Functional Medicine Approach to Anxiety
Updated: Aug 11, 2020
Anxiety can significantly impact one's quality of life. Anxiety disorders are the most common mental illness affecting adults in Canada with at least one in four Canadians experiencing an anxiety disorder in their life.
Treatment of choice is often medications and sometimes counselling.
Taking a functional medicine approach to treating anxiety involves looking for the root cause - aka why are you experiencing anxiety?
This article is going to discuss two common drivers of anxiety that I see in my practice:
-Poor digestive health
First I want to mention the basics - these are the things I talk to everyone with mood concerns about. For most (including me) these will always be a work in progress!
1.) Nutrition: Balancing your blood sugar throughout the day is critical. Gear your diet away from sugar and heavily processed foods. Instead of going for the sweet treat in the afternoon (e.g., chocolate bar) try having a spoonful of almond butter or a handful of nuts.
2.) Movement: When it comes to treating anxiety, the more exercise the better. BUT even a single bout of exercise can help ease anxiety symptoms when they come on. Evidence has demonstrated anxiety treatment effects with everything from Tai Chi to high intensity interval training. If you are just starting out, I recommend starting with a 15 minute walk daily.
3.) Sleep: Too little sleep makes us irritable and more anxious. Prioritize 8 hours of sleep every night. This will help improve your energy levels as well! Click here to learn more about how to optimize your sleep.
Low levels of magnesium have been correlated with MANY health conditions, as it is used for over 300 biochemical reactions in our body.
Deficiencies in magnesium are associated with:
Poor sleep quality
Anxiety and depression
Menstrual cramps and PMS
When we reduce magnesium levels in rodents, they exhibit symptoms of depression. Existing evidence suggests supplementing with magnesium leads to an improvement in anxiety.
Food sources of magnesium include nuts, seeds, avocados, green leafy veggies and even chocolate!
Not all forms of magnesium are equivalent. When looking for a magnesium supplement be sure to choose magnesium bisglycinate if you are looking to improve absorption from the bowels and have a systemic effect.
I screen Vitamin D levels in all patients, especially those that have depression or anxiety.⠀
Supplementing with Vitamin D has been shown to improve mood, and reduce inflammatory markers in women with anxiety and Vitamin D deficiency.⠀
There is a significant relationship between depression and Vitamin D deficiency, meaning the lower the levels of Vitamin D, the higher the rates of depression.⠀
In 2018, a study of 126 women found that lower Vitamin D levels were correlated with higher levels of depressive symptoms.⠀
A study of 30 individuals in 2019 with generalized anxiety disorder (GAD) found that supplementation with Vitamin D reduced the severity of their GAD symptoms, as well as a significant reduction in inflammatory levels.
Should I Supplement?⠀
At this latitude on Vancouver Island in Canada, we simply do not get enough sun exposure throughout the year to allow our body to produce an adequate amount of Vitamin D.⠀
Current Health Canada recommendations are that everyone should supplement Vitamin D throughout the year.⠀
Dosing of Vitamin D3 depends on the level of deficiency, I recommend getting your blood levels of Vitamin D tested. From this, it can be determined how much Vitamin D you should be taking. Doses vary between 1,000 IU and 10,000 IU a day.⠀
Vitamin D3 is the optimal form of Vitamin D to supplement with, and since it is a fat-soluble vitamin, taking it as an oil emulsion or with another fat source is ideal for absorption.⠀
Since it is a fat-soluble vitamin, it will accumulate, therefore do not supplement high doses without guidance from your primary healthcare provider as it can cause toxicity.⠀
Omega 3 fatty acids are an essential building block of the brain, with 20% of brain cell membranes composed of fatty acids.⠀They are deemed an ‘essential nutrient’, meaning they must be obtained from your diet as your body cannot produce them.⠀In addition to contributing to cellular structure, Omega 3’s have an anti-inflammatory effect on brain cells.⠀
There are two types of Omega 3’s: EPA and DHA.⠀
How do Omega 3's support mood?
Possibly support mood because they reduce brain inflammation (e.g., neuro-inflammation).⠀
Diets with reduced amounts of Omega 3’s have been associated with many depression and anxiety disorders.⠀
Individuals diagnosed with depression or anxiety, have significantly lower levels of Omega 3’s in their blood and brain.⠀
A 2019 study determined that taking an Omega 3 supplement with more than 60% EPA at 1 gram/day has beneficial effects on depression.⠀⠀
Sources of Omega 3’s⠀
Fish and other seafood (specifically cold water fatty fish like salmon)⠀
Nuts and seeds (e.g., flaxseed, chia seeds and walnuts)⠀
Marine algae (e.g., seaweed)⠀
FYI: Our oceans are contaminated, so it is important to purchase fish oil that has been tested by a 3rd party for contaminants. This includes plastics and heavy metals such as mercury. These types of fish oil are widely available in health food stores and you can always ask the company directly for their testing certificates if it is not displayed on the label.⠀
Gut & Mood
Our gut influences our brain.
