5-htp and L-tryptophan:

Sleep Aids for Many People with FM

[More technical information and journal references are also available here.]
If you wonder about the Mayo Clinic report on 5-HTP, click here.

5-htp (5-hydroxytryptophan) is the breakdown product of tryptophan, an essential amino acid present in most protein foods. It is a precursor to serotonin (5-HT), so people with a serotonin deficiency, or too-rapid uptake of serotonin can probably benefit from 5-htp. I use it for sleep in place of the psychoactive drugs so commonly prescribed for people with fibromyalgia. It has the delightful side effect of reducing carbohydrate cravings. (I believe this is because people with sufficient serotonin don't have to load up on tryptophan-containing carbohydrates.) 

5-htp is available both by prescription from a compounding pharmacy and over the counter in many drug stores in the US, and on the Web.  I've even seen it in Wal-Mart.  The most economical places to buy it that I know of are Vitaglo (www.vitaglo.com) and Vitamin Planet (www.vitamin-planet.com). I don't make any money if you buy from them (or anyone else), and I can't vouch for their product or service, but I've been buying from both companies for quite a while have had no trouble of any kind.

It is derived from the seeds of a tree that grows in West Africa.  No pharmaceutical house has the patent, hence it is not in the PDR or Physicians GenRx, and there is no one to fund the costly clinical trials that would bring it to the attention of physicians.

5-htp is being used for Parkinson's, myoclonus, depression, Alzheimer's, anxiety disorders, autism, dementia, and more. 

People who are taking SSRIs (especially Wellbutrin and Zoloft) should exercise caution in taking 5-htp. The result may be an overdose of serotonin; the effects are not pleasant. I know of one person who experienced severe nausea on taking her first 100mg dose. This does not happen to everyone, and I have not heard of it happening to people on Prozac, but it might, and you should weigh the risk of an episode of severe nausea against the benefit of obtaining restful sleep in making your decison. I have heard of some people experiencing nausea when they begin taking 5-htp, but have no personal knowledge of any other adverse effects, although the papers abstracted below mention that some exist.

The usual dose for sleep is 100-600mg at bedtime. For people who had success with L-tryptophan in years past, the ratio of tryptophan to 5-htp seems to be about 5:1. Thus, if you used to take 1500 mg of L-tryptophan, you'd probably take 300 mg of 5-htp.

Some compounding pharmacies sell 5-htp's precursor, L-tryptophan, by prescription. It is also possible to buy L-tryptophan without a prescription (see the end of this article) as long as you don't offer the information that it's for your own use.  For reasons that elude me, L-tryptophan can be legally purchased to put in infant formula, animal feed, and enteric feeding formulas for people unable to take nourishment by mouth. In other words, it's legal for the most vulnerable of people, but not for the rest of us. 

The actions of both L-tryptophan and 5-htp are similar, with one exception explained below. Suggestions for heightening their effectiveness are identical. L-tryptophan is also available in powder form from sources listed below. Some people sprinkle it on their food; others buy a capsule filling machine and roll their own. To do this, a well-calibrated gram scale might also be necessary. The rule-of-thumb dose is 25mg per kilogram (2.2 lbs) of body weight.

The difference between L-tryptophan and 5-htp is this: L-tryptophan breaks down into 5-htp and kynurenin. There is some evidence to suggest that people with FM may be deficient in serotonin because the tryptophan they obtain from food metabolizes into kynurenin rather than both it and 5-htp. Therefore, 5-htp seems likely to be more efficient than L-tryptophan in boosting serotonin.

Here are some journal abstracts that you and your doctor may find of interest.. 

Puttini PS; Caruso I Primary fibromyalgia syndrome and 5-hydroxy-L-tryptophan: a 90-day open study. Rheumatology Unit, L Sacco Hospital, Milan, Italy. J Int Med Res 1992 Apr;20(2):182-9 

ABSTRACT: The efficacy and tolerability of 5-hydroxy-L-tryptophan (5-HTP) were studied in an open 90-day study in 50 patients affected by primary fibromyalgia syndrome. When all the clinical variables studied throughout the trial (number of tender points, anxiety, pain intensity, quality of sleep, fatigue) were compared with baseline results, they all showed a significant improvement (P less than 0.001). The overall evaluation of the patient condition assessed by the patient and the investigator indicated a 'good' or 'fair' clinical improvement in nearly 50% of the patients during the treatment period. A total of 15 (30%) patients reported side-effects but only one patient was withdrawn from the treatment for this reason. No abnormality in the laboratory evaluation was observed. It is concluded that 5-HTP is effective in improving the symptoms of primary fibromyalgia syndrome and that it maintains its efficacy throughout the 90-day period of treatment. 

Byerley WF; Judd LL; Reimherr FW; Grosser BI 5-Hydroxytryptophan: a review of its antidepressant efficacy and adverse effects. J Clin Psychopharmacol (HUD), 1987 Jun; 7 (3): 127-37 

ABSTRACT: Alterations in serotonin metabolism may be an important factor in the etiology and treatment of depression. In this regard, 5-hydroxytryptophan (5-HTP), a serotonin precursor, has been given to patients with depression. Although a review of these studies suggests that 5-HTP possesses antidepressant properties, additional trials are clearly indicated. Following a discussion of the pharmacology of 5- HTP, the authors highlight adverse effects associated with its administration to depressed patients, neurologic subjects, and normal individuals. Relatively few adverse effects are associated with its use in the treatment of depressed patients. [Contains 59 references.] 

Caruso I; Sarzi Puttini P; Cazzola M; Azzolini V. Double-blind study of 5-hydroxytryptophan versus placebo in the treatment of primary fibromyalgia syndrome.. J Int Med Res, 1990 May-Jun, 18:3, 201-9 

ABSTRACT: A double-blind, placebo-controlled study of the efficacy and tolerability of 5-hydroxytryptophan (5-HTP) was conducted in 50 patients with primary fibromyalgia syndrome. All the clinical parameters studied were significantly improved by treatment with 5-HTP and only mild and transient side-effects were reported. Further controlled studies are required to define properly the value of 5-HTP in patients with primary fibromyalgia syndrome. 

L-tryptophan sources: powder, no prescription

Ronald Sturtz BIOS Biochemicals, 800-404-8185

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