The Curse of Panic Attacks
Just about all of us have experienced severe anxiety or panic at some point in our lives. You know, the feeling of absolute and uncontrollable anxiety and dread accompanied by cold sweats, rapid and labored breathing, a pounding heart and wobbly feet. Nobody in their right mind would voluntarily sign up for this type of experience because it is extremely unpleasant to the point of almost being unbearable.
In essence there are two forms of this type of severe panic. The first is the “fight or flight” response that Mother Nature hardwired into our brains during evolutionary times when there were lurking beasts and life threatening dangers around every corner. The famous Walter Cannon from Harvard was the first to describe this response to danger in animals and he showed that it was a result of activation of the sympathetic nervous system combined with adrenaline being released from the adrenal gland. There were also many downstream effects that were mobilized in an attempt to improve survivability. Once the danger had disappeared, the system would return to its normal homeostatic state.
Over the past 100 years or so the concept of panic disorder began to slowly evolve in the psychiatric community. The term “panic disorder” didn’t enter the psychiatric lexicon until DSM III was published in 1980. I find that to be a bit odd because most other common psychiatric disorders were described in detail centuries earlier. The state of generalized anxiety was certainly frequently described since antiquity but it wasn’t until the past 30 years that the concept of panic disorder as a distinct entity emerged. The recent release of DSM V defines panic disorder as comprising “recurrent unexpected panic attacks” and at least one of these attacks needed to be followed by a one month or more period of extreme worry about having further panic attacks or significant maladaptive behavior designed to avoid further attacks.
The lifetime prevalence of panic disorder in the United States is about 5%. Compare this figure to the lifetime prevalence of major depression at about 17%, bipolar disorder at 4.4% and generalized anxiety disorder at 5.7%. The level of panic disorder is our society today is surprisingly high, especially when the concept didn’t really coalesce into its modern form until 1980. When you combine the prevalence of panic disorder with other anxiety disorders such as generalized anxiety disorder, it quickly becomes apparent that for the first time in history anxiety is our number one mental health problem. This increase in anxiety can only be due to one of two things—both panic disorder and other anxiety conditions are actually increasing in both incidence and prevalence or we are getting much better at diagnosing them. In my opinion both scenarios are likely in play.
If panic disorder and similar anxiety disorders are becoming more frequent, why might this be so? To even take a guess at the reason why anxiety seems to be more common, it would be very helpful to understand the cause of these disorders. Panic attacks are virtually identical to “fight or flight” reactions that occur in response to a real threat, except panic attacks occur spontaneously without any obvious trigger. In essence some relatively new physiological process has more or less high-jacketed this natural survival circuit. We know that hereditary factors seem to play a strong role, but beyond that we really don’t really have a good understanding of this phenomena. We do know that common anxiety disorders seem to be intertwined with many other common psychiatric disorders. Hudson and Pope from Harvard first published reports that a group of disorders including major depression, ADHD, bulimia, fibromyalgia, irritable bowel syndrome, PMS, PTSD and social phobia make up part of a disorder they termed Affective Spectrum Disorder or ASD. Because they never figured out the triggers or pathology of the condition, their concept never made it out of academic medicine.
Patterns in the Noise
Over my many years of medical practice I also noticed that many of these conditions seemed to travel together in the patients that I was seeing. Instead of focusing on labels, I focused on their symptoms and over a long period of time I accumulated 22 symptoms that seem to eventually develop in many of these patients. At the same time I was paying careful attention to their metabolic state and I was measuring their body composition, the most accurate way to assess obesity. I noticed that their brain dysfunction symptoms always seem to lead the changes in metabolic parameters and body composition. Like Hudson and Pope, I was seeing a pattern in the noise and eventually this concept coalesced into a new disease that I now call Carbohydrate Associated Reversible Brain syndrome or CARB syndrome. It was also clear to me that this disease is triggered by exposure to highly processed food including excessive fructose mainly from added sugars, high glycemic carbohydrates especially from grains, and omega 6 fatty acids mainly from vegetable oils. Of course this would be your average pizza, snack food or breakfast cereal.
