Theanine, Theanine Serene, GABA Soothe: Anti-Anxiety Supplements

Benzodiazepines (Valium, Xanax, Klonopin, Librium, Halcion and others) are anti-anxiety drugs that work by affecting the activity of gamma-aminobutyric acid (GABA), a naturally occurring neurotransmitter in your system that produces relaxation effects. These drugs are meant to be used for short periods (2-3 weeks), but many people end up taking them for much longer periods, resulting in tolerance (meaning you need a higher and higher dose to get the same effect), followed by addiction, and, when discontinuing use, withdrawal effects that can be severe. Benzodiazepines also deplete many important nutrients in the body: Vitamins D and K, folic acid, calcium, and melatonin (the naturally produced hormone in the body that regulates sleep).

So, many in the Complementary/Alternative Medicine field have looked for alternatives to benzodiazepines, to minimize both side effects and potential long-term harm. One of the most interesting alternatives is Theanine, an amino acid found in green tea. Theanine acts as a relaxing agent by increasing levels of certain neurotransmitters, including serotonin, dopamine, and GABA. One small study showed that theanine decreases stress responses such as elevated heart rate. Another investigation compared theanine’s calming effect to that of a standard anti-anxiety prescription drug, and found that theanine performed somewhat better.

NYBC stocks Theanine (Jarrow).

NYBC also stocks two combination supplements that include theanine:

Theanine Serene (Source Naturals), which includes theanine and GABA.

GABA Soothe (Jarrow), which includes theanine, GABA, and an extract of ashwagandha, an herb which has long been used in the Ayurvedic tradition of India to reduce fatigue and tension associated with stress.

References

Alramadhan E et al. Dietary and botanical anxiolytics. Med Sci Monit. 2012 Apr;18(4):RA40-8.

Rogers PJ, Smith JE, Heatherley SV, Pleydell-Pearce CW. Time for tea: mood, blood pressure and cognitive performance effects of caffeine and theanine administered alone and together. Psychopharmacology (Berl) 2008;195(4):569–77.

Kimura, K et al. L-Theanine reduces psychological and physiological stress responses. Biol Psychol. 2007 Jan;74(1):39-45.

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Supplements have a role in treating depression/sleep disorders

As 2013 drew to a close, there was much buzz about new studies showing that curing insomnia in people with depression might double the chance of a complete recovery from depression. The studies, financed by the National Institute of Mental Health, were welcomed as the most significant advance in treating depression since the introduction of Prozac 25 years ago. In effect, the new research findings turn conventional wisdom on its head, since they suggest that insomnia may be a main cause of depression, rather than just a symptom or a side effect, as has usually been assumed. So, if you can successfully treat a depressed person’s insomnia, you may be eliminating one of the main factors causing the depressed state.

As we followed news stories about this breakthrough research on insomnia and depression, we were especially encouraged to read comments from Washington DC psychiatrist James Gordon, who has advocated for an integrative approach to treating depression. Here’s his letter to the New York Times:

I welcome a new report’s finding that cognitive behavioral therapy is improving the outcome for depressed people with significant insomnia (“Sleep Therapy Seen as an Aid for Depression,” front page, Nov. 19).

It reminds us that changes in attitude and perspective, and a therapeutic relationship, can right biological imbalances — like disordered sleep — and significantly enhance the lives of troubled people. The study also puts the therapeutic role of antidepressant medication in perspective: the depressed participants who received behavioral therapy did equally well whether or not they were taking the drugs.

I hope that these results will encourage the National Institute of Mental Health, researchers, clinicians and all of us to expand our horizons.

There are a number of other nonpharmacological therapies — including meditation, physical exercise, dietary change and nutritional supplementation, acupuncture and group support — that show promise for improving clinical depression and enhancing brain function.

It is time to undertake authoritative studies of integrative approaches that combine these therapies, perhaps as well as behavioral therapy, in the treatment of both depression and insomnia.

