Mice Who Tear Their Fur Out and The Psychiatrists Who Treat Them

Chris Highcock of Conditioning Research mentioned a fascinating paper yesterday, and then Dr. Emily Deans blogged about it. The paper tells about mice who tore their fur out – akin to the condition of “trichotillomania” in which humans tear their hair out – after being put on a high-tryptophan diet. [1]

Dr.Deans points to the paper’s importance:

As far as I know, it may be the only paper showing a definitive development of psychopathology with an adjustment of diet.  So that’s a big deal!

Since I suspect that most psychopathologies are induced by diet in the context of infection, I think this shows that psychiatric researchers have barely begun to understand their diseases.

As soon as I saw Chris’s post I knew I had to blog about it, because I had similar symptoms to these mice.

My Experience

Briefly, I had a chronic bacterial infection of the brain and nerves, probably from Chlamydophila pneumoniae, plus a few other problems which masked the bacterial infection until I fixed my diet.

C. pneumoniae is a parasitic intracellular bacteria whose main activities are reproduction and diversion of the immune system. Its main effects are:

  • Neuronal hypoglycemia. C. pneumoniae steals glucose products like pyruvate for energy. This can create hypoglycemia in neurons even if blood glucose levels are normal.
  • Serotonin deficiency. C. pneumoniae steals key amino acids like tryptophan, tyrosine, and phenylalanine for protein and niacin synthesis. Of these tryptophan is most important. To block C. pneumoniae activity, the innate immune response triggered by interferon gamma sequesters tryptophan. This denudes neurons of the neurotransmitter serotonin, which is made from tryptophan.
  • Inflammation. C. pneumoniae is able to trigger inflammation which re-directs the immune response away from itself toward extracellular pathogens.

Thus common symptoms of a bacterial infection of the brain are those of cognitive hypoglycemia and serotonin deficiency. Symptoms include:

  • Hypoglycemia : Feeling nervous or jittery; mood changes such as irritability, anxiety, restlessness; confusion, difficulty in thinking, and inability to concentrate; poor coordination.
  • Serotonin deficiency: Anxiety, depression, impaired memory or cognition, low self-esteem, loss of pleasure, poor impulse control, insomnia.

These lists don’t fully capture the experience however.

I started having these symptoms in 1992 during a year-long course of antibiotics, and they would get worse for about the next 15 years. I experienced a dramatic loss of happiness and positive emotions. I had always been happy; now suddenly I wasn’t. Along with this came a weird mental state which is hard to describe, because it has no normal analog. Irritability or anger come closest, so I’ll use those words. But understand that it was a generalized state, not irritation or anger directed at anyone in particular; being naturally phlegmatic, I doubt in 20 years I was uncivil to anyone on more than a few occasions. It was just a persistent irritated/angry emotional state that I was well aware was unnatural and could consciously control.

It seemed like this negative emotional state would build up, and could be discharged a bit by a few expressive habits. I would wring my hands; I still have some slightly twisted finger bones and calluses from over a decade of hand-wringing. And, when alone, I would sometimes scratch my head. This sometimes led to hair loss and bare patches.

Trichotillomania

This kind of behavior turns out to be not that rare. About 4% of the population is said to have “trichotillomania,” compulsive pulling or twisting of the hair causing hair loss. Trichotillomania strikes women more frequently than men. [Wikipedia, “Trichotillomania” ]

Serotonin depletion is a common feature of mood disorders. I wouldn’t be surprised if most of these disorders are due to brain infections, and the serotonin deficiency is due either to theft of tryptophan by bacteria or to the immune response to intracellular infections, which increases interferon gamma and decreases serotonin.

Evidence, such as it is, is consistent with that idea. People with mood disorders or depression are far more likely than normal people to test positive for antibodies to chronic intracellular pathogens like coronaviruses. [2]

Drugs Help At First, But Often Do Long-Term Harm

The first impulse of modern medicine is to fight the body’s response to disease. If the body has downregulated serotonin, doctors look for drugs that upregulate it.

That is why people with depression and mood disorders are commonly given SSRI’s, drugs that raise serotonin levels.

If these diseases are due to infections, then we would expect the SSRI’s to improve mood immediately, but also to defeat the body’s immune response, supply the pathogens with tryptophan, and promote their replication. As a result, the disease should progress faster. In time, the patient will become worse than would have been the case without the drugs.

And, more often than not, this is what actually happens. Drugs are often “unsafe at any dose”. Antidepressant treatment increases mortality in men by 30%.

