According to 2015 data from the National Institute of Mental Health, more than 40 million American adults experience an anxiety disorder over their lifetime, with women 60 percent more likely than men to be affected. Anxiety disorders include generalized anxiety disorder, panic disorder, and social phobia. They often co-occur with other mental and/or physical conditions. Although each disorder has a different set of symptoms, common to them all are excessive, irrational fear, and dread.
“A good definition of anxiety is that it is abnormal and overwhelming sense of apprehension or fear of misfortune that can be accompanied by physiologic signs like increased sweating, heart pounding, and muscle tension,” says Dr. Marcey Shapiro, a board-certified family physician specializing in integrative medicine, and the author of Freedom from Anxiety: A Holistic Approach to Emotional WellBeing. “But I prefer the Buddhist teacher, Thich Nhat Hanh’s, explanation of anxiety, which is: anxiety, the illness of our times, comes primarily from our inability to dwell in the present moment. I prefer that because that kind of shows us a way out the door of anxiety.”
Mainstream medicine seeks to alleviate anxiety by using drugs to calm the nervous system. Unfortunately, as Dr. John Douillard, Ayurvedic physician and author of Body, Mind and Sport, explains, “Giving a sedative in this situation will only suppress symptoms and may deplete the nervous system further, making the situation chronic.” Instead of being depleted, “the nervous system must be built up and rejuvenated so that it can put itself to sleep, stabilize its energy and moods, and stay that way.” Recent scientific studies have shown the value of the natural approach: omega-3 fatty acids, magnesium, and adaptogenic herbs such as rhodiola can help the body deal with anxiety by harnessing its stress response mechanisms, and the B vitamins and amino acids can help with neurotransmitter synthesis and signaling.
Anxiety can have many different causes. Psychiatrist Helen Derosis, author of Women and Anxiety, talks about external pressures on people who lead busy lives and have never learned to plan properly and set priorities: “Practically everyone I encounter in this country is anxious to some extent. One can be slightly anxious or very anxious, anxious occasionally or continuously. The most devastating type involves being anxious all the time over the little things we have to do every day. People worry that somehow things will not turn out right for them.”
Dr. Derosis continues, “A woman about twenty-five years old came to me who was very bright and educated and was working for a large TV company. She wanted to be a producer, but was only a gofer, though at a very good salary. She was very upset, disappointed, and angry. She would cry to her husband every night when he got home. Yet as soon as she realized it wasn’t possible to achieve that goal so quickly and saw that life was not as easy as she thought, she calmed down.
“Earlier, a doctor or psychiatrist would have treated her with Valium and said her problems were not real, all in her head. Remembering those older treatments, a patient will come in today asking for medication, which is not a solution. Getting over anxiety involves growing. If you can keep growing, you will have problems, but the constant activity of being alive, thinking about what you want to do next, and planning how to achieve it will keep you from being bogged down in anxiety.”
Dr. Shapiro tells about her recent research on the impact of the environment on our genes. “There’s a constant barrage of environmental toxins that we are exposed to that can turn on different genes, and make it more difficult to overcome depression and anxiety,” she says. She has been focusing on catechol-Omethyltransferase (COMT), a protein-coding gene that is involved in breaking down hormones such as epinephrine and norepinephrene. “Those things are associated with fight or flight, so when people have a gene mutation for COMT, and that is turned on by environmental factors or emotional milieu, then it’s very difficult to break down fight or flight hormones.”
From the perspective of orthomolecular psychiatry, practically any nutritional deficiency that affects the mind—and almost all do in one way or another—can cause anxiety as a symptom.
A glucose tolerance test is important in determining whether sugar is being properly metabolized. Anxiety attacks can occur when sugar levels get too low, as in hypoglycemia. Hypoglycemia can also cause a rebound effect when adrenaline is secreted to raise blood sugar levels. This adrenaline rush also causes anxiety. Orthomolecular psychiatrist Dr. Michael Lesser checks out sugar tolerance “rather than getting involved immediately in looking for Oedipal or pre-Oedipal fantasies,” because in a recent review of his cases he found that 92 percent of people with neuroses had abnormalities in the glucose tolerance test.
