How Nutrition, Proper Specific Hydration, Inflammation, and Body Flora affect Anxiety

(Peer Review Acceptance)

To see the article below on ResearchGate click Here.

By Dr. Keith Kantor

Generalized anxiety disorder (5)

Generalized Anxiety Disorder (GAD) is a psychiatric disorder characterized by a constant sense of worry and fear that interferes with daily life. People with Generalized Anxiety Disorder may experience feelings of dread, distress, or agitation for no discernible reason – psychiatrists refer to this unexplained, trigger-less anxiety as “free floating anxiety”.

Those with GAD may constantly expect the worst, and worry about things like work, money, their family and friends, or their health, even when there’s no realistic cause to be concerned. The anxiety experienced with this disorder may occur for a specific reason or be triggered by an event, but be disproportionately great or unrealistic for the situation.

General Anxiety Disorder can turn into a cycle of excessive worrying. Though many people with GAD realize that their worry is unrealistic or unwarranted, feelings of anxiety persist and seem unmanageable, leaving sufferers feeling out of control. Some of those afflicted can still lead normal lives with productive jobs and active social lives, but be constantly internally struggling with worry and distress.

Symptoms

GAD (General Anxiety Disorder)

  • Excessive anxiety about everyday things. Thoughts consuming you with worry daily and causing you to not function properly in your daily life. “The distinction between an anxiety disorder and just having normal anxiety is whether your emotions are causing a lot of suffering and dysfunction,” says Sally Winston, PsyD, co-director of the Anxiety and Stress Disorder Institute of Maryland in Towson.
  • Inability to control your constant worries – A sudden, trapped feeling of fear and helplessness that can last for several minutes, accompanied by scary physical symptoms such as breathing problems.
  • Free floating anxiety Obsessive Compulsive Tendencies – Repeating phrases or behaviors can be linked to both OCD and Anxiety disorders. The need to be perfect, check things off a list, etc. can start to run one’s life.
  • Distress or worry that you feel is disproportionate to the situation. Your phobias arise and all of a sudden you cannot function because you think that you or your family are going to get eaten by pythons.
  • Inability to relax Chronic Muscle Tension – You may clench your fist, or suffer from           lockjaw. Stress makes us clench and over time this can disrupt quality of life.
  • Difficulty concentrating.
  • Feeling on edge and startling easily.
  • Trouble falling asleep or staying asleep.
  • You have difficultly falling asleep, toss and turn, wake up feeling wired, your mind is racing, and you’re unable to calm yourself down.
  • Fatigue.
  • Tendency to worry about or jump to the worst possible conclusion.
  • Headaches, stomach aches, muscle aches, or other unexplained pains.
  • Difficulty swallowing.
  • Shakiness or twitching.
  • Irritability.
  • Profuse sweating pounding or racing heart, tingling or numb hands, sweating, weakness or dizziness, chest pain, stomach pain, and feeling hot or cold.
  • Light-headedness and/or breathlessness.
  • Frequent need to urinate / bowel issues Anxiety may start in the mind, but it often manifests itself in the body through physical symptoms, like chronic digestive problem, (IBS), a condition characterized by stomachaches, cramping, bloating, gas, constipation, and/or diarrhea.

The neurological correlates of GAD are not well known, however there is evidence of cortical dysregulation in patients with GAD. (3)

Conditions Labeled Under “Anxiety”

Panic Attacks are short (typically less than 15 minute) episodes of intense fear that are often accompanied by serious physical symptoms and uncontrollable feelings of dread and doom. A panic attack differs from a normal fear response in that it strikes without the presence of a threat or an oncoming attack. A person who experiences several panic attacks may develop a Panic Disorder, where the individual begins to spend a significant amount of their time worrying about having another attack, worrying that they are losing their mind, or changing their daily routine because of the panic attacks.

Separation Anxiety Disorder describes an individual’s feelings of persistent and excessive anxiety related to current or oncoming separation from an attachment figure (someone or something that provides the individual with comfort). Separation Disorder frequently occurs in children, and can induce long-lasting, continuous anxiety for periods up to six weeks. Individuals afflicted by separation anxiety disorder experience overwhelming distress and anxiety when separated from their attachment figure.

