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.

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.

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.

A literature search provided some unexpected results. Several research articles showed that long term use of SAMe causes depletion of serotonin, dopamine and norepinephrine, which can exacerbate symptoms of depression (and presumably other disorders related to neurotransmitter imbalance) over time. One of the studies even found that this depletion led to the development of Parkinson’s-like disease symptoms.

These are very interesting observations, as it appears that although SAMe is often recommended for symptoms of depression and other disorders relating to imbalanced neurotransmitter levels, long term use depletes the very neurotransmitters that are implicated with those diseases.

I obviously told my client that I would not advise that she use SAMe as a trich treatment. However, that if she chose to use it, she would need to take additional amino acid precursors at the same time in order to prevent further depletion of serotonin, dopamine and norepinephrine. This meant more pills and more money; she gratefully declined.

Sources:

1)      Striatal dopamine depletion, tremors, and hypokinesia following the intracranial injection of S-adenosylmethionine: a possible role of hypermethylation in parkinsonism. http://www.ncbi.nlm.nih.gov/pubmed/8748929

2)      Depletion of nigrostriatal and forebrain tyrosine hydroxylase by S-adenosylmethionine: a model that may explain the occurrence of depression in Parkinson’s disease. http://www.ncbi.nlm.nih.gov/pubmed/9247319

3)      Parkinson’s disease-like effects of S-adenosyl-L-methionine: effects of L-dopa. http://www.ncbi.nlm.nih.gov/pubmed/1359575

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 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.

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

Image: dream designs / FreeDigitalPhotos.net

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.

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.

One of the products we use to help bring those neurotransmitter levels back into proper balance is called NeuroReplete. NeuroReplete was developed by Martin Hinz, MD, and is sold exclusively through CHK Nutrition to licensed health care professionals. It provides the amino acids 5-HTP and L-tyrosine along with the necessary co-factors (vitamins, minerals and amino-acids) to give the body everything it needs to make serotonin and dopamine in a balanced fashion. This is extremely important, as research has shown that administering only 5-HTP or L-tyrosine will lead to depletion of neurotransmitters, creating further imbalances.

Providing only 5-HTP will increase the amount of serotonin in the brain. In response to this, the body increases the amount of enzymes to break down some serotonin to maintain balance. However, these enzymes also breakdown dopamine, which is the main excitatory neurotransmitter that needs to be kept in balance with serotonin in order to keep everything working well. Because no dopamine precursor was given (i.e., L-tyrosine), relatively more dopamine than serotonin is broken down, so the imbalance between them becomes greater. This often leads to additional issues over time.

It works something like this: let’s say I have two bank accounts, both with $100 in them. I put $1,000,000 in one of them (which is like taking just 5-HTP), but leave the other one where it is. Now let’s say I take $90 out of both accounts (which is equivalent to the enzymes breaking down serotonin and dopamine non-selectively). The account with $1,000,000 isn’t affect much, but the account with only $100 in it is affected a great deal. Moreover, the imbalance between the two accounts has also gotten a lot more lopsided. This is similar to what happens if one takes only 5-HTP with no l-tyrosine (or vice versa, taking only l-tyrosine and no 5-HTP) – it can create greater imbalances over time and really deplete the competing system. This can lead to the development of other health issues over time.

The bottom line is that net effect of giving improperly balanced amino acids is neurotransmitter depletion and further neurotransmitter imbalance. Even though some people may initially see some positive results due to the increase in either serotonin (if 5-HTP is given) or dopamine (if L-tyrosine is given), they will eventually develop other symptoms as the two systems become imbalanced. Creating more problems is definitely not going to help you over the long haul.

NeuroReplete contains the precise amounts of 5-HTP and L-tyrosine to assist the body in achieving proper neurotransmitter balance. For many people suffering from trich, NeuroReplete provides all the building blocks their bodies need to completely eliminate the urge to pull. Even for those that do not achieve a complete resolution of symptoms with NeuroReplete alone, taking it establishes the foundation necessary to attain proper neurotransmitter balance in the future.