The anxiety guide inc. a full CBD oil explainer + anti-anxiety supplements

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0:59Plus, you can be assured that all ingredients undergo rigorous third-party testing. Buy Primadine now at OxfordHealthSpam.com and use the discount code DrSophie, that's D-R-Sophie, for 20 % off. Hi, I'm Sophie and this is Age Well with Dr. Sophie Schotter, a space devoted to all things health, wellness and longevity. Because for me, aging well is about looking and feeling like the best possible version of ourselves inside as well as out. So together with my producer Fee, I'll be deep diving into the latest research sifting fact from fiction. I'll also be talking to all kinds of trusted experts tapping into their knowledge, along with bringing you conversations from a range of interesting women and men finding out how they age well.

1:47So this is my show, welcome along. And as always thank you so much for listening okay sophie so just to set the stage this is less a chat about

2:04Dr Sophie Shotter:anxiety itself and more to do with which if any functional or nutritional supplements can help anxiety and what the options are but before we get into it do you want to say a few generic words just to create some context. Yeah, great idea. I suppose one of the things that's important to say is that anxiety can present in so many different ways from occasional nausea to full-blown regular panic attacks to knots in stomachs to racing heartbeats and palpitations. It can be daily or it can come and go and it can manifest for so many different reasons, which is why in terms of solutions there really isn't a one-size-fits-all approach and it's often about really delving down to the root cause.

2:50For example for some people it might be poor sleep because as studies now show this makes a huge difference to our mental health. Poor gut health is another contributing factor and a really significant one. Don't underestimate the data we now have around gut health and mental health. We also know that high GI carbohydrates spike our blood sugar, which can mean a burst of energy followed by a crash and a boom and bust cycle that's correlated with anxiety. So I know that these all may seem like overplayed messages, but all of this is really important. This is like the basics. What we always talk about with wellbeing and lifestyle, there are foundations and these are the ones of mental health.

3:29Starving ourselves is also really bad news because if you haven't eaten enough and your blood sugar crashes, your body pulls the alarm that makes it secrete cortisol, which is a stress hormone and adrenaline, which creates that feeling of panic. For some people, the cause of anxiety might be too many stimulants. Caffeine can be a culprit here. No one's saying give up coffee. As I said in our dedicated episode on coffee last year, it's a bean and it's great for gut health, but it's the caffeine in it that can be the issue. And there are now great decaf options. Anxiety might also be due to lifestyle things, a stressful job, a toxic relationship, or challenging one-off situations or all of the above.

4:12Scientists also now think that there may be fundamental brain issues at play and hormonal fluctuations could also be the problem, be it puberty, PMS, pregnancy, postpartum, perimenopause, menopause, and even things like thyroid hormones or stress hormone imbalances like cortisol. And all of these directly influence mood chemicals like serotonin, the happy hormone, and this then creates anxiety and stress. So you really do need to figure out what the cause or causes might be and definitely fix these things or at least work on addressing them before you think about buying what could be very expensive supplements.

4:51Dr Sophie Shotter:Such good advice. And the brain function part of it is really interesting. Yes. And in preparation for this chat, I was also looking at some of the work of Jack Nitschke, as an associate professor of psychology and psychiatry who's been analyzing the brains of people with anxiety and really interestingly he's found that people with anxiety have reduced connections between their prefrontal and their anterior cingulate cortex which is kind of the center of our emotional regulation and their amygdala which is the part that initiates that fight or flight response so he thinks that this broken connection between these specific areas of the brain might explain why some people really suffer with anxiety.

5:32It is very early research but definitely worth considering. There's also now research that is again in the very early days but the data does suggest that people with anxiety maybe perceive significantly more threats and that they also tend to process those threats differently perhaps bringing fear into what others might perceive as very safe situations and it's apparently a subconscious bias towards fear again more research is needed although I'd say that something like CBT cognitive behavioral therapy might be useful here.