Social Anxiety Disorder or SAD also known as Social Phobia, is characterized by a strong and persistent fear of social or performance situations in which humiliation or embarrassment may occur. While it’s normal to feel some anxiety in some social situations, those afflicted by Social Anxiety Disorder experience intense distress, self-consciousness, and fear of judgement in everyday social interactions. SAD often prevents people from having normal friendships, interactions, or romantic relationships, and can keep sufferers from functioning in daily life, at work, or at school. Additionally, people with SAD sometimes experience intense worry, fear, or dread about a social situation days or weeks in advance.

Obsessive-Compulsive Disorder or OCD (4) is characterized by intrusive obsessive thoughts that result in compulsive ritualistic behaviors and routines. While it’s possible to have only obsessive symptoms, or only compulsive symptoms, they usually occur in conjunction. People suffering from OCD experience uncontrollable, distressing thoughts or fears about certain things (such as dirt, germs, or order) which then lead to compulsive behaviors performed as an attempt to alleviate worry or anxiety. Just being a “neat freak” or afraid of germs doesn’t necessarily constitute OCD – OCD is diagnosed by obsessions and compulsions which significantly interfere with daily life.

Post-Traumatic Stress Disorder or PTSD (4) is an Anxiety Disorder that may develop after witnessing a deeply distressing or disturbing experience, or after experiencing a serious injury. PTSD can also develop after a threat of death or serious injury, even if no one was physically harmed. While most people experience anxious reactions after a serious traumatic effect, PTSD develops when these symptoms and negative reactions remain for long periods of time and begin to disrupt daily life and functioning. Sufferers of PTSD experience feelings of intense fear, lack of control, and helplessness as a result of their traumatic experience.

Selective Mutism occurs when an individual has difficulty speaking or communicating in certain environments. Selective mutism usually occurs in children – children with the disorder speak at home, with friends, or with family, but not in other situations like at school or in public. The disorder usually presents itself very early, in children under five. In selective mutism, the failure to speak and communicate interferes with daily life and lasts at least a month.

A Phobia is a type of Anxiety Disorder that describes an excessive and irrational fear of a specific object, activity, or situation. Phobias are different from common fears in that the anxiety associated with the object or situation is so strong that it interferes with daily life and the ability to function normally. People with phobias may go to great lengths to avoid encountering their feared object or situation.

Inflammation and Anxiety

The idea of the existence of an interaction between the immune system and the central nervous system (CNS) has prompted extensive research interest into the subject of “Psychoneuroimmunology” (1) taking the field to an interesting level where new hypotheses are being increasingly tested. Specifically, exactly how the cross talk of pathways and mechanisms enable immune system to influence our brain and behavior is a question of immense significance. Of particular relevance to this topic is the role of cytokines in regulating functions within the CNS that ultimately modulate behavior. Interestingly, psychological stress is reported to modulate cytokine production, suggesting potential relevance of this mediator to mental health. In fact, cytokine signaling in the brain is known to regulate important brain functions including neurotransmitter metabolism, neuroendocrine function, synaptic plasticity, as well as the neural circuitry of mood. It is rather obvious to expect an aberrant behavioral outcome as a result of a dysregulation in cytokine signaling which might lead to occurrence of depression, anxiety, and cognitive dysfunction. An “oxidative stress theory,” has been proposed by Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, TX, this theory suggest that it works perhaps as a “sensor of distress,” the imbalance of which leads to neuroinflammation and causes anxiety disorders.

Inflammation effects brain disorders like Anxiety in many ways one of them being the insulin mechanism. Even slight blood sugar elevation raises the binding of glucose to protein. This process, known as glycation profoundly increases the production of inflammatory chemicals in the body and is the main reason we check the A1c blood test as it measures this process.

Immune system to brain signaling: neuropsychopharmacological implications.

