For many of you this is a much anticipated newsletter, thank you for your patience. It has been a busy year at the Children's Center for OCD and Anxiety, your hosts for this site. As we start the new school year we have moved into a new space, and have expanded our staff. In our continued effort to find safe, effective treatments for anxious children and adolescents, we have also expanded the types of treatments we offer to our families. This fall two new treatment modalities - homeopathy and cranial sacral massage - will be available to the children and families we see. While new to many of us, homeopathy has been in existence for at least 200 years, curing conditions using remedies that are prepared from natural substances to precise standards that work by stimulating the body's own healing powers. Cranial Sacral Massage is a specific type of massage for dysfunctions that can develop within the cranial/sacral system. Both of these treatment modalities address anxiety by looking at the whole child, whole body and targeting either aspects of the body that are out of synch and that may contribute to the child's anxiety, or to correct the imbalances in the body that occur as a result of a child's ongoing anxiety.
We are excited to be broadening our concept of treating anxiety and including these other useful tools that complement the work we do as cognitive-behavior therapists. In this spirit, our inaugural issue of the WorryWise Kids Newsletter puts the focus on vitamins and nutrition as adjunctive treatments to calm the anxious body and mind.
Your Anxious Child: Looking for Answers in Some New Places... like the Kitchen! How Diet, Vitamins and Minerals Help Fight Anxiety
By Tamar Chansky, Ph.D.
Are We What We Eat? When our kids are home sick with the flu, we wouldn't dream of serving them chips and soda. That's the time that whatever chaos we may have going in our lives, we focus on nutrition and nurture them with the good stuff - fruits and veggies for Vitamin C, delicious hot soup for that internal hug! While anxious kids are not "sick" in the same way, managing worry is draining for kids. Even more than their less-stressed counterparts, anxious kids are very much in need of restorative foods and restorative sleep. Anxiety also causes a great deal of wear and tear on the body, and depletion of certain vitamins and minerals, so when we are thinking of treating the anxious child, we need to think of the whole child. There is CBT for the thinking patterns and avoidance behaviors. Good nutrition and sleep will help your child have energy to tackle anxiety, and will also help your child be less anxious from the inside out.
When you mention things like vitamins or supplements for treating anxiety, some folks get excited at the possibilities of non-medication treatments, and others get their backs up. Recently I was talking with a psychiatrist of a mutual patient, and at the mere mention of the possibility of adding vitamins to the patient's current treatment plan which consisted of several different medications, the doctor went on a veritable rampage about how there is no evidence that supplements are necessary or effective. Though the conversation was going nowhere, I couldn't help but blurt out that parents and kids deserve more information about the safety and effectiveness of medications.
Clearly, when it comes to the welfare of children, passions run high. These passions need to be tempered by information and by experience. While a recent statement from the American Academy of Pediatrics suggested that vitamin supplements are not necessary for children whose eating habits are consistent with the food pyramid, I imagine that most of us can count the days when our kids have actually eaten 3 full servings of vegetables. No this doesn't mean eating 3 dreaded string beans no matter how many times you've chased them around the plate, but rather 2 1/2 cups per day of veggies and 2 cups a day of fruits. Given that kids tend to be less than perfect eaters, and anxious kids tend to burn more fuel with hypervigilance, false alarms, muscle tension and sleeplessness, it is prudent to investigate the need for supplementation to ensure that proper balances of vitamins and minerals are maintained. I invite you to read, learn, question and do further research. Talking with the pediatrician or a dietician would be a good place to start. Suggested reading for those interested is included at the end of the article.
The Body Keeps Count When a person has been anxious for a long time, certain physiological patterns get coded in the body. Posture and breathing change, muscles tighten, and stomachs clench. While these physical changes may initially come from a danger signal from the brain, over time they become automatic. In an effort to be efficient, the brain gets used to whatever it does a lot of. If we are in a chronic anxious state, the brain will make sure we are constantly ready for danger. This is one of many reasons why things like sleep and concentration are impacted by anxiety. If we need to be ready to defend ourselves, our fight or flight response, things like eating, sleeping and concentrating are irrelevant. Also there are certain chemical reactions (releasing adrenaline being one) that occur with anxiety; if we are not discharging that energy through actual fight or flight, those biochemicals are reabsorbed in the system and can contribute to ongoing feeling of anxiety as well as other health conditions. What can we do about these chronic settings? How can that biochemical imbalance be treated? We now look at the role of diet, vitamins and minerals in a child's experience of anxiety.
The Challenges of the American Diet: Caffeine, Carbohydrates, and Sugar
Many of us are aware that caffeine is not good for anxiety. The fact that the effects of caffeine - hyperarousal, jitteriness, heart palpitations, nausea - are very similar to the symptoms of a panic attack makes caffeine a poor choice for a child that has an anxiety disorder. Substitute bottled water, juice cut with water, or milk. Remember that while colas are caffeinated, some root beers and even clear sodas like Mountain Dew are too. But while we are on the subject of soda, let's look at how sugar impacts anxiety.
Sugar is a trickier subject. Sugar is the body's fuel; we need it to function. But there is a huge difference between high quality fuel - what we find in whole grains, beans, fruits and vegetables, and what we find in processed foods - cereals, pastas, cookies and candy.
Less processed sugar is one issue, keeping a consistent sugar level in the blood stream is another. Blood sugar levels being too low (as when not eating for long stretches) can create a hypoglycemic state. This can trigger anxiety symptoms. The autonomic nervous system perceives the lowered glucose level and in response, anxiety, trembling and sweating may result. While this suggests that kids should eat small, healthy meals regularly, it doesn't mean, as we well know, that more sugar is better.
When kids have too much sugar, their glucose levels in the blood stream can be too high. The pancreas oversecretes insulin to cover the refined carbohydrates, and in response, the adrenal glands produce adrenaline. Adrenaline supercharges us to fight or flee. So when your child eats a lot of sugar, not only are they missing out on good nutrition and fuel, they are inadvertently triggering the body's alarm system.
To keep the sugar level consistent, many experts recommend 5 smaller meals a day rather than 3 larger ones. To introduce a healthier diet, start one meal or snack at a time: Here are some snack ideas, see if your child can choose one or two to introduce to the weekly routine. That would be a great start.
- Home-made trail mix: almonds, raisins, sunflower seeds
- Carrots, broccoli, and celery sticks with ranch dressing
- Cheese and crackers
- Rice cakes and nut butter
And at breakfast, try:
- Yogurt, bagels and cream cheese, fruit smoothie
- Sprinkling a teaspoon of sugar on unsweetened cereals, throw in bananas or cut up strawberries
- Whole grain waffles with jam
Vitamins and Minerals: Multitaskers
Another sort of fuel for our system is the many vitamins and minerals that we store and use for every task in the body. Below is a list of vitamins and minerals that have been identified as facilitating anxiety management through various pathways. Thinking of the cure in your kitchen by introducing a few new healthier eating habits will help boost your child's own system and help reduce their anxiety. While you may be dreading one more food battle with your kids, it doesn't have to be that way. Make this fun. Have your child look at this list of healthy food and choose 10 foods he or she is ready to try; then you can brainstorm together how to make those foods tasty and fun to eat. Healthy eating is another way of empowering your child to take charge of anxiety.
Inositol is a vitamin involved with serotonin receptors. Serotonin is the neurotransmitter or chemical messenger in the brain involved with anxiety and depression. It has been found to be more effective than placebo in reducing symptoms of panic and agoraphobia, it has also been found in some studies to be as effective as medications such as prozac and paxil in reducing OCD symptoms. Inositol is taken in powder form and can be found at your health food store. Dosage recommendations vary, Dr Fred Penzel, author of Obsessive Compulsive Disorders: A Complete Guide to Getting Well and Staying Well. Reports that at his clinic in West Suffolk, New York, patients start with 1 teaspoon (2gms) twice per day, and go as high as 3 teaspoons, three times per day. A study conducted in 1996 by Israeli researchers recommended 18 grams a day. Inositol can be found in cereals with a high bran content: such as whole wheat, brown rice, oats and millet.
Calcium: A necessary element for many bodily functions, it is considered a natural tranquilizer, it helps buffer the body against stress. Found in foods such as milk, cheese, fish as well as sesame seeds, tahini (sesame paste), steamed tofu, sardines, kale okra, broccoli, and spinach.
Potassium: Is essential for proper functioning of the adrenal glands. It can also promote clearer thinking by allowing more oxygen to reach the brain. Bananas, nuts seeds, raisins, baked potato with the skin, soybeans, apricots, and tomato puree.
Magnesium has a reputation to have a calming effect. A gallup poll conducted in 1994 determined that adequate magnesium is lacking in nearly 72% of diets, and that nearly half of the population consumes less than 75% of the Recommended Daily Allowance (RDA) of magnesium. Foods high in magnesium include: peanuts, broccoli, tofu, even canned tomato paste, spinach, sweet potatoes and black beans.
B Vitamins have also been found effective in alleviating the symptoms of anxiety. Because B vitamins are water soluble, the body eliminates any B vitamins it does not need, so you needn't be concerned about having "too much of a good thing."
B1 Thiamine: Helps reduce anxiety and has a calming effect on the nerves. It supports the nervous system and facilitates the apparatus of efficient neuron communication, the myelin sheath. Foods rich in thiamine include: asparagus, romaine lettuce, mushrooms, spinach, sunflower seeds, tuna, green peas, tomatoes, eggplant, Brussels sprouts, watermelon, pork, and avocado.
B3 Niacin promotes the sound functioning of nerve cells and can soothe feelings of anxiety and panic. Foods rich in niacin include: chicken breast, lamb, salmon, tuna, crimini mushrooms, asparagus and halibut.
Vitamin B6 helps the body to manufacture brain chemicals (neurotransmitters) essential for the body to cope with stress, such as serotonin. Vitamin B6 may also help boost the immune system during times of stress. In The Townsend Letter for Doctors and Patients (October, 2004), they cite research which states that pyridoxine (B6) deficiency can result in increased sympathetic nervous discharge, the system which mobilizes with perceived danger. B6, pyridoxine can be found in liver, pork, chicken, turkey, cod, bread, whole cereals (such as oatmeal, wheatgerm and rice), eggs, vegetables, soybeans, peanuts, milk, potatoes and some fortified breakfast cereals. Foods rich in B6 include: Sweet potatoes, Avocados, Sunflower seeds, Tuna, Chick-peas, Salmon, Pork, fresh, Potatoes, Turkey, Chicken, Bok choy, Rice, brown, Barley, Mangoes, Bananas.
Vitamin B12 helps the body to cope with stress because it works in concert with other B vitamins. B12 assists the body in converting food to energy, while also supporting the nervous system especially the myelin sheath. This is the part of a nerve cell that facilitates the efficient transmission of nerve messages. Foods rich in B12 include: beef, eggs, dairy, oysters, trout, crab, clams, tuna, yogurt, and lamb.
Although we would all like to get our vitamins from our foods, vitamin supplements such as multivitamins or specific supplements can be necessary. Because the Recommended Daily Allowances (RDA) were established for the nutritional needs of an average healthy adult, factors such as stress, sleep habits, gender, presence of illness etc are not reflected in the RDA. It is important to consult your child's pediatrician for information about appropriate vitamin doses for your child. But next time your child actually finishes a serving of sweet potatoes or downs some sunflower seeds for a snack, know that together you are helping the body have what it needs to be the boss of anxiety rather than anxiety bossing around your child. Here's to our children's good health!
For More Information:
Dr. Penzel's website information about inositol for neuropsychiatric conditions
Townsend Letter for Doctor's and Patients
Articles written by researchers, health practitioners and patients. As a forum for the entire alternative medicine community, presents scientific information (pro and con) on a wide variety of alternative medicine topics. Several articles about anxiety and vitamins.
Vegetarian Society of the UK
Excellent descriptions of various vitamins, possible RDAs, and food sources
A website hosted by Susan Clark, award-winning United Kingdom health journalist and broadcaster who is also the author of the What Really Works series on health issues in kids.
Some suggestions for appropriate dosages of vitamins for children. See the Vitamins pages.
Balch, Phyllis A. (2000). Prescription for Nutritional Healing, Penguin-Putnam.
Bissex, Jancie and Weiss, Liz, (2004). The Mom's Guide to Meal Makeovers: Improving the Way Your Family Eats, One Meal at a Time! Broadway Books.
Eades, Mary Dan (2000). The Doctor's Complete Guide to Vitamins and Minerals, Dell.
Lieberman, Shari and Bruning, Nancy (2003) Real Vitamin and Mineral Book:A Definitive Guide to Designing Your Personal Supplement Program. Avery Publishing Group.
Brought to you by The Children's and Adult Center for OCD and Anxiety.