We live in a very stressful world, no one can dispute this. Currently there are 40 million Americans suffering from some anxiety related disorder ranging from mild to severe. Though it is still taboo to discuss mental health issues openly as one is viewed as "weak", many people report feeling some level of anxiety, which leads me to believe that a lot more of us are walking around anxious and stressed than we think.
Unfortunately in today's world when we approach our primary care doctor and discuss symptoms of anxiety, little is done to address the root cause. And after the 8-10 minutes you spend with the doctor, out you walk with a prescription for anti-anxiety medication, left on your own to navigate the side effects and emotional changes no one discussed or prepared you for.
Don't misunderstand me, I'm not opposed to medication when it is necessary. I think medication has its place and if someone is properly diagnosed, then by all means, do whatever it takes to help a person feel better. And in certain cases, the benefits far outweigh the side effects BUT, doctors generally (though some do) don't have the time to ask: "How is your sleep? How is your diet? How is your home life? Work life? Do you have any coping mechanisms?" Our healthcare model is not set up for patients to go into long discussions about their lives. This is not to say that doctors don't genuinely want to help, but most have a quota to meet and 8-10 minutes just isn't enough to weed out the particular issues troubling a patient.
So now that I'm through with my tirade let's move on.
While we can't always change our home life, work life and stressors, we are for the most part, fully in charge of what goes into our bodies. Although lifestyle plays a big role in anxiety, there doesn't seem to be much focus on how gut health affects mental health and how diet can be a major player.
What is anxiety?
Anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.
People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat.
I'm fairly certain we've all experienced some level of anxiety at one time or another to varying degrees. What we often don't stop and consider if how the integrity of our gut can in fact be affecting our emotional state.
The gut-brain connection
Let's talk about serotonin. Did you know that there is about 400 times more serotonin in the gut than there is in the brain? Yes, and 90% of the body's overall serotonin is produced in the intestinal tract. There is no doubt why you get butterflies in your stomach when you get nervous or why a gripping stomach ache takes hold when you're stressed. The gut and the brain are interconnected.
Additionally, if you are suffering from IBS-C/D, leaky gut, SIBO (small intestinal bacterial overgrowth) or other digestive issues, these can impact mental health. One study suggests that anxiety may in fact start in the gut, not in the head as we always assumed. Bacteria found in the intestines may actually be responsible for altering brain function as this study suggests.
When it comes to mental health, several nutrients are required in order for the brain function at its highest capacity. These nutrients include, but are not limited to: vitamin D, B12 and B6, folate, zinc, copper, choline, riboflavin, EPA and DHA. Please note that vitamin B12 is only found in animal products, so it's possible that unless supplementing, vegetarians and vegans do have a lower level of this important nutrient so it's crucial to pay close attention to this one. Furthermore, low vitamin B12 has been linked to depression.
I won't focus on all the micronutrients here as some of them overlap, but I can't stress enough the importance of vitamin B12, D and EPA/DHA in the form of Omega 3s. Additionally, zinc is a nutrient that has been linked to reduced anxiety.
Sources of vitamin B12:
- Beef liver: 1 ounce: 20 micrograms (over 300 percent DV)
- Sardines: 3 ounces: 6.6 micrograms (over 100 percent DV)
- Atlantic mackerel: 3 ounces: 7.4 micrograms (over 100 percent DV)
- Lamb: 3 ounces: 2.7 micrograms (45 percent DV)
- Wild-caught salmon: 3 ounces: 2.6 micrograms (42 percent DV)
- Nutritional yeast: 1 tablespoon: 2.4 micrograms (40 percent DV)
- Feta cheese: 0.5 cup: 1.25 micrograms (21 percent DV)
- Grass-fed beef: 3 ounces: 1.2 micrograms (20 percent DV)
- Cottage Cheese: 1 cup: 0.97 micrograms (16 percent DV)
- Eggs: 1 large: 0.6 micrograms (11 percent DV)
Sources of vitamin D:
- Sunlight - Promotes vitamin D synthesis from cholesterol in the skin.
