by Ali Miller
Genetic predispositions can drive higher susceptibility to anxiety, the influence of the epigenome via nutrigenomics can address genetic areas of concern through enhanced expression. The diet, supplement, and lifestyle changes recommended in this book can free you from a life of worry and anxiety regardless of your genetics by compensating for areas of enhanced need.
Ways to Address a MTHFR and COMT genetic SNP
1. Reduce stress levels and practice relaxation.
2. Reduce exposure to toxins in cosmetics, household, diet, and environment.
3. Avoid use of synthetic estrogen in birth control pills and prescription hormone replacement therapy.
4. Avoid processed enriched foods or supplements using folic acid (the only acceptable forms of folate are: natural folate, 5-methyl-tetrahydrofolate, 5-MTHF, and L-methylfolate). Watch out for many health products that have non-methylated B vitamins, such as folic acid and cyanocobalamin.
5. Aim for at least 7 hours of sleep per night.
6. Eat a diet rich in foliage or leafy greens such as kale, spinach, collards, and broccoli, and consider pasture-raised organs such as chicken and beef liver for bioavailable B-vitamins.
7. Take an activated B-complex to provide a moderate amount of methyl-donors, such as 5-MTHF and B6 in the form of pyridoxal 5’ phosphate (P5P).
8. If the addition of a quality B-complex drives anxiety and insomnia, consider SAM-e at 400 to 800 milligrams to support COMT and reduce over-methylation or methyl-build up.
When Eating Healthy Isn’t Enough and Drugs Don’t Work
Pairing all of the complexities of inability to absorb with fluctuating demands based on aging, exercise, hormonal and emotional distress, and state of dysfunction in the body, you may start to see that it’s nearly impossible to provide for the body’s need to heal and create balanced brain chemistry with mood stability. This is where micronutrients in a supplement form are a very powerful tool in helping you reclaim your mental health.
Research points to poor diet quality, intake of refined processed sugars, inflammation, and gut damage as primary factors of micronutrient deficiency, all of which have a strong risk association with depression and anxiety. The anti-anxiety diet program is developed to reset the foundational environment of your gut to optimize absorption of nutrients as well as the actions of neurotransmitter production.
During this therapeutic approach, it will be necessary to supplement the diet to achieve brain balance and mood stability with less panic and anxiety. In order to truly see outcomes from food as medicine in the anti-anxiety approach, it is essential to pair a therapeutic diet with strategic nutrients in concentrated form to ensure functional deficiency is repleted while improving the function of the system. Studies have found orthomolecular dosing, or dosing at mega nutrient levels beyond the dietary reference intake (DRI), to be both effective and safe interventions for anxiety and mental health.
In order to get clinical outcomes with supplementation, you will not likely get results from a product purchased at your grocery store; this will likely be a synthetic form of nutrients, manufactured at low quality, and not tested for potency and contaminants. Use the quizzes in this book to determine if you need to start supporting a leaky gut to enhance absorption, microbiome to enhance production of neurotransmitters and reduce stress to system, or adrenals to balance neurotransmitters and rebound chronic fatigue. The nutrients to follow are highlighted for their varied functions to support anti-anxiety outcomes and may be used to strategically address a specific need.
When choosing supplements, select from lines that are third-party assessed for potency, optimal absorption, purity, and contaminants to ensure you are using effective nutritional medicine. Learn more about what I use in my clinic the Appendix’s Supplement Support for the 6 Foundational Rs section.
Antidepressants, anti-anxiety, and antipsychotic drugs may be effective in the short term but become ineffective or drive greater mood instability and symptoms over time. In fact, a 2014 systematic review, “Outcome of Mood Disorders Before Psychopharmocology,” found “no support to the belief that pharmacological treatments have resulted in an improvement in the long-term outcome of patients with mood disorders.”
Yet the use of medications as primary intervention for anxiety prevails and continues to increase in both adults and children, with a 65 percent rise over the last 15 years. At the same time, there are higher incidents of anxiety than ever. Using food as medicine paired with strategic quality nutritional supplement support, you can rebalance your brain chemistry and achieve mood stability while eliminating side effects and achieving synergistic response in your body, such as increased energy, brain clarity, weight loss, improved digestion, reduced joint pain, and overall disease risk.
