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10 Ways to Boost Your Naturally

by Peter Bongiorno, ND, LAc www.InnerSourceHealth.com www.drpeterbongiorno.com note: this paper is purely informational, and is not a substitute for medical advice.

When anxiety and depression is discussed, at some point, the word ‘serotonin’ gets into the conversation. Known in the scientific community affectionately as “5-hydroxytryptamine” (or 5-HT, as a fun nick-name), serotonin is the focal point for many and anxiety . Some biologists called this molecule enteramine (‘entera’ is a word that refers to anything pertaining to the digestive system) because it is found high levels in the digestive tract. Others researchers who found it in the blood named it serotonin (‘sero’ refers to the blood).

One of the hundreds of molecules of emotion, serotonin has a widespread distribution in the body and brain. It is considered to be a calming , and important for best sleep and balanced appetite. This is why sometimes drugs that affect serotonin can help sleep, and cause increased eating which leads to the weight gain side effect of the serotonin inhibitor (SSRI’s).

Gaining confidence and feeling like you’ve been respected by others also trigger serotonin. Maybe Rodney Dangerfield might have been low in serotonin Ð he never felt like he got any respect. Low levels will also contribute to depression, panic attacks and anxiety. When levels are too high, a person can feel agitated and irritable. 2

Happy Clams and the History of Serotonin

Interestingly, serotonin was originally discovered as the molecule which allowed the happy clam to keep it’s shell on nice and tight with minimal energy expended. Think about it Ð if the clam had to constantly flex that retractor muscle, it would never be able take in enough nutrients and calories.

Maybe serotonin is the reason the happy clam is so happy? Mmmm.

Anyway, the reason why it works to keep a muscle contracted is because serotonin creates chemical impulses that lock the muscle in place. In 1952, Dr. Betty Twarog, a newly minted PhD student (at 25 years of age) figured out this serotonin connection, and disrupted a male-dominated world that, up until that point, believed only in electrical (not chemical) impulses in the body as the causes of movement and emotion.

A few years later, it was figured out there was a connection between mood and serotonin. Tuberculosis patients were given a new at the time called isoniazid to help with their TB. What they noticed is that the drug allowed serotonin to stay at higher levels in the body. It turned out that it didn’t really help the TB, but it was noted that depressed patients became less depressed. The drug changed the body’s ability to brake down serotonin properly Ð since it was not broken down, serotonin raised up, and people seemed to feel better. Since then, modern pharmaceutical companies have scrambled to make more and more medications to increase serotonin. The monoamine oxidase inhibitors came first, then the tricyclic , then the first generation SSRI’s (like Prozac) and today we have second generation versions.

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Serotonin and the Digestive Tract

The gut is so inextricably related to good mood that someday, psychiatrists are going to to want to become competent nutritionists and holistic gastroenterologists, as they realize it is hard to fully fix imbalances in mood and serotonin without working on a healthy digestive system.

Serotonin is found in many tissues, including the blood, platelets, the intestines, and the central . About 90% of our serotonin supply is actually found in the digestive tract Ð a likely connection between mood disorder and digestive dysfunction. With this pleiotropism (a fancy word for “broad effects throughout many parts of the body”), serotonin is implicated in many physiologic effects, including inhibition of gastric secretion (stopping needed for digestion), stimulation of smooth muscles (which can lead to diarrhea when the stimulation is in your digestive tract), vasoconstriction (tightening vessels for higher blood pressure), as well as brain communication and mood effect.

The digestive tract breaks down protein (from foods like meat and nuts) into the component tryptophan. In the digestive tract, tryptophan is transformed into the neurotransmitter serotonin. When your digestion isn’t working well (often due to stress, poor diet, sleep problems, and toxins), there is a lot more inflammation in the digestive tract. And when inflammation is high, the body is much less prepared to absorb tryptophan into the brain.

A prime example of this is in patients who have celiac disease, where chronic inflammation leads to poor nutrient absorption. Additionally, irritating foods and inflammation will spur the digestive tract to send high amounts of serotonin into the digestive system as a protective mechanism, where it encourages fast movement as a means to empty out the gut.

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Did you ever get frightened and later on end up with diarrhea? This action of serotonin is a prime cause of diarrhea in people who have mood disorders, poor diet, and high stress.