Within our digestive tract, we have essentially another organ, known as the microbiome. This is a collection of bacteria, approximately 1 trillion of them.
Recent research demonstrates that the health of our digestive system impacts our mood. A striking example of this relationship was recently demonstrated in animal research. To elicit a depressed state, researchers administered LPS (lipopolysaccharide) from gram-negative bacteria, which causes inflammation of the gastrointestinal tract. The immune response that occurs as a result of this inflammation subsequently led to symptoms of depression. Using fluoxetine, a commonly prescribed antidepressant, the researchers were able to eliminate the neurobehavioural symptoms that had been induced by LPS after 3 weeks.
90% of our serotonin, the chemical in our brain that is influenced by many antidepressant and antianxiety medications, is produced in our gut by microbes.
We can therefore hypothesize that maintaining healthy flora within our gastrointestinal tract is fundamental to mental health.
In my clinical practice I have noticed that individuals who have depression and/or anxiety, tend to experience a lot of co-occurring digestive symptoms, such as diarrhea, constipation, gas, bloating or heartburn.
How do you improve the health of your gut?
Add more good bacteria.
There are a few ways to do this:
1.) Eat prebiotics, also known as food for the good bacteria.
2.) Take probiotic capsules.
3.) EAT FERMENTED FOODS.
My favourite way is #3. Adding in sauerkraut, kimchi or other fermented veggies will drastically enhance your gut bacteria.
Which probiotics? There are so many options!
There are multiple strains of bacteria contained in some probiotics that have proven directly beneficial to mood, such as Lactobacillus rhamnosus in depression While some strains of Bifidobacterium can alleviate anxiety.
There are a surplus of probiotic options available on the market, so ensure the one you are choosing has sufficient amounts of colony forming units (CFU’s) for your condition, and requires refrigeration.
This information is provided as a general source of information only and should not be considered medical advice. Please ensure you consult with your primary care provider for your personal health concerns.
References Eid, A., Khoja, S., AlGhamdi, S., Alsufiani, H., Alzeben, F., Alhejaili, N., ... & Tarazi, F. I. (2019). Vitamin D supplementation ameliorates severity of generalized anxiety disorder (GAD). Metabolic Brain Disease, 34(6), 1781-1786.
Fazelian, S., Amani, R., Paknahad, Z., Kheiri, S., & Khajehali, L. (2019). Effect of Vitamin D supplement on mood status and inflammation in Vitamin D deficient Type 2 diabetic women with anxiety: A randomized clinical trial. International journal of preventive medicine, 10.
Giordano, N., Goracci, A., & Fagiolini, A. (2017). Depression and vitamin D deficiency: causality, assessment, and clinical practice implications. Neuropsychiatry, 7(5), 606-614.
Larrieu, T., & Layé, S. (2018). Food for mood: relevance of nutritional omega-3 fatty acids for depression and anxiety. Frontiers in physiology, 9, 1047.
Lason, W. (2013). A new animal model of (chronic) depression induced by repeated and intermittent lipopolysaccharide administration for 4 months. Brain, behavior, and immunity, 31, 96-104.
Liao, Y., Xie, B., Zhang, H., He, Q., Guo, L., Subramaniapillai, M., ... & Mclntyer, R. S. (2019). Efficacy of omega-3 PUFAs in depression: a meta-analysis. Translational psychiatry, 9(1), 1-9.
Kubera, M., Curzytek, K., Duda, W., Leskiewicz, M., Basta-Kaim, A., Budziszewska, B., ... &
Evrensel, Alper, and Mehmet Emin Ceylan. "The gut-brain axis: the missing link in depression." Clinical Psychopharmacology and Neuroscience 13.3 (2015): 239.
Neurogastroenterol Motil. 2014 Nov;26(11):1615-27.
Pouteau, E., Kabir-Ahmadi, M., Noah, L., Mazur, A., Dye, L., Hellhammer, J., ... & Dubray, C. (2018). Superiority of magnesium and vitamin B6 over magnesium alone on severe stress in healthy adults with low magnesemia: A randomized, single-blind clinical trial. PloS one, 13(12), e0208454.
Sartori, S. B., Whittle, N., Hetzenauer, A., & Singewald, N. (2012). Magnesium deficiency induces anxiety and HPA axis dysregulation: modulation by therapeutic drug treatment. Neuropharmacology, 62(1), 304-312.