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.

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.

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.

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

“I was diagnosed with trich in 1^st grade and I’ve pulled every 1-3 days since then. By the time I found Dr. Oler I was 17 years old and had pulled out all my eyebrows, eyelashes and about 50% of the hair on my head. My dad’s a doctor, so I’ve tried pretty much every possible medical treatment and drug for trich out there. They didn’t help me get rid of the urge and I usually felt awful when I took them.

Within a month of starting the amino acid therapy my urge to pull was completely gone! It was great! And unbelievable! Dr. Oler told me to continue my current dosing for 2 months and follow up. Over those 2 months, I pulled a couple times, but it wasn’t an urge; it felt more like the hairs weren’t growing right and I just pulled those and left everything else alone. My eyelashes, eyebrows and hair on my head all started growing back. During this time, I stopped taking the amino acids a couple times, but noticed the urge to pull increased, so I went back to Dr. Oler’s recommendations.

After 2 more months, all my hair was grown back and I wasn’t having any urges anymore. However, I forgot to take my supplements with me when I went away from Christmas and New Years and the urges came back BIG TIME and I pulled everything out again in about 5 days. As soon as I got home, I started the supplements again and didn’t have any urge to pull after about 5 days.

I continued at this dose for 6 months. I wasn’t pulling, my energy levels were great, I slept well, my cravings were gone and I started playing rugby again. I also noticed that my focus, concentration and memory had improved and I was doing better in my classes. I was very content.

After a couple more months, Dr. Oler recommended that we start to decrease the amino acids, as by this time, my neurotransmitter stores should be back to where they belong. I was apprehensive, but reassured that I could always go back to taking what I was currently taking and get the same results within a few days even if the urge to pull returned. I had a little bit of an increased urge to pull after changing the dose, but it only lasted a few days and it wasn’t too bad, but no urges after that.

We continued to decrease the amino acid dosing over time, adjusting as needed if I had an increased urge to pull or stress triggered me to pull. I also started learning some other ways to manage stress, like deep breathing, taking a quick walk around the block and aerobic exercise which helped.

It’s now been two years since I started working with Dr. Oler and I (1) don’t have any urges to pull, (2) am no longer taking medications for trich, and (3) haven’t taken any of the amino acid supplements for over 3 months. All my hair is grown back and I have absolutely no urge to pull anymore unless there is a lot of stress in my life. Even then, I can get through it without pulling very much. I am very content where I am at. Thank you for helping me beat trich!”

-Stephanie, 08/02/11

Image: Graeme Weatherston / FreeDigitalPhotos.net

“I started pulling when I was 13 years old. At first it was more of a nervous habit, but pretty soon, I couldn’t help myself. I lived with it until I was an adult, then I began trying medications; none of them helped, and many of them made my symptoms worse or made me feel horrible. Over this time, I also started to developed terrible anxiety which got worse and worse with each pregnancy (she has 3 kids).  I also started to gain weight. The worst part is that I am starting to see signs of trich in my kids.

When I first started working with Dr. Chad, I immediately started to feel better, with some decrease in anxiety and a substantial increase in energy. I also started to work with my doctor to decrease the Wellbutrin that I was taking by 50%. The trich wasn’t doing so great, as I still had urges, but I didn’t pull.

Dr. Chad adjusted the amino acid therapy and within 3 weeks my urge to pull was gone, my anxiety was doing really well and my appetite had gone down, so I was starting to lose weight. I was also able to completely get off my Wellbutrin with no increase in symptoms. Now I am going to try and get off the amitriptyline that I am taking for anxiety as well.

I am so grateful to Dr. Chad for helping me get my life back. I can now enjoy my time with my kids because I’m not so stressed out and not thinking constantly about pulling. I’ve started to go out socially again and it feels wonderful. Thank you Dr. Chad for all you do and for helping me get rid of trich!”

Margaret’s story goes to show that no matter how long you may have suffered from trich, you can still get your life back and eliminate the urge to pull. Now we are working with Margaret’s kids to help them eliminate the urge to pull and stop the trich before it starts.

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.

Dry mouth —- 34 (2.1%)
Insomnia —— 14 (0.9%)
Headache —– 12 (0.7%)
Nausea ——– 10 (0.6%)
Dizziness ——- 6 (0.4%)
Constipation — 6 (0.4%)

All other side effects were reported at a rate of less than 1 in 500 visits (0.02%). No irreversible side effects were noted.

Amino acid precursors are safe to administer with any prescription drug, but amino acid precursors can also cause the side effects of the prescription drugs to be displayed. Any side effect associated with the drug can be triggered.  When drug side effects occur, it is necessary to manage the situation by working with your prescribing physician to help reduce the unwanted side effects; this generally entails decreasing or stopping the drug not the amino acid.

