By symptom
Anxiety.
Some anxiety is psychological. Much of what shows up in clinic is biological with a psychological face.
What’s actually going on
How I think about this.
Anxiety that will not quit despite therapy, lifestyle work, and sometimes medication is often biology, not character. The cellular substrate that runs most of what HOMe reads shows up here too: neurotransmitter precursors running short because methylation is bogged down or B-vitamins are not being absorbed, blood sugar variability triggering an adrenaline response the patient experiences as panic, cortisol pulses misaligned to the day, gut dysbiosis disrupting the gut-brain signal that calibrates calm.
This is the unifying read across most chronic symptoms. Anxiety, sleep disruption, mood symptoms, and cognitive struggle are different surface presentations of the same underlying cellular biology. When the substrate gets better, multiple symptoms improve together. When the substrate stays stuck, no single-target intervention holds.
I want the biology read properly before anyone calls a patient resistant to treatment.
The physician’s lens
How I read this in practice.
Neurotransmitter precursors first. The methylation cycle. The B-vitamin functional markers on a metabolomic panel. Then cortisol — a four-point salivary curve, not a single AM number — because the rhythm matters more than the level. A CGM if blood sugar is plausibly part of the story. Most patients with persistent anxiety I see have at least two of these moving in a direction the standard workup has not caught.
The systems behind it
Where this symptom comes from.
Most cases touch more than one. Open each area to read the biology underneath.
Biological pillars
Pillar
Chronobiology.
Every hormone, immune function, and metabolic process runs on a circadian schedule. The disruption is measurable, and the consequences are systemic.
Read this pillarPillar
Metabolomics.
Urinary organic acids read the upstream patterns of energy production, neurotransmitter balance, detoxification, and recovery.
Read this pillarPillar
Gut-Immune health.
The microbiome runs 70% of your immune system, shapes inflammation, mood, and metabolism. Read the ecosystem directly.
Read this pillarWhat I’d test first
The data that explains it.
Anxiety that has not responded to obvious interventions usually has a metabolic, methylation, or cortisol signal underneath. I read for all three in the first workup.
Advanced testing
Metabolomix+
Reads neurotransmitter precursors, methylation function, and the B-vitamin status that drives both. The panel that catches the biological substrate of mood symptoms most workups never see.
Read the panelBlood work
Full hormone and adrenal panel
Cortisol curve across four points in the day, thyroid axis with reverse T3, and the markers that drive the stress response.
Read the panelWhile you wait
Moves worth making before testing.
These are the levers I’d pull while we set up the workup. Most of them produce real signal inside two weeks.
- Anchor your wake time within 30 minutes daily for two weeks. Cortisol curves respond to consistency faster than to any supplement.
- Cut caffeine after 10 a.m. for two weeks. Late caffeine drives evening cortisol and morning anxiety.
- Get 10 minutes of outdoor light within an hour of waking. The single highest-leverage circadian intervention available.
- If you menstruate, note when anxiety hits hardest. The cycle phase is often the strongest signal in your own data.
If two weeks of the basics doesn’t move the needle, that is exactly the kind of presentation a Precision Call exists for. Your biology is telling you something the lifestyle layer cannot fix on its own.
More reading
What I’ve written on this system.
Article
The future of precision medicine, and the role metabolomics plays in it.
Precision medicine is where the field is going. Metabolomics is one of the most important reads it brings online. Here is what is real, what is hype, and what I think a practice will look like in ten years.
Read thisArticle
Metabolomics and weight loss: finding the blockers.
When weight loss is not responding to the right inputs, the blocker is usually metabolic. A metabolomics panel surfaces the specific blocker so the intervention can match it.
Read thisArticle
Hormone imbalances, read through a metabolomics lens.
A hormone panel tells me the levels. Metabolomics tells me what the body is doing with those levels. Together they explain symptoms a hormone panel alone misses.
Read thisBrowse other symptoms
Something else on your mind?
Fatigue and low energy
When the tank stays low no matter how much you sleep.
Brain fog
The lights are on but the signal feels weak.
Poor sleep
Either you can't fall asleep, or you can't stay asleep.
Digestive issues
Bloating, irregularity, sensitivities that keep widening.
Mood and stress
Patience runs short, recovery from stress takes longer.
Hormonal imbalance
Energy, sleep, libido, and weight stop responding to the basics.
Perimenopause
The years when the body's hormonal rhythm changes, before the period stops.
Low libido
Desire that used to be reliable is gone or muted. Both sexes, both directions.
Hair loss
Thinning, shedding, or texture changes that didn't used to happen.
Erectile dysfunction
ED is the canary. The body is telling you something about vascular and hormonal health.
Weight loss resistance
You eat well, you train, the scale doesn't move. Something deeper is in the way.
High cholesterol concern
Your last lab flagged it. You want a second opinion before you take a statin.
High blood pressure concern
The reading came back elevated. You want the full picture before you start a prescription.
Insomnia
You can't get to sleep. You can't stay asleep. Or both.
Athletic recovery problems
You train hard. You don't bounce back. Something physiological is in the way.
Headaches and migraines
Recurring headache patterns the standard workup hasn't solved.
Joint pain
Pain in one joint is often a local problem. Pain that travels, or pain in multiple joints, is usually a systemic one.
Anxiety
Some anxiety is psychological. Much of what shows up in clinic is biological with a psychological face.
Acne and skin issues
The skin is rarely the problem. It is the most visible report on what is happening one layer down.
Thyroid symptoms
Cold all the time. Hair shedding. Sluggish mornings. A 'fine' TSH that explains none of it.
PMS and cycle issues
A difficult cycle is often a window into how your body handles hormones across the rest of the month.
Food cravings
Cravings are biology pulling for what it needs, often dressed up as what it can get easily.
Chronic allergies
New or worsening allergies in adulthood usually point to a barrier and an immune tone, not a specific allergen.
Start here
Want me to read your data?
A complimentary 30-minute call by phone or video with me. You tell me what is going on. I tell you how I would approach it. You decide if I am the right physician for you.