Anxiety: A Naturopathic Psychiatric Approach

Anxiety: A Naturopathic
Psychiatric Approach
Dr. Maya Nicole Baylac

Anxiety Statistics
Anxiety is the most common psychiatric disorder in the US and Europe
Affects 18% of the US population (1), 7.3 % of the rest of the world (2)
One of the major health problem of the western world (WHO, 2004)
Poorly detected and treated: Only one third of those suffering from anxiety
receive treatment
Economical burden is high: People with anxiety disorders use doctors three to
five times more than those without anxiety disorder
(1) US statistic anxiety and depression association of america: http://www.adaa.org/about-adaa/press-room/facts-statistics
(2) Prevalence of worldwide anxiety disorders was obtained from 87 studies across 44 countries
http://www.ncbi.nlm.nih.gov/pubmed/22781489
www.HawaiiNaturopathicRetreat.com

What is Anxiety?
A state of anhedonia due to the perception of a
hostile environment threatening survival
It is an allostatic state due to the disruption of the
homeostasis by acute or chronic stress

HOMEOSTATIC STATE ALLOSTATIC STATE
Pleasure, safe Anhedonia, insecure, fear
Oxytocin NE, Epinephrine, cortisol, fatty acids
GABA and glutamate are in physiological
equilibrium
Glutamate > GABA
Parasympathetic dominance
Sympathetic dominance, HPA axis
Normal heart rate, blood pressure and blood
sugar
Increased heart rate, blood pressure, blood
sugar, respiration rate
Fat and carbohydrate breakdown
Rest digest
Increased insulin, blood sugar LDL
Immune digestive systems suppressed
Homeostasis and Allostasis

Psychological Symptoms
 Restlessness, excessive alertness, hypervigilence
 Difficulty concentrating or mind going blank
 Irritability, impatience, worry
 Anger, negativity
 Easily fatigued
 Sleep disturbance
 Bad dreams

Physical Symptoms
 Cardiovascular: pain or pressure in the chest, palpitations,
tachycardia
 Respiratory distress: hyperventilation, dyspnea, tachypnea,
choking
 Gastro-intestinal: diarrhea, nausea, heartburn
 Neuromuscular: muscle tension, sweating, dizziness,
tremors and twitches, headache

DMS V: Anxiety Disorders
Disorder Symptoms
Generalized Anxiety Disorder Exaggerated worry about health, safety, money, and other aspects of daily
life that lasts six months or more. Often accompanied by muscle pain,
fatigue, headaches, nausea, breathlessness, and insomnia.
Phobias Irrational fear of specific things or situations, such as spiders
(arachnophobia), being in crowds (agoraphobia), or being in enclosed spaces
(claustrophobia).
Social Anxiety Disorder
(social phobia)
Overwhelming self-consciousness in ordinary social encounters, heightened
by a sense of being watched and judged by others and a fear of
embarrassment.
Post-Traumatic Stress
Disorder (PTSD)
Reliving an intense physical or emotional threat or injury (for example,
childhood abuse, combat, or an earthquake) in vivid dreams, flashbacks, or
tormented memories. Other symptoms include difficulty sleeping or
concentrating, angry outbursts, emotional withdrawal, and a heightened
startle response.
Obsessive/Compulsive
Disorder (OCD)
Obsessive thoughts, such as an irrational fear of contamination,
accompanied by compulsive acts, such as repetitive hand washing, that are
undertaken to alleviate the anxiety generated by the thoughts.
Panic Disorder Recurrent episodes of unprovoked feelings of terror or impending doom,
accompanied by rapid heartbeat, sweating, dizziness, or weakness.www.HawaiiNaturopathicRetreat.com

Pathological Anxiety: A Response
To Chronic and Acute Stress
 These symptoms are due to the effect of chronic stress on
the brain
 Chronic stress creates anatomical and physiological changes
in the limbic system
 For example: amygdala shrinking
 Chronic stress causes mental emotional changes:
 For example: the misinterpretation of symptoms of chronic
stress
 Chronic stress becomes the new homeostatic state.

