There's more to our bad moods than just "waking up on the wrong side of the bed."
From her own journey with crippling anxiety, Trudy has cultivated a passion for helping others overcome their own mood and mental health challenges.
Today in Part 1, Trudy takes us through the core neurotransmitters that influence our mood and behaviour and how to recognise the patient presentation when they're out of balance. Trudy shares her clinical experiences with implementing dietary interventions and targeted nutraceuticals as part of a personalised medicine approach to mood disorders.
Covered in today's episode
[00:52] Introducing Trudy Scott
[03:29] Trudy's journey into nutrition
[14:44] Understanding and assessing neurotransmitters
[24:25] Research on nutrients and neurotransmitters
[26:16] Functional pathology
[28:30] Cravings and neurotransmitters
[31:22] Using GABA clinically
[36:56] True effect or placebo?
[41:08] The role of neurotransmitters and sleep
[43:22] The role of minerals in neurotransmitter pathways
[48:36] Cautions to be aware of
[51:45] Inviting Trudy back for Part 2
Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. And joining me in the studio today, I was going to say all the way from America… from when she... You've moved, but you've now moved to Australia, Trudy. So welcome to Australia, first of all. But let me introduce you to our listeners.
Trudy Scott is the food mood expert. She's a certified nutritionist on a mission to educate and empower anxious individuals worldwide about natural solutions for anxiety, stress, and emotional eating. And she serves as a catalyst in bringing about life-enhancing transformations that start with the healing powers of eating real, whole food, using individually-targeted supplementation, and making simple lifestyle changes.
She works primarily with women, but the information she offers works equally well for men and children. Trudy also presents nationally to nutrition and mental health professionals on food and mood, sharing all the recent research and how-to steps, so they too can educate and empower their clients and patients. She's past president of the National Association of Nutritional Professionals. She was a recipient of the 2012 Impact Award, and served as special advisor to the board of directors for many years.
Trudy is a member of the Alliance for Addiction Solutions and Anxiety and Depression Association of America. She was a nominee for the 2015 Scattergood Innovation Award, and is a faculty advisor at Hawthorn University. Trudy is the author of "The Anti-anxiety Food Solution: How the Food You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings."
And I would warmly welcome you to FX Medicine in our studio and in Australia. Trudy, thank you.
Trudy: Thank you, Andrew, for having me. I'm really excited to be here to talk about anxiety today.
Andrew: Yeah. So we're going to be discussing neurotransmitters and anxiety. And I've got to say, we met you through Dr Maya Shetreat-Klein, who's just a lovely lady, who has a different way of looking at dirt. As a healthy thing that we've just forgotten, that it's not this horrible germ-laden thing that we need to avoid, but something that we need to… not be mucky, but be not paranoid about. And so, you know, I've got to thank Dr Maya Shetreat-Klein for introducing you to us.
Before we go into neurotransmitters, I'd like to get a little bit of a background because you've come from America, but you have a definite South African accent. Take me through this. So were you a certified nutritionist in South Africa or did you gain that in America?
Trudy: I gained that in America. So in South Africa, I was working in computers and that's how I went to America. Actually, I met my husband on a rock face, and we had this big plan to go to America and climb. And so we were going to work and then climb for a year. So we did that. We went to America, I went as a computer programmer, and we saved up, and then we hit the road. We bought an old Chevy camper van and we spent a year on the road, rock climbing.
Trudy: Climbing in Zion National Park, spending the night on a porter ledge. We did ice climbing, so we did the whole thing. So I would always consider myself an adventurous type of outdoorsy person. I've traveled through Europe. I've actually traveled through Australia, you know, in my early 20s. And so I'm an adventurous kind of person. We went to America to have this adventure, and I was working in computers, working, you know, once we finished the trip, we did another three-month trip, and then a few years later, another three-month trip. So this was our kind of our lifestyle.
But in my late 30s, still working in corporate America, I started to get increasingly anxious. And it's, you know, where did this come from? I'm an adventurous person. Why am I anxious? Why am I feeling social anxiety? And then I started to get panic attacks, and it was terrifying. I had no idea where they were coming from. The first one I had, I had no idea what it was, you know, I thought I was dying. I couldn't breathe, my heart was racing, my skin was clammy, you know, "I've got to get some oxygen. I've got to get some oxygen." I had no idea what it was.
And long story short, I… Growing up in South Africa, we didn't go to the doctor a lot. We ate real, whole foods. So I didn't even think of medication, and I worked with a nurse practitioner and a naturopath, and started to put together all of these puzzle pieces that were contributing to my anxiety. Stress was a huge thing, gluten sensitivity, adrenal fatigue, heavy metals. I discovered I had this genetic condition called pyroluria, which was causing the social anxiety.
And working with these practitioners and starting to delve into this, I started to figure out that it was my diet, and it was nutritional deficiencies, and brain chemical imbalances that were causing my anxiety. And once I started to address that, the anxiety went away. And I just thought, "Wow, this is incredible." Some of the anxiety went away, not all of it. It took a number of years to get all the answers.
But this naturopath that I was working with, she said, "You know, why don't you go back to naturopathy school." I said, "I'm really interested in nutrition. What about nutrition school?" So I went to nutrition school to become a nutritionist to learn about it for myself. Once I learned about this, I just thought, "Wow, this is incredible." And then I started finding out that more and more women were going through what I went through: late 30s, going into perimenopause, all of these hormonal changes, increasingly getting anxious, panic attacks. And I started to think, "Well, this is what I need to do. I need to help other women who are going through what I went through."
