Naomi was a twenty-three-year-old woman who was suffering from a host of symptoms: digestive issues, headaches, fatigue, and insomnia. She told me that she often felt like her body was falling apart. Her primary care physician had referred her to me after ruling out serious physical conditions, suspecting that anxiety might be at the root of her symptoms. Naomi was skeptical, since she hadn’t been experiencing any strong anxious feelings, but I explained to her how somatic anxiety can be responsible for problems in the body, even in the absence of the classic mental symptoms. Gradually, she agreed that it was worth pursuing treatments for anxiety.
Naomi’s diet was already in good order, with a healthy balance of macronutrients and micronutrients, so there weren’t any major changes to be made there. She was totally opposed to trying any kind of pharmaceutical. Both SSRIs and benzodiazepines were out of the question, since she didn’t want to use medication for a condition she wasn’t sure she had. I realized we would have to get a bit creative.
When patients approach me with anxiety symptoms, I do not generally prescribe herbal supplements as first-line treatments, but given the limitations of Naomi’s case, it felt reasonable to try. I suggested trying an oral supplement of lavender oil, a natural herbal preparation that has been shown to improve symptoms of somatic anxiety without causing serious side effects or drowsiness.1
Though lavender isn’t commonly used in cooking beyond flavorings in teas and baked goods, it has been used as a scent in perfumes and soaps since the Middle Ages and is a popular component of alternative treatments like aromatherapy massages. While there is some anecdotal evidence that lavender can ease anxiety through its scent, the evidence isn’t ironclad.2 However, lavender oil is also available in an oral supplement—notably in a preparation called Silexan, a government-approved medication in Germany, and as an herbal remedy in the United States. Silexan has shown promising results in clinical trials as an antianxiety treatment,3 likely due to the way it binds to serotonin receptors in the brain.4
Naomi did her own careful research, which helped her feel more in control, and settled on a clean supplement that contained only lavender oil. We agreed this was a safe option for her. After two weeks on an intermediate dose of lavender oil capsules, Naomi’s symptoms began to improve, and before long they disappeared entirely. This isn’t always the case—I’ve had patients who didn’t see results from herbal medication until six to eight weeks, often with adjustments in dosage made along the way—but I was delighted that Naomi was able to find relief so quickly without using pharmaceuticals. While she also took up acupuncture again, along with tai chi—both of which helped her relax and feel more at ease—the initial results came after using the supplement, and these were the supporting act. Once she saw how effective the herbal treatment was, she became even more committed to an integrated and holistic approach to fend off her anxiety.
Despite its roots in folk medicine, the effectiveness of lavender oil isn’t due to mysticism or magic. Just like pharmaceuticals, it’s effective because it contains chemicals that exert an impact on the biological mechanics of your brain or body. These chemicals are called bioactives, and they have gained prominence as an area of research and in the medical community in recent years. Bioactives are a broad, complex category of chemicals, so we will only be able to scratch the surface, but in this chapter, we will explore their potential to relieve anxiety, whether found in foods we eat or in herbal supplements.
Bioactives appear in only trace amounts in food and herbs, but they can have an outsize effect on health. If that reminds you of the micronutrients we discussed in chapter 8, that’s no coincidence. There is no official consensus, but some experts classify vitamins and minerals as types of bioactives. Others make a key distinction: unlike micronutrients, bioactives are not specifically required by your body. While their presence may help you maintain optimal health, their absence isn’t going to keep your body from functioning normally. For example, if you have a severe shortage of iron or vitamin C, your body will gradually succumb to conditions like anemia and scurvy. The lavender oil that helped Naomi wasn’t essential to her health; it simply bolstered her brain and body against her somatic anxiety.
While vitamins and minerals come from a broad range of plant and animal sources, almost all bioactives are phytochemicals, meaning they are produced by plants (“phyto” is the Greek word for plant). The vast range of plants we can eat or turn into herbal preparations means there are a multitude of bioactives that have different biological effects, ranging from the antioxidants in berries to the caffeine in coffee and tea to the opioids in addictive drugs. Trying to learn the specifics of every bioactive compound, what their effects are, and what foods contain them can feel like a Sisyphean effort of confusing terminology (for example, a class of phytochemicals called flavonoids is further divided into flavones, flavonols, flavanones, flavanonols, and flavanols, among a few others5—not exactly designed to be distinctive and easy to remember).
