Everyone experiences anxiety from time to time. You might feel anxious when doing a presentation at work, taking a test, or making an important decision. However, anxiety disorders go beyond temporary worries or fears. For people who suffer from anxiety disorders, the condition does not go away. Instead, it worsens over time and affects every aspect of their life.
There are various types of anxiety disorders, such as panic disorder, generalised anxiety disorder, and various phobia-related disorders. In this section, we are going to discuss generalised anxiety disorder (GAD).
GAD is associated with excessive and persistent worry about various topics. People with GAD often feel anxious almost every day, and they have a hard time remembering the last time they felt relaxed.
GAD is a common disorder that affects around 5% of the UK population, with women being affected slightly more than men.
Generalised anxiety disorder symptoms can be both psychological and physical including:
-Heart palpitations and muscle tension
-Feeling restless or concerned
-Difficulty concentrating or sleeping
-Dizziness
GAD’s exact cause is not fully understood and many people develop GAD for no apparent reason. However, it’s likely that a combination of factors contributes to its development such as:
– The exposure to stressful events in early childhood or during adulthood
– Experiencing stressful or traumatic situations, such as child abuse, or bullying – Having a relative who suffers from anxiety or other mental illnesses – suffering from painful long-term health conditions, such as arthritis
(NHS 2022; NIMH 2022)
Although nutrition cannot cure anxiety, many nutrients and techniques have been found to help ease anxiety symptoms. Here are some evidence-based nutritional strategies which may help for anxiety.
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1. Include fatty fish and omega-3 in your diet
Omega-3 fatty acids are polyunsaturated fats found in foods. Eicosapentaenoic acid(EPA) ,docosahexaenoic acid (DHA), and alpha-linolenic acid (ALA) are the three most common omega-3s.
ALA can be found in plant sources such as flax seeds, chia seeds, walnuts, and canola oil. Both EPA and DHA can be obtained from fish and marine foods like mackerel, sardines, and salmon, as well as algae and its oil and seaweed (Anderson & Ma, 2009)
Omega-3 fatty acids, especially EPA and DHA are potent anti-inflammatory signalling molecules important for cognition and mental health.
Our bodies convert ALA to EPA and DHA, but the process is inefficient and can be influenced by many factors. That’s why obtaining EPA and DHA from foods (or supplements) is the only feasible approach to boost your body’s amounts of these omega-3 fatty acids. Lower intakes of fish were associated with greater anxiety and higher intakes were associated with lower anxiety. In a study on pregnant women, women who rarely consumed Omega-3 from seafood there was a 38% higher likelihood of experiencing high levels of anxiety, than in women who consumed dark or oily fish 1–3 times per week. (Vaz et al., 2013).
The long-chain Omega-3 fatty acids EPA and DHA found in Atlantic salmon have been indicated to be useful for reducing anxiety, also. According to a recent study, Men who ate salmon (150 to 300 g/serving) three times a week had lower emotional activation and cognitive concern than men who ate chicken, pig, or beef three times a week (Kris-Etherton et al., 2021). Fatty fish, such as salmon, sardines and mackerel contain not only omega-3 fatty acids but also other nutrients such as vitamin D, iodine, selenium, and protein. All of these components may have a role in reducing anxiety as well. (Kris-Etherton et al., 2021)
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2. Take care of your gut microbiome
Your intestinal tract is home to trillions of microorganisms and their genetic material known as your “gut microbiome” (Strandwitz, 2018). Researchers believe that any disruption to the gut microbiome’s balance might cause the immune system to overreact, contributing to gastrointestinal tract inflammation and ultimately, the development of disease symptoms that appear not only throughout the body but also in the brain (Bull & Plummer, 2014). This system is called the “gut-brain axis” because it provides neural connections between the gastrointestinal tract and the brain (Bull & Plummer, 2014). Gut bacteria has been discovered to be capable of producing a variety of key neurotransmitters, including serotonin, dopamine (DA), GABA, and noradrenaline (NE) (Bull & Plummer, 2014). According to studies, 90% of the body’s serotonin is made in the digestive tract (Strandwitz, 2018). As a result of neurotransmitter imbalance, mental health diseases such as depression and anxiety disorders develop.
