Being from Boston, I like reading my “home town” medical journal, the New England Journal of Medicine. This is likely the most prestigious medical journal in the world, yet I find it interesting just how often they get things wrong.
NEJM—Master of Mistakes?
In 1980 they published a one paragraph letter from Jane Porteer and Hershel Jick, M.D. claiming that narcotics had very little abuse or addiction potential. Since then this single paragraph has been sighted 901 times in various articles and studies. Of course now we know the truth. In 2015 over 50,000 people died of opioid overdoses. Yikes! I can’t imagine a more devastating misstep and the NEJM was right in the middle of this mess. Because they are so well known, when they make a mistake it often has huge negative consequences. Of course they rarely admit to screwing things up.
The Complexities of Clinical Anxiety
In the most recent issue of the NEJM they had an article titled “Social Anxiety Disorder”. This article caught my attention because of my long-standing interest in Neuroscience, especially the connection between diet and brain function. There is even an emerging new medical field called Nutritional Psychiatry that explores the connection between food and various mental disorders. Over 25 years ago Hudson and Pope from McLean Hospital in Boston proposed that social phobia or social anxiety disorder was part of a single disease process called Affective Spectrum Disorder (ASD). ASD also included 14 other common psychiatric conditions. The ASD list includes:
- Major depressive disorder
- ADHD
- Bulimia nervosa
- Cataplexy
- Dysthymic disorder
- Migraine
- Obsessive compulsive disorder
- Fibromyalgia
- Generalized anxiety disorder
- Irritable bowel syndrome
- Fibromyalgia
- Panic disorder
- Premenstrual dysphoric disorder
- Social phobia
Once Again, Ineffective Treatments Seem to be the Order of the Day
Below is the abstract for the NEJM article. Long story short, these “experts” recommend two treatments for social anxiety disorder: SSRI type anti-depressants and therapy like cognitive behavioral therapy. There’s only one problem with this approach—the experts have once again missed the role of diet, the core issue driving anxiety in most people. In my experience most people who would qualify for a diagnosis of social anxiety disorder actually have a form of food-induced brain dysfunction called Carbohydrate Associated Reversible Brain syndrome or CARB syndrome. This disease is slowly triggered when your brain is exposed to highly processed food. You can easily make a self-diagnosis of CARB syndrome by going through the 22 symptoms of CARB syndrome. This type of food contains the toxic triad of excessive fructose mainly from added sugars, excessive high glycemic carbohydrates mainly from grains and excessive omega 6 fatty acids mainly from vegetable oils.
The Right Treatment for the Right Disease
Unfortunately, when you present to your health care provider with anxiety you will come away with one of these diagnoses: social anxiety disorder, generalized anxiety disorder, panic disorder or dysthymic disorder. In standard medicine all of these diseases are treated the same way with a combination of medications or therapy. Some of your symptoms may improve with standard treatments, but over time they will lose their effectiveness if you have CARB syndrome. You will also likely develop metabolic problems like insulin resistance, obesity or diabetes. Rather than medications or behavior therapy, I recommend that you first try traditional CARB syndrome treatments because they are cheap, safe and effective.
One of my favorite supplements for any type of anxiety is L-theanine. It is available at LEF.org and many other Internet sites. You can take 100-200 mg up to 3 times daily. I have taken it for years with excellent results.
EFT: A Safe and Novel Approach to Treating Anxiety
My friend Joe Mercola also taught me the wonders of Emotional Freedom Technique. I love it because it is simple, safe and effective so I recommend that everyone with anxiety give it a try.
Even though benzodiazepine drugs like Valium, Xanax and Ativan are effective for anxiety, they have significant abuse and addiction potential so I don’t recommend taking them. If you are going to take an SSRI like Celexa, Lexapro or Prozac, keep the dose very low and combine it with a precursor product like CARB-22. Later if you eat a healthy diet you should be able to slowly taper off the SSRI with no withdrawal symptoms.
This is the abstract of the NEJM article on Social Anxiety Disorder:
CLINICAL PRACTICE
PERMISSIONS
Social Anxiety Disorder
Falk Leichsenring, D.Sc., and Frank Leweke, Dr.Med. NEnglJMed2017;376:2255-2264 June8,2017 DOI:10.1056/NEJMcp1614701
Social anxiety disorder is characterized by an intense fear of social situations in which a person anticipates being evaluated negatively. Preferred treatments include cognitive behavioral therapy and selective serotonin-reuptake inhibitors.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
No potential conflict of interest relevant to this article was reported.
We thank Dr. Christiane Steinert for inspiring us to write this article and for providing guidance during the preparation of the manuscript.
SOURCE INFORMATION
From the Department of Psychosomatics and Psychotherapy, Justus-Liebig- University Giessen, Giessen, Germany.
Address reprint requests to Dr. Leichsenring at the Department of Psychosomatics and Psychotherapy, University of Giessen, Ludwigstr. 76, 35392 Giessen, Germany, or at falk.leichsenring@psycho.med.uni-giessen.de.