Dr Karen Faisandier - The Integrative Practice Ltd - Wellington Central

If you're a human in 2022, then stress, anxiety, panic and worry are likely to have featured to some extent in your life over the past two years. These are natural responses to stressors that we all experience from time to time, but when these escalate and get in the way of life, they are one of the most common reasons people seek the help of a professional therapist. 

Pre-pandemic, anxiety disorders were found to affect around 1-in-4 Kiwis, however there is evidence that these rates have now increased. This is unsurprising given the role of chronic unremitting stress and the development of both physical and mental health symptoms. The current diagnostic manual, DSM-5, identifies several anxiety disorders including panic disorder, generalised anxiety, specific phobias (e.g., social anxiety or agoraphobia) and obsessive-compulsive disorder. These each involve a certain cluster of symptoms and level of severity that can include sleep disturbance, muscle tension, fight-or-flight activity, and accompanying anxious thoughts that relate to particular types of worries. There can also be substance- or medically-induced anxiety disorders (e.g., caffeine or alcohol induced anxiety, or anxiety induced by a struggling thyroid). People experiencing anxiety often do things to avoid or numb their psychological and physical discomfort - ultimately keeping the anxiety stuck - and may feel entirely overwhelmed and hopeless about their experience.

When experienced chronically, anxiety may also impact various systems in the body - the most obvious being the brain and nervous system. However these interact with multiple other systems including the gastrointestinal system, immune system, and endocrine (hormonal) system. As a result, chronic or repeated anxiety can contribute to physical health symptoms in any of these areas - such as thyroid or hormonal imbalances, impaired immune function and gut health woes like food sensitivities or irritable bowel syndrome. Multiple interacting factors are usually involved in developing an anxiety disorder though, and a typical treatment approach suggested by psychologists may include breathing or relaxation techniques, exercise and sleep interventions, and modalities like cognitive behavioural therapy or mindfulness-based therapies. These latter techniques help with the management or resolution of anxious thoughts, feelings and sensations and can address the avoidance or numbing techniques that can keep people stuck in anxiety. Some therapists use trauma-informed models (e.g. EMDR or somatic therapies) which are thought to work by clearing anxiety that may be “stuck” in the body, allowing anxiety to be processed so it is less physically or emotionally reactive.

The approach I use clinically is integrative, meaning it can include all the above techniques but also enlists dietary and lifestyle modification. A less understood aspect of anxiety is the contributing role of nutrition in causing or driving ongoing symptoms.  However in my experience, it can sometimes be the case that addressing a nutrient deficiency will result in the complete cessation of anxiety symptoms - even in the absence of any psychological intervention. For this reason I have come to suggest nutritional intervention early when it is indicated, so we can save time, and people can reclaim their life and focus on thriving, not just surviving. 

Nutritional interventions for mental health are what I consider to be low-hanging fruit. They help stabilise the body - sometimes resolving many symptoms - and better enables someone to explore deeper psychological change that may be desired.

One common example of a nutritional cause of anxiety I encounter that can sometimes feel like a magical fix is Iron deficiency - or more commonly, suboptimal Iron levels. The Iron reference range for menstruating women in New Zealand is very wide. This is helpful if you’re a doctor trying to detect the possibility of serious physical illness which will push values outside of the range. However, within the context of working toward optimal nutritional and mental health, it is less helpful. 

Let's take the example of Ferritin (Iron) where the range for pre-menopausal women is 20-200. As you can imagine, the woman who returns the result of 20 is going to feel very different from the woman who returns a result of 100! But both of these results will be deemed “normal” if the laboratory range is strictly used to assess nutritional adequacy and psychological symptoms are not considered as part of the picture. 

Early symptoms of sub-optimal Iron levels can include increased anxiety, low mood, fatigue and “brain fog” - symptoms I hear about regularly from people coming to see me. I have learned to look carefully at blood test results from women presenting with these symptoms and also to look at trends in their Iron levels over time. If they were returning Iron results of 85 three years ago when they were anxiety-free, and now their results are 22, then I will think carefully about whether, whilst technically “normal”, their nutrient levels may be contributing to their mental health concerns. What is normal for one person may be suboptimal for another. Addressing situations like these with gentle, affordable dietary and supplementation options that are easily undertaken by people at home can sometimes be the only intervention required to bring about rapid and dramatic improvement to mental wellness. 

While more commonly it is a combination of strategies from multiple domains - both integrative and traditional psychological techniques - that result in the most success and future proof someone against future episodes of anxiety, I highly recommend that people consider the role of nutrition in their symptoms. If you are struggling with anxiety, then there are various ways to assess whether you are low in key nutrients to find out how much of a role nutrition may play in your own mental health picture.  

This can include an assessment based on your psychological and physical symptoms over time, plus you can include blood tests for some of these nutrients as biomarkers to assess your baseline and monitor change over time.  Another way is to do a dietary assessment to see if you are consuming enough of each of the macro and micronutrients required and to check if there are any depleting substances like caffeine or alcohol, gluten for those with coeliac disease or non-coeliac gluten sensitivity, as well as certain medications which can block absorption. Gut health problems and having been through long-term stress can also impact on absorbing nutrients consumed even if the diet is abundant in healthful nutrients - and can be other reasons someone has become depleted.

Once you’ve identified and resolved a nutritional issue the question always has to be asked - how did I get here and how do I future proof myself?