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Ending panic attacks

Reading time: 5 minutes

Correcting low blood sugar and depleted minerals cured a patient’s perplexing panic attacks, says Dr Jenny Goodman

Forty-three-year-old father of one Anthony was happily married and doing a job he enjoyed when he began experiencing panic attacks “out of nowhere.” They could happen anywhere—in the supermarket, on the train to work, even in the garden at home—day or night. He had seen a psychotherapist, but it hadn’t helped.

“She was really nice, but we couldn’t find anything that I was seriously unhappy or anxious about,” he said.

Then Anthony tried cognitive behavioral therapy (CBT). It had certainly helped him to manage the overwhelming anxiety that gripped him on these occasions, anxiety that seemed to not be about anything in particular. The CBT psychologist had taught Anthony some breathing and “self-talk” techniques that helped him calm down somewhat through these episodes, and to sense when a panic attack was about to happen so he could immediately put the breathing techniques in place. But it had not made the panic attacks any less frequent. It had not solved the problem.

So, Anthony came to see me, as a last resort and because, he said, “It actually doesn’t feel psychological. It feels biological.”

Getting to the cause

In all other respects, Anthony seemed well, and there was nothing of note in his past medical history. Then he showed me his one-week food diary.

Every day except Sunday, breakfast was a cup of black coffee. Every day except Saturday and Sunday, lunch was also a cup of black coffee. Most days he had a piece of cake, chocolate bar, donut or croissant around 3:00 p.m. With a black coffee. Then dinner in the evening, a normal meal.

“But it works for me,” he said. “I just don’t really get hungry till mid-afternoon.”

He wasn’t feeling hunger, but I thought he was probably going hypoglycemic—that is, his blood sugar was falling too low. When the blood sugar falls too low, as can happen to some people if they haven’t eaten all day, it can produce a feeling of panic, as in Anthony’s case. It’s not surprising, really, because the body thinks they are about to die of starvation.

Other people become terribly irritable or even violently angry (“hangry”) when their blood sugar drops. It is not so much how low it falls that determines these symptoms, but how fast it falls. We are not talking here about blood sugar levels so low as to be dangerous (as can happen in a Type 1 diabetic who has injected their insulin without eating enough food), but in some people the body experiences it as a danger signal—hence the apparently inexplicable panic attacks.

Well, this was my hypothesis, and now we had to test it. I asked Anthony if he would be prepared to try eating three meals a day for a couple of weeks and see if the panic attacks went away.

He said he was fine with that in principle, but that he was one of those people who just couldn’t eat breakfast. He would vomit if he tried to eat anything solid before 11:00 a.m. So, we reached a compromise whereby he would take a packed breakfast to work and eat it at 11:00 a.m. Then he would have a late lunch at 3:00 p.m., a proper meal instead of his usual sugar hit. And dinner as per usual.

Missing minerals

At our second consultation, five weeks later, Anthony reported that his panic attacks were down from about three per week to one per week. His test results told me what it was that remained to be fixed. He was very low in all four of the minerals that help to keep blood sugar stable, namely the trace minerals chromium and manganese, and zinc and magnesium. Also in three of the B vitamins, similarly important for blood sugar regulation.

These nutrients were probably low because of Anthony’s strange eating (or rather non-eating) patterns. But once depleted by the constant demands of trying to maintain blood sugar levels in a body that isn’t being fed, the low levels in turn would make it even harder to keep blood sugar levels stable, and so on, in a vicious circle.

So, I gave Anthony supplements of these missing nutrients, all in liquid form except the magnesium and the B complex (see my supplement protocol below).

When I saw him again three months later, his panic attacks had tailed off gradually, and in the preceding month, he’d had none at all. Within another three months, he could stop all the supplements, as he had normalized his levels and could now maintain them by eating three meals a day.

The backlog effect

Anthony’s case is unusually simple—for most patients I’ve seen, the solution is not nearly so straightforward—but there is a lot to learn from it, especially about something I call the “backlog” effect: the hypoglycemic episodes were not necessarily straight after missing a meal but could occur many hours later.

To understand this, we need to know that the pancreas actually produces two hormones to balance our blood sugar: insulin, which lowers the blood sugar level when it goes too high, and glucagon, which raises the blood sugar level when it falls too low. They should work in tandem, a great example of homeostasis.

By hardly eating all day, Anthony was relying heavily on his glucagon just to keep his blood sugar level normal. At some point he would have used up his day’s supply of glucagon; the pancreas’s capacity to produce it is not infinite. At that point, his insulin would be unopposed—nothing to balance it—and his blood sugar level would crash.

Some people can go without food for much longer than others; everybody’s pancreas is different. But Anthony was making things worse by, when he did finally eat at around 3:00 p.m., eating sugar. That sends the blood sugar level straight up, which triggers insulin release, which sends the blood sugar level crashing down, which calls for more production of poor, old overworked glucagon. And so on.

The tendency to hypoglycemia is a recognized medical condition in some European countries, but not in the UK, for some reason. Ditto with low blood pressure. Both of these conditions are commoner in women; Anthony was unusual although not unique.

What about the role of coffee in all this? The eagle-eyed among you may have spotted that I did not stop Anthony drinking coffee, which is perhaps surprising. Let me explain. In some people, excess coffee can indeed contribute to panic attacks, by raising adrenaline levels.

But in Anthony’s case, I suspected the problem was not with coffee per se, but with the fact that he was using it as a substitute for food. When he started eating properly, and we normalized the relevant nutrients, his panic attacks, which were really hypoglycemic episodes, went away even though he continued to have a black coffee with each meal.

So, there was no need to take away what was for him one of life’s pleasures. If proper eating and temporary supplementation had not done the job, then we would indeed have had to look at Anthony withdrawing from caffeine.

Anthony’s case is another example of why getting to the root cause of your health problems is so important. Knowing the cause can provide the solution.

My supplement protocol for Anthony

Metabolics magnesium bisglycinate, 2 capsules at dinner

Biocare vitamin B complex, 1 capsule at breakfast

Biocare Nutrisorb Liquid Chromium, 1 drop at breakfast

Biocare Nutrisorb Liquid Manganese, 1 drop at lunch

Biocare Nutrisorb Liquid Complex, 1 tsp daily with dinner. Important—this is the Zinc Complex. Biocare offers other zinc products, including liquids, for which 1 tsp would be an overdose. The code for this product, to avoid any confusion, is 220150.

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