YOU ARE NOT ALONE

If you experience anxiety, you are not alone.  Conditions like anxiety and depression are becoming increasingly common.  In Australia and New Zealand about 20% of adults will experience a mental illness at some stage in their lives.    3% of Australian adults experience anxiety in a year (this is high!) and 55 to 60 % of these are women.  The higher incidence of women with anxiety may be due to the fact that men seek treatment less frequently.  The average high-schooler today has the same level of anxiety as the average psychiatric patient in the early 1950’s. We are getting more anxious every decade.

When we are presented with a stressful situation it is normal to feel some anxiety, however it is when this becomes more prolonged or severe that anxiety is considered to be a ‘disorder’.  Anyone who has experienced anxiety knows that you can’t just “stop worrying” or “snap out of it” – if it was that simple then it wouldn’t be such a problem.  Thankfully, there is much that can be done.  One of the first steps to overcoming anxiety is understanding that it’s not ‘all in your head’, but learning about the condition, and then taking steps to get better by seeking help.

 WHY?

There are several types of anxiety, such as generalised anxiety disorder (GAD), panic attacks, obsessive compulsive disorders, post traumatic stress disorders and phobias.  These can be caused by slightly processes in the body, and will give different symptoms as well.

Given the increased pressure we have on ourselves with work, finance, family, relationships and not to mention all the scary things the media warns us about, it’s no wonder that anxiety is so common.  Support networks (groups of people that we can turn to who listen to and understanding our concerns) used to exist in greater strengths, however with everyone’s busy lives and the impact of technology on social interactions we are no longer able to ‘debrief’ as we once were, and so our stresses are exaggerated and not dealt with properly.

There are many different causes and triggers of anxiety (so many that it could fill a book) so I will only list some of them.

• Neurotransmitters are chemicals which allow our neurons to communicate with the rest of our body by an electrical signal.  If there is an imbalance in these, we can get a problem with mood.  Serotonin, Glutamate, GABA and Dopamine are most often involved with anxiety.  The way that we make neurotransmitters is like a factory line – we start with protein and there are several steps along the way where certain vitamins and minerals add bits and pieces to get the final product.  If something goes wr0ng with that factory line, you get neurotransmitter imbalances.
• Emotional triggers.  This doesn’t really need explaining.
• Hormonal imbalances.  Many women (and their partners) are well aware of the affects of PMS on mood.  Anxiety and depression are very common around ‘that time of the month’.
• Blood sugar level fluctuations.  When your blood sugar levels drop it can cause feelings of anxiety, so eating a low GI diet is important to prevent anxiety.
• Diet : deficiencies.  What you eat can affect your mood.  A lot.  There are a few vitamins and minerals in particular that have very important roles in making our neurotransmitters (think of the factory line mentioned before), and if you are missing one or any of these then the process either doesn’t occur, or goes in the wrong direction. 
• Diet : triggers.  Food intolerances, caffeine or other stimulants, preservatives and additives can trigger anxiety via a complicated chemical process which ultimately – you guess it – disrupts that neurtransmitter factory line.
• Digestive problems.  Did you know we make most of our neurotransmitters in our digestive system?  It makes sense then that digestive problems can upset the subtle balance of these neurotransmitters, affecting your mood.  Most people with IBS have probably noticed this connection for themselves – have a stressful day, and your gut suffers (and vice versa).  Liver issues can also be connected with anxiety, potentially via their effect on intestinal health and bilirubin toxicity, even though some conditions such as Gilbert’s syndrome are frequently labelled as being symptom free.
• Toxicity (e.g. heavy metals)
• Inflammation.  A lot of mental health conditions are now being linked to other auto-immune/inflammatory conditions, and depression itself is considered to be an inflammatory condition.

WHAT CAN I DO?

 Seek help!

According to a research paper from the Lancet published in 2006, despite the great number of pharmacological options less than half of the patients suffering from panic disorder experience a full and sustained remission.  What should we take from this disappointing fact?

