Anxiety is defined as  “an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure,” according to American Psychological Association. Anxiety is common; some degree of worry affects everyone at some point in life.

But when symptoms are lasting and cause significant impairment, this could be a sign of a formal anxiety disorder that warrants being addressed. Anxiety is one of the most common mental disorders. Up to 20% of adults are affected by anxiety disorders each year which is more prevalent than many would guess.

Common symptoms of an anxiety disorder

• Chronic, excessive worrying
• Feeling restless or on edge
• Easily tired
• Difficulty concentrating
• Irritability
• Muscle tension (often linked to headaches)
• Gastrointestinal manifestations (such as diarrhea)

When to see a Physician for anxiety?

Contact your healthcare team when anxiety is affecting your daily life or causing you distress. Immediately call 9-1-1 if you are having thoughts of harming yourself. Anxiety is nothing to brush under the rug as there is a close relationship between anxiety and quality of life.

Why does anxiety happen in the first place?

The etiology for Anxiety can be multifactorial. The following non-modifiabile risk factors include chronic stress or trauma, genetics and other contributing factors as this is a non-exhaustive list.

There are modifiable risk factors that can influence anxiety, and I will be focusing on those for the context of this blog post. Modifiable risk factor means something we have some degree of control over. Each of these are nutrition or environmental or lifestyle related concerns can exacerbate anxiety:

• High dietary intake of processed foods
• Vitamin D deficiency as seen in bloodwork
• Inadequate magnesium intake
• Vitamin B12 deficiency as seen in bloodwork
• Copper Deficiency as seen in bloodwork
• Low iron stores or iron deficiency anemia as seen in bloodwork
• Gut dysbiosis as seen in a GIMAP test
• Low Progesterone as seen in a bloodwork or a urine DUTCH test
• Exposure to endocrine disruptors (personal care products)
• Living in toxic indoor mold in clinically significant amounts
• Heavy metal bioaccumulation (tap water, food, soil, air)

Now let’s take a look at each of these areas:

High intake of processed foods and Anxiety

There is an association between a high intake of processed foods and symptoms of anxiety. A diet high in processed foods means consuming foods that focus on extracted or synthesized ingredients. Some of the concerns of a highly processed diet include lack of fiber, high amounts of added sugars, and controversial additives. Examples of ultra processed foods include: white flour, pretzels, sugary breakfast cereals, reconstituted meat products, baked goods, etc. Any of these alone is not detrimental, but when the diet is primarily highly processed, it contributes to health problems.

This is a very complex topic that needs an overhaul on a systemic level in the United States. In an ideal society that is more supportive of health and its ease in pursuing, humans would be eating more local, whole foods as the mainstay. Whole foods are foods that are unprocessed and unrefined and have little to no additives. Some examples include: legumes, fruits, vegetables, whole grains, and tubers. A diet of less processed foods and more whole foods may help in the prevention or management of anxiety, and many other health concerns.

Vitamin D Deficiency and Anxiety

So much research confirms the relationship between vitamin D deficiency and anxiety. Many experts agree that when the vitamin D (25-hydroxy) labwork drops below a certain threshold measured in ng/dL (some argue less than 30 and some argue less than 20), then supplementation is warranted. There is emerging research that striving for vitamin D labs between 50-60ng/dL is more optimal for health. Anyone can self order vitamin D bloodwork (and I do recommend discussing your results with your healthcare team). Vitamin D Labwork can be performed at any Quest Labs for about $40 bucks! Once results are available, proper dosing is important from a safety perspective and it is dependent upon the results.

Most adults can safely take vitamin D3 at 1000IU per day as a maintenance dose and to help meet daily vitamin D needs, but you should check with your healthcare team before starting any supplement. If a vitamin D deficiency exists, then prescription strength vitamin D is most likely indicated. Addressing low vitamin D status can help in the management and prevention of anxiety.

Inadequate Magnesium Intake and Anxiety

Estimates show at least half of adults do not consume adequate magnesium, which is a mineral necessary for many functions in the body. Magnesium can affect almost all aspects of the nervous system, and deficiency is believed to play a role in anxiety symptoms. The recommended daily allowance (RDA) for adults for Magnesium intake is around 300mg per day, but the majority do not hit this amount consistently.

Research shows that magnesium glycinate is one of the best forms of magnesium for helping anxiety. Always check with your healthcare team, but magnesium supplementation is generally very safe and serious side effects are rare. This is a quality magnesium glycinate supplement I recommend.

Vitamin B12 Deficiency and Anxiety

Studies show people experiencing anxiety have lower levels of vitamin B12. Vitamin B12 is a vitamin that plays a role in many bodily functions, including the formation of red blood cells, nerve function, and DNA production – which are all linked to mood. If you’re experiencing symptoms of anxiety, having the following tested is a good idea: serum vitamin B12 (self order here), methylmalonic acid (MMA) and homocysteine. Both MMA and homocysteine compounds are elevated with vitamin B12 deficiency and are more sensitive predictors of deficiency than just a serum level of the vitamin B12. If these come back showing a problem, talk with your healthcare team about supplementation. Vitamin B12 supplements rarely cause side effects unless megadoses are taken. Many can safely take a supplement to help meet the dietary reference intake of vitamin B12. I always recommend Methylated forms of folate and Vitamin B-12 as they are more bioavailable.

Vitamin B12 is found primarily in animal foods, so if vegetarian or vegan, consider screening for a deficiency via bloodwork. Other risk factors for Vitamin B12 deficiency include being age 60 or older, having had bariatric surgery, having a gastrointestinal condition that impacts absorption of nutrients, or long term use of certain medications like Metformin or Omeprazole or other antacids. Talking with a dietitian in consultation too can be helpful to assess if you are getting enough from food intake and absorbing it well.