HPA Axis Activation and Negative
Feedback

Neuroendocrine Secretions In The
Stress Response
 Catecholamines activate the sympathetic nervous system
and the HPA axis: Increased secretion of Dopamine and
Norepinephrine in the locus coerulus induces secretion of
CRF in the hypothalamus.
 CRF is released in the amygdala
 Glutamate receptors are activate either by CRF or
disinhibited by GABA
(Decavel and Van Del Pol, 1990, 1992)

Catecholamine Synthesis

Brain Neurotransmitters
Inhibitory
• GABA
• Dopamine
• Glycine
• Taurine
• Serotonin
Excitatory
• Glutamate
• Norepinephrine
• Epinephrine
• Histamine
• Aspartic acid
• PEA

GABA and Glutamate Receptors
 Glutamate and GABA make up 90% of the brain’s
neurotransmitters
 Excessive Glutamate is neurotoxic to GABA
 Receptors for glutamate are NMDA
 Receptors for GABA are GABAA
 NMDA receptors can be excited by other chemicals, heavy
metals, exogenous neurotoxins and too much glutamate

Cofactors for
Neurotransmitter Synthesis
 Iron
 Copper
 Magnesium
 Zinc
 Folic acid or MTHF
 B6
 B12
 Vitamin C + D
 SAMe
 Tetrahydrobiopterin
Approximately 75% of the population has an MTHFR genetic defect

Glutamate/GABA Cycle
Patel A B et al. PNAS 2005;102:5588-5593
©2005 by National Academy of Sciences

Adapted and
Maladapted Stress
Response
Acute and Chronic Stress

Adapted and Maladapted
Stress Response
Adapted Stress Response or Acute Stress
 Temporary mood that disappears when the challenge of
acute stress is resolved
 Triggered by external or internal circumstances perceived as
threatening and disturbing the state of homeostasis (taking
an exam or getting married)
Maladapted Stress Response or Chronic Stress
 Stressors are permanent or permanent perception of stress.
 Adaptation to chronic stress

Stressors Disrupting Homeostasis
 Biochemical: toxins, excess glutamate, blood acid imbalance, low
oxygen supply
 Psychological-Emotional: fear threatening emotional
homeostasis, insecurity, trauma, abuse
 Mental: negative thought activating neurological fear pathway
 Social: family, major life events, personal conflicts
 Physical-physiological: excessive weight, pain, intense heat or
cold, vigorous exercise
 Environmental: pollution from crowding or noise
* Many of these stressors are experienced on a long term basis in
chronic stress

Acute Adapted Stress Response
Perception of Danger
Activation of Amygdala
Interpretation by Prefrontal Cortex
SNS
Feedback Loop to Hypothalamus
Homeostasis
Catecholamine Release
Glutamate Release
GABA Inhibition
Fight or Flight
NE + E Decrease
Return to Homeostasis

Chronic Stress Response
Perception of Danger
Activation of Amygdala
Activation of HPA axis
Disruption of feedback loop to
hypothalamus and pituitary
Atrophy of neurons in hippocampus
and prefrontal cortex
Adrenal Fatigue + Thyroid Dysregulation
Catecholamine
Release
Glutamate Release
GABA Inhibition
CRH  ACTH 
Cortisol
Thyroid + Sex
Hormone Inhibition

Chronic Stress Response and
Neuroendocrine Changes
 Disruption of the feedback loop
 Shrinkage of the hippocampus and amygdala
 Cortisol decrease and adrenal failure
 Hormonal imbalance

Pregnenolone Steal

Physiological Symptoms of
Chronic Stress
Prolonged secretion of cortisol causes multiple symptoms in a
variety of systems:
 Gastrointestinal: Increased appetite, increased centralized
weight gain
 Immunological: frequent colds, prolonged healing times
 Central Nervous System: Memory loss
 Endocrine: Decreased thyroid function, increased risk of
developing Cushing’s Syndrome, bone loss, menstrual
irregularities in women, decreased libido in men

Maladaptive Chronic Stress Response
 Adaptation to abnormal state: chronic stress is the new
homeostatic state
 Chronic anhedonia and difficulty to return to the normal
state of homeostasis.
 Life is centered on manipulating circumstances to return to
the homeostatic state.
 Quality of life is negatively affected.

