Anxiety Flashcards
Anxiety
Anxiety — an umbrella term that includes:
- Anxiety due to a general medical condition.
- Substance-induced anxiety.
- Generalised anxiety.
- Panic.
- Acute stress.
- Social phobia; specific phobias.
- Post-traumatic stress.
Signs and symptoms:
Signs and symptoms:
- Palpitations, or accelerated heart rate.
- Shortness of breath.
- Sensation of choking, chest pain or discomfort, nausea or abdominal distress.
- Sweating, trembling or shaking.
- Feeling dizzy, unsteady, lightheaded.
- Fear of losing control or going crazy, fear of dying.
- Specific phobias; paresthesia; chills or hot flushes.
- Somatic symptoms: IBS; fibromyalgia or chronic, persistent muscle pain; excessive blushing; chronic fatigue.
Causes and risk factors:
Causes and risk factors:
- Stressful, negative life experiences in early childhood or adulthood.
- Chronic stress — reduces GABA and increases adrenaline and noradrenaline (responsible for many of the physiological effects of anxiety).
- Genetic SNPs including genes associated with the HPA-axis, GABA (see earlier). Also linked to BDNF SNPs.
- Nutrient deficiencies — lack of cofactors for NT production (e.g., GABA) and neuronal health — especially B vitamins (e.g., B6), magnesium, zinc, protein and EFAs.
Inflammation:
- An increase in inflammatory markers including CRP, IL-6 and TNF-alpha has been linked with anxiety disorders.
- Exposure to LPS (endotoxemia) with subsequent increase in inflammatory markers is associated with increased anxiety.
Poor gut health:
* Dysbiosis negatively affects the gut-brain axis. Lactobacillus and Bifidobacterium play a role in the synthesis of GABA.
- Increased intestinal permeability ↑ systemic inflammation.
- Sugar and processed foods — promote inflammation and oxidation in neuronal cells; cause fluctuations in blood glucose hypoglycaemia triggers adrenaline release, worsening anxiety.
- Caffeine — ↑ anxiety, shown to precipitate panic attacks; is an adenosine antagonist impeding sleep; depletes B vitamins.
- Alcohol — depletes the body of vital nutrients; fragments sleep and blocks the REM phase (sleep is less restorative); regular consumption decreases serotonin levels affecting mood.
- Poor sleep — downregulates dopamine receptors.
Natural approach to anxiety
- CNM Naturopathic Diet with a ‘Neuro Nutrition’ approach:
- Increase antioxidant-rich and anti-inflammatory foods (oxidative stress has shown to increase anxiety directly and by ↑ inflammation).
- Fresh fruit and vegetables — high phytonutrients e.g., anthocyanins (blueberry, blackcurrant), proanthocyanidins (grape skin / seed), quercetin (red onion), isothiocyanates (brassica vegetables). Antioxidant and inflammatory effects.
- Curcumin decreases anxiety through antioxidant and anti-inflammatory mechanisms.
- Ensure quality protein to provide amino acids for NT formation and blood glucose balance.
- Optimise omega 6:3 ratio (1:1–1:3) — wild oily fish, flaxseeds, chia seeds, hemp seeds. Provides lipids for neuronal health and modulates inflammation. Curcumin enhances synthesis of DHA from ALA. DHA deficiency is linked with ↑ anxiety.
- Avoid: Caffeine, alcohol, sweeteners, refined carbohydrates and processed foods. Certain additives can trigger anxiety in some individuals
Supporting GABA levels naturally
- Regular exercise (e.g., yoga); address stress (see stress and fatigue lecture); diaphragmatic breathing (Vagal stimulation).
- Optimise GI health (digestion, intestinal barrier, microbiome). Increased Bifidobacterium levels increases gut GABA production.
- Probiotics to support GBA containing Bifidobacterium strains, or prebiotics such as GOS that feed Bifido. GABA is found in fermented foods (e.g., tempeh) and germinated brown rice
Magnesium 200‒400 mg / day Epsom salt baths.
- Co-factor for GABA synthesis. Deficiency associated with HPA-axis dysregulation and increased anxiety.
- Decreases hyperexcitability by inhibiting NMDA receptors and glutamate. May be particularly useful to use taurine, bisglycinate forms as taurine and glycine also support GABA.
Zinc 15–60* mg / day
*Short term or with 1 mg Cu for every 15 mg zinc.
Essential for GABA synthesis. Anxiolytic effects by regulating GABA / glutamate. Low zinc ↑ NMDA receptors, which respond to glutamate (increases anxiety).
B-complex vitamins 50–150 mg / day
- As a group are essential for healthy NS function supporting NT production via methylation and decarboxylation processes.
- B6 is especially important for the conversion of glutamate (excitatory) to GABA (inhibitory).
- Shown to reduce anxiety and improve mood
Vitamin C 500 mg x 3 daily
- A co-factor in glucocorticoid synthesis (anxiety increases adrenal output).
- Concentrates in neuron-rich areas of the CNS and reduces anxiety by ↓ oxidative stress
Theanine 50–200 mg / day
- Inhibits glutamate reuptake (competitive receptor binding) and ↑ GABA (anxiolytic).
- Increases alpha brain waves, ↓ anxiety and improves mood without sedative effects.
- Longer-term intake increases BDNF providing neuroprotective effects.
Lemon balm Melissa officinalis Aerial parts. 300 600 mg
Used traditionally for insomnia, anxiety, irritability, depression, colic, nervous dyspepsia.
- Effect thought to be by inhibition of GABA transaminase system, raising levels of GABA
Passionflower Passiflora incarnata
1 tsp. dried herb infused 2–3 x daily, or label dose
- Modulates GABA pathways; appears to bind to benzodiazepine site of GABA receptors.
- Benefits seen for GAD and anticipatory anxiety.
- The constituent chrysin is neuroprotective
Other useful GABA-promoting herbs
hops, valerian, chamomile, ashwagandha, lavender.
Green oat (Avena sativa)
Green oat (Avena sativa) — a nervous system trophorestorative rich in B vitamins that improves mood and reduces anxiety. It inhibits MAO-B. 800–1000 mg per day, see labels if using a tincture
Reishi , Lion’s mane
Reishi — its polypeptides act as NT and endorphin precursors; inhibitory actions on neuronal activity. Lion’s mane