6:07Dr Sophie Shotter:Okay well to look at the various non-prescription options let's move on to the list that you sent me and I'm particularly intrigued by CBD because we've talked about cannabis before but we haven't talked about CBD or at least not in depth so I know we're going to focus on this a fair bit because it seems you have a lot to tell us and from what I've read things have been changing an awful lot in the world of CBD. Yeah and let's just say first of all I say this just because some people are still unsure CBD is perfectly legal and no it will not get you high. It's a very popular choice for anxiety and is really readily available in both shops and online although I would also add that cannabis can also be a good choice for anxiety and medical cannabis is legal in the UK from an approved prescriber.

6:56So again, listen to our guest episode with Professor David Nutt for more on that. The other caveat I will give is that if you are on prescription anxiety medications, then CBD may not be a good choice for you. So it's really crucial to remember that our body doesn't know the difference between a supplement and a drug. and so if you are on medications you need to check the interactions between supplements and medications and it's important to know that with anxiety medications. But back to CBD or cannabidiol to give it its full name, this comes from the cannabis plant specifically from hemp and this is a type of cannabis with very low THC and THC is the thing that gets you high.

7:40so CBD is a non-psychoactive compound and I think it's fair to say that CBD is now really mainstream to the point that Claudia Winkleman is a brand ambassador for the brand Cannare. As I said you can pick it up in all kinds of places including Harlan and Barrett and Boots so very high street. One thing that I will say from the get-go is that anecdotally some people claim amazing benefits across quite a broad spectrum of ailments not just anxiety and other people are very nonplussed by it. So this might be because of what I've talked about. So it's no good if you're taking CBD and you're not doing those foundations, your diet is rubbish, or you're going through this very stressful life event and you're still in the depths of it.

8:25So we do have to bear that in mind. But it does seem that CBD is better for day-to-day anxiety in people who do have that generally healthy lifestyle. I've certainly dabbled with it in the past as a sleep aid. for me it's more about if I've struggled to switch my brain off at night and I have spoken about that on our sleep episode the other factors are dose and quality which we'll get into in a few moments and by the way I will also get on to recommended brands because I know listeners will want to hear about this and I do also want to cover the latest research so people can make their own informed

8:59Dr Sophie Shotter:decisions brilliant and should we talk about the politics too because I've been reading a little a bit about this. And I do think it's quite important that people understand some of the politics behind CBD because what's interesting but also quite tricky is that in 2019 the UK Food Standards Agency or FSA stepped in and classified CBD as what's called a novel food and this has certainly had impacts. On the one hand it required CBD brands and producers to go through a lot of paperwork and it's now restricted what brands can medically claim about it. this could be perceived as a good thing because it sort of smoked out some of the bad players making dubious claims or creating products that contain very little CBD or even products with illegal levels of THC.

9:45But the FSA's intervention has also created issues around dosing which to be honest has become a bit of a hot potato. So the FSA recommends a maximum of 70 milligrams per day which some people consider to be too low to have a therapeutic effect on something like anxiety. And there are claims that this could scare monger people off the idea of dosing higher. So the FSA from what I hear is also apparently trying to introduce this one size fits all safety limit, recommending a much lower maximum daily intake of 10 milligrams of CBD. And this is really very low compared to the amounts that a lot of people routinely take, not just in this country, but for example, in the States where CBD is far more widely used.

10:28and while they are suggesting that this 10 milligrams would be a guideline and not a legal cap some industry groups argue that this 10 milligram recommended limit wouldn't reflect safety data and they say that this is the FSA being very overcautious. From the FSA's perspective however this recommended limit is apparently to avoid long-term potential risks like liver issues and to offer balance an FDA study in the US has found that CBD might cause liver issues in some people. So as you can tell, it's kind of complicated. And as always, you can probably guess what I'm going to say. We need more studies.