Dietary recommendations based on the results of a glucose tolerance test may help a patient far more effectively, quickly, and safely than either psychotherapy or drug treatment will. The main objective is to create stability so that sugar levels neither drop nor rise too sharply or rapidly. For a person with hypoglycemia, a high-protein diet is recommended by Dr. Lesser because it digests very slowly, sending just a small trickle of sugar into the bloodstream so that the blood sugar is kept stable for a long period of time. Then, when the patient eats frequently, the blood sugar remains stable. “I have these patients eat six or seven times a day, small snacks so as not to put on weight,” he reports. “Actually, they can handle more calories than they could if they were eating one, two, or three large meals a day because the body is set up to metabolize the small meals frequently. When you have a large meal, you cannot metabolize all that nutrition, and the body turns a portion of that into fat.”
Dr. Walt Stoll, a board-certified family practitioner who combines his traditional Western training with holistic healing practices, has found that anxiety disorders are often linked to an inability to completely break down proteins during the digestive process into their amino acids.
“Just three or four amino acids still hooked together (peptides), if they get through the intestinal lining, can stimulate the immune system to make antibodies against them. Since the body is also made up of peptides hooked together to make proteins, these antibodies can attack us. To an antibody, a peptide is a peptide. It frequently doesn’t matter whether the peptide came from outside the body or is a part of the body. It is now being found that many of the chronic diseases that are so baffling to the allopathic disease philosophy of conventional Western medicine are related to autoimmune processes.
“In addition, some of these peptides have been found to be identical to certain brain hormones (endorphins) that are associated with panic attacks, depression, manic depression, schizophrenia, and other conditions. In these cases—with more certain to be discovered-—there is no need for the immune system to be involved; the effect is direct. The two first examples to be discovered were peptides from imperfectly digested casein (milk protein) and gluten (wheat protein). Of course, these are the two most commonly eaten foods in our culture.”
Dr. Stoll usually sees patients after they have tried a number of different therapies. “These patients come with stacks and stacks of records documenting that nothing seems to have worked in spite of every imaginable test having been done and every imaginable treatment having been tried. Psychoactive drugs either have worked poorly or have even caused the problem to worsen because the side effects exceeded the benefits.
“Since every other conceivable cause has been ruled out by the time I get to see them, I am free to look for the things that have not been evaluated. One of the first things I look for is how well the lining of their intestinal tract protects them from their environment. I frequently find that either they don’t have the normal bacterial balance in the colon or they have gone beyond that stage to having candidiasis. Candida can escape from our control only if the normal bacteria are not under control. If candida has converted from the yeast form, which is a normal part of the intestinal flora, into the disease-causing fungal form, it further damages the lining so that the leakage of peptides is much greater.
“The greater the amount of peptide leakage, the more likely it is that the brain will interpret these protein particles as being identical to the endorphins it produces during panic attacks, depression, and the like. This leakage is responsible for the increasing sensitivities we see in patients who are sensitive to environmental substances other than foods. In most cases, it is much simpler to correct the leakage than it is to eliminate the substance. But why not do both?”
According to Dr. Stoll, dramatic improvement is often seen once the reason for the leakage is corrected. “The antibodies involved last only for seventy-two hours. Once the leakage is stopped completely, symptoms lessen substantially in just a few days; even a reduction of the leakage helps. There are many patients today who have had that kind of experience. Not everyone’s mental symptoms are caused by poorly digested food playing tricks on the brain. However, in my experience it is the most commonly missed diagnosis and one that is relatively easy to resolve.”
