Anxiety - diagnosis and treatment

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Anxiety is a psychological and physiological state characterized by cognitive, somatic, emotional, and behavioural components. These components combine to create an unpleasant feeling that is typically associated with uneasiness, fear, or worry.

Anxiety is a generalized mood condition that occurs without an identifiable triggering stimulus. As such, it is distinguished from fear, which occurs in the presence of an observed threat. Additionally, fear is related to the specific behaviours of escape and avoidance, whereas anxiety is the result of threats that are perceived to be uncontrollable or unavoidable.

I believe anxiety is caused when the brain cannot resolve conflicts. It is a stress response. This results in circular thoughts so the same thing is thought over and over again.

Symptoms of anxiety

  • Feeling anxious is very unpleasant
  • Muscle tension and spasm. Muscles control all movements in the body, both conscious and unconscious. Muscle spasm in arteries can cause angina, cold hands and feet or high blood pressure. Muscle spasm in the gut can cause colic, diarrhoea or constipation. Muscle spasm in muscles causes pain and fatigue. A great many symptoms can be caused by muscle spasm.
  • Insomnia. This is a disaster and creates a vicious cycle of inability to sleep causing more anxiety. In order to sleep the brain has to be in the present. If you are thinking about the events of the previous day, or what is going to happen in the future, you will not be able to fall asleep. Often drugs are needed here to break this vicious cycle. See Sleep is vital for good health - especially in CFS

Sleep patterns help distinguish depression, anxiety and CFS

Anxiety - difficulty getting off to sleep, light sleep, easily disturbed. Depression - early morning wakening Fatigue - owls - at best in evening, go to bed late, wake late.

Often there is an element of all three! It essential that proper attention is paid to sleep - without good quality sleep on a regular basis all other interventions are to no avail. See Sleep is vital for good health - especially in CFS


Some people are born highly strung and anxious. From an evolutionary point of view this could be very helpful. The anxious man would be a light sleeper and wake at the first sign of trouble, he would jump at any slight noise and react to any danger. He would be the sentry-man alerting the tribe to danger.


Some people are anxious because they find themselves in difficult situations (financial, social, emotional or whatever) from which they seem to have no escape. This may be very understandable and amounts to fear! They must recognise that they have a problem, ask for help, make a plan and stick to it. Very often in my practice I find myself "making plans" for people who simply cannot see any way out of their situation. Nobody should be left without a "plan" for improvement, however modest that plan may be. Just having a plan, and therefore hope that things can improve, helps considerably.

Getting the stress balance right

There is a fine line between good stress and bad stress. Good stress causes excitement, bad stress causes anxiety - you can't define the stress by what it is, only by what effect it has on you. If you are feeling pessimistic or tired, what would have been a good stress becomes a bad stress. All stresses are different to all people. Everybody has to work out for themselves the sort of stresses they want in their life. Obviously personality has a large role to play here!

There are many useful psychological techniques to cope with anxiety, but it is the old story - try to address the underlying causes.

Physical causes of anxiety

  • Hypoglycaemiais the single largest trigger of anxiety. The incidence of obsessive compulsive disorder, eating disorders, psychological problems in children and anxiety are rising because of Western diets rich in sugar and refined carbohydrate. This results in a tendency to hypoglycaemia which caues adrenaline release and therefore exacerbates any underlying tendency to anxiety.

See Ketogenic diet - the practical details and Hypoglycaemia - the full story. Without full attention to this aspect of problems, all other interventions will never be curative! Please see also My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds.

  • Exercise - the right sort - having strong muscles and exercising them properly is an essential part of maintaining a steady blood sugar. Sugar is the petrol of the engine - highly necessary but highly dangerous. When blood sugar levels rise after a meal the best sponge for mopping it up is muscle glycogen. Normally this is depleted by exercise - but no exercise, glycogen remains saturated and blood sugar levels spike and the hypoglycaemia roller coaster is triggered.
  • Excessive caffeine
  • Allergies to foods - this is a greatly overlooked cause of anxiety and further good reason to eat a Ketogenic diet - the practical details. Please see also My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds.
  • Lack of sleep
  • Symptoms which cannot be explained. Depression for example is a common allergy symptom and a common symptom of nutritional deficiency. As a fellow doctor put it to me - "Mental pain is far worse than physical pain". The depressed person who can see no good reason for his/her depression will diagnose him/herself as being mad and attempt suicide. This is another good reason for the environmental approach to illness - it puts the patient back in control of his life.
  • Withdrawal symptoms or side effects of drugs: (prescribed or illicit), such as SSRIs (yes - they are addictive!), antidepressants, alcohol, tobacco, tranquillisers, cannabis etc. If drugs like Xanax are withdrawn it must be done very slowly - levels come down exponentially - that is to say, it is easy to reduce dose initially but much more difficult as you get lower.
  • Hyperventilation: this is often driven by allergies and low magnesium.

Treating anxiety

Address all the above factors. The general approach to maintaining and restoring good health

Try to work out what you are anxious about and do something positive to tackle this. Always have some plan of action. It may be a long term plan - something to look forward to in order to help the present situation. In this respect psychotherapy and counselling can be very helpful.

There are some herbal and drug preparations which may be useful, but they should not be used regularly because they become addictive. However, it can be useful to have them to hand so if an unexpected situation comes up, they can be used with confidence. This gives the sufferer the comfort of knowing that he/she can at least survive that particular situation. The more effective the drug is at doing this, the more likely it is to become addictive. Most people turn to sugar, chocolate ("comfort eating") nicotine, alcohol or cannabis, doctors prescribe tranquillisers such as diazepam (Valium). I do not mind people using these things to help them through a stressful situation so long as they stop when the stress is gone. Usually they don't! Very often people switch from one "tranquilliser" to another.

I do prescribe the tranquillisers to help anxiety problems. I would rather a patient used diazepam than alcohol because alcohol is so damaging to the liver. However I am aware that many doctors will not prescribe simply because they know they will be "blamed" if problems of dependence subsequently arise. Some patients just need the knowledge that their tranquilliser is to hand and just that prop alone may allow them to cope with a difficult situation.

The key to using tranquillisers is to save them just for the stressful situations and not use them regularly. You should have at least 3 days in every week when you do not resort to any type of tranquilliser (sugar, chocolate, nicotine, alcohol etc) - more than that and you are on the road to dependency.

Exercise is very good for anxiety for two reasons. Firstly Exercise - the right sort helps metabolically to stabilise blood sugar levels. Secondly exercise gives us an endophine buzz! There is a right balance between physical and mental exercise - preferably both. In fact some people become hooked on exercise and look forward to their daily buzz to stay healthy - this wants to be low grade exercise such as walking, swimming, gentle cycling - so that you get a buzz without wearing out muscles and joints and risking injury.

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