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Can Paleo Help with Anxiety?

panic button

From the heart-pounding terror of a panic attack to the life-constricting demands of a social phobia, anxiety disorders are brutal to live with. Including PTSD, OCD, panic disorder, social phobias, and the catch-all Generalized Anxiety Disorder, diagnosed mental health problems that revolve around anxiety affect about 18% of the general population, but undiagnosed anxiety issues are likely far more widespread.

There’s no guarantee that any particular diet intervention will help you manage an anxiety disorder, much less cure one. Nobody’s claiming that Paleo is the magic panacea that opens the door to a world into sunshine and rainbows where panic attacks are just an unpleasant memory. But there are quite a few interesting reasons why diet might be connected to anxiety, and why improving your diet might help. Take a look at some of the many potential diet and lifestyle factors that play into anxiety below.

Anxiety and the Gut Brain

Did you know that according to the latest medical research, you actually have two brains? One is on your head. The other – where 95% of the mood-controlling hormone serotonin lurks – is in your gut. The gut brain “talks” to the head brain through the vagus nerve (a bundle of fibers running from your brain down through your neck and into your chest and belly).

Whatever one brain feels will eventually make its way to the other brain as well. This works in a top-down direction (getting “butterflies in your stomach” when your head brain is nervous) but it also works the other way around. If your gut isn’t happy, your mood won’t be great. This isn’t just speculation: it’s an established fact even among mainstream medical circles. The best illustration is the close association between irritable bowel syndrome (IBS) and all kinds of mood disorders.

To put it very briefly, a diagnosis of IBS is a fancy medical name for any gut problem that obviously exists, but doesn’t seem to have a physical cause. Symptoms include constipation, diarrhea, bloating, abdominal pain, and pretty much any other vague set of GI symptoms that aren’t caused by some obvious physical problem.

Patients who suffer from IBS are far more likely to suffer from mood-related disorders like depression and anxiety. In this study, the rate of generalized anxiety disorder (chronic worrying, restlessness, fatigue, irritability, and sleep disturbances) among IBS patients was five times as high as the rate in the general population. And IBS was almost 5 times more common in anxiety patients than mentally healthy people.

It also works the other way: anxiety and stress can set off IBS symptoms (which in turn usually cause more stress). Once you’re in the cycle, it’s self-perpetuating. But whichever problem ultimately comes first, the upshot is clear: anxiety and gut health go hand in hand. So to figure out how diet can affect anxiety, our prime suspect should be how diet affects the gut.

Diet and the Gut Brain

As you’d expect from the previous section, treating anxiety symptoms helps relieve symptoms of IBS. But it works the other way too: if patients take steps to heal their guts, their mental health symptoms generally improve. And even in people with no obvious IBS symptoms, interventions with gut-healing foods or supplements still help manage anxiety.

So what are these magical gut-healing diet strategies? First and foremost, healing means eliminating gut irritants like gluten, lectins, and phytic acid. Gluten gets a special mention here: gluten intolerance often shows up as anxiety disorders of various kinds, including social phobias and panic disorders. Anxiety is more common in Celiac patients than the general population. And eliminating gluten from the diet generally resolves the problem. If you’re trying to manage anxiety with diet, gluten should be among the first to go.

A basic Paleo diet eliminates most of these prime culprits as a matter of course, so it’s not hard to see how some people go Paleo and find their anxiety improves just like that. If you’re already eating Paleo and still having trouble with anxiety, some Paleo-friendly changes that are particularly powerful at fighting gut dysfunction are:

Probiotics

At this point, everyone is aware that the gut flora are important for everything from weight loss to acne, and that probiotics (supplements with healthy flora) can be very beneficial in restoring healthy gut function after a treatment with antibiotics. Anxiety is not an exception to this rule. For a comprehensive review of how managing your gut flora affects your brain, see this study (free full-text). The short version: it’s important. Taking probiotics has been shown in several studies (this one, for example) to help reduce anxiety symptoms – and that was in healthy volunteers, not volunteers with diagnosed IBS. And even some apparently unrelated treatments – like Omega-3 fats or antioxidants – may actually work through their effect on the quantity or diversity of gut flora (more on this below).

