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Anxiety, It's not just in your head.

Updated: Apr 1, 2023

- from the desk of Dr. Brkich

Anxiety is a universal feeling that we all experience in times of stress, uncertainty, or danger. It is an innate, built-in, adaptive response that is initiated by internal mechanisms over which we do not have full control. Anxiety is triggered automatically by the nervous system without the need for rational, deliberate, or conscious thinking, although thinking negative, scary, or irrational thoughts can bring it on.

In appropriate circumstances anxiety is appropriate. Anxiety is a normal survival mechanism and a part of the “fight or flight” or sympathetic division of our autonomic nervous system. If a grizzly bear is approaching us it is essential and appropriate to be anxious. Anxiety that is felt when there is no reason to be anxious is a functional anxiety that is very common but is neither desirable nor beneficial. A persistent functional anxiety that doesn’t turn off may feel as if something is wrong with the brain or nervous system. In medical terms persistent functional anxiety may be categorized as generalized anxiety disorder. In my opinion the hormones and neurotransmitters that underlie generalized anxiety disorder are no different from those that trigger the anxiety that we would normally feel when we are faced with a stressful event or danger. Anxiety is anxiety no matter where it comes from. Putting a descriptive label on anxiety on the basis of its symptoms or its severity doesn’t help us understand or treat it.

Anxiety has a spectrum of intensity. Some may experience mild anxiety while others may be consumed by horrific, scary, and very realistic panic attacks characterized by feelings of overwhelming doom and gloom and imminent and certain death. Medical convention is to label anxiety on the basis of its intensity and concomitant symptoms. The labels may sound scientific or medical but are, in my opinion, not very useful for treatment.

There is always a reason for being anxious even when there is no reason to be anxious. Let’s say that another way. When we feel anxious for no reason, there is always a reason why we are anxious, even if we don’t know the reason. No matter how complex or elusive the symptoms of anxiety may appear, there is always an underlying reason for its existence. Just because there may be no easily identifiable reason to be anxious does not mean that our anxiety is not real. Anxiety that has no obvious cause is just as real as anxiety caused by imminent and impending danger.

The underlying molecular or biochemical cause of anxiety is the same, regardless of the labels that we attach to the symptoms based on their intensity or the uniquely individual ways in which the symptoms are expressed. Hormones and neurotransmitters that are out of balance in a person with anxiety are no different from the hormones and neurotransmitters that trigger and initiate the automatic fight or flight response to real danger. It doesn’t matter what labels we attach to the symptoms. Attaching a label to anxiety may be important for purposes of establishing a diagnostic code for medical billing purposes. However, anxiety is anxiety by any name, regardless of what brings it on. How we label it is more or less irrelevant for treatment. The anxiety of someone experiencing a panic attack is just as real as the anxiety of a person being chased by a grizzly bear. It is wrong, in my opinion, to think that anxiety experienced during a panic attack is unreal or fictitious or “all in the head”. Such a perception and characterization of anxiety engenders shame that generates even more anxiety from the stigma that arises from being labelled in a way that infers or attributes responsibility or fault to the person experiencing genuine anxiety over which they have no control. The result is too often suffering in silence rather than seeking help.

Anxiety is a symptom, not a disease. It is a normal physiological state that we all experience in times of stress. The stressors can be different but the stress response is physiologically the same. In times of stress we automatically go into the fight or flight mode. Heart rate goes up. Blood flow to the digestive organs is diminished. Numerous biochemical and physiological changes occur, all of which enable us to better defend ourselves or escape danger. Counterbalancing the fight or flight is the “rest and digest” or parasympathetic division of the autonomic nervous system. There is a yin and yang relationship between the sympathetic and parasympathetic nervous systems. One helps us avoid or escape danger. The other helps to nourish and rebuild our bodies by digesting and processing the food we eat to maintain our health. One acts as the gas pedal in our vehicle while the other acts as the brakes. Although they may seem like opposing systems that appear to work against each other, they work in a harmonious, synchronized, and balanced way. In a person with anxiety the two systems are out of balance.

Hormones and neurotransmitters can be tested in saliva and urine. A common finding often observed in anxiety is a pattern of high excitatory and low inhibitory hormones and neurotransmitters.

Why do hormones and neurotransmitters get out of balance?

Naturopathic and functional medicine practitioners have long understood that anxiety and anxiety-like symptoms can be ameliorated by repletion of deficiencies or insufficiencies of various vitamins, minerals, amino acids, and antioxidants. There are specialized tests now available to test for these nutrients. Repletion of missing nutrients often resolves the anxiety, requiring no further treatment. However, if the anxiety persists despite the correction of the nutrient deficiencies, what then?

I have come to realize after 25 years of practice that hormones and neurotransmitters, commonly believed to be made entirely in exocrine glands and the brain and nervous system are, surprisingly, governed by our gut microbiome. There is accumulating evidence demonstrating that hormones and neurotransmitters are made in the intestinal tract by bacteria. A surprising fact is that these gut bacteria make more hormones and neurotransmitters than the brain and nervous system, much more in fact. Estimates are that 90% of the serotonin in the body is made in the gut and not the brain.

Anxiety is never caused by a deficiency of pharmaceutical antianxiety drugs or antidepressants commonly used to treat anxiety. Nor is it caused by a deficiency of herbal medicines or homeopathic remedies commonly used to treat anxiety naturally. Any symptomatic treatments that fail to address the underlying cause of anxiety will have only temporary and partial resolution of the anxiety.

What can we do for anxiety that is unresponsive or only partially responsive to standard pharmacologic or natural treatments? We know that the brain and enteric nervous system are connected by a so-called gut brain axis. By optimizing gut function, we can affect brain function. Repairing a broken intestinal microbial system directly impacts the functioning of the enteric nervous system of the gut, often called the second brain. The enteric nervous system has a regulatory and modulating effect on the brain and its related nerves. Correcting intestinal dysbiosis, reducing mucosal inflammation and immune dysregulation, and repairing intestinal endothelial hyperpermeability, or leaky gut, gives us a new and novel avenue of approach in the treatment of anxiety and all neurological disorders.

If you or a loved one or someone you know suffers from anxiety, it’s time to take control rather than allowing it to control you. There is a saying that a journey of a thousand miles begins with a single step. We are just a phone call or an email away. All you have to do is take the first step.

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