We need to realise that what causes anxiety is not the same for everyone.  Treatment of anxiety and other mental health conditions needs to be holistic.  By this I mean that all the factors that combine to cause anxiety need to be addressed, and that treatment should incorporate different methods to do this, such as counselling, nutrition, herbal medicine, massage and acupuncture to relieve the symptoms of anxiety and address the underlying causes.

Complementary medicine can do marvellous things for anxiety, however if your anxiety is severely debilitating then medication may be necessary in the short term.  It is advisable not to self prescribe as anxiety and depression require specific doses and quality of herbs which are difficult to find in the retail range, and there are interactions between some medications and herbs which should be avoided.

There are many different treatment options available giving you plenty of choice and whichever one you choose it is most likely you will get some relief – choose a therapy that you have an affinity with and combine it with a cognitive therapy (e.g. counselling, hypnotherapy or meditation) and you’re on the right path.

Don’t lose hope – if you seek help then you can regain control over your anxiety.

Some tips to help you along your way

Meditation is one of the oldest and most effective ways of managing anxiety and mood disorders.  Research has shown that people who take conventional medications for anxiety who also meditate have a better result.  This is a good practice to incorporate into your daily ritual to help manage anxiety.

Breathing techniques are a very important part of managing anxiety.  A lot of people don’t breathe correctly, which is usually a habit we don’t even realize we have.  Some of us are chronically bad breathers as a result of growing up with breathing conditions such as asthma or sinus disorders.  This incorrect way of breathing can worsen anxiety, often leading to hyperventilation.

Your diet can have a strong impact on anxiety, both positively and negatively.  To begin with, simply reduce the foods that can trigger anxiety (see above) and try to increase your intake of nourishing foods like good fats, vegetables and whole (intact and unprocessed) grains – preferably organic.  For further guidance consult a naturopath or nutritionist.

Exercise.  Walking, jogging, swimming, pilates, yoga.  Get moving – it does wonders for burning up your stress hormones and clearing your thoughts.

Keep Rescue Remedy or Emergency Essence handy to use if you have an acute episode.

Mindfulness exercises are a great technique to ‘unclutter’ your mind.  There are plenty of different techniques available (just do an internet search) but the core of the technique is that you are concentrating solely on what is happening at that moment in time.  Mindful eating is a great habit to get into – it improves stress as well as digestion.

Works Cited

• Brito, D. B. (2012). Bilirubin Toxicity. Retrieved from http://www.ff.ul.pt/FCT/RECI/BIM-MEC/0188/2012/1.pdf
• Charles L. Raison, M., Christopher A. Lowry, P., & Graham A. W. Rook, B. M. (2010). Inflammation, Sanitation, and ConsternationLoss of Contact With Coevolved, Tolerogenic Microorganisms and the Pathophysiology and Treatment of Major Depression. Arch Gen Psychiatry, 67(12), 1211-1224.
• Hechtman, L. (2011). Clinical Naturopathic Medicine. Churchill Livingstone Australia.
• Leahy, R. H. (2008, April 30). Anxiety: How Big a problem is it? (Psychology Today) Retrieved April 21, 2012, from http://www.china-consult.com.au/2010/09/17/anxiety-how-big-a-problem-is-it/
• Mindfulness in Everyday Life. (2007, January). (Black Dog Institute) Retrieved April 21, 2012, from http://www.blackdoginstitute.org.au/docs/10.MindfulnessinEverydayLife.pdf
• Overeview of mental illness in Australia. (n.d.). Retrieved from http://www.responseability.org/site/index.cfm?display= 134563
• Roy-Byrne, P. P., Craske, M. G., & Stein, M. B. (2006). Panic Disorder. Lancet, 1023-1032.
• Satish A. Eraly, M. P., Caroline M. Nievergelt, P., Adam X. Maihofer, M., Donald A. Barkauskas, P., Nilima Biswas, P., Agorastos Agorastos, M., . . . Team, f. t. (2014). Assessment of Plasma C-Reactive Protein as a Biomarker of Posttraumatic Stress Disorder Risk . JAMA Psychiatry, 71(4), 423-431. Retrieved from http://archpsyc.jamanetwork.com/article.aspx?articleid=1833091&resultClick=3