Chronic Stress Alters Mental State
 Misperception and misinterpretation of physiological
symptoms and external stimuli leads to acute stress reaction
 Stress induced anaphylaxis
 PTSD
 Phobias
 Accumulation of chronic stress and acute stress evolve into
acute anxiety crisis or panic attack that may takes the
patient to the emergency room

Effect of Anxiety on
Mental and Physical
Health

Anxiety and Mental Disorders
 Bipolar disorders
 Eating disorders
 Headaches
 Sleep disorders
 Substance abuse or drug withdrawal
 Adult ADHD
 Body Dysmorphic Disorder
 Schizophrenia

Medical Disorders Associated
with Anxiety
 Heart disease
 Diabetes
 Hyperthyroidism
 Asthma and COPD
 Withdrawal from alcohol, anti-
anxiety medications
(benzodiazepines) or other
medications
 Irritable bowel syndrome
 Rare tumors that produce
certain "fight-or-flight"
hormones
 Premenstrual syndrome
 Chronic pain
 Fibromyalgia
 Cancer

Conventional Treatment
of Anxiety
Benzodiazepines + SSRIs

Benzodiazepines
 Benzodiazepines are hypnotic, sedative, anxiolytic and
anticonvulsant
 Enhance the action of GABA by binding to GABAA receptors
 Manipulate brain chemistry to achieve calmness but it does
not restore normal levels of neurotransmitters
 Memory impairment and interaction with alcohol can occur
 Psychomotor impairment: studies show increased road
accidents

Benzodiazepine Side Effects
 Paradoxical side effects: Increased depression,
hallucinations, personality changes
 The most common adverse side effects are: ability to induce
tolerance and dependence, sedation and myorelaxation
(Millan, 2003)
 Tolerance and drug withdrawal between dosage lead to
increased doses and dependency, even at therapeutic doses
and in a short course of treatment
 Addiction occurs most often with short half life drugs such
as ativan (lorazepam) and Xanax (alprazolam)

SSRI
Selective Serotonin Reuptake Inhibitor (SSRI)
 Serotonin is involved in the regulation of mood, appetite
and sleep
 SSRI’s prevent the degradation of serotonin in the synaptic
cleft

SSRI Side Effects
 SSRIs cause weight gain, insomnia, headaches, nausea,
diarrhea, sexual dysfunction: decreased libido, male
impotency, anorgasmia. (Prim Care Companion J Clin Psychiatry. Feb
2001; 3(1): 22–27.)
 Doubles suicidal ideation: “When compared with a placebo,
all antidepressants, including SSRIs, seem to double the
risk of suicidal thinking, from 1%–2% to 2%–4%, in both
children and adults.” (SSRI Side Effects: Harvard Mental Health Letter
discusses the real risks of antidepressants, May 2005)
 Increases suicide risks by 2

Beta Blockers
 Used in extreme cases
 Can relieve acute anxiety by slowing the heart rate and
reducing blood pressure; they are often used to treat stage
fright

Naturopathic
Assessment
History taking – Physical Exam - Laboratory testing

History Taking
 Rule out any mental or physical condition
 Rule out family abuse and external causes of stress
 Rule out drug / alcohol use
 Exposure to toxic chemicals such as organophosphate,
chlorinated compounds, heavy metals
 Nutrition: processed versus whole, organic food
 Assess stress

History Taking
Physical Conditions
Underlying physical illness threatening survival:
 Cardiovascular: mitral valve prolapse, myocardial infarction, abdominal
aortic dissection
 Respiratory: COPD, asthma
 Hyperthyroidism
 Diabetes, hypoglycemia
 Cancer
 Drug abuse
 Anaphylaxis
 Cushing’s Syndrome

Anxiety and the
Cardiovascular System
 Chest pain is a symptom of both anxiety and heart
attack.
 Mitral valve prolapse causes anxiety and panic
attack
 Anxiety is a risk factor for heart attack
In the Nurses' Health Study, women with the highest levels of phobic anxiety were 59% more likely to have a heart
attack, and 31% more likely to die from one, than women with the lowest anxiety levels. Data from 3,300
postmenopausal women in the Women's Health Initiative showed that a history of full-blown panic attacks
tripled the risk of a coronary event or stroke.
Two studies — one involving Harvard Medical School and the Lown Cardiovascular Research Institute; the other,
several Canadian medical colleges — concluded that among both men and women with established heart
disease, those suffering from an anxiety disorder were twice as likely to have a heart attack as those with no
history of anxiety disorders.