11:05We need more data. But anyway, CBD still remains a very popular choice for many people with anxiety. So I'm going to give you all a little user guide. Firstly, and before we go into any real detail, if you do decide to take it, my advice would be to start slow and low and build up if you need to. And just so we cover all our bases, if you do end up taking a higher dose on a regular basis, maybe just have your liver function checked every so often.

11:32Dr Sophie Shotter:Yeah, great idea. So can you cover, we've got a few things to say, but can you cover the latest data? What do the studies and research say that we do have so far tell us about CBD and anxiety? Well, there are definitely some really interesting and very positive sounding research projects out there. One that caught my eye is a 2012 review of all of the evidence available, and this concluded that CBD has anti-anxiety effects that are similar to those of prescribed anti-anxiety drugs which is obviously really impressive. For the record anxiety is actually the second most common reason for people taking CBD with physical pain being the first reason and a lot of people with things like backache, endometriosis and rheumatoid arthritis swear by it.

12:19More generally on the mental health and anxiety front multiple studies have shown that CBD brings down inflammation and balances adrenal function, which again helps to lower cortisol and stress, which is why it's thought to really help with anxiety. Also, if it's taken long term, the benefits are thought to increase. So CBD is thought to act as an adaptogen, which again, in the long term is working on your adrenal function and inflammation. I think rather than quote lots of studies at you, we can put some links in the show notes, but the headline message is that yes, there is quality research that suggests it can really help with anxiety amongst other things.

12:56Dr Sophie Shotter:So in terms of quality, how do we know if we're buying high quality CBD or have the new regulations, as you say, helped remove some of the bad players? Yeah, broadly speaking, yes. The good thing about the 2019 regulations was that the brands really had to jump through some hoops to stay in the UK market. They had to submit a serious amount of data about batch quality and safety, meaning that again, a lot of the dodgy brands quietly slipped away. But so did some lovely brands who simply didn't have the time or the money to go through all the testing requirements. So it's not all good news. There's also actually a huge backlog of companies still waiting for UK approval.

13:34So one thing that listeners can do is a quick check of the FSA public list of CBD brands who are applying for what's called this novel food approved status. But in general, if it's for sale in a reputable UK health store or pharmacy or a well-known online retailer, then it will have jumped through the FSA's rigorous testing. So I think you can be sure of the quality. I also think that buying certified organic might give an extra level of reassurance, as it's good to know that the original hemp plant hasn't been sprayed with any pesticides, but that's again personal choice.

14:05Dr Sophie Shotter:Okay, so you mentioned dosing. what's the best way of dosing is more better? Not necessarily and it all depends on your body's unique response which I'll get to as this is interesting. The FSA recommends that healthy adults don't take more than 70 milligrams of CBD per day unless a doctor has agreed more. For reference this is roughly about 14 drops of a 10 % CBD oil or 28 drops of a 5 % oil but do check each specific product and remember that this is your maximum recommended limit not what you should just routinely take. Many people though do take more plus one of them might be three times the price and one might be more concentrated and end up therefore being better value.

14:51I think the key thing is everyone responds differently so I was reading that one in ten people appear to metabolize CBD very slowly so we'll probably do fine on a lower dose but on the other hand there are some people who metabolize the CBD very quickly. And as I said earlier, they therefore don't feel enough of an effect, even on larger doses, because it works its way out of their system so quickly. So these are the ones that end up saying CBD did nothing for me.

15:16Dr Sophie Shotter:That is interesting. Very interesting. Okay, more questions. What's broad spectrum CBD? So some brands use what's called CBD isolate, which is pure CBD in a carrier oil. And they sometimes claim that this is purer but actually many experts believe that CBD works far better in conjunction with the other natural compounds found in the original leaves of the hemp plant so not just the CBD but other cannabinoids like CBG and CBN plus these things called terpenes and flavonoids but nearly all of the THC is removed again the stuff that gets you high so this is what we mean by broad spectrum. It contains most or all of the other natural cannabinoids, but without the THC.

