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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by NoMotic on October 27, 2003, at 7:48:38
Hi, I would say the following is true for anywhere from 20 - 80% of social anxiety problems: Social anxiety is caused by a mix of mental symptoms caused by food sensitivities (dairy, gluten, yeast, etc), caffeine (via downregulation of 5-HT1a, possibly upregulation of 5-HT2a receptors through cortisol excess - very important factor in my opinion), alcohol, lack of sleep, and hypoglycemic like symptoms (without blood sugar actually being low defined by a test). I know this to be 100% true for myself and definitely true for other people on boards who are more interested in immune disorders and candida type illness. These people tend to call it "brain fog" but its all the same. Gluten and dairy both cause symptoms in me that would seem like some sort of downregulation of prefrontal dopamine chemistry, mediated maybe directly via dopamine, or indirectly through exorphin opiates, 5-HT2a or Cytokines (most likely). Caffeine probably is the most important for me. Any amount of caffeine sets off the excess glucocorticoid syndrome and I think my feedback mechanism, like most people w. depression / anxiety, is severely impaired. Unattended to, I believe that excess glucocorticoids definitely alter monoamine levels and I believe that 5-HT1a and 2a are probably important, with 1a having a lot of scientific backup. Note that 1a is implicated in social anxiety, as Buspar is a partial 1a agonist, and kava may act as a 1a agonist. As far as blood sugar levels, I have read studies that people with ADD often lose blood flow to the prefrontal cortex after a high carb meal. This makes sense, and would be similar in symptoms to DA or 5-HT dysregulation in the PFC. Anyone have any thoughts to add to this? For me, when I avoid caffeine, food sensitivities, alcohol, and watch my blood sugar levels, my social anxiety symptoms decrease to the point where I would without question call myself extroverted and having little if any social fears. Under the influence of any caffeine, this changes very very quickly, and since anxiety is a learned experiencem, in a way, I can easily get myself into "learning" to be anxious again in social situations by using caffeine and eating foods I am sensitive to rather than "learning" to be more extroverted by knowing what makes me feel good. Anyway, that's it. Thoughts? Comments?
Posted by Mid- Life Crisis on October 27, 2003, at 19:57:30
In reply to This is what I think causes social anxiety., posted by NoMotic on October 27, 2003, at 7:48:38
You are lucky to have discovered the cause of your social anxiety and a way to prevent it without meds. However, none of that could apply to my social anxiety, which is specific to the performance type (i.e., I only get it when having to give speeches, take important exams, meet with my supervisor, etc.) I have had this form of social anxiety for at least 35 years, long before I drank caffeine or alchohol. So for me, I know that isn't the cause. Also, if diet affected it, I would think I would be anxious or not anxious in all situations, or at least all social situations instead of just some involving performance.
There's a strong genetic component in SAD, and anxiety disorders in general. But, again, if limiting your diet works for you, perhaps it can work for some others as well. It can't hurt to try! (I have found that cognitive behavioral therapy helps mine somewhat.)
Posted by NoMotic on October 28, 2003, at 7:28:11
In reply to Re: This is what I think causes social anxiety., posted by Mid- Life Crisis on October 27, 2003, at 19:57:30
am thinking along the lines of people like myself who never were all that anxious, then sort of developed anxiety out of nowhere, and you can tell that the shakiness, heart palps aren't due to stress or anything. For me, it was totally out of nowhere and I could pinpoint the problem. Then I went back to my normal self after removing the offending foods and reworking my own biochemistry. Even if its not related to diet directly, the immune system component to depression and anxiety cannot be argued. Cytokines can cause experimental depression in animals... possibly viruses and other non dietary components are involved? Who knows. But it's my belief that in people who were normal then get a mental disorder, the core problem lies in some sort of abnormal immune activation that didn't exist before the disorder.
Posted by ramsea on October 28, 2003, at 9:53:23
In reply to Re: This is what I think causes social anxiety., posted by NoMotic on October 28, 2003, at 7:28:11
What you say is very interesting. Some people with autism, which has some association with SAD at some level anyway, are helped by avoiding dairy/wheat and grains, and the candida diet. Now I am willing to give all this a go. My SAD isn't helped by lithium, at least not yet. There is an improvement in my social ability though, as a result of either a)giving up Ativan which was confusing and depressing me; b) moving out of depressive features of Mixed Bipolar; c) lowering does of Seroquel to 25 mgs prn (from 100-400 mg) d) good karma in a last lifetime (joke---everyone knows I had bad karma, lol).
