Hey there, let's talk about anxiety for a moment. It's this mental health challenge that can really throw you off balance, you know? It affects a significant chunk of people worldwide, around 25%. And if you're already dealing with other health issues, that number can shoot up to about 70%. And hey, women seem to experience it more often than men.

But here's the thing: Functional Medicine offers a different approach to dealing with anxiety. It's all about looking at the whole picture, digging into lifestyle habits, environmental factors, and running some tests to understand what's going on.

Symptoms? They vary, but you might feel restless, irritable, struggle to concentrate, or have trouble sleeping. And your body might join the party with tension headaches, stomach aches, or a racing heart.

What causes it? Well, it's a mix of things. Genetics can play a role, as can your diet. Turns out, those sugary, processed foods might not be helping. And caffeine? While it keeps you going, too much can amp up anxiety.

Nutrition matters too. Low levels of certain vitamins and minerals have been linked to anxiety, like vitamin D and omega-3s. Lifestyle factors like stress and trauma can also contribute, along with issues like thyroid imbalances or gut problems.

But don't worry, there are tests available through Functional Medicine that can help pinpoint what's going on. From checking your gut health to assessing nutrient levels and hormone balance, they're tools to guide us toward understanding and managing anxiety better.

So take a breath, you're not alone in this. With the right approach and support, managing anxiety can become more manageable, leading to a brighter outlook ahead.

In functional medicine we think about the following in relation to anxiety. 

Micronutrient Deficiencies

Studies demonstrate that low levels of vitamin d, omega 3, zinc and magnesium are associated with anxiety and that supplementation with these minerals improves symptoms. 

Lifestyle Factors

In addition to nutritional status, other lifestyle factors that should be considered as possible causes include stress, trauma, physical inactivity, and inflammation. 

HPA Axis Dysfunction

A stress hormone called cortisol, which is released from the adrenal glands, is the end product of the HPA axis. Chronic exposure to this hormone can lead to changes in the brain that may contribute to the development of anxiety. 

Health Conditions

Evidence indicates various health conditions have known associations with anxiety, including thyroid conditions, heart arrhythmias, IBS, anemia, and dysbiosis. 

Neurotransmitters

Anxiety is associated with the dysregulation of several neurotransmitters, including GABA, serotonin, glutamate, and dopamine. Neurotransmitters are chemical messengers that utilize the nervous system to usher information throughout the body.

The Gut

Our microbiome is in constant communication with our nervous system. It can drive anxiety through production of toxins and neurotransmitters OR it can help reduce it through production of anti-inflammatory compounds and GABA.

Functional Medicine Labs to Test for Root Cause of Anxiety

There are no specific laboratory tests that can diagnose anxiety. However, your Functional Medicine practitioner may perform several functional lab tests to better understand the imbalances in your biology that may be associated with your anxiety.

Comprehensive Gut Health Testing

Since gut health can play a role in anxiety, it’s important to get a comprehensive evaluation of the patient's microbiome. Tests like the GI Map shows how well the patient is digesting and absorbing foods, breaking down foods into usable micronutrients, and if there is any inflammation or dysbiosis that could be leading to anxiety.

Nutrient Testing

The Genova NutrEval / Metabolomix is a comprehensive test that evaluates for deficiencies or insufficiencies in various nutrients. This test is a valuable option because it evaluates multiple antioxidants, vitamins, minerals, Omega-3 essential fatty acids, as well as markers that indicate the need for microbiome support. 

Hormone & Neurotransmitter Testing 

Hormone testing will give insight into whether there is dysfunction in the HPA axis. There are several options for evaluating this system, including tests that also evaluate neurotransmitters, highlighted below.

Saliva or urine hormone testing evaluates sex and adrenal hormones and the daily free cortisol pattern giving insight into the HPA axis. The test also evaluates several organic acids that provide information on the level of certain neurotransmitters. Other organic acids measured give insight into the presence of B-vitamin deficiencies and dysbiosis.

Comprehensive Blood Workup

A comprehensive blood workup, including CBC, CMP, thyroid panel, iron panel, and Vitamin D testing, will help assess overall health and rule out underlying health conditions that could be contributing to anxiety.

Let's talk bloating, shall we? 

It's that pesky discomfort that can really throw you off your game – feeling tight, full, and gassy in the belly. And about half the folks experiencing bloating also deal with a visibly swollen tummy. It is a common annoyance that often comes hand-in-hand with constipation or alternating constipation/diarrhea. But there's more to it than meets the eye.

Did you know that up to 90% of folks with irritable bowel syndrome (IBS) deal with bloating? And it's not just them – even 10-25% of otherwise healthy individuals get hit with it occasionally, with about 10% facing it regularly. Hormonal changes can stir up the bloat pot too – about 75% of women deal with it before and during their period.

Functional medicine steps in as the detective in this scenario, aiming to uncover the root cause of bloating. It's like peeling back the layers of an onion to understand why it's making you cry. Your reason for bloating might be totally different from someone else's. 

Let's dive into some common causes:

SIBO, or Small Intestinal Bacterial Overgrowth, is when there's an abnormal increase in bacteria in the small intestine. It often happens as a result of other gut issues or abdominal surgery, slowing down food and waste transit and inviting all sorts of bacteria to the party.

Then there's dysbiosis, an imbalance in the gut microbiome. This means fewer good microbes and more bad ones, thanks to things like antibiotics or high stress. It can lead to inflammation, gut wall tears, and all the bloaty feels.

Ever heard of Exocrine Pancreatic Insufficiency (EPI)? It's when your pancreas doesn't produce enough digestive enzymes, leaving food undigested and primed for bacteria to feast on, leading to more bloat.

