This article originally appeared in the August/September 2003 issue of the Townsend Letter for Doctors & Patients.

Input on Benzodiazepines from Pat Hallman, N.M.D.

Pat Hallman, NMD, a private practitioner and naturopathic consultant from Mesa, Arizona, says, “Avoid benzodiazepines like the plague they are. In all the years I have been personally using and prescribing natural therapies as an alternative to prescription medications, I have heard many complaints and concerns about the side effects and withdrawal challenges of pharmaceutical drugs. By far the greatest outcry has been regarding the addictiveness of benzodiazepines such as Valium® and Ativan®. (Ambien®, while not a true benzodiazepine, shares many of the same characteristics.)

While these drugs are effective in quickly relieving anxiety, the rebound that follows as patients attempt to stop using them has been described as “horrendous.” Many patients struggle for years, decreasing their dosages by tiny fractions per week in order to wean themselves off. Some simply give up and resign themselves to a lifetime of “benzo” addiction.

While many are helped by natural therapies in recovering from this pharmaceutical addiction, the best advice I can give is to avoid them in the first place by using L‑Tryptophan and other natural therapies.

After the tragedy of contaminated L‑Tryptophan brought on by Showa Denko K.K. in 1989,^8-11 it was believed that another precursor for serotonin would be a viable substitute. The health professional community and nutrient distributors who supply it turned to 5-Hydroxy-L-TryptoPhan (5-HTP) as the alternative supplement. In fact, the 5-HTP has been effective therapy for some, but according to Joan Mathews Larson PhD, author of the book, Depression Free Naturally, 5-HTP has been somewhat troubling as a therapeutic agent. Because it bypasses the body and brain’s regulatory control mechanisms, 5-HTP may put patients at risk for the same heart-valve problems caused by the pharmaceutical diet drug Fen-Phen®. As with 5-HTP, Fen-Phen® also promotes uncontrolled creation of serotonin. L‑Tryptophan, unlike 5-HTP, is an essential amino-acid, which the body also uses to create proteins, vitamins (niacin), and enzymes. L‑Tryptophan can be readily converted to 5-HTP as needed, but 5-HTP is no substitute for L‑Tryptophan.

Since research has shown that 5-HTP is poorly absorbed across the blood-brain barrier in patients who have ever had major depression (See Diagram 1) these individuals would more likely respond to treatment with L‑Tryptophan than to 5-HTP.

Uncontrolled or excess serotonin levels can also be a factor in an illness related to the overabundance of serotonin, known as Serotonin Syndrome (SS). Though serotonin syndrome can occur with any substance that manipulates serotonin levels, the greatest risk for SS occurs in patients taking MonoAmine Oxidase (MAO) inhibitors which produce an antidepressant effect. Thus MAO inhibitors should be strictly avoided in combination with any prescription or natural depression therapy such as Tryptophan. To reduce the risk of SS, other natural or pharmaceutical antidepressants should only be combined with the approval and close supervision of the patient’s health-care provider.

Experience with Selective Serotonin Reuptake Inhibitors

The lead author of Healing Nutrients Within,12 Eric Braverman, MD, is Medical Director of the Place for Achieving Total Health (PATH) Medical Inc., located in New York City. Dr. Braverman uses L‑Tryptophan therapy for relieving serotonin deficiency syndrome and L‑Tryptophan depletion syndrome. “Whenever I might employ Zoloft®, Paxil®, Prozac®, or other SSRI’s [Selective Serotonin Reuptake Inhibitors], my preferred product of choice is to substitute the nutrient, L‑Tryptophan,” says Dr. Braver-man. “And I succeed with the patient as indicated by blood level tests for L‑Tryptophan. If I find an imbalance from mapping a person’s brain and do observe that the workings of its left and right sides are uncoordinated, a tryptophan deficiency becomes recognizable as the pathology. Therefore, my prescribing an SSRI becomes unnecessary.”

(Please note: See Diagram 2 which shows that the SSRI’s decrease serotonin levels in the brain over time and cause this neurotransmitter’s receptors to atrophy. In contrast to the actions of SSRI conventional drugs, L‑Tryptophan increases serotonin levels and enhances the number of serotonin receptors.)

