One hidden or secret link that I can promise you that 95% or more of doctors will never hear about in their careers. There is a link between your balance systems and your frontal lobe's ability to put the brakes on the anxiety signal, which means that many people with anxiety also have balance problems. And sometimes it's not just blood sugar control that we're after, but improved balance and coordination.
Hey guys, and welcome back to The Inflammation Nation, where we like to stay up to date on how science can help you craft your own wellness journey. If you haven't done it yet, take a second to hit that subscribe or follow button so that we can stay connected and you can help me reach more people with the message of science informed wellness. Today we're talking about anxiety and the hidden link with poor blood sugar control. Because right now, somewhere out there, someone is talking to a psychiatrist and
Is probably going to be handed a prescription medication for their anxiety that may have nothing to do with the root cause of their anxiety. Just to be clear, anxiety is a real complex condition. And I'm certainly not here to talk anybody out of any medical care that they actually need. But for a huge subset of people, what gets labeled as anxiety is actually a blood sugar problem wearing the cloak of anxiety. Same racing heart.
Same nervous and jittery feeling, same 3 a.m. wake up with palpitations and maybe a feeling of fear or dread, different root causes. Today we're going to walk through the physiological mechanism, connecting blood sugar crashes and anxiety, not as two separate problems that happen to show up at the same time in the same person, but as one connected feedback loop. Your blood sugar drops, your brain reads that as a crisis.
Your stress hormone spike, and that spike feels exactly like anxiety because physiologically it is. Then the anxiety changes your behavior in ways that make the next blood sugar swing even worse. The loop closes, but it's set on repeat. By the end of this episode, you'll understand why you're getting hangry instead of just hungry, why you might be waking up at one or three o'clock with your heart pounding for no reason that you can name, and why
Fixing your foundational metabolism
is a better long-term choice than masking symptoms with medications or blindly loading up on calming herbs and pounding back GADS and GADS of magnesium. The DSM V, which is the Diagnostic and Statistical Manual of Mental Disorders, is published by the American Psychiatric Association.
And it gives the standardized diagnostic criteria and the descriptive text for every recognized mental disorder. And in the latest fifth edition, they describe seven different types of anxiety. And I'll pop this up on the screen if you're watching this on YouTube.
And according to medical statistics, the most common types of anxiety are social anxiety, generalized anxiety, and panic disorders. And the most common medical treatment for these is either an SSRI drug that works on serotonin levels or an SNRI that works on norepinephrine. Both of these are neurotransmitters that are involved in different aspects of mood control in the brain, as well as many other things. And I don't want to bore you with a lot of medical detail.
But I do want you to understand a few things right off the bat. None of these diagnostic terms tell us what the problem is. Social anxiety is just anxiety in social situations. Generalized anxiety is defined as worrying about different things in life in general for more than six months at a time. And panic is anxiety that comes on suddenly and it has a peak and a crescendo and then starts to taper off. But none of them, like none of them.
Tell us what anxiety is, where it comes from, what triggers it, and what to do about it. And we could play a little game where we try to infer the root cause by what meds are commonly prescribed. But if we do that, we simply reduce anxiety to a chemical imbalance or a deficiency of serotonin or norepinephrine. And probably deficiency is a better word than an imbalance, because the assumption with these medications.
Is that these neurotransmitters, either serotonin or norepinephrine, are too low or they're deficient. And it's this deficiency that is causing the anxiety. And the goal for the treatment is the same. In fact, the letters RI in SSRI or SNRI stand for reuptake inhibitors. So an SSRI inhibits the reuptake of serotonin, and an SNRI inhibits the reuptake of norepinephrine.
And the result of this, the net result, is that there is more serotonin or more norepinephrine available to facilitate neuronal signaling in the neurological networks that control anxiety. But if anxiety was a simple deficiency of these neurotransmitters, then increasing their level should make a huge difference, which it does, but for only a small percentage of people who take these medications. According to the study,
Published in 2025 in the journal Molecular Psychiatry, more than half of people taking anti-anxiety meds have unresolved symptoms even after four years of use. And this is not the only study that shows similar results.