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PMS stands for Pass My Shotgun, Pardon My Sobbing, Perpetual Munching Spree, Pimples May Surface…

PMS jokes are everywhere, as it is probably the most common female hormonal disorder. Many women accept monthly changes to their mood, appetite, energy and sleep patterns as an annoying but inescapable part of life, and yet PMS is a treatable condition. In Australia, it is estimated that up to 75% of women experience PMS at some time in their lives, with 18% of women suffering the more severe form – premenstrual dysphoric disorder (PMDD). PMS and PMDD are often poorly recognised, let alone diagnosed or treated.¹ These conditions can have a severely detrimental effect women’s lives, but PMS can be easily and effectively treated with diet, exercise and Natural Medicines.

What causes Premenstrual Syndrome?

As you would expect, most of this havoc is due to hormonal imbalance, however very commonly it is existing nutritional deficiencies, as well as diet, stress and exercise combined, that really tips you over the edge.

Studies have shown that women who experience PMS have excessive amounts of oestrogen which causes relatively lower levels of progesterone compared to women who don’t². Not everyone is the same of course, and some women may have low progesterone but not necessarily excess oestrogen.

The psychological symptoms

Progesterone has a metabolite called allopregnanolone, which acts in the Central Nervous System  by interacting with the sedating GABA A receptors to positively affect mood and behaviour, whilst improving stress response and cognitive function.³

When progesterone and its metabolites are low, less of the calming effect from the GABA receptors are experienced so you can experience all sorts of mood imbalances such as irritability, anxiety or depression. On top of this, oestrogen has excitatory effects in the CNS by acting on the glutamate system, so women with excess oestrogen often feel wound up and irritable. ⁴

The physical symptoms

A common complaint with PMS is fluid retention. High prolactin (another reproductive hormone) is associated with cyclic breast tenderness and fluid retention. Prolactin naturally elevates during the second half of your cycle and may be further increased by stress, low blood sugar and high oestrogen. Aldosterone (a hormone produced by the adrenal glands) also contributes to symptoms of fluid retention, contributing to weight gain and bloating. Stress is the key driver of high aldosterone. Interestingly, stress may also reduce your sensitivity to progesterone.⁵ Another relatively common symptom accompanying this time is latent virus activation e.g. getting cold sores at that time of the month.

What can we do about it?

The specific treatment varies on the woman as everyone experiences PMS differently. The core focus is to use nutritional supplements and herbal medicine which can help to balance hormones, support stress levels and reduce unpleasant symptoms. In clinic I use high strength herbal medicines which includes use both liquid and tablet forms, all of which are stringently tested for quality, safety and the strength of the active parts. Working towards a healthy eating (diet) and balancing lifestyle factors (e.g. reducing stress) is important as well.

One of the main herbs Naturopaths use for treating PMS is Vitex (Vitex agnus castus, also known as Chaste tree). It is best taken first thing in the morning for two or three months to see results. Various studies have demonstrated that Vitex supplementation significantly improves the spectrum of premenstrual symptoms over a period of three months. One study showed that symptoms of irritability, breast fullness and bloating were improved by 50%,⁶ whilst another found that 93% of 1634 participants reported an improvement or complete remission of symptoms monitored, including depression, anxiety, food cravings and fluid retention.⁷ Furthermore, by normalising the luteal phase, Vitex has been shown to improve fertility in women with luteal phase defect.⁸ In a study on infertile women with pathologically low progesterone levels, a dose of 36 mg of dried fruit daily improved fertility rates by approximately 15% within three months.⁹

Peony (Paeonia lactiflora) and Dong quai (Angelica sinensis) are also great hormonal regulators specific for PMS and menstrual irregularities.¹⁰

To support mood and stress levels there are herbs that calm the nervous system and balance GABA levels such as Passionflower (Passiflora incarnata), herbs to support adrenal gland function such as Rehmannia (Rehmannia glutinosa) and Licorice (Glycyrrhiza glabra); and adaptogens – herbs that help you ‘adapt’ to stress such as Siberian ginseng (Eleutherococcus senticosus) and Withania (Withania somnifera).

