By Barry Keate
Henry Emmons, MD is an integrative psychiatrist who blends mind-body and natural therapies into his clinical work. He has recently published “The Chemistry of Calm”, which describes how to combat anxiety through proper supplemental support of brain neurotransmitters. This has applications for people with tinnitus as stress and anxiety worsen it.
Long time readers of Quiet Times will know that we have devoted several articles to the subject of brain neurotransmitters and their effect on tinnitus. Neurotransmitters are chemicals that transmit electrical signals from a neuron, across an open space called a synapse, to a target neuron. This is the way different parts of the brain communicate with each other and coordinate their roles.
In past articles discussing neurotransmitters, we have discussed Dr. Abraham Shulman’s hypothesis for a common pathway through the brain for all tinnitus.We have explored excitotoxicity and new drugs for tinnitus.We looked at food-borne neurotoxins in food additives and sugar substitutes that lead to excitotoxicity.And we examined SSRI antidepressants and the serotonin deficiency syndrome.
Dr. Emmons' book delves into the same subjects we have explored and expands on many of these topics as well as addressing new themes. “The Chemistry of Calm” presents a comprehensive look at neurotransmitters and how to properly support them.
His discussion begins with the statement that medications used to try to improve brain chemistry can only offer short-tem relief. Over time, the brain accommodates to medications and they lose their effectiveness. Benzodiazepines (anti-anxiety medications) such as Valium, Ativan and Xanax work by stimulating the GABA receptors, mimicking the calming effects of GABA in the brain. GABA (gamma-aminobutyric acid) is a brain neurotransmitter that inhibits electrical activity and reduces tinnitus and other conditions, such as anxiety, depression and epileptic seizure. Over the long-term however, these medications lose their effectiveness, requiring higher dosages or even different medications. When trying to stop using them, there are frequently serious withdrawal symptoms.
The other way to approach this problem is not to mimic the effects of a neurotransmitter but to create it in the brain as needed. When the brain produces a neurotransmitter, it starts with the raw material, which is usually an amino acid. Enzymes, along with various cofactors, such as B vitamins, then convert the amino acid to the brain chemical required.
Dr. Emmons proceeds with a discussion of the various neurotransmitters and their role in brain chemistry and continues on with descriptions and specific dosages of therapeutic supplements that promote the individual neurotransmitters.
The Role of Neurotransmitters Dr. Emmons provides the chart below listing the major neurotransmitters, their role in brain chemistry and the nutritional support needed to ensure the proper balance.
|Brain Chemical||Role in Brain Chemistry||Nutritional Support|
|Glutamate, the excitatory chemical||Heightens overall brain activity||Taurine, NAC, green tea, vitamin D3, magnesium, omega-3s|
|GABA, the inhibitory chemical||Slows overall brain activity||GABA, L-theanine, taurine, vitamin B6, zinc, inositol, tonic herbs|
|Noreprinephrine, the arousal chemical||Raises level of alertness||L-theanine, NAC, omega-3s, inositol|
|Dopamine, the reward chemical||Focuses attention and enhances pleasure and reward||L-theanine, B vitamins, omega-3s, St. John’s wort, ginkgo|
|Serotonin, the soothing chemical||Calms, regulates sleep and appetite, protects against stress||Tryptophan/5-HTP, DHEA, folic acid, vitamin B6, vitamin B12, vitamin D, omega-3s, St. John’s wort|
|Cortisol, the stress hormone||Prolonged elevation leads to fat storage, insulin resistance, degenerative brain disorders, memory loss, inflammation||DHEA, B vitamins, antioxidants, herbal adaptogens|
1. Glutamate and GABA These two chemicals account for 80% of brain activity. They work to counteract each other. Glutamate accelerates brain activity and GABA puts the brakes on it. Glutamate is excitatory and GABA is inhibitory. If we experience anxiety, the balance of these two chemicals is off and the brain’s activity level is turned up too high.
Both of these chemicals are necessary and beneficial when they are in balance. Neurons would not communicate if it were not for glutamate. In fact, glutamate is used extensively in transmitting electrical signals from the cochlea to the auditory cortex, thereby facilitating hearing.
