Supplement Interaction Warning: BCAA and SSRI

Summary: Supplements can cause complications with a clients medication. St Johns Wort is the interaction most people know about, but BCAA’s and SSRI’s is one most of us don’t. Always have clients double check with their GP if they want to try out a supplement. If there’s a doubt, don’t risk it.

The Story

I have Client A.

Client A takes an  SSRI.

Client A decides to start taking BCAA supplement to help with recovery.

Client A starts taking 3 grams of a common BCAA supplement Monday morning.

Monday afternoon, their partner notices a behavioural change.

Monday evening, they start to feel flu like symptoms but assume food poisoning.

Tuesday morning to Tuesday evening involved cold sweats, vomiting, and a slew of other symptoms. BCAA intake stops. After consulting their GP and working backwards, the only variable that comes up is the BCAA supplement.

GP and Client A are puzzled. Client A keeps taking regular dose of SSRI’s and throws BCAA supplements out.

Thursday morning to evening, symptoms subside, but client cannot hold down food.

By Friday, Client A is munching on toast and feeling much better.

On Sunday, they can eat normally again and come back in the train on Monday.

So what the hell happened? Serotonin Discontinuation Syndrome. Or, another way to look at it, is Serotonin Withdrawal.

The Problem

There is the misguided thought that because you can buy supplements over the counter, there’s no risk to taking them. Just because you can buy it easily, or the label says “herbal” doesn’t mean it can’t cause complications. (1)

While in my undergraduate, I was able to take a class that examined evolving trends in the application of pharmaceuticals to the practice of psychology. One of the more eye opening moments was reading the warning label of different SSRI’s. There’s a huge list of possible side effects when taken alone as well as a possible set of side effects due to interactions to other medications and even food, including things like caffeine, alcohol, grapefruit and bananas.

St Johns Wort

One of the common listed items to avoid is St John’s wort. An herbal supplement which is very commonly used for treating depression with less side effects then most SSRI’s.(2)

It also has the side effect of making your body more efficient at breaking down things like alcohol, medication and contraceptives, making them less effective. Not a huge issue with something like a headache, more of an issue with something like immunosuppressant drugs after a transplate.

If you take it, make sure to mention it to your GP.

SSRI’s and BCAA’s

BCAA’s (Branche Chain Amino Acids) are a very common supplement available in stores and on line. Athletes use it to recover for performance and body composition purposes all the time. However, there is research showing a link between BCAA consumption and neurotransmitter function both in rodent studies (3) and in the elderly (4).

Basically, the BCAA supplement that Client A took made their brain think they had stopped taking their high dose SSRI overnight, which lead to withdrawal symptoms. Whenever a patient wants to stop taking SSRI’s they are tapered off slowly, and closely monitored specifically to avoid withdrawal symptoms.

There wasn’t much to do that could have avoided this. There wasn’t a warning on the SSRI label, and the mechanism between BCAA and SSRI’s isn’t well understood. The Client’s GP had never heard of it, I had never heard of it, and neither have any of the fitness professionals or doctors I spoke to afterwards.

Bottom Line

- If you take medication, read the label. All of it. Everyone knows that you shouldn’t drink and take drugs, but who thinks to check whether or not you can eat bananas or grapefruit with it?

- Do your research. Supplement wise, make sure that you know what you are taking and why you are taking it.

- Test drive small doses. People react differently to certain supplements. Certain brands of supplements make me feel sick, but others don’t. Always test out a small dose to make sure it agrees with you.

When in doubt, stop. Which is generally a good rule of thumb for life. But don’t mess around with your body too much. You only really get one. If you’re taking something and it feels dodgy, stop taking it.

- Mention if you’re taking anything to your GP and your Coach. Yes. It’s a pain. Yes your GP will probably look at you funny. Tell your Coach if there’s some medication you might need to take. But mention it early, so everyone gets to avoid weird surprises.

