Anxiety & Food

There may be a link between the western diet and anxiety. [1]  In a recent article published in the American Journal of Psychiatry, the authors conclude that a “traditional” dietary pattern characterized by vegetables, fruit, meat, fish and whole grains was associated with lower odds for major depression, dysthymia and anxiety disorders.  On the other hand, a “western” diet of processed or fried foods, refined grains, sugary products and beer was associated with a higher likelihood of such symptoms. 

Despite the abundant research linking systemic inflammation, oxidative stress and cortisol levels to psychiatric symptoms, little research is being carried out exploring the impact of functional foods on psychiatric malaise. [2]  One article suggests that foods that support mitochondrial efficiency may be useful. [3] Of course, caffeine consumption has been linked to anxiety. [4-7] But are we getting any closer to understanding the link between food and mood?

A recent study suggests that for certain individuals, stress may increase the hedonistic food appetite control mechanism. [8, 9]  High trait anxiety individuals, the study asserts, are more likely to respond to stress with the urge to consume sweet foods.  However, when these individuals consume alpha-lactalbumin (whey protein), the urge to eat sweet foods in response to stress is reduced. [10]  Apparently whey protein increases tryptophan levels, which in turn may modulate serotonin physiology. [10, 11]  Could this be a food to reduce emotional eating?

If we include herbs as food in this discussion, many other options emerge.  Kava-kava has long been recognized for its anxiolytic effects.  However, adverse reactions such as kava-dermatitis, liver damage and drug interactions have been reported, suggesting that it is not appropriate for clinical use by non-medical providers.[12-14]  St. John’s Wort is another herb with a strong history of psychiatric uses. One recent study suggests it may help reduce age related memory loss by “increasing the levels of cyclic adenosine 3′, 5′-monophosphate response element binding protein (CREB) and phosphorylated CREB (pCREB) in the hippocampus.”  Of course this research was in rats and there is no data to support human use for this purpose.[15] 

Numerous other herbs are common place either due to CAM providers prescribing them or due to self-use. This brings us to the observation that it is wise to routinely ask our patients what they are taking to avoid inadvertent interaction effects.[16, 17

I am interested in an herb called Ashwagandha.  It is an ayurvedic herb that has recently been shown to have anxiolytic and stress tolerance benefits and is safe and effective.  Is anyone else using this with patients?
Phytonutrients, botanicals, herbs and functional foods are rapidly moving into our clinical landscape.  One report suggests that 67% of persons suffering depression or anxiety may be using such alternatives to psychoactive drugs. [16] The tone of such articles is generally worrisome in that the implied value appears to be to minimize the risk of pharmaceuticals and magnify the risk of nutraceuticals.  I think that it is our job to discuss such risks candidly in the spirit of informed consent and to make every effort to stay current with the avalanche of research in our fields.  What do you think?  Please comment below.

1.    Jacka, F.N., et al., Association of Western and traditional diets with depression and anxiety in women. Am J Psychiatry, 2010. 167(3): p. 305-11.

2.    Wattanathorn, J., et al., Piperine, the potential functional food for mood and cognitive disorders. Food Chem Toxicol, 2008. 46(9): p. 3106-10.

3.    Casucci, G., V. Villani, and C. Finocchi, Therapeutic strategies in migraine patients with mood and anxiety disorders: physiopathological basis. Neurol Sci, 2010. 31 Suppl 1: p. S99-101.

4.    Luebbe, A.M. and D.J. Bell, Mountain Dew or mountain don’t?: a pilot investigation of caffeine use parameters and relations to depression and anxiety symptoms in 5th- and 10th-grade students. J Sch Health, 2009. 79(8): p. 380-7.

5.    Bruce, M., et al., Anxiogenic effects of caffeine in patients with anxiety disorders. Arch Gen Psychiatry, 1992. 49(11): p. 867-9.

6.    Mino, Y., et al., Caffeine consumption and anxiety and depressive symptomatology among medical students. Arukoru Kenkyuto Yakubutsu Ison, 1990. 25(6): p. 486-96.

7.    Mathew, R.J. and W.H. Wilson, Behavioral and cerebrovascular effects of caffeine in patients with anxiety disorders. Acta Psychiatr Scand, 1990. 82(1): p. 17-22.

8.    Neary, M.T. and R.L. Batterham, Gaining new insights into food reward with functional neuroimaging. Forum Nutr, 2010. 63: p. 152-63.

9.    Jesudason, D. and G. Wittert, Endocannabinoid system in food intake and metabolic regulation. Curr Opin Lipidol, 2008. 19(4): p. 344-8.

10.    Verschoor, E., et al., Effects of an acute alpha-lactalbumin manipulation on mood and food hedonics in high- and low-trait anxiety individuals. Br J Nutr, 2010. 104(4): p. 595-602.

11.    Orosco, M., et al., Alpha-lactalbumin-enriched diets enhance serotonin release and induce anxiolytic and rewarding effects in the rat. Behav Brain Res, 2004. 148(1-2): p. 1-10.

12.    Zhou, P., et al., Flavokawain B, the hepatotoxic constituent from kava root, induces GSH-sensitive oxidative stress through modulation of IKK/NF-{kappa}B and MAPK signaling pathways. FASEB J, 2010.

13.    Anke, J. and I. Ramzan, Pharmacokinetic and pharmacodynamic drug interactions with Kava (Piper methysticum Forst. f.). J Ethnopharmacol, 2004. 93(2-3): p. 153-60.

14.    Singh, Y.N. and N.N. Singh, Therapeutic potential of kava in the treatment of anxiety disorders. CNS Drugs, 2002. 16(11): p. 731-43.

15.    Trofimiuk, E., A. Holownia, and J.J. Braszko, Activation of CREB by St. John’s wort may diminish deletorious effects of aging on spatial memory. Arch Pharm Res, 2010. 33(3): p. 469-77.

16.    White, K.P., A crash course in Chinese herbology for the psychopharmocological prescriber. Exp Clin Psychopharmacol, 2009. 17(6): p. 384-95.

17.    Carrasco, M.C., et al., Interactions of Valeriana officinalis L. and Passiflora incarnata L. in a patient treated with lorazepam. Phytother Res, 2009. 23(12): p. 1795-6.

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