Anxiety has quickly been establishing itself as one of the most encountered diseases among primary care.1 40 million people in the United States alone1 are subject to bouts of general anxiety symptoms that have them calling their providers. While there are many variations upon the anxiety spectrum, general anxiety disorder (GAD) is most common among them.1,2
Anxiety sufferers might present with complaints of headache, excessive sweating and trembling, as well as manifestations of the mind including rumination of thoughts1 (repetition of the same thoughts over and over). A patient might experience irritability, muscle tension, sleep disturbances and feel easily fatigued.1 The key diagnostic indicator to GAD, however, is the level of disruption it presents to daily life. The level of anxiety, worry, and rumination prevent a client from functioning normally in the present with impaired memory and a decline in concentration.1
Causation of anxiety disorders is known to encompass many factors. It is believed that the amygdala stores stressful memories and relays information to the autonomic nervous system, signaling to a person the perception of danger or threat.1 The amygdala also stores these stress memories in preparation for the next threat when in a similar situation,1 so when a person finds themselves in a similar setting, this alone can trigger anxiety.2 In certain types of anxiety, like Post Traumatic Stress Disorder, and chronic disease states like fibromyalgia and asthma, studies have identified low cortisol and increased levels of norepinephrine and epinephrine as relevant biochemical indicators.3 Dysregulations of the adrenal glands, coping and personality styles, as well as prior history of stressful events will also have an impact on biochemistry that influences experiences of anxiety.3 As studies involving anxiety and exercise have shown, physical activity further positively affects biochemicals including serotonin and dopamine,1 neurotransmitters known for mood regulation.4,5
From a nutritional perspective, caffeine has been associated with anxiety, and alcohol has been associated with decreased levels of serotonin, glutamine, and interference with GABA receptors6, all necessary for healthy mood support. For these reasons, discontinuation of both may be an effective strategy for anxiety sufferers. Interestingly, even well-intended herbs and supplements have anxiogenic properties, demonstrating the necessity of a comprehensive evaluation before prescribing the use of supplements.7 Deficiencies in Omega 3 fatty acids, B vitamins, and folic acid have been indicated as having an increasing association with the manifestation of anxiety.1
Glucose regulation is key in managing anxiety.2 For this reason, a diet low in carbs and processed sugars like a keto diet might prove to be appropriate. A low carb diet like the keto diet puts the focus on a healthy balance of brain and nerve nourishing fatty acid intake along with carbs from fruits and vegetables, and appropriate levels of protein for amino acids which convert to neurotransmitters necessary for brain and nerve health.8
A 3 ounce serving of fish two to three times a week may improve mood.1 A 12 week study among students supplementing with EPA and DHA, which is found in fish, identified a 20% reduction in anxiety.9
14 weeks of a diet supporting a focus on vegetable intake was associated with reduced scores of depression, anger, and irritability.10 These vegetables mainly focused on non starch vegetables and green leafys and were supported by a low intake of saturated fats at the same time.
A search of 15 studies on keto diet and its effects on anxiety evidenced marked improvement of symptomatology, one animal model demonstrating changes in 3 weeks on the keto diet.11 Common drug therapies like pharmaceutical Effexor, Wellbutrin, Paxil and Prozac compound problems by having the often inconvenient side effect of weight gain.1 Known for its support of weight loss, the keto diet can be proactive on multiple levels.
A potential conflict of choosing to employ the use of the keto diet is the possible confusion that can come from unsupported theories by influencers of the keto diet, promoting harmful behaviors associated with using keto. This “dirty” version of an otherwise beneficial diet can be problematic if the client is not well educated on which version of keto mechanics are to be followed. One way to counteract this potential problem is to obtain evidence backed, trustworthy sources as the resource for questions and guidelines.
