042: Food As Medicine To Help Anxiety w/ Ali Miller

In today’s Couch Talk, we're going to talk about food as medicine, how it helps deal with anxiety and some of the symptoms related to anxiety, such as:

  • Restlessness
  • Fatigue
  • Hypervigilance
  • Palpitations

Anxiety is our body’s natural response to stress. It is what we feel when we are scared about what’s to come such as when you are going to a job interview or when you have to give a speech.

It is very important to be able to differentiate normal feelings of anxiety and an anxiety disorder that needs medical attention. For most individuals, they don’t get so anxious around larger animals or impending danger, as much as they get around work, family life, money, health as well as other important issues that require a person’s attention.

So, I wonder: how can you let food be your medicine to help with anxiety? What are the food that help with anxiety? What are the healing foods to consume instead of having to use medications like Benzodiazepines, Buspirone, Zoloft, Lexapro etc.?

I'll be addressing this issues today with a really special guest that I'm really honored to introduce to you all — Ali Miller.

She is an expert in the nutritional space and functional nutrition and using food as medicine for optimal health. As a matter of fact, she has a cookbook that was published in 2016 titled: "Naturally nourished food as medicine for optimal health" and she recently released her book "The anti-anxiety diet".

Min 01:45 - 04:17 Ali's personal story of how she became a registered dieticianali miller

Min 05:30 - 12:22 Root cause of anxiety and more in-depth about symptoms

Min 12:22 - 14:58 Importance of gut in providing serotonin

Min 14:58 - 18:57 Problem with common treatments of anxiety

Min 19:26 - 23:18 A day Ali Miller's nutritional life

Min 23:29 - 26:29 The Six R's (excerpt from the book "The Anxiety Diet")

Check out the book:

Ali Miller


Dr. Anna Cabeca

Many of you might not know, Ali and I were at Keto Conference together. And that is a fabulous get together of likeminded people working with empowering people through Keto programs. So, I met Ali there and she had all the integrative and functional aspects of nutrition testing, analyses through food sensitivities and I was like: “oh great”. All her research oriented and just also a fabulous speaker. And a fabulous person.

I’m really excited to have you here Ali, to talk about anxiety and the diets to help take care of anxiety. Can you tell our audience, for those that don't know you yet, a little bit more about your background?

Dietitian Career

Ali Miller:

Well, my background is in naturopathic medicine, I went to best year university outside of Seattle, Washington and it is one of the only accredited naturopathic colleges of medicine that the American Medical Association acknowledges based on the curriculum and the criteria that they have within their board examination program.

Hence, instead of going the RD or naturopathic doctor route, I went the RD route and became a registered dietician and I quickly moved from the Seattle area to Houston, Texas for the Texas Medical Center.

And I did all my dietetic rotations and checked off all my boxes. Afterward, I worked for three years for a physician's practice group and I was their director of integrative medicine and I predominantly worked there with this metabolic syndrome.

So we were working with hypertension, hyperlipidemia, highly elevated blood pressure, elevated cholesterol levels, and diabetes. Later on, I also ran a medical weight loss program there where we used the ketogenic diet.

I really transitioned the program from what was like a manifest very low calorie, very processed powdered shape program into a real food fat as fuel. Keto food is medicine program.

After three years of doing that, I opened my private practice, Naturally Nourished and I'm in my sixth year of running my clinic.

Chronic Disease Comes From Stress

I transitioned last year, virtually may have a two-year-old now. I had a five-year lease. And I knew once I got pregnant I was like: “I gotta figure out something to create this bubble.”

I know too as being a functional medicine practitioner that if you don't feel mentally and emotionally onboard with your day to day lifestyle and if you feel stressed or distressed or overwhelmed, you’re going to drive yourself off kilter and start to have symptoms of inflammation, have chronic disease, and even a personal history of autoimmune disease.

I decided I needed to bubble wrap; that was really the premise and I think the driving force of putting out my new book: The Anti-Anxiety Diet.

HPA Axis Imbalance

I have found that when I'm looking for root causes, even if I'm addressing leaky gut, progesterone deficiency or estrogen dominance or toxicity – really, one of the Achilles heels of wellness is anxiety or HPA axis imbalance.