Food sensitivities are sneaky too. Unlike allergies, sensitivities trigger a delayed immune response, often days later. The result? Inflammation and – you guessed it – bloating.

And let's not forget our hormonal friends. PMS can bring on a whole host of emotional and physical symptoms, including bloating, thanks to those monthly hormone shifts.

Functional medicine doesn't just stop at diagnosis – it's all about treatment too. From customized dietary strategies for SIBO to gut-healing protocols for dysbiosis, there are tailored approaches to help you reclaim your non-bloated self.

Testing plays a big role too. Breath tests for SIBO, stool analyses for dysbiosis, and hormone tests for PMS – they're all tools in our detective kit to crack the case of your bloating.

So, if bloating's got you feeling like you're carrying around a balloon in your belly, know this – you're not alone, and there's light at the end of the tunnel. With a bit of detective work and some functional medicine magic, that flat, non-gassy belly could be yours once again.

Functional Labs to Run for Bloating

SIBO & Carbohydrate Malabsorption

The best way to test for SIBO is through the breath since the bacterial overgrowth will produce certain gases that can be detected in the breath. We use glucose and lactulose to formally test for SIBO. 

Other substrates (fructose, sorbitol, etc) may be used to test for specific carbohydrate intolerances or malabsorption.

Dysbiosis

Stool tests such as the GI-MAP, biomesight, Dr. Data GI360 provide comprehensive analysis that measuring gastrointestinal microbiota RNA/DNA. We can evaluate various pathogens, including bacteria, yeast, viruses, and parasites. Looking deeper into the makeup of your microbiome will enable you to understand the overall balance. If sufficient diversity and beneficial microbes are present, then dysbiosis is unlikely. But, almost everyone nowadays has some degree of dysbiosis.

EIP

To diagnose pancreatic exocrine insufficiency, testing for Fecal Elastase-1 in the stool is necessary. Values under 200 are considered diagnostic for this condition. 

Food Sensitivities

There are a vast amount of food sensitivity tests available. The Cell Sciences ALCAT is unique because it measures food sensitivities and inflammation by testing for your white blood cell response to foods. This means that the only foods that will show up positive are ones that actually activate an immune response in your body. Testing this way typically reduces false positives, which significantly helps the compliance factor of an elimination diet (because fewer foods will need to be removed from the diet).

This is different than the more mainstream IgG tests which simply look for an elevation of IgG in response to foods. IgG will ALWAYS raise in response to food. That’s normal. This is why IgG food sensitivity testing has a high rate of false positives.

PMS

Because PMS is strongly related to hormonal imbalances, a thorough hormone test, like the DUTCH Cycle Mapping test, or DUTCH Complete may be warranted. DUTCH cycle mapping assesses the hormonal pattern throughout an entire menstrual cycle. This test uses dried urine, which is more valuable than a blood test that only detects levels at the moment of the blood draw. DUTCH Complete assesses your hormones and the pathways through which they are metabolized. 

Why I don't use IgG Sensitivity Testing

IgG testing is the most popularly marketed food sensitivity testing. And it also is a scam... Part of my job is to prevent you from spending money on things that won't provide you a return on your health.
The problem with IgG testing is that it assumes all IgG is pro-inflammatory. However, research clearly points out that some IgG is anti-inflammatory and protective against sensitivity. In fact the more it builds up the more protective it is. This is true for IgG4, and other types of IgG, which are still being discovered.

The pro-inflammatory activity also depends on which immune cells the IgG is binding to. IgG's job is to show the immune system the item it has found, and then the immune system can launch an attack, or a protective defence.

IgA testing has been found to be somewhat more accurate than IgG, however, we face the same problem, that many labs are not able to identify which immune cells IgA is binding to.

Unless a lab's IgG tests can differentiate between pro and anti-inflammatory IgG I won't be using it with my clients.

The argument for using testing?

Food sensitivities are mediated by IgM, IgG food antibodies and other immune cells, which usually result in a delayed symptom response to a food. Real allergies, mediated by IgE antibodies, usually result in immediate-hypersensitivity to a substance. It is generally easier for patients and clinicians to identify a food that causes an immediate response. A delayed-response to food may be more challenging to determine via elimination.

In particular food sensitivity testing would be useful for those who also have an autoimmune disease or who have neurological symptoms.  If you feel like you don't tolerate any food and you can't tell what you do or don't tolerate. 

When not to use food sensitivity tests

If financial resources are limited do not start with food sensitivity testing. Focus on stool testing, correcting the gut and microbiome and the gut barrier, which often does help reduce food sensitivities. If symptoms persist despite consistent work with the gut, then use food sensitivity testing, but be careful about the type of testing you use.

Tests that cover food AND chemical sensitivities  (my first choice if accessible)

The ALCAT Test

This testing measures the entirety of your leukocyte response to food and chemical sensitivities, which includes them binding to IgM, IgG and IgG4, among others. You can mix and match your own test choosing to test sensitivity items such as:

mold

preservatives

expanded preservatives and additives

commonly used superfoods and herbs

male herbs

female herbs

antibiotics and antiinflammatories

and from 50 to 250 foods.

This test is available in Canada

KBMO FIT Test

KBMO measures IgG antibody specifically in immune complexes with complement (which dramatically helps eliminate false positives but may have false negatives).  This one is notably less expensive but still a sizable investment.  For US based patients who can afford to do so, these are excellent choices.  (This company drop ships)

– FIT 22 $150 USD
– FIT 132 $350 USD (fingerstick or blood draw)
– FIT 176 $450 USD

This test is available in the USA