Anxiety is the most common mental disorder in Australia. It is estimated that one in seven people in any 12-month period will be affected by an anxiety disorder.
The disorder presents in many forms, including generalised anxiety disorder, posttraumatic stress disorder, social phobia and panic disorder. Anxiety often goes hand in hand with depression.
The development of an anxiety disorder is a complex process. The aetiology is thought to be related to an interaction between susceptible genes and biopsychosocial environmental factors. Putative neurotransmitters mediating anxiety include gamma-aminobutyric (GABA), serotonin, noradrenaline and dopamine.
THERAPIES AND MEDICATIONS
Pharmacotherapy as well as specific models of psychological therapy can help relieve anxiety. However, only about a third of people with anxiety seek treatment.
Evidence-based treatments include cognitive behavioural therapy, either via the internet or face-to-face; antidepressants such as selective serotonin re-uptake inhibitors (SSRIs); pregabalin (generalised anxiety disorder); and short-term benzodiazepines.
A decision to trial any of these medications would be based on a discussion with a medical practitioner about the associated risk benefit profile.
EATING TO EASE ANXIETY
Emerging scientific evidence indicates that a poor diet (processed foods high in energy, saturated fat and sodium, and low in nutritional value) is linked to an increased risk of developing an anxiety disorder. Improving diet quality can assist with improving mood and sense of wellbeing.
Specific nutrients which may be beneficial for anxiety disorders include vitamins such as folate, vitamin B12 and choline; minerals such as magnesium and zinc; omega-3 fatty acids; the amino acid tryptophan (precursor of serotonin); and antioxidants such as vitamin E, C, carotenoids and flavonoid polyphenolics.
Eating according to the Australian Dietary Guidelines (www.eatforhealth.gov.au) provides a balanced diet for good health. This involves eating plenty of fresh fruit and vegetables, wholegrains, reduced fat dairy, lean meat and poultry, seafood, legumes, nuts and healthy oils.
People with anxiety might benefit from starting the day with rich sources of tryptophan, such as eggs, turkey, tofu, legumes, salmon, nuts, seeds, cheese and milk. These foods also help promote satiety and regulate blood glucose levels. Including at least three serves of oily fish (salmon, sardines, tuna, trout, mackerel) a week will help to meet the recommended daily intake of 500mg of long-chain omega-3 fatty acid, so vital for brain health.
Eating small nutritious meals frequently throughout the day at regular times may help stabilise mood by assisting with nausea or loss of appetite and keep blood glucose levels stable. Erratic meal times may trigger binge-eating and result in excess body weight, which is a key risk factor for developing chronic disease, including mental health issues.
Choosing low glycaemic index (GI) carbohydrates (www.glycemicindex.com) at each meal will help to fuel daily activities and keep blood glucose levels stable. Sugary processed foods and drinks are high GI foods. They are quickly absorbed, especially if eaten on an empty stomach, creating glucose spikes and dips that may contribute to symptoms of anxiety.
Sipping water throughout the day will protect against dehydration, dry mouth and constipation. Even mild dehydration can cause irritability and restlessness.
Care needs to be taken with caffeine and alcohol intake. Tea contains antioxidants but also contains caffeine, which is a stimulant. Other common caffeine-containing drinks include coffee, cola and energy drinks. Ingesting more than 500mg of caffeine a day is associated with an increased risk of anxiety. Caffeine has a long half-life of 3–7 hours and may contribute to insomnia if consumed in the late afternoon or evening. Alcohol is a depressant. Heavy drinking may contribute to mood dysregulation, interfere with metabolism and medication effectiveness, and disturb quality of sleep.
NEW DIRECTIONS: PSYCHOBIOTICS
The microbiome-gut-brain axis, or psychobiotics, is the new frontier for improving brain health. It appears that what you eat will change the composition and metabolic activity of the gut microbiota, with significant health consequences.
A diet rich in fermentable fibres (prebiotics) such as vegetables, fruit and whole grains, and fermented foods (probiotics) such as yoghurt, sauerkraut, kimchi, tempeh and kefir, is believed to prevent neurotoxicity through anti-inflammatory and antioxidant effects.
THE RIGHT SUPPORT
Those already living with an anxiety disorder may find it challenging to eat well due to a lack of energy and motivation, financial insecurity, fluctuating appetite, binge-eating behaviour and illicit substance and alcohol comorbidities. So, it is important they have the right support.
An accredited practising dietitian (APD) considers individual circumstances and comorbidities when providing tailored dietary advice. To find an APD in your area, visit the Dietitians Association of Australia website (www.daa.asn.au) and click ‘Find an Accredited Practising Dietitian’ or freecall 1800 812 942.
Tania Mathewson is an accredited practising dietitian (APD) with a fourteen year background in the pharmaceutical industry. She now works as a dietitian in the community as well as aged care in Canberra and Queanbeyan. She is passionate about a food first approach but acknowledges the vital role that supplements play in nutrient and energy deficiencies.Do you have an idea for a story?
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