Anxiety – Nutritional Protocols & Natural Treatments

by Nathan Zassman May 30, 2007

Of all mental health issues, anxiety is the most common. This category includes generalized anxiety disorder (GAD), panic disorder, agoraphobia, social phobia, obsessive compulsive disorder (OCD), specific phobia(s), post traumatic stress disorder, and acute stress disorder. Approximately 5 million people per year suffer from post-traumatic stress, while panic disorder ranges from between 3 to 6 million, with twice as many women suffering from panic disorder. Obsessive compulsive disorder affects two to three percent of the population, with women and men being affected equally.

Anxiety, in a number of different forms affects the lives of approximately 15% of people. General anxiety disorder can affect children between the ages of six and eleven. Children can worry about grades, performance in competitive activities, punctuality, health, and family issues. Obvious physical symptoms can include restlessness, fatigue, difficulty sleeping and concentrating, irritability and muscle tension. Children with GAD are often perfectionists, and may seek constant approval or reassurance from others. Woman with Insomnia

Feeling anxious is not something you should feel badly about, as anxiety is a mood disorder, and it can be successfully treated with nutrition, drugs (if required, but I would hope that drugs would be a last resort, or an initial treatment that would give way to nutritional approaches), and cognitive behavioral psychotherapy.

Anxiety disorders and panic attacks are not signs of a character flaw. Most importantly, feeling anxious is not your fault. It is a serious mood disorder, which affects a person’s ability to function in every day activities. It affects one’s work, one’s family, and one’s social life.

There can be many causes of anxiety disorders, including family history and genetics. Anxiety caused by medications or substance or alcohol abuse is not usually considered a true anxiety disorder.

Some psychiatrists use conventional drug therapy to more quickly normalize anxiety, combined with nutritional protocols. As drugs work more rapidly, they can sometimes be useful initially. Nutritional therapies work more slowly, so as the nutritional approach begins to work, the drug dosages are often gradually lowered, and hopefully discontinued. I recommend finding a nutritionally oriented health professional who is familiar with these methods.

I recommend a natural 10-step approach, including:

Relaxed Woman (1) Stress reduction techniques including meditation and brainwave entrainment audio programs, and relaxing breathing exercises (including the Frolov Breathing Device).

(2) Nutritional supplements designed to help improve the quantity and quality of sleep.

(3) A sound nutritional program to eliminate nutritional deficiencies as contributing factors that includes a comprehensive vitamin and mineral supplement, omega 3 fatty acids, Gamma Linolenic Acid (GLA).

(4) A healthy diet that eliminates foods that may contribute to anxiety.

(5) Specific supplements as listed below that have been shown to help relieve anxiety

(6) Regular aerobic and resistance exercise.

(7) Spending time doing something you love.

(8) Spending time in a creative pursuit such as art or music.

(9) Listening to classical music.

(10) Cognitive behavioral therapy when required.

Below are recommended supplements, along with meditation, brainwave entrainment products, and aerobic exercise recommendations:

Diet – Eliminate refined sugar, refined grains (carbohydrates), caffeine, and alcohol. Food allergies may be a factor, but the vast majority of anxiety disorders show improvement from reducing consumption of refined carbohydrates, caffeine containing drinks, sugar (in any form) and alcohol.

GABA – Gamma Amino Butyric Acid has been the subject of numerous studies on panic disorder as well as other psychiatric disorders and substance abuse conditions. Scientists believe that GABA, a brain chemical, works by limiting the nerve cell activity in areas of the brain associated with anxiety. GABA is an amino acid produced in the brain that functions as an inhibitory neurotransmitter.

It has been hypothesized that people with anxiety disorders have increased cell activity in these areas. Another theory, is that people with anxiety and/or panic disorders have abnormally low levels of GABA. For fast relief of chronic anxiety, I recommend 750-1000 mg, 3X per day of standard USP, or 25 mg of “Pharma GABA,” a new, more potent, more natural form of GABA, combined with P5P, the active, coenzyme form of Vitamin B6.

