Root Causes of Anxiety and Functional Medicine Solutions

Anxiety is the most common mental health issue worldwide. It is estimated that 22.2% of the US population has an anxiety disorder (Schiele MA, 2017). 

In this blog on anxiety, you will learn:

• What is anxiety and its symptoms
• What are the root causes for anxiety that are often missed 
• How Functional Medicine can help address anxiety disorders
• What solutions are available to reduce or eliminate anxiety disorders

WHAT IS ANXIETY?

Anxiety is a feeling of fear, dread and uneasiness. It is a normal response in the face of danger. Experiencing anxiety from time to time is a normal reaction to stress and part of life. People worry about health, work, money, relationship or family problems.

Overwhelming anxiety that lasts too long is a problem. Irrational, excessive anxiety out of proportion to the situation that interferes with a person’s ability to function in daily life qualifies as an anxiety issue. 

• Nearly 39.3% of adults in the US had symptoms of anxiety or depression in February 2021, compared to 32.3% in 2023 (KFF, 2023). 
• 18–24-year-olds suffer the most as 50% had symptoms of anxiety/ depression (KFF, 2023). 
• Of 25–49-year-olds, 38% suffer from anxiety/ depression, of 50–64-year-olds, 29% do. Senior citizens of 65+ years olds have a 20% prevalence of anxiety / depression (KFF, 2023).

These numbers may be somewhat elevated given they were taken during and just after the pandemic. But the trend is clear, anxiety is on the rise. 

For those who suffer from anxiety disorders, the anxiety does not easily go away. It can get worse over time and symptoms often interfere with daily activities of work, school and relationships.

There are several types of anxiety disorders; generalized anxiety disorder (GAD), panic disorder, phobia-related disorders, agoraphobia, social anxiety disorder (social phobia), PTSD, OCD, selective mutism, substance-induced anxiety disorder and separation anxiety.

Generalized anxiety disorder (GAD) is a common anxiety disorder, defined as excessive worry or anxiety about normal daily life which is felt more days than not, for a period of six months or more. 

• Anxiety disorders often co-occur with other mental disorders, such as depression or substance use and dependence (Schiele MA, 2017).
• Women are approximately two times more likely to have anxiety than men (Schiele MA, 2017).

SYMPTOMS OF ANXIETY

Common signs and symptoms of anxiety are:

• Feeling nervous, restless, ‘on edge’, panic or a sense of impending danger or doom
• Increased heart rate, hyperventilation, sweating or shaking
• Feeling weak or exhausted
• Difficulty concentrating or thinking about anything other than the present worry 
• Having difficulty controlling worry
• Sleeping issues
• Gastrointestinal disturbances
• Having the urge to avoid things that trigger anxiety like social situations

ROOT CAUSES OF ANXIETY

There are certain life circumstances that can contribute significantly to being prone to anxiety. People who have experienced trauma, abuse, a significant accident, serious illness, significant stress, loss like a death or divorce may experience anxiety that lasts for a certain time after the event or that is persistent. 

Someone with one mental disorder, such as depression or others, can also have an anxiety disorder. A drug or alcohol addiction can cause anxiety. Certain underlying health conditions can cause anxiety. 

In addition, there can be other overlooked or misunderstood root causes of anxiety. Finding the overlooked or unrecognized cause of anxiety could be all that is needed to get back onto the road of optimal health.

Here are some of the unexpected issues that could be the cause of your anxiety:

A Poor Diet

Food and mood are closely linked. A poor diet can actually contribute to or even cause anxiety and other mental health issues. A poor diet can cause insulin surges and poor blood sugar control, inflammation, poor immune system function, impaired gut health and metabolic syndrome. These physiological issues will absolutely affect mood, brain function and mental health. 

Practical examples include too much sugar in the diet causing blood sugar to crash which can make you feel shaky and anxious. Excessive caffeine can have the same effect. Too many inflammatory foods cause inflammation in the brain and the gut. These can contribute to an anxiety disorder. Unknown food sensitivities will increase inflammation if not removed from the diet. A diet high in processed foods contains chemicals and toxins which can contribute to toxic overload and anxiety.