Supplements to Consider
Kava – Kava is a root herb generally recognized as safe for anxiety.1,12 The action appears to be similar to pharmaceutical benzodiazepines by blocking GABA binding sites, and by altering the limbic system, which includes the amygdala, to reduce stress response signaling by the autonomic nervous system.13 Kava also has muscle relaxant, anti convulsant, and anesthetic properties which may help support physical relaxation of the body. Dosage is 50-70mg three times a day.1
Those using sedative medications should avoid the potential over-sedation possible when combined with kava. The herb should also be avoided for those individuals with Parkinson’s disease, or in pregnant women.1
Valerian - Valerian is another botanical option for anxiety relief as a calmative appropriate for mild to moderate anxiety. Studies have shown disease of 100mg of valerian root over a period of 15 weeks was identified with reduced anxiety.1 Importantly no side effects were reported with the use of valerian in comparison to pharmaceutical interventions.14
Dosage of 300mg divided over 3 doses daily is recommended.1 Valerian takes several weeks for its benefits to be noted and thus is not suitable for short term use.1
People to Add To Your Team
An herbalist or natural practitioner trained in herbology could prove to be a beneficial partner in the reduction of anxiety if they are willing to share their methods of botany, not for the ingestion of herbs but for the beneficial effects of caring for and being in the space of plants. “Green care” has been researched well as there is increasing evidence that exposure to plants and green areas has benefits on mood and mental health.15 One Japanese study was able to show that simply viewing plants was associated with reduced muscle tension, blood pressure, and feelings of sadness, anger, and stress.15
ANMC's use of low level light therapy and infrared sauna with chromatherapy helps to previde an environment conducive to calm and relaxation, promoting a downregulated stress response. You might also want to check out Amanda's book, "Unbound" available at our office. Call 320-639-0044 with any questions.
When feelings of anxiety have generalized to encompass the every day, general anxiety strategies could be utilized alongside supportive nutrition and supplements to improve the quality of life of those that suffer. Talk with your doctor about what might be appropriate for you, as anxiety strategies are many and varied.
- Rakel D. Integrative Medicine. In: Integrative Medicine. 4th ed. Elsevier; 2018:320-333.
- Ross K. Anxiety Types of Anxiety : DSM-5. :1-20.
- Heim C, Ehlert U, Hellhammer DH. The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology. 2000;25(1):1-35. doi:10.1016/S0306-4530(99)00035-9
- Ross K, VanNortwick M, Dragone D. Innovative therapies for mood disorders: A case report. Explore. 2021;17(3):208-212. doi:10.1016/j.explore.2020.03.011
- Erickson KI, Kramer AF. Aerobic exercise effects on cognitive and neural plasticity in older adults. Br J Sports Med. 2009;43(1):22. doi:10.1136/BJSM.2008.052498
- G F Koob, A J Roberts, G Schulteis, L H Parsons, C J Heyser, P Hyytiä, E Merlo-Pich FW. Neurocircuitry Targets in Ethanol Reward and Dependence. Alcohol Clin Exp Res. Published online 1998. https://pubmed.ncbi.nlm.nih.gov/9514280/
- Mccarthy CE, Candelario DM, Liu MT. Anxiety-Inducing Dietary Supplements: A Review of Herbs and Other Supplements with Anxiogenic Properties. Pharmacol Pharm. 2014;5:966-981. doi:10.4236/pp.2014.510109
- Ross K, VanNortwick M. Managing mood-related symptoms utilizing diet, targeted nutrient supplementation, and lifestyle changes: A case series. Explore. 2021;000. doi:10.1016/j.explore.2021.09.006
- Kiecolt-Glaser JK, Belury MA, Andridge R, Malarkey WB, Glaser R. Omega-3 supplementation lowers inflammation and anxiety in medical students: a randomized controlled trial. Brain Behav Immun. 2011;25(8):1725-1734. doi:10.1016/J.BBI.2011.07.229
- Kris-Etherton PM, Petersen KS, Hibbeln JR, et al. Nutrition and behavioral health disorders: depression and anxiety. Nutr Rev. 2021;79(3):247. doi:10.1093/NUTRIT/NUAA025
- Bostock ECS, Kirkby KC, Taylor BVM. The Current Status of the Ketogenic Diet in Psychiatry. Front Psychiatry. 2017;8(MAR):1. doi:10.3389/FPSYT.2017.00043
- Marciano M, Vizniak N. Botanical Medicine. ProHealthSys
- Medicines TN. Natural Medicines Database. https://naturalmedicines-therapeuticresearch-com.scnmlib.idm.oclc.org/#A
- Shinjyo N, Waddell G, Green J. Valerian Root in Treating Sleep Problems and Associated Disorders—A Systematic Review and Meta-Analysis. J Evidence-based Integr Med. 2020;25. doi:10.1177/2515690X20967323
- Thompson R. Gardening for health: a regular dose of gardening. Clin Med (Northfield Il). 2018;18(3):201. doi:10.7861/CLINMEDICINE.18-3-201