichotillomania. The simple answer is ‘it depends’.

The word ‘cure’ or ‘curing’ are used and strictly protected as medical terms, only to be used by medical doctors and other health care professionals that are licensed to practice medicine. Judging by the number of law suits against integrative, complementary and alternative practitioners who have mistakenly used this term in regards to what they do, I’d say that it is strictly enforced. As I am a naturopathic doctor and do not practice medicine, I am not entitled to use the terms ‘cure’, ‘cures’ or ‘curing’ in relation to what I do or to describe the effects that what I recommend may have on or for a person.

Interestingly, the general public often use these terms without recourse. I even had one client look up the word ‘cure’ and forward me the definition: ‘A cure or remission is the end of a medical condition’, so they stated that because we helped them eliminate the urge to pull their hair out, we helped them ‘cure’ their trichotillomania and should therefore be listed in any list of ‘trichotillomania cures’.

While I am glad this person feels better, this discussion brought up a couple additional points that are important to keep in mind (not only for a person considering amino acid therapy, but also for me as a complementary health care practitioner). In addition to the above discussion about the use of the words ‘cure’, ‘cures’ and ‘curing’, we are not specifically addressing any medical condition(s), including trichotillomania using amino acid therapy. What we are doing is looking for and addressing fundamental root imbalances in body or brain chemistry and addressing them using natural methods if at all possible. These imbalances can manifest themselves in conditions that are diagnosed by medical professionals as trichotillomania. However, they can also manifest themselves in other ways that prompt people to seek medical help; these diagnoses can include depression, anxiety, OCD, ADD, ADHD, insomnia, migraines, fibromyalgia and numerous other sets of symptoms labeled as ‘diseases’ by the medical profession.

We don’t concern ourselves nearly as much with what a group of symptoms is called by the medical profession as we do with figuring out what imbalances created these symptoms and addressing those underlying imbalances. By addressing the underlying imbalances, our clients often see a reversal of many previously diagnosed medical conditions, not just the one(s) they are seeking us out for. That is why when you read the many testimonials and background information about amino acid therapy throughout this site, you see that many, many conditions can be corrected through the proper use of amino acid therapy. We cannot say amino acid therapy ‘cures’ trichotillomania or any other diagnosed medical condition as I am not a medical doctor; I am a naturopath.

But what really matters is that by finding and addressing the underlying neurotransmitter imbalances that a person with trichotillomania has, they can eliminate the urge to pull. If they want to find out if they are ‘cured’ or if this ‘cures’ trichotillomania, they just need to ask their medical doctor if no longer having the urge to pull means that they are ‘cured’.

Where Do Neurotransmitter Imbalances Come From?

We have pointed out in a couple previous posts that high levels of stress and drinking soda can cause or create imbalances in neurotransmitter levels over time. However, there are a number of other factors that can cause imbalances in these precious chemicals.

The single most important factor that a person can control on a daily basis that impacts their brain chemistry is what they eat and drink. We’ve already discussed how soda can deplete key neurotransmitters over time, but there are other habits that also create imbalance. These include eating fast-food regularly and/or high-fat, high-sugar foods, lots of processed (aka ‘junk’) foods and not eating sizeable portions of vegetables (i.e., colorful foods that contain fiber, tons of vitamins and minerals and that don’t need a label) and good quality proteins on a daily basis. The reason is two-fold: (1) a poor quality diet doesn’t supply the body with the necessary building blocks (i.e., amino acids and cofactors) to make the necessary neurotransmitters, and (2) most of these foods are so depleted in nutrients that they actually rob the body of vitamins and minerals to process them.  Either way, getting the right foods into your body is a key to correcting this potential cause over time.

Another area that can create imbalance has to do with environmental toxins. These include such things as industrial cleaners, air and water pollution, solvents, heavy metals, herbicides, pesticides, drugs and countless chemicals that we can be exposed to in one form or another on a regular basis. Many of these chemicals cause what is referred to as ‘neurotoxicity’ which means that they can permanently destroy neurons and/or brain cells that can dramatically effect neurotransmission over time. The key here is to develop a plan of action to identify where these toxins may be coming from, minimize further exposure and help the body eliminate stored toxins while repairing the damage as much as possible.