The Mice Who Tear Their Hair Out

One of the common breeds of mice used in laboratory research is the C57BL/6 breed. This breed has “an easily irritable temperament … [and] a tendency to bite … [and] display barbering behavior.” [Wikipedia, “C57BL/6”] In barbering, “individuals pluck whiskers and/or fur from their cage-mates and/or themselves.” [1]

C57BL/6 mice also have a modified immune response:

The immune response of mice from the C57BL/6 strain distinguish it from other inbred strains like BALB/c. For example the immunological response to the same pathogen in C57BL/6 mice is often of an opposite spectrum compared to BALBb/c mice, namely C57BL/6 shows Th1 and BALB/c shows Th2 response in response to intracellular pathogen Leishmania major, where a Th1 response results in a resistant ie healer phenotype (since the pathogen is intracellular), whereas a Th2 response results in a susceptible (nonhealer) phenotype. [Wikipedia, “C57BL/6”]

This Th1 response increases interferon gamma levels:

The Th1 response is characterized by the production of Interferon-gamma … [Wikipedia, “Adaptive Immune System”]

Interferon gamma, of course, sequesters tryptophan and diminishes neuronal serotonin levels.

All this sounds familiar: C57BL/6 have lower serotonin; they become irritable and will bite and tear fur out.

Like trichotillomania in humans, tearing of fur is more common in female mice than males:  “Barbering is more frequently seen in female mice; male mice are more likely to display dominance through fighting.” [Wikipedia, “C57BL/6”]

Research Idea: Treat the Mice As We Do Humans

If these mice went to a human psychiatrist (and had health insurance), they’d be prescribed SSRIs to raise their serotonin levels.

A group at Purdue led by professor of animal sciences Joseph Garner decided to see if they could cure barbering through an alternative dietary therapy that would raise serotonin levels just like SSRIs.

[W]e wished to test the hypothesis that a diet which increases serotonin metabolism would decrease the hair-plucking behavior of barbering mice. [1]

The treatment diet was essentially identical to the control diet, except for these differences: Tryptophan levels were four times higher, methionine levels were the same, and other amino acids were halved. Overall protein levels were cut from 24% to 13.3% of calories. Since tryptophan competes with other amino acids for entry to the brain, this shift in amino acid composition led to much larger tryptophan entry to the brain. [1, Table 2] The lost protein calories were made up by increasing carb intake from 57.3% to 68.0%, which I consider a relatively marginal change. In both diets fructose was minimal, 2.5% of calories, and glucose, mostly from starch or dextrose, provided the bulk of the carbs.

The tryptophan was converted to serotonin in the brain, but not for long. Serotonin levels were 55.5 ng/ml in brains of mice on the control diet, 57.6 ng/ml in brains of mice on the high-tryptophan diet [1, Table 3]. However, levels of serotonin metabolites – the leftovers after serotonin destruction – were much higher in the treatment mice.

The results weren’t good:

[E]levating brain serotonin metabolism by tryptophan and carbohydrate supplementation increased the severity of barbering, and induced ulcerative dermatitis. In humans, the induction of compulsive skin-picking by serotonergic agents (SSRIs) has been reported. (24,43) Thus, the current data suggest a homologous outcome in mice, achieved nutritionally instead of pharmacologically. [1]

If you don’t like scientific-ese, here’s Professor Garner in the press release:

[The] diet … was expected to reduce abnormal hair-pulling. Instead, mice that were already ill worsened their hair-pulling behaviors or started a new self-injurious scratching behavior, and the seemingly healthy mice developed the same abnormal behaviors….

“We put them on this diet, and it made them much, much worse,” Garner said.

This does indeed sound like a “homologous outcome” to the experience of human patients treated with SSRIs!

Very likely if the mice had been interviewed at Day 1 after initiation of the high-tryptophan, they would have reported mood improvements, just as human patients do on SSRIs. As with humans on SSRIs, the negative effects took some time to appear. The increase in scratching behavior was not apparent at 6 weeks after initiation of the high-tryptophan diet, but was apparent at 12 weeks (3 months) [1, Figure 4]. Ulcerative dermatitis tended to appear after about 10 weeks on the high-tryptophan diet [1, Figure 3]. 

Conclusion

I’ll follow up in my next post, on Monday, with speculation about what is happening in these mice.

In the meantime, I think it is worth remarking how an intervention thought to be beneficial – restoring serotonin levels to “normal” – has health-impairing consequences over time in both mice and people.

In many ways, contemporary medical practitioners resemble the Sorcerer’s Apprentice. They have at their disposal powerful magic drugs, whose long-term consequences they do not fully understand. The drugs come into wide use, and only years later do we learn that they do more harm than good. And the data showing they don’t work is always “surprising” and “paradoxical.”

