The Interconnectedness Between Anxiety and Inflammation

Hanscom's COVID-19 prevention focuses on strengthening immune function through stress and anxiety reduction, with very precise recommendations on how to do that

Amid COVID-19, people have felt as if under a constant threat.(shurkin_son/Shutterstock)

Dr. David Hanscom, an orthopedic surgeon whom I’ve previously interviewed about strategies for chronic back pain, quit his practice to focus on educating others on becoming pain-free without surgery. After surviving COVID-19, he turned his attention to prevention and surviving it, which is an important part of this discussion.

We’ve known for some time now that with diet, exercise, and other interventions, you can radically reduce your risk of COVID-19. The focus of Hanscom’s COVID-19 prevention is on strengthening immune function through stress and anxiety reduction, and he has very specific and precise recommendations for how to do that.

As explained by Hanscom, pain is largely a symptom of stress and anxiety, which in turn are predicated on inflammation more so than psychological factors.

“You have to feel safe. When you feel safe, there’s a profound shift in your body’s chemistry. You’re going from adrenalin, cortisol, histamines, and inflammatory cytokines to growth hormone, dopamine, serotonin, and GABA—all these incredible hormones and anti-inflammatory [compounds]. So there’s a profound shift in the body’s chemistry, and people’s pain disappears. They don’t just manage the pain. The pain disappears.”

Cytokines, Anxiety, Pain, and Poor Immune Function

Cytokines are small proteins that serve to regulate different tissues. There are both pro-inflammatory and anti-inflammatory cytokines. Cytokines have specific relevance to COVID-19, as they modulate your immune system and its function.

By reducing or resolving stress and anxiety, you lower levels of inflammatory cytokines, thereby allowing your immune system to function better. Hanscom has developed a working group that meets once a week to discuss and share information.

Other members of the group include Stephen Porges, a behavioral neuroscientist who developed Polyvagal 30, and Dr. David Clawson, a physiatrist who specializes in physical medicine and rehabilitation and who is very knowledgeable about cytokines.

Hanscom said: “Cytokines are everywhere. Every cell in the body has cytokines. It’s how [cells] talk to each other. It turns out that the glial cells in your brain, that connect the tissue of the brain, put out cytokines. So do the endothelial cells, the linings of blood vessels.

“When you have a threat—surgeons think in terms of muscle tension, sweating, and heart rate—that to us is a threat response, versus safety where you relax and regenerate. What I didn’t realize is that threat fires up the immune system, and ’threat' is all sorts of stuff. It’s viruses, bacteria, cancer cells, a bully, a difficult boss, but also your thoughts, emotions, and repressed emotions.

“Neuroscience has shown us that those thoughts and emotions are processed in the brain the same way as a physical threat. It turns out that every degenerative disease is, what Clawson says, the same soup. In other words, we know that cardiac disease, critical vascular disease, adult-onset diabetes, obesity, Parkinson’s, and Alzheimer’s are just examples of inflammatory disorders. It’s all inflammatory.”

Anxiety Is a Symptom of Inflammation

When your autonomic nervous system becomes dysregulated, you can—as Hanscom did—go from feeling fine one day to having a panic attack out of the blue the next. He explains:

“It turns out that anxiety, bipolar, depression, and schizophrenia are all inflammatory processes. It’s inflammatory. It is not psychological. Remember, anxiety is a result of a threat. [Threat] is the cause.

“The threat creates a bodily response, which includes your immune system, and that sensation generated by the adrenalin and cortisol and these inflammatory cytokines, that’s the sensation of anxiety. Since the unconscious brain processes about 20 million bits of information per second, and the conscious brain only processes 40, you can’t do it with mind over matter.

“I went to a psychiatrist for 13 years and talked and talked and talked ... but I got worse. And, see, the solution for chronic pain is actually changing your brain to go a different direction. If you talk about the problem, you’re actually reinforcing it.