The last major factor that can play a role in neurotransmitter imbalances is genetics. Some people are genetically predetermined to have suboptimal neurotransmitter levels. This is why you can often see patterns in families with such disorders as migraines, insomnia, depression, anxiety, OCD, ADD/ADHD, weight problems and trichotillomania.

The good news is that no matter the cause, the solution is to get the body the necessary nutrients it needs to rebalance proper neurotransmitter function. You may not be able to control all the factors that can cause neurotransmitter dysfunction, but you can control what you eat, how you handle stress and choose to give your body the nurturing and support necessary to achieve optimal neurotransmitter function – this will allow you to overcome any of these deficits and live your life the way you want.

Trich – Two Kinds of Pulling

We spend a lot of time on this blog talking about the ins and outs of amino acid therapy as an effective solution to the underlying neurotransmitter imbalance(s) that often lead to trich. However, there is also a behavioral component that cannot be overlooked and must also be addressed. Most people experience both the ‘urge’ to pull and develop a ‘habit’ of pulling.

For instance, many people pull at certain times of day or under certain situations, such as while driving, while studying or when watching TV. They may not even notice that they are doing it. The key is what happens when they do notice – can they tell themselves to stop and move on without giving it another thought? Or do they then have to constantly think about it in an internal struggle not to begin pulling again?

When the underlying neurotransmitter imbalances have been addressed, the urge to pull disappears. However, the habit remains. The good news is that once the urge is gone, when a person catches themselves pulling, they can take a look at the situation and make a decision to stop pulling – and then let it go. Because the urge is gone, they no longer need to bother with any thought of pulling. If they catch themselves pulling again out of habit, they simply correct the behavior. This is in stark contrast to someone that has to continually battle with themselves to not pull their hair out.

Once the urge is gone, behavior modification therapies often are an incredible help. These can be as simple as sitting on ones hands or keeping the hands busy to help break those habitual patterns, or involve more in-depth therapy, such as cognitive behavior therapy (CBT). Many of our clients who had tried CBT in the past with little success report outstanding results once their neurotransmitter levels are balanced.

Differentiating between the urge and habit is important. Habits can be changed with time and attention. Urges require that the underlying biochemical imbalance be corrected.

To find a Cognitive Behavioral Therapist, visit the National Association of Cognitive-Behavioral Therapists website or the Trichotillomania Learning Centers Resource page.

Neurotransmitter Systems Priority

This post has to do with the optimal sequence we follow to help people get to their goals. In regards to neurotransmitter related disorders, there is a definite sequence that works best.

The serotonin and/or catecholamine system has a role, either directly or indirectly, in controlling most of the other systems and functions in the body. For example, cortisol synthesis is controlled in part by norepinephrine. Hormone synthesis is dependent on norepinephrine. The sympathetic nervous system is controlled by norepinephrine.

We have noted previously that neurotransmitters are chemical messengers in the body that control bodily functions. There are many other chemical messages as well, including hormones. With hormones in particular, we have found that if we balance the primary neurotransmitters as a first course of action (i.e., serotonin and dopamine), many symptoms associated with hormone imbalance (e.g., hot flashes, mood swings, irregular menses, etc.) often resolve. Therefore, it is our assertion that in most cases, the primary neurotransmitters need to be balanced first (or at the very least in concert with hormones) in order to properly manage symptoms of hormone imbalance.

In addition, other neurotransmitter systems are partially controlled by the serotonin and/or catecholamine systems. For example, the GABA neurotransmitter system is associated with control of anxiety and panic attacks. Yet when the serotonin and/or catecholamine neurotransmitter levels are brought to proper levels, as confirmed by lab testing, these diseases may be fully under control. This would indicate control of GABA by the serotonin / catecholamine system even though at this time we have been unable to identify a chemical pathway for such in the literature. Therefore, it is also are assertion that we need to rebalance the primary neurotransmitters first (i.e, serotonin and/or dopamine) before moving onto to secondary neurotransmitters (i.e., GABA, glutamate, etc.).