In Dr. Derosis’s plan for reducing anxiety, the first step is to identify one thing that causes anxiety or creates tension, guilt, anger, and so on. One of the main problems in anxiety is that the person cannot discriminate between “distracting and anxiety-producing components” of life.
“For example, one of my patients had a teenage son who was troubling her a great deal. She said her son was coming to the dinner table that summer without any shoes, in his underwear, and with dirty, unkempt hair. She would yell at him, then they would argue, and he would get up and stomp out. Then she’d feel bad because she was kicking him out. In other words, those little details of life. So I asked, ‘What is it that bothers you the most?’
“She responded, ‘It’s his wearing underwear to the dinner table.’ Then she added, ‘But he does so many things to get me mad.’
“I stopped her and said I wanted only one thing. Then I asked, ‘What could you do about that one thing?’ This was the second step. Once you have isolated a problem, you have to plan what you are going to do about it.
“I also suggested that she behave in a low-key way, for she had been carrying on just as her son did, and it never got her anywhere. In fact, it made things worse. “She was able to keep quiet for quite a while and then she thought, ‘What if I got him some summer shorts. Maybe he might wear them.’
“So she asked him if he might like them and he said, ‘Yes.’ She did that, and he wore them all summer. Every once in a while, she would grab them and put them in the washing machine. As a result, their whole relationship changed. But this change involved one of the little details that can make life easy or anxietyfilled.”
Medical science shows repeatedly that anxiety is deeply associated with the onset of a variety of stress-related illnesses and immune-compromised conditions. The immune system is actually linked to positive mood, and proper functioning is associated with overall good health. “The endorphin system, our natural opiates, really boost the function of the immune system, while stress and anxiety suppress it, leading potentially to a host of diseases, particularly, the inflammatory diseases that are so prevalent and at the basis of many different health problems today,” Dr. Shapiro says. “If there are ways to change your set point, if there are ways to relieve anxiety and find more serenity and more ease, then you can profoundly affect not only your health but also the well-being of those around you.”
Dr. Lesser stresses that good nutrition is also important, since junk foods can spur anxiety. Simple, processed carbohydrates such as white sugar and white flour products may give a quick lift to the a person with hypoglycemia, but this is followed by excessive insulin secretion that drives the blood sugar down again, only to be pumped up once again by an adrenaline rush. This episode leaves a person with cold hands, jitters, anxiety, and panic.
Special nutrients can help alleviate this problem, especially chromium—also called the glucose tolerance factor–which helps normalize blood sugar. Zinc and the B vitamins, especially thiamine and vitaminB1, are also beneficial. Niacin, has also been identified as an antistress factor. It lowers cholesterol and triglyceride levels, which are increased by anxiety, and affects the brain in ways that are similar to the effects of tranquilizers. Dr. Lesser is convinced of the efficacy of this nutritional approach, but emphasizes the need to be patient when looking for results.
It may take months for the condition to begin to clear because “the body has often been run-down for a number of months or years, and you have to gradually repair all the cells in the body. The old cells have to die off and be replaced by new ones that are better nourished. The natural life span of cells varies throughout the body. Some, such as blood cells, live 120 days, so you cannot really expect sudden, dramatic improvement unless the condition has come on suddenly and you have caught it early.”
According to Dr. Allan Spreen, a specialist in nutrition-based medicine, anxiety disorders respond to treatment with certain natural substances. The advantages of treatment with natural substances can be numerous and substantial: by freeing people from having to take more toxic medication, the holistic approach can spare the patient the medication’s side effects as well as the extra expense.
“Some amino acids, when given individually,” says Dr. Spreen, “can be very effective in calming down the symptoms of anxiety disorders and panic attacks.” For example, tryptophan, which has been banned from public sale as a nutritional supplement, “was used as a sleeping agent until there was a problem with some batches of it being contaminated, which caused a syndrome that was related not to the tryptophan but to the contaminant. Some doctors use tyrosine for depression and anxiety. The ‘DL’ form of phenylalanine is often used on a shortterm basis for depression and can be very effective if given correctly. It can lessen anxiety and depression in people by giving them more of an ‘up’ mood. Phenylalanine is also an appetite suppressant for many people. If they’re given correctly, there seems to be no toxicity associated with amino acids, and they’re much cheaper than antidepressants or antianxiety prescription medications.”