Iron Status and Anxiety

Iron is essential to the making of red blood cells, which carry oxygen to tissues and muscles. When there is low levels of iron, less oxygen gets to cells, keeping them from functioning properly and often leading to fatigue, weakness, and even anxiety. Research in the European Journal of Clinical Nutrition has shown that a ferritin level (stored iron form) was significantly lower in people with anxiety.

If you do have low iron levels, a dietitian can help optimize your iron intake through diet to help you reach optimal ferritin levels. If you’re not able to reach optimal levels through diet alone, an iron supplement may be needed and I would also recommend medical evaluation. There are varying degrees of iron status ranging from low iron stores to diagnostic iron deficiency anemia. Being evaluated is crucial, so proper dosing and interventions occur as iron supplements can cause iron overload which is dangerous to the human body. I think it’s important to also check copper, ceruloplasmin and retinol to see the interplay between all these nutrients and iron. Low copper and low retinol can be more deeply rooted culprits to a surface level presenting low ferritin. Self order and check the full panel here!

In addition to caring for the low iron levels, it is important to work with your healthcare team for a good work up to investigate why your iron panel is abnormal in the first place (like is it just decreased iron intake, or a GI bleed, or an underlying H. Pylori infection, etc or another nutrient deficiency like I said). Getting to the root cause of low iron status is crucial, and next working towards optimal iron status can help in management of anxiety.

Gut dysbiosis and Anxiety

It has long been known that the gut and brain have direct bi-directional communication, and research continues to link gut health and anxiety. Gut dysbiosis can be defined as an overgrowth of pathogenic or harmful bacteria, yeasts and/or parasites, and too few beneficial bacteria. Achieving and maintaining a normal, balanced gut microbiome is a nuanced topic and individualization is key and something best addressed in consultation.

Endocrine Disruptors and Anxiety

The endocrine system is a network of signaling via hormones that are critical to many of the body’s core functions, like growth and development, reproduction, metabolism, sleep, and stress and immune response. Endocrine disruptors do just that – disrupt the endocrine function – and are linked to anxiety and behavioral concerns. Some examples of endocrine disruptors includes:

• Pesticides
• Phthalates
• Parabens
• Perchlorate
• Heavy metals
• PFAS
• BPA and BPA alternatives

Our government (compared to Europe) moves slowly to regulate and ban endocrine disruptors, so here are things to help decrease endocrine disruptor exposure in daily life.

• Choose clothing, carpeting, furniture and curtains without stain- and water-resistant finishes or fire-retardant treatments.
• Use an air purifier when possible to help you lower your exposure to phthalates and PFAS
• Eat fresh, rather than processed or canned, food whenever possible.
• Aggressively Filter your drinking water, that you drink which can help remove PFAS and pesticides that you drink and filter your water you bathe in
  • Don’t believe me how bad tap water is and fridge filtered water? Check your water here at the EWG database. Fridge filters are glorified chlorine removers and don’t take out pharmaceuticals, PFAS, heavy metals,radium, chromium hexavalent….
• Use glass in the microwave and stainless steel for food storage. Avoid shatterproof plastic, PC 7, which can contain BPA, and flexible vinyl, PVC 3, which contains phthalates.
• Read product labels and avoid those that list the mystery blend of chemicals simply called “fragrance.” Use safe personal products like haircare and skincare that avoid ingredients that are endocrine disruptors and aim to get 100% organic.
• Use safe laundry detergent that does not use the common endocrine disruptors as ingredients that are found in most detergents sold at the grocery stores

Toxic indoor mold and Anxiety

It is a neurotoxin, hence it can cause anxiety. And yes “all homes have some mold,” but about 50% of all homes have significant levels that can impact health. You really should check your home with an ERMI – the medically acknowledged way to check your home for mold that has data behind it. Order an ERMI Kit (Get Kit # 1) and if the score is above 5, the the levels are contributing to health problems and next steps would be hiring a certified mold inspector and remediator to find the WHERE and WHY it grew.

Tackling indoor mold is a large topic that can’t be covered well in a blog so I would recommend checking out my Healing from Mold Online Program – the Step by Step Roadmap you didn’t know you needed.

Heavy metal bioaccumulation and Anxiety

Most people don’t have life threatening exposure,s but almost everyone has varying degrees of accumulation in their body. Heavy metals in low level, chronic amounts can disrupt neurotransmitters and neurotrophic proteins and can led to anxiety. There are many options to help detox it from the body, but I would highly recommend taking my Discerningly Detoxing Program for the fully story and protocols.

Thee above are all excellent “stones to overturn” as a relates to anxiety prevention and management from a wellness and lifestyle perspective.

Remember this: sometimes anxiety is not just psychological, but physiological.

*This website and blog is maintained by Katie Driessens, Owner of Dietetics with Driessens LLC, and all opinions are her own and for general educational purposes. Advertising, affiliate links or other forms of compensation are within this website and a small commission is earned for sales made through these links (with no extra cost to you) that help cover costs of running a small business. Products and services listed are prior carefully created and/or evaluated to ensure that they are accurate and supported by scientific evidence. Items or programs that are endorsed are based on Katie’s professional experience and expertise & are worthy of such endorsement. Dietetics with Driessens LLC assumes no responsibility or liability for damage or injury to persons arising from any use of any product, information, or opinion contained in the information of this blog, none of which is to be considered personal medical advice. By viewing, using, and shopping from this website, you agree to release Dietetics with Driessens LLC from full responsibility to the fullest extent allowed by law. Products & Services sold are not intended to diagnose, treat, cure any disease. Consult your physician before beginning any exercise, supplement, meal