Diet and Nutritional Supplements in Stress, Anxiety and Depression:
Important Note: The following information is for educational purposes only and is NOT meant to take the place of medical advice. Always discuss medical questions with your personal physician or health care provider.
Vitamins:
Vitamin B6 (50-200 mg per day) may alleviate depression, fatigue, anxiety, and many of the emotional symptoms which are associated with menopause or PMS. Vitamin B6, chromium, and tryptophan are serotonin potentiators, and facilitate the synthesis of the neurotransmitter serotonin by the hormone insulin. Because serotonin potentiators theoretically act as partial antidepressants, 1255 they may be beneficial in the treatment of depression by reducing the anxiety/agressive component of the depressive syndrome. Supplementation with chromium and vanadium may be beneficial in patients suffering from depression which is accompanied by hypoglycemia. A history of chromium and vanadium deficiencies and hypoglycemia (which may be caused or exacerbated by these mineral deficiencies) is present in many patients with clinical depression. 1267
Several studies have shown improvements in sleep or the quality of sleep following supplementation with vitamin B1, and inositol. The sleeping patterns of 198 of 200 patients (99%) improved after magnesium supplementation in one experimental study. In addition, anxiety and tension were diminished during the day. 1119 Sleep patterns of a group of women aged 18-81 were related to whether their magnesium intake was low (less than 100 mg/day) or high (more than 300 mg/day), and whether their aluminum intake was low (less than 1 mg/day) or high (more than 1,000 mg/day). A high magnesium, low aluminum diet was associated with high quality sleep time and few night-time awakenings. 1122
Quasivitamins and minerals:
Pyridoxine, chromium, and tryptophan are recognized as serotonin potentiators. Because serotonin potentiators theoretically act as partial antidepressants, 1255 they may be beneficial in the treatment of depression by reducing the anxiety/agressive component of the depressive syndrome. The amino acid tryptophan is a serotonin precursor, and supplements or foods rich in tryptophan boost serotonin levels in the brain. Paradoxically, diets high in carbohydrates increase blood serotonin levels more effectively that diets rich in protein foods. Starchy and sweet foods increase blood glucose levels, which trigger the pancreas to release insulin. Insulin increases cellular permeability to glucose and lowers blood glucose levels as glucose migrates from the blood to the tissues. Similarly, cellular permeability to other amino acids (with the exception of tryptophan) is increased. This reduces blood levels of other competing amino acids, and allows latent blood levels of trypotphan unhindered access to the brain where it is transformed into serotonin. Enterochromaffin cells located in the small intestine detect emetogenic stimuli and release serotonin, which causes nausea and vomiting. Acetylcholine precursors such as lecithin and choline will increase brain acetylcholine and may be effective in patients with hyperkinesis or inability to concentrate. The herb kava kava has a calming effect in nervous syndromes and certain agitated states. Phenylalanine is an effective and quick remedy for a wide variety of depressive illnesses, including the depressive phase of manic depressive illness, as well as endogenous, schizophrenic, and post-amphetamine depression. 1016 Tyrosine is a natural monoamine precursor for the neurotransmittors dopamine and norepinephrine, and consumption of tyrosine increases levels of these neurochemicals. Increases in these neurotransmitters have been associated with antidepressive effects, and is the mechanism of action of tyrosine's antidepressive effects. Research suggests that certain phytochemicals such as polymannans found in aloe vera may be beneficial in the treatment of depression. An unpublished study was recently conducted by Kaats G, Pullin D, and Parker L, et al at Baylor College of Medicine in Houston, Texas which followed 528 subjects (68% female, average age 50.5; 32% male, average age 53.1) for 4 to 8 weeks to study the effects of a polymannan derivative of aloe vera or placebo in conjunction with lifestyle modification. Four hundred and twenty eight of these subjects took the active polymannan supplement, while 100 subjects were given placebo.
