Anxiety is a general term and includes milder states of increased arousal, increased worry, and various somatic symptoms including fatigue, dizziness, or chest pain. It is also a symptom of psychiatric disorders including generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder, or phobia-related disorders.
At the psychological level, anxiety can be caused by several factors, a history of traumatic events, increased demands at home or at work, isolation, habitual negative thought patterns, or genetic and inherited tendencies. Anxiety is also caused by physiological responses to physiological factors, a largely underestimated area of contributions to its origins that we are learning more about.
Some of these factors may include blood glucose dysregulation, physical ailments such as heart or thyroid disorders, an unbalanced low-fiber diet with increased sugar intake, and low protein intake (4). Since anxiety symptoms can stem from psychological and physiological factors, it is important to understand that most of these factors are modifiable. Let’s look at how to assess anxiety and what lifestyle interventions and supplements can be included in a treatment plan.
Anxiety Assessment
As professionals, it is vital to consider a client’s current concern about anxiety and other underlying conditions. It is possible that someone may come to us with “anxiety” is actually a symptom of an underlying disorder, such as post-traumatic stress disorder or drug withdrawal. Anxiety symptoms can be caused by withdrawal from alcohol, various prescription drugs, as well as countless other substances, or they can also be a symptom associated with an illness. Anxiety can also be a normal symptom; however, if the discomfort is too much for the person to handle, they will seek help.
A useful screening tool for assessing generalized anxiety disorder (GAD) is the GAD-7, which has been well-studied. Keeping in mind that a naturopathic physician does not make a mental health diagnosis, he or she can be a primary care provider to help identify when it is normal or pathological and whether a referral to a specialist is necessary.
For example, if a patient’s case includes symptoms of obsessive-compulsive disorder, reducing anxiety levels naturally may reduce symptomatology, but a more complex comprehensive evaluation and treatment plan involving other healthcare professionals would be necessary. This may include psychologists, nurse practitioners, or psychiatrists, depending on the nature of the anxiety and behavioral tendencies, as well as access to care.
When it comes to blood tests, several commonly performed laboratory tests are associated with anxiety, including:
- Vitamin B12: low levels of B12 correlate with both anxiety and depression.
- Thyroid function can affect anxiety levels: hyperthyroidism and associated conditions are often known to increase anxiety levels. Chris Kresser, a renowned physician, analyzes optimal TSH, T3, and T4 ranges to rule out abnormal thyroid function, which can be a possible physical cause of anxiety.
- Blood/plasma glucose: Hypoglycemia can contribute to increased levels of anxiety and is usually tested during an episode of hypoglycemia. Reactive hypoglycemia, which is hypoglycemia that occurs after a meal rather than during fasting, is another consideration and can be evaluated with a glucose tolerance test.
- Vitamin D: Many studies suggest an association between low vitamin D levels and increased anxiety, as well as other mental health problems.
- Ferritin and hemoglobin: Many sources suggest a link between iron levels and anxiety levels.
Other functional tests that may be indicated include:
- Imbalances in gut flora can contribute to both anxiety and depression.
- There are companies that offer gut microbiome studies using specialized sequencing technology to analyze and report on the biochemistry of an individual’s gut microbiome.
- James Greenblatt, a leading integrative psychiatry physician in the U.S., discusses the association between magnesium deficiency and anxiety and emphasizes testing for magnesium in red blood cells if any symptoms arise. Clinical symptoms of magnesium deficiency can include insomnia, anxiety, irritability, and constipation. If someone has two out of four of these symptoms, a magnesium test can be very helpful.
Functional genetic testing can be a useful tool to establish the root cause and create individualized and specific treatment plans. Genetic predispositions have been shown to be related to different types of anxiety and different treatments.
Genetics: How much can be predicted?
Do genes play a role in our tendency to anxiety? Some correlations have been discovered and are detailed below. While not the magic cure for anxiety, this information may provide some clinical explanation, which may help validate patient concerns or provide motivation to further optimize mental health. Some people may be relieved to know that it’s all in their genes, rather than in their heads!
- COMT is a gene that encodes the COMT enzyme that metabolizes neurotransmitters. Those genes with the “slow” variation of COMT have been described as “worriers” versus the “fast” variations of COMT which are likely to be associated with the attitude of “Warriors” in the face of difficulties and challenges. Those with slow COMT also tend to have an increased response to noradrenaline, one of our major stress neurotransmitters, which increases the anxiety response, and are more prone to obsessive-compulsive tendencies (13). Approximately 20-30% of Caucasians of European ancestry have this variation.
- ADRA2Bis is a gene associated with norepinephrine binding sensitivity, with suboptimal variations leading to increased fear and thus an anxiety response. These more sensitive variations may also increase the memory of negative events and make sufferers more prone to post-traumatic stress disorder (PTSD).
- 5HTTLPR is a gene associated with serotonin secretion and reuptake, where suboptimal variations can lead to increased irritability, increased fear response, and increased sensitivity to stress.
- BDNF is a gene responsible for encoding brain-derived neurotrophic factor (BDNF), which helps the brain recover from physical or emotional trauma. Those with suboptimal variations have been shown to have a greater attentional bias to social threats, as well as being more prone to trait introversion and neuroticism.
With this, it is worth mentioning that these associations have not all been validated, and the field of functional genomics is in its infancy. Lifestyle interventions can be a powerful tool, particularly for the long-term management of anxiety. Anxiety is not simply “in your head,” but also in your body, and listening to that can be a relief for some people trapped in a cycle of guilt and helplessness in the face of their condition.