To further support your nervous system it’s important to ensure you don’t have nutritional deficiencies that will leave your nervous system frazzled. For example, B vitamins and magnesium are crucial for combating stress and so many people are deficient these days. Your body uses more of these when you’re stressed so if you lead a stressful, busy lifestyle at times then you most likely need top up with some supplements to get you back on track.

As well as having a diet that is high in protein, fibre and good fats (these are all crucial!), there are key nutrients that are needed for blood sugar regulation, such as chromium and magnesium, to improve carbohydrate metabolism and blood sugar control.

Vitamin B6 – for production of neurotransmitters, essential fatty acid metabolism, oestrogen metabolism, and progesterone support.

Magnesium – to reduce cramps, to support mood, for blood sugar control, to reduce aldosterone, and support energy production. Intracellular (but not plasma) magnesium levels have been found to be lower in women with PMS, so women who are deficient in magnesium are more likely to suffer from PMS.

Calcium – this is also important for nervous system support, and to regulate the control of muscular contraction and relaxation. Interestingly, symptoms of calcium deficiency are similar to many PMS symptoms and in some women PMS may be due to underlying calcium dysregulation which may be driven by vitamin D deficiency.

Chromium – essential for blood sugar level control, insulin production and pancreatic health. Chromium deficiency can lead to more sugar cravings and blood sugar fluctuations.

Omega fatty acids – Omega 3 is important for healthy prostaglandin levels, and a deficiency of Omega 3 can cause a variety of symptoms such as menstrual and premenstrual cramps, depression, irritability, dry/rough skin, acne and cravings for oily and fried foods.

If you’re someone who really suffers in the lead up to your period each month, it’s certainly worth getting some professional advice from a naturopath about the key elements of treatment for you. It’s something that many women seem to think they just have to endure and put up with, without looking into ways they could reduce their symptoms. If you’re one of those people – now you know there are things you can do, so why not give naturopathy treatment a try?

READY TO DISCUSS YOUR HEALTH NEEDS?

CONTACT ME TO MAKE AN APPOINTMENT

1. Halbreich U, Borenstein J, Pearlstein T, Kahn LS. The prevalence, impairment, impact and burden of premenstrual dysphoric disorder (PMS/PMDD). Psychoneuroendocrinology 2003; 28(3): 1-23.
2. Wang M et al. Relationship between symptom severity and steroid variation in women with premenstrual syndrome: study on serum pregnenolone, pregnenolone sulfate, 5a-pragnane-3,20-dione and 3a-hydroxy-5a-pregnan-20-one. J Clin Endocrinol Metab 1996; 81: 1076-1082.
3. Monteleone P et al. Allopregnanolone concentrations and premenstrual syndrome. Eur J Endocrinol 2000; 142: 269-273.
4. Backstrom I et al. Pathogenesis in the menstrual cycle-linked CNS disorders. Ann N Y Acad Sci 2003; 1007: 42-53.
5. Kumar S, Mansel RE, Scanlon MF, Hughes LE, Edwards CA, Woodhead JS, Newcombe RG. Altered responses of prolactin, luteinizing hormone and follicle stimulating hormone secretion to thyrotrophin releasing hormone/gonadotrophin releasing hormone stimulation in cyclical mastalgia. Br J Surg 1984; 71(11):870-3.
6. Loch EG et al. Treatment of premenstrual syndrome with a phytopharmaceutical formulation containing Vitex agnus castus. J Womens Health Gend 2000;9(3):315-20.
7. Berger et al. Efficacy of Vitex agnus castus L. extract Ze440 in patients with premenstrual syndrome. Arch Gynecol Obstet 2000; 264 (3): 150-3.
8. Wuttke W et al. Chaste tree (Vitex agnus-castus)- pharmacology and clinical indications. Phytomedicine 2003; 10(4): 348-57.
9. Bone K. Clinical Guide to blending liquid herbs. Churchhill Livingstone 2003, p 145.
10. Sakamoto S et al. Pharmacotherapeutic effects of kuei-chih-fu-ling-wan on human uterine myomas. Am J Chin Med 1992; 20 (3-4): 313-7.

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