In my view, the philosophy behind drug-based medicine is misplaced. Too often drugs are designed to fight or defeat the body’s natural mechanisms. As my parable argued, I believe it is much more effective to cooperate with the body through diet and nutrition.

References

[1] Dufour BD et al. Nutritional up-regulation of serotonin paradoxically induces compulsive behavior. Nutr Neurosci. 2010 Dec;13(6):256-64. http://pmid.us/21040623.

[2] Okusaga O et al. Association of seropositivity for influenza and coronaviruses with history of mood disorders and suicide attempts. J Affect Disord. 2010 Oct 26. [Epub ahead of print]. http://pmid.us/21030090. Hat tip Dr. Deans, http://evolutionarypsychiatry.blogspot.com/2010/11/depression-flu-and-to-do.html.

Leave a comment ?

38 Comments.

  1. Paul,

    Fascinating. I look forward to the next post.

    If your theory is correct, wouldn’t we expect initial improvement in the mice eating the extra tryptophan and then a decline later? Is there any evidence for this pattern in the study?

  2. Yes … I’ve edited the post to include that data. The negative effects appeared after about 12 weeks / 3 months.

  3. In my mind there are only two interpretations of the data that make sense, really, though one can wonder about serotonin stability,

    1) increased serotonin turnover = reduced active serotonin. A similar theory to bodybuilder Rob Faigin in his book, “Natural Hormonal Enhancement.”. Increased sertonin turnover = serotonin burnout. A scary theory, as what would that mean for the population hopped up on glucose, year after year? But show me an anxious, burnt out Kitavan, or that guy on the potato diet – of course neither of them were expected to subsist also on casein and soybean oil.

    2) Massively increased inflammation due to tryptophan/dextrose increase, accelerated by the 10% soybean oil as fat.

    I’m not necessarily interested in defending the profession of psychiatry, or the medical profession in general. There is too much, too many years, hours of sleep lost, money spent, time sacrificed learning about people, and systems, and medicine, so that to participate in such a debate, my mouth opens and I am nearly speechless. We are doctors. We gave up our youth to study. We could have gone to Wall Street or law school, but we didn’t, because we are supposed to be the good guys. We care about you. We want you to be healthy. We could work 24 hours a day, so believe me we are not prescribing statins because we want to check your liver function tests and cholesterol every 3 months to jack up our productivity. We don’t have enough time with you as it is, and we are all on the same side. Though we don’t always have the luxury to recommend what makes sense, only what there is “evidence” for. And the environment for common sense gets worse and worse as time goes on.

    I’ve seen people hearing voices and compeltely nonfucntional transformed in a matter of days by an adjustment in medication – and the basic science literature supports the idea
    of many psychiatric medicines as anti-inflammatory. People with psychiatric illness are
    more likely to use drugs, more likely to die of heart attack, stroke, diabetes, every
    conceivable inflammatory issue that exists, so let’s account for that before we throw out an increased 30% mortality rate for medications. That said, of course I am interested in preventing the use of medication. Medication is limited and risky. Always. Would that the incentives were aligned, and the data squared away that we could start with the
    perfect diet first, before things spiral out of hand.

    Dr. Garner’s mice hold a truth. Hopefully one we are smart enough to figure out. In the brain one plus one usually equals five, or one half. Wholesome food can only help. Despite how common it is, there’s never been much good data for trichotillomania, and whether you try SSRIs or dopamine blockers, nothing much seems to work well, med wise.

    It is rare that I see people before things have spiraled out of hand.

  4. Also, if picking increases with SSRIs, it tends to happen immediately, not delayed. Along with yawning and sweating. If that is helpful to know. Goes away with withdrawal of the medicine.

  5. Dear Emily,

    Thank you for that passionate reply!

    I’m still thinking about what happened, and will keep your ideas in mind this weekend.

    Doctors certainly deserve our respect and gratitude for the immense effort they put into trying to bring the rest of us health. It’s unfortunate that we scientists have failed to arm doctors with better treatments.

    Drugs have extremely complex effects; they usually do good and bad together. Mitigating an extremely dangerous symptom can be life-saving, even if the drug has dangerous long-term consequences.

    Since I think psychiatric illness, like other diseases, is usually caused by toxins, malnutrition, and pathogens, it’s no surprise that many other diseases are co-pathologies of psychiatric illness. Pathogens and toxins don’t restrict themselves to a single cell type. That’s why therapies for the whole body, not just a specific neurotransmitter, are called for in psychiatric illness.

