by Ali Miller
Pyridoxine (B6)
Pyridoxine is potent cofactor used to activate amino acids into neurotransmitters, including dopamine, serotonin, GABA, and melatonin. Even mild levels of deficiency have been tied to suboptimal levels of serotonin and GABA, the two most potent anti-anxiety players. Supporting the body with ample B6 aids in rebounding levels of serotonin and GABA while reducing homocysteine, a vascular marker of inflammation. B6 in ample amounts can reduce homocysteine by combining with serine to produce glutathione, a favorable antioxidant. Using folate and serine as a building block, B6 drives production of glycine associated with inhibitory activity along with GABA, further driving relaxation and improved sleep quality. Ample levels of B6 activate neurotransmitters that aid in mental stability and support antioxidant levels while reducing inflammation.
Pyridoxine is found in chicken, tuna, salmon, beef, shrimp, nuts/seeds, bananas, pork, carrots, and spinach.
When selecting a supplement of B6, ensure you use the “active” B6 known as P5P (pyridoxyl-5-phosphate) to ensure absorption and utilization. Use caution to avoid high-dose intake and be sure to watch the add-up from various formulas as often stress or adrenal support supplements will provide dosages of 20 to 30 milligrams per capsule. Doses higher than 500 milligrams may cause nerve injury and damage.
Folate (B9)
Folate, made famous for its role in preventing neural tube defect and supporting healthy fetal development, has a role in DNA synthesis and repair as well as red blood cell formation. Folate deficiencies were seen to increase when refined white flour was introduced to the Standard American Diet. This drove governmental requirements of synthetic folate in processed foods in an attempt to prevent neural tube defects; however, the type of folate used in enriched products (and most over-the-counter vitamins, for that matter) are synthetic folic acid, which has very little bioavailability. Folate produces an array of compounds for whole-body health, including myelin to protect nerves, coenzyme Q10 to stabilize energy, carnitine to support fat utilization, and SAM-e to reduce anxiety and pain.
Folate is found in organ meat, leafy greens, sunflower seeds, asparagus, and avocado.
Avoid enriched foods and low-quality supplements that have synthetic added B-vitamins in non-methylated forms, as this can further drive imbalance. Select folate in the nature made form, folinic acid, or activated methyl-forms, such as 5-methyltetrahydrofolate, 5-MTHF, or L-methylfolate.
Vitamin B12
B12 has the most significant research backing its in reducing anxiety and supporting healthy neurological function. It has a vital role in the production of myelin, the protective coating of our nerves. When myelin is damaged, individuals can experience numbness, neuropathy, and delay or improper nerve impulse for mental health. Beyond nerves, B12 deficiency has been tied to anemia, specifically causing pernicious anemia. The influence of B12 on the nervous system directly, as well as the limited ability of blood cells to carry nutrients of focus, are two delivery impacts of B12 deficiency, which drives the perfect conditions for anxiety and often panic.
Hypochlorhydria, or low stomach acid, as well as stress and the increased use of antacids and PPI medications for heartburn, drive increased risk for B12 deficiency. Stimulating optimal digestive juices with Bragg Raw Apple Cider Vinegar may accelerate rebound from deficiency, aiding in your body’s ability to better break down and absorb nutrients. Also, if taking an antacid or PPI drug, consider working with a functional medicine practitioner to wean off the drug and address the digestive concerns from the root cause versus silencing the symptoms and causing other areas of distress. A blood sugar stabilizing drug, metformin, has been shown to deplete B12 stores in 30 percent of patients using the drug. A diet that is low in animal products can also drive B12 deficiency. The anti-anxiety diet plan will provide stimulation to optimal digestive juices while reducing your need for blood sugar–stabilizing drugs in the low-carb, high-fat protocol. Also, the diet is rich in whole food sources of B12 to rebound and boost your body’s neurological function.
B12 is found in organ meat, salmon, shellfish, octopus, beef, lobster, egg yolk, turkey, and grass-fed dairy products (whey is within the anti-anxiety diet).
Consider using 1 tablespoon of Bragg Raw Apple Cider Vinegar with 1 ounce of water as a “shooter” in the a.m. to stimulate stomach acid and enhance the digestive environment.
