Neurotransmitters & Psychiatric Medications: The Turkey Shoot Revisited

ADHD Medications: Neurotransmitters to the Rescue
November 2, 2009
Vyvanse diminishes Memory? Watch The Top of The Therapeutic Window
November 14, 2009
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Gluten, Immunity, and Neurotransmitters

You might miss this comment on an earlier post on celiac and gluten withdrawal – quite interesting question. The approach of Turkey Season serves as a great reminder for what-not-to-do with psychiatric medications and supplements, and how to consider withdrawal from gluten with neurotransmitters.

Peter asked:

I have been Gluten free for a 1 and a half weeks now and think I'm having withdrawal symptoms.  A year and a half ago I had glandular fever, since when I haven't fully recovered, suffering from, insomnia, anxiety, extreme fatigue after lunch (normally bread based) and digestive disturbances (bloating, flatulence, loose stools, etc…).  So last week I started taking a Betaine HCL supplement and went gluten free.

Initially, I felt much better but after a couple of days I started to get really tired and depressed and anxious!  I then had a better day then a worse one and then a better one again.  Today I've got really tired and was a bit anxious but generally better than yesterday.  My flatulence and loose stools have completely gone since going gluten free though I still see a large amount of undigested bits in the stools.  What I would like to know is your thoughts on my self diagnosis and whether these symptoms sound ‘normal'.  I'm hopeful that they will continue to clear up in the week to come.  I've been taking many vitamins too and also am eating in excess of 8 fruit/veggies per day to speed it up.

My Reply With Some Neurotransmitter Details

Sounds like you are doing well all around, and does sound like you might be experiencing gluten/opiate withdrawal. Also, well done on recognizing that you must ‘replace’ as much as ‘remove.’ Healing is a two step process with immune challenges.

The opiate sites with celiac will set the neurotransmitters off, as the immune system dysregulates a number of the neurotransmitters, both acutely with the gluten discontinuation, and over time with the overt depletion of amino acid precursors. Cytokines aggravate/dysregulate neurotransmitters If you don’t have neurotransmitters you will not only feel the pain, you simply won't improve with SSRIs or other antidepressants.

Your recovery journey would be significantly supported and accelerated by precise measurement of exactly what you have on board, both excess and deficiency are possible – as stress over the years could have pushed up norepinephrine, epinephrine or your cortisol, & DHEA levels. On the other hand, you may have simply bottomed out on serotonin and the opiates would have kept you blissful, and somewhat up.

Over time with adrenal fatigue the neurotransmitters uniformly bottom out as does the cortisol. Listen to this Adrenal Fatigue podcast over at CorePsych Podcast for any easy review. We have many in-the-dirt, refractory folks who come in, almost in wheelchairs, with cortisol levels thru the day completely flat across all levels. They simply can’t get out of bed and everyone is mad at them for being lazy. And guess what, many of them suffer from gluten sensitivity.

Taking out the offending antigen has neurotransmitter, hormonal and direct cytokine consequences. The antigen removal will help with the healing, but very well may reveal the covered, underlying nutritional and neurotransmitter imbalances.

I am including all the links in this note for you to see the multiple possible consequences, not forming a conclusion. A simple interview would direct the informed practitioner to the correct testing and then would guide your team to the easiest intervention strategy with the fastest turn around.

Easy supplements for the inflammation would be to add Omega 3 Fatty acids, and Probiotics may be helpful in restoring bowel integrity – they are available as a Missouri Turkey Shoot – scattershot intervention without precise parameters. But why just throw supplements when you can be precise with the new technology?

Interesting how some on both sides of the functional/traditional fence just cookie cut the intervention strategies.

-Many comments on the gluten post over the years, just thought it might be of renewed interest with the Neurotransmitter perspective.



