Tics and TS
Some Helpful Strategies
Some children experience what is referred to as a “tic”. Common motor “tics” would be something like nervous twitching and atypical eye movements, moving the neck in an odd way and grimacing. Vocal or phonic tics could be minor, such as a grunt. Or they can be more severe, such as yelling out profanity. Tourette’s Syndrome or “TS” is often diagnosed when someone displays phonic and motor tics for a prolonged period of time. Adults of course can and do have TS and other “chronic tic disorders” as well.
The typical type of medication given to people with TS would be antipsychotic or neuroleptic drugs. These drugs often carry terrible side effects and tend to not work well in many cases. This leads many doctors to recommend against the use of these drugs as they may not make the patient any better and have the potential to come with side effects far worse than the tics to start with. There are “safer” medications used off-label such as clonidine (a hypertension drug) that show some promise, especially for children with tics. However, for some, no medication really helps at all and alternative approaches are required.
Thus, alternative treatments are sought after by parents with children who have tics and adults who have TS. Many OTC supplements seem to be able to significantly reduce the severity and frequency of tics.
There are many “co-morbidities” with tics such as OCD and ADHD. Males are more affected by tics than females. OCD and tics/TS seem to have a lot in common, especially because in both the person does not want to act on the compulsion or the tic. If someone with TS feels the urge to blink their eyes unusually or to make a grunting sound they will typically not want to do it, especially in public and will try to suppress the tic. Similarly, many people with OCD know their compulsions are making their lives harder and often wish they didn’t feel the need to act on them. Stress can tend to increase both OCD and the frequency and severity of tics. Sometimes, the line between OCD and a tic/TS is very blurry. A good example of this is a compulsion like hair pulling or skin picking, or maybe severe versions of nail biting. OCD and TS may also share common causes.
“Autoimmunity has been implicated in a subset of TS and OCD patients in the form of PITANDs (pediatric infection-triggered autoimmune neuropsychiatric disorders) and PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)”
-The Central Role of Magnesium in TS
The following is a list of vitamins, minerals and amino acids that seem to be able to help with tics and TS:
Vitamin B6 (P5P)
Magnesium
Taurine
Theanine
Vitamin D and A
Lithium
Vitamin B6 and Magneisum
Vitamin B6 (P5P) and magnesium are potentially two of the most useful things someone can take if they have any tics.
Quinolinic acid may increase the severity and frequency of tics. When we consume the amino acid tryptophan we want it to become niacin (vitamin B3), but for this to happen we need different nutrients, notably vitamin B6 and magnesium, and to a lesser extent riboflavin (vitamin B2) and iron. If you do not have enough of these nutrients, the tryptophan can go down harmful pathways and this can result in the production of quinolinic acid. It has been shown that supplemental vitamin B6 and magnesium can help to lower the conversion of tryptophan into quinolinic acid. This is thus one way that both of these nutrients can improve tics.
Magnesium and vitamin B6 are also required for the enzyme “kynureninase” which breaks down kynurenine. Kynurenine seems to be high in TS so lowering it is likely beneficial. Vitamin B6 and magnesium are also very important in keeping glutamate in check. Glutamate is an excitatory neurotransmitter which means it causes extreme excitation/stress/anxiety when it is in excess. High glutamate is likely involved in tics and TS. Vitamin B6 helps us convert glutamate into GABA, and GABA is kind of like the “off switch” to glutamate, and thus it is calming. Kynurenine can block the effects of GABA, which can worsen tics.
Magnesium can block what is called the “NMDA”. The activation of the NMDA “N-methyl-D-aspartate” increases glutamate. So blocking this can help us lower glutamate, thus this is likely one way that magnesium can help against tics. I should also note that quinolinic acid can activate the NMDA.
There is no clear indication of the “perfect” dose of vitamin B6 and magnesium. However, there are studies where young children will be given 50mg of P5P vitamin B6 (pyridoxal 5’ phosphate) daily with no ill effects. Most people do well on a range of 10-60mg of P5P daily which is admittedly a large range. 15-25mg a day sounds like a reasonable dosage to start off with. I prefer P5P as opposed to pyridoxine HCL as P5P is the useable form. There is also some evidence that pyridoxine HCL inhibits the very enzyme that is needed to convert it into P5P, so pyridoxine HCL may actually end up worsening a vitamin B6 deficiency.