ORGANS AS SUPERFOODS
Liver, which is often regarded as an old-school superfood, is making a resurgence in traditional food communities, and rightly so! Organs in general are nutritional powerhouses with compact delivery of nutrient density. Liver is incredibly rich in vitamins, minerals, quality protein, and fat. Pasture-raised or grass-fed young glands are particularly rich in nutrients that support optimal brain function, including the essential fatty acids EPA and DHA as well as fat-soluble vitamins A, D, E, and K.
Organs are concentrated source of B vitamins, B12 in particular, which is essential for neurological function and is helpful in preventing and treating anxiety. Consumption of organs provides a balance of minerals such as copper, selenium, and iron; however, it is important to note that most are significant in copper while moderate in zinc. So, if consumed in excess, it may throw off anti-anxiety mineral balance. In most senses, the benefits outweigh the risk and the bioavailable nutrients in organs are quickly and easily absorbed into your body! A serving of 2 ounces twice per month is ample to provide a B vitamin boost while promoting whole-body balance.
Check out alimillerRD.com for Frozen Liver Pills and Simple Organ Pate recipes.
Vitamin D
Access to the sun and time outside is not often considered in the scope of optimizing nourishment, but in the case of vitamin D, sun bathing for 15 minutes per day and providing direct exposure of lighter areas of the skin (such as the forearms) to the sun may be the best path to optimizing levels of this necessary nutrient and regulating circadian rhythms. Vitamin D deficiency is one of the primary proposed drivers of seasonal affective disorder (SAD), including depression and mood irregularities in times of winter with shorter days and colder conditions leading to less sun exposure. Vitamin D is the only nutrient that has hormonal structure, and its expression is directly connected to fight-or-flight response as the pituitary gland, has vitamin D receptors that play a role in utilization and absorption, which may be the reason why vitamin D levels are also connected to thyroid and metabolism.
Vitamin D also has an influence on sexual hormone balance. Too much an cause excessive estrogen, and too little can result in estrogen deficiency. Vitamin D is in high demand during stress because it stimulates releases of mellow-out neurotransmitters and supports immune and inflammatory processes, which are typically thrown off in stressful events.
When vitamin D levels drop, production of serotonin and dopamine decline as well. Beyond mood stability, vitamin D has mechanisms on immune health and inflammation with low levels highly correlated to chronic illness, including cancer and autoimmune disease.
Benefits of vitamin D are enhanced in the presence of vitamin K. Also, excessive vitamin D levels from supplementation with deficient levels of vitamin K can drive calcification of soft tissues or calcium stones, creating risk of kidney stones. For this reason, a diet rich in vitamin K1 with leafy greens and vitamin K2 from bacterial fermentation in probiotic foods is important for balancing vitamin D. When considering supplementation, look for a product that pairs vitamin D3 with K1 and K2 in a blend that is 10:1 in IU:mcg; for example, 5000 IU vitamin D3 to 500mcg K1 K2 blend. See the Appendix’s Supplement Support for the 6 Foundational Rs section for more information.
Vitamin D is found in liver and organs, fatty fishes, mushrooms, cheeses, and egg yolks, especially from pasture-raised products.
FOOD AS MEDICINE
Restore Your Micronutrient Status
The recipes in this chapter provide rich forms of antioxidants, mood-stabilizing minerals, and bioavailable B vitamins to support nutrient repletion and the methylation process.
To support micronutrients:
Mellow Mama Dressing, page 121
Herb-Crusted Pork Tenderloin, page 134
Slow Cooker Carnitas, page 136
Carnitas Burrito Bowl, page 137
Spaghetti Squash Bolognese, page 138
Simple Salt and Pepper Scallops, page 140
Grain-Free Low-Carb Peanut Butter Cookies, page 146
Matcha Coconut Gummies, page 149
To support methylation:
Butternut and Brussels Breakfast Hash, page 99
Electrolyte-Boosting Avocado with a Spoon, page 113
Greek Deviled Eggs, page 114
Whole Roasted Cauliflower, page 116
Asian Braised Bok Choy, page 119
Warming Chicken Thighs with Braised Greens, page 129
CHAPTER 6
Rebound Your Adrenal Glands
Following the Remove, Reset, and Repair phases of the anti-anxiety diet, you are likely in an enhanced state of micronutrient repletion with the ability to absorb nutrients in a less inflammatory state. Additionally, you are now empowered with lists of foods to focus on to replete deficiency.