Rather than getting too lost in the jargon, we will discuss the potential of bioactives to fight anxiety in two main groups: those that are concentrated in certain phytochemical-rich foods and those that may be worth incorporating into your routine via herbal supplements.
Everyone knows you should eat your vegetables. In the previous two chapters, we’ve discussed how fruits and vegetables are packed with helpful macro- and micronutrients, but they are also a key source of dietary bioactives. This is another reason why it’s so important that fresh fruits and vegetables make up a large proportion of your diet.
The most common type of bioactives found in fruits and vegetables is polyphenols, a group of phytochemicals known for their powerful antioxidant properties. Polyphenols have been found to have a range of positive effects on health, including decreased risk of heart disease and stroke, protection against neurodegenerative diseases, and improved metabolic indicators like blood pressure and lipids.6 As we’ve seen in many cases throughout this book, foods that correct metabolic imbalances and decrease inflammatory disease also tend to reduce anxiety. Polyphenols have also been shown to help promote a healthy gut microbiome, which, as we know, is an essential part of calming your mind.7
Studies on polyphenol supplementation and anxiety have been somewhat mixed—a 2021 meta-analysis found polyphenols helpful in depression,8 but with no strong improvement in anxiety, whereas a 2022 meta-analysis found benefits for both conditions.9 But it’s also important to consider a large body of research that has correlated eating lots of fruits and vegetables with better mental well-being and lower anxiety scores. For example, in the Lettuce Be Happy study, British researchers followed participants for seven years, tracking their diets and mental health, finding that those who ate the most fruits and vegetables tended to be the happiest, and even a modest increase in fruit and vegetable consumption had a large positive effect.10 While such studies don’t tie these improvements directly to polyphenols, I feel confident that they are a part of the picture, alongside vitamins, minerals, and dietary fiber.
Because there are so many varieties of polyphenols in fruits and vegetables, you shouldn’t get too hung up on trying to trace which compound is found in which specific food. Instead, the best way to ensure that you’re getting a range of polyphenols is to eat a widely varied diet that incorporates all kinds of different fruits and vegetables. One good rule of thumb is to eat fruits and vegetables of many different colors—those with rich colors are particularly rich in polyphenols. Think of the reds and blues of berries, the oranges and yellows of citrus fruits and carrots, the deep greens of kale and spinach, and the vibrant purple of eggplant.
Berries are particularly well known for their antioxidant properties, protecting the brain from oxidative stress.11 Most of the research into the positive effects of berries has centered on their potential to protect against neurodegenerative diseases, such as Alzheimer’s and Parkinson’s, but given that neuroprotective foods often seem to improve anxiety, I’m confident in recommending them—especially since they have a low glycemic index and can deliver a sweet, satisfying treat without negatively affecting metabolic health when eaten in moderation, about ¼ cup to ½ cup a day.
A new favorite vegetable of mine is purple sprouting broccoli, a beautiful purple form of broccoli I was introduced to when I visited London. Thanks to the anthocyanins that give it its purple color, it has almost double the antioxidant polyphenol content of regular green broccoli, which is already an amazing source of nutrients.12 (See the recipe for Pan-Seared Purple Sprouting Broccoli here.)
Cruciferous vegetables like purple sprouting broccoli, along with green broccoli, Brussels sprouts, collard greens, kale, and other vegetables also contain bioactives called glucosinolates, which give them their bitter taste and odor.13 Research has shown that glucosinolates are key in the prevention and treatment of several chronic diseases. Specifically, studies show that cruciferous vegetables can help improve blood sugar regulation and blood pressure, which can help fight against metabolic disorders. Glucosinolates can also improve psychiatric conditions such as depression, anxiety, autism, and Alzheimer’s disease, as well as immune disorders such as multiple sclerosis, and a particular compound called sulforaphane has shown potential in fighting cancer.14 I was first alerted to the incredible benefits of this food group when I battled breast cancer. Human studies have shown that exposure to sulforaphane helps slow breast cancer progression, arresting the cancer cell cycle and discouraging metastasis.15
While you may need to visit a farmers’ market to find purple sprouting broccoli (or grow it yourself!), I have high hopes that this beautiful, delicious, and brain-healthy choice will become more commonly available as its positive effects are studied further. In the meantime, I encourage you to take advantage of the polyphenols, glucosinolates, and other bioactives in cruciferous vegetables like green broccoli, cauliflower, Brussels sprouts, and cabbage.