And slowly but surely, I've become an expert in this area, and now I get to help other people, other women find this powerful connection between what we put in our mouths and how we feel. And it's so rewarding and so powerful.
Andrew: A couple of questions there, one that really piqued with me there is, in South Africa, you don't see medical practitioners often, why?
Trudy: No, we do. So there's the same medical, you know, doctors...
Trudy: … offerings there, less so in the naturopathy world, and certainly less so in terms of nutritionists. But I just grew up... You know, my mum wasn't a big fan of medication and drugs. So I didn't think of...
Andrew: So you were well versed in the naturopathic paradigms, if you like. You were quite open to it.
Trudy: I was and Adelle Davis was an author that I read a lot, you know, she was one of the first authors that I read and was really interested in the work that she did. So yeah, I just sort of didn't go to meds first. I thought, "I've got to think of another reason why this could be happening."
And I think I've got a very curious mind, I always have had a very curious mind, and I've always been open to possibilities and learning, and that's the direction I went.
At one stage, when I did, you know, go to the doctor when I was working in computers, and I actually had this terrible cotton-wool brain. I thought, "I can't do my work anymore." And I went to the doctor and I said, "I think, you know, maybe have I got a brain tumor?" They did a brain scan, nothing going on. And they actually offered me antidepressants and I said, "No."
Andrew: It's the only box.
Trudy: I don't, you know, this is not the problem. I need to find out... At that time, I didn't know there was a term called "what the root cause is." But that's what I intuitively knew. I needed to figure out what was the trigger.
Andrew: So you're one of these searchers?
Andrew: I think it's an interesting divide. Like, I was a…I'm a turncoat. I used to hate, you know, vitamins. I used to lambaste them.
Trudy: Oh, really?
Andrew: Oh, yeah. I was shocker. And I mean that. I actually had to apologise to a friend whose mum was a naturopath. I… cap in hand, went back later, I said, "I am so sorry for being so mean." And I was mean. I was, yeah, like a bully.
But what I think is interesting is though you've become an expert because you yourself has suffered that issue. I think it's really interesting how there are these practitioners who have become an expert, and have really delved further than what most practitioners would, because it's affected them. And they know why it's bad, how it's bad, how it affects you.
Whereas, a professional, a health professional, and I'm going to just pick on them. Let's say a GP who has never suffered a psychiatric disorder, but has studied psychiatry, and K-N-O-W-S, knows every term, every leaf of every book of the textbooks and the DSM, whatever it's up to now. They know that professionally, but they don't know it intrinsically how it affects you. And it's a...sometimes can be such a real disconnect. Like, how do they really know how it affects you? And so therefore they just offer you a pill, rather than looking into these lifestyle factors. And this is one of these frustrations with me.
Do you speak to these people that are in that box and say, "Hey, listen guys you need to open your minds a little bit?" And how do they respond?
Trudy: Well, there definitely are some of them like you who are turncoats, and that's one of my missions is helping some of the psychiatrists, psychologists, doctors become turncoats. Because most people who have anxiety are not going to seek out a nutritionist. They are going to go to a psychologist, or they're going to go to a psychiatrist, or their doctor, their GP. So if I can get them to become turncoats, then I'm, you know, I'm furthering my mission. Because then they will then help their people and direct them to nutrition. So that's definitely one thing that I would like to do.
There are some who are not interested at all. But it's very encouraging to see that, you know, the feedback that I am getting from practitioners, because there are so many of them who are now open to this. And I think a lot of them are realizing that what they're doing is not working, you know, you can only give someone six or seven different SSRIs or, you know, take this benzodiazepine and they're just not getting results to start thinking, "Well, maybe there's something else that need to be doing." And those are the…you know, we welcome those 'turncoats' in and say, "Yes, you know, this is... You've got to be open to it."
Andrew: I think it's thankfully reached that age that finally we're seeing more and more papers coming out that CBT, cognitive behavior therapy, and mindfulness have been shown to be as good as, if not better, than some of these pharmaceutical medication interventions for psychiatric, call them a disorder. So finally, we're sort of having to open up because people just aren't getting the results from the medicines. They've got a high rate of dropout because they don't like the side effects.
But it's important, I think, you know, we can look at behavior but there's been some really good research, like from people, like Professor Felice Jacka down in Melbourne that are looking at nutrition and mood disorders and showing a definite improvement from a research perspective. You're now taking this to the people and the practitioners and saying, "This is how you do it." Yeah?
Trudy: Exactly, and I'm glad you mentioned Professor Felice Jacka, she's one of my heroes. I actually got to meet her in December of last year here in Sydney at an event. And the research that she's doing is just groundbreaking.
Andrew: Oh, absolutely.
Trudy: And the latest study that just came out at the end of January this year was the first study, diet depression study. And they found a strong correlation between diet and improved mood. Now, I would feel, you know, I'd like to just say that they... I feel that there's some limitations to the study, because all it was looking at was, and I shouldn't say all, it's a powerful change, but they were looking at people going from a junk food...
Andrew: Crap diet.
Trudy: ... crap diet, to a real foods diet. And it did include gluten. They did mention low-fat dairy, which I'm not a proponent of, and they do talk about, you know, thinking about lean meats, and they didn't talk about quality of food. So these are all things that, I would say, taking it to the next level. We want to be eating organic, pesticide free...
Andrew: That's the next $3 million study.