Studies done over shorter periods show that as much as 50% of people taking anti-anxiety meds don't get relief. And this is not a good track record, and it should tell us something very important. And that is that in most cases, the framing of anxiety as a neurotransmitter problem alone or a neurotransmitter deficiency is probably wrong.
Well, if that's wrong, what is the right way to think about anxiety?
Understand that neurotransmitters can be characterized as being either excitatory or inhibitor hi inhibitory. There's different ways to classify neurotransmitters, either by structure, by function, and so on. And they have to work in balance for your brain to function properly. So we need a balance of excitatory impulses in the brain and a balance of inhibitory impulses in the brain. And this concept is actually reflected
In current research, which now sees anxiety as a dysregulation across serotonergic, noradronergic, dopaminergic, gabergic, and glutamatergic systems. Not a single deficiency of one neurotransmitter all by itself.
But the problem here is twofold. On average, it takes about 17 years for new research to translate down into changing how doctors practice. That's the most widely quoted statistic. That means don't
expect your medical doctor to change his or her prescribing habits anytime soon. You're still going to see Zoloft and Paxil and Lexapro and Cymbalta and benzos commonly prescribe for anxiety without ever trying to find and fix the underlying mechanism.
The second problem is that medical research is actually still stuck in the neurotransmitter model. That's not entirely true because if you look in the right places, you do find research that shows how both hormonal and immune systems are involved as well. And that means at its core, anxiety is actually a dysregulation of the neuroendocrine immune supersystem. And I'll be talking about that specifically probably in the next episode. Without a doubt,
Faulty neurotransmission is a feature of anxiety as part of the neurological component. But that doesn't even scratch the surface or answer the question as to why neurotransmitters might be dysregulated to begin with. And this is the obsession of a good functional medicine practitioner asking the question what's the mechanism? Because a good functional medicine practitioner will base their diagnostics as well as their treatment protocols, and he used that term with.
Error quotations, because we have to be careful about the words that we use. But the protocols that we use should be based on what the mechanism is. They shouldn't be based on just alleviating symptomatology. So why don't we do that? Why don't we trace the mechanisms of anxiety and talk about some real practical things that you can do to improve it? I want to be careful here because this topic gets oversimplified constantly online. However,
It is deep and wide, and it's got a lot of depth and breadth. And so there's only so much that I can go into for the sake of time. And for that, we have to sacrifice a little bit of complexity and detail. But let's go ahead and build this. Let's start with core concept number one. And that is anxiety is a full-blown neuroendocrine immune integration problem. And that means that whatever you do for your anxiety has to touch on some aspect of.
your brain, your hormones, and your immune system all together. From a brain perspective, anxiety comes from a part of the brain called the amygdala. You may have heard about this before. That's actually an oversimplification because fear and anxiety and the control of that is actually part of a distributed network that spreads over multiple different brain regions. So to say it comes from one place, it's probably a little bit inaccurate. But for the sake of today, that's what we're going to go with.
I'll put this up on the screen for you visual people, but know that the amygdala is part of what we will call your primitive brain. It's actually the part of your brain that the neurological signal that we know is fear or anxiety actually is generated. But the amygdala doesn't work on its own. It's deeply tied to your autonomic system, which is why when you're anxious enough, you can see changes in your heart rate and heart rhythm, changes in breathing pattern, blood pressure, and more beyond that.
The amygdala is also tied into your immune system, where fear and anxiety tend
to create a pro-inflammatory response. Plus, it hooks directly into the hypothalamus of the brain that controls both your adrenals and your reproductive hormones, such that fear and anxiety charges up your stress hormones and actually suppresses your reproductive ones, especially estrogen and progesterone. And these relationships are bidirectional.
Such as elevated cortisol and adrenaline can sensitize the amygdala and make it more likely to activate under conditions where it would normally stay quiet. And when anxiety suppresses estrogen and progesterone, you lose the inhibitory or controlling influence of those hormones that allows you to normally control your anxiety. But control of anxiety is not just predicated on stress and reproductive hormones or your inflammatory state.
You see, when something triggers the amygdala to create a fear or anxiety response, the signal activates a second neurological pathway that turns back around and puts the brake on the fear response itself. It's actually quite an elegant design in that anxiety signal triggers its own inhibition and control. And these design features are in place to make sure that if we do get a fear response, that we have a way to control it.