JAMES S. GORDON
Washington, Nov. 19, 2013
The writer, a psychiatrist, is the author of “Unstuck: Your Guide to the Seven-Stage Journey Out of Depression.”

We at NYBC have long been interested in exploring research on supplements and mood disorders, and supplements and sleep disorders. In fact, you’ll find these categories of supplements in a single section of our catalog, at

Supplements for Mood and Sleep Disorders

Please feel free to browse this section, and learn more about supplements such as melatonin, theanine, SAMe, DHEA, and others. There is considerable research on many of these already published, and we believe they will have a role to play in a new, more integrative treatment strategy for depression.

HIV and Aging: Living Long and Living Well

By 2015, more than 50% of the United States HIV population will be over 50. There are approximately 120,750 people now living with HIV/AIDS in NYC; 43% are over age 50, 75% are over age 40. Over 30% are co-infected with hepatitis.

What does the future hold for people with HIV and HIV/HCV as they get older?

These statistics and this question furnished the starting point for the New York Buyers’ Club March 28 event HIV and Aging: Living Long and Living Well, presented by Stephen Karpiak, PhD, of the AIDS Community Research Initiative of America (ACRIA).

Dr. Karpiak’s background uniquely positions him to paint the full picture behind the bare statistics, and to provide expert guidance through the complex healthcare challenges faced by the growing population of older people with HIV. After two decades as a researcher at Columbia University’s Medical School, Dr. Karpiak moved to Arizona, where he directed AIDS service organizations through the 1990s, including AIDS Project Arizona (which offered a supplements buyers’ club similar to NYBC’s). In 2002, back in NYC, he joined ACRIA as Assistant Director of Research, and was the lead investigator for the agency’s landmark 2006 study, Research on Older Adults with HIV. This report, the first in-depth look at the subject, surveyed 1,000 older HIV-positive New Yorkers on a host of issues, including health status, stigma, depression, social networks, spirituality, sexual behavior, and substance abuse.

Why are there more and more older people with HIV? The first and principal answer is very good news: HIV meds (HAART), introduced more than 20 years ago, have increased survival dramatically. Secondly, a smaller but still significant reason: older people are becoming infected with HIV, including through sexual transmission. (Older people do have sex, though sometimes healthcare providers don’t seem to acknowledge this reality.)

As Dr. Karpiak noted, HAART prevents the collapse of the immune system, and so it serves its main purpose, to preserve and extend life. And yet, as he reminded the audience, HIV infection initiates damaging inflammatory responses in the body that continue even when viral load is greatly suppressed. These inflammatory responses, together with side effects of the HIV meds, give rise to many health challenges as the years pass. In people with HIV on HAART, research over longer time periods has found higher than expected rates of cardiovascular disease, liver disease, kidney disease, bone loss (osteoporosis), some cancers, and neurological conditions like neuropathy.

That brings us to “multi-morbidity management”—a term we weren’t enthused about at first, since it sounded more like medical-speak than the plain talk our NYBC event had promised. But Dr. Karpiak gave us a simple definition: dealing with three or more chronic conditions at the same time (and HIV counts as one). He then made the case that this is a critical concept to grasp if older people with HIV are going to get optimal care. Multi-morbidity management, he explained, is a well-accepted healthcare concept in geriatric medicine, which recognizes that older people may have several conditions and will benefit from a holistic approach in order to best manage their health. Treating one condition at a time, without reference to other co-existing conditions, often doesn’t work, and sometimes leads to disastrously conflicting treatments.

And here’s where Dr. Karpiak warned about “polypharmacy”–another medical term worth knowing. “Polypharmacy” can be defined as using more than five drugs at a time. Frequently, it comes about when healthcare provider(s) add more and more pills to treat a number of conditions. But this approach can backfire, because, as a rule of thumb, for every medication added to a regimen, there’s a 10% increase in adverse reactions. That’s why adding more and more drugs to treat evolving conditions may be a poor approach to actually staying well.

