Q: I'm a 65-year-old woman with bad anxiety. It's worse at night and sometimes I can hardly sleep. My doctor has prescribed different medications but I'm sensitive to drugs and would love to find a safe, natural way to deal with this problem. -Elaine J., Tulsa, Okla.
A: Anxiety is a very real and unpleasant physiologic condition that is created by an overstimulation of the adrenal glands. These tiny organs, which sit above the kidneys, secrete potent hormones-including cortisol and adrenaline.
Adrenaline, as you probably already know, is the "fight or flight" hormone that can cause intense core vaso-constriction as blood is shunted to the brain and major running muscles. This temporary-but extreme-shift in blood flow causes many immediate symptoms, including sweaty palms, palpitations to the point of chest pain, shortness of breath, a level of vigilance that prohibits relaxation, inability to digest food, and inability to defecate.
Adrenaline is extremely useful in an emergency situation: It inhibits bleeding and creates a temporary, nearly superhuman ability to escape from danger. That was great back in the days when our ancestors were likely to stumble across a hungry saber-tooth tiger while they were out searching for food. Today, however, most of our stressors are less life-threatening-but more chronic. The daily traffic. A petty supervisor. Your teen hanging out with the wrong crowd. Money problems. Definite grounds for worry, to be sure, but nothing that a jolt of adrenaline can help you escape.
State of Calm
Anxiety medications are rarely, if ever, the answer-especially long-term. A well-designed study published in the Canadian Journal of Psychiatry followed 14,000 people who were using prescriptions for anxiety and found that they had a 36 percent greater risk of mortality than the general population. This is because many anxiety medications greatly increase the risk of accidents and suicide. The prescription drugs also significantly worsen sleep apnea, which increases the risk for heart attack.
Instead, the first step toward overcoming anxiety is often a few simple lifestyle changes. First, identify the major stressors in your life and take stock of what you can change. For instance, let go of "friends" that cause stress. Then, practice some form of slowing down the hectic pace of your life-even 5 nice deep slow breaths-every day. Exercise also helps. I like to commit weekly to 3 cardio sessions (brisk walking, running, or swimming), 2 stretch sessions (yoga, Pilates, or Tai Chi) and 1-2 strength sessions (free weights or machines at the gym). Also be sure to get enough sleep and drink plenty of water rather than overly sugared or caffeinated beverages.
Most everyone knows that B vitamins are called the "anti-stress" vitamins. A strong over-the-counter "stress B" blend will contain in the range of 50-100 mg of B1, B2, B3, B5 (the most important for adrenal health-also known as pantothenic acid), and B6 with 1,000-2,000 mcg of B12, and usually also 400-1,000 mcg of folic acid. Take one or two a day in the morning or during periods of high stress. Don't take B vitamins at night because they can be mildly stimulating for some.
All of these Bs are water soluble-you'll eliminate what your body can't absorb. And absorption is a problem for many. If you have been taking a good B multi for a while and can't say you notice any improvement with your anxiety, your body may not be properly absorbing your vitamins.
The lower part of the small intestine (the ileum) is where B vitamins are absorbed into the bloodstream, and any irritation to the lush "brush-border" of millions of microvillae in the ileum will compromise absorption. By far, the most common cause of villae abrasion is gluten. Dairy, corn, soy, coffee, peanuts, tomatoes, and shellfish are other likely culprits. Work with a naturopathic physician in your area (you can find one at naturopathic.org) to sort out food irritants and "leaky gut."
Of course, there is another type of B vitamins-the fat-soluble ones. These include lecithin, inositol, and phosphatidylcholine. I mention these because you can add 1 Tbs. of lecithin (unless you're allergic to soy, which is the source of most over-the-counter lecithin) daily to a smoothie or into yogurt or oatmeal. These fat-soluble B vitamins are the building blocks for the calming neurotransmitter acetylcholine, which promotes sleep, digestion, feelings of love and nurturing, and relaxation.
If you're prone to feeling anxious, and you also have a "spare tire" of extra fat around your middle, you're likely to be over-producing not only adrenaline, but also cortisol, a steroid hormone that happens to be the basis of several steroid drugs.
Cortisol (the natural secretion) is the body's anti-inflammatory, but just like the drug version, large amounts can mess with your appetite and blood sugar levels and proper energy conversion. In other words, steroids make you want to eat sugar, but then you store that sugar as fat, specifically triglycerides, which typically piles up around the heart, lungs, liver, and abdomen.
So if you are anxious and "apple-shaped," your body might have been overproducing cortisol, and you probably need to make use of some type of adrenal support. I prefer the Ayurvedic herb known as ashwagandha (also called Withania somnifera), as well as magnolia. These two plant medicines combined with phosphatidylcholine are featured in a product called Cortisol Manager from Integrative Therapeutics that I've found to be very helpful in alleviating stress, especially stress that also causes poor sleep.
These few simple supplements and lifestyle strategies should help with all cases of anxiety. But you also have to remember that changes will keep happening. That's the only sure thing in life, so it's important to be able to "roll with the punches." There's a nice saying: smooth sailing doesn't make for good sailors-and getting through the rough patches can make the good times that much sweeter.