Anxiety Five
Chronic Illness and Anxiety
I’ve addressed the trinity of illness, anxiety and intellect in Anxiety Four. In this post I want to look at the act of trying to improve the health outcomes of a chronic condition with healthy foods and supplements.
Quality of Life Trap
Some chronic conditions can be maneuvered into remission. But many more involve symptoms where improvement is unlikely. These conditions cause a loss of independence, financial instability, stresses on primary relationships, and often a lot of physical pain.
However in our culture, “I am going to beat this!” is the war cry you must convincingly utter as you suit up each morning. And there is an entire industry ready to help you go to war on yourself.
The chronically ill understandably turn the full force of their intellectual ability and focus on how to restore their health. But instead of an exercise in research, logic, analysis and action, it ends up being a covert takeover by the amygdala (more accurately the amygdalae— brain structures implicated in threat identification). This takeover reduces an already compromised quality of life even further.
In the absence of the strong emotional connection to pain, a creature might not experience sufficiently strong aversion to potential threats to ensure its survival. However, that loop can become problematic in the presence of chronic illness.
Patients with a predisposition to anxiety will experience a reinforced loop of emotional connection with overly sensitized interoceptive senses (the sense of what's going on inside the body) that leads them to see patterns where none may exist.
In my experience it is very difficult to help someone in this situation identify that the very behaviours they apply, that they are sure improve the symptoms of their chronic condition, are further reducing their overall quality of life.
Few things are harder to disentangle than an anxiety disorder enmeshed with physical illness.
Chemical Body Burden: The Siren Song of Recovering Your Health
We all have varying levels of resilience to environmental stimuli, but not everything is about the food. And even when it might be about the food (which is far more rare than we think) then it still might not be in our locus of control to manipulate its impact on our health.
Ever since the time of Kellogg, we have been entranced by the belief that everything is about the food. Yes, it all started with cornflakes. I won’t get into it here, but John Harvey Kellogg: The Religion of Biologic Living is a good place to start if you would like to know more about the water in which we swim (i.e. all the untested assumptions we make about food and health).
We likely breathe in far more heavy metals and toxins than we consume through food.[1],[2],[3],[4],[5]
If you are alive on the planet today then you are exposed to atmospheric toxins. Nonetheless, the organs most exposed to environmental transfer, the lungs and the gastrointestinal tract, also have a commensurate concentration of all our body’s natural neutralizers of things that might damage the body as a whole.
However, for those struggling with a chronic illness, finding ways to avoid ingesting heavy metals and toxins appears to be a completely logical pursuit. All the more reason to eat organic you might say?
For most, eating organic foods actually depends on a complex and opaque industrial supply chain that means the "organic" label includes a long list of allowable synthetic compounds for organic crop production. [6] Third parties conduct the annual recertification process for organic producers in the United States. The program is certainly not optimized to inhibit corruption. Also, the regulatory inspection agencies are unable to keep up to a level that can really ensure either labeling accuracy or overall safety. [7],[8]
Of course organic foods are also absorbing the same atmospheric toxins around the planet as we are. [9] The next reasonable step might be to turn to boosting the chronically burdened body with nutrients that support our body’s natural ability to neutralize toxins.
Supplements are marginally regulated in all countries with the possible exception of Germany. Adulteration and contamination are the norm, not the exception. [10]
“Due to a number of factors, potentially harmful dietary supplements reach— and often remain— in the market. DSF [dietary supplement fraud] is a type of product fraud, as is food fraud, which is often classified by the U.S. Food and Drug Administration as Economically Motivated Adulteration (EMA). Since the adulterants are unconventional, DSF may represent an even greater public health threat than traditional dietary supplement safety issues (though it is important to note that adulteration is only one type of fraud).”
Even the EU has some worrisome gaps in this area. When researchers in Finland compared patterns of food fraud and adulterations in the EU rapid alert system against Finland’s own Food Safety Authority, there were many more fraud cases of supplements found in the Finnish authority assessments than in the EU rapid alert system:
“Both in RASFF [EU Rapid Alert System for Food and Feed] fraud notifications (50%) and in local Finnish cases (88%), the majority of cases concerned food of animal origin, whereas in Evira’s [Finnish Food Safety Authority] fraud notifications food supplements dominated (44%) and food of animal origin was reported only once (2%)...Although the differences detected in patterns of fraud/adulteration cases may be a reflection of true differences in frauds on the market, it may also indicate a risk of an overly narrow scope in surveillance of frauds/adulterations at the international, national or local level.”
Unfortunately when people with both anxiety and a chronic illness recognize they cannot stop breathing; they cannot be sure of eating contaminant-free food; and they cannot rectify possible damage with contaminant-free supplementation, they can experience a combination of increased anxiety, oncoming depression and hopelessness.
Of course outright denial features prominently as well.
Doubling Down
For those in denial, more and more time will be spent reading labels and trying to deduce the relative merits of one source of food, clothing, furniture, household product and supplement over another.
Even without denial, doubling down will occur when efforts to improve symptoms don’t generate results. I have watched patients consult a who’s who list of experts and undergo every test the medical establishment can provide. They log, monitor, screen, decaffeinate, detoxify, de-stress, cleanse, fast, juice, and supplement the heck out of their chronic condition— to no avail.
Beyond the hopes that have been repeatedly dashed lies a person, and likely a family, who has lost not only what the chronic condition may have taken from them and the family, but also the additional quality of life that has been sucked into the spiral of the amygdalae check again loop. Check again, check again. “I will beat this.”