As Medical Director of the Stockton Family Practice in Stockton, New Jersey, Stuart Freedenfeld, MD, says, “For treating depression, anxiety syndrome, serotonin deficiency, irritable bowel syndrome, and fibromyalgia, I use quite a bit of the Lidtke Technologies L‑Tryptophan. I see excellent results from it. I generally start dosing at 1500 mg daily and go up to 3 grams a day or even higher. Since it is costly because of Lidtke’s high standards of quality, I try to keep the dosage down out of consideration for my patient’s pocketbook. And the reduced dose seems to do as good a job as the more elevated dosage.

“My preference is to dispense L‑Tryptophan, not for insomnia alone but only when this condition is associated with anxiety, depression, or some other mental dysfunction,” says Dr. Freedenfeld. “Because there is more serotonin made in the gastrointestinal tract than in the brain, my observation is that irritable bowel syndrome responds very well to L‑Tryptophan. It calms down the anxious and irritable bowel.

“After visiting lots of other doctors, a 55-year-old male patient consulted me. He reported numbers of symptoms such as loss of libido, nightmares, and a sense of being drugged from taking prescribed SSRI’s,” Dr. Freedenfeld says. “Subsequently, my substituting L‑Tryptophan for the patient to take, returned him to once again feeling like his old self. My patient’s symptoms were eliminated by his taking L‑Tryptophan instead of a selective serotonin reuptake inhibitor.”

Naturopathic Physicians Enjoy Using L‑Tryptophan

Naturopathic physicians, Alan Christianson, PhD, ND, Medical Director of Integrative Health Care in Scottsdale, Arizona and Pat Hallman, NMD, describe their success in using L‑Tryptophan therapy with their patients.

Alan Christianson, Ph.D., N.D.

Dr. Alan Christianson states: “Because it is exceedingly helpful for treating starch cravings, insomnia, anxiety, depression, and for those patients with markers indicating low Tryptophan levels, I prescribe the Lidtke Technologies L‑Tryptophan product. My patient, Alice P., age 16, had suffered with bulimia and took lots of different antidepressants as treatment. Nothing helped. I performed an amino acid test and followed up with a separate dosing using L‑Tryptophan. Four months later she exhibited a remarkable improvement. The young woman’s food binges had reduced substantially and weight was stabilized at normal for her. Such good results make it very enjoyable to utilize L‑Tryptophan in this manner.”

Dr. Pat Hallman confirms: “L‑Tryptophan is the precursor for serotonin, a shortage of which leads to a variety of neuro-transmitter illnesses including clinical depression, insomnia, anxiety, aggression, and a lack of satiety or “fullness” in overeating disorders. SSRI drugs, on the other hand, force serotonin to remain in contact with its neural receptor. Over time, receptors decrease and SSRI’s can cease to be effective. In contrast, L‑Tryptophan brings about an increase in serotonin recirculation. It’s enjoyable to see this happen, for the patient then thrives over time.

Pat Hallman, N.M.D.

“Many of my patients need relief from the side effects of prescription antidepressants, which include anxiety, fatigue, and even seizures,” Dr. Hallman continues. “Food avoidance is a problem with taking the SSRI’s, and food cravings are troublesome with the tricyclics. Some also complain that the prescription drugs that once helped no longer work. An effective therapy for mood disorders includes L‑Tryptophan with P5P, the active form of B6; niacin, and in some patients, melatonin. A few patients have commented: ‘Tryptophan doesn’t fatigue you,’ ‘Never any side effects occur,’ and ‘It worked so well I bought some for my neighbor.’

“I usually recommend that insomnia patients start with one capsule an hour before bed and increase the dose if needed. This works well for most patients, but some have to experiment with other amounts and time of day. A computer programmer, for example, who drinks tea to keep alert during his late-hour shift found that swishing the L‑Tryptophan powder in his mouth helped him fall asleep more quickly,” says Dr. Pat Hallman in his concluding remarks. “One patient’s wife spent a year trying different drugs for sleep without success. She finally agreed to try L‑Tryptophan and by the fourth night was, ‘sleeping better than I have in years.’”

Tryptophan for Eating and Digestive Disorders

California naturopath, Elisa S. Lottor, PhD, ND, conducts her nutrition practice at Pacifica Women’s Health Care in Los Angeles. Dr. Lottor, author of Female and Forgetful, published in 2001 by Warner Books, describes the success she experiences from using L‑Tryptophan for a variety of patients’ health difficulties. She states: “I do feel excitement using L‑Tryptophan for patients with eating disorders such as bulimics and anorexics plus digestive problems including GI problems like acid reflux and gastric ulcers. L‑Tryptophan really works well for these conditions.

