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Better Health Update #39 - Monte Kline, Clinical Nutritionist

Panic Attacks

One of the most common, yet least suspected, health problems around is panic attacks. Conservative estimates from the National Institutes of Mental Health find over four million Americans suffer from panic attacks, though this is generally considered a low number given the problem is often never diagnosed. Other researchers state that one in ten Americans has experienced a panic attack (most not knowing it) within the past year and one in four sometime during their life. One study found that the average sufferer went to ten doctors before being diagnosed with the problem - in other words, it generally goes undiagnosed.

SYMPTOMS OF PANIC ATTACK

The American Psychiatric Association's DSM-IV defines a panic attack as fear or discomfort that arises suddenly and mounts to high intensity in 10 minutes or less, along with several of the following symptoms:

Palpitating or pounding heart
Labored breathing
Sweating
Trembling or shaking
Choking sensation
Chest pain or discomfort
Nausea or dizziness
Feelings of unreality or detachment from self
Numbness or tingling sensations
Chills or hot flushes
Fear of collapsing
Fear of dying or becoming insane

Other indicators might be:

Do you have periods of fear or unexpected discomfort?
Do you constantly worry about having additional attacks?
Do you not do things you used to do out of unexpected fear or discomfort?
Do you worry that escaping a place or situation will be difficult or embarrassing?
Do you worry that help may not be available if you have a panic attack?
Do you avoid certain situations?
Do you have anxiety about having a panic attack in certain situations?
Do you endure certain situations with significant distress?
Do you require a companion to endure certain situations?

Again, you don't have to have all of these symptoms - any of them may indicate a panic attack problem.

AGORAPHOBIA CONNECTION

Agoraphobia (literally "fear of the marketplace") is the fear of being alone in public places from which the person thinks escape would be difficult or embarrassing if he were incapacitated. Agoraphobia often develops after suffering panic attacks in public places. Because panic attacks seemingly occur without any warning or provocation, it's impossible to predict what situation will trigger such a reaction. This unpredictability "trains" the victim to anticipate future panic attacks, and therefore to fear any situation where an attack might occur. Thus, agoraphobics avoid going out in public. Other associated problems may develop such as depression, fatigue, tension, and obsessive disorders.

MISCONCEPTIONS

Most people falsely associate panic attacks with stressful situations. May I say this whole problem would be a lot easier if it were that logical. But it just isn't. Panic attacks often happen with no particular triggering event, particularly the initial experiencing of a panic attack. They may happen in a place where you are comfortable and relaxed, in a situation you really want to be in. That's the maddening part.

However, once you have had a panic attack in a particular situation or setting, an expectancy is set up of having the same thing happen again. Often typical "agoraphobic" locations like cars, busses, trains, planes, theaters, church, lines in stores, etc. will be involved.

ROOT CAUSES

There are many ideas about both the physical and mental causes of panic attacks:

1. Anxiety Stress - Research has been done on U. S. Air Force Academy cadets to see if there's a relationship between people who psychologically test out as being more anxious and the incidence of panic attacks. Though those with a higher Anxiety Stress Index had more panic attacks and vice-versa, it wasn't a conclusive predictor. Other researchers promoting "expectancy theory" postulate that panic attacks are largely caused by "fear of fear." In reality most people only learn to fear panic attacks from already having had one.

2. Carbon Dioxide Imbalance - The rapid, heavy breathing associated with panic attacks may give a valuable clue. Hyperventilation may cause excessive carbon dioxide to be exhaled. The resultant lowering of CO2 may produce dizziness and heart palpitations and may even cause harder breathing still with more CO2 loss and increased anxiety symptoms.
Ironically too much carbon dioxide may cause similar symptoms. One theory holds that during a panic attack the brain is falsely signaling an oxygen shortage or an increase in carbon dioxide is setting off a "suffocation" alarm.

3. Lactate Sensitivity - Researchers have found that injection with sodium lactate produces panic symptoms in about 80% of the people prone to panic attacks and in only 20% of the general population. Lactic acid is produced in the muscles from vigorous exercise and indicates oxygen insufficiency.

4. Adrenal Weakness - I believe the adrenal glands play a significant role in panic attacks. The adrenal glands produce various hormones in response to both physical and emotional stresses. Frankly, in this day and age most people's adrenals are shot! Too many people live in a constant state of uncomfortable overextension - occupationally, financially, time-wise, even recreation-wise.

My personal experience in having Addison's Disease since 1991 (failure of the adrenal glands) has taught me a great deal about this. I never had a panic attack before having non-functioning adrenal glands, but I've had many since. Someone with Addison's Disease is an extreme example of how adrenal deficiency would affect panic attacks, but those with just weak adrenals could be correspondingly affected.

5. Neurotransmitter Imbalance - Another aspect of the adrenal gland connection involves norepinephrine (noradrenaline), which is produced by the adrenal glands. Norepinephrine imbalance affects the body's natural alarm system. False alarms can also be created by endocrine disease, drug intoxication or withdrawal, epilepsy, and other neurological disorders. Other neurotransmitters that may be involved include serotonin and GABA (gamma-aminobutyric acid).

6. Stimulant Usage - The above neurotransmitters, as well as overall adrenal function, are aggravated by drugs like cocaine, amphetamines, and caffeine. Due to the "drug-like" character of refined sugar, it could also aggravate the problem.
7. Nutrient Deficiencies - B vita
min deficiencies including B-1, B-3 and B-6 can trigger anxiety. In my experience magnesium is also very key to a relaxed body and nervous system.

DRUG APPROACHES

The conventional medical approach for panic attacks center around anti-anxiety or anti-depressant drugs. While only treating the symptom, drugs are nevertheless valuable and necessary for getting through difficult panic situations and breaking the expectancy that "I'm going to have a panic attack in this situation."
Alprazolam (Xanax) is the most commonly used drug. It and other benzodiazepine drugs are unfortunately very addictive. Using this drug once in awhile for a problem situation is not a problem, but the continuous taking of it is. Withdrawal is very difficult.
Imipramine, a tricyclic antidepressant, is reported to have similar effectiveness to Xanax, while not being as addictive. However, its side-effects of drowsiness, dry mouth, increased heart-rate, weight-gain and/or dizziness are intolerable to many who try it.

Serotonin-specific reuptake inhibitors like Prozac, Paxil and Zoloft have also been used to reduce incidence and severity of panic attacks. Side effects of agitation and increased anxiety have caused over 35% of patients to drop the treatment, though.

PSYCHOTHERAPY APPROACHES

Cognitive Behavioral Therapy is often recommended. The approach focuses on the present panic and how to eliminate it. It assumes that people with panic attacks are catastrophically misinterpreting ordinary physical sensations. The aim is to get the patient to reinterpret the sensations and thus short-circuit the panic reaction.

Another therapy called Non-Prescriptive Treatment (NPT) was found to be as effective simply by providing sympathetic listening along with breathing and muscle relaxation exercises. A gradual re-exposure to the previously avoided situations should be implemented to break the "expectancy" aspect of the problem. For example, after experiencing panic attacks on three successive return flights from Hawaii, I got some various therapies and flew again. I broke the pattern on the fourth flight and greatly lessened my expectancy of panic attack when flying.

BREATHING AND MUSCLE RELAXATION

Various books are available on panic attacks that discuss breathing and muscle relaxation. Taking a long slow breath, holding it for two seconds, and exhaling slowly while puckering your lips is recommended. Visualization exercises, as taught on tapes or by a therapist, can also help in a relaxing and retraining way. I definitely recommend getting help from a trained therapist for these approaches.

A related mental distraction exercise is to count backwards from 200 by threes or by fours while breathing appropriately. This technique can be self-administered or directed by someone around the victim to help get them through the panic attack.

NUTRITIONAL APPROACHES

1. Basic healthy diet - Like all health problems getting off refined sugar, refined grains, food additives, and caffeine beverages is essential.
2. Avoid sensitive foods - With panic attacks you're likely to be more sensitive to foods. Testing, avoidance and desensitization are recommended.
3. B-Complex - Since B vitamin deficiencies can contribute to panic attack, as well as other nervous system problems, this is a key area. The amount of B in a multi may not be enough.
4. Inositol - The B vitamin Inositol is specifically recommended for panic attacks. There is research indicating it is just as effective as imipramine but without the side-effects.
5. Adrenal Glandular - Believing that adrenal weakness is a major component in panic attacks, some kind of natural adrenal supplement should be tested.
6. Vervain - This herb is recommended for usage prior to situations where panic attack is expected.
7. Minerals - A good multi-mineral, and possibly extra magnesium may be helpful.

The above supplements are "possibilities" only. Individual testing can determine if they are right for you.

DISCLAIMER: The information contained in this publication is for educational purposes only. It is not intended to diagnose illness nor prescribe treatment. Rather, this material is designed to be used in cooperation with your nutritionally-oriented health professional to deal with your personal health problems. Should you use this information on your own, you are prescribing for yourself, which is your constitutional right, but neither the author nor publisher assume responsibility.