Anxiety - How normal is your normal

It is likely that we have all experienced some form of anxiety throughout our lifetime as short-term anxiety is a normal part of life. You may feel anxious before an exam, before your menstrual cycle, or when faced with a problem at work. However, anxiety that is experienced over a long period of time can be problematic, causing a range of psychological and physical symptoms.

The WHO estimates that 1 in 13 people globally have some form of anxiety disorder,1 and the 2019 Global Burden of Disease Study found that anxiety disorders are the most predominant mental health problems worldwide.2

The NHS characterises anxiety as a feeling of unease, such as worry or fear that can be mild or severe³ and comprises disorders including generalised anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder and social phobia.⁴ Psychological symptoms include restlessness, a sense of dread, feeling constantly ‘on edge’, difficulty concentrating and irritability. Physical symptoms include a fast or irregular heartbeat, dizziness, tiredness, muscle aches and tension, trembling or shaking, dry mouth, excessive sweating, shortness of breath, stomach ache, nausea, headache, pins and needles, and insomnia.⁵  
 
Western lifestyles have long been associated with stress and chronic disease due to demanding jobs, sedentary lifestyles and diets high in processed foods and low in fresh produce.⁶ However the COVID-19 pandemic has seriously impacted mental health,⁷ with the NHS reporting 1.45 million individuals in contact with mental health services in May 2021.⁸ The psychological impact of the pandemic is highlighted by a rise in trauma-related stress amongst healthcare workers, ⁹ increase in mental health conditions amongst young people,¹⁰ and rise in reported loneliness.¹¹ In particular, significant impacts on the mental health of children has been observed,¹²  with 337,400 children and young people in contact with mental health services in May 2021.⁸  
 
Whilst the pandemic has presented numerous psychological challenges, it has forced mankind to adapt to a new way of life,¹³ which arguably presents opportunities to improve mental health.¹⁴ For many, working from home has encouraged an improved work-life balance, opportunity to spend more time with family, and appreciation of the simpler things in life like going for a walk to the park or a cup of tea in bed. 
 
The Japanese philosophy of Kintsugi revolves around an idea that our imperfections can be a strength and stems from the traditional art of repairing broken crockery using gold. By accepting that the world is imperfect and broken items can be mended, we begin to appreciate ‘flaws’. By following Kintsugi principles, the aim is to find balance in life by reframing thoughts to appreciate what we have, focus on being unique and finding purpose, which research highlights can reduce symptoms of anxiety disorders.¹⁵  
 
‘The whole you create is as new – actually stronger – unique – and more beautiful than before’¹⁶ 

Anxiety can occur for a variety of reasons and is influenced by your individual biology combined with environmental factors. The nervous system plays a fundamental role in our sleep-wake cycle, mood regulation, overall level of activity and ‘arousal’ (intensity of physiological activity), our response to stress, and reproductive behaviour.17 Neurotransmitters are chemical messengers that facilitate signalling between neurons, which are parts of the brain responsible for sending commands to different parts of the body.17 When working effectively, these neurotransmitters [e.g. serotonin, dopamine, noradrenaline and gamma-aminonutyric acid (GABA)] enable us to effectively adapt and respond to stressors, putting us into a sympathetic (activity mode) or parasympathetic (rest mode) state.

Fight or flight is an activity mode which is stimulated by a rise in cortisol and adrenaline that makes the body alert in response to stressors, which is normal in short bursts and is still essential when we face threats today. Those stressors used to be sporadic and consisted of animal predators or approaching tribes, but these days we rarely face serious threats. Instead, our body is constantly stimulated by alerts on devices, work, relationships and health issues. This results in chronically high circulating levels of cortisol, resulting in stress and anxiety.

The gut-brain axis refers to the bidirectional signaling between the gastrointestinal tract and the brain which is vital for maintaining homeostasis.18 The vagus nerve is the longest nerve in the body and connects the brain with the gut,19 enabling the brain to influence intestinal activities and vice versa.20 Research demonstrates that different strains of bacteria can alter the formation of neural pathways critical for the stress response, influencing symptoms of anxiety.20 There is often a high co-morbidity between anxiety and gastrointestinal disorders including irritable bowel syndrome (IBS) and irritable bowel disorder (IBD) highlighting that poor microbial diversity is associated with anxiety.21

Genetics can also influence the onset of anxiety disorders, with variations in genes know as SNPs (Single Nucleotide Polymorhisms) predisposing individuals.22 The COMT gene is involved in the breakdown of neurotransmitters, so variations that result in impaired metabolism can increase activity of dopamine and norephedrine, influencing feelings of overwhelm, worry, and anxiety.23

MAO-A is an enzyme that regulates the levels of serotonin, dopamine and noradrenaline (monamines) in the brain and variants known as warrior : worrier can influence anxiety.24 The ‘worrier’ gene breaks monamines down slowly and so individuals with this variant are overwhelmed easily as they cannot break down excess levels of neurotransmitters created under stress. Those with the ‘warrior’ gene however tend to thrive under stressful situations as they are able to effectively break down the excess levels of neurotransmitters.24

Methylation is a key process in the body and regulates a range of biochemical processes from growth and repair to DNA synthesis.25 It plays a key role in the nervous system from aiding neurotransmitter metabolism to synthesis of structural components, so individuals who have methylation issues can often experience mental health issues. COMT is methylation dependent, so the effective metabolism of neurotransmitters is dependent on methylation.26

The gut plays a crucial role in brain health so it is important to effectively support it, but also, it is vital to obtain the nutrients needed to support the formation and effective transmission of neurotransmitters and hormones. The following can be implemented by both adults and children, however we’ve outlined some specific lifestyle recommendations for children.

