The Anti-Anxiety Diet

by Ali Miller

  Low blood levels of tryptophan have been correlated to anxiety and depression. Inflammation in the body drives depletion of tryptophan, so removing the pro-inflammatory foods discussed in Chapter 2 can be equally as important as the abundance focus in supporting all 6 Rs of this program!

  As you may also recall, serotonin is primarily manufactured in the gut by the probiotic strain, Lactobacillus. In fact, it is estimated that greater than 90 percent of the serotonin of the body resides and is produced in the gut! Supporting your body with a serving of probiotics daily can enhance your body’s production of serotonin, aiding in a stable, healthy mood. Consider 5-HTP or tryptophan as supplemental support for short-term targeting of serotonin to give a “leg up” and rebound, and a quality probiotic formula with a focus on Lactobacillus and Bifidobacterium strains as a foundational supplement with broad support for your system. Beyond serotonin production, these healthy gut bacteria strains are correlated with GABA.

  Signs of low serotonin:

  •Aches throughout the body (muscular, fascia related)

  •Anticipatory distress

  •Anxiety

  •Constipation

  •Depression

  •Flat affect (emotionally low, difficult to excite)

  •Lack of pleasure

  •Loose stools

  •Poor sleep

  •Ruminating thoughts

  GABA

  Rapid anxiety relief can be seen with release and use of GABA, the main inhibitory neurotransmitter in the central nervous system targeting the brain’s conscious and behavioral center. GABA works both as relaxer and anxiolytic, a reducer of anxiety, with rapid effects that can influence the brain and body for hours. GABA is also sought for its ability to reduce seizure activity with epilepsy, rigidity, and neuromuscular spasms. It is used as a neuroprotectant in Parkinson’s and multiple sclerosis, and has even been sought out for use in PMS and migraines to reduce pain and stabilize mood. As discussed previously, active neurotransmitters are not able to cross the blood-brain barrier; however, in the case of GABA, there seems to be a workaround via the gut and peripheral tissues.

  Similar to serotonin, the majority of GABA is produced in the enteric nervous system of the gut, and signals are carried back and forth from brain to gut via the vagus nerve. Lactobacillus and Bifidobacterium strains seem to have the greatest effect on GABA production, specifically a strain called Lactobacillus rhamnosus. Studies confirm both consumption of these probiotics as well as forms of PharmaGABA, a fermented form of GABA molecule, reduce anxiety and support relaxation via reduction of cortisol, reported symptom reduction, and reduced blood pressure.

  GABA supplementation seems to be a rapid-acting tool with limited side effects. I explain GABA in its chewable form to have the ability to reduce the “white knuckle effect” of stress. It tends to take the physiological tension, impulsivity, and irritability of anxiety down. PharmaGABA may influence memory and for this reason should be used as a tool when working the system of the 6 Rs of your program. For long-term sustainable support, maintaining a healthy gut microbiome and supplementing with a 50:50 blend of Lactobacillus and Bifidobacterium probiotic strains ensure optimal serotonin and GABA expression while optimizing cognition and memory.

  Signs of low GABA:

  •Compulsive eating

  •Cravings or addiction to sweets, alcohol

  •Elevated blood pressure

  •Feeling buzzing or flighty (not grounded)

  •Feeling of physiological tension

  •Heart palpitations

  •Mental exhaustion from racing thoughts

  •Panic attack

  •Tightness in the chest

  Acetylcholine

  This neurotransmitter is primarily thought of as anti-aging due to its protective effects over neurodegenerative diseases such as Alzheimer’s and dementia. Acetylcholine is known for its role in memory, concentration, and cognitive reasoning as it signals brain communication as well as synaptogenesis, the process of building new brain synapses or communication channels. All the message-carrying fibers in both the sympathetic and parasympathetic nervous system are protected by a coating called myelin and use acetylcholine as a transmitter. The building block choline and fatty acids in the diet create a fattier myelin sheath for quicker neurotransmitter signal travel.

  In anxiety research, lower choline levels trend with high anxiety and panic. Choline has been acknowledged for decades for its role in maternal health, protection from neural tube defects, and support for fetal brain development, but in 1998 it was deemed an essential nutrient by the Institute of Medicine. Choline is a fat-soluble B-vitamin required as a building block for phosphatidylcholine, an integral component of cell membranes, as well as acetylcholine. Choline also plays an integral role in methylation to produce feel-good neurotransmitters and reduce inflammation.

  The dietary trend of avoiding saturated fat and dietary cholesterol likely contributed to deficiencies, as the richest forms of this nutrient are egg yolks and liver! Eating 12 to 16 eggs a week from pasture-raised chickens with beautiful orange, nutrient-rich yolks will provide your body with this essential nutrient to protect healthy cells from damage, produce neurotransmitters, and ensure healthy signaling and communication of your neurotransmitters.