This chapter moves beyond the gut-brain axis and will focus on the adrenal gland. These walnut-sized glands that sit above your kidneys work to regulate your body’s stress response. Although an independent gland, the adrenals are connected to the gut, as dysbiosis increases the adrenal demand in the production of stress neurotransmitters. In this chapter, you will learn more about the function of your adrenals in driving your fight-or-flight response via the influence of steroid hormones and neurotransmitters. An imbalance of adrenal output can drive heart palpitations, worry, distress, racing thoughts, insomnia, and ultimately, chronic anxiety.
HPA-Axis
The adrenals have both regulatory and reactive functions, which are driven by the hypothalamic-pituitary-adrenal (HPA) axis. The HPA-axis is comprised of three primary glands (hypothalamus, pituitary, and adrenals) that regulate the fight-or-flight (sympathetic) mechanisms of the body, as opposed to the rest-and-digest (parasympathetic) mechanisms. When under chronic stress, any one of these glands can demonstrate dysfunction leading to hindered metabolism, chronic fatigue, immune system distress, and mood disturbances.
The fight-or-flight state stimulates the release of stress hormones and puts the body’s metabolism and regulatory functions on hold as it focuses on survival. It often leads to cravings, increased fat storage, and difficulty with weight loss, as well as excessive anticipatory stress response and irritability or anxiety. Conversely, the rest-and-digest mode reduces the anxiety response, driving relaxation of the muscles, nerves, and blood vessels while providing a surge of digestive enzymes that aid in the body’s ability to metabolize, absorb nutrients, and effectively burn fuel.
A balanced parasympathetic response in the HPA-axis supports healthy hormone levels, relaxation, and optimized digestion to experience a grounding, balanced mental state. This is significant, as the state of the HPA-axis can greatly influence the body’s ability to metabolize and can imply that even a perfect diet can be unsuccessful if the mind is overworked and the body is not able to reset. The stress hormones released by an unbalanced sympathetic response can directly hinder digestive enzymes, sterilize the microbiome, and drive leaky gut.
The adrenal glands themselves are the primary fight-or-flight responders. They provide steroids, neurotransmitters, and hormone-building blocks to respond to stressors. They also provide blood pressure and sodium regulation. The adrenal cortex, a part of the adrenal glands, regulates cortisol, the body’s primary stress-responding steroid hormone, which has both reactive and regulatory function. The adrenal medulla regulates dopamine, norepinephrine, and epinephrine.
The hypothalamus gland, located in the brain, plays a primary role in homeostasis, or keeping the body at its baseline. It plays a role in thirst regulation throughout the day and satiety at meal times, telling the body when it has consumed enough fuel and is satisfied. Beyond intake regulation, this gland produces thyroid-releasing hormone and plays a key role in body temperature, which influences how thermogenic or warm the body is, ultimately impacting caloric burn at basal metabolic rate. The hypothalamus also plays a role in circadian rhythms, which regulate sleep cycles, fatigue, and energy cascades. It also analyzes information such as light exposure, stress, environmental factors, and perceived risk. In relationship to the HPA-axis, the hypothalamus responds to stress and anxiety by making corticotropin-releasing factor (CRF), which drives the pituitary to stimulate the adrenals to release cortisol and stress neurotransmitters, thus driving continued anxiety response.
Also located in the brain, the pituitary gland has a great influence on the thyroid, a major metabolic organ; the ovaries or testes as sexual hormone regulators; and the adrenal glands, the primary stress-responding agents. The pituitary releases many hormones that regulate fluid, sexual function, growth, mood instability/anxiety, pain management, and caloric burn. The pituitary produces thyroid stimulating hormone (TSH), which functions as a direct stimulant to the thyroid gland to produce thyroxine (T4) and becomes activated as triiodothyronine (T3) hormone. In a state of hypothyroidism or underactive thyroid, the TSH increases, stimulating the thyroid to increase output. Conversely, when the thyroid is overworked in a state of hyperthyroidism, TSH production in the pituitary will drop to reduce output from the thyroid. Imbalance within the thyroid gland can be an independent driver of anxiety.
