Natural remedies for anxiety

Townsend Letter for Doctors and Patients, Oct, 2004 by Alan R. Gaby

It would seem that a little bit of anxiety is a normal reaction to a world awash in terrorism, debt, declining moral values, and Reality TV. Furthermore, a modest amount of anxiety is useful at times, stimulating people to perform better and to achieve greater things. Excessive anxiety, on the other hand, can interfere with one's life and often requires treatment.

Psychotherapy and aerobic exercise may each be beneficial for people suffering from chronic anxiety. Pharmacological treatment for anxiety, for those who need it, consists mainly of selective serotonin-reuptake inhibitors and benzodiazepines. While these treatments may help control symptoms, they often cause adverse side effects, and benzodiazepines tend to be addictive. Fortunately, a number of safe and effective alternatives are available to treat anxiety.

Dietary factors

Caffeine consumption is one of the most common causes of anxiety. People who suffer from anxiety disorders tend to be unusually sensitive to the effects of caffeine, so even small amounts may cause problems for them. Withdrawing from caffeine can be difficult, as it usually results in severe headaches, lethargy, and other symptoms. I have learned, from a small series of cases, that caffeine-withdrawal headaches can be prevented by supplementing with Siberian ginseng (Eleutherococcus senticosus) three times a day, beginning on the day of or the day before withdrawal, and continuing for a few days.

Reactive hypoglycemia also appears to be an important cause of anxiety. (1) Hypoglycemia should be suspected in patients whose anxiety occurs or becomes worse before mealtime and is relieved by eating. Reactive hypoglycemia can be treated effectively by avoiding blood sugar-destabilizing foods (e.g., refined sugar, caffeine, and alcohol); eating small, frequent meals; and supplementing with chromium, B vitamins, magnesium, and other micro-nutrients.

Food allergy may be a triggering factor for anxiety in some cases. (2) Allergy should be suspected if symptoms occur after eating or improve with fasting, or if a person has other manifestations of allergy, such as migraines, asthma, rhinitis, or irritable bowel syndrome. An elimination diet followed by individual food challenges can usually identify which foods are causing symptoms.

Nutritional supplements

Magnesium deficiency is one of the most common nutritional deficiencies. The typical Western diet contains only about two-thirds of the RDA for this mineral. Other factors that can promote magnesium deficiency include chronic stress, certain diseases (e.g., inflammatory bowel disease and heart disease) and the use of diuretics and some other medications. (3) Symptoms of magnesium deficiency include anxiety, fatigue, depression, irritability, fear, restlessness, insomnia, faintness, hyperventilation, muscle cramps and twitches, intestinal complaints, tightness in the chest, poor attention, confusion, and memory loss. These symptoms are remarkably similar to those of patients diagnosed with anxiety disorder. A large proportion of patients report that taking a magnesium supplement, with or without calcium, helps their anxiety to some extent, and occasionally the results are dramatic.

Animal studies have shown that niacinamide (vitamin B3) has actions that resemble those of benzodiazepines. (4) Anecdotal reports suggest that niacinamide has an anxiolytic effect in humans, although no clinical trials have been done. A typical therapeutic dose of niacinamide is 500 to 1,000 mg three times a day. Liver enzymes should be monitored periodically in people taking large doses of niacinamide, as rare cases of hepatotoxicity have been reported.

Other micronutrients may also have antianxiety effects. In a double-blind study of healthy male volunteers (aged 18-42 years), those who received a daily supplement containing thiamine (15 mg), riboflavin (15 mg), niacin (50 mg), pantothenic acid (23 mg), vitamin B6 (10 mg), biotin (150 mcg), folic acid (400 mcg), vitamin B12 (10 mcg), vitamin C (500 mg), calcium (100 mg), magnesium (100 mg), and zinc (10 mg) experienced statistically significant reductions in anxiety and perceived stress, compared with those who received a placebo. (5)

Herbal Treatments

Kava kava (Piper methysticum) has been shown in at least seven double-blind studies to be an effective treatment for anxiety. (6) Although kava kava was generally well tolerated in these studies, there have been rare reports of severe hepatotoxicity from the use of this herb. As a result, kava kava has been banned in some countries, although it is still available in the United States. Preliminary evidence suggests that the reported adverse effects were due to an idiosyncratic reaction, rather than to a toxic effect per se. Because there is no way at the present time to predict who might react to kava kava, people taking this herb should be alert for any early warning signs of hepatotoxicity, such as nausea, fatigue, dark urine, or right upper quadrant tenderness. Despite the rare but serious adverse reactions, kava kava appears to be better tolerated than benzodiazepines.