Trudy: It is and that she's getting there, you know, this was the sort of ground-level study which I think is great. She actually reached out as part of the ISNPR; International Society of Nutritional Psychiatry Research, asking for people to be interviewed for the media. And I didn't have anyone in my community who could say they went from junk food to real food because they were taking it to the next level. They've got rid of gluten, they've, you know, eating organic. But I did get a lot of feedback from people in my community who have been eating a paleo diet, caveman-type diet, and have seen tremendous improvements. You know, off medications, no longer have a bipolar diagnosis, no longer have anxiety and depression.
So I think we're heading in the right direction. And just the fact that we've got research showing this connection is so powerful.
Andrew: You piqued something there. I have to ask it. Are you saying, "no longer have a bipolar diagnosis from a psychiatrist?"
Trudy: That's what this women said.
Andrew: That's a powerful thing. That's, you know, I don't know how you get undiagnosed from bipolar, wow. That's certainly controlled but...
Trudy: I've seen a lot of people with bipolar-type symptoms get on a gluten-free diet, and those swings go away.
Andrew: Their symptoms disappear.
Trudy: Yeah, very powerful.
Andrew: So, let's talk about neurotransmitters because there are so many. The age-old issue is measurement. And so the pharmaceutical thing has been, "Try this, because we've got no way of looking at what's happening in your brain. So we'll just give you something that acts on it and see if it works." Talk to our listeners, help us understand neurotransmitter assessment, what they are, what they do?
Trudy: So they're these brain chemicals that affect how we feel emotionally. And the one that we know most about is serotonin because of SSRIs. And you're right. The thinking is you've got low serotonin and therefore take this SSRI and let's see if your mood improves, the anxiety and the depression.
There are others that we can consider. GABA is another one, gamma-Aminobutyric acid, which is one of the calming neurotransmitters. Serotonin is also actually calming. We know it more being beneficial for depression, but it's also helpful for calming. With the low serotonin symptoms, we have the worry in the head, the ruminating thoughts, the reprocessing kind of anxiety. Whereas with low GABA anxiety, it's physical tension. We can feel it in our gut. We might feel this tension in our shoulders. So that's the difference between the low GABA versus the low serotonin type of anxiety.
And there are targeted individual amino acids that can be used to raise these levels. And you asked about assessment. How do we determine if someone is low? The way that I have found to be the most effective is a questionnaire.
Trudy: And then a trial. So do the questionnaire for low serotonin, and I'll go through some of those symptoms. And then, do the question for low GABA, and then try one of these amino acids. And the dosing is very different, depending on each person. But there is a guideline, you know, a baseline that we would start with.
So with low serotonin you would fill in this questionnaire, and rate your symptoms on a scale of 1 to 10. Do you have the worry? Do you have the ruminating thoughts? Do you second-guess yourself? Do you have negative self-talk? Do you feel depressed? Do you have the winter blues? Do you have PMS? Do you suffer from insomnia? Do you have the afternoon and evening cravings? Do you have TMJ, rage issues, anger issues?
So rate all your symptoms on a scale of 1 to 10. And then what you will do is say, "Okay, it looks like I've got a lot of low serotonin symptoms. Let's do a trial of one of the amino acids." Now for low serotonin, we can use either tryptophan or we can use 5-HTP. I tend to go to tryptophan first. I have amazing results with tryptophan, but some people do better on 5-HTP.
Trudy: The concern with 5-HTP is, there is one study that shows that it can raise cortisol levels. So if we know from a saliva test that someone has high cortisol, then we would definitely wanna consider tryptophan first.
So the starting dose for tryptophan is 500 milligrams, twice a day, mid-afternoon, and evening. And what I have a client do in the office, or if I'm working with them over the phone, is pick two or three of the symptoms from the questionnaire and say, "We're going to do a trial right now and see how you respond." Because if you take these amino acids sublingually, you can get feedback within five minutes. You will start to notice something.
Andrew: Our problem in Australia is because of a manufacturing issue, many decades ago now, three decades ago now, where they used a bacteria instead of a yeast. I think that was it. The bacteria caused a toxin, a toxic by-product. It was not the tryptophan that caused the problem, but there was, I think, there was three deaths, and it was because of the toxin from the bacteria. However, tryptophan got banned. As is always the case, certainly in Australia, and so tryptophan is not allowed in tableted doses. I think it's above 25 milligrams, but you can get powdered formulations for what's called extemporaneous dispensing and you can use those.
I have to ask though, before we go on, with those questionnaires, with those symptom questionnaires that you've got, how do we know that they relate to only serotonin? Who's vetted those questions?
Trudy: So these questions are based on the work of Julia Ross, she's the author of The Mood Cure, and she's a pioneer in the use of the amino acids and a mentor of mine. I actually spent two years working in a clinic with her. And she's been using these questionnaires for 20 years, and I've modified them, tweaked them according to feedback that I've had from clients.
And there's research for each of these questions showing that, for example, PMS is related to low serotonin. There's also research... Now there's less research on the amino acids than we would like. But there's, for example, is a wonderful study looking at tryptophan being used in the second half of a woman's cycle to help with PMS-type symptoms. So we've got research supporting…
Andrew: PMS-A, PMS anxiety type symptoms?
Andrew: Yeah, yep.
Trudy: So we've got research supporting those sorts of correlations.
Andrew: Right. Because our age-old problem has been how do you actually measure without doing a lumbar puncture, which would be devastating for many people. But with it, you know, there's no direct correlation… there's no direct gold standard measure of what is actually happening with that neurotransmitter within the brain, indeed within the certain cortexes. And the only sort of way that I can think of measuring it would be looking at active MRI imaging?