Reduction or Elimination of FODMAPs and Fructose

FODMAPs are a group of carbohydrates found in some fruits and vegetables; they’re fine for most people, but some have trouble digesting them. This is so strongly linked to IBS – 75% of IBS patients find relief with a low-FODMAPs diet – that some gastroenterologists have actually proposed that IBS might be nothing more than a FODMAPs intolerance.

In some studies (see here and here for examples), restricting or eliminating FODMAPs carbohydrates improved both IBS and mood symptoms. So if you have both gut and mental symptoms, and you haven’t tried a FODMAPs elimination diet, it’s a good place to start.

Cutting back on nuts and seeds

Nuts and seeds contain some of the same gut irritants that make grains and legumes unhealthy; the difference is that grains and legumes are staple foods, while nuts and seeds are eaten rarely. So the amount of gut irritants in nuts and seeds is low enough for most people to handle without an issue. But people with gastrointestinal symptoms might want to try eliminating them to see if they notice a difference, especially since nuts and seeds are also very high in omega-6 PUFA, which is also linked to anxiety issues (more on this below).

Bone Broth

The proteins in bone broth are excellent for improving digestion and soothing a damaged gut lining. And on a more psychological level, a big mug of bone broth is a wonderful “comfort food” to replace unhealthy drinks like hot chocolate. So if your stomach isn’t feeling quite right, this delicious drink might be just what the doctor ordered.

Aside from FODMAPs, these strategies were all parts of traditional diets around the world, but most people eating the standard American diet have never even heard of bone broth, and rarely eat probiotic foods. So perhaps it’s not surprising that after returning to a more traditional eating pattern with Paleo, symptoms of anxiety tend to improve.

Managing IBS symptoms with diet can help reverse the vicious cycle: reducing physical symptoms reduces the anxiety they cause, which in turn reduces symptoms further. So dietary changes – like Paleo – that help heal the gut show significant promise in treating anxiety and related mood disorders.

Dietary Fat, Cholesterol and Anxiety

The connection between gut health and anxiety is powerful, but there are also other foods that affect anxiety even though the effect isn’t necessarily mediated through the gut. The first one is fat. Your brain is made of fat. When you get enough fat in your diet, your brain gets happier. In this study, for example, switching from a 41% fat to a 25% fat diet caused significant increases in tension and anxiety (as well as anger and hostility). But here’s the catch: it has to be the right kind of fat.

Omega-3 vs. Omega-6 Fatty Acids

Omega-3s (the famously healthy fats found in seafood) have gotten a lot of overenthusiastic press lately, but there is some truth behind the hype: they really do help combat anxiety. An adequate daily intake of omega-3s (especially when combined with a low intake of their pro-inflammatory cousins, Omega-6s) helps reduce anxiety and depression symptoms.

What’s the evidence for this? To start with, there are plenty of population studies: in this study, for example, symptoms of anxiety were associated with the lowest serum levels of Omega-3 fatty acids. This one demonstrated improvement in the mood of heart attack patients (a huge majority of whom also have symptoms of anxiety) with daily Omega-3 supplementation. This suggests that the cardiovascular and mood-related benefits of Omega-3 fats may even be linked.

This study is very interesting. It tested Omega-3 intake in pregnant women, who were divided up into five groups: “health-conscious” (whole grains, fruits and vegetables), “traditional” (red meat and plant foods; more or less Paleo), “processed” (exactly what it sounds like), “confectionery” (cakes and candy), and “vegetarian.” The “traditional” eaters did just as well as the “health-conscious” eaters: these two groups were the least likely to report anxiety symptoms. So much for red meat causing depression! On the other hand, women who identified as vegetarians were the most likely to be anxious (25% increased risk), even more than the “processed” or “confectionery” groups. Across all the dietary patterns, women with the lowest intake of dark and oily fish also had the highest levels of anxiety.