In the active treatment groups, subjects self-reported significant improvement in numerous medical conditions including depression. Choline supplementation, 1016 thiamine and vitamin B6 have shown some beneficial effects in clinical depression. Vitamin B12 levels may be deficient in psychiatric patients and in the clinically depressed, and supplementation may be beneficial in depression. 1251, 1252, 1253, 1254 Research conducted at the University of Pennsylvania suggests that capsaicin stimulation may cause the release of endorphins within the brain, combatting depression by producing a feeling of well being or mild euphoria. Some limited scientific research suggests that DHEA may be beneficial in the treatment of depression.
Insomnia:
The amino acid L-tryptophan (in doses ranging between 1,000 mg to 2,000 mg) has shown significant benefit in treating insomnia, although supplemental forms are no longer commercially available in the United States. Natural sources of tryptophan should be consumed in combination with complex carbohydrates (i.e. pasta, bread, potatoes), 1121 and taken in conjunction with vitamin B6 (100 mg), niacinamide (100 mg), 1085 vitamin C (1,000 mg), vitamin B12 (1,000 µg HS, or 1.5 mg TID), 1016, 1120 calcium, (1,000 mg QD), 1085 and magnesium (500 mg QD). Melatonin is a non-prescription, natural human hormone (produced by the pineal gland) which regulates the body's internal circadian or biological rhythms governing sleep/wake cycles, body temperature, and stress response. Supplementation can improve sleep disorders in deficient individuals (2-3 mg H.S.). 1112, 1117, 1118 In one experimental study, melatonin significantly decreased the time subjects were awake before sleep onset, decreased the number of awakenings during sleep, and increased daytime alertness and energy levels. 1112 Inositol may be beneficial in certain individuals in the treatment of anxiety and insomnia which may be associated with stress. 1376 Anecdotal data and a few limited studies sugest that herbal extracts of hops flower may be effective in the treatment of resistant insomnia. Hawthorn, valerian, and kava kava have been used effectively in the treatment of insomnia. Peppermint, ginseing, turkey, and milk are among the foods or herbs that may alleviate insomnia. 1085 Research suggests that certain phytochemicals such as polymannans found in aloe vera may be beneficial in the treatment of insomnia. An unpublished study was recently conducted by Kaats G, Pullin D, and Parker L, et al at Baylor College of Medicine in Houston, Texas which followed 528 subjects (68% female, average age 50.5; 32% male, average age 53.1) for 4 to 8 weeks to study the effects of a polymmanan derivative of aloe vera or placebo in conjunction with lifestyle modification. Four hundred and twenty eight of these subjects took the active polymannan supplement, while 100 subjects were given placebo. In the active treatment groups, subjects self-reported significant improvement in numerous medical conditions including insomnia.
Diet:
A high protein diet (which supplies a wide range of amino acids) may be beneficial in patients suffering from depression.
FOODS RICH IN THE FOLLOWING VITAMINS AND MINERALS: Investigators at the University of Miami School of Medicine found that vitamin B6 deficiency is linked to increased psychological stress, especially in depressive symptoms. Selenium supplementation may be beneficial for mood elevation, depressive syndromes, and memory improvement. In one recent study conducted by the U.S. Department of Agriculture, men whose diets were rich in selenium reported feeling "clear headed and elated," reported an upswing in their mood, and improved general outlook on life. Men on low selenium diets felt that their moods had deteriorated over the course of the experiment.
Vitamin B6, chromium, and tryptophan are serotonin potentiators, and facilitate the synthesis of the neurotransmitter serotonin by the hormone insulin. Because serotonin potentiators theoretically act as partial antidepressants, 1255 they may be beneficial in the treatment of depression by reducing the anxiety/agressive component of the depressive syndrome. Supplementation with chromium and vanadium may be beneficial in patients suffering from depression which is accompanied by hypoglycemia. A history of chromium and vanadium deficiencies and hypoglycemia (which may be caused or exacerbated by these mineral deficiencies) is present in many patients with clinical depression. 1267
Lithium concentrations in American soils are significantly lower than the average levels recorded during the first decades of this century. The reduction in soil lithium content has been accompanied with a significant increase in the incidence of depression and depressive syndromes in the United States. Lithium deficiency can be aggrevated by a diet high in refined carbohydrates and sugar.