Trudy: Yes, they do, there is some research looking at that. But that's obviously not something that could be done in a practice.
Andrew: No that would be a specialist…
Trudy: But there is platelet testing available in the U.S. I don't know if that's available here in Australia?
Trudy: And there's… with platelets, you can measure the serotonin and you can measure the catecholamines. And there has been correlation with those and the questionnaire as well.
Andrew: Right, Gotcha, okay.
Trudy: And I just wanted to mention something about tryptophan, because you talked about quality. I have only ever used the Lidtke brand of tryptophan, L-I-D-T-K-E. Because of this possible quality issue. And I've had a number of clients who've used other brands of tryptophan and then seen some benefits and then worked with me and we've switched them to this Lidtke brand, and their symptoms have improved dramatically. And I actually had one client use a brand, and they actually had some side-effects from it. So I think quality's a really important issues, so I'm glad you brought that up. And using something that we know is good quality is really important.
Andrew: Oh absolutely, and then, I've got to say, this is, you know, despite their faults, which are many, their inherent faults. But the TGA really is the world envy in the quality manufacture of supplements. And this is something that frustrates the hell out of me, when you get people who continually, no offence to the U.S, but they continually quote quality issues that are based in the U.S and put it out on an Australian TV program, as if it's got to do with Australian supplements. That is a lie, and they should know that. So there's only two answers for that, they're either dumb, or mischievous. So, they can take their pick which that one is.
So, regarding tryptophan, you said 500mg BD? The old thing that I remember learning was that tryptophan, you needed an insulin spike to help its absorption, is that true?
Trudy: That can definitely help. So taking it with a little piece of fruit can be beneficial. Now, when I'm doing the trial, I'll have someone open up the capsule and put it on their tongue. So you could mix it with a little bit of banana. And the capsule, the powdered tryptophan doesn't taste very pleasant, so that's a way to try and change that taste.
Andrew: To mask it.
Trudy: And then it does definitely help. And so they'll, say for example, while we're doing the trial, they'll say, "I'm feeling worried, I've been thinking about my daughter, or I've been having this conversation with someone at work, and I can't stop thinking about it, and I'm really craving some cookies right now." And we'll have them do the trial with the 500mg, there and then. And I'm saying to them, "I want to see how much your symptoms improve? Did they reduce by one notch, two notches, three notches?" And within five minutes, I'm looking for an answer. This is how quickly they work, because they're getting through the blood vessels in the mouth and then into the brain.
And often I'll have someone say to me, "Could that really be working this quickly, you know?" And they're starting to smile and they're looking relaxed, and I'll say, "Well, what about that condition that you were thinking about? Or that argument that you were having with someone that you were worrying about?" "Oh, it's just gone out of my head. I'm not even thinking about it." "And how about that cookie that you were craving?" "No, it's definitely... I don't... I'm not really thinking about it."
So you'll get results that quickly, and that'll gauge how much someone might need to use. So over the course of the next week, then I'll have them do 500 milligrams twice a day, if they saw quite a substantial improvement during the trial. If not, then I'll say, "You could try two in the afternoon and two in the evening."
Now there are some people who I call "pixie dust people", and they are super sensitive. And 500 milligrams is way too much. And in that case, if they have indicated on the intake form that they are affected by medications or they've been very sensitive to supplements in the past, we'll just open up the capsule and I'll have them do a dab and just put that dab on their tongue, and that can be enough. So it is very individualized.
Andrew: Has anybody like, you know, let's say Ben Lynch, Amy Yasko. Has anybody been looking at this from a research perspective? Because that's a pharmacological response, that's a quick response. I would hope that it would be pretty easy to pick up placebo. I'm not a researcher. I'd leave that to the researchers. Has anybody done this? Is anybody looking at this?
Trudy: Using them sublingually to show an immediate…? No. But that's on my list to do is to try and get something published.
Andrew: That's something that needs...
Trudy: And there's actually some good research coming out on GABA. Certainly, there's a researcher in Italy that I'm corresponding with that I'm hoping we can get something going. And then there's an addiction mood clinic in Canada that actually had a very interesting paper come out. I don't know if it's been published but it was certainly presented at a conference. And this was looking at postpartum depression, and they had them use tryptophan and tyrosine five days postpartum, and saw a huge improvement right away. Whether or not that was done sublingually or not, I'm not sure. But there is definitely more interest in this area and new research coming out which is exciting.
Andrew: Yeah. And I've got to say, you know, like I'm already jumping the gun. Because pyroluria is something that I feel very ignorant about, suspicious of, a little bit. I think people are sort of saying everything's pyroluria where it's not. But I'd certainly think there's this real issue with certain population, that they need help with. I think what happens though is we need people to be more expert in saying, "That's the pyroluria, not this massive envelope, but that subset." So it'd be interesting, I think, for people to read your book, and to learn about how they can target that more specifically, that area of true need.
But what about… You talk about assessment. So questionnaires. In Australia, we have the functional pathology labs, and they look at metabolites of neurotransmitters in the urine, maybe, possibly in the blood. Maybe that's some of the platelets that they're looking at? But what about the urine analysis do you find that correlative?
