IV. What nutrition and medication strategies can I use for my anxiety?

There are a number of nutritional strategies you can use to improve health and wellbeing and ultimately lower your anxiety. You will be provided with general guidelines for a healthy diet and information on specific substances that can lower or increase anxiety symptoms. There is also helpful information on nutrients that people with anxiety often lack and should take to reduce symptoms as well as alternative strategies to improve the understanding of how food can affect your anxiety experience.

General Dietary Guidelines for Overall Health

There are basic guidelines for overall health that all people should follow, regardless of whether or not they experience anxiety symptoms or are diagnosed with an anxiety disorder. All people can benefit from a diet low in fat and sugar. You may be wondering what foods you can eat and those that have a lot of fat and sugar. The table below will show you some examples of these foods:

To start on a path of good dietary practice, try keeping these nutritional principles in mind even as your anxiety symptoms improve.

• Always eat breakfast.
• Eat at least five helpings of fruits or vegetables per day.
• Reduce intake of high-fat and high-sugar foods.
• Bake, grill or steam food instead of frying.
• Include starchy foods like rice, grains, or small amounts of bread in your meals to limit fats and excessive amounts of meat.
• Snack throughout the day between meals to keep your metabolism going； it will also give you energy throughout the day and prevent overeating at meal time.
• For snacks, use fruit, nuts, or vegetables instead of typical snack foods that are high in fat and sugar. Limit alcohol use since it contains many calories with no nutritional value (except for a small, daily amount of red wine).

Substances that can affect Anxiety

• Caffeine:
  Although many people around the world drink coffee and caffeinated beverages regularly throughout the day, people prone to stress and anxiety find that caffeine can make their symptoms worse. This happens because caffeine activates the hormones and chemicals in your brain that give you energy and alertness artificially. Long-term use of caffeine has also been associated with anxiety and depression. Caffeine is also an addictive substance that some people become dependent on for energy.
• Sugar:
  Your body actually needs sugar as a source of easily-accessible energy. Fruits, grains and other carbohydrates produce the natural sugar your body needs.  Many people tend to eat refined sugars that come from pastries and sweets but high levels of refined sugar can create feelings of panic and anxiety artificially. It can disrupt your metabolism, and confuse your body to enter into a natural stress response mode, even when there are no causes for stresses. With frequent and high levels of sugar intake, you can also experience withdrawal symptoms, including irritability, difficulty concentrating, and heart palpitations even when you are not overindulging in sweets.
• Salt:
  Salt depletes potassium which can prevent a healthy nervous system. Salt also raises blood pressure and high salt consumption is associated with a number of heart conditions.
• Saturated Fats:
  Saturated fats found in fried foods lead to sluggishness and fatigue, even when you are physically active. It also leads to poor blood circulation to the brain, and is associated with many heart conditions.
• Alcohol:
  Long-term alcohol use lowers brain chemicals needed for proper sleep and for the stress response to function properly. In the short term, alcohol disrupts the workings of the brain and decision making. It is also associated with chronic diseases and cancer.
   
  Alcohol is a depressant, and can be used by some people as a form of self-medication for anxiety and stress symptoms, especially if they are unaware of other treatment options that can lower symptoms properly in a healthier way.  Alcohol as a self-medication is especially harmful because it is an addictive substance that has detrimental effects on the brain functioning well.
   
  Since alcohol is known to complicate anxiety symptoms and lead to an overall poorer state, its use should be reviewed and replaced with alternative therapies if you find that you use it for self-medication purposes.
• Nicotine:
  Nicotine is an addictive substance with no nutritional value found in most tobacco products. Although many people turn to these products when they are nervous, worried, or anxious, nicotine is actually a stimulant that increases brain activity and induces an unnatural relaxation response. The temporary calming effect people feel when smoking may actually be a mask for the anxiety symptoms and stressors that will return after nicotine passes through your body.
  
  This is especially important in China, where one quarter of the world’s smokers light up cigarettes every day.  With high smoking rates together with the higher fat diets people have in China today, there is as much cause for concern about physical health as there is mental health. Among certain Chinese groups, stress is associated with greater levels of smoking. Smoking increases the risk of heart disease, stroke and cancer, so it is vital for your overall long-term health to quit smoking if you are using it as a crutch for anxiety, because it does not work and it only increases the risk of a serious health condition or fatal disease.