There’s is a growing body of evidence that improving gut health can alleviate anxiety (Yang et al., 2019). In order to improve the health of your microbiome, you should eat foods that your “good” gut microbes like and reduce those that promote “bad” microbes. One way to improve your gut health is by adding probiotics and prebiotics to your diet. Probiotics are live microorganisms that are intended to have health benefits when consumed or applied to the body (Sanders et al., 2019). You can increase your intake of probiotics by either consuming more probiotic-rich foods, including fermented foods like kimchi, kefir, sauerkraut and yogurt, or taking probiotic supplements. Several studies found that probiotics effectively decreased anxiety and depressive symptoms in a similar way to anti-anxiety medications (Clapp et al., 2017).
Of equal importance a prebiotics, which promote the growth of beneficial gut. Prebiotics can be found in foods such as whole grains, legumes, tomatoes, bananas, Jersualem artichokes, chickory, onions, and garlic (Sanders et al., 2019). Another way to improve your gut health is by consuming omega-3 rich foods. Recent research found that women with a higher dietary intake of omega 3 and higher serum levels had a more diverse gut microbiome (Menni et al., 2017).
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3. Increase your polyphenols and antioxidants intake:
Polyphenols are powerful antioxidants found abundantly in plants. Anxiety reduces the number of antioxidants in the body, therefore people with anxiety tend to have fewer symptoms when they eat an antioxidant-rich diet. (Jensen et al., 2019) Consumption of antioxidant-rich vegetables and fruits, such as vitamin C, vitamin E, and other carotenoid components, was linked to lower inflammation and oxidative stress in a study. (Xu et al.,2021). Fresh fruits and vegetables with anti-inflammatory characteristics have also been proven to influence monoamine concentrations, which are regarded to play a key role in mood and cognition regulation. (Xu et al., 2021)
Curcumin, a polyphenol that is the active component found in turmeric, has been shown to reduce anxiety in humans.
One study showed that just 1 gram of curcumin as a supplement may have similar effects to Prozac when it comes to improving mood and decreasing anxiety. (Sanmukhani et al., 2014)
Also, it has been found that 8 weeks of curcumin supplementation decreased anxiety in patients with diabetes (Norwitz and Naidoo, 2021).
Curcumin, however, is poorly absorbed into the bloodstream, and its bioavailability must improve in order to benefit fully from its effects.
If you decide to take turmeric supplements, it is best to take them with meals or choose a supplement that contains bioavailability enhancers.
It is also useful to consume it with black pepper, as it contains piperine, which is a natural chemical that boosts the absorption of curcumin by 2,000% (Prasad et al., 2014)
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4. Increase magnesium in your diet:
According to recent research, magnesium may be useful in decreasing anxiety in a variety of ways. It improves brain function, lowers stress hormones like cortisol, and increases the release of the neurotransmitter GABA, resulting in a more calm, restful state (Boyle et al., 2017). You can get magnesium from two sources: diet and supplements. To ensure you have enough magnesium in your diet, eat foods that are rich in magnesium like almonds, spinach, pumpkin seeds, and cashews.
The Recommended Dietary Allowance (RDA) for magnesium for adults is 300 mg for men and 270 mg for women. The optimal intake is 450mg. Most people don’t consume enough magnesium, ith an average intake close to 200mg. and in this case, supplementing with magnesium (300mg) is ideal. If you suffer from insomnia, magnesium has not only been shown to decrease anxiety but also, improve sleep quality.
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5. Make sure you’re getting enough vitamin D:
Due to the fact that people nowadays spend most of their time indoors and fully clothed, endogenous vitamin D production is often insufficient. Studies have suggested that vitamin D deficiency increases the risk of anxiety and major depressive disorders, which has led to vitamin D supplementation being investigated as a treatment and prevention for these disorders. (Casseb et al., 2019). In a study of 30 anxiety patients, taking 50,000 IU of vitamin D once a week for three months greatly alleviated symptoms (Eid et al., 2019). Another study in 51 women with type 2 diabetes found that taking 50,000 IU of vitamin D monthly reduced inflammation and anxiety symptoms over the course of four months (Fazelian et al., 2019)
Although vitamin D has been shown to relieve anxiety, it is possible that supplementing with vitamin D for anxiety is only useful in those with vitamin D deficiency. However, it should be noted that in the UK the RDA (10 micrograms or 400 IU) and upper safe limits for Vitamin D (100 micrograms or 4,000IU) are set much lower than the dosages that were used in the studies above (NHS, 2022). During the winter it is essential to supplement at least 1,000iu if not 3,000iu to achieve an optimal blood level of 75nmol/l (25 ng/ml).