Trudy: There are some markers on organic acid testing that can be used in conjunction with questionnaires. There's also, you know, I'm looking at things like low zinc levels, because zinc is one of cofactors to make the neurotransmitters. Iron as a cofactor. So looking at those nutrient levels together with something like vitamin B6, which is one of the, you know, one of the things that we look at certainly with pyroluria, which is a very common issue that I see with large majority of my clients. It's interesting that you say so many people are lumping, you know, everything into that bucket. But it is something that I see very common. And when you think of how common… I've seen this correlation between pyroluria, which is a social anxiety condition, and introversion, about 50% of the population would be able to say, "I'm an introvert." And a lot of those people, I believe, it's not a personality thing, it's a biochemical imbalance. And when you address that with a pyroluria protocol, a lot of them say, "I no longer feel like I'm an introvert." I certainly can say that.
So is it personality? Yes, some of it…
Andrew: Amy Yasko says that too.
Trudy: But is it a biochemical?
Andrew: Well, I will remember in my most orthodox of nursing training, Robin Holden, our psychiatric nursing lecturer, stated I always remember this, "It is only a matter of time before it will be deemed that all psychiatric disease will be of a biochemical nature." That was a…
Andrew: That's a quote word-for-word. It is indeled in my brain. I'll always remember that lecture, and she was amazing lady, I think she's in the University of Tasmania now or something.
Trudy: I want to to meet this woman.
Andrew: Yeah. She was a lovely lady, lovely, helped me through quite a lot.
But so just getting back to those cravings that you mentioned, I also remember Dr Robert Buist teaching me about the various types of cravings that people would have, and that was…had some indication with regards to the potential imbalance of the neurotransmitter. One was serotonin, one was tryptophan, one was carbohydrate, the other one was protein. Now that was decades ago. How's that correlation of cravings evolved? What do we see now?
Trudy: So with each of these different areas of brain chemical or neurotransmitter imbalances that I look at, there's an associated craving. So I'll say to my clients, "What is your drug of choice? Is it sugar, is it bread, is it, maybe, it's a pain medication? It's something that makes you feel good. Is it a street drug? Is it caffeine, is it chocolate?" You know, it can be anything, "And then think about how you feel before you need it, and then how do you feel afterwards?"
So if we look at the five different areas of brain chemical imbalances that I look at, we've got low serotonin. In that case, it's a craving for carbohydrate and it tends to be often in an evening because our serotonin takes a dip at that time. If it's a low GABA, which is physical anxiety, then it's a stress eating, maybe you eat... you drink a glass of wine, that's your drug of choice, and it relaxes you. Then there's also the low catecholamines, and in this case, it's often coffee. You're craving something to give you stimulation, you're craving something for focus and for energy. Some people may go for candy to give them that sugar.
Then we've got the low endorphins cravings, and with that it's the craving for comfort, reward, treat, "I deserve it, I love chocolate chip cookies, I love a bowl of ice cream." That's low endorphins. And for each of these in us, there's an associated amino acid that raises the brain chemical, gets rid of the mood problems, and then gets rid of the craving as well.
And then the fifth area is low blood sugar. And this is obviously adding in protein at breakfast is going to help, but then using the amino acid glutamine can completely stop those cravings in their tracks, if it's low blood sugar. And opening up a glutamine capsule or using glutamine on the tongue, will completely remove those sugar cravings.
Andrew: And glutamine versus glutamic acid?
Trudy: Glutamine, yes.
Andrew: And that's because of the size of the molecule. So glutamine changes to glutamic acid outside of the body, but you need... I better get this right… You need glutamine to cross the blood-brain barrier?
Trudy: Yes. And some of that glutamine also converts to GABA, so it can be calming as well.
Andrew: Right. Now I have a question about GABA. And that is that the small amount of research that I've read on GABA, was that, particularly to do with oral administration of GABA, was that it really didn't have an effect on brain GABA. That it worked via a gut-type mechanism for stress. And that's where my placement is, help me with this. Does it get absorbed? Does it work on the gut-brain axis? How is it working, if at all?
Trudy: It's such a great question, and it's something that is probably the question that I field the most on Facebook or on my blog or via interviews because so many people...
Andrew: It's not just me? Good.
Trudy: No, so many people will say, "It definitely, it doesn't work." Firstly, that's one of the… At least you're saying it works in a different mechanism, you know, through the gut and the gut-brain axis. But a lot of people say, "Don't even bother using it. It's not going to have an impact." And it was a lifesaver for me, personally, so I found the effects. You'll often hear people say, "It only works, and will only get through the brain if you've got a leaky blood-brain barrier."
Andrew: Uh-huh, right. Yeah.
Trudy: So..we don't have enough research to confirm that.
Andrew: How do you assess it? Yeah.
Trudy: So we just, you know, looking at old research. So as soon as I get asked questions, I start digging because I've got this curious mind. So I've been looking at a lot of the research, and there's a lot showing that we've got these GABA receptors in different parts of the body. We've got them in the endocrine system, we got them in the pancreas, we've got them in our muscles. So is it, you know, having an effect at a peripheral level, rather than getting into the brain?
There's also this Italian researcher that I mentioned, and I can't think what her name is off hand. But she's got some papers looking at, talking about the possibility that it is actually getting through the blood-brain barrier. Whether… and she doesn't mention the fact that the blood-brain barrier may be compromised. And then she also talks about the vagus nerve and the gut-brain connection. So we just don't know enough yet, but, you know, you just got to talk to people who've tried GABA and seen the effect.
Now, I will say that it seems to be most effective taken sublingually.
Andrew: Now, I'm going to answer that one. I'm going to have a stab at this. Because we think, "Oh, anatomy is anatomy." And we know what, you know, we know that we have two elbows. And we've always known that we have two elbows because we have two elbows. Well, guess what? They've only just found a sort of accessory, perhaps a pathway, or an entry pathway through the blood-brain barrier via the lymph. And how do we take these sublingual medications? Where do they get absorbed? Into the blood and into the lymph, they bypass the portal system. Hmm.
