Anxiety and Panic Attacks

Some of the Physiology Behind Them and What to do About It

In this article I discuss a few common causes of anxiety and panic attacks, and what to do about them.

1. CO2 - necessary for the utilization of Oxygen, loss of CO2 (hyperventilation) can lead to a panic attack

2. Glutamate = anxiety-inducing, GABA = calming

3. Low blood sugar (hypoglycemia) amplifies every stressor

4. High catecholamines (adrenaline, norepinephrine..) + Histamine and Anxiety

5. Protective hormones for anxiety (Progesterone, Allopregnanolone..)

6. Gut inflammation causes anxiety

BTW I am a frequent guest on the podcast “Stuff Your Doctor Should Know”

-None of this is medical advice, I am not a medical professional-

Carbon Dioxide (CO2) in the body is essential for using Oxygen (O2), hyperventilation and mouth breathing lower CO2.

Have you ever wondered why bag-breathing helps when someone is having a panic attack? Or why it helps with someone having an anxiety episode in general?

It has to do with the fact that bag breathing increases our retention of carbon dioxide (CO2). When you are very anxious or having a panic attack you typically hyperventilate, which rapidly depletes you of your CO2. Hypoventilation, or breathing slowly, would be a useful thing to do during a time of stress, and bag breathing helps to mimic this.

Breathing into a paper bag, or breathing very slowly and only through your nose can increase your retention of CO2. One example is “box breathing” or when you breathe in 4 seconds, hold for 4 seconds and release for 4 seconds, then hold for 4 seconds again, but only with your nose! Mouth breathing makes us expel our CO2 quickly, nose breathing helps us retain it. You can do this with 8 seconds each instead of 4.

CO2 is crucial for the utilization of oxygen (O2). When you don’t have enough CO2 in your body, you cannot utilize oxygen appropriately, and this can cause hypoxia-like symptoms (feeling like you are suffocating, not having enough oxygen etc). So when you breathe from your mouth too much or if you hyperventilate like in a panic attack you lose CO2 rapidly and then you cannot use oxygen, this makes you feel like you are suffocating making the panic and anxiety far worse. Low CO2 can also lead to an increase in lactate or lactic acid, making anxiety and panic way worse.

In addition to bag breathing or forcing yourself to breathe slowly and through your nose only there are other things you can do to maintain a good level of CO2 in the body. One quick way is actually consuming baking soda or “sodium bicarbonate”. You can dissolve some baking soda into the water a drink it, or you can even take some “Alka-seltzer” which is aspirin + baking soda in little tablets that you put in water and watch dissolve. Then you can drink that water which will of course now contain baking soda and aspirin.

The normal way that we produce CO2 optimally is by oxidizing glucose (utilizing or colloquially known as “burning” glucose or “carbs”). I describe in great deal how to utilize glucose well in my article titled “How To Utilize Glucose Well” on substack. However, a quick recap is that the most important nutrients for utilizing glucose well are Thiamine (Vitamin B1), Magnesium, Biotin (Vitamin B7), Manganese, Potassium and Chromium. By far the most powerful nutrients in that list are Thiamine and Magnesium. In fact, if someone feels a panic attack coming on, taking some thiamine should be able to help as it will help you directly “burn glucose” better which will result in a large increase in CO2, helping to prevent the panic attack.

Glutamate can cause anxiety, GABA can calm you down.

There is far more to anxiety and panic attacks than CO2 retention. One anxiety-inducing neurotransmitter is Glutamate and one potent calming neurotransmitter is GABA. I discuss glutamate and GABA and their relationship in great detail in my post titled “The Dance of Glutamate and GABA”. However, I will give some quick recap points here.

If you are an anxious person or are experiencing any symptoms of anxiety, you may have high glutamate and low GABA. Glutamate can cause anxiety, and GABA can calm you down, but GABA comes from glutamate! One way that you can help increase the conversion of glutamate into GABA is by consuming enough vitamin B6, or taking it as a supplement such as in the useable form “P5P” or pyridoxal-5’-phosphate.