Contributory Factors to Anxiety, Stress, Depression, and Insomnia:
Sunlight suppresses the body's production of melatonin, the hormone which causes sleepiness. Without sufficient natural sunlight (especially during the winter months) some individuals suffer from seasonal affective disorder (SAD) which is a form of depression that may lead to fatigue. Stress has been shown to significantly increase cortisol levels. Feelings of entrapment cause cortisol levels to rise, and elevated cortisol levels are a common finding in clinical depression. In humans, cortisol levels are indirectly proportional to the perceived degree of control over psychological stressors. 10, 225 Chronically increased adrenaline levels (secondary to stress) may contribute to depression, increased alcohol, tobacco, and coffee consumption, poor nutrition, and depletion of tissue antioxidant vitamins. Depression and poor diet can play a role in the development of arthritis. At the Stanford University School of Medicine, a study found that arthritis patients who underwent psychological intervention for depression reported less pain and suffered less joint swelling than did patients who did not receive any intervention. Excessive use of the artificial sweetener aspartame may cause depression. At the World Environmental Congress, a keynote lecturer stated that when products containing the artificial sweetener aspartame are subjected to heating, a minute quantity of methyl alcohol (or wood alcohol) is produced. Methyl alcohol undergoes oxidation to form formaldehyde which then may be converted to toxic formic acid, resulting in metabolic acidosis and a host of serious physical complaints such as multiple sclerosis (which is often a misdiagnosis for chronic methanol toxicity), systemic lupus, symptoms of fibromyalgia, spasms, shooting pains, numbness in legs, cramps, vertigo, dizziness, severe headaches, tinnitus, joint pain (occasionally misdiagnosed as arthritis), depression, anxiety attacks, slurred speech, blurred vision, and memory loss. It has been the subject of more "adverse reaction reports" to the Food and Drug Administration than any other food additive in history. According to the FDA Consumer (Folkenberg, J.; Oct, 1988: pp.16-17), which compiles statistics on reported illnesses from food ingredients and supplements, 80% of all consumer illness complaints reported to the agency were caused by aspartame. Vincent Felitti (of the Kaiser Permanente medical group in San Diego) and colleagues, interviewed 9,000 people about their health and found that instances of childhood abuse were closely linked to a variety of health problems in adulthood. Those respondents who had been abused also had four to 12-fold increased risks for depression, suicide attempts, alcoholism, and drug abuse. In addition, they were two to four times more likely to smoke, to be generally ill, and to have had more than 50 sex partners and sexually transmitted diseases.
Contributory Factors for Insomnia:
Stress, hormonal imbalance, nutritional deficiency.
Contributory Nutrient Side-effect or Contraindicated nutrient:
Anxiety:
Excessive intake of copper has resulted in schizophrenic behavior. 1099 Estrogen promotes increased absorption of copper from the small intestine, as well as the formation of additional copper-binding proteins. This absorption of excess copper has been demonstrated to cause headaches, insomnia, depression, and worsen hypertension among women with these conditions treated with oral contraceptives or estrogens. 1099 Acetylcholine precursors such as choline should not be used in the depressive phase of manic-depressive psychosis, since they have the potential to deepen this specific type of depression. 1016
Excessive caffeine (or guarana) consumption can cause flushing of the face, palpitations of the heart, high blood pressure, tremors, anxiety, nervousness, sweating, heartburn, and insomnia.