• Limit the amount of these groups of substances you eat or take, or remove them from your diet altogether.
• With sugar, salt, and saturated fats, you can find healthy alternatives that you can eat instead of these substances. Look for labels on packaged food with "low sodium" or "low fat" or "no sugar". Eat more fresh or steamed fruits and vegetables instead of tinned or pickled.
• With caffeine, alcohol, or nicotine, you may have to remove these substances from your diet gradually because their addictive properties can have harmful effects to your body if you stop suddenly. If you find that you are addicted, it may be more difficult to remove these from your life. You can:
• Set a date to stop using them altogether
• Get social support from friends and others who have stopped using these substances
• Seek help from addiction professionals to stop using these substances
• Use alternatives that do not have negative physical or anxiety-producing effects

Nutrient Deficiencies that lead to Anxiety Symptoms

A lack of essential nutrients we all need can leave you feeling anxious but it is something you may have never noticed before because it is locked in the foods you eat. Depending on the foods you eat particularly those with high-fat and high-sugar content, you may not have enough of the essential minerals and vitamins. Your anxiety may come from a lack of important minerals your brain needs for natural relaxation responses and brain functioning.

• Calcium: is a natural tranquilizer that can bring about your relaxation response.
• Zinc: can calm your central nervous system.
• Magnesium: helps to relieve nervous tics and movements, anxiousness, nervousness and tension.
• Potassium: is needed for healthy nervous system functioning. Without it, you may experience heart rate and breathing fluctuations or insomnia.

• Omega-3 Fatty Acid: imbalances have been associated with increased anxiety and depression.
• B Vitamins and Folic Acid (B12): are known to regulate brain function and mood. A lack of these vitamins can lead to mood disorders, depression and increased anxiety.
• Iron: deficiencies can lead to the same anxiety-increasing effect. A lack of this vitamin increases risk of panic attacks. 
• Vitamin C: is associated with your body’s stress control functions, and can help with stress and anxiety reduction. 
• Gamma-aminobutyric (GABA): is not a vitamin lacking in people with anxiety. Instead it is an amino acid that naturally occurs in your central nervous system. It can be taken in small amounts to increase calmness, without having the addictive effects of tranquilizers.

• Wherever possible, it is best to eat foods that are rich in these minerals and vitamins. The chart below show some of the foods that are rich in the minerals and nutrients described above.
• You can also take supplements so that you reach the daily allowance needed to gain the anxiety-reducing effects of these nutrients.
• Some of these nutrients, like Zinc and GABA, can have negative health effects if you take more than the dosage needed to reach daily limits to treat anxiety. Be sure to take no more than is necessary for health benefits.

Alternative Eating Strategies

These strategies are designed to change your eating habits to counteract anxiety symptoms, or for you to stop eating in ways that lead to greater stress and anxiety. You can also learn about foods that can affect your overall wellbeing.

Writing down the foods you eat at specific times of the day along with the way you feel after you eat them can help you find out why you select unhealthy food choices, what you may be missing in terms of nutrients, and what foods you can avoid. From there, you can personalize your diet and eating habits to treat anxiety. When you make changes to your diet, you can also track the times you eat and your feelings, to test whether a food change has helped lower anxiety, stress or panic.

Remove foods and drinks that lead to anxiety (see above). Reduce refined sugar and salt intake by replacing them with natural flavours in fruits, vegetables and spices.

You may want to start gradually, by replacing one food at a time. As an example, you can start with low-sodium versions of the foods you eat. Then, you can start trying different spices to replace the salt in foods. As you become comfortable with a lowered salt diet, you can move on to changing your sugar eating habits.

Since vegetables and grains are sources for many nutrients, and red meat is associated with aggressive or anxious behaviour, a change of diet can systematically reduce anxiety.

You may need to start by ensuring that you are eating enough fruits and vegetables in your diet. From the basic guidelines mentioned earlier in the lesson, try to eat at least 5 servings of fruit or vegetables per day. Once you achieve that and are comfortable with your new diet, you can start substituting other meats with vegetable protein alternatives. They can include soya beans, nuts, beans and legumes, or soya-based dairy products. If you already enjoy eating chicken, fish, or meats, you do not have to replace them completely. You can just try different options occasionally.

Eating in a hurry can lead to stress, poorer digestion and anxiety because you may not be getting all the nutrients you can out of the foods you eat. Even without anxiety, eating fast keeps you from really enjoying your meal! To get the most out of your food, try the following:

• Don’t multitask or do other activities while you are eating - just eat!
• Don’t eat in a hurry or when on the run. Sit down, relax and enjoy your meal.
• Take time to chew the food properly and enjoy the sensations, tastes, smells that you experience while you eat.
• Avoid overeating so that your body can fully digest your food and limit your chances of obesity. You can also try eating smaller meals more often as a way to avoid over eating and feeling hungry.

Medication may be an important treatment for those who experience high levels of anxiety and stress in their work, completing basic daily life activities, or taking pleasure and enjoyment from life.

