A Functional Medicine Approach To Addressing Anxiety

Anxiety can significantly impact your quality of life. While the conventional medicine approach focuses on balancing neurotransmitters in the brain, a Functional Medicine approach is to look for the root cause. Functional medicine is a holistic approach to healthcare that looks teaches healthcare practitioners including medical doctors to look for and treat the underlying causes of chronic disease. In this article, we will discuss the conventional versus functional medicine to anxiety, the top three factors that can contribute to anxiety, namely gut health, HPA axis issues and nutrient deficiencies as well as steps you can take to correct these issues.

Conventional versus Functional Medicine Approach To Anxiety

In orthodox medicine, the cause of anxiety is understood to be an imbalance of neurotransmitters in the brain. The treatment frequently involves prescribing medication that increases the availability of those neurotransmitters in the brain. I know from personal experience that these medications can be useful and lifesaving. So, I am not arguing that they should not play any role at all. However, the purpose of drugs in the treatment of anxiety should be short term while you look at identifying and treating the underlying causes. In Functional medicine, health practitioners are taught to discover the underlying causes of the problem and address it at that level, instead of just suppressing symptoms.

Below is a useful analogy I sometimes use to illustrate this concept.

If you have a rock in your shoe and it is causing your foot to hurt, you could take Advil, and that would certainly reduce the pain. Although clearly, that is not a great long-term answer. The best long-term option would be to take your shoe off and dump the rock out, and that is what we are working to accomplish in functional medicine.

What The Underlying Causes Of Anxiety From A Functional Medicine Perspective?

When we think about anxiety through a functional medicine perspective, we want to consider what are the underlying causes that lead to anxiety in the first place. For example, even if we establish that the reason for someone's anxiety is an imbalance of neurotransmitters in the brain, what is causing those neurotransmitters to go out of balance in the first place?

To help answer this question I am going to explain how I would approach a client with anxiety who came to see me in my clinic. Of course, I will not have a full case history to consider or any laboratory test results, so I can not make any specific recommendations. However I can tell you what I would do, what I would look at, and then I can give you some ideas for your exploration and then some things to try in the meantime while you’re taking a closer look at some of these mechanisms that may be contributing to the anxiety.

Gut Health And Anxiety

The first place in the body I would look, which may surprise you, is the gut.

The Gut-Brain Axis

There is a vast and growing body of evidence connecting the health of the gut to the health of the brain. In fact, there is a saying in functional medicine, fire in the gut, fire in the brain. This saying means that inflammation in the gut that can trigger inflammation in the brain. The inflammation in the gut may be in the form of food sensitivities, parasites, small intestinal bacterial overgrowth, fungal overgrowth, or dysbiosis. The theory that gut health affects the brain is not new. Back in the 1920's, researchers at Duke University were making connections between the gut and the brain. Today, the gut-brain axis is a well-established in the scientific literature. Unfortunately, not many conventional doctors, psychologists or psychiatrists are aware of this connection.

Another important point regarding the gut-brain connection concerns serotonin. Serotonin is a neurotransmitter that plays a role in mood. We tend to think of the brain when we think of neurotransmitter production, but the fact is, the gut produces 400 times more serotonin compared to the brain.

The Second Brain

Some researchers argue that the gut is the second brain. The gut is an organ that contains an entirely distinct branch of our nervous system that we refer to as the enteric nervous system. In basic terms, it is a big bundle of nerves. So it should not be that surprising that there is a clear connection between the gut and the brain, and that dysfunction in the gut can lead to a variety of cognitive, mood, and behavioural disorders including anxiety.

The Inflammatory Cytokine Theory

The most current theory on what causes depression is called the inflammatory cytokine theory of depression. This theory believes that inflammation, whether it starts in the gut or somewhere else in the body, suppresses the activity of the frontal cortex and causes depression. There is also research linking gut disturbances with Parkinson’s and Alzheimer’s disease, with ADHD, sensory processing disorder, OCD, and even schizophrenia and psychosis. Thus, at this point, there are not very many cognitive, behavioural, or mood disorders that we can not link to problems in the gut. And, I expect that the connection between the gut and the brain will grow and grow as we do more research in the future.

