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Suffer From Anxiety Or Panic Attacks? Here's How To Stop Them

Wendie Trubow, M.D., MBA
August 31, 2018
Wendie Trubow, M.D., MBA
Functional Medicine Gynecologist
By Wendie Trubow, M.D., MBA
Functional Medicine Gynecologist
Wendie Trubow is a functional medicine gynecologist with almost 10 years of training in the field. She received her M.D. from Tufts University.
Photo by Jack Sorokin
August 31, 2018

Anxiety is so common that sometimes my patients forget to tell me about it. But it's still not normal, even though it affects up to one in three Americans1 during their lifetime. Each year, anxiety affects approximately 40 million Americans, which makes it more common than diabetes. One of the most common ways anxiety manifests is through anxiety attacks, also known as panic attacks.

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Anxiety attacks: a holistic approach.

Nothing can tank your plans for the day like an anxiety attack. They're extremely scary, unbearably frustrating, and if you suffer from them frequently, they can leave you feeling hopeless that you'll ever live a normal life. But as a functional medicine doctor who treats anxiety on an almost daily basis, I can tell you that all hope is not lost. From a holistic medicine standpoint, the top causes of anxiety can be not only understood but also addressed so that you can get your arms around your anxiety instead of your anxiety squeezing the breath and life out of you.

Lesser-known causes of anxiety attacks.

So what can we do about anxiety and panic attacks? There are a few key underlying causes of anxiety, and the good news is that each one can be improved. The bad news is that sometimes it can take time. The following are considered top functional medicine causes for anxiety:

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1. Adrenal fatigue

Severe fatigue, also known as adrenal fatigue or dysfunction, is one of the top causes of anxiety. The greatest risk of developing adrenal fatigue is if you're...alive. Especially in the United States, where the pace of life can sometimes go faster than our ability to keep up! Have you ever noticed that you're a little grumpy when you haven't slept enough? Multiply that by 100, and you have adrenal fatigue, which can worsen our mood (think: anxiety and panic attacks) and cause sleep disturbances, heart palpitations, hot flashes, and brain fog.

2. Gluten intake

Yep, the grain found in wheat, barley, malt, and rye is another top cause of mood disorders, anxiety attacks, panic attacks, depression, and OCD. While initially, eating gluten can cause the endorphin receptors to kick in, for the 40 percent of the population who has a genetic sensitivity to gluten, eating gluten can increase the experience of anxiety.

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3. Poor gut health

Which leads me to the next major cause of anxiety attacks: the GUT. The gut is the site of 80 percent of our production and receptors for serotonin (our happy hormone!). It is, quite literally, known as our "second brain"—although I'd argue it's actually the first brain that runs the brain above our necks! When the microbiome is out of balance, it can worsen mood.

4. Nutrient deficiencies

A gut that is out of balance often doesn't absorb minerals and nutrients effectively, and severe vitamin D deficiency is another major cause of anxiety and anxiety attacks. Most people who live in the Northeast, Northwest, and Midwest have strong sun for only three to four months a year, and because we don't want to get skin cancer, we put on sunscreen when we go outside, lessening the absorption of the vitamin D.

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5. Underlying infections

One often overlooked cause of anxiety attacks is Lyme disease and/or the coinfections (Babesia, Bartonella, Ehrlichia, etc.). People usually think of joint pain when they think of Lyme disease, but anxiety, depression, headaches, and severe fatigue are also often present.

Three other extremely common causes of anxiety are post-traumatic stress disorder, severe nutrient deficiencies, and integrity issues that cause someone to feel out of balance or "off."

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How to stop an anxiety attack in the moment.

Having an anxiety attack can feel very threatening and make it difficult to get through a meeting, the commute, or your day. Fortunately, there are immediate, midrange, and longer-term solutions that can help you conquer anxiety. Many of these immediate—or short-term—solutions to anxiety don't involve a prescription and can significantly blunt the impact of an anxiety attack you're in the middle of. I'll call these "reactive" remedies, since you take them on an as-needed, reactive basis, although they can be taken as a preventive measure, too. So let's dive in!

1. Magnesium

Magnesium, which often comes in the form of magnesium citrate—although there are many other types of magnesium—is often found as a powder that can be dissolved in water and drunk. It takes effect pretty quickly and is great for anxiety (and other mood imbalances), headaches, muscle fatigue and constipation. The only downside to magnesium in this form is that it can lead to diarrhea if too much is taken. If that occurs, try switching to a form that includes taurate and glycinate in it to lessen the impact on the gut. Otherwise, magnesium is water-soluble, and if you take too much, you'll simply pee or poop it out. It's unlikely to cause any other side effects and is one of the safest remedies out there!

2. 5-HTP

Another reactive remedy that's available is 5-HTP, which is shorthand for 5-hydroxytryptophan, which is actually a metabolite of L-tryptophan (the reason you get sleepy after the turkey dinner or warm milk!). 5-HTP is the immediate precursor to serotonin, which directly affects mood and is what many antidepressants work to increase. We often think that if a little is good, more is better, but this isn't the case with 5-HTP. Ideal doses range between 25 and 150 mg daily depending on how sensitive you are. Higher doses may actually worsen anxiety, so it's important to go slowly if you're taking this. Also interesting is that serotonin ultimately gets converted into melatonin, which can affect sleep quality (and worsen anxiety if sleep is inadequate).

3. GABA supporters

The next group of reactive therapies often go together since they are all part of the same "family" of chemicals that work to support the neurotransmitter GABA, which acts like the brakes on a train to keep the brain from moving too fast. This means that the benefits of GABA include relaxation and better sleep, among others. Interestingly, GABA comes from glutamate, which is the neurotransmitter that excites you (or speeds things up!). What's really interesting is that a magnesium, zinc, and/or B6 deficiency can each make it harder to produce GABA from glutamate, so you'll want to make sure you're getting adequate levels of these nutrients in your diet and supplement if necessary. Taurine is a substance that acts as a precursor to GABA, binding to GABA receptors to increase enzymes that produce GABA and puts the brakes on the enzymes that break GABA down, allowing it to hang around in the brain longer to promote relaxation. Taurine also inhibits glutamate, which as you just learned is the neurotransmitter that acts to rev you up.

Lastly, we can't leave L-theanine out of the group! From the view of the receptor, L-theanine "looks" like glutamine, and as a result, it binds to the receptors meant for glutamine. Except that instead of activating that receptor and revving you up, it occupies the receptor but doesn't activate it and instead slows things down. L-theanine also stimulates the production of GABA, which relaxes you. Inositol is a substance that improves the production of serotonin and also sits in the GABA receptor when the GABA has been depleted and helps to slow the train down when the other substances are depleted.

4. Cannabis

The last category of reactive remedies is marijuana. Now, on one hand, it would make all our lives more relaxed if we went along in a hazy state of buzz, but that's obviously not going to work for most of us! But all joking aside, marijuana has very potent anti-anxiety properties that make it useful both as a preventive and a reactive remedy. Marijuana has two main families: Sativa, which tends to be energizing, and Indica, which tends to be sedating.

The marijuana plant has a ton of active ingredients, but the two we focus most on are THC and CBD. THC is the component that alters your brain function and makes you "high." In higher doses, it can make you paranoid and anxious, so this would not be my suggested treatment of choice if we want to eliminate anxiety! CBD, on the other hand, is wonderful for treating anxiety and has ZERO brain-altering properties, so it is a wonderful choice to manage anxiety. The best formulation is a tincture, which means you put it under your tongue and let the skin of your mouth absorb the medicine. CBD can be derived either from marijuana or hemp, and both can be highly effective.

All of the reactive remedies work pretty quickly, which is great if you need relief!

Preventing an anxiety attack in the long-term.

Now let's turn our attention to measures that you can take to prevent an anxiety attack in the first place. Some of these are quick fixes, and others take a little longer to take effect:

1. Rest

One of the best preventive measures for anxiety attacks is to prioritize rest and get a good night's sleep. Not sleeping enough alters the function of the thyroid, adrenals, liver, and gut, and can either directly or indirectly worsen anxiety.

2. Exercise

Cardiovascular exercise is another critical preventive measure since it helps you "blow off steam" and causes the release of endorphins that improve mood.

3. Mindfulness practices

A third critical preventive measure is meditation. There is a TON of data out there showing the benefits of meditation2 for anxiety! Plus, it's free. Yoga falls into this category for many, as it is a meditative form of exercise and can assist with managing anxiety.

4. Life coaching or talk therapy

Sometimes, we need the help of someone who is trained to listen to us and identify powerful opportunities for us to grow. This may or may not be someone who is actually a therapist; often this is someone who has coaching training. The goal of working with this person is for them to be able to identify when your thought processes are cutting your off at the knees and worsening the anxiety. Their role is to offer up a different perspective, approach, or response that allows you to respond more proactively and powerfully to whatever situation you're in. Life coaching and traditional talk therapy can feel similar, but the goals and interactions are actually very different and can lead to different outcomes. It's all about finding what resonates best with you.

5. A gluten-free, processed carb-free, and sugar-free eating plan.

Ever heard the saying "You are what you eat"? Well, it's true. There's a ton of data linking gluten sensitivity to mood disorders including anxiety3, depression4, OCD, and schizophrenia. (Just remember that the sugar-filled gluten-free substitutes aren't good for you, either!) If you're struggling to get a handle on anxiety, the best diet is a whole food, gluten-free, processed carb-free, sugar-free eating plan.

It's also important to address the medically based underlying causes of anxiety. I highly recommend you see a functional medicine provider for this part. If you have unexplained anxiety, it could be adrenal fatigue, Lyme disease, gut dysbiosis, a severe nutrient deficiency, celiac disease (or non-celiac gluten sensitivity), PTSD, or even something else. Each issue has its own evaluation and treatment, but they are most certainly treatable. Don't give up, and don't let anyone tell you there's no reason for your anxiety; there almost always is!

Want to learn more about using CBD oil for anxiety?

Wendie Trubow, M.D., MBA author page.
Wendie Trubow, M.D., MBA
Functional Medicine Gynecologist

Wendie Trubow, M.D., MBA is a functional medicine gynecologist. She received her M.D. from Tufts University in 2000 and has been practicing functional medicine since 2009. After all these years, she is still passionate about helping women optimize their health and their lives. There are so many different challenges in a woman’s life: work, home, relationships, spirituality, health, and they all matter! While her credentials allow Trubow a solid medical backdrop to help women achieve vitality, her own health journey has also inspired and supported her methods of care.

Through her struggles with mold and metal toxicity, Celiac disease, and a variety of other health issues, Trubow has developed a deep sense of compassion for what her patients are facing. When she's not helping patients in her practice (5 Journeys) you can find Trubow alongside her husband and their four kids, creating a beautiful ecosystem in our yard that provides nourishment to both our body and soul. She also co-authored the book Dirty Girl: Ditch the Toxins, Look Great, and Feel Freaking Amazing!