And the part of the brain that is the braking system to the amygdala's accelerator is your frontal lobe. So when you get
anxious, what is supposed to happen is that your frontal lobe fires a signal down to the amygdala with an inhibitory message that helps you to control your anxiety. And while several neurotransmitters are involved with this, the final act of controlling anxiety is not tied up in serotonin or dopamine or norepinephrine.
But it's tied up in the neurotransmitter GABA. And this is where the conversation starts to pivot to something few doctors are ever going to learn in their careers. And that is the most common reason why people get anxious is the link between GABA and blood sugar control. Let me explain how this works. Core concept number two says that the brain's alarm system can't tell a threat from a sugar dip. GABA is not just GABA.
An inhibitory neurotransmitter. It's the one that does most of the calming and regulating work of the brain. About 90% of your brain is there to control the other 10% of your brain that always wants to make stuff happen. And without inhibitory control of your brain, your emotions, your hormones, your immune system run unchecked, wreaking havoc on your physiology. And GABA does most of the heavy lifting here. It's not the only inhibitory neurotransmitter, but it's certainly the most important one.
And I hate to break it to you, but many of you are making choices with your diet and your lifestyle that really are not helping you at all, and actually maybe working against the very thing that you're trying to fix. But to make these connections make sense, I have to explain a few things first. First, your brain is the most metabolically sensitive organ that you have. In fact, your brain has energy-sensing neurons in the hypothalamus.
That control things like hunger signaling so that as your fuel starts to run low, your brain senses that and creates a hunger signal so that you go eat something. During the day, your brain triggers these hunger signals to make sure that you are eating enough through the day to keep it fueled and happy, because the brain does not like being deprived of fuel. In fact, it's really bad for it. When the brain is deprived of fuel, it perceives this as a threat to its own survival.
And it has the potential to create anything from being a little hangry to a full-blown fight or flight response, spitting out large amounts of cortisol and adrenaline. Why? Because cortisol and adrenaline tell the liver to make or to release stored glucose into the bloodstream, which then makes its way to the brain. So every few hours, while you're awake and running throughout your day, you get hungry, or at least you should get hungry and not hangry.
When everything is working the way it should, you get hungry, you eat, and you stop being hungry. There's no change in function. There's no mood shift, there's no loss of focus or mental clarity, no dip in energy, and certainly no anxiety. But what happens during the day when your blood sugar drops and you ignore the signal because you're too busy at work? Well, again, if everything is working normally, it's not that big of a deal.
You get hungry during the day, you ignore the signal, you decide you're going to skip or just eat later. And your brain compensates with a small dollop of cortisol and adrenaline, just enough to get a short-term supply of glucose, and the brain is going to be happy for another few hours. Now, on a happy little side note here, the adrenaline that comes from these periodic dollops of cortisol and adrenaline that come out of the adrenal system.
can also help break down body fat, which just gives your body and brain another fuel source to use when you choose to skip or delay a meal. But what happens during the day when your brain and your body can't compensate? Because there's no guarantee that things are going to work as they're designed. What happens if you ignore the hunger signal for too long because you're really too busy to stop and eat? Or because you don't even get the hunger signal at all, especially if your brain is already not in a healthy state.
Well, what happens is that you either get a larger cortisol and adrenaline surge than you need, because your adrenal system is out of whack, or you get the right amount, but your brain is already inflamed and unhealthy, and it acts like a man when he gets a common cold. Right? Everything is exaggerated beyond reality. And even though the amount of cortisol and adrenaline produced is normal, your brain acts like it's being chased by a hungry bear.
So anxiety during the day is often triggered by low blood sugar and some combination of an abnormal adrenal response and or a pre-existing unhealthy brain. But what about anxiety at night? You know, that kind that wakes you up somewhere between one and three o'clock in the morning with that slight jittery feeling, maybe a racing heart rate or maybe some palpitations. Well, the same rules apply. Your brain is smart enough to know that it shouldn't wake you up with a hunger signal at two o'clock.
