Home/Anxiety
Condition Deep-Dive

Anxiety

The body's alarm response firing when there is no proportionate threat, often enough and strongly enough to interfere with life. Nutrition has two genuine levers here, and both of them are things to remove rather than add. Nutrition supports treatment for anxiety. It does not replace it.

Neurological & Mental Health Evidence-Based

Last updated:

🚨 If you are thinking about harming yourself, or feel unable to keep yourself safe, please get help now rather than reading on. In the US, call or text 988, or call 911 if you are in immediate danger. Elsewhere, call your local emergency number or a crisis line, or go to your nearest emergency department. Separately, and just as important: do not assume new chest pain, breathlessness or a racing heart is anxiety. Panic attacks and cardiac events are not reliably distinguishable by how they feel, and treating a heart attack as a panic attack is one of the more dangerous mistakes available. New or severe chest symptoms are an emergency until a doctor says otherwise.
Definition

What Is Anxiety?

Fear is a response to a present threat. Anxiety is the same physical machinery running in anticipation of one, and it becomes a disorder when it persists, generalizes and starts costing you sleep, work and relationships.

The physical symptoms are not imagined and not secondary. A racing heart, tight chest, shortness of breath, churning stomach and trembling are the measurable output of a real stress response: the brain signals, adrenal hormones enter the blood, the heart speeds up, breathing quickens and digestion slows. That is why anxiety feels physical, and why people so often present to a doctor convinced something is wrong with their heart.

Nutrition enters this picture mainly through two substances that act directly on the same system. Caffeine is a stimulant that produces the physical signature of the alarm response. Alcohol calms it briefly and then rebounds it harder. Neither is a footnote here; between them they explain a great deal of avoidable anxiety.

💡 Key Insight: In people with panic disorder, a caffeine challenge of 400 to 750 mg brought on a panic attack in about half, against under 2% of healthy controls12. Sensitivity to caffeine is not uniform, and if you are in that group the dose that is fine for a colleague is not fine for you.
A body outline with arrows from the brain to the heart, lungs, adrenal glands and gut, and callouts on how each responds to the alarm, beside panels on common physical symptoms and the two things that make it worse, caffeine and alcohol

🚨 Two calming supplements are linked to liver injury

Kava and ashwagandha, both sold widely for anxiety, are both associated with liver injury34. The supplement section below explains the risk and the warning signs.

⚠️ Several conditions imitate anxiety closely, and each has its own treatment. An overactive thyroid produces palpitations, tremor, sweating and restlessness; see thyroid disorders. Heart rhythm disturbances produce episodic palpitations. Sleep apnea produces nighttime waking with a racing heart. Low blood sugar produces trembling and dread. Caffeine and stimulant use produce all of it. These are worth excluding rather than assuming, particularly if anxiety has appeared suddenly in someone who never had it.
By the Numbers

Anxiety by the Numbers

470 million
people worldwide had an anxiety disorder in 2023, the most common of all mental disorders5
1 in 4
people with an anxiety disorder receive any treatment, although highly effective treatments exist5
19.1%
of US adults had an anxiety disorder in the past year: 23.4% of women and 14.3% of men6
31.1%
of US adults have an anxiety disorder at some point in their lives6
400 mg
above this dose, caffeine was most clearly linked to anxiety in a meta-analysis of healthy people7
53.9%
of people with panic disorder had a panic attack after a high caffeine dose in blinded trials, against 1.7% of healthy people 1
Signs & Symptoms

Symptoms of Anxiety

Anxiety frequently shows up first as a physical complaint. Many people are investigated for their heart or their stomach long before anxiety is discussed.

SymptomWhat happens
Persistent worry that is hard to controlRunning ahead to what might go wrong, most days. Worth knowing: The cognitive core, though often not the presenting complaint.
Racing heart, palpitations, chest tightnessSometimes in discrete attacks, sometimes constant. Worth knowing: Never assume this is anxiety the first time. See the warning above.
Shortness of breath, a feeling of not getting enough airOften with tingling in hands or around the mouth. Worth knowing: Over-breathing explains the tingling, which is frightening and harmless.
Digestive symptomsChurning, nausea, urgency, appetite change. Worth knowing: The gut is part of the stress response; see IBS, which frequently coexists.
Muscle tension, jaw clenching, headachesEspecially neck, shoulders and jaw. Worth knowing: Frequently the symptom people notice before they use the word anxiety.
Difficulty falling asleepMind active at the moment the day stops. Worth knowing: See insomnia; the two feed each other.
AvoidanceDeclining things because of how they might feel. Worth knowing: The symptom that most shrinks a life, and the one therapy targets most directly.
Panic attacksSudden intense fear peaking within minutes, with strong physical symptoms. Worth knowing: They pass, they are not dangerous in themselves, and the fear of the next one is often the bigger problem.
💡 A useful question to ask yourself before changing anything else: how much caffeine, and when? Count everything: coffee, tea, energy drinks, cola, pre-workout powders, some painkillers and some weight-loss products. People are routinely surprised by the total, and by how late the last one is.
Causes

Causes of Anxiety

The cause of an anxiety disorder is unknown; genetics, brain biology, stress and environment may all play a part9, and some physical problems and substances produce or worsen the same symptoms.

CauseHow It Contributes to AnxietyWhat Helps
Family history and temperamentA family history of anxiety or other mental disorders, and being shy or withdrawn in new situations, are general risk factors9Cognitive behavioral therapy, the best-studied talking therapy for anxiety10
Traumatic or stressful eventsTrauma in childhood or adulthood, and living in a stressful environment, raise the risk910Talking therapy; exercise, mindfulness and enough sleep help alongside it, not instead of it10
CaffeineCaffeine can make anxiety symptoms worse9; the link was clearest above 400 mg in a meta-analysis7, and caffeine challenges provoked anxiety or panic in people with panic disorder2Counting and then tapering caffeine over one to two weeks, as the diet section sets out
Alcohol, smoking and drugs used to copeUsing alcohol, cigarettes or drugs to relieve anxiety can add to poor mental health8, and alcohol and substance misuse commonly go with anxiety disorders10Cutting back alcohol, particularly the evening drink, and stopping smoking, as the diet section describes
Physical conditionsThyroid problems and heart rhythm disturbances are risk factors, and some health problems cause the same symptoms, which is why a physical exam and lab tests come first9The thyroid, heart rhythm, blood count and glucose checks in the diagnosis section, before anxiety is assumed
Some medicines and substancesCertain medicines and other substances can make anxiety worse9A medication and supplement review with your prescriber; never stop a prescribed medicine on your own
Diagnosis

How Anxiety Is Diagnosed

There is no test for anxiety. The tests exist to rule out what looks like it.

TestWhat it shows
Clinical assessment and symptom questionnairesThe diagnosis, its type and its severity. Worth knowing: Questionnaires screen and track rather than diagnose.
Thyroid functionAn overactive thyroid, which imitates anxiety closely and is treatable. Worth knowing: See thyroid disorders.
ECG, and cardiac assessment where indicatedRhythm disturbances, and reassurance that carries weight. Worth knowing: A normal result at rest does not capture an intermittent arrhythmia.
Complete blood count and ferritinAnemia, which causes palpitations and breathlessness. Worth knowing: See iron-deficiency anemia.
GlucoseLow blood sugar episodes, which produce trembling, sweating and dread. Worth knowing: Random tests miss episodes; the timing of symptoms matters more.
Caffeine, alcohol and substance historyThe most modifiable contributors on this list. Worth knowing: Rarely quantified properly unless someone counts it out.
Sleep history and apnea screeningNighttime waking that presents as anxiety. Worth knowing: See sleep apnea.
Medication and supplement reviewStimulants, decongestants, some inhalers and thyroid over-replacement all provoke it. Worth knowing: A prescriber conversation, never a reason to stop something yourself.
Treatment Comparison

Conventional and Holistic Treatment for Anxiety

🌿 HOLISTIC
💊 CONVENTIONAL
🌿

Holistic / Functional Approach

Caffeine, alcohol, sleep, regular eating and activity. Alongside treatment, not instead of it

Biggest Dietary Lever
Caffeine, which is associated with anxiety in meta-analysis7 and capable of provoking panic in susceptible people2
Second Lever
Alcohol, which reduces anxiety briefly and increases it as it clears, most noticeably the following morning
Timeline
Caffeine changes can be noticeable within days. Taper rather than stopping abruptly, since withdrawal causes headache and irritability
Limitation, stated plainly
No supplement has convincing evidence for treating an anxiety disorder, and the two most heavily marketed carry liver risk

Full Holistic Approach Includes

  • Counting and then reducing caffeine, tapering over a week or two rather than stopping overnight.
  • Reducing alcohol, particularly the evening drink used to unwind.
  • Eating regularly, since the trembling and dread of a long gap without food is hard to distinguish from anxiety itself.
  • Sleep, treated in its own right; see insomnia.
  • Physical activity, which has reasonable evidence and also discharges the physical side of the response.
  • Breathing practice, which addresses over-breathing directly and is free.
  • Correcting documented deficiencies, because they are deficiencies, not because they treat anxiety.
🌿 Worth knowing: removing caffeine and alcohol makes a real difference for some people and not much for others. It is worth doing first because it is cheap and quick to test, not because it is sufficient.
Supplement Protocol

Evidence-Based Supplements for Anxiety

The two best-selling calming supplements are the two with documented liver injury. That is the headline here.

🚨 Kava and ashwagandha are both associated with liver injury, and both are sold specifically for anxiety. Kava has been linked to severe hepatotoxicity including liver failure, and has been restricted or withdrawn in several countries as a result3. Ashwagandha, currently among the most heavily marketed calming supplements, has an accumulating literature of liver injury cases4. Stop either immediately and seek medical advice if you develop nausea, unusual tiredness, abdominal pain, dark urine or yellowing of the eyes or skin. Avoid both entirely if you have liver disease, drink heavily or take other medicines that affect the liver.
SupplementWhat it is forTypical rangeTimingNotes & cautions
Magnesium Correcting a dietary shortfall. Frequently sold for calm; the evidence for that is weak. 200 to 400 mg per day of elemental magnesium if intake from food is low Evening, with food A systematic review concluded the existing studies were of poor quality and could not support a recommendation for anxiety13. Citrate and glycinate are better tolerated than oxide. Can loosen stools. The upper intake level for magnesium from supplements is 350 mg per day15, so the top of this range is above it; check any dose over 350 mg with your clinician. Above the limit, diarrhea and cramping are the usual effects. Reduce or avoid in reduced kidney function; see chronic kidney disease.
Omega-⁠3 (EPA and DHA) Modest and inconsistent evidence for anxiety symptoms. Food first, fatty fish twice weekly. Agree on any supplement dose with your clinician With a fat-containing meal A systematic review found the evidence limited and heterogeneous12. Tell your clinician if you take an anticoagulant or antiplatelet, and before planned surgery. In heart trials, fish oil supplements raised the risk of atrial fibrillation, an irregular heartbeat, more so above 1 g a day16, so check any fish oil supplement with your clinician first.
Probiotics Sold on the gut-brain axis. The evidence is early and the certainty is low. No established dose or strain for anxiety As directed on the product A GRADE-assessed review of pre-, pro- and synbiotics for anxiety and depression symptoms found low certainty of evidence14. Generally well tolerated. Discuss first if you are immunocompromised or seriously unwell, where live organisms carry real risk.
Kava and ashwagandha Kava: listed only so its risks are stated, and not recommended. Ashwagandha: some preparations may help stress, but the evidence on anxiety is unclear17. Kava: not recommended. Ashwagandha: no dose given for anxiety. n/a See the warning above. Both are associated with liver injury34. Kava is additionally sedating and additive with alcohol and sedative medicines. Ashwagandha may affect thyroid hormone levels and is not for use in pregnancy or breastfeeding, in thyroid or autoimmune disorders, or before surgery; ask your prescriber first if you take sedatives, thyroid hormone or medicines for diabetes, blood pressure, seizures or immune suppression17.
🚨 What to avoid, specifically. Kava (for the liver reasons above) and ashwagandha taken without the checks in its row. Any calming product taken alongside a prescribed sedative, since the effects add up and the combination with alcohol can suppress breathing. Stopping a prescribed anxiety medicine to try a supplement, and in particular stopping a benzodiazepine abruptly, which can cause seizures. High-dose CBD products, which interact with several medicines and have their own liver signal. And treat any product promising to cure anxiety as a reason to distrust the seller.
💡 Where the real leverage is. Counting your caffeine and halving it. The evening drink. Sleep. Movement. Breathing. And therapy, which is the treatment with the best evidence of anything on this page and is not sold in a bottle.
What to Expect

What to Expect Over Time

With the right treatment and support, people with anxiety disorders can manage their symptoms and improve their quality of life10.

Treatment and supportive care, together
First Weeks

New chest pain comes first; see When to Seek Care. A clinician checks for a physical cause9. A talking therapy, usually CBT, is normally tried before medicine8. Start cutting back caffeine and alcohol8.

Months 1 to 3

Therapy and medicine both take time to work, and finding the right plan can take trial and error. Antidepressants used for anxiety may take several weeks; benzodiazepines are usually prescribed only briefly, because tolerance and dependence can develop10.

Months 3 to 12

Symptoms often rise and fall, and are worse during stress10. Never stop an antidepressant suddenly18, or a benzodiazepine abruptly, since withdrawal can include seizures; any reduction is planned with your prescriber11.

Long Term

Less caffeine, enough sleep and exercise help when paired with treatment, but cannot replace it10.

When to Seek Care

For thoughts of suicide or self-harm, call or text 988 in the US or chat at 988lifeline.org, and call 911 if life is in danger10. Call 911 for sudden crushing, squeezing or tight chest pain or pressure, pain spreading to the jaw, left arm or back, or chest pain with shortness of breath, sweating or a racing heart: a panic attack can feel like a heart attack, so do not assume it is anxiety19.

📬

Get new guides in your inbox. Once a month: new condition guides and research updates, including the trials that did not work. Free, no spam, and you can unsubscribe in one click.

Sign up

Next Steps

Count the Caffeine, Keep the Therapy

Therapy, usually cognitive behavioral therapy, has the best evidence of anything on this page. Taper caffeine gradually, cut back the evening drink and protect your sleep. These help alongside treatment but cannot replace it.

Explore Depression → Explore Insomnia →

References & Evidence Notes

Each numbered entry below is either a source you can follow or a note setting out what the evidence does and does not support. Both are numbered together so the markers in the text line up.

Last reviewed October 20, 2026. Supplement entries are cross-checked against the NIH National Center for Complementary and Integrative Health and the Linus Pauling Institute Micronutrient Information Center.20 This page is nutrition education, not medical advice, and it does not replace your doctor. Nutrition does not treat anxiety. Anxiety disorders have effective treatments (psychological therapy foremost among them), and nothing on this page has been shown to replace those. Nothing here is a reason to decline, delay or stop treatment, and no prescribed sedative should ever be stopped abruptly. What nutrition education can do is help you understand the evidence well enough to have a better conversation with the clinician who does treat you.

