Hidden Causes of Anxiety: Breathing, Brain Types, and a Missing Mineral

So the first is, in patients with anxiety, what's the number one cause that I look for? Good morning, everyone. Dr. Stillman here. Welcome back for another fun and exciting episode. So today's episode, case study, hidden causes of anxiety. So a couple weeks ago in the practice, welcomed a new member, 26-year-old lawyer, Scottsdale, Arizona. He described on the call his baseline anxiety was about 2 to 3 out of 10, but feelings of anxieties would become extreme at times and he would have what he described as borderline. Panic attacks. Now, in addition to this, he has abdominal pain, bloating. He constantly sighs, has racing thoughts, poor sleep. He has chest tightness. When he's anxious, he'll get nausea. And he's just dealing with all these issues all at the same time while trying to pass the bar, right? He's noticed that some supplements he takes will take the edge off and help him sleep, but they'll still leave him feeling groggy and nothing really has moved the needle so far. So he came to us because he wanted to understand why. He and a number of other patients recently have been attracted by a case study we published where we showed A very significant aluminum and copper elimination in a boy who had OCD. So this is why we've gotten more of these cases in the practice right now. So I wanna walk you guys through the questions that I ask in a case like this that I'm expecting often to find interesting answers to, and also the things that prompt me to ask these questions and the things I look for as clues to help the patient. So the first is, in patients with anxiety, what's the number one cause that I look for? So this may surprise you. And I write about this in my book in chapter 3. It starts with this after the 14-day reset, which you can also check out at drstillmanuncensored.com. The number one thing I look for is dysfunctional breathing mechanics. Why? So dysfunctional breathing mechanics are really underappreciated both by patients and by clinicians. And there's many reasons for this that I won't get into today. But what I want you to understand about your breathing mechanics is that the more you breathe per minute, breaths per minute. And the deeper those breaths are, so the more air you're moving, the lower your CO2 levels are going to be in your body. Now, people have this idea that CO2 is a waste gas. Your cells excrete it, and then you have to breathe it out. That's really not fair to CO2 at all. CO2 is really interesting. Higher levels you'll find in highly conditioned athletes because they're used to operating at high levels due to exercise. Right now, what you'll also see Is that, and this is because of the way that CO2 works, it opens your blood vessels and it causes oxygen to leave the hemoglobin molecule where it's bound in the blood to actually be delivered to the cell. So what happens is when you end up stuck in respiratory patterns that cause you to overbreathe per minute, you wind up with low CO2 levels and then you end up feeling anxious. Why? Because your blood vessels feeding your frontal lobe constrict. And oxygen delivery drops. And what you'll see is these people all describe this similar psychological phenomenon when they're in a panic attack of sort of the world closing in on them and these overwhelming feelings, and they can't focus and they can't think and they make bad decisions and they just can't even process basic information. This happens when people are in very stressful scenarios. Like for example, you hit another car with your car, not maybe a big wreck, not even necessarily something to worry too much about, but you just bump the car and all of a sudden you're flustered, you're anxious. What's happening there is your anxiety, your stress is triggering you to hyperventilate. That's then driving your CO2 levels down. And this is having a real impact on your frontal lobe. And this is why in the military, they'll teach soldiers to control their breathing in order to improve their marksmanship under fire, because when they're in combat and they're under acute stress, what will happen is CO2 levels will drop due to hyperventilation. They'll lose their motor control or their motor control will be reduced, fine motor control specifically, and their shots will go wider than they would if they just slowed their breathing down, open those blood vessels back up and improve their frontal lobe function. This happens because the frontal lobe feeds back to the limbic system and the limbic system is really the middle of the brain. And when the frontal lobe shuts down, the limbic system becomes overactive. And that's when people really get these very intense emotional anxiety or panic attack type episodes. So I always look for this in these patients. Now in the actual visit with them, which is often on a Zoom call, usually on a Zoom call, here's what I'm looking for. Do they sigh a lot? Do they mouth breathe? Do they talk quickly? Do they breathe with their neck? And their shoulders. You'll notice this subtly. They have tension held here in their upper chest and their