Symptoms of anxiety can be debilitating and can negatively impact your client’s home life, work productivity, school performance, friendships, and ability to function at all in certain circumstances.
Children with Anxiety
Anxiety can greatly impact quality of life for adults and children alike. And children with anxiety often display physical and behavioral signs different than adults such as restlessness, recurring headaches, withdrawing from family, or refusing to go to school.
If you have a pediatric practice, in addition to anxiety being common in children, anxiety is particularly high in children with ADHD and autism. Researchers found that 41% of children with ADHD had anxiety and/or depression. According to a research paper published in Neuropsychiatry, “up to 80% of children with ASDs experience clinically significant anxiety, with high comorbidity rates for social phobia, generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD) and separation anxiety disorder (SAD) (30, 35, 37 and 38%, respectively).”
Children with ADHD and autism often find the uncertainty of their environment very stressful. Some have sensory processing disorders that can add to the problem. Shopping centers, crowds, cramped spaces, bright or fluorescent lighting, and loud noises can overwhelm their system. This can push them into sympathetic overdrive, also called “fight or flight.” Everyday activities such as going to school and shopping can cause anxiety.
Food, Nutrients, and Biochemical Factors in Anxiety
Certainly lifestyle strategies such as stress reduction and mindfulness can help people with anxiety, it’s still important to get to the root causes or contributing factors. Understanding and addressing the biochemical roots affecting anxiety help support your client from the inside out.
1) Food reactions can contribute to anxiety
As a nutritionist, I have worked with adult clients with a variety of conditions, as well as children with ADHD and autism for 20 years, and I have both seen food cause (and alleviate) symptoms of anxiety. What foods affect anxiety varies based on their underlying biochemistry and personalized nutrition needs. I bet you have seen this in your clients as well.
Food sensitivities: Inflammation, as we’ll discuss further in #2, is a common underlying factor in anxiety. And food sensitivities are a huge cause of anxiety including gluten, casein (the protein in dairy products), soy and eggs. When foods are not tolerated, they can create inflammation that can trigger anxiety.
Glutamate: Glutamate is excitatory and can stimulate the nervous system. In other words, foods containing glutamate, such as soy products, corn starch, corn syrup, and products containing carrageenan can cause anxiety.
Histamine: Foods containing a large amount of histamine and those that can trigger a release of histamine can also cause inflammation and anxiety. Histamine-rich foods include aged or fermented foods, cured meats, canned or smoked seafood, yogurt, citrus fruits, most berries, spinach, tomatoes and tomato-containing products, spices, artificial food colors, and preservatives.
Salicylates: In addition to glutamate and histamine, salicylates can also cause anxiety and a host of neurological and behavioral challenges. Examples of salicylate-rich foods include grapes, berries, apples, green bell peppers, canned mushrooms, red chili, chicory, apricots, herbs, and spices. Almonds and peanuts are also rich in salicylates.
Oxalates: Furthermore, oxalates can also not only trigger inflammation but also are known to cause anxiety.
Grains: For people with gut inflammation, grains can be particularly problematic. And once the gut is chronically inflamed, it can cause systemic inflammation.
Sugar: Sugar can contribute to anxiety. For example, poorly regulated blood sugar is a factor in anxiety, and a high sugar diet over time can lead to blood sugar dysregulation. When blood sugar drops too low, anxiety can be a symptom. Also a high sugar diet is often associated with low nutrient intake and depletion of nutrients, which can also affect mood and anxiety.
2) Chronic inflammation in anxiety
Chronic systemic inflammation is an underlying factor in anxiety conditions. Inflammation is also common in ADHD, autism, depression and most other neurological conditions, as well as most chronic diseases.
During an inflammatory reaction, chemicals known as cytokines are produced by the body – and research shows that these cytokines can cause many neurological (and physical) symptoms including anxiety.[3, 4]
Anything that triggers inflammation, such as allergens, inflammatory foods, chemicals, and food additives can cause or exacerbate anxiety.
3) Leaky gut can exacerbate anxiety
Leaky gut is a condition where the tight junctions in the intestinal lining are damaged. This creates an environment where bacteria, fragments of bacteria, and even proteins from foods that are not fully digested can “leak” into the bloodstream. It is also known as intestinal permeability. This mechanism can trigger the immune system and create systemic inflammation as the immune system becomes hyper-stimulated.