Dr. Anna Cabeca:

Yeah. And I think that's exactly a good way to put it. HPA axis imbalance, because we hear different terms thrown around adrenal fatigue, burnout, different things like that. And really it comes down to our HPA axis. I always throw in the gonads to HPA axis, right?

Ali Miller:

HPA. Yes. Fairly chunky then does.

Dr. Anna Cabeca:

But they… we imply them when we say HPA axis because every organ interacts with every other organ.

It's like being in a community.

You all interact together and being in a family, right? Everyone has a different voice, but when they work together as a family, as a unit, there's harmony.

When our body is not working well together, there is disharmony – we get that anxiety, depression, the mood disorders.

Let's Talk A Bit About Anxiety

Now, let's talk a bit about anxiety because it's definitely a part of a woman's life, a man's, anyone.

Ali Miller:

Yes, tt some point or another.

When I'm doing my initial consultation with the client, I'm spending the first 60 minutes of that 90 minutes just being in an investigative researcher or really kind of questioning all of their symptoms, all of their levels of dysfunction. Often they leave that initial session knowing themselves more than when they came in.

The Specific Symptoms Of Anxiety

They don't even think about these things. When I asked people about stress, most people say: moderate to low. But when I start asking them specific symptoms of not managed stress, like:

  • Do you clench your jaw? “Oh yeah, I wear a night guard.”
  • Do you have disrupted sleep patterns? “Oh yeah. I'm constantly waking up and having rumination.”
  • Do you have racing thoughts?
  • Do you fill anticipatory distress?
  • Do you deal with heart palpitations?
  • Do you have body temperature changes?
  • Are you dealing with fatigue?

And if you go through them the rhythm of roar and it's like, check, check, check, check.

Well, whether you want to deem it anxiety or unmanaged stress or chronic stress demand that you don't have the tools to be resilient with.

I think that my book is a great fit and we really go into it with that mindset.

I want to ensure that I'm really giving you the tools in your tool belt for the chronic stress and the multi hats that we're wearing.

We also, as a society, have this demand and this kind of award mechanism of you should be a working mother. You should be wearing different hats and doing 12 different things and you just do it.

This is just aging, this is just normal.

And I think that little white flag of surrender often comes up with the defeat of the body and, my goal is to provide you to be more resilient.

Dr. Anna Cabeca:

I think that brings up a great point: that we can have all the numbers of hats, just not at the same time. But it's just as rewarding if we can look back on our lives from some point.

“Yeah, I have that.” “Oh yeah, I had that. I had it fully.” Right? To be able to have that perspective like you're doing now, you've created a bubble so that you can be a mom and, take also your business and message in another way.

You're defining your purpose.

The other important thing that you mentioned is that we don't know what's not normal if we experience it as our normal. So like that whole idea of “yeah, no, I wear a night guard, it’s normal”.

No, that's not normal.

I always find that when I ask clients: “Are you constipated?” “Oh No, I have a bowel movement once every week.” “That's constipation”. We don't know what's not normal.

Anxiety, Stress, And Resilience

Dr. Anna Cabeca:

Let's talk about anxiety, stress, and resilience. You mentioned some of the symptoms of anxiety: insomnia, teeth clenching. Let's talk about more symptoms.

Ali Miller:

I often try to classify in the individual if they're dealing with more anticipatory, hypervigilance or if they're dealing with rumination and anxiety.

It can be on both ends of the spectrum of that anticipatory distress or that reflective over sensitive, over-reactive. Those are the primary mental influences is that the kind of questioning the over rumination.

I often say rumination leads to bloat just like in a cow. That is really true.

My book goes into 6 different foundational R’s which are root causes of dysfunction in the body that drive and manifest anxiety. But it also discusses with up-to-date clinical research and peer-reviewed studies on how anxiety or HPA axis imbalance can drive dysfunction in that same area.

The Leaky Gut And Stress

Just looking at the leaky gut, for instance, we use a marker and secretory IgA. Secretory IgA can be measured in the saliva, in the blood, it can also be measured in the stool.

We usually see this value elevated in stress. The body does this with almost everything – it goes hyper before it kind of crashes.

If the body perceives a battle or if the body is actually battling a pathogen or a bad bacteria strain, then, over time we start to see that secretory IgA totally deplete and plummets. That's when we start to see leaky guts.