In closing, Dr. Karpiak focused especially on a finding from ACRIA’s 2006 study: the most prevalent condition for older people with HIV, aside from HIV itself, was depression. Over two-thirds of those surveyed had moderate to severe depression. Yet while depression can have serious conse-quences–such as threatening adherence to HIV meds–it has remained greatly under-treated. It may seem an obvious truth, but as Dr. Karpiak underlined, psychosocial needs and how they’re met will play a big role in the health of people with HIV as they age. What social and community supports are available becomes a big medical question, and how healthcare providers and service organizations respond to it can make for longer, healthier lives for people with HIV.

And now we come back to NYBC’s contribution to the discussion on HIV and Aging. While NYBC doesn’t keep track of such information in a formal way, we do recognize that quite a few of our members have been using supplements since the days of our predecessor organization DAAIR–going back 20 years now. That’s a lot of accumulated knowledge about managing symptoms and side effects among people with HIV! To accompany the March 28 presentation, our Treatment Director George Carter drew up a pocket guide to complementary and alternative approaches: HIV and Aging – Managing and Navigating. Partly derived from his long experience, and partly drawn from a 2012 Canadian report, the guide ranges over those kinds of “co-morbidities” that Dr. Karpiak spoke of, including cardiovascular, liver, kidney, bone, and mental health conditions. Interventions or management strategies include supplements, but also diet and exercise recommendations, as well as psychosocial supports (counseling, support groups, meditation, and activism).

NYBC has also updated several info sheets from its website and blog, offering these as a way to address some of the most common healthcare issues facing people with HIV as they get older: cardiovascular topics; :digestive health; NYBC’s MAC-Pack (a close equivalent to K-PAX®); key antioxidants NAC and ALA and their potential to counter inflammatory responses; and supplement alternatives to anti-anxiety prescription drugs. These info sheets, together with the HIV and Aging – Managing and Navigating pocket guide, are available on the NYBC website and blog.

We hope that our HIV and Aging: Living Long and Living Well event has been useful to all. Special thanks to our audience on March 28, many of whom brought excellent questions to the session. Now let’s continue the conversation…

To your health,

New York Buyers’ Club

NYBC_March282013

Supplements for the Brain (and Nerves)

“For Your Peace of Mind…”

Recent research on supplements for memory, cognition and other neurological functions
You may remember (we hope you remember!) the Scarecrow’s petition to the Wizard of Oz for a brain. Be advised–we at NYBC do not stock new brains, so don’t come to us with that request.

However, we do follow the sometimes startling new research on supplements, brain function and related neurological issues. In this department, there’s special cause for concern for people with HIV. According to a Canadian study released in 2010, in a group of 1615 people receiving treatment for HIV during the decade 1998-2008, one fourth had neurological problems, including memory loss, cognitive impairment and peripheral neuropathy. Of course being worried about brain function–and neurological function in general–is not unique to people with HIV. As people age, they are more likely to experience memory loss or forms of dementia such as Alzheimer’s. And the nerve condition called peripheral neuropathy (pain, tingling in the feet and hands) is found not just in people with HIV, but also among the growing population with Type 2 diabetes.

Now, on to what we see as some of the most valuable recent findings about supplements and brain or neurological function:

B vitamins can be considered a foundation because they are needed in so many processes essential to the brain’s operation, from energy supply and healthy blood flow, to the formation of neurotransmitters (=chemical messengers of neurologic information from one cell to another). Furthermore, there is evidence that several groups of people, including those over 60 and those with HIV, have a greater risk for Vitamin B deficiencies. So supplementing with a B complex vitamin is a sensible start to cognitive health. More specifically, there is good research linking deficiency of vitamins B12 and B6 to mood disorders like depression—and depression earlier in life is associated with higher risk of dementia in later life. Last, there is also some evidence that B vitamins may reduce stroke risk in older people.