But it is possible to have too much glutamate for your own good. If it becomes too excessive, the excess stimulation can become dangerous to the neurons. Glutamate then changes from being simply excitatory to being excitotoxic. This leads to excessive firing of the cell, depleting it chemically and leading to cell death. This process leads to the later development of neurodegenerative diseases such as Alzheimer’s and Parkinson’s disease. It also leads to neurodegenerative conditions such as tinnitus.
It is also possible to have too little GABA, which leads to the same result. Like a car that has lost its brakes, the brain loses the ability to slow things down.
Nutritional support for Glutamate and GABA includes: the amino acids taurine, GABA and L-theanine, the antioxidants NAC (N-acetyl cysteine) and green tea, vitamins B6 and D, minerals magnesium and zinc, and omega-3 fatty acids.
2. Norepinephrine This raises our level of alertness and arousal. This is fine if we’re doing something like hunting or evading capture, but it is harmful if we are speaking in front of a group or if we have developed panic anxiety. People who are depressed often have too little norepinephrine but in anxiety it is frequently elevated.
To tone down norepinephrine take L-theanine, NAC, inositol and omega-3 fatty acids.
3. Dopamine Both dopamine and norepinephrine tend to be energizing and aid in mental focus and concentration. Both can aggravate anxiety when levels are extremely high. But dopamine has benefits that tend to lower anxiety as well. It improves motivation and the experience of pleasure and reward. Unless dopamine levels are extremely elevated, anxiety may improve when dopamine is increased.
Signs of dopamine deficiency include feeling apathetic and fatigued, difficulty losing weight, feeling unmotivated, low sex drive and a general difficulty getting pleasure from daily life. If these symptoms are present, take B vitamins, omega-3 fatty acids and L-theanine.
3. Serotonin Everyone feels better when their serotonin levels are high. This is the neurotransmitter that is involved with everything from how well we sleep to a feeling of well-being; from appetite and impulse control to sexual desires.
Because it is such a key brain chemical, the signs of serotonin deficiency are numerous: insomnia, craving sweets or carbohydrates, muscle aches and pains, impulsive behaviors, moodiness, sadness, anxiety and irritability, lacking self confidence and low stress tolerance, to name a few.
Serotonin is so central to feelings of depression that pharmaceutical companies have developed SSRI (selective serotonin reuptake inhibitor) antidepressants. These chemicals stay in the synapse and prevent serotonin from being recycled, thereby keeping it active longer. These antidepressants can have serious side effects, including tinnitus, and recent research has shown that long-term use actually decreases serotonin levels in the brain. Nonetheless, they are some of the most widely used, and profitable, medications on the market today.
To boost serotonin naturally, take L-tryptophan or the related precursor 5-HTP, the hormone DHEA, vitamins B and D, and omega-3 fatty acids.
4. Cortisol This is the stress hormone. While we all wish for a stress-free life, a world without any stress creates numerous problems. If we were unable to produce the stress hormones, our body’s physiology would collapse.
Stress is not the problem. Unremitting stress and a consistently high level of cortisol is the problem. Chronic high cortisol can lead to weight gain, insulin resistance and type 2 diabetes; high blood pressure and coronary artery disease; possibly dementia and other neurodegenerative diseases; immune system dysfunction that can lead to diseases of all types including cancers.
Protection may be found with the steroid hormone DHEA, which tones down the effects of cortisol, the B vitamins, and antioxidants.
Therapeutic Supplements Dr. Emmons lists the following supplements in the order in which he recommends them. He considers these supplements medicinal and discusses the function and proper dosage of each.
1 – L-theanine is an amino acid found in high concentrations in green tea. You cannot drink enough green tea to get a therapeutic dosage but it is available in green tea extract or labeled as L-theanine.
L-theanine changes brain waves as measured on an EEG (electroencephalograph), promoting the relaxed and alert state associated with alpha waves. It can sharpen mental focus and calm anxiety at the same time.
L-theanine is one of the most common treatments recommended by Dr. Emmons for anxiety. It is usually taken in doses from 50 to 200 mg once or twice daily. For severe anxiety it can be taken up to four times daily. It is not habit forming and there are no known drug interactions. However, he recommends talking to your doctor first if you are on any medications.
2 – L-tryptophan or 5-HTP are precursors to serotonin and help to elevate serotonin levels in the brain.
