A Functional Medicine Approach To Treating Panic Attacks: Panic Disorder

by 
Dr. Kate Henry, ND
A Functional Medicine Approach To Treating Panic Attacks: Panic Disorder

If you’ve ever seen someone have a panic attack or had one yourself, you know they can be intense, frightening, and unpredictable.

Symptoms of a Panic Attack

The National Institutes of Mental Health define panic attacks as “episodes of intense fear accompanied by physical symptoms that may include:

  • Chest pain
  • Heart palpitations
  • Shortness of breath
  • Dizziness
  • Abdominal distress”

These episodes occur ‘out of the blue,’ not [always] in conjunction with a known fear or stressor.” Additional physical symptoms that people with panic attacks report feeling during an attack include sweating, trembling, shaking, nausea, numbness, and tingling. The DSM-V includes the psychological symptoms of “depersonalization (feeling detached from oneself)/derealization, fear of losing control/going crazy, or fear of dying” in its definition of panic attacks.

When someone has repeated and recurrent episodes of panic, this is termed “panic disorder.” Panic disorder will affect up to 4.7% of adults at some point in their lives, and 44.8% of people with panic disorder report that it severely impairs their ability to function. Panic disorder can cause people to miss work and school, avoid travel, impact relationships, and much more.

There are many effective options for managing panic attacks and panic disorder, including mindfulness and biofeedback interventions, pharmaceutical medications, nutritional and herbal approaches, psychotherapy, etc. Don’t give up if you’ve tried some but not all of these interventions! There’s a solution for you that takes your root cause, history, lifestyle, and more into account. Healing is possible. Below we’ll review the number of potential root causes of panic and the techniques that a trained functional medicine practitioner can help you use to heal and thrive.

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Possible Root Causes of Panic Attacks

Nutrient Deficiencies

A number of nutrient deficiencies are linked with panic attacks and panic disorders in the medical literature. Nutrient deficiencies are common even in normal and overweight adults. Working with a functional medicine doctor can help analyze your typical diet and screen for nutrient deficiencies as part of a comprehensive plan.

Common Nutrients Deficiencies Linked with Panic Attacks

Vitamin C, E, and selenium are antioxidants that are thought to combat the influence of oxidative stress on mental health, which has been linked with disorders like severe depression, PTSD, anxiety, suicidal ideation, and more.

Minerals like magnesium have a calming effect when taken in large doses and change the excitatory threshold of many cells in the nervous system.

Iron affects how oxygen is carried in the blood and matters, particularly for people with respiratory subtypes of panic disorder (read more below).

Certain nutrient excesses have also been linked with panic; one study found that too much dietary sodium can induce anxious behavior in animals.  

Hormone Disorders

Thyroid hormone abnormalities can cause symptoms that look very much like panic attacks. Having hyperthyroidism or Grave’s disease, for example, can lead to episodes of insomnia, palpitations, anxiety, and sweating that are often misdiagnosed as panic disorders for days, weeks, or years before they are properly identified and treated.

Adrenal issues can cause panic disorders as well and are often accompanied by physical symptoms like weight gain, stretch marks in the skin, sleep issues, immune issues, and more.

Progesterone, estrogen, testosterone, and DHEA are also implicated in panic disorder. Researchers and clinicians have observed that panic disorders tend to affect people in cis-female bodies at twice the rate that they affect people in cis-male bodies, and it’s thought that the cycling of progesterone and estrogen that occurs during the menstrual cycle may play a role.

Heart Rate Variability and Resilience

Many people with panic disorder experience a respiratory subtype (RS) of panic disorder (PD). People with RS PD experience panic symptoms directly related to the balance of oxygen and carbon dioxide in their blood. When their breathing or heart rate changes, it can induce a panic episode. Likewise, when their breathing and heart rate are controlled using various techniques, their symptoms can improve. A trained practitioner in respiratory therapy, pulmonology, or biofeedback can help someone with PD determine if they have the respiratory subtype and teach them to use breathing and other techniques to control their symptoms.

Allergies and Histamine

Food and environmental allergies (not sensitivities) are mediated by IgE immunoglobulins and histamine reactions that can induce panic attacks. Symptoms of an allergic reaction can include hives, itching, runny nose, watery or swollen eyes, stomach pain, nausea, low blood pressure, dizziness, diarrhea, palpitations, trouble breathing, and more.