Omega-3 fatty acids (fish oil) support cognitive health in a variety of ways. In 2008, UCLA researchers reported on a lab study showing that the omega-3 fatty acid DHA, together with exercise, improved cognitive function. This caught our attention, because there is wide agreement that regular exercise strongly supports brain function as we age, and here the suggestion is that omega-3 fatty acids multiply that known benefit. A diet rich in omega-3 fatty acids/fish oil has also been linked to lower risk of depression—another plus. And still more: recent research found that omega-3 fatty acids block the development of retinopathy, a chief cause of blindness as we age. (The retina of the eye is actually part of the brain–it is full of nerve cells essential for vision.) All in all, the neurological benefits of omega-3 fatty acids seem both wide-ranging and quite convincing, so it’s high on our recommended list.

The amino acid acetylcarnitine has shown benefit for brain function in a number of studies with humans. In the last decade, acetylcarnitine has also been investigated for peripheral neuropathy in people with HIV. (Some recommend using it with evening primrose oil and Vitamin C.) A 2008 study found that acetylcarnitine influences a chemical process in the brain that triggers Alzheimer’s, so researchers are continuing to puzzle out how this supplement produces its neurological benefits.

Antioxidants. There’s much suggestive research about how antioxidants counter destructive oxidative processes in the brain, thus blocking memory loss and cognitive decline. For example, a 2003 report found that the antioxidant combination alpha lipoic acid and NAC reversed memory loss in aged laboratory mice. And there’s also been a lot of attention to the combination acetylcarnitine and alpha lipoic acid for memory impairment. Furthermore, other antioxidants such as curcumin are under study for their potential to fight the processes that lead to declining brain function.

Acetylcholine. The first neurotransmitter to be identified, acetylcholine is closely associated with memory, with lower levels linked to memory loss. NYBC currently stocks two combination supplements that support acetylcholine levels in the brain, while also providing other nutrients for neurological function: Neuro Optimizer (Jarrow), which includes acetylcholine enhancers, acetylcarnitine, and alpha lipoic acid; and Think Clearly (SuperNutrition), which includes B vitamins, as well as acetylcholine enhancers and a botanical traditionally used for cognitive support, ginkgo biloba.

Resveratrol. In the past decade, there has been intense scientific interest in this compound, most famously found in red wine. While some research ventures have hoped to find in resveratrol a life-extending supplement (a capacity demonstrated in animal studies), others have focused on its therapeutic value for conditions like diabetes or cognitive decline. For example, Cornell researchers reported in 2009 that resveratrol reduced the kind of plaque formation in animal brains that causes Alzheimer’s. And a year later another lab investigation, this one at Johns Hopkins, found that a moderate dose of the compound protected animal brains from stroke damage.

Ginkgo biloba, a botanical derived from Earth’s most ancient tree species, has been widely used for cognitive function. In the late 1990s, two reviews of dozens of ginkgo studies concluded that it could improve symptoms of dementia. However, a long-term trial of ginkgo published in the Journal of the American Medical Association in 2008 found that the supplement did not prevent development of dementia in a group of more than 3000 older people who had normal cognitive function at the start of the research. One possible conclusion: ginkgo may help symptoms of cognitive decline, but doesn’t address underlying causes.

NYBC’s RECOMMENDATIONS: A B complex supplement (like Jarrow’s B-right) and fish oil (like Jarrow’s Max DHA) are foundations for maintaining cognitive health, especially important for people with HIV or people over 60. There is some evidence for acetylcarnitine, alpha lipoic and acetylcholine supplementation for memory impairment and possibly for cognitive decline. Acetylcarnitine and other supplements can be used to address peripheral neuropathy. And stay tuned for emerging research on preserving brain function with compounds like resveratrol, NAC and curcumin.

Supplements as alternatives to benzodiazepines

Here’s an update on this topic:

In her 2007 book, Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition, Dr. Hyla Cass has an interesting section (pp. 139-140) dealing with supplement alternatives to benzodiazepines and other drugs such as Ambien. (These drugs are generally prescribed as anti-anxiety agents and as sleep aids.)

