A New Approach To Managing Anxiety

We’ve all experienced them—those little moments of alarm. They range from the benign, Where’s my cell phone? or Did I miss my flight by a whole day? to the more terrifying, I can’t find my 7-year-old on a crowded beach! (Or, you know, that time when your children, unbeknownst to you, decide to play hide-and-seek in Target and you have no idea where they are, despite screaming their names at the top of your lungs … Ah, memories.)

But while occasionally feeling anxious is a normal part of life, those with anxiety disorders can experience intense, excessive, and persistent worry about everyday situations. This can involve episodes of sudden, intense anxiety, fear, and actual terror that reaches a peak within minutes—also known as panic attacks, and often accompanied by physical manifestations such as heart palpitations, sweatiness, chest pain, nausea, and more. So, how do you know what true anxiety feels like, and what are some options to help get it under control?

• Feeling uneasy and irritable
• Sleep disturbances (difficulty falling asleep or staying asleep)
• Headaches
• High blood pressure
• Racing heart or palpitations
• Chest tightness
• Shortness of breath
• Chronic stomach pain or diarrhea and constipation

For some, these feelings of anxiety not only interfere with day to day activities, but are difficult to control and can be disproportionate to the actual danger of the situation. This can lead to avoiding places or situations to prevent these feelings.

Some studies estimate that a whopping 18% of the U.S. population are affected by anxiety disorders—a figure that I see reflected among my patients, with an unusually high number of them suffering from anxiety—especially since the start of the pandemic. Equally concerning is the number of patients being put on what I call the “pharmaceutical gravy train” in order to ease their pain.

So why is this of concern? Well, for starters, long-term use of anxiolytic medications (the Xanaxes, Valiums, and Klonopins of the world) have been linked to increased risks of dementia and mental decline. This is not OK. Even less addictive anti-anxiety medications like SSRIs, or selective serotonin reuptake inhibitors (Prozac, Zoloft, and Lexapro, for example), can cause withdrawal symptoms when patients attempt to eventually get off of them. Using medications exclusively also neglects searching for underlying causes of anxiety and mood disorders.

That’s why, instead, I try to steer my patients to other, non-pharmaceutical treatment options.

First of all, what I love about an integrative approach is that it is highly personalized to the person who is experiencing distressing levels of stress and anxiety. It’s not a blanketed: “Here’s your blue pill, have a nice day!” approach. But it definitely takes a village to treat and manage an anxiety disorder, so you’ll want to build a team of professionals to address the underlying causes of anxiety. This may include any/all of the following:

• A well-trained therapist to address the psychosocial causes of stress and anxiety. Ideally, someone familiar with cognitive behavioral therapy (CBT) techniques, which teaches patients how to change unhelpful behavioral patterns.
• A health care provider who looks for physical and physiologic causes of underlying anxiety. Your brain is a physical organ. When mental health issues arise, it is not always “just” about stress. Even if stress is an immediate cause, the impact of stress on your body can leave a lasting mark and prevent resolution of the anxiety response back to a normal state.
• A medical doctor trained in the effective, personalized prescribing of psychotropic medications.
• A health and lifestyle coach to examine ways to alleviate triggers and stressors that elevate stress reactions.

Additionally, you want to find specific providers that aim to build a complete picture of you in order to get to the root cause of your anxiety. They should be asking about things like your family history of mood disorders to check for any genetic tendencies, head trauma or injury to rule out brain inflammation, as well as your current stressors, sleep/exercise habits, medications, medical diagnoses, and more.

Although there is no diagnostic lab test for anxiety, I typically examine three basic areas of function that can lead to mood disorders:

• Nutrient status - Many vitamin and mineral depletions are related to an increased risk of anxiety and depression symptoms.
• Hormone status - Imbalances in various hormone systems can influence mood. Ask your providers to check levels of the following:
  • Sex hormones like estrogen, progesterone, and testosterone
  • Thyroid hormone levels
  • Stress hormone levels
  • Blood sugar and insulin levels
• Inflammation status – There is a clear association between inflammation and depression and anxiety. Inflammatory processes in the body can lead to inflammation in the brain.

Additionally, a functional medicine doctor will likely order blood panels to evaluate for markers of anxiety and depression, including:

• Complete blood count (CBC)
• Ferritin
• Serum B12, B6, and folate
• Homocysteine
• Serum vitamin D
• Magnesium
• Plasma zinc
• Day 21 estrogen, progesterone, and testosterone
• AM cortisol (or morning cortisol) and DHEA
• Thyroid functions testing (expanded panel)
• Fasting glucose, HgA1c, and insulin

hsCRP and ESR – markers of inflammation in the body

One last place to look for answers when it comes to your anxiety is right within your gut. Butterflies in your tummy? Pit in your stomach? The unplanned bout of diarrhea when you’re stressed or anxious? No, you’re not just imagining it. There is a definite connection between the health of your gut and your brain—so much so that it even has a name: the gut-brain axis.

Abnormal gut bacteria impact neurotransmitter production and absorption of nutrients that influence mood. Remember that 90% of serotonin, the feel good brain chemical, is made in your gut. But the relationship between the gut and brain isn’t a one way street—that communication happens in both directions. Your state of mind can impact your gut and, likewise, what’s happening in your gut will impact your brain.

Being in a calm, controlled, balanced state of mind means that your parasympathetic (or rest and digest) nervous system is working. This allows for digestion, normal bowel movements, excellent absorption of nutrients and an overall well-functioning intestinal tract. Stress, anxiety, and general feelings of overwhelm will trigger your sympathetic (or fight or flight) nervous system. The gut basically shuts down and stops working properly. A chronic state of fight or flight will even change the bacterial balance within 24 hours.

But beyond better bowel movements, oftentimes fixing gut imbalances will have dramatic effects on your level of anxiety and depression, too.

^{*Editor’s note: This is part one of a two-part series. Click here for the second installment, which will take a deeper dive into the link between anxiety and your gut health.}

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