Jamie Foti contributed to this article.
Recently it seems like everyone either has anxiety or has experienced situational anxiety at some point in their life. With over 40 million Americans diagnosed with an anxiety disorder and even more experiencing bouts of anxiety, it is extremely common. The high prevalence means a high volume of anti-anxiety prescription medication like Valium, Xanax, Ativan and Klonopin that help to promote calmness. And while these drugs, coupled with therapy can be extremely useful, they are not the only effective intervention. Given that the root cause of conditions like anxiety are typically multifactorial, the best interventions are multidimensional.
Diving into possible root causes requires doing some detective work. Common causes of anxiety can include: blood sugar imbalances, gut imbalances since the majority of neurotransmitters are produced in the gut, leaky gut, genetic mutations like MTHFR and COMT, adrenal dysfunction, environmental toxins (mold, heavy metals), poor sleep, lack of movement, poor stress management, shallow breathing, nutrient deficiencies, and an inflammatory diet. A big contributor can be lifestyle changes that lead to alterations in the gut-brain communication system.
1. Check your Gut-Brain Axis
The gut and the brain are constantly chatting it up via that gut-brain axis. There are three main routes of communication: the nerve pathway, the endocrine or humoral pathway, and the immune pathway. The nerve pathway speaks to the direct influence that the gut microbiome has over neurotransmitter production and synthesis, like serotonin (5-HT), Gamma-aminobutyric acid (GABA), dopamine, norepinephrine, glutamate, and acetylcholine. Signals from the gut influence the enteric nervous system via the vagus nerve. The second is by way of the neuroendocrine pathway, which includes the hypothalamic–pituitary–adrenal (HPA) axis and is where the gut influences neuropeptide function, gut peptides and neuro-hormones like melatonin. The gut also impacts the brain through the immune pathway, regulating the function of tight junctions and the blood-brain barrier, which are important in preventing leaky gut. Leaky gut can lead to a neuro-excitatory response that stimulates levels of anxiety.
Because of this close connection between the gut and the brain, it’s important to eat like your brain and mental health depend on it, because they actually really do. There are five main protective food habits that can positively influence these three communication pathways by protecting the gut microbiota and the mucous layer which allows for the production of beneficial microbes and short chain fatty acids: probiotics, prebiotics, fermented foods, beans or legumes, and 100% whole grains (mostly gluten-free). Because of this, scientists are actively pursuing the use of diet and psychobiotics, which are supplements that contain brain-benefiting microbes, as treatments for psychiatric and behavioral disorders.
There are five factors that disrupt the normal function of the gut-brain axis when eaten in excess and these include conventionally raised meats, unhealthy fats like fried foods and trans fats, sugar, food additives, and antibiotic use. These five factors can harm the gut by leading to mucus loss, alterations in the gut and increased production of harmful substances like lipopolysaccharides (LPS) and ammonia. It can be helpful to see a functional medicine dietitian or doctor to get a stool test and better understand your microbe needs. If this is not possible then you can start by incorporating and removing the above nutrition recommendations.
2. Balance Your Meals
Tightly regulated blood sugar levels are associated with neurotransmitter production like GABA (will help calm you) and dopamine (will help motivate you). If your blood sugar levels get too low this can make you feel more anxious because it increases stress hormones like cortisol and adrenaline. This can happen if you go too long between meals before eating or if your blood sugar levels are fluctuating dramatically from high carbohydrate/sugar foods.
When you’re stressed and anxious, doesn’t it seem like your body is begging you for that warm bakery cookie or those glazed donuts hanging in the break room? You want these treats when you’re anxious because they immediately activate the reward center in your brain, causing you to feel better temporarily. However, this pleasure is short-lived, and that sugar high soon becomes a crash that leaves you feeling anxious and cranky. Unfortunately, these spikes and crashes in blood sugar cause a vicious cycle.
A case study that compared eating mostly refined carbohydrates foods to eating meals balanced with fat, protein, and carbohydrates filled with fiber demonstrated that these balanced meals control not only blood sugar, but also symptoms of anxiety. Make sure you keep all of your meals and snacks balanced throughout the day with protein, fat, and complex carbohydrates (fiber) to ensure that you don’t experience these wild blood sugar and mood swings.
3. Supplement with Magnesium
Magnesium is a wonder mineral, involved in over 300 biochemical reactions within your body. Though it is so important, with the increase in processed foods and the reduction in soil quality, at least 50% of Americans are now magnesium deficient. This deficiency presents a problem since magnesium plays a large role in keeping the parasympathetic nervous system (rest or digest) activated. When this part of your nervous system is unable to stay activated, your fight or flight system takes over, keeping your stress levels, cortisol levels and anxiety high. Furthermore, magnesium is important in producing the neurotransmitters that regulate your mood. Supplementing with magnesium has shown to be an effective treatment for anxiety in research. To best lower your levels of anxiety, take Magnesium Glycinate before bed, up to 300mg per night. I recommend Magnesium Glycinate by Pure Encapsulations or Magnesium Citrate if you experience constipation.
