What is False Anxiety?

Has this ever happened to you? -… you are trying to get to sleep and you start to feel anxious. It’s not full-on panic, but maybe just a few butterflies in your stomach? And then you start to wonder what you could be anxious about. Is it the meeting I have next week? Or the way my friend looked at me funny today? Or maybe an upcoming doctor’s appointment? You’re not quite sure what it’s about, but it must be something because you feel the butterflies, right??

Well, maybe not. 

More and more information is coming to light about what is being called our second brain. And, guess where that is located…in our guts! What this new information is showing is that what we identify as anxiety might actually be our body signaling us that something is off internally, in our guts, and that anxiety we feel is not actually connected with anything we have going on in our lives. 

The cool part about this, for those of us who struggle with anxiety, is that there is so much we can do starting today to heal our guts and decrease that icky, anxious feeling!

How to Deal With False Anxiety

Dr. Ellen Vora in her book The Anatomy of Anxiety,  describes this feeling as “false anxiety”. She explains that this occurs when our brains assign meaning to what is a physiological response to an imbalance in our bodies. This imbalance is typically created by a stress response to a toxin or gut-related systemic inflammation. 

On page 13, she goes on to explain that, when we feel physically off, “when we seem to just wake up on the wrong side of the bed or, seemingly out of nowhere, find ourselves feeling irritable, sad, angry or anxious…our minds are all too happy to swoop in with an explanation. …Our minds are meaning makers…[they] like to tell us stories to explain our physical sensations”

In other words, we have the physical sensation that we associate with anxiety and then create a narrative that helps us explain that feeling. Let’s break this down a bit so we can more fully understand what might be happening in our bodies to set off such an alarm. 

Anxiety disorders are on the rise throughout the world - we all know that. Know what else is on the rise? Metabolic disorders - obesity, type 2 diabetes, Alzheimers, and heart disease. In fact, half of US adults now have some sort of metabolic disorder. 

Could there be a connection? We are starting to understand that there is indeed a connection between our metabolic health (the health of our guts) and our mental health.

False Anxiety & Gut Health

Let’s start with a quick overview of the gut microbiome (which is another world for the millions of bacteria we all have in our guts). The types of bacteria and the diversity of those bacteria dramatically impact both our mental health and physical health. When healthy, those bacteria are pretty amazing. Here are some things they are responsible for:

1. Digestion: The gut bacteria are needed to break down our food. They do this by producing enzymes that break the food into smaller pieces, thereby releasing nutrients and energy that can be absorbed and used by the body. 
2. Immune Function: Gut bacteria also have a profound impact on the immune system. They help regulate our immune response by interacting with immune cells in the gut lining and influencing the production of immune molecules. These bacteria are critical for maintaining immune balance and preventing maladaptive immune responses such as allergies, autoimmune diseases, and inflammation.
3. Protection: Those millions of bacteria are like little guards. They act as a barrier along the walls of our intestines, between the inside of the intestine and the bloodstream,  to keep harmful substances (think pathogens and toxins) out of our systems.
4. Regulating Metabolism and Hormones: Through some chemical processes, the bacteria in our guts produce metabolites which then help to regulate glucose and lipid metabolism (the breakdown of fats for energy). Additionally, they interact with certain cells in the gut lining that influence the secretion of the hormones that regulate appetite, satiety, and energy balance.

Factors That Impact Our Microbiome

 This is all interesting, you might be saying, but what does it have to do with anxiety? We’ll look at that in a minute, but first I want to touch on some things that impact our microbiome:. 

• 1. Diet: Diet is one of the most significant factors influencing our gut microbiome. Every morsel of food we put in our mouths either positively or negatively impacts the health of our gut bacteria. Every morsel!
• 2. Antibiotic Use: Antibiotics can significantly disrupt our gut microbiome by killing not only harmful bacteria but also beneficial ones. We definitely do not want to kill off the good bacteria if we can help it! The effects of antibiotics on the gut microbiome can be long-lasting, and it takes some time to rebuild a healthy gut after antibiotic treatment.
• 3. Stress: Psychological stress can also influence the gut microbiome. This happens, in part. through the gut-brain axis which is a bidirectional communication system between the gut and the brain. Stress-induced changes in gut motility, secretion of digestive enzymes, and permeability of the intestinal barrier can alter the gut environment and affect the composition of gut bacteria.
• 4. Lifestyle Factors: Various lifestyle factors, including physical activity levels, sleep patterns, and exposure to environmental factors, can all impact the gut microbiome. Regular physical activity has been associated with a more diverse and stable gut microbiome, while disrupted sleep patterns or exposure to environmental pollutants alter the balance of good and bad bacteria in our guts.
• 5. Age: The gut microbiome changes throughout the lifespan, with distinct microbial profiles associated with different age groups. Factors like birth mode (vaginal delivery vs. cesarean section), breastfeeding vs. formula feeding during infancy, and dietary habits across different life stages can influence the development and maturation of the gut microbiome.
• 6. Medications and Supplements: Besides antibiotics, other medications such as proton pump inhibitors (antacids), nonsteroidal anti-inflammatory drugs (NSAIDs like ibuprofen) and certain supplements can affect the gut microbiome. For different reasons and through different pathways, these have been associated with negative changes in the composition of the gut microbiome. 