Insomnia:
Excess copper can lower zinc levels and lead to insomnia. 1099, 1112, 1117, 1118 Estrogen promotes increased absorption of copper from the small intestine, as well as the formation of additional copper-binding proteins. This absorption of excess copper has been demonstrated to cause headaches, insomnia, depression, and worsen hypertension among women with these conditions treated with oral contraceptives or estrogens. 1099 Ephedrine supplementation can increase circulating catecholamines which result in sleeplessness. Substances which are thermogenic may occasionally cause difficulty in falling asleep or insomnia if taken late in the day. There are occasional reports of sleep disturbances and insomnia due to the stimulation of energy by DHEA. Supplementation only in the morning can usually prevent this side effect.
Lifestyle effects upon anxiety, depression, stress and insomnia:
Anxiety:
The American Psychosomatic Society cautions that clinical depression is associated with cholesterol reduction therapies, however this finding may have been due to the types of agents used. Several large trials with dietary interventions, (i.e. Lifestyle Heart Trial (LHT)), nicotinic acid, and HMG Co-A reductase inhibitors did not reproduce this finding. Additionally, studies of animals on extreme fat-restricted diets noted increases in aggressive behavior rather than in passive behavior more frequently associated with depressive states. 225 Acupuncture has been shown to have an antidepressant effect in some studies.
Scientific data suggests that smoking may adversely effect an individual's ability to cope with stressful life situations. Epstein and Perkins 496 stated that smoking reduces anxiety and sensitivity to unpleasant situations which may lead to "increased and extended attempts to actively cope with ongoing stressful tasks to the point where coping becomes physiologically maladaptive." Experiencing psychological stress frequently leads to increased smoking for subjective stress reduction, 496, 791 however smoking exacerbates stress-induced increases in autonomic nervous system activity, and increases serum catecholamines. 496, 699, 788 Gilbert 789 called this differential effect of smoking on specific psychological and subjective responses the "nicotine paradox".
In an on-going study conducted at Johns Hopkins University by M.J. Klag et al of over 1,000 men who were enrolled at age 22 and followed for up to 46 years, those young men who were identified as having the hottest tempers upon enrollment were three times more likely to suffer myocardial infarction or stroke during their middle age than their calmer counterparts. Research has confirmed that emotional stress is associated with angina and silent myocardial ischemia, 351, 692, 714, 718, 737, 768, 770, 771, 772, 773 coronary atherosclerosis, 688, 689, 690, 739 myocardial infarction, 688, 689, 690, 706, 707, 711, 713 left ventricular hypertrophy, 701 transient left ventricular dysfunction, 351, 774 arrhythmias, 225, 351, 493, 700, 738, 775, 776, 777, 778, 779 and sudden death. 225, 351, 493, 738, 776, 777, 780 Stress causes metabolic changes which can increase cardiovascular risk, 10, 145, 148, 149, 150, 225, 495, 688, 689, 690, 691, 692, 693, 694, 695, 696, 697 and these changes are mediated largely by increases in cortisol or serum catacholamines. 225, 351, 492, 493, 494, 495, 697, 699, 700, 741 Stress also has a direct effect on the initiation and continuance of other known (and possible) coronary risk behaviors such as cigarette smoking, 225, 246, 493, 496, 736, 755, 756, 764 poor nutrition, 739 depression, 225 inhibition of immune system response, 281 inability to schedule or avoidance of exercise, excessive alcohol consumption (contributing to loss of critical electrolytes such as magnesium and potassium, alcoholic cardiomyopathies, and cardiac arrhythmias), 493, 738, 764 drug abuse, excessive coffee consumption (contributing to increased risk of cardiac arrhythmias through increased catecholamine release and electrolyte loss resulting from diuresis), 207 and obesity. 10, 80 According to the March of Dimes Birth Defects Foundation, stress experienced by couples who are attempting pregnancy may decrease the chance of a healthy pregnancy and delivery.