In addition to a wide variety of fruits and vegetables, there are several foods and beverages that are known to be bursting with polyphenols and other helpful bioactives, including tea, chocolate, wine, and various herbs and spices. Unlike fruits and vegetables, some of these foods and drinks are easy to overindulge in, so let’s consider the pluses and minuses of each one.
Tea has been used to improve mood and soothe worry for thousands of years, and a steaming cup of tea certainly helps me to calm my mind. Modern medical research has backed up this association, as tea contains polyphenols that can help relieve anxiety. Of course, tea isn’t monolithic, and different black, green, and herbal tea preparations have varying effects on mental health.
Black tea is the most prominent type of tea in the United States and Europe and is popular across the globe. The crucial polyphenols in black tea are theaflavins, which have been shown to have antioxidant and antibacterial properties. Theaflavins have also been shown to ease anxiety symptoms in animal studies, likely via spurring the release of dopamine.16 Black tea has also been shown to assist with recovery from stress and boost relaxation.17 Even just inhaling the aroma of black tea has been shown to ease feelings of stress and reduce stress markers found in saliva.18
Green tea is popular in Asia as both traditionally brewed tea and the ground powdered preparation called matcha. Green tea is increasingly prevalent throughout the world, as it has been recognized for its good health effects, including boosts to mood and cognition.19 The most important bioactive in green tea is L-theanine, an amino acid that has been shown to reduce feelings of stress and anxiety.20
It’s important to remember that both black and green tea contain caffeine, a familiar bioactive compound that is part of the alkaloid group. Caffeine has a somewhat complicated relationship with mental health. I think many of us can attest that caffeine in moderation is a net positive for our ability to function in a busy, fast-moving world. But it’s important not to go overboard. High levels of caffeine consumption can lead to an increase in anxiety symptoms and even to serious events like panic attacks, especially in people already suffering from anxiety disorders like GAD and panic disorder.21 My recommendation is to keep caffeine consumption under 400 mg/day. One cup of black tea contains about 47 mg of caffeine, and 1 cup of green tea contains about 28 mg,22 so it’s unlikely that you’d exceed the limit while drinking only tea. But be careful if you’re also drinking coffee or other beverages that contain caffeine.
I also want to note that tea recommendations are focused on plain, steeped tea, not tea drinks with tons of added unhealthy fats and sugars or nonnutritive sweeteners. These additives can easily overpower the positive benefits of tea. A 2021 study found that regular drinkers of sugary bubble tea are more likely to suffer from depression and anxiety;23 that study meshes with my clinical experience, as we saw with my bubble tea–loving patient Mary in chapter 3. (See the recipe for Matcha Green “Bubble” Tea here for an alternative.)
Herbal teas generally do not contain caffeine, and certain preparations have been shown to ease anxiety. For example, rosemary tea has shown promising antianxiety effects.24 Given Naomi’s success at battling her anxiety with lavender oil, it’s no surprise that lavender tea has also been found to help.25 The classic chamomile tea has been shown to significantly reduce symptoms of GAD.26 And the South African herbal tea rooibos has been shown to have powerful antioxidant properties, especially when steeped for long periods to boost the polyphenol content.27
Chocolate is another food that’s thought of as a mood enhancer, though often for more indulgent reasons than tea—rich, sweet, high-calorie chocolate candies are popular forms of comfort food that put taste and satisfaction over health concerns. But while most chocolate candy isn’t good for you, that’s more the fault of the sugar and unhealthy fats than of the chocolate itself. Dark chocolate that has less sugar and greater cacao concentration contains a wealth of polyphenols with the potential to improve anxiety.