When it comes to magnesium I think it is best to try many different forms. Magnesium l-threonate is supposedly the most usable to the brain and central nervous system. Magnesium glycinate and taurate are both very useable by the body and also come with the added benefit of glycine and taurine which are very beneficial amino acids. Magnesium bicarbonate water (it is always in liquid form) is highly bioavailable and since you can drink it, it may be easier to give to young children who can’t swallow capsules. You can make magnesium bicarbonate by adding magnesium hydroxide powder to carbonated water and shaking it periodically over an hour or so. Lastly, magnesium baths and topical sprays can also be a way to get more magnesium and are again useful for children who cannot swallow capsules. I get my magnesium products from LifeBlud, you can use discount code DEAN.
Taurine and Theanine
The amino acids taurine and theanine are shown to be helpful for people with tics. Taurine is naturally high in shellfish and seafood, especially scallops. Theanine is naturally high in tea.
Taurine can help us use magnesium better, it can increase GABA, block calcium channels, is beneficial for the liver and helps us make more bile. There is even some evidence that taurine can block the NMDA, leading to less glutamate. I think that taurine is largely helping by increasing GABA, but the other beneficial effects are likely playing a positive role as well. One mother informed me that her daughter with tics is improving on 500mg of taurine 2x a day. Typically people take 500-5000mg of taurine a day.
“In conclusion, taurine is safe and effective on tics, especially on the moderate or severe tics of CTD [chronic tic disorders] and TS”
-Safety and efficacy of taurine as an add-on treatment for tics in youngsters
Theanine is a very calming amino acid and it seems to be useful for a wide variety of conditions such as anxiety and ADHD. Theanine and vitamin B6 were shown to be useful for tics. Theanine can block some of the effects of glutamate and is pro-GABA. It is also shown to have some anti-histamine activity which is useful, especially since histamine can worsen tics. The dosage of theanine varies widely, with people usually taking around 100-300mg a day. However, it has been used in much higher doses, such as 300mg 3x a day. Starting at the lower end seems reasonable.
Vitamin D and A
Vitamin D is shown to be helpful against tics, there is also some evidence for vitamin A. Both of these are very important for a well-functioning immune system, among other things.
“Vitamins A and D deficiency in children is strongly associated with tic disorders”
-Correlation between Serum Levels of Vitamin A and Vitamin D with Disease Severity in Tic Disorder Children
Vitamin A is also needed to make the steroid hormones, such as pregnenolone, progesterone and testosterone. It is very important for brain health, eyes and skin as well. Eating more organ meats (like liver) is a great way to increase the consumption of vitamin A, eggs and dairy are also ok sources.
“Our study confirmed again that children with CTDs [chronic tic disorders] are more likely to be vitamin D insufficient or deficient, with significantly reduced 25(OH)D levels relative to healthy controls. Furthermore, decreased 25(OH)D levels were linked to worse severity of tic symptoms. After 3 months of vitamin D3 supplementation, severity of tic symptoms in children with CTDs was reduced without adverse effects.”
-Clinical improvement following vitamin D3 supplementation in children with chronic tic disorders
Vitamin D is shown to be useful in autoimmunity, and some believe that vitamin D deficiency can make someone more susceptible to an autoimmune disease. Immune system overactivation seems to be related to tics and OCD. Thus, one of the reasons vitamin D seems to help with tics could be via the modulation of the immune system.
Vitamin D on a blood test should ideally be 40-50 ng/ml (American values) or 100-125 nmol/L. If one has a blood vitamin D below the ranges mentioned then they would likely benefit from increasing their levels and checking often (2-3x a year) to see if optimal levels are maintained. I think that vitamin D supplementation can be highly therapeutic when levels are low (for example if your vitamin D is less than 40 ng/ml). I like vitamin D supplements that are in softgels with olive oil. I think MCT oil can be allergenic to some, so it’s safer to go with olive oil-based softgels.
Lithium
Lithium is a trace element that seems to be highly therapeutic for a variety of neurologic disorders, including dementia. It seems that there is some good evidence that lithium can lower tic frequency and severity.
"[after] 3 weeks of lithium therapy, there was a marked decrease in his symptoms. His [tics] were extinguished along with a significant reduction in his obsessions [and] compulsive behaviour. ... [after] 3 months his anxiety and moodiness also dissipated"
-"COMPLEX TOURETTE’S DISORDER WITH OCD TREATED WITH LITHIUM"
I was unable to find the dosages of lithium used in the studies that mention its benefit for TS, but it seemed like the form used was almost always lithium carbonate. This form of lithium is a prescription so you will have to talk to your doctor about obtaining it if they feel it is right for your situation. Lithium orotate and lithium aspartate can be purchased OTC. Common dosages for lithium orotate are 1-40mg a day, usually in divided doses. For more information on nutritional lithium supplementation such as lithium orotate, I highly recommend reading the book “Nutritional Lithium, a Cinderella Story”.
