The Case: 

• Lauren is 32 and has been dealing with anxiety most of her life
• She noticed that her anxiety can be worse during stressful times and during the winter.
• She was  on anti-anxiety medication but they made her feel flat.
• She tried meditation for anxiety but this wasn't enough and didn’t completely resolve the panic attacks. 

The Investigation

Lauren’s situation is pretty common and I knew that we had to get to the root of the problem if we were going to help her deal with her anxiety. I suspected her neurotransmitters were part of the solution so that’s where I started investigating.  

Trudy Scott is a certified nutritionist and food-mood expert. She’s the author of The Anti-anxiety Food Solution: How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood and End Cravings and is the host of The Anxiety Summit. 

Neurotransmitters Role in Anxiety

While anxiety is seldom only caused by neurotransmitters, there are several that can play a role. In this week’s episode, and for Lauren’s case, we look at two neurotransmitters - serotonin and gaba - which are both proven to impact our ability to handle stress and deal with different types of anxiety.

Can Low Serotonin Causes Anxiety?

Most people understand the relationship between serotonin and depression but they don’t realize that it also impacts anxiety. Low serotonin results in a specific type of anxiety, according to Trudy. She explains that it is linked to anxiety that may present as negative self talk, low mood, lack of confidence and self-esteem. Low serotonin can also result in panic attacks, phobias, ruminating thoughts (where you replay past events or constantly re-processing things) obsessive behaviors or obsessive thinking (often lying awake at night thinking about things). Another tell tale sign of low-serotonin-anxiety is afternoon and evening cravings were the only way to calm the anxiety is with eating (fulfilling the craving). Because serotonin naturally slows down during the darker winter months, anxiety can be seasonal. 

Low GABA Triggers Anxiety

Anxiety triggered by low GABA (Gamma-Aminobutyric Acid) presents differently than anxiety caused by low serotonin. Low GABA anxiety is physical. This might present as general stiffness and tension in the body. You may lay awake at night feeling physically tense which stops you from being able to sleep. Often, low GABA suffers will feel tension in the gut, they may even feel sick to their stomach. Unlike those with low-serotonin anxiety who may self-medicate with food, those with low-GABA anxiety are more likely to self-medicate with alcohol. 

Diagnosing Neurotransmitter Triggered Anxiety

There are a few tests (like urinary neurotransmitter tests and platelet serotonin tests) that can determine serotonin or GABA levels that can help determine if this might be the root cause of the anxiety. However, Trudy prefers to use a questionnaire to pinpoint the symptoms and then do a trial. For this, she has patients rank specific anxieties and then gives them a small dose, sublingually, of either GABA or an amino acid that replicates serotonin. She then re-administers the questionnaire. If there is a significant drop in their anxiety response, then she proceeds with a treatment plan. 

Treating Anxiety Caused by Low Serotonin 

Instead of just replacing the serotonin with a supplement, Trudy likes to help the body relearn how to make its own. Each treatment is highly individualized but a common plan would include amino acids including 5HTP and Tryptophan. These amino acids are considered substrates or precursors to us for us to make serotonin. There are some other nutrients that are needed like zinc, vitamin B6, magnesium, that are all cofactors that, together with tryptophan and 5HTP, help us to make our own serotonin.This supplement protocol, should be done along with dietary and lifestyle changes. Whatever caused the serotonin to slow down in the first place needs to also be addressed. This may be things like a gluten sensitivity, dysbiosis, parasites, autoimmune disease  (like Hashimoto’s), or chronic stress.

Treating Anxiety Caused by Low GABA

Again, the treatment needs to be individualized and go hand in hand with diet or lifestyle changes that relate back to the root cause of the lower GABA production. Trudy prefers to use sublingual GABA supplements because its faster and it also ensures that there aren’t any issues with digestion. In this episode, she also addresses the controversial theory that GABA can’t cross the blood/brain barrier. There are different GABA receptors in the body (including muscle and gut) which she outlines as part of the reason that she feels GABA can still be effective. GABA has other benefits such as supporting the endocrine system,  pancreas, liver, and fluoride-induced hypothyroidism. There are also benefits for people with diabetes. 

The Gut Connection to Anxiety

So many things that happen in the gut can cause reduced levels of serotonin and GABA. 95% of our serotonin originates in the gut, so that is the first place to look when trying to determine the root cause of low-serotonin anxiety. Studies have found that 5HTP can improve motility. Poor motility is often linked to gut issues like SIBO (Small Intestinal Bacterial Overgrowth) so an added benefit to treating low-serotonin is that it improves gut health, which we know in turn improves communication through the vagus nerve resulting in decreased depression and anxiety. 

Additionally, studies have shown that lactobacillus rhamnosus probiotics not only affect GABA receptors, they also lowers cortisol. High levels of cortisol are often related to depression and anxiety. So, this probiotic is improving gut health and simultaneously altering GABA and cortisol levels. 

Deficiencies Related to Anxiety

Trudy also tests patient levels of B12, methylmalonic acid, and homocysteine. These can often contribute to anxiety. Constipation may also indicate a B12 deficiency and, as mentioned above, can contribute to anxiety through poor gut health. This may be treated with a B12 supplement.

Cautions About Supplements and Anxiety

Each protocol is highly individualized because there may be other factors to consider. For example, if someone is on an antidepressant or anti-anxiety medication, natural treatments must be monitored carefully. Additionally, if someone has Lyme disease, an auto-immune disease or heavy metal toxicity, the protocol needs to be altered. Some do find that by getting to the root cause, dealing with it, and then retraining the body to produce adequate amounts of serotonin or GABA results in them being able to stop taking medication - but that would need to be determined by the individuals professional health team. 

Mystery Solved

When we looked at Lauren’s symptoms in light of a potential neurotransmitter issues, they pointed directly to low serotonin. Here’s what she was experiencing:  

• Anxiety
• Panic attacks or phobias 
• Feeling worried or fearful 
• Obsessive thoughts or behaviors 
• Perfectionism or being overly controlling