  1. Kim says:

    Our son has been tested for food allergies and has the information from NEI. We have been following it by removing all things from the high level. How long does it take to see difference in energy levels ? What determines when the nerurotransmitters will be rechecked. We have been reading how diet changes can effect the neurotransmitters when foods are removed and wondering if that might be needed. Please advise.

    • Kim,
      Often just removing foods from the ‘high’ level doesn’t cover the spectrum entirely. The food elimination process can take some time but works, as follows for on of the elimination paradigms: There are food allergies, and food intolerances. So just removing the allergic foods won’t solve something like lactose intolerance if milk is not an allergen and not on the list.

      1. Start with that IgG antigen list, go off all of them, and you will often see resolution of GI symptoms in 7-10 days – do start with the high group.
      2. Look carefully for patterns even in the medium and low group, and don’t pay attention to the IBA score [Intestinal Barrier Assessment] if it indicates low numbers. He could have significant problems even with very low IBA scores in the low 400’s.
      3. Regarding patterns: Look, for example, for all milk products and circle them. No milk in high or med, but 8 in low: still = a milk/casein still an important issue.
      4. Elimination diet: take all the foods possibly contributing to either intolerance or allergy off for 7-10 day, reintroduce them one at a time, and see which one then cause resurgence of symptoms: GI or psychological: anger outbursts, sadness, impulsivity, etc.

      Do keep us posted please, – it will be interesting for others to hear about the actual objectives and the outcomes.

  2. Mariett Ramm says:

    Hello Dr Parker,
    I have been doing a BSc degree in nutrition, and my final project involves a research done on an area of interest. Mine is gluten peptide(Oopioid)-OCD and co-morbidities -and withdrawal on a gluten free diet. I have read your blogs on some very interesting case studies with people experiencing withdrawal on a gluten-free protocol. I also have started to look for research and studies on the subjects but it is so limited. Would it be possible to contact you if you could share some of your experience with me or point me in the direction of some interesting research, please.Thank you.

    • Mariett,
      Just finished an interview with Christine Boyd, a writer with Living Without [see a list of articles here] – and she has the article already completed. Do feel free to drop me an email off line, and if I can help will be glad to pitch in.

    • Gina Pera says:

      Sounds like a wonderful research topic, Mariett. Please let us know when you complete it. I’d be interested in reading!

      • Gina,
        My point exactly!!

        • Gina Pera says:

          As a sidenote, I experimented with an old favorite cake recipe yesterday. Instead of wheat flour, I used Kamut, and made other “healthier” substitutions including that accommodation for the wheat/gluten sensitivity indicated by the NeuroScience testing with you.

          The cake tasted delicious, but why was it causing my tonsils to swell (always the first line of defense with my immune system reaction). I did a little research and learned that Kamut is NOT gluten-free, wheat-free.

          So much to learn……

          • Gina,
            Thanks so much – it sounded so tasty, … ‘old favorite cake recipe.’ Bummer.

            BTW my wife and I found a great rice based bread at Trader Joe’s that tastes almost like unsweetened pound cake – gluten free, great for snacks. I tried it even tho I don’t have the gluten probs, and found it outstanding and easy.

          • Gina Pera says:

            Yes, we’ve tried that Brown Rice bread, Dr. P. It’s pretty good. It’s the closest to dense white bread that my husband’s seen in a long time (used to have high-protein, multi-grain bread). So he is happy!

            TJ’s tend to run out of it, though, so I’ve learned to stock up when they have it and freeze it.

          • Gina,
            Excellent idea, haven’t missed that bread recently, as we have been just going no/low carb across the board – out here the hot stew plan keeps us cookin’ stead of freezin’

  3. James says:

    Dr. Parker,

    Forgive me if my question(s) don’t fit the bill for your original post, but I like my odds on a current topic addressing neurotransmitters.