Freeman and colleagues 229 demonstrated that cardiac patients under stress experienced significantly more asymptomatic ischemia, and those with higher levels of urinary cortisol and norepinephrine had a significantly greater number of ischemic episodes. Similarly, Rozanski and co-workers 714 found that silent or painful myocardial ischemia was easily induced by mental stress testing among patients with CAD. Coumel and Leenhardt 700 suggested that strong emotion and panic produce a powerful adrenergic stimulation capable of producing cardiac arrhythmias in patients with underlying heart disease. This finding has been supported by other research. 351, 493, 714, 735, 738 Even patients without underlying CAD may respond to stress with increases in catacholamines, heart rate, and subsequent changes in the electrical irritability of the heart which may predispose to sudden death. 230 Researchers at the Stanford University school of medicine and in Montreal, Canada have demonstrated that training to relieve feelings of anger and hostility can reduce the risk of repeat myocardial infarctions. 1110
The stress hormones epinephrine (adrenaline), norephinephrine, and cortisol are beneficial in fight or flight situations which threaten life or safety. During these (or any psychological stress situation) the brain floods the circulatory system with these chemicals to prepare the body to vigorously confront the threat or to rapidly flee from it. Even in the absense of external stimulation, the body can elicit these reactions in response to the self-talk, or internalized dialogue within our minds.1138 Heart rate increases and vasoconstriction (the body's mechanisms to increase energy and strength and to reduce blood loss in the event of injury) can serve to increase risk of cardiovascular events in susceptable individuals. Chronic stressful situations or lifestyles can result in high levels of circulating stress hormones which may ultimately lead to hypertension or cause damage to the heart muscle in the form of contraction band necrosis (which can predispose an individual to a significantly greater risk of sudden death). 10 Chronic levels of stress and agitation can also do damage to the immune system. 1110 Numerous scientific studies have demonstrated that individuals who where classified by researchers as "most hostile," or who had less support of friends and family or had poor social networks had significantly lower natural killer cell activity, reduced immune function, were more likely to fall prey to viral infections, and suffered from higher rates of mortality from the diseases they contracted.
Hostile individuals are significantly more likely to abuse alcohol, smoke, and over-eat than are the more sedate personalities, all of which may contribute to the increased risk of cardiovascular disease or death among persons exhibiting high levels of hostility. 742
In the 1920s, Walter Cannon was the first to describe the "fight or flight" response, and in the following decade, Wilhelm Raab, demonstrated the effects of, and risks associated with adrenaline and cortisol during this response. 10 In 1939, Alexander 350 theorized that anger and anxious emotional states could lead acutely to blood pressure elevations, and chronically to established hypertension. In 1956, Hans Seyle popularized the term "stress" and increased the general public awareness of the detrimental effects of stress on human health in his widely-read book, The Stress of Life. 58 Seyle called stress "the salt of life", and defined it as the nonspecific response of the body to any demand. 145, 146, 147 He demonstrated that stress contributed to illness and death in animals, and postulated that the same effects may occur in humans. Friedman and Rosenbaum were some of the first researchers to demonstrate and publish proof of this association in their 1974 work, Type-A Behavior and Your Heart. 57 They defined "Type-A behavior" as verbal and non-verbal behavior characterized by impatience, anxiety, and hostility. In 1980, a scientific panel convened by the National Institutes of Health concluded that Type-A behavior is a risk factor equal to, or greater than any other risk factor for coronary artery disease. 10 Eliot and co-workers 148, 149 demonstrated that "hot reactor" patients who had exaggerated responses to mental stress (as evidenced by significant increases in total peripheral vascular resistance, and accompanied by no change or a decrease in cardiac output) were at high risk for severe cardiovascular disease. Verrier and Dickerson 741 have demonstrated in animal studies that in the presence of coronary stenosis, heart rate acceleration secondary to psychological responses of fear or anger is associated with substantial increases in coronary vascular resistance and a decrease in coronary artery blood flow, and numerous other researchers have identified subsets of patients suffering from CAD who display exaggerated heart rate, blood pressure, cardiac output, and vasomotor responses to mental stress. 700, 714, 735, 737, 738 In an investigation of 63 patients with coronary artery disease, L'Abbate and co-workers 737 determined that psychological stress significantly increased myocardial oxygen demand (by increasing heart rate and blood pressure), while simultaneously decreasing myocardial oxygen supply (by increasing coronary vasomotor tone and reducing coronary blood flow at the level of the microcirculation). Ansel Keys, in a 23-year prospective study, 150 demonstrated that an exaggerated hypertensive response to environmental stress (a cold-pressor test) was the best single predictor for the future development of CAD.