How Your Gut Microbiome Affects Mental Health

Okay. Now that we have a basic understanding of the gut, let’s look at how those little buggers communicate with our brains and, therefore, impact our mental health.

The gut-brain axis is a bidirectional communication system that connects the central nervous system ( the brain and spinal cord), with the enteric nervous system (ENS) which is located in the gastrointestinal tract that runs from the esophagus to the large intestine. This enteric nervous system is also referred to as our second brain. So, to be clear, there is an entire network in our bodies that is specifically designed to allow communication from the gut to the brain and from the brain to the gut!

A major component of the gut-brain axis is the vagus nerve. The vagus nerve is part of our parasympathetic nervous system which is what calms us down after a stressful event. The vagus nerve is connected with our gut and internal organs and is constantly collecting and distributing information about those organs to our brains. In short, the vagus nerve connects the emotional and cognitive areas of our brains with our guts.

A large part of how this communication happens is through neurotransmitters and hormones. And, guess what is needed to make those neurotransmitters and hormones - that’s right! A healthy gut! Here’s how that works: that influences mood, behavior, and cognitive function. 

Basically, neurotransmitters are chemical messengers that transmit signals between neurons (nerve cells) in the brain and nervous system.The neurotransmitters that play key roles in the regulation of our moods, emotions, and overall feelings of well-being, are serotonin, dopamine, GABA and norepinephrine.

Serotonin: Serotonin is often referred to as the "feel-good" neurotransmitter because it contributes to feelings of happiness, contentment, and well-being. It is involved in regulating mood, appetite, sleep, and social behavior. Imbalances in serotonin levels have been associated with depression and anxiety. And, guess what - 95% of our body’s serotonin is made in the gut! Clearly, if we do not have a healthy gut, the production of serotonin is greatly impacted.

Dopamine: Dopamine is commonly associated with the brain's reward system and is involved in motivation, pleasure, and reinforcement of behavior. It plays a crucial role in regulating mood, attention, and movement. Dysregulation of dopamine signaling is associated with depression, bipolar disorder, and schizophrenia. The enzymes from healthy gut microbiota are essential for the synthesis of dopamine, which is what makes it usable in our systems. Again, in order for our bodies to properly use dopamine, we need to have a healthy gut. 

Norepinephrine (noradrenaline): Norepinephrine is both a hormone and a neurotransmitter. It is secreted by both the adrenal glands (above the kidneys) and the central nervous system.  It’s involved in the body's "fight or flight" response and helps regulate arousal, attention, and mood. It plays a role in increasing alertness and focus during stressful situations. Dysregulation of norepinephrine has been linked to mood disorders, sleep issues and memory problems. Norepinephrine as a neurotransmitter is made from dopamine - again, dependent on the health of the gut. 

GABA (gamma-aminobutyric acid): GABA is the primary inhibitory neurotransmitter in the brain, meaning it helps calm our brains and reduces excitability. It is essential for reducing anxiety, promoting relaxation, and regulating sleep. Imbalances in GABA levels are connected with anxiety disorders and depression. Recent studies show that GABA is actually produced by certain bacteria in the gut (lactobacillus). So, not a lot of lactobacillus in your gut means a decreased level of GABA. 

Is it starting to make more sense why a disruption in the health of our gut bacteria can directly impact the production of these important neurotransmitters and lead to problems with our mental health?

But, unfortunately, there is more. An unhealthy gut not only disrupts the neurotransmitters, it also triggers some harmful physical changes in the small intestine that lead to negative downstream impacts on our mental health. 

How Your Gut Microbiome Affects Us Physically

One of the structural changes that takes place when our microbiome is off is called leaky gut. Let’s take a look at how leaky gut happens and how it directly impacts our anxiety levels:

When we have dysbiosis (which is another way of saying an imbalance in the gut bacteria) this can lead to increased intestinal permeability, also known as leaky gut. Basically, when we eat things that our bodies don’t recognize as food (toxins, additives, highly processed foods) our immune systems react just as they should to any foreign object or invader - they launch an immune response that includes inflammation. When this inflammation happens repeatedly, the cells that line the small intestine begin to separate. These small gaps in the lining of the small intestine allow harmful substances such as bacteria, toxins and larger particles of food to enter the bloodstream and trigger further immune responses throughout the body.  This is called systemic inflammation and it can lead to a host of problems, including anxiety, and depression. 

