N-acetylcysteine and Treatment of Trichotillomania

I am periodically asked about the use of N-acetylcysteine (NAC) in the treatment of trichotillomania, and have seen this subject come up on numerous occasions on the trich blogs and forums. There is some research to suggest how n-acetylcysteine works as well as how it can be used to lessen compulsive behaviors like hair pulling.

N-acetylcysteine is an amino acid that appears to work by reducing the release of glutamate (an excitatory neurotransmitter) into the synapse of neurons in a part of the brain called the nucleus accumbens. The nucleus accumbens plays a key role in our feelings of reward, pleasure, addiction, aggression and fear.(1-2) By inhibiting the release of glutamate, NAC causes an increase in glutamate concentration in the nucleus accumbens which reduces compulsive behaviors and hair pulling.(3-6)

The most prominent study done on NAC in relation to trichotillomania found that 56% of people were “much or very much improved” with NAC use compared with 16% of those taking placebo.(3) The dosages used in this study were 1200-2400 mg of NAC per day for 12 weeks, with significant improvement initially noted after 9 weeks of treatment with NAC. Thus, NAC appears to be a very promising therapy for those suffering from trich. However, there are a couple things to consider.

NAC should not be used by those with asthma as it may worsen that condition. In addition, because of the way that NAC is processed by the body, it is recommended that you should take supplemental zinc, copper, selenium and other trace minerals along with extra vitamin C when taking NAC for a long period of time. This can easily be done by taking a quality full spectrum multivitamin/multimineral along with supplemental vitamin C.

NAC appears to be a safe and moderately effective way to decrease hair pulling. However, as we will discuss in a future post, it may be more beneficial to address other key neurotransmitters that can rebalance the neurotransmitter status of the nucleus accumbens further upstream.

References

1. Schwienbacher I, Fendt M, Richardson R, Schnitzler HU (2004). “Temporary inactivation of the nucleus accumbens disrupts acquisition and expression of fear-potentiated startle in rats”. Brain Res. 1027 (1–2): 87–93. doi:10.1016/j.brainres.2004.08.037. PMID 15494160.
2. ^ Dopamine Involved In Aggression – Medical News Today
3. http://yale.tsocd.org/wp-content/uploads/2010/03/Trich-and-NAC-PDF.pdf
4. 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.
5. Odlaug BL, Grant JE. N-acetyl cysteine treatment of grooming disorders. J Clin Psychopharmacol. 2007;27(2):227-229.
6. 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.

Can Probiotics Improve Your Mental Health

We talk at great length on this site about how neurotransmitter imbalance can greatly impact your urge to pull and that correcting underlying imbalances is the key for many people to stop pulling. I just came across an interesting article that may provide additional insight into the causes of neurotransmitter imbalance and the how probiotics may be useful in correcting the problem.

Probiotics and mental health

Probiotics are the “good” bacteria that normally reside in a health gastrointestinal (GI) tract. Different formulations are available in many health food stores containing one or more strains of different bacteria. Recently, Professor Mark Lyte and associates at Texas Tech University Health Sciences Center have come up with a radical new concept: that you may be able to affect your neurotransmitter levels – and therefore your psychological health – by taking and establishing the right blend of probiotics.

What these researches found was that several neurotransmitters (normally produced in the brain) are also produced by various probiotic strains in the gut. For instance, they found that bacillus and serratia strains of bacteria produce dopamine; streptococcus, Escherichia and Enterococcus strains produce serotonin; Escherichia, Bacillus and Saccharomyces produce norepinephrine; and Lactobacillus and Bifidobacterium strains produce GABA.

The Second Brain

This has potentially startling implications. First, it provides another pathway to help explain why a person’s neurotransmitter levels become imbalanced in the first place. If the microbial environment of the gut is abnormal from birth, let’s say, this research suggests that over time, neurotransmitter imbalances could result. This could help explain why some kids exhibit symptoms of trich from an early age and why others develop it over time. In addition, we have noticed that several people find a dramatic change in their urge to pull after a round of antibiotics; this research could help explain this as any shift in the microbial environment in the gut could lead to alternations in neurotransmitter levels.

In addition, it provides other possible avenues to correct those underlying imbalances. This research suggests that altering the bacteria in the gut could dramatically affect a person’s overall neurotransmitter balance.

More research needs to be done, but if this hypothesis is confirmed, probiotics could prove to be a valuable adjunctive therapy to help those who suffer from trich and other disorders relating to neurotransmitter imbalance.

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.