A Comprehensive Gut Protocol to Address Teenage Anxiety

When treating anxiety in teenagers, Everest Goldstein, M.Ed, APRN, PMHNP-BC, IFMCP, likes to start with the gut, addressing any root-cause issues that may be contributing to their poor mental health.

"Gut health is a big factor in how our bodies respond to different stressors and how we process nutrients, which can directly impact mental health,” explained Goldstein, who is a functional Psychiatric Nurse Practitioner in Dallas, Texas.

After gathering data from her patients’ lab tests, which often involve a comprehensive blood panel, hormone tests, and a stool test, Goldstein will often implement the “Five R” approach. This gut protocol addresses common issues associated with teenage anxiety including hormone imbalances, acne, and mental health symptoms. 

The steps include:

1. Remove: Eliminate food sensitivities, toxins, and hormone-disrupting chemicals from skincare, cleaning products, and diet.
2. Replace: Add missing nutrients and healthy foods, focusing on balanced intake of fats, proteins, fibers, and essential vitamins like D and B.
3. Reinoculate: Reintroduce beneficial bacteria with prebiotics (fiber-rich foods) and probiotics (fermented foods or supplements). For anxiety, Goldstein might consider psychobiotics, probiotics that specifically impact mental health.
4. Repair: Address potential gut lining issues, such as leaky gut, with supplements and foods to improve digestion and nutrient absorption.
5. Rebalance: Enhance overall lifestyle and nervous system health by reducing anxiety with magnesium, adaptogens, and better sleep hygiene. Encourage reduced social media use, increased mindfulness, therapy for social anxiety, and physical activity like ballet, even at home.

Careful to consider the changes that teenagers are actually willing to make, Goldstein always encourages them to prioritize a high protein breakfast with healthy fats and ample fiber. She also emphasizes transitioning to a whole food diet, telling her patients to shop in the outer aisles of the grocery store and find healthier alternatives to their go-to snacks.

Editor’s Note: This is an excerpt from the case study, “Addressing Anxiety in Teenage Patients.” To access the full text, click here.