Here’s a guest blog I wrote about the link between nutrition and anxiety for The Anxiety Lab. Freddie writes a fantastic blog for anxiety sufferer’s, providing some much needed positive support and community. Give her blog a follow!

According to research, there were 8.2 million cases of anxiety reported in 2013 in the UK, which indicates over 5% of the population, or 1 in 20 people, suffer with this condition. Women are twice as likely to be diagnosed than men in England. This is clearly something affecting a large number of people with more individuals being diagnosed daily. So why are these numbers increasing and what can be done beyond medications and psychotherapy to help anxiety sufferers? Perhaps the key lies in what we eat…

Firstly, what is anxiety?

Anxiety could be defined as the chronic feeling of fear, worry or unease that continues even after a stressor has been removed, it can occur for no particular reason or can be an amplified emotional response to a situation. People may be anxious most days because of a range of circumstances or issues and the anxiety can be mild or severe, with attacks often being triggered by a stressor.

What are the signs and symptoms of anxiety?

Anxiety will be experienced differently from person to person, with these being some of the main presentations;

• Restlessness, impatience, feeling “edgy” or irritable
• Palpitations
• Muscle tension
• Insomnia, trouble falling or staying asleep
• Excessive sweating
• Pain in the head, chest or abdomen
• Difficulty concentrating and being easily distracted
• Fatigue
• Digestive issues such as stomach pain or diarrhoea

Where does it come from?

Anxiety can develop due to a neurotransmitter imbalance in the brain, often triggered by a traumatic life event. Conventional treatment therefore usually involves treating this imbalance with medication and may also include therapy. Medications, psychotherapy and psychology can be immensely helpful for the management of symptoms for many, however, the following question is seldom asked: what caused this imbalance in the first place? This is a key part of the puzzle and by understanding the root cause of the imbalance we can address the underlying reasons that caused the imbalance in the first place thus expanding our supportive tool kit for anxiety sufferers. Ideally, we would take a multi-factorial approach: address the root cause of the imbalance whilst supporting symptom relief and helping with the psychological aspect of the disorder until the root cause has been resolved or at least minimised.

So, what are the potential root causes of anxiety?

Research suggests there are a number of possible root causes, three of the main possibilities and some of the science behind them are explored here.

Stress response dysfunction and inflammation

We live in fast-paced world with an increasing amount of daily stress, which may be one of the reasons why we have seen a surge in anxiety diagnoses over recent years.

Our stress response and tolerance to stressors is governed by the hypothalamic-pituitary-adrenal (HPA) axis. This is a feedback system controlling communication between the brain and the adrenal glands. When this axis becomes disrupted, from exposure to chronic stress, it causes disturbances in the production of cortisol, our stress hormone, from the adrenal glands which in turn affects the production of other hormones and neurotransmitters, leading to imbalances. This disruption can be triggered by a variety of stressors, for example;

• Our perception of stress – this is highly individual, what might be stressful for one person, might not be for another. We may be more sensitive to certain situations which will impact our stress response to it
• Inflammation – stress can be physiological too, for example, it can be triggered by gut (see below) or hormonal imbalances, illness, even surgery or traumatic accidents which can lead to an inflammatory response in the body which is a stressor
• Blood sugar imbalances – constant and extreme fluctuations in insulin and blood sugar levels from eating highly refined, sugary foods place a strain (stress) on the body, stimulating excess cortisol production
• Disrupted circadian rhythms – interrupted sleep cycles, irregular work patterns or working night shifts can all impact on the how the HPA axis works and thus our response to stress and the communication between the brain and body

Gut health issues

Research is increasingly indicating the link between the brain and the gut, known as the gut-brain-axis. This axis is a bi-directional system that allows communication between the brain and the gut via the enteric nervous system and the bloodstream. Issues in the gut may therefore lead to various cognitive, behavioural and mood disorders, including anxiety and depression due to this intimate link between the gut and brain.

The gut is also, surprisingly, responsible for 400x more production of serotonin than our brains are, making this a crucial site for this “happy hormone” and for neurotransmitter function to happen. Should there be an issue in the gut, this production becomes compromised, leading to issues like anxiety and depression.

