Category Archives: anxiety

Could passionflower be useful to sufferers of anxiety?

 Last week I wrote about the herb valerian and how it might help some individuals suffering with insomnia.  A very recent study (1) investigated the herbal remedy passionflower (Passiflora incarnata) for the treatment of sleep disturbance in 41 individuals.  In the study passionflower in the form of a tea preparation was investigated but passionflower is also available in the form of supplements, tinctures and tonics.  The researchers of the study found that sleep quality was significantly better with passionflower compared with placebo tea.  They conclude that (1) These initial findings suggest that the consumption of a low dose of Passiflora incarnata, in the form of tea, yields short-term subjective sleep benefits for healthy adults with mild fluctuations in sleep quality.”

Traditionally passionflower  has been used as a herbal sedative and sleep aid as well as for its anxiolytic, anxiety reducing, properties.  Anxiety is a problem that impacts many individuals and I have previously written about some natural solutions to anxiety which can be found here: including the benefits of walking, chamomile, Ashwagandha (or Indian Ginseng), antioxidants and omega 3 fatty acids.

A review paper last year looked at nutritional and herbal supplements for anxiety and anxiety-related disorders (2) based on the results the authors concluded that strong evidence existed for the use of passionflower for the treatment of anxiety symptoms and disorders.  The review comments that several studies involving the biochemical makeup of passionflower have been conducted and between the 1970 s and 1990s passionflower was listed as an official plant drug by the pharmacopoeias of America, Britain, Germany, France, Switzerland, Egypt and India.  Passionflower contains many hundreds of different phytochemicals (bio active plant chemicals), it is difficult to elucidate which specific biochemicals are responsible for the active, anti-anxiety, properties of passionflower.  So, although passionflower supplements often produce positive results, identifying the active ingredients can be difficult.  It is also possible that some herbal passionflower remedies may be ineffective due to not containing the active anti-anxiety components.

One of the studies (3) included in the review paper compared the use of passionflower supplements to oxazepam in patients with GAD (generalised anxiety disorder).  Oxazepam is a prescription medical drug used to treat anxiety symptoms and insomnia (marketed under brand names such as Alepam, Medopam, Murelax, Noripam, Opamox, Ox-Pam, Purata, Serax and Serepax).  The results showed that Passiflora extract and oxazepam were both effective in the treatment of generalized anxiety disorder. In fact no significant difference was observed between the passionflower and oxazepam at the end of trial. Oxazepam did show a rapid onset of action, however, significantly more problems relating to impairment of job performance were encountered with subjects on oxazepam.  The authors of this study conclude that “The results suggest that Passiflora extract is an effective drug for the management of generalized anxiety disorder, and the low incidence of impairment of job performance with Passiflora extract compared to oxazepam is an advantage. A large-scale trial is justified(3).

The authors of the review paper (2) say that evidence does suggest that passionflower is an effective anti-anxiety agent but that studies have, to date, been conducted in different types of individuals and that more research is needed to prove its usefulness in anxiety related disorders.  There are many herbal preparations containing passionflower, such as these available to buy.  If you are experiencing anxiety symptoms it is important to visit your medical doctor where you can discuss the option to try passionflower containing remedies as a treatment.  If you do try passionflower supplements please follow the dosage guidelines carefully, there is some evidence to suggest (2) that in some cases passionflower may cause dizziness, drowsiness and confusion.

(1) Ngan A, Conduit R.  2011.  A Double-blind, Placebo-controlled Investigation of the Effects of Passiflora incarnata (Passionflower) Herbal Tea on Subjective Sleep Quality. Phytother Res. 2011 Feb 3. doi: 10.1002/ptr.3400. [Epub ahead of print]

(2) Lakhan SE, Vieira KF.  2010.  Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review.  Nutr J. 9:42.

(3) Akhondzadeh S et al.  2001. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther.   26:363–367. doi: 10.1046/j.1365-2710.2001.00367.x

 

Written by Ani Richardson

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Naturopathic aid for anxiety disorders

Anxiety can be a debilitating condition with many individuals seeking natural ways to try and overcome their symptoms.  An interesting paper (1) was recently published that closely looked into anxiety disorders and whether naturopathic care could be helpful to sufferers.