Anxiety and the Respiratory
System
Asthma
 Most studies have found a high rate of anxiety symptoms
and panic attacks in people suffering from Asthma
COPD
 In several studies involving COPD patients, anxiety has
been associated with more frequent hospitalization

The Gut Brain Connection
Anxiety and IBS
 A 2007 New Zealand study of subjects with gastroenteritis
found an association between high anxiety levels and the
development of IBS
 Anxiety can trigger symptoms in the gut and a troubled gut
can send signals to the brain
 Microbiota imbalance

Anxiety Endocrine
Connection
 Hypoglycemia
 Hyperthyroidism/Hypothyroidism
 PMS
 Menopause

Self-Medicating Anxiety:
Substance Abuse
 Alcohol blocks NMDA receptors to glutamate, binds to
GABA, acetylcholine and serotonin
 Benzodiazepines bind to GABAA and have the same effect as
alcohol
 Nicotine increases dopamine
 Opiates bind to endorphins and increase dopamine
 Coffee, cocaine and methamphetamines increase dopamine,
epinephrine, NE and serotonin secretion

Observation
 General demeanor: how the patient responds to the
environment, personal hygiene
 Posture: buffalo hump, abdominal obesity
 Signs of nervousness: rapid speech, knuckle cracking, nail
biting, finger tapping, hand wringing, trichotillomania

Lab Tests
 CBC, Comp Metab Panel
 TSH, FT3, FT4, RT3, TSH, Thyroid
AB
 Pregnelonone, DHEA’s
 Adrenal stress index ASI
 25-OH vitamin D3
 Mg, Zn, Cu, Fe, TIBC, Ferritin
 Folate, B12, B6
 MTHFR DNA mutation
 Homocysteine
 Lipid panel
 CRP
 Heavy metal test
 HGB A1C
 ION test Genova Diagnostics
 Biopterin
 Stool analysis

Physical Exam
 Vitals: HR, BP, Respiratory rate,
temperature
 HEENT: hair distribution,
pupillary reflex test, moon face,
thinning eye brows
 Thyroid: size, nodules, boggy,
symmetry, tenderness
 CVS: JVP, auscultation of valves
 Respiration: auscultation
(Asthma, COPD)
 Skin: scars, sores, temperature
 Abdomen: obesity, tenderness
(IBS)
 Extremities: nervous movement,
nail biting, capillary refill (COPD)
 Reflexes: prolonged Achilles
tendon reflex (hypothyroid)
 Genitals: hair distribution pattern
(excess androgens)

Special Tests
 Seargent's white line test
Take a sharp object and draw a line on the abdomen length and width.
 Normal response: line turns red
 Stage 1 adrenal fatigue: line turns white and widens
 Rogoff’s Sign
Tenderness in the mid to lower back area. A sign of adrenal dysfunction
 Ragland's Sign- a test for postural hypotension
Take BP while the patient is seated have them stand up and immediate
check the blood pressure again. The systolic BP should increase about 4-
10 mm indicating adequate adrenal activity. If the BP is the same or
lower it can indicate sluggish adrenal activity.

