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Anxiety


Anxiety is a feeling of worry, nervousness, or unease that everybody experiences at some point in their lifetime. If one gets severe and prolonged levels of anxiety to the point where they aren’t able to function as they normally would, they may be categorized as having an anxiety disorder.

 
  • Overview
  • Action Plan
  • Ask The Doctor
  • Read & Watch
  • Success Stories
  • See Also

Overview


Anxiety is commonly a symptom and feeling that goes along with depression, and both are quite common in the U.S., likely for a variety of reasons. The cause of anxiety in most is psychological or social in nature but can be caused, or at least influenced, by other causes such as nutritional deficiencies, drug or alcohol use, and other environmental factors. Some are more vulnerable to stressful events or situations than others, thus having a higher risk of anxiety. Interestingly, observations of dietary influence on anxiety risk reveal a pattern where those who consume a Western diet style high in refined foods and animal products have a higher risk of developing an anxiety disorder.1

 
References
  1. Jacka FN, Mykletun A, Berk M, et al. The association between habitual diet quality and the common mental disorders in community-dwelling adults: the Hordaland Health study. Psychosom Med 2011, 73:483-490.

Action Plan


Diet

  • The Nutritarian eating style, which is high in micronutrients and healthy fats, supports brain function and may reduce anxiety, as it reduces the changes of nutrient deficiencies and avoids potentially harmful foods that may negatively harm the brain.
  • In some cases, low vitamin B12 or other deficiencies may cause or worsen anxiety. The use of a multivitamin to achieve sufficient amounts of zinc, iodine, vitamin B12, magnesium, and vitamin D is important.1
  • Phytochemical-rich foods, such as greens, berries, and nuts are linked to better brain health, largely because carotenoids, flavonoids, cruciferous-derived isothiocyanates and other phytochemicals have antioxidant and anti-inflammatory effects that protect the brain. Oxidative stress and neuroinflammation are thought to contribute to anxiety and other brain disorders.2

Supplements

  • Dr. Fuhrman’s general supplement protocol for adults (see Vitamin Advisor for details) includes:
  • Additional notes:
    • Higher doses of omega-3 fatty acids (DHA and EPA) may be helpful for reducing anxiety symptoms.3
    • Certain plant extracts, such as lemon balm, passionflower, chamomile, and valerian have been studied for their ability to relieve stress or reduce anxiety symptoms.4-12
    • There is evidence L-theanine, an amino acid from green tea, helps to calm stress.13,14
    • L-tryptophan, an amino acid that is converted to serotonin and melatonin in the brain, which regulate mood and sleep, may be helpful.15

Exercise

  • Exercise has been shown to lower anxiety scores for those who engage in it regularly.16

Other Considerations

  • Therapy or counseling is an important strategy to implement while improving one’s health overall with diet and exercise to get the best results.

Read

Find additional help

ONLINE: All members of DrFuhrman.com can search the Ask the Doctor archives for discussions on this topic. Platinum and Diamond members can connect with Dr. Fuhrman by posting questions in the forum. Not a member? Join now.

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References
  1. De Souza MC, Walker AF, Robinson PA, Bolland K. A synergistic effect of a daily supplement for 1 month of 200 mg magnesium plus 50 mg vitamin B6 for the relief of anxiety-related premenstrual symptoms: a randomized, double-blind, crossover study. J Womens Health Gend Based Med 2000, 9:131-139. doi: 10.1089/152460900318623

  2. Salim S, Chugh G, Asghar M. Inflammation in anxiety. Adv Protein Chem Struct Biol 2012, 88:1-25. doi: 10.1016/B978-0-12-398314-5.00001-5

  3. Su KP, Tseng PT, Lin PY, et al. 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, 1:e182327. doi: 10.1001/jamanetworkopen.2018.2327

  4. Kennedy DO, Little W, Haskell CF, Scholey AB. Anxiolytic effects of a combination of Melissa officinalis and Valeriana officinalis during laboratory induced stress. Phytother Res 2006, 20:96-102. doi: 10.1002/ptr.1787

  5. Kennedy DO, Little W, Scholey AB. Attenuation of laboratory-induced stress in humans after acute administration of Melissa officinalis (Lemon Balm). Psychosom Med 2004, 66:607-613. doi: 10.1097/01.psy.0000132877.72833.71

  6. Kennedy DO, Wake G, Savelev S, et al. Modulation of mood and cognitive performance following acute administration of single doses of Melissa officinalis (Lemon balm) with human CNS nicotinic and muscarinic receptor-binding properties. Neuropsychopharmacology 2003, 28:1871-1881. doi: 10.1038/sj.npp.1300230

  7. Kennedy DO, Scholey AB, Tildesley NT, et al. Modulation of mood and cognitive performance following acute administration of Melissa officinalis (lemon balm). Pharmacol Biochem Behav 2002, 72:953-964. doi:

  8. Amsterdam JD, Li Y, Soeller I, et al. A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol 2009, 29:378-382. doi: 10.1097/JCP.0b013e3181ac935c

  9. Keefe JR, Guo W, Li QS, et al. An exploratory study of salivary cortisol changes during chamomile extract therapy of moderate to severe generalized anxiety disorder. J Psychiatr Res 2018, 96:189-195. doi: 10.1016/j.jpsychires.2017.10.011

  10. Mao JJ, Xie SX, Keefe JR, et al. Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial. Phytomedicine 2016, 23:1735-1742. doi: 10.1016/j.phymed.2016.10.012

  11. Akhondzadeh S, Naghavi HR, Vazirian M, et al. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther 2001, 26:363-367. doi:

