Anxiety: Your Gut, Brain, HPA, Detox and Functional Health Care
Hello, I am Julie Donaldson and I am a clinical nutritionist with functional medicine training. I specialize in restoring balance in complex, chronic and acute health conditions. I welcome you to peruse other articles that may be of interest to you in your health investigation!
“I suffered from chronic anxiety from childhood on, without relief. I was very much in the illusion that it was all “me”, defining myself as a damaged person. I had no idea that the problem was connected to immune issues and detox issues. Once those were resolved, I began to experience my brain and emotions in a brand new way. Thank you, Julie, this was truly the gift of a lifetime.”
Anxiety sits in the top 3 of the most frequently searched health conditions in the U.S. We are a nation of worriers. But is it all in the head? Absolutely not. Anxiety has connections with poor gut health, poor nutrition, poor brain/neurological health, stress on the HPA (hypothalamus-pituitary-axis) resulting in hormonal imbalances and methylation pathways. While life can be very stressful and certainly create a primary mental response of anxiety, it is much more typical that we find multiple functional health concerns adding to the mix. Fortunately, we have incredible tools for investigating and repairing poor physical and biochemical function in the body. Let’s talk about what holistic health care can do to help heal anxiety.
Let’s face it, life is challenging
Anxiety and depression are the top mental health conditions in the U.S. today. Anxiety symptoms are real, such as
sense of impending doom or danger
irregular heartbeat
trouble concentrating and controlling thought patterns
exhaustion
It is important to acknowledge and to de-stigmatize the fact that most of us will deal with significant perceived stress and incidental mental health challenges over the course of a lifetime. It is also important to acknowledge that we are not living in a society that supports our souls, but rather our accomplishments and status, our possessions, and our abilities to “stay positive” no matter what’s coming at us. This is unsustainable and soul-sapping. I believe that “happiness” can be a stressful goal and that peace is a much more inclusive experience. Anxiety abounds when we are unable to be present - its force is attached to worry for the future. If we are to be present, we must give ourselves permission to feel what is, without shame and without judgment. In my article on peace and happiness, I explain how set points and well-being measures provide different reflections on the truths of life and balance. I also acknowledge that many people have endured adverse childhood experiences (ACEs) that have power to establish unhelpful coping patterns and weak points in the psyche that cannot be denied. These are real experiences that require an individual to do substantial work learning to heal adversity through resilience. Anxiety (and other stressful psychological patterns) can be a very normal part of life in these circumstances.
Anxiety and the gut-brain axis
In conventional medicine views of anxiety, the idea is that it is caused by an imbalance of neurotransmitters in the brain. Treatment would then involve medications that increase the availability of those neurotransmitters, or at least have some effect on those neurotransmitters in the brain. In functional health care, however, we are always seeking to understand the root cause of a problem and would therefore be asking “What is causing the disruption in those neurotransmitters?”
At the top of the list of additional causes of anxiety is poor gut function. The gut-brain axis has been studied since the early 1900’s. The bidirectional communication between the central nervous system and gut microbiota, referred to as the gut-brain-axis, has been of significant interest in recent years. Dysbiosis and inflammation of the gut have been linked to mental illnesses including anxiety. Conditions affecting this axis include microbiome composition, intestinal bowel disease, leaky gut and the production inflammatory cytokines such as TNF-a and interleukins. (The inflammatory cytokine model of mental illness informs us that inflammation, whether it starts in the gut or somewhere else in the body, also suppresses the activity of the frontal cortex in the brain. Control of other brain areas by the frontal cortex, such as the amygdala and limbic system, impact mood and self-regulation.)
When the human microbiome is challenged with changes in diet, stress or antibiotics, the physiology of the normal microbiome undergoes change. This includes susceptibility to both bacteria and fungi.
A dysbiotic state leads to increased intestinal permeability and allows contents such as bacteria and their metabolites to leak through the submucosa and into the systemic circulation, a phenomenon aptly named leaky gut syndrome. Coupled with the increase in intestinal permeability, these molecules then travel systemically with the potential to incite inflammatory and autoimmune responses. Elevated blood levels of inflammatory cytokines increase the permeability of the blood-brain barrier, enhancing the impacts of rogue molecules from the leaky gut. The release of these cytokines (TNF-a and MCP) negatively influences brain function and can produce anxiety.
Approximately 70% of serotonin is produced in the gut (400 times more than in the brain). Serotonin is a key mood-balancing neurotransmitter. Dopamine is a neuromodulator produced in the brain but also has influences upon digestion and gut health.
These chemicals support numerous important functions, including:
helping your body to absorb nutrients from food via enzyme production
improving blood flow to your digestive system
helping to maintain levels of healthy gut bacteria
improving gut motility (movement of waste products through your intestines).
A review of 21 studies including over 1,500 patients showed that interventions for gut dysfunction improved anxiety symptoms by up to 86%. Improvements were much higher with non-probiotic treatments than with probiotics. This is not surprising to me, as I have written about the lack of effectiveness of probiotics. For proper protocol development, the evaluation of immune status needs to include blood tests and subjective assessments, including Th1 and Th2 function. (For high quality gut supplements and to see Julie’s association with the Healthy Gut Company, please visit https://healthygut.com/practitioners/)
Anxiety and the HPA
Pro-inflammatory cytokines are also important stimulators of the hypothalamic-pituitary-adrenal (HPA) axis. The hypothalamus releases corticotropin releasing factor, stimulating the adenohypophysis to release adreno-corticotropic hormone (ACTH). In turn, ACTH stimulates the adrenal release of cortisol, a known stress hormone that acts as a negative feedback signal in pro-inflammatory signaling. Hyperactivity or dysregulation of the HPA is one of the most reliable biological findings in anxiety conditions.
