The Anti-Anxiety Diet
Page 26
Alternatives: Look for B-vitamins in methylated forms not cyanocobalamin. You may consider a hydroxy or adenosyl form if already using a methyl form without results or experiencing more neurological effects.
Anti-anxiety focus: B-12 is used in red blood cell function and neurological, gastrointestinal, and psychological health. There is importance of vitamin B12, folate, and homocysteine in carbon transfer metabolism (methylation) required for the production of serotonin, other monoamine neurotransmitters, and catecholamines. Agitation, irritability, negativism, confusion, anger, and insomnia can be associated with B12 deficiency, with severe symptoms of panic and psychosis that can be resolved when levels are repleted.
adrenals
Nervine and adaptogen blend with L-theanine
Dosage: Blend of B vitamins in active form with nervine and adaptogen herbs, along with phosphatidyl serine, taurine, and L-theanine
Naturally Nourished formula: Calm and Clear
How to take: 1–2 capsules three times daily with or without food
Alternatives: Look for a product that provides methylated B12, but if getting methylated folate in a complex or multivitamin avoid extra folate. Look for a product that has a blend of 3–5 herbs in combination of nervines and adaptogens, such as passion flower, lemon balm, valerian, and ashwagandha. Ideally product also provides L-theanine, taurine, and phosphatidyl serine to regulate neurotransmitters and cortisol levels.
Anti-anxiety focus: Clinical effects of anxiety reduction and stress resilience is seen in use of ashwagandha, a featured adaptogen in this formula. Lemon balm has tonifying nervine effects to aid in relaxation and anxiolytic influence, creating a state of calmness. Taurine plays a role in supporting liver function and modulating both excitatory and inhibitory neurotransmitters, namely GABA. Phosphatidyl serine can blunt excessive cortisol stress-responding effects in the body.
adrenals
Adaptogen blend
Dosage: 600mg synergy blend of adaptogens per capsule
Naturally Nourished formula: Adaptogen Boost
How to take: 2–4 capsules daily with or without food
Alternatives: Blend of adaptogenic herbs, including panax ginseng, rhodiola, and cordyceps.
Anti-anxiety focus: Adaptogens aid in responding to stress without depleting the HPA-axis or driving imbalanced action. These herbs can support energy and stress tolerance without depletion. Adaptogens aid in reducing the impact of stress to the adrenal glands by helping the body respond more directly and providing support for energy. Rhodiola in particular can reduce anxiety with dose-dependent reduction in symptoms of panic and distress.
neurotransmitters
Pharma GABA
Dosage: 100–300mg pharma-GABA
Naturally Nourished formula: GabaCalm chew
How to take: 1–3 chews as needed in acute times of anxiety and/or as a base to regulate physiological stress response
Alternatives: Look for a chewable product that has limited binders and fillers, providing 100–200mg pharmaGABA per chew.
Anti-anxiety focus: GABA serves as a critical calming agent for the body, helping to combat stress and anxiety. It has an acute response to stress and is best used when needed per stress-induced demand such as public speaking, performance review, social engagement, and flying. Via influence of the vagus nerve running from the brain through the gut, pharmaGABA has anxiolytic effects to create a sense of peace and calmness with reduced tremors and physiological stress response.
neurotransmitters
5-HTP
Dosage: 50–200mg.
Naturally Nourished formula: N/A
How to take: 50–100mg capsule once or twice daily; without food in the evening to aid with sleep, may be taken in the day as well to support mood stability. WARNING: 5-HTP cannot be combined with an SSRI medication as it can cause serotonin excessive syndrome.
Alternatives: Look for a formula that pairs 5-HTP with B6 and L-theanine to support conversion and modulation of neurotransmitters.
Anti-anxiety focus: 5-HTP has symptom management for pain, mood stability, and sleep support when compared to a placebo.
neurotransmitters
L-theanine
Dosage: 200–1000mg.
Naturally Nourished formula: Calm and Clear
How to take: 1–2 200mg capsules 2–3 times per day without food; This can be taken at rise, mid-day, and bed as it may improve REM cycles with sleep.