  12. Miyasaka LS, Atallah AN, Soares BG. Passiflora for anxiety disorder. Cochrane Database Syst Rev 2007:CD004518. doi: 10.1002/14651858.CD004518.pub2

  13. White DJ, de Klerk S, Woods W, et al. Anti-Stress, Behavioural and Magnetoencephalography Effects of an L-Theanine-Based Nutrient Drink: A Randomised, Double-Blind, Placebo-Controlled, Crossover Trial. Nutrients 2016, 8. doi: 10.3390/nu8010053

  14. Kimura K, Ozeki M, Juneja LR, Ohira H. L-Theanine reduces psychological and physiological stress responses. Biol Psychol 2007, 74:39-45. doi: 10.1016/j.biopsycho.2006.06.006

  15. Jenkins TA, Nguyen JC, Polglaze KE, Bertrand PP. Influence of Tryptophan and Serotonin on Mood and Cognition with a Possible Role of the Gut-Brain Axis. Nutrients 2016, 8. doi: 10.3390/nu8010056

  16. Wipfli BM, Rethorst CD, Landers DM. The anxiolytic effects of exercise: a meta-analysis of randomized trials and dose-response analysis. J Sport Exerc Psychol 2008, 30:392-410. doi: 10.1123/jsep.30.4.392

Ask The Doctor


The following are sample questions from the Ask the Doctor Community Platinum and higher members can post their health questions directly to Dr. Fuhrman. (All members can browse questions and answers.)

Q.

My stress, when it gets high, turns into mild panic and does manifest as chest pain, left arm pain, increased heart rate, and all the typical symptoms related to heart disease. I’ll have chronic chest or left arm pain for months at a time, but it’s muscular, as I can push on my ribs around my heart and make the pain worse. I’ve learned to live with it for five years and combat it via meditation, breathing, and exercise. It still gets a bit unnerving. I do a thorough check up with a cardiologist every year and have a clear bill of health

Adhering to a Nutritarian diet has greatly reduced my anxiety and I do take Lexapro. Why, when I have an anxiety attack, do I get arm pain? I need some reasonable tips on how to tell the difference between anxiety and having a heart attack, and what can I do to lessen this anxiety?

There is so much information out there regarding the negative effects of stress to your heart. While my arteries are clear and will remain clear, can I also assume that a Nutritarian diet will also protect our cardiac systems from the strain we all put on our heart during high stress periods? If so, how?

A.

If you are committed to a Nutritarian diet, then you can basically forget the idea of having a heart attack. In addition to excellent nutrition and regular exercise, it could also help by optimizing those nutrients that are important for brain function, such as essential fatty acids and vitamin D. You’ve eliminated toxic substances like sugar, trans fats, additives, and hormones which negatively impact mood and brain function, so over time, you should experience less agitation and panic as your cortisol levels are lower which reduces strain on your heart. Also, I’ve seen a number of patients reduce anxiety and stress with a daily meditation practice, particularly transcendental meditation.

Panic attacks leading to anxiety can be caused by unconscious over-breathing. Read up on Buteyko Breathing, which is very effective at relieving panic and anxiety. It is an under-breathing exercise that should be done five times a day. Even better is to do them for five minutes every waking hour. It essentially is trying to maintain a mild oxygen debt by breathing more shallowly so that you remain in mild respiratory discomfort for a full five minutes.

 
Q.

I have a good friend who has a very severe anxiety problem, and he has to quit his job as he can no longer handle a lot of his daily job functions. His main symptoms are tightness in his chest and difficulty breathing. Here is a description of him and his health condition: He is a male in his early forties, height about 5’11", weight is 125 (very slim), slightly anemic, used to have low blood pressure like 80 something/60, slightly low on vitamin D, he has been a vegan for more than a decade (but not Nutritarian). His diet consists of white rice, white noodles, and vegetables, etc. He meditates a lot. He went to the ER a couple of times because of difficulty breathing. The doctor’s findings were all normal and said it is probably due to anxiety. His primary doctor also thinks it is caused by anxiety attacks. Can you please advise what he should do? Will a Nutritarian diet help his situation? Please help as he is feeling really miserable. Thank you.

A.

Without knowing your friend’s full history, here are a few thoughts: 1. A B12 deficiency can cause anxiety. I have seen at least one patient with low B12 levels have complete resolution of panic attacks after supplementation. If he is not taking B12, a methymalonic acid level will determine if he is deficient. 2. Omega-3 fatty acid deficiency is associated with depression/anxiety, and supplementing with EPA and DHA could be helpful too. 3. Vitamin D has an impact on psychological health. If his level is low, he should get safe sun exposure and probably supplement. Besides all this, a Nutritarian diet can be a major factor to help him get better too.

Of course, there are many underlying psychological reasons for prolonged anxiety. Hopefully, he has sought counseling.

 
Q.

My 13-year-old suffers from anxiety and OCD. We have tried medication (anti-depressants) in the past, but they didn’t help so we stopped them. Her symptoms seem to fluctuate and some days are better than others. I try and get her to eat a Nutritarian diet, but it is difficult because she will get candy and cookies at school.

Are there any supplements that she could take that would help with her anxiety?

A.

The junk food will only exacerbate the situation, so do what you can to help her move toward whole food. Ultimately, it has to be her decision to make the significant change, so you have to ask her if she would be willing to eat this way if her condition would improve significantly. I think it can make a world of difference, but it takes time and a change in the way the entire family eats. EPA/DHA can be beneficial. Other supplements that may help include magnesium, theanine, and lemon balm, which can usually be found in a health food store.