Anxiety is undoubtedly high in 2020. But did you know that way back in 2019, anxiety was already on the rise? Here in the U.S., it’s estimated that 1 in 5 people experience an anxiety disorder, with women affected twice as often as men. The thing about anxiety is that many people don’t realize they are experiencing anxiety until things are really bad. It can take a trip to the ER with chest pain for the diagnosis to occur!
I believe this is because we normalize anxious states. It’s normal to work more than 40 hours a week at a job or two or three, while managing households and raising children, often with no outside help. It becomes normal to rush, stress, overwork, shortchange sleep, forget about exercise, and lose awareness of our body’s subtle signals. When anxiety hits it can be full-blown and a total surprise.
Other sensitive people may be aware of their persistent anxiety. Anxiety is a horrible mind-body experience that can include physical symptoms like trembling, upset stomach, profuse sweating, insomnia, chest pain, or a pounding heart. Mentally it can feel overwhelming, like a continuous sense of impending doom, or a surreal and unpleasant out of body state.
Counseling and meditation are the standard of care for anxiety. Counseling, especially cognitive-based therapy (CBT) can help if there’s a psychological root cause. Medication has a time and a place for use, but it won’t address the root cause of your anxiety, and it will have undesirable side effects.
What’s missing here is the recognization that anxiety often has biological root causes to identify and solve. (Examples include nutrient deficiencies, inflammation, dysregulated gut bacteria, genetic SNPs that affect neurotransmitters, and more). Wouldn’t it make sense to explore these potential biological root causes before (or in addition to) medication and therapy? This is particularly true if there’s anxiety for no apparent reason.
To be clear: anxiety and other mental health conditions can absolutely stem from life experiences and circumstances. However, even in these cases, it’s worth looking at other reasons that your brain biochemistry is off. Our physiology plays a major role in creating psychiatric symptoms. As clinicians, we are obligated to try to uncover the biology behind the symptoms.
In this series, we dig into these biological root causes and include action steps to assess and solve them, either on your own or with your integrative practitioner.
This is a very common nutrient deficiency, one that is difficult to test for since most of your magnesium is inside your cells and bones. You need more of this “great relaxer” mineral when you’re stressed or anxious, so if your levels are already low it’s a double whammy. Common symptoms of magnesium deficiency include constipation, irritability, anxiety, and insomnia. Read this deep dive article to learn more about magnesium deficiency.
- With anxiety, assume you are deficient in magnesium and take it. There are no side effects except loose stools if you take too much. Divide your dose throughout the day, with or without meals.
- Start with 600 mg in divided doses. My first choice is Buffered Mag Chelate or Neuromag. Back off if you experience loose stools. Go up if you’re constipated.
Vitamin B12 deficiency
Like magnesium, this is a common deficiency that can cause anxiety, especially for vegetarians, vegans, people on acid-blockers, and older people. You can ask for a B12 blood test, but the conventional lab range of 180-914 ng/L makes no clinical sense. Integrative psychiatrist James Greenblatt teaches that “no one feels well under 500-600 ng/L.” For a more complete look at your B12 body and brain levels, you can also test the urinary metabolite MMA, available at conventional labs.
- Ask for a B12 blood test and an MMA urine test.
- If needed take a supplement with sublingual delivery like this one.
Need for more vitamin B6 and zinc
Some people have genetic SNPs that cause a higher need for one or both of these, especially during times of stress. Other people have a condition called pyroluria which causes a much greater need for both of these and requires lifetime supplementation. With sudden onset anxiety, or anxiety in young people under 25, consider pyroluria.
- Ask for a blood test for zinc and copper (important for these to be in balance so if you do supplement with zinc, then test both annually).
- B6 is best tested with functional urine organic acids like Organix or Dutch Complete. An option without testing B6 is to simply take 50-200 mg twice a day for 2 weeks, with 50-60 mg of zinc, to see if you feel better.
- If you feel better, you may have pyroluria and you can seek a test for this from DHA labs.
Low vitamin D
70% of adults and 67% of children in the U.S. have inadequate vitamin D levels. You may think that your D is fine since you “go out in the sun” but do you go out nearly naked at noon for 30 minutes a day without sunscreen? Probably not.
You’ve may have heard that low vitamin D is associated with depression. This is because you need sufficient vitamin D to make the uplifting neurotransmitter serotonin. It turns out, you also need enough serotonin to quell anxiety.
- Ask for a 25(OH)D test. It’s not fringe to test vitamin D anymore, conventional docs now test it frequently.
- Supplement to get your levels in the upper quadrant of the lab range. Supplementing 10,000 iu per day typically moves the lab level up by 10 units per month.
- Then drop to a lower dose, test regularly, and find your maintenance amount (often 2,000-10,000 iu daily with greater requirements in the winter).
Need for methylfolate
This is all about the MTHFR genetic variations that are very common. Not everyone who has an irregular MTHFR gene requires additional folate. However, for those who are affected, it can severely affect mental health. It’s not useful to take folic acid blood levels, but the organic acid FIGLU (on Organix) is useful.
- Request your MTHFR test from a conventional lab (or look up your 23 and me traits).
- 677CC is normal and getting 400 mcg of folate per day is sufficient.
- 677CT means that your MTHFR enzyme activity is 71% reduced, so get 800 mcg of folate per day from food or supplements.
- 677TT means you have a 34% reduction in enzyme activity, so take 1200 mcg of supplemental methylfolate to bypass the need for this enzyme.
For supplementation, everyone may as well take methylfolate rather than folic acid, as there’s evidence that supplemental folic acid can have adverse effects. Main food sources include fortified breakfast cereals and bread, liver, Brussels sprouts, potatoes, spinach, chickpeas, and brewer’s yeast.
In Part 2 of this series, we will dive deeper into the other biological causes of anxiety. Want to test your vitamin and mineral levels? A comprehensive test like the NutrEval® includes all of the markers mentioned on this page. Please reach out for help with testing these nutrients, and troubleshooting the biological causes of anxiety for you or a loved one.