Alternatives: Look for a formula that uses suntheanine form with enhanced bioavailability. Matcha is a great food-as-medicine option and provides a potent amount of L-theanine but is not at an effective supplemental level, providing around 20 mg per tsp.
Anti-anxiety focus: L-theanine crosses the blood-brain barrier and can influence the central nervous system by enhancing levels of dopamine, GABA, and serotonin; however, L-theanine effects are balancing and won’t overproduce one given neurotransmitter.
neurotransmitters
L-tyrosine
Dosage: 500–1500mg
Naturally Nourished formula: N/A
How to take: Best taken without food to support use of amino acid influence without competing with protein-containing foods. Best taken during the day. WARNING: Do not combine this supplement with Wellbutrin, Ritalin, or other dopamine reuptake inhibitors.
Alternatives: Be mindful; If not dealing with adrenal fatigue and instead suffering from racing thoughts and excessive adrenaline response, this formula may not be for you as it can increase catecholamine stress chemical responders.
Anti-anxiety focus: L-tyrosine has anti-stress effects that can promote energy and alleviate anxiety. It has been shown to enhance cognition under times of stress and support adrenal output of stress-responding chemicals in a time of adrenal fatigue. This would be a go-to if dealing with fatigue-induced anxiety, but may drive stress chemical response and may need to be paired with GABA, 5-HTP, and/or L-theanine.
neurotransmitters
SAM-e
Dosage: 400–1600mg
Naturally Nourished formula: N/A
How to take: 1–2 capsules 1–2 times per day without food.
Alternatives: Look for a formula that combines SAM-e with methylated B12 and methlyfolate (5-MTHF) to ensure you can support methylation while reducing the risk of overdriving this pathway.
Anti-anxiety focus: SAM-e plays a role with methylation while preventing overdrive of this metabolic function. It can influence serotonin, melatonin, and dopamine activity while reducing excessive adrenaline. Research suggests that SAM-e can be an effective, well-tolerated, and safe adjunctive treatment strategy as an alternative or in conjunction with SSRI drugs.
Advanced Functional Labs
Now that you understand the Foundational 6 Rs of anxiety, you may want to dig deeper into your body’s greatest area of focus. Using the quizzes in this book and symptoms noted, you will be able to prioritize where to start. The labs are ordered as follows: inflammatory, microbiome, leaky gut, micronutrients, and HPA-axis and neurotransmitters.
Inflammatory Assessments
Inflammation may be the root cause of your anxiety! Chemical messengers of inflammation cross the blood-brain barrier and interfere with signaling of feel-good, mellow-out neurotransmitters while increasing sense of panic and distress, fight-or-flight survival response. Here are the panels I recommend:
C-Reactive Protein (CRP)
CRP is elevated in inflammatory disease conditions and can be used as both an acute and chronic marker of inflammatory distress. This marker has been assessed to have a correlation with anxiety and, if found to be elevated above 3.0, it is recommend to proceed with the Mediator Release Test (page 167). If above 1.0, it is highly recommended to add a therapeutic anti-inflammatory supplement to your daily routine, such as omega-3, turmeric, or tropical enzyme support.
Specimen: Blood test
Company: Any, non-specific
Ideal range: HS-CRP <0.8 mg/L
Fasting Insulin
Fasting insulin is a marker o
f imbalanced blood sugar and elevated levels of blood sugar along with low-grade inflammation. Elevated insulin drives more oxidative stress in the brain and interferes with neurotransmitters. Beyond crashes and mood instability, with blood sugar spikes and drops, insulin has direct anxiety effects.
Specimen: Blood test
Company: Any, non-specific
Ideal range: <8 uIU/mL
Hemoglobin A1C% (HgbA1C%)
HgbA1c% is a 3-month average of how glycosylated or coated in sugar your red blood cells are. When elevated, the quickest way to reduce this value is to reduce reliance on glucose as fuel and help the body to become more fat-adapted. Following Phase 1 of the anti-anxiety diet would be recommended to accelerate your blood sugar reduction with a ketogenic diet.
