the increase, anxiety seems to be cropping up everywhere today. A seemingly
many people's lives, anxiety
not only affects the mind but the body as well. Although it is important
to discern the difference between a DSM-IV (Diagnostic
and Statistical Manual of Mental Disorders)
diagnosis and anxiety in the form of a generalized state that so many
people find themselves
in today, the
matter may only be one that is measurable by degree of intensity. Anxiety
can be defined in two separate ways; the first as an apprehensive state
of mind, typically that which is due to an anticipated event or general
life stressors, and the second, more clinical definition that defines
anxiety as an abnormal, overwhelming feeling of apprehension and fear
that is often punctuated by physiologic reactions including tension,
sweating, and rapid heart rate. Included in this picture of anxiety
is often an extreme form of self-doubt over one's abilty to cope
with particular stressors. Regardless of the definition, anxiety can
affect individuals' minds and bodies in varying degrees. Of course,
feelings of anxiety (as well as sadness, depression, fear, loneliness,
etc.) are completely normal, (contrary to what the manufacturers of
antidepressants will have us believe) especially given the tumultuous
environment that we find ourselves in today. What is not normal is
when these feelings pervade our entire being and are no longer remedied
by simple resolution of stress. A comment also must be made that perhaps
the rise of anxiety may be due in part to the over-medicalization of
this symptom; television and print advertising regularly recommend
medication for those with any degree of trepidation over daily lifetime
occurrences as if feelings of anxiety are improper and should be medicated.
It must also be said that, the authors do not in any way intend to
negate those with true symptoms of anxiety nor disregard the incredible
burden that anxiety can impose on one's life. We have all, at
one point in time, experienced a glimpse of the horror that those with
generalized anxiety live with when faced with the stressors of work,
home, school, finances, deadlines and other events in our lives.
Anxiety in the population today is continually on the rise. We continue
to work longer and harder to get ahead (or stay afloat) all the while
balancing relationships, family and home responsibilities. It is no
wonder that more and more people experience stress and anxiety today
than ever before. What may be arguable is whether more people are experiencing
pathologic anxiety itself. Regardless, feelings of anxiety are more
prevalent, and more and more people are seeking treatment for relief
of their suffering.
DSM-IV diagnosed anxiety disorders
are the most common psychiatric illnesses affecting both adults and
children today. Anxiety disorders
may spring from a set of complex risk factors including genetic predisposition,
alterations in neurochemicals, personality traits, and life events.
Anxiety disorders can be grouped into the following general categories.
- Generalized Anxiety Disorder: characterized by excessive, unrealistic
worries that last beyond 6 months. This form of anxiety can be
accompanied by physical symptoms associated with stress such as insomnia, gastrointestinal
upset, and headaches.
- Obsessive-Compulsive Disorder: People suffering
form this form of anxiety often experience persistent, recurring
thoughts that are caused
by exaggerated fears or anxiety. These obsessive thoughts may cause the
person having them to perform ritualized routines in an attempt
to absolve their anxieties.
- Post-Traumatic Stress Disorder (PTSD): This type
of stress becomes manifested following an extremely traumatic event.
PTSD generally experience flashbacks, avoidance behaviors and emotional
numbing and physiologic symptoms such as insomnia and poor
- Panic Disorder: People with panic disorder suffer from debilitating
attacks of panic that are often accompanied by symptoms such
as heart palpitations, chest tightness, difficulty breathing and overwhelming
- Social Anxiety Disorder: Characterized by an extreme
fear of being judged by others or becoming embarrassed typically
people with this type of anxiety to avoid situations involving other people.
Phobias: people with phobias will react intensely with an intense
level of fear to a specific situation or object
that can lead to avoidance of the most common everyday situations.
Approximately 19 million adults in the U.S. alone are estimated
to suffer from anxiety disorders. The economic and individual
from anxiety is incredibly high as these conditions are often
debilitating. People with anxiety disorders tend to utilize primary
health care providers more often than psychiatric medical personnel.