When the pituitary is responding in the state of anxiety or chronic stress, it focuses all its energy on driving adrenal gland output. In an androgenic state, which is when the adrenal glands are overused, the body suppresses thyroid and sexual hormone expression to prioritize survival function; in this sense, the parasympathetic relaxed system includes rest and digest, as well as metabolize and reproduce! Because of this, some practitioners refer to this axis as the HPA-TOG (hypothalamus-pituitary-adrenal-thyroid-ovary-gonad) axis. In women, when the HPA-axis is in overdrive, they can see irregular cycles, PCOS, infertility, and hirsutism (female facial hair growth), which is often seen with excessive testosterone or DHEA. Even though testosterone in an androgenic state is expressed in women under stress, in men testosterone is counter-regulated by cortisol, which can actually drive erectile dysfunction and low testosterone levels. In this sense, the root of hormonal imbalance often lies in anxiety or excessive stress response.
The adrenals are the primary drivers of anxiety, irritability, and panic on the HPA-axis. They release steroids such as cortisol, and stress chemicals norepinephrine and epinephrine (adrenaline). Under stress, more cortisol is released, which increases blood sugar production and release while reducing the body’s ability to use fat as fuel. The adrenals also produce DHEA, a hormone-building precursor for estrogen and testosterone that aids in stress resilience and naturally declines with age. DHEA is also used as a precursor or building block in ketone production, which is achieved in a very low carbohydrate diet. (More on ketosis and its anti-anxiety effects in Chapters 2 and 8.)
Each gland of the HPA-axis releases hormones and neurotransmitters that not only have direct effects on the body, but also signal the next gland in the HPA-axis. This chart shows HPA-axis responses in relationship to specific symptoms.
HPA-Axis Responses to Specific Symptoms
Unbalanced fluid retention
Hypothalamus signal: Vasotensin
Pituitary signal: Antidiuretic hormone
Adrenal signal: Aldosterone; Cortisol depletes potassium and magnesium, further increasing blood pressure
Appetite control
Hypothalamus signal: Leptin
Pituitary signal: Oxytocin
Adrenal signal: Dopamine; Cortisol drives blood sugar spikes, influencing hunger and fat storage increase
Weight gain
Hypothalamus signal: TRH
Pituitary signal: TSH, growth hormone
Adrenal signal: Cortisol, which drives rT3, mimicking T3 and breaking active thyroid hormo
ne function; also interferes with muscle function, driving fat storage
Infertility/Hormone imbalance
Hypothalamus signal: GnRH
Pituitary signal: FSH, LH, Prolactin
Adrenal signal: DHEA, testosterone, estradiol, and cortisol, which steals from progesterone production
Anxiety
Hypothalamus signal: CRH
Pituitary signal: ATCH
Adrenal signal: Epinephrine, norepinephrine, cortisol in excess
One of the benefits of Phase 1 of the anti-anxiety diet is that ketone production can be a great regulator of excessive DHEA, thus supporting fertility in an individual with PCOS, who would likely express elevated DHEA values. However, chronic adrenal stimulation and demand over time can tax the glands, leading to reduced output of cortisol and DHEA, as seen in adrenal fatigue. In this state, the adrenals may be too fatigued to produce ketones, in which case DHEA supplementation would be recommended.
If an individual is in advanced adrenal fatigue, a strict Phase 1 ketogenic approach is not recommended to ensure that the gland is not overtaxed or DHEA depleted. Optimizing levels of DHEA aids in stress resilience and tolerance as well as sexual hormone balance. During adrenal rebound, the Phase 1 diet can be cycled with Phase 2 diet, or one may choose to stay within the freedom of low-glycemic Phase 2 only. This level can be assessed both in the blood and the saliva and is discussed further in Advanced Functional Labs on page 166.