Nutrition in Anxiety
Anxiety is a persistent feeling of threat or stress, without a particular reason or cause. Currently, 14% of Australians are affected by anxiety.1
While what you eat will not prevent anxiety, a healthy diet can help manage the symptoms.
Vegetables & Fruit
Vegetables and fruit are integral to a healthy diet and while many people include some vegetables in their diet, only 7% of Australians eat the recommended number of daily serves.2 The current guidelines recommend eating five serves of vegetables a day for women and six vegetable serves each day for men.3 A serve of vegetables is a half-cup of
cooked vegetables or one cup of raw vegetables or a medium potato/sweet potato.
While fruit consumption more closely meets requirements than vegetables, only half of Australian adults meets the recommended daily fruit intake of two serves.2 One serve of fruit is a medium piece such as an apple or orange, or two smaller ones, such as kiwi fruit or apricots.2
Meeting these core food groups helps maintain health and wellbeing which helps mental health management.
Prebiotics & Probiotics
Evidence is emerging around the role of a healthy gut in mental health.
Some fruits and vegetables are high in prebiotic ingredients called FOS (fructooligosaccharides) and GOS (galactooligosaccharides). FOS and GOS are undigestible carbohydrates that reach the colon intact and may work with probiotics to manage mental health. These prebiotics are found naturally in fruit such as nectarines, white peaches, watermelon, grapefruit and dried fruit.
Vegetables high in FOS and GOS include those from the allium group (onions, garlic, shallots, leeks), legumes (e.g. chickpeas, red kidney beans), asparagus, beetroot, green peas, sweetcorn, savoy cabbage and Jerusalem artichokes.
While select strands of probiotics are available as a supplement, some are also naturally found in food. Probiotics in the diet are found in naturally fermented foods such as yoghurt, sauerkraut, kefir, pickled foods, tempeh and kombucha.
Blood Glucose Level
Carbohydrate-containing foods may be absorbed slowly or quickly, which impacts blood glucose level. Low-Glycaemic Index (“low GI”) foods are slowly digested, resulting in a lower peak of blood sugar. Low GI foods include soy products, beans, fruit, milk, pasta, grainy bread, porridge and lentils.
Small, frequent meals help keep blood glucose levels stable. Three medium-sized meals daily and two to three snacks in-between help moderate blood glucose levels. Maintaining steady blood glucose levels helps manage emotions too.
Foods with added sugar but few other nutrients can also wreak havoc with blood sugar levels. Restrict added sugars by limiting sugar-sweetened beverages, confectionary, biscuits and cakes.
Eating primarily from the five groups will give the best chances of anxiety management.
Check out eatforhealth.gov.au for food and drinks included in each food group, serve sizes and recommended serves per day.
Caffeine increases the heart rate which can increase stress and anxiety, so limiting coffee, tea and energy drinks may help manage anxiety.
While alcohol feels like it is doing the opposite and can temporarily induce feelings of calm, it changes the levels of serotonin and other neurotransmitters in the brain and can worsen anxiety.8 Alcohol consumption also results in lower quality sleep, which makes anxiety more difficult to manage.
Alcohol can interact with medications, worsening side effects. It is best to avoid alcohol when taking antidepressants.7
What About Medication?
Cognitive Behaviour Therapy (CBT), Behaviour Therapy and counselling are usually the go-to recommendations once an anxiety diagnosis has been made. Medication is often also used in supporting these therapies for anxiety.
The most commonly used medications for anxiety are antidepressants and anxiolytics (anti-anxiety drugs). Many of these drugs have specific nutrition issues that need consideration.
Monoamine oxidase inhibitor antidepressants, such as Nardil and Parnate, can be associated with severe hypertension if consumed in a diet rich in foods high in tyramine (like aged cheeses, beers, some overripe fruits, soy products, cured or smoked meats), or other pressor amines (found naturally and added into foods), as well as vitamin B6 deficiency.5
Tricyclic antidepressants like Sinequan, Tofranil and Tryptanol can slow gastric emptying (slow rate of food emptying from the stomach), as well as cause significant weight gain.3
Other antidepressants can interact with alcohol and may have side effects affecting dietary intake, and causing diarrhoea, constipation and gastrointestinal upset.5,6
Sedatives or anxiolytic drugs commonly used include benzodiazepines, oxazepam (alepam, Murelax, Serepax) and Diazepam (Valium, Ducene).5 These can alter taste, increase drowsiness and contribute to constipation, resulting in a decreased appetite and leading to decreased food intake and weight loss.5
Herbal remedies are often used by those with anxiety disorders, in particular kava, valerian, lavender and St John’s Wort. Kava is the only one to have been found effective in clinical trials but has been linked with liver toxicity.4
Patients taking medication for anxiety should see an Accredited Practising Dietitian to help manage diet around symptoms and side effects.
Dietary summary for anxiety management:
- Eat plenty of fruits and vegetables.
- Choose low-Glycaemic Index foods.
- Limit discretionary foods.
- Limit caffeine/stimulants.
- Aim for 30 minutes of exercise daily.
- Eat small frequent meals.
- Include dietary prebiotics & probiotics.
- Consider and address drug-nutrient interactions for anti-anxiety medications.
Anna Reeves, Accredited Practising Dietitian. B Nut & Diet (Hons).
Anna works as an Accredited Practising Dietitian in Toowoomba, Queensland, in clinical and mental health dietetics.
1. 4326.0 – National Survey of Mental Health and Wellbeing: Summary of Results, 2007. ABS Media Release “One in five Australians have a mental illness: ABS” 23 Oct 2008. Retrieved 16th Aug 2017 from http://www.abs.gov.au/ausstats/abs@.nsf/latestProducts/4326.0Media%20Release12007
2. 4364.0.55.001 – National Healthy Survey: First Results, 2014–15. “Daily Intake of Fruit and Vegetables”. Retrieved 16 Aug 2017 from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001~2014-15~Main%20Features~Daily%20intake%20of%20fruit%20and%20vegetables~28
3. Australian Government, National Health and Medical Research Council, Department of Health and Ageing, 2013. Eat for Health, “Australian Dietary Guidelines Summary”.
4. Bray, K. Are you suffering from an anxiety disorder? [Internet]. Last updated: 17 July 2014. Retrieved from: https://www.choice.com.au/health-and-body/conditions/depression-and-anxiety/articles/anxiety
5. Stewart, R. The Handbook of Clinical Nutrition and Dietetics, 4th Ed.