    We won’t know until dietary and nutritional therapies are thoroughly tested, but I think it’s possible that dietary changes might bring improvements that are nearly as rapid, and more lastingly effective, as drugs in many of these illnesses. In my case antibiotics had an immediate effect, but only after dietary and nutritional changes. So drugs and diet may be complements.

    Best, Paul

    PS – That is helpful about the picking. Thanks. It’s a difference with the mice, and one more piece of evidence showing how complex these diseases are!

  6. Paul,

    Your experiences mirror almost identically how one of my coeliac patients described how they felt prior to us figuring our she was coeliac. I’m not suggesting coeliac or gluten has anything to do with your specific example, but rather that there might be multiple pathways to various mood disorders that elicit effectively the same thing (inflammation?) and become expressed in a similar manner or spectrum of behaviours and moods.

  7. Hi Jamie,

    Yes, I think there are multiple pathways. Many brain illnesses produce strikingly similar symptoms – it seems that neurons have a few failure pathways that can be initiated many ways. Very interesting about your coeliac patient. And another example of how dietary changes can sometimes work big improvements — perhaps very quickly.

    Best, Paul

  8. Fascinating stuff and a really helpful set of observations. I await the next instalment.

    I tend to find these reports and throw them out there, but rely on those such as yourself, Emily, Chris Masterjohn and Stephan to do the scientific analysis.

    Thanks

    Chris

  9. Just want to add to my speculation about increasing inflammation (which I think is the more likely scenario) – tryptophan is e precursor for both serotonin and kyrunetic. The former helps modulate major brain circuitry communication, the latter seems to encourage excitatory communication, and in excess will be neurotoxic. Kyurnetic is elevated in cases of inflammation. SSRIs increase serotonin initially, but then after 2 weeks, the post synaptic receptors are down regulated, so the overall effect is not so much to increase serotonergic transmission, but to make what transmission there is go through more efficiently. SSRIs also seem to favor the metabolic pathway of tryptophan to serotonin rather than kyrurnetic.

    It is possible that by massively increasing the tryptophan uptake into the brain in the context of the baseline inflammatory diet and a genetically vulnerable mouse population, there were increases in kyurnetic, leading to neurotoxicity and mouse psychopathology. I’m not a big fan of l tryptophan and 5 htp for that reason – I know you are not a fan due to tryptophans role in the infectious theory of neurotoxicity. Since this scenario probably occurs in the human brain as well, it makes one wonder about our USDA diets.

    Just some ideas, anyway.

  10. Thanks, Emily. Good to keep in mind that dietary tryptophan and SSRIs are not the same, and SSRIs may be better.

  11. very interesting! i definitely have noticed increased anxiety these past years after first getting ill. i am a psychologist (working on phd in cognitive development) and when i was first ill i went to a psychotherapist thinking it might be stress/depression related. interestingly she was the first person to say its not in your head go to a doctor – in the mean time the doctor’s seem to have given up and think its in my head… anyway hopefully continuing with a ketogenic diet and nutritional supplements will help! i’m looking forward to your next post.

  12. Hi Claire,

    It may be in your head but it’s definitely physiological, not psychological!

    Whatever it is, promoting neuronal autophagy is likely to be helpful. So, ketogenic dieting and intermittent fasting. But you would really benefit from a diagnosis of the pathogen if you can get one.

    Best, Paul

  13. Thanks for the reply 🙂 Its very motivating and I really appreciate it. I am having a hard time getting my doctor to refer me to an infectious disease specialist – a down side of socialized medicine. I am trying to figure out a way to get the right tests done… in the mean time I will continue with the ketogenic diet and intermittent fasting (right now usually 8pm to 12/2pm) and maybe longer fasts if I can handle it.

  14. I feel the same way about the knee-jerk impulse among most doctors for a drug based solution.

    My own experience relates to Accutane, which I was prescribed to help a moderate/severe acne problem. The only thing was that this potent drug actually made my skin problems worse (along with many other side effects; too many to list). Yet this was seen as a sign of progress, as a worseing of symptoms was a common side effect, along with many, many other potential complications. I was also required to have routine blood work done to ensure this drug wasn’t slowly killing me. My psycological health was also monitored, as there was an increased likelyhood of suicidal thoughts and/or actual suicide.

    Yet after all I went through (without solving the problem) the solution was found elsewhere, and right there in front of me: food. It turned out that certain dietary intolerances were the casue of my acne, and contine to be, even as an adult. So, by strictly avoiding dairy, gluten, excessive sugar and soy (and a few others)my skin problems virtually disapeared within days. Gone.