How Functional Medicine Can Help

Working with a functional medicine practitioner, if that’s possible, to check for food sensitivities, SIBO, parasites, fungal overgrowth, dysbiosis, is an excellent step to take if you’re suffering from anxiety.

How You Can Help Yourself

If that is not accessible to you for any reason, the best place to start would be to check out the book, Healthy Gut Healthy You by Dr Michael Ruscio, which has an excellent self-help section on the steps you need to take to improve your gut health.

The HPA Axis And Anxiety

The second area of the body I would investigate is called the Hypothalamic Pituitary Adrenal or HPA axis. The HPA axis refers to the system that governs how well we handle stress.


You have probably heard about the HPA axis in the context of the fight-or-flight response. The fight-or-flight response occurs when you face a stressful event. For example, if we are in a dark alley, and someone’s walking toward you. This a potentially fearful situation. In such circumstances, our body will automatically prepare itself, via the HPA axis, by increasing blood flow to the muscles to either run away or fight. Once you pass by the stranger, the fear will diminish, and the body will turn off any physiological changes.

In our modern world, we have constant stressors like financial stress, relationship stress and work stress. Unlike the example above this stress never goes away, so we remain in the fight-or-response, and our HPA axis becomes chronically activated.

What happens when HPA axis is chronically activated?

A chronically activated HPA axis leads to changes in the output of stress hormones like DHEA and cortisol and pregnenolone, which in turn affects the production of neurotransmitters in the body. In other words, our bodies remain in a permanent state of fight-or-flight.

A Mismatch Between Our Environment And Our Stress System

Our stress response system or HPA axis evolved in an environment that had more acute stressors such as predators. The design of our HPA axis is not a good fit for the chronic low-level persistent stressors that we face today. In other words, there is a mismatch between our stress system that evolved in the environment that humans lived in for thousands of generations and the context that we are living in now.

The scientific literature supports this theory, and it has been shown to be one of the primary contributors to modern inflammatory disease.

What The Main Factors That Affect Our HPA Axis?

When we think about the HPA axis, five main triggers lead to dysfunction of this system.

1. Perceived Stress

The only stress that negatively affects our health is the stress that we recognise to be stressful. That might seem obvious, but it explains why not all stress is harmful. Two factors determine whether we perceive something as stressful. Firstly, the novelty of the event, new things stress us more than familiar things. Secondly, the unpredictability of an event, the more unpredictable something is, the more stressful it is for us. These are the kinds of factors that determine whether something is stressful for us in the first place.

2. Past Trauma

Past trauma can take the form of emotional or physical abuse, which usually occurs during childhood. If the trauma is significant or extends over a length of time, the body can become stuck in the fight-or-flight response, even though the shock has gone. Subsequently, the stress system will remain permanently turned on.

3. Inflammation

If you have inflammation from a gut problem, even if you have no perceived stress, it will still act as a stressor on your body.

4. Blood Sugar Dysregulation

The fourth factor is blood sugar dysregulation, which is epidemic in our country. Blood sugar dysregulation occurs when there is either too much or too little glucose in the blood. This situation can occur if you consume too many processed or refined carbohydrates.

5. Circadian Rythm disruption

Circadian Rythm disruption means too much exposure to artificial light at night and not enough exposure to natural light during the day. Humans evolved in a natural 24-hour light-dark cycle. In the last 150, years there has been a change in that cycle that has had a profound impact on our health.

How Functional Medicine Can Help HPA Axis Dysregulation

If you can work with a functional medicine provider, they can assess your HPA axis using a Dried Urine Total Comprehensive Hormone (Dutch) test. But if you don’t have access to a practitioner you can focus on addressing those four triggers of perceived stress, inflammation, blood sugar, and circadian disruption.