We have shared a lot of information in various posts on the science of amino acid therapy and we hope that it provides you a more thorough understanding about how and why amino acid therapy is a very viable and effective therapy to use with trichotillomania and why we have had such great success eliminating the urge to pull.

Trichotillomania and Stress

Here is a story that sounds so familiar that I wanted to share it:
Trichotillomania Story

In it, Michelle explains that her pulling started after a severe amount of stress and that she often pulls more when she is stressed out. This is very, very common as stress is one of the key reasons neurotransmitter imbalances develop (see our latest post on 2 Major Causes of Neurotransmitter Imbalance).

Even though you can rebalance your neurotransmitter levels through proper amino acid therapy, properly addressing chronic stress involves a lot more than taking pills. As Michelle points out, she feels she could deal with this much better with a strong support network; this is, in fact, exactly what we have found in our clinic as well. Luckily, that support network can be made up of not only people you can see day-to-day, but also those who you can interact with via social networks and online forums. The key is to feel and be connected – to others and often to whatever higher power you believe in.

Outside of staying connected and feeling supported, many people need to implement specific daily strategies to help them management stress. This may include psychotherapy, EMDR, meditation, yoga, deep breathing, exercise and any number of other daily or regular therapies to help them lessen the impact stress has on their lives.

It may not seem easy, but getting the pieces in place certainly raises the potential for eliminating the urge to pull. Once more, it also sets the stage for long term health and healing on many levels.

Two Major Causes of Neurotransmitter Imbalance

Neurotransmitter imbalances often have many origins. Genetic predisposition certainly plays a role; however, genetic impact can often be overridden or minimized with other therapies. However, the most common reasons for neurotransmitter imbalances are stress and a nutrient-deficient diet.

Long periods of chronic stress gradually deplete serotonin as the body tries to down regulate excitatory signals. Once serotonin is sufficiently depleted, the excitatory arm of the nervous system has free reign, often creating prolonged states of anxiety and agitation or irritability. Many people describe that they ‘just can’t relax anymore’. With continued stress, excitatory neurotransmitters also become depleted; this is when the body just can’t keep up anymore and many people struggle just to get up in the morning (or anytime during the day). These people often experience depression or chronic fatigue.

The problem is greatly exacerbated by a nutrient-deficient diet. The Standard American Diet (SAD) is almost designed to cause neurotransmitter imbalances, emphasizing lots of carbohydrates as well as many highly allergenic foods that can cause the body to dump serotonin and stimulate the output of excitatory neurotransmitters.

Neurotransmitters are made from specific amino acids, so a balance of high-quality protein is essential for long-term balance. However, the SAD diet is very high in refined carbohydrate, which provides plenty of stimulation for an already burn-out system and offers nothing to replenish the exhausted neurotransmitter supplies. This sets the stage for immediate and long-term imbalances.

What we choose to drink also has a dramatic effect. Stimulants like coffee and energy drinks deplete the excitatory neurotransmitters (like epinephrine and norepinephrine) and alcohol adversely affects serotonin and GABA production, which are inhibitory neurotransmitters. Alone or combined, these drinks immediately confuse the brain and cause all sorts of biochemical imbalances.

The biggest wrench in the neurotransmitter machinery, however, has to be soda. Soda is the perfect food to promote neurotransmitter imbalance – many contain lots and lots of sugar, often up to 12 teaspoons in one 12 ounce can (just imagine what the ‘large’ sodas contain!), caffeine, artificial colors and flavors and no amino acids. Diet soda is often worse, as many of the artificial sweeteners are known to be neurotoxic or cause dramatic swings in neurotransmitter levels. And people in the US drink a LOT of soda – upwards of 54 gallons per person per year! It’s no wonder that drugs that manipulate neurotransmitter levels are the most prescribed group of drugs in this country!

You have a lot of control of your neurotransmitter levels. While it is true that you cannot appreciably raise your neurotransmitter levels through dietary changes or stress management, you can dramatically limit the deficiencies caused by both of these by making some simple, daily changes, such as: ditching soda, coffee and alcohol; eating protein at every meal; limiting simple carbohydrates; eating lots of whole vegetables, fruits, nuts, seeds and legumes along with good-quality protein; and undertaking daily stress management. It’s not glamorous, but I doubt glamour is what you are after. Oh, yeah – and it works!