I do have ADD traits however and am afraid that giving up caffeine will cause total lack of focus; it really does seem to help. Maybe I should try it anyway. But I do get scared that I will find a caffeine world a foggy, dreary, hopeless place to be.
Posted by KimberlyDi on October 28, 2003, at 14:58:24
In reply to This is what I think causes social anxiety., posted by NoMotic on October 27, 2003, at 7:48:38
Posted by JonW on October 28, 2003, at 20:53:26
In reply to Isn't Social Phobia, just plain old Shyness? (nm) » NoMotic, posted by KimberlyDi on October 28, 2003, at 14:58:24
Posted by cybercafe on October 29, 2003, at 0:14:29
In reply to Re: This is what I think causes social anxiety., posted by NoMotic on October 28, 2003, at 7:28:11
> am thinking along the lines of people like myself who never were all that anxious, then sort of developed anxiety out of nowhere, and you can tell that the shakiness, heart palps aren't due to stress or anything. For me, it was totally out of nowhere and I could pinpoint the problem. Then I went back to my normal self after removing the offending foods and reworking my own biochemistry. Even if its not related to diet directly, the immune system component to depression and anxiety cannot be argued. Cytokines can cause experimental depression in animals... possibly viruses and other non dietary components are involved? Who knows. But it's my belief that in people who were normal then get a mental disorder, the core problem lies in some sort of abnormal immune activation that didn't exist before the disorder.
okay so what vitamins/minerals/steroids should we have examined to see if we really are suffering the effects of poor diet ??
Posted by ramsea on October 29, 2003, at 3:04:09
In reply to Isn't Social Phobia, just plain old Shyness? (nm) » NoMotic, posted by KimberlyDi on October 28, 2003, at 14:58:24
Shyness is not a phobic reaction in itself. Think of people with a phobia to spiders or small, enclosed spaces like closets, and then think of people with a phobic reaction to people. You are talking major, disturbing physiological symptoms that a person has in the presences of other people. Most often there are some people a social phobic is fine around, but situations (like a classroom) or a party, where they simply get ill from being with these people. Since we are social animals, having a social phobia of any kind can be devastating. For a rare group almost all people in almost all situations cause major physiological reactions like racing pulse, inability to breathe properly, stomach turning, sudden explosive diarrhea, sweating profusely, and so on. So the short answer is--social phobia should not by definition be indicating "plain old shyness"---which can be hard enough on shy people in a world that celebrates loud mouthed, joking extroverts
Posted by Ame Sans Vie on October 29, 2003, at 6:34:18
In reply to Re: Isn't Social Phobia, just plain old Shyness?, posted by ramsea on October 29, 2003, at 3:04:09
100% agree with ramsea -- I've been a shy kid, and I've been a social phobic adult. There's definitely a huge difference.
Posted by JonW on October 29, 2003, at 9:30:23
In reply to Isn't Social Phobia, just plain old Shyness? (nm) » NoMotic, posted by KimberlyDi on October 28, 2003, at 14:58:24
I dropped out of high school, and have been hospitalized twice... for just "plain old shyness". You see what I'm saying?
Social anxiety is a normal part of life and everyone experiences it. Just as saddness is a normal part of life, and everyone experiences it. Anxiety is supposed to sharpen you and make you perform better... people learn to harness it. Having social anxiety disorder is a dysfunction of that system, and it can be very debilitating. Imagine a life-threatening situation that would invoke fight or flight, and cause you to panic and run. Imagine choosing to stay in that situation, but not having the ability to fight. The way you would feel in that situation is what it feels like for someone with social phobia to have a conversation with someone they don't know, ask another person out, go to the mall, or pretty much anything that involves people. It may be hard to understand, but people with social phobia often find being mugged less anxiety provoking than asking a girl out, for example. The other important thing to note, is that social phobia is not a phobia. Phobias respond to exposure alone, and social anxiety disorder does not. Cognitive Behavioral Therapy and/or medication can be very helpful for people with this problem. Both genetics and environment have a role in who develops the disorder.
Jon :)
Posted by KimberlyDi on October 29, 2003, at 15:34:50
In reply to Re: Isn't Social Phobia, just plain old Shyness?, posted by ramsea on October 29, 2003, at 3:04:09
My question wasn't meant as a mocking reply. I've suffered from shyness all my life. Being in the public eye is painful and I start to faint if I have to speak publicly. That's if I'm lucky, rest of the time, mind goes blank and I stutter and look like a lost dunce. I would rather eat veggies than make a speech. Is shyness a fear of the public's opinion? A fear of exposing oneself to rejection of any sort? I don't know but I would like to. I'm not diminishing it by any means.
