As if we needed any more stress in our modern world…then along comes Coronavirus 2019. The virus and its disease COVID-19 are boosting our collective anxieties. This is an exceptionally bad time for those that normally suffer from anxiety disorders. The extra daily stressors created by the COVID-19 crisis, the ever present 24/7 news cycle and social media combined with increased time on our hands has been a recipe for heightening anxieties, depression and sleeping disorders.
This is part 2 of a 3-part blog (Mild, Moderate, Severe Anxiety) on anxiety coping mechanisms. As a naturopathic doctor, my suggestions are holistic in nature, which I hope will challenge some to break harmful habits and try some new ways to help create a more balanced mood.
In general, moderate anxiety is similar to mild anxiety but can be, at times, overwhelming with noticeable nervousness and agitation. Moderate anxiety often occurs when something or a situation that makes you feel anxious consumes all your attention to the point of ignoring everything else around you. COVID-19 has provided more people with an all-encompassing topic to fixate on at the expense of a healthier more optimistic and content outlook.
People with moderate levels of anxiety have more frequent/persistent symptoms than those with mild anxiety, but are better able to function day-to-day than someone with severe anxiety or a panic disorder. Although moderate anxiety symptoms are disruptive, people often successfully manage them with coping mechanisms. However, destructive coping mechanisms like excessive alcohol or recreational drug use should be avoided. These mechanisms end up worsening the nervous system imbalances associated with anxiety and cause degradation to mental acuity and overall health.
Moderate Anxiety “Fight or Flight” Symptoms:
The proportions of people with different levels of anxiety (normal, mild, moderate or severe) and who are depressed with chronic disease. Jones Et. al 2012.
How you sense your environment and respond has a lot to do with the ability of your neurons to communicate properly with each other. Neurons use small chemical messengers called neurotransmitters to coordinate thoughts, actions, sensations. Neurotransmitters also impact your body’s physiological responses including muscle relaxing/contracting, glandular secretions, immune modulation, digestion, etc.
Everything we do and experience is a result of neurotransmitter activity and your neurons response to them. There are thousands of chemicals that act like neurotransmitters but there are five neurotransmitters that play a significant role in moderate anxiety.
During my work as a laboratory executive and a doctor, I have seen urinary neurotransmitter data on hundreds of thousands of people and worked with thousands of patients to help them achieve greater nervous system balance. This experience has taught me that most people with mild to moderate anxiety benefit from trying some simple nutritional supplementation.
There are many ways to promote calm. Supplements that support calming neurotransmitter activity (GABA and serotonin) are key. It is also important to reduce unstable fluctuations in stimulatory neurotransmitters (epinephrine, glutamate, norepinephrine). The odd neurotransmitter is dopamine. Although it serves as a precursor to the stimulatory neurotransmitters epinephrine and norepinephrine, dopamine can also calm anxiety by balancing anxiety-causing brain activity.
Disclaimer: It is best to work with a qualified healthcare provider when attempting to treat with nutritional supplements. Additionally, if you notice that you are not responding predictably to any recommended supplemental support below, you should stop and follow up with your healthcare provider.
Calming Serotonin Support
Serotonin is the brain’s “happy” neurotransmitter. Low levels are tied closely to poor sleep quality, depression, anxiety and headaches. Although serotonin is used in the brain, an estimated 90% of it is produced in the gastrointestinal tract. Low serotonin levels are linked to gastrointestinal issues like constipation and slow gut motility. Using precursors and modulators of serotonin activity can help with mood disorders, headaches, gut motility, irritability, hot flashes, night sweats and overall stress tolerance.
5-hydroxytryptophan (5-HTP) is the direct amino acid precursor your body uses to make serotonin. 5-HTP freely passes through the protective barrier surrounding the brain, known as the blood-brain barrier. This allows a quick boost in brain serotonin levels.
Many antidepressant medications prevent the re-uptake of serotonin (e.g. SSRIs). While these meds help with symptoms, they never increase overall serotonin synthesis or storage levels. Actually, in time, SSRIs further deplete serotonin neuron storage, causing lower serotonin levels. In response, the benefits of the medication seem to lessen often requiring higher SSRI doses or switching of medications.