A 2022 meta-analysis concluded that cacao-rich products spurred significant improvement in anxiety symptoms in the short term (studies were too sparse to make a conclusion about long-term effects).28 Dark chocolate has been shown to reduce stress chemicals and help regulate the gut microbiome in anxious study participants.29 Furthermore, chocolate has shown potential in increasing positive mood states30 and protecting against depression.31 Clinically I’ve seen the benefit in anxiety-ridden patients who were accustomed to sugary desserts that made their anxiety worse. Acquiring a taste for extra-dark chocolate as a replacement for sweeter options helped lower their symptoms.
I want to stress that these findings aren’t an excuse to eat every candy bar you can get your hands on. The ill effects of eating too much sugar can certainly outweigh chocolate’s positive effects, especially since sweeter milk chocolate has lower amounts of helpful polyphenols. Even some dark chocolate can be high in added sugars, so make sure you focus on high-quality, cacao-rich, minimally sweetened extra-dark chocolate.
Wine is rich in polyphenols and antioxidants that can have positive effects on health. Moderate consumption of red wine has long been associated with improved cognition and neuroprotection.32 The polyphenol resveratrol can help regulate the release of neurotransmitters like serotonin and dopamine.
Again, moderation is key. Overconsumption of alcohol is a serious problem. Alcohol abuse has been found to be highly concurrent with anxiety disorders, and the two can worsen each other. No amount of polyphenols is going to overcome the damage that drinking too much can cause, so if you’re going to drink, limit your consumption and pay close attention to how you feel after consuming alcohol. If you’d rather avoid drinking wine but don’t want to miss out on the helpful effects of resveratrol, it’s worth speaking to your doctor about a resveratrol supplement.
Turmeric is known as a brain-healthy spice due to its high levels of curcumin, a bright yellow phenolic compound that is used in cooking and as an herbal remedy in Ayurvedic traditions. Curcumin is most often suggested as a possible treatment for depression, due to how it increases levels of brain chemicals like monoamines and brain-derived neurotrophic factor; it also reduces inflammation and helps reverse metabolic abnormalities.33 However, recent studies have shown positive effects on anxiety too, with some finding that curcumin is even more effective at treating anxiety than at treating depression.34 When cooking with turmeric, it’s important to include black pepper, which has been shown to make it easier for your body to absorb curcumin, multiplying its effects.35
Saffron is another seasoning that garners a lot of attention as a possible anxiety reducer. Saffron contains around 150 phytochemicals that have antioxidant and anti-inflammatory properties, including several that have been shown to be helpful for reducing anxiety.36 A meta-analysis of twenty-three studies on saffron’s effect on depression and anxiety found that it had a large positive effect on both conditions.37
Other herbs like rosemary,38 an Indian variety of basil called tulsi, or “holy basil,”39 and oregano40 have also been shown to help reduce stress and alleviate anxiety. But while cooking with these herbs and spices is never a bad idea, it’s a challenge to get large enough amounts of them into your diet. Since bioactives occur only in tiny amounts, and we generally season our food with small amounts of herbs and spices, it’s not practical to try to get enough of an herb or spice through your cooking to make a difference. I once had a patient who was delighted that I mentioned the positive effects of saffron, because she loved to cook pastas and rice dishes that were flavored with it. But once we broke down the amount of saffron she would need to eat to get the recommended dosage—it takes around twenty-one threads of saffron to yield the same effect as a 50 mg saffron supplement—she agreed that it would be more sensible (and more cost-effective, as saffron is very expensive) to look to a supplement. She ended up having a positive response to the supplement, lowering her anxiety within six weeks, and continued to cook with saffron on the side.
For this reason, while I certainly encourage you to cook with a broad range of herbs and spices in order to reap the benefits of their phytochemical content, if you want to try a regimen of a specific compound to target your anxiety, it’s often best to work with a holistic medicine or integrative medicine practitioner to determine a quality supplement and an appropriate dose.
That is a good note on which to shift our discussion to the topic of herbal medicine.