Pharma GABA is a natural source form produced from sugarcane by bacterial fermentation that is much more highly concentrated, requiring much smaller dosages than the commonly produced synthetic form of GABA. Pyridoxal-5-Phosphate (P5P), which is the active form of Vitamin B6, plays an important role in helping to regulate GABA levels in the body. GABA with P5P inhibits the transmission of stress-related nerve impulses in the brain, which helps to gently ease feelings of nervousness and anxiety. GABA with P5P brings excellent results and is usually my first recommendation for those looking for a natural approach to alleviating anxiety.

L-Theanine – Abundant in green tea, L-theanine has a significant effect on the release or reduction of neurotransmitters like dopamine and serotonin, resulting in improved memory and learning ability. L-Theanine has been shown to be effective in the treatment of anxiety, nervousness, sleep disturbances, Premenstrual syndrome (PMS), and ADD/ADHD. L-Theanine increases brain GABA and dopamine levels, and does not produce drowsiness at normal dosages of 100 to 200 mg per day.

Holy Basil (tulsi) – An important herb that has been used for over 3000 years as part of the rich Ayurvedic tradition of natural healing, many recent studies have proven the remarkable benefits of Holy Basil, for stress and anxiety. Products containing Holy Basil have been shown to be effective in the treatment of anxiety. Other benefits include support for blood sugar and insulin metabolism, helping to counteract the effects of cortisol (the stress hormone), while elevating the spirit. Holy Basil has the unique ability to help bring balance and calm.

Magnesium – 300-600 mg/day. Anecdotal evidence has shown low levels of magnesium to be a factor in anxiety, but magnesium is involved in over 300 biochemical reactions in the body. I recommend magnesium taurate for anxiety, as magnesium that has been “reacted” with taurine has been shown to be more effective than other forms of magnesium. Other forms of magnesium that are effective in helping to reduce anxiety include magnesium glycinate and magnesium aspartate or asporotate. A very successful product is Natural Calm, a flavoured, powdered magnesium supplement that has worked well for many with anxiety.

5-HTP – Studies using L-tryptophan or 5-HTP, which increase serotonin activity, suggest that these amino acids may also be effective anxiety-reducing agents. Recommended dosage, 5-HTP, 100mg, three times a day with or without food. Carlson Laboratories produces an excellent chewable 5-HTP product. Preferred Nutrition feels that the effects of 5-HTP are enhanced if the supplement bypasses the stomach, so they have enteric coated their product, called Happy Sense.

L-Tryptophan – L-Tryptophan, when taken alone, when vitamin B3 and B6 are also included, converts to serotonin, the “feel good” brain chemical during daylight, and to melatonin, under complete darkness. Zenbev, made from gourd seeds, is one of nature’s richest natural sources of L-Tryptophan. For L-Tryptophan to be effective, it cannot be taken with other proteins. In addition, the inclusion of a carbohydrate (even a simple sugar) is critical for pushing the L-Tryptophan across the blood brain barrier, a requirement for the conversion of L-Tryptophan to serotonin and melatonin.

More on Zenbev – Source of natural L-Tryptophan derived from pumpkin seeds. Zenbev functions as a sleep aid at night, and as a treatment for anxiety during the daytime. Zenbev only needs to be taken three or four days out of seven days, as it has a cumulative effect. Zenbev is often prescribed for insomnia and sleep disorders. While Zenbev was formulated for anxiety, it has become extremely popular for treating fibromyalgia. L-Tryptophan is a precursor for melatonin in the evening, and serotonin (the feel good brain chemical) during daylight. Remember to recommend a good B Vitamin (or multi with all the B-Vitamins), a light, low protein, predominantly carbohydrate dinner (other proteins/amino acids compete with L-Tryptophan and lessen the benefit), and eye shades, as complete darkness is a prerequisite for a good night sleep. Lack of sleep is also a contributing factor for those with anxiety disorders.

Niacin/Niacinamide – Start with 50 mg of niacin, taken with food, and gradually, over the period of two weeks increase to two 500 mg tablets, three times a day. If you don't want the flushing, niacinamide can be substituted, 500 mg, at least four times per day. Recent research has shown niacinamide to be as effective as benzodiazepines for reducing anxiety. Niacin also has the side benefit of increasing HDL (the good) cholesterol, while reducing LDL (the bad) cholesterol. Niacinamide has also been shown to be effective for treating osteo-arthritis. Dr. Jonathan Prousky, a well known Naturopath in Toronto has had excellent results in treating anxiety with niacinamide.