Neurotransmitter testing – what does it measure and how does it help? Part II

Now that you have a better understanding of what we are looking for, you can quickly see that it takes a very specialized laboratory to do these measurements; it also helps you to see why the interpretation of the results isn’t quite so straightforward.  We have used and done tests on several laboratories across the country and we have only found one that produced consistently reliable results, and that laboratory was DBS Labs (www.labdbs.com). This is the lab we use and the only one that is qualified to run these OCT Assay Interpretations.

The good news is that we have found that the vast majority of people (~80-85%) have a complete resolution of symptoms before any kind of lab testing is necessary. This means that majority of people will have their symptoms go away (i.e., eliminate the urge to pull) within about 3-4 weeks with proper guidance and weekly follow ups. Even if a person doesn’t see a complete resolution of symptoms in this time frame, a urine test can help guide the way to reach the goal.

A health care provider has to take many hours of training to even begin to interpret the results from these tests, and then have the experience of reviewing and working with hundreds of clients before they can say they understand what they are doing. This is because it is not a simple matter of ‘is the number too high or too low’. The client’s clinical symptoms and changes in those symptoms must be coupled with the OCT functional assessment to determine the proper next steps. That is why it can take years for a health care provider that has had the proper training to become proficient at using these tests properly. Again, that is assuming they have been properly trained in the first place; currently there is only one seminar that covers this peer-reviewed information; it is a 37.5 hour seminar and has continuing education for MDs, DOs and NDs (you can learn more about it at www.neurosupport.com).

If this all sounds overwhelming and to ‘geeky’ just know this: most people will experience a complete resolution of symptoms without the need for any kind of testing. If you do need a test to help determine the proper amino acid dosing, we have worked with thousands of clients over the past decade and evaluated hundreds and hundreds of OCT Assay Interpretations (i.e., Neurotransmitter tests) to help people eliminate their symptoms. That is why we can help over 86% of people with trich eliminate the urge to pull and over 98% of people with other neurotransmitter-related disorders achieve a complete resolution of their symptoms.

If you’d like more information or really get into the science of this, here’s a place to find more detailed information:  http://www.neuroassist.com/OCT-functional-status%20determinatino.htm.

Amino Acid Therapy: The What’s, How’s and Who Cares: Part 2

Once your neurotransmitter levels are rebalanced, your symptoms will disappear. This is like a ‘light-switch’; you either have enough or you don’t. When you do, you will wake up one day and your symptoms will be gone. It often seems miraculous, but it is actually just a sign of balanced brain chemistry. You will be back in control and able to function optimally.

Once this happens, you will stay on that dose of amino acids for 6-9 months while your body replenishes its stores of neurotransmitters. After that time, we will work with you to steadily decrease the amino acids to the minimum dose necessary to keep your symptoms under control. Many people can eliminate the need for the amino acids altogether with the proper dietary and lifestyle adjustments.

There are four reasons why someone would need to take amino acid products ongoing in order to control their symptoms:

1. Head trauma – this can cause permanent nerve damage and the need for continual amino acid therapy
2. Neurotoxicity – this is caused by environmental and/or other toxic exposure that permanently damages neurons
3. Genetics – a person can have impaired ability to create or maintain proper neurotransmitter imbalance from birth
4. Continuation of dietary or lifestyle habits that cause neurotransmitter imbalances

The first three are permanent states and people with these impairments will need some amount of amino acid therapy to remain symptom free. However, the amount needed long-term is often much less than the amount needed to establish proper neurotransmitter balance. The fourth cause is completely correctable and we will work with you to establish the dietary and lifestyle habits to help you maintain neurotransmitter balance.

Note: you cannot substantially increase your neurotransmitter levels through diet or lifestyle alone, but you can maintain your neurotransmitter levels using diet and lifestyle. This is because in order to achieve proper neurotransmitter balance, you need specific doses of specific nutrients at specific times to maximize absorption and conversion of the raw materials into neurotransmitters. Even though the raw materials used are normal components of food, they are administered in much higher amounts and in different combination than those found in food.