Deficiencies of molybdenum and manganese can also cause glutamate sensitivity so try to consume enough of those minerals. Liver, mussels, maple syrup and legumes like peas are good sources. Gluten-free oats are also a good source of molybdenum.

You can also lower glutamate by doing things that inhibit the NMDA receptor, this is because “activating the NMDA” can increase glutamate.

Please do not be confused by terms like NMDA, all you need to know is:

Glutamate = ANXIETY

GABA = CALM

NMDA activation = Glutamate

There are many natural ways to “block the NMDA”. Three examples are Magnesium, Zinc and the amino acid Agmatine. You can also try and lower ammonia in the body, as ammonia activates the NMDA (and thus increases glutamate). The best way to get rid of ammonia is… to increase CO2! Carbon Dioxide will help you convert ammonia (toxic) into urea (which is not toxic). You can also take 1-6 grams of Ceylon Cinnamon which can help chelate ammonia. Another thing that activates the NMDA is called quinolinic acid and it is made in excess when we don’t have enough vitamin B6, magnesium and riboflavin (vitamin B2). Even more reason why vitamin B6 protects against anxiety!

You can try and increase GABA (and thus calmness) with beneficial amino acids such as theanine, taurine and glycine. The most potent is probably theanine, it goes well with coffee and helps to take away jitters too. You can also take some herbs or have some herbal teas. For example, lemon balm tea (or lemon balm tincture) helps us to “hold on” to our GABA. This means lemon balm prevents us from degrading GABA too quickly, which will increase GABA levels and leave us feeling calm and anxiety free. There are many other herbs that can increase GABA, they make you really sleepy too so be careful. One potent example is Valerian Root, things like Holy Basil (Tulsi) can also be really calming. I’m also a big fan of chamomile tea with honey!

Oxaloacetate can also be very useful for PMS-related anxiety and depression, via many mechanisms. It can help lower glutamate and increase GABA. We make oxaloacetate via the enzyme “pyruvate carboxylase”. The main required nutrients for this enzyme are biotin and manganese. Biotin is very high in egg yolks and organ meats, and manganese is high in mussels, pineapple, maple syrup and legumes. You can also supplement oxaloacetate directly.

Low blood sugar (hypoglycemia) can make every stressor feel far more potent than it actually is.

Low blood sugar, or hypoglycemia, makes people really susceptible to anxiety and panic. When our blood sugar is low the body doesn’t have a good reserve of glucose ready to be used in response to a stressor. So even minor stress, like dropping a box of tissues in the grocery store, can set someone right off the edge and lead to them losing their cool. Little children that have trouble focusing and who are really fussy likely have a hard time regulating their blood sugar.

We want a situation where our blood sugar, our blood “glucose”, is always within range, not too high and not too low. In a normal healthy body if the blood sugar is dropping too low things will happen so we can increase it. For one, we will get hungry so we know it is time to eat food which will help increase the blood glucose back up to normal. The liver can start releasing stored glucose in the form of glycogen to help bring our blood glucose back to normal. If we go a long time without eating our body gives up on trying to make us eat and it starts making our own glucose. If we don’t eat, the body makes glucose from our own tissue, our amino acids, such as from the thymus gland or our muscles.

If you have impaired liver function or are hypothyroid in some way, your body can have a really hard time regulating blood glucose, that is, it can have a very hard time preventing hypoglycemia (low blood sugar). In the popular book by Broda Barnes MD called “Hypoglycemia, it is not your mind it’s your liver” the doctor explained how he helped many people with their low blood sugar issues by finding out they were hypothyroid and then he treated them for this. He showed how hypoglycemia can cause, or at least influence, things like ADHD, migraine, asthma and even seizures. Having low blood glucose can make you more susceptible to lots of things, and yes even seizures!

Some doctors and researchers have stated that hypoglycemia is due to deficiencies in manganese, chromium and zinc. I think biotin is also an important nutrient to prevent low blood sugar.

