The Importance of Using Balanced Amino Acids

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

Amino Acid Synthesis

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

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

Synthesis Interactions

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

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

Professional Guidance

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

Trichotillomania Help – Tina’s Story

Tina came to us after her parents found this site on the internet and were intrigued by our success with trichotillomania. Tina was 11 years old and had been suffering from trich for about a year when we first met. She had been on Zoloft during that time, but as her dad stated, “it has done nothing to discourage her urge to pull.” Tina was also developing a lot of anxiety around her pulling, as she didn’t want others to know that that she was doing it. She pulled her eyebrows and eyelashes as well as the hair on her legs in addition to pulling hair out of their pet dog.

We started Tina on a very low level of amino acids, as she was a very small girl. However, as the weeks went by we continually ratcheted up her dosing, as the urge to pull was not changing. After about two months, Tina said, “I’m still pulling the hair on my legs and occasionally my eyebrows, but my eyelashes have almost completely grown back in. However, a whole lot of other things have changed. My anxiety is much better and I am not ‘tensing’ as much anymore.”

A couple weeks later, Tina’s parents were ecstatic. Tina’s mom said, “Tina is doing really well! Her eyebrows and eyelashes are mostly grown in and she’s (Tina’s) really proud they are. She will still occasionally pull when she gets really angry, but later she’ll tell us that she just did it because she was mad, not because she felt the urge to pull. In addition, she is not pulling from the dog anymore and all the dog’s bald spots are filling back in. Her anxiety is much better.”

Her dad continued, “A lot of other things have markedly improved. In softball, Tina used to be so scared of the pitch that she would continually jump away from the plate with every pitch. Now, she’s not afraid to stand in there and swing the bat. She even got hit by a pitch last week, and she got right up and got a hit the very next pitch! She also complains a lot less than she used to and is hanging out with her friends a lot more. She also seems to have a better relationship with her friends.”

“I’m 100 times better!”

I just spoke with Tina and her parents and she is continuing to do well as we work with her physician to decrease and eliminate the Zoloft. She’s already cut the dose in half with no negative changes. Tina told me, “I feel 100 times better than I did before. My eyebrows and eyelashes have completely grown back in and I’m not afraid anymore. I have gone swimming a few times with my friends and it feels great.”

Tina came to us when she was still young and hadn’t been pulling for very long. Luckily, her parents took a very active role in her care and didn’t shame or blame Tina for pulling her hair out. Tina’s case was somewhat unique in that she required much higher doses of amino acids than was originally expected. However, with patience, persistence and testing, we were able to determine the correct dosing to get Tina symptom free so she can enjoy being a kid.

Support for People With Trich

One of the things we hear most often in the clinic from people suffering from trich is that they feel very alone, very isolated and very fearful. They are usually afraid that someone will find out about their pulling and they are burdened by the stress of guilt and shame. Most of the time, this only adds to their stress levels, which causes anxiety and an increased need to pull. Obviously, in order to stop pulling their hair out, they need to break this vicious cycle.

Many people find relief in some form of counseling. As we’ve mentioned in several other posts, cognitive behavioral therapy (CBT) works especially well for some people with trich. For many people, simply telling their story and how trich has affected their lives allows them to release a HUGE burden – for this, support groups are wonderful.

If you live in a large city, you may be able to find a local support group where you can go in person. Here is a great resource to see if there is a support group in your area: http://www.trich.org/treatment/support-groups.html.

Going to an actual group can be a big stretch for many people and/or they don’t have the luxury of having a local support group, so online support groups can play a vital role. There are many support groups out there, so find one that works for you. Here are a couple to get you started:

http://trichotillomania.supportgroups.com/

http://www.dailystrength.org/c/Trichotillomania-Hair-Pulling/support-group

http://www.mdjunction.com/trichotillomania-ttm

http://health.groups.yahoo.com/group/TLCTrichSupport/

Check some of these out, read some of the posts and get involved to your comfort level. There are a LOT of people out there that know exactly what you are going through and just connecting with them may help ease some of your pain. It certainly won’t hurt.

There is a great quote that I have posted in my office – “True understanding is found through compassion.” Nowhere is this more true than with trich. Reach out and let yourself be supported.

Treatments for Trichotillomania – What Works and What Doesn’t

A search of the internet for ‘treatments of trichotillomania’ brings back over 335,000 results. This can make the search for a viable treatment option very difficult, if not downright impossible.  However, upon closer investigation, you will find that there are really only a few treatments for trichotillomania that have any scientific evidence behind them, although even within this select group of therapies, results are highly individualized.

Treatments for Trichotillomania

Cognitive Behavioral Therapy (CBT): Cognitive behavior therapy attempts to alter behavior by identifying environmental factors that trigger hair pulling and then helping a person learn skills to interrupt and redirect their responses to those triggers. Used over time, the new behavior replaces the old (i.e., pulling). CBT should be performed by a therapist trained in this method, ideally with experience in the treatment of trichotillomania. Certain methods of CBT such as Habit-Reversal Training and the Comprehensive Model for Behavioral Treatment of Trichotillomania have shown to be the most successful CBT treatments for trichotillomania, so be sure to ask your provider if they use or have been trained in these therapies.