References:

1. Izzo, A., and E. Ernst. “Interactions Between Herbal Medicines and Prescribed Drugs: A Systematic Review.” Drugs 61.15 (2001): 2163-175.

2. Ernst, E. “St John’s Wort, an Anti-depressant? A Systematic, Criteria-based Review.”PHYTOMEDICINE 2.1 (1995): 67-71.

3. Cole, J., Mitala, C., et al. Dietary BCAAs Ameliorate Injury-Induced Cognitive Impairment. Proceedings of the National Academy of the Sciences. January 2010. 107(1), 366-371.

4. Rondanelli, M., Opizzi, A., Antoniello, N., Boschi, F., Iadarola, P., Pasini, E. Effect of Essential Amino Acid Supplementation on Quality of Life, Amino Acid Profile and Strength in Institutionalized Elderly Patients. Clinical Nutrition. 2011. 30(3).

The breakfast of champions

This is a test. I’m attempting to write and submit this entirely on my phone. Apologies if it looks strange.

I would like to apologise to all the Colombians who have ever told me that adding something to coffee would make it better. I should never have doubted you.

A few months ago I was trying to find a way to ingest more food during my day, and I decided that it would be a good idea to tweak my morning shake/coffee recipe.

There were a few winners and a few giant losers, but there was an interesting trend:

If I had fat+protein in the morning, my body composition improved.

Some reading around, some experimenting and I stumble across a recipe for “bulletproof coffee” over here.

Grassfed butter in coffee. It sounds really weird.I figured, how bad could it be? I’ve survived natto. Plus, if I tossed in some eggs, that would take care of my morning “fat+protein” requirements.

So, I bite the bullet and fave it a shot.

I could not be prepared. The level of amazing has no words.

Here’s how to do it.

You will need:

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1. Your favorite coffee/brewing method.
2. Blender
3. Grass fed butter
4. Cojones.

Step 1:
Put 1 tablespoon grass fed butter in your favorite mug.

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Step 2:
Brew coffee however you like, and immerse the butter.

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Step 3:
Blend it until a creamy layer forms.

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Step 4:
Add coffee/water to taste.

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Step 5:
Relish it.

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No joke. This stuff is liquid gold. It’s amazing in ways that you can’t imagine.

The fact that it improves body composition is an excellent added bonus.

Be warned: you do need to ease into higher doses of butter. If you take too much too fast you will have some digestive issues.

Start off with a half tablespoon, and work your way up over a few days till you find a dose that you like.

We’ll do a moe in depth look at the mechanics of why it works at a later date, bottom line:

Fat+protein in the morning is excellent for saiety and body composition. Test it out, let me know how it goes.

A Beginner’s Guide to Nutrition.

Nutrition is tricky. Not only is there individual variance on the physical level, but there are some very deeply ingrained social and environmental factors that play a role in eating habits.

Add in the social stigma associated with being overweight (be it real or imagined), and nutrition quickly becomes a topic best avoided in polite company, along with religion and politics.

However, if you just want some general rules for eating a bit better and some resources for further study, here you go.

The Crossfit Prescription for nutrition boils down to:

Base your diet on garden vegetables, especially greens, lean meats, nuts and seeds, little starch, and no sugar.

From working with athletes, here’s a few other important pointers:

- Get enough Sleep- Not getting enough sleep wrecks havoc on fat oxidation, mental and physical performance, etc. Do yourself a favor, get enough sleep.

- Take a multivitamin- Odds are very high that you don’t get all the vitamins and minerals that you require from your food. Take a “once-a-day” multivitamin.

- Don’t rely on willpower- If you want to eat healthier, don’t have unhealthy food within easy access. Willpower inevitably fails. Make it as easy as possible to achieve your goals, especially when starting out.

Further reading (Beginner level):

- Check out “Primal Blueprint 101” over at Marksdailyapple.com. It’s a literal goldmine of information for nutrition and primal living.

MobilityWOD: Fixing Phil.

Quick update: San Francisco has been fun. I got to visit a few gyms here as well as hang out with some very talented coaches and athletes.