There has been an explosion in our knowledge of the pathways and mechanisms by which the immune system can influence the brain and behavior. In the context of inflammation, pro-inflammatory cytokines can access the central nervous system and interact with a cytokine network in the brain to influence virtually every aspect of brain function relevant to behavior including neurotransmitter metabolism, neuroendocrine function, synaptic plasticity, and neurocircuits that regulate mood, motor activity, motivation, anxiety and alarm. (2)

A series of vulnerability factors including aging and obesity as well as chronic stress also appears to interact with immune to brain signaling to exacerbate immunologic contributions to neuropsychiatric disease. The elucidation of the mechanisms by which the immune system influences behavior yields a host of targets for potential therapeutic development as well as informing strategies for the prevention of neuropsychiatric disease in at risk populations

Experiencing anxiety, fear and stress is considered a normal part of life when it is occasional and temporary, such as feeling anxious and stressed before an exam or a job interview. However, when those acute emotional reactions become more frequent or chronic, they can significantly interfere with daily living activities such as work, school and relationships. Chronic stress is a pathological state that is caused by prolonged activation of the normal acute physiological stress response, which can wreak havoc on immune, metabolic and cardiovascular systems, and lead to atrophy of the brain’s hippocampus (crucial for long-term memory and spatial navigation).

Pathological anxiety and chronic stress are associated with structural degeneration and impaired functioning of the hippocampus and the prefrontal cortex (PFC), which may account for the increased risk of developing neuropsychiatric disorders, including anxiety, depression and dementia.

Key structures in the neurocircuitry of fear and anxiety (amygdala, medial prefrontal cortex, hippocampus) which are impacted during exposure to chronic stress. The researchers noted similar patterns of abnormal brain activity with fear/anxiety and chronic stress — specifically an overactive amygdala (associated with emotional responses) and an under-active PFC (thinking areas of the brain that help regulate emotional responses through cognitive appraisal). (6)

Stress wreaks havoc on the mind and body. Until now, it has not been clear exactly how stress influences disease and health. Now researchers have found that chronic psychological stress is associated with the body losing its ability to regulate the inflammatory response. The research shows for the first time that the effects of psychological stress on the body’s ability to regulate inflammation can promote the development and progression of disease. (11)

Inflammation is partly regulated by the hormone cortisol and when cortisol is not allowed to serve this function, inflammation can get out of control.

Prolonged stress alters the effectiveness of cortisol to regulate the inflammatory response because it decreases tissue sensitivity to the hormone. Specifically, immune cells become insensitive to cortisol’s regulatory effect. In turn, runaway inflammation is thought to promote the development and progression of many diseases. (11)

People with greater intake of a high fat, high sugar diet may do more poorly on the learning and memory tests because of how the diet impacts the hippocampus. This would make it hard to resist delicious treats even if one were full. Prior animal studies have shown that a Western diet — one high in fats and sugars and low in fruit, vegetable and fiber — impairs memory inhibition abilities of the hippocampus. (13)

Anxiety and Gut Flora Balance

Microbiota are important in normal healthy brain function. There is a relation between stress and microbiota, and how alterations in microbiota influence stress-related behaviors. New studies show that bacteria, including commensal, probiotic, and pathogenic bacteria, in the gastrointestinal (GI) tract can activate neural pathways and central nervous system (CNS) signaling systems. Ongoing and future animal and clinical studies aimed at understanding the microbiota–gut–brain axis may provide novel approaches for prevention and treatment of mental illness, including anxiety and depression.

Accumulated data now indicates that the gut microbiota also communicates with the CNS — possibly through neural, endocrine and immune pathways — and thereby influences brain function and behavior. Studies in germ-free animals and in animals exposed to pathogenic bacterial infections, probiotic bacteria or antibiotic drugs suggest a role for the gut microbiota in the regulation of anxiety, mood, cognition and pain. Thus, the emerging concept of a microbiota–gut–brain axis suggests that modulation of the gut microbiota may be a tractable strategy for developing novel therapeutics for complex CNS disorders.

Our Nutritional Program has implemented these concepts in addition to the anti-inflammation nutrition nature of the plan. Food chemicals are not new, but years ago people were only exposed to them sporadically. Unfortunately, today’s population is exposed to harmful food chemicals every day resulting in inflammation and metabolism disruption. In order to minimize the amount of chemicals you consume, be sure to purchase quality, all-natural, additive-free beef, poultry, seafood and produce. As mentioned before consuming foods that will reduce inflammation including a special Hydroxide Alkaline water, raw fatty nuts, nut butters and seeds, avocados, dark berries, leafy greens, healthy oils and fatty fish like wild caught salmon.