Specimen: Blood test
Company: Any, non-specific
Ideal range: 4.5–5.4%
Ferritin
This is a marker of iron storage and too low of a value can drive issues with thyroid hormone, hair loss, brain fog, and anemia. Too high of a value can be an acute phase reactant to inflammation seen with autoimmune disease, liver disease, cancer, and other non-specific inflammation.
Specimen: Blood test
Company: Any, non-specific
Ideal range: 70–200
Mediator Release Test (MRT)
The Mediator Release Test (MRT), also known as the MRT Inflammatory Food Panel, looks at the release of inflammatory chemicals in your blood when certain foods or chemicals hit it. In this sense, it assesses how your body responds to foods and chemicals and the level of leaky gut status based on reactivity. Food sensitivity symptoms are often chronic because the chemical mediators that make us feel sick are released every time you eat your unknown reactive foods. Also, to add complexity, your body may react up to 72 hours post consumption, and the reaction may be dependent on a synergy of ingredients. Certain foods may be moderately inflammatory and on their own tolerated, but if you have meals or snacks that are in higher amounts of moderate foods, their impact can accumulate, and if in a given window, drive increased inflammatory response such as diarrhea, joint pain, skin flares, anxiety, and panic! The MRT test helps you determine a starting point for identification of dietary and chemical irritants, allowing for an elimination diet to reset the system, and your immune system and inflammatory pathways to cool and reset.
Specimen: Blood test
Company: Oxford Biomedical
Ideal range: No severe RED reactions, <5 moderate YELLOW reactions
Microbiome
As serotonin and GABA are manufactured by healthy gut bacteria, dysbiosis (the imbalance of bad bacteria or yeast) may be the root cause of your anxiety! Assessing your levels of bacteria, both good and bad, can be helpful in determining if you need to proceed with a bacterial cleanse or simply a flourish of probiotics. Here are the panels I recommend:
Comprehensive Digestive Stool Analysis
Stool analysis is gold standard for assessing the microbiome. This panel specifically identifies both positive and negative bacteria strains to determine state of gut symbiosis. The three-day stool collection assesses bacteria, yeast, and parasites, both active and in dormant form. If a pathogen is found, this panel provides therapeutic guidance on what natural and pharmaceutical compounds will be most successful in eradication through a cleanse. Beyond microbiome assessment, this panel provides information on digestive function including pH, enzymes, and malabsorption status, as well as state of gut inflammation and damage.
Stool test should include:
•Beneficial, commensal, and pathogenic bacteria, yeast culture
•Parasite assessment: ova and active parasites
•Digestive/Absorptive markers: elastase, fat, carb, protein malabsorption
•Inflammatory bowel markers: calprotectin, lactoferrin, white blood cells, mucus, lysosome
•Leaky gut markers: calprotectin, secretory IgA
•SCFA (short chain fatty acids) and their distribution
Specimen: Stool 1 or 3 day collection
Company: Doctor’s Data or Genova Diagnostics
Ideal range: Beyond 30 markers, needs to be reviewed with practitioner
Breath Test
The breath test is the gold standard for upper intestinal imbalance or small intestinal bacterial overgrowth (SIBO). Although the testing can be time consuming and unreliable based on exhale, it is the best way to determine action in the small intestines and stomach. Most panels will include a base collection followed by drinking a solution with testing in 15–30 minute increments for up to 4 hours.
Specimen: Breath
Company: Any, non-specific
Ideal range: H. pylori negative, hydrogen within normal limits (WNL), methane WNL, fructose, other sugars WNL
Organix Dysbiosis
The Organix Dysbiosis test looks at organic acids in the urine as a marker of metabolism of microbes in the biome. The results are able to determine yeast and pathogenic bacteria activity with presence of particular compounds absorbed along the small intestine. This test can be used to confirm yeast overgrowth and SIBO, but may overlook microbes in the colon.