neck. I'll see that in the first 5 minutes and know immediately that I'm dealing with someone who's got dysfunctional breathing mechanics. And I've been called to first class in flights to talk people down from panic attacks successfully. They think they're having a heart attack. They're just breathing wrong. Might shock you. Might not seem believable. I've literally done it. I will regularly get patients in the practice who come in. I'm talking to them. Their blood pressure is high. I'll tell them to go get their cuff. We'll check it. We'll do a breathing drill. We'll drop their pressure systolic by 15, 20 points. I've done that twice in the last 30 days. I do this all the time. And one of the reasons I'm so passionate about this, as you can tell, is that patients tend to want to blow off the breathwork and they don't believe how much it's going to help them. And if you don't fix your breathing mechanics and you have dysfunctional breathing mechanics, I'm praying for you because I don't think you're going to make the progress you want. Dysfunctional breathing mechanics ruin a lot of people's hard work on their health and wellness. And if patients won't fix them, it just doesn't seem to matter what supplements or biohacks or whatever we throw at them, because fundamentally we can't overcome this effect that it has on oxygen and its delivery to cells and tissues. So That's why it's the first section in chapter 3 in my book. All right. Second question. Why do some people feel calmer in more stressful situations and anxious the rest of the time? This is a really interesting phenomenon. What did I just say earlier? I said that people will often get into a stressful situation and they'll panic. Okay. And they'll lose their ability. They'll lose their calm. They'll lose their cool and they'll start making worse decisions. Very common. But some people, feel more calm in stressful situations and they actually feel anxious when nothing is going on. These people are really interesting. They have what we call a driven brain type, and they're about 10% of the general population here in the United States. And their frontal lobe doesn't have the same level of baseline function as normal people. The other 90% of the population, they need pressure and stress to get that frontal lobe to activate, engage. These are the kids who clown around in class and then the teacher slaps them on the hand. And I guess they don't do that anymore or reprimands them or whatever. They get in trouble and all of a sudden they're focused. They're paying attention, or you put them in sports and there's a game to play. There's a goal to be scored. There's something to be won. They just light up and they're totally driven and focused. These people tend to become Let's say they go into the military. They'll tend to gravitate towards the special operations community. Very, very, very high density of driven personality types in those sorts of units. You'll also see— my wife's bringing me my tea. What will you also see these people gravitating towards? High-level executive positions. They'll be CEOs, chief technical officers, chief anything officers, C-suite executives. They'll be highly paid professionals. The kind of people who go out and become the best CPA in town, the best lawyer, the best doctor, whatever. They'll often or usually subspecialize. They'll become fascinated by a single problem and they'll just spend all their time solving it. They often become pilots. I've got a number of pilots in the practice who are like this, and I could go on, but you get the idea. They gravitate towards these more stressful situations because The stress actually paradoxically increases or activates their frontal lobe and they feel normal. And when they're not doing anything, they feel bored. And this often leaves them feeling sort of left out. Normal situations, social situations, everyone is having a good time, having polite small talk conversation, enjoying themselves. They're sitting there thinking about their next flight, their next deployment, their next move. in the boardroom, their next, you know, thing they're going to do in their professional life. These people love stress. And if they're not under it, they generally speaking go a little bit nuts. So anyway, now what ends up happening to these people is they put themselves under a lot of stress, but then often they don't fuel themselves correctly. And so they end up running out of the raw materials needed to run the frontal lobe. We'll talk more about those in a minute. And then what happens is they're putting themselves under pressure and instead of performing at a high level, They actually just end up crumbling. So you'll see this a lot in those sorts of people I just mentioned, right? They'll have a, they'll call it a midlife crisis, right? Or they'll have a nervous breakdown. A lot of the time, this is after a very intense short period of stress that's finally pushed a person who was already really running their engine at say 6,000 RPMs, pushed them to 7,000 and all of a sudden, boom, they just ran outta gas. And that's when they come to our practice