Dr. Jessica Petrusma, ND

Integrated Health Care 577 Ontario St., St. Catharines

Phone: 905-988-9160

Anxiety

Types

•GAD

•Social phobia

•Specific phobia

•OCD

•PTSD

•Panic Disorder

• Aldosterone• Adrenaline• Cortisol

1. Learning/memory2. Immune function3. Bone density/growth4. Testosterone & estrogen (skin and menses)5. Weight gain6. Blood pressure, cholesterol, heart disease risk

Naturopathic Medicine

“The art and science of disease diagnosis,

treatment and prevention using natural

therapies and gentle techniques to support and

stimulate the body’s ability to heal itself”

1. Nutrition 2. Lifestyle Counseling3. Botanicals4. Acupuncture5. Homeopathy

3 servings protein: meat, legumes, cheese, eggs

Healthy fats! 2 tbsp olive oil plus nuts/seeds

Nutrition• Unprocessed whole foods• Combination of Mediterranean

and Paleo Diet• Mindful eating

2:1 ratio

0 > 2 > 4 legs and lean

5-6 veggies, 2-3 fruits

Sweets (optional but hard to avoid)

1-3 servings of grains, starchy vegetables and dairy (diet dependent)

• Water, caffeine, fiber & protein

• 5 colour approach

Nutrition Supplementation

The Big 5 For Anxiety

1. Magnesium

2. B Vitamins

3. L – Theanine

4. Glycine

5. Gaba

1. Magnesium• Several Forms: Citrate, Bisglycinate, Oxide,

Carbonate, Malate, Sulfate, Threonate & Taurate

• Standard dose: 300-500mg 1-2x/d before bed

• Best absorbed when taken at night and combined

with an acid (fruit, meat)

• Food sources: brown rice, beans, nuts, seeds and

kelp.

2. B Vitamins• B3 – Niacin. Harmless Niacin Flush. 25mg–75mg(div)

or Niacinamide (non-flush) 500mg 1 – 2x/d

• B5 – Pantothenic acid. 150-500mg/d

• B6 – Pyridoxine. 50-100mg/d

• Food sources: Whole grains, Brewer’s yeast, Miso (a

Japanese soup stock), Marmite (a vegetable

concentrate paste), Liver & Rice bran soup

3. L-Theanine• Acts on GABA, Serotonin and Dopamine

• Adaptogen and changes brain wave stateo Increases alpha waves and decreases beta waves

• Standard dose: 200-300mg/d

• Food sources: Green tea (3 small cups/d), [black

tea]

4. Glycine• Helps regulate digestion & heal lining of intestines,

builds muscle, supports the immune system, helps

with sleep and calms the nerves

• Standard dose: 5g/d as powder

• Food sources: Bone broth, beans, spinach,

pumpkin, bananas, kiwis

5. GABA• Inhibitory Neurotransmitter

• Synthetic GABA supplement or supplement that supports GABA function

• Magnesium, L- Theanine, Glycine, Taurine, Kava Kava & PharmaGABA all work on the GABA system

• Standard dose: 200 - 500mg/d

• Food sources: spinach, brown rice, apples, broccoli, carrots, beans, onions, mushrooms, sweet potato, tomato, oatmeal, fermented foods (probiotics)

Note on Depression

• More than 50% of patients with anxiety also have depression

• 5HTP is a precursor for Serotonin (mood)

• 90% is naturally made in our intestines

• Cortisol depletes tryptophan which is used in 5HTP

Testing• Urinary testing

o Calming

• Serotonin

• GABA

• Glycine

• Taurine

o Stimulating

• Epinephrine

• Norepinephrine

• Glutamate

o Modulating

• Dopamine

• Salivary testingo Cortisol

o DHEA

Thorough history • Nature and onset of symptoms• Presence of comorbid medical

or psychiatric conditions

Physical exam to exclude endocrine, cardiac disorders and exclude substance abuse