I’m also very thankful that I was able to see Kelly Starrett, the owner of San Francisco Crossfit and the mind behind Mobility WOD. Long story short: I broke my arm about a decade ago and I haven’t been able to put it over head correctly since. Barbell movements I could approximate as long as the load was light, but everything else was close to impossible.

Enter Kelly.

My arm still moves a bit awkwardly, but I hadn’t been able to press my left arm upwards in about a decade. Now, I might even be able to strict press more than an empty bar. My overhead squat position and handstands have improved as well because my shoulder position doesn’t suck anymore.

We’ll get into some more theoretical stuff next time, specifically surrounding the voodoo band, and the changing model of sports conditioning.

Sidenote: Kelly is a lot bigger in person then he looks on his videos.

Victim or Villain?

This is part of a larger piece of work that I’m building on. The inspiration came from an essay by Sebastian Marshall and is well worth the read.

If you’re the first among your friends to make a lifestyle change, a very large majority of them are going to hate you for it, unless the change can be externally attributed.

So you’ve done some reading and decided that you want to try the 30-Day Paleo Challenge?

If your friends don’t know Gluten from Guetta and you all go out to dinner, your food choice just labeled you “that diva” who eats funny.

Forget getting support, your friend eating the cookie in front of you is going to offer you one.

If you accept, you’re weak and “weren’t that serious anyway”

If you refuse, you just reinforced the label of “diva”

Congratulations.

Because you made a choice, you just became the enemy. You’re a Villain of the vilest sort.

If, on the other hand, your doctor told you that you had to cut out wheat because you have a Gluten allergy?

Your friends will not only support you, they will do everything to make your life easier.

Going out? One of them is going to double-check that the restaurant can accommodate you.

Dinner party? Someone will make a dish just for you.

You aren’t “that diva” you’ve become “that poor thing”.

Because the choice was taken out of your hands, you are now a Victim.

When a lifestyle change is a choice, people get defensive. They feel threaten. As far as they’re concerned, you’ve just said, “What you’re doing is wrong.”

They now have two choices: Either they justify why they continue the behavior, or they can discredit the person not maintaining the behavior.

When the lifestyle change is externally attributed, people don’t get defensive because they secretly think “They would still behave this way if they could!” No one feels threatened so there’s no reason to act defensively.

It’s ridiculous, but it’s true.

If you’re going to make some lifestyle changes, especially when it comes to health and nutrition, here are three steps to help make the transition easier.

1) Externally attribute your lifestyle change, regardless of the actual reason for it

“I have a gluten allergy so I have to go paleo.”

“My doctor told me I needed to quit drinking.”

This makes the initial transition easier. You’ll have to face much less social pressure which makes it easier to ingrain the lifestyle change. Once you aren’t worried about regressing to old habits while under stress, you can try step 2.

2) Internally attribute your lifestyle change and ignore everyone who gives you grief. 

“Sorry, I don’t eat bread. It makes me feel weird.”

“Sorry, I don’t drink. It messes up my sleep.”

No matter how apologetically you might do it, if you internally attribute your habit change, you’re going to get grief. If you hang out with cool people and everyone is happy for you or at least no one cares? Good for you. The amount of grief will be minimal. Enjoy your new habit and all the changes it brings. If the group of people you spend time with aren’t as cool and they start to bother you, enter step 3.

3) Draw the line in the sand and potentially Get New Friends. (More on this in a later post.)

“I don’t eat bread.”

“I don’t drink.”

You’ve made your lifestyle change, you’ve reaped the benefits, and you’re happy. The rest of the people in your life don’t need to be happy for you, but they can’t make you feel bad about yourself for choice either.

Draw the line in the sand. Tell them when enough is enough. Give them plenty of warning. They might not know that their behavior or comments are actually bothering you.

But.

The moment that a friend knows that what they do or say is a problem and they do it anyway?

Cut them loose and find a new friend.

There are plenty of people who can hang out with you without making you feel like shit for your choices.