  1. On caffeine in panic disorder: a 2022 meta-analysis of blinded, placebo-controlled caffeine challenges, mostly at 400 to 750 mg, found that 53.9% of people with panic disorder had a panic attack after caffeine against 1.7% of healthy controls, and none after placebo; caffeine also raised anxiety in healthy adults at these doses, but less, PubMed 34871964. ↩
  2. Vilarim MM, et al. Caffeine challenge test and panic disorder: a systematic literature review. Expert Rev Neurother. 2011;11(8):1185-⁠1195. PubMed 21797659. All eight randomized, double-blind studies it reviewed found caffeine linked with anxiety or panic in people with panic disorder, which is direct experimental evidence rather than association. ↩ ↩ ↩
  3. Review article: herbal and dietary supplement hepatotoxicity. Aliment Pharmacol Ther. 2013;37(1):3-⁠17. PubMed 23121117, and the NIDDK LiverTox database, LiverTox. Kava is among the herbal products most consistently associated with severe liver injury, which led to regulatory restriction in several countries. ↩
  4. Ashwagandha (Withania somnifera) associated liver injury: a scoping review of clinical characteristics. Cureus. 2026. PubMed 42367407. Case reports and series describing liver injury associated with ashwagandha. These are reports rather than trials, so they establish a signal rather than a rate, and that signal matters given how heavily the product is now marketed for anxiety. ↩
  5. On how common anxiety disorders are: the World Health Organization estimates that 470 million people had an anxiety disorder in 2023, making anxiety disorders the most common of all mental disorders, and that although highly effective treatments exist, only about 1 in 4 people who need treatment receive any, WHO, anxiety disorders. ↩
  6. On US figures: from national diagnostic interview data, an estimated 19.1% of US adults had an anxiety disorder in the past year, 23.4% of women and 14.3% of men, and 31.1% have one at some point in their lives, NIMH, anxiety disorder statistics. ↩
  7. Caffeine intake and anxiety: a meta-analysis. Front Psychol. 2024;15:1270246. PubMed 38362247. In 14 studies of 546 healthy people, most comparing caffeine with decaffeinated drinks or placebo, caffeine raised anxiety, most clearly at doses above 400 mg. It is included because the association is consistent and the change is free to test. ↩
  8. On first-line care and self-help: NHS guidance says the main treatments are talking therapies (usually cognitive behavioral therapy) and medicines (usually an antidepressant), and that a doctor will usually advise trying talking therapy before prescribing medicine. It advises against drinking lots of coffee, tea, cola or energy drinks and against using alcohol, cigarettes, gambling or drugs to relieve anxiety, NHS, generalized anxiety disorder treatment. ↩
  9. On risk factors and what makes anxiety worse: US National Library of Medicine guidance says the cause of anxiety disorders is unknown, with genetics, brain biology, stress and environment possibly playing a role; lists a shy or withdrawn temperament, trauma in childhood or adulthood, a family history of anxiety or other mental disorders, and physical conditions such as thyroid problems or heart rhythm disturbances as risk factors; says caffeine, other substances and certain medicines can make symptoms worse; and says a physical exam and lab tests are used to make sure another health problem is not the cause, MedlinePlus, anxiety. ↩
  10. On causes, treatment and outlook: the US National Institute of Mental Health describes cognitive behavioral therapy as the best-studied psychotherapy for generalized anxiety disorder, notes that therapy and medicine both take time to work, that antidepressants may take several weeks, and that benzodiazepines may be prescribed only for brief periods because tolerance and dependence can develop. It lists trauma and stressful environments as risk factors, notes that the disorder is commonly associated with alcohol and substance misuse, that symptoms fluctuate and worsen with stress, and that healthy habits such as less caffeine and enough sleep help alongside standard care but cannot replace it. With the right treatment and support, people can manage their anxiety. Anyone having thoughts of suicide can call or text 988, or call 911 in a life-threatening situation, NIMH, generalized anxiety disorder. ↩
  11. On stopping a benzodiazepine: US National Library of Medicine guidance for a benzodiazepine used for anxiety advises not stopping it or taking fewer doses without talking to your doctor, who will usually reduce the dose gradually, and lists seizures among the withdrawal symptoms that need a doctor or emergency care, MedlinePlus; a 2018 review notes that abrupt cessation can cause death, PubMed 29713452. ↩
  12. Efficacy and safety of omega-⁠3 fatty acids supplementation for anxiety symptoms: a systematic review and dose-response meta-analysis. BMC Psychiatry. 2024;24(1):455. PubMed 38890670. Evidence limited and inconsistent across heterogeneous trials, which is why this page rates omega-⁠3 as modest rather than recommended. ↩
  13. Boyle NB, et al. The effects of magnesium supplementation on subjective anxiety and stress, a systematic review. Nutrients. 2017;9(5):429. PubMed 28445426. The authors concluded that existing evidence was suggestive but that the quality of the studies was poor, and that well-designed randomized trials were needed. Included because magnesium is sold for calm on evidence that does not support it. ↩
  14. Pre-, pro- and synbiotics on anxiety and depression symptoms: a GRADE-assessed systematic review and meta-analysis. Ann Gen Psychiatry. 2026. PubMed 42010690. Certainty of evidence was low, which is the honest summary of the gut-brain supplement field at present. ↩
  15. On magnesium: the tolerable upper intake level for magnesium from supplements and medicines in adults is 350 mg a day, and higher intakes can cause diarrhea, nausea and abdominal cramping, NIH Office of Dietary Supplements. ↩
  16. Gencer B, Djousse L, Al-Ramady OT, Cook NR, Manson JE, Albert CM. Effect of long-term marine omega-⁠3 fatty acids supplementation on the risk of atrial fibrillation in randomized controlled trials of cardiovascular outcomes: a systematic review and meta-analysis. Circulation. 2021;144(25):1981-⁠1990. PubMed 34612056. Seven trials with 81,210 people followed for about 5 years: omega-⁠3 supplements were linked to a higher risk of atrial fibrillation (hazard ratio 1.25), more so in trials of more than 1 g a day (1.49), and the risk rose with each additional gram. ↩
  17. On ashwagandha: the NIH National Center for Complementary and Integrative Health reports that some preparations may help insomnia and stress but that the evidence on anxiety is unclear; that it may be safe for up to 3 months while long-term safety is unknown; that rare cases of liver injury have been linked to it; that it should be avoided in pregnancy and breastfeeding, before surgery and in autoimmune or thyroid disorders; and that it may interact with medicines for diabetes, blood pressure, seizures and thyroid disease, with immunosuppressants and with sedatives, NCCIH, ashwagandha. ↩
  18. On stopping antidepressants: NHS guidance says an antidepressant should not be stopped suddenly or without talking to a doctor, and that the dose is reduced gradually, usually over several weeks or months, because most people get some withdrawal symptoms, NHS, stopping antidepressants. ↩
  19. On chest pain and panic: US National Library of Medicine guidance says to call 911 for sudden crushing, squeezing, tightening or pressure in the chest, pain spreading to the jaw, left arm or between the shoulder blades, or chest pain with nausea, dizziness, sweating, a racing heart or shortness of breath, MedlinePlus, chest pain; and the US National Institute of Mental Health notes that panic attacks often include physical symptoms that can feel like a heart attack, NIMH, panic disorder. ↩
  20. National Center for Complementary and Integrative Health (NIH), nccih.nih.gov, and the Linus Pauling Institute Micronutrient Information Center, lpi.oregonstate.edu. ↩