Test your vitamin D here
6. Risk factors for vitamin D deficiency:
1- Limited sun exposure
Vitamin D is created in our bodies when the skin is exposed to direct sunlight. However, many people have insufficient levels of vitamin D because they live in areas where sunlight is scarce in the winter or because they spend most of their time indoors.
2-Darker skin tone
People with darker skin tend to make less vitamin D in the sun than people with lighter skin. The reason is that people with darker skin have more melanin, which is the pigment that gives skin colour, than those with lighter skin. Having more melanin lowers the body’s ability to synthesize vitamin D from sunlight, resulting in lower vitamin D levels (Webb et al., 2018).
Studies have shown that individuals with darker skin pigmentation require longer or more intense ultraviolet radiation exposure to synthesize sufficient levels of vitamin D.
3-Obesity
There is a relationship between vitamin D insufficiency and persons who have a BMI of 30 or above. It’s believed that the amount of vitamin D synthesised by the body and stored in its subcutaneous fat is reduced in people with excess body fat (Nair & Maseeh, 2012)
4- Inadequate dietary intake of vitamin D-containing foods.
Vitamin D can occur naturally In some foods in small amounts, and you can increase your intake by eating more of these great natural sources of vitamin D:
– fatty fish like salmon and mackerel
– vitamin D-fortified food products, such as orange juice, dairy and non-dairy milk products, and cereal
– mushrooms
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7. Limit your alcohol and caffeine intake:
Caffeine stimulates your fight or flight response, and anxious individuals and those who are prone to panic attacks have been shown to have a higher sensitivity to caffeine, which can exacerbate anxiety and even trigger an anxiety attack (Lee et al., 1988; Winston et al., 2005).
The same is true for alcohol consumption. Heavy drinking can disrupt the function of neurotransmitters in the brain that are essential for mental health and cause new onsets of anxiety as well as make pre-existing anxiety symptoms worse. (Charlet & Heinz, 2017).
If you have anxiety, it’s crucial to limit your alcohol and caffeine intake as this can result in reducing your anxiety symptoms. If you decided to consume them, try at least taking them after a meal and not on an empty stomach. You can also switch to decaf coffee and non-alcoholic beverages.
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8. Decrease your sugar and refined carbohydrates intake:
High sugar intake has been linked to depression, mood swings, and symptoms of anxiety. It’s also been related to cognitive issues and a decrease in the brain’s ability to form new connections when learning or after an injury. (Jacques et al., 2019).
Many people crave sugary meals and drinks because of the energy boost they get from eating them. However, once the energy surge has worn off, blood sugar levels rapidly decrease, resulting in increased worry, lethargy, and anxiety.
Balanced blood sugar levels and avoiding sugar spikes are crucial if you’re trying to manage anxiety symptoms.
The following tips will help in managing your blood sugar levels:
– Pair carbohydrate foods with protein, fat, and fibre
– Eat your dessert after a meal and not on an empty stomach
– Eat a low Glycemic Load carbohydrates such as oats, whole-wheat bread and brown rice. Try quinoa instead of rice.
– Go for a walk or do some exercise most days, especially after eating sugary foods
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Always remember that you don’t have to eat perfectly all the time to make positive changes and have results. Many people get very excited after reading nutrition articles and decide to change their entire lifestyle all at once. However, this is incorrect, and will make them feel overwhelmed as a result. Change the habits that negatively impact your anxiety one at a time. Start in one place such as reducing the cups of coffee you have from 3 cups to 2 and then, you can build from there.
Researcher: Huda Set Abouha, MSc Nutrition and Behaviour Bournemouth University
References
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