Other costs are incurred by emergency care, hospital, medication
and psychiatric care sectors of the health care system; total
include decreased work productivity and absenteeism.
The costs associated with dealing with anxiety approaches $42
billion a year, $23 billion is associated with repeated medical
for relief of anxiety symptoms that appear as physical illnesses;
with anxiety are 3 to 5 times as likely to seek medical care
and are 6 times more likely to be hospitalized for these disorders
without anxiety.1 Approximately 30% of individuals afflicted
anxiety disorders seek treatment for their anxiety condition
while 30 million
of us will experience some type of anxiety disorder at some point
in life.2 Assigning a specific number to prevalence figures is
difficult due to the fact that small changes in diagnostic criteria,
and study methods can greatly affect results.
The etiology of anxiety disorders is multifactorial. The likelihood
that a person will develop anxiety is related to a combination
of life experience, genetic predisposition and personality/psychological
Individual effects of these influences differ from person to
person and between different forms of anxiety. Some influences
as well, as in the case of a familial pattern in panic disorder
no gene has yet been located that directly links the two. It
is however, generally accepted that a majority of anxiety originates
lifestyles and events and most anxiety disorders have a state
increased arousal and fear as the common denominator.3 Additionally,
it is important
to realize that in many classic states of anxiety there appears
to be no immediate external stressor. Science continues to attempt
discern a complete understanding of neurobiology and anxiety.
Diet and Anxiety
In of itself, poor diet can be a major contributor to anxiety states
and may therefore serve to inhibit the onset of some anxiety symptoms.
An important contributor of anxiety is hypoglycemia as a result of
infrequent eating or unbalanced dietary choices. Hypoglycemia symptoms
(fatigue, hunger, drowsiness, poor concentration, irritability) have
been traced to the effects of glucose deprivation in the neurons
themselves; physiologic symptoms (anxiety, sweating, hunger, tremors,
and palpitations) are thought to be the result of the autonomic nervous
system's perception of lowered blood glucose levels.4 People
who do not consume a good balance of macronutrients necessary to
sustain blood sugar levels are at risk for this phenomenon. Many
people can identify with the aforementioned symptoms that typically
occur in the late afternoon after no or very little lunch that contains
inadequate caloric value. Infrequent and/or poor food choices, mainly
those with a high glycemic index, are the most frequent causes of
lowered blood sugar levels.
An interesting study utilized dietary therapy on patients who demonstrated
anxiety in the form of obsessive behavior as a result of hypoglycemia
(confirmed by glucose tolerance test); the dietary therapy was designed
to avoid hypoglycemic states in the patients.5 Of the two
study subjects, one experienced complete recovery while adhering to
dietary plan while the other subject made improvements that were concordant
with his level of compliance to the dietary plan. Despite its small
nature, this study displays that low blood sugar can indeed affect
anxiety states and by maintaining adequate levels of blood sugar (roughly
90–110 milligrams per deciliter) we may offset some symptoms
of anxiety. Another study investigated the link between diet and anxiety
by examining the relationship between diet (vegetarian versus omnivorous)
and reported levels of anxiety and depression in a group of 80 subjects.6
Significant differences in levels of anxiety and depression existed
between the two dietary groups, with more symptoms experienced by the
omnivorous group. Reasons for this result is undetermined; however
the investigators stipulate that increased regulation of blood sugar
levels may be one reason for the large difference in symptoms experienced
between the two groups.
Included as other dietary factors having an influence on anxiety states,
are alcohol and caffeine. Despite the fact that alcohol exerts a calming
effect on the brain via its depressant effects (alcohol engages gamma-aminobutyric
acid receptor (GABA) (A) receptors; potentiation of the response of
these inhibitory neurotransmitter receptors results in anxiolytic,
sedative, and anesthetic activities in the human brain), alcohol is
thought to be responsible for increased feelings of anxiety. In one
experiment, subjects were given ethanol or a placebo and then evaluated
for symptoms of anxiety using an objective testing device (Spielberger
State Anxiety Inventory). Those subjects receiving ethanol experienced
significant increases in anxiety symptoms in comparison to those given
placebo.7 (The placebo group actually reported decreased feelings of
tension). This may be due to the sedative effects of alcohol resulting
in a lowered inhibition, but this is difficult to analyze. In short
however, alcohol is only recommended in small, infrequent amounts,
and more importantly, should probably be avoided altogether by those
experiencing frequent anxious symptoms.