Treating the Cause
Fear, Emotional Stress and Oxidative Stress

Causes of Anxiety: Fear
 Some fears are inherent to the species: fear of dying, dark,
aloneness
 Fears can be from a current abusive relationship or family
environment
 Fears can come from national or job insecurity
 Fears can be triggered by reactivation of past trauma in
personal history
 Fear of change perpetrates chronic stress

Example: Fear of Change
Past History of Abuse

Acute Stress Response: Flight

Acute Stress Response: Fight

Homeostasis Maintained:
Chronic Stress

Neither Fight or Flight or
Chronic Stress
 Psychotherapy: Cognitive
behavioral therapy
 Exposure therapy
 Mindfulness, meditation
 Identifies and challenge
negative thinking patterns and
irrational beliefs feeding
anxiety. Ex: I have a terminal
illness
 Identifies feared object or
situation and repeats exposure
to the object or repeats feared
action in a controlled
environment
 Dis-identify from anxious
thoughts, focus on the present

Causes of Anxiety:
Oxidative Stress
 Oxidative stress occurs when free radicals are in excess of
antioxidants
 The brain is susceptible to lipid peroxidation and oxidative
damage from high O2 consumption, its lipid rich constitution and
low anti-oxidant defenses
 Studies to determine a causal relationship between oxidative and
emotional stress suggest that oxidative stress can provoke anxious
behavior in rats
Masood A, Nadeem A, Mustafa SJ, O'Donnell JM. Reversal of oxidative stress induced
anxiety by inhibition of phosphodiesterase-2 in mice. Masood A, Nadeem A, Mustafa
SJ, O'Donnell JM. Reversal of oxidative stress-induced anxiety by J Pharmacol Exp
Ther. 2008;326:369–379

Chemicals and NMDA
Receptors
 Ammonia: ammonia produced by the body can cross the
BBB and produce biochemically induced anxiety
 Heavy metals: in particular mercury
 Chemicals from food

Treatment
Eliminating Environmental and Social Stressors

The Inpatient Model
Removes External Life Stressors
 Substitutes a safe space in nature
 Provides a compassionate staff and multiple caring therapists dispensing
hydrotherapy treatments, massage, spiritual and emotional support
 Reestablishes trust in the environment
 Allows a progressive de-structuration of chronic stress adaptation
syndrome and the emergence of the natural self healing power
 Encourages daily focus on personal growth
Ecotherapy and the healing power of Nature “Vis Medicatrix Naturae”
 Emphasizes interaction with natural environment
 Mindful walking produces grounding
Group Therapy Sessions
 Generates community and support

Treatment:
Biochemistry of Anxiety
Nutrition – Detoxification – IV – Exercise

Nutrition
Mediterranean Diet
• Eating traditional ‘Mediterranean’ diets – lower rate of mood and anxiety
symptoms
Processed Food
• Eating ‘Western’ processed diets – higher rate of mood and anxiety
symptoms
Fried Food
• Avoid fried foods forming advanced glycation end products’ (AGE’s)
during the frying/crisping of foods (increase oxidative stress in the body)
GMO
• Avoid GMO
Davison & Kaplan (2012), “Nutrient intakes are correlated with overall psychiatric
functioning in adults with mood disorders,” Cdn J Psychiatry, 57(2):85–92

Nutritional Compounds
Magnesium:
• Magnesium deficiencies cause HPA dysregulation
Flavonoids:
• Flavonoids modulate the activity of GABAA receptors and have demonstrated
anxiolytic, sedative and anti convulsing activities.
GABA Modulators:
• Such GABA modulators have been found in fruit (e.g., grapefruit), vegetables (e.g.,
onions), various beverages (including tea, red wine, and whiskey), and in herbal
preparations (such as Ginkgo biloba and Ginseng).
Astaxanthin:
• Astaxanthin is a powerful antioxidant and anti inflammatory compound that can
balance the inflammatory effect of cortisol
Zinc:
• Zinc studies show that zinc behaved as typical NMDA antagonist. C.E. Brown, R.H.
Dyck, Distribution of zincergic neurons in the mouse forebrain, J Comp Neurol, 479

Detoxification
Heavy Metal
Detoxification
Candida
Detoxification
FIR Saunas
Coffee Enemas
and Colon
Hydrotherapy
Juice Fast or
Raw Food Diet
Fermented
Foods to
Replenish the
Beneficial Flora

IV Therapy
 Supports detoxification pathways : Glutathione, ALA
 Replenish quickly vitamins and mineral deficiencies with IV
nutrient therapy: B vitamins, magnesium, amino acids,
calcium, vitamin C.