“The way you decrease anxiety is simply to decrease that stress response. And you do it through direct means: mindfulness, meditation, relaxation, anti-inflammatory diet. The anti-inflammatory diet turns out to be a huge deal ... because what happens when you’re in a constant threat, i.e., inflammation, which includes processed foods, these inflammatory cells start destroying your body.

“The biggest message I want to get out there [is that] anxiety is a physiological response to a threat. Your whole body is on fire. You need to decrease anxiety, decrease cytokines, decrease that stress response. Again, if your body’s inflamed, you’re going to feel anxious.”

With regard to diet, there are several reasons why processed foods cause inflammation. For starters, they tend to be very high in refined carbohydrates which, when consumed in excess, cause insulin resistance, thereby raising inflammatory cytokine production and massively increasing your risk of COVID-19. They’re also loaded with industrially processed omega-6 vegetable oils, which are pro-inflammatory.

Lowering Inflammation Improves COVID-19 Survival

According to Hanscom, removing the threat and creating a sense of safety not only lowers inflammatory markers and eliminates pain, it also improves your immune system’s ability to respond appropriately to fight off foreign invaders, be it SARS-CoV-2 or any other pathogen.

“The virus, of course, is the threat, [and] you want your immune system to respond. A vast majority of people fight off the virus very quickly, but the elephant in the room, the obvious factor that has to be looked at, is that almost every person that dies from COVID-19 has ‘risk factors’ ... [and] every one of these risk factors has elevated inflammatory markers.”

The problem with these elevated inflammatory markers comes into focus with one of the most common causes of death for those who suffer severe COVID-19—cytokine storms. In some people, COVID triggers a rush of pro-inflammatory cytokines leading to a fatally mismanaged immune response. Hanscom said dealing with the roots of elevated inflammatory markers can alleviate this risk.

“The idea is, if you take charge of your health and lower those inflammatory markers, then we have this normal cytokine rise. In other words, the cytokines are your defense against the [virus]. We have this normal cytokine rise that stays below that threshold.

“If you hit a certain threshold, the inflammatory response becomes too strong, and you flood your lungs out. You drown in your own fluids because everything becomes inflamed. Almost every person that’s passed away from COVID-19 has had some risk factor where this inflammatory process is going out of control.”

The Vagus Nerve

As explained by Hanscom, your vagus nerve, the 10th cranial nerve which is the main part of your parasympathetic nervous system, acts as a brake on your sympathetic nervous system. Your sympathetic nervous system is activated in response to threats and is responsible for your fight-or-flight response. Your parasympathetic nervous system is activated through the relaxation response and is responsible for your rest, digest, and recovery response.

“The vagus nerve is seeing all this input, and it decides what to do with your body. There’s a direct effect on metabolism, the endocrine system, your blood sugars, the cytokines. Under threat, the parasympathetic brake comes off.”

One of the few things that can reliably tell us we are safe is the security we get from another person. Sympathetic or friendly faces have an immediate impact on our perceived security, explains Hanscom.

“When I walk up to you, I look at your facial expressions, you look at mine, and we do what’s called coregulation, which calms down the autonomic nervous system. The problem with COVID-19 is we have masks on. We can’t see each other’s faces and we’re socially isolated.”

Hanscom notes that behavioral neuroscientist Stephen Porges has pointed out that this situation dysregulates the autonomic nervous system. Amid COVID-19, people have felt as if under a constant threat.

“What happens is, when you’re under chronic threat, your immune system is fired up. Then people become socially isolated, which also fires up the immune system even more. You can’t coregulate, you’re socially isolated, your nerve conduction doubles, you feel the pain more, and when this autonomic response is sustained, there are over 30 physical symptoms that occur.

“Stress isn’t the problem. It’s this physiological response to the threat. And the way you calm down anxiety is simply drop down the body’s chemistry.”

Fortunately, there are many ways people can actively manage their biochemistry, including meditation practices that have existed for thousands of years. One of the more popular methods these days is mindfulness, the act of observing our own thoughts and feelings without judgment. This process allows us to gain awareness of, and better control over, many of the internal causes of our stress response.

