By : Dr. Talia Marcheggiani
With 12% of Canadians suffering from anxiety every year (1), it is clear why anxiety is one of the most common mental health conditions in North America. Through clinical practice, I’ve quickly come to learn that “anxiety” is a term that means many different things to different people. Its symptoms can range from a mild sense of unease to full-blown panic attacks and the heavy weight of impending doom (2).
Anxiety disorders are quite diverse. They include, according to the DSM-IV, specific phobias, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), social anxiety, obsessive-compulsive disorder (OCD) and even mixed anxiety and depression (3). Often the symptoms become crippling; they prevent the patients I see from living their optimal, authentic lives, instead of living in a state of fear and self-loathing.
The symptoms of anxiety are holistic. They range from mental symptoms: excessive worry, insomnia, nervousness, and anticipation, to name a few, to genitourinary symptoms like frequent urination, and gastrointestinal symptoms (4).
There is a strong connection between anxiety and mental stress and irritable bowel syndrome(IBS), an elusive condition of the gut that results in unpredictable symptoms like bloating, diarrhea, constipation and stomach pain, which is often debilitating for those who suffer from it and tough to actually treat.
Other symptoms of anxiety include excessive sweating, muscle tension, rapid heart rate, changes in vision, hot and cold flushes and can be associated with suicidal ideation, self-harm, and substance abuse disorders (5) when anxiety becomes severe.
Unfortunately, the standard treatment for anxiety is limited. The first-line treatment is pharmaceutical and involves using a medication like citalopram, a selective serotonin re-uptake inhibitor (SSRI) (6), the same drug used to treat mild-moderate depression.
This drug is prescribed based on the theory that anxiety is an extroverted version of depression and that both involve disturbances in the production and signalling of serotonin, the “happy hormone,” in the brain.
Benzodiazepines (7) are another line of drugs used to treat anxiety symptoms, as they increase brain GABA levels, a calming brain chemical. However, “benzos” are best prescribed only in the short term (2-4 weeks) to manage serious symptoms.
They are addictive in the long-term and can have serious side effects, such as being overly sedating, and depressing breathing, especially when mixed with other sedatives, such as alcohol.
When I first meet a patient who is suffering from anxiety, I begin by taking a complete case. I have never met two patients who have had same anxiety symptoms—no two cases of anxiety are alike and therefore, no two cases should be approached in the same way.
Therefore, it is important for me to get a complete case history, with details of how anxiety manifests in my patients’ lives: how it affects them, where it might have come from and what specific symptoms are faced on a daily basis.
I also inquire about hormonal systems, digestive symptoms, sleep, diet and past medical history. It is important for me to treat the person, not the condition. This means that my patients and I spend time developing a relationship. I make an effort to get to know them during the first few visits, thereby getting to know how their condition uniquely occurs for them.
A significant portion of the naturopathic diagnostic process is identifying the cause of anxiety. While conventional medicine points to dysfunctions in the brain, naturopathic medicine approaches anxiety holistically. We understand that because stress can affect nearly every body system, it can also manifest as a result of imbalances in some organ systems.
In the first few visits, we spend time analyzing the web of our patients’ symptoms to untangle the clues that might lead us to the cause.
The 5 Root Causes of Anxiety
A holistic approach to anxiety aims to uncover the cause of symptoms by investigating imbalances in a variety of body systems. In the body, there is a balance between the sympathetic nervous system (fight or flight) and the parasympathetic nervous system (rest and digest).
When one system is turned on, the other is turned off. A healthy body can oscillate between the two states quickly, activating the fight and flight response during times of stress and activating the rest and digest response the rest of the time. Anxiety is present in the fight or flight, sympathetic nervous system state.
1. Cause: Stress
More than half of North American adults are experiencing some mental, emotional or physical stress. Chronic stress relies on the production of the hormone cortisol, which on its own can disrupt brain levels of happy hormones, like serotonin and dopamine.
Chronic stress can also lead to burnout, or adrenal fatigue, which results in an inability of the body to respond to stress in a healthy manner. Instead of producing cortisol, the adrenal glands rely on epinephrine and norepinephrine (adrenaline and noradrenaline) to confront stressful situations (8).
These hormones result in symptoms of anxiety like racing heart rate, rapid respiration, muscle tension, mental worry, dry mouth and sweating palms. Being stuck in the fight or flight state, can cause anxiety or worsen existing symptoms (9).
2. Cause: Malnutrition and Hypoglycaemia
Protein, vitamins, and minerals are the building blocks our bodies need to perform its millions of chemical reactions. Trying to heal anxiety without the proper ingredients for health is like trying to build a house without bricks, cement or nails.
Neurotransmitters like serotonin and dopamine and hormones like cortisol require the amino acids (protein) tryptophan and tyrosine for their synthesis, respectively. They also require cofactors, or “builders,” to make neurotransmitters, which include zinc, b-vitamins, magnesium, and iron.
Stress, because of its demands on cortisol production, can deplete these precious ingredients, increasing our dietary requirements. Decreasing vitamin and mineral content in food due to poor quality food production also means we’re not getting enough of these vital nutrients and supplementation might be necessary to ensure our body is running optimally.
