05/12/2026
Anxiety is not one thing.
It is a symptom with multiple possible biological drivers. And the reason most people spend years trying interventions that help a little but never quite get there is because the type was never identified.
Here are the four types I see most often in practice and what distinguishes them.
📌Metabolic anxiety
Worst before meals, mid-morning around 10 or 11am, and mid-to-late afternoon. Comes with physical symptoms like heart pounding, shakiness, and a sudden urgency around food. Often misidentified as generalized anxiety or panic.
The root is reactive hypoglycemia and blood sugar instability. Adrenaline releases as a counter-regulatory hormone when glucose drops, and the physiological experience of adrenaline is indistinguishable from anxiety.
📌Inflammatory anxiety
More diffuse and harder to pin to a specific time. Accompanied by brain fog, fatigue, low motivation, and a flat mood. Often co-presents with a history of gut issues, autoimmune conditions, or chronic infections.
The root is neuroinflammation driven by inflammatory cytokines crossing the blood-brain barrier and disrupting neurotransmitter synthesis and receptor function.
📌HPA-axis anxiety
Follows the cortisol curve. Highest in the morning, often with a racing mind and difficulty settling into the day. May include a secondary spike in the evening with wired-but-tired insomnia.
Driven by a dysregulated hypothalamic-pituitary-adrenal axis, often from chronic stress, poor sleep, or a history of acute stress events that altered the setpoint of the stress response system.
📌Hormonal anxiety
Cyclical and predictable in premenopausal women. Intensifies in the luteal phase, particularly the 7 to 10 days before menstruation, and at perimenopause.
Driven by estrogen fluctuations that affect GABA receptor sensitivity, serotonin synthesis, and allopregnanolone, the progesterone metabolite that acts directly on GABA-A receptors and produces a calming effect. When progesterone and allopregnanolone drop, GABA signaling drops with them.
Most people have more than one type running simultaneously. Have questions? Reach out!