The authors of the study note that “anxiety is a serious personal health condition and represents a substantial burden to overall quality of life. Additionally anxiety disorders represent a significant cost to the health care system as well as employers through benefits coverage and days missed due to incapacity” “Anxiety disorders are among the most prevalent type of psychiatric disorder with an estimated lifetime incidence ranging between 7.9% and 14.5% worldwide”. 

The study(1) was small but well designed, employees with moderate to severe anxiety of longer than 6 weeks duration received naturopathic care or a psychotherapy intervention over a period of 12 weeks.  Participants in the naturopathic care group received dietary counselling, deep breathing relaxation techniques, a standard multi-vitamin, and the herbal medicine, ashwagandha (Withania somnifera, known as Indian Ginseng) (300 mg standardised to 1.5% withanolides).  The Psychotherapy group received psychotherapy, deep breathing relaxation techniques, and placebo (inactive ‘dummy’ pills).  Various measures were used to assess anxiety, mental health and quality of life (1)

The participants in the naturopathic care group has significantly decreased measures of anxiety compared to the psychotherapy group, significant differences between groups were also observed in mental health, concentration, fatigue, social functioning, vitality, and overall quality of life with the naturopathic care group exhibiting greater clinical benefit. No serious adverse reactions were observed in either group.  In conclusion the study authors state “The whole system of naturopathic care for anxiety needs to be investigated further including a closer examination of the individual components within the context of their additive effect(1).  

“Naturopathic medicine (also known as naturopathy) is a school of medical philosophy and practice that seeks to improve health and treat disease chiefly by assisting the body’s innate capacity to recover from illness and injury. This alternative medical system of care employs the use of many therapies including acupuncture, herbal medicine, osteopathy, nutrition, homeopathy, and lifestyle counselling in a combined manner to address the underlying cause of disease”(1).

The herb, ashwagandha (Withania somnifera), in the study has been used for over 3000 years and previous evidence indicates that it might be useful for anxiety, inflammation, cognitive (mental function) and neurological disorders.  Ashwagandha (or Indian Ginseng as it is often known), is often used by naturopathy practitioners for people with nervous exhaustion, insomnia, debility due to stress, and as an immune stimulant in patients with low white blood cell counts.  It is considered to be an adaptogen – I have written about adaptogens previously  when discussing rhodiola & Siberian Ginseng.  Adaptogens are considered to be herbal preparations that increase tolerance to mental exhaustion and enhance attention and mental endurance in situations of decreased performance. The beneficial stress-protective effect of adaptogens appears to be complex, these herbs seems to work via several mechanisms including actions on the hormonal and immune systems (2).  Sometimes adaptogens are simply referred to as rejuvenating herbs and their use dates back thousands of years in China and India. 

The lifestyle and nutritional counselling given during the study was specific to the individual patient but special emphasis was placed on: reducing intake of stimulants such as caffeine and cigarettes (since these are known to aggravate anxiety), eating small, meals at regular intervals (this helps to keep blood sugar levels stable which is useful to prevent anxiety), and increasing the consumption of fruit, fish, vegetables, nuts, and whole grains. Participants were also encouraged to exercise on a regular basis.  This kind of healthy lifestyle advice is relevant to the population as a whole!  A healthy diet, rich in nutrients can impact so many areas of health.

Anxiety can be a very distressing condition, if you feel that your life is being trongly affected by anxiety and stress I would urge you to visit your doctor.

(1)Cooley K et al.  2009.  Naturopathic care for anxiety: a randomized controlled trial ISRCTN78958974.  PLoS One.  4(8):e6628 http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0006628

(2)Panossian A, Wikman G.  2009.  Evidence-Based Efficacy of Adaptogens in Fatigue, and Molecular Mechanisms Related to Their Stress-Protective Activity. Curr Clin Pharmacol. 2009 Sep 1.

Written by Ani Kowal

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Healthy diet, healthy mind

Nutrition and eating for the brain and mental health are topics I have written about regularly here.  Our mood can have powerful influences on many aspects of life and eating for a healthy body naturally impacts the brain.  A recently published study (1) highlights the importance of eating for mental health by demonstrating that there is an association between diet quality and the prevalence of mental disorders in women.  The study is preliminary and certainly warrants further investigative trials but the data is important to note.