KDi
> Shyness is not a phobic reaction in itself. Think of people with a phobia to spiders or small, enclosed spaces like closets, and then think of people with a phobic reaction to people. You are talking major, disturbing physiological symptoms that a person has in the presences of other people. Most often there are some people a social phobic is fine around, but situations (like a classroom) or a party, where they simply get ill from being with these people. Since we are social animals, having a social phobia of any kind can be devastating. For a rare group almost all people in almost all situations cause major physiological reactions like racing pulse, inability to breathe properly, stomach turning, sudden explosive diarrhea, sweating profusely, and so on. So the short answer is--social phobia should not by definition be indicating "plain old shyness"---which can be hard enough on shy people in a world that celebrates loud mouthed, joking extroverts
Posted by KimberlyDi on October 29, 2003, at 15:43:12
In reply to Re: Isn't Social Phobia, just plain old Shyness? » KimberlyDi, posted by JonW on October 29, 2003, at 9:30:23
I didn't mean to step on any toes. I haven't heard about social phobias until recently and didn't know if I was a misdiagnosed shy child like ADHD'ers used to be "hyperactive misbehaving" children who shouldn't eat preservatives. They always talk about the flight or fight response. What about the Freeze response. Doe in the headlights response.
Apologies to all social phobia folks who misunderstood what I was trying to say!
Good luck to everyone.
KDip.s. I'm also withdrawing from Effexor, feeling like doo-doo, and suffering from memory problems. Small wonder if I make little sense!
Posted by NoMotic on October 29, 2003, at 16:24:28
In reply to Re: This is what I think causes social anxiety., posted by cybercafe on October 29, 2003, at 0:14:29
> > am thinking along the lines of people like myself who never were all that anxious, then sort of developed anxiety out of nowhere, and you can tell that the shakiness, heart palps aren't due to stress or anything. For me, it was totally out of nowhere and I could pinpoint the problem. Then I went back to my normal self after removing the offending foods and reworking my own biochemistry. Even if its not related to diet directly, the immune system component to depression and anxiety cannot be argued. Cytokines can cause experimental depression in animals... possibly viruses and other non dietary components are involved? Who knows. But it's my belief that in people who were normal then get a mental disorder, the core problem lies in some sort of abnormal immune activation that didn't exist before the disorder.
>
>
> okay so what vitamins/minerals/steroids should we have examined to see if we really are suffering the effects of poor diet ??Ok, i guess I have to clarify. I'm saying nothing about vitamins / minerals / steroids. I know what you're getting at, but I think the evidence I've read to back up my points is well supported. I'm not one of those freaks who puts down the american diet at every chance. What I am trying to get you to do is investigate a few possibilities in WHATEVER mental disorder you have. Accepting there is NO CAUSE for your mental disorder seems unacceptable to me, and I feel you all should be searching for real answers. An explanation like "too little dopamine and norepinephrine in the prefrontal cortex causes ADD" isn't sufficient for me. I can't see why anyone else would accept that answer... unless the medication they take cures them perfectly, in which case, good for you, I'm happy for you. Medication can make me feel better, but what I am involved in essentially CURES me (though dietary restrictions can be extremely tedious!!!), it doesn't just make me feel better. Sorry if this ends up being really long, but I feel it has to be long to get my point across.
I'm sorry if i wasn't clear enough to begin with. I don't necessarily mean social anxiety per se (with regard to my previous posts), but rather the whole spectrum of anxiety disorders. While I'm at it, I'll include depression and attention deficit disorder in the list of things that can be helped by addressing these points below:
Again, the major points: Caffeine, Food sensitivites / allergies (aka immune reaction to food), not enough sleep and hypoglycemic type reactions.
