Anxiety

Anxiety is something I have struggled with myself, so the ideas I’m presenting in this post are things I have looked into to improve my own anxiety. I think these nutritional approaches are worthy of suggesting to others because many of them have helped me personally, whilst still being supported by good scientific evidence.

Everyone is different, so these are general ideas. I suggest working one to one with a Registered Nutritional Therapy Practitioner for personalised nutritional support.

The stress response

Anxiety is a natural part of the fight or flight stress response. Anxiety is designed to help us overcome or escape threat or danger and keep us safe (1). If we were being chased by a sabre tooth tiger it would be very useful to use a rush of adrenalin to run away or fight the opponent. However, anxiety can be problematic when this fight or flight response is too sensitive or activated inappropriately. If someone has a cat phobia, a harmless friendly moggy can seem like a terrifying tiger, eliciting the fear response unnecessarily.

There are many reasons why someone might struggle with anxiety or have a sensitive or activated nervous system. Some of these reasons might be due to environmental conditioning, such as previous stressful experiences. Some might be psychological, like the way we think about things or the anxiety fuelling beliefs we may have formed. These areas might be best explored with a trained psychotherapist or psychologist (2).

Some of the factors which contribute to anxiety might be physiological, and these are the things that we may be able to work on with nutritional therapy.

1. Neurotransmitters

   Neurotransmitters are the brain’s chemical messengers. There is some evidence linking anxiety disorders to imbalanced levels of particular neurotransmitters such as serotonin and GABA (3). GABA is our brain’s main calming chemical, so low levels of GABA might contribute to anxiety. Anxiety drugs like valium work by increasing GABA levels in the brain. Serotonin is known as the happy neurotransmitter, and low levels have been linked to depression and anxiety. Antidepressants supposedly work to increase serotonin levels in the brain.

   Our neurotransmitters are made partly from the foods we eat, so what we eat may have an effect on our mood. The neurotransmitters GABA and serotonin are made from amino acids from the protein we eat, so if we aren’t eating enough protein for our needs we might struggle to have adequate levels of these calming chemicals (4).

2. Gut flora

   There is a lot of research indicating that the health of our gut bacteria is also very important in the production and use of these neurotransmitters . Most of our serotonin is purportedly made in the gut, so if our gut flora is imbalanced, we may not be making adequate levels of this chemical (5). Certain strains of probiotic have been studied to show they may have a beneficial effect on depression and anxiety (6). Probiotics can be taken as a supplement, or can be found in fermented foods such as yogurt, kefir or sauerkraut. Prebiotics are the fibre rich foods which feed probiotics, such as asparagus, onions and bananas, so eating more of these can contribute to a healthy gut flora, which might contribute to better mental health (7).

3. Hormones

   Our hormones such as cortisol, insulin, thyroxine, oestrogen and progesterone are well documented for their possible effects on our mental health.

   If our thyroid is over or under active it can affect our metabolism, our weight, our energy and our mood. Hyperthyroidism can cause palpitations and anxiety (8), but hypothyroidism can contribute to depression and anxiety (9). Autoimmune thyroid conditions can sometimes contribute to or mimic conditions like manic depression due to swings in thyroid levels from hyper to hypo (10).

   Cortisol is a stress hormone which can be directly related to anxiety. If we are stressed, our body secretes the stress hormones adrenalin and cortisol to mobilise our stress response. These chemicals can give rise to symptoms of anxiety such as a racing heart, shaking, sweating, feeling like we need to go to the loo or having tunnel vision (11). One way to manage anxiety levels is to decrease the amount of adrenalin and cortisol we secrete by trying to reduce stressors in our life, practising relaxation and improving our response to stress (12).

   Insulin works in a counterbalance to cortisol, so if cortisol levels are high, insulin is lower, but if insulin is high, cortisol is lower, which is one way very low carbohydrate diets may contribute to anxiety because they can reduce our secretion of insulin but increase our secretion of cortisol (13). Personally, I found a very low carb diet made me much more anxious, partly I think because of it’s effect on stress hormones.

   However, high insulin levels might contribute to anxiety because of insulin’s role in balancing our blood sugar level. When we eat carbohydrate foods our blood sugar levels rise, and it’s insulin’s job to keep our blood sugar in a safe, healthy range (14). If we eat lots more sugar than we need, we can secrete excess insulin, which can reduce our blood sugar to a range that is too low. If our blood sugar is too low, we secrete adrenalin and cortisol to elevate it to a suitable level, which can cause anxiety symptoms such as a racing heart, shakiness, dizziness, sweating and the need to eat more carbohydrate (15).

