Host: Deanna Minich, PhD
Guest: Sara Gottfried, MD
In this discussion at the forefront of personalized lifestyle medicine, Drs. Sara Gottfried and Deanna Minich explore anxiety in women and the connection to female-centric physiological changes throughout the life cycle. In addition to helping remove the stigma of anxiety, clinicians can partner with women to explore their unique biology and to identify and address the root causes, the why, behind their anxiety.
With anxiety, comes stigma. With stigma, come shame and perceived failure. Clearly, a pernicious sequence. Healthcare practitioners can choose to halt this deleterious cycle. Instead of shame, practitioners have the privilege of being inquisitive, exploring the biological underpinnings of any physiological dissonance in their patient, including that which manifests in mood disorders like anxiety.
Conventional medicine conversations focus on mental health conditions resulting from an imbalance in neurotransmitters. Along with being an oversimplification, this approach neither identifies nor targets the etiology of the imbalance. Dr. Sara Gottfried asserts that anxiety, depression, and any health condition should be approached by identifying upstream root causes, which is standard in Functional Medicine.
Chronic inflammation (i.e., the “brain on fire”) plus gene-environment and hormonal interactions are all key players in mood disorders and myriad health conditions. Drs. Gottfried and Minich caution against creating organ silos in our discussions of chronic disease; it’s not about one organ, for example the brain or the gut. The etiology of anxiety and mental health conditions is multifactorial and thus, the clinical approach must also be pleiotropic.
Epidemiologically, women experience a higher prevalence of anxiety than men. The reasons for this gender difference are numerous and diverse. Differences in brain structure and functions, vulnerability for HPA axis dysregulation, sex hormonal milieu, and societal differences (e.g., gender bias and unequal pay) are all contributing factors. Honing in on sex hormones, Dr. Gottfried explains that estrogen is the “master regulator” of mood, which is why anxiety can increase during life stages with estrogen flux like puberty, pregnancy, and perimenopause.
Women are more likely than men to possess and practice the “tend and befriend” reflex. This can be a positive when those friends are benevolent, but it can also expose women to the stress of toxic individuals and/or feeling too heavily responsible for others. Women are generally more emotionally vulnerable than men, with the female sex manifesting a more pronounced ebb and flow of moods. Dr. Gottfried encourages us to think of this unique female design as a strength, not a weakness. It’s also important to recognize that coping and resilience differ from person-to-person, with individual differences in social genomics clearly at work.
So what’s the answer? Dr. Gottfried explains that the goal is to achieve harmony in the sympathetic (fight, flight, freeze) and parasympathetic (rest and digest) nervous systems. That includes resetting the HPA axis. To that end, we need to become better listeners when it comes to our own body; listening to body cues and tracking them can help identify potential triggers of anxiety. Dr. Gottfried encourages practitioners and patients to approach self-care with an à la carte mentality. Experiment and then pick a few tools that work for the individual. Self-care “menu” items may include meditation, prayer, breathing exercises, yoga, reading, painting, writing, exercising with friends, and being outside (e.g., forest bathing), to name a few! Screen time is also discussed, with smart technology being an obvious stress culprit. Depending on the content, TV shows and movies can be helpful or hurtful to anxiety-reduction efforts. So, this is one more common social practice to be cognizant of and smart about.
Lastly, Dr. Gottfried delves into anxiogenic vs. anxiolytic factors. For example, when considering targeted nutrition tools, supplementation with omega-3 fatty acids from fish oil yield anxiolytic effects, and Siberian rhubarb phytoestrogen bioactives support estrogen receptor balance and activity.
Practitioners can help lead the way in changing the conversation about anxiety and other health conditions tarnished by taboo. Dr. Gottfried encourages us to be rebels, to go against the negative branding of anxiety that our society and even traditional medicine have espoused. Practitioners can approach anxiety with a positive, curious mindset, asking, “how do we maximize vulnerability?” and believing sensitivity to be a strength. Because along with identifying root causes, affirmative, life-promoting terminology is equally important to provide meaningful, sustainable relief to patients with anxiety and assuredly, any health condition.
This Personalized Lifestyle Pearls broadcast took place live February 5, 2019 on the Metagenics Institute Facebook page.