A paper published by the Canadian College of Naturopathic Medicine last month supports what I see with my clients on a daily basis: when it comes to anxiety caused by low blood sugar (or hypoglycemia) the correct diet can have a huge impact. And this means is the inclusion of enough protein, fats and fiber, especially at breakfast.
Here is the abstract from the paper: Generalized Anxiety Disorder and Hypoglycemia Symptoms Improved with Diet Modification
Observational evidence suggests that a relationship may exist between high glycemic index diets and the development of anxiety and depression symptoms; however, as no interventional studies assessing this relationship in a psychiatric population have been completed, the possibility of a causal link is unclear.
AB is a 15-year-old female who presented with concerns of generalized anxiety disorder and hypoglycemia symptoms. Her diet consisted primarily of refined carbohydrates. The addition of protein, fat, and fiber to her diet resulted in a substantial decrease in anxiety symptoms as well as a decrease in the frequency and severity of hypoglycemia symptoms.
A brief return to her previous diet caused a return of her anxiety symptoms, followed by improvement when she restarted the prescribed diet.
This case strengthens the hypothesis that dietary glycemic index may play a role in the pathogenesis or progression of mental illnesses such as generalized anxiety disorder and subsequently that dietary modification as a therapeutic intervention in the treatment of mental illness warrants further study.
Here are some details about this case report for AB, who was a 15-year-old female student of south-Asian descent:
- she had anxiety (rated as 8/10 with 10 being the highest level of anxiety), worried excessively, experienced heart palpitations, shakiness, discomfort in her stomach, and muscle tension and often missed school because of how she felt
- she experienced symptoms of hypoglycemia/low blood sugar and when her blood sugar dipped too low she experienced muscle weakness, headaches, nausea, anxiety, and poor concentration
- when she felt anxious she would eat she would eat chocolate, chips, fruit and when her blood sugar dipped she would eat a granola bar
As you can see from her typical daily diet she was eating mostly carbohydrates, with very little protein, fat or fiber:
- Breakfast: fruit smoothie containing fruit, fruit juice, and water.
- Morning snack: bagel with margarine.
- Lunch: pasta or white rice with vegetables.
- Afternoon snack: granola bar or cookies or gummy candies.
- After school meal: white pasta; it may include meat.
- Dinner: white rice or spaghetti; it may include meat.
- Evening snack: cookies and toast.
- Beverages: 2 liters of water, 1 cup of juice, 1 cup of lactose-free milk, and 1 cup of tea.
She made the following changes in her diet adding protein at breakfast, lunch, dinner and at snack time, and adding healthy fats like flax seeds, olive oil and nut butters:
- Breakfast: includes a smoothie containing fruit, water, 1 scoop of protein powder, and 1 tablespoon of flax seeds or olive oil.
- Lunch and dinner: include a serving of protein (meat, legume, and soy) and a serving of vegetables.
- Snacks: include protein when possible (e.g., apple with sunflower seed butter, vegetable sticks with hummus, and pumpkin seeds).
- Continue to eat carbohydrate-containing snacks as needed for the management of hypoglycemia symptoms.
Over a 4-week period she made a few simple dietary changes and saw profound results: her anxiety decreased significantly from 8/10 to 4 or 5/10, she had more energy, she had fewer headaches, better concentration and improved mood.
The interesting factor is that when she slipped up for a week and went back to her old diet she felt more anxious within a day, but felt better within 2 days of adding back protein, fats and fiber.
These results are very typical with my clients and getting a handle on stabilizing blood sugar is the first thing I do with all my clients. Believe it or not, for some people this is ALL they need to do. I would add that I recommend making these changes in conjunction with the removal of gluten and caffeine.
I also like to see animal protein (and fat) as part of the snacks: like grass-fed beef jerky, grass-fed beef sticks, boiled eggs or pemmican. AB was allergic to eggs, nuts, and fish so these were not an option for her. Soy is often as issue so would need to be watched.
So this case study supports the fact that we must not forget the basics like blood sugar control. It’s very common for me to get questions like this on my blog: “I’m anxious, which amino acid should I use?” I always reply: focus first on real whole food and eating to balance blood sugar, remove sugar, gluten and caffeine, and then look at doing a trial of one or more of the amino acids
I do like to make things easier for my clients and this is where an amino acid like glutamine is very helpful in terms of providing added blood sugar stability, a calming effect and help with gut healing
Adding the glutamine and also doing a trial of an amino acid like GABA Calm may get the anxiety down a few more notches because we are always aiming for zero.
Addressing adrenal issues (which are closely related to blood sugar issues), and of course addressing all the other possible factors like thyroid health, gut health, other food sensitivities and so on would be the next step.
Have you see the positive impacts of keeping your blood sugar stable? What makes the most impact for you?
If you are a practitioner, how do you help your clients or patients address blood sugar issues?
