July 28, 2016

Could 5-HTP Be Even More of a Wonder Drug than I'd Thought?

I started this blog shortly after I was diagnosed with Parkinson's disease (PD) in the fall of 2009. The title I picked for the blog was "Parkinson's and 5-HTP." I intended to use the blog to tout this wonder drug for alleviating the major non-motor symptoms of Parkinson's.

5-HTP is a dietary supplement that can be bought over-the-counter without a prescription. I had used it to combat the insomnia I experienced during my extensive travels to Nepal and elsewhere from 2001 to 2008. As I started researching to learn more about PD, I found that the three most common non-motor side effects of PD ere insomnia, constipation, and depression. From my experience using 5-HTP during my travels, I knew that it helped me deal with two of those three symptoms.

After talking it over with my neurologist and with his approval, I started taking 5-HTP every night at bedtime. I found that it definitely helped with the insomnia and constipation I’d been experiencing. I'm usually not troubled by depression, but I did sense that the supplement was making my usual good mood a bit more euphoric.    

I couldn't find anything in the medical literature about using 5-HTP to help people with PD deal with these issues. So I started this blog mainly to let others know about this wonder drug.

Others with Parkinson's tried 5-HTP as a result of my blog posts. A few found that it helped alleviate constipation. But no one reported that it helped with insomnia, mood, or anything else. Later, I began having my own reservations about this wonder drug when it resulted in my ending up in the emergency room at Sibley Hospital on two occasions because it caused spikes in my blood pressure that had me close to fainting.

So I stopped advocating 5-HTP for use by others. But I continued posting reports on my own experience.

I could detail the ups and downs of my years dealing with 5-HTP, but I've told that story too many times and I want to get to the current developments sooner rather than later. But if you want a summary of my history with 5-HTP, click here.

My Decision to Stop Using 5-HTP
In early March of this year, I ended up in the emergency room at Sibley Hospital after a strange collapse at home. The doctors, after spending hours testing and examining me, found nothing wrong and couldn't come up with an explanation for the incident. 

But I thought it was probably a result of my experimenting with a new OTC sleep aid I had discovered at Trader Joe's. This supplement combined 5-HTP with melatonin and L-theanine.

This incident came at a time when I was brooding about the time and effort I was spending constantly monitoring my blood pressure because of the 5-HTP. So I decided to stop taking the supplement. For a full report on that issue, click here.

After four months of not taking 5-HTP, I decided to resume taking it a month ago. The developments that led to this decision have given me new insights about the supplement and its potential for helping me and others with Parkinson's. 

5-HTP in Brief
5-hydroxytrytophan (5-HTP) is a chemical that the body manufactures from the amino acid tryptophan. The tryptophan then is changed into serotonin, the neurotransmitter that helps regulate mood and behavior.

Tryptophan is found in foods like poultry, eggs and cheese. Eating foods with tryptophan does not increase 5-HTP levels very much. But the 5-HTP supplement, which is made from the seeds of an African plant called griffonla simplicolla, helps raise serotonin levels in the brain and central nervous system and thereby may help boost mood and aid sleep.

I use "Google alerts" to keep me updated on new reports about 5-HTP. But I've been disappointed in the dearth of useful  news until recently. Interest in 5-HTP seems to be picking up, particularly with respect to the supplement's potential for dealing with insomnia.

A Good Update
I noticed that many of these new reports referred to a 2014 study by the University of Maryland Medical Center. I checked it out and found that it provides an excellent summary on 5-HTP research. What follows comes from that report.

No serious side effects: In 1989, a contaminant called Peak X was found in tryptophan supplements. Researchers believe that an outbreak of eosinophillic myalgia syndrome (EMS) -- a potentially fatal disorder that affects the skin, blood, muscles, and organs -- could be traced to the contaminated tryptophan. The FDA pulled all tryptophan supplements off the market.

Later Peak X also was found in some 5-HTP supplements, and there have been a few reports of EMS associated with taking 5-HTP. However the level of Peak X in 5-HTP was not high enough to cause any symptoms, unless very high doses of 5 HTP were taken.

Insomnia: In one study, ​people who took 5-HTP went to sleep quicker and slept more deeply than those who took a placebo. Researchers recommend 200 to 400mg at night to stimulate serotonin, but it may take 6 to 12 weeks to be fully effective​. (my italics)

There are two points to make here with regard to 5-HTP and Parkinson's.
  1. The researchers recommend taking 200 to 400 mg of  5-HTP at night. But I've been using the lowest dose of 5-HTP available – – 50 mg – – and taking only one half of the pill two or three times a day for a total daily consumption of 50 or 75 mg. I find that if I go much beyond this, I'm likely to have a big spike in my blood pressure. Initially I couldn't figure this out. Finally the light bulb clicked on. Like most people with Parkinson's, I take carbidopa/levodopa  (brand name Sinemet ). Levodopa is the active ingredient. It rebuilds the dopamine cells that Parkinson's disease kills off. The carbidopa is used to greatly enhance the ability of the levodopa to cross the blood brain barrier. I finally realized that the carbidopa must be having the same effect on my 5-HTP pills. My guess is that the carbidopa I take can have a multiplier effect on the 5-HTP so that 50 mg becomes more like 400 mg.
  2. I've underscored the phrase that it can take 6 to 12 weeks for 5-HTP to be fully effective. This could explain one of the things that has troubled me the most about 5-HTP when taken by others -- the fact that others who have tried it did not get anywhere near the benefits that I did. The explanation could well be that I had been using 5-HTP for several years prior to my PD diagnosis and therefore it was fully effective when I used it after my diagnosis. I doubt that very many of those who experimented with 5-HTP took it for 6 to 12 weeks.

