November 30, 2010

A Tylenol PM Slip

One problem I've found with 5-HTP is that my sleep can be very fragmented, interrupted by 3 or 4 or more "pee breaks" during the night.  Most of the time I fall back to sleep immediately but sometimes, particularly if it's a 5 a.m. or thereabouts break, I'll lie awake for 15-30 minutes before getting back to sleep. But since 5-HTP also stabilizes my mood, I'm calm and relaxed during the time awake. And then I usually log in another 2 hours of sleep.

Every once in awhile, however, I decide it would be nice to have a less interrupted night's sleep and I take two Tylenol PM's rather than the 5-HTP at bedtime. That's what I did last night and I logged in 7-plus hours of sleep with only one  break. 

I do this rarely because I have had a bad experience with extended use of Tylenol PM.  Since 2001, I've made a dozen or more trips to Nepal and neighboring countries. To deal with the jet lag from the long flights coming and going, I would use Tylenol PM for the first few post-flight days.  Sometimes I've continued to use it off and on during the  two or three weeks I'm traveling. And, I'm embarrassed to admit, on particularly difficult nights I sometimes would throw in half of an Ambien. As a recovering alcoholic, I should know better than to abuse drugs like this!  

Beginning in June 2006, I had probably my worst summer ever -- several difficult months marked by insomnia, depression and panic attacks.  I attributed this at the outset to a reaction to my abuse of Tylenol  PM and ambien during and after a trip to Nepal.  But when I went to a sleep center and several doctors and a psychiatrist, they heard "depression" and "panic attacks" and got out their prescription pads. Over the course of the summer, I was prescribed trazodone, remeron, Lunesta, Rozerem, Lexapro, and clonazepam, none of which worked.  Most made it worse.  Finally it was suggested I try a holistic approach, which eventually did work. I remain convinced that overuse of Tylenol PM and ambien was the initial trigger and that piling on the other drugs compounded the problem.

So I have good reason to be cautious about these meds. I've also read warnings that the drug  (Diphenhydramine) in Tylenol PM (and in Benadryl) should not be used on a regular basis by the elderly.

I'm writing this mainly to remind myself that 5-HTP is a much safer and better choice as a sleep aid.

November 28, 2010

5-HTP and Problem Solving

I hesitate to post this because it sounds so "New Age."  But here goes.  Since taking 5-HTP, I've found that often when I go to bed wrestling with a problem, I wake up the next morning with a solution and not just a solution but also a detailed plan of action.  Prior to 5-HTP, a good night's sleep sometimes would help resolve a problem, but not with the clarity and details that I'm now experiencing.

This morning was an example.  After spending much of yesterday researching and writing the two posts on the faulty cautions about the safety of 5-HTP  (see posts below), I went to bed worried that sooner or later I'd run out of things to say about 5-HTP..  I woke up at 5 a.m.  (instead of the usual  7 or 8 a.m.) with the decision to broaden the blog's narrow focus so that I could discuss all of the other things that have made this, my first year after the Parkinson's diagnosis, one of the best years of my life. Then, I stood frozen at the bathroom mirror getting ready to brush my teeth as all sorts of ideas on how to go about this came flooding in..

I've Googled "5-HTP and problem-solving" in the past and not gotten any hits.  This is a reminder that Parkinson's is a very idiosyncratic disease and that each individual's reaction to 5-HTP also is unique.

Thanksgiving Weight Loss!

I, once again, give thanks for 5-HTP,  In the week before Thanksgiving, I began experiencing a return of constipation and I also was urinating less frequently AND my weight was going back up.(Prior to switching to 5-HTP, I had taken the prescription antidepressant Elavil and gained 5 pounds in a couple of months; after switching to Elavil, I lost 10 pounds).  Since 5-HTP is used by many for weight control, I decided to up my dosage from the 100 mg I take at bedtime to 150.  However, on the few occasions when I've taken 150 mg. at bedtime, I've logged in only 5 or 6 hours sleep and awakened in a semi-manic go-go mood.  So I decided instead to take the extra 50 mg. with my afternoon nap on the day before Thanksgiving.  On Thanksgiving I overindulged as usual and was prepared for bad news when I got on the scale the next morning.  I was pleasantly shocked to find that I'd lost a pound!