On the other hand, caffeine is a well-known stimulant that results
in excitatory neurotransmission. The effects of caffeine in patients
with agoraphobia and panic disorder were studied and were found to
produce significant increases in anxiety, nervousness, fear, nausea,
heart palpitations, restlessness, and tremors compared to the group
of patients who received placebo.8 In addition, 71% of the study subjects
consuming caffeine reported that the effects of caffeine were very
similar to the symptoms experienced during a panic attack. A separate
investigation showed that patients with anxiety experienced a degree
of anxiety that directly correlated with their consumption of caffeine.9
In addition, this study suggested that those who are most at risk of
anxiety have an increased sensitivity to the effects of even one cup
of coffee. This finding was reinforced by the observation made that
patients with panic disorder are more likely to discontinue coffee
because of its negative side effects in comparison to those without
panic disorder. Large doses of caffeine can mimic the symptoms experienced
during anxiety while increased caffeine sensitivity may contribute
to symptoms. Some anxiety cases were much improved over the course
of a 6-month followup period after caffeine was discontinued.10 Because
of these findings, it is important that patients with anxiety disorders
avoid caffeine-containing foods and beverages.
Specific treatments for anxiety disorders include psychological therapies
(psychotherapy), pharmaceutical medication, and a combination of both.
Typical medications that are used in anxiety include selective serotonin
reuptake inhibitors (SSRIs), tricyclic antidepressants, benzodiazepines,
beta-blockers, and monoamine oxidase inhibitors (MAOIs). These medications
can be helpful to some patients, however a large majority of people
on these medications report negative side effects and discomfort with
Several non-pharmacologic treatments exist for anxiety, with backing
in appropriate research trials. Anxiety treatment without pharmaceutical
intervention strives to prevent the initiation of anxiety, using nutritional
and or botanical medicines that work to alter the patient's susceptibility
to anxiety. Counseling and other forms of psychotherapy are quite helpful
in assisting the anxious person in working through and addressing unhealthy
patterns. The complexity of anxiety warrants that several therapies
be used, however a change in treatments, whether pharmaceutical or
naturally derived, demands strict attention to side effects and interactions
that may occur when using such treatments.
Vitamin and Mineral Deficiencies
As the basis for healthy functioning, complete nutrition is mandatory.
True, it is often observed that life continues despite less than
optimal nutritional habits; however just getting by is in itself
a less than optimal situation, especially when confronted by symptoms,
regardless of origin. Several vitamin and mineral nutrients and their
lack in certain people may contribute to the occurrence of anxiety.