and we help them. Ideally, they come to us before that and we're able to prevent that, but you know, it's just how it is sometimes. Okay. Next question. So how can improper nutrition cause anxiety in driven people? I see this all the time. So these people are driven. They want to be under stress. They enjoy stress. They're always out there doing, achieving, succeeding, doing big things, right? They're often so focused on what they're intending to do and what they love that they forget to eat. And when they do eat, they're often eating quick, fast, cheap processed food. This is a disaster for them. Why? The reason they're driven is that they tend to go through or need more stimulation to get the same dopaminergic or dopamine activity in their frontal lobe. So then what happens if they don't eat enough protein? Say they don't get enough tyrosine. What do you need tyrosine to make? Dopamine. You also need it to make then norepinephrine and epinephrine. You also need it to make thyroid hormone. Guess what thyroid hormone and dopamine do together? They light up a lot of the brain, particularly the frontal lobe, as well as the rest of your metabolism. So what happens if they don't say get enough protein and they run out of tyrosine is you'll see these levels drop. They don't drop into the basement. They gradually decline. And that's why it's usually a subjective change in function. These people don't show up in the ICU in florid myxedema coma or hypothyroidism. They're not being wheeled in on a gurney comatose because their free T3 is 0.5. No, they're just tired, stretched too thin. They break down, they get exhausted, they can't focus anymore, they can't perform. Finally, they rest. Hopefully they get enough protein and then eventually they get back in the saddle. So you have to understand, if you're a driven type person, you have to properly nourish your body. We frequently see too little protein in these patients' diets. We'll often see a big imbalance between carbohydrates and fats. More on that later. We'll almost always see a lack of critical minerals that are both essential for production of things like dopamine and thyroid hormone, but we'll also see a lack of critical vitamins as well that are necessary for these processes. And all of that is also necessary for cellular function. So even if you've got the tyrosine to make the dopamine or whatever, you don't end up having the right mix of minerals and vitamins in the cell to respond to the signal being made by the dopamine or the thyroid hormone. Hopefully that makes sense. So we see this all the time. It is one of the things we specialize in. Okay. Next question I ask in cases like this. So what mineral deficiency do I always look for in anxious patients? This is one that gets totally ignored by most people. And the first thing people will probably think if they're in the health and wellness space, when they hear anxiety and minerals, they're probably going to think of magnesium. All well and good. But here's the thing I find. Most patients coming to us have heard that magnesium is responsible for optimal sleep, for optimal mood, performance, energy. Magnesium's amazing. We use it in every patient. But guess what? Magnesium works with another element that gets forgotten a lot of the time. And that forgotten element is potassium. Why do people forget about potassium? Because potassium is dirt cheap. A bottle will last forever and you have to take crazy high quantities of it to actually make a huge impact on your daily intake. And what that translates into is no one in the supplement industry can make an enormous amount of money selling potassium. And so they don't talk about it. And because the supplement industry, for better or for worse, funds a lot of the education in the health and wellness info space, No one talks about potassium and no one knows about it. And so the overwhelming rule in the practice is that patients can come to us on magnesium and copper and manganese and zinc and iron and every other mineral in the book. But you ask them if anyone's ever talked to them about potassium and they give you this blank stare. Like, I think I've heard of it. What does it do? Why is potassium so important for anxiety? And generally speaking, in all patients. So potassium is the main intracellular cation. Or positively charged mineral. What does it do? It's responsible, or it is essential for cellular energy generation. So when patients have low potassium levels, guess what happens? Nothing works. You add dopamine to the tank, you give them thyroid hormone, you tell them to eat more protein, you send them to the gym, you have them do the EMDR and the neurofeedback and the mind-body medicine and the meditations and everything, right? If there is not enough potassium around, Mm-hmm. nothing will happen. And they will just keep struggling with their symptoms. We'll see this a lot. We'll see low hair potassium levels. We'll even see low blood potassium levels. I look for low blood potassium that's really in the lower end of the normal range. And this is why most people, or one reason why most people don't know about