Consult your health care provider if you are taking an antidepressant or psychotropic medication and want to trial 5-HTP.
Myo-Inositol, also known as vitamin B8, is the biologically active form of inositol used in dietary supplements. Inositol is involved in brain cell signaling and is a component of cell membranes. Additionally, inositol can improve neurotransmitter receptor density and signaling.
Inositol has been shown to help with mood and behavioral disorders safely by itself or in combination with medications. Inositol can be used to treat panic attacks and anxiety, depression, Obsessive Compulsive Disorder (OCD), bulimia, depression in bipolar disorder and mood swings.
Calming GABA Support
Gamma aminobutyric acid (GABA) is your brain’s primary inhibitory transmitter. Its role is to keep glutamate, the primary brain excitatory neurotransmitter, from overstimulating you. Most of the common sleep and anxiety medications work by stimulating GABA receptors. However, prolonged use of these medications is associated with declining benefits and can be habit forming.
L-Theanine is an amino acid found in green tea (Camellia sinensis) that boosts alpha and theta brain waves associated with alert relaxation, creativity and relief from trauma. L-theanine crosses the blood-brain barrier and has been shown to boost calming neurotransmitter activity, reduce oxidative stress and reduce the excitatory neurotransmitter glutamate.
L-theanine is very safe to use with and without other medications. However, the benefits are typically short-lived with activity only felt for 2-3 hours. L-theanine can be found in delicious gummy candies which allows for easy usage with young children; both in body and mind ;)
Calming Glutamate-Reducing/ GABA Support
L-Theanine: See above.
N-acetylcysteine (NAC) has many total-body benefits including being an antioxidant, a glutathione precursor (antioxidant activity), neurotropic (boosts brain activity) and anti-inflammatory. It is beneficial for anxiety, because it can support the reduction of total glutamate levels, which is one of the most excitatory central nervous system neurotransmitters.
NAC reduces neuronal intra- and extracellular exchange of glutamate through the cystine–glutamate antiporter. NAC is typically safe to take with psychotropic medications and is not known to affect drug metabolism. People who typically do not tolerate NAC usually have sulfur metabolism issues and are also highly sensitive to high sulfur foods such as garlic and onions.
People suffering from a form of small intestinal bacterial overgrowth (SIBO) with elevated hydrogen sulfide gas production (rotten-egg smelling flatulence/ belching) will react negatively to NAC due to its high sulfur content. NAC can be a useful supplement for patients with COVID-19 and lung issues by supporting the thinning of lung mucous secretions, reducing lung oxidative stress levels and promoting healthier levels of glutathione.
Kava kava (Piper methysticum) has traditionally been used in Polynesia as a ceremonial drink for kings and religious activities. Kava is best known for elevating contentment, mood, well-being and relaxation. Clinical studies have found kava to be effective in treating anxiety and sleep issues.
Kava kava has been shown to increase GABA receptors, which boost overall neuronal GABA activity. Kava extracts have also been seen to bind to GABA, dopamine, serotonin and opiate receptors. This explains why kava might help with anxiety, support healthy sleep and reduce chronic pain.
What’s Your Anxiety Level?
While everyone suffers from mild anxiety at some point in life, others experience much more intense feelings of stress and anxiety. Check out Part 1: Mild Anxiety and stay tuned for Part 3: Severe Anxiety of our series on managing stress for options to help you deal with your level of anxiety.
If you would like to try one of the supplements mentioned here, please contact the clinic to set up a consult. We can help you get your stress under control to handle whatever comes your way.
Jones KH, Ford DV, Jones PA, John A, Middleton RM, Lockhart-Jones H, Osborne
LA, Noble JG. A large-scale study of anxiety and depression in people with
Multiple Sclerosis: a survey via the web portal of the UK MS Register. PLoS One.
Dean O, Giorlando F, Berk M. N-acetylcysteine in psychiatry: current therapeutic evidence and potential mechanisms of action. J Psychiatry Neurosci. 2011;36(2):78‐86. doi:10.1503/jpn.100057