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The focus of today’s show is Anxiety.  Anxiety can be a debilitating health challenge and if you or a loved one is dealing with it, you are not alone.  Did you know that world-wide more than 40 million people suffer from Anxiety and Anxiety related health challenges?  What I am about to share with you today is an article written by Dr. Ronald Grisanti. Dr. Grisanti is the lead instructor of Functional Medicine University and is one of the leading pioneers in Functional Medicine.  The significant difference between functional medicine and traditional medicine is that functional medicine looks to restore health by addressing an individual’s underlying root cause or root causes of dysfunction as opposed to taking steps to merely cover up symptoms.  

Without any further ado, here is the article by Dr. Grisanti titled

“Has Your Doctor Missed Something? Causes of Debilitating Anxiety”

Real Life Example of Anxiety

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.

This concludes Dr. Grisanti’s article.  I hope you found this article helpful and I hope that it shed some light as to the benefits of applying the functional medicine approach to a very common health challenge.  I have personally seen numerous patients come into our functional medicine based nutrition therapy program with Anxiety as their main health challenge that they were able to overcome by addressing a number of the underlying causes that Dr. Grisanti covered in this article.  For more information please see our show notes page at www.backtohealthchiropracticpodcast.com where we will have a copy of Dr. Grisanti’s article as well as applicable links.

This concludes today’s episode of The Back to Health Chiropractic Podcast, where we discuss tips, tools & strategies to improve the health and wellness of you & your family!  Please SUBSCRIBE to this podcast so that you never miss a future episode, also PLEASE SHARE this podcast with ANYONE you feel may benefit from what we covered today.

Finally, Thank you very much listening and until next time, have a Fantastic Day!

Links

https://www.functionalmedicineuniversity.com/public/1018.cfm