this potassium, the last place you're going to run out is the blood. So what ends up happening? Patients go to the doctor, they see a normal potassium level. They don't think, is this low normal or is this high normal? And lo and behold, the patient continues to struggle. Their potassium intake Their intake is low. Their cellular levels are inadequate, but their blood level is normal. Why? Because when you get hypokalemia in your blood, there's a good chance you're going to die. Another reason why people don't learn about potassium is that when you have kidney disease, and this is why it's important that you know that I'm not practicing medicine through podcast and YouTube video, you have to discuss these things with your doctor and get appropriate clinical oversight. If you have serious kidney disease and you eat too much potassium, it can also be fatal. So a lot of people don't talk about potassium. I talk about it because I see it coming up over and over and over again. And at the end of the day, it's one of the most important things that we help patients fix. I'm not going to get deeper into that today. What do we do to fix potassium? It's in my 14-Day Reset. The dietary recommendations I make there will bring someone's potassium load up from very low in many cases, up to a normal optimal level with proper execution. Of course, last thing I want to say about potassium, potassium and magnesium together run the parasympathetic nervous system. It's a lot more complicated than that, but for the sake of simplicity, they run the parasympathetic nervous system. And that means when either, let alone both magnesium and potassium are low, people will not be able to relax and get into the rest, digest, sleep mode. So I've had many patients come to me over the years, and when we get their magnesium and their potassium levels and intakes right, all of a sudden sleep, rest, digestion get to where we want them to be. It's an essential mineral. Almost no one pays enough attention to it. It's one of my favorite things to share with patients because it has such a profound impact on how they feel, function, and their clinical outcome. Okay. Next question. Are some of his daily dietary choices robbing his body of minerals? We see this all the time. So one of the things you've got to know about minerals and your diet is that the types of foods you eat are going to determine the demand of minerals on your system. So for example, if you drink a lot of soda or other carbonated beverages, beer, energy drinks, et cetera, if you eat a lot of beans, if you eat a lot of red meat, if you eat a lot of grains, so breads, cereals, pastas, those all form an acid environment in the body. Now, as that acid load rises in the body, you will see an increase in mineral losses in the urine. So I want you to imagine the patient is not getting enough of these minerals in the first place, potassium, magnesium, calcium, et cetera. Then they're eating foods that are not only relatively low in those, but they create an acidic load that pulls those minerals out through the urine. So you have inadequate input and then you have excess loss. And this is how these patients get to a place where they think I'm broken. No one can fix me. I fast and I don't feel better. I eat and I don't feel better. All I do is feel worse. What is it going to take for me to feel well? Little things like this often make all the difference. We say small hinges swing big doors. See it all the time. There's some simple swaps I share with these patients. It's why in the 14-day reset, we have root vegetables, green leafy vegetables, and then protein. So the root vegetables are not acidifying the grains and the legumes. The green leafy vegetables are very alkalizing. And then we continue to have protein in that 14-day reset diet. Why? We often end up in a scenario like this where tyrosine levels are presumably low, and if we give them more red meat protein, et cetera, they're gonna feel better because they're gonna have more tyrosine to make things like thyroid hormone and dopamine. So see it all the time. All right, next question. What mineral is often elevated in patients with anxiety, racing thoughts, and poor sleep? So I've mentioned potassium and I've talked about magnesium a little bit. We see copper elevated in patients with anxiety, racing thoughts, and poor sleep. Oh, interesting. All the time. Now you won't necessarily see an elevated copper level in the blood. In fact, that's actually rather rare. It's particularly rare in men. Where you'll find this is the hair. And it sounds strange, and most people are not aware of this, but you'll see these really incredible elevations in copper in patients with symptoms I just mentioned. Not always, but commonly. Now you'll often see that when you start to treat them, with things that compete with, interfere with, or cause the body to eliminate copper, copper levels will rise. So I've seen 10x elevations in hair copper from one quarter to another in patients who had these kinds of issues. And as they get rid of all that copper, they dump that copper. Sometimes they feel worse, but often