The Serotonin- Light Connection

Three ways healthful exposure to sunlight can calm and balance mood are by maintaining healthy levels of serotonin, balancing your circadian rhythm, and building up your vitamin D stores. John Denver sang “Sunshine, on my shoulder, makes me happy.” While I am not sure he ran a full human research trial on this, he did seem to have a clear understanding of sunlight’s benefit on mood.

Serotonin levels are known to increase with brighter light, and not surprisingly, research sampling the vein blood of 101 men suggest serotonin levels are at their lowest in the winter. Even more, the rate serotonin is produced depends on how long a person was exposed as well as the light intensity. Other studies have also shown how serotonin transporters, which will bind up and inactivate serotonin, are more plentiful in the brain during dark periods. Darkness sends a signal to our bodies to stay ‘low.’

But, Is Serotonin Really Important?

We’ve been talking about serotonin like it's the only or most important factor in mood. Certainly, conventional biomedicine, with its use of drugs that manipulate is pretty convinced that serotonin and the are the key for proper mood. Me? I think serotonin and neurotransmitters are part of a much larger picture. And some research will suggest this as well.

In Gary Greenberg’s excellent book, Manufacturing Depression, he retells an old joke about a drunk man looking for his car keys outside the bar in the only lighted spot in a large parking lot. A cop comes up to him and says “hey man, why are 5 you only looking here, when there’s the whole parking lot to check?” The inebriated man answers “cause the light’s better here.” Greenberg goes on to explain that this joke exemplifies what we do with neurotransmitters in psychiatry. Because serotonin and neurotransmitters is the focus of research (and patented medications), this is what is focused on for treatment. And this may be a mistake - pretty strong research by Fournier in the 2010 Journal of the American Medical Association shows that with anti-depressant drugs, SSRI’s drugs may not work any better than placebo in mild and moderate cases of depression Ð the majority reason these are prescribed.

Also, research from 2009 looking at genetic differences in receptors for serotonin. Receptors are the little docking stations that serotonin binds to in order to create an effect. What they concluded was that there is “no evidence of an association between the serotonin gene and the risk of depression.” Even more confusing is research on the drug (Coaxil). This is a serotonin reuptake enhancer, which works completely opposite of SSRI’s by helping to break down serotonin at faster rates (instead of keeping it around, the way SSRI’s do). This drug has been shown to be as effective in depression and interestingly more effective than some medications at lowering anxiety. This shows you we really don’t know what’s going on Ð we do know some can drugs work for some people in the short term, but not for many others. In the long term, they can stop working anyway, and side effects are typical for most people anyway. Even more, these drugs do not fix any of the underlying issues that caused the imbalance, if indeed it is an imbalance to begin with.

Mood disorders like anxiety and depression are really just symptoms of a greater physiologic imbalance that requires adjusting lifestyle, diet, and getting in the right nutrients. To be fair to the drugs, when SSRI drugs do clearly work for an individual, then it is possible that for that person, serotonin may be more of a factor, and is worth focusing on. We can learn from the use to focus on natural ways to support serotonin and fix the underlying cause.

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How to Naturally Enhance Serotonin

In this spirit, I would like to offer a number of ways that I find helpful to enhance and balance serotonin, in order to lower anxiety and lift mood.

1 Ð Work On Relationships

Our interactions with one another is a very important part of the process of balancing the brain. It is true that we need each other. The first step is to focus on those who love and respect you. Take the time to thank them for all they do for you. Sometimes - and this is the hard part, it may also mean disconnecting with people in your life who are toxic.

Relationship with yourself, in some senses, can be measured by a sense of self- esteem. Carolyn Myss, the well-known medical intuitive, has a wonderful CD called “Self Esteem” that you may want to pick up. After decades of working with patients, she realized that self-esteem is at the root of many physical and emotional challenges.

2 Ð Women, Balance Your Hormones:

Estrogen is the body’s primary female hormone, and research shows how ups and downs in estrogen will change the levels of the feel-good neurotransmitter serotonin. Work with your naturopathic doctors to review clinical symptoms and laboratory work can help understand if this hormone is low for you. When estrogen is low, consider estrogen treatments and support to help serotonin work its best.