So perhaps the problem has been why GABA has not been using is because we've been doing the oral dosing. So I've got to ask you. Did you do oral dosing of GABA or sublingual dosing?
Trudy: Personally, myself?
Trudy: So my top nutrient that I use for GABA is an over-the-counter product. Can I mention the name?
Trudy: Source Naturals called GABA Calm, and the reason I use it is Julia Ross taught me that, you know, we used it in her clinic. And it's very nice. Firstly, because it is sublingual and it's a small dose. A lot of people will jump to 500 milligrams or 750 milligrams because that's what's available, certainly in America in the stores. And I mentioned earlier about some people being sensitive, 500 milligrams is often way too much for the average person.
Trudy: This Source Natural sublingual is 125 milligrams, and it's got a tiny bit of tyrosine in there, just at 25 milligrams, which counters some of the sort of relaxing effects of the GABA, so it's not too relaxing. So yes, I used sublingual GABA. And it's the one that I use with most of my clients. Now, there are some contraindications with tyrosine. Certainly, if you've got melanoma, or high blood pressure, or migraines…
Andrew: But 25 milligrams, they're, like, really…
Trudy: Usually, it's fine. Usually, it's fine. This one...
Andrew: I don't know how you're going to avoid 25 milligrams of tyrosine in your diet when you've got melanoma, you know?
Trudy: That's true. It's just a precaution, just a precaution. So if they didn't use that, I would have them do... I've got a nice product that I found that has 200 of GABA and 200 of theanine. They open that and put that on their tongue, and that's... They're getting those results right away.
Andrew: Yeah. We've got some nice extemporaneous products in Australia now. And yes, they're powders. But if one is…can be bothered, please, to measure with a good measuring device. You can buy them on Amazon. You can buy them on eBay. A nice sensitive measuring set of scales. The results that you can find by personalising your medication doses with patients can revolutionise your clinic.
Thank You, Penelope North, who taught me this. Hello, Rusty, call out to you there. She's an amazing practitioner in Brisbane. And she did extemporaneous dispensing years ago, decades ago.
Trudy: I love it. I think that's so perfect…
Andrew: She was so ahead of time.
Trudy: …because there's no one-size-fits-all for anyone. It's very individualised. And I love that my clients can try something and get the effects, and then adjust accordingly. So I'll have them keep this food-mood log, and I'll be writing down how much they used, doing one at a time so they can gauge. Is it the tryptophan that's helping? How much is it helping? And then we'll add in the GABA, and then we maybe add in the DPA, or the glutamine. But one at a time so they can gauge.
And it's so powerful for them to feel the results, and to feel empowered, and to feel in control, instead of being told, "Take this. Go away and come back in a month, and then let's see how you're feeling." They can actually adjust accordingly.
Andrew: I've got to ask the devil's advocate question here though. And that is that I'm always very cautious about, "Am I really seeing that result in my patient? Indeed, is my patient really experiencing that, or is that high placebo rate, particularly in an emotionally-charged condition?" So do you ever correlate this sort of thing?
Admittedly, these aren't medical gold standards. I get it. But at least if we started to show correlation between what we thought we're seeing is a symptom-benefit, and then measuring that with a platelet benefit. To me, that is the groundwork that needs to be done to say, "Yeah, there is actually a correlation there. That grows." And then we get a base of evidence to say, "Shove that up your jacksie. You guys really need to open up your minds, you know, what you thought was true is not true." Then we can buck the system.
Trudy: I agree, I agree. We need the research. We definitely do. And as I said earlier when someone says to me, "Could this really be working so quickly? Is it really the amino acid or is it because I'm sitting here working with someone who cares about me and helping?" And to me, if they're feeling better, that's great. But I agree, we need this research to start showing this.
And, you know, when I'm... I'll give you an example of something that really blew my mind. I mostly work with women in their late 30s, 40s, 50s. And so they can, you know, articulate, you know, "Maybe it's because you're trying to help me." But I worked with the child of a mum that I was working with, and she was a 10-year-old kid who had no idea what we were doing, and I was talking to the mum, and she had this terrible, terrible rage issue. She was actually diagnosed with reactive attachment disorder. Such bad rage issues, anger issues, explosive, so bad that, you know, her mum had to physically almost sit on her to hold her down when she was having one of these rage issues. And turned out she was anemic. She had gluten issues, and we've discovered she needed some serotonin support.
But the way I figured this out is, as I normally do it, I wanted to do a trial. She loved candies and we were... I'm talking to her and we're trying to figure out where she was on the scale of loving candies. And turned out, pretty hard, didn't want to talk to me. Sitting in the office on a swivel chair, and I said, you know, "How would you feel about giving up candies?" Didn't want to know about it. Turned her back on me, and didn't want want to hear about it.
So I continued to talk to the mum, gave more information. And I took out a 100 milligram of a chewable tryptophan, and I said to this little girl, "Would you, you know, be willing to try this? And then we'll talk a little bit more about everything else later?" So I gave her this chewable 100-milligram tryptophan. She was sitting on her own. Within five minutes, she turned her swivel chair back to me, smiling, and she said, "I think I could give up the candies," in five minutes… Now, here was a little kid who didn't know what we were doing. There was no placebo effect and that addressing the low serotonin with the tryptophan, getting her off gluten, getting some additional iron in her diet. She actually needed an iron supplement as well. This little girl was a new kid.