To really feel what its like to be caffeine free, I think it takes at LEAST a week, possibly 2 weeks. Why so long? Your body stops being dependent on caffeine after maybe 72 hours, but the effects, in my opinion, may last for days after the initial terrible 72 of going caffeine free. You can still be suffering from the effects of caffeine induced borderline vitamin and mineral deficiencies. I wont go and say that one WOULD be deficient in vits and mins from using too much caffeine, but rather, a low level of vitamins and minerals can still bring about mild symptoms. That includes B1, magnesium, iron (from tannins in tea possibly), calcium and other I cant remember off the top of my head. My point: it takes more than 72 hours to replenish a borderline mineral deficiency, I think. The poor blood sugar regulation caused by caffeine might not be fixed for a few days after the caffeine dependence is gone, which will effect mental function. Most importantly, though, caffeine indirectly increases cortisol levels via adenosine antagonism. Many studies show this. Cortisol and glucocorticoid increases indirectly increase serotonin reuptake (aka the opposite of antidepressants). So picture this: You have caffeine at 6am, 8am, and 10am, 400mg total. This causes a 350% total increase in cortisol levels. By 6pm, you feel like shit because your body is suffering not only the effects of poor blood sugar regulation, but the effects of enhanced serotonin reuptake and decreased dopamine in the prefrontal cortex. After a month straight of using caffeine in the amounts of 3 or 4 cups per day of coffee, you MIGHT be low in several minerals and vitamins, your hippocampus might have shrunk from too much glucocorticoids being released, your PFC might have low levels of monoamines (again another reaction to excess glucocorticoids), your blood sugar levels might be all over the place, reducing blood flow to the brain and further causing increased glutocorticoids, and finally your overall serotonin reuptake is significantly ENHANCED. For those who know about biochem of the brain enough, you can imagine what this does. For those who don't, caffeine theoretically can directly cause the symptoms of ADD, depression, and anxiety disorders. This is well established in literature that a small % of people get caffeine induced mental disorder. I know there's a ton of people who will disagree with me, but the actual symptomatic effects of what I described above happens to me when I consume excess caffeine, no question about it. My advice for those who want to quit caffeine is this: don't use ANY other drug if you want to quit caffeine. All other drugs can cause cravings for caffeine. And if you do stop, wait a whole week and THEN see how you feel. If you feel no better, why not begin using caffeine once again and reap the benefits of increases in concentration, attention, etc that it can offer in the short term? I use caffeine myself. My point is: be aware of the effects it MIGHT have on you. Investigate the effects it MIGHT have on you. Don't cast away the possibility. Chances are you might realise you DON'T have a mental disorder after all - you just have to be more aware of whats going into your body and be careful with it.
My next point... food sensitivities...One popular theory that gains more popularity with every month that passes that is that depression is actually a disease of chronic sickness, caused by the immune system. How does the flu make you feel tired and worn out? One way is that it causes your body to release chemicals called cytokines that work basically to make your body able to heal itself better. Your body can better heal itself from a sickness via by sleep and reduced activity. Cytokines can modulate brain activity, serotonin, dopamine, and norepinephrine so that one feels tired, lethargic, bored, and generally just disinterested in everything (symptoms of ADD and depression). In animal models, scientists can create a pseudo ADD and depression by activating certain aspects of the immune system. Interleukin 6 (correct me if I'm wrong) used for Hepatitus C has been proven to cause major depression in some patients. Imagine, however, if one has a condition that causes cytokines to be released in response to food eaten rather than just your everyday flu. The scary thing is, this happens. In my personal opinion, MUCH MUCH more often than we realise at this point in time. Such people have a condition where their intestinal tract is slightly more permeable than it should be, thus letting larger food peptides into the bloodstread, where the body recognizes these peptides as foreign and attacks them. The next step as the body attacks these large food peptides is the release of certain cytokines. One major component of almost every mental illness (please name one where this isn't true if you think of it...?) is the activation of the immune system. I don't know how much I can go further, since this whole post is longer than I thought it would be originally, but basically, I think that increased intestinal permeability (through a weak infective agent) allows food peptides, toxins, and other random antigenic molecules to enter the bloodstream causing cytokine release. Depending on what cascade of immune components are released, one is presented with a variation of the normal mental function. This doesnt have to be relegated to the gut, though. As I said, the flu can cause a depressive like illness, not to mention all those viruses that are potentially involved in Chronic Fatigue Sydrome (cytomegalovirus, epstein-barr, etc). The key point is that immune activation, through whatever pathway, can cause a mental disorder, in my opinion.
All of this doesn't even include this theory... Dairy proteins and Grain proteins break down into Opiates. This is a fact. Whether they are actually taken up into the brain is remained to be seen. Certain small studies (often excluded by doctors and researchers b/c they are small) show that people with mental disorders have significantly larger amounts of these grain / dairy induced opiate peptides in their blood. In particular, autism is one mental disorder (if you will call it that) where doctors + the medical community actually fully accept that a nice portion of autistic cases can be helped w. gluten and dairy restriction. Interesting.
Next point:In a nutshell, lack of sleep increases cortisol levels and stress hormone levels. As explaned in the caffeine paragraph, too much cortisol increases serotonin reuptake, causes lower amounts of monoamines in the frontal lobe and shrinks the hippocampus. Lack of sleep can make one depressed and anxious and my own experience backs this up. How many of you out there can share these arguements with me? I can't say. I suspect a lot more than might seem.