- Cod liver oil - 1 tsp: 440 IU (over 100% DV)
- Sardines - 3 ounces: 164 IU (41% DV)
- Salmon - 3 ounces: 400 IU (100% DV)
- Mackerel - 3 ounces: 400 IU (100% DV)
- Tuna - 3 ounces: 228 IU (57% DV)
- Raw Milk - 1 cup: 98 IU (24% DV)
Sources of DHA/EPA in the form of Omega-3s
- Mackerel: 6,982 milligrams in 1 cup cooked (174 precent DV)
- Salmon Fish Oil: 4,767 milligrams in 1 tablespoon (119 percent DV)
- Cod Liver Oil: 2.664 milligrams in 1 tablespoon (66 percent DV)
- Walnuts: 2,664 milligrams in 1/4 cup (66 percent DV)
- Chia Seeds: 2,457 milligrams in 1 tablespoon (61 percent DV)
- Herring: 1,885 milligrams in 3 ounces (47 percent DV)
- Salmon (wild-caught): 1,716 milligrams in 3 ounces (42 percent DV)
- Flaxseeds (ground): 1,597 milligrams in 1 tablespoon (39 percent DV)
- Tuna: 1,414 milligrams in 3 ounces (35 percent DV)
- White Fish: 1,363 milligrams in 3 ounces (34 percent DV)
- Sardines: 1,363 milligrams in 1 can/3.75 ounces (34 percent DV)
- Hemp Seeds: 1,000 milligrams in 1 tablespoon (25 percent DV)
- Anchovies: 951 milligrams in 1 can/2 ounces (23 percent DV)
- Natto: 428 milligrams in 1/4 cup (10 percent DV)
- Egg Yolks: 240 milligrams in 1/2 cup (6 percent DV)
Sources of Zinc:
- Lamb: 3 ounces: 6.7 milligrams (45 percent DV)
- Pumpkin Seeds: 1 cup: 6.6 milligrams (44 percent DV)
- Grass-Fed Beef: 100 grams: 4.5 milligrams (30 percent DV)
- Chickpeas (Garbanzo Beans): 1 cup: 2.5 milligras (17 percent DV)
- Cocoa Powder: 1 ounce: 1.9 milligrams (13 percent DV)
- Cashews: 1 ounce: 1.6 milligrams (11 percent DV)
- Kefir or Yogurt: 1 cup: 1.4 milligrams (10 percent DV) (values vary)
- Mushrooms: 1 cup: 1.4 milligrams (9 percent DV)
- Spinach: 1 cup: 1.4 milligrams (9 percent DV)
- Chicken: 100 grams: 1 milligram (7 percent DV)
While these are wonderful additions to any diet in order to optimize gut and brain function, it's imperative to keep in mind the foods that may worsen anxiety. While there is no conclusive evidence that certain foods cause anxiety, consuming the below foods on a regular basis can in fact exasperate feelings of anxiety. So while I'm biased as I love coffee (benefits of coffee will be for another post) and wine, these have to be moderated, especially if you suffer from anxiety.
The worst 10 foods for anxiety:
- Refined flour
- Artificial sweetners
- Hydrogenated oils
- Excess alcohool
- Processed foods
- Excess caffeine
Best foods for lowering anxiety
- Oysters: This study suggests that an imbalance between zinc and copper, may potentially trigger anxiety symptoms. Often times copper levels in the body are higher than zinc. "Based on the results presented in this study, we suggest that the low levels of zinc, possibly associated with concurrent oxidative stress, may cause lower GABA and glutamate, having an anxiogenic effect, and that zinc supplementation, raising GABA levels, may help improve anxiety symptoms."
- Salmon: I've discussed salmon at length in this post. But in this particular study, students were given a supplementation of Omega 3s and results show that supplementing with Omega 3s can actually help lower symptoms of anxiety in healthy adults.
- Asparagus: Rich in folate, this vegetable is one of the best things you can eat if you do suffer from anxiety. Folate converts to folic acid in the body and has been linked to reduced anxiety. In an animal model, it was shown that aqueous extract of asparagus stem (AEAS) was successful in helping with the management of anxiety disorder.
- Avocado: One of my favorite foods on the planet. This fruit is rich in B vitamins and research suggests that deficiency in B vitamins has been linked to anxiety. Depressed and anxious patients reported improved symptoms when supplementing with vitamin B complex compared to placebo.
- Turkey: Another great food to help with symptoms of anxiety is Turkey. Tryptophan in turkey has been a great area of interest and this review evaluates the effects of tryptophan and serotonin on mood and cognition as it relates to the gut brain axis. An additional study looked at the effects of consuming tryptophan and found that after consuming a diet rich in tryptophan, both anxiety and depression were reduced.
- Probiotics: There has been much research that suggests that gut health plays a role in anxiety. "The intestine has its own separate nervous system, and generates many of the same neurotransmitters (including acetylcholine and serotonin) that the brain generates. These neurotransmitters are very important in promoting gut motility, and too much or too little of them may result in constipation or diarrhea. Similarly, we believe that the brain and the gut can talk to each other. Therefore, it is possible that anxiety and depression may trigger abdominal pain or other GI symptoms. It is also possible that gastrointestinal conditions such as chronic abdominal pain or constipation might also result in anxiety or depression." I've discussed probiotics at length in several posts so you can check these out here and here.
While there is no magic pill for increasing serotonin unless you take an actual prescription pill, you can boost serotonin by including these foods in your diet. Additional serotonin boosting foods include, eggs, cheese, pineapple, tofu (though I would be wary to recommend this on a regular basis), nuts and seeds.