    I don’t know why that’s the case with me, but it simply is. I tried explaining this to my doctor but he basically rolled his eyes at the thought. Sadly, this opinion is still widley held today.

    Now I’m not trying to compare acne to a chronic bacterial infection, but the effect it can have on those who suffer from it can be severe. The approach to treatment seems to be similar, however.

    In your last paragrah, Paul, you mentioned that “Too often drugs are designed to fight or defeat the body’s natural mechanisms”. I read this and felt I had to share my experiences, becasue this is exactly what Accutane was meant to do for me. In a nutshell the drug was supposed to suppress all oil production in the skin thereby preventing any excess from clogging the pores. Yet the question was never asked why my body was producing such a reaction in the first place. And now with the changes in my diet things are back to normal. You’d never guess looking at me today that I had the problems I did a few years ago. Yet certain changes in one’s diet can be that dramatic, as you know!

    Keep up the good work, Paul. It’s becasue of blogs and alternative information that people like you provide that helped me (and others) challenge conventional notions of health and well being with great success.

    Side Bar: Accutane has been off the market since 2009 due to the high cost of defending against (and losing)the many personal injury lawsuits brought by patients who suffered far worse than I.

  15. I had two years of manic depression, and after trying a dozen psychiatric medications to little avail I tried a supplement for bi-polar from Canada (EmPower Plus from Truehope.com). I have had no symptoms or drugs for five years beginning several months after I started taking the supplement, though I have no way to be sure it was the supplement that did the trick. I’m not recommending that anyone try it, much less discontinue their medication: this was just what happened to me.

  16. Hi Peter,

    Very interesting. The ingredient list in EmPower Plus doesn’t seem very unusual: https://www.mytruehope.net/store/_documents/EMP_Capsules_Facts_Sheet.pdf

  17. I may have asked this before but are there any reliable tests for C. pneumoniae? Should we all be getting tested for this?

    • Hi woly,

      Unfortunately there aren’t really good tests for it. One problem is that everyone gets infected with it, so that ~70% of adults are antibody positive for it. But adults can lose their antibodies to it after a few years, even if it is maintaining a persistent intracellular infection (which it does), so many antibody-negative people are infected with it and may have severe disease.

      Since everyone has it, the big debate is over whether it’s the cause of disease or a “hitchhiker” pathogen that is there but doesn’t do much harm. Unfortunately there is no good test for whether it is causing severe problems or not. Antibody titers are not a useful indicator of that.

      Researchers have gone a different way — they take cell samples and use real-time PCR to quantify bacterial DNA. This works well but it’s not so easy to get brain or artery samples from human patients and it hasn’t come into clinical use.

      So in practical terms the “test” is to try antibiotics that are effective against C. pneumoniae like doxycycline or azithromycin and see if they help.

  18. Paul,
    About Empower plus, TrueHope have several studies that were done using this supplement http://www.truehope.com/truehope_bipolar_disorder_research_empowerplus_1.aspx

    Did you have a look – if so what are your thoughts?

  19. Hi julianne,

    I’ve only looked briefly, but it does look promising.

    I like the vitamin/mineral mix. It seems like a well-made multivitamin/multimineral supplement. Extra copper and chromium, and low vitamin A, are among our recommendations. Raising other B vitamins but not folic acid or niacin is also good. Choline and inositol are important and often deficient. I’m not sure about the amino acids, grape seed extract, ginkgo biloba, or germanium sesquioxide – I would have to study the bipolar literature to see what the logic for those is.

    The papers you link to make it look promising.

    In my experience people with mental health disorders – bipolar, schizophrenia, etc. – often have very bad diets. So is it helping by relieving malnutrition? Would it still have benefits on a good diet? Perhaps Peter can give us some guidance.

    I think this would make a good multivitamin to go with the Perfect Health Diet.

  20. Perfect Health Diet » Tryptophan Poisoning and Chronic Infections - pingback on December 21, 2010 at 1:00 am
  21. “In humans, the induction of compulsive skin-picking by serotonergic agents (SSRIs) has been reported”

    WOW! This actually happened to me while on SSRIs, I picked out every mole in my body, and wouldn’t let any scab heal, and started pulling my hair out to the point I had a bald patch. It’s a relief to finally understand why I did that.

    Thank you so much Paul!

  22. Hi Paul,

    I just got your book from a relative for Christmas (I told them to buy me it!) and am reading through it now. Very interesting, although some of it is beyond a simple layman like me.