My last point, hypoglycemia. A semi-recent study has shown that chromium can help depression. This effect is indirect and works first of all by enhancing and refining blood sugar regulation. Cells become more sensitive to insulin. Blood sugar levels somehow have an effect on Serotonin 2(A?C?) receptors, and chromium has an effect on the 2a/c receptors similar to antidepressants. Blood sugar levels effect mental status, actutely and chronically. When your blood sugar levels go too low, your body releases catecholamines and glucocorticoids to bring it back up. While effectively bringing the blood sugar back up, your body is left with the lasting effects of these chemicals... lower serotonin, etc etc etc.
Imagine this:
Someone wakes up at 5 am after 6 hours sleep. - already, cortisol levels are a bit out of control from lack of sleep and the body is unable to properly regulate blood sugar. For breakfast, she / he has a bowl of rice crispies. This sends a FLOOD of sugar into the bloodstream, the body overreacts sending a FLOOD of insulin into the blood. An hour later, blood sugar is low, blood flow is reduced to certain key areas of the brain (PFC...). BUT, blood sugar comes back up... through release of stress hormones. Already, we have a 2-fold combo of abnormal stress hormone release: not enough sleep, and food that causes low blood sugar and stress hormone release to bring blood sugar back up. But, the person has a cup of coffee... feels tired 2 hours later again, has another cup of of coffee and another. By lunch, the person has... a bowl of rice thinking its healthy. Bam blood sugar is low again and bam the body has to release more stress hormones. This is probably the average american at this point... however, then the immune system enters the picture and I think this is where things get really ugly. This is where scary terms like "schizophrenia", or "psychotic major depression" start to come into play.
I could go on and on and on... but really, just within the contex of diet + lifestyle, we have neurotransmitter levels under our own control, to a great extent. Involve one in some form of maybe meditation, psychotherapy, etc and your raelly on a roll to recovery, and TRUE recovery, not drug induced recovery... which, again, i dont have a problem with. Its just nice to know some answers to your problems rather than wondering why the hell your DA2 receptors are hyperactive in your PFC and your serotonin 2a receptors are overactive in your PFC. Everyone has different genetics, and everyone's body reacts differently to all these different variable I suggested. One person might get ADD from too much cortisol, while another might develop psychotic symptoms.
Anyway, hope to hear some replies.
Posted by ramsea on October 30, 2003, at 5:17:05
In reply to Re: Isn't Social Phobia, just plain old Shyness? » ramsea, posted by KimberlyDi on October 29, 2003, at 15:34:50
I'm sorry you have this suffering too. It's possible, or even likely, that some social phobics are neurologically driven this way. An inborne tendency. Why???? I wish I knew!!!!!! But behavioral therapies like CBT do seem to help. If public speaking is the worst, have you considered joining Toastmasters, or the like, with a therapists support in the wings? Strangely, though I don't like giving speeches especially, I usually give presentations that are very well-received. Though once or twice nerves gave the game away. Still it's not as bad to me as going to the doctors or having a family visit, or trying to have a friend. These sorts of situations can make me quite ill. There are some useful links in another thread for social anxiety websites/support groups.
Posted by Mid- Life Crisis on October 30, 2003, at 12:24:24
In reply to Isn't Social Phobia, just plain old Shyness? (nm) » NoMotic, posted by KimberlyDi on October 28, 2003, at 14:58:24
There's a huge difference between shyness and social anxiety disorder. I am not a particularly shy person, I'm actually sociable, enjoy people, and always got in trouble in school for talking too much. (In fact, was tested for "hyperactivity" as a child due to this, and as an adult recently was diagnosed with ADHD.) However, from my mid-teens on, I invariably had panic attacks, complete with all the symptoms, whenever I had to give a speech, book report, take an important test, etc. My anxiety/panic attacks only occurred whenever I had to "perform", and I was probably most anxious about a) making a fool of myself b) losing control and fainting c)being scrutinized/judged. (All of the above.) I still have racing heartbeats and extreme nervousness in these situations, but rarely full-blown panic attacks anymore. I know it has nothing to do with caffeine consumption, because it was worse when I was much younger and didn't consume caffeine, as opposed to now, when I do. I think my self-esteem was lower then (as a teenager and young adult with undiagnosed ADHD as well as other problems in my life) so I DO feel that low-self-esteem contributes to this problem, but it isn't the whole answer, either. I think there's a good possibility that whatever causes ADHD may also be related to the cause of this problem for me.
In contrast, my oldest son was shy as a child, and is still rather quiet as an adult, but he has never experienced nervousness/anxiety to any abnormal degree. I would love to just be "shy."
This is the end of the thread.
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