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  1. #1

    Panic Attacks, Brain Acidity, and Lactic Acid

    Panic Attacks as a Problem of pH
    By Richard Maddock, Scientific American Mind Matters
    May 18, 2010

    Study casts new light on the brain mechanisms behind recurrent bouts of intense anxiety

    "My heart starts to race, I can't breathe, I get all sweaty, and I feel very scared - like I am about to die."

    This is how one of my patients recently described her panic attacks. Her diagnosis is panic disorder. The cause of this condition is still not understood, but we have long known that the vulnerability to panic disorder is strongly genetic. Now, a recent study from the laboratory of John Wemmie at the University of Iowa may have revealed an important new clue to the underlying cause of recurring panic attacks: It may, in effect, be a problem of pH -- of acidity at key junctures in the brain.

    The amygdala, an almond-shaped structure deep in the brain, has a critical role in the circuits that control the experience of fear, both instinctive fear (like being afraid of snakes or large carnivores) and fear that is learned from life experiences. The Iowa study shows that a very basic metabolic factor, pH -- acidity -- also has an essential role in fear.

    In general, the pH of our brain is carefully regulated. A large increase or decrease in brain acidity can seriously disrupt brain functioning. This new study indicates that pH can sometimes rise and fall in synapses, the points of communication between individual neurons in the brain. Some synapses include specialized proteins that "sense" acidity. These proteins (called "'acid-sensing ion channels", or ASICs) stimulate neurons when increased acid is detected.

    The Iowa study shows that genetically modified mice lacking these acid-sensing proteins have a greatly reduced capacity to show either instinctive or learned fear. When the researchers restored the ASIC gene only in the amygdala of these genetically modified mice, they observed a normalization of fear behaviors. So their studies suggest that the ability to detect changes in synaptic pH in the amygdala is essential for normal fear behavior.

    The Iowa paper also examined another element in the panic equation: Carbon dioxide. Carbon dioxide acts like an acid in the body and the brain. Several of the experiments described in the Iowa paper showed that inhaling elevated concentrations of carbon dioxide triggered strong fear reactions in normal mice, and that some of these fear reactions required the presence of the acid-sensing protein in the amygdala.

    These experiments are especially relevant to understanding panic disorder. One of the most consistent findings in patients with panic disorder is that they are unusually sensitive to carbon dioxide inhalation and other laboratory procedures that increase brain acidity. Most patients with panic disorder will experience a panic attack when they inhale air containing 35% carbon dioxide, while most healthy volunteers will not.

    Interestingly, the close relatives of panic patients will also panic during carbon dioxide inhalation, even if they have never suffered from an anxiety disorder. A hypersensitivity to acid in the brain appears to be part of the inherited vulnerability to panic attacks. The recent studies in mice lacking the ASIC protein add further credence to this understanding of why some people are more prone to having panic attacks.

    The Iowa findings might help explain the significance of another curious observation: patients with panic disorder tend to generate excess lactic acid in their brains. Scientists have long hypothesized that an abnormality affecting basic cellular metabolism or pH lay at the heart of the genetic vulnerability to panic disorder. One of the products of glucose metabolism is lactic acid, or lactate. Lactate is constantly being produced and consumed during brain activity, but if it accumulates in the brain, it will make the brain more acidic. Recent studies have shown that patients with panic disorder consistently build up excess lactate in their brains during ordinary mental activities. The results of the Iowa studies suggest that one of the triggers for “spontaneous” panic attacks in patients with panic disorder might be lactic acid accumulating in acid-sensitive fear circuits.

    Although there are several effective treatments available for people with panic disorder, current treatments do not work for all patients. It is unlikely that any of the current treatments specifically act on the underlying genetic vulnerability in panic disorder patients. The new studies show that brain pH changes are a crucial part of the mechanism of many fear behaviors. At present, no available medications affect the responses of acid-sensing ion channels in the brain. It may be possible to develop medications that inhibit these ASICs or otherwise modify the metabolic or neurochemical pathways involved in the regulation of fear and anxiety by brain acidity.

    For example, one of the many beneficial effects of aerobic exercise training (like running or cycling) is that metabolically active tissues (including the brain) become more efficient at consuming -- removing -- lactic acid. There is growing evidence that exercise training has powerful anti-anxiety and anti-panic effects. This invites the speculation that exercise training may reduce anxiety in part by improving the brain's ability to prevent excess acid accumulation in acid-sensitive brain regions involved in fear. If experiments support this idea, then specific exercise training regimens could be designed to take maximum advantage of this anti-anxiety mechanism.

    This is just one example of what are sure to be many new ideas about treatment to arise from our growing understanding of the fundamental role of brain pH in fear. Already, even with those treatments still only on the horizon, people with panic disorder, like my patient, may find some comfort in the mounting evidence that what they experience is not just “in their head” -- it is in their acid-sensing ion channels.

  2. #2

    Re: Panic Attacks, Brain Acidity, and Lactic Acid

    If I understand it aright, research associated with Konstantin Buteyko (better known for asthma treatment) suggests that hyperventilation through the mouth restricts blood vessels and thus blood flow to and from the brain. There is a further bit I do not entirely understand suggesting that over-breathing for the given physical activity level decreases the rate at which hemoglobin sheds carbon dioxide molecules for oxygen in the lungs. If so, there are two mechanisms by which hyperventilation causes a rise in carbon dioxide levels in the brain ... and hence anxiety level. Hyperventilation of course is common among anxiety and panic attack sufferers. If rapid breathing is functional for real fight-or-flight response, it is counter-intuitively counterproductive for irrational anxiety and panic.

  3. #3

    Re: Panic Attacks, Brain Acidity, and Lactic Acid

    These findings are intriguing with respect to my personal experience. Specifically, I am a recreational bicycle racer and thus, need to perform a variety of training routines. When I perform workouts targeted at either anaerobic capacity or neuromuscular power, I develop a panic attack. These efforts are characterized by relatively short bursts (15 - 90 seconds) of very high power generation. The attacks dissipate within 30 seconds of stopping the effort.
    These attacks are not heart rate related; I can perform lower level effort over a longer period of time and gradually bring my H/R up to maximum without inducing an attack.
    It's worth noