Today’s post is much more than just an acknowledgement of Mental Health Awareness Month, which in and of itself is massively important.
It’s an acknowledgement of the massive spike in anxiety and depression in Canada during the COVID-19 pandemic.
It’s an acknowledgement of some of my own personal and professional struggles during this challenging period.
It’s an acknowledgement, above all else, that only a few years ago I lost my dear friend Josh to his own battle with mental illness.
Josh, for those who may not know, devoted his life to mental health research and was days away from wrapping up his work looking at the protective effects of antioxidant supplementation in mediating the side effects of anti-psychotic medication.
He was posthumously awarded a MSc for his tremendous efforts in the field.
This one’s for you dude!
An Intro To The Problem Of Anxiety
Global data suggests that more people are affected by anxiety disorders than any other mental illness, including depression.
Closer to home, the Canadian Mental Health Association suggests that approximately 5% of Canadians experience anxiety which leads to various degrees of impairment to their daily lives.
Let’s be clear here, 5% of a population of 37 million is no small number and when you consider both mood and anxiety disorders, this number jumps to closer to 12%.
According to Statistics Canada data, over 1/4 of those who deal with these conditions report saying their lives have been affected either “quite a bit” or “extremely” as a result.
Anxiety disorders can be both complex and crippling conditions and my goal for today’s article is to more closely explore what role dietary choices have to play in their prevention and/or management.
Let’s see what I learned.
Dietary Interventions & Anxiety Management – Three Areas Of Interest
Having recently explored its interaction with CBD, the topic of non-prescription anxiety management has certainly become one of great personal and professional curiosity.
While I don’t dare to suggest that dietary modification will ever be the most important intervention in this field, there is emerging evidence to suggest that food choices do play a meaningful role.
My exploration of the best available data led me to find this to be particularly true across three primary categories.
#1 – Probiotics & Fermented Foods
Given the emerging science in the world of the Gut-Brain Connection, it’s perhaps unsurprising that the research community continues to explore the use of probiotics as a potential complimentary management tool for anxiety disorders.
Although more definitive research will be required, multiple recently published systematic reviews and meta-analysis point to a role for probiotic supplementation as a means to reduce anxiety symptoms in a variety of contexts.
These include:
A 2020 paper out of Frontiers In Neurology
A 2019 paper out of Neuroscience And Biobehavioral Reviews
A 2020 paper out of the British Medical Journal
In each case we are looking at the suggestion that probiotic supplementation has a minor but meaningful impact on the symptoms of anxiety.
The state of the science is not such that we can confidently “prescribe” certain strains and guarantee a specific outcome, but there does appear to be something here worthy of future and more definitive exploration.
There is also evidence to suggest a connection between a reduction in anxiety and the consumption of fermented foods.
Commonly available fermented food items include yogurt, miso, kimchi, kombucha, tempeh and sauerkraut.
#2 Dietary Antioxidant Content
In popular nutrition discourse the word antioxidant is almost inevitably connected with good health and longevity.
This is an oversimplified but probably a fair connection to make, given that it is the foods that we tend to consider to be the most nutrient dense that also bring with them a high level of various antioxidant compounds.
These include conventional selections such as leafy green vegetables, all types of berries and other colourful food choices like beets, sweet potatoes and so on.
Other antioxidant rich food groups include items such as nuts, seeds and legumes and spices such as oregano, mint, turmeric, and cinnamon as well as beverages like coffee and green tea may also go under the radar.
But what role do these types of items have to play in the world of anxiety management?
Well, there is preliminary observational evidence to suggest a connection between dietary antioxidant content and anxiety severity and that those living with anxiety may have lower circulating levels of common dietary antioxidants such as vitamin A,C,E.
These findings have also been observed in different demographics.
With this knowledge in tow, it is perhaps unsurprising that fruit and vegetable intake as well as more plant-based eating on the whole are both associated with reductions in anxiety prevalence and severity.
While more definitive research in this area will be required, it’s hard to to deny that the general inclusion of more antioxidant rich foods wherever possible is probably a good practice to uphold.
#3 Omega-3 Fatty Acids & Vitamin D
Omega-3 fatty acids, also known as Omega-3s, are among the most popular topics in the world of nutrition.
They are revered for their anti-inflammatory capabilities ( which derives from the impact their presence in cell membranes has on cellular signalling) yet are quite elusive from the dietary perspective.
Considered essential because our bodies cannot synthesize them, Omega-3s occur naturally in very few foods.
Plant-based sources include flaxseeed, hemp seed, chia seed, walnuts as well as soy-based foods such as tofu to a lesser extent.
These foods contain the omega-3 fatty acid known as ALA which is weakly converted to the more prominent long-chain omega-3s known as EPA and DHA.
Marine-based sources include most varieties of fish but especially fatty varieties such as salmon, herring, mackerel, trout, sardines.
It is the marine-based versions of omega-3s, which can also be acquired via algae-based supplements, that tend to garner the most attention.
It’s important to note that fish are also uniquely rich sources of vitamin D, a nutrient which is easy to fall short in and may play a role in anxiety management in some populations.
Perhaps unsurprisingly, fish intake has associated with a reduced risk of suffering from anxiety in certain populations ( women, pregnant women).
We have to be honest in saying that it would be very easy for one to carry out what superficially appeared to be a strong dietary pattern, omit these foods, and find themselves lacking in both vitamin D and omega-3 fatty acids as a result.
This is problematic from both the general and mental health perspective, especially considering the growing body of evidence identifying omega-3 fatty acids as potentially protective against the symptoms of anxiety.
A randomized controlled trial from a 2011 paper out of the Brain, Behavior & Immunity journal found, for example, found that omega-3 supplementation reduced anxiety in medical students.
This quote, taken from a 2018 paper out of Frontiers In Physiology best captures the state of the evidence:
“[S]ummarized literature indicate that low ω3 PUFAs intake may predispose certain individuals to depression and anxiety and that dietary supplementation with LC ω3 PUFAs represents an interesting strategy for preventing or treating depression and anxiety disorders in certain individuals.”
Final Thoughts
The prevention, management and treatment of anxiety disorders go well beyond the world of food, yet we cannot turn a blind eye to the potential protective effects of certain dietary components.
I will strive to continue to pursue a high level of understanding of the connection between nutrition and mental health in order to honour both my dearly departed friend Josh and the hundreds of millions worldwide who may benefit from attacking the problem from every available angle.
Until next time,
Andy De Santis RD MPH