Herbal medicine has deep roots all over the world, with herbs playing a major role in allopathic, Ayurvedic, and Eastern medicine. Many people don’t know that as late as 1890, 59 percent of American pharmaceutical products were based on herbs or herbal combinations.41 Even today, herbal medicine is the most common form of alternative medicine, with an estimated 20 percent of Americans taking herbal medications to treat or prevent diseases.42 While some practitioners of conventional medicine may raise an eyebrow at the efficacy and reliability of herbal medicine, I have seen it help enough patients of mine that I would never rule out the possibility that it can help ease anxiety.
Of course, given that herbal medicine is less regulated than pharmaceuticals, with less rigorous testing required to bring a product to market, it’s a world that requires some research and guidance to navigate. One of the main selling points for herbal medicine is that natural treatments are safer than pharmaceuticals, ideally making them less risky to experiment with. That’s often true—for example, I didn’t have any reservations about directing Naomi to take a lavender oil supplement, which has no serious negative side effects—but it’s worth exercising caution. Just because a substance is natural doesn’t mean it’s automatically safe. Any herbal preparation should be consumed with medical supervision, whether that means your primary care physician or another health care provider with experience in herbal medicine.
Let’s look at some prominent herbal remedies for anxiety and review the research on their effectiveness.
Ashwagandha—sometimes referred to as Indian ginseng—is an herb of the Indian Ayurvedic system of medicine, which can be traced back to 6000 BC. According to tradition, the root smells like a horse, and consuming it gives the power of a horse (“ashwa” is the Sanskrit word for horse). Sure enough, in animal studies, ashwagandha has been shown to increase stamina and endurance.43 More relevant to us, recent studies have shown promising results of the use of ashwagandha to reduce stress and ease anxiety,44 and a review concluded that all qualifying studies showed ashwagandha was more effective at fighting anxiety than a placebo.45 The theory is that this herb helps ease stress and anxiety by having a moderating effect on the HPA-axis.46
Clinically I’ve seen this supplement help my patients with anxiety, so it’s worth pursuing if other avenues aren’t effective. Since ashwagandha naturally has a bitter taste, you may need to try a few different brands before you settle on a clean supplement with a neutral taste and no added sugars.
I am asked a lot about berberine, a supplement that went viral and has been called “nature’s Ozempic” in the press. From earlier on, you may recall that Ozempic and Wegovy are both prescription medications made popular by their weight-loss effects.
Berberine is a plant supplement obtained from the barberry plant. It is a natural isoquinoline alkaloid obtained from several herbal plants, such as Berberis Hydrastis canadensis (goldenseal) and others. Its first documented appearance was in traditional Asian medicine dating back to 3000 BC. Some research has shown that berberine can help lower blood sugar levels and act like a popular prescription medication called metformin, which is widely prescribed for T2D. In addition, a systematic review showed that it reduces insulin resistance. While it’s not entirely clear that berberine is a “stand-in” for Ozempic, it has shown some effect on weight loss in a meta-analysis that found a significant reduction body weight, BMI, waist circumference, and C-reactive protein levels associated with berberine intake. It was also thought this may have had an indirect role in helping metabolic disorders. In this way, berberine could potentially help ease anxiety by improving metabolic health.
For anxiety, animal studies have shown some positive impact from berberine. The mechanism to help lower anxiety may be related to its effect on monoamines in the brain stem and the lowering of serotonergic activity. In addition, berberine inhibits glutamate receptors and can lower glutamate, 5‐HT (5-hydroxytryptamine) and NE (norepinephrine) levels.
Since we know from chapter 6 that metabolic health is linked to mental health, as more research emerges, berberine may be an option to review with your doctor to help anxiety and/or any weight gain side effect from a psychotropic medication you are prescribed. Again, always discuss any supplement with your doctor before embarking on a trial.