Andrew: Wow-wee. Wow…
Trudy: That needs to be written up, I think, in the literature because then people can start to see that kind of results that we're seeing.
Andrew: Yeah. You and I are definitely going to be podcasting again, Trudy. Now that you've moved to Australia, you won't be able to let go.
Andrew: I'll stalk you. But I think it's really interesting, practitioners start to get a bank of case histories, so that they can feel that there's a consensus, if you like, out there. That it's not just one. It's not just me. If this really is coming from sort of several reports saying, "Yes, there really is a clinical effect."
Because for me, we can all feel nice and rosy and good. It's all about the patients. And, you know, somebody with anxiety, unless you've suffered anxiety, as you know well, the feelings of doom, the feelings of death, of that incredible fear. Unless, you really know what somebody's... Unless you've walked in their shoes, you know, you really don't know what they put up with. So we really need that sort of bank of evidence to sort of make a consensus.
So talking about sleep patterns, can you take me through sleep patterns and what happens with the neurotransmitters here?
Trudy: So we can have sleep issues with some of these neurotransmitter imbalances. Certainly, low serotonin is a classic one. If you've got a client or a patient who's not able to fall asleep or waking in the early hours, that can be low serotonin, and using tryptophan at night can help. Some people need maybe one in the afternoon for the anxiety-type symptoms, and they may need 2 of the 500 milligrams at night time.
Then we could have low GABA, if they're lying awake in bed tense that could be a need for GABA and using some GABA at a higher dose at nighttime. You may be able to get away with 500 milligrams at night. Low blood sugar, also needs to be considered. If someone hasn't had a good breakfast with protein, and they've had these blood-sugar swings throughout the day, that can actually affect their blood sugar levels and wake them at night.
And then the other area that I always look at with sleep is high cortisol. Because you can have the shift in the circadian rhythm where your cortisol goes high at night, and no amount of GABA or tryptophan is going to help it, if you've got high cortisol. So you need to address that. And I like a product as it's, not phosphatidyl serine, it's a phosphorylated serine, which helps to lower that high cortisol. There's also a really nice Lactium product, which is a hydrolyzed casein, which helps to lower that high cortisol and that can help people sleep.
Andrew: Yeah. But there's this real, a real ignorance between what is dairy? What is milk? and, you know… and like for instance, whey has different actions from milk. Somebody can be sensitive to both. But just because somebody can't handle milk, or doesn't want to eat milk, doesn't necessarily that you need to avoid all milk-based products, like this alpha casein.
Andrew: Have I got that right?
Trudy: Hydrolyzed casein.
Andrew: Hydrolyzed casein. Forgive me. I've got an alpha casein as in A2 milk, forgive me, beta-casein. So I mean it's got great attributes. It's really wonderful. What about things like minerals though, and indeed herbs, beautiful herbs…
Trudy: You asked about minerals?
Andrew: Yes, about minerals… Now, the classic flagship to help you relax at night has been magnesium. I've always tried to tie that in with the nocturnal leg cramps, and indeed the ocularis muscle flickers, not always evident, seems to work. What do you use? How high do you go?
Trudy: So I think magnesium is such a common deficiency, and most people can benefit from it. The other thing is it does help relax people, and then we've got, you know, it can help with bowel issues as well. So and that's a common issue with a lot of people. I like a chelated magnesium, like a magnesium glycinate. For calming effects, magnesium threonate seems to be pretty good.
Andrew: Can't wait till this is available in Australia.
Trudy: Yeah. And then, you know, I mentioned earlier some of the cofactors like vitamin B6, and if you're doing higher doses of vitamin B6, which I find a lot of my clients do well with, you need to make sure that you've got enough magnesium on board. And then the other mineral that I really like is zinc, and that is such a common deficiency, you know, depleted by stress, and depleted by sugar, and depleted by exercise, and...
Andrew: Depleted by flour because they mill it and they lose the zinc and give you cadmium instead. Thank you very much, white flour.
Trudy: Lovely. So getting good levels of zinc is, you know, important to address as well. And we've got this zinc-copper imbalance, and if your zinc's low, obviously, you're going to have higher copper and then more anxious. And interestingly enough, I'm seeing a lot of people who on a paleo diet becoming depleted in zinc, simply because they are replacing their breads and their cookies with nut flours, baking with nut flours. And these nuts, consuming those large amounts of nuts in baked goods, means they're getting higher than they should normally be getting, and we've got this copper from the nuts. So I'm seeing a lot of people reporting that, you know, they're thinking their zinc levels are low.
Andrew: So pecan nuts were traditionally the zinc-type supplement, pecan nuts and pepitas, pumpkin seeds.
Trudy: Pumpkin seeds I like because the ratio of zinc to copper is a little bit better.
Andrew: Or get 'em on oysters.
Trudy: Yes, definitely.
Andrew: As long as they like oysters.
Trudy: Or eat grass-fed red meat, you know, that's wonderful source of zinc.
Andrew: Yes, and that's a real, actually, salient point. It must be grass-fed, otherwise there is no point.
Andrew: Yeah. So I want to talk about different forms and different ligands of minerals, because, you know, there's been this move away from the old forms of vitamins into the new, the active forms. And we've seen this in the folate metabolism, certainly. The first one off the rank was actually B6, in Australia. So it was Pyridoxal-5-Phosphate. And I remember this. To me, it was a wishy-washy term they said, "Oh it's 10 times as good." Show me that evidence. There's no evidence on that.