Foods to include in daily nutrition: Omega 3 fatty acids (7) from walnuts, wild caught salmon, avocados, brain boosting healthy fat from coconut oil, and copious amounts of vegetables and some fruit.

Foods to Avoid: Gluten, sugar, syrups, processed meats, juice, candy or pastries.

Please note the menu is approximately 70% alkaline and 30% acidic. This lean towards alkalinity will help reduce inflammation which we have discussed above.

This nutrition plan will help reduce inflammation.

It is rich in Omega 3 fatty acids 7, low in processed sugar, gluten free, optimal high quality proteins, dye free and chemical pure whole foods (12) are recommended as much as possible.

This plan incorporates healthy fats, antioxidants, fiber and optimal macro nutrient breakdowns.

This plan will help optimize gut flora balance, and brain function. (8,9)

Specific foods that can help fight inflammation include:

Hydroxide rich alkaline water * (see details below)

Heart healthy nuts

Nut butters and seeds like walnuts, pumpkins seeds

Heart healthy oils like coconut oil and extra virgin olive oil antioxidant rich produce including berries and dark leafy greens.

This plan specifically works to manage symptoms of anxiety by incorporating Omega 3 fatty acids, it is low in processed sugar, optimal high quality proteins, dye free and chemical pure whole foods are recommended as much as possible. This plan incorporates healthy fats, antioxidants, fiber and optimal macro nutrient breakdowns. This plan will work best in additional to a professional support team, supervised medication regimen if necessary. The menu is ideal for those who are under supervised clinical treatment and therapies of qualified health professionals.

Proper Hydration through Hydroxide Rich Water for Treating Anxiety and Inflammation

Acidity and inflammation go hand in hand. By chemical definition, acidity is a problem of too much hydrogen (H+). Too much acidity in the body can stem from diet, disease, exercise, and other life style factors. It is generally recognized that excess acidity in the body creates inflammation which leads to other disease conditions. Acidity causes a lack of oxygen and a lower pH condition in which pathogens flourish.

Hydroxide (OH) is a natural hydrogen hunter that does not merely buffer the body against excess hydrogen but eliminates by combining with it to form harmless water. That water can then be used for hydration or eliminated through urination. Here is the formula of the elimination reaction: OH + H+ = H2O.

Most alkaline waters attempt to help the body buffer acidity by providing alkaline minerals. But this does not address the underlying problem of excess hydrogen and instead only helps the body maintain pH balance. Potential hydrogen (pH) balance helps the body but it does not fix the issue. The main goal of most alkaline waters is pH balance but this misses the point.

A water rich in hydroxide seeks to eliminate acidity by eliminating the excess hydrogen. Most alkaline waters contain some hydroxide if they claim either to contain negative ions or have gone through ionization. The problem is most alkaline waters rely more on alkaline minerals to buffer the excess hydrogen than they use the hydroxide to eliminate hydrogen. This is why it is imperative to find a hydroxide rich water because elimination is far more effective in restoring balance to the body than mere buffering.

Benefits of a hydroxide rich water:

  • Hydroxide eliminates acidity rather than just buffering the acidity.
  • Hydroxide produces no toxic by-products. It produces only water which can be used for hydration or eliminated through urination.
  • By eliminating excess acidity (hydrogen), it frees up the body’s own oxygen to use for other biological processes.
  • Hydroxide restores completely the acid-alkaline balance beyond just pH balance.
  • Hydroxide helps reduce inflammation by eliminating acidity and not just buffering it.

