Deficiencies of members of the vitamin B complex appear to be common
in patients with agoraphobia (fear of open spaces).1 The same is
likely to be true for other anxiety-related conditions. We will review
the evidence suggesting that individual members of this family may
affect the experience of anxiety.
Inositol Supplementation
Inositol is a key intermediate of the phosphatidyl-inositol cycle,
a second-messenger system used by several noradrenergic, serotonergic
and cholinergic receptors.2 Since ingestion has been shown to raise
inositol levels in the cerebrospinal fluid,3 this nutrient could
potentially serve as an anti-anxiety agent.
Indeed, when a group of 21 patients with panic disorder either with
or without agoraphobia received 12 grams daily of inositol or placebo
in random order for 4 weeks each, the inositol supplement was associated
with a significantly greater reduction in the frequency and severity
of panic attacks and of agoraphobia than the placebo. Moreover, while
the efficacy of the nutrient was judged to be comparable to that
of imipramine, its side effects were minimal.4
Niacinamide Supplementation
Niacinamide has been shown in an animal study to have benzodiazepine-like
actions including anti-conflict, anti-aggressive, muscle relaxant
and hypnotic effects.5 In contrast to niacin, it passes readily
from the plasma to the cerebrospinal fluid where it is taken up
into brain cells by a high-affinity accumulation system,6 suggesting
it is the preferred form of vitamin B3 for the treatment of anxiety.
Lactate (which is associated with anxiety) reacts with niacinamide-adenine
dinucleotide [NAD+] to form pyruvic acid and reduced NAD (NADH +
H+). The equilibrium of this reaction favors lactate and NAD+, but
it can be driven by adding excess NAD+. It may be that supplementation
with niacinamide helps to drive the reaction, thus reducing lactate
concentrations.7
Anecdotal reports suggest that niacinamide has anxiolytic effects
comparable to the benzodiazepines,8 and it may be particularly effective
for patients whose anxiety is secondary to reactive hypoglycemia.9
Typical dosages are between 500 mg twice daily and 1,000 mg 3 times
daily.9 Hoffer believes that the optimal daily dosage is just below
the amount that produces nausea.10
Thiamine Deficiency
Elevated lactate may also be caused by inadequate pyruvate dehydrogenase
activity resulting from a thiamine deficiency or dependency. In
that case, the conversion of pyruvate to acetyl CoA is inhibited,
fostering its conversion to lactic acid.11 Symptoms of a prolonged
moderate thiamine deficiency may include fearfulness progressing
to agitation as well as emotional instability and psychosomatic
complaints.12
When more than 1,000 healthy young men were studied, those who
were chronically borderline thiamine-deficient were currently feeling
significantly more anxiety—although they were not customarily
nervous individuals.13 There are no published studies on the repletion
of a borderline thiamine deficiency to treat anxiety.
Vitamin B6 Deficiency
Gamma aminobutyric acid (GABA), an inhibitory neurotransmitter which
is involved in the regulation of anxiety, requires vitamin B6 for
its synthesis; thus a deficiency of this vitamin may theoretically
result in heightened anxiety. Vitamin B6 is also required for the
conversion of tryptophan to serotonin, a neurotransmitter suspected
of being involved in anxiety.14
When over 1,000 healthy young men were studied, those found to be
chronically deficient in vitamin B6 had a significantly greater tendency
to become anxious, although they were not significantly more anxious
at the time of the study.13 Also, in an open trial, patients with
hyperventilation syndrome who also had abnormal xanthurenic acid
excretion (an indicator of vitamin B6 deficiency) improved following
the administration of pyridoxine and tryptophan, suggesting that
a marginal B6 deficiency, by causing serotonin depletion, may have
produced the syndrome.15
Vitamin B12 Deficiency
Anxiety may be part of the neuropsychiatric syndrome seen in advanced
cases of pernicious anemia which is well-known to be caused by
B12 deficiency.16 When cobalamin levels of more than
1,000 healthy young men were studied, those who were chronically
borderline vitamin
B12-deficient were significantly more anxious at the time of the
study—although they were not customarily nervous individuals.13
Whether B12 supplementation reduces anxiety when the vitamin is
borderline deficient remains to be investigated.
Doctor Werbach cautions that the nutritional treatment of illness
should be supervised by physicians or practitioners whose training
prepares them to recognize serious illness and to integrate nutritional
interventions safely into the treatment plan.
References
1. Abbey LC. Agoraphobia. J Orthomol Psychiatry 11:243–59,
1982
2. Benjamin J et al. Inositol treatment in psychiatry. Psychopharmacol
Bull 31(1):167–75, 1995a
3. Levine J et al. Inositol treatment raises CSF inositol levels.
Brain Res 627(1):168–70, 1993
4. Benjamin J et al. Double-blind, placebo-controlled, crossover
trial of inositol treatment for panic disorder. Am
J Psychiatry 15(7):1084–6,
1995b
5. Möhler H et al. Nicotinamide is a brain constituent with
benzodiazepine-like actions. Nature 278:563–5, 1979
6. Hankes LV. Nicotinic acid and nicotinamide, in LJ Machlin, Ed.
Handbook of Vitamins. New York, Marcel Dekker, 1984:329–77
7. Wendel OW, Beebe WE. Glycolytic activity in schizophrenia, in
D Hawkins & L Pauling, Eds. Orthomolecular
Psychiatry: Treatment of Schizophrenia. San Francisco, W. H. Freeman, 1973
8. Prousky JE. Niacinamide’s potential role in alleviating
anxiety with its benzodiazepine-like properties: a case report. J
Orthomol Med 19(2):104–110, 2004
9. Gaby AR. Vitamin B3 (Part 2): Powerful tool in nutritional medicine.
Nutrition & Healing December, 1995
10. Hoffer A. Vitamin B-3: niacin and its amide. Townsend
Letter for Doctors and Patients 147:30–39, 1995
11. Wick H et al. Thiamine dependency in a patient with congenital
lactiacidaemia. Agents Actions 7(3):405–10, 1977
12. Williams RD et al. Induced thiamine (Vitamin B1) deficiency in
man; relation of depletion of thiamine to development of biochemical
defect and of polyneuropathy. Arch Intern
Med 71:38–53, 1943
13. Heseker H et al. Psychological disorders as early symptoms of
mild-moderate vitamin deficiency. Ann NY
Acad Sci 669:352–7,
1992
14. Johnston AL, File SE. 5-HT and anxiety: promises and pitfalls.
Pharmacol Biochem Behav 24(5):1467–70, 1986
15. Hoes M et al. Hyperventilation syndrome, treatment with L-tryptophan
and pyridoxine; predictive values of xanthurenic acid excretion.
J Orthomol Psychiatry 10(1):7–15, 1981
16. Ambrosino SV. Neuropsychiatric aspects of pernicious anemia:
report of a case. Psychosomatics 7(1):24–8, 1966
Updated from Werbach MR with Moss J. Textbook
of Nutritional Medicine.
Tarzana, California, Third Line Press, Inc., 1999.
In Foundations of Nutritional Medicine, one of Dr. Werbach’s
internationally acclaimed Sourcebooks of Clinical Research, health
practitioners concerned with nutritional influences on illness will
find valuable information which will improve the quality of their
practices. A free brochure describing all of his books is available
from Third Line Press, 4751 Viviana Drive, Tarzana, California 91356.
(800–916–0076; 818–996–0076; FAX: 818–774–1575;
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