Antioxidants as Anti-Anxiety Support
Oxidative damage occurs in the presence of toxins, free radicals, light, heat, and oxygen exposure. Oxidative stress in the brain drives neurological dysfunction, including depression, anxiety, panic, and acute anxiety distress. These symptoms accelerate in the state of antioxidant deficiency. Imagine lemon or lime juice on an avocado. When you mix the vitamin C (ascorbic acid) as an antioxidant with the avocado, the oxidative damage, or browning, is reduced. This is a direct mechanism of an antioxidant preventing oxidative stress or damage, and the same mechanism can protect your brain from neurological imbalance and mood instability.
To add insult to injury, research demonstrates chronic emotional stress as a driver of reactive oxygen species (ROS), which drives more oxidative damage in the brain. Beyond management of stress and reduction of exposure to toxins, a diet rich in antioxidants can be a great way to support protection against free radicals and reduce ROS activity.
Top antioxidant-providing nutrients include glutathione, cysteine, CoQ10, selenium, vitamin E, vitamin A, and vitamin C. Sulfur-containing vegetables such as broccoli, cauliflower, cabbage, and Brussels sprouts provide a rich source of cysteine and glutathione to aid in both detoxification and antioxidant support. Glutathione is really the “granddaddy” antioxidant in the hierarchy of free radical scavengers. Beyond sulfur-containing compounds, vegetables, herbs, and fruits provide flavonoids, plant-based compounds that exert a positive health effect in neurodegenerative and anxiety disorders.
VITAMIN C AND CORTISOL CONNECTION
The most concentrated storage site of vitamin C is in the adrenal glands, which is likely due to the fact that vitamin C demands can increase tenfold in times of stress! The adrenals use vitamin C in the regulation of cortisol production and release. Vitamin C is used in the production of adrenal hormones, namely cortisol, the primary stress responder, and ample levels of vitamin C encourage the gland’s optimal function. When vitamin C levels become deficient, rather than reduced cortisol production from the adrenals, they go into “freak out” mode and surge more cortisol release. Optimizing vitamin C through a diet rich in berries, bell peppers, and citrus is a priority when addressing adrenal imbalance. In the case of adrenal fatigue, vitamin C is required in amounts of 2 to 5 grams/day to rebound the function and production in the gland. As if managing cortisol wasn’t enough, research demonstrates vitamin C supplementation as a way to reduce blood pressure, enhance antioxidant status, and reduce anxiety in both acute and chronic settings.
Boosting Antioxidant Status with Whole Foods
Adding fresh herbs and generous portions of spices into your food is a great way to boost antioxidant status! By eating real foods in their most whole form, you get more abundant polyphenols, which include the varied plant antioxidant forms of anthocyanins, isoflavones, and flavonoids.
Rutin, for example, is an antioxidant classified as a citrus flavonoid, and is found in the white pith and rind of citrus. When consuming lemon, lime, grapefruit, or orange juice, you get very little rutin; however, if you consume the whole fruit, the white furry fiber will enhance the citrus fruits’ disease-fighting properties due to the presence of rutin. Rutin may also aid with mood stability and reduced an
xiety through activation of cannabinoid mediated antidepressant activity on certain receptors in the brain.
A diet that is focused around whole foods in a spectrum of colors, providing plant antioxidants, will not only reduce free radicals and thus reduce inflammation to the brain, but will also provide drivers for optimal neurological function and mood stability.
Best Sources of Antioxidants
Berries: Blackberries, blueberries, cranberries, elderberries, goji berries, raspberries
Cacao: Cacao butter, cacao nibs, cacao powder
Roots: Ashwagandha, ginger, maca, turmeric
Herbs: Basil, cilantro, cinnamon, cumin, oregano, parsley, rosemary
Teas and coffee: Black tea, coffee, espresso, green tea, matcha, oolong, rooibos, white tea
Mood-Stabilizing Minerals
Minerals play a dynamic role on mood stability, from enzyme activation to muscle relaxation and neurotransmitter regulation. Mineral deficiency can drive dynamic mood shifts and anxiety to the level of psychosis and panic. I will highlight five minerals for food-as-medicine support for anxiety below, but first I want to discuss reasons for mineral deficiency.