We've seen in research (studies on people at parties) that we have social anxiety. In the situation of new social environments, public speaking, secretory IgA levels go up super high.

So it's like an acute stressor. I equate that to stress drilling holes in the gut. You could be eating an AIP protocol and it could be your vigilance of perfection of the diet that is perpetuating your leaky guts. Then leaky gut allows more inflammatory chemical mediator action which crosses the blood-brain barrier and interferes with our neurotransmitters and perpetuates anxiety.

All of the areas of my entry points do that dance of chicken and egg. I tried to give the reader a quiz in each chapter to determine which area they want to focus the most energy and efforts and which area they may want to focus on strategic supplementation support. Then maybe do some advanced functional labs.

Whereas every chapter they can incorporate the food as medicine strategy, but everyone is going to have their own unique entry points in the premises of what I see as foundational causes.

Dr. Anna Cabeca:

I think it's important to recognize too that one thing you mentioned was AIP protocol, so the autoimmune protocol, very stringent, very restrictive nutritional protocol.

Even in those instances, stress can overpower it. It's like that constant barrage opens up essentially.

Importance Of Gut In Providing Serotonin

Ali Miller:

This breaks down the fence here to your gate, and that causes that intrusion or that leaky gut.

Let's spend a moment on how important the gut is in providing serotonin or anti-anxiety neurotransmitter.

Beyond the role of the gut, intestinal enteropathy or leaky gut, I talk about rebalancing or restoring your microbiome because on both ends of the spectrum: the good strains that we know of the Lactobacillus and Bifido are the two strains that we've seen in clinical research to help the manufacturers.

GABA v.s Serotonin

Serotonin and GABA, those are our more popular. I think because of the SSRI drug family, but GABA truly is a huge influencer of antianxiety influence.

Whereas serotonin has anti-anxiety effects and mood stabilizing effects, GABA has more of the physiological influence of stress effects tremors, shaking, shortness of breath.

I think of GABA is a great tool when we're public speaking or flying on an airplane or going to conferences. It gets us a little bit wound up physiologically and that is a stress response.

When the biome isn't a symbiotic state, which means a good balance of gut bacteria, it has a good expression of Lacto and Bifido.

We're manufacturing about 90 percent of our serotonin, but in that GI tract, then we're calling that our entire nervous system. That is the second brain of the body and that compound is able to contribute back and forth with our central nervous system in our brain.

GABA and serotonin also have an influence on receptors outside of the brain. This is where we tie like fibromyalgia to low serotonin levels, the kind of systemic aching and tenderness in the fashion the tissue can be due to low serotonin.

Then like I said, the low GABA can drive more of the tremors and that's what we see to an extreme state with Parkinson's disease.

Having a good symbiotic gut is a big piece of production of the good neurotransmitters.

Then, comes the chicken and egg if we're in a dysbiotic state or we have imbalanced gut bacteria, especially if we have harmful bugs, pathogens like Klebsiella or Citrobacter.

These strains actually increase our epinephrine, which is the bells and whistles of our alarm system, which drives panic, anxiety, elevated blood pressure, and more of this kind of fight or flight response in the body.

Dr. Anna Cabeca:

I think that's very important to differentiate too. Let's talk about our common treatment for anxiety, right? Like what would we as prescribers retrained to, right? When we have someone with anxiety, it's the SSRI.

Problem With Common Treatments of Anxiety

Ali Miller:

Let's talk about that.

Just so you know, in allopathic or conventional medicine, we start right at neurotransmitters as the focus of anxiety. That's really important for viewers and listeners to understand the difference of how we approach a client or a case when you're looking at it with functional integrative medicine.

It's not just the “what needs to be changed” if the why is dysfunction occurring and how do you resolve from the root.

I work with neurotransmitters and neurotransmitter testing, but rather than starting with something that works on a receptor level and this feedback mechanism, I think it's important to understand, that individual deficient in this x, y, or z neurotransmitter.

Do they access in different neurotransmitters so we can be strategic? And if we have to hardest and lower or something like if someone’s high epinephrine. I'm going to drive like nerving herbs and I'm going to work with a stool test to look at.