Pyridoxine, also known as vitamin B-6, serves as an important coenzyme
in the synthesis of neurotransmitters. Specifically, gamma-aminobutyric
acid (GABA), dopamine and serotonin neurotransmitters are synthesized
using pyridoxine as an enzymatic substrate, and all are affected in
anxiety, depression, and even perception of pain. Pyridoxine deficiency
can lead to an increased sympathetic nervous discharge (increased excitatory
nerve impulses) as well as hypertension in laboratory animals.11 Investigators
hypothesize that this is a reflection of decreased production of dopamine,
serotonin, and GABA. Interestingly, adding pyridoxine to deprived animals
will lead to a decrease in blood pressure. A separate study that investigated
the use of magnesium and pyridoxine on anxiety-related premenstrual
(PMS) symptoms found that women who supplemented with as little as
200 milligrams of magnesium and 50 milligrams pyridoxine each day experienced
much less anxiety-related PMS symptoms including nervous tension, irritability,
and generalized anxiety.12 Although magnesium could be considered a
confounding variable in relation to the complete anxiolytic effects
of pyridoxine, the information contained in this study is relevant
in reference to the effects of vitamin B-6 on resolving anxiety and
Nicotinamide, a form of the B vitamin niacin, is known to exert similar
effects on the brain as benzodiazapenes.13 Nicotinamide
stimulates the GABA-benzodiazapene receptor complex, an inhibitory
By activating these neurons, a calming effect is the end result.14
Other investigations designed to test the efficacy of nicotinamide
and brain function revealed that GABA nerve receptors were under less
control (meaning that because they are inhibitory in nature, when they
are not activated the brain is more excitable-which in theory may lead
to more anxiety) when nicotinamide was found at suboptimal levels in
the subject, and reintroduction of nicotinamide led to a calming effect
on the GABA receptors.15 These are important findings in nutritional
medicine and warrant further research. More importantly, this evidence
points to the necessity of this B-vitamin in modulating feelings of
Magnesium supplementation enjoys a broad reputation as having a calmative
effect on anxiety symptoms and stress levels. Research is just beginning
to highlight magnesium's effect on anxiety, with interesting
results. One researcher observed decreased levels of nervousness as
well as insomnia symptoms in patients supplemented with 200 milligrams
of magnesium in combination with 400 milligrams calcium and an association
between magnesium deficiency and anxiety symptoms was noted.16 A different
investigation looked at the use of magnesium in post-surgical patients
and its effectiveness in alleviating pain. Patients were infused with
magnesium both during and following surgery and were evaluated for
anxiety levels. Patients receiving the magnesium infusion required
significantly less pain medication (morphine and fentanyl) in comparison
to the control group that received no magnesium.17 Additionally, the
magnesium group reported less anxiety as well. Magnesium deficiency
is reportedly common in the typical American diet, with one major survey
determining that adequate magnesium is lacking in nearly 72% of diets,
and that nearly half of the population consumes less than 75% of the
Recommended Daily Allowance (RDA) of magnesium. Furthermore, one third
of these people consumed less than 50% of the RDA for magnesium.18
Those taking oral contraceptives, diuretic medicines and who overuse
laxatives may be at risk of magnesium deficiency. Supplementing with
magnesium is a simple and inexpensive means to further reduce anxiety.
Lavender (lavendula officinalis)
has mild relaxant effects, and is used traditionally for restlessness,
insomnia, depression and nervousness.
Lavender preparations are commonly derived from the plant oil; internal
ingestion is contraindicated due to concentration of active constituents
in the oil. Inhalation of lavender oil constituents leads to relaxation
and decreased alertness.19 Inhalation of lavender oil scents may
serve to modulate feelings of anxiety in patients with mania, heading
off a full-blown episode of anxiety.
Lemon balm (Melissa officinalis)
is another botanical medicine with mild calming effects and the ability
to reduce alertness,20 which is
useful in the treatment of nervous anxiety, as well as other non-related
medical problems. Brain function is directly affected (terpenes are
thought to act on some of the inhibitory neurons (GABA) in the brain),
thereby eliciting their calmative effects.21 A study utilizing
both valerian and lemon balm demonstrated an improvement in the amount
quality of sleep in subjects taking this herbal combination.22
Additional nutrients (Tryptophan, 5-HTP, Melatonin and Serotonin) are
applicable in the treatment of anxiety; the reader is referred to the
authors' article addressing insomnia in the April 2004 issue
of The Townsend Letter.
These studies highlight the utility of nutrition as an essential factor
in both the prevention and treatment of anxiety symptoms. With multiple
causes, anxiety is a condition that more than likely has multiple
treatments in different individuals. Treating the person with anxiety
with adequate nutritional sources may possibly alter anxiety levels
and offer the patient a greater quality of life. The human experience
includes anxiety in varying levels. However, when anxiety becomes
a permanent fixture in one's life, preemptive approaches are
necessary. Discovering one's own way of relaxing and engaging
in stress reducing exercise and mental exercises (meditation, for
one) can all play a very important role in maintaining an inner peace
that seems so illusive at times.
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