I stress the recurring “chicken and egg” theme throughout this book because it is important to understand that some minerals, such as selenium and magnesium, are depleted with stress demand. As they are depleted, this further drives the anxiety and stress response. Both selenium and magnesium activate the production of thyroid hormone to support balanced energy and metabolism in times of stress.
Beyond stress-driving depletion, all minerals are at risk for deficiency with a processed diet, lack of soil diversity in farming, excessive use of fiber supplements, and/or use of medications that block nutrient absorption or drive excretion. Sugar and refined foods drive mineral depletion, as the body burns through 54 molecules of magnesium to process one molecule of sugar! As your blood sugar spikes from high carbohydrate intake, insulin responds in a surge, which uses up your zinc and chromium. Although there are many factors in mineral depletion, your transition to reduced carbohydrate intake with the anti-anxiety diet will play a foundational role in preventing deficiency and supporting rebound for sustainable mood and metabolism.
Magnesium
Magnesium is involved in over 300 enzyme pathways and has a role in both neuromuscular stress response as well as neurotransmitter and HPA-axis function. Research supports that magnesium deficiency can drive increased anxiety reactivity and stimulation of cortisol, which further drives anxiety and distress response. Diabetes, hypertension, heart disease, and inflammation are all linked to magnesium deficiency, and over 68 percent of Americans are estimated to be deficient. Magnesium has been deemed the “original chill pill” as it directly works to suppress cortisol and adrenal output via reduced release of ACTH (adrenocorticotropic hormone) from the pituitary. Also, magnesium has the unique ability to cross the blood-brain barrier, serving as gatekeeper to block the entrance of stress hormones into the brain.
Magnesium is found in dark chocolate, nuts, seeds, leafy greens, avocados, and beets.
Due to the prevalence of deficiency and significant relaxation response with low risk for toxicity, I recommend supplementation of magnesium in the form of magnesium glycinate (see Supplement Support for the 6 Foundational Rs on page 159 for recommendations). This becomes especially important when adapting to a high-fat, low-carbohydrate diet as electrolytes are often thrown off with hydration shifts in a ketogenic state.
Chromium
Chromium is known for aiding blood sugar regulation due to its role in carbohydrate metabolism. It supports the body’s ability to take up and use insulin. In recent findings, researchers discovered insulin sensitivity may also support the ability of tryptophan to cross the blood-brain barrier. Tryptophan is the amino acid building block to serotonin. We will get deeper into all things neurotransmitter in Chapter 7, Rebalance your Neurotransmitters.
A rat study used chromium supplementation with exposure to chronic unpredictable mild stress (CUMS) and discovered chromium’s ability to aid in delivery of tryptophan as well as reduce concentration of corticosteroid stress hormones. In this sense chromium may have the ability to modulate stress response by enhancing the delivery of feel-good mood stabilizers while reducing the influence of anxiety-driving stress hormones.
Chromium is found in broccoli, cinnamon, nuts and seeds, green beans, prunes, pasture-raised meats, and wild seafood (especially shellfish).
Selenium
Selenium is a mineral with antioxidant properties, most known for its ability to promote healthy thyroid function. It aids with glutathione generation, serving to scavenge free radicals and reduce oxidative stress in the body and brain. Selenium status has been inversely related to frequency and severity of anxiety, depression, and chronic fatigue. A study examined a five-week period of increased intake of selenium by diet and supplementation and determined an elevation in mood and, most remarkably, a reduction in anxiety.
Selenium is found in Brazil nuts, cashews, sunflower seeds, tuna, oysters, sardines, snapper, shrimp, liver, garlic, and dark meat cuts of chicken.
Zinc
Zinc plays a role in hormone regulation, both in reducing excess estrogen and enhancing testosterone expression, and it is widely acknowledged for its immune-supporting properties. But, in the anxiety world, zinc is a hero due to its effects on neurotransmitters and its ability to counteract copper.
