It has been described as a silent epidemic. The number of people living with anxiety has rocketed in recent years. Well before the pandemic, it seemed we were already a highly anxious nation. In 2013, there were 8.2 million cases of anxiety in the UK, with women almost twice as likely to be diagnosed with anxiety disorders as men. Now, in any given week in England, one in six people will be diagnosed with generalised anxiety disorder, according to the mental health charity Mind. It’s not just us either. In the US, up to a third of people are said to be affected by an anxiety disorder in their lifetime.
The numbers are so enormous, they can seem hard to credit. But Dr Ellen Vora, an American psychiatrist and author of a new book, The Anatomy of Anxiety, has an explanation – and it lies not in our mental wiring or genetics, but instead in our bodies. Essentially, in what we are putting into them and how we are looking after them.
It may be an unsettling thought, but what if instead of suffering from an anxiety disorder, for which the only effective remedy was medication, you were actually drinking too much caffeine? Or failing to regulate your blood sugar, get enough sleep or place sufficient boundaries between your work and home life?
These variables may sound too simple to explain the feelings of uncontrollable worry, fear or unease that plague the lives of those with anxiety. But, says Vora, they really are the root cause far more often than we might think.
This is more than just a theory: she has seen not only her patients’ mental health issues resolve after they have made some basic physical changes, but also her own.
“I do think we’ve fundamentally misunderstood mental health,” says New York-based Vora when we speak over Zoom. From being shrouded in “shame and secrecy”, mental illness has evolved to being seen as a chemical imbalance, she says. “It’s taken away that moral judgment and people really take comfort in the idea that ‘it’s my genes, it’s my brain chemistry’, [they] really like that idea and it came with this promise of ‘it’s your serotonin and therefore take this pill and you will feel better’.”
Except there is a “but”. Vora is not opposed to medication per se; she’s aware it works for some. But for others, it demonstrably doesn’t. Not only this, but it can produce what she calls “negative downstream effects”, such as problems coming off the pills once you are on them.
“I want to know the true root cause [of the anxiety], identify it and address it and then obviate the need for medication,” says Vora, who takes a functional medicine approach to mental health, considering the whole person rather than focusing on a specific symptom in isolation.
The good news is the true root cause is quite often something we can tackle: a physical trigger that activates a stress response in our body, which, Vora writes “transmits signals up to our brain telling us something is not right and our brain, in turn, offers a narrative for why we feel uneasy”.
But the real reason we feel uneasy, she argues, is a state of physiological imbalance in the body: “Something as simple as a blood sugar crash or a bout of gut inflammation.”
What we’re experiencing, in this scenario, is what Vora calls false anxiety: our modern diet and habits, or the constant stream of information and messages we’re receiving through multiple channels, can initiate the kind of stress response our ancestors might have experienced when facing a threatening wild animal. Tweak our diet and habits and we can dampen down this response and thus our anxiety, she believes.