Healthy Food Healthy Mind
Studies have found a link between diet and mental health.

The study authors wanted to examine the extent to which the high prevalence of mood disorders are related to diet/eating habits.  The research involved 1,046 women between the ages of 20 and 93 who were randomly selected.  A diet quality score was devised and the habitual eating patterns of the women were analysed.  The women also underwent a specialised questionnaire and clinical interview to assess their psychological health.  Current depressive and anxiety disorders were recorded.  The researchers found that a traditional western diet which includes processed/fried foods, refined grains, sugary products and beer was associated with anxiety and depression.  The results were not confounded by age, education or a variety of other behaviours, indicating that diet was having a very real impact on mood (1).

Eating a ‘traditional western diet’ was associated with more than a 50% increased likelihood for depressive disorders in the women involved in the study.  Depression and anxiety disorders were around 30% less likely among women who ate a healthier diet which consisted mainly of vegetables, fruits, fish and unrefined wholegrains (1)

The authors suggest that further investigations are needed to determine whether unhealthy eating leads to declining mental health or whether declining mental health leads to unhealthier eating.  It is probable that these events are not mutually exclusive.  Feeling good often means that a better quality diet is eaten, self-esteem is high and we tend to look after our bodies and feed them healthfull foods.  Feeling ‘low’ may lead to lowered self-esteem and poorer quality food choices at a time when high quality foods would probably make a difference to mind and body.

As my previous posts relating to mood and mental health aim to highlight, a healthy diet and lifestyle which includes some regular exercise really can go far in impacting mental health.  Diets rich in vegetables, fruit, unrefined meats, fish, and wholegrains are a good basis health.  Omega 3 fats from oily fish and/or supplements seem particularly important for the brain and mood elevation.

References

(1) Jacka FN et al.  2010.  Association of Western and Traditional Diets With Depression and Anxiety in Women.  Am J Psychiatry (published online January 4, 2010; doi:10.1176/appi.ajp.2009.09060881)

 

Written by Ani Kowal

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Can chamomile impact anxiety?


Many of us experience a certain level of anxiety at some point or another but for some individuals anxiety can become a debilitating problem.  Generalised Anxiety Disorder, or GAD, “can be defined as a disorder in which the sufferer feels in a constant state of high anxiety” according to the charity Anxiety UK.  “The anxiety experienced is not as a result of any specific trigger, but those with this condition feel that they are on edge all the time for no specific reason. GAD is often accompanied by depression. GAD is sometimes called ‘free-floating’ anxiety condition”.  For further, more specific information on GAD please visit the Anxiety UK website



Anxiety UK is a national registered charity formed 30 years ago by a sufferer of agoraphobia for those affected by anxiety disorders. Today the charity is still a user-led organisation, run by sufferers and ex-sufferers of anxiety disorders supported by a high-profile medical advisory panel.  The ANXIETY UK works to relieve and support those living with anxiety disorders by providing information, support and understanding via an extensive range of services, including 1:1 therapy services.  The charity can provide support and help to those who have been diagnosed with, or suspect they may have an anxiety condition.


For many years people have advocated having a cup of chamomile (Matricaria recutita) tea to help soothe and calm nerves.  I was interested to find that recently (1) a study showed that chamomile may be useful to those suffering from mild to moderate GAD.  The study was well designed and looked at the usefulness of chamomile extract therapy in individuals suffering with mild to moderate GAD.  Individuals in the study received chamomile extract or placebo (inactive dummy pill) for 8 weeks.



The research was designed to detect changes in clinical anxiety ratings using special, professionally recognised, anxiety scores.  The results(1) showed that there was a significantly greater reduction in the anxiety scores during the chamomile therapy when compared to the placebo.  This was the first controlled clinical trial of chamomile extract for the treatment of GAD and the results suggest that chamomile may well have modest anti-panic activity in treating GAD in patients with mild-to moderate GAD.  Further clinical trials are needed to confirm these results and before any recommendations can be made. 