A number of gut health issues may exist, for example;

• Dysbiosis – this is an imbalance in the microbiome (the beneficial and non-beneficial bacteria and yeast that reside in our guts) and can come about for various reasons; eating a diet high in sugar and processed foods and low in nutrient dense foods – common in our modern world of fast food, drinking too much alcohol, taking certain medications or taking numerous courses of antibiotics to name a few
• Parasites or other infections causing inflammation
• Increased permeability of the gut wall (also known as leaky gut, which can be caused by dysbiosis, infections and inflammation) – this causes unwanted toxins and molecules to cross the gut wall into the blood stream where they can travel to other parts of the body, causing issues to occur there

Deficiencies of key nutrients

Many nutrients play a vital role in the production and function of neurotransmitters. They are like the keys, without which, the door cannot be opened (production and function cannot happen).  Our modern diets are often very “beige” with lots of refined carbohydrates and fast food and not enough nutrient dense whole foods which can lead us to develop deficiencies.

Key nutrients include: omega-3 fatty acids (EPA and DHA), B vitamins, especially folate, B2, B6 and B12, choline, vitamin D, magnesium, copper and zinc.

GABA, a neurotransmitter with a calming effect; tryptophan, the pre-cursor for serotonin; and tyrosine, the precursor for dopamine, adrenaline and noradrenaline, have been found to be low in anxiety sufferers suggesting an important role in the disorder.

What can be done to address these root causes?

Manage stress and inflammation

• Eat a diet rich in whole, unprocessed foods daily like vegetables and fruit, healthy fats and oils like avocado, olive and coconut, and good quality proteins like wild-caught fish and grass-fed meat which are anti-inflammatory
• Avoid inflammatory foods like gluten, sugar, processed foods, baked/packaged goods and alcohol
• Food intolerances can cause inflammation too, common culprits include gluten, dairy, soya, corn and sometimes eggs and nuts. Get intolerance testing done through a professional or ask them to support you through an elimination diet
• Wild-caught oily fish have been shown in numerous trials to support healthy brain function and reduce inflammation as they are an excellent source of omega-3 fatty acids, aim for 3 to 4 portions per week
• Manage stressors as far as possible, this can be as simple as minimising time spent on social media and increasing time spent outdoors, being part of a supportive community, talking to someone who can help you gain perspective on your perceived stress, trying yoga, meditation or mindfulness

Support gut health

• Determine if you have an infection, overgrowth or inflammation in the gut. Work with a professional who can help with stool and organic acids testing which can be helpful in identifying issues and can put a targeted plan in place for you
• Eat an abundance of organic vegetables and some fruit every day. This diversity helps to support a healthy microbiome
• Fermented foods like sauerkraut, kimchi and kefir and probiotics can be helpful to repopulate the gut with beneficial bacteria. The probiotic strains Lactobacillus and Bifidobacterium in particular have been shown in trials to help reduce anxiety symptoms
• Support the integrity of the gut lining by drinking and cooking with bone broths and collagen-rich foods like gelatine

Address nutrient deficiencies

• By including a range of whole, unprocessed foods in your daily diet, you are less likely to have deficiencies
• Some individuals however may require higher amounts of certain nutrients. For those with anxiety, it may be beneficial to include the following foods if tolerated as they are high in the key nutrients needed for neurotransmitter function;
  • organ meats, wild-caught oily fish, shellfish, eggs, nuts and seeds, dark leafy greens and other vegetables
• Get tested for nutrient deficiencies – common ones that can be tested via your GP include B12, Vitamin D (most of us are deficient due to the lack of sun in the UK!), folate and iron
• You may need supplemental support to address nutrient deficiencies – work with a professional who can safely recommend the best options for you

Research is digging deeper into the root causes of anxiety with some illuminating results which are suggesting that nutrition and the role of the gut may in fact play a bigger role in the development of anxiety than was previously thought. More research in this area needs to be done but it certainly proposes it is an avenue worth exploring to support those with anxiety.