    The part of this blog post that starts “Thus common symptoms of a bacterial infection of the brain are those of cognitive hypoglycemia and serotonin deficiency” and continues for several paragraphs describes precisely the mysterious changes I have experience over the last decade of life (I am now 33), with the one variation being that I suffer extreme fatigue rather than insomnia or restlessness. Every other sympton, including the odd mental state you mention, is a perfect match, and I experience them all to a marked degree.

    I began to decline after suffering the second subdural hematoma of my life at age 20 when I was in Italy, followed by a 5 year binge on alcohol. I have been diagnosed with general anxiety but never depression. I do not feel sad ever, just irritable and anhedonia-ac, if I may coin a word. Anti-depressants, and I’ve tried a bunch, do absolutely nothing for me. I am strongly considering getting adderall because the few times I have taken it in the past it has helped lessen my anhedonia and cognitive loss (although it increases anxiety).

    I know a lot of the symptoms mentioned in the above-referenced part of the blog post are associated with lots of different medical conditions, but your story is nonetheless intriguing to me due to its remarkable similarity to mine. If you could elaborate on how you overcame this infection and its detrimental results on your personality, I would be eternally grateful.

  23. Clarification of last post: I don’t have any hair pulling or hand-wringing habits or anything like that.

  24. Hi Thomas,

    I don’t know what is causing your symptoms – neurons only fail in a few ways so as you say a lot of different brain conditions generate similar symptoms – but I would seriously consider trying an antibiotic that penetrates the brain like doxycycline and seeing if you notice any changes. If you don’t have a bacterial infection then you shouldn’t notice much difference.

    This is an inexpensive and easy way of diagnosing an infection.

    Alcohol abuse depresses bacterial immunity and would be a risk factor for a brain infection: http://www.ncbi.nlm.nih.gov/pubmed/16413723, http://www.ncbi.nlm.nih.gov/pubmed/20161709. Subdural hematomas frequently show infections, e.g. http://www.ncbi.nlm.nih.gov/pubmed/20430901.

    My strategy is basically the program in the book (including a therapeutic ketogenic diet and fasting) + antibiotics. So now that you have the book, you have my program.

    Best, Paul

  25. Thanks for the response and the very interesting links, Paul. I started the PH diet two days ago, and may shift to the lower carb, therapeutic version once I get the hang of the basic version.

    If I can trouble you with one last question . . . I am sure I can get a script for doxycycline from my doc, but don’t how long I should take it for. (And I am sure my general practitioner doc doesn’t run across this question very often.) Any general suggestion on how long to take something like doxycycline for a possible brain infection would be much appreciated.

    Thanks for all your work on the book and the great advice on this site. Have a happy New Year.

  26. Hi Thomas,

    I would recommend getting on the diet and nutrition, and reaching some kind of stability / equilibrium, before starting antibiotics. That way you’re not changing too many things at once and it’s easier to judge what effect the antibiotics are having.

    Antibiotics are mostly protein synthesis inhibitors, they don’t kill bacteria, they just slow them down. In acute infections, where bacteria are exposed to the immune system and have to reproduce rapidly just to stay even, antibiotics are very effective. In chronic infections, where bacteria are good at hiding from the immune system but don’t reproduce as quickly, the effect of antibiotics is less. Therefore you generally have to take them much longer to recover.

    Combinations of antibiotics often work best.

    When you’re ready, start by taking a single antibiotic for diagnostic purposes. Two weeks would be enough to do a good test. The quieting of bacterial activities by protein synthesis inhibition would likely have noticeable effects. They can be good or bad, depending on the nature and state of the infection. However, if you don’t have an infection you won’t notice much.

    Before and during the 2 week trial, monitor things like blood cell counts with your doctor. You might try a coconut oil fast during the antibiotics.

    If it looks like you do have an infection, then you should continue the antibiotics and look to add other antibiotics in combination as side effects diminish. http://cpnhelp.org has a good protocol.

    Let me know if you have any other questions.

    Happy New Year!

  27. So glad I stumbled onto this site!

    I am a 27 y.o. female from Seattle, WA, who had struggled with trichotillomania for 10 years, since I had a bad drug interaction at 18 y.o. The hair pulling symptoms emerged after being on hormonal contraceptives for 2 weeks, while taking adderall for ADD and lexapro for depression (had been on both for 3 years prior). I also developed bipolar disorder type II from this drug interaction.