The histamine and adrenaline releases that accompany an allergic reaction are thought to be responsible for the panic-related symptoms. Histamine, for example, changes the ventilatory threshold and makes it likely that someone will experience trouble breathing. The adrenaline release that often accompanies these reactions can cause people to feel anxious. Mild and exercise-induced anaphylaxis can sometimes persist for years until they are appropriately diagnosed because the symptoms can appear to be primarily gastrointestinal or mental-health related. This is why it’s important to see a doctor who will help you connect your symptoms and look deeper to help you find your root cause!

Minerals and Heavy Metals

Having a mineral deficiency like iron deficiency anemia can predispose people to hyperventilate and experience panic attacks at a higher rate than those without anemia.

The presence of heavy metals in nervous system tissue is also linked with mental health issues. Mercury toxicity, for example, has been linked with panic disorder.

Functional Medicine Labs to Find the Root Causes of Panic Attacks

There are several ways to assess nutrient deficiencies, including at-home blood spot tests and blood draws. Even a standard CBC and CMP that your doctor runs every year at your check-up can detect some B vitamin and iron deficiencies.

Additionally, a trained practitioner can help you evaluate your diet to see if your typical eating pattern has nutrient gaps that may be affecting your mood.

To detect heavy metal abnormalities, practitioners can check hair, blood, and urine to ensure none are above the reference range. If findings are normal, but you still suspect you may have heavy metal toxicity, you can do a provocation challenge test, where you take a small dose of a heavy metal chelator and then check how much of that metal is excreted into the urine.

When assessing food allergies & sensitivities, there are many blood draw collection kits that your practitioner can use to find the foods you may be reacting to.

Note: For food sensitivities - The suspected food must have been consumed in the last two weeks (preferably three days) for your body to make enough immunoglobulins to detect a reaction. Ask your practitioner for more information if you’re confused about this.

With The Dutch Plus Test, your practitioner can measure various sex hormones in the urine and saliva, including progesterone, testosterone, DHEA, cortisol, and estrogen.

A Complete Thyroid Panel should include at least TSH, Free T4, Free T3, and Reverse T3 to get a comprehensive overview of how well the thyroid is functioning.

Functional Medicine Treatment for Panic Attacks

The treatment for your unique form of panic attacks will determine your root cause. If you have a nutrient deficiency, your practitioner will help you design either a food-as-medicine plan or prescribe a supplement to help replete you.

If your issue is hormonal, your clinician will prescribe hormone replacement or work to eliminate the barriers to normal hormone production using a combination of lifestyle, nutrients, herbs, and possibly pharmaceuticals.

If you have a food allergy, it pays to see a nutrition expert to develop a nutrition plan that allows you to avoid the foods you’re intolerant of while still ensuring that you get great nutrition.

You can address histamine issues holistically by adopting a comprehensive histamine protocol that stabilizes mast cells and reduces sensitivity to proteins and pollen. If you have a pollen allergy, seeing an allergist who can help you decrease your sensitivity to environmental allergens is a great first step to managing your symptoms.

Treating panic disorder and anxiety disorders with biofeedback and mindfulness can be an incredibly empowering and effective way to give people more control over panic attacks. This usually involves bio tracking or in-person trips to the office where the practitioner can measure heart rate variability and breathing and mindfulness exercises designed to give a person more control over their physiology. Many wearable trackers also measure heart rate variability and oxygen saturation throughout the day and night to provide real-time feedback and much more control over your symptoms.

Many people ask if natural medicine can be used instead of pharmaceuticals to treat panic attacks. For many people, the answer is yes. For others, natural medicine makes a great addition to their existing treatment plan. Prescriptive medications, therapy, and other traditional treatments alongside a functional medicine approach are commonly combined. Your unique plan will be tailored for whatever works best for you.

Summary

There are many root causes of panic attacks that a functional medicine practitioner can help you detect, treat and heal so that you can thrive. These include nutrient deficiencies and excesses, hormonal imbalances, allergies, altered parasympathetic nervous system function, and so much more. A skilled practitioner who knows your history can help you find your root cause and heal your panic attacks naturally if you choose so that you can get back to feeling happy, healthy, calm, and in love with your life.

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Dr. Kate Henry, ND
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This article was written by Dr. Kate Henry, a naturopathic doctor with advanced training in mind-body medicine and functional approaches in psychiatry. Her study of nutrition, botanicals, and lifestyle medicine has enabled her to offer unique expertise and out-of-the-box solutions for chronic and stubborn health issues, including SIBO, PCOS, constipation, anxiety, POTS and more.
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