At some point in our lives, most of us can expect to experience some form of anxiety. It might occur as the result of a life challenge, whether that be a relationship, health issue, work conflict, finance, or traumatic event. Such anxieties are normal and seldom anticipated.

Having said that, I believe it’s important to avoid downplaying the impact that stress has on our lives. It can ruin a person’s health and yet it’s so often treated superficially or worse — it’s blown off by the medical provider.

However, if you are going through a period of acute stress, or you remain in a state of chronic stress and now find yourself feeling fatigued, unmotivated, or irritable, you may be experiencing the negative health impacts of stress. And that stress might possibly be diagnosed as Generalized Anxiety Disorder (GAD).

Anxiety is Normal but Not Optimal.

In our culture — curated as it is by conventional medicine — anxiety is often seen as a disorder and, in such fashion, labeled GAD. However, anxiety is also a normal part of life. It’s a normal part of physiology and in many cases it’s not a disorder. When anxiety becomes a disorder, it is far more obvious to recognize in ourselves and those around us and there is a greater likelihood a diagnosis of GAD will be provided by a psychologist or similar health care professional.

Whether you actually have GAD or just suffer mild to moderate anxiety, it can feel as if you’re being treated for anxiety or depression abstractly, and even with such treatment your health can decline because the underlying issues have not been resolved.

I have observed many patients seeking out functional medicine or holistic medicine who are struggling with a low to moderate anxiety level that doesn’t fit the formal diagnosis of Generalized Anxiety Disorder.

Some men and women can be reluctant in acknowledging their anxiety, while others freely discuss their concerns. It is also common for people to dismiss anxiety or lower the value it has on their health outcomes.  In some ways I think we have the wrong understanding of what anxiety is and how it blocks us from reaching our optimal health.

Breaking anxiety down, I like to classify it as follows:

  1. Generalized Anxiety Disorder — advanced anxiety often benefitting from prescription medication
  2. Moderate/ mild anxiety — successfully treated without the use of prescription medication

Conditions and Symptoms Associated with GAD and Moderate to Mild Anxiety

Anxiety can create or exacerbate many conditions including:

  • Chronic Fatigue
  • Cortisol Imbalances
  • Hormone Imbalance, altered libido or painful cycles
  • Hypoglycemia
  • Irritable Bowel Syndrome (IBS) — Constipation or Diarrhea
  • Insomnia or restless sleep
  • Neurological Symptoms
  • Restless Legs
  • Weight Gain or Loss

Besides the commonly known symptoms of anxiety, which cause worry, upset and inability to relax, there are others, including:

  • Hot flashes or night sweats
  • Irritability
  • Lightheadedness
  • Nausea
  • Shaky or jittery feeling
  • Waking in the middle of the night or having a hard time falling asleep

The result of anxiety is a disruption in life that can lead to avoiding certain social situations, fear of driving, loss of motivation, relationship stress, difficulty concentrating at work, loss of sex drive, and constant worrying that leads to indecisiveness, no decisions, or poor decisions.

Case Study in Generalized Anxiety Disorder

One recent example of a patient experiencing anxiety that comes to mind is a 45-year-old female named Johanna who presented with digestive problems. She complained of having to use the bathroom numerous times in the morning and afternoon. Johanna additionally reported that changing her diet had some influence, but it appeared when she would travel for work or was spending time away from home participating in outdoor activities she had to “run” to the bathroom no matter what changes she made to her diet.

Johanna’s main concern was that she was starting to lose the joy in previously fun activities with her family and she was fearful that her digestion was impacting her work.

When she completed her new patient intake forms, and based on her answers, it was clear Johanna was experiencing additional symptoms besides digestion problems. She reported restless sleep, afternoon fatigue, lightheadedness, and frequent headaches. In my opinion, she was suffering mild to moderate anxiety, exacerbating her digestive concerns.

Note: It can be difficult when a doctor labels a patient with anxiety. As the patient you may feel like the doctor is dismissing your symptoms and just saying “it’s all in your head.” The truth is, things just aren’t that simple. While the anxiety might be causing or contributing to symptoms like bloating, digestion, or hormone imbalance, the end result is that those symptoms are real and they are happening to you. So when your doctor tells you that you have anxiety, it can feel dismissive. However, if we take a more holistic view, a person’s symptoms can be dealt with simultaneously — in this case addressing the digestive concern along with the anxiety.

Johanna had made various attempts to heal her digestion. She visited her primary care physician, who recommended a gastroenterologist visit. She was diagnosed with gastritis and treated with proton pump inhibitors, which did little to help with the Irritable Bowel Syndrome (IBS) she was experiencing. She was also prescribed antidepressants that are known to be helpful with IBS. However, she was not happy with how they made her feel and complained of weight gain. After several more attempts and years of feeling miserable she decided to pursue a more holistic approach, which is what brought Johanna to my functional medicine-focused practice.