I've continued on this regimen for the past few days and have lost an additional pound or two.  I may keep this up for another day or two, but then return to the 100 mg at bedtime only.  The first few days of taking the extra 50 mg at nap time, I got my usual 7 hours plus sleep at night without the manic morning after.  But now I'm beginning to experience the loss of sleep and morning mania. (But this has its plus side.  See the posting today on "5-HTP and Problem Solving.")

The reports on 5-HTP and weight loss assume that this is because 5-HTP acts as an appetite suppressant. This hasn't been my experience.  Instead, 5-HTP seems to produce much more frequent bowel movements and urination.

November 27, 2010

Cautions about 5-HTP contamination and EMS are ill-founded

 Anyone doing internet research on the safety of  5-HTP will quickly find cautions like this one from WebMD, which is normally one of the best sites for checking out drugs and supplements:

"Don’t use 5-HTP until more is known. 5-HTP might be UNSAFE. Some people who have taken it have come down with eosinophilia-myalgia syndrome (EMS), a serious condition involving extreme muscle tenderness (myalgia) and blood abnormalities (eosinophilia). Some people think the EMS might be caused by an accidental ingredient (contaminant) in some 5-HTP products. But there is not enough scientific evidence to know if EMS is caused by 5-HTP, a contaminant, or some other factor. Until more is known, avoid taking 5-HTP."

The precursor of  5-HTP was L-tryptophan which was used as a dietary supplement until it was banned in 1989 due to an outbreak of EMS that was traced to a contaminated lot of 5-HTP from one manufacturer. Because of its chemical and biochemical relationship to L-tryptophan, concerns have been raised about 5-HTP and there were reports of a possible EMS-like contamination with 5-HTP in 1994.  But a 2004 study reviewed all of the earlier studies and reports on 5-HTP and came to this conclusion:

 "no definitive cases of toxicity have emerged despite the worldwide usage of 5-HTP for last 20 years, with the possible exception of one unresolved case of a Canadian woman. Extensive analyses of several sources of 5-HTP have shown no toxic contaminants similar to those associated with L-Trp, nor the presence of any other significant impurities. A minor chromatographic peak (peak X) reported in some 5-HTP samples lacks credibility due to chromatographic artifacts and infinitesimal concentrations, and has raised undue speculations concerning its chemistry and toxicity."

A 2006 study at Georgetown University's Medical Center on whether 5-HTP causes EMS experimented with a group of rats and concluded that "no significant evidence of EMS was seen in rats receiving high-dose 5-HTP for 1 year."

Once again, as with the concerns about 5-HTP and carbidopa (see posting below), a single ambiguous finding has led to repeated website warnings despite the fact that 5-HTP has been very widely used  for years without any verifiable reports of EMS contamination.

Carbidopa and 5-HTP mixed messages

If when contemplating 5-HTP you do what I did and check it out on Google to see if there are safety concerns, you find that the most oft-cited concern is about mixing 5-HTP with carbidopa.  Since Carbidopa/Levodopa is the "gold medal" med for treating Parkinson's, this concern would seem to make it advisable to forget about 5-HTP, particularly since the numerous mentions made it appear that a number of studies had led to this concern.

However, when I checked into it further, I found that virtually every website that expressed a caution about this used exactly the same words: 
 “A scleroderma-like skin condition has been reported in some taking a combination of 5-HTP and carbidopa."

I began  to suspect that everybody was quoting each other.

Then I went to PubMed, the service of the US National Library of Medicine that includes over 19 million citations from MEDLINE and other life science journals, and searched for "5-HTP and carbidopa and scheroderma" This produced 7 hits.  But in examining them, it appeared that the 6 most recent reports were on unrelated studies that happened to cite  the 7th study -- a 1980 study in France that was published in the New England Journal of Medicine  and involved 15 people.   The published abstract provided a very thin basis for all of the subsequent cautions.  See:

It's amazing that one small study in 1980 can generate a web-full of warnings.  Meanwhile thousands, if not millions, of people have used 5-HTP without any current reports of this condition. Europeans have been using 5-HTP much longer and more frequently than in the U.S.  AND in Europe it is recommended that 5-HTP be taken WITH carbidopa.