How To Address Perceived Stress

Addressing perceived stress might involve reducing your exposure to stress. For example, some strategies may include:

  • Learning to say “no”,
  • Not spending time with people that stress you out, if that’s possible and you have a choice about it, and;
  • Managing the stress that you can’t avoid.

Strategies for managing stress may include meditation, a yoga practice, tai-chi or qigong, deep relaxation practices, mindfulness-based stress reduction, and prayer.

How To Address Past Trauma

Past trauma affects the body by permanently turning on your HPA axis or stress system. In my clinical experience, it is difficult to fix this problem without a little or a lot of help. That help can take the form of some different therapeutic interventions including:

How To Improve Your Circadium Rythm

You can help your circadian rhythm by regulating your light exposure. Strategies for managing light exposure may include:

  • Not using tablets and other devices that emit blue light at night too close to bed
  • Making sure you get some bright light exposure during the day

How To Reduce Inflammation And Regulate Blood Sugar

You can reduce inflammation and at the same time regulate blood sugar by following an anti-inflammatory diet and removing processed and refined foods.

Nutritional Deficiencies and Anxiety

The next factor that can affect anxiety is a nutrient deficiency. Many nutrients play an important role in mental health including but not exclusively B12, folate, zinc, copper, EPA and DHA, vitamin D, choline, B6, and riboflavin.

How Can Functional Medicine Help Nutrient Deficiencies

If you have access to a functional medicine provider, you could consider getting nutrient testing. Both blood serum and urine Organic Acids Testing can be helpful for assessing nutritional status. After screening, you can systematically address those deficiencies as you identify them.

How Can You Help Yourself

If you do not have access to a practitioner and testing, you can make some assumptions about which nutrients might be low. For example, if you follow a vegan or vegetarian diet, you may be low in B12, folate, choline, B6, and zinc. These are nutrients that are especially important for a process called methylation. Methylation is a process in the body that profoundly affects neurotransmitter production. So if you are not methylating correctly, you will not produce neurotransmitters efficiently. Poor neurotransmitter production can lead to anxiety and other cognitive and mood disorders.

Interestingly, the two food categories that are highest in those nutrients that are important for methylation are shellfish and organ meats. So for a patient who has impaired methylation and who is dealing with anxiety, I would recommend a diet that includes shellfish and organ meats. Clams and oysters are particularly valuable regarding their nutrient density. They are the highest sources of iron, zinc, and B12.

Other helpful supplements

So gut health, HPA axis dysregulation and nutrient deficiencies are the three factors that I would focus on first concerning anxiety. There are a few other supplemental interventions that I want to mention that could be helpful in the meantime while you are working on those factors or maybe while you are seeking out a functional medicine provider.

Cannabidiol (CBD)

CBD is the non-psychoactive component of cannabis which means it does not give you a high. If you are not familiar with CBD, it has been the subject os a lot of research. CBD has been shown to exert an anti-inflammatory and anti-anxiety effect. A water-soluble form of CDB is best, such as Super CBD. The recommended therapeutic dose 250 mg a day. You probably want to start with a lower dose and slowly increase the amount because there is a small subset of people who seem to experience an increase in anxiety from taking CBD.


Taurine is a precursor to and an activator of GABA, which is the primary inhibitory neurotransmitter. Many people with anxiety have been shown to have low levels of GABA, so taking taurine can help increase GABA levels. The recommended dose is 500 mg up to 3 grams per day. And again, it is recommended to start with a lower dose and increase slowly.


L-theanine is an amino acid, found in green tea, that can have a calming and relaxing effect without causing drowsiness. L-theanine can make you feel simultaneously more alert but calmer. The recommended dose is 200 to 400 mg per day.

So, those a number of my suggestions for helping anxiety from a Functional Medicine perspective. Both looking at the core factors and the underlying mechanisms that contribute to anxiety and some other ideas to give you some relief right in the short term while you’re addressing those other underlying mechanisms.

If you have anxiety and would like to see if a Functional Medicine approach might help you, you can find your nearest practitioner by going to the Institute of Functional Medicine website.