“A note just arrived from one of my eating disorder patients who is highly compulsive about watching her weight which had been rising steadily. I put her on tryptophan, and the woman wrote that she loves what I've done to help her lower and maintain her weight,” says Dr. Elisa Lottor.

A Cautionary Note Regarding the Quality Control of Supplements

One of the most serious problems facing the nutrition industry today is the fact that a flood of inferior ingredients is pouring into our country and into nutritional supplements from unmonitored manufacturing plants around the world. Raw materials from these com-panies typically cost a fraction of the price of nutrients produced by established and responsible “high-end” manufacturers. The dangerous part is that manufacturing plants in developing regions of the world sometimes exercise the same primitive level of quality control that Showa Denko exercised when it became responsible for contaminating L‑Tryptophan about fourteen years ago. There are extremely high-quality products available, but now, just as then, some supplement producers – pressured by the marketplace – often seek out the cheapest raw materials and take the position that someone else will have to pay if there is a problem.

Samples of nutrients received from “cheap” manufacturers are often badly contaminated with organic solvents used in the manufacturing process. These Organic Volatile Impurities (OVI’s) include solvents such as acetone, toluene, hexane, and ether.

Although there are many steps a health professional or consumer can take to ensure the safety and quality of one’s nutritional supplements, your chances are better if:

• Your supplement manufacturer does business with the most respected (and usually most expensive) producers/suppliers of raw materials.


• Your supplement manufacturer tests every batch of ingredients that comes through their door.


• Your supplement manufacturer employs the most advanced techniques and reference standards for identifying impurities.


• Your supplement manufacturer utilizes clean facilities and well-trained personnel in the encapsulation and bottling processes. You would be amazed how many companies are lax in this regard, with the unnecessary handling and exposure to contaminants of food supplements.

Perhaps the most important factor that drives manufacturers to cut corners is the economic pressure placed on them by consumers. When consumers rush in droves to purchase their supplements at discount prices, the entire industry is forced, as a matter of survival, to follow the whims of the consumer. Thus, through your purchasing power and vigilance, there are many ways that consumers can signal manufacturers to adhere to quality standards.

Resource

For more information about a highly purified L‑Tryptophan, USP at 500 mg per capsule in containers of 60 servings or 120 servings, please visit the Lidtke website, www.lidtke.com. Lidtke products are distributed by BIOS Biochemicals Corp., 800-404-8185 or 480-858-0502; Fax: 480-858-0547; email: customersupport@biochemicals.com

References

1. Hartmann, E. L‑Tryptophan: A rational hypnotic with clinical potential. American Journal of Psychiatry 134:4, April 1977.
2. Hartmann, E. L‑Tryptophan as an hypnotic agent: a review Waking and Sleeping 1:155-161, 1977.
3. Hartmann, E. and Spinweber, C.L. Sleep induced by L‑Tryptophan: effect of dosages within the normal dietary intake. Journal of Nervous and Mental Disease 167(8)d, 1979.
4. Wurtman, R.J.; Hefti, F.; Melamed, E. Precursor control of neurotransmitter synthesis. Pharmacological Reviews 32(4):315-330, 1981.
5. South, J. L‑Tryptophan: nature’s answer to Prozac. International Antiaging Systems, 2002, p. 6.
6. Ibid, p. 2.
7. Herrera R, Manjarrez G, Nishimura E, Hernandez J. Serotonin-related tryptophan in children with insulin-dependent diabetes. Pediatric Neurology 2003 Jan;28(1):20-3
8. Smith KA, Williams C, Cowen PJ. Impaired regulation of brain serotonin function during dieting in women recovered from depression. British Journal of Psychiatry 2000 Jan;176:72-5
9. Maes M, etal. Serotonin-immune interactions in major depression: lower serum tryptophan as a marker of an immune-inflammatory response. European Archives of Psychiatry & Clinical Neuroscience 1997;247(3):154-61
10. Agren H, etal. Low brain uptake of L-[11C]5-hydroxytryptophan in major depression: a positron emission tomography study on patients and healthy volunteers.; Acta Psychiatr Scand 1991 Jun;83(6):449-55
11. Braverman, E. Healing Nutrients Within, Third Edition (New York City: Basic Books, 2003).