u/GothicOnion

Not sure if this is even the right place to be asking this, but a few years ago I fell for the “primal” diet meme after being exposed to many influencers preaching its benefits, and while following it I felt quite good, my lipid levels went out of control, for reference these were my readings after 3 years of following this diet:

• Total cholesterol: 7.2 mmol/L
• LDL: 5.01 mmol/L
• HDL: 0.85 mmol/L
• Triglycerides: 2.1 mmol/L
• Non-HDL Cholesterol: 6.4 mmol/l

This made me change my approach, I started eating under 12g of saturated fat daily, alongside a minimum of 40g fiber a day (with a large emphasis on soluble fiber), with the addition of a plant sterol supplement, and after a year I was able to get my lipid levels mostly within range:

• Total cholesterol: 4.1 mmol/L
• LDL: 2.0 mmol/L
• HDL: 1.1 mmol/L
• Triglycerides: 1.4 mmol/L
• Non-HDL Cholesterol: 2.4 mmol/l

While this way of eating has significantly improved my blood work, I have felt like crap, my energy levels have been low, my digestion has worsened (frequent loose stools, gas), and I’m getting acne for the first time in years. I’ve tried to figure out what could be causing this but am having trouble doing so, my lifestyle (sleep, exercise, stress) has remained entirely the same, I eat the same amount of calories as I previously did, my diet is 90% whole foods, my main staples are oats, barley, legumes, vegetables, fruit, soy products (tempeh and firm tofu), nuts and seeds, fish and chicken breast. I also made sure to very gradually up my fiber intake over the course of many months to avoid digestive issues.

Has anyone else ever experienced something like this? I’m almost certain there is nothing magical about saturated fat that made me feel better, perhaps I’m just better suited to a lower carbohydrate way of eating? Any insight into this would be much appreciated.

I have severe, debilitating social anxiety and generalised anxiety, which significantly limits my daily functioning.

Over time, I have tried multiple medications, including SSRIs, SNRIs, antipsychotics, atypical antidepressants, tetracyclic antidepressants, beta blockers, buspirone, and benzodiazepines. With the exception of benzodiazepines, most of these medications were either ineffective or caused side effects that I found intolerable, including sexual dysfunction, significant weight gain (25kg / 55lbs in 8 months!), emotional blunting, and, in some cases, worsened anxiety.

Benzodiazepines were well tolerated and significantly improved my functioning, and I did not experience a loss of effectiveness over time. However, my psychiatrist is reluctant to prescribe them long term. As we are running out of options, they have suggested considering an MAOI, such as Parnate or Nardil.

From what I have read, MAOIs can be very effective for anxiety, particularly Nardil for social anxiety. However, I am concerned about the side-effect profile, especially because I seem to be prone to medication side effects. In particular, I am worried about sexual dysfunction, weight gain, insomnia, and orthostatic hypotension. The latter is especially concerning because I already have POTS and frequently experience low blood pressure or light-headedness on standing.

Given my history of poor tolerance to many medications, do you think an MAOI would be worth considering in my situation, or would it be more prudent to approach this option with caution? I would also appreciate any thoughts on whether Parnate or Nardil might be more appropriate given my anxiety symptoms, POTS, and sensitivity to side effects.