Anxiety is a mental health condition that can significantly impact an individual's quality of life and well-being, and those struggling with this condition know how debilitating it can be. The prevalence of anxiety is staggering. Up to 25% of people struggle with anxiety disorders globally, with the prevalence skyrocketing to an estimated 70% in those battling a chronic disease. Additionally, current data suggests women are more than twice as likely as men to experience this mental health condition.

A Functional Medicine approach to anxiety offers a therapeutic option focused on uncovering the root cause of your condition through careful consideration of all potential contributing factors. Your Functional Medicine practitioner will always start with a comprehensive history to better understand the lifestyle and environmental factors contributing to your condition, in addition to a physical exam and functional lab testing. This allows for a treatment approach that is targeted and individualized.  

A Functional Medicine approach can be used in conjunction with conventional care for a well-rounded, comprehensive plan to address anxiety.

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What is Anxiety?

Anxiety is a feeling of dread, fear, and worry in response to certain situations, often accompanied by a rapid heartbeat, sweating, and tension. These symptoms can be a normal response to stressful situations, such as public speaking or a job interview, and can even be beneficial by alerting us to dangerous situations. However, Anxiety Disorders occur when the feelings of nervousness and fear are excessive, counterproductive, and debilitating. Anxiety becomes problematic when a person is unable to control these responses, and activities of daily living are negatively impacted.

An important element to understanding anxiety is a basic understanding of the stress response. Humans respond to stress with a series of nervous system and hormone actions (including the release of the primary stress hormone, cortisol), which are controlled by a mechanism we call the Hypothalamic-Pituitary-Adrenal (HPA) axis. The HPA axis mediates the effects of stressors on the body, and anxiety is associated with dysfunction in this vital mechanism.

There are multiple types of Anxiety Disorders, including generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, and phobia-related disorders.

Symptoms of Anxiety

The symptoms associated with anxiety disorders vary somewhat depending on the type. However, general symptoms include:

• Restlessness
• Irritability
• Difficulty concentrating
• Difficulty sleeping
• Excessive feelings of fear or dread
• Muscle tension
• Headache
• Stomachache
• Chest pain
• Racing heart
• Sweating
• Trembling

What Causes Anxiety?

The exact cause of anxiety is unknown. However, researchers believe it is likely due to a complex combination of factors.

Genetics play a role. Generalized anxiety disorder (GAD) is a heritable condition, and you're at greater risk if you have a first-degree biological relative with it.

With a focus on uncovering a root cause, your Functional Medicine practitioner also considers the following biological and environmental factors contributing to your anxiety.

Western Diet

Epidemiological studies in different countries reveal a Western Diet consisting of refined grains, sugary foods, fried or processed foods, and beer, and low in fruits and vegetables is associated with more psychological symptoms and a greater risk for anxiety.

A review study of the existing literature also revealed associations between anxiety levels and inadequate tryptophan (an amino acid) and protein intake.

Several studies indicate that a diet low in Omega-3 essential fatty acids is associated with a higher risk for anxiety. Conversely, a high intake of Omega-3 essential fatty acids, whether in the form of fish or marine-derived supplements, is associated with a lower risk for anxiety.

Caffeine

Excessive caffeine consumption can cause anxiety and associated symptoms, including rapid heart rate, restlessness, and difficulty sleeping. If you're a devoted coffee connoisseur, you might be wondering how much is too much; More than 600 mg per day, which is equivalent to 4 to 7 cups.

Micronutrient Deficiencies

Studies demonstrate that low levels of vitamin d, omega 3, zinc and magnesium are associated with anxiety and that supplementation with these minerals improves symptoms.

Lifestyle Factors

In addition to nutritional status, other lifestyle factors that should be considered as possible causes include stress, trauma, physical inactivity, and inflammation.

HPA Axis Dysfunction

A stress hormone called cortisol, which is released from the adrenal glands, is the end product of the HPA axis. Chronic exposure to this hormone can lead to changes in the brain that may contribute to the development of anxiety.

Health Conditions

Evidence indicates various health conditions have known associations with anxiety, including thyroid conditions, heart arrhythmias, IBS, anemia, and dysbiosis.

Neurotransmitters

Anxiety is associated with the dysregulation of several neurotransmitters, including GABA, serotonin, glutamate, and dopamine. Neurotransmitters are chemical messengers that utilize the nervous system to usher information throughout the body.

Functional Medicine Labs to Test for Root Cause of Anxiety

There are no specific laboratory tests that can diagnose anxiety. However, your Functional Medicine practitioner may perform several functional lab tests to better understand the imbalances in your biology that may be associated with your anxiety.

Comprehensive Gut Health Testing

Since gut health can play a role in anxiety, it’s important to get a comprehensive evaluation of the patient's microbiome. Tests like the GI Map shows how well the patient is digesting and absorbing foods, breaking down foods into usable micronutrients, and if there is any inflammation or dysbiosis that could be leading to anxiety.

Nutrient Testing

The Genova NutrEval Plasma is a comprehensive test that evaluates for deficiencies or insufficiencies in various nutrients. This test is a valuable option because it evaluates multiple antioxidants, vitamins, minerals, Omega-3 essential fatty acids, as well as markers that indicate the need for microbiome support.