All this is epidemiological research, but there’s also evidence from randomized controlled trials to back it up. In this study, researchers gave subjects either 2.5 grams/day of omega-3 fats (about the same amount as you’d get from a palm-sized serving of wild-caught salmon) or a placebo; the Omega-3 group showed a 20% reduction in anxiety symptoms. Further tests showed that “decreasing n-6:n-3 ratios led to lower anxiety.”

In other words, getting the right (anti-inflammatory) kind of fats significantly reduces anxiety; getting the wrong (pro-inflammatory) kind of fats significantly increases anxiety. The take-home is simple: enjoy plenty of fish and seafood, and limit or eliminate foods rich in inflammatory Omega-6 fats (seed oils, soy, and nuts).

Cholesterol

We saw in the study of the pregnant Australian women that a “traditional” diet including red meat had one of the lowest anxiety scores, which ought to raise some big question marks about the theory that red meat, saturated fat, or cholesterol cause anxiety. Another problem with this (completely false) assumption is one of the most famous side effects of statins: mood disorders. Statins are most famously linked to depression (many trials of cholesterol-lowering drugs are plagued by suicide and violent death among subjects), but there’s also some evidence that inadequate dietary cholesterol or artificially low blood cholesterol may be related to anxiety.

How does this work? Cholesterol is necessary for the function of the neurotransmitter serotonin, which controls mood. Abnormal serotonin levels are correlated not only with depression (explaining the suicidal men on statins) but also with anxiety. Cholesterol deficiency also decreases the sensitivity of receptors in your brain for the neurotransmitter GABA, which is responsible for feelings like calmness and relaxation.

This is more complicated than it seems at first (the association between anxiety and low cholesterol could be because anxious people eat less, not the other way around, and the relationship between serotonin and mood disorders is also complicated), but whatever way you interpret it, your brain needs cholesterol. There aren’t any human trials, but in this study, rats fed a cholesterol-enriched diet showed lower signs of anxiety and stress when confronted with challenges than rats fed a normal diet.

The upshot: for an anti-anxiety diet, get plenty of fat, and get the good stuff. Rely on stable saturated and monounsaturated fats for the bulk of your diet, don’t fear cholesterol, limit Omega-6 PUFA, and eat fish regularly to take advantage of their delicious and healthy Omega-3s.

Caffeine and Anxiety

Caffeine is a gray area food at best, and for anxiety sufferers, it’s generally a bad idea. People with all kinds of anxiety disorders have more violent reactions to caffeine than healthy controls (this study listed “anxiety, nervousness, fear, nausea, palpitations, restlessness, and tremors”). The same cup of coffee that delivers a mild pick-me-up for a healthy person could set off a morning of jittery overstimulation for someone with an anxiety disorder.

This effect is partly genetic: some people are just more sensitive to caffeine than others: they get the shakes where the rest of us only get a pleasant buzz. In a fascinating analysis of data from thousands of sets of twins, this study concluded that the effect goes both ways: people with anxiety disorders were more sensitive to caffeine, and that caffeine abuse could contribute to anxiety.

There’s even a distinct diagnosis – caffeine-induced anxiety disorder – for anxiety symptoms that get worse on caffeine. As a concrete example of this, this study on panic attacks found that many people have panic attacks because they’re hypersensitive to accumulated carbon dioxide (that’s why panic attacks involve hyperventilating: it’s an attempt to get more oxygen and get rid of that carbon dioxide). Caffeine increases carbon dioxide concentrations in the blood, and so when these panic disorder patients took caffeine, the drug triggered them into a panic attack.

Since caffeine is such a recognized anxiety trigger, coffee and even caffeinated tea should really be first on the chopping block when it comes to an anxiety disorder.

