Most people would never suspect food as a culprit with trich, but there is some good evidence pointing to the possibility that what you eat can dramatically alter your neurotransmitter balance, particularly serotonin levels. Serotonin is an important neurotransmitter that affects sleep, mood, cravings (especially for carbohydrates), migraines and a host of other functions, including the urge to pull. It has been estimated that about 95% percent of the serotonin in your body is stored in your gastrointestinal tract. Therefore, gastrointestinal function is very important in maintaining proper neurotransmitter balance.

A great many studies support the fact that intestinal permeability and enzyme deficiencies  are often found in folks suffering from depression (which is caused by imbalances of serotonin with dopamine); this is underscored by reports that depression is a very common symptom of celiac disease (which is  a condition of severe gluten intolerance). (1-8)

Here at the clinic, it is almost universal that long standing gastrointestinal imbalances, including food allergies almost always lead to or exacerbate depression as well as other conditions related to neurotransmitter imbalances, including the urge to pull, migraines, anxiety, obsessive compulsive tendencies and sleep disturbances.

Therefore, as we are working to help people correct their underlying neurotransmitter imbalances, we will often begin to investigate the many possible reasons why these imbalances are there in the first place. Looking at what someone is eating can provide major insights into eliminating the urge to pull.

We have found the most accurate food hypersensitivity test to be the Lymphocyte Response Assay from Elisa/Act Technologies. Using this test, one can run any number of foods, additives, colors, drugs, supplements, and environmental contaminants to determine which, if any, of them are causing an immune reaction with subsequent neurotransmitter disruption. Once the offending agents are determined, we then work with clients to help eliminate them so their bodies can heal while reestablishing optimal neurotransmitter levels. In doing so, many people can reduce or eliminate the need for ongoing supplementation and remain symptom free for the rest of their lives.

NOTE: If you cannot find a practitioner in your area that can run the LRA test, contact us to arrange for an in-home blood draw.

References

1. Corvaglia L, et al. Depression in adult untreated celiac subjects: diagnosis by the pediatrician. Am J Gastroenterol. 1999 Mar;94(3):839-43.
2. Ciacci C, et al. Depressive symptoms in adult coeliac disease. Scand J Gastroenterol. 1998 Mar;33(3):247-50.
3. Addolorato G, et al. Anxiety and depression in adult untreated celiac subjects and in patients affected by inflammatory bowel disease: a personality “trait” or a reactive illness? Hepatogastroenterology. 1996 Nov-Dec;43(12):1513-7.
4. Pellegrino M, et al. Untreated coeliac disease and attempted suicide. Lancet. 1995 Sep 30;346(8979):915.
5. Cheliout W. [A misleading depression]. Encephale. 1994 Sep-Oct;20(5):531-4. French.
6. Hernanz A, et al. Plasma precursor amino acids of central nervous system monoamines in children with coeliac disease. Gut. 1991 Dec;32(12):1478-81.
7. van Praag HM. Affective disorders and aggression disorders: evidence for a common biological mechanism. Suicide Life Threat Behav. 1986 Summer;16(2):103-32. Review.
8. Hallert C, et al. Psychic disturbances in adult coeliac disease. I. Clinical observations. Scand J Gastroenterol. 1982 Jan;17(1):17-9.

A quick look at the literature shows exactly that; an example:  there is a strong association between sleep disturbances and mood disorders, including depression. (1, 2) In fact, insomnia is reported by more than 90% of depressed patients. (3) This is all well and good, but how do we know that this correlation is due to neurotransmitter levels?

Research shows that in people suffering from insomnia, balancing the brain’s neurotransmitter levels can improve sleep. (4) This has led many researchers to believe that complete relief of insomnia may improve the symptoms of depression. (3) But what does this have to do with trich and the urge to pull?

Well, as we have talked about in previous articles, the urge to pull is often due to or intensified by imbalances in neurotransmitters, including serotonin and dopamine. Decreased sleep can cause, as well as be caused by, imbalances in these same neurotransmitters. This means that if a person has insomnia or purposefully does not get enough sleep over time (i.e., goes to bed late, has odd sleep habits, etc.), neurotransmitter imbalances can result. These imbalances will then lead to increased urges to pull. Incidentally, they also usually lead to increased cravings for carbohydrate or sugar-laden foods, particularly in the afternoon or evening, along with the need for stimulants of one kind or another to keep focused and alert (think coffee, soda, ‘energy’ drinks and chocolate). Unfortunately, in addition to keeping you a little more alert in the short term, these stimulants can also cause further neurotransmitter imbalances that keep you awake – and pulling.

Here are some simple things that you can do to begin lessening the effect of too little sleep on your urge to pull:

1. Get as much sleep before midnight as possible; set a time and go to bed, say at 9-10 PM. Even if you can’t go to sleep right away, do some deep breathing and/or meditation and don’t worry about it. Your body is resting and eventually sleep will come.
2. Set an alarm and get up at the same time daily, even if you don’t fall asleep well the night before. You may be in for a few rough days, but eventually, most people will begin to get into a more normal sleep cycle.
3. Make your bedroom peaceful – turn off the lights, TV, radio and anything else that may distract you or keep you engaged. Sometimes, peaceful music or sounds can help, as can ‘white-noise’ such as a fan. Earplugs often help.
4. Stop drinking liquids 2-3 hours before bed to limit the number of times you need to get up to use the bathroom
5. Keep a notebook by your bed and write down everything that is churning through your mind and make a ‘to-do’ list for the next day. If new things come to you during the night, write them down and forget about them – they’ll be waiting for you in the morning.
6. In the morning, so some exercise or yoga to help you wake up and minimize the need for stimulants. If you still need something, try green tea (Earl Grey Green Tea is a bit heavier for those die-hard coffee drinkers.)

If you have insomnia or long-standing sleep issues, these simple steps are unlikely to be of much help. In this case, a more thorough workup is often necessary and additional therapies may be needed. Luckily, we have found (as have numerous other researchers) that re-establishing optimal neurotransmitter balance can safely and effectively improve sleep over time. This, combined with giving yourself the opportunity to get enough sleep will not only have you sleeping better, it will help you eliminate your urge to pull. Small things really can make a big difference over time and sleep is KING when it comes to maintaining neurotransmitter balance.

References

1. Ohayon MM, roth T. Place of chronic insomnia in the course of depressive and anxiety disorders. J Psychiatr Res. 2003 Jan-Feb;37:9-15.
2. Germain A, Kupfer DJ. Circadian rhythm disturbances in depression. Hum Psychopharmacol. 2008 Oc;23(7):571-85.

1. Thase ME. Antidepressant treatment of the depressed patient with insomnia. J Clin Psychiatry. 1999;60 (Suppl. 17):28-31.
2. Irwin MR, Wang M, Ribeiro D. et al. Sleep loss activates cellular inflammatory signaling. Biol Psychiatry. 2008 Sep15;64(6):538-40.

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.

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.

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

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.

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’.

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