Lab tests: CBC, LFT, GGT, TSH, and possible referral for ECG

Lifestyle Counseling

The Big 5 For Anxiety

1. Exercise

2. Time Management

3. Good Sleep Habits

4. Breathing Techniques

5. Meditation

1. Exercise

• Massive impact on mood, energy, performance at

school, sleep and self-esteem

• Increases GABA

• Yoga increased GABA levels by 27% in 1 hour

• Spend more time in nature

2. Time Management

• IEP – Individualized Education Plan

• Schedule the month with your child

• Break down large goals in to small steps to meet

deadlines

• Avoid being rushed and rushing your child

3. Sleep Hygiene1. Regular sleep-wake cycle

2. Quiet period before lights out

3. Dark and soundproofed, as much as possible

4. Avoid napping

5. Regular exercise

6. Avoid large meals shortly before bed

7. Turn clock face away and use alarm

8. Avoid caffeine, nicotine (esp > 7pm), alcohol

9. Keep electronics and homework out of bedroom

10. Sleep restriction to avg. sleep time of last week

4. Breathing Techniques

• Belly breathing

• Calming breath

• Alternate nostril breathing

• Can combine with techniques learned in Cognitive

Behavioural Therapy (CBT)

5. Meditation

• Stop, Breathe & Thinko Have an app especially for kids!

• Mindfulness training o A form of meditation that helps people focus attention on the present

and encourages a positive attitude towards that experience

BotanicalsThe Big 5 For Anxiety

1. Passiflora incarnata (Passion Flower)

2. Matricaria recutita (Chamomile)

3. Melissa officinalis (Lemon Balm)

4. Rhodiola rosea (Rhodiola)

5. Piper Methysticum (Kava Kava)

Actions:

• nervine

• anxiolytic

• antispasmodic

• anticonvulsant

• antioxidant

• aphrodisiac

• anodyne

• hypotensive

1. Passiflora incarnata(Passion Flower)

2. Matricaria recutita(Chamomile)

Actions:

• carminative

• antispasmodic

• antiemetic

• nervine

• vulnerary

• antiinflammatory

• antiulcerogenic

• gastroprotective

• antiseptic

• antiemetic

• antiallergic

• bitter

3. Melissa officinalis(Lemon Balm)

Actions:

• carminative

• antispasmodic

• nervine

• antidepressant (mild)

• antimicrobial

• antiviral

*Not to be taken if hypothyroidism*

4. Rhodiola rosea(Rhodiola)

Actions:

• adaptogen

• sedative

• antidepressant

• cardioprotective

• antiarrhythmic

• antihypertensive

• anticancer

• antiinflammatory

*Not to be taken at night or with antidepressants*

5. Piper Methysticum(Kava Kava)

Actions:

• nervine

• sedative

• anxiolytic

• antispasmodic

• muscle relaxant

• anodyne

• analgesic (urinary)

• antitussive

• anticonvulsant

• sialogogue

• diaphoretic*Not in pergnancy or if liver pathology*

Acupuncture

Acupuncture

• Can be combined well with

counseling & mindfulness training

Homeopathy• Gelsemium: Feels weak and may have some trembling. Feel

like the task ahead is too much.

• Argentum nitricum: Anticipatory anxiety, very nervous with diarrhea and flatulence.

• Lycopodium: Performs well but still has preceding anxiety. Afraid to look foolish in front of others.

• Aconite: Intensely scared and can’t sit still.

• Silica: Talking exhausts and causes anxiety, gets stuck and can never find the right words.

• Calc-carb: Anxiety about health and despair of recovery.

My Top 10 Products1. Individually prepared mix of botanicals

2. Zen Theanine by AOR

3. PharmaGABA-100 by Thorne

4. RelaxMax by Xymogen

5. Mg Citrate powder by Natural Factors

6. Rhodiola by Cytomatrix or AOR

7. Best Rest by Pure Encapsulations

8. Niacin (B3) by Natural Factors

9. Kava Kava by NOW

10. Neurapas balance by Pascoe (homeopathic)