Exercise Therapy
 Increases serotonin levels
 Oxygenates the brain
 Reduces epinephrine and cortisol

Case Study: JS
• 26 year old Female NursePatient:
• Eating Disorder, Panic attack, General Anxiety Disorder,
Agoraphobia
Diagnosis:
• Food Allergies, Weight Loss, Reducing Food Intake to
Familiar Foods
Presenting
Complaints:
• Started 3 years ago when she had her first panic attack
after eating some Chinese food at her friend’s wedding.
Had several hospital emergency visits after that (6 in 3
years).
History of Panic
Attacks:
• Flying, Any substance entering her body: New Foods, IV,
Supplements
Phobias:
• Hx of Claustridia Difficile treated with antibioticsDysbiosis:

Case Study: JS
Patient symptoms self-management:
• remaining close to a hospital, no more than 3 miles radius, having her car nearby and
carrying an epi-pen
Recreational Life:
• Could not socialize, go for hikes, which she was doing a lot prior (she was an athlete).
Was hard for her to take a plane and come and visit us in Hawaii from Canada
Relationship with Food:
• Could only eat some foods that she felt safe with. Believed that she had food
intolerance and reacting to foods would lead to a panic attack
Weight:
• Was losing weight
Emotions:
• Crying all the time
Professional Life:
• Could not work any more and resigned 6 months before coming for treatment.
Secondary Complaints: Life Limitations and Health Effects

Case Study: JS
Benzodiazepine: Lorazepam, Ativan
• 1 mg 5 AM and 5 PM
SSRI Citalopram 25 mg for the last 2 years
Pantoprazole for Acid Reflux
Pharmaceutical Management:

Treatment
 ION Test from Metametrix (Genova Diagnostics) shows elevated
homocysteine level, low tyrosine and phenylalanine, low vitamin D,
yeast infection
 Oral supplementation to treat deficiencies: Vitamin D, Folic Acid as
Methyltetrahydrofolate, Neurotransmitter Precursors and Cofactors
including Biopterin, Tyrosine, Phenylalanine, GABA, B Complex, Fish
Oil, Probiotics, Antioxidants, Adaptogenic and Anxiolytic Herbs.
 IV Therapy: Anxiety Protocol, Benzodiazepine Withdrawal Protocol,
Glutathione, Nutritional IV, Myers Cocktail.
 Raw Food Nutrition with Green Juices (organic, non-GMO)
 Exercise Program: Reformer Pilates, Walking, Swimming

Treatment: Psychotherapy
Meditation Mindfulness
 Address the presenting layer: fear of new foods, supplements, IV
 Treat the eating disorder with cognitive behavioral therapy and exposure therapy
 Challenge her belief system
 We taught her how to take her pulse and test new foods prior to eating them. She
learnt that she did not have any reaction to any of the foods she was eating. She
was very upset, crying each time she was eating or waking up or taking supplements.
We were present at the beginning every time she was eating holding her and talking
to prevent a panic attack.
 Preventing panic attack: breathing and mindfulness
 She learnt that she could prevent a panic attack with breathing while crying in fear
of having a reaction
 We taught her how to practice mindfulness to watch how she could stop herself
from having a full blown reaction

Treatment Outcome
 Following 3 weeks of in-house treatment she was eating all
foods without doing the pulse test or having anxieties
 She was taking her supplements under 15 minutes
 Her pharmaceutical medications were tapered down:
 Citalopram: Off,
 Lorazepam: From 1mg to 0.25mg
 6 Month Follow Up:
 She got off Lorazepam herself the following month
 She has resumed working and her social life and has no panic
attack

Thank you!
Merci!
Mahalo!
Dr. Maya Nicole Baylac
www.hawaiinaturopathicretreat.com
239 Haili street, Hilo, HI 96720, US
drbaylac@HawaiiNaturopathicRetreat.com
808.933.4400
www.facebook.com/HawaiiNaturopathicRetreatCenterwww.HawaiiNaturopathicRetreat.com

Anxiety: A Naturopathic Psychiatric Approach

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