So if you are asking yourself if what goes on in the gut can impact what happens in the brain, and especially conditions like anxiety, the answer is “yes, it can!” The gut-brain axis is the mechanism by which the gut and brain communicate with one another. Inflammatory cytokines can be formed as a result of leaky gut and they can cross the blood brain barrier. When that happens, the cytokines can cause a whole host of symptoms which include anxiety, depression, headaches, and irritability.[5, 6, 7]
In addition to increased inflammation, pathogens also thrive in a leaky gut. These pathogens can compound issues related to mood and increase anxiety and they also compete with good bacteria in our microbiome – which can help reduce anxiety.
Poor digestive function usually occurs with leaky gut and this results in impaired absorption of critical nutrients and amino acids that the body and brain need for good mental health (and reduced anxiety).
4) Decreased methylation in anxiety
5) Dopamine imbalances and anxiety
An important neurotransmitter involved in social interaction and reward behaviors is dopamine. Dopamine has also been found to be a factor in social anxiety disorder. Dopamine has been studied in regards to anxiety in autism  and can also be imbalanced in ADHD. Under normal circumstances, the dopamine transporter is able to clear excess dopamine from the synapse. A synapse is a gap where nerve cells can send impulses to other nerves via neurotransmitters. Genetic variations in autism disrupt this transporter.
In addition, pathogenic bacteria can contribute to high dopamine and therefore increased anxiety. One toxin, HPHPA which stands for 3-(3-hydroxyphenyl)-3-hydroxypropionic acid, is produced by Clostridia bacteria in the gut and can be a causal factor for autism. For ABC News Dr. James Greenblatt explains that “HPHPA causes deactivation of an enzyme [Dopamine Beta-Hydroxylase] so that dopamine cannot be converted to the neurotransmitter norepinephrine.’’ This inability to convert dopamine effectively can lead to oxidative stress and a depletion of glutathione. Glutathione is a major antioxidant key in the detoxification process. This reduced detoxification can also worsen anxiety.
6) Excess glutamate, hyperactivity, and anxiety
Another important neurotransmitter linked to anxiety is glutamate. Glutamate (an excitatory neurotransmitter) converts to GABA (a calming neurotransmitter. Many studies have found that glutamate and GABA play a role in anxiety.[11, 12]
Glutamate is an excitatory neurotransmitter that has been studied in regards to ADHD and autism as well. Some individuals can be deficient in an enzyme (glutamic acid decarboxylase) that breaks down glutamate and turns it into GABA. GABA (γ-Aminobutyric acid) is an amino acid that produces a calming effect through inhibition of nerve transmission in the brain. Studies show that glutamic acid decarboxylase enzymes may play a role in autoimmune conditions (and many people with autoimmune conditions state that they struggle with anxiety). Additionally, in individuals with autism (who often have anxiety), also have an increase in glutamate.[15, 16]
In addition to being made in the body, glutamate can come from the foods we eat, either from food additives in packaged food or naturally in certain foods that are fermented and processed. Many of these food additives are derivatives of glutamate (think MSG) including autolyzed yeast extract, hydrolyzed protein, even “natural flavors.” They can cause significant reactions, including anxiety, for sensitive individuals. Reading ingredient labels is important, especially for those who react poorly to glutamate.
7) Pyroluria, nutrient deficiencies, and anxiety
Another common biochemical factor in anxiety is a condition called pyroluria, also known as pyrrole disorder. There can be a genetic component to pyroluria and it can be induced by stress. People with pyroluria over-produce pyrrole which is a by-product of hemoglobin synthesis. This results in depletion of vitamin B6 and zinc because the excess pyrrole bind to these nutrients. Vitamin B6 and zinc are two key nutrients linked to anxiety, sleep issues, reduced cognitive function, and problems concentrating when deficient. Individuals with ADHD, anxiety, schizophrenia, autism, and other neurological conditions have an increased rate of pyroluria, for some conditions the rates of pyroluria are over 40%.