16:02Then there's also full spectrum CBD, which again has all of the above. So all of the cannabinoids, terpenes and flavonoids, plus a trace amount of THC under one milligram per bottle, which is still legal in the UK. And to be clear, again, this is not enough to get you high. You might recall that Professor Nutt talked about this on our cannabis episode. It's the idea that all of the compounds of the cannabis plant are thought to work better in synergy, which is known as the entourage effect. And there is some science here. So if it were me, I'd look for either full spectrum or at least broad spectrum CBD and not at CBD isolate products.

16:39Yeah, same. And what are terpenes? Terpenes are these plant molecules that are part of the plant's defence mechanism. And again, interestingly, these are thought to positively affect the human nervous system, creating this calming effect. But there are lots of different types of terpenes and each has specific effects and research is really still ongoing to identify the best molecules to be used therapeutically. You can actually buy CBD with added mood balancing terpenes and the word added is important because apparently the current extraction method can easily destroy them. So again I'd be looking for full spectrum CBD with the terpenes already in there or I'd want to know how they've extracted those terpenes.

17:23Dr Sophie Shotter:Okay so brands are there any you'd recommend and what do you personally use are you using any at the moment? I'm not going to mention loads and loads of brands because I think personal recommendation and online reviews are a brilliant tool but let me run through a few of them. I am not using one at the moment but I have previously used Dream distillery which offers 800 milligrams of CBD in 10 mils of oil so this is an 8 % oil that gives you four milligrams of CBD per drop. I've certainly enjoyed good sleep on this but do be warned it's not cheap so for example if you wanted to dose 40 milligrams a day the 75 pound bottle wouldn't unfortunately last you for a month.

18:05I think it would last probably about three weeks but it certainly has great reviews. It's broad spectrum with terpenes, including limonene and linalool to soothe and relax. And I have to say, it also tastes nice pepperminty. I'm really impressed by a small independent brand called Bristol CBD. Their customer service is really amazing. They'll talk you through all the options. They only sell CBD extracted from organically grown hemp, and they hand harvest the buds and flowers. So they offer full spectrum and whole plant oils to harness that entourage effect. And you can buy a range of strengths from 5 % up to 23%.

18:42I will say 23 % is very strong, so please don't go straight in with that. The Trip brand always reviews really well. Their Orange Blossom Blend is a UK bestseller, and it has 1 ,000 milligrams of CBD. Although again, because it's in 15 mils of oil, you'll need a sizable amount of drops to get a good dose. So around 12 drops for that 40 milligrams. but it is broad spectrum, it tastes good, has added chamomile and is a decent price. Another brand called Unique has a 20 % oil that gives 10mg of CBD in a single drop. Again full spectrum with the added terpenes to increase its effects. But these stronger oils are usually used for physical pain rather than anxiety so be warned you could feel a bit knocked out on them.

19:28Remember what I said, start low and slow and test your own reaction and response. Just to say CBD drops, so the little bottles of oil, are generally faster acting than any sort of capsules as they're absorbed really quickly into the bloodstream. But if you do want to try capsules, then I've heard really good things about Healthspans, OptiCBD capsules, and they have apparently got a really good absorption rate.

19:53Dr Sophie Shotter:Okay, so I think you've covered CBD. Thank you so, so much. Let's run through some other potential options for anxiety. I'm going to start with St John's Wort. This is quite an old school herbal remedy, isn't it? Yes, and it's one of the most heavily researched for efficacy. A 2008 review of 29 different studies suggested it might be as effective as antidepressants or prescription medications for mild to moderate anxiety. We think this is because it increases serotonin, the happy hormone, but it does have side effects ranging from headaches to tiredness and dizziness and also be warned it doesn't play nicely with other medications.

20:31So for example, oral contraceptives can be problematic. And again, while it works for some people, for some others, it has very little effect. Bear in mind, it can take up to six weeks to take effect. So again, you need patience with it.