We have to do a cleanse because we might need to plow their gut bile to receive the good. And you know, that's why unfortunately when we weren't blind with the prescription and we just start throwing Zoloft and Cymbalta, and these different medications without even looking why we're just using symptoms to prescribe medications, we might be throwing a dart at completely the wrong target and that's unfortunately why we don't get the best outcomes.

I mean we see in research from the 1940s, we don't have any improvement in the treatment of anxiety and depression and all of these new drugs being developed, but they're missing the mark is truly what I'd feel.

They're not addressing the underlying root cause.

I mean, you talk about plowing the field. It's, for example, treating CBOS small intestinal bowel overgrowth because it's really important to understand we're not going to throw more.

We've really got to cleanse the system.

Importance of Keto-Green™ (Keto-Alkaline®) Diet In Cleaning The Gut From Bad Bacteria

Let’s talk about Keto, how did you start using Keto-Green™, Keto-Alkaline® approach in the work with anxiety as well?

Bad bacteria or dysbiotic bacteria, whether it's candidiasis, like yeast overgrowth and its varied strains or whether it's CBO or whether it's a dysbiotic bug and the large intestine, all of these bad bacteria strains and yeast strains feed off of sugar.

And you know, we've seen this in like elementary science classes or even if you bake bread – you add sugar and water and it goes crazy.

We know that dysbiotic flora thrives in sugar.

And when you reduce your sugar intake in the Diet, then you take it a step further to actually reduce carbohydrate intake in the diet, my gut cleanses are at 60 grams of carbs or less.

That individual may or may not be key to ketogenic, but they're going to be low carbohydrate, they're going to be yeast free and they're going to be very limited on their use of vinegar and prebiotic fibers and probiotics in the beginning.

Just for us to create that sterilizing and plowing with strategic, antifungal, antibacterial, natural agents. You know, that's one thing is not feeding the beast, if you will, and then really, the actual production of ketone bodies themselves have such magnificent function on the brain.

Back from what we've researched with the influence of epilepsy and then being able to reduce excitatory nerve impulse and activity that drives seizure.

Ketones can actually help to sit on the brain receptors and give us a very rounded mood, stabilizing influence and then if we have weight to lose and we're using fat as fuel; that can help with our sexual hormone balance as well.

So there are a lot of factors on how Keto can help because even if we're dealing with estrogen dominance, we know that low progesterone drives anxiety.

There's just a lot of pieces.

And I think personally when I am in a Ketogenic state, which is how I live, I just feel really even-keeled, less erratic, and I sleep better. Even my thought process is clearer.

A Day Of Ali Miller's Nutritional Life

“I'm on a high octane fuel” is how I describe it to people.

That's a good example.

When I'm in clinic, I see patients three to four days a week and I'm still seeing about 20 clients a week. I like to eat in bookends and for me, what that means is that I like to eat most of my calories in the morning and in the evening.

I think it's predominantly because when I'm under high stress and I'm rocking and rolling during the day, I know my digestive enzymes are suppressed and food doesn't sit very well in my belly, even in the middle of the day.

I do a really kind of funky fasting model where I'll eat like two to three eggs, half an avocado, maybe some kale chips with that or some Kimchi on the side.

And probably also some other protein, like some pasture-raised bacon or a sausage or something like that. That's my breakfast. I drink lemon water prior to that and then at around 10:00 AM I'll do like maybe a little bit of fat in matha or a cold brew coffee.

If I do coffee I like to add CBD to my coffee to help with that excitatory output of the caffeine I find I don't need to. So I use coconut or, and then I also like a smoothie of sorts or something light.

I might just eat frozen macadamia nuts or a fat bomb pack. Dinner is going to be another 700, 800 calories where I'm going to have for example burger with vegetable patty: avocado roasted brussels sprouts and curry roasted cauliflower.

Dr. Anna Cabeca:

Sounds delicious. I think that's key what you just outlined. It is really helpful.

A Sunday might be a little different. Therefore, during this workday, how you're accommodating your Keto, getting into Ketosis, knowing that you need that high brain function to sustain you and also know where you're, where you need additional support to sustain you.

So I think it's really cool.

I love how you figured that out and I think this is the tweaking that our guest, our listeners will appreciate as you learn.

You continue to learn and find out what works for you and as you are able to lift off the cloud.

The carbohydrate cloud as your or the glucose or brain fog cloud, you're liberated from that. You have the better ability to discern what is working for you versus what is working against you.