Causes of Anxiety

In my clinical experience, anxiety has root causes, some that we can clearly see and others that are unknown or hidden.

Clear causes of anxiety may include:

  • Being a caretaker for a loved one
  • Burn out
  • Chemical imbalances in certain neurotransmitters, (not tested for in conventional medicine) — which can be found in vitamin and mineral deficiencies
  • Emotional traumas of abuse or childhood neglect
  • Loss of a loved one or loss in a relationship
  • Physical trauma — motor vehicle accident, abuse, head injury

Hidden causes of anxiety may include:

  • Dietary patterns of food and timing
  • Digestive issues / IBS
  • Dysregulation in blood sugar balance, hyper or hypoglycemia
  • Environmental exposure to mold or other toxins
  • Hormone levels, which have a direct impact on the brain. If the mind is feeling stressed, signals to the endocrine organs are impacted, resulting in altered sex hormone levels or problems with hormone receptors. This can lead to cramping, bloating, skin problems, headaches, and even more anxiety!
  • Premenstrual syndrome (PMS)
  • Sleep disturbances that lead to daytime irritability

Treating Anxiety

Let me be clear, I do not take a blanket opposition to the use of anti-anxiety or antidepressant medications. In more than 20 years of practice, I have observed too many scenarios where such medications are being used inappropriately, too quickly, without any attention to the underlying causes or worse, with no end in sight.

When was the last time you felt really relaxed?

When I ask this question, patients often laugh out loud. We live in plentiful times; we have everything we need to enjoy and sustain life. This does not seem to keep us from feeling overwhelmed or shield us from some difficult traumas and losses.

The idea is so simple and yet often missed. Chronic stress depletes a person’s ability to heal.

And we don’t always recognize the stress we are under because it has become our “normal.” We live with it. We push through it. Or do we? When the nervous system and the mind are not feeling relaxed or are being overstimulated, healing can be frustratingly slow or non-existent, lending to further anxiety. In essence, it becomes a vicious cycle. This can lead to hypothalamic pituitary adrenal axis dysfunction. (which you can read more about in my article “HPA Axis Dysfunction is a Legitimate — and Accurate Medical Diagnosis”).

Johanna had a history of IBS that was somewhat controlled. However, in the last few years things started to progressively decline with her health. So what was going on?

When digging into Johanna’s history, it was discovered that about five years ago is when she really began to feel poorly. Her mother had passed away, and Johanna — along with her sister — had cared for their mother. Now, five years later, in addition to that loss, her hormones are beginning to change as she enters pre-menopause.

There were two main treatments that helped Johanna recover, which we discovered after we performed tests and determined a course of action for her case.

  1. The use of natural supplements to help her body produce more GABA. GABA (Gamma Aminobutyric Acid) is a calming neurotransmitter that helps with sleep, anxiety and general relaxation. GABA helps to remove a person from feeling “fight or flight” and supports “rest and relaxation.” Unlike the pharmaceutical version that alters GABA receptors and has unintended side consequences, natural alternatives can take the edge off without any undesirable side effects or feelings of complacency. GABA can be deficient when we overuse adrenaline, cortisol and with the depletion of B-vitamins and the mineral Lithium.
  2. Dietary modification to balance hormones. Changes in diet can assist in balancing hormones. In Johanna’s case, we needed to reduce foods that were taxing the liver and gallbladder. She was eating too much fried food. The liver and gallbladder are responsible for the metabolism of the sex hormones estrogen, testosterone and progesterone.

Providing a dietary detox helped Johanna rest her liver and gallbladder, leading to improved hormone metabolism. When the liver is overworked with fat or excess animal protein, it can create a functional backup of hormones leading to imbalance, which can clinically exacerbate anxiety.  The liver and gallbladder can also contribute to IBS symptoms when a person is struggling to digest fat.

IBS, when left untreated or unresolved over years, can have an impact on the gut brain axis. This essentially means the brain and gut are in a tightly intertwined communication. When one is not happy the other tends to follow. Neurotransmitter and hormone imbalances are the fallout of this miscommunication.

That is why it’s so important to recognize that all of Johanna’s treatment could not be directed solely to her gut. We needed to work on both the gut and brain simultaneously.

I have observed the similar pattern for women and men in their teens through fifties — emotional stress, trauma, or burn-out, coupled with gut and hormone imbalances. Working through the case on an individual basis and identifying the root causes has helped my patients find their optimal health.

Thankfully, Johanna is now in control of her health. Her digestion has improved greatly and she reports sleeping well at night and enjoying time with her family.

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Dr. Matt