Also note: many medications can cause depletion of neurotransmitters, including all anti-depression, anti-anxiety, migraine and sleep medications. If you have taken or are currently taking medications that deplete neurotransmitter levels (including all selective serotonin reuptake inhibitor (SSRI) and selective norepinephrine reuptake inhibitor (SNRI) medications), you may want to consider taking the following to restore proper nutritional status:

CoQ10 (100 mg) – 1 gelcap daily with food

Glycogenics – 1 tablet twice daily with food

In addition, taking a low level of amino acid therapy along with these medications will help stop further depletion of neurotransmitters and will help improve the effectiveness of anti-depression, anti-anxiety, migraine and sleep medications (including all SSRI and SNRI) medications.

For more information, please visit our websites (www.naturalpathhealthcenter.com, www.optimalbodybalance.com or www.stoppullinghairout.com ) or www.neuroassist.com.

Amino Acid Therapy: The What’s, How’s and Who Cares: Part 1

Neurotransmitter imbalances have been associated with many conditions, including food cravings, increased appetite, binging, addictions (food, alcohol, drugs, gambling, etc.), trichotillomania, obsessive-compulsive tendencies and disorders, depression, anxiety, insomnia, migraines, fibromyalgia and other chronic pain syndromes and obesity. Restoring proper neurotransmitter balance is essential to managing, eliminating and overcoming these conditions.

Amino acid therapy involves giving the body the nutrients it needs to rebalance neurotransmitters. This begins with using two formulas NeuroReplete or D5, and CysReplete (depending upon your condition). These formulas provide the necessary amino acids and cofactors the body needs to bring up the two primary neurotransmitter systems (serotonin and the catecholamines (which include dopamine, norepinephrine and epinephrine)) in a balanced manner.

It takes 3-5 days for the body to reestablish its new level of neurotransmitters. Therefore, after 7 days of taking your recommended supplements exactly as directed, if you are still experiencing symptoms, your amino acid dosing needs to be adjusted. Your new dosing level will be determined at your next appointment. If need be, a simple urine test can be run to help determine the proper amino acid dosage.

In order to eliminate your symptoms as quickly as possible, it is imperative that you take the amino acid products as recommended and follow up after being on a new dose for 7 days if you are not where you want to be. There is no point in waiting longer to see if they will ‘kick-in’; this just delays you reaching your goals.

There is only one known side effect when beginning amino acid therapy and that is nausea. This occurs when a person’s serotonin levels are exceptionally low. If this happens, it is a sign that a person needs the amino acids, but we must slow down the dosing schedule to allow the body to adapt to the increased neurotransmitter levels. When serotonin levels are very low, taking the amino acids cause nausea because the body converts the 5-HTP in the supplements into serotonin immediately in the gut, which you experience as nausea. The solution is to discontinue taking the amino acids during the daytime and follow a protocol (that we will provide to you) where you slowly introduce the amino acids, beginning with just one pill before bed.

It is very important that you take the recommended doses of each supplement every day. If you miss a dose, you need to take it as soon as possible to avoid fluctuations in neurotransmitter levels. Missing even a single dose of amino acids will cause your neurotransmitter levels to drop and it will take 3-5 days to get back to the level you were at before missing the dose. This means that you will have a higher probability of experiencing symptoms during that time.

You can quickly see that missing doses regularly will mean that you will never be able to rebalance your neurotransmitter levels, so establish a routine and stick to it. If you miss a dose, take it as soon as possible. One good trick is to always have a small bottle of whatever supplements you are taking with you at all times (or keep the bottles in your purse, at work, at home and/or where ever you regularly find yourself) so you are never in a situation where you miss a dose.