Which is roughly when your blood sugar drops for the first time while you're sleeping. So it uses the same strategy that it uses during the day when you skip a meal or ignore a hunger signal or you intentionally fast. Every few hours while you sleep, your blood sugar drops and your brain taps into the adrenals for that same cortisol and same adrenaline that it uses during the day. And depending on the situation, you s may simply wake up and be restless for a while and toss and turn and go back to sleep.
Or you may have enough cortisol and adrenaline to wake you up so that you're like wide awake and you're, I may as well go get some work done. And if things evolve past that, you may have some combination of a bad brain with an adrenal response that kicks in the racing heart, that sense of fear, or you can have an outright panic attack just sitting right there in your bed. But it's all driven by poor blood sugar control and bad energy metabolism.
So, how does all this about blood sugar and energy metabolism have anything to do with GABA, which we said is the main neurotransmitter that puts the brakes on anxiety as the frontal lobe kicks in to control stress and fear? Well, that brings us to core concept number three. GABA is produced as a byproduct of energy metabolism. Now, in past episodes, I've shared with you how we have two core energy production systems.
In the interest of time, I'm not going to launch into a mitochondrial deep dive. So here are the basics. Each
cell has hundreds to thousands of mitochondria where we can burn glucose and fats and ketones for fuel. These are different types of fuel sources.
And this aerobic system we're talking about is the most efficient energy producing system that we have. And every time we run the system, we make energy,
but we also make GABA as a byproduct of that. And this happens in the brain as well as in the body. So, from a neurotransmitter standpoint, if GABA is the most important neurotransmitter that we have that can help control anxiety, and if GABA is made as a byproduct of energy metabolism,
Why is the very first thing that your doctor thinks about is whether to give you Xanax or Paxil or Symbolta? It doesn't make sense. Why
isn't your doctor working with you to understand what's happening with your adrenal system, your blood sugar control, your hormones, your frontal lobe, and doing things to optimize energy metabolism? Now, let me take a pause here and just point out that.
it used to be the case, I don't know if it's still the case right now, but it used to be the case that GABA was the most commonly sold nutrient, if you will, consumed by healthcare consumers, as a solution for things like anxiety and insomnia. Well, that's all great and well and good, but you may have heard this before. There's this thing called the blood-brain barrier. It's
Really, the lining of the blood vessels or the capillaries that go into your brain tissue and how we deliver nutrients and so on to the brain tissues. But the GABA molecule is too big to fit through the tiny spaces of the cells that line the blood vessel. And there's no active or passive transport mechanism that allows GABA that we take by mouth to get into the brain where it can exert an inhibitory influence.
And so if somebody takes GABA by mouth and that calms them down and maybe helps them sleep better at night, it's just telling us that it's getting into the brain. And what that really says to us is that they have a leaky brain. Just like you can have a leaky gut, that is one way that we can test or look for evidence that somebody has a leaky brain. And that's a whole different conversation that we'll probably save for a different episode where we just talk about barrier systems in general. But let me get back to this question about.
Why isn't your doctor working with you to stabilize blood sugar and optimize your energy metabolism?
Looking at the image on the screen here, the central circle represents the Krebs cycle. This is happening inside the mitochondria in your brain,
and this is your aerobic system. At the three o'clock position, there on the right-hand side of that central circle, you'll see something called two-oxyglutarate. Not that you need to remember these names. But as this system works, we create two-oxyglarate and that spins off into something called glutamate. And then we take that glutamate and use an enzyme to make GABA.
Now, there's a lot of detail
and nuance here that I'm skipping because honestly, you don't really need to know any of this yourself. What you need to know is that poor blood sugar control and energy metabolism is a big player in driving anxiety because it affects how we make GABA. And if we're not making GABA efficiently, we lose the inhibitory control over things like our emotionality. Now, is this the only root cause? Of course not.
But it's the most common one we see in clinical practice. So it's the one that you need to be thinking about most if you have anxiety yourself.
And if we connect this back to what I said earlier about how the medical community is about 17 years behind current research, if you have anxiety, you have to think through
the lens of the neuroendocrine immune controls, not simply do I need an SSRI or an SNRI. We have to ask simple questions like what's going on with hormones, especially cortisol, estrogen, and progesterone? What's going on with your general inflammatory load, and maybe more specifically,
Do we see evidence of neuroinflammation in the form of depression, brain fog, and cognitive fatigue? And then we have to ask questions like how's how's my frontal lobe doing? Can I focus and concentrate? Can I make a plan and look at complex problems and make decisions and actually pull the trigger and execute them? What's your blood sugar control like? All of these are critical questions to ask if you're in a situation where.
Especially if you're taking these medications and they're not helping you. And that brings me to this end note, which I know it's going to be a little bit of a teaser for you, but this is core concept number four, and this is a secret link between anxiety and poor balance. Remember a moment ago when I told you that when your amygdala fires an anxiety response, that at the same time it fires the frontal lobe to put the brakes on the anxiety. Sometimes the anxiety
Problem is not this GABA blood sugar connection at all, but it's a lack of frontal lobe activation. And of course, they can coexist. You can have a bad frontal lobe and you can have a blood sugar issue that's affecting GABA. Well, sometimes when the amygdala puts the foot down on the accelerator, the frontal lobe doesn't hit the brakes. And in these cases, you need to train your frontal lobe. You can exercise it just like you can exercise a muscle, which is going to look different for each case. But here's
One hidden or secret link that I can promise you that 95% or more of doctors will never hear about in their careers. There is a link between your balance systems and your frontal lobe's ability to put the brakes on the anxiety signal, which means that many people with anxiety also have balance problems. And sometimes it's not just blood sugar control that we're after, but improved balance and coordination. And maybe you know you have a balance problem, maybe you don't.
Maybe it takes someone like me to come along and test your balance in specific and different ways. But I tell you that if you have anxiety and you bump into things, if you're a little clumsy, you drop stuff or knock things over, maybe you're dizzy or lightheaded. Either way, you need someone to help fix that. My first lesson in this was back in the 1990s when I was doing brain-based spinal care in the clinic.
And people started telling me that the balance exercises that I had them doing for their low back pain had reduced their anxiety too. It got me curious. And wouldn't you know it? I found some of the early research showing this connection between balance and anxiety. And if you've listened or watched to my last episode where I talked about thyroid antibodies and cross-reactivity with the cerebellum, you would remember that the cerebellum not only coordinates balance and control of movement, but it also helps.
control cognition and emotions. Not going to say that every person who has anxiety has a balance problem, but it is certainly worth looking at. So here's the takeaway that I want you to leave with. If you remember nothing else from this episode, remember this. For many of you, anxiety and blood sugar are not two separate problems taking turns showing up in your daily life. They are one feedback loop wearing two different masks. Fix the fuel supply
And a meaningful piece of the anxiety often improves with it. Not because the anxiety wasn't real, but because you finally addressed the thing that was setting it off in the first place. Beyond the blood sugar connection, you need to have someone qualified check your adrenals, check your hormones, check your frontal lobe, and check your balance systems. And this is part of a true functional medicine approach using the lens of the neuroendocrine immune supersystem. This is exactly the kind of pattern that I work through with people in my one-on-one practice.
Most of the women that I work with are dealing with more than one thing tangled together. It's blood sugar stuff and adrenal stuff and thyroid and gut and bad brains and so on. And untangling which piece is the driving factor is most of the work that I do. And it's really rarely one clean answer. And it's almost never fixed by a single supplement and certainly by biohacking. It's fixed by figuring out your actual root causes, your physiological patterns and
Building your diagnostic, diet, lifestyle, and supplement protocols around that on purpose instead of guessing and hoping that the next thing you try is the one that finally sticks. Even though I'm based in Florida, I work with people all around the world from my virtual practice, mostly women exactly having this kind of tangled chronic picture, often after they've already been through a few other doctors without clear answers, results, or hope. And if the pattern that
I described today sounds familiar. There's a contact form on my website, drnosworthy.com, where we can talk about what testing and next steps would actually make sense for you. There's also contact information in the episode description. Thanks, guys, for listening to the Inflammation Nation. Remember, put in your big rocks first. Stay rooted and grounded in the fundamentals. And I'll see you on the next episode.