First, it is best to start an exercise regimen and work on sleep, as well as liver detoxification. Then, try non-hormonal support, such as herbal remedies like maca, chaste tree, soy isoflavones, and flax to gently balance estrogens. If this is not sufficient, then consideration to add small amounts of bio-identical hormone 7 might be beneficial. In addition to the estrogen, it’s always a good idea to also use some progesterone to protect the tissues in the body that may be susceptible to cancer risk (such as the breast and uterus). While natural bioidentical hormones are likely safer, the research is still not as strong as I would like. As a result, I do not prefer using any hormones unless all other natural remedies are exhausted first.

Compounding pharmacies are the best source for natural hormones, and will formulate them based on your specific needs. Natural hormones are prescribed as creams, oral suppositories, or subdermal pellets, and can include estrogen, progesterone, testosterone, and DHEA.

3 Ð Exercise:

Exercise is one of the best mood supports ever. It will help prevent and treat anxiety and depression better than any drug or supplement. Exercise is well- known to induce serotonin and balance all the neurotransmitters. Choose something that is fun for you to do, and schedule it in everyday. You will burn extra stress hormones, and build your neurotransmitter system in the process.

4 Ð Massage and Hugs:

Studies from the mid-1990s show that massage increases a profound sense of calm while lowering levels of the stress hormone cortisol by 30 percent. At the same time, it increases levels of the feel-good neurotransmitters dopamine and serotonin by about the same amount. Therapeutic touch will also increase oxytocin, another feel good hormone we will discuss in a little bit. As you work on your relationships (see #1), venture to hug people you feel comfortable with for a boost of oxytocin and serotonin. I had a teacher in naturopathic school who used to say we all need a minimum of 12 hugs a day.

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5 - Water:

Water is necessary to bring the amino acid tryptophan into the brain for it’s use as a main building block to make serotonin. You need water to make to tryptophan, and you need to make serotonin. No water Ð no serotonin.

My recommendation is to drink a large glass of water first thing in the AM, and then at least 40 ounces sipped throughout the day. I like to carry a stainless steel water bottle to work and keep perched on my desk so I can keep track of my water intake. Also, I find personally if it is in front of me, I tend to drink it more.

6 Ð Foods:

Of course, eating whole foods with lots of vegetables is a key to any health plan. If you are going to work on balancing serotonin, the nutrients in veggies and fruits help to naturally give you the neurotransmitter cofactors you need.

Next on the food list is eating enough protein. Protein brakes down in the body to amino acids, including the amino acid tryptophan. If you are not eating protein, you will not have the tryptophan precursor you need to make serotonin.

Also, do not limit healthy carbohydrates. The brain needs some good carbs (as found in whole grains, root vegetables, beans, wild and brown rice, fruits etc…) in order to open the gates for tryptophan to get in, in order to make serotonin. While I don’t recommend three doughnuts a day, it is important for a brain predisposed to anxiety to get a regular intake of carbs in balance with healthy fats and protein. 9

If you are on a paleo or atkins style diet, check in to make sure this is working for you from a neurotransmitter standpoint. I do realize some people may be sensitive to gluten, grains, or bean lectins. So of course, food recommendations may need to be individualized for you.

7 - Morning Bright Light:

As we mentioned above, there is a strong relationship between light exposure, and serotonin levels. If you are predisposed to low serotonin, consider picking up a 10,000 lux light box to use 30 minutes to 1 hour a day in the morning. Stay no more than 30 inches away, and bask in the morning glow of good serotonin production.

8 Ð Take Good Care of Your Gut:

As we mentioned earlier in this article, most of the serotonin is made in the gut. Keeping your gut healthy, will go a long way to balance this neurotransmitter. Also, most of the immune system is in the digestive tract. When the gut is not functioning well, inflammation goes up. And inflammation will dampen serotonin levels too.

So, how to do this? Eating healthy, lowering stress, sleeping 7 or 8 hours or more will all help your gut repair and be it’s healthiest. If needed, my books (listed in the references below) explain in greater detail ways to heal the gut using natural remedies, herbs and the elimination diet.

9 ÐSupplements:

Supplementation by themselves may not fix every problem, but used with a good lifestyle, stress reduction and food plan, these can be very powerful allies to gaining balanced mood. 10

B vitamins and folate: Vitamin B3 (niacinamide), Vitamin B6 (pyridoxine), Vitamin B12 (methylcobalamin)

Known for its effectiveness as a treatment in anxiety conditions, vitamin B3 helps mood in two ways. Research dating back to 1975 shows how vitamin B3 allows the liver to keep more tryptophan available to produce serotonin. Vitamin B3 is also responsible for activating the that converts tryptophan to 5-HTP (which we will discuss below). Vitamin B3 supplementation in the form of nicotinamide was found to prevent development of anxiety in baby animals that were exposed to low oxygen around the time of birth when compared to a placebo group.