These results are particularly interesting since many individuals suffering from anxiety disorders would prefer not to take pharmaceutical drugs for their condition.  I have previously written a little about anxiety in my posts – gentle exercise such as yoga and Tai Chi, healthy diet (especially managing blood sugar levels) and magnesium may also be useful in anxiety disorders.  Caffeine is also known to aggravate anxiety in many individuals so having chamomile tea is a good alternative.  Supplements containing chamomile are available and often these are marketed as ‘calming’ these supplements have not been tested specifically for anxiety disorders but if you wish to try them to see if they have a soothing effect then please follow the manufacturers guidelines.



(1)Amsterdam JD et al.  2009.  A Randomized, Double-Blind, Placebo-Controlled Trial of Oral Matricaria recutita (Chamomile) Extract Therapy for Generalized Anxiety Disorder.  Journal of Clinical Psychopharmacology. 29(4):378-382
Written Ani Kowal

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De-stress this Valentine’s day with a bit of dark chocolate

It is Valentine’s Day on Sunday and chocolate sales are bound to be high.  Readers of this blog may remember reading about my penchant for good dark chocolate (my preferred chocolate is very rich and dark at 85% cocoa solids), well it seems like giving this treat to yourself or a loved-one could really be a stress-buster.



Cocoa and good quality dark chocolate (the 70%+ cocoa solids varieties) have been shown to have numerous health benefits mainly due to their antioxidant capacity in the body.  A recent study has found that dark chocolate may also be useful in reducing emotional stress (1).



The study (1) was small and very preliminary but certainly interesting.  The study participants were first tested using validated psychological questionnaires to see if they had low or high anxiety traits.  They were given 40g of dark chocolate daily for two weeks.  Blood and urine samples were collected 3 times during the study – at the start, middle and end.  The samples were rigorously tested to see whether various measures of body chemistry of the individuals was changed by the chocolate eating and also to see whether specific processes of gut bacteria was altered.



Interestingly the participants with higher anxiety traits showed a distinct change in their metabolic (bodily chemical processes) profiles when eating the dark chocolate.  Dark chocolate was, amongst other things, found to reduce the urine levels of the stress hormone cortisol as well as other body chemicals related to stress.  Dark chocolate was also found to partially normalise and correct stress-related differences in specific body chemistry levels as well as the activity of specific gut bacteria (1)



In conclusion the scientists suggest that the study provides strong evidence that a daily consumption of 40 g of dark chocolate daily during a period of 2 weeks is sufficient to modify the metabolism of healthy human subjects (1)



Further studies to confirm these results are needed and the study definitely does not justify chocolate binges!  However, reaching for a few squares of good quality dark chocolate may be a soothing way to treat yourself to something indulgent, especially on Valentine’s Day.



(1)Francois-Pierre J. Martin, FPJ et al.  2009. Metabolic Effects of Dark Chocolate Consumption on Energy, Gut Microbiota, and Stress-Related Metabolism in Free-Living Subjects.  J. Proteome Res. 8 (12), pp 5568–5579
Written by Ani Kowal

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Could antioxidants help reduce symptoms such as stress, anxiety and fatigue?

Due to the economic events occurring over the last year many people have felt under incredible stress.  A recent study (1) has found that an antioxidant supplement may be helpful in reducing symptoms such as fatigue, stress and anxiety which are fairly prevalent in developed populations at this current time.  There have been several suggestions in the scientific literature that there is a link between individual perceived stress and ‘oxidative stress’ – a kind of stress that occurs in the cells of our bodies when they are under attack by molecules known as ‘free radicals’.  In the body antioxidant defences are important to prevent damage by these free radical molecules which can cause inflammation and are linked to many diseases.  Our bodies contain many enzymes that act as antioxidants, a main one being SOD, superoxide dismutase.  The study mentioned (1) used a melon juice supplement that was high in SOD to see if it had any effect on individual symptoms of stress.



This pilot study (1) was well planned and included seventy healthy volunteers aged between 30 and 55 years, who felt daily stress and fatigue. They took the dietary melon supplement or a placebo once daily over a 4 week period. Symptoms of stress and fatigue were measured using four specific psychometric scales.



Supplementation with the melon concentrate supplement significantly improved perceived signs and symptoms of stress and fatigue linked to e.g. pain, sleep troubles, concentration, weariness, attitude, irritability compared to the placebo. In the same way, quality of life and perceived stress were significantly improved with supplementation (1).



One of the authors of the study said in a press release (2) “Several studies have shown that there is a link between psychological stress and intracellular oxidative stress. We wanted to test whether augmenting the body’s ability to deal with oxidative species might help a person’s ability to resist burnout. The 35 people in our study who received capsules containing superoxide dismutase showed improvement in several signs and symptoms of perceived stress and fatigue.” She added that ” It will be interesting to confirm these effects and better understand the action of antioxidants on stress in further studies with a larger number of volunteers and a longer duration.”



The best way of providing the body with antioxidants is to eat a diet that is rich in vegetables and fruits.  These foods provide antioxidant vitamins, minerals and bioflavonoids (bioactive plant compounds).  Antioxidant supplements made from natural berries and herbs are now also available to buy but should not be viewed or used as an alternative to a healthy diet.  If you feel that you are under particular stress/mental strain at the moment you may wish to increase the number of antioxidant containing foods in your diet.  If you are struggling to reach the daily minimum of 5 portions of vegetables and fruits then a good quality antioxidant supplement may be something you wish to consider in the short term in order to boost your antioxidant levels during periods of stress.


It will be interesting to see what further research uncovers in the realm of antioxidants and stress symptoms, with so many people feeling pressure in their lifes these kinds of studies could represent important steps toward helping to ease difficult symptoms.


 


(1)Milesi MA et al.  2009.  Effect of an oral supplementation with a proprietary melon juice concentrate (Extramel) on stress and fatigue in healthy people: a pilot, double-blind, placebo-controlled clinical trial.  Nutrition Journal.  8:40 (15 September 2009)
(2)Press Release: Antioxidant Ingredient Proven To Relieve Stress. ScienceDaily. Retrieved September 16, 2009, from
http://www.sciencedaily.com/releases/2009/09/090914194652.htm


Written by Ani Kowal

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Omega 3 fatty acids from fish oil may be helpful for some menopausal symptoms

A common problem for women going though the menopause is the experience of psychological symptoms such as anxiety, mood swings and depression.  Hormone replacement therapy (HRT) and/or antidepressant medication is often offered to women going through the menopause in order to address such features.  These medications are linked with a variety of side effects and often women prefer to seek more natural alternatives in order to deal with their symptoms. 



A very recent study (1) has indicated the usefulness of the long chain omega 3 fatty acids EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), naturally found in oily fish such as salmon, mackerel, trout and sardines, in the protection against depressive and mood related symptoms in menopausal women.  The study involved 120 women with moderate-to-severe psychological distress.  These individuals were randomly assigned to receive either an omega 3 supplement (containing EPA and DHA) or a placebo supplement (containing sunflower oil) for 8 weeks.  Changes in psychological wellbeing and depressive symptoms was assessed in these women via the use of specific medical scales and questionnaires.



Previous studies have shown the usefulness of using omega 3 fatty acids in the treatment of depression and mood disorders but this was the first trial using omega 3 fats in the treatment of psychological distress and depressive symptoms in menopausal women.  The results were useful and positive.  In a press release (2) the lead study scientist, Dr Lucas, said that the test results before and after the eight-week period indicate that omega-3s significantly improved the condition of women suffering symptoms of psychological distress and mild depression.  (No positive effect was observed among a small sub-group of women with more severe depressive symptoms). These results suggest that omega-3 supplementation may be beneficial for improving the psychological wellbeing of some menopausal women.



Women with hot flashes also noted that their condition improved after consuming omega-3 fatty acids.  The change that could be attributed to the use of omega-3 fats was equivalent to results obtained with hormone therapy and antidepressants (1,2).



The results do not surprise me.  There is now mounting evidence to support the use of omega 3 fatty acids in the treatment and prevention of anxiety and depression/depressive symptoms in a range of individuals (including children with ADHD).  Omega 3 fatty acids are absolutely essential for healthy brain structure and function.  Our bodies cannot make these essential omega 3 fatty acids (that is why they are known as essential fats), they must be taken in through the diet and are vital to numerous aspects of health.  We really do need to feed our brains!



If you do not regularly eat oily fish you may wish to consider a fish oil supplement providing around 350mg EPA and 350mg DHA daily.  Vegetarians may wish to think about taking a flaxseed oil supplement providing 500-1000mg alpha linolenic acid daily.  In the UK, and western world as a whole, most of us do not get enough omega 3 fats from our diets.  A supplement could be very useful to provide widespread health benefits.  As you will notice from my previous blog posts I mention omega 3 fatty acids regularly and am incredibly interested in the ongoing medical research surrounding these fats.