   Thus, in my opinion, it is very important to maintain a healthy, stable, blood sugar balance by not eating too much or too little carbohydrate so our hormones are balanced and our stress hormones are not unnecessarily triggered. My experience is that balancing blood sugar is one of the most helpful aspects of nutrition in relation to anxiety.

   Imbalances in the sex hormones oestrogen or progesterone have been linked to anxiety or depression. Many women experience feeling depressed or anxious as part of pre menstrual syndrome when oestrogen levels are naturally lower (16). Oestrogen and progesterone levels are sensitive to stress, so if we are under a lot of stress our production of these sex hormones might be compromised (17). Functional testing can look in detail at whether imbalances of sex hormones might be contributing to low mood or anxiety.

4. Infection

   Interestingly there is a huge amount of current research indicating the possible role of infection in anxiety disorders, particularly OCD (18).

   There is a recognised condition in children, called PANS or PANDAS, where an infection such as strep throat can trigger severe anxiety and OCD or ticks. The theory is that it is an autoimmune condition where an infection triggers an autoimmune response to areas in the brain which are connected to anxiety, OCD or ticks (19). In my opinion, if an infection can trigger neurological autoimmunity in children it might be relevant in adults, but more research is needed in this population.

   In a client with ticks or high anxiety and OCD, I would suggest testing for stealth infections, particularly in the gut, or look at any possible nutritional or lifestyle elements which might be contributing to an inflammatory immune response.

5. Nutrient deiciencies

   Some nutrient deficiencies have been linked to depression or anxiety, because we need a variety of micronutrients in order for our brain and nervous system to function optimally.

   Omega 3 essential fatty acids are important for the proper functioning of our brain, our nervous system, our immune system and our hormones. Studies have indicated that regularly eating fatty fish or taking fish oil supplements high in the omega 3 essential fats DHA and EPA might contribute to our mental wellbeing and improvements in clinical anxiety (20).

   B vitamins are needed to synthesise serotonin and GABA, so low levels of these nutrients might contribute to higher anxiety levels (21). B6 supplementation in particular has been shown in studies to potentially improve anxiety (22). We can obtain vitamin B6 from foods such as beef liver, salmon, chicken, green leafy vegetables, chickpeas or bananas (23).

   Low levels of minerals like magnesium (24) or iron (25) have been studied in the context of anxiety, so appropriate supplementation or eating foods high in these foods might be helpful. Magnesium is rich in pumpkin seeds, green leafy vegetables like spinach, legumes, and whole grains like brown rice (26), iron is found in animal foods such as liver and read meat, or beans, nuts and dried fruit in plant foods (27) .

   Vitamin D deficiency has been shown in studies to contribute to mood disorders like depression (28). As vitamin D is predominantly synthesised via sunshine exposure, levels may be low in the winter when there is less sunlight, so appropriate supplementation might be considered (29).

Good luck with your journey towards improved mental wellbeing, I know how challenging anxiety can be.

Personally I have found working on nutritional and lifestyle components alongside psychotherapy to be the most helpful, holistic approach to improving my own anxiety.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6930825/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079864/Harvard Health Publishing. Understanding the stress response. https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response (Accessed 30th August 2023).

2. Beckers T, Hermans D, Lange I, Luyten L, Scheveneels S, Vervliet B. Understanding clinical fear and anxiety through the lens of human fear conditioning. Nature Reviews Psychology. 2023; 2: 233-245. https://www.nature.com/articles/s44159-023-00156-1

3. Nasir M, Trujillo D, Levine J, Dwyer J.B, Rupp, Z.W, Bloch M.H. Glutamate Systems in DSM-5 Anxiety Disorders: Their Role and a Review of Glutamate and GABA Pyschopharmacology. Frontiers in Psychology. 2020; 11. https://www.frontiersin.org/articles/10.3389/fpsyt.2020.548505/full

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7. Davani Davari D, Negahdaripour M, Karimzadeh I, Seifan M, Mokham M, Jalil Masoumi S, Berenjian A, Ghasemi Y. Prebiotics: Definitio, Types, Sources, Mechanisms, and Clinical Applications. Foods. 2019; 8(3):92. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463098/

8. Fukao A, Takamatsu J, Arishima T, Tanaka M, Kawai T, Okamoto Y, Miyauchi A, Imagawa A. Graves' disease and mental disorders. J Clin Transl Endocrinol. 2019;11(19):100207. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6864135/