The Mediterranean diet is recognised for its anti-inflammatory properties due to high intakes of essential fats, antioxidants and fibre which supports brain, cardiovascular and gut health.27 Focus on including 2-3 portions of oily fish (salmon, mackerel, trout) per week, fruit, vegetables, wholegrains, beans, pulses, nuts and seeds and good quality oils including olive and flaxseed oil. Limit refined (white) carbohydrates, dairy and processed meats, opting for one portion of good quality red meat per week if you eat meat. Some individuals with mental health problems may also benefit from avoiding gluten containing grains.

Balancing blood sugar is important for moderating stress levels and anxiety, as chronic imbalance is a stress on the body, which triggers the release of excitatory hormones and so can contribute to feelings of anxiousness.28 Limit foods that spike blood glucose levels including biscuits, cakes, chocolate, cereals and white carbohydrates (pasta and bread) and include protein with every meal as it is a slow releasing form of energy that helps to stabilise blood sugar. Also ensure a good intake of key nutrients including B vitamins, Vitamin C, magnesium, chromium and manganese.

Avoid stimulants and depressants including caffeine and alcohol. Whilst coffee and alcohol may have immediate feel good effects, they deplete the body of important nutrients, cause dehydration, interfere with hormones and can become addictive.29 Opt for herbal teas including chamomile, lemon balm and green tea and organic coffee, drunk before noon. Alcohol alternatives include Seedlip (alcohol-free gin), Freixiente 0% (alcohol-free sparkling wine) and kombucha.

Fermented foods contain live bacteria which are beneficial for supporting the gut microbiome. Foods include kefir, kimchi, kombucha, sauerkraut and sourdough and you should aim to include a portion per day. Top tip: kefir works well in a smoothie. A good probiotic supplement can be beneficial, especially if you have gut problems. The LAB4 blend of bacteria has been found to reduce anxiety symptoms and increase GABA levels.30

If your children are anxious, you can try many of the above dietary suggestions as well as increasing their intake of nutrients. Using a suitable multinutrient, fish oil or probiotic might be helpful, especially for picky children.

Magnesium is a natural relaxant for the nervous system and can become heavily depleted during times of stress.31

B vitamins also become easily depleted during stress and are key in supporting multiple functions in the body. In particular, they are important for supporting mood, hormone synthesis, stress and energy,32 and folate, B12 33 and B634 are key in the methylation process.

5-HTP is a precursor to the neurotransmitters serotonin and melatonin which are crucial for the regulation of the nervous system, brain function and sleep.35

Omega-3s are essential fats that make up cell membranes and are crucial for effective neurotransmission, communication between cells, exchange of nutrients and reduction of inflammation.36

L-theanine in an amino acid that exerts a relaxing effect by inhibiting excitatory signals sent to the brain. 37

Lemon balm is a herb that increases levels of GABA, which promotes a calming effect.38

Chamomile is also a herb that has similar effects to lemon balm by helping to increase levels of GABA to encourage calm.39

To help you adapt to daily stress better, especially if your energy levels are also low, consider adaptogens such as rhodiola, ginseng and reishi mushroom.

Practice meditation and/or mindfulness daily to promote a calm state.40 This could be anything from sitting in silence and simply becoming aware of your own breath to using a meditation app such as Headspace or Calm or making time to do something you enjoy like gardening or reading. Keeping a daily gratitude journal where you write 3 things you are grateful for can be effective and we also recommend listening to podcasts including Happy Place by Fearne Cotton, Feel Better Live More by Dr Rangan Chatterjee and Stronger Minds by Kimberley Wilson. Encourage children to paint or draw as an outlet for an anxiety.

Find a hobby that you enjoy and that encourages development of social relationships. This also acts as a form of mindfulness, but connecting with others and developing relationships can be effective in relieving stress,41 particularly for children who have struggled due to COVID-19 42

Connecting with nature can help to reduce stress and exposure to sunlight supports the sleep-wake cycle. 43 Encouraging children to connect with nature can be a really effective way to reduce anxiety and there are so many activities to try which are completely free, including den building, playing pooh sticks to collecting fallen leaves to make pictures. You could also search for local forest schools or visit the National Trust to find a location close to you that offers children’s activities.44

Incorporate daily movement. Any form of movement can benefit your mental state by relieving tension and releasing feel good endorphins, in particular yoga exercises that stimulate the vagus nerve can be effective in reducing anxiety. For YouTube workouts, try Yoga with Adrienne or Pilates by Lottie or, start by introducing a daily 10 minute walk to start your day.

Improve sleep quality. Sleep is essential for our brains to effectively function and so disrupted sleep can seriously affect anxiety levels. Aim to get 7-9 hours undisturbed sleep per night by establishing a bedtime routine that involves going to sleep at the same time each night.

Limit your intake of news and time spent on social media by turning off notifications on devices. Unfortunately, much of the news we receive is negative and often exaggerated by the media and so it can easily influence negative thoughts.

Taking a bath can help to relieve tension. Adding essential oils like lavender promotes a calming environment and magnesium bath salts help to ease muscle tension. Having a warm bath shortly before bed can help to lower the body temperature in preparation for sleep.

Whilst anxiety is something we are all likely to experience at some point in our lifetime and may be more influenced by genetics, implementing a holistic approach to manage the stress response may be an effective way to prevent the onset of chronic symptoms. Incorporating nutritional and lifestyle strategies that support the nervous system may therefore be a successful way to reduce the likelihood of developing co-morbidities associated with anxiety.

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