So, eating well can be really helpful for someone with anxiety. You want to prevent periods of very low blood glucose. The amino acid taurine can be useful here, it supposedly increases our liver’s ability to “store” glucose which means we are less likely to experience hypoglycemia. Taurine is also beneficial for the liver, anything good for the liver will be good for preventing low blood sugar. Many nutrients are important for managing good blood sugar levels, especially vitamin B5 (pantothenic acid).

Lastly, oxaloacetate is supposedly good for normalizing blood glucose, and this is part of the reason it can help with PMS. You can supplement oxaloacetate “benaGene” is the product, or you can increase your production of oxaloacetate by consuming more biotin and manganese.

Increased catecholamines (epinephrine/adrenaline norepinephrine/noradrenaline etc) can increase anxiety.

Catecholamines like adrenaline, norepinephrine and even dopamine can cause anxiety if they are high. Lots of things can increase the catecholamines. Having low blood sugar directly increases the catecholamines like adrenaline as they increase as a response to the low blood glucose to keep you alive! If you have very low blood glucose you can faint, or even die. So we increase these stress hormones to keep us from fainting and dying!

However, these stress hormones can… stress you out.

Some common things that can cause adrenaline to increase are, not eating enough, being cold, being stressed out, time constraints, not eating enough carbs, and of course not having good thyroid function. When thyroid function is not optimal the body compensates by increasing stress hormones like adrenaline.

So low thyroid = high adrenaline. I describe this in detail in my article on PCOS.

If you are experiencing extreme anxiety or even feel a panic attack coming on, eating something, especially something sweet, may be able to help you stave off that anxiety episode. Even drinking some juice like grape juice or orange juice may be able to give you a quick rise in glucose (and maybe CO2) to help you lower the adrenalin and avoid an anxiety attack. Also, consuming enough salt can keep aldosterone down and salt can help keep you calm. So, eating something salty may also help, or just consume enough salt in your diet in general.

I should also mention that high histamine can cause anxiety. Interestingly enough the calming amino acid that I already talked about earlier, Theanine, has some strong anti-histamine actions, in addition to increasing GABA. Stinging nettle leaf tea and stinging nettle root extract can help lower histamine as well. Avoiding foods you are allergic to is important to prevent histamine from increasing. Doing a skin prick test with an allergy doctor can show you some of the common foods that you react to. You may not even realize, as an example, that when you eat pineapple you are increasing histamine, a skin prick allergy test can show you this. Methylation is related to histamine clearance, but that’s out of the scope of this article. Vitamin B6, zinc, copper, vitamin C and vitamin A are also important for preventing high histamine levels.

Wow, vitamin B6 is just so great.

Calming hormones and neurosteroids like progesterone and allopregnanolone prevent anxiety.

Part of the reason why some women experience unrest and anxiety before their period “PMS - premenstrual syndrome” is that they are having a hard time producing progesterone, which is calming. You see, during the luteal phase (the second half of a woman’s cycle) you are supposed to be producing a lot of progesterone, this is the time when the need for progesterone is highest. If you are struggling to produce enough progesterone then you can feel terrible, moody and anxious. Read more about PMS here.

Common reasons why a woman may not be producing enough progesterone could be that she isn’t eating enough vitamin A, as this nutrient is needed to produce all steroid hormones, progesterone being one of them. Not eating enough, or enough carbohydrates, in general, can also lower progesterone production. Progesterone is made from cholesterol, and active thyroid hormone is crucial for the conversion of cholesterol into the steroids like pregnenolone and then progesterone.

Progesterone itself is pro-GABA and very calming and thus useful for anxiety. But the progesterone metabolite allopregnanolone (a neurosteroid that comes from progesterone) is extremely calming and anti-anxiety. Allopregnanolone production is essential for staying calm and it helps prevent anxiety, depression and even seizures. If you don’t make enough progesterone, you probably are not making enough allopregnanolone.

Some women take bio-identical progesterone (dissolved in vitamin E is a must!) topically or orally (with a meal) during their luteal phase to give themselves some extra progesterone, and in fact to promote their own production of progesterone. Some good vendors of progesterone dissolved in vitamin E are Ona’s, LifeBlud and Health Natura all of which you can use discount code DEAN for when purchasing products. Progest-E is another fantastic option.