Unlike other treatments for anxiety, you must consult with a doctor or psychiatric professional when you start, change or end a medication treatment plan. There are many medications for the treatment of anxiety and some may or may not work for you personally. Dosage levels and schedules are based around your personal needs, and taking medications outside of their usual dosage can have harmful side effects. Whether or not you see a doctor regularly for health concerns or trust a doctor’s advice, you will need to see one to be prescribed medications. At the same time, you can learn more about medications regarding their positive and negative effects.

Information on some of the different medications for treating anxiety, their side effects, and basic guidelines about how these medications can be taken are shown below. This information however, is not meant to be detailed, and consulting with a doctor is essential to obtain a medication treatment plan that is right for you personally. There is also information on alternative supplements to reduce anxiety. Alternative supplements should be used carefully since they can have toxic side effects and their benefits are still to be proven.

Medications to treat Anxiety

Medication is a highly effective option for people who have different levels of anxiety, particularly when the fear or panic is so great that they may not be able to cope with the symptoms on their own, or that their anxiety interferes with their ability to deal with everyday life.

If your anxiety is occasional, and you can control it, you will probably not need medication and can use other strategies to deal with stress and anxiety. You can review other lessons for more information. Medications are meant for people who cannot use other options to control their anxiety.

If you have been diagnosed with an anxiety disorder, or believe you may have one, you will need to see a doctor to learn about your medication options, and the side effects of taking medication. Medication can be harmful:

• if taken incorrectly
• if changing from one drug to another
• if stopping altogether
• if increasing or lowering the dosage.

Once you start taking medications for anxiety disorder, you can effectively learn and use non-medication strategies like cognitive or behavioural exercises, relaxation, or other activities to control your anxiety symptoms. When you learn to seek relief from these different strategies, you may be able to stop using medications altogether.

Different medications are usually prescribed for different anxiety disorders. The table below will give you an idea of the different medication options you have and their possible side effects. You will also need to see a doctor to find out which is best for your anxiety and whether you should be prescribed medication at all. If you do end up taking medications, your dosage should be specially selected for your needs.

• Use of medications must be in conjunction with a doctor who will help you find the right medication and dosage for your specific anxiety symptoms or diagnosed anxiety disorders.
• Take medications only as prescribed； the dosage level and frequency have been designed specifically for your needs. Once you begin taking medications regularly at the prescribed dosage, taking more, less or stopping altogether can have negative health consequences.
• If you want to stop or change your medication or dosage, consult with your doctor.
• There are numerous side effects that come with taking medications to treat anxiety, including high weight gains or losses, lack of energy, and dependence on medication to relieve (or mask) anxiety symptoms. The side effects are sometimes difficult to deal with and may lead you to stop taking medication altogether and you would then lose all benefits from the medications. Using other anxiety treatments may help lessen these negative side effects (see Part V below.)

Herbs and Botanicals that may Treat Anxiety

There are some botanicals and herbs that have stress reduction, calming, or anti-anxiety effects. Although these have not been fully supported by research, many herbs like chamomile, peppermint, or hops are safely taken as teas on a regular basis and do not have extreme side effects.

Other herbs like kava, valerian root and passionflower have become popular more recently for their anti-anxiety or stress reduction properties, but they have their limitations. There has been evidence to show that valerian and passionflower may have better anxiety-reduction effects than some medications but studies are few and far between and do not specify an ideal dosage. There have been documented cases however of liver damage from the use of Kava in the U.S. and Europe.

The table below gives you some options for herbal remedies for anxiety treatment. Dosage levels are only suggestions and should not be taken as a prescription, since none of these botanicals have been widely approved by doctor or validated by research.

Herb	Uses
Kava	General Anxiety Disorder
Valerian Root	General Anxiety Disorder, Sleep Disturbance, Calming
Passionflower	Anxiety, calming
Lemon Balm	stress reduction, sleep improvement, calming
Chamomile	anxiety, insomnia
Peppermint	calming, tension headaches
Hops	anxiety, insomnia
St John’s Wort	anxiety, sleep disorders
American Skullcap	relaxation, anxiety, nerve tension

• Take care in using these supplements. Their benefits have not been widely supported scientifically. Herbs like chamomile, peppermint, or hops, can be safely taken in tea.
• Valerian must be taken for long periods before anxiety reduction occurs, so it would not be an effective treatment for situational anxiety or panic attacks.
• As much as these herbs provide a calming effect or mimic anti-anxiety medications, they also have potential side effects like extreme drowsiness, digestive irritation, rash, eye redness, and complications with neurological disorders like Parkinson’s disease.
• Herbals may also have interactions with other medications and treatments, so it is best to consult with your doctor if you are taking other medications.
• Kava has been cited to cause liver toxicity. Although the toxic effects of other herbal remedies for anxiety have not been widely found, you should still be careful in the amount and frequency you take if you choose to use these herbals as an anxiety treatment.