Zinc, like magnesium, plays a role in over 300 enzymes in the body, and its use is widespread. It is depleted with stress and anxiety due to demand. The role of zinc in the connection of anxiety and brain chemistry is twofold. Zinc aids in optimized stomach acid, which in turn supports the breakdown of amino acid glutamine, which can then convert into the excitatory glutamate, which can further be metabolized under optimal conversions to the mellow-out compound GABA. Zinc competes with copper, which has been shown to drive excitatory stress hormone output seen in the primal survival part of the brain that is often overstimulated during times of panic.
A study by the Journal of Nutrition and Metabolic Insights found that individuals with chronic anxiety had elevated levels of copper paired with very low zinc in their plasma and demonstrated improvement of symptoms with the addition of zinc supplementation. If your body has excessive stores of copper due to improper multivitamin supplement, tap water treated with copper and leaching from copper pipes, estrogen dominance, sluggish liver, and/or adrenal fatigue, the copper buildup in your body will block use of zinc, which can further perpetuate panic and anxiety response.
Zinc is found in oysters, liver (from pasture-raised sources), grass-fed beef and lamb, egg yolk, fish, pork, turkey, pumpkin seeds, sesame seeds, dark chocolate, and nuts.
PYROLURIA: A TOXIC DRIVER OF ANXIETY?
Pyroluria is a chemical imbalance due to a genetic error in red blood cell formation. Hemoglobin is a protein that holds iron in the red blood cell, and individuals that have pyroluria experience a buildup of hemoglobin builders called kryptopyrrole (KP), which is passed in the urine in normal amounts in healthy individuals. Individuals with pyroluria have an excess of KP, which has toxic effects and binds vitamin B6 and zinc, driving deficiency of these key mood-stabilizing nutrients. Those that suffer from pyroluria cannot effectively produce serotonin, as B6 is an important cofactor in production. Pyroluria can be assessed by excessive presence of KP in urine and can often be treated and managed by optimizing B6 and zinc along with monitoring red blood cell function and buildup.
Calcium
This final mineral has a reputation for its role in bone health as a building block for bone-supporting repair, growth, and preventing injury. The use of SSRI antidepressant and anti-anxiety drugs is associated with calcium deficiency and negative impact on bone health. Serotonin receptors are located throughout the body, including in the bone cells. Calcium with SSRIs disrupts feedback mechanisms of serotonin which, on the bone level, regulates calcium resorption.
Beyond bone mass, the skel
etal muscular system is influenced by calcium via biochemical pathways called the calcium channel, in which calcium is used to tighten and release muscles for development and function. Calcium channel blockers are drugs that are typically prescribed for blood pressure regulation, as they keep calcium from entering the heart and vessels, preventing tension in arteries and reduced blood pressure. Because the reduction of vascular and muscular tension can lead to generalized relaxation, calcium channel blockers are being studied as drug options for anxiety.
Although it sounds like blocking calcium activity may be a solution for relaxation, calcium is required as a mineral to regulate neurological function, and deficiency has been tied to mania, panic, confusion, and chronic anxiety. Calcium, like glutamate, has excitatory impact on a neurological level, and the neuron impact is regulated by magnesium. In simple terms, magnesium is the relaxer while calcium is the activator. For this reason, if taking a calcium supplement as recommended by your doctor for bone health, it is extremely important to balance out the calcium with magnesium to ensure optimal relationship of these minerals and aid in the utilization of calcium by the bones. Also, if using a calcium supplement, I only recommend the MCHC form of calcium, which is more available for bone cells and less prone toward excessive blood calcium deposits and calcification.
Calcium is found in grass-fed dairy products (whey and ghee are within the anti-anxiety diet), canned salmon and sardines with bones, tahini, almonds, and leafy greens.
Mood-Stabilizing Vitamins
B-Vitamins (B6, B9, B12)
From thiamin to vitamin B1 through B12 and beyond, B vitamins have long been acknowledged for their role in energy metabolism and mood stability. Like the minerals mentioned above, B vitamins are driven to deficiency under anxiety, often due to a chronic stress response. B vitamins play a role in stabilizing DNA, synthesizing neurochemicals, regulating signaling, driving methylation process, and serving as precursors or cofactors to build or activate necessary compounds for whole-body balance. Although all B vitamins are involved in managing mood and reducing anxiety, the most prominent are B6, B9, and B12 due to their roles in methylation.