In the end all the intellect, the vastness of thought and creativity that this individual might apply absolutely anywhere, despite an indisputably limiting chronic condition, has been entirely enslaved to do the bidding of that check again loop. [13]
Those With Eating Disorders and Those Without
It is possible for anyone with a chronic condition, not just those with a predilection to be anxious due to being on the eating disorder spectrum, to be ensnared by the amygdala. Being and feeling ill is absolutely an existential threat that the threat identification system is designed to, well, identify. It is precisely why so many with chronic conditions are dismissed by the medical establishment as “just” having anxiety. Yes they are anxious, but they’re also ill and the medical establishment lacks the curiosity and sophistication to a) listen, and b) persist in trying to uncover the source(s), or c) at the very least work to alleviate symptoms with whatever off-label options might hold some promise.
And who knows whether the misidentification-of-food-as-a-threat-anxiety/phobia cycle that is an eating disorder isn’t the result of some pathogen that’s taken up residence in the body and that threat identification system is sounding an alarm? Or is that alarm being sounded a manipulated and false alarm designed to trigger food avoidance? By that I am suggesting that maybe avoiding food has some strange lifecycle benefit to a pathogen, for example, like Toxoplasmosis gondii? [14],[15],[16] T. gondii acts on neurotransmitters/hormones to change the behaviours of its host to nudge its lifecycle along. However, along with everyone else at this point, I have absolutely no idea what causes that misidentification of food as a threat.
But the bottom line is, even if the cause or causes were identified, that doesn’t mean a cure would even be likely or possible. Much as we like to think enough time and resources thrown at medical conundrums will lead to cures, there are plenty of things so complex and intertwined that any outlier possible cure is liable to just kill the patient alongside the offending cause or causes.
The reality of most chronic conditions, and in particular eating disorders, is that the check again loop doesn’t solve a thing. It hijacks everything in service of its loop: intellect, spirit, spark, creativity, a life.
I am not suggesting that anyone with a chronic illness simply grind their way through, ignoring the need for symptom alleviation and management. Just because there is no cure does not mean that the chronic illness must be accepted into your inner circle of being. It is no more core to your identity than your check again loop might be.
Other reading:
How to Be Sick, by Toni Bernhard
A Besis, C Samara, Polybrominated diphenyl ethers (PBDEs) in the indoor and outdoor environments–a review on occurrence and human exposure, Environmental Pollution, Vol.169, pp.217-229, 2012.
B Wei, Binggan, L Yang, A review of heavy metal contaminations in urban soils, urban road dusts and agricultural soils from China, Microchemical Journal, Vol.94(2), pp.99-107, 2010.
S Tong, Shilu, YE von Schirnding, T Prapamontol, Environmental lead exposure: a public health problem of global dimensions, Bulletin of the World Health Organization, Vol.78(9), pp.1068-1077, 2000.
I Pope, C Arden, MJ Thun, MM Namboodiri, DW Dockery, JS Evans, FE Speizer, DW Heath Jr., Particulate air pollution as a predictor of mortality in a prospective study of US adults, American journal of respiratory and critical care medicine, Vol.151(3-1), pp.669-674, 1995.
National List of Allowed and Prohibited Substances, UDSA.gov.
The FDA’s Insepction Problem: One Reason Our Food Supply Isn’t Safe Atlantic, 2011.
AV Roth, AA Tsay, MF Pullman, JV Gray, Unraveling the food supply chain: strategic insights from China and the 2007 Recalls*, Journal of Supply Chain Management, Vol.44(1), pp. 22-39, 2008.
BP Jackson, VF Taylor, MR Karagas, T Punshon, KL Cottingham, Arsenic, organic foods, and brown rice syrup, Environmental health perspectives. Vol.120(5), pp.623-626, 2012.
JC Moore, J Spink, M Lipp, Development and application of a database of food ingredient fraud and economically motivated adulteration from 1980 to 2010, Journal of Food Science, Vol.77(4), pp. R118-R126, 2010.
VM Wheatley, J Spink, Defining the public health threat of dietary supplement fraud, Comprehensive Reviews in Food Science and Food Safety, Vol.12(6), pp.599-613, 2013.
S Tähkäpää, R Maijala, H Korkeala, M Nevas, Patterns of food frauds and adulterations reported in the EU rapid alert system for food and feed and in Finland, Food Control, Vol.47, pp.175-184, 2015.
A Öhman, The role of the amygdala in human fear: automatic detection of threat, Psychoneuroendocrinology, Vol.30(10), pp.953-958, 2005.
Dardona Z, Amane M, Boussaa S. Toxoplasmosisrelated psychological, behavioral, neurological, and hormonal changes: a literature review. Eur J Med Health Sci. 2023;5(5):128-44.
Martinez VO, de Mendonça Lima FW, De Carvalho CF, Menezes-Filho JA. Toxoplasma gondii infection and behavioral outcomes in humans: a systematic review. Parasitology research. 2018 Oct;117:3059-65.
Daher D, Shaghlil A, Sobh E, Hamie M, Hassan ME, Moumneh MB, Itani S, El Hajj R, Tawk L, El Sabban M, El Hajj H. Comprehensive overview of Toxoplasma gondii-induced and associated diseases. Pathogens. 2021 Oct 20;10(11):1351.
