A Genomic Medicine Approach to Anxiety
Jessica felt helpless, hopeless and alone. She had just turned 18, realizing her dream of living in the big city, yet something was getting in the way. She struggled with worsening anxiety, felt exhausted, was not eating well, and couldn’t focus in school. She felt her dream slipping away, and knew she needed help.
On the recommendation of her therapist, Jessica sought help from a psychiatrist, who felt she would benefit from medication. 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. Less than three weeks later, she found herself in the hospital suffering from unexplained symptoms. Her inpatient team of professionals determined that her symptoms were likely due to an additional psychiatric condition that had not been diagnosed previously. Five days after admission 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. Although exhausted and disheartened, she found the strength to look for another solution. She had to drop out of school to focus on getting healthy, and find a better way to manage her symptoms. Jessica wanted answers, not continued guessing as to what might work for her. After doing some research, she decided to try a Genomic Medicine approach and came to us for help.
Genomic testing is a cornerstone of genomic 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 DNA variations can lead to disease. Inherited diseases are more rare, but these small changes in DNA called SNPs are common. More than 10 million have been discovered in the human genome. SNPs can cause problems in the body’s biochemistry and metabolism if they are not properly supported by the right diet, lifestyle and medication choices. If you know your SNPs, you can learn what to do about them.
Genomic Medicine is an integration of comprehensive genomic testing, functional/integrative medicine and nutrition, all within a whole-person model of health. The model we use is the GENESIS Matrix Personalized Health Model developed by Dr. Veltmann. With the advent of the Human Genome Project, he adapted the model to include genomic testing in 2001, and it continues to be updated regularly.
Genomic testing is part of our overall comprehensive assessment for 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 Genoma International’s Pharmacogenomic test panel. We examined the genes involved in processing many types of medications, including the three medications she was currently taking. The testing revealed that Jessica had many SNPs associated with ability to process each of these medications, and the combination was proving particularly toxic to her.
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 Genoma International’s comprehensive Ultimate Wellness genomic test panel, we analyzed Jessica’s DNA related to nutrition and lifestyle to understand how her body was operating at the DNA level, and identify the SNPs that were contributing to her symptoms. Below are just a few highlights from the comprehensive plan we 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, she needed more than the typical recommended intake.
- 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.
- Add Ubiquinol. CoQ10, critical for energy, 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.
- 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. These are toxic to her body and brain, and she needed to be alert to avoiding foods that may contain these toxins as well as ensure optimal support of the nutrients and bioactives needed to support her particular detoxification gene profile. This finding also altered our suggestion to increase intake of fish rich in EPA/DHA, which are often high in these contaminants, and therefore a supplement was recommended instead.
- 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 understand 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 was to be part of her life always. 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. She graduated and is now pursuing her dream career.