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Generalised Anxiety Disorder

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). 

What is 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  


Risk factors:  

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)

Nutrition and Anxiety  

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. 


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)  


    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). 


    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) 


    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. Some people don’t consume enough magnesium  and in this case, supplementing with magnesium is ideal. However, there are many  forms of magnesium supplements and it’s critical to choose a kind of magnesium  that is easily absorbed by the body when supplementing with it. Two of the most  effective magnesium supplements for anxiety are magnesium glycinate and  magnesium taurate.  

    If you suffer from insomnia, magnesium glycinate is the best form for you as it has  not only been shown to decrease anxiety but also, improve sleep quality.

    Remember: always seek your doctor’s advice before trying any supplements. 


    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).

    Remember: always seek your doctor’s advice before trying any supplements. 


    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. 


    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 


    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.  


    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 starchy or sugary foods with protein, fat, and fibre

    – Eat your dessert after a meal and not on an empty stomach 

    – Opt for complex carbohydrates like whole-wheat bread and brown rice

    – Go for a walk or do some exercise after eating sugary foods 


    Final Thoughts

    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


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