Another nutritional approach is advocated by Dr. Steven Whiting, author of The Complete Guide to Optimal Wellness. He argues, “Once we have addressed the question of whether you are eating the proper foods, then you need to take certain supplements.”
For Dr. Whiting, key supplements are calcium and magnesium. “We have been told that the B complex is centrally important. Although this is true, the importance of calcium and magnesium should not be underestimated. Remember, at periods of high stress, calcium and magnesium as well as vitamins C, B1, B12, and pantothenic acid are consumed by the body at a phenomenal rate. One recent clinical study showed that up to 1,200 milligrams of pantothenic acid can be consumed in a twenty-four-hour period of severe anxiety. With the rec-ommended dietary intake of those nutrients well below that, we can see it is not sufficient for high-stress periods.
“So in addition to these supplements that are commonly given for stress, calcium and magnesium are probably the best weapons we have because of their action on the central nervous system. I would recommend 800 milligrams of calcium and 400 milligrams of magnesium. By accelerating that, you can create what I designate ‘a natural tranquilizer replacement.’ While it should be used only for short periods of time, it certainly can be used for three to five days with no side effects whatsoever.”
Dr. Whiting also believes in using vitamin and mineral supplementation to replace tranquilizers. He notes, “A combination that I have used successfully to replace such harmful drugs as Valium and Librium goes as follows: calcium at 600 milligrams, magnesium at 400 milligrams, potassium at 500 milligrams, vitamin B6 at 200 milligrams, potassium at 1,600 milligrams, and vitaminB12 at 500 micrograms every four hours under the tongue. This is used every four to six hours. We have had a phenomenal response with this, in terms of removing people’s need for these highly habit-forming drugs.”
Dr. Shapiro is also a strong proponent of magnesium. An important mineral that is in short supply in most American diets, magnesium plays a role in activating the calming part of our nervous system, the parasympathetic nervous system, which handles functions like muscle relaxation, heart rhythm, and digestion. She suggests magnesium that is bound to glycine (magnesium glycinate) or taurine (magnesium taurate).
“One other supplement I would mention is inositol, which is in the B-complex family of vitamins, and is also very helpful for helping people to calm down, and decrease repetitive thoughts, and intrusive feelings,” Dr. Shapiro says.
In addition to dietary modifications and nutritional supplements, anxiety may be ameliorated by relaxation techniques, yoga, massage, exercise, and stress management. An orthomolecular psychiatrist will often suggest these approaches before turning to drugs. Drugs, unlike nutrients or stress-reduction techniques, often become addictive. If you suffer from anxiety and then develop an addiction to drugs that were intended to help that problem, you will only have augmented the agony you were trying to eliminate. In addition, the direct side effects that drugs often have may leave you less capable of living a normal, healthy life than you were when you first underwent treatment.
Cognitive behavioral therapy can help people change behavior resulting from anxiety and revamp their thought processes to prevent symptoms from worsening or developing. This type of therapy is short term, lasting perhaps eight to twelve weeks. Goals of cognitive behavioral therapy include learning to identify behavior patterns and interrupt them with physical activities, such as tapping, learning breathing and other relaxation techniques to prevent some of the symptoms of anxiety from gaining hold, and gradually becoming less sensitive to situations and thoughts that provoke stress and anxiety.