    Over the years, I have been on numerous psychiatric medications to balance my moods, but found the most relief when treated with an orthomolecular approach at a clinic called Pfeiffer Treatment Center in Naperville, Il. They started me on an antifungal diet (basically ketogenic), which made the urge to hairpull disappear for 4 months (until I broke the diet on a trip to europe). I have reattempted the diet one time since for a 5 month duration, and experienced immediate relief from the hairpulling within 4 days of switching over (although heinous Herxheimer effects). Out of all the treatments I have done for the trich (behavior modification therapy, luvox, treatment for P.A.N.D.A.S, heavy metal detoxification including almalgam removal, neurofeedback, NAET, amino acid therapy including taking tryptophan, dopamine, and gaba, epsom salt scalp treatment, msm scalp treatment, apple cider vinegar scalp treatment,and various hormone balancing efforts), the carb-free diet, along with anti-fungal medications, seems to have done the trick. however, my body rebels; the diet and the medications are very hard to follow for long term, and I usually lapse back into the hairpulling.

    I’ve been personally working with a ‘resistant fungus’ hypothesis that is causing my hairpulling (which piggy-backs on a heavy metal toxicity idea; fungal overgrowth =? body control for excess heavy metals). I had a chronic 2 year mercury exposure during ages 12-14, which happens to coincide with the emergence of many of my neurological issues, but 6 years prior to the hairpulling. The hairpulling stops only as long as I follow the no-carb diet (lots of protein, fats, and veggies, and non-sweetened yogurt) and my anti-fungal is working (not developing a resistance).
    Active heavy metal detoxification will 95% of the time exacerbate the hairpulling (it intensifies the strange bumps on my scalp that instigates the urge to pull). I am also a skin picker, which goes way back to when I was 8 y.o., though it did intensify with the 4 years on adderall and antidepressants, and especially with the addition of birth control. The college nurse practitioner who prescribed the contraceptives had me on it for 2 months to try to “ride out the symptoms”.
    Needless to say, much psychological damage has ensued due to this ridiculous disease (most likely with hereditary roots: my mother picked at her split ends during my childhood compulsively, and my 16 y.o. maternal half-sister picks at her skin more and more.)

    Luckily, the mercury detoxification efforts done via the hand of a naturopathic doctor has reinstated my mental capacities to the point that I have chosen (and been able) to go back to school and study to become a dietician (I am trained as a chef, and have been a foodie all my life, with a minor two year jaunt into the liberal arts)… hence the joy at finding your website! I just purchased your book and look forward to perusing it.

    I am over-sharing here to let you know at least ONE person with both trich and skin picking disorders has benefited with the non-carb (ketogenic) diet, and your hypothesizing and curiosity might actually have some heft to it! I wish I had a stronger scientific background to surmise with you, but maybe a couple more quarters of biochem is what it will take to be able to offer a more biologically-rooted hypothesis based on my own observations. I currently attend a naturopathic university outside of Seattle, and wear beautifully knitted hats by my mother to cover up the hair pulling.

    Thanks for your website!

    • Hi Heather, do you have any updates? I’m in a similar situation with trich, I’m curing candida infection and I’m going to start a heavy metal detox

  28. To Robert:

    I found this article to be an interesting tidbit concerning the prevalence of gluten- and casein-free diet and neurological symptom relief.

    http://www.flcv.com/hgopioid.html

    Concerning skin picking, has anyone looked at the neurotransmitter profiles of meth users, or even adderall (generic: amphetamine) patients, who developed the disorder? I wonder what role my 4 years on adderall had on the perfect storm development of the hairpulling. Thanks!

  29. Hi Heather,

    A ketogenic diet is the first thing I always recommend for any kind of brain disorder. Neurons are very metabolically limited and glucose- or glutamate-related problems are involved in many if not most brain conditions. Ketogenic diets help with both.

    So I’m not surprised a ketogenic diet helped you.

    However, I prefer a ketogenic diet that has some carbs and generates the ketones from coconut oil, rather than from protein via the starvation response. This is safer in the long run.

    Your very low carb diet is a risk factor for fungal infections. Glucose is important for the fungal immune response.

    You mentioned Herxheimer effects on your very low carb diet. This suggests that you have a bacterial infection. Have you tried antibiotics?

    The fact that your mother and sister have had a similar condition does not necessarily mean that it is genetic. It may be an infectious condition.

    What do you do for heavy metal detoxification?

    I am not familiar with the effects of those drugs, but it’s possible they could have depressed immune function and caused an infection to spread. Tryptophan in particular promotes bacterial infections, so you have to be careful.

    Thanks for a fascinating story and I hope our book helps you fix these conditions! Feel free to share your progress with us.

