Anxiety - A Functional Medicine Aproach

It's normal to feel anxious or worried at times. Everyone experiences a certain amount of nervousness and apprehension when faced with a stressful situation. However, when anxiety becomes excessive or prolonged and begins to interfere with your ability to perform your daily activities, that's when you can say one has crossed the road from simple worry to a full force illness.

Imagine you are walking down a dimly lit road and out between two parked cars a man with a gun confronts you and demands that you give him all your money or he will kill you. As you can imagine, your heart quickly begins to thump, your legs feel like rubber, you want to run but you are paralyzed with fear. By shear luck, out of the corner of your right eye, you see a police car and without a moment hesitation, you scream and gain the attention of your hero. You are saved!

As the criminal is whisked away in handcuffs, you begin to gain a sense of calm. Still nervous but all in all an inner contentment that you just for the first time in your life you looked death right in the eye.

Now what would you say if I told you that a full blown anxiety or a major panic attack have all the same characteristics as the above scenario.

Yes, you will get that same pounding heart, you will be paralyzed with an intense terrifying fear, you will get nauseous, get lightheaded and a bunch more symptoms soon to be explained.

Unfortunately, unlike the victim who was lucky to be saved by the police officer, anxiety suffers continue to experience these terrible symptoms day in and day out. The anxiety victim soon becomes a prisoner within their own body not knowing if they will ever see the sunshine or the birds sing again.

Anxiety Overview

You see, there are more than 19 million Americans suffering from all anxiety disorders combined. It's normal to feel anxious or worried at times. Everyone experiences a certain amount of nervousness and apprehension when faced with a stressful situation. However, when anxiety becomes excessive or prolonged and begins to interfere with your ability to perform your daily activities, that's when you can say one has crossed the road from simple worry to a full force illness.

Most people are convinced they are minutes from dying and experience something commonly called "impending doom". They are frequent visitors of the local emergency room. Test after test continues to show that nothing life threatening is wrong.

Unfortunately, the anxiety sufferer is still not satisfied. Something has obviously been overlooked. So more tests are run only to once again find nothing wrong. Soon their family and friends begin to label you a hypochondriac. It must be all in your mind they say. Signs and Symptoms The signs and symptoms of anxiety can vary in combination or severity. They may include:

Restlessness
Feeling of being keyed up or on edge
Feeling a lump in your throat
Difficulty concentrating
Fatigue
Irritability
Impatient
Being easily distracted
Muscle tension
Trouble falling or staying asleep (insomnia)
Excessive sweating
Shortness of breath
Stomachache
Diarrhea
Headache
If you have anxiety you may feel on edge about many or all aspects of your life. For example, you may feel intense worry about your safety or that of your loved ones, or you may feel that something bad is about to happen, even when there's no immediate danger. When you feel anxious, your body releases hormones that prepare you to react to a threat. This is called the fight-or-flight response. When anxiety gets out of control, this response can occur almost continuously, even at times when you seem calm. Clinical Lab Assessments Some of the following laboratory testing can provide information necessary for diagnosis and treatment. In addition, the tests listed may also give insight to functional metabolism and functional nutrient status in the body.
Adrenal Stress/Cortisol Testing/Neurotransmitter Testing: Adrenal insufficiency can lead to a host of problems, including a weakened immune response, anxiety and panic attacks. Imbalance in the Hypothalamic-Pituitary-Adrenal axis (HPA) is involved in anxiety related disorders. In this complex, adrenal functional abnormalities are relatively simple to identify and address. Plasma or salivary cortisol measurements can be used as a marker in the evaluation of stress syndromes that may relate to anxiety disorders. Some study has suggested that altered cortisol response to stress in panic disorders may complicate successful lifestyle intervention.
Thyroid Profile Elevation of thyroid antibodies has commonly been found in individuals with anxiety disorder. Correlations have been observed between thyroid laboratory values and anxiety. Assessment of thyroid hormone production, peripheral hormone conversion, cellular sensitivity response, thyroid hormone antibody activity can provide critical information for intervention with a goal of optimal function.
Allergy and Food Sensitivity Response Assessment Allergic responses to foods, inhalants and environmental chemicals, and other substances can cause a variety of responses that induce or aggravate anxiety. Screening can enable an individual to eliminate or minimize exposure to unfriendly allergens.
Organic Acids Organic acids analysis is a useful method for measurement of biochemical intermediates in urine. These intermediates can offer information about key enzyme functions and nutrient competence (amino acids, nutrient cofactors, minerals, and fatty acids). Elevation of vanilmandelate reflects elevations in epinephrine and homovanillate indicates norepinephrine elevation. High levels of these neurotransmitters are associated with physiologic inability to manage stress.
Melatonin Level
Rule out Progesterone deficiency or Estrogen Dominance
Rule out Lyme Disease
Rule out Mycotoxins (Mold)
Rule out Pyroluria Pyroluria is a known biochemical marker for life long anxiety symptoms. According to one alcoholism treatment center, one-third to one-half of alcoholics treated have this marker. High levels of pyrrolles systematically bind to B6 and zinc, preventing the use of these nutrients in the body and brain. The result is a myriad of symptoms, including severe inner tension, ongoing anxiety, poor stress control, fearfulness, and sometimes episodic anger.
Obtain Magnesium Levels via RBC erthrocyte assessement
Rule out Mercury Toxicity
Amino Acids Deficiencies or imbalances in amino acids can indicate fundamental reasons for numerous disorders. Amino acid malabsorption syndrome or imbalanced amino patterns reflect abnormal organ and glandular processes that have critical bearing on optimal function. Phenylalanine and tyrosine are precursors to the catecholamines and affect the capability to manage stress in anxiety disorders. Treatment Options Conventional Medical Approach Prescription drug treatment includes anti-anxiety agents such as lorazepam (Ativan), alprazolam (Xanax), and buspirone (Buspar). Antidepressants, such as fluoxetine (Prozac), paroxetine (Paxil), and venlafaxine (Effexor), are often prescribed to treat generalized anxiety and panic attacks. Nutritional Medicine Magnesium Magnesium may provide benefit for people with anxiety. Symptoms of magnesium deficiency include anxiety, nervousness, insomnia, muscle fatigue, and tachycardia. Clinical studies have supported the theory that anxiety is one of the symptoms that can occur in individuals with magnesium depletion. Vitamin B6 In a study of individuals suffering from frequent anxiety attacks, patients were given vitamin B6 (125mg, 3 times daily) and tryptophan (2 grams daily). This regime enabled in 70 percent of patients (9 of 13) to become free of anxiety attacks within three weeks. Vitamin B6 is required for the conversion of tryptophan to serotonin. Therefore, a deficiency of vitamin B6 may result in symptoms of anxiety and depression due to inhibition of serotonin synthesis. In a study of individuals suffering from frequent anxiety attacks, patients were given vitamin B6 (125mg, 3 times daily) and tryptophan (2 grams daily). This regime enabled in 70 percent of patients (9 of 13) to become free of anxiety attacks within three weeks. Inositol Clinical studies have found that inositol may be a valuable natural aid for patients suffering with Panic Attacks and may provide benefit for anxiety suffers. Biochemically, inositol is precursor for the phosphatidyl-inositol system and as such should be considered for its impact on elevated cortisol levels. A double-blind, controlled study comparing the effect of inositol against fluvoxamine in panic disorder. Twenty patients completed 1 month of inositol up to 18 g/day and 1 month of fluvoxamine (Luvox) up to 150 mg/day. Improvements on Hamilton Rating Scale for Anxiety scores were similar for both treatments. In the first month, inositol reduced the number of panic attacks per week by 4.0 compared with a reduction of 2.4 (2) with fluvoxamine. 5-Hydroxytryptophan (5-HTP) Studies that induce low levels of tryptophan result in low serotonin levels, which can cause anxiety. Tryptophan and 5-hydroxytryptophan (5-HTP) are the precursors for serotonin. Tryptophan is an essential amino acid that the body cannot manufacturer. Tryptophan is converted into 5-HTP, which in turn is converted into serotonin. There is ample evidence that tryptophan depletion causes reduced synthesis of serotonin, which can result in anxiety and other mood disorders. Patients taking anti-anxiety drugs or other antidepressants should not take tryptophan or 5-HTP without the supervision of a health care professional because it can increase the effects of other antidepressants. Tyrosine Tyrosine is the precursor to the neurotransmitters dopamine, norepinephrine, and epinephrine, which all influence and regulate mental and emotional states. In a clinical study reduced brain tyrosine levels caused a reduction in catecholamine synthesis. This caused decreased calmness, increased tension and anger. The authors of this study state that brain catecholaminergic dysregulation is involved in pathological anxiety states. Phosphorylated Serine: should be considered with elevated cortisol levels Herbal Medicine Several plants, known as nervines (nerve tonics), are used in traditional herbal medicine for people with anxiety, with few reports of toxicity. Most nervines have not been rigorously investigated by scientific means to confirm their efficacy. However, one study found that a combination of the nervines valerian and passion flower reduced symptoms in people suffering from anxiety. In a double-blind study, 45 drops per day of an extract of passion flower taken for four weeks was as effective as 30 mg per day of oxazepam (Serax), a medication used for anxiety. Passionflower Passionflower has been reported to have sedative, hypnotic, antispasmodic properties. In humans, passionflower has been reported effective when used in combination with other sedative and anti-anxiety herbs such as valerian. Valerian Valerian has long been used as an agent to soothe the nervous system in response to stress. It has been reported that valerian helps improve sleep quality.