Ginkgo biloba and ginseng have been staples of Eastern medicine since ancient times, used for a wide variety of health effects. Ginkgo biloba has been prized for its antimicrobial, anti-inflammatory, and neuroprotective effects.47 It contains a variety of bioactive compounds, including polyphenols and terpenes, that modulate different neurotransmitter systems. Ginseng is rich in antioxidants and has been used to boost the immune system. While most studies of ginkgo biloba’s and ginseng’s effects on the brain center on their protection against neurodegeneration, studies have shown that ginkgo biloba improves anxiety symptoms in patients with GAD,48 and ginseng helps mitigate the effects of stress, with the potential to ease depression and anxiety.49
I’ve seen mixed results in patients who use these two traditional remedies to try to fight anxiety. Still, since they are beneficial in other aspects of health, it may be worth discussing them with your doctor.
Kava is a plant traditionally used in ceremonial drinks in the Pacific Islands. It has picked up steam throughout the world as an alternative treatment for stress and anxiety. Though it has social effects similar to those of alcohol, kava proponents claim that it eases anxiety and promotes relaxation without any reduction in cognitive abilities.
Some recent medical studies into kava’s effectiveness have shown improvement in anxiety symptoms in participants with and without a GAD diagnosis,50 but others have found insufficient evidence to make a firm conclusion.51 Given this uncertainty, and possible concerns about effects on the liver (kava has been banned at times in some European countries, though most bans have been lifted), I wouldn’t recommend it as a go-to herbal remedy for anxiety.
Passionflower, specifically the species Passiflora incarnata, is native to South America, Australia, and Southeast Asia and has been used as an herbal remedy by many different cultures for a variety of different afflictions, including anxiety. It’s a rich source of vitamins and minerals, as well as alkaloid and polyphenol bioactives, and several recent studies have sought to prove its effectiveness as a treatment for anxiety and other mental health conditions.
While not every study is in total agreement, a review of recent studies suggests that passionflower has an effect comparable to that of powerful benzodiazepines for quick relief of anxiety. But while those drugs can come with drowsiness and dependence, passionflower has no such side effects, making it an ideal substitute in certain cases.52 It could be worth a try if you are suffering from acute episodes of anxiety, like panic attacks.
Passionflower is available as a tea, which I often suggest my clients try before they commit to a supplement (see my recipe here for Passionflower Tisane).
Rhodiola rosea, also known as roseroot, golden root, or arctic root, grows at high altitudes and in cold climates in Europe and Asia and has been used as an herbal medication in Scandinavia and Russia for centuries. The root of the plant contains adaptogens, substances that help the body adapt to stress, having neuroprotective and antianxiety properties.53
Studies have shown that treatment with Rhodiola rosea has led to significant improvement in anxiety symptoms among GAD patients54 and among patients struggling with only mild anxiety.55 For my patients who aren’t seeing strong results from dietary changes, I often recommend trying a Rhodiola rosea supplement.
Cannabinoids are terpenes found in the cannabis plant. Cannabis is a familiar recreational drug, with ever-growing support as a medical treatment for chronic pain and other conditions. The two most prominent cannabinoids are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). The two compounds have quite different effects, particularly on anxiety. While medical cannabis is sometimes touted as an anxiety treatment, THC, especially in high doses, can actually cause anxiety, leading to feelings of panic and paranoia. CBD has shown promise as an antianxiety treatment.56
While there is potential in CBD and other cannabinoids in fighting anxiety, the conversation surrounding them needs to cool down a bit before I’m confident making medical recommendations regarding their use. Too often, discussions about cannabis products end up reflecting either a positive or negative bias, depending on preconceptions about their use. I’m certainly cautious about recommending them—I’ve spent too much time on call in the busiest Boston emergency rooms treating substance-induced psychoses and related complications to be fully comfortable endorsing cannabis products. However, I remain open to the ongoing scientific research and always feel that science should be served with a dose of humility—we simply don’t know everything!
I want to reiterate that while the bioactives we’ve discussed in this chapter have the potential to improve anxiety, none of them should be considered a magical cure. Just like all anxiety treatments, they have strengths and limitations, and different people will react to them in different ways. But once you’ve ensured that you’re eating the right balance of macro- and micronutrients, the bioactives in food and supplements can sometimes provide the final boost you need to defeat anxiety.
Now that we know how the component parts of different foods can help relieve anxiety, it’s time to develop a balanced, sustainable eating plan full of delicious foods that calm your mind.