Dr. Cass is a practicing physician and an expert on integrative (“holistic”) health, and one of her main concerns is to present ways to counter prescription medication side effects, or to identify supplement alternatives to prescription drugs.

Of benzodiazepines (the best-known tradenames in this category are Valium, Xanax, Ativan, Klonopin, Librium, Halcion), Dr. Cass writes that a principal problem is that these drugs develop dependence, and so can require steadily increasing dosages as time goes on. (Ideally, she says, they are intended as short-term therapies, but in fact many patients end up being prescribed them for a much longer time.) Withdrawal from these drugs can be quite hazardous, and should be done only under medical surpervision. Moreover, the effect of this class of medications is often a dulling of response, so their use can be associated with accidents.

Since benzodiazepines deplete needed nutrients, Dr. Cass advises supplementing as follows if you take them:

1000-1200mg Calcium/day, plus 400-600mg/Magnesium
400-800mg Folic acid/day
1000 IU Vitamin D/day
30-100mcg Vitamin K/day

She also states that in her own practice she has often successfully substituted supplements for these prescription drugs. Among the calming supplements that she has used:

5-HTP: 100-200mg at bedtime
Melatonin: 0.5-3.0mg at bedtime
L-theanine: 200mg, one to three times daily, as needed

In Dr. Cass’s view, supplements such as these, sometimes used in combinations, can provide a good alternative to the addictive benzodiazepines and their side effects (which, she says, are also characteristic of the newer drug Ambien).

—–

See the following NYBC entries for additional information on the supplements mentioned above:

Melatonin 1mg and Melatonin 3mg

Theanine Serene (includes L-theanine)

NYBC also stocks 5-HTP and the closely related Tryptophan.

Also note that the Jarrow supplement Bone Up very closely matches the set of supplements recommended by Dr. Cass to offset the nutrients depleted by taking benzodiazepines (Calcium, Magnesium, Folic acid, Vitamin D, Vitamin K).

Supplements for anxiety

A while back, we posted a review of holistic M.D. Hyla Cass’ recommendations for avoiding the dependence-inducing benzodiazepines for anxiety. Her prescription was to use supplements instead, and she had some specific recommendations:

In her 2007 book, Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition, Dr. Hyla Cass has an interesting section (pp. 139-140) dealing with supplement alternatives to benzodiazepines and other drugs such as Ambien. (These drugs are generally prescribed as anti-anxiety agents and as sleep aids.)

Of benzodiazepines (the best-known tradenames in this category are Valium, Xanax, Ativan, Klonopin, Librium, Halcion), Dr. Cass writes that a principal problem is that these drugs develop dependence, and so can require steadily increasing dosages as time goes on. (Ideally, she says, they are intended as short-term therapies, but in fact many patients end up being prescribed them for a much longer time.) Withdrawal from these drugs can be quite hazardous, and should be done only under medical surpervision. Moreover, the effect of this class of medications is often a dulling of response, so their use can be associated with accidents.
[…]
She states that in her own practice she has often successfully substituted supplements for these prescription drugs. Among the calming supplements that she has used:

5-HTP: 100-200mg at bedtime
Melatonin: 0.5-3.0mg at bedtime
L-theanine: 200mg, one to three times daily, as needed

In Dr. Cass’s view, supplements such as these, sometimes used in combinations, can provide a good alternative to the addictive benzodiazepines and their side effects.

—–

See the following NYBC entries for additional information on the supplements mentioned above:

Melatonin 1mg and Melatonin 3mg

Theanine Serene (includes L-theanine)

NYBC also stocks 5-HTP and the closely related Tryptophan.

If you do decide to take one of the prescription benzodiazepines, Dr. Cass further notes, it is advisable to supplement to offset the key nutrients that these drugs tend to deplete in the body. We note that the Jarrow supplement Bone Up very closely matches the set of depleted supplements listed by Dr. Cass (Calcium, Magnesium, Folic acid, Vitamin D, Vitamin K).

One last note: rather small doses of melatonin may do the trick in terms of helping you to sleep. A 1mg dose may be all that’s necessary.