Intestinal inflammation can be a direct cause of anxiety

Anything that irritates the gut can cause anxiety and inflammation. For example, hurting the gut with harmful things can lead to an increase in different substances such as histamine and inflammatory markers causing worsened mood and of course anxiety. Eating food that ferments in the intestine leading to bacterial overgrowth is one way to cause intestinal irritation. If you have too much bacteria in the gut they can cause extreme inflation, especially by activating what is referred to as the toll-like receptor 4 (TLR4).

To put it simply,

Activating TLR4 = Increase in Inflammation = Anxiety inducing

Eating hard-to-digest food, like a lot of raw leafy vegetables such as raw kale or spinach, or a lot of beans can cause intestinal irritation. Eating packaged food with harmful additives can easily cause intestinal inflammation, talc, titanium dioxide, and even added citric acid can be very allergenic and inflammation-promoting in the gut.

Eating easy-to-digest foods is a good idea. Fruit, eggs, meat, goat dairy (or A2 cow dairy) and well-cooked starches like potatoes and rice can be easy on the gut. Gluten from wheat and A1 cow dairy products can be very harmful to the gut. Just assume cow milk is A1 unless stated otherwise, goat dairy is always safe, as it does not contain the harmful A1 casein.

Other than avoiding hard-to-digest foods you can try to lower excess bacteria in the intestines. Having Ray Peat’s daily raw carrot salad is a great way to do this. It is grated raw carrots, vinegar, olive/coconut oil and salt. You eat it daily and it acts like a broom, brushing your intestines clear of excess bacteria.

The point of this section is, what you eat can directly cause anxiety by causing intestinal inflammation. So pay attention to what you eat and see what triggers anxiety or poor mood, wheat is a likely culprit and excessive salad consumption. Lots of gas, cramps and stomach upset are classic signs the meal you just ate caused some intestinal problems.

Conclusion:

Lots of things can increase anxiety, and thus there are lots of things you can do to prevent anxiety!

Utilizing glucose well and breathing slowly (and through the nose!) to keep CO2 up can help prevent panic attacks. Bag breathing and consuming sodium bicarbonate “baking soda” dissolved in water can help to increase CO2, allowing you to use oxygen better. Thiamine and magnesium are really useful here.

Lowering excess glutamate and increasing GABA can protect against anxiety. Vitamin B6 and magnesium are very useful here.

I use Mag+ from LifeBlud for magnesium.. use discount code DEAN. I also use magnesium threonate, I just buy it from amazon.

Hypoglycemia can be a big problem as low blood sugar makes stress amplified! Eating well and maybe taking some taurine are some tips, but this is a vast topic and out of the scope of this article.

High adrenaline can be a big issue when it comes to anxiety. Not eating enough is a classic cause of high adrenaline, and so is low thyroid function as adrenalin is increased as a response to this. Eating something sweet and maybe salty can lower adrenaline and help prevent anxiety episodes.

Progesterone and allopregnanolone help prevent anxiety and PMS. This is a big topic, vitamin A is one thing you can consume (liver, eggs, dairy) to increase progesterone production. Some women also take bio-identical progesterone, orally or topically.

Gut inflammation can directly cause anxiety. The daily raw carrot salad can help, avoid foods that hurt your stomach.

*None of this is medical advice. I am not a medical professional, always talk to your doctor*

If you enjoyed this article, please consider checking out the other articles I’ve written. Also, please feel free to subscribe (it is free to do so) and share the articles with others. Thank you!

BTW: I am a frequent guest on the podcast “Stuff Your Doctor Should Know”.

Discount code DEAN works at:

1. Ona’s Naturals (progesterone oil, topical progesterone and pregnenolone creams)

2. LifeBlud (Magnesium products, Taurine, Theanine, B vitamins, Methylene Blue)

3. Health Natura (oral pregnenolone, Methylene Blue)

4. Saturee (skin care products, desiccated liver, aged Cascara Sagrada)