    Best, Paul

  30. Very interesting post and comments.

    I’ve experienced persistent anxiety, brain fog, and depression for about four years now. I’ve tried various treatments in response, but the most clearly helpful (particularly with anxiety) have been the SSRIs (or one, anyway–Zoloft in my case).

    The strange thing is, though the SSRIs (as noted in the comments above) are supposed to take upwards of 2-3 weeks before they even start to have a noticeable positive effect (either through promoting new neuron growth or down-regulating serotonin receptors), in my case I noticed anxiety relief nearly immediately (within a few hours).

    So, I’m left wondering two things:

    1. I know your general view on depression (and many other maladies) is that they have an infectious origin. But, as some of the commenters note, given that most depressed people take two or more weeks to respond to SSRIs, low serotonin can’t be the only thing going on for them. In my case, though, given the quick response, maybe it is.

    Do you see my response as evidence that a brain infection is at work in my case?

    2. From your post above: “If these diseases are due to infections, then we would expect the SSRI’s to improve mood immediately, but also to defeat the body’s immune response, supply the pathogens with tryptophan, and promote their replication.”

    But do SSRIs effectively provide a brain infection with more tryptophan? My understanding was that they mainly acted to keep serotonin in the synaptic gap longer than usual before reuptake. Wouldn’t SSRIs have to increase the total amount of serotonin broken down (either through making more of it than usual or causing more of it than usual to be broken down in the neuro-transmission process) for more tryptophan to be available to an infection?

    Best,
    RW

  31. Hi RW,

    I had thought that pathogens could extract tryptophan from serotonin, but upon further investigation it seems that is probably not true.

    So SSRIs may not promote infections after all.

    Your experience may well be consistent with a brain infection, but the brain is so complex, there may be other explanations. The best test might be to try a broad-spectrum antibiotic like doxycycline and see if that does as well as the SSRI.

    Best, Paul

  32. Interesting approach you have Paul on brain disorders with the ketogenic diet.

    I experienced ketogenic diet from a healthy body and I had noticed my mind was much more ‘present’.

  33. So maybe branched-chain amino acids, that compete with tryptophan, might be worth trying.

    “Patients with liver cirrhosis frequently complain of various symptoms. In our case, the patient experienced fatigue, and this clinical symptom was improved by the VAL treatment. Fatigue is associated with brain levels of 5-hydroxytryptamine, which is a neurotransmitter synthesized from tryptophan [13]. The transport of tryptophan across the blood-brain barrier is the rate-limiting step in the synthesis of 5-hydroxytryptamine, and BCAA is known to compete with tryptophan for transport into the brain [5]. Since serum valine level was markedly increased by VAL treatment in our case, valine may have inhibited the transport of tryptophan into the brain and subsequently improved fatigue through suppression of 5-hydroxytryptamine synthesis in our case.”

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3506047/

  34. Paul,

    I have virtually the exact same symptoms as you although I’ll add dehydration to the mix. I’m curious as to how you were able to determine you had Chlamydophila pneumoniae. I’ve pretty much struck out with all doctors as they think it’s just in my head so I’m looking for some more information. I’ve also just started a ketogenic diet.

    Thanks.

  35. Paul, I sent you an email within the last 2 weeks to which you graciously replied. Unfortunately, your reply was trashed before I could read it. Reading more about C. pneumoniae, I realized I have had, or have,Asthma, Alopecia, Osteo-Arthritis, Depression, Neck Pain, severe, debilitating Headaches, and been diagnosed with, and treated for, Encephalitis, during which I was bedridden for 5 weeks. This was in 1974. Everything except the Asthma has been after 1974. Every few years I have the same symptoms of the 1974 illness, but without the fever and the hyper sensitivity to noise. This usually persists for about a month. I am now in the 5th week of it now. The last time was in 2011. Would you please re-send your Reply, and do you think I might be on the right track? Also, am currently being treated for Depression with 20 mg. Citalopram per day. Was on 40mg. per day, but have told my doctor that I want to wean off the Citalopram, hence the 20mg. dose. BTW, I have had 3 doctors prescribe SSRI medication for me over the last 23 years. None of them did any bloodwork or any Checkup of any kind before prescribing. Thank you for your help. Any advice is appreciated. Bud Trout

  36. Hi paul,
    I have been having a symtom of fever for like 20years now, basically heat from inside which later resulted to continuous headache. About 3years ago i was diagnose of having depression and efexor-xr, although it seems to work for like a month or two but later still fill its not improving. i was refer to the infectious decease department but they couldn’t diagnose the problem. Now i always have to be on effexor each time i feel depress or headache for a temporary relieve. Could this be as a result of my diet or is their another way out. Thanks for your help.

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