4. Get Genetic Testing for MTHFR and COMT
The MTHFR gene is key in the processes of making neurotransmitters like serotonin and dopamine that play such a large role in levels of anxiety. Because of its connection to these neurotransmitters, a MTHFR gene mutation has been linked to symptoms of anxiety. That may be largely because this mutation affects how you activate vitamin B6, B9 and B12. Because of that you will want to eat lots of green, leafy vegetables for their folate content and supplement with a methylated b-complex vitamin. However, make sure you do this with a functional medicine dietitian or doctor so they can help with the correct dosing.
The COMT gene is responsible for cleaning up the dopamine in your brain. If you have a mutation that makes your COMT gene sluggish, you will have an accumulation of dopamine in your brain. While this may not sound bad since dopamine is tied to good mood, too much of a good thing can be harmful. This excess dopamine will keep you wired and increase your levels of anxiety. If you have this genetic SNP–single nucleotide polymorphism–otherwise known as a mutation, try to avoid caffeine, supplement with magnesium, and experiment with calming herbs such as holy basil.
5. Limit Caffeine
Caffeine is a huge trigger of anxiety, especially for those that are slow caffeine metabolizers. You can determine whether you are a fast or slow caffeine metabolizer through a genetics test, looking at the CYP1A2. But you may already know whether you are based on your response to drinking a big cup of coffee–can you fall asleep right after or would you be awake for hours on end? Caffeine can increase feelings of anxiety however, even if you are a fast caffeine metabolizer. Caffeine increases the amount of cortisol running through your veins, prompting your body to think you are in a state of stress. This release is seen in increased caffeine sensitivity and worse feelings of anxiety throughout patients who suffer from anxiety disorders. If you struggle with anxiety, try to keep your intake minimal by swapping out coffee for green tea or, even better, cutting it out cold turkey. See more on the subject of coffee and matcha green tea here.
6. Limit Alcohol
Alcohol is a strange player in anxiety because it reduces symptoms of anxiety at first by enhancing GABA production in the brain like many anti-anxiety drugs. However, these effects are short-lived and alcohol actually worsens anxiety the more you drink. This feeling of immediate anxiety relief followed by worsened anxiety after can create a vicious cycle in which one keeps drinking to calm the anxiety produced from drinking. Drinking can also impair short and long term serotonin production, increasing anxious feelings. Finally, drinking disrupts your sleep cycles, and even short-term sleep deprivation can increase depressive and anxious feelings. To keep your anxiety to a minimum, limit your alcohol consumption to one to two drinks less than twice per week. You will likely notice significant improvements in your anxiety if you consistently wrap your evening with a warm cup of bedtime tea, a book or other non-blue light stimulating activity and an early bedtime.
7. Practice Yoga & Breathwork
There are few activities that are as healing and calming as practicing yoga. Yoga has saved my life on many occasions and has given me the tools to go inwards and relieve any anxiousness. Read more in my reflection of my yoga teacher training here. If you show up consistently and put in the work, yoga works miracles.
First, yoga reduces the impact of stress on your body, even decreasing the physiological symptoms of stress such as high blood pressure and heart rate. A study on yoga and anxiety found that even just attending ten classes had a significant impact on participants’ anxiety and perceived quality of life. Yoga also forces participants to focus on their breathing which is one of the most powerful tools for calming the nervous system. Try to incorporate at least one yoga session into your weekly workouts to start experiencing some of these benefits.
8. Consider Adding Lavela
Lavela is a lavender supplement that can work wonders in treating anxiety. I have been recommending this product to patients for a number of years and have seen significant improvements in people’s ability to handle stress and/or stressors. This can even include test taking and other anxiety provoking tasks! In a study comparing the anxiety drug Lorazepam and lavender supplements, the lavender was proven to be just as effective as the drug. Even better, the lavender supplements didn’t give participants the same sedative effects as the Lorazepam did. I recommend Lavela by Integrative Therapeutics. In order to get 15% off of Lavela and all supplements, you can create an account with my supplement store website.
9. Chill Out with Ashwagandha
Ashwaghanda is a powerful adaptogen, used for centuries to treat anxiety, help reduce stress, and improve feelings of fatigue. It accomplishes these tasks through its ability to help calm the central nervous system, which is responsible for interpreting and signaling events as stressful. A review of five studies showed that all found this adaptogen to be more effective, when compared to a placebo, in reducing anxiety. Furthermore, ashwagandha can reduce serum cortisol levels which are closely tied to developing anxious and depressive feelings. Adaptogens like ashwagandha are found in capsule or powder form and can be swallowed or added to smoothies and other foods.
10. Considering Trying CBD Oil
CBD is the new buzzy product and for good reason. It is the extract of the hemp plant that is known to have a calming effect. A review of studies on the extract found that it displayed a clear effect in reducing anxiety. Furthermore, CBD oil can calm the central nervous system, keeping stress and cortisol low. This may be a beneficial intervention if you have tried the above nine tips and none of them seem to help. If you try purchasing CBD, it’s best to get full spectrum and be sure that the brand is organic. Also, note that CBD oil can counteract a number of medications, most of which are also influenced by the consumption of grapefruit.
Here’s the thing, anxiety can be completely deblitiating but hopefully the tips above help you see that there is a lot that you can do to take back your power and feel more calm and grounded. Keep these tools on hand to help you give the body what it needs and finally get your anxiety under control.