How Sugar Affects Your Mental & Physical Health

On a side note, consuming lots of sugar can cause the same problem!  Even scarier, the inflammatory molecules and immune cells that enter the bloodstream as a result of leaky gut can cross the blood-brain barrier and trigger inflammation in the brain. As you can imagine, this can lead to a host of physical, mental and cognitive problems.

Additionally, this same inflammation can activate the hypothalamic-pituitary-adrenal (HPA) axis, which is the body's central stress response system. Once that is activated, it leads to elevated cortisol levels which often feel like anxiety.

And, just to throw some icing on this inflammation cake, dysbiosis and inflammation can disrupt the communication along the gut-brain axis that can lead to changes in the levels of stress hormones (such as cortisol) and dysregulated stress responses. An increase in cortisol and dysregulated stress responses are closely linked to anxiety disorders.

How to Improve Gut Health & Reduce False Anxiety

Now that we have an understanding of how problems in our gut can trigger reactions that we recognize as anxiety, but that don’t get better through talk therapy or anti-anxiety medications, let’s take a look at things we can do to improve our gut health, support our vagus nerve, stabilize our blood sugar and reduce the prevalence of those internal alarms.

First and foremost, be mindful about what we put in our bodies! We want to decrease processed foods. They are filled with sugar, additives and toxins. All of these things disrupt our microbiome. We can do this by focusing on eating whole foods. These include grass-fed, antibiotic-free meats, organic fruits and vegetables, whole grains, nuts, seeds, eggs. Cook at home. Decrease man-made fats (highly processed oils). Increase good fats (nuts, avocados, olives, coconut oils). Increase fermented foods - these are filled with probiotics, which is another world for the good bacteria. Eat plenty of prebiotic foods - these are the foods that the good bacteria like to eat. They include garlic, onions, leeks, and dandelion greens to name a few. Drink lots of water. Decrease alcohol  - this is important because alcohol acts on GABA receptors to make us feel calm at first but there is a rebound effect when the body produces more glutamate (the excitatory neurotransmitter) in an effort to regain equilibrium. This leads directly to anxiety. 

An added advantage of eating foods with quality proteins and good fats is that they stabilize our blood sugar. Low blood sugar creates a stress response that signals our adrenal glands to release adrenaline and cortisol which then tell the liver to break down glycogen into glucose for energy. This stress response can feel like anxiety. 

Prioritize sleep. This can be tricky because, if our gut health is off, our sleep is also likely to be off. As we learned earlier, gut health is needed for the production of GABA (the brain-calming neurotransmitter) and melatonin which we need to fall asleep. And, we all know that chronic lack of sleep leads to anxiety. 

Sleep is super important for many reasons - during sleep, our body repairs damaged cells, consolidates learning, restores energy and detoxifies the brain. This detoxification process is called autophagy and it is like the brain’s trash removal system - damaged brain cells are repaired and dead cells and toxins are removed. When we don’t get enough sleep, this process doesn’t happen completely so our brains feel foggy and inefficient the next day.

Tips to Get The Most from Your Sleep

Here are a few tips to get the most from your sleep. First, set a bedtime routine that includes getting to bed and waking up at the same time each day. Turn off all screens 1-2 hours before bed. Leave your phone away from your bed, and make sure the room is dark and cool. 

There are also some things we can do during the day to improve our sleep. Ten minutes of morning sunshine and evening light helps to reset our circadian clocks, making it easier to fall asleep at night. Connecting with nature or walking barefoot on the earth is an easy way to get some grounding. According to the NIH, “grounding appears to improve sleep, normalize the day–night cortisol rhythm, reduce pain, reduce stress, shift the autonomic nervous system from sympathetic toward parasympathetic activation, increase heart rate variability, speed wound healing, and reduce blood viscosity.” Not a bad pay-off for stepping outside!

 Move your body. In more and more studies, exercise has been found to be effective in treating anxiety and depression - sometimes even more effective than taking medication. It does this by reducing inflammation, triggering the release of norepinephrine (which we know decreases feelings of stress and anxiety) and triggering the release of endogenous (made within our own systems) opioids so we feel less pain and feel better.

And, we don’t need a lot of exercise to get these benefits - a 10 minute walk or dancing around to your favorite song will make you feel better. 

Create stress-reduction practices. The goal of these is to engage the parasympathetic nervous system. Relaxing the body through yoga, meditation, mindfulness, and breathing sends signals through the vagus nerve to the brain that it can relax as well. The trick, when using breathing, is to slow the movement of the diaphragm which directly signals the brain to relax. We can do this by accentuating the exhale of the breath. 

Another trick that works is to stimulate the vagus nerve - remember that it’s a large part of the parasympathetic nervous system. We can do this by simply humming or chanting. If you are feeling more adventurous, cold showers or a cold plunge will do the trick as well!

Bringing this all full circle, these techniques work to decrease anxiety in part because they trigger the release of neurotransmitters. And, what do we need to have in order to create and disseminate neurotransmitters correctly?...a healthy gut!