Sensoril – Sensoril is a proprietary extract of Withania somnifera (Ashwagandha). Well known as an Ayurvedic herbal treatment for stress and anxiety (see Ortho Adapt and other Adaptogenic Herbal Formulas), Sensoril has been shown to (1) increase energy, (2) reduce fatigue, improve sleep, lessen irritability, bring greater levels of concentration/focus, reduce stress symptoms, and increase general feeling of overall wellbeing.

Sensoril has been shown to reduce cortisol levels (up to 26%), fasting blood sugar, total cholesterol (LDL,VLDL, and triglycerides), while increasing HDL and DHEA (the counter balance to cortisol, the stress hormone).

Relora – Relora or relora-containing supplements, including Cortisol Control by Complementary Prescriptions. Relora is an exciting new natural anti-anxiety and stress relief ingredient used to control stress-related eating and drinking that has the added value of being non-sedating with potential anti-depressant properties. Relora helps reduce anxiety by acting as a “precursor” to DHEA, the hormone that helps counteract the negative effects of the stress hormone cortisol. DHEA is not available in Canada, making Relora, or Relora containing supplements an excellent alternative.

Relora was developed to improve mood, help stressed individuals relax, and to normalize the hormones related to stress-induced eating. Eighty percent (80%) of stressed adults studied feel more relaxed with Relora. Relora has also been shown in a pilot study to normalize cortisol levels in stressed individuals. Preliminary findings suggest that Relora can decrease the cravings for high fat, high sugar foods in stressed individuals, most likely due to its ability to normalize stress hormone levels that cause these cravings.

Chinese Red Date, Red Jujube – Used for thousands of years in traditional Chinese Medicine for the treatment of anxiety and insomnia, you can find Red Jujube in Chinese markets, and also as an ingredient in many natural anxiolytic preparations.

Chill Pills by New Roots Herbals is a creative combination of L-Theanine, Magnolia and Phellodendron (Relora), Ashwagandha (Sensoril), Inositol, Red Jujube, Passion Flower, and a full complement of B-Complex vitamins. Chill Pills may be effective for stress, insomnia and anxiety.

Vitamin B-6 (Pyridoxine, or P-5P) – 100 mg, 3X per day, or 50mg of P-5-P daily.

The use of vitamin B6 in the body has many influences, including the neurotransmitters GABA and serotonin. Research in animals has proven that deficiency of vitamin b6 can affect many of the central nervous system functions. The GABA and serotonin neurotransmitters are known to affect the level of depression as well as anxiety in humans. Vitamin b6 has already been shown to have positive effects on cardiovascular health, and it is believed to have added benefits in aiding to manage depression and anxiety. Supplementation with vitamin b6 can be useful in regulating anxiety and depression levels, and is a cost effective way to help control these in humans.

Calcium – 600-1200 mg per day. Anecdotal evidence has shown low levels of calcium to be a factor. I recommend Chelated calcium (especially glycinates combined with Vitamin B6), MCHC (Microcrystalline Hydroxy Apatite), and Calcium Carbonate, contrary to popular opinion, is effective and well absorbed if taken with food. Calcium Citrate is recommended if taken without food (on an empty stomach).

Vitamin B-Complex (high potency) – I recommend products from New Roots and NOW Foods. Every quality multi vitamin carried by Aviva has the full complement of B Complex vitamins, with the highest potency in the Douglas Laboratories product line. The many complex enzymatic reactions that convert the amino acid L-Tryptophan to serotonin and (3 chemical steps later) melatonin require vitamin B3 (niacin) and Vitamin B6. A quality multi vitamin with all the required B-Vitamins must be part of an overall comprehensive nutritional approach to anxiety. It is possible that anxiety can be caused by a lack of critical B-Vitamins, which prevent the important biochemical and enzymatic reactions necessary for conversion of important brain chemicals into serotonin.

Vitamin B12 – 2-4 mg per day, as Dibencozide, Hydroxocobalamin, or Methyl Cobalamin, sublingual tablets or liquid.