What I think is interesting though is that pyridoxine, pyridoxal, pyridoxamine has to be phosphorylated by the liver. So the issue with giving, perhaps, you know, the old form of pyridoxine hydrochloride to somebody that has a compromised liver function, they are the ones that might not be able to do it. I've certainly seem to have seen issues with hepatitis, chronic fatigue, lots of drugs, that sort of thing. But do you tend to use Pyridoxal-5-Phosphate and just not even use pyridoxine hydrochloride?
Trudy: So I use both. The other questionnaire that I use is the pyroluria questionnaire, and we talked a little about that.
Andrew: Yeah, so this where I was going.
Trudy: So everyone will do that. And most of my clients seem to have a need for vitamin B6, and the classic clue that it might be low B6 is that poor dream recall. So they're not remembering their dreams. And there's only one study on that one and it's a little bit of iffy study. So we definitely need some more research in that area.
But that a lot of people do well with just regular pyridoxine, and starting at 100 milligrams, going up to 500 milligrams. If we're not getting results there, and that would be the dream recall should be coming back. It's helping to make GABA, it's helping to make serotonin so they should start to feel some of that calming effects. And it helps with the social anxiety, big time, together with the zinc.
Then I'll switch them over to the P5P. If they've used B6 in the past, the regular pyridoxine, then we'll just go straight to the P5P. And that some people do well with a combination, a little bit of each. So I think it is very individualised. And, you know, cost is a factor, the P5P is more expensive than the B6.
Andrew: It's the new kid on the block.
Trudy: So if someone can get the same benefits with a more affordable product, and then use that money somewhere else, that's what I'm also thinking about as well.
Andrew: Perhaps, for good fresh food?
Andrew: I did want raise a red flag, and only, basically, to destroy a myth. I see a lot of practitioners being extremely paranoid about high doses of B6 because of an extremely rare, and I mean extremely rare, problem with it and that's the peripheral neuropathy. I then have to think about interactions, but it seems to occur extremely rarely. I haven't done that search on the DAEN, I think I will. But I've only noted it like once or twice in research papers. Do you ever see it?
Trudy: I have not seen it. I've had a few clients who've said they've got an inkling of it, and then we've just cut back and it's completely gone away. So I am cautioning them about that. And...
Andrew: Do you ever think… Sorry to interrupt, but do you ever maybe augment with B12, which can actually help in paresthesia?
Trudy: Yes, definitely, so that would be something else I'll be looking at as low B12, and a lot of people, you know, we'll do blood work. In that case, I look at B12, methylmalonic acid and homocysteine in conjunction with symptoms on a questionnaire. And then also some of the genetic markers as well.
Trudy: But, yes, so that would definitely be something that you want to do. And I'm glad you brought it up because a lot of practitioners are very cautious about higher doses of vitamin B6. And...
Andrew: I've never seen an issue.
Trudy: But I must admit there are some people in... There's a group, a Facebook group for people with Ehlers-Danlos Syndrome. And there have been some questions about a few people having some effects from high levels of vitamin B6, and it may be just the subset of people. And I actually did a blog post on showing this connection between pyroluria and Ehlers-Danlos syndrome. And a lot of people who get on the pyroluria protocol have noticed that their symptoms improve when they're on the pyroluria protocol.
So it's pretty interesting, the connections that we're seeing with pyroluria and some of these other conditions like Ehlers-Danlos, like dystonia. There's a condition called Alice in Wonderland syndrome, where people see everyone around them as tiny, little, you know, little Alice in Wonderland creatures.
Andrew: How cool… I don't mean to trivialize that.
Trudy: And pyroluria protocol has helped.
Trudy: So it's very interesting that there's these correlations with some of these other conditions. A little bit of a tangent there, but I thought it was quite fun.
Andrew: Well, it's actually important to know about these very rare things, and to know that they're rare. Like for instance, who would think of worrying about vitamin C just because somebody had G6PD deficiency? You know, high doses of vitamin C can actually send them into a cascade. So who would worry about that? These people have normally found out, through some other avenue, I think though it's worthwhile, due to your expertise, to note these, so the people can go, "Red flag. I remember that." So that they can make appropriate adjustments to their therapy, so it's actually great to know.
Trudy, I thought this was going to be a rather simple podcast, and speaking to you and knowing about now some of your expertise to the point where you look at even ligands, and how much, and dosages, and not just dosing frequency, but dosing timing. There's so much more to cover. There is so much more to cover. Would you be amenable to join us back on FX Medicine at another time, and we can look at some other areas?
Trudy: I would love that.
Andrew: Because we've covered on, you know, we've covered off on serotonin, we've covered off on GABA. I think there's some more to cover off with GABA. I want to also get into things like histamine. I also want to get into things like, what happens with other mood disorders, not just anxiety? So would you be amenable to join us on a second podcast to cover off these subjects and more?
Trudy: I would love it. I've thoroughly enjoyed today and I would love to continue.
Andrew: Absolutely, true. I've got to say it's like, seriously, I could make this into an hour, you know, three-hour podcast but I don't think our listeners have that much time. So we will invite you back and we will continue with part 2 on a second occasion. So thank you, Trudy Scott, for joining us in the studio today on FX Medicine.
Trudy: Thanks, Andrew, for having me.
Andrew: This is FX Medicine and I'm Andrew Whitfield-Cook.
|Book: The Anti-Anxiety Food Solution|
|International Society for Nutritional Psychiatry Research|
|Julia Ross: The Mood Cure|
|Dr Ben Lynch|
|Dr Amy Yasko|
|Penelope North: Health Compass|
|DAEN: Database of Adverse Event Notifications|