Properly balanced amino acid therapy: Part Two

In our last post we discussed diet alone cannot help to properly balance amino acids and how supplementation plays a vital role.  Below is further detail:

The use of cysteine, selenium and folic acid are used to prevent depletion of the methionine-homocysteine cycle (figure 5) by L-dopa and presumably by L-tyrosine from which L-dopa is synthesized from, the immediate precursor of L-dopa. Administration of L-dopa leads to depletion of S-adenosyl-methionine (SAMe), a component of the methionine-homocysteine cycle which is the one carbon methyl donor of the body; proper levels of SAMe are needed in order for norepinephrine to be methylated to epinephrine. Long-term use of L-dopa without proper administration of amino acids of the methionine-homocysteine cycle leads to depletion of epinephrine.³⁷

There is a, total loss of sulfur amino acid associated with treatment of Parkinsonism with L-dopa as evidenced by the loss of total glutathione which occurs.⁴¹ Glutathione is synthesized in a side chain reaction off the methioninehomocysteine cycle( see figure 5). The loss of total glutathione leads to a state where the body’s most powerful detoxifying agent (glutathione) is no longer functioning properly and is unable to neutralize further toxic insult leaving the patient in a state where more toxic damage is facilitated. All people taking L-dopa and/or L-tyrosine need to be supplemented with adequate levels of sulfur amino acids to prevent depletion of the methionine-homocysteine cycle, depletion of glutathione, depletion of epinephrine, and the other components dependent on the methionine-homocysteine cycle. While administration of any of the sulfur amino acids in the cycle is adequate if the dosing is high enough, cysteine is chosen because it is the most cost effective.

Figure 5: The methionine – homocysteine cycle , the heart of the sulfur amino acids.

Selenium needs to be administered with cysteine to prevent cysteine (or any sulfur amino acids) from creating an environment that contributes to central nervous system neurotoxicity from methylmercury. Administration of cysteine can potentially facilitate concentration of methylmercury into the central nervous system.⁴⁶ Selenium binds irreversibly to methylmercury in the central nervous system rendering the methylmercury biologically inactive and non-toxic.⁴⁷

Folic acid is required in order to provide optimal function of the folic acid cycle which in turn prevents hyperhomocysteinemia from preventing the methioninehomocysteine cycle from functioning properly. As noted previously, without proper administration of amino acids of the methionine-homocysteine cycle leads to depletion of epinephrine. It would appear the second factor driving epinephrine levels beyond methionine-homocysteine cycle depletion is hyperhomocysteinemia. It can take 3 to 6 months for hyperhomocysteinemia to return to normal when proper levels of folate, vitamin B6 and vitamin B12 are provided for. It appears to be no coincidence that it can take 3 to 6 months for epinephrine levels to return to normal a fact that appears to parallel homocysteine improvement.

When the goal of therapy is to prevent depletion of neurotransmitters by prescription drugs or in associated situations where prescription drugs are no longer working effectively during treatment due to the neurotransmitter levels falling too low from depletion due to circumstance set up by the drug ⁴⁵, the person needs to begin properly balanced amino acid therapy along with the prescription drug. While amino acid precursors when properly used alone are highly effective, a drug/amino acid combination may be desirable with severe disease, such as the suicidal patient, the catatonic patient, or the patient that is unable to take part in normal day-to-day functions such as work. Supplementing with amino acid precursors allows reuptake inhibitors to continue to function optimally without further depletion of neurotransmitter levels.

37. O-methylation and decarboxylation of alpha-methyldopa in brain and spinal cord: depletion of S-adenosylmethionine and accumulation of metabolites in catecholaminergic neurons Neuropharmacology. 1976 Jul;15(7):395-402 Lo CM, Kwok ML, Wurtman RJ.

41. Characterization of intracellular elevation of glutathione (GSH) with glutathione monoethyl ester and GSH in brain and neuronal cultures: relevance to Parkinson’s disease. Exp Neurol. 2007 Feb;203(2):512-20. Epub 2006 Oct 17. Zeevalk GD, Manzino L, Sonsalla PK, Bernard LP.

45. Role of norepinephrine in depression. Department of Psychiatry, University of Arizona, J Clin Psychiatry 2000;61 Suppl 1:5-12 Delgado PL; Moreno FA.

46. Brain, kidney and liver 203Hg-methyl mercury uptake in the rat: relationship to the neutral amino acid carrier. Pharmacol Toxicol. 1989 Jul;65(1):17-20 Aschner M.

47. Direct determination of seleno-amino acids in biological tissues by anionexchange separation and electrochemical detection. J Chromatogr A. 1995 Jul 7;706(1-2):429-36. Cavalli S, Cardellicchio N.