Theanine

Diet & Lifestyle
All sources of caffeine should be avoided, including coffee, tea, chocolate, caffeinated sodas, and caffeine-containing medications.
Avoid sugar and refined carbohydrates. Stress Reduction Stress reduction can take form in a variety of ways. Some of the more structured forms of anxiety relief include; counseling, tai chi, yoga, meditation, deep breathing. These tips may help reduce your anxiety:
Take action. Determine what's making you anxious and address it. For example, if finances are your concern, draw up a budget.
Let it go. Don't dwell on past concerns. Change what you can and let the rest take its course.
Break the cycle. When you feel anxious, take a brisk walk or delve into a hobby to refocus.
Take care of yourself. Get enough rest, eat a balanced diet, exercise, and take time to relax.
Talk to someone. Share your problems with a friend or professional counselor who can help you gain perspective. Clinical Notes A variety of conditions could contribute to feelings of anxiousness. Consider evaluating the individual for heavy metal toxicity, dysbiosis, as well as DHEA and cortisol as initial steps. The key nutrient to consider is magnesium.

References

Stones A, Groome D, et al. The effect of stress on salivary cortisol in panic disorder patients. J Affect Disord. Jan1999;52(1-3):197-201.
Bandelow B, Wedekind D, Pauls J, Broocks A, Hajak G, Ruther E. Salivary cortisol in panic attacks. Am J Psychiatry. 2000 Mar;157(3):454-6.
Khalfa S, Bella SD, Roy M, Peretz I, Lupien SJ. Effects of relaxing music on salivary cortisol level after psychological stress. Ann N Y Acad Sci. 2003 Nov;999:374-6.
Vedhara K, Miles J, Bennett P, Plummer S, Tallon D, Brooks E, Gale L, Munnoch K, Schreiber-Kounine C, Fowler C, Lightman S, Sammon A, Rayter Z, Farndon J. An investigation into the relationship between salivary cortisol, stress, anxiety and depression. Biol Psychol. 2003 Feb;62(2):89-96.
Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med. Feb2000;160(4):526-34.
Balada F, Torrubia R, Arque JM. Thyroid hormone correlates of sensation seeking and anxiety in healthy human females. Neuropsychobiology. 1992;25(4):208-13. ISSN:0302-282X.
McCann UD, Thorne D, Hall M, et al. The effects of L-dihydroxyphenylalanine on alertness and mood in alpha-methyl-para-tyrosine-treated healthy humans. Further evidence for the role of catecholamines in arousal and anxiety. Neuropsychopharmacology. Aug1995;13(1):41-52.
Goddard AW, Charney DS. Toward an integrated neurobiology of panic disorder. J Clin Psychiatry 1997;58(suppl):4-11.
Seelig MS, et al. Latent tetany and anxiety, marginal magnesium deficit, and normocalcemia. Dis Nerv Syst. Aug1975;36(8):461-5.
Seelig MS. Consequences of magnesium deficiency on the enhancement of stress reactions; preventive and therapeutic implications (a review). J Am Coll Nutr. 1994 Oct;13(5):429-46.
Bockova E, et al. Potentiation of the effects of anxiolytics with magnesium salts. Cesk Psychiatr. Aug1992;88(3-4):141-4.
Benjamin J, Levine J, Fux M, Aviv A, Levy D, Belmaker RH. Double-blind, placebo-controlled, crossover trial of inositol treatment for panic disorder. Am J Psychiatry. 1995 Jul;152(7):1084-6.
Palatnik A, Frolov K, Fux M, Benjamin J. Double-blind, controlled, crossover trial of inositol versus fluvoxamine for the treatment of panic disorder. J Clin Psychopharmacol. 2001 Jun;21(3):335-9.
