By Dr. Jeremy Fischer, a naturopathic doctor practicing in Los Angeles, serving West LA, Hollywood, Santa Monica, Beverly Hills, Culver City and the rest of the west side, as well as Studio City.
Anxiety is a feeling of discomfort or worry, in relation to events that may or may not occur in the future. It can be associated with physical symptoms and behaviors, such as repetitive motions or movements, stomach or abdominal discomfort, muscle tension, nausea, fainting, insomnia, and decreased concentration, to name a few.
Inappropriate anxiety is common in the U.S. It can range anywhere from mild anxiety, to crippling anxiety that interferes with your ability to enjoy life and do the things you want to or need to do. Note that I said ‘inappropriate anxiety’, because there can be a beneficial purpose to anxiety: it helps shine a spotlight on potential dangers, and motivates us to plan and examine our lives and choices, thus allowing for informed decision-making, and helps us to avoid dangers and problems. However, when anxiety occurs too frequently, during inappropriate situations, or at too great an intensity, such that it interferes with your ability to enjoy life, or do the things you want to or need to do, this is when seeing a professional is a good idea.
I approach anxiety in a similar way to my approach with all health concerns, whether they be mental, emotional, or physical – that is, from a Naturopathic medicine perspective, looking at the various factors that may be contributing as the underlying causes of the issue. So, of course, if someone had experienced trauma in the past, that is one important cause, as are abuse, neglect, and a whole host of other social and interpersonal experiences, both severe and more subtle. Let’s group these together into physical, emotional, and social experiences. These factors can all affect the way we process our emotions and thoughts. If there is the possibility that one of these factors is a significant player in a client’s anxiety, then in addition to my work, I will refer them to an appropriate therapist, who can help examine and modify the way we experience the world by helping them to take control of their own mental function, using techniques like cognitive behavioral therapy and mindfulness training.
However, at times just treating the mind in isolation isn’t enough. We now know that your thoughts and emotions can significantly affect the functioning of the rest of the body, and vice-versa – it is a two-way street. In other words, 1. long-term anxiety can seriously impact your physical health, and 2. various health issues can cause or contribute to your anxiety. Thus, the importance of looking at the WHOLE PERSON, as opposed to just treating the anxiety, since we know there are multiple connecting pathways between mind, emotions, and body. Just treating with psychiatric medications alone won’t address these multiple factors. So, while in some cases they may be appropriate or necessary, when we look at the whole person, we can often either
Factors that I consider which can contribute to anxiety are:
Inflammation – inflammation has been shown to cause anxiety-like behavior in animals, and we see a correlation between anxiety and inflammation in people as well. Inflammation can occur from infections such as viral/bacterial/fungal infections, autoimmune diseases, exposure to toxins (from the body or from the environment), lack of sleep, being overweight, digestive issues, and certain dietary choices. (1)
Toxins – As mentioned above, toxins can contribute to inflammation, and can alter mental function.
Gut flora – everyone has multiple types of bacteria – aka gut flora – living in their intestines. Studies have shown that an imbalance in this flora can increase anxiety and stress, and that we can decrease anxiety by balancing the flora. (1)(2)One way to balance gut flora is to take a quality probiotic. High carb diets and use of antibiotics can create unhealthy gut flora. We can help rebalance the gut flora by taking a quality probiotic.
Hormone imbalance – Imbalances of various hormones can contribute to feelings of anxiety. Some hormones I consider for anxiety are thyroid hormone, cortisol, epinephrine, and in women, the estrogen/progesterone ratio. If anxiety is associated with the menstrual cycle, addressing hormonal imbalances can be key. Regulating these hormones, through diet, lifestyle, herbal and nutraceutical supplementation, and at times with hormone replacement, can play a key role in the treatment of anxiety.
Genetic variations – Certain gene variants, called SNP’s, contribute to the body’s ability to break down compounds such as toxins, hormones and neurotransmitters, thus potentially causing an imbalance of the levels of these compounds in the body. This imbalance can manifest in a variety of ways, including anxiety. (3) When I work with patients whom I suspect may have these SNP’s, I may order special tests to diagnose and treat the condition, and treat using specific supplementation.
Low Blood Sugar – Excessive drops in blood sugar, called hypoglycemia, can cause us to get anxious, irritable, even panicky. This can occur from excessive intake of carbs . In some sensitive individuals, they can be sensitive to even whole (not refined) carbohydrates. Having less carbs, or eating them with foods rich in protein and fats, can slow the rise in sugar, and prevent the blood sugar crash that comes after the spike.
Nutrient deficiencies – production of neurotransmitters in the brain requires a host of nutrients in adequate supply. This supply may be impaired because of improper diet, poor soil quality upon which the food was grown, and illnesses and stressors which may cause increased consumption or excretion of nutrients. Genetic variations, also, can result in greatly increased need for certain nutrients in order to attain balanced mood and health. Finally, long-term use of some medications, including psychiatric medications, can also result in deficiencies. We address nutrient deficiencies by addressing diet, using supplementation, and using IV therapy. Adding in specific amino acids and vitamins at high doses can be a very effective way of regulating anxiety by increasing production of certain neurotransmitters in the brain. This is the natural alternative to the regulation of neurotransmitters and mood via pharmaceutical medications.
Exercise – One of the best things you can do for your physical AND mental health is to regularly engage in exercise. It has been shown to regulate mood, decrease stress hormones, and decrease anxiety.(4) Get up and move – why are you still sitting here reading this?!
This gives a fairly broad snapshot of the way I approach anxiety in my practice. By taking a comprehensive approach, considering all the variables, we can more adequately deal with the situation and create a treatment plan that is relevant to you as an individual.
I’m Dr. Jeremy Fischer and I practice integrative medicine in Los Angeles, including the areas of Beverly Hills, Burbank, Encino, North Hollywood, Sherman Oaks, Studio City and Van Nuys.
To your health,
Jeremy Fischer, ND, L.Ac
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*Dr. Fischer sees patients for various mental, emotional, and physical health concerns. Please feel free to contact him at vitalityintegrativemedicine@gmail.com or 424-278-HEAL (4325), or CLICK HERE to sign up for a free ten minute phone consultation.
References:
1. Saulnier et al. The intestinal microbiome, probiotics and prebiotics in neurogastroenterology. Gut Microbes. 2013 Jan-Feb;4(1):17-27. PMID: 23202796
2. Gareau, et al. Probiotic treatment of rat pups normalizes corticosterone release and ameliorates colonic dysfunction induced by maternal separation. Gut. 2007. vol 56: 1522-1528
Moloney, et al. The microbiome: stress, health and disease. Mamm Genome. 2014 Feb;25(1-2):49-74.
PMID: 24281320 (link to full text here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555881/)
3. Stein, et al. COMT Polymorphisms and anxiety-related personality traits. Neuropsychopharmacology. 2005 Nov;30(11):2092-102. PMID 15956988 (link to full text here: http://www.nature.com/npp/journal/v30/n11/full/1300787a.html)
4. Schoenfeld, et al. Physical exercise prevents stress-induced activation of granule neurons and enhances local inhibitory mechanisms in the dentate gyrus. J Neurosci. 2013 May 1;33(18):7770-7. PMID 23637169