Diet and Nutrition Considerations
There are a number of diet and nutrition strategies that help reduce anxiety. The key is to help your client identify and then address the underlying factors that are contributing to the individual’s anxiety and this requires a personalized nutrition approach. As you know, a BioIndividual Nutrition and therapeutic diet approach takes into account a person’s unique biochemistry, genetics, and environmental factors to determine the right nutritional intervention. This approach helps your clients address the root cause of the issue.
Allergen-free and elimination diets
Low salicylate diet
Special therapeutic diets
Additional meal strategies
For your clients who are looking for nutritional guidance to help with anxiety, here are some additional suggestions.
- Maintain healthy blood sugar levels. Including healthy protein, fats, and fiber with every meal helps to stabilize blood sugar. These can include but are not limited to: grass-fed meat, wild caught fish, poultry that is pasture-raised, organic eggs, grass-fed butter, virgin coconut oil, extra virgin olive oil, and vegetables. It is also important to consume as many deep colored vegetables as possible for their nutrient density.
- Avoiding foods that can cause or exacerbate inflammation like gluten and other foods I have mentioned above can help as well. Industrial seed oils such as cottonseed, sunflower, safflower, and canola should be avoided.
- Many additives in foods can also cause or make anxiety worse. Avoiding artificial sweeteners, artificial nitrites and sulfites, food dyes, potassium bromate, BHA/BHT, propylene glycol, propyl gallate, MSG, disodium inosinate and guanylate can be helpful.
- Supporting the good gut bacteria through probiotic-rich and prebiotic-rich foods can be beneficial as well. However, if your client is sensitive to glutamate and/or amines, watch for any negative reactions to fermented foods as those sensitive can see increased anxiety as a result.
- Create the optimal diet right for your client based on their bioindividual needs. There is no one-size-fits-all diet and determining what your client needs is key to reducing anxiety.
A multivitamin/mineral formula and essential fatty acids are a great place to start.
Proper nutrients can play a pivotal role in reducing certain symptoms and behaviors. In fact, I was part of a 12-month study on nutritional and dietary intervention in autism. Along with a healthy gluten, casein, and soy free diet, the study also included a high quality multi-vitamin/mineral formula and essential fatty acid supplement. The study found, “ improvements in aberrant behaviors (Irritability, Lethargy/Social Withdrawal, Stereotypy, and Hyperactivity), sensory processing, and GI symptoms, and Overall.”
By the end of the study, parents reported statistically significant improvements in:
- Attention focus
Understanding someone’s underlying biochemistry and SNPs (single nucleotide polymorphisms) can help determine proper supplementation needs. For example, folate and B12 are important for methylation; B6, zinc, and magnesium help support transsulfuration and pyroluria; and magnesium has calming effects.
No one wants to see anyone struggle, especially with something as debilitating as anxiety. There are things your clients can do, starting today, that can make a profound improvement. Dietary and nutritional intervention is something that they can implement, with your expert guidance and support.
Because of the complexity of anxiety and the high rate of comorbid conditions such as clostridia infection or PANDAs, two infectious conditions that can cause increased anxiety, or an autoimmune condition, always make sure your clients are working with a qualified healthcare provider to assess for any underlying medical issues.
- AlZaben, F.N., Sehlo, M.G., Alghamdi, W.A., Tayeb, H.O., Khalifa, D.A., Mira, A.T., Alshuaibi, A.M., Alguthmi, M.A., Derham, A.A. and Koenig, H.G., 2018. Prevalence of attention deficit hyperactivity disorder and comorbid psychiatric and behavioral problems among primary school students in western Saudi Arabia. Saudi medical journal, 39(1), p.52.
- Nadeau, J., Sulkowski, M.L., Ung, D., Wood, J.J., Lewin, A.B., Murphy, T.K., May, J.E. and Storch, E.A., 2011. Treatment of comorbid anxiety and autism spectrum disorders. Neuropsychiatry, 1(6), p.567.
- Vogelzangs, N., Beekman, A.T.F., De Jonge, P. and Penninx, B.W.J.H., 2013. Anxiety disorders and inflammation in a large adult cohort. Translational psychiatry, 3(4), pp.e249-e249.