9. Bathla M, Singh M, Relan P. Prevalence of anxiety and depressive symptoms among patients with hypothyroidism. Indian J Endocrinol Metab. 2016;20(4):468-74. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911835/

10. Barbuti M, Carvalho AF, Köhler CA, Murru A, Verdolini N, Guiso G, Samalin L, Maes M, Stubbs B, Perugi G, Vieta E, Pacchiarotti I. Thyroid autoimmunity in bipolar disorder: A systematic review. J Affect Disord. 2017;15(221):97-106. https://pubmed.ncbi.nlm.nih.gov/28641149/

11. Cay M, Ucar C, Senol D, Cevirgen F, Ozbag D, Altay Z, Yildiz S. Effect of increase in cortisol level due to stress in healthy young individuals on dynamic and static balance scores. North Clin Istanb. 2018;29;5(4):295-301. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371989/

12. Manzoni GM, Pagnini F, Castelnuovo G, Molinari E. Relaxation training for anxiety: a ten-years systematic review with meta-analysis. BMC Psychiatry. 2008;2(4)1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2427027/

13. Janssen, J.A.M.J.L. New Insights into the Role of Insulin and Hypothalamic-Pituitary-Adrenal (HPA) Axis in the Metabolic Syndrome. Int. J. Mol. Sci. 2022, 23(8178). https://www.mdpi.com/1422-0067/23/15/8178

14. The Nutrition Source. Carbohydrates and Blood Sugar. (Accessed 30th August 2023)

15. Diabetes Education Online. Blood Sugar and Stress. (Accessed 30th August 2023)

16. Walf A. A, Frye C. A. A Review ans Update of Mechanisms of Estrogen in the Hippocampus and Amygdala for Anxiety and Depression Behaviour. Neuropsychopharmacology. 2006;31(1097-1111). https://www.nature.com/articles/1301067

17. Ranabir S, Reetu K. Stress and hormones. Indian J Endocrinol Metab. 2011;15(1):18-22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079864/

18. Della Vecchia A, Marazziti D. Back to the Future: The Role of Infections in Psychopathology. Focus on OCD. Clin Neuropsychiatry. 2022 ;19(4):248-263. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9442856/

19. Cocuzza S, Maniaci A, La Mantia I, Nocera F, Caruso D, Caruso S, Iannella G, Vicini C, Privitera E, Lechien JR, Pavone P. Obsessive-Compulsive Disorder in PANS/PANDAS in Children: In Search of a Qualified Treatment-A Systematic Review and Metanalysis. Children (Basel). 2022 ; 26;9(2):155. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8869780/

20. Su KP, Tseng PT, Lin PY, Okubo R, Chen TY, Chen YW, Matsuoka YJ. Association of Use of Omega-3 Polyunsaturated Fatty Acids With Changes in Severity of Anxiety Symptoms: A Systematic Review and Meta-analysis. JAMA Netw Open. 2018; 7;1(5):e182327. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324500/

21. Calderón-Ospina CA, Nava-Mesa MO. B Vitamins in the nervous system: Current knowledge of the biochemical modes of action and synergies of thiamine, pyridoxine, and cobalamin. CNS Neurosci Ther. 2020 ;26(1):5-13.

22. Durrani D, Idrees R, Idrees H, Ellahi A. Vitamin B6: A new approach to lowering anxiety, and depression? Ann Med Surg (Lond). 2022;15;82:104663. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9577631/

23. The Nutrition Source. Vitamin B6. https://www.hsph.harvard.edu/nutritionsource/vitamin-b6/ (Accessed 30th August 203)

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25. Lee, HS., Chao, HH., Huang, WT. et al. Psychiatric disorders risk in patients with iron deficiency anemia and association with iron supplementation medications: a nationwide database analysis. BMC Psychiatry. 2020; 20(216). https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02621-0#citeas

26. National Institutes of Health. Magnesium. https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/ (Accessed 30th August 2023)

27. NHS. Iron. https://www.nhs.uk/conditions/vitamins-and-minerals/iron/ (Accessed 30th August 2023)

28. khan, B., Shafiq, H., Abbas, S. et al. Vitamin D status and its correlation to depression.Ann Gen Psychiatry. 2022; 21, 32. https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/s12991-022-00406-1#citeas

29. The Nutrition Source. Vitamin D. https://www.hsph.harvard.edu/nutritionsource/vitamin-d/ (Accessed 30th August 2030)