Gut Issues

A little-known fact is that gut issues can cause mental health issues. Imbalances in the gut can contribute to depression, anxiety and a lower stress resilience. 

Gut dysbiosis is a cause of mental illness. Dysbiosis is an excess of bad gut bacteria in relation to good and healthy gut bacteria in the gut microbiome. Gut dysbiosis usually causes digestive symptoms and can contribute to anxiety, depression and other mental illness. Dysbiosis can be caused by many things; a poor diet, stress, antibiotics, other medications, alcohol and other toxins that change the normal microbiome balance and contribute to dysbiosis.

During dysbiosis, the gut brain axis is dysregulated. The blood-brain barrier (BBB) becomes more permeable. Bad gut bacteria produce more LPS toxins, which cause inflammation. This inflammation, due to LPS and other microbes, increases pro-inflammatory cytokines (Rutsch A, 2020). With a permeable BBB, these cytokines and toxins get into the brain, leading to neuroinflammation. 

This is how gut dysbiosis can cause neuroinflammation and inflammatory gut/brain conditions, such as anxiety and depression (Rutsch A, 2020). 

Dysbiosis & Leaky Gut

Dysbiosis leads to increased intestinal permeability, letting substances such as bacteria and other toxins leak through the gut lining and into systemic circulation in the body. This is called leaky gut syndrome. Gut microbiota control the degree of gut permeability. Increased gut permeability is inflammatory, damages the immune system and is involved in anxiety (Clapp M, 2017).

Dysbiosis & IBS

IBS is a common disorder of the gut-brain axis. IBS is chronic abdominal pain with either constipation or diarrhea. Up to 50% of people diagnosed with IBS also have an anxiety disorder (Margolis KG, 2021). People with IBS have 3 times higher risk of anxiety (Margolis KG, 2021).

Often, people with IBS have issues such as trauma, stress or abuse that can trigger anxiety. But 50% of IBS patients have an intestinal trigger for their anxiety (Margolis KG, 2021). 

In many cases, IBS is a driver for mood disorders and happens even before the mood disorder does  (Margolis KG, 2021). People with higher baseline levels of anxiety and depression are more likely to develop IBS. Conversely, people with IBS report higher levels of anxiety or depression (Margolis KG, 2021).

Depression & Anxiety

Gut dysbiosis and gut inflammation are potential causes of anxiety and depression (Clapp M, 2017). 

In one study, endotoxins, like LPS, were infused into healthy subjects with no history of depression (Clapp M, 2017). The LPS triggered a release of inflammatory cytokines, which triggered classic depressive symptoms. The increased levels of inflammatory cytokines are correlated with symptoms of anxiety and depression. In this case, the toxins and LPS induced pro-inflammatory cytokines created inflammation which caused mood issues that led to anxiety and/ or depression (Clapp M, 2017).

Anxiety, Fear & the Gut

The fear response is closely linked to stress and the gut-brain axis. Fear is regulated by the amygdala and hippocampus in the brain. These brain regions, and the rest of the brain, are affected by changes in gut bacteria (Cryan JF, 2019).

Fear responding in lab rodents can be affected by different strains of probiotics. For example, Bifido bacterium longum can reduce stress-induced cortisol increases and decrease anxiety (Cryan JF, 2019). Another probiotic, Lactobacillus plantarum, can lower pro-inflammatory cytokines, stress and anxiety (Cryan JF, 2019).

Proteobacteria and Bacteroidetes are both gram negative bacteria which produce LPS and are involved in mental health. People with distress, anxiety, depression, and a high stress perception have higher levels of Proteobacteria (Peter J, 2018). Patients with anxiety have higher Bacteroidaceae (Peter J, 2018). 

