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What Your Doctor Hasn’t Told You About Anxiety [HINT: It’s Not Just In Your Brain]
May 28th 2021
by: Vincent Pedre M.D.

If you’re struggling with anxiety, there’s a good chance you’ve looked for support either online or from your doctor. There’s also a good chance that the only advice you were given included things like cognitive behavioral therapy or medications, like SSRIs, like Prozac or Zoloft, or Benzos like Xanax or Lorazepam. If your doctor was really progressive, he or she may have even suggested more holistic relaxation techniques like meditation, breathwork, or yoga.

All of these pieces of advice — for example, medication, therapy, and mindfulness practices — can be helpful in their own way, and I don’t want to discount their value in certain scenarios. However, even medications have only been proven to be 50% effective in studies, so we need a different approach to anxiety to hack what is really happening internally.

Today I want to talk about what your doctor HASN’T told you about anxiety and mental health as a whole. Spoiler alert! It’s intricately connected to your gut and what you eat.

Understanding the Gut-Brain Connection

Conventional mental health advice often tells us that anxiety is a chemical imbalance; an issue that results from an imbalance in brain chemicals like serotonin and GABA that make us feel happy and relaxed. They often leave out the fact that many brain chemicals rely on the gut. For example, more than 90 percent of serotonin is produced in the gut

Studies have demonstrated this connection directly. For example, the authors of a systematic review paper wrote that “more and more basic studies have indicated that gut microbiota can regulate brain function through the gut-brain axis, and dysbiosis of intestinal microbiota was related to anxiety.” Another review paper looked at 21 studies, some of which used probiotic interventions and others used dietary interventions to reduce the harmful bacteria in the gut. The results showed that 11 out of 21 studies demonstrated a positive effect on anxiety symptoms by regulating the intestinal microbiota. Of the 14 studies that had used probiotics as the intervention, more than one third showed that they were effective in reducing anxiety symptoms. Even more, six of the remaining seven studies that had used dietary  interventions found those to be effective, which cumulatively is an effectiveness rate of 86%. 

Imbalances between gut bacteria and an unhealthy gut can also trigger chronic inflammation, which is now being identified as one of the main underlying causes of depression and anxiety. For example, studies have shown that certain inflammatory chemicals, called cytokines, are reliably elevated in a significant proportion of patients with major depressive disorder (MDD), bipolar disorder, anxiety disorders and post-traumatic stress disorder (PTSD).

Can I scream this from the rooftops? So many people are suffering, and they don’t realize it’s not “all in their heads.”

Making this known to the masses is a really big deal and could be a game changer in how we view and treat mental illness! Especially considering these facts:

  • According to data from the National Institute of Mental Health, some 38 percent of girls ages 13 through 17, and 26 percent of boys, have an anxiety disorder. 
  • A 2016 national study of more than 150,000 students by the Center for Collegiate Mental Health at Pennsylvania State University found anxiety has taken over depression as the number one mental-health concern.
  • According to Google Trends, the number of anxiety web searches has nearly doubled over the last five years.

Meet the Vagus Nerve

The connection between the gut and anxiety isn’t just about the gut bacteria, either. There are also important anatomical connections, mainly one large nerve called the vagus nerve, which runs from the base of the brain, down the neck, and innervates most major organs, including the gut. In the last few years researchers have identified this nerve as the key regulator of the gut-brain axis. It’s one of the main components of the parasympathetic nervous system, which is known as our “rest and digest” system and controls that “gut feeling” many of us get when something just doesn’t feel quite right. The vagus nerve modulates a wide range of bodily functions, including:

  • Mood and mental health 
  • Heart rate 
  • Digestion (enzyme secretion and stomach acid levels)
  • Gut motility
  • Gut permeability
  • Immunity 
  • The stress response

It’s main job is to send information about our organs back to the brain, which means if something is off in the gut, the vagus nerve carries that information back to the brain and can end up influencing mood, anxiety, and mental health. In fact, the nerve endings of the vagus in the gut have 5HT receptors that sense serotonin secreted by gut bacteria, sending a signal to the brain that releases GABA (a calming neurotransmitter) in certain brain regions that control nerve activation. Research shows that better your vagus nerve is functioning — which is typically referred to as your “vagal tone” — the more ability you have to regulate your stress response. 

It’s all pretty fascinating, isn’t it? We’re learning more about the vagus nerve and how it affects the gut-brain connection each day. And while there’s still a lot to learn, it’s helpful to know this:

Getting a handle on anxiety is about more than just brain chemicals — it’s about the health of the whole body, especially the gut!

That’s why I wanted to write this blog in honor of May Mental Health Awareness Month. I work with my patients all the time to give them strategies to improve anxiety that have nothing to do with the brain.

Like Jonah (name changed to protect identity) who came in to see me after reading my one-day anti-anxiety diet. Except he followed it for 8 weeks, lost over 10 lbs, and started feeling a shift in how his body held and experienced anxiety. It was the beginning of a journey he embarked with me by becoming a concierge member of my practice, where over the coming year we made major progress in how he dealt with stressful situations, weaning him off addictive anti-anxiety medications.

The same tips that Jonah read four years ago have come into good use this past year, when all of us were feeling the stress and uncertainty associated with living through a global pandemic. There has been a sharp spike in the number of people seeking mental health counseling. So let’s dive into some of my go-to suggestions and how they can help with your anxiety, no CBT or meditation necessary.