Medications: many medications have been tried as a treatment for trichotillomania. Unfortunately, the results have been disappointing (see other posts on this site for more information on drug treatments for trichotillomania). That said, some people do benefit from drug therapies, either alone or in conjunction with cognitive-behavior therapy or amino acid therapy. The effect, however, is almost always temporary because drug therapies cannot address the underlying cause of trichotillomania in most people. In addition, the use of medications for the treatment of trichotillomania in children or adolescents brings additional concerns. Very few drug trials involve children and to date there have been no studies of the use of medication for the treatment of trichotillomania in children.  Due to the limited evidence supporting these medications effectiveness, as well as concerns about the long-term effects of medications on the developing brain, several groups, including the Trichotillomania Learning Center’s Scientific Advisory Board have advised that “for most children and adolescents with trichotillomania, medications should not be used as a treatment of first choice.”

Amino acid therapy: Amino acid therapy involves providing the body the nutrients it needs to optimize neurotransmitter balance in the body. One of the main underlying causes of trichotillomania for many people is an imbalance in one or more neurotransmitters. The ONLY way to correct this for the long term is to supply the body the amino acids and co-factors it needs to restore proper neurotransmitter balance, which will eliminate the urge to pull, allowing you to stop pulling.  Once the urge to pull is gone, other therapies, like Cognitive Behavior Therapy are much more effective as a treatment for trichotillomania in order to address any remaining behavioral and/or habitual triggers to pull.

It can be a confusing and frustrating experience for people searching for treatments for trichotillomania. However, after looking at the scientific and clinical evidence, only two have shown reproducible results – cognitive behavioral therapy and amino acid therapy – for people with trichotillomania.

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’.

Stephanie’s Story

We just did a post on Stephanie’s story with trich and how amino acid therapy helped her ‘beat trich’ in her words. I wanted to follow up with a couple points regarding Stephanie’s story to point out a few things that we see often when working with people with trich.

First, many people see results in just a month or two, just as Stephanie did. In fact, about 80% of people can completely eliminate the urge to pull in that time frame. For those 20% that don’t, additional testing is used to help them eliminate the urge to pull.

Second, once we find the right dose of amino acids that a person needs, they need to take them about 6-9 months before we can start tapering the dose without the recurrence of symptoms. If a person misses a dose or multiple doses, the urge to pull will often return within a few days and will persist until a person gets back on the recommended supplements for about 3-5 days. This means that the person continues to need the amino acids to eliminate the urge to pull.

Third, eliminating the urge to pull does not mean that a person automatically stops pulling. We’ve talked in other posts about the difference between the urge to pull (the compulsion) and the behavior of pulling. Once the urge is gone, a person can still find themselves pulling when they get triggered by certain events (the most common one is stress). When this happens, they may find their hands playing with or pulling their hair before they even realize what is happening. The difference is that once they become conscious of it, a person on the proper dose of amino acids and stop pulling and not think about it anymore. This is where other therapies, such as stress reduction, exercise and Cognitive Behavioral therapies can be a big help.

Fourth, exercise, lifestyle and dietary recommendations can often decrease the need for amino acids. If a person addresses the day-to-day reasons for neurotransmitter imbalance, they can often substantially reduce the amount of amino acids they need over time to eliminate the urge to pull.

And finally, just like Stephanie, many people can reduce and eliminate the need for the amino acids and still have no urge to pull. Most of the time, these people have taken the amino acids as recommended for at least 6-9 months and have incorporated other strategies to help deal with the behavioral and environmental component of pulling (we help guide them through this process as well). This provides them the life skills that they need to function as they want to without the need for the amino acids. This doesn’t always happen, but it happens a great deal of the time, and it’s so wonderful to see the confidence, the pride and the relief in the people that ‘beat trich’ as Stephanie did.

Image: scottchan / FreeDigitalPhotos.net

Urge, Drug, and Supplement Free!

The following is a compelling story from one of our clients:

“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

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.

Resources For Those With Trichotillomania

I was asked by a recent client about what resources were available for those that wanted to find out more about trichotillomania. The woman sitting across from me was bewildered with all the information on the internet in regards to trich and wanted my help to try and sort through it. Here are some great places to get you started if you need a reference point to learn more about trich, if you or someone you love has the disorder and what you can do about it.

General Information

WebMD: http://www.webmd.com/anxiety-panic/guide/trichotillomania

Trichotillomania Learning Center: http://www.trich.org/

Tests for Trich

http://www.pamguide.com.au/anxiety/ttm_test.php – provides an easy self-test

http://www.ocdla.com/trichotillomania-hair-pulling-test.html – provides a more in-depth questionnaire, but you have to send your information out to get results from them

Treatments/Therapies for Trich

Neurotransmitter Function: http://www.neuroassist.com/trichotillomania-treatments.htm and http://stoppullinghairout.com/blog/

Cognitive Behavioral Therapy: http://www.trich.org/treatment/options-cognitive.html

Amino Acid Therapy and Safety

The following is a side effect profile developed from approximately 50 patient-years of data based treatment in hand at NeuroResearch Clinics, Inc. The following results were obtained from patients taking only amino acids with no prescription drugs:

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.