The Interconnection Between Anxiety and Inflammation

Your body has 2 major biochemical states—and the wrong one is running rampant
November 16, 2020 Updated: December 2, 2020

Dr. David Hanscom is an orthopedic surgeon who quit his practice to focus on helping teach people about nonsurgical strategies for chronic back pain. Most recently, after surviving COVID-19, he turned his attention toward raising awareness about COVID-19 prevention and how those who get infected can better survive the virus.

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 method is on strengthening immune function through stress and anxiety reduction, and he has very specific and precise recommendations on how to do that.

Stress, especially the chronic stress so common today, is closely linked to anxiety, and both can cause inflammation. Inflammation is an effective immune response for healing disease and injury but leaves the body depleted and vulnerable when it’s overactive.

The chemistry that unfolds in your body due to the stress-inflammation cycle has a profound impact on disease, pain, and your ability to feel well.

As explained by Hanscom, pain is very often a symptom of stress and anxiety. “You have to feel safe. When you feel safe, there’s a profound shift in your body’s chemistry.”

“You’re going from adrenaline, 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.”

In essence, your body has two biochemical states. One based on stress and inflammation, and one based on relaxation and recovery. The first state helps keep you alive in a crisis—but can kill you slowly if it never shuts off.

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.

“Cytokines are everywhere. Every cell in the body has cytokines. It’s how they talk to each other,” Hanscom said.

He used non-neuronal glial cells in the brain as an example. These cells don’t produce electrical impulses like neurons, but they do put out cytokines. Glial cells are responsible for helping keep a state of homeostasis, which is when your body maintains a stable state despite changes in the environment. If these cells are putting out too many inflammatory cytokines, the impact can be significant.

Endothelial cells also put out cytokines, Hanscom said. These cells line blood vessels and create a permeable barrier that’s critical to wound healing, inflammation, and the blood-brain barrier.

In short, your stress response affects your body in profound ways at the very root of its life-sustaining chemistry. Inflammation caused by stress has a foundational role in the most common diseases of our day. This is something Hanscom wants more people to understand.

“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,” Hanscom said.

“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

Your body is incredibly intricate, with complex systems managing endless functions, from turning food into cellular energy to programming disease reactions into the acquired immune system for future use against a returning pathogen.

These systems are tuned to a careful balance. They regulate how your body handles things such as organ function and metabolism. When these systems fall out of tune and become dysregulated, the consequences can be immediate and severe.

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. Inflammation is the primary way these systems become dysregulated for people today.

Just watching the news can create stress, and this stress triggers inflammation. And the biochemical processes within this stress response also create feelings.

“The threat creates a bodily response, which includes your immune system, and that sensation generated by the adrenaline and cortisol and these inflammatory cytokines, that’s the sensation of anxiety,” Hanscom said.

Because of the powerful physiological component to anxiety, Hanscom emphasizes the need for a physiological response.

“The way you decrease anxiety is simply 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.”

Much of the modern diet triggers inflammation. That’s because the chemistry of your food doesn’t register as nourishing to your body. When you eat heavily processed substances that include toxic pesticides, chemical preservatives, and flavor enhancers, your body receives them as a threat that needs dealing with.

“What happens when you’re in a constant threat, i.e., inflammation, which includes processed foods, these inflammatory cells start destroying your body,” Hanscom said. “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.”

Sometimes that threat is self-imposed. It’s a consequence of repetitive negative thoughts and skewed perspectives. In that sense, there is a mental component, but Hanscom’s point is that your common state of constant inflammation is creating a physiological—and psychological—condition.

With regard to diet, there are several reasons processed foods cause inflammation. For starters, they tend to be very high in refined carbohydrates which, when consumed in excess, causes 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 also pro-inflammatory. They also include excess sugar, which is associated with inflammatory diseases.

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,” he said.

“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

Your vagus nerve, the 10th cranial nerve, is the main part of your parasympathetic nervous system. It acts as a brake on your sympathetic nervous system. Your sympathetic nervous system is activated in response to threats, and, among other things, triggers the fight-or-flight response. Your parasympathetic nervous system is activated through the relaxation response, and is responsible for, among other things, “rest and digest” activities.

“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.”

The vagus nerve is also connected to your facial and neck muscles, which play important roles in facial expressions, a critical component of how we communicate. Hanscom said this element becomes more important amid current pandemic conditions.

“Instinctively we’re a competitive species; we want to stay alive. 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.

Coregulation refers to a psychological process that has physiological aspects. At the social level, it’s the process of being shaped by and shaping your social environment. This social process has physiological dimensions. Just as being in an angry mob can stir your fight-or-flight response, seeing a kind human face can stir your rest-and-digest response.

“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,” he said.

“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.”

“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.”

Hanscom credits much of his understanding of this process to the work of Stephen Porges. Hanscom has developed a working group that meets once a week to discuss and share information. Porges, a behavioral neuroscientist who developed polyvagal theory, and Dr. David Clawson, a podiatrist who is very knowledgeable about cytokines, are members.

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? Hanscom suggests several strategies known to do this, including the following:

Expressive Writing: Research shows expressive writing reduces viral load and inflammatory markers. How to do it: Simply write down your thoughts. Hanscom advocates tearing up the paper when you’re done.

“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,” he said.

“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: For dozens of sleep hygiene tips, see the article “Sleep — Why You Need It and 50 Ways to Improve It” at

Forgiveness Practice: The antidote to anxiety is control. If you lose control, your body secretes more stress hormones, more cytokines, triggering anger and anxiety. In a study published in the Journal of Pain in 2004, researchers linked an inability to forgive to chronic back pain.

Hanscom said most people in chronic pain have not let go of the situation that caused the problem in the first place.

“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.”

Intermittent Fasting: There are several ways to do this type of time-restricted eating. Some of the most common schedules are summarized in the article “Intermittent Fasting May Prevent Diabetes” on 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 that 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. For example, they inhibit NRLP3 inflammasome and activate NRF2.

Viruses also don’t like ketones, they like sugar, Hanscom said. Ketones can help lower viral replication. His work group has developed a nutritional protocol they believe is necessary as we face the pandemic. This protocol 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.

Other simple ways to activate your vagus nerve, thereby triggering the relaxation response and lowering inflammatory markers include: deep breathing exercises, mindfulness, meditation, relaxation, humming, calming music, and acupuncture.

More Information

To learn more, be sure to peruse Hanscom’s “Thrive and Survive” manual, available on 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 or online.

Hanscom is also in the process of releasing a subscription-based app, called DOCjourney, 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.

For more details on Hanscom’s strategies to combat pain, listen to the interview or read through the transcript at

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.” And, that 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.

Dr. Joseph Mercola is the founder of An osteopathic physician, best-selling author, and recipient of multiple awards in the field of natural health, his primary vision is to change the modern health paradigm by providing people with a valuable resource to help them take control of their health. This article was originally published on