Here's what the Wikipedia entry on Carbidopa has to say:

"Carbidopa is also used in combination with 5-HTP, a naturally occurring amino acid which is a precursor to the neurotransmitter serotonin and an intermediate in tryptophan metabolism. Carbidopa prevents 5-HTP's metabolism in the liver and the resulting elevated levels of serotonin in the blood. Research shows that co-administration of 5-HTP and carbidopa greatly increases plasma 5-HTP levels. 5-HTP has no reported cases of heart valve disease associated with it as found in the peer reviewed literature. [2][3] In Europe, 5-HTP is prescribed with carbidopa to prevent the conversion of 5-HTP into serotonin until it reaches the brain.[4]"

November 21, 2010

CDP-Choline and Parkinson's

I included a reference to this in my post on Thursday and "Anon." wrote to ask if I had any more information.  I googled this and found a number of studies reporting promising results from this supplement. Several of them specifically involved Parkinson's.  Here is one report:


Short for cytidinediphosphocholine, CDP-choline (sometimes called citicholine) is a substance that occurs naturally in the human body. It is closely related to choline, a nutrient commonly put in the B vitamin family. For reasons that are not completely clear, CDP-choline seems to increase the amount of dopamine in the brain.3,4  On this basis, it has been tried for Parkinson’s disease.
In a 4-week, single-blind study of 74 people with Parkinson's disease, researchers tested whether oral CDP-choline might help levodopa be more effective.5  Researchers divided participants into two groups: one group received their usual levodopa dose, the other received half their usual dose without knowing which dosage they were getting. All the participants took 400 mg of oral CDP-choline 3 times daily.
Even though 50% of the participants were taking only half their usual dose of levodopa, both groups scored equally well on standardized tests designed to evaluate the severity of Parkinson's disease symptoms.
Support for the use of CDP-choline also comes from studies in which the supplement was administered by injection.6-9 
In general, CDP-choline appears to be safe.11  The study of oral CDP-choline for Parkinson's disease reported only a few brief, nonspecific side effects such as nausea, dizziness, and fatigue.12  In a study of 2,817 elderly people who took oral CDP-choline for up to 60 days for problems other than Parkinson's disease, side effects were few and mild and reported in only about 5% of participants.13  Two-thirds of these side effects were gastrointestinal (nausea, stomach pain, and diarrhea), and none required stopping CDP-choline. The dose in this study was 550 mg to 650 mg per day, about half the dose used for Parkinson's disease.

I intend to discuss CDP-Choline when I have my regularly scheduled meeting with my neurologist in late December.




November 20, 2010

Upping 5-HTP dosage results in less sleep but more "manic" energy

Having an event-free day today, I decided last night to experiment with upping my 5-HTP dosage from 100 mg to 150 mg. I had done this recently during a trip to California and it seemed to help boost my energy level and enable me to be on the go all day long. In fact, I worried a bit that I was on a high similar to what Kay Redfield Jamison described in her classic book "The Unquiet Mind" on her bipolar disease.  :-)

As I noted in a post below, on 100mg 5-HTP, I 've been averaging 8 hours sleep a night. This morning, after the 150 mg dosage, I woke up after 5 hours but full of energy AND with answers to a problem I had been wrestling with all week.  I have found generally with 5-HTP that it often results in problem-solving on waking.

So in addition to taking care of depression, insomnia, and constipation and helping with weight loss, 5-HTP also resolves problems! What's not to like?

November 18, 2010

Levadopa/carbidopa positive interaction with 5-HTP

This is from a recent U. of Michigan study:

"The supplement 5-HTP may help with depressive symptoms in Parkinson's disease when combined with Levadopa and carbidopa. The University of Michigan Health System warns that if you have Parkinson's disease, you should not take 5-HTP alone."

Read more:

Confirms other recent reports that are just the opposite of the older reports warning against combining the two.

The UofM article also has this to say about a supplement I haven’t even heard about:

Another supplement that may help with your Parkinson's disease symptoms is cytidinediphosphocholine, also called CDP-choline. This supplement appears to increase the level of dopamine, which decreases the motor symptoms of Parkinson's disease. When Parkinson's disease patients took 400 mg of CDP-choline three times a day, they could take less levadopa, a Parkinson's disease medication that converts into dopamine. Before starting CDP-choline for Parkinson's disease, talk to your doctor.

November 14, 2010

This is crazy!

Last night I slept for over 9 hours! I can't remember ever having slept that long . . . at least not since I got sober over 30 years ago. :-)

Of course, I only got 5 hours of sleep the night before (by my choice)and I worked outside in the yard for over 4 hours during the day. But still I don't think I would have slept that long were it not for the combination of 5-HTP and Ginkgo Biloba.