Challenges and Best Practices for Overcoming Benzo Withdrawal – Part 2

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM

Read Part 1

The NeuroEndoMetabolic Stress Response and GABAs

Finding peace after a benzo withdrawalGABAs and benzos calm the body and mind when stress is present. Thus, it is important to understand the body’s natural anti-stress mechanisms to understand how benzo withdrawal fit into the overall picture.

The NeuroEndoMetabolic (NEM) Stress Response is the body’s global strategy in the handling of stress, whether physical or mental. It is composed of six circuits that work together as an ecosystem: the cardionomic, the neuroaffect, the metabolism, the hormone, the detoxification and the inflammation responses. Together, they form a holistic and functional apparatus to help the body deal with stress. The HPA hormonal axis is part of the hormonal circuit, but the body’s approach to stress is much more complex than simply the HPA axis.

The central nervous system, the autonomic nervous system, and the gut regulate one of the circuits of the NEM: the neuroaffect response. When this response is dysfunctional, the neurotransmitters that helped keep it in balance are also dysregulated. This leads to an increase of adrenaline and norepinephrine and a decrease in GABA. This can result in anxiety, tension, restlessness, sleep disturbances, racing thoughts, panic attacks, fears, and constant worrying.

The adrenals, part of the HPA axis, are central to the hormonal circuit of the NEM stress response. They are the first and main defense against stress. They secrete cortisol, the most important stress-fighting hormone, as well as over 50 other hormones. Cortisol helps regulate blood pressure, normalize blood sugar, maintain heart and blood vessels, suppress the immune system, and fight inflammation.

Though fully equipped to handle short-term stress, when stress becomes chronic or severe, the adrenals are overworked and cortisol levels dysregulate. This dysregulation produces a set of symptoms known as Adrenal Fatigue Syndrome (AFS).

AFS symptoms include fatigue, difficulty falling asleep, waking up in the middle of the night, easily gaining weight, difficulty losing weight, brain fog, poor concentration, anxiety, depression, hypoglycemia, heart palpitations, sensitivity to certain foods and drugs, heart palpitations, PMS, low libido, fertility issues, and more.

The type and severity of the symptoms experienced will depend on the stage of AFS.

In the beginning stage of AFS, the adrenal glands will increase their production of cortisol to meet the growing demand. After a while, though, they begin to weaken, and their output eventually decreases. This leaves the rest of the NEM to compensate, and the body is even more exposed to the dangers of constant stress. If left this way, the rest of NEM begins to dysregulate as well.

Cortisol and GABA are not directly related. Each one acts on stress through different channels. GABA acts through the brain and nervous system, while cortisol acts through the HPA axis. However, they both affect stress, allowing one to partially relieve symptoms of stress when the other is out of balance.

For example, if you suffer from AFS, GABA becomes a very important component in recovery, helping you get more rest and react less intensely to stressful triggers. This is especially true during the later stages of AFS when cortisol levels are low. However, prolonged stress can also affect GABA levels, reducing its ability to compensate for low cortisol and help with AFS recovery.

Benzodiazepines and Adrenal Fatigue

One study, The Netherlands Study of Depression and Anxiety (NESDA), researched this link between benzodiazepine and cortisol.

They categorized 1531 people who have had a lifetime diagnosis of depression or anxiety into three groups: (1) daily benzo users, (2) infrequent benzo users, and (3) nonusers. There were 93 people in the first category, 172 in the second, and 1263 in the third. Dosage, duration, and dependence were also taken into consideration.

medical testing and benzo withdrawalThe subjects had their salivary cortisol recorded during different phases. What the NESDA found was that daily and infrequent users of benzodiazepines had lower evening cortisol than nonusers. The results did not show that long-term use has a role in dysregulating the HPA axis, however.

For those in the later stages of AFS, a reduction in the level of cortisol can lead to an adrenal crash. The body is already struggling to neutralize chronic stress with the little cortisol it can produce. Add to that the cortisol-suppressive effects of benzodiazepines, and you have a recipe for such low levels of cortisol that the stress can overwhelm the system.

The NEM stress response and the adrenals are weakened by long-term benzo use and withdrawal. This is another important aspect of the relationship between benzodiazepines and cortisol.

At first, benzos and sleeping pills reduce cortisol production. But as tolerance to the drugs builds, side effects and symptoms begin to emerge that are stressful to the body and mind, making the adrenal glands produce more cortisol to counter this stress.

This is especially true for those going through benzo withdrawal, as the symptoms can be quite stressful and take a long time to disappear. This puts pressure on the adrenals to produce enough cortisol to neutralize that added stress. Also, sleep disturbances and fatigue demand higher cortisol production, taxing the adrenals heavily.

As benzos increase GABA activity, they also lessen the output of excitatory neurotransmitters like adrenaline and dopamine. Although initially, that’s what benzos are meant to do, these neurotransmitters facilitate normal functioning of memory, coordination, muscle tone, blood pressure, heart rate, alertness, and emotional response. When they’re lacking in the system, all of these functions suffer.

