The information provided is not intended to be a substitute for medical advice from a licensed physician or other qualified healthcare professional.

Diet

• Follow a Mediterranean-type diet with adequate protein and good fat to stabilize blood sugar
• Reduce or remove refined sugar and starches [link]
• Reduce or remove foods that contain additives [link]
• Consider as a trial, removing gluten and dairy for 4 to 10 days

Substances

• Incrementally reduce alcohol, caffeine, and nicotine
• An appropriate approach is to reduce and eliminate only one substance at a time

Nutrients to supplement daily

• multivitamin/mineral or B-complex
• vitamin C
• magnesium

Further steps

• Look at identifying potential food allergies and avoiding suspect foods
• If you suspect blood-sugar issues, it may be tied to your anxiety. Refer to Hypoglycemia and Anxiety section

Additional nutrients to consider supplementing
(see each nutrient for food sources and dosing information)

• niacinamide
• vitamin B6
• vitamin B12
• zinc
• inositol

If you are taking medications

• Ask your doctor if they may be inducing your anxiety symptoms, and what can be done about it
• Research any associated nutrient depletions and consider supplementing those nutrients
• Do not discontinue taking medications without consulting with your doctor

If you suspect pyroluria

• refer to Pyroluria section for supplementing information

Seek qualified guidance

• Consider working with someone trained in Orthomolecular practice or Orthomolecular Psychiatry

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Supporting Interventions for Anxiety

Exercise

• Moderate exercise helps relieve anxiety symptoms (Petruzzello, Landers, Hatfield, Kubitz, & Salazar, 1991) and has been shown to influence brain serotonin (Dunn, & Dishman, 1991) and may promote increased release of endorphins .
• Evidence shows that aerobic exercise is more effective than stretching or weight training regimens (Rakel, 2012) for improving anxiety symptoms (Paluska, & Schwenk, 2000: Martinsen, Hoffart, & Solberg, 1989).
• Benefits of exercise on anxiety are dependent on the length of individual exercise sessions, and how long one continues with the sessions.
• Research shows that, for beneficial effect, exercise sessions need to be at least 12 minutes long (Moses, Steptoe, Mathews, & Edwards, 1989), with maximum benefit at 40 minutes per session (Paluska, & Schwenk, 2000)

Further reading

DeBoer, L. B., Powers, M. B., Utschig, A. C., Otto, M. W., & Smits, J. A. (2012). Exploring exercise as an avenue for the treatment of anxiety disorders. Expert Review of Neurotherapeutics, 12(8), 1011–1022. https://doi.org/10.1586/ern.12.73

Relaxation techniques

• Relaxation techniques can help address anxiety, especially when use in conjunction with other anxiety treatment approaches.
• Some techniques that can help address anxiety include mindfulness meditation (Hoge et al., 2013), yoga (Saeed, Cunningham,  & Bloch, 2019), massage, sound therapy, guided meditations, and hypnotherapy. 

Mindfullness

• Mindfulness meditation involves paying attention to the current moment, focusing on the breath, and bringing one’s awareness to the body. 
• Many studies show benefits of mindfullness and reduction of anxiety, for example:

Further reading

Hoge, E. A., Bui, E., Marques, L., Metcalf, C. A., Morris, L. K., Robinaugh, D. J., Worthington, J. J., Pollack, M. H., & Simon, N. M. (2013). Randomized Controlled Trial of Mindfulness Meditation for Generalized Anxiety Disorder: Effects on Anxiety and Stress Reactivity. The Journal of Clinical Psychiatry, 74(8), 786–792. https://doi.org/10.4088/JCP.12m08083

Saeed, S. A., Cunningham, K., & Bloch, R. M. (2019). Depression and Anxiety Disorders: Benefits of Exercise, Yoga, and Meditation. American Family Physician, 99(10), 620–627.

How to Meditate with Anxiety. (2019, June 12). Mindful. https://www.mindful.org/mindfulness-meditation-anxiety/