Treating Anxiety with Lifestyle Medicine

Dr. David Wiss

May 14, 2022

Mental Health

Diagnostic criteria for anxiety include the presence of excessive worrying that is challenging to control. According to a recent meta-analysis, adverse childhood experiences (ACEs) can be attributed to about 30% of anxiety cases in North America [1]. According to this study, the pooled relative risk for anxiety following two or more ACEs is 2.25 (95% CI: 1.43-3.56) compared to individuals with no ACEs. In plain language, childhood adversity more than doubles the risk for anxiety in adulthood.

Comorbid anxiety and substance use disorders (SUDs) have a mutual maintenance pattern wherein each condition perpetuates the other [3]. General anxiety disorder and panic disorder (which include panic attacks) have the strongest associations with SUDs [3]. Pathways capturing the co-occurrence can include: 1) self-medication where anxiety leads to SUD, 2) substance-induced anxiety disorder pathway, and 3) a third variable pathway via genetic predisposition to both or through anxiety sensitivity, which may also serve as shared vulnerability to both.

Anxiety disorders are more likely to emerge during childhood than most other psychiatric disorders [2]. Early intervention is key. Trauma-focused treatments during critical developmental periods are likely to offset the risk of worsening anxiety over time. Increasingly, nutrition interventions are being integrated into trauma treatment. We think it is long overdue and are very excited to see the growth of nutritional psychology, which investigates the psychological components of eating behavior. Are you curious about nutrition for anxiety? We are too! 

Because anxiety is so common, there is great interest in finding novel solutions to anxiety disorders. While there are several medications available, a growing number of people are interested in lifestyle medicine including exercise and nutrition. Are you here for it? A critical component is finding the right anti-inflammatory foods to eat which should include lots of fiber for gut health. Probiotics can also be very helpful. 

Anxiety disorders show a dose-response association with worsening diet quality [4] however directionality remains unclear (it is possible that poor food choices lead to anxiety, and that anxiety can lead to poor food choices). The Mediterranean Diet is the most promising approach for improving mental health and may be helpful in reducing the likelihood of anxiety [5]. This may be due to its high omega-3 fatty acid content, as well as the higher amounts of fiber. 

The role of gastrointestinal microbiota has also received attention as a potential mediator linking diet quality to anxiety symptoms [6–9]. An optimal environment in the gut improves communication along the gut-brain axis and can improve the function of the vagus nerve. Studies have shown that various forms of yoga are helpful for both SUDs and anxiety [10–13]. A daily yoga practice may be one of the best ways to manage anxiety. 

Wise Mind Nutrition is proposing that various forms of lifestyle medicine can be helpful to reduce anxiety, especially when utilized in conjunction with psychotherapy and in some cases, psychiatry. 

We are working hard to integrate nutrition into mental health care and invite you to be a part of the nutritional psychiatry revolution! The right diet for anxiety will be different for each person and should incorporate principles of mindful and soulful eating. There are so many health benefits with learning how to slow down and be present. 

References

1. Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, Jones L, Dunne MP (2017) The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. The Lancet Public health 2:e356–e366

2. Sullivan RM, Opendak M (2020) Neurobiology of Infant Fear and Anxiety: Impacts of Delayed Amygdala Development and Attachment Figure Quality. Biol Psychiat. https://doi.org/10.1016/j.biopsych.2020.08.020

3. Smith JP, Book SW (2008) Anxiety and Substance Use Disorders: A Review. Psychiatric Times 10:19–23

4. Gibson-Smith D, Bot M, Brouwer IA, Visser M, Penninx B (2018) Diet quality in persons with and without depressive and anxiety disorders. Journal of Psychiatric Research. https://doi.org/10.1016/j.jpsychires.2018.09.006

5. Sadeghi O, Keshteli AH, Afshar H, Esmaillzadeh A, Adibi P (2019) Adherence to Mediterranean dietary pattern is inversely associated with depression, anxiety and psychological distress. Nutr Neurosci 1–12

6. Cryan JF, O’Riordan KJ, Cowan C, et al (2019) The Microbiota-Gut-Brain Axis. Physiological reviews 99:1877–2013

7. Cryan JF, Dinan TG (2012) Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour. Nat Rev Neurosci 13:701–712

8. Noonan S, Zaveri M, Macaninch E, Martyn K (2020) Food & mood: a review of supplementary prebiotic and probiotic interventions in the treatment of anxiety and depression in adults. Bmj Nutrition Prev Heal bmjnph-2019-000053

9. Foster JA, Neufeld K-A (2013) Gut–brain axis: how the microbiome influences anxiety and depression. Trends in Neurosciences 36:305–312

10. Lou M, Turetzkin S, Lawlor S, Jones L, Brooks J (2021) Community-based yoga for women undergoing substance use disorder treatment: A descriptive study. Int J Yoga 14:50

11. Brooks J, Lawlor S, Turetzkin S, Goodnight CW, Galantino ML (2020) Yoga for Substance Use Disorder in Women: A Systematic Review. Int J Yoga Ther. https://doi.org/10.17761/2021-d-20-00008

12. Gorvine MM, Haynes TF, Marshall SA, Clark CJ, Lovelady NN, Zaller ND (2020) An Exploratory Study of the Acceptability and Feasibility of Yoga Among Women in Substance Use Disorder Recovery. J Altern Complementary Medicine. https://doi.org/10.1089/acm.2020.0351

13. Simon NM, Hofmann SG, Rosenfield D, Hoeppner SS, Hoge EA, Bui E, Khalsa SBS (2020) Efficacy of Yoga vs Cognitive Behavioral Therapy vs Stress Education for the Treatment of Generalized Anxiety Disorder. Jama Psychiat. https://doi.org/10.1001/jamapsychiatry.2020.2496