Specimen: Urine
Company: Genova Diagnostics
Ideal range: Arabinose <29 mmol/mol creatine, benzoate <1.3 mmol/mol creatine, benzoate, and all other markers WNL
Leaky Gut
If your gut is in a state of increased permeability, you will have less micronutrient absorption and more inflammation. As both nutrient deficiency and inflammation are drivers of anxiety, leaky gut may be your root cause. If you score high on the Anti-Anxiety Leaky Gut Quiz (page 38) you may want to run advanced labs to get a baseline read; however, you will want to run the MRT test regardless to get the information of what to do to start healing your leaky gut! When looking to heal leaky gut, it is most important to understand what needs to be removed so you can put the fire out before you start rebuilding the house. Here are the panels I recommend:
Zonulin Protein
Zonulin is a protein that functions with tight junctions of the gut lining, essentially working as the gatekeeper to your gut lining on the gut-blood barrier. Both gluten and gut bacteria imbalance can increase zonulin, which releases the seal on the gut, driving leaky gut reactivity of inflammation, mood disturbances, and autoimmune disease.
Specimen: Serum or stool
Company: Doctor’s Data and Genova Diagnostics
Ideal range: Within normal limits (WNL) per lab
Secretory IgA
Secretory IgA (sIgA) is the first line of defense lining our mucosal membranes in the mouth, nose, respiratory tract, sexual orifices, and gut. An elevation of secretory IgA is seen with stress response from bacteria imbalance, infection, food particle insult, or mental stress. Low secretory IgA is indicative of prolonged distressed state and, often, immune insufficiency or chronic illness.
Specimen: Saliva, serum, or stool
Company: Doctor’s Data, Labrix, Genova Diagnostics
Ideal range: WNL per lab
Calprotectin
Calprotectin is a protein that drives white blood cell action in intestinal lining and is used as the primary indicator to distinguish between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) such as colitis and Crohn’s disease. It is the primary marker to establish remission of IBD conditions and monitor flares of disease presence.
Specimen: Serum or stool (stool is superior)
Company: Any, non-specific
Ideal range: WNL, ranges, shifts based on lab company
Mediator Release Test (MRT)
See page 167 for details.
Specimen: Blood test
Company: Oxford Biomedical
Ideal range: No severe RED reactions, <5 moderate YELLOW reactions
Micronutrients
If you are low in key nutrients that build neurotransmitters, reduce inflammation, and provide anxiolytic effects, your root cause of anxiety may be micronutrient deficiency. Individuals at hig
h risk for this area are those recovering from an injury, excessive exercisers or marathon runners, individuals on specialty diets or limited from diversity for wide spectrum nutrient exposure, and mothers with demand from carrying and breastfeeding children. It is highly recommended to start with a quality bioavailable multivitamin with methylated Bs to support your foundational needs. Here are the panels I recommend:
Micronutrient Test
The SpectraCell panel uses white blood cell proliferation to assess the viability of the cells based on nutritional status. This test looks at 35 vitamins, minerals, and antioxidants in levels available on a cellular level in your body. The unique nutrition assessment of intracellular status provides information on micronutrient status for a more long-term assessment providing 3–6 month status as opposed to more of a snap shot focus.
Specimen: Blood test, white blood cell proliferation
Company: SpectraCell
Ideal range: No functional deficiency, <2 borderline deficiency
Vitamin D
The only vitamin that functions as a hormone, vitamin D plays a role in thousands of genes influencing the immune system, inflammatory processes, and metabolism via thyroid and sexual hormone balance. Beyond these mechanisms, seasonal affective disorder tends to trend with times of the year when vitamin D levels drop due to less sun access. One driver toward mood imbalances during winter is that both serotonin and dopamine rely on vitamin D for optimized function. Optimized vitamin D status can support your anti-anxiety program while boosting metabolism, balancing hormones, and reducing inflammation.
Specimen: Blood test, 25-hydroxy vitamin D
Company: Any, non-specific
Ideal range: 50–100 mg/mL
Red Blood Cell (RBC) Magnesium
Magnesium plays a role in over 300 enzyme pathways and influences neuromuscular relaxation. It directly hits the HPA-axis by suppressing cortisol and adrenal output, which reduces stress response that drives anxiety. Optimizing your magnesium can aid in sleep quality and reduced tension or muscle aches.
Specimen: Blood test, RBC magnesium