Coronary artery disease may leave an individual more susceptible to the damaging effects of uncontrolled rage and emotional stress. 495 In a recent study reported in the American Journal of Cardiology, researchers asked patients undergoing cardiac catheterization to recall incidents that angered them. Researchers were angiographically able to document a significant narrowing of diseased coronary arteries during the anger recall. Healthy arteries with undamaged intima and without visible atherosclerotic narrowing showed no significant response to anger. While stress can hasten the development of CAD, unresolved anger may be one of the trigger mechanism which predisposes atherosclerotic coronary vessels to vasospasm and possible myocardial infarction. Thus, while smoking, lack of exercise, and the effect of a poor diet may take decades to exert their detrimental effect on coronary health, unresolved anger has the potential for more immediate and acute effects.
Because individual differences in perception and coping skills vary greatly, it is difficult to define any particular set of conditions as inherently stressful, and many clinical studies structured to detect associations between stress and certain cardiovascular risk factors have been unsuccessful due to differences in coping styles among subjects. 736 In a 1992 review of the clinical literature, Niaura and Goldstein 351 documented a strong correlation between poor anger coping styles and the presence of hypertension. These researchers also noted a high degree of correlation between the presence of hypertension and an individual's unsuccessful attempts to actively cope with stressors not within his or her control. Sommers-Flannagan and Greenburg, in their 1989 review 353 of the relationship between psychosocial variables and hypertension, reported a strong and consistent relationship between the degree of anger and subsequent blood pressure elevation. Markovitz and co-workers 250 examined a large cohort of men and women from the extensive Framingham Heart Study database who were normotensive at baseline, and followed this group for as long as two decades. Their research suggested that long-term anxiety, rather than a tendency to explosive anger itself, was most predictive of the future development of hypertension.
Environmental stressors can also increase cardiovascular risk. 145, 170, 234, 238 In epidemiologic studies, an association between environmental noise (traffic noise, aircraft take-offs and landings) and blood pressure elevations has been demonstrated. 145, 170 Harburg et al 234 found that hypertension was more prevalent among blacks living in the most high-stress areas of urban Detroit than among blacks living in areas with lower levels of crime and civil unrest. In a nine-year follow-up study by Berkman and co-workers, 238 which compared an area of poverty with an affluent area, the incidence of hypertension was 50% higher in the poor area, regardless of social interaction, availability of medical care, smoking or other identified CAD risk factors. Among a group of more affluent people who chose to live in the poverty area, the pattern of hypertension was more closely related to that seen within the poor area, rather than to that of a group with a similar income living in the affluent area. Interviews with these individuals revealed fears of robbery, injury and violence, and there was evidence that the distribution of hypertension correlated directly with the number of police, ambulance, and fire department calls. Epidemiologic studies and anecdotal reports suggest that hypercholesterolemia, and menopausal symptoms frequently respond well to a regimen of stress reduction.
Insomnia:
Deficiencies of vitamin B1 and inositol may be caused by high stress; high protein or low calorie diet; diabetes; and antibiotic medications, and these deficiencies may cause insomnia. Prescription or non-prescription drugs containing caffeine, ephedrine, aminophylline, norepinephrine, or amphetamine frequently disturb sleep. Alcoholism, excessive alcohol consumption, (three or more drinks per night), anxiety, depression, coffee, cola, or chocolate consumption in the late evening, stress, cigarette smoking, and lack of exercise may all lead to insomnia.
This material is excerpted from my doctoral dissertation
References for the footnotes above
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