5-HTP can be taken by itself in doses starting at 50 mg per day, increasing every few days as required. Most people do well with 100-150 mg daily but can go to 300 mg if needed. It is normally best to take in divided doses two or three times throughout the day. If it becomes sedating, it may all be taken at night. It is best absorbed if taken one half hour before meals. That also helps to reduce carbohydrate cravings.
Many people prefer using L-tryptophan along with its essential cofactors lysine and niacinamide instead of 5-HTP. The reason is some of the 5-HTP can convert to serotonin in the bloodstream and will not be able to cross the blood-brain barrier. Tryptophan is stable in the blood and easily crosses the blood-brain barrier where it is converted to serotonin.
Editor’s Note: Dr. Emmons did not list a dosage of L-tryptophan. However, it is commonly believed that 100 mg of 5-HTP is the equivalent of 500 mg of L-tryptophan so a normal dose of L-tryptophan would be around 500 mg up to a maximum of 1,500 mg daily.
3 – NAC (N-acetyl cysteine) is a simple and inexpensive antioxidant. It is used in emergency rooms to treat patients who are at risk of liver damage from excessive use of acetaminophen or other poisons. It protects the brain for the same reason, it boosts levels of the body’s own primary antioxidant, glutathione.
NAC is used to correct the glutamate/GABA balance as well as for other anxiety disorders and even Obsessive-Compulsive Disorder (OCD). Researchers at Yale are now conducting a clinical trial with patients whose OCD symptoms have not improved with other treatments.
NAC typically comes in a dose of 600 mg and may be taken two or three times daily. It is generally well tolerated but if headaches or stomach upset occurs, take with food.
4 – Taurine is an amino acid that increases glycine and GABA to calm the brain and it also protects the brain by reducing the harmful effects of excess glutamate.
Taurine is usually taken in doses of 500 mg one to three times daily. It can cause slight drowsiness and if so may be taken at bedtime. It has also been known to reduce blood pressure.
5 – Inositol is often classified as a B vitamin although it’s technically not because the body can produce it. It has long been known to reduce general anxiety, panic, and OCD symptoms. Researchers found it to be just as effective as a popular antidepressant for panic disorder and it was well tolerated.
Inositol is often recommended at a dosage of 1,500 mg daily though in studies it has been used in much higher doses. Side effects are mild, including occasional nausea or diarrhea, dizziness fatigue and headache. There has been a report of Inositol worsening bipolar disorder so Dr. Emmons does not recommend it to patients who have that condition.
6 – GABA is both the neurotransmitter itself and a dietary supplement that supports it. It is not higher on the list because most of it gets broken down before it gets to the brain. A portion of it does get to the brain, though, and it has been shown in studies to create a relaxed alpha brain wave pattern even more effectively than L-theanine.
GABA may be taken in doses as small as 100 mg twice daily, up to 750 mg three times daily. If drowsiness occurs, take at bedtime.
7 – DHEA is a steroid hormone produced in the adrenal glands, where cortisol and adrenaline are also made. It can be converted into testosterone and estrogen. Levels of DHEA are higher in men than in women. More and more physicians are recommending it for those in midlife or beyond, when DHEA levels drop. Some clinicians recommend doses up to 50 mg or more. Levels should be monitored to be sure it doesn’t get too high.
Tonic Herb: Rhodiola. Dr. Emmons has this listed on a sidebar and highlights its use. Rhodiola rosea, otherwise known as arctic root, is a tonic herb that has long been used to strengthen immunity, improve energy, and enhance the body’s ability to handle stress. Dr. Emmons recommends this for people with stress, anxiety and even depression.
A study conducted at UCLA in 2008 showed that participants with general anxiety improved greatly on rhodiola, with minimal side effects. It may work by improving serotonin and dopamine levels and counteracting the effects of cortisol.
Look for an extract standardized to at least 3% rosavins and about 1% salidrosides. A typical dosage is 100-250 mg twice daily, with breakfast and dinner. It is usually best not to take it just before bedtime as it may prevent sleep. While it is generally considered safe and is not known to interact with other medications, it is contraindicated for those with bipolar disorder.
1 - The Chemistry of Calm: A Powerful, Drug-Free Plan to Quiet Your Fears and Overcome Your Anxiety by Henry Emmons. Touchstone, a Division of Simon & Schuster, Inc. (October 5, 2010).