 

ANXIETY NUTRITION PLAN
MEAL MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
BREAKFAST

1-2 c stable hydroxide rich water

Sweet Potato Breakfast burrito* PB & J Oats* Baked Quinoa Apples* Gluten Free Bacon, Egg, and Cheese* Mango, pineapple, banana smoothie* Super food Parfait* Banana Peach Pancakes*
SNACK

1-2 c stable hydroxide rich water

¼ c nuts Apple, banana, or celery with almond or cashew butter Coconut yogurt (none dairy) 1 medium serving Low sugar fruit- berries, apple, plum, grapes Rice cake with almond butter and berries Hummus or guacamole* and bell pepper slices ¼ c nuts
LUNCH

1-2 c stable hydroxide rich water

Strawberry Arugula Salad* Fajita Chicken Wrap* Stuffed Sweet Wrap* BBQ chicken salad* Cucumber, tomato, and avocado salad* Sweet Potato cranberry salad* Skinny Potato*
SNACK

1-2 c stable hydroxide rich water

Apple, banana, or celery with almond or cashew butter Coconut Yogurt (none dairy) ¼ c nuts Hummus or guacamole* and bell pepper slices 1 medium serving Low sugar fruit- berries, apple, plum, grapes ¼ c nuts Rice cake with almond butter and berries

Coping with anxiety can be a challenge and often requires making lifestyle changes. There aren’t any diet changes that can cure anxiety, but watching what you eat may help. Try these steps:

Lifestyle/Environmental Impact

Certain lifestyle trends and habits may contribute to inflammation leading to anxiety symptoms. (13)

Regular exposure to toxins, such as dyes, chemicals (10,12) pollution can also affect brain health.

Consuming a balanced diet, rich in nutrients, is essential for preserving the health of one’s nervous system and metabolic systems.

  1. Eat a breakfast that includes some protein. Eating protein at breakfast can help you feel fuller longer and help keep your blood sugar steady so that you have more energy as you start your day.
  2. Eat complex carbohydrates. Carbohydrates are thought to increase the amount of serotonin (14) in your brain, which has a calming effect. Eat foods rich in complex carbohydrates, such as whole grains — for example, oatmeal, quinoa, whole-grain breads and whole-grain cereals. Steer clear of foods that contain simple carbohydrates, such as sugary foods and drinks.
  3. Drink plenty of water. Even mild dehydration can affect your mood.
  4. Limit or avoid alcohol. The immediate effect of alcohol may be calming. But as alcohol is processed by your body, it can make you edgy. Alcohol can also interfere with sleep.
  5. Limit or avoid caffeine. Avoid caffeinated beverages. They can make you feel jittery and nervous and can interfere with sleep.
  6. Pay attention to food sensitivities. In some people, certain foods or food additives can cause unpleasant physical reactions. In certain people, these physical reactions may lead to shifts in mood, including irritability or anxiety. Common sensitivities include: gluten, soy, corn, dairy, and shellfish.
  7. Try to eat healthy, balanced meals. This is important for overall physical and mental health. Eat lots of fresh fruits and vegetables, and don’t overeat. It may also help to eat fish high in omega-3 fatty acids, such as salmon, on a regular basis.

Changes to your diet may make some difference to your general mood or sense of well-being, but they’re not a substitute for treatment. If your anxiety is severe or interferes with your day-to-day activities or enjoyment of life, you may need counseling (psychotherapy), medication or other treatment.

Other preventive measures, such as getting a minimum of seven hours of sleep each night will reduce symptoms of anxiety.

NAMED Program (www.namedprogram.com) has implemented these concepts in addition to the anti-inflammation nutrition plans that NAMED offers.

Food chemicals are not new, but years ago people were only exposed to them sporadically. Unfortunately, today’s population is exposed to harmful food chemicals every day resulting in inflammation and metabolism disruption.

In order to minimize the amount of chemicals you consume, be sure to purchase quality, all-natural, additive-free beef, poultry, seafood and produce. (13)

As mentioned before, consuming foods that will reduce inflammation including alkaline water (AQUA OH!), raw fatty nuts, nut butters and seeds, avocados, dark berries, leafy greens, healthy oils and fatty fish like wild caught salmon.

Foods to include in daily nutrition: Omega 3 fatty acids (7) from walnuts, wild caught salmon, avocados, brain boosting healthy fat from coconut oil, and copious amounts of vegetables and some fruit.

Foods to Avoid: Gluten, sugar, syrups, processed meats, juice, candy or pastries.