Orthomolecular psychiatry puts psychotherapy on the back burner. The shortcoming of psychotherapy, according to Dr. Michael Lesser, “is that most people who suffer from anxiety have only a limited capacity to deal with it through insight psychotherapy. There is a real risk and danger that an individual, by concentrating on her pathology—phobias and anxiety—and by delving deep into her childhood and looking for trauma, will become ‘fixed’ on the idea of her pathology. Rather than becoming more able and competent, she will become fixed in her neurosis and in some cases will become even more anxious as a result of exploring the so-called unconscious. I have seen many cases—I am not saying this occurs in every case; perhaps I am seeing only the failed cases—of individuals who have been in psychotherapy for four, six, eight, or even twelve years with no apparent improvement. It seems to me that when a case goes on that long, someone should think about the possibility of using another approach.”
Dr. Shapiro strongly recommends breathing techniques as a means of breaking a cycle of negative thinking. “Many traditional civilizations have taught breathing,” she says. “I work with patients to teach heart-centered techniques that are calming and soothing, and center them in the wisdom of the heart.” Deep breaths are not needed, but rather regular, easy breathing in and out focusing awareness on the center of the chest.
Walking meditations, such as walking a labyrinth or walking in nature, also help people connect with their inner sense of well-being.
In addition, essential oils can be calming, soothing, and uplifting, Dr. Shapiro says. “One real benefit is that where we process scent in the olfactory cortex is right next to where we process emotions in the brain, the limbic system. So working with scent can actually cut through a lot of our verbal chatter” and reduce anxiety. Dr. Shapiro uses ylang-ylang, clary sage, lavender, and chamomile.
According to Stephanie Marohn, a writer and editor of books on psychospirituality and alternative thought, Dr. Roger Callahan has pioneered a kind of energy therapy known as Thought Field Therapy (TFT). TFT uses acupuncture points on the body to break up energy patterns that produce anxiety. By tapping on these acupuncture points, the energy is redirected, and the pattern contributing to anxiety is broken. TFT is a self-practiced therapy that gives the individual immediate control in reducing anxiety in particular situations.
My baseline wellness protocol can be found in Chapter 16. The following chart summarizes additional supplements I recommend for individuals who suffer from, or are specifically concerned about, anxiety. If you are concerned about conditions discussed in other chapters, consult with a health professional about how you can safely impact multiple conditions. As always, if you are taking medication—whether prescription or over-the-counter—or have any food restric-tions, consult with your doctor before beginning the supplement program. Your health care provider should always be up-to-date on all vitamins, supplements, and herbal or homeopathic remedies you are taking. Supplement overdoses are rare, but possible, and certain combinations may affect individuals adversely.
| SUPPLEMENT | DOSAGE | CAUTIONS |
|---|---|---|
| Adapton (Garum Armoricum) | 4 capsules as directed daily for fifteen days; stop for one week, then continue with maintenance dose of 2 capsules daily. | |
| Inositol (vitaminB8) | Increase daily dosage from 250 mg to 800 mg. Do not exceed a daily supplement of 1,000 mg. Take in two divided doses. | |
| Magnesium | 1,000 mg (for women) 1,000 mg (for men) | May take six weeks or more for effects to be felt |
| Melatonin | 300 mcg–1 mg at night a half hour before bed. | |
| Theanine | 200 mg |
An increasing body of evidence is showing the benefits of natural modalities to overall health and well-being. Following is a sample of recent peer-reviewed scientific studies in the area of anxiety.
In 2010, researchers reported in Maturitas that supplementing with 80 milligrams of red clover isoflavones per day for ninety days reduced anxiety in postmenopausal women. A 2010 report in Psychopharmacology found that supplementation with L-tryptophan increased brain serotonin levels and enhance mood and sense of well-being. A study published in the Nutrition Journal by French scientists found that individuals given a supplement derived from melon juice and high in the antioxidant superoxide dismutase experienced significant reductions in perceived stress after four weeks compared to a group given a placebo. A 2011 study published in the Journal of Neuroscience found that elevating levels of magnesium enhanced synaptic plasticity in the brain, which in turn, altered learned fear responses.