they just see this significant improvement in their clinical issues. So it's not always there, but it is an extremely common finding. And as that copper goes up and then comes down, what we tend to see is improvement in how they feel, how they function, and the issues they came to us with. We frequently see this in patients with autoimmune or inflammatory conditions. And it's one of the reasons why serum copper is in my repair deficit panel, which is my panel that I run most accurately prognosticate how well or sick or inflamed is this patient. Because what you'll see is that as copper levels in the serum rise over a certain level, A patient's risk of death goes up. And in a certain band, which we call optimal, that's where we don't see that elevation in their risk of death. Now, there's a lot more to copper handling than that. It's not just as simple as be below a certain level, but I like to screen for this because we'll often find that patients have very high levels of copper in their blood that usually correlates with hair levels. And either way, we've gotta know if they're copper toxic before we can intelligently use copper or other minerals in order to help them heal. So, all right. I talk more about this in my book. There's a lot of case studies of copper toxicity in here with hair tests that you can actually see real results from real people. So pick up a copy if you haven't already. All right. Next question. So one thing that always comes up in young professionals is how does screen time trigger anxiety? So how does screen time trigger anxiety? Screens are one of the big things I see commonly in patients with severe anxiety. And I'm only going to go into one of the ways that I see screen time triggering anxiety. There's more in my book in chapter 4, and you should read it for that reason. But when When we're looking into screens, right? There's a lot going on. Things are constantly moving, flashing, things pass across the screen. You've experienced this, right? And all of that stimulation, what does it do? It triggers dopamine release. As this gets worse and worse, or as this becomes more and more someone's norm, they're constantly being stimulated. They tend to run out of that dopamine. Frontal lobe goes bye-bye. Limbic system gets overstimulated. Activated, they feel anxious. When you take these people and you have them put tight guardrails around their screen time, and you even change how they interact with screens, like you could add a grayscale to your screen. So it's not color. You can dim your screen or put a night mode or a filter on it. So it's less blue and green lights because blue and green light is the most activating light. It's what keeps us up at night. Right. And that's why, if you've ever noticed, right, you can scroll through your phone for hours and hours at night. But you open a book and turn on an old-fashioned incandescent warm-colored bulb and you fall asleep right away, right? It's because of the frequency of the light and the level of stimulation coming through the screen. That's all it is, right? So what happens when these people have a lot of screen time, video games, social media apps, et cetera, they end up running out of dopamine, frontal lobe goes kaput, limbic system gets upregulated or overactive activated, and they end up feeling really anxious. You get them to rest, nourish, they feel much better. I usually tell these people, try to delay your screen time or keep your screen time less stimulating early in the morning. And then completely avoid screens after dark. Sometimes dark doesn't work for them because they live in say Minnesota and it's dark when they leave work and they have to use a screen at work. If that's the case, I just try to keep the 3 to 4 hours before bed, sort of a sacred screen-free time. Work puzzles, play board games, talk to real people in your actual house or apartment, you know, read a book. These are the sorts of things I encourage patients to do because what you'll find is that if they just have a little buffer on the front and the back end of their day from their screen time, and then they ideally take some time out during the day to say, take a few 10-minute walks, that's in our 14-day reset. If they do that, a lot of their anxiety will get better without doing anything else because their brain just has more time to rest and recover. Their sleep will also be deeper because they have less stimulation prior to bed. That means that their brain is going to rest, restore, rejuvenate more deeply overnight, and they're going to feel better. Again, more on this in chapter 4, pick up a copy, read it. I strongly encourage you. Okay. What other dietary patterns do we see triggering anxiety? So aside from everything I've already mentioned, there's one more thing I want to really drive home that I see triggering anxiety in patients. So we'll often see these big imbalances in macronutrients. In patients who have anxiety. What does that mean? Proteins, fats, and carbohydrates are not balanced. Now, the balance of these macronutrients really does need to be tailored to the individual and their goals. I'm not