Vitamin B6 is a main for enzymes that convert L-tryptophan to serotonin, a likely reason vitamin B6 deficiency contributes to poor mood. Studies in the early 1980’s showed in women with known evidence of serum vitamin B6 deficiency due to oral contraceptive use (a known depletory of B vitamins), how supplementation with 40 mg/day of vitamin B6 improved both anxiety and depression. Studies supplementing vitamin B6 found modest anxiety benefit in anxious females with premenstrual disorder were given 200mg of magnesium along with 50 mg of vitamin B6, over either alone or placebo. Another study by Villegas-Salas in the later 1990’s found little improvement using solely supplementation with vitamin B6 versus placebo in depressed patients. This suggests that B6 deficiency alone is not a likely cause, and that using it in conjunction with other nutrients, especially magnesium, is probably best due to synergistic effects.

Vitamin B12 is a key player in the synthesis of serotonin. There is some evidence that people with depression respond better to treatment if they have higher levels of vitamin B12. Anecdotal reports from Dr. Alan Gaby, a teacher of mine, and nutrient therapy expert, suggest weekly intramuscular administration of vitamin 11

B12 may improve unexplained anxiety patients with normal serum vitamin B12. One study showed a full response to anti-depressant medications when B12 levels were higher.

Low status of folate makes it much less likely a drug treatment will work, for folate is required for the synthesis serotonin. Besides being an important factor in serotonin synthesis, folic acid is also needed to support dopamine, norepinephrine and epinephrine. Be sure to use the methyl-folate version of folic acid, and consider checking your folate gene (called the MTHFR) status via a gene test to see if you are genetically susceptible to poor folate processing.

Probiotics: Lactobacillus and Bifidus

A very recent study out of Cal Tech looked at mice that were engineered not to have any healthy, flora (good germs) in their digestive tract. What was found was that their mood was not happy, and they produced 60% less serotonin in the body. Other research has also shown how lactobacillus and bifidus can help increase gamma amino butyric acid, a calming neurotransmitter that relaxes the brain and body.

With any patient with anxiety or depression, I will always recommend a probiotic combination called Restoraflora, which has the right strains of probiotics to help get the mood balance. You can find these at www.3UNeed.com starting in July, or on my www.InnerSourceHealth.com website store.

Tryptophan, 5-Hydroxytryptophan (5-HTP) and lysine and arginine

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Tryptophan and 5-HTP

Found naturally in small amounts in banana, turkey, red meat, and food with protein, tryptophan gets converted to 5-HTP in the body, which gets converted to serotonin.

While selective serotonin reuptake inhibitors (SSRIs) can artificially keep levels of serotonin high by stopping the enzyme that breaks serotonin down, tryptophan and 5-HTP naturally help the body to make more serotonin as needed. To be honest, there is very little research using tryptophan or 5-HTP, for most research was halted when SSRI medications started becoming in fashion. Remember, you cannot patent natural substances like tryptophan or 5-HTP. Unfortunately, the financial incentive to study natural medicines is not strong.

There are a few scant research studies using tryptophan, 5-HTP and even tryptophan with antidepressant medication, and these do look promising. Also , anecdotal evidence is strong. Along with myself, many of my colleagues use both of these in my practice to help patients with depression and anxiety, and we do see clear benefits with no side effects.

I find tryptophan (500mg up to 2000mg) can help people fall and stay asleep, and is beneficial for daytime food cravings and anxiety. 5-HTP (50 or 100mg up to three times a day) is also helpful for both anxiety and weight loss.

Modern psychiatry and WebMD still warns patients of the dangers of tryptophan toxicity due to cases in the 1989 where 30 people died from contaminants in a poorly made supplement. Please note these deaths had nothing to do with tryptophan itself. In fact, tryptophan has been back on the market for over a decade, with no problems whatsoever. If you are taking anxiety or depression medications, you should check in with a holistic doctor before starting these, for there is a concern for creating too much serotonin (called “serotonin syndrome”).