Please note the menu is approximately 70% alkaline and 30% acidic. This lean towards alkalinity will help reduce inflammation which we have discussed above.

REFERENCES

1. Salim S1, Chugh G, Asghar M. Inflammation in anxiety. Adv Protein Chem Struct Biol. 2012;88:1-25. doi: 10.1016/B978-0-12-398314-5.00001-5.
2. Capuron L, Miller AH. Immune system to brain signaling: neuropsychopharmacological implications. Pharmacol Ther. 2011 May;130(2):226-38. doi: 10.1016/j.pharmthera.2011.01.014. Epub 2011 Feb 17.
3. Wang Y, Chai F, Zhang H, Liu X, Xie P, Zheng L, Yang L, Li L, Fang D. Cortical functional activity in patients with generalized anxiety disorder. BMC Psychiatry. 2016 Jul 7;16(1):217. doi: 10.1186/s12888-016-0917-3.
4. In the revised DSM-5, Obsessive-Compulsive Disorder and Post-Traumatic Stress Disorder are no longer included within the chapter of anxiety disorders. OCD is now included with obsessive-compulsive and related disorders and PTSD is included with trauma- and stressor-related disorders. However, a close relationship between anxiety disorders and OCD and PTSD are maintained throughout the publication.
5. Alan E. Kazdin, Ph.D (ed). Encyclopedia of Psychology. (2000, APA/Oxford University).
6. Linda Mah, Claudia Szabuniewicz, Alexandra J. Fiocco. Can anxiety damage the brain? Current Opinion in Psychiatry, 2016; 29 (1): 56 DOI: 10.1097/YCO.0000000000000223.
7. Corina O. Bondi, Ameer Y. Taha, Jody L. Tock, Nelson K.B. Totah, Yewon Cheon, Gonzalo E. Torres, Stanley I. Rapoport, Bita Moghaddam. Adolescent Behavior and Dopamine Availability Are Uniquely Sensitive to Dietary Omega-3 Fatty Acid Deficiency. Biological Psychiatry, 2013; DOI: 10.1016/j.biopsych.2013.06.007.
8. Kirsten Tillisch, Jennifer Labus, Lisa Kilpatrick, Zhiguo Jiang, Jean Stains, Bahar Ebrat, Denis Guyonnet, Sophie Legrain-Raspaud, Beatrice Trotin, Bruce Naliboff, Emeran A. Mayer. Consumption of Fermented Milk Product with Probiotic Modulates Brain Activity. Gastroenterology, 2013; DOI: 10.1053/j.gastro.2013.02.043.
9. Society for Neuroscience. “Probiotics improve behavioral symptoms of chronic inflammatory diseases in mice.” ScienceDaily. 28 July 2015.
10. Sheela Sathyanarayana, Garry Alcedo, Brian E Saelens, Chuan Zhou, Russell L Dills, Jianbo Yu, Bruce Lanphear. Unexpected results in a randomized dietary trial to reduce phthalate and bisphenol A exposures. Journal of Exposure Science and Environmental Epidemiology, 2013; DOI: 10.1038/jes.2013.9.
11. Sheldon Cohen, Denise Janicki-Deverts, William J. Doyle, Gregory E. Miller, Ellen Frank, Bruce S. Rabin, and Ronald B. Turner. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. PNAS, April 2, 2012 DOI: 10.1073/pnas.1118355109
12. Susanna D. Mitro, Cassandra A. Phillips, Ami R. Zota. Recent Fast Food Consumption and Bisphenol A and Phthalates Exposures among the U.S. Population in NHANES, 2003–2010. Environmental Health Perspectives, 2016; DOI: 10.1289/ehp.1510803.
13. Society for the Study of Ingestive Behavior. “Western-style diet linked to state-dependent memory inhibition.” ScienceDaily, 12 July 2016.
14. G Clarke, S Grenham, P Scully, P Fitzgerald, R D Moloney, F Shanahan, T G Dinan and J F Cryan. The microbiome-gut-brain axis during early life regulates the hippocampal serotonergic system in a sex-dependent manner. Mol Psychiatry, June 12, 2012 DOI: 10.1038/mp.2012.77.

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