Hormone & Neurotransmitter Testing

Hormone testing will give insight into whether there is dysfunction in the HPA axis. There are several options for evaluating this system, including tests that also evaluate neurotransmitters, highlighted below.

The DUTCH Complete is a comprehensive dried urine test that evaluates sex and adrenal hormones and the daily free cortisol pattern giving insight into the HPA axis. The test also evaluates several organic acids that provide information on the level of certain neurotransmitters. Other organic acids measured give insight into the presence of B-vitamin deficiencies and dysbiosis.

The Doctor's Data NeuroAdrenal Profile is a saliva and urine test that evaluates the daily free cortisol pattern, as well as nine neurotransmitters.  

Comprehensive Blood Workup

A comprehensive blood workup, including CBC, CMP, thyroid panel, iron panel, and Vitamin D testing, will help assess overall health and rule out underlying health conditions that could be contributing to anxiety.

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Conventional Treatment for Anxiety

A Functional Medicine approach can be used in conjunction with conventional care for a well-rounded, comprehensive treatment plan to address anxiety. Conventional treatment for anxiety often includes a combination of medication and psychotherapy (talk therapy).

Medications that are used in the conventional treatment of anxiety include antidepressants, beta-blockers, and anti-anxiety medications such as benzodiazepines. Cognitive Behavioral Therapy (CBT) is a form of psychotherapy that is considered to be the gold standard for treating anxiety disorders.

Functional Medicine Treatment for Anxiety

A Functional Medicine approach to treating anxiety consists of a well-rounded, individualized plan that includes diet, nutraceuticals, and other lifestyle modifications, such as physical movement and stress management.

Nutrition for Anxiety

We know that a simple, healthy eating pattern greatly supports our overall health, so it should be no surprise that eating healthy foods is also good for our mental health. A Mediterranean Style of eating that is low in sugar and includes fruits, vegetables, and adequate intake of lean protein, nuts, legumes, and whole grains may lower the risk of anxiety, according to epidemiological evidence.

As discussed earlier, caffeine can cause anxiety symptoms, so limiting caffeine intake may be helpful. Green tea offers an alternative to coffee as it’s lower in caffeine and is shown to reduce symptoms of anxiety.

Herbs & Supplements for Anxiety

Nutraceutical supplementation may help address nutrient imbalances contributing to the condition. Supplements are, of course, intended to be just that, a supplement to a well-rounded nutrition plan. The emphasis is always on eating a healthy diet and using nutraceuticals as an adjunct to other lifestyle changes for the best outcomes.

A multivitamin and mineral supplement is an easy way to increase intake of the several vitamins and minerals shown to reduce anxiety symptoms in adults and children.

Supplementation with Vitamin D has been shown to be effective in reducing anxiety symptoms. Your Functional Medicine practitioner will determine the amount of Vitamin D supplementation that's best for you individually based on your blood test results.

Omega-3 essential fatty acids in supplement form have been shown to reduce anxiety scores when supplemented in the amount of 3 grams per day.

Probiotic supplements have been shown to alleviate anxiety symptoms and can be a helpful addition to a healthy diet and lifestyle changes to support balance in the microbiome.

L-lysine and L-arginine are two amino acids that have been shown to increase the ability to handle stress and reduce anxiety scores when taken together in supplement form.

Cannabidiol (CBD) is a compound found in cannabis that is shown to improve both sleep and anxiety scores. In addition to its anxiolytic properties, CBD has been shown to have both anti-inflammatory and antioxidant effects, making it an option worth considering, especially when sleep disturbances or inflammatory conditions are present.

Passionflower and kava herbal extracts have been shown to reduce anxiety symptoms effectively.

Exercise for Anxiety

In addition to a healthy diet, another universal tenet is that exercise is extremely valuable in supporting overall health and well-being. Studies show that aerobic and resistance exercises effectively reduce anxiety and would be excellent adjuncts to a comprehensive approach to addressing this mental health condition.

Stress-Management Techniques for Anxiety

Relaxation practices such as yoga, deep breathing, and meditation are shown to improve anxiety symptoms. Whether they're performed together, as is often the case in a group yoga class, or performed individually in the comfort of your own home, each practice is a wonderful way to support mental health. Even one session of deep breathing can positively impact symptoms of anxiety, making these techniques quick and easy ways to make progress.

Summary

Anxiety can be a debilitating condition that significantly impacts the quality of life for those struggling with it. While the exact cause of anxiety is unknown, it's likely due to a combination of genetic, biological, and environmental factors.

A Functional Medicine approach to anxiety seeks to identify imbalances in your biology, utilizing functional lab tests in conjunction with a comprehensive history to construct an effective individualized treatment plan. Whether in combination with conventional care or alone, Functional Medicine offers a targeted approach to treating anxiety by addressing an individual's nutritional status, physical movement, and stress management to overcome this condition.

If you struggle with anxiety, considering a Functional Medicine approach, in conjunction with any conventional treatments you're already using, is a wonderful way to move forward on your healing journey with a targeted and individualized plan.