GABA Hey! Blood Pressure and Sleep

NYBC carries Pressure Optimizer and GABA Soothe to help manage a range of issues. Among them, the data below suggest a benefit for managing borderline hypertension (high blood pressure). A related item in the NYBC catalog, Theanine Serene, also has a fair amount of GABA along with green tea-extract theanine; this combination was designed especially as an anti-anxiety or anti-stress formula.

The second study below looked at a combo of GABA and 5-HTP and found some benefits for helping to get a restful sleep.

Shimada M, Hasegawa T, Nishimura C, Kan H, Kanno T, Nakamura T, Matsubayashi T. Anti-hypertensive effect of gamma-aminobutyric acid (GABA)-rich Chlorella on high-normal blood pressure and borderline hypertension in placebo-controlled double blind study. Clin Exp Hypertens. 2009 Jun;31(4):342-354.

Abstract
The anti-hypertensive effect of GABA-rich Chlorella was studied after oral administration for 12 weeks in the subjects with high-normal blood pressure and borderline hypertension in the placebo-controlled, double-blind manner in order to investigate if GABA-rich Chlorella, a dietary supplement, is useful in control of blood pressure. Eighty subjects with Systolic blood pressure (SBP) 130-159 mmHg or diastolic blood pressure (DBP) 85-99 mmHg (40 subjects/group) took the blinded substance of GABA-rich Chlorella (20 mg as gamma-aminobutyric acid) or placebo twice daily for 12 weeks, and had follow-up observation for an additional 4 weeks. Systolic blood pressure in the subjects given GABA-rich Chlorella significantly decreased compared with placebo (p < 0.01). Diastolic blood pressure had the tendency to decrease after intake of GABA-rich Chlorella. Neither adverse events nor abnormal laboratory findings were reported throughout the study period. Reduction of SBP in the subjects with borderline hypertension was higher than those in the subjects with high-normal blood pressure. These results suggest that GABA-rich Chlorella significantly decreased high-normal blood pressure and borderline hypertension, and is a beneficial dietary supplement for prevention of the development of hypertension.

PMID: 19811362 [PubMed – indexed for MEDLINE]

***
Shell W, Bullias D, Charuvastra E, May LA, Silver DS. A randomized, placebo-controlled trial of an amino acid preparation on timing and quality of sleep. Am J Ther. 2010 Mar-Apr;17(2):133-139.

Abstract
This study was an outpatient, randomized, double-blind, placebo-controlled trial of a combination amino acid formula (Gabadone) in patients with sleep disorders. Eighteen patients with sleep disorders were randomized to either placebo or active treatment group. Sleep latency and duration of sleep were measured by daily questionnaires. Sleep quality was measured using a visual analog scale. Autonomic nervous system function was measured by heart rate variability analysis using 24-hour electrocardiographic recordings. In the active group, the baseline time to fall asleep was 32.3 minutes, which was reduced to 19.1 after Gabadone administration (P = 0.01, n = 9). In the placebo group, the baseline latency time was 34.8 minutes compared with 33.1 minutes after placebo (P = nonsignificant, n = 9). The difference was statistically significant (P = 0.02). In the active group, the baseline duration of sleep was 5.0 hours (mean), whereas after Gabadone, the duration of sleep increased to 6.83 (P = 0.01, n = 9). In the placebo group, the baseline sleep duration was 7.17 +/- 7.6 compared with 7.11 +/- 3.67 after placebo (P = nonsignificant, n = 9). The difference between the active and placebo groups was significant (P = 0.01). Ease of falling asleep, awakenings, and am grogginess improved. Objective measurement of parasympathetic function as measured by 24-hour heart rate variability improved in the active group compared with placebo. An amino acid preparation containing both GABA and 5-hydroxytryptophan reduced time to fall asleep, decreased sleep latency, increased the duration of sleep, and improved quality of sleep.

PMID: 19417589 [PubMed – indexed for MEDLINE]