20:45Dr Sophie Shotter:That's with lots of these things. Rhodiola is on your list and this is one that I think Trini Woodall name-checked is one of her all-time favourite supplements. Yeah and this again is another herb I think Trini mentioned Magnolia rhodiola which is a combination of herbs including rhodiola which is an adaptogenic which is traditionally used for stress fatigue and mild anxiety it basically works on the stress response system particularly the HPA axis which we've talked about before on the show so it balances levels of serotonin dopamine and norepinephrine or noradrenaline they're the same thing which are all linked to mood and stress.

21:22In terms of the science, some research suggests it might be comparable to antidepressants, but with fewer side effects. It's commonly used in doses of anywhere between 100 and 600 milligrams daily, and is generally for that more mild anxiety and stress rather than for severe anxiety or clinical anxiety disorders. It can cause restlessness and in some people digestive issues. And again, it might interfere with other medications, so antidepressants and anti-diabetics. So don't just blindly take it without first getting qualified advice. But as with the St. John's Wort, some people do really well on it.

21:59So again, be patient if you try it, give it time.

22:04Dr Sophie Shotter:Which sort of leads me to Trini's yoga buddy and friend of our show, our former guest, Victoria Woodall. She waxed lyrical about saffron, didn't she? Yeah. And saffron has been used for thousands of years for its calming effect. And there are actually good quality clinical studies that demonstrate it can help not only with anxiety, but sleep and even libido. One study actually showed that saffron is comparable to the SSRI antidepressant fluoxetine, which I thought was really interesting. Saffron basically raises serotonin levels and therefore acts a little bit like anti-anxiety medications do.

22:40To give a little explainer, saffron has three active substances in it that work on our hormones and our neurotransmitters to help lessen anxiety or boost our mood. And these are known as saffron leptichrosolides. I think that's right. So you need to find a saffron supplement that has a proven balance of these at a minimum 3.5 % concentration. So look out for terms like 3.5 % crocus sativum stigma extract, or 3.5 % leptichrosolides, or afron saffron, which is the gold standard saffron extract. Saffron's side is also well regarded and experts suggest a daily dose of around 28 to 30 milligrams of pure extract.

23:23But it's a very familiar story with saffron. For some, it's quite transformational. For others, it doesn't seem to make a noticeable difference. So I think the theme of this episode is that you do need to be patient and perhaps try a few different things before you hopefully land on what works for you. And if you do want to try saffron you might want to look at something like Pippa Campbell's chill supplement which blends together good quality saffron with things like L-theanine, magnesium, citrate and vitamin B6 which all work together for nervous system support.

23:53Dr Sophie Shotter:Okay I know you mentioned ashwagandha but we did an entire dedicated episode on ashwagandha last year so let's leave ashwagandha but are there any other supplements? Yes it's worth mentioning a few more as hopefully people can find what's right for them. But yes, please do look up our ashwagandha episode as for some people it's wonderful and the only reason I'm not covering it is because as you say we already did a dedicated episode. But to name check a few other options, I just mentioned L-theanine so let's cover that because it's quite buzzy at the moment. L-theanine is an amino acid that's been shown to increase low levels of serotonin and dopamine.

24:29A lot of people also like taking it at night as a sleep aid. Siberian ginseng is another adaptogenic herb that helps the body adapt to stress. And since we know that stress can be a causative factor of anxiety, it makes sense to try and manage any stress and then to see if the anxiety reduces. Do just make a note though that Siberian ginseng should not be confused with others such as Chinese or Korean ginseng, as these are used for very different purposes. Siberian ginseng is uplifting while also being calming and balancing. so if you do want to try ginseng for anxiety go for the siberian one 5-htp is another this is an essential amino acid that the body makes naturally it works by helping to raise the serotonin levels in the brain and is said to have a positive effect not just on anxiety but also sleep appetite and pain i think it's also worth mentioning magnesium and in particular magnesium glycinate although do listen again to our magnesium episode with Caroline Allen from Bean Minerals as she does bring a really interesting perspective on fulvic and humic minerals.