“When I do mindfulness, I’m actually directly lowering cytokines. That’s not psychological, that’s a true effect on my body. Same thing with diet. When you can link things like diet, relaxation, and calming the nervous system to your inflammatory cytokines, it makes a big difference.”

How to Activate Relaxation Response and Lower Inflammation

So, just how do you activate this vagal response to induce relaxation and lower your inflammatory markers? In the interview, Hanscom reviews several strategies known to do this, including the following:

Expressive writing: According to Hanscom, there are more than 1,000 research papers showing expressive writing reduces viral load and inflammatory markers. How to do it: Simply write down your thoughts, then tear up the pages. As explained by Hanscom:

“You can’t escape your thoughts, but you can separate from them. You tear them up for two reasons. One is to write with freedom, positive or negative.

The second one, which is more important, is to not analyze these things, because they’re just thoughts. If you analyze and try to fix them, you actually reinforce them. What you’re trying to do is stimulate neuroplasticity [through] awareness, separation, then redirection.”

Quality sleep: The writing helps with going to sleep, Hanscom said, but it’s also important to get seven hours of sleep. “It’s a big deal,” he said.

Forgiveness practice: The antidote to anxiety is control. If you lose control, your body secretes more stress hormones and cytokines, triggering anger and anxiety. Knowing this is important to addressing pain control.

“They found that 90 percent of people in chronic pain have not let go of the situation that caused the problem in the first place, but interestingly enough, the person they haven’t forgiven is themselves,” Hanscom said.

“We find that in this healing process, anger and forgiveness are always a tipping point. When you’re angry or fired up, you’re in a constant threat. When you’re trapped by anything, especially chronic pain or trapped in your house from COVID, you’re frustrated. Well, that has cranked up your inflammatory cytokines.” Acceptance and forgiveness go hand-in-hand and can free you of grievances over situations you can’t change.

Intermittent fasting or time-restricted eating: There are several ways to do this. One of the easiest is simply to restrict your eating to a six-to-eight-hour window each day, making sure you eat your last meal at least three hours before bed. Research has shown time-restricted eating will significantly lower your inflammatory markers.

Exogenous ketones: While time-restricted eating and intermittent fasting will boost your ketone production, you can also use a ketone supplement. Ketones catalyze metabolic pathways that reduce inflammation.

As explained by Hanscom, viruses also don’t like ketones: They like sugar, so ketones can help lower viral replication. His workgroup has developed a nutritional protocol they believe could help solve the pandemic, as it affects every step of the viral stage.

“As far as COVID-19 is concerned, you have to take vitamin B and C. Vitamin D is a big deal. It’s the No. 1 deficiency in the world. And then you have to take zinc and magnesium just for your enzymes to work,” he said.

Activate your vagus nerve: Other simple ways to activate your vagus nerve, thereby triggering the relaxation response and lowering inflammatory markers include the following.

• Deep breathing exercises
• Mindfulness
• Melatonin
• Relaxation
• Humming
• Listening to lullabies
• Cold washcloth on your forehead
• Acupuncture

More Information

To learn more, be sure to peruse Hanscom’s “Thrive and Survive“ manual, available on BackInControl.com. There, you can also find free guides explaining expressive writing and other pain-treatment guidelines.

Hanscom is also the author of “Do You Really Need Spine Surgery?” available at your local bookstore and online.

Lastly, Hanscom is in the process of creating a subscription-based app called DOC Journey, designed to help you resolve chronic pain without surgery. DOC stands for “direct your own care.” The subscription includes virtual group coaching, live seminars, exclusive content, and more.

“The app will take you through steps of what we call sematic work of calming things down, breathing, et cetera. It’s very concise, and I think something that will be very effective,” Hanscom said.

In closing, I'd like to reiterate one of the key take-home messages Hanscom stressed in this interview, namely that “anxiety is a physiological response to a threat. If your body is inflamed, you’re going to feel anxious.” The answer, not just for anxiety, stress, and pain, but also for general immune system health, is to implement strategies that reduce your stress response, make you feel safe again, and lower inflammation.