With regards to pregnancy there is nothing in the literature indicating that the amino acid precursors are a problem. Nor is there anything in the literature indicating studies have been performed indicating they are safe. In this light it is recommended that amino acid precursors not be used in the first trimester of pregnancy, although no studies indicate this is harmful to the mother or the fetus.

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.

First, some background. This is a woman in her mid-40s, we’ll call her Tracie; she had pulled off and on for many years, but started pulling uncontrollably in 2004 when she was finally diagnosed with trichotillomania. However, she had a number of prior imbalances that most likely led to, or at least exacerbated the neurotransmitter imbalances that led to the compulsive urge to pull.  Tracie was diagnosed with depression in the mid-80s and started medication to address it. About 10 years later, she was diagnosed with major depression and fibromyalgia syndrome (FMS) and put on more medications. She was also experiencing extreme pain, diagnosed with arthritis and given heavy doses of pain killers. Finally, just last year, she was diagnosed with Crohn’s disease. Just today Tracie confided in me that she has experienced gastrointestinal (GI) distress since she was a child. She also mentioned that she was a very restless sleeper and never slept through the night or felt rested.

The reason all this matters is that every one of these conditions and treatments has an adverse effect on neurotransmitter levels. Most people know that depression is thought to be due to imbalances with a neurotransmitter called serotonin. What most people don’t know is that the medications used to treat depression actually make the underlying neurotransmitter imbalances worse over time. This makes it nearly impossible for people taking these medications to get off of them and they may feel worse and worse – unless they begin a program using amino acid therapy to address the underlying neurotransmitter imbalances.

Once more, FMS and pain are also related to neurotransmission. In our clinic, we have seen remarkable remissions of FMS and dramatically increased pain tolerance and reductions in perceived pain with properly balanced amino acid therapy. It has been shown in the literature that chronic pain often induces depression; this is due, at least in part, to the neurotransmitter imbalances that occur due to chronic pain, which then lower the pain tolerance, exacerbating pain, thus creating a vicious cycle pain inducing more pain.

Furthermore, chronic gastrointestinal disorders often cause neurotransmitter imbalance. This is thought to be for two reasons: 1) malabsorption of nutrients and 2) exaggerated loss of serotonin due to inflammation of the GI tract. The GI tract is where about 90-95% of the body’s serotonin is stored. Chronic GI distress can cause the body to ‘dump’ these stores, creating imbalance; GI imbalances can also be caused by neurotransmitter imbalances. In particular, recent research is suggesting that Crohn’s disease may be due to serotonin toxicity due to defects in neurotransmitter transporters in the gut. What’s exciting about this is that clinical experience also shows that reestablishing proper neurotransmitter imbalance using amino acid therapy can cause a complete remission of the symptoms of Crohn’s disease.

Lastly, one of the latter stages of neurotransmitter imbalance is sleep disturbance and insomnia. The sleep cycle is regulated by melatonin. This compound is created from serotonin, a process which is regulated by another neurotransmitter called norepinephrine. Again, you can see that imbalances in these neurotransmitters will lead to sleep issues over time.

So what did Tracie experience? Well, she had quite a bit of nausea when she first started on the amino acids. This is very common in people when their serotonin levels are very low. This is because the gut is so depleted of serotonin that it converts the amino acids into neurotransmitters right there in the gut rather than putting them into the circulation where they can reach the brain, which creates the experience of nausea. The solution – go slower. So, we adjusted her dosages to allow her body the time it needed to absorb and utilize the amino acids properly.

The result: as soon as Tracie got up to the original recommended starting dosage, she noticed she was much less restless while sleeping and that she actually slept through the night a few times. Her husband also noticed, as he too was now able to sleep through the nightJ. And what about the trich? Tracie stated that after about 2-3 days on the recommended dosage she had absolutely no compulsion to pull, although she did catch herself pulling a few times out of habit. However, unlike before, she could now catch herself and stop pulling and not think about it (or obsess over it) again.

What can we learn from Tracie’s story – lots of bodily and mental functions are impacted by neurotransmitter balance. However, the solution is quite simple: reestablish proper balance. Tracie did it and has eliminated the compulsion to pull with the ‘side benefit’ of better sleep. She’s so happy that we are now going to work on her other health imbalances to reestablish optimal health and function.

Tracie’s story is not uncommon – reestablishing proper neurotransmitter balance can cause dramatic positive changes in your life, and quick. We have helped 1000s of people regain their health and their lives using amino acid therapy and we’d love the opportunity to help you.