As the HPA becomes stressed, neurotransmitters such as adrenaline and noradrenaline overtake other neurotransmitters such as serotonin and dopamine. All neurotransmitters relay messages between neurons. They are all needed and all have relationships with one another. It is the disruption of the balance, (as with many things in the body) that becomes problematic.
Hypothalamus-pituitary-axis, stress and the gut membrane
As part of the HPA, the pituitary gland is also impacted with these dysfunctions. The pituitary is referred to as the master gland, signaling other glands with hormone production needs. Hormones secreted from the pituitary gland help to control growth, blood pressure, energy management, all functions of the sex organs, thyroid function, metabolism, some aspects of pregnancy, childbirth and breastfeeding, water/salt concentrations in the kidneys, temperature regulation and pain relief. (Note: Hyperthyroid conditions may result in nearly 60% of those affected having anxiety, panic attacks and/or agoraphobia.)
Also of concern is the SAS, which stands for sympathoadrenal medullary system. In short, this system governs our stress tolerance and stress responses. It incites the fight-flight-freeze response to stress, which can be acute or chronic.
In our modern world, we have chronic stressors like finances, work, relationships/family, and so on. What happens when these systems are chronically activated (which they weren’t designed to be) is that we get changes in the output of hormones such as DHEA, cortisol and pregnenolone. This, in turn, affects the production of many other hormones and neurotransmitters in the body. As anxiety becomes more chronic, it may also become anticipatory - in other words, without a particular trigger, we wait for something bad to occur.
As you can see, an increase in pro-inflammatory cytokines and/or chronic worry can reap a considerable amount of damage on the HPA, neurotransmission and neuromodulation.
Anxiety and methylation
Here at True Nature, investigating methylation function is a major priority with nearly all clients. The unfortunate, toxic nature of our world has placed undue burdens upon methylation pathways that are responsible for breaking down toxins and turning them into water soluble molecules. Pathways such as MTHFR, CBS and COMT along with glucuronidation are very commonly compromised, leaving our bodies with an overload of dangerous toxins. What are some of these?
Glyphosate
Heavy metals
Pesticides
Petrochemicals
Methylation requires adequate stores of a number of nutrients, including zinc, B12 and B6, riboflavin, folate, lecithin, selenium, molybdenum and choline. Many people are deficient in these nutrients and/or using them up with recycling toxins vs. excreting them. Without proper nutrient status, neurotransmitters cannot be adequately produced. Specialty diets (especially vegan and vegetarian) contribute to lower amounts of these nutrients.
Let’s circle back to dopamine for a moment. In this category of methylation pathways is that of COMT (Catechol-O-Methyltransferase). It is one which triggers the release of enzymes that regulate the amount of dopamine in the body. (It is also responsible for the 2nd phase of methylation of dangerous estrogen metabolites.) Over or under-production of these enzymes can result in either high or low amounts of dopamine, changing the expressions of mood and cognition. COMT mutations and malfunctions are another common root cause of anxiety.
Anxiety and nutrition
We simply cannot avoid the direct connections between diet and anxiety. In the world of metabolic nutrition, we are constantly attending to the balance of homeostatic mechanisms such as blood sugar, blood pressure, electrolyte status, respiration (gas exchange in the lungs) and temperature control. The format for nutrition at True Nature is Metabolic Typing ®, one of the only formats that provides a truly individualized plan for nutrition. With the practice of this format, homeostatic mechanisms begin to stabilize and provide crucial, ongoing support for the body to do what it needs to do naturally.
Without this support, we are in a perpetual state of shoveling water out of a sinking boat. The effort required to keep systems afloat is a consequential drain on precious energy resources.
Research has shown connections between anxiety and blood sugar regulation, anxiety and electrolyte imbalance, anxiety and respiration, anxiety and temperature regulation (also connected to thyroid function), and anxiety and blood pressure. In every functional health care scenario, we must begin at the most important foundational level, which is proper nutrition for your individual needs.
Summations and Solutions
Let’s get on the healing path and make peace your mainstay! As always, I leave you with a summary of the challenge and some solutions we can implement.
In a conventional world of either medicine or psychology, anxiety may be boxed out as a strictly mental issue. It is so much more complex than this, potentially involving the health of the brain, vagus nerve, gut, immune system and HPA. The mind and body are in constant partnership with one another. Negative emotions can impact physical health just as much as the body can affect the emotions, as we’ve been discussing.
In order to understand and work with root causes, we must carefully test and plot an individual course to holistic health. We begin with nutritional assessment that is personalized for the individual’s needs. This is followed by appropriate testing for history and symptoms and then the development of a personalized program for healing. We may include some of the following in investigations:
Dutch hormone test
GI Map stool test
Blood tests including methylation and thyroid markers
Pyroluria testing
CBD is a potentially universal choice for dealing with anxiety. Read more on this topic here.
Whatever the individual biological contributing factors are in your struggle with anxiety, we will carefully search and apply the appropriate functional health care for you. Email me today at Julie@truenaturehealthconsulting.com. I provide holistic telehealth services for your convenience.