In another study, an amino acid preparation containing both GABA (a calming neurotransmitter) and 5-HTP reduced falling asleep time, increased the duration of sleep, and improved sleep quality. 

Depression:  Preliminary studies indicate that 5-HTP may work as well as certain antidepressant drugs to treat people with mild to moderate depression. Like the class of antidepressants known as serotonin reuptake inhibitors (SSRIs), which include Prozac and Zoloft, 5-HTP increases the levels of serotonin in the brain. One study compared the effects of 5-HTP to Luvox in 63 people and found that those who were given 5-HTP did just as well as those who received Luvox. They also had fewer side effects than the Luvox group. These studies, however, were too small to conclude with certainty that 5-HTP works. More research is needed.

Obesity:  A few small studies have investigated whether 5-HTP can help people lose weight. In one study, those who took 5-HTP consumed fewer calories (they were not trying to diet), compared to those who took a placebo. Researchers believe 5-HTP leads people to feel more full after eating, so they eat less.

A follow-up study, which compared 5-HTP to a placebo during a diet and non-diet period, found that those who took 5-HTP lost about 2% of body weight during the non-diet period and another 3% when they dieted. Those taking a placebo didn’t lose any weight.

(In the month that I've been back on 5-HTP, I've lost over 5 pounds without any intention of dieting. One of the doctors I saw last week expressed concern that I was getting too thin! That certainly was a first for me.)

Constipation and Insomnia and Me
Constipation wasn’t discussed in the update from the University of Maryland Medical Center. But it was my major concern during the four months I was off the 5-HTP pills.

As soon as I stopped taking the 5-HTP, I immediately had to deal with nonstop constipation. This was accompanied by a feeling throughout the day and night of tightness in my gut. It felt like World War I trench warfare was being fought in my gut.

Coincidentally, during my continuing effort to clean out my files, I came across an August 2006 report from a Center for Sleep and Wake Disorders on a consultation I had with them that I had completely forgotten about. The report describes the same constipation and gut tension I was experiencing then. I also felt that this tension was causing my insomnia.

I've dubbed the summer of 2006 as my "summer from hell." I was suffering from the consequences of overdosing on Ambien and Tylenol PM to deal with jet lag insomnia on my return from one of my trips to Nepal.

This blog post from 2006 details how that summer was filled with insomnia and anxiety attacks nonstop. I consulted with my internist and a psychiatrist who specialized in pills and the sleep center. Nothing worked.

Interestingly, the blog post mentions that the only thing that helped at all was 5-HTP. What finally brought relief was a meditation/relaxation program. The more things change, the more they remain the same.

Intriguing New Study Suggests Laxatives Can Help People with Parkinson's
Use of laxatives by patients with PD can alleviate the progression of rigidity that normally accompanies Parkinson's, according to a recently released study. The results strongly support the growing belief that gut factors play a big part in PD.

This report would be of great interest in and of itself. But for me, it has a special fascination because of the experience and insights I gained from my four months of abstinence from 5-HTP and my return to it last month.

As I reported above, the constipation that came roaring back once I stopped taking 5-HTP reinforced the feeling I've had for years that my Parkinson's disease is centered in my gut.   

In the recently published retrospective study, researchers from Kings College London reviewed laxative use among 79 Parkinson's disease patients who participated in a gut-brain clinic between August 2002 and July 2014. The study used a strict regimen of laxative types, from bulk or osmotic laxatives to prucalopride (Resolor), the serotonin stimulator approved in Europe.

The patients contributed to 1493 measurements of rigidity. Arm rigidity increased an average 5.5% per year before patients started using laxatives. Once laxatives were introduced, the rigidity figures reached a plateau. The effect remained throughout the entire study period.

Adjusting the analysis for the use of other drugs and factors that might have affected the result did not change the outcomes. The slowing of rigidity progression could also be observed in patients who had never used drugs for PD, suggesting that the effect is not changed by medication.

"That the apparent effect of regular laxatives appeared in those who had never received drugs for Parkinson's disease points to modification of an underlying disease process," said Dr. John Dobbs, senior author of the study.

Different classes of laxatives gave similar results, indicating that relieving constipation affects a common factor linked to rigidity.

Signs of inflammation both in and outside the brain can be detected early in Parkinson's disease. The study suggests that limiting peripheral inflammation in the gut might affect brain inflammation and the spreading of a-synuclein fibrils which contribute to the disease progression.

We don't classify 5-HTP as a laxative. But it’s more effective for me than any of the many laxatives I've tried. And standard laxatives don't alleviate insomnia and depression, as 5-HTP does.

To read this report in full, click here. 

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