Can Hypoglycemia Cause Anxiety and Panic Attacks?
Can hypoglycemia cause anxiety or panic attacks? What is the role of blood glucose in triggering panic and anxiety? Is there a theoretical role or is there actually a role? Is there any clinical data or research to support this. In this article we look at the relationship between anxiety and hypoglycemia, how those two are interrelated, and what you might do about it.
If you think this could be going on with you and want to know more about the role of hypoglycemia in anxiety, keep reading.
What Is Hypoglycemia?
The question we want to look at today is can hypoglycemia or blood sugar issues lead to anxiety and panic attacks. My clinical experience with this is it absolutely can. It makes a lot of theoretical sense why it would too. Before you assume this is going on with you, you do have to figure out if you are actually having hypoglycemia.
First of all, what is hypoglycemia? Hypoglycemia is when you have an acute drop in your blood sugar below what the body senses as normal. Typically that's going to be below 60 milligrams per deciliter. However, your threshold may be lower than that or slightly higher than that. This is based on what your body is used to what your pancreas and other tissues in your body are used to. Generally hypoglycemia comes from an excess of insulin that drives your glucose down very quickly. Then within 30 minutes to 3 hrs after, your blood sugar drops below that critical threshold. How quickly the drop occurs is different for different people. For most it occurs within the first hour. Once your blood sugar drops, your body starts producing more epinephrine and cortisol. Epinephrine and cortisol are there to help release some of the stored glucose and the stored sugar that's in your muscles and in your liver. What that epinephrine also does is active the fight-or-flight chemicals in your body. That chemical, epinephrine is designed to make you feel anxious. It is designed to make you fight or flight the area. It is a danger response.
Naturally when you have more epinephrine flowing through your system, you will be a little bit more on edge and see the things around you in a panicked way or stressed way. That panicked feeling will cause you to look for what's wrong. You may not understand that it is your blood sugar that's causing this in the moment. Keep in mind that not everyone has hypoglycemia and even those that do may have anxiety in addition to hypoglycemia. Still there are certain cases where this could be the main thing going on. Hypoglycemia is not that hard to fix for people. The trick is identification of the problem. First a little more on the epinephrine story. When that epinephrine is released it's going to bring your blood glucose back up but it doesn't happen immediately. You may be in an anxious state for some time before things even out and you may not really understand why that is happening.
The other thing is not everyone that has hypoglycemia is going to feel anxious. Some people may actually like the feeling. It really depends on how you're wired, how much epinephrine is being produced and what your normal baseline is. That's the reasoning or the theory behind why hypoglycemia and low blood sugar can lead to panic attacks and generalized anxiety for some people. That's not to say that everyone that has this is going to have anxiety or panic attacks. When you do have hypoglycemia, you're going to have a relatively higher anxiety level, and relatively higher stress level than if you're not hypoglycemic. That is just by the nature of what epinephrine does to human body and psychology. Just because this makes a lot of theoretical sense, doesn't mean it is necessarily valid.
Research Behind Can Hypoglycemia Cause Anxiety?
I have seen this in my practice and there are case reports about this. However, let's see what kind of actual research there is about this. A relatively older study looked at this question in healthy (non-diabetic) participants. With diabetics you will definitely have more hypoglycemic events compared to the regular population. What the researchers found was there was a significant increase in things like hedonic tone, tense arousal, and a decline in energetic arousal compared to the normal glycemic control group. They also found that there were substantial changes in mood observed in the healthy participants with acute hypoglycemia. The participants described it generally as a tense tired state that persisted for thirty minutes after normal glucose was restored. That's where that feeling can linger even after your blood sugar normalizes.
You may start having hypoglycemia and think, I better do something about it. Yet it may linger for for a while afterwards and that's normal. Some people experience things like heart palpitations, sweating, anxiety and things like that. This is what epinephrine and some of the other chemicals that kick in do when you are hypoglycemic.
Epinephrine can be measured in the urine. Another study used this to look at this question. They looked at the association between depression and anxiety symptoms overlaying with twenty four hour urinary catecholamines. Catecholamines are epinephrine, norepinephrine. dopamine etc. What they found is interesting. The epinephrine twenty four hour was positively correlated with anxiety but it wasn't correlated with depression. Meaning that those that had higher epinephrine levels tended to have anxiety. Does that mean epinephrine is always what's causing anxiety? Is anxiety always epinephrine driven?
No it doesn't but in this one fairly small study there was an association or correlation there. The last study I looked at was with a high glycemic index (GI) diet. This is a high carbohydrate diet and the researchers found this diet was a risk factor for depression. Depression is not anxiety but it is mood related. The study suggests that a high GI diet could be a risk factor for depression in postmenopausal women. The general theme here is that there's a lot of smoke around the idea of hypoglycemia causing anxiety or contributing to anxiety and panic attacks. I would predict hypoglycemia is a trigger for panic attacks specifically. That's because panic attacks are more of an acute event. It makes sense because panic attacks are typically not happening every single day. For people with generalized anxiety disorder along with panic attacks, they may have really low blood sugar during the panic attacks and just slightly low during the parts of the day where they're feeling anxious.
Testing For Hypoglycemia As A Cause for Anxiety
How would you go about testing for hypoglycemia? Generally speaking, you would just do a fasting blood sugar test. You fast for 12 hours and you see what the glucose is. If it's low, you have hypoglycemia. What you want to look at more closely at is the intervals around after eating. You can test one hour after eating, two hours after eating, and three hour after eating etc. You are looking to see what's happening with your insulin and what's happening with your glucose during those times. Those are the times when your insulin is at its peak, usually an hour or two hours after eating. This is the time when you will be more susceptible to hypoglycemia.
Glycemic index or GI foods are the foods that are going to have more carbohydrates. They will raise the blood sugar higher than other foods. High glycemic and high glucose foods are the types of foods that are also going to raise your insulin levels high. It's always important to test for these things, if you think it could be there. You can see if this is a contributing factor and what to do about it. There are lots of ways to lower blood sugar and balance it out. If you already know you have insulin resistance, then for sure this is something that could be contributing to your anxiety. If you don't know, I recommend testing and not making assumptions. Do the testing that shows you, maybe a two-hour postprandial glucose test or multiple serial testing for your blood sugar after eating.
That should give you a better understanding of the role of glucose and specifically hypoglycemia and triggering anxiety and panic attacks. If you have questions about the content in this article, please ask it in the comment section below.
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