Additionally, there are benzodiazepine receptors in the blood cells, adrenal glands, colon, and kidneys, making these areas susceptible to damage by long-term use as well. This is why there is such a wide variety of symptoms and side effects, ranging from hormonal imbalance to endocrine problems, including problems with the pituitary, pineal, adrenal, thyroid, and reproductive glands.

For someone struggling with AFS, the high levels of cortisol over long periods of time can affect the production of dopamine and serotonin. This can then lead to anxiety, depression, insomnia, and other symptoms. When such symptoms persist, this person may go to a doctor and receive benzodiazepines. This affects cortisol levels in turn, creating a problematic cycle.

How To Approach Benzo Withdrawal

When reducing benzo use, it is of utmost importance that you do not go cold turkey. Suddenly stopping benzodiazepine medication can increase your risk of having a stroke, seizures, heart attack, or hallucinations.

When the level of benzodiazepine in your system dips too low, the panic and anxiety you may experience can be overwhelming, forcing you to seek relief by either upping the dosage again or taking another drug.

proper supervision from benzo withdrawalIt is important to prepare yourself with the understanding that this will be a long process. In fact, the slower you taper off benzos, the gentler the process can be. Consider aiming for months or, in extreme cases, years before getting completely off the medication. This is especially wise if you have AFS as well.

Also, it is very important to make sure you are supervised by a doctor who is well versed in benzo withdrawal. Avoid medications to ease withdrawal symptoms, but that actually worsen your condition. This is a common mistake that can prolong the process.

The good news is that what you do during the benzo withdrawal phase will influence how quickly and fully you return to good health. For example, during your withdrawal, avoid consuming alcohol, caffeine, honey, monosodium glutamate (MSG), artificial additives, and sugars.

Also, if you can avoid it safely, do not take hormone supplementation or hormone replacement therapy without proper supervision. Steroids such as DHEA supplements, progesterone creams, and hydrocortisones can have an adverse effect on your recovery.

Your main aim should be to let your body restore its hormonal balance naturally. If you supplement with hormones at this time, your body’s own production will be inhibited and remain in a weak state. Many of these preparations can also be too stimulating, adding to the anxiety and excitation that is experienced in benzo withdrawal.

AFS Recovery and Benzo Withdrawal

When working towards AFS recovery, GABA can play a supportive role. Some may find GABA supplements help relax the body and mind. They can also help with some AFS symptoms, such as anxiety and sleep disturbances. Herbal supplements that stimulate the GABA receptors are also an option.

Unfortunately, most people tend to overlook the need to pre-plan their exit strategy when it comes to GABA enhancement drugs. As a result, they can end up being chronic benzo users.

Not everyone with AFS can tolerate GABA. The weaker the body, the higher the risk. For those who can tolerate them, GABA supplements can help reduce reactions to stressful triggers. Because stress is the main cause of adrenal fatigue, reducing and managing it is one of the most important steps you can take. Giving your system the break it needs to relax and repair can help rebalance to your HPA hormonal axis.

It is important that, if you’ve been on benzo drugs, you do not try adjusting your GABA levels on your own. The receptors may have been damaged by long-term use, and benzo withdrawal can be very stressful on the body. Thus, any changes you intend to make to your supplementations, medications, or diet should first be discussed with an experienced medical professional. You should have medical supervision in order to start weaning off of benzo drugs.

There are several other things you can do to make this process easier and safer. These steps can also help you handle benzo withdrawal properly while you recover from AFS.

The most important step is to reduce as much stress, physical or mental, as possible. For example, if your blood sugar levels are not stable, this is a big stressor. Stabilizing your blood sugar could do wonders for your stress levels and AFS recovery. Following an adrenal fatigue diet may also be helpful and support your adrenals.

benzo withdrawal talk, with the familyHave honest conversations with your family and friends about what you are about to undertake. Have your doctor explain to them the process and what to expect. Show them how they can best support you during this time.

Be careful about joining online or offline support groups if you have AFS. A body with adrenal fatigue cannot be handled the same as a body that is healthy. What works for one person can backfire for another. Everyone is different.

Keep regular mealtimes and sleeping/waking times. Make sure you give yourself the best possible chance at a good night’s rest by keeping your room dark and cool, eating a small snack before bed so you don’t wake up from hypoglycemia, limiting caffeine during the day, and avoiding electronic devices for at least two hours before bed.

Light exercise is okay, but this also depends on your stage of AFS. If you are going through benzo withdrawal, you should keep your exercise regiment light. Avoid anything strenuous. You can try adrenal breathing exercises and adrenal yoga exercises. Walking in nature can also be calming and refreshing at the same time.

Remember, if you are going through AFS, benzo withdrawal, or both, you can regain your health and well-being with the right strategy, medical guidance, and community support.

A healthier, happier and more energetic day-to-day life is very possible. Just take it one step at a time in the right direction. The process may take months or longer. All six circuits of the NEM response must be healed. A holistic approach is necessary, along with a comprehensive adrenal support plan that helps the body regain its balance. Some setbacks are expected. Having an expert to coach you each step of the way will help facilitate your recovery in a smooth and comfortable manner.

Read Part 1

© Copyright 2017 Michael Lam, M.D. All Rights Reserved.

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