5 Foods That Triggers Anxiety + What to Do Instead

1. Sugar

When it comes to anxiety, sugar might be the number one food additive to trigger internal unrest. Have you ever noticed your heart rate speeding up after eating a really sweet dessert? Sugar creates an internal wave that can feel like riding a rollercoaster, except it’s a “sugarcoaster.” As it rushes into your bloodstream, it causes a feeling of internal unrest. Then, an hour later the crash comes, and you find yourself craving your next hit. Sugar also leads to an imbalance in gut bacteria, allowing sugar-eating bacteria (and possibly yeast) that sabotage mental health to take over. A recent 2019 study showed that the regular consumption of added sugars was linked to higher feelings of anxiety in adults over age 60. If you’re dealing with anxiety, I recommend limiting your added sugars as much as possible to less than 25 grams per day.

What to eat instead: I recommend real, whole fruits rich in fiber or dark chocolate with 1 gram or less of sugar per serving to fulfill that sweet craving throughout the day. Or, try sugar substitutes like stevia or allulose, which won’t feed those sugar-eating gut bugs.

2. Caffeine

Coffee and tea can be healthy for some, but if you have anxiety, there’s a good chance caffeine is contributing to your symptoms. For example, one study showed that caffeine consumption led to significantly greater increases in subject-rated anxiety, nervousness, fear, nausea, palpitations, restlessness, and tremors. It may feel impossible to give up your morning latte or cold brew, but once you feel the difference in your nervous system, you’ll be motivated to keep caffeine out of your life!

What to drink instead: Instead of that morning caffeine boost, try herbal tea like chamomile, peppermint or Kava, which are all great for soothing the nervous system. If you really want to keep some caffeine, try switching to green tea, which also contains a calming nutrient called l-theanine. And if you want to try going caffeine-free, try this Kundalini breath sequence [start video below at 15:40] as a way to wake up in the morning.

3. Alcohol

Alcohol can disrupt your gut bacteria, promote yeast overgrowth, and contribute to leaky gut, so if you’re dealing with anxiety, limiting alcohol is a great step to take. Studies have shown that while alcohol can reduce anxiety in the short-term — especially social anxiety — it can worsen it overall. For example, it can disrupt the neurotransmitter system in the brain and even sabotage the effectiveness of medications. In addition, alcohol affects sleep, reducing the quality and duration of sleep, leading to worsening mental health, making it harder to recover from traumatic situations and aggravating anxiety symptoms.

What to drink instead: Try Kombucha! It’s not only good for the gut, it tastes amazing and feels celebratory like a cocktail, glass of wine, or beer. I recommend looking for brands that are low in sugar. My personal go-to is the HealthAID Lemon Ginger Kombucha.

4. Refined Carbs

Refined carbohydrates also fall into the category of “helps in the short-term but hurts in the long-term.” Simple carbs like those found in cakes, cookies, donuts, and white bread can trigger your nervous system to release feel-good chemicals. If you’ve ever found yourself craving these foods during times of stress, you’ve seen this connection in real time. That said, these foods can disrupt the gut, cause blood sugar imbalances, and lead to chronic inflammation, which as we learned above is one of the underlying causes of anxiety. So, short-term, they give you a feel-good dopamine hit; however, over time, they actually cause imbalances and increase your anxiety state.

What to eat instead: Instead of relying on quick-burning carbs that spike blood sugar, opt for complex carbs like those found in sweet potatoes, greens, and non-starchy vegetables like squash and green beans. Or try something different and Latin (Hey, that’s my background!), and go for boiled cassava, which is rich in prebiotic fibers to feed the good gut bacteria. You can easily find it and other unique island root vegetables in the Hispanic supermarkets in your area.

Balanced Gut Microbiome
Efficient Digestive System

5. Unhealthy Fats

Multiple studies have linked the consumption of unhealthy fats — like those found in hydrogenated oils and vegetables oils — to anxiety. This is likely due to an increase in inflammation in the body after eating certain fats. But here’s where it gets tricky — not ALL fats trigger anxiety. In fact, healthy fats are critical to preventing anxiety and promoting good mental health. For example, one meta-analysis of 14 studies found that subjects with depression and social anxiety disorders had lower circulating levels of the omega-3 fatty acids but higher levels of omega-6 fatty acids. Omega-3 fatty acids are anti-inflammatory, whereas omega-6 fatty acids are inflammatory in general.

What to eat instead: Instead of eating fats like canola oil or vegetable oils (corn or soy), opt for omega-3 rich fats like those found in olive oil, avocado, and salmon.  Alternatively an Omega-3 supplement is the way to go if you don’t consume these foods often or quality foods are pricey or hard to come by in your local grocery store.

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When I talk to my patients about anxiety, many of them tell me that they’ve struggled with their mental health for years. For a lot of people, anxiety is thought of as something that’s out of your control — like the only option is medication, which you can then become dependent on. This approach is very disempowering, and I hope you leave here today knowing that anxiety control is a whole lot more nuanced than that. It comes down to the powerful connection between your gut and brain and the foods and beverages you choose to feed yourself and your gut bacteria.

3 Comments

  1. Adriana

    A clear and simple explanation about why sugar, alcohol,caffeine, etc should be avoided, how to replace in order to improve our gut health and therefore, believe or not, our mental health as well as our heart and much more.
    How important our gut health is!!!!!!!!!! Thank you Dr Pedre

    Reply
  2. Ann

    What natural product or food could I take that won’t cause constipation and will calm anxiety?

    Reply
    • Vincent Pedre M.D.

      Magnesium is great for that, especially magnesium threonate, because it crosses the blood-brain barrier, and helps increasing relaxing GABA in the brain.

      Reply

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