going to tell a 26-year-old lawyer who wants to gain 20 pounds to eat the same diet as a 75-year-old lady who wants to lose 20 pounds. There's going to be similarities, but there's also going to be some key differences. But the Overwhelming pattern I see is that patients are not getting enough protein. What happens when they don't get enough protein? Protein gives us stable, sustained energy through the day. If you've ever had a glass of juice or a juice box or a sugary drink or sugary snack, and you've felt jittery or maybe just energized by it, but then you've crashed and felt shaky or tired 2, 3, 4 hours later, that often is perceived as anxiety. When you get people to add protein or adequate protein to each meal, what you'll see is they tend not to have these big fluctuations in how they feel and how they function, because the protein is a sustained source of energy. Okay. I've seen this very recently. It happens all the time. Someone's not getting enough protein at breakfast. They end up shaky in the middle of the day or the morning. They're maybe not getting enough protein at night. They're not sleeping well through the night. They're maybe not getting enough protein at lunch. They end up feeling tired or foggy or exhausted or just unable to focus in the middle of the afternoon. This really can make a huge impact. Now, the other thing we'll see is that patients are consuming a large quantity of carbohydrates. I think that probably, how shall I put it? They're consuming a large quantity of carbohydrates, often in foods they know they shouldn't be eating. But even if you're eating healthy foods, you're having a lot of fruit here or there, and you're not balancing it with proteins and fat, those people will also end up With the same problem, because the blood sugar goes up too fast and then comes back down too quickly. So I like to see moderation, reasonable portion sizes. And exactly what I usually start patients on is in the 14-Day Reset to help solve some of these issues. I also really strongly believe that patients who have anxiety should really pace their meals. I like to tell them to set a timer for their meal and they're not allowed to finish what's on their plate within 30 minutes. They want to eat for at least 30 minutes and they want to not be stimulated. No phone scrolling, no games on your phone. Just sit, relax, chew your food, focus on digesting your food, and focus on relaxing your body. You'd be shocked at what's possible when you do this. Okay. Last question. What other hidden causes of anxiety do I look for in patients? So we frequently see heavy metal levels elevated in patients with anxiety. We often don't see them on the first test. So in this particular case, I did not see a significant elevation in heavy metals, but it wouldn't surprise me if when we reconvene to go over another test in 3 months. We see that mercury, aluminum, cadmium, other heavy metals. I mentioned copper, which is a mineral, but can be a toxic mineral in that respect. I wouldn't be surprised if those levels have significantly risen in this patient's hair as the body dumps these from cells and tissues where they're creating dysfunction. I will also often see a history of a water-damaged building in these patients. They lived in a moldy this, moldy that. They had a moldy dorm room. They had a moldy office. Mold is often a problem for these patients. We have a totally different way of addressing that, but we also don't just look at the mold because almost always when you see mold, you will also see people have metal and mineral imbalances. Women, this will often come back to progesterone. So I've talked a lot about progesterone in other videos, other episodes. I won't go deep into it here. But essentially, if we can solve the reason for their low progesterone function with either bioidentical progesterone or improving their underlying physiology, their diet, et cetera, that can have a huge impact on these women as well. In other patients with, with anxiety, we'll see a history of trauma. Frequently they've had emotional abuse from narcissists and psychopaths, not always, but when that's there, you want to have an integrated approach where you are obviously not just dealing with Minerals, metals, vitamins, nutrition, you're also addressing that underlying trauma. I find that our approach works very well with something like EMDR or neurofeedback because the minerals and vitamins and dietary changes we recommend to patients help their brains work better so they can get the most out of their therapy. So that's it for today. Hope you all enjoyed that as much as I did. You can ask me questions. Link is below. If you're tired, foggy, and inflamed, and you'd like our help with your case, link is below to book a consult with a member of my team. And if There's not a link wherever you're watching this, stillmanmd.com, book a consultation. If you're a coach, practitioner, or you'd like to learn what I do and how I do it, you can train with me every week. The link's below to our private coach and practitioner community. Thanks everyone for watching me. Take care. Have a great week.