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Lysine and Arginine

Calming brothers of sorts, I like to use lysine and arginine together. Lysine lowers the activity of the anxiety-producing part of the brain called the amygdala, while adjusting serotonin in such a way that it helps decrease digestive symptoms when they are caused by stress. Arginine helps calm the brain to reduce cortisol output.

Studies of using lysine and arginine for anxiety have both shown benefits. In the first, men with high anxiety levels were given 3 grams a day of each, or placebo, for ten days. The men were more able to handle the stress of public speaking, while the placebo had no effect. A second evaluation of 108 anxious men given 2.6 grams of lysine and arginine per day found lower salivary cortisol in men, but not in women. While I am not clear why cortisol was found to lower only in men, we do know women tend to run higher levels of cortisol. So, it’s possible this study was not run long enough to see women’s levels of cortisol decrease. More importantly though, we did learn that both men and women found greatly lowered feelings of fear, tension, and apprehension.

Both are dosed fairly high at 2 to 3 grams each, twice a day, taken away from food. They are known to be safe in the long term. Some literature suggests that arginine may exacerbate herpetic sores if present. Lysine, on the other hand, may actually help herpes sores, and is used as a natural treatment for them.

10 Ð Remove the artificial chemicals, metal toxins and statin drugs:

Artificial sweeteners (saccharin, aspartame, sucralose, acesulfame potassium) are also known to possess toxic effects on the nervous system, and may be a direct assault on the neurotransmitters of mood. A 1984 paper in the American Journal of Clinical Nutrition revealed that aspartame may contribute to abnormal balance in the neurotransmitter serotonin. Anxiety relief has been reported in numerous cases by removing ingestion, with recurrence upon re-exposure. One 14 large study in 2002 did find aspartame as “safe”, with “no unresolved questions regarding its safety.” It should be noted this study was funded by the Nutrasweet Company. Hmmm.

Find your sources of heavy metals in your diet and environment. For instance, self-registered symptoms of patients with mercury intolerance have revealed many commonalities with serotonin dysregulation. Heavy metals may raise inflammation in the brain. Heavy metals deplete antioxidants in the body and damage the reuptake proteins the brain uses to remove glutamate (a common excitatory toxin the brain normally makes) , thus rendering the brain cells damaged and inflamed. Excess brain inflammation contributes to anxiety and likely messes up our brain serotonin, too. In a cyclic fashion, inflammation makes brain cells more vulnerable to toxins, which causes more anxiety.

Statin drugs are the most prescribed drugs in the world and work by stopping the liver from producing cholesterol for the body. Cholesterol is crucial for the function of the receptors that work in the brain to recognize serotonin, the “feel- good” brain chemical that is often low in people with chronic anxiety. A fascinating study from 2010 looked at human cells treated with a statin medication. Researchers noted that the medication stopped the serotonin receptors from working properly, and only when extra cholesterol was added did these receptors start working again. Since the effect of serotonin is vitally important for good mood, it is important that cholesterol does not get too low. If you are predisposed to anxiety or depression, you may want to be especially careful about using statins.

A Natural Conclusion

Mood issues like anxiety and depression are caused, and can be helped, by numerous lifestyle, dietary and psychological factors. Working on all of these 15 together will have the best results. Serotonin is certainly a piece of this puzzle, but is not the whole ball game. In that light, remember that there are lifestyle, dietary and supplemental factors that will support your serotonin system. You can use these in a balanced holistic approach to help feel your best.

References: all scientific and medical references mentioned in this article can be found in Dr. Peter’s books:

http://www.amazon.com/Holistic-Solutions-Anxiety-Depression- Therapy/dp/0393709345

http://www.amazon.com/How-Come-Theyre-Happy- Not/dp/1573245801

Peter Bongiorno, ND, LAc, is the author of How Come They’re Happy and I’m Not? The Complete Natural Guide to Healing Depression for Good. His newest book is Holistic Therapies for Anxiety and Depression, and was released by Norton Press.

Please join Dr. Peter on twitter: @drbongiorno Dr. Peter’s practice newsletter: http://www.innersourcehealth.com/news_newsletters.aspx Dr. Peter’s personal website: www.drpeterbongiorno.com Dr. Peter’s clinic: www.InnerSourceHealth.com

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