Anxiety: It’s not all in your head

Updated: Apr 26

Stress and worry are things that most of us deal with from time to time, so we’re generally familiar with feelings of anxiety that come from our daily stressors and significant life events. What’s less commonly known and explored are the physiological causes of anxiety, or in other words physical changes that trigger an emotionally anxious response. If you’ve been struggling with anxiety, or even sleep disturbance where you are waking up anxious here is my checklist of issues to explore. In some cases anxiety really isn’t all in your head.

1. Low Iron or Anemia

One of the most common physiological causes of anxiety is simply low iron levels, which is extremely common in women. When iron levels are too low, and especially when hemoglobin also drops the body can go into a state of anxiety, and sometimes poor sleep. Iron levels can be low because of low intake of iron, poor absorption, and most commonly from heavy menstrual cycles. This is very simple to test for with bloodwork: ferritin and hemoglobin.

2. Hypoglycemia

Periods of low blood sugar can also trigger an anxiety response, and I’m sure most of you have experienced this before – when lunch or dinner is delayed and you’re not prepared with snacks. If you’re prone to getting anxious, irritated or light-headed if you go longer than a few hours without eating, it’s time to look at the way you’re building your meals. Including protein, fat and fiber each time you eat will help your blood sugar levels to stay balanced for longer.

3. Insulin Resistance

This cause of anxiety is a little less intuitive, so let me explain: with insulin resistance, your body is over-producing insulin in response to carbohydrates in your diet. Common signs of insulin resistance include: weight gain, intense cravings for carbohydrates and sweets, increased appetite, feeling tired after eating, carrying extra weight around the abdomen, and slow and difficult weight loss.

The way insulin resistance causes anxiety is through ‘reactive hypoglycemia‘. If you eat too many carbohydrates or sweets, your body over-produces insulin in response to the rise in blood sugar, which then triggers a rapid drop in blood sugar or hypoglycemia. In other words, if you go overboard in carbohydrate intake, a couple of hours later your blood sugar crashes which can make you feel very anxious, and in some cases bordering on a panic attack. Reactive hypoglycemia can also hit in the night-time if you’ve eaten too many carbohydrates with dinner or sugary snacks at night causing you to wake up suddenly and have difficulty getting back to sleep.

The key to stopping this anxiety is to get your blood sugar and insulin response back into balance again. This means reducing carb and sugar intake, eating balanced meals each containing protein and fat, and adding in more exercise. You can read more about insulin resistance here:

4. Low cortisol

We hear mostly about high cortisol levels as a response to stress, but after a prolonged period of high stress cortisol levels can decline. One key symptom of  low cortisol is feeling overwhelmed by everything, as if you have lost your buffer for stress. When you are faced with stresses, both emotional and physical, your body reacts with feelings of anxiety. Cortisol levels can be tested with bloodwork, saliva panels or in urine, and low cortisol can be treated by addressing your current levels of stress, B-vitamins and nutrients to support adrenal repair. If your anxiety developed after or during a prolonged period of high stress, it is definitely important to look at cortisol levels.

5. Low progesterone

Did you know that progesterone plays a huge role in regulating the HPA (hypothalamus pituitary adrenal) axis which is how your body regulates stress. In fact, women in their late 40’s are much more prone to experiencing anxiety and insomnia in the years leading up to menopause, and largely because of the drop in progesterone.

Progesterone is a hormone produced by your ovaries, and it naturally declines with age usually starting in the late 30’s, and steadily decreasing towards menopause. It can also decline with prolonged periods of high stress, as a primitive adapatation to protect from pregnancy when stress levels are too high.

It’s quite simple to test for progesterone levels with a simple blood test done mid-luteal phase (usually on day 21 of the cycle), and then to restore balance with herbs, nutrition, stress relief, and in some cases the use of bioidentical hormones.

Learn more about progesterone here: and perimenopause here:

6. Postnatal depletion

The term “Postnatal depletion” was coined by an Australian Doctor, Oscar Serralach, MD a few years back. It describes constellation of symptoms that can occur after pregnancies (usually multiple pregnancies), where the body takes a long time to fully recover energetically, hormonally and emotionally. Symptoms can include fatigue, feeling unrefreshed from sleep, exercise intolerance, weight gain or loss, hair loss, light-headedness and low mood or anxiety.

The science behind the diagnosis is that during pregnancy, a mother’s body becomes depleted of several key nutrients especially iron, zinc, vitamin B12, folate, iodine and selenium, as well as omega-3 fats like DHA, in order to support the baby’s growth and development in-utero. This depletion is compounded with each pregnancy, especially if they are close together with extended periods of breastfeeding, you have had twins, or if you had hyperemesis (extreme nausea and vomiting in pregnancy).

The key for optimal recovery is to replenish nutrients, get the body out of state of perpetual stress, and reset sleep rhythms. You can read more about postnatal depletion here:

7. Hyperthyroid

Although we hear much more about hypothyroid or low thyroid function, the opposite condition hyperthyroidism is also something to be aware of. One sign is an increase in anxiety, but this would also come with other symptoms such as: heart palpitations, heat intolerance, increased sweating, an increase in bowel movements and difficulty sleeping. Thyroid function can be tested with a simple blood test for TSH and free T4 to understand if anxiety may be caused by an overactive thyroid.

8. Genetics

Since the world of personal genetic testing has opened up in the past decade or so, there are a couple of genes that I often flag related to chronic anxiety, and understanding the genetic susceptibility can make a big difference in how they are treated:

  1. MTHFR (C677T and A1298T) stands for methyl-tetrahydrofolate reductase, an enzyme that is responsible for a process called methylation, which takes place in every cell of your body. Having a genetic variant with MTHFR means that your enzyme functions at a reduced capacity, and this is quite common affecting up to 20% of the population. The MTHFR gene affects many processes in the body, but for the essence of this article we will just look at neurotransmitter synthesis (dopamine, serotonin and norepinephrine) which affects mood and addiction (anxiety, depression, bipolar disorder, all types of addiction). If this gene is identified, support for methylation pathways, and the addition of methylated B-vitamins especially folate and vitamin B12 can make a significant impact on mood and anxiety. Read more about MTHFR here:

  2. COMT (V158M Gene) stands for Catechol-O-Methyltransferase, which affects the rate at which the neurotransmitters epinephrine, norepinephrine and dopamine are broken down. In cases where the enzyme activity is decreased, there is typically a higher incidence of anxiety, OCD, panic disorder and phobias, along with lower emotional resilience to stress and negative events. The reason is because when your brain releases the neurotransmitters mentioned above, these stress chemicals stay in circulation for longer and it’s harder to let go of the stressor both emotionally and physically. This gene is not all bad news though, because when you are not under stress, there is better cognitive function, and stronger working memory.

If you have had personal genetic testing done (ex. 23andme), these genes can be located in your raw data in order to help understand some of the underlying causes of anxiety.


In conclusion, I hope this short article has given you some ideas to explore if you’ve been struggling with anxiety. Of course, it is always helpful to get emotional support, learn tools to deal with your thoughts, and to address the stresses in your life, but don’t forget about some of the possible physiological causes of anxiety too. If you need help with this, I’m happy to assist!

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