    I am currently prescribed 70mg Vyvanse(AM)/20mg Adderall IR(PM) and 75mg Effexor XR daily to treat ADD & depression. I purposefully left out the “H” in ADD because I am the unmotivated, inattentive, bored most of the time type. Also, my depression is characterized by more lack of motivation as well as dissatisfaction and constant sleepiness. I have posted on this bog before about feeling a need to take additional doses of my ADD meds most evenings for achieveing an entire day’s coverage. Until my insurance refreshes at the beginning of the year, I can only get 30 Vyvanse per month- no matter what mg. That said, I recently did some brief web research on the Effexor since an ideal combo for ADD meds seemed unattainable through the end of the year. FINALLY… my question. Based on the info I found on the web and previous comments by my psych dr., I wanted to get your opinion on possibly increasing the Effexor from 75mg/day to 150mg/day. In addition to the lack of motivation mentioned, impulsivity is a major symptom of my ADD that I failed to mention earlier. So, increasing my dosage to 150mg, ensuring the reuptake of norepenepherine, seems like it could help. I appreciate your opinion and advice on the matter. Thanks for reading.

    • James,
      Yes, you are in that managed care pickle experienced by so many. If medicine were in the hands of your thoughtful doc, rather than under the “care” of cookie-cutter bureaucrats who defy accountability, you would be in much better, more efficacious shape.

      I do agree with your plan, & understand/agree that the mixing of 2 AMP products is not a problem, – and won’t be as long as all concerned watch the DOE as you have been.

      Regarding Effexor: I don’t know of any refs in regards to the question of NE and DA augmentation for ADHD, for cognition. I always try to stay clear in my own mind in questions like this re: how much of the ‘motivation’ is Gran Torino Depression issue [is a real depression], and how much is secondary to cognition – to unmanageable cognitive abundance.

      And, truthfully, this question can often remain unresolved until neurotransmitter testing. The simple question restated from a neurotransmitter point of view: is the problem DA or 5HT [or, when more informed, is it a NE, EP, PEA dysregulation – more coming soon].

      My long distance view on your situation: it will help, but [guessing] more because your motivation is secondarily decreased with the good stimulants, and the antidepressant would significantly correct that presentation.

      One other thought for your medical team: If you don’t get the correction from the Effexor, my new first choice is Pristiq, a new SNRI with a different metabolic signature, and improved side effect profile.
      PS This is a perfect question generated from informed inquiry and precisely fits the evidence-based theme of this post! Thanks –

  4. Readers,
    This direct mailing from my colleague Joe Ailts, Directory of Medical Education at NeuroScience Inc, the primary laboratory we use at CorePsych for gluten and food sensitivity testing:

    “a little more insight into the situation as an FYI for you and your readers,

    Longstanding celiac perpetuates the degradation of tight junctions between the GI epithelial cells. It does so by upregulating Zonulin, the protein responsible for “tearing down the Berlin wall of the gut” – if you will. Thus, one of the hallmarks of celiac, in addition to gluten sensitivity, is a leaky gut. In the “autoimmune triad” (genetic predisposition, environmental antigen/trigger, leaky GI tract), fixing that leaky gut is a primary target of the intervention strategy.

    Removing gluten checks one off the list. Repairing the gut checks another. That’s the most powerful road to recovery.

    Leaky gut is assessed through our IBA 110 food sensitivity test [this is the one we use most often for sensitivity screening at CorePsych] . We can now customize a dietary plan specific to the patients imbalances to encourage the recovery/repair of the leaky gut. Seal up the holes, he may avoid many of the negative reactions he’s experiencing, because immune-stimulating chunks [of protein] are still getting into circulation.

    As a word of caution, Priobiotics may not be the best recommendation out of the gate for leaky guts….forward thinking researchers in this field have proposed that while the gut still has holes, fragments of probiotic bacteria may be entering circulation, thereby perpetuating/stimulating a pro-inflammatory state.

    Probiotics are certainly key in restoring intestinal health, but the holes need to be sealed first!”

    Thanks, Joe Ailts

  5. Gina Pera says:

    Fascinating! Thanks for all the details!

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