  Acetylcholine aids as the signal carrier so speed of access to memory, stored information, or sensory reaction can be tied to its activity in the brain. Acetylcholine can actually have both excitatory and inhibitory functions. At the brain and mood level, the primary experience of optimal acetylcholine activity is calm and collected with a clear mind. Peripherally, outside of the brain, acetylcholine activity maintains healthy neuromuscular function and tone as well as digestive and hormonal activity such as peristalsis, the involuntary pumping of the gut that supports bowel regularity.

  Low acetylcholine can reduce signaling for mood stability and pleasure such as arousal. As choline plays a primary role in detox, low levels drive sluggish liver function, resulting in toxicity and fatty liver. To add insult to injury, the genetic COMT SNP, discussed in Chapter 5, plays a role in women’s ability to convert estrogen into choline, leading to both estrogen dominance and choline deficiency as well as taxing the process of the liver.

  It is important to note that an excess of acetylcholine has been demonstrated to drive depression, as it interferes with dopamine expression. For this reason, a choline-rich diet with liver support is a priority for regulation. If you are dealing with significant symptoms, especially memory issues, or elevated liver enzymes, supplementation support may be considered. Phosphatidylcholine and choline bitartrate salts are absorbable safe options for whole-body support of fatty liver and inflammation, but these forms may not cross the blood-brain barrier. CDP-choline and Alpha GPC are two forms that can cross the blood-brain barrier and have a more direct effect on mood and memory, but may interfere more directly with dopamine. For individuals with elevations of dopamine, acetylcholine supplementation may be a powerful tool in regulating neurotransmitter expression.

  Signs of low acetylcholine:

  •Cognitive decline

  •Constipation and gastroparesis

  •Fatigue

  •Fatty liver or elevated liver enzymes

  •Memory loss

  •Reduced creativity

  •Reduced physical reactivity

  •Reduced speed and strength

  •Slow mental processing

  Epinephrine

  The surge when racing to meet a deadline, the primary driver of your stress response, and the bell-and-whistle alarm system of your body also known as adrenaline is a powerful excitatory neurotransmitter, epinephrine. This neurotransmitter can function as lighter fluid to an anxiety fire like a steam train on the tracks without brakes! A balance of epinephrine can aid in creating professional drive and vigor. After all, adrenaline surges can be exciting and invigorating, but an excess can lead to an out-of-body panic and significant anxiety response. Produced by the adrenal
glands, epinephrine is a primary responder to HPA-axis stress demands in the body and brain. Epinephrine is built from tyrosine, an amino acid precursor that also builds neurotransmitters norepinephrine and dopamine, collectively known as catecholamines.

  Beyond anxiety itself as a stimulant to epinephrine release, bright light, loud noises, and high-intensity activity such as excessive exercise can drive output, which can be expressed in excess. Although this neurotransmitter is not produced in the gut, when dealing with leaky gut or increased food sensitivity to the level of anaphylactic reaction of a food allergy, epinephrine is the go-to drug in the form of EpiPen to deliver adrenaline to stop systemic reaction. Studies demonstrate excessive epinephrine output with both elevated blood pressure and anxiety disorder. On a supplemental level, the best line of defense for reducing epinephrine is through balancing the HPA-axis, specifically focusing on adrenal support and using L-theanine to reduce excess. The formulas discussed in Chapter 6 as nervines and adaptogens would be the go-to tools to reduce stress response and excessive epinephrine output.

  Signs of high epinephrine:

  •Anxiety

  •Elevated blood pressure

  •Excessive nerve firing (feeling on edge)

  •Hyperactivity

  •Incredible hulk mentality

  •Insomnia

  •Pain

  •Panic attack

  •Rapid heart rate

  •Shortness of breath

  •Social anxiety

  Norepinephrine

  Norepinephrine acts similarly to epinephrine and is also made in the adrenal glands. Like epinephrine, it too has effects in the central nervous system (CNS) and peripheral tissues on an adrenaline-like level; however, norepinephrine seems to have a bidirectional role where it can normalize anxiety activity. Epinephrine is actually made from norepinephrine in the adrenal glands as the attack dog that reacts more aggressively to stress, driving an exaggerated anxiety and stress response, whereas norepinephrine has a more tonifying effect.

  Norepinephrine is more acknowledged as a neurotransmitter for mood maintenance and regulation while epinephrine is seen as more reactive or stress responsive in panic or acute anxiety attacks. Since norepinephrine plays a role in baseline function, many drugs for anxiety as mood stabilizers, as well as drugs for elevated blood pressure and tremors (typically the physical effects of anxiety), have been developed to work on the expression of norepinephrine. Propranolol, for example, is a beta-blocker drug that is targeted for blood pressure through action on both epinephrine and norepinephrine, has influence on performance anxiety, tremors, and migraines.

