Probiotics for Anxiety

Can probiotics improve anxiety?

If you’re one of the one out of 6  of Australians who experience anxiety disorders, you may want to consider trying probiotics for relief.  Anxiety and other mood disorders may have a lot to do with what’s happening in your gut. Our mental and physical health cannot be separated.

Probiotics have emerged as a potential anti-anxiety treatment with minimal side effects.

Let’s take a look at the facts. 

Probiotics and the Gut-Brain Axis

Research tells us that the gut and brain share a very close connection. Through multiple lines of communication, your central nervous system (which includes the brain) talks to your endocrine and digestive systems. [1]

Inflammation in the intestines is known to cause digestive and immune system symptoms and also inflammation in the brain. This may look like brain fog, irritability, and yes, anxiety. Changes in the gut microbiota can produce many different types of symptoms, including mental health symptoms like anxiety and depression, and loss of cognitive function. [2]

Anxiety Symptoms

According to the Black Dog Institute,  common symptoms of general anxiety disorder include:

• Feeling restless, wound-up, or on-edge
• Being easily fatigued
• Having difficulty concentrating
• Being irritable
• Having muscle tension
• Difficulty controlling feelings of worry
• Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep

Panic disorders are a form of anxiety and  symptoms include:

• Heart palpitations, a pounding heartbeat, or an accelerated heart rate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath, smothering, or choking
• Feelings of impending doom
• Feelings of being out of control

Can Probiotics Improve Anxiety?

Meta-Analysis Summary: Probiotics and Anxiety

Data from multiple meta-analyses (the highest quality science) suggest that probiotics are likely helpful for anxiety, but more research is needed.Four meta-analyses all determine that there may be some anti-anxiety effect from probiotics, but that the current available data isn’t conclusive.

• One meta-analysis determined that the available data wasn’t clear, and more high-quality human clinical trials were needed. [3]
• A second meta-analysis identified possible anti-anxiety effects from probiotics, but found the total sample sizes too small to make widespread claims. [4]
• A third meta-analysis found a clear anti-anxiety effect in animal studies, but not enough data in human clinical trials. [5]
• A fourth meta-analysis determined a likely positive benefit of using probiotics for anxiety and depression. [6]

Even more interesting, a significant number of people experience relief from mental health symptoms when they rebalance their gut.

In a systematic review of randomized control trials, 56% of participants experienced improved anxiety with the use of probiotics and a low FODMAP diet. [7]

Anxiety May Start in the Gut

It’s no secret that people with gut health problems often feel anxious or depressed. But which comes first, the mental health challenge or the gut symptoms?

• A 2016 study of 1,900 people found that two-thirds of them experienced irritable bowel syndrome (IBS) before mental health symptoms, implying that for many people, the gut disturbance was the source of their anxiety. [8]

Another way to think about this connection is by considering the role of a leaky gut. Gut inflammation can make the gut lining permeable, which allows bacterial toxins to enter the bloodstream. These toxins have been shown to contribute to anxiety and depression symptoms. [9]

We know that probiotics help improve leaky gut.  [10] So probiotics may help reduce anxiety by reducing leaky gut.

Anxiety, Gut, and Thyroid Connection

A systematic review found that people with underlying autoimmune thyroiditis or hypothyroidism are likely to experience anxiety and depression. [11] But hypothyroidism is also closely linked with gut dysbiosis, especially Small Intestinal Bacterial Overgrowth (SIBO). [12] I often find restoring my patients’ gut function resolves their thyroid symptoms, and this includes their related anxiety symptoms.

Using Probiotics for Anxiety

Many people advocate for choosing probiotics based on your health condition. Usually this is because particular probiotic strains, such as B. infantis, or B. longum, were used in one or more studies. For anxiety or depression, this may include recommendations to include “psychobiotics”, or probiotics that have shown promise for psychiatric conditions. For example, a recent study on rats showed that Lactobacillus helveticus reduced their anxiety scores. [13]

And so the thinking goes, “If that probiotic helped anxious rats, maybe it will help me.”  If it is doing no harm, then why not consider this option. 

But probiotic supplementation doesn’t work like a medication (and animal studies aren’t necessarily a good way to assess how a therapy will benefit you).

Probiotics repair function and restore your gut environment. Though there may be hundreds of probiotics, almost all of them fall into one of three categories.

The best approach is to choose one high-quality probiotic supplement from each category and use regularly. The specific brand or strains aren’t as important as making sure you are using one probiotic from each type:

• Type 1: Lactobacillus and Bifidobacterium blends: includes examples such as Lactobacillus acidophilus, Lactobacillus rhamnosus, and Bifidobacterium longum.
• Type 2: Saccharomyces boulardii, a beneficial yeast.
• Type 3: Soil-Based Probiotics, usually Bacillus strains.

Use all three probiotics daily for about a month, and see how you feel. If you notice positive effects, you can continue, or reduce your dose to the smallest effective dose. Common effects of probiotics include:

• Improved mood
• Improved digestion
• Improved sleep
• Improved hormones

If you didn’t notice any improvements, you can stop, knowing that you gave probiotic therapy a try. There’s no need to continue trying out new probiotic strains.

The TGA doesn’t closely regulate probiotics so do your homework and choose a reputable brand. 

Many sources also recommend using fermented foods to reset your gut microbiota because they contain good bacteria. Though fermented foods, like kimchi or sauerkraut, coconut yogurt, and pickles  are healthy, they generally don’t have enough colony-forming units (CFUs) to provide a clinical benefit.

Similarly, prebiotics, which feed your beneficial bacteria, aren’t necessary to supplement, as long as you’re eating a diet rich in fiber from fruits, vegetables, and nuts and seeds. Prebioitics are things like garlic, onions and leek and they are wonderful for many but gassy for others. 

Do Probiotics Work Better with the Right Diet?  

In one study that compared probiotic use with a low FODMAP diet, many participants experienced significant relief of anxiety from trying the low FODMAP diet. The low FODMAP diet alone has been shown to restore a healthy gut microbiome, and decrease symptoms related to IBS, like bloating and stool changes. [14] It works by decreasing the food supply for bad bacteria in your gut. Improving your diet reduces gut inflammation, which helps improve many types of symptoms, including anxiety.

Combining a low FODMAP diet with probiotics may be a powerful one-two punch to the bad gut microbes that may be causing anxiety symptoms.

 Last thoughts...

Though there isn’t yet iron-clad evidence that probiotics improve anxiety, the research suggests that they may help. Following a low FODMAP diet along with probiotics may be even more  effective. Because probiotics are typically safe and don’t cause negative side effects, a trial of probiotic therapy makes sense if you suffer from anxiety.

Original article by Dr Ruscio, modified by Michele Chevalley Hedge

References 

• Chin Med J (Engl). 2016 Oct 5;129(19):2373-80. doi: 10.4103/0366-6999.190667.

• Trends Neurosci. 2013 May;36(5):305-12. doi: 10.1016/j.tins.2013.01.005. Epub 2013 Feb 4.

• Depress Anxiety. 2018 Oct;35(10):935-945. doi: 10.1002/da.22811. Epub 2018 Jul 11.

• Neurosci Biobehav Rev. 2019 Jul;102:13-23. doi: 10.1016/j.neubiorev.2019.03.023. Epub 2019 Apr 17.

• PLoS One. 2018 Jun 20;13(6):e0199041. doi: 10.1371/journal.pone.0199041. eCollection 2018.

• J Altern Complement Med. 2017 Apr;23(4):249-258. doi: 10.1089/acm.2016.0023. Epub 2016 Nov 14.

• Yang B, Wei J, Ju P, et al. Effects of regulating intestinal microbiota on anxiety symptoms: A systematic reviewGeneral Psychiatry 2019;32:e100056. doi: 10.1136/gpsych-2019-100056

• Aliment Pharmacol Ther. 2016 Sep;44(6):592-600. doi: 10.1111/apt.13738. Epub 2016 Jul 22.

• Gut. 2018 Aug;67(8):1555-1557. doi: 10.1136/gutjnl-2017-314759. Epub 2017 Aug 16.

• J Int Soc Sports Nutr. 2012 Sep 20;9(1):45. doi: 10.1186/1550-2783-9-45.

• JAMA Psychiatry. 2018 Jun 1;75(6):577-584. doi: 10.1001/jamapsychiatry.2018.0190.

• Pol Merkur Lekarski. 2018 Jan 23;44(259):15-18.

• Ohland CL, Kish L, Bell H, et al. Effects of Lactobacillus helveticus on murine behavior are dependent on diet and genotype and correlate with alterations in the gut microbiome. Psychoneuroendocrinology. 2013;38(9):1738–1747. doi:10.1016/j.psyneuen.2013.02.008