If someone has tried many different medications for their tics (such as clonidine) without benefit, then maybe asking their doctor about trying lithium would be worthwhile. Lithium is used off-label for tics and TS, so there is no guarantee that a doctor will prescribe it. You can also work with a naturopath who understands lithium well, they may be able to help you figure out a good dosage protocol for an OTC lithium, such as lithium orotate.
Concluding Thoughts
There is an idea out there that “dopamine causes tics”, but I’m dubious about this. First, someone told me their child stopped having tics when they went on amantadine. This medication is a known dopamine booster and is even used for Parkinson’s disease (a situation related to a lack of dopamine). If dopamine really did make tics worse, you would expect amantadine to worsen them, not ameliorate the tics. Further, vitamin B6 is very useful for tics, and it can increase dopamine and lower prolactin.
I think other things that can help balance glutamate and GABA would be beneficial for tics and TS. Agmatine is an amino acid that can help lower glutamate and it has many other neurological benefits. Many different herbal products could be useful, such as lemon balm (tincture or tea) which can help maintain good levels of GABA in the body. Manganese and molybdenum are also important for keeping glutamate in check, so it’s a good idea to consume a lot of these minerals in your diet. Manganese is high in mussels, pineapple, maple syrup and legumes. Molybdenum is very high in gluten-free oats and legumes such as peas, and liver. Find out more about glutamate and GABA balance in my article “The Dance Of Glutamate and GABA”.
High levels of stress hormones and catecholamines may make tics worse. Cortisol (and cortisone drugs) are known to increase tics. Maintaining strategies to keep stress hormones low is paramount. You can find more information on how to do this in my other various articles, such as the one on anxiety and panic attacks. I also talk about what can cause excessive adrenal hormone output (adrenaline, cortisol) in my article on PCOS, that article is relevant for anyone to read, not just people with PCOS.
Diet is important for tics, one aspect of this is to make sure you do not eat things that cause intestinal irritation. Gluten and A1 dairy can be major culprits, goat dairy or A2 cow dairy would be a much better option. Avoid packaged food if you can, especially foods with artificial colours and dyes. Avoid consuming things like talc, titanium dioxide, silica and other excipients in foods, supplements and medications if you can.
Fixing a “leaky gut” can also potentially be helpful. Gelatin, collagen and glycine can be very useful here. Zinc carnosine is a very effective supplement for digestive issues and leaky gut as well. The raw carrot salad should also be helpful, especially if consumed daily. This is grated raw carrots, olive/coconut oil, salt and vinegar. The carrot salad is meant to act like a broom “sweeping” the intestine keeping it free of bacterial overgrowth.
There is some evidence that phospholipids and lecithin can help with TS. Egg yolks are a very good source of lecithin, but there are also supplements. Phosphatidylcholine is one example of a phospholipid supplement (it essentially cured my asthma - find out more in my article “Wheeze No More”).
Different doctors may be comfortable with trying out some medications off-label. Low-dose naltrexone, clonidine, amantadine and memantine are some options that a doctor could prescribe. It is useful to have options other than the neuroleptics, as the neuroleptics have terrible side effects whereas something like clonidine has far fewer side effects. Be that as it may, all drugs have potential side effects and some people want to avoid them completely.
I should mention that there is surprisingly quite a bit of research indicating that nicotine can help manage tics. Typically a 7mg nicotine patch is used, but nicotine gum has also been studied. It looks like wearing a 7-10mg nicotine patch for a full 24 hours, then replacing it with another one for a further 24 hours is what is the most therapeutic approach. So, this means having a nicotine patch on for 48 consecutive hours. Apparently, this method allows for weeks of tic symptom reduction. It is unclear exactly how nicotine helps with tics, but it does seem clear that it generally has the effect of reducing tics. Further to this, nicotine seems to be useful in other related conditions such as OCD.
Some people say vitamin K2 has helped with their tics.
I hope the information here was useful, my goal was to show people suffering from tics, and parents of children suffering from tics, that there are many therapeutic options out there. If the medications are not working, or if the side effects are too much of a burden to bear then there are other options. Simple things like vitamin B6, magnesium, taurine, theanine, vitamin D, vitamin A and even lithium can be helpful. Changing the diet can also be useful, especially avoiding gluten and A1 dairy, along with food colourings and dyes, and other harmful additives.
*None of this is medical advice. I am not a medical professional, always talk to your doctor*
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