- Salim, S., Chugh, G. and Asghar, M., 2012. Inflammation in anxiety. Advances in protein chemistry and structural biology, 88, pp.1-25.
- Bested, Alison C., Alan C. Logan, and Eva M. Selhub. “Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: Part II–contemporary contextual research.” Gut pathogens 5.1 (2013): 1.
- Emeran A. Mayer, Tor Savidge, and Robert J. Shulman. Brain Gut Microbiome Interactions and Functional Bowel Disorders. Gastroenterology. 2014; 146(6): 1500–1512.
- Saskia van Hemert, Anne C. Breedveld, Jörgen M. P. Rovers, Jan P. W. Vermeiden, Ben J. M. Witteman, Marcel G. Smits, Nicole M. de Roos. Migraine Associated with Gastrointestinal Disorders: Review of the Literature and Clinical Implications. Front Neurol. 2014; 5: 241.
- Cervenka, S., Hedman, E., Ikoma, Y., Djurfeldt, D.R., Rück, C., Halldin, C. and Lindefors, N., 2012. Changes in dopamine D2-receptor binding are associated to symptom reduction after psychotherapy in social anxiety disorder. Translational psychiatry, 2(5), pp.e120-e120.
- Cartier, E., Hamilton, P.J., Belovich, A.N., Shekar, A., Campbell, N.G., Saunders, C., Andreassen, T.F., Gether, U., Veenstra-Vanderweele, J., Sutcliffe, J.S. and Ulery-Reynolds, P.G., 2015. Rare autism-associated variants implicate syntaxin 1 (STX1 R26Q) phosphorylation and the dopamine transporter (hDAT R51W) in dopamine neurotransmission and behaviors. EBioMedicine, 2(2), pp.135-146.
- Chen, L., Ding, Y., Cagniard, B., Van Laar, A.D., Mortimer, A., Chi, W., Hastings, T.G., Kang, U.J. and Zhuang, X., 2008. Unregulated cytosolic dopamine causes neurodegeneration associated with oxidative stress in mice. Journal of Neuroscience, 28(2), pp.425-433.
- Nasir, M., Trujillo, D., Levine, J., Dwyer, J.B., Rupp, Z.W. and Bloch, M.H., 2020. Glutamate systems in DSM-5 anxiety disorders: their role and a review of glutamate and GABA psychopharmacology. Frontiers in Psychiatry, 11, p.1186.
- Lydiard, R.B., 2003. The role of GABA in anxiety disorders. Journal of Clinical Psychiatry, 64, pp.21-27.
- Huang, X., Wang, M., Zhang, Q., Chen, X. and Wu, J., 2019. The role of glutamate receptors in attention‐deficit/hyperactivity disorder: From physiology to disease. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 180(4), pp.272-286.
- Lernmark, Å., 1996. Glutamic acid decarboxylase–gene to antigen to disease. Journal of internal medicine, 240(5), pp.259-277.
- Ghanizadeh, A., 2013. Increased glutamate and homocysteine and decreased glutamine levels in autism: a review and strategies for future studies of amino acids in autism. Disease markers, 35(5), pp.281-286.
- Fatemi, S.H., Halt, A.R., Stary, J.M., Kanodia, R., Schulz, S.C. and Realmuto, G.R., 2002. Glutamic acid decarboxylase 65 and 67 kDa proteins are reduced in autistic parietal and cerebellar cortices. Biological psychiatry, 52(8), pp.805-810.
- McGinnis, W.R., Audhya, T., Walsh, W.J., Jackson, J.A., McLaren-Howard, J., Lewis, A., Lauda, P.H., Bibus, D.M., Jurnak, F., Lietha, R. and Hoffer, A., 2008. Discerning the mauve factor, Part 1. Alternative therapies in health and medicine, 14(2), pp.40-51.
- Adams, J.B., Audhya, T., Geis, E., Gehn, E., Fimbres, V., Pollard, E.L., Mitchell, J., Ingram, J., Hellmers, R., Laake, D. and Matthews, J.S., 2018. Comprehensive nutritional and dietary intervention for autism spectrum disorder—a randomized, controlled 12-month trial. Nutrients, 10(3), p.369.