~ National Council for Behavioral Health (mentalhealthfirstaid.org, 2019)
If stress or anxiety interferes with your daily life, productivity, or happiness, you have a lot of company. More than 75% of Americans regularly experience physical symptoms caused by stress, and anxiety disorders are the most common mental illness in the United States, impacting almost 20% of the population each year. If you prefer to use natural remedies to manage your responses to stress, including your anxiety, the options discussed below may prove helpful.
Definitions & Symptoms
Stress and anxiety frequently coexist, often with depression, eating disorders, and substance abuse. Unmanaged stress and anxiety can accompany or contribute to a wide range of physical conditions, including cardiovascular disease, diabetes, chronic headaches and fatigue, ulcers, and various digestive ailments, including candidiasis (yeast overgrowth).
Stress is an automatic, negative, psychological, and physical response to overwhelming internal and external forces called stressors (including lack of sleep, allergens, pain/poor health, and work/social pressures). It releases neurochemicals and hormones to prepare the body for action (often called the “fight-or-flight” response) and, if excessive or prolonged, can greatly undermine one’s life and health. Symptoms of stress include fatigue, sleep disorders, irritability, and constant worrying.
Anxiety, with emotional, physiological, and cognitive components, has been noted as the sixth most important contributor of non-fatal negative health outcomes. Internal or interpersonal conflict can provoke anxiety, which causes people to feel frightened and apprehensive for no apparent reason, or out of proportion relative to present stressors. While its causes are not fully understood, genetics, biochemistry (including excess lactic acid in the blood and hormonal imbalances), environment, personal history (especially trauma), physical illness, poor diet, and medication side effects, can all contribute to its development.
Anxiety symptoms can include heart palpitations/throbbing/pain, insomnia/restlessness, severe muscle tension/spasms, excessive sweating, headaches, severe digestive problems, concentration difficulties, and impatience/irritability. The degree of anxiety can vary and, if extreme, may rise to the level of one of five anxiety disorders: panic disorder; obsessive-compulsive disorder (OCD); post-traumatic stress disorder (PTSD); phobia; or general anxiety disorder (GAD).
The Conventional Approach
To alter the brain’s neurotransmitters (chemical messengers), conventional practitioners commonly prescribe various medications for stress and anxiety. Unfortunately, they all have potential side effects: (1) benzodiazepines (Valium®, Xanax®, Librium®): increased anxiety, significant memory impairment, and addiction (especially in alcoholics); (2) SSRIs (Prozac®, Lexapro®, Zoloft®): agitation, decreased libido, delayed/lacking ability to orgasm, and insomnia; and (3) beta-blockers (Tenormin® and Inderal®): fatigue, depression, erectile dysfunction, memory loss, and insomnia.
Supplements to Manage Stress & Anxiety
Various natural remedies generally can manage moderate levels of stress and anxiety safely and without side effects. The alphabetically arranged list below includes those that clinical practice or scientific research has proven to be especially effective when used either individually or in combinations.
When the brain produces a neurotransmitter, it starts with a raw ingredient, usually an amino acid from the diet or another chemical already present in the brain. Enzymes are then used to convert the amino acid into the needed brain chemical. There are various cofactors that help the enzymes work faster, including B vitamins (see below). Insufficient intakes of various aminos (tryptophan, phenylalanine, tyrosine) are associated with increased symptoms of anxiety.
1. GABA: Gamma-aminobutyric acid is the primary inhibitory neurotransmitter that counterbalances glutamate, an excitatory neurotransmitter. It is known to promote restful sleep and stop panic attacks, especially when 500mg is dissolved under the tongue or taken on an empty stomach.
2. L-Theanine: Brain cells readily absorb L-theanine, an amino acid mainly derived from green tea. Without daytime drowsiness, it helps relax muscles, increases the concentration of the neurotransmitters serotonin (the “happiness hormone”) and dopamine, boosts cognitive function, and supports brain health and the production of alpha brain waves that are associated with a calm, worry-free mind. In a 2016 double-blind placebo controlled study of thirty-four healthy adults presented with a multitasking cognitive stressor, researchers found: (1) subjective stress response was significantly reduced after one hour of L-theanine administration; and (2) cortisol response to the stressor was reduced three hours post-treatment. Published studies indicate that doses of 200 – 400 mg for up to 8 weeks are safe to treat acute and chronic stress and anxiety. More studies are needed to confirm the presumed safety of its long-term use, especially for the liver.
3. L-Tyrosine: L-Tyrosine is a non-essential amino acid that is a precursor to the neurotransmitters dopamine, epinephrine and norepinephrine (adrenaline), which regulate mood and stimulate metabolism. Substantial research has especially focused on tyrosine’s ability to prevent the decline in cognitive function in response to physical stress. While it’s adrenaline-producing activity seems to contradict tyrosine’s potential role as a relaxant, its dopamine production balances its norephinephrine production, yielding an alert, clear, uplifted but calm mind state. It may reduce stress and anxiety also by supporting the function of the adrenal and thyroid glands. In some sensitive individuals, tyrosine’s fast action can cause rapid heart rate, hypertension, or anxiety, and should not be taken with thyroid medication without a practitioner’s guidance. If you are concerned, start with 200 mg/day on any empty stomach and work up to a level that manages your anxiety.
