A Nutrigenomics Approach to Anxiety

Jessica had just moved to a big city to follow her dream to become an artist but found herself struggling with anxiety. Despite getting into the school of her choice, with everything seeming terrific on the outside, on the inside, she just felt more stressed. Despite seeking help from a therapist, the anxiety got so bad that her life began to seem like it was falling apart-- she couldn’t sleep, was having panic attacks, was exhausted and not eating well, couldn’t focus in school, and felt lost. How could this be happening to her?

On the recommendation of her therapist, Jessica sought help from a psychiatrist, who felt she would benefit from medication. But over just a few months, she found herself on multiple medications in a pattern that is so often seen in patients seeking mental health help. The first medication created side effects with minimal improvement in her anxiety, so a second medication was added. Jessica noted her sleeping was better with the additional medication, but was having vivid nightmares and had gained significant weight. A third medication was then added to counteract the weight gain.

Jessica sought help from a psychiatrist but soon found herself in the hospital suffering from serious medical, mental, and emotional side effects from the multiple prescribed medications. It took weeks to detox from those meds, forcing her to drop out of school.

Less than three weeks later, she found herself in the hospital suffering from unexplained symptoms. Instead of looking into the actual causes of her symptoms, her inpatient team of professionals decided it was easier to give her an additional psychiatric diagnosis. Five days after admission, despite having no improvement, she was discharged with instructions to increase her medication and follow up with her psychiatrist.

While it would have been so much easier to just be able to manage her symptoms with medication, she intuitively knew this was not the answer. Exhausted and disheartened, she somehow found the strength to look for another solution. 

Determined never to be in this kind of situation again, Jessica vowed to find other ways to manage her anxiety. That's when she came to me and learned the power of working with her DNA, rather than against it.

Using Genomics for Personalized Medicine

Genomic testing is a cornerstone of personalized medicine. Genomic testing evaluates the DNA code that instructs how the body optimizes nutrients, balances emotional and physical health, processes toxins, and fights infections. Glitches in the code called SNPs, or single nucleotide polymorphisms, can create a faulty switch in a person’s system, causing the system to falter or crash.

Many types of variations in DNA can lead to disease. Inherited diseases are rare, but small changes in DNA called SNPs are very common. Millions of SNPs have been discovered in the human genome. While they are part of what makes us each unique, SNPs can also cause problems in the body’s biochemistry and metabolism if they are not properly supported by the right diet, lifestyle, and medication choices. The good news is that if you know your SNPs, you can learn what to do about them.

Personalized Integrative Medicine is an integration of comprehensive genomic testing, functional/integrative medicine, and nutrition, all within a whole-person model of health that incorporates the energetic, emotional, and spiritual.

Genomic testing is part of my overall comprehensive assessment of all new patients, and Jessica was no exception. Suspecting toxicity from her medications was contributing to her recent symptoms, the first priority was to evaluate how she was processing her medications with a Pharmacogenomic test. This test examined the genes involved in processing many types of medications, including the three medications she was currently taking.

The pharmacogenomic test revealed that Jessica had many SNPs that impaired her ability to process each of her medications, and the combination was proving particularly toxic to her.

Finding Solutions in Our DNA

The solution was clear. With this information, she decided to stop taking her medications, and after a few weeks started to feel significantly better. Jessica was cautioned against taking any of the numerous problematic medications identified in her pharmacogenomic testing report unless her prescribing physician was aware of her unique genotype and could personalize the medication or dosage accordingly.

The next step was to look at her nutritional genomic testing results to gain insight into how her genes were contributing to her symptoms, and what nutrition and lifestyle interventions would be effective for her. The findings would also help her new therapist personalize her strategies to understand and manage her symptoms more effectively.

With a comprehensive nutritional genomic test panel, I analyzed Jessica’s DNA related to nutrition and lifestyle. This gave me insight into how her body was operating at the DNA level, which gene SNPs were contributing to her symptoms, and how best to address them through personalized dietary, supplement, and lifestyle strategies.

Below are just a few highlights from the comprehensive plan I created to address her emotional health:

• Increase Omega-3 fatty acids from animal sources. Jessica was unable to utilize the form found in plants.

• Increase folate and choline. The genes responsible for metabolizing these two nutrients were impaired, and she needed more than the typical recommended intake. She also needed a more specific form of folate called methyl folate.

• Increase Vitamin D. Jessica did not produce vitamin D from sunlight, and her cells also had trouble using the vitamin D she gets from food— here she needed a supplement and a higher dose.

• Add Ubiquinol. CoQ10, critical for energy and mitochondrial functioning, was useless for her because she couldn’t convert it into the active form ubiquinol. She needed the ubiquinol form, which is only available as a supplement. Lab tests for CoQ10 were also not a good biomarker for her, so other markers of oxidative stress and mitochondrial functioning would be a better use of her resources.

• Organic foods were especially important. Jessica had a reduced ability to process the toxins in pesticides or heavy metals like mercury or arsenic that are more often found in conventionally grown produce and city water. These are toxic to her body and brain, and she needed to be alert to avoiding foods that may contain these chemicals as well as ensure optimal support of the nutrients and bioactives needed to support her particular detoxification gene profile. This finding also altered my suggestion to increase the intake of fish rich in EPA/DHA, which are often high in these contaminants, and therefore a supplement was recommended instead.

• Add fiber and probiotics. Her genes showed a predisposition to imbalances in her microbiome and gut health. In addition to supporting the production of neurotransmitters to help her mood, these would also help reduce inflammation that could impact her well-being.

• Stress management, magnesium, B vitamins, and Sam-e. Jessica’s genomic profile indicated an exaggerated and prolonged response to stressors. She produced excessive cortisol with heightened activation of the HPA axis. She also produced excessive adrenaline, and coupled with impaired breakdown of the catecholamines this resulted in inducing a prolonged “fight or flight” response, contributing to her anxiety. In addition, her neurocognitive flexibility was impacted, decreasing especially when under stress – an important insight for both Jessica and her therapist. By understanding her unique makeup, and specifically supporting the genes involved, she could reduce the stress response that triggers anxiety.

With her unique DNA profile in hand, Jessica understood what she needed and why. She had a roadmap, and no longer had to resort to trial and error.

Gradually Jessica began feeling significantly better. As often happens in response to successful treatment, Jessica started to wonder if she really needed to stick so closely to her plan. As she became more lax, anxiety flared again. She then realized that, for her, managing her anxiety always needed to be part of her life.

But it didn’t have to rule her life. While she couldn’t change her genomic makeup, she could manage her symptoms more effectively by following her DNA-directed plan. Five months after her hospitalization, she was able to return to school. With her new tools and insights, she was better able to manage the stress of school and successfully graduated from her program.

This is a more expanded version of the original article published in Psychology Today.