"I feel like I’ve been cruising all day and then bam, it hits me like a ton of bricks about 10 every night," my 33-year-old patient Margaret told me during our initial consultation. To alleviate her bedtime anxiety that oftentimes left her a miserable, sleepless mess, Margaret’s former doctor had prescribed Xanax. He simply followed conventional medical thinking: To him, Margaret had a neurotransmitter imbalance that required medication to fix.
I get it: I’ve struggled with anxiety for years in the past, and it sucks. Chronic anxiety can feel debilitating, and using pharmaceutical drugs is one quick and very effective way to dial down that awful feeling. Trouble was that over time, Margaret needed to increase her dose get the same anxiety relief. While it somewhat helped calm her down, she awoke the following morning groggy and craving multiple cups of coffee to get moving.
As a doctor who helps women heal from autoimmune disease and balance their hormones, I take a different approach to anxiety. In functional medicine, we see anxiety as a symptom of something else. So rather than treat that symptom with medication, I look at what my patient’s body is trying to tell them. While anxiety can occur at any time, Margaret’s nighttime anxiety suggested her stress levels stayed up when they should be simmering down. Underlying that nocturnal anxiety was an imbalance of cortisol, a hormone your adrenal glands secrete.
Cortisol has a circadian rhythm: It should be highest in the morning and gradually taper throughout the day. When it doesn’t taper naturally, symptoms like anxiety occur.
To fix that, I began with Margaret’s diet. She often grabbed a large dark roast and a fruit-on-the-bottom yogurt in the morning, sometimes worked through lunch, and snacked on what she thought were healthy foods like organic dried raisins. Her food journal revealed that when she skipped meals, her anxiety went through the roof. Because she wasn’t "a morning person," Margaret hit the gym after work, yet by 10 p.m. she was "wired and tired." When she couldn’t sleep and Xanax wasn’t kicking in, she would get up and browse social media on her phone or laptop.
Stress comes in many forms, and it often manifests as anxiety. For Margaret, it all piled up at night.
While your body typically handles stress well, almost constantly feeling overwhelmed and nervous can burn out your adrenals and create symptoms like anxiety. Numerous hormonal and metabolic imbalances besides cortisol can underlie these symptoms. During subsequent consultations, we discovered factors like HPA dysregulation (aka adrenal fatigue), insulin resistance (creating a blood sugar roller coaster when she skipped meals), and leaky gut affected Margaret’s anxiety. That’s why I recommend working with a functional medicine practitioner and why I developed a seven-day meal plan and recipe guide to balance hormones, anxiety, and other mood disorders.
At the same time, whatever time of day or night you struggle with anxiety, you want fast relief. Whether anxiety leaves you fidgety in the morning or tossing and turning at night, I’ve found these nine strategies can help dial down those feelings so you feel more centered and focused"
1. Reinforce circadian rhythm.
Finding her natural sleep-wake cycle dramatically improved Margaret’s anxiety. Here’s how to find yours. Upon waking, expose yourself to natural light. (You might need a natural light alarm clock.) About two hours before bed, wear amber glasses to drop cortisol levels and increase levels of your sleep hormone melatonin. Eliminate screen time—TV, laptops, phones, everything—about an hour before bed and take a hot bath. Then fall asleep in a completely dark room.
2. Nix sugar.
Margaret’s sugar sources were sneaky and included many "healthy" things like fruit-on-the-bottom yogurts and dried fruit. Yet any form of sugar is still sugar. Subsequent blood sugar spikes and crashes became a surefire way to increase anxiety. Margaret kept a journal to keep a consistent meal schedule and identify hidden sugar, including processed grains (that your body turns into sugar almost immediately). She also increased protein intake at every meal, which kept her full, steadied her blood sugar levels, and provided the amino acids to build neurotransmitters.
3. Meditate or practice mindfulness.
Find a practice that works for you. That could mean Transcendental Meditation, yin yoga, or deep breathing. Margaret spent five minutes in the morning, afternoon, and evening closing her eyes and focusing on her breath. Without judgment, she sat mindfully with whatever she felt, observing her emotions and focusing on her breath.
4. Lower inflammation.
Beyond mental or emotional stress, chronic inflammation can imbalance your hormones, which creates a vicious cycle that keeps inflammation fired up and puts you in a state of panic. Margaret’s anti-inflammatory protocol included foods like wild salmon and freshly ground flaxseed as well as nutrients like curcumin and fish oil.
5. Move big muscles.
Your body wants you to move when you’re anxious. Big-muscle movement—stuff like jump squats, walking, lunging, and kickboxing—can dial down anxiety during the day. But exercising too late can have the opposite effect and wind you up when you should be winding down. I convinced Margaret to keep the gym to weekends and do a tough but time efficient 10-minute high-intensity interval training (HIIT) routine three days of the week in the morning.
6. Cut the caffeine.
This was Margaret’s biggest challenge since she loved her morning java jolt. But if you’re feeling anxious, giving your body a jolt is the last thing you need. You’d be surprised by how many women lower anxiety just by cutting that morning coffee. To transition, try organic green tea, which has a little caffeine but also calming L-theanine.
7. Address nutrient deficiencies.
Eating a restrictive diet for too long (including veganism or paleo) can put you at risk for deficiencies if you’re not being mindful about meeting your body’s needs. I also factor in nutrient-depleting medications—Margaret had been on birth control pill for years—that can manifest as anxiety. To cover the nutrients that she wasn’t always getting from whole foods, Margaret began taking a professional-quality multivitamin with additional vitamin D and magnesium.
8. Try calming remedies.
9. Fix your gut.
I realize this is more of a long-term strategy, but you can begin right away by pulling gluten and other inflammatory foods from your diet. If your gut is inflamed, your brain probably is too. Problems like dysbiosis, small intestinal bacterial overgrowth (SIBO), parasites, yeast overgrowth, leaky gut, H. pylori, and food sensitivities can impact inflammation and rev up anxiety. Mood disorders often begin in your gut because many feel-good neurotransmitters like serotonin get manufactured there.
This is the one supplement this psychiatrist always recommends to her patients.
And are you ready to learn more about what anxiety, brain health, and your diet all have in common? Register now for our FREE Functional Nutrition Webinar with Dr. Mark Hyman.