Condition - Anxiety - Dr Mark Atkinson's Case Notes
Not all mental health issues are psychological in origin and, those that are, often have a variety of biological contributing factors. While, of course, this is not ground-breaking news to the majority of nutritionists, few doctors, psychologists and psychotherapists appreciate this, much to the detriment of the care of their patients. The following case notes give an insight on how one practitioner, Dr Mark, approaches a complex series of nutritional and emotional imbalances.
One way to help clients with health challenges, and the one I use myself, is the functional medicine approach. Functional medicine is a personalised approach to patient-centred care, which, wherever possible, attempts to discover and address the underlying imbalances that are contributing to a client’s health challenge. It’s becoming an increasingly popular approach in the USA and in the UK. Here is a case study of mine, to demonstrate functional medicine in action:
A lady in her 60s came to see me with severe anxiety that had been getting progressively more debilitating over the previous six months. She had trouble getting to sleep at night, was “worrying constantly” and was increasingly irritable and restless. She had been taking benzodiazepines for years. She came to me because she was fed up, exhausted, concerned about her dependency on her benzodiazepines and just “wanted to be free of anxiety”.
I use a series of questionnaires with all my patients, which capture personal and historical data, provide an assessment of physical and emotional needs and identify dietary habits and deficiencies, enabling me to evaluate the health of various systems in the body.
In her case, the questionnaires suggested that there were several factors contributing to her anxiety. Adrenal exhaustion was suggested by her anxiety, mental/physical tension, general restlessness, insomnia and recurrent colds. Her sugar cravings, drop in energy and mood after lunch, frequent mood swings and swings in energy throughout the day suggested blood sugar imbalances. Plus gut dysbiosis was suggested by a series of digestive problems, including constipation. Finally, sleep deprivation was suggested by the fact that she slept on average six hours a night and woke up two to three times during the night.
In order to assist clients with anxiety, from a functional medicine perspective, a personalised programme is required, that addresses the underlying biological and psychological factors that may be contributing to the experience of anxiety. In addition to educating about anxiety and teaching practical stress reduction skills; such as mindfulness, guided imagery and deep breathing exercises; I used the following programme:
Stable blood sugar levels are an important part of the approach I used in this case. She was essentially eating a high-carbohydrate diet, consisting mainly of processed foods; for example, Weetabix with cow’s milk, followed by white toast, margarine and jam for breakfast, a packet of crisps, cake and/or a chocolate bar for snacks, cheese sandwiches/baguettes for lunch and either pasta, pizza or meat and two vegetables for dinner and then, usually, ice cream or yoghurt for dessert. She drank four cups of coffee and three cups of tea a day and hot chocolate prior to going to bed. Her mood and diet were definitely linked and I suggested a low glycaemic load, healthy eating programme and a modified, ‘anti-Candida’ diet as well, to help her digestive system.
I reduced her fruit intake to one portion of fruit a day, reduced her caffeine consumption to two cups of tea or coffee a day, explained the importance of eating three meals and two snacks (each with protein) and provided her with some new, healthier options to eat. She embraced it wholeheartedly, although she did experience a temporary increase in her anxiety symptoms for one week, as she started to come off sugar and caffeine.
The new diet consisted of alternating between poached eggs on rye toast, wholemeal/rye toast with almond nut butter, protein powder shake with organic whole soya milk or goat’s milk and oat porridge with nuts, seeds and chopped fruit for breakfast. Snacks included vegetable sticks (carrot, cucumber, peppers, baby sweetcorn and celery) with hummus or guacamole, a handful of nuts (five or six), instant miso soup and nut and seed bars (with no added sugar).
Lunch and dinner ideas were salad or steamed vegetables with beans, chickpeas, lentils, quinoa, tuna, chicken/turkey, goat’s cheese, grilled fish or tofu, vegetable soups, fish/lean meat with steamed vegetables, sandwiches using wholemeal bread, tortilla or lettuce wraps, vegetable frittata, stir fries and oat cakes with hummus/nut butter.
Our body and brain have an immense capacity for healing and improving our mental health and emotional wellbeing, as long as certain physical needs are met. I find it very useful and revealing to explore each of the following physical needs with my patients:
A healthy environment
Usually, two or three of these will not be in balance. In this case, she agreed to go for a 20-minute walk each day, do two Pilates sessions a week, turn the TV off after 9pm and get to sleep by 10-10.30pm. She was instructed that if she did wake up during the night, she should do something she didn’t find enjoyable – such as cleaning – this negative association to waking up works a treat to correct insomnia. She also agreed to learn some conscious breathing techniques and to take 20 minutes a day to actively unwind and de-stress.
I find that both general health and mental health will often improve considerably just by meeting these basic needs.
I tend to divide any nutritional supplementation programme into stages. In this case, for the first six weeks, the focus was on emotional and physiological balance and the digestive system. I used a combination of octanoic acid, plus herbs; including pau d’arco, rosemary, lemon balm and thyme; and I also suggested she took alkalising minerals; six capsules with warm water, just prior to bedtime.
I find the amino acid L-theanine, in combination with B vitamins, lemon balm, taurine and passion flower helpful, as L-theanine has been shown to promote the production of alpha brainwaves, which, in turn, create a state of deep relaxation and mental alertness, without any drowsiness. This lady was warned that taking these in addition to her benzodiazepines might enhance their sedative effect.
To help her maintain healthy blood sugar levels, alongside the dietary modifications, I started her on a metabolic support supplement containing nutrients to help balance blood sugar, including chromium, fenugreek, cinnamon and liquorice, plus B vitamins, zinc, magnesium and manganese. After six weeks on the programme – and, testament to her, she had stuck to it really well – her digestive system and her mood and energy levels were much improved. I stopped all of the original supplements and switched the focus to re-populating the bowel with a high-potency probiotic (containing Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium lactis and Bifidobacterium bifidum). Then I looked to help feed the lining of the gut with L-glutamine powder and a full-spectrum digestive enzyme formula with each main meal, to assist digestive function. To support adrenal health, I suggested the adaptogenic herbs rhodiola and ashwagandha.
In addition, I included a high-potency multivitamin/mineral, plus an EFA oil containing omega 3, 6 and 9 essential fatty acids.
Within three months of commencing her functional medicine programme, a reassessment of her anxiety showed that she had moved from moderate anxiety to no anxiety. She described herself as “eerily at peace”. What’s more, her digestive system was working well, her foggy thinking had disappeared and her energy levels were much improved. Now that she had achieved some emotional and physical balance, I supported her in coming off her benzodiazepines. This was successfully done, slowly, over a period of six months.
Dr Mark is the author of The Mind Body Bible (Piatkus).
Dr Mark Atkinson MBBS BSc (Hons) FRSPH FBSIM is a holistic medical doctor, well-being expert and one of the UK’s leading authorities on integrative approaches to mental health, addictions, stress-related illness and chronic fatigue syndrome/fibromyalgia.
His website is www.drmarkatkinson.com
Editor’s note: Caution should be used when taking supplements alongside benzodiazepines and this is best done under the supervision of a qualified practitioner. Withdrawal from benzodiazepines should only be done under medical supervision.