4. 5-HTP/L-Tryptophan: The onset of stress and anxiety has been traced to the depletion of brain levels of serotonin. Supplementation with 5-hydroxytryptophan (5-HTP), or its precursor L-tryptophan, has proven to improve both mood and one’s sense of well-being by elevating serotonin, and reduce aggression. It also appears to provide resilience to uncontrollable stress.
B-Complex generally contains eight B vitamins, plus other related substances like choline and inositol (especially effective for stress/anxiety/sleep at doses of 500mg or more), and is available in multi-vitamin-minerals, or separately in balanced 50mg or 100mg formulas. The B vitamins it contains include thiamine (B1), riboflavin (B2), niacin/niacinamide (B3), pantothenic acid (B5), pyridoxine (B6), biotin (B7), folic acid (B9), and methyl- or cyanocobalamin (B12).
Daily consumption of safe, water-soluble, B-Complex, especially in the cell-ready, coenzymated form, helps the body cope with periods of stress and anxiety by supporting the adrenal glands and nervous system. In a 2019 randomized, double-blind, placebo controlled (RDBPC) study of 66 college students, researchers found that a multi-vitamin-mineral supplement containing B vitamins significantly decreased anxiety symptoms. A 2017 study found that subjects with lower blood levels of vitamin B-12 were more likely to have anxiety or depression.
1. Ashwaganda (withania somnifera): This Ayurvedic, adaptogenic herb safely enables the body to cope better on a daily basis with stress, anxiety, and mental and physical fatigue. In one 2012 RDBPC study of 64 chronically stressed subjects, researchers found that 300mg of Ashwaganda extract significantly reduced stress and serum cortisol levels and thereby improved quality of life. A 2008 study also proved that this standardized herb, in doses ranging from 125-500 mg/day, can lower pulse rate, blood pressure and cardiac risk, raise serum DHEA sulfate levels, and improve fasting blood glucose levels.
2. Echinacea angustifolia (Anxiocalm): This patented, clinically studied, safe strain of echinacea is intended to address mild anxiety, a risk factor for Generalized Anxiety Disorder. It does not interact with prescription medications and its benefits to adults and children over age 3 increase with continued daily use. It can also relieve anxiety-related symptoms, including nervous sweating, intestinal issues, muscle tension, and disrupted sleep.
3. Kava: Various extracts of this widely studied tropical herb have proven to demonstrate anti-anxiety effects similar to the prescriptions buspirone and opipramol, and to reduce anxiety in both peri- and postmenopausal women.
4. Lavender (Silexan®): This ingestible lavender has been tested in several human studies that have demonstrated anxiolytic activity comparable to prescription drugs such as paroxetine and lorazepam, with fewer side effects.
5. Progesterone Cream (Natural Wild Yam): Women are more than twice as likely as men to feel anxiety, especially during PMS, perimenopause, and menopause. Although menopause doesn’t typically occur until age 50 or later, many women can begin experiencing hormonal imbalance from decreasing progesterone levels even before their 30s, and it can continue into the 60s. By the time women reach perimenopause, their bodies may have lost as much as 75% or more of their progesterone secretion. According to Marcelle Pick, OB/GYN NP, only the restoration of hormonal balance can provide relief from menopausal anxiety and panic attacks. When applied properly, natural progesterone not only balances excess estrogen, a potential breast cancer risk, but is also used in the body to make adrenal hormones and needed estrogen or testosterone. Several studies have proven that natural progesterone cream combats anxiety, and it is considered to do so by acting on GABA receptors in the brain.
While normalizing hormone levels can be an integral part of managing anxiety disorders, it is also important to address the factors that cause hormonal imbalances (e.g., blood sugar dysregulation, oxidative stress, inflammation, and other disruptions in metabolic function).
Omega-3 Fatty Acids (Fish Oil)
Based on their systematic review and meta-analysis of 19 clinical trials that included over 2000 participant from 11 countries, researchers recently determined that improvement in anxiety symptoms is associated with omega-3 polyunsaturated fatty acid treatment.
Lifestyle greatly impacts the body’s coping mechanisms. Specifically, diet modification, physical activity, relaxation techniques, getting adequate sleep, and staying connected to friends and family can be especially supportive. Daily dietary regimens that best protect the body against stress and anxiety exclude caffeine/stimulants, sugar, alcohol, food allergens, and tobacco, but include large quantities of water and organic vegetables, high-density protein, and soaked legumes and nuts. Clinical trials demonstrate that yoga and Tai Chi relax the body and mind, reduce heart rate, and improve mood, even after only 20 minutes. Other forms of daily aerobic exercise also greatly reduce stress and anxiety.
It is important to be well-informed about whether the above remedies could help your own condition, and to know especially whether they would interact with your medications. If you take an anti-anxiety drug but prefer to try a natural approach, consider asking your doctor to help you first lower the dose of your medication. Also consider seeking the guidance of a natural practitioner, and inform your doctor before terminating treatment with any anxiolytic.
The statements in this article have not been evaluated by the Food and Drug Administration, are for educational purposes only, and are not intended to take the place of a physician’s advice.
Submitted by Erika Dworkin, Board Certified in Holistic Nutrition®, Owner of the Manchester Parkade Health Shoppe (860.646.8178), 378 Middle Turnpike West, Manchester, CT, www.cthealthshop.com, nutrition specialists trusted since 1956. Erika is available to speak to groups.
All statements in this article are evidence-based and references are available upon request.