Panic Disorder And Nutrition

Introduction

We all know about the importance of a healthy, balanced diet for our physical health, but what about our mental health? And how can we strive to achieve this ‘healthy’ diet?

Panic disorder is an anxiety disorder that induces intense, recurrent, and unexpected panic attacks. Symptoms include, but are not limited to: 

• A racing heartbeat 
• Sweating 
• Feeling faint 
• Chest pain 
• Shortness of breath 
• Chills 
• Hot flushes 
• DIzziness 
• Numbness or tingles in limbs 
• Nausea 
• A feeling of dread 
• Feeling disconnected from your body 

These characteristic symptoms often occur for no apparent reason. Usually, people who experience these attacks tend to avoid certain situations they think trigger the anxiety sequence. However, this is not a reliable management strategy due to the creation of a ‘fear cycle,’ which inevitably leads to more panic attacks.

The more prone you are to experiencing this type of panic disorder, the more important your personalised nutrition becomes. Although the gut-brain axis (the communication between the digestive and nervous systems) is well established in nutritional psychiatry,¹ diet is often an overlooked tool in psychological therapies. Utilising nutrition to help manage your anxiety disorder could help minimise these unwanted attacks.  

Nutritional strategies to manage panic disorder

Eating a well-balanced diet with complex carbohydrates, proteins, and healthy fats

A healthy diet considers the macronutrients (fat, protein, and carbohydrates) that make up your plate. Contrary to popular belief, radically cutting out fats or carbohydrates isn’t usually recommended for optimal nutrition. Instead, these are seen as vital components that should make up a substantial percentage of your diet. The NHS Eatwell Guide prioritises proteins, healthy fats, starchy carbohydrates, and fruit and vegetables. In order for your diet to be considered complete, you should have a good balance of each of these.

Notably, individuals’ dietary requirements will vary dramatically. It is important to be aware of what works and doesn’t work for you. Even so, the Eatwell Guide is a good place to start when aspiring to build a balanced diet.

Consuming foods high in vitamins and minerals such as magnesium, vitamin B, and zinc

Stress is known to negatively impact your hormone regulation and digestive system, meaning nutrients are absorbed less efficiently. As a result, when you enter a state of stress and/or panic, your body often feels drained and depleted. This in turn can make you susceptible to further low moods and anxiety attacks. Therefore, it is essential to consume an excess of micro nutrients (vitamins and minerals) during periods of anxiety. We will go into more detail later, but some examples include:

• Magnesium
• Vitamin B
• Zinc

Avoiding caffeine, alcohol, and processed foods

You may want to avoid caffeine if you are vulnerable to panic attacks. A recent systematic review concluded that caffeine not only induced panic attacks in the majority of individuals diagnosed with a panic disorder, but also increased the likelihood of experiencing anxiety for healthy people.²

Many people gravitate towards coping mechanisms when experiencing mental health issues. Coping mechanisms such as drinking alcohol or smoking further depletes macro and micro-nutrients in your body. For example, the liver uses vitamins to metabolise alcohol in the liver.³ Smoking can also impact your appetite due to its effects on the brain and central nervous system.

Similarly, recent findings indicate that ultra-processed foods are associated with anxiety and depressive symptoms.⁴ This further supports choosing positive dietary patterns and ‘anti-inflammatory’ diets to reduce stress on the body and curb negative mental disorder symptoms. This includes diets that fight inflammation - for example, Mediterranean diet patterns. Specific foods to incorporate in an ‘anti-inflammatory’ diet are discussed below.

Staying hydrated to improve mood

Although most people with anxiety will experience symptoms whether they are hydrated or not, water intake can significantly impact how severe your symptoms feel. The link between water and stress is apparent through the hormone cortisol, the ‘stress hormone.’ When you are dehydrated, cortisol levels rise. Therefore, if you are trying to avoid increasing your stress levels further, make sure to stay hydrated.

Specific foods to incorporate in a panic disorder diet

Whole grains

Whole grains are an important part of a balanced diet. These complex carbohydrates are metabolised in the body at a slower rate. This means your blood sugar is less likely to spike and instead stays at a constant level, lessening mood swings and anxiety symptoms.⁵ 

Examples of whole grain foods include:

• Wholewheat pasta
• Rye bread
• Muesli
• Wholemeal bread

Fruits and vegetables

Fruits and vegetables contain many of the much-needed nutrients that keep your body energised and replenished. They are also an excellent source of fibre to maintain a healthy gut. Fruit and vegetables that are fresh, frozen, tinned, cooked and dried can all count towards your intake. They should be your first port of call rather than supplements. 

Examples include:

• Oranges
• Kiwis
• Dark leafy greens
• Berries

Lean proteins

Inadequate protein intake has been associated with increased anxiety symptoms.⁵ Protein contains amino acids. These are essential components for the function of neurotransmitters, which are crucial in the production of serotonin. Serotonin, a type of neurotransmitter, has a known association with anxiety disorders; hence protein is essential in an anxiety-reducing diet.⁵ 

Examples include:

• Lean meat
• Fish
• Eggs

Nuts and seeds

Nuts and seeds contain fats which are vital to a healthy diet. Dietary fat can influence inflammatory processes in our bodies; for instance, omega-3 helps reduce levels of inflammation. Inflammation plays a role in many psychiatric disorders.⁵  

Examples include:

• Chia seeds
• Flax seeds
• Walnuts

Supplements to consider

Magnesium 

Magnesium is essential for central nervous system function and may be lowered in a range of psychiatric disorders.⁶ Therefore, supplementation could be beneficial. Additionally, magnesium has been shown as an important nutrient that modulates the gut-brain axis.⁷ This further supports its role in psychiatric disorders.

Vitamin B complex 

B vitamins are organic compounds found in vegetables or meat. The B vitamin complex is the combination of 8 key B vitamins. Each of these vitamins plays a crucial role in essential bodily energy conversions that help maintain life.

These include, but are not limited to: 

• Thiamine (B1) 
• Riboflavin (B2) 
• Cobalamin (B12) 

They play a significant role in cognitive function and mood, mainly through homocysteine (another type of amino acid) metabolism.⁸ Reviews of clinical trials have demonstrated the therapeutic benefits of B vitamin supplementation on anxiety symptoms.⁹

Omega-3 fatty acids 

Omega-3 fatty acids, commonly located in fish oil tablets, have been associated with a reduction in anxiety disorder symptoms. A scoping review publicised the potential benefits of nutrient supplementation, including omega-3, on mental disorders.¹⁰  

Probiotics 

Lastly, probiotics have been recognised for their therapeutic properties in mood disorders. These disorders have been linked to high levels of ‘bad’ gut bacteria, so adding ‘good’ bacteria in the form of probiotics can regulate the gut-brain axis.¹¹ Therefore, probiotic supplementation could be helpful in panic disorder management.  

Summary

The importance of the gut-brain axis in maintaining psychological equilibrium has been gaining traction within clinical nutrition in recent years. Evidence highlights the importance of maintaining a healthy diet and avoiding certain inflammatory foods and drugs (e.g. alcohol and caffeine). 

Keeping a good balance of macronutrients, whilst ensuring an adequate vitamin and mineral intake, is crucial to help mitigate the negative psychological and physical symptoms associated with panic disorder.