Hartvig P, et al. Pyridoxine effect on synthesis rate of serotonin in the monkey brain measured with positron emission tomography. J Neural Transm Gen Sect. 1995;102(2):91-7.
Hoes MJ, et al. Hyperventilation syndrome, treatment with L-tryptophan and pyridoxine: Predictive value of xanthurenic acid excretion. J Orthomol Psychiatry. 1981;10(10):7-15.
Birdsall TC. 5-Hydroxytryptophan: a clinically-effective serotonin precursor. Altern Med Rev. Aug1998;3(4):271-80.
Klaassen T, et al. Effects on mood of acute phenylalanine/tyrosine depletion in healthy women. Neuropsychopharmacology. Jan2000;22(1):52-63.
De Souza MC, Walker AF, Robinson PA, Bolland K. A synergistic effect of a daily supplement for 1 month of 200 mg magnesium plus 50 mg vitamin B6 for the relief of anxiety-related premenstrual symptoms: a randomized, double-blind, crossover study. J Womens Health Gend Based Med. 2000 Mar;9(2):131-9.
Miller HE, et al. Effect of acute tryptophan depletion on CO2-induced anxiety in patients with panic disorder and normal volunteers. Br J Psychiatry. Feb2000;176:182-8.
Bell C, Forshall S, Adrover M, Nash J, Hood S, Argyropoulos S, Rich A, Nutt DJ. Does 5-HT restrain panic? A tryptophan depletion study in panic disorder patients recovered on paroxetine. J Psychopharmacol. 2002 Mar;16(1):5-14.
Klaassen T, Klumperbeek J, Deutz NE, van Praag HM, Griez E. Effects of tryptophan depletion on anxiety and on panic provoked by carbon dioxide challenge.Psychiatry Res. 1998 Feb 27;77(3):167-74.
Monteiro-Dos-Santos PC, et al. Effects of tryptophan depletion on anxiety induced by simulated public speaking. Braz J Med Biol Res. May2000;33(5):581-7.
Sandyk R. L-tryptophan in neuropsychiatric disorders: a review. Int J Neurosci. Nov1992;67(1-4):127-44.
McCann UD, et al. The effects of L-dihydroxyphenylalanine on alertness and mood in alpha-methyl-para-tyrosine-treated healthy humans. Further evidence for the role of catecholamines in arousal and anxiety. Neuropsychopharmacology. Aug1995;13(1):41-52.
Leyton M, et al. Effects on mood of acute phenylalanine/tyrosine depletion in healthy women. Neuropsychopharmacology. Jan2000;22(1):52-63.
Moller SE. Effect of oral contraceptives on tryptophan and tyrosine availability: evidence for a possible contribution to mental depression. Neuropsychobiology. 1981;7(4):192-200.
Soulimani R, et al. Behavioural Effects of Passiflora incarnata L. and Its Indole Alkaloid and Flavonoid Derivatives and Maltol in the Mouse. J Ethnopharmacol. Jun1997;57(1):11-20.
Bourin M, et al. A Combination of Plant Extracts in the Treatment of Outpatients with Adjustment Disorder with Anxious Mood: Controlled Study Versus Placebo. Fundam Clin Pharmacol. 1997;11(2):127-132.
Wolfman C, et al. Possible Anxiolytic Effects of Chrysin, A Central Benzodiazepine Receptor Ligand Isolated from Passiflora coerulea. Pharmacol Biochem Behav. Jan1994;47(1):1-4.
Diego MA, Jones NA, Field T. Aromatherapy positively affects mood, EEG patterns of alertness and math computations. Int J Neurosci. Dec1998;96(3-4):217-24.
Brown D. Valerian root: Non-addictive alternative for insomnia and anxiety. Quart Rev Nat Med 1994;Fall:2214 [review].
Akhondzadeh S, Naghavi HR, Vazirian M, et al. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther 2001;26:3637.
Spence DW, Kayumov L, Chen A, Lowe A, Jain U, Katzman MA, Shen J, Perelman B, Shapiro CM. Acupuncture increases nocturnal melatonin secretion and reduces insomnia and anxiety: a preliminary report. J Neuropsychiatry Clin Neurosci. 2004 Winter;16(1):19-28.