Micronutrients and Anxiety

No one micronutrient deficiency is responsible for anxiety or mood issues. Many theoretically could cause problems, depending on how your body specifically reacts to them, so a nutrient-rich, balanced diet is a good safety precaution in any case (and for many more reasons than preventing anxiety!). Two nutrients to take a quick glance at:

Anxiety and the Thyroid

Like the gut flora, the thyroid seems to be connected to everything, and anxiety is no exception. While hypOthyroidism (an underactive thyroid, resulting in a slower metabolism, easy weight gain, fatigue, and depression) is better known, hypERthyroidism (an overactive thyroid, resulting in a very fast metabolism, difficulty gaining weight, and anxiety) is also a possibility. Imagine it like driving a car: if a person with a normal thyroid is driving on the highway at 65mph, then a person with hypothyroid symptoms is creeping along at 35mph on that same road, but a person with hyperthyroid is whizzing past them both at 80 or 90 mph.

Driving at 90mph would be pretty nerve-wracking, and inside your body the consequences are similar. Sending everything into “overdrive” like that is understandably very stressful for your mind and your body, and hyperthyroid symptoms frequently first show up as panic attacks or other psychological problems. In this study, out of 33 patients with hyperthyroidism, 15 showed signs of anxiety unrelated to previous history of anxiety disorders (that’s a nearly 50% prevalence rate, compared to 18% in the general population). Especially if the anxiety shows up suddenly and without any obvious cause, this might be an option to look into.

Dietary factors that can contribute to hyperthyroid symptoms are very poorly understood. Massive iodine supplements could be a culprit, but the most common cause of hyperthyroid symptoms is an autoimmune disease called Graves’ Disease. Paleo already eliminates a lot of autoimmune trigger foods (especially grains), but an autoimmune Paleo diet (eliminating eggs, nuts/seeds, nightshade vegetables, and dairy) might be an avenue to look into here.

Putting it All Together: an Anti-Anxiety Diet

Piecing together the dietary clues (IBS, gluten, dairy, caffeine, fat…), it starts to become clear how a Paleo diet might help with anxiety issues: it touches on most of the major areas by default and can easily be adapted to the others. Just to summarize, here are some things to treat, eat, and delete:

Treat (if applicable):

  • Irritable Bowel Syndrome
  • Autoimmune disorders (hyperthyroid)
  • Gut flora dysfunction

Eat:

  • Enough fat, especially enough Omega-3 fats (from fish and seafood) and enough saturated fat and cholesterol.
  • Gut-healing foods: probiotics and bone broth.
  • Nutrient-dense foods, especially foods high in zinc and magnesium.

Delete:

  • Gut irritants like grains, legumes, and seed oils.
  • Caffeine.
  • Excess Omega-6 PUFA.

Lifestyle and Anxiety

Of course, the elephant in the room when you’re talking about diet and anxiety is lifestyle. If you have a high-stress lifestyle, even the most perfectly designed diet of anti-anxiety foods won’t make up for it. Diet might help you control the symptoms, but lifestyle interventions are unavoidable.

This isn’t the news most of us want to hear. Changes in diet are easier to squeeze into hectic schedules: after all, it doesn’t take any more time to eat a steak than it does to eat a plate of pasta. It’s a lot less drastic (and therefore a lot more comfortable and familiar) to change your diet. But if the problem is actually lifestyle, searching for the “perfect anti-anxiety food” is pointless: that time would be better spent meditating, sleeping, or otherwise managing stress instead of adding more of it.

Exercise has also been clinically shown to help reduce anxiety even more effectively than other types of treatment. So if you don’t already get your sweat on regularly, a brisk walk in the morning is a great place to start.

Conclusion

No one food or diet is a cure for anxiety. Even with the best diet in the world, some people will still need to seek out pharmaceutical therapies – and that’s OK. But given what we know about diet, the gut, and the brain, a Paleo diet seems like a pretty good bet as far as nutritional interventions go. It supplies high levels of the good stuff (Omega-3 fats, cholesterol, and nutrients) and more or less limits the bad stuff (Omega-6 PUFA and gut irritants of various types). Tweak it specifically for anxiety (by cutting out caffeine, for example), and it gets even better. Diet can’t fix everything, but diet can be the foundation to help you recover, and for that purpose, Paleo seems like one of the better options around.