Toxins & Anxiety

Toxins can come from insecticides, herbicides, personal care products and thousands of other industrial and household chemicals. Environmental and chemical toxins can affect brain chemistry in ways that contribute to anxiety and depression. Here are a few to watch out for:

• Chronic mercury exposure from sources like dental amalgams is associated with anxiety, fatigue and depression (Kern JK, 2014). Removing these amalgams can improve symptoms (Kern JK, 2014). 
• Long-term lead exposure is linked to generalized anxiety disorder (Vorvolakos T, 2016). High blood level concentrations of lead can induce psychotic symptoms, delusions and hallucinations (Vorvolakos T, 2016). 
• The EPA, Environmental Protection Agency, says that mercury, lead and arsenic can negatively impact health, potentially causing anxiety and/or depression. Heavy metal toxicity disrupts brain function and the immune system (Bouchard M, 2009).
• Environmental pollutants (air pollutants, heavy metals, ionizing radiation, pesticides, light pollution, noise pollution, environmental catastrophes) are associated with anxiety, mood and psychotic syndromes (Ventriglio A). These pollutants affect the brain and long-term exposure can cause stress and anxiety (Ventriglio A).
• Glyphosate (Gly) is the most used herbicide in agriculture. It has known probable carcinogenic effects. It also inhibits beneficial gut bacteria. Gly can cause dysbiosis, which we previously saw contributes to anxiety. The overgrowth of bad bacteria and Gly-induced intestinal dysbiosis has neurological effects, which affect anxiety disorders (Rueda-Ruzafa L, 2019).
• Pesticide exposure likely leads to anxiety, depression and psychiatric disorders.  A study on farmers with a history of low-level exposure to pesticides found they more likely suffer from anxiety than people not exposed to pesticides (Harrison V, 2016). Conventionally grown non-organic food is grown with pesticides. If we eat that every day, we are exposed to pesticides every day. 

Infections

Different types of infections can cause anxiety and mental health issues. The immune system dysfunction caused by the infection may result in anxiety symptoms. 

As infection enters the body, the immune system produces antibodies to fight the infection. Sometimes these antibodies mistakenly attack healthy cells in the brain. This causes brain inflammation and symptoms such as anxiety and depression.

In these cases, the patient may not have an anxiety disorder but rather an infection of the brain that can trigger an autoimmune process in the brain. Symptoms, such as irrational fears (phobias), anxiety or panic attacks, could result from an autoimmune attack on the brain. Chronic anxiety symptoms that will not go away can be due to an autoimmune response, triggered by common infections (Frankovich J, 2017).

Severe infections in childhood are linked to major depression, overanxious disorder, separation anxiety and specific phobias (Goodwin, 2011).

Strep:

A strep throat infection can be the trigger for neuropsychiatric symptoms in childhood such as anxiety, obsessive-compulsive disorder (OCD) and tic disorders. As a result of the infection, antibodies against brain tissue are created, which cause structural damage to the brain, neuroinflammation and symptoms.

Viral infections: 

A virus can be a significant cause of illness, inflammation, immune problems and mental health issues. Viruses like Epstein-Barr, herpes simplex virus, chicken pox / shingles, and now COVID-19 are common. 

Everyone contracts viral infections and most people usually recover completely. However, viruses are linked with mental health issues, which can develop in the weeks or months after a viral infection.

Bacterial infections are typically fully eliminated from the body. Exceptions to this rule are Lyme and Bartonella. 

Viral infections, however, remain dormant in the body. A virus can be re-activated at any time. It can become a low-level chronic infection, even after the acute symptoms resolve. Stress is one of the main triggers for reactivation. When the immune system becomes overwhelmed by something else, a virus can re-activate. If you are under constant stress and too weak to fight the virus off, it can develop into a chronic underlying viral infection.

Bacterial or parasitic infections and exposure to toxins (mold toxins or toxic metals) can trigger the reactivation of latent viral infections. Other viruses such as COVID-19 may be able to reactivate dormant viruses like Epstein-Barr Virus. Chronic viral infections can cause neuroinflammation or brain antibodies that can lead to anxiety and mental health issues.