Also, rising and falling blood sugar levels from a high-carb diet can cause hypoglycemia (10). Hypoglycemic symptoms can mimic anxiety symptoms, such as dizziness, racing heart, irritability, sweating, and fatigue.
Iron deficiency is also a common finding in North Americans, especially menstruating women or vegetarians. Since iron is responsible for carrying oxygen in the blood, a decrease in oxygen carrying capacity results in rapid heart-rate and increased breathing rate, which can also be confused with symptoms of anxiety or panic attacks.
3. Cause: Digestive Issues
Although serotonin, the happy hormone, is primarily active in the brain, studies show that up to 90% of it is made in the intestinal tract. Therefore, a disruption in the health of digestive cells or the bacteria that coats the gut can result in a disturbance in mood as well as digestive symptoms like IBS.
Food sensitivities and issues with the health and integrity of intestinal cells can lead to widespread inflammation in the body, affecting the nervous system (12). Scientists have found that low levels of inflammation in the brain and an overactive immune system can contribute to depression and other mental health conditions as well as the breakdown of brain function, contributing to memory loss, headaches and difficulty concentrating and retaining information.
Furthermore, an inability to break down and absorb protein and micronutrients results in an inability for the body to make neurotransmitters like serotonin, which require protein and various vitamins and minerals for its production.
4. Cause: Hormonal Imbalance
Because of the high exposure to xeno-estrogens, or toxic estrogens, many women in North America suffer from a phenomenon called “estrogen dominance,” where there is either too much estrogen in the body or not enough progesterone to provide hormonal balance.
Symptoms of estrogen dominance include weight, gain, painful and heavy periods, irregular periods, fibroids, acne, PMS, infertility and an increased incidence of female cancers, such as breast and ovarian cancer (13).
Estrogen and progesterone, in addition to being female hormones that control secondary sex characteristics like breast and hip development and fertility, also exert effects on the brain. It can cause irritability and anxiety symptoms, while progesterone has a stress-relieving and calming effect. Estrogen dominance, when not controlled, can worsen existing anxiety or be the cause.
5. Cause: Core Beliefs and Mental Schemas
Our brains are wired to retain the lessons we learn, especially if these lessons have been experienced alongside strong emotions, such as trauma. These emotional memories are often implicit and non-verbal, located in lower brain centers, below the level of our conscious thoughts.
Once the memories are laid down, they can last a lifetime, influencing our thoughts, emotions and behavioral reactions to present day triggers.
Anxiety and other mental health conditions can often be symptoms of these emotional memories, also called “core beliefs” or “mental schemas.” These beliefs dictate to us implicitly how the world works and, if left unexamined, can limit what is possible for us in our lives.
When these feelings get triggered, anxiety symptoms can result. Getting to the core of the symptoms and making the implicit memories verbal is the key to unlocking unknown psychological causes of mood disorders.
Holistic Solutions for Anxiety
Healing anxiety first involves identifying the specific symptoms that my patients present with and looking for potential causes among the common causes outlined above. In addition to a thorough history, I may order blood work to check the B12 and iron status of my patients.
I may order a food sensitivity test or check for hormone levels like progesterone, estrogen and cortisol in the saliva and blood, depending on the symptoms a patient presents with.
When I work with patients, we often work together to develop a comprehensive strategy for coping with stress. Often this involves looking for ways to decrease stress in their lives, such as cutting back on work hours and setting healthy boundaries.
Other times it means looking for activities to incorporate into their lifestyles to manage stress, such as going for long walks (walking slowly for 1 hour can lower cortisol levels and help manage stress), engaging in meditation, yoga, nature exposure, journaling and other activities that have been proven to reduce stress hormones.
Creating a nutritional plan is also essential for managing anxiety. I work with the place my patients are at, rather than pushing a full dietary overhaul.
Making minor adjustments to diet, such as adding more protein, especially in the morning, more fruits and vegetables and less refined carbs and sugars, can do wonders for decreasing anxiety symptoms. Reducing caffeine and alcohol consumption can also greatly benefit symptoms.
Depending on the specific symptoms and lifestyle of my patients, I might recommend nutritional supplementation to improve neurotransmitter synthesis. I also prescribe supplements to help my patients’ bodies through times of stress, depending on their stress levels and other symptoms they present with.
Keeping supplements to a few key nutrients that treat the cause of symptoms is preferable to taking handfuls of pills every day.
Improving gut health is important. This means supplementing with a high-quality probiotic, identifying and removing food sensitivities, and eating a diet that is low in inflammatory fats and high in health-promoting omega-3 fatty acids. A digestive aid such as digestive enzymes or herbal bitters can also help with the body’s ability to absorb valuable nutrients from a healthy diet.
Balancing hormones by supporting liver function, adjusting birth control brand and dosage, and minimizing exposure to hormonal toxins such as BPA, fragrances or phthalates can help treat symptoms of estrogen dominance, if present.
Finally, counseling to identify core beliefs can also be beneficial for eradicating emotional memories that are no longer beneficial to patients, and that can be contributing negatively to symptoms of anxiety and mood, is important. CBT, Narrative therapy, mindfulness training and Coherence therapy are all processes through which patients can begin to identify and challenge the core beliefs that may be contributing to or causing their anxious symptoms.