"You’ve got a pacer in your office," my medical assistant told me. I took a deep breath and entered the room to feel a palpable tension where I found my 29-year-old patient Thom pacing restlessly as he gulped from a giant coffee cup.
I get patients like Thom more often these days. They’re overworked, underslept, sometimes feeling spiritually empty, and oftentimes wanting to discuss tapering off pharmaceutical drugs (like Xanax or Prozac) their conventional doctors prescribed, preferring a more holistic, natural regimen to alleviate depression or anxiety (of course, never go off prescription medicine without a doctor's guidance).
As a medical doctor who specializes in gut health, I regularly see how the gut microbiome affects these and other mental conditions. Among its roles, optimized gut health improves depression by reducing inflammation and boosting hormones like serotonin. About 95 percent of this feel-good neurotransmitter, in fact, gets manufactured by your gut.
Newer studies show your microbiome can also influence other emotions like anxiety, which I see far more often among patients like Thom these days.
"Anxiety has become our everyday argot, our thrumming lifeblood," writes Alex Williams in a recent New York Times article titled "Prozac Nation Is Now the United States of Xanax."
The most striking statistics mentioned by Williams include:
- 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 No. 1 mental-health concern.
- According to Google Trends, the number of anxiety web searches has nearly doubled over the last five years.
For Thom and other patients, I take a comprehensive approach to treating anxiety that focuses on a multifaceted approach, balancing sleep, stress levels, exercise, nutrition, and of course, gut health.
Among the science-supported tactics I use to reduce anxiety and restore calm are:
- Deep breathing
- Eight hours of quality sleep every night
- High-intensity interval training (HIIT)
All of those things improve long-term anxiety, but Thom also needed fast relief. Like with most patients, I started with his diet. That’s because food significantly affects your anxiety levels, and foremost among its anxiety-inducing culprits are sugar and caffeine.
Thom’s breakfast usually entailed a muffin and several cups of cream-and-sugar-infused coffee. Working in a hectic high-stress job, he often skipped lunch and grabbed a few slices of pizza or Chinese takeout before he hopped on the subway.
Here’s what a day in the "anti-anxiety prescription" looked like:
Upon Waking: Meditation, Yoga & Supplement.
Instead of immediately checking his smartphone and rushing to get out the door, we started with five minutes of meditation (simply slowing down and observing the breath), followed by a yoga routine for grounding and relaxation to start the day off on the right note.
Yoga means "union." In essence, when you do yoga, you connect with your body and ground the nervous system. I recommended 10 minutes of yoga stretches right after his morning meditation. This sets the tone for the day. If it means waking up a few minutes earlier, that’s OK because you don’t want to start the day in sympathetic nervous system "fight-or-flight" mode. It’s easy enough to find short yoga routines to follow online.
This was followed by a nutrient-packed, blood-sugar balancing, anti-anxiety herb-infused smoothie for breakfast. I had him skip the coffee as well.
Breakfast: Zen Smoothie.
This anxiety-lowering blend is not only filling, but it also helps you start the day on a grounded note. Lavender, along with passion flower and valerian root, are widely used for their calming properties. Lucuma is a fruit very similar to an avocado with a yellow flesh and a maple-like taste that was known as the "Gold of the Incas." Low on the glycemic scale, it is rich in beta-carotene (a precursor to vitamin A), minerals, protein, and niacin (vitamin B3). Kefir offers a healthy dose of the probiotic lactobacillus, which produce calming neurotransmitters like GABA (gamma-amino butyric acid).
- 1 cup unsweetened coconut milk
- ½ cup filtered water
- ½ cup plain organic kefir
- 1 scoop hemp protein powder
- 1 cup frozen organic blueberries
- ½ banana
- 1 tablespoon dried lavender buds
- 1 teaspoon passion flower extract
- 1 teaspoon lucuma powder
- ½ teaspoon valerian root extract
- 2 to 3 ice cubes (optional)
- Add all ingredients in the order listed.
- Blend in a high-speed blender, making sure all ingredients are smoothly emulsified.
- Serve and enjoy while you get ready for work.
Midmorning: Skip the Caffeine and Go for Tea & Supplements.
There was endless-refilled coffee and to a lesser degree, energy drinks that fueled Thom’s overscheduled, adrenaline-fueled work days. I don’t oppose caffeine in small doses for most people, but overuse can become a crutch and impede things like solid sleep. In Thom’s case, too much caffeine exacerbated his anxiety.
One study looked at caffeine’s effect on brain regions implicated in social threat processing and anxiety among 14 healthy males who either used caffeine infrequently or not at all. They either got a 250-milligram amount of caffeine (about what you’d get in a tall brewed coffee) or a placebo. Among their findings, researchers found caffeine increased self-rated anxiety and the feeling of being threatened.
Another study looked at caffeine intake in secondary school children. Researchers found significant connections between total weekly caffeine intake and mental disturbances like anxiety and depression.
Living in Manhattan, I especially see the connection between increased anxiety levels and overworked, sleep-deprived folks (including high schoolers) who suck down sugar-loaded, caffeine-laden liquid desserts.
With the breakfast smoothie powering his morning, I made sure Thom wouldn’t suffer from caffeine withdrawal with a better alternative—green tea. With its smaller dose of caffeine than coffee, and anxiety-lowering l-theanine in the tea leaves, green tea offers more steady energy without the peak/trough produced by sympathetic "fight-or-flight"-accelerating coffee. I had him go for a cup of Tazo Zen Tea, which includes green tea with calming lemon verbena, spearmint, and lemongrass.