Inositol – In a double blind trial, supplementation with 12 grams/day of inositol significantly reduced the frequency and severity of panic attacks and the severity of agoraphobia.

Passionflower Extract – 45 drops per day for 4 weeks, passionflower was as effective as 30mg/day of oxazepam (double-blind trial) and significantly better tolerated. Improvement was seen within 7 days.

Valerian – In addition to promoting sound sleep, valerian has a reputation for easing anxiety and relaxing tense muscles. Valerian is thought to lessen anxiety because in blocking brain receptors for the neurotransmitter GABA, it also inhibits nerve impulses and stress-related messages from reaching the brain. Many have taken valerian for occasional sleeplessness, often with inconsistent results. For valerian to be effective for anxiety or sleep, it needs to be taken daily, with results usually within two to three weeks of continued use.

L-Tyrosine – Promotes healthy thyroid, adrenal and pituitary function. Suppresses appetite and helps reduce body fat. Research indicates tyrosine may help chronic fatigue, narcolepsy, anxiety, depression, allergies, headaches, and Parkinson’s disease.

Adaptogens – Many adaptogens have been shown to be helpful for anxiety, including Rhodiola and Ashwagandha. I recommend Ortho Adapt from Advanced Orthomolecular Research.

True Calm – An impressive combination of amino acids, vitamins and botanicals, that work synergistically for a wonderful effect. This formula includes niacinamide, Vitamin B6, Magnesium, GABA, Taurine, Inositol and Valerian.

Melissa (Lemon Balm) – Melissa Officinalis is often used as a general nervous system restorative, digestive calmative and to reduce blood pressure. Its active ingredients include volatile oil, tannins, flavinoids, tocopherols and choline.

Kava Kava – One of the most impressive herbs for anxiety and sleep, Kava was at one point removed from the Canadian market, as the herb was thought to increase risk of liver disease, based on reports of liver toxicity in Germany. Further research has proven the safety of the herb and it has returned to the Canadian market as a fully licensed natural health product. Kava induces a wonderful and natural state of relaxation without a “drugged” feeling. Kava helps reduce muscle tension, and encourages a more peaceful and content mental state. Other benefits include helping people become more sociable, although high doses may induce withdrawal. Kava does not affect mental alertness, but does encourage drowsiness, which is why it helps so many with sleep disorders.

Kava was having a major impact on sales of popular pharmaceutical antidepressants, including Prozac, Paxil, Zoloft, Luvox, Serzone and Effexor, of the Selective Serotonin Reuptake Inhibitor (SSRI) family. Unfortunately, the strength of “big pharma,” large pharmaceutical drug companies who have very deep financial pockets, can often influence the “experts” to indicate that a natural product (in this case an herb that has a tradition going back three millennia and has never been known to cause serious health problems) should be removed from the market. This is why Kava was made unavailable in Canada and some European countries; however, after reviewing the research, Health Canada has reversed their stance on this valuable herb, and it is now available in Canada.

Aerobic Exercise – Daily aerobic exercise is vital, for control, and relief of anxiety; however, new research has cast some doubt on the long term health benefits of excessive aerobic exercise. Recent studies at Harvard University indicate that short duration high intensity aerobics provide greater cardiovascular and cognitive benefits, without the damage to the joints that is so often the result of long duration (30-60 minutes) high intensity aerobic exercise. I recommend a combination of short duration (10-15 minutes) of high intensity exercise, up to three times each day, combined with resistance exercise on alternate days, to build stronger muscles and build greater bone mineral density. Short duration, high intensity aerobic exercise releases endorphins and other “happy” brain chemicals that are now also being linked to improved cognition and lower rates of Alzheimer's or other forms of dementia. Regular exercise, even if you are not dealing with anxiety, should be part of everyone's healthy lifestyle. People Laughing

Brainwave Entrainment – Using Binaural Beat Technologies. CD-Audio programs designed to help achieve a more relaxed or focused state of mind.

Laughter – An effective coping skill against fear, anxiety or depression. Laughter can temporarily alleviate the symptoms of anxiety and depression, but is generally not practical during a panic attack. Some studies suggest that laughter may have neurochemical benefits regarding chronic anxiety or pain.

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