Ali Miller:

The weekends I do my fatty coffee and I take my daughter to the farmer's market. That’s well because then we breakfast at noon and have a beautiful brand from what we picked up from the market.

But I think that's a great point you make. I always say one of my mantras is doctrine creates a disconnect. You go into any new program, any new plan with rules and guidelines, and you start to feel better, which is wonderful because going from terrible to mediocre isn't a very big change. But once you get to feeling awesome, then you can start to tweak the mediocre and then you arrive high gear zone.

And like you said, that's that individualized approach. I realized when I'm stressed a Kale Salad and salmon doesn't sit well with me and I can't be munching on that between clients because I'm not going to appropriately to. And I'm not going to appropriately break things down.

The Six R's (Excerpt From The Book "The Anxiety Diet")

Dr. Anna Cabeca:

I think that's beautifully well said. I love that. Share with us a little bit more about your book. You said that you've customized the six R's.

Tell us what those R’s are.

Ali Miller:


First is reducing inflammation, then I go through the five primary pro-inflammatory foods and within that the fifth food is sugar. Therefore, I eliminate corn, soy, I do eliminate dairy because of the casein protein.

I went talk about world pros and cons and considerations after 12 weeks of removal: corn, soy, dairy, gluten, and sugar.

Also, within the sugar I talked about removing excess carbs and transitioning into Keto; then the next R is- looking at repairing leaky guts.

The following R is restoring that gut microbiome.

The next R is rebounding your micronutrient status. So we talk about mood stabilizing minerals. We talk about the role of being by the men's and methylation and various amino acids that actually are building blocks for our neurotransmitters.

The final two R's are focused on the adrenals and we end with neurotransmitters.

  1. Reducing inflammation
  2. Removing excess carbs and transitioning into Keto
  3. Repairing leaky guts
  4. Rebounding your micronutrient status
  5. Adrenals
  6. Neurotransmitters

Then it's again, kind of more upstream versus downstream slaying of just starting right away with the brain chemicals.

My book encompasses all of this with the last chapter which ties it all together into a program, gives you a two-week meal plan and I break things down into a phase of ketogenic and phase two low glycemic. I give people options of whether you want to do Keto for the first three months as a reboot and then transition whether you want a cyclical use, Keto.

Since that's what I personally do. I park cycle four times a month based on my sexual hormones or whether you want to stay tight Keto and I give you guidance on what's going to work for you and things to look for as feedback within your body.

Dr. Anna Cabeca:

Oh, and I love that in your book, you have great desserts like walnuts, maca, I'm a big maca fan.

We have to try it with Mighty Maca.

Ali Miller:

I try to like each recipe open with a food as medicine focused.

What was the strategy of this synergy of ingredients in this recipe so the reader can be empowered by that and beyond making a tasty dish, they can use that information and apply that with their selection as well as their day to day intake as well as other recipes they'll try.

They might really home in on a particular ingredient like the market to a new user and then find out about a bunch of different products and how that feels in their body.

Dr. Anna Cabeca:

Exactly! I love that you put that in there because that's like the story with the recipe and that makes us more inclined to follow it or remember it too.

So I love that dinner party.

Tell our listeners how they can get your book and also learn more about you.

Ali Miller:

Everything is available on alimillerrd.com.

Dr. Anna Cabeca:

I just want to thank you for being my guest on my show today and I look forward to good success with your book and just end with what is one thing in your day that you absolutely must do to have a good day?

Take adaptogens?

Ali Miller:

Breathe or something like that. A little more hippie then, but it takes adaptogens.

I'm a huge fan of Ashwagandha and Rhodiola. Because I do wear many hats, I am all about that bubble wrap girl, and I'm just layering, layering, layering, and giving myself the resilience I can so I can be for human status.

Dr. Anna Cabeca:

I love it. Thank you for sharing that.

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Dr. Anna Cabeca

Dr. Anna Cabeca

Certified OB/GYN, Anti-Aging and Integrative Medicine expert and founder of The Girlfriend Doctor. During Dr. Anna’s health journey, she turned to research to create products to help thousands of women through menopause, hormones, and sexual health. She is the author of best-selling The Hormone Fix, and Keto-Green 16 and MenuPause.

Learn more about my scientific advisory board.