(1)Lucas M et al.  2009.  Ethyl-eicosapentaenoic acid for the treatment of psychological distress and depressive symptoms in middle-aged women: a double-blind, placebo-controlled, randomized clinical trial. Am J Clin Nutr 89: 641-651.
(2)Université Laval (2009, February 1). Omega-3 Fatty Acids Ease Depressive Symptoms Related To Menopause.
ScienceDaily. Retrieved February 2, 2009,


Written by Ani Kowal

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Walk and breathe those anxious thoughts away

Generally I am a very calm and relaxed individual.  However, this morning I woke up with an underlying feeling of anxiety for no specific reason.  This may be affecting many of you at the moment with all the news headlines regarding the ‘credit crunch’ and various other negative stories.  Within an hour I was feeling great again so I thought I might share some of my tips with you here today.


For me it was the following that helped me to get my happy feeling back: 10 minutes of deep breathing followed by a 40 minute walk and then ten minutes of hula-hooping in the sun!  Hula-hooping has now become my exercise of choice as it causes me much laughter.


Any exercise will produce feel good chemicals in the brain.  There are all sorts of studies that have shown the positive effects of exercise on mood.  Going out for a walk has always helped me to feel very calm.  It takes me out into a different environment and allows my mind to drift free of thought.  Both low intensity exercise, such as a gentle walk, or higher intensity exercise, such as running, may help to reduce feelings of anxiety(1).  Yoga and deep breathing can also help to reduce worry(2).  Concentrating on the breath during deep breathing is also used during meditation and yoga relaxation.  It allows us to be focussed on the now, the present moment, minimising any fraught thinking about the past or the future.  A recent study(3) found that this sort of meditation was related to reduced feelings of anxiety and improved well-being.


A small preliminary study published last year(4) gives us a few clues as to why yoga and associated conscious breathing exercises may be useful in reducing anxiety levels.  The study found that brain GABA levels (gamma amino butyric acid) increase after an hour yoga session compared to an hour of reading.  GABA has calming and anti-anxiety effects in the brain.


So, if you feel a little anxious I suggest ten minutes of conscious breathing and a walk around the block (or some yoga or even hula-hooping), it may well help to calm and centre your thoughts.


Having a good nutritional status is important for the efficient functioning of the brain and body.  A well-balanced diet packed with vegetables, fruits, nuts, seeds and wholegrains will boost your body with all kinds of nutrients and may help to keep anxious thoughts at bay.  Calcium, magnesium, many B vitamins are important for the proper functioning of the nervous system.  Many people in the UK do not achieve good intakes of magnesium from the diet (found abundantly in nuts, seed and wholegrains).  Studies have shown that magnesium deficiency can enhance stress reactions in the body and anxiety can also increase our bodily need for magnesium(5).  You may wish to consider taking a high quality multivitamin and mineral supplement during periods of anxiety, a study(6) found that a multi supplement taken for 28 days was associated with a consistent reduction in anxiety and perceived stress (when compared to placebo).  


(1) Broman-Fulks JJ et al.  2004.  Effects of aerobic exercise on anxiety sensitivity.  Behav Res Ther.  42(2):125-136
(2) Kjellgren A et al.  2007.  Wellness through a comprehensive yogic breathing program – a controlled pilot trial.  BMC Complement Altern Med.  19:7-43
(3) Carmody J, Baer RA.  2008.  Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J Behav Med. 2008 Feb;31(1):23-33
(4) Streeter CC et al.  2007.  Yoga Asana sessions increase brain GABA levels: a pilot study. J Altern Complement Med. 13(4):419-26.
(5) Seelig MS.  1994.  Consequences of magnesium deficiency on the enhancement of stress reactions; preventative and therapeutic implications, a review.  J AM Coll Nutr.  13:429-446
(6) Carroll D et al.  2000.  The effects of an oral multivitamin combination with calcium, magnesium and zinc on psychological well-being in healthy young male volunteers: a double blind placebo controlled trial.  Psychopharmacology.  150:220-225


Written by Ani Kowal

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