I also had Thom start taking 100 milligrams of L-theanine three times a day. L-theanine is found in green tea but can also be taken as a supplement to lower anxiety and stress by working directly in the brain. It bears a close resemblance to the excitatory neurotransmitter glutamate, but by binding to glutamate receptors it blocks the effects of glutamate, instead having an inhibitory, relaxing effect on the central nervous system. And it promotes the production of GABA—an inhibitory, relaxing neurotransmitter. The great thing is it does all this without causing drowsiness while actually improving alertness and focus.
Lunch: Anti-Anxiety Salad.
Skipping meals crashes blood sugar, leaving you feeling lethargic and anxious.
Rather than working through lunch without a break, I asked Thom to prepare a well-balanced salad that included optimal protein, healthy fats, antioxidants, and fiber. Among the superfood ingredients you may include in an anxiety-busting salad are raw Jerusalem artichoke, raw dandelion greens, and scallions, which are all excellent sources of gut-boosting, anxiety-lowering prebiotic fiber.
For the salad, I had him toss chlorophyll-rich, cleansing baby spinach with a protein of his choice (like chicken, salmon, or shrimp) and a healthy fat (like avocado, walnuts, almond slivers, hemp hearts). You can enhance the salad’s nutrient power with raw carrots, scallions, red beets, radishes, and broccoli. Separately, in a small Mason jar, I had him put ¼ cup of extra-virgin olive oil, 2 tablespoons of freshly squeezed lemon (about 2 lemons), and ½ teaspoon of mineral-rich Himalayan sea salt with cracked black pepper to taste. It’s easy to mix in the Mason jar and add just before eating the salad.
Afternoon Snack: Walnuts.
Walnuts provide a blood-sugar-steadying blend of fiber, protein, nutrients, and the anti-inflammatory omega-3 fatty acid alpha-linolenic acid (ALA). One study found mice fed walnuts showed a significant improvement in memory, learning ability, anxiety, and motor development compared to non-walnut-eating mice. To keep Thom's blood sugar stable (and his sugar cravings at bay), I had him snack on a handful of raw walnuts in the afternoon.
Dinner: Salmon With Greens.
Thom didn’t like to cook and made that emphatically clear. However, I’ve been able to convince even the most stubborn anti-chefs to venture into the kitchen. To make his long workday easier, I gave him a few healthier dinner options. Instead of a grab-and-go pizza, I had him visit the local hot bar, which featured several paleo options including coconut curry chicken and cauliflower rice. Cooked onions and asparagus provided more gut-boosting, calming prebiotics. To lower anxiety, slow starches like butternut squash and sweet potato are better alternatives to white rice, bread, and pasta.
Basically, dinner should focus on high-quality fat and protein like grass-fed beef, free-range poultry, or wild-caught fish along with plenty of leafy and cruciferous veggies. I’m seeing more "paleo rice" options, including broccoli and cauliflower. They add variety to your meals.
Another alternative to his fast carb-laden on-the-go dinners is the Happy Gut–approved Wild Salmon on a Bed of Spring Greens. The salmon filet can be prepared the day before or over the weekend to make heating up dinner easier on a busy workday. A simple salad dressing will do with just a touch of your favorite extra-virgin olive oil, lemon juice, and salt and pepper to taste (as described above). A 3- to 4-ounce serving of wild salmon will provide half of your weekly anti-inflammatory omega-3 requirements, which also helps lower anxiety. Toss in a slow, complex carb, like a baked sweet potato, to make it a filling meal and promote harmony-inducing serotonin production.
Evening Ritual: Herbal Tea and Zen Breath.
Instead of his several glasses—or more likely, bottle—of wine, I had Thom turn off overstimulating electronics (it wasn’t easy!), take a magnesium-rich Epsom salt bath, practice another 5 to 10 minutes of deep breathing in the evening, and sip chamomile or peppermint tea to unwind before bed.
Thom gradually added a five-minute break every few hours at his office to practice a breathing technique I taught him. Here’s what I had him do:
Find a comfortable place to sit quietly where you won’t be disturbed. Begin to listen to your breath. Don’t try to change it; simply listen. How does it sound to you? Is it deep or shallow? Is it comfortable to breathe? Does breathing make your mind calm or anxious? Try not to judge this information. Give yourself the space to be curious about what you feel.
Now let the breath lead you around the body like a guide. Notice what you feel. What part of you moves easily with the breath so that it feels free and open? What part feels sore, agitated, tight, or disconnected? Slowly create movement in the places that feel tight. For example, if a part of your chest wall is not moving, then breathe into it and create more movement there. If a part of your abdomen feels tight, then take your breath there.
Listen to your body. Use this exercise to create more space in those areas.
Over time I developed a more comprehensive protocol for Thom (you can get a sense of what that would look like with my free Quick Start Guide to a Happy Gut), but taking control over his eating and practicing a simple breathing technique helped him gain control over anxiety almost immediately. This eating and lifestyle prescription is a start to resetting your anxiety meter for good.
In summary, my short-term strategy to manage Thom’s anxiety involved nixing sugar, caffeine, and in his case, excessive alcohol, and then adding in healthy whole foods that stabilize blood sugar and feed healthy gut flora. He also eliminated energy drinks and gradually traded in coffee for green tea, which balances some caffeine with the anti-anxiety amino acid L-theanine.