Anxiety is often cited as a mental health symptom.
Several different models exist for the cause and treatments of anxiety. One is the "Chemical Imbalance Theory" where it involves a disruption in neurotransmitters.
Another is the "Immune Cytokine Model" which acknowledges the physical/inflammatory contributions to mental health conditions.
Today’s email will touch on the following:
- Useful tests when evaluating anxiety
- Some research for your perusal
- An EMR template you can incorporate into practice
1: Useful tests when evaluating anxiety
Commercial labs like Quest and Labcorp offer a handful of tests that are useful in identifying elevations or deficiencies in various markers that are useful when it comes to anxiety (many of which originate in an orthomolecular approach to health). These include:
- Elevated hsCRP
- Imbalanced glucose dynamics (e.g. fasting glucose and insulin)
- **Elevated serum copper (over 100). Clinical pearl: elevated levels almost always seen in those who are taking oral contraceptives (OCPs) and are more difficult to address as a source of anxiety without discontinuing the OCP
- Thiamine (Vitamin B1) or Pyridoxine (Vitamin B6) deficiency.
- RBC Folate deficiency
- **Elevated MMA (this is preferred over serum vitamin B12 levels)
- **Homocysteine over 10
- Plasma zinc deficiency
- **Low vitamin D3
- **Omega 3 Index under 6%
- Overt RBC magnesium deficiency (I say “overt” because I find that magnesium is one of my top treatments for anxiety, but it is rare to see magnesium deficiency on labs due to where most magnesium is stored in the body)
- **Iron deficiency
- **Thyroid hormone imbalances, or even just elevated thyroid antibodies with normal thyroid levels (Clinical pearl: I rarely give thyroid medication to anyone with “low T3 syndrome” or suboptimal free T3 i.e. free T3 levels that are not “optimal”, since I historically have found that majority of patients have increased anxiety with thyroid medication)
- Celiac antibody testing of all 5 antibodies associated with this condition (Clinical pearl: ask a patient first if they are ok with this test being run since going gluten-free is not an easy lifestyle change for many! And make sure they are currently consuming wheat/gluten for accuracy of the testing)
Tests that require more advanced training to interpret include:
- ** Amino acid testing (serum or urine)
- Genetic SNP testing (in particular, GAD, COMT, and MTHFR)
- Infectious disease markers (e.g. bartonella, strep)
- **DUTCH testing that looks for inflammatory or excess estrogen levels, low or high free cortisol
- Stool testing (e.g. GI Map or GI Effects)
- LPS antibody testing via Cyrex
- Kryptopyrrole test (controversial if pyrrole disorder is a true condition, but when run through the right lab company and interpreted by someone with advanced training, using the high doses of specific nutrients for this disorder can be a game changer)
- **Oxidative stress testing (I often run Genova’s Metabolomix since this also includes amino acids and quinolinic acid testing, and is easier to run than NutrEval for many patients)
- Environmental toxins, including mycotoxin testing
- Food sensitivity testing
**Note, the starred tests are some of my preferred first-line tests in my patients, many of whom are cost-conscious or prefer to only use commercial labs over functional labs.
2: Some research for your perusal
3: EMR Template on the complexities of addressing anxiety
Anxiety can have many "root causes". As we work together to address anxiety, I will be looking at patterns in your medical history and other symptoms that may seem unrelated to mood. Treatment with supplements or herbs always involves trial and error experimentation, but I will guide you on dosing and prioritize treatments from which you should ideally feel a difference within a few days. A few things I consider as primary underlying causes, which I may or may not be able to test, include:
- A need for neurotransmitter support (e.g. serotonin, GABA, dopamine)
- Evaluation of underlying nutrient, blood sugar, and hormone imbalances
- Addressing lifestyle contributors (e.g. reduction of stimulatory foods, prioritizing good sleep quality, exercising or moving daily, etc)
- Addressing how histamine could be impacting symptoms
- And more advanced testing that may include looking for dysbiosis in the gut or environmental toxins
Thanks for reading!
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