  It is also important to acknowledge that norepinephrine, when too low, can drive flat affect and lack of drive. Drug companies that saw shortcomings in SSRIs developed SNRIs, such as Effexor and Celebrex, that allow increased concentration of serotonin and norepinephrine. Typically, anxiety is seen with norepinephrine being too high, but social anxiety and withdrawn anxiety symptoms can be seen with values that are too low. Just like a note in the symphony of the brain, something off key on either end can throw the brain signals off, manifesting in anxiety and distress. I suggest using a blend of nervines and adaptogens to tonify stress response in general. A diet rich in tyrosine can be a good foundation and allow the body to use what it needs while preventing excess. Tyrosine, like tryptophan, is found in protein-containing foods and is concentrated in poultry, duck eggs, almonds, avocados, bananas, lima beans, pumpkin seeds, and sesame seeds. Tyrosine supplementation would only be recommended in the case of adrenal fatigue and low catacholamines, along with low cortisol and DHEA, as excess levels can drive stress response. The adaptogenic herbs discussed in Chapter 6 are the best option.

  Signs of high norepinephrine:

  •Anxiety

  •Blood sugar elevation

  •Nausea

  •Racing thoughts

  •Rapid heart rate

  •Sweating

  •Tremors

  Dopamine

  This neurotransmitter is typically second in pop culture to serotonin due its association with bliss and reward, but dopamine has a complex relationship with anxiety. Many addictions and self-medication outlets, from drugs and alcohol to caffeine, food, gambling, video gaming, and social media scrolling, target dopamine release and expression. Getting enough dopamine to feel good about yourself while reducing any excess that can put the mind into overdrive is equally important when managing anxiety. Associated with our pleasure centers in the brain, dopamine has activity in libido and excitement, and motivates performance with complex reward centers; hence, addiction is seen with high release.

  Dopamine-blocking medications are strongly acknowledged to have antipsychotic and anxiolytic effects. However, we need some dopamine for the ability to drive confidence and a feeling of self-efficacy, which can in turn reduce anxiety and rumination. In fact, a popular antidepressant, Wellbutrin, increases activity of both norepinephrine and dopamine to enhance feelings of self-worth and purpose, which can reduce social anxiety. But, this drug can cause anxiety by producing excessive dopamine activity, manifesting as racing thoughts and almost a manic creativity.

  Although too much dopamine can drive anxiety, compared to other stress-responding neurotransmitters, excess dopamine is less attributed to anxiety. For this reason, when looking to balance neurotransmitters for mood stability, it would be reasonable to stimulate dopamine only or prevent dopamine breakdown into norepinephrine and epinephrine to prevent their more anxious reactivity. (Remember norepinephrine is made from dopamine and epinephrine is made from norepinephrine, so rather than concentrating on production of dopamine, which can in turn increase the other two, blocking its breakdown can be the best approach when selecting supplemental support.)

  SENSORY OVERLOAD!

  Are electronics depleting your dopamine stores? The brain is overburdened with bright blue screen lights and rapid visual effects from electronic monitors flickering quicker than the eye can detect, both driving dopamine dumping. Checking your social media and email, scrolling your digital device, and bombarding the brain with information at a rapid rate can release a surge of dopamine in the brain. This partially explains why we are all so addicted to our smartphones and tablets. Stressful games can drive surges of epinephrine with adrenaline in some, or deplete GABA in the brain’s attempt to mellow out the racing brain!

  To support your success with the anti-anxiety diet, it is recommended to limit screen time, including phones, computers, and television to five hours/day. If this is not possible due to your field of work, consider blue blocker glasses, which reduce the impact of artificial bright blue light that can throw off your melatonin and serotonin levels, and also drive cortisol release.

  For mood stability with anxiolytic effects, compounds that inhibit the breakdown of dopamine are preferred. Phosphatidylserine is a component of cell membranes that functions to balance nutrients and waste in the brain. It has been shown to increase dopamine levels while reducing excessive cortisol and ACTH, thus supporting memory, concentration, and positive feedback signals of dopamine without the stress response of adrenaline. The Calm and Clear formula I use in clinic is a foundational tool to modulate neurotransmitters, as it includes activated B vitamins, nervines, adaptogens, phosphatidylserine, and L-theanine (to be discussed).

  Dopamine isn’t able to cross the blood-brain barrier. However, L-dopa, its precursor made from L-tyrosine, is often prescribed to support production in conditions such as Parkinson’s disease. This approach can be used with anxiety via the use of Mucuna pruriens, also known as the velvet bean, that has naturally occurring L-dopa. Mucuna pruriens is also being studied for memory and mood stability, and research for Parkinson’s has shown it to have more beneficial effects with less side effects than pharmaceutical synthetic L-dopa. However, in high dosage and if taken out of balance, it can drive a too-low blood pressure as well as drug interactions with many Parkinson’s drugs, so is not advised without review from your healthcare p
ractitioner.

  Lifestyle supporters of dopamine boost include movement, meditation, ample sleep of 7–9 hours per night, listening to music, and experiencing touch by both humans and animals, which all stimulates your dopamine output, giving your brain a feel-good boost! Research has found overeating and obesity associated with people that have less dopamine receptors, so if you are looking for weight loss as well, participating in other lifestyle support (see Chapter 8) and considering supplementation may be key.

  Signs of low dopamine:

  •ADHD

  •Anxiety

  •Boredom

  •Depression

  •Difficulty multitasking

  •Fatigue

  •Lack of focus

  •Low libido

  •Parkinson’s disease