Show Me the Pathology
When it comes to the “how” question we are mainly guessing because the randomized controlled trials to study this cause and effect relationship have yet to be done. Let me tiptoe out to the leading edge of science and give it a shot. Years ago Judith and Richard Wurtman from MIT showed that when you consume sugar and high glycemic carbohydrates, increasing amounts of tryptophan enters the brain and the tryptophan is then converted to 5-htp and finally to the calming neurotransmitter serotonin. Thus that donut gives you a temporary serotonin surge helping to define a classic “comfort food”. The Wurtmans assumed that this serotonin would make you less hungry at your next meal so they developed the “Serotonin Power Diet” where you consume junk food before every meal in an attempt to make you eat less overall. You can imagine how that worked out!
Depleted Brains = CARB Syndrome
They also didn’t realize that all of this dumping of serotonin might eventually lead to serotonin deficiency. Highly palliative food has also been shown to activate the dopamine pleasure centers in the brain and this repeated release of dopamine also eventually leads to dopamine depletion. So what would you get if you took away most of the brain’s dopamine and serotonin? I would speculate that you would end up with a long list of brain dysfunction symptoms.
How About an Acid Trip?
It’s also interesting to note that people with panic attacks seem to generate more lactic acid in their brains and this creates a slightly acidic environment. Some people seem to have acid sensitive fear circuits so this lactic acid accumulation could be responsible for so-called spontaneous panic attacks. It is also interesting to note that at least 25% of fructose is converted to lactic acid. Of course most people get their fructose from the added sugars in processed foods. Thus it seems like that old donut/panic connection is becoming much more likely. Ketogenic diets seem to push the excitatory substance glutamate into GABA, which is one of the brains most potent inhibitory neurotransmitters. That’s the main reason ketogenic diets have been shown to be very effective at suppressing refractory seizures in children.
Unfortunately, there are no well-controlled studies in humans showing that ketogneic diets are effective for panic disorder. Some individuals have even reported an increase in anxiety and panic especially when transitioning to a ketogenic diet. In these cases they may not be taking in enough calories or fat and they are thus suffering from hypoglycemia. There is some evidence that adding intermittent fasting to a ketogenic diet improves the effectiveness of the diet, especially for weight loss and reversing metabolic syndrome and type 2 diabetes.
As Patty Duke Used to Sing: “Tell Me Momma What to Do.”
Even though I suspect that a ketogenic diet when properly introduced might help relieve anxiety and panic, we do know that it can be very effective for metabolic syndrome, pre-diabetes, type 2 diabetes and obesity. The brain dysfunction symptoms associated with panic disorder at least theoretically seem to be connected with these metabolic problems through the CARB syndrome concept. Because changing your diet is extremely low risk, when in doubt try it out! If you are going to initiate a ketogenic diet, I highly recommend following the advice of the experts. When it comes to nutritional ketosis Dr. Jason Fung’s excellent book “The Obesity Code” or Jimmy Moore’s “Keto Clarity” are great places to start. These two keto-masters recently collaborated on a book called “The Complete Guide to Fasting”. You are much more likely to be successful in your quest to follow a healthy diet if you rely on these masters. I also recommend spending some time on Joseph Mercola’s web site where he has almost endless amounts of information on healthy eating and exercise. He also focuses on nutritional ketosis and intermittent fasting.
It’s Time to Go to Nutrition School
Don’t stop your education with Jason Fung and Jimmy Moore. Loren Cordain and Robb Wolf have written excellent books outlining the Paleo approach to eating, a time tested dietary approach that is very close to ketogenic. I also recommend reading the many books written by Gary Taubes, Robert Lustig and Richard Johnson to fill you in on the toxic nature of added sugars. Because each of us is different, it’s important that you listen to your body and stick with the approach that consistently leaves you feeling healthier. If you are on the right track, any pesky CARB syndrome symptoms will likely improve or disappear and your metabolic problems and excessive body fat should slowly melt away. A brain that works as intended and outstanding metabolic health—what could be better?