Anxiety is a body-wide phenomenon. It is not all in your head.

It's origins can be traced to not only your brain, but your adrenal glands, thyroid gland, gastrointestinal system, heart, ovaries (women), testes (men) and even your bones. And of course, theyre all interrelated. Since neurotransmitters and hormones are the messengers of anxiety, well begin there.

Neurotransmitters and anxiety.

A neurotransmitter imbalance can sensitize your brain, making you more prone to a fear response. Consistently high levels of excitatory neurotransmitters (e.g., adrenaline/epinephrine and noradrenaline/norepinephrine) and correspondingly low levels of the calming, inhibitory neurotransmitters (e.g., serotonin and gamma-aminobutyric acid [GABA]) can actually alter the brains circuitry.

This alteration can develop over time as the result of acute or repeated trauma or simply a life of low-grade chronic stress, particularly when coupled with a genetic predisposition.

Popular anti-anxiety medications work on these neurotransmitters and their receptors, as do caffeine and alcohol.

Caffeine raises adrenaline and dopamine levels, whereas alcohol raises dopamine levels and binds to GABA and serotonin receptors, among others. Anti- anxiety medications (particularly benzodiazepines), caffeine, and alcohol are all highly addictive. People who inherit or develop anxiety-sensitive brains also have greater risk for addiction.

The Hypothalamus-Pituitary-Adrenal Axis, adrenal health, and anxiety.

When you feel anxious (an emotion), your sympathetic nervous system jolts you into action (a physical response). This stress response is mediated along the HPA axis. Your hypothalamus (H) releases a hormone called corticotropinreleasing factor (CRF), which flows to your pituitary gland (P), where it stimulates adrenocorticotropic hormone (ACTH), which in turn tells your adrenal glands (A) to release epinephrine (adrenaline) and cortisol.

Together these hormones (some of which have dual roles as neurotransmitters, by the way) elevate your blood pressure and blood sugar to give your brain, heart, muscles, and skeleton the edge they need to respond to crisis.

Meanwhile, they also suppress less dire bodily functions like immunity, digestion, and bone building, which is why chronic anxiety leads to accelerated aging.

In a healthy system, the stress- hormone flood recedes once the threat is disabled. But if the gates stay open, the adrenals become tapped-out, resulting in chronic anxiety, depression, weight gain, accelerated aging, osteoporosis, and other metabolic imbalances.

Many of my patients with high anxiety have elevated levels of CRF, epinephrine, and cortisol  which indicate that this response is always on.

Sex hormones and Anxiety.

Women are more than twice as likely as men to feel anxiety, especially during PMS, perimenopause, and menopause.

Men also commonly experienc anxiety.

Anxiety is often the first sign of perimenopause (women) or periandropause (men).  Women with moderate anxiety are three to five times more likely to experience hot flashes. Many women also experience rampant anxiety symptoms when transitioning off hormone replacement therapy.

In women, the hormone- progesterone has a particularly soothing effect on the mind and the body which is similar to, and interdependent with, the feel good neurotransmitter- serotonin.

When levels begin to drop as a woman approaches menopause, this can leave her susceptible to anxiety-related problems, including insomnia.

As women approach menopause, estrogen and progesterone levels often fluctuate widely, amplifying any existing anxiety symptoms.

In my experience, relief from menopausal anxiety and panic attacks can only be gained once hormonal balance is restored.

Digestion and Anxiety.

As I ask a patient with gastrointestinal problems to share a little more about what is going on in their life, they will almost invariable identify some component of anxiety.

But whether its nervous stomach, heartburn, irritable bowel syndrome, gluten intolerance, diarrhea, ulcers, nausea, bloating, or bleeding- anxiety does not necessarily precede a digestive concern.

Though anxiety was blamed for generations as the cause of stomach ulcers, for instance, we now know now that a bacterium (H. pylori) is the primary causal agent. Yet the very fact that a patient has an ulcer  or any another GI problem  can precipitate anxiety, which can then set up a vicious cycle of symptoms. Scientists are only beginning to understand the weblike connections between our emotions and gut health. We do now recognize the digestive system as an independent center of nervous activity, intricately connected with brain chemistry, hormonal balance, and moods.

In essence, we have a second brain in our gastrointestinal tract.

Indeed, the gut is even a major site of serotonin production and utilization, where it functions as an enteric neurotransmitter.

Genetic variations in receptors for cholecystokinin, another hormone synthesized in our guts, have also been linked with the development of panic disorder and anxiety.

So clearly, anxiety is not all in our heads.Relief from chronic anxiety comes from restoring your body's natural equilibrium: by learning to process your emotional history while making changes to lifestyle, nutrition, exercise habits, and hormonal balance.

This is what I recommend:

Fresh air, sunshine, and exercise- as often as possible. A healthy measure of each will not only to help you manage better when under pressure, but aid restorative sleep at the end of the day.

Deliberate dietary choices that support your neurotransmitters (feel good hormones). I discuss this at length in the Member Center in an e-booklet and on the video.

Sound nutrition so heavily influences our hormones and transmitters  it is simply a must.

Choose whole, nutrient-rich foods with a low glycemic index that support neurotransmitter production and don't let yourself get too full or too hungry. These simple tips will help to normalize your two major hormones, insulin and cortisol, which in turn will help optimize your neurotransmitters and balance your sex hormones.

Eliminate potential food allergens. Gluten, for example, is notoriously associated with anxiety. If you are experiencing anxiety-related gastrointestinal problems, an elimination diet may help you identify any sensitivities at play.

Consider nutritional supplements. Some nutritionists regard the B-complex as the most important nutritional factor for healthy nerve cells, but there is also evidence that omega-3 fatty acids can help reduce symptoms of anxiety. Likewise, vitamin D is a key nutrient for mood, and deficiency is widespread. If youre elderly, overweight, dark-skinned, live in a northern climate, or dont get much sun, vitamin D testing and appropriate supplementation is strongly suggested.

Balance your sex hormones. When anxiety is related to perimenopause or menopause, gentle endocrine support can often restore balance. I recommend bioidentical hormone replacement therapy for men and women, if they are a candidate. Botanical therapies such as passionflower, valerian, and chamomile have been used for many generations to dissolve restlessness, nervousness, and anxiety.

Emotional work-Just as you developed coping skills as a child, so too can you unlearn old patterns that no longer serve you. It may take commitment and perseverance, but you can learn new skills to free yourself of the emotional and physical trappings of anxiety. These include methodologies that quiet the nervous system, raise awareness of your personal emotional triggers, and provide coping strategies you can draw on when nerve-wracking situations arise. I recommend meditation and prayer. Medical meditation is particularly useful for lowering chronic stress levels.

You can read more about this in the new e- booklet in the Member Center.