Porras N (2026) Dietary Treatment to Improve Recovery. J Subst Abuse Alcohol 13(1): 1104.

This is an emotional state characterized by disproportionate worry and anticipation in response to perceived threats, accompanied by physical and cognitive symptoms that can become clinically significant and impair daily functioning [1]. It is an affective state characterized by a persistent or non-persistent feeling of nervousness, restlessness, or tension, accompanied by excessive worry and anticipation of future danger or harm, which may be associated with somatic manifestations (such as tachycardia, sweating, or muscle tension) and cognitive and behavioral disturbances, and which, when intense and prolonged, significantly interferes with personal, social, or work functioning.

According to DSM-5-TR criteria, it is considered anxiety when these symptoms are persistent, difficult to control, and last for months.An adequate eating pattern can reduce symptoms and improve overall mental well-being [2]. Evidence suggests that certain dietary patterns, especially the Mediterranean diet, are associated with a lower prevalence of anxiety, depression, and psychological distress. An appropriate diet can reduce symptoms and improve overall mental well-being [2]. Evidence suggests that certain dietary patterns, especially the Mediterranean diet, are associated with a lower prevalence of anxiety, depression, and psychological distress. This pattern is characterized by daily intake of fruits and vegetables, legumes up to four times a week, whole grains, nuts, fish, extra virgin olive oil, and moderate consumption of red meat and dairy products.

In intervention studies, promoting a Mediterranean diet in adults and pregnant women has been associated with a significant reduction in anxiety levels, perceived *Corresponding author Nuria Porras, Dietitian-Nutritionist, Hospital Comarcal La Axarquía. Fimabis, Málaga. Biomedical and Health Research Center, Spain Submitted: 07 December 2025 Accepted: 02 January 2026 Published: 03 January 2026 ISSN: 2373-9363 Copyright © 2026 Porras N OPEN ACCESS stress, and better sleep quality, compared to control groups without specific nutritional intervention. These effects are related to a greater availability of nutrients involved in neurotransmitter synthesis (tryptophan) and a higher intake of antioxidants and anti-inflammatories. Likewise, including foods with omega-3 is associated with fewer risks and symptoms of anxiety, possibly due to its influence on neurotransmitters such as serotonin and the reduction of inflammation [3]. Micronutrient deficiencies such as vitamins B and D, magnesium, and zinc, or low intake of tryptophan and antioxidants aggravate anxiety symptoms, while diets high in ultra-processed foods, sugars, and fats worsen them [2].

The Hospital Anxiety and Depression Scale (HADS), originally developed by Zigmond and Snaith in 1983, has been widely validated in various populations and clinical settings, establishing itself as a reliable tool for detecting anxiety and depression in hospitalized and outpatient patients. Its validation has been carried out in multiple international studies, demonstrating high internal consistency and robust convergent and discriminant validity with other standardized measures of anxiety and depression. Scientific evidence shows that the HADS has good sensitivity and specificity indices for identifying cases with mental health problems. These findings support the use of the HADS as an effective tool in the psychological assessment of patients, thus facilitating early and appropriate clinical intervention [4].

The Predimed (PREvention with MEDiterranean Diet) study primarily evaluated the Mediterranean diet supplemented with extra virgin olive oil or nuts in primary cardiovascular prevention, showing reductions in clinical events such as heart attacks and deaths, with benefits in clinical cognitive impairment and observational depression, but without direct use of the HADS [5]. Secondary reviews of PREDIMED and derivative trials associate greater adherence to the Mediterranean diet (rich in antioxidants, omega-3, and whole grains) with lower HADS-A (anxiety) scores, mediated by reduced inflammation and oxidative stress. A trial in high-risk pregnant women (IMPACT, inspired by PREDIMED) resulted in a 25-28% reduction in anxiety as measured by standardized questionnaires (including HADS as a scale) after personalized Mediterranean intervention [6].

• Follow a Mediterranean diet pattern, prioritizing plant-based foods, fish, nuts, and extra virgin olive oil.
• Include omega-3 fatty acids (oily fish, nuts, seeds) and omega-6 fatty acids (olive oil) to modulate inflammation and mood [4].
• Ensure an adequate intake of high biological value proteins (eggs, dairy products, white and oily fish, seafood) combined with low biological value proteins (legumes, nuts) containing tryptophan, a precursor of serotonin [3].
• Increase your consumption of complex and whole carbohydrates (oats, brown rice, quinoa, whole wheat pasta) to avoid glycemic spikes that can lead to nervousness and irritability.
• Limit caffeine, alcohol, and refined sugars, which have been linked to increased nervousness, sleep disturbances, and sudden mood swings.
• Reduce ultra-processed foods rich in saturated fats and added sugars, which are associated with poorer mental health and increased anxiety and depression symptoms.
• Include strength training at least four days a week, and aerobic exercise on the other days.
• Drink plenty of water, as dehydration (the body does not have enough water and other fluids to function as it should) can affect mood [3].
• Having a quiet space and place to eat will encourage you to take your time over meals and, in turn, eat more calmly and relaxed, which helps to reduce anxiety levels. It is advisable to plan your meals to ensure a balanced intake of nutrients, always with the help of a health professional, such as a dietitian- nutritionist.

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