Your Anxiety May be Biological

Our big and difficult feelings may not always be explained by a typical nervous system response to learnt patterns, triggers, perceived or actual dangers in the world (they often are so your somatic work and therapy is really important.) 

Anyone who has suffered from chronic mood disorders or sleep disruptions will know that finding solutions is long term work and most often requires the solutions to be multifactorial. 

One approach alone is rarely the whole answer for many women.

For this reason, I admire the health care professionals who provide excellent services and encourage their clients to seek help in multiple places. 

The way we feel emotionally can have biological causes, meaning our feelings can be a symptom of what is happening in our bodies. For some people, their mood may partly be a response to: 

Micronutrient deficiencies 

Our bodies require micronutrients (vitamins and minerals) to synthesis and metabolise the neurotransmitters essential for mood and sleep. Micronutrients are often described as the co-factors or raw materials involved in biologically essential processes like the production of neurotransmitters and ATP (Adenosine triphosphate - our cells main energy source) which we need to survive and to feel good.

Without sufficient raw materials, the production of energy (ATP) and neurotransmitters can be compromised.

It’s important to consider that it is not always a deficiency driving the symptoms. Sometimes having micronutrients at suboptimal or sub-functional levels is relevant.

Increased inflammation 

Systemic (let’s say peripheral or in the body) or neuro (central nervous system) inflammation can induce feelings that have been associated with depression and chronic fatigue (1),(2). Inflammation is an essential immune response but chronic stress can sometimes induce a maladaptive inflammatory response that can lead to symptoms of depression and impaired cognitive functioning(2). Microglia, the innate immune cells of the central nervous system, can become primed, over-sensitive or overactive when exposed to chronic stress or infections. In their primed or active state, they can pump out pro-inflammatory chemicals such as cytokines that can leave us with depression like symptoms and cognitive deficits (2). 

Gut dysbiosis 

The ratio of beneficial to harmful bacteria in our gut is important. If you have gut dysbiosis then the composition of your microbiome may be favouring harmful bacteria. There are many reasons we want to correct this composition, keeping in mind that there is not one microbiome profile, everyone is different. In saying this, there are strains of bacteria that have been shown to be helpful which we want present, just like there are strains that are unhelpful and we don’t want an overgrowth of these. 

The helpful bacteria in our gut are beneficial for many reasons: they help metabolise hormones, preventing them from being recycled through the body; they produce metabolites that help mitigate unwanted inflammation; they help maintain a healthy gut lining and mucosal layer. Without a healthy gut lining, pro inflammatory or unhelpful substances can pass through this permeable membrane which may contribute to systemic and neuro-inflammation which can affect mood (3).

Unrecognised or misdiagnosed neurodivergence  

While this is being corrected, there are many women who have struggled most their lives with symptoms associated with neurodivergence, without the neurodivergence itself being recognised and acknowledged. Some neurodivergent women have been misdiagnosed with depression, generalised or social anxiety, burnout, personality disorders and bi-polar disorder. 

Understanding neuro-divergence in all its beauty and challenges can really help you to understand yourself, what is going on with your brain and body and how you can adapt your life to align better with your beautiful brain and biology. Trying to fit in and produce like a neuro-typical person may not work for you and may lead to burnt out. Burnout is common and can be felt physically in many people with neurodivergent brains (4).

Unrecognised or misdiagnosed PMDD

PMDD can be described as a neuroendocrine condition. Women with PMDD respond differently to their normal hormonal fluctuations throughout the month. The results for each women may vary but for many the symptoms are devastating and impact life, work and relationships. Symptoms can include affective lability, irritability, depressed mood, anxiety, anhedonia, sense of overwhelm, difficulty concentrating, fatigue, changes in appetite or food cravings, sleep changes, and physical symptoms such as breast tenderness, bloating or headaches and suicidal ideation (5). PMDD occurs more in neurodivergent women than neurotypical women (5,6).

You may not suffer from PMDD but you may have expended an enormous amount of energy trying to understand why other people seem to manage life and social situations with much more ease than you. This in itself takes a toll.

Systemic violence and chronic stress 

Some may say this is not a biological consideration for your mood but I argue that it is and that it cannot be overlooked. The very real feelings and challenges faced by people trying to survive systemic oppression cannot be dismissed as a part of your health care plan. Our gut, immune and central nervous system all communicate and influence each other. The communication between these systems is bidirectional meaning long term stress can alter the gut microbiome and immune response just as the microbiome can alter an individuals immune and central nervous system response (or mood). Racism, sexism, discrimination and chronic stress may have implications for your health, gut health included (7,8). This needs to be acknowledged by health care providers alongside making affordable and accessible solutions available. 

This list is far from comprehensive, but as you can see there are potential biological factors contributing to your anxiety, mood or sleep disturbances. This does not mean we need to despair, this could actually be good news for someone who hasn’t yet looked into the biological reasons for their mood (brain fog, irritability, anxiety, low mood, anger and so on.) if you haven’t looked into your gut dysbiosis or the nutritional profile of your food or bloods then you could benefit hugely from investigating these. 

Having all the information is always more helpful than not. If you the have the time, money, energy and accessibility to do all the testing then your tailored health care plan may be more responsive and successful so this is always the best option. When testing, optimal or functional levels are relevant. We are not trying to diagnose and treat disease here which is what many blood tests are designed to do, we are looking for functional levels so we can feel our best. 

For the women who have such constraints on their time, energy and finances, there are some really accessible and potentially beneficial adaptations we can make to our diet and supplements to see if we can move the needle a little. 

Sometimes moving the needle a little leads to a small break through that then allows for other small breakthroughs. These can slowly add up over time so don’t underestimate your small adjustments and improvements - they are all wins in this long game.

Here are some really simple adjustments you can make to your diet:

They will hopefully help you to improve the composition of your gut microbiome and increase the raw materials you need to make the neurotransmitters that will help you to feel more like you. 

Fibre 

The fibre in our food can be wildly helpful! Fibre can help to combat the low grade systemic inflammation contributing to some peoples symptoms. Fibre feeds the microbes that help metabolise hormones; produces metabolites that combat unwanted inflammation and maintain a healthy gut lining and mucosal layer. There is a lot of talk of probiotics which are very helpful as they help seed the gut with the microbes we need. Prebiotics, some of our dietary fibres, are also incredibly helpful because they feed the useful microbes, improve the composition of our gut microbiome by diversifying and increasing the number of helpful microbes. 

If you are unsure as to whether you have been eating much fibre or not, as a general rule, highly processed foods are either low or lacking in fibre and whole foods contain the helpful fibres we are talking about: think nuts, seeds, fruit, vegetables, whole grains. 

When making big changes to your diet, it is always best to work with a health professional, increasing fibre dramatically if you haven’t been eating much fibre can cause discomfort or constipation so monitor how you are feeling and seek help from a medical professional if you have symptoms of discomfort.

Colours 

Colourful fruit and vegetables provide us with helpful phytochemicals, vitamins and minerals. Each colour has different helpful properties so eating many different colours ensures you are getting a  wide range of nutrients and phytochemicals. If you are eating a wide range of colours you will also be eating a good amount of fibre and will be feeding the microbes which could help alter the composition of your gut microbiome to one that you want. 

Fish oil

Omega 3 fatty acids have many benefits for brain health and can influence inflammation. If you can eat fatty fish regularly, this is helpful and/or supplement with a really good quality fish oil. 

Protein 

A diet sufficient in protein is highly beneficial for mood and overall health. Aiming for 30g with each meal is a rough guide remembering perfection is never the goal.

Iron

Being intentional about eating sufficient iron can be beneficial or getting your iron tested and following a supplement protocol can potentially influence mood and energy. Iron has been studied in patients with gut health issues and in patients with mood disorders. There seems to be a connection between gut dysbiosis and a loss of and/or lack of iron absorption (9). Low iron is implicated in the impaired production of neurotransmitters such as dopamine which affects mood, motivation and concentration (10). When supplementing it is best to seek medical advise, especially if you have gut health issues. For some people with chronic gut health issues, oral iron supplementation can be ineffective or harmful and your health care provider may be able to test multiple markers and recommend intravenous iron if needed (11). It is well documented that taking iron with vitamin c rich foods helps absorption just as it is important to avoid eating calcium rich foods at the time of supplementation as it affects absorption. Although I have specifically mentioned iron here it is actually really important we don’t focus too much on one particular micronutrient but try to get a sufficient amount of all our micro-nutrients. I could have just as easily focused on B vitamins, magnesium or any other micronutrient which has been studied in relation to mood and resilience. 

This is personal, this is my lived experience. I had my gallbladder removed at 16 and had chronic gut dysbiosis post op for the next 20 years which led to my mental health tanking. No amount of regular blood tests, doctors visits, specialist visits, medication, or in my case counselling would lead to any kind of break through. 

My journey back to wellness indicates that the inflammation in my body starting in my gut may have been the big player, preventing me from absorbing nutrients and functioning optimally on a biological level. My gut dybiosis resulted in my mood dropping and to regular battles with insomnia. When I healed the gut issues and improved my diet drastically, my mood and sleep altered significantly (this won’t be the case for everyone). Then at 40 I had appendicitis surgery which had a small complication and again my gut health deteriorated. With this deterioration, my mood, energy and immunity was impacted again. I went back to having chronic pain, headaches, worsened PMDD symptoms, amplified emotions, exhaustion and a base mood that was pretty low, my neurodivergence showed up more significantly meaning a lot of energy went to combating ruminating thoughts, heightened sensitivities, trying and failing to stay on top of household chores, high overwhelm, quicker to anger, tears and a sense failure. So not a lot of fun. For me, my gut health and the quality of my nutrition has been the platform from which to launch my healing journey that of course includes multiple avenues of health care.  

It is important to me that women who have major constraints on their money, time, energy, accessibility, women who face discrimination, are able to access good information and make small modifications where possible. Keep this information free for the women who need it the most and who cannot readily afford all the options available to people who are well resourced.

It can be hard to go it alone. If you are on a budget and know your neighbours, can you order foods in bulk online and share cooking and meal times? We weren't meant to be living in such isolated nuclear family scenarios - creating community where we can and sharing our burdens and joys could be a part of the solution.

I am an advocate of working with doctors and therapists and finding a therapist who can meet you in liberation, who is systems informed. 

This article is not about your therapy being ineffective or your doctors not being attentive enough. This article is about looking into your biology as a potential contributing factor for your mood or sleep disturbances. I am not a doctor, therapist or scientist and this article should be read and interpreted as it is; as someone looking for solutions in the research to their longterm health needs and sharing that information as I find it. You should always cross reference my work for yourself, do your own research and take any advice in consultation with your doctor and therapist. 

References: 

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC6658985/ Lee CH, Giuliani F. The Role of Inflammation in Depression and Fatigue. Front Immunol. 2019 Jul 19;10:1696. doi: 10.3389/fimmu.2019.01696. PMID: 31379879; PMCID: PMC6658985

2. https://pmc.ncbi.nlm.nih.gov/articles/PMC5025335/  DiSabato DJ, Quan N, Godbout JP. Neuroinflammation: the devil is in the details. J Neurochem. 2016 Oct;139 Suppl 2(Suppl 2):136-153. doi: 10.1111/jnc.13607. Epub 2016 May 4. PMID: 26990767; PMCID: PMC5025335.

3. https://pmc.ncbi.nlm.nih.gov/articles/PMC12038870/  Mehta I, Juneja K, Nimmakayala T, Bansal L, Pulekar S, Duggineni D, Ghori HK, Modi N, Younas S. Gut Microbiota and Mental Health: A Comprehensive Review of Gut-Brain Interactions in Mood Disorders. Cureus. 2025 Mar 30;17(3):e81447. doi: 10.7759/cureus.81447. PMID: 40303511; PMCID: PMC12038870.

4. https://pmc.ncbi.nlm.nih.gov/articles/PMC11733788/  Quadt L, Csecs J, Bond R, Harrison NA, Critchley HD, Davies KA, Eccles J. Childhood neurodivergent traits, inflammation and chronic disabling fatigue in adolescence: a longitudinal case-control study. BMJ Open. 2024 Jul 22;14(7):e084203. doi: 10.1136/bmjopen-2024-084203. PMID: 39038862; PMCID: PMC11733788.

5. https://pmc.ncbi.nlm.nih.gov/articles/PMC10176022/ Hantsoo L, Payne JL. Towards understanding the biology of premenstrual dysphoric disorder: From genes to GABA. Neurosci Biobehav Rev. 2023 Jun;149:105168. doi: 10.1016/j.neubiorev.2023.105168. Epub 2023 Apr 12. PMID: 37059403; PMCID: PMC10176022.

6. https://pmc.ncbi.nlm.nih.gov/articles/PMC7617793/ Broughton T, Lambert E, Wertz J, Agnew-Blais J. Increased risk of provisional premenstrual dysphoric disorder (PMDD) among females with attention-deficit hyperactivity disorder (ADHD): cross-sectional survey study. Br J Psychiatry. 2025 Jun;226(6):410-417. doi: 10.1192/bjp.2025.104. Epub 2025 Jun 18. PMID: 40528384; PMCID: PMC7617793.

7. https://pmc.ncbi.nlm.nih.gov/articles/PMC5143478/ Weber MD, Godbout JP, Sheridan JF. Repeated Social Defeat, Neuroinflammation, and Behavior: Monocytes Carry the Signal. Neuropsychopharmacology. 2017 Jan;42(1):46-61. doi: 10.1038/npp.2016.102. Epub 2016 Jun 20. PMID: 27319971; PMCID: PMC5143478.

8. https://pmc.ncbi.nlm.nih.gov/articles/PMC8264434/#s1 Westfall S, Caracci F, Estill M, Frolinger T, Shen L, Pasinetti GM. Chronic Stress-Induced Depression and Anxiety Priming Modulated by Gut-Brain-Axis Immunity. Front Immunol. 2021 Jun 24;12:670500. doi: 10.3389/fimmu.2021.670500. PMID: 34248950; PMCID: PMC8264434.

9. https://pmc.ncbi.nlm.nih.gov/articles/PMC4957448/  Martinelli M, Strisciuglio C, Alessandrella A, Rossi F, Auricchio R, Campostrini N, Girelli D, Nobili B, Staiano A, Perrotta S, Miele E. Serum Hepcidin and Iron Absorption in Paediatric Inflammatory Bowel Disease. J Crohns Colitis. 2016 May;10(5):566-74. doi: 10.1093/ecco-jcc/jjv242. Epub 2016 Jan 4. PMID: 26733407; PMCID: PMC4957448.

10. https://pmc.ncbi.nlm.nih.gov/articles/PMC4253901/ Kim J, Wessling-Resnick M. Iron and mechanisms of emotional behavior. J Nutr Biochem. 2014 Nov;25(11):1101-1107. doi: 10.1016/j.jnutbio.2014.07.003. Epub 2014 Aug 2. PMID: 25154570; PMCID: PMC4253901. 

11. https://pmc.ncbi.nlm.nih.gov/articles/PMC4957448/#s14 Martinelli M, Strisciuglio C, Alessandrella A, Rossi F, Auricchio R, Campostrini N, Girelli D, Nobili B, Staiano A, Perrotta S, Miele E. Serum Hepcidin and Iron Absorption in Paediatric Inflammatory Bowel Disease. J Crohns Colitis. 2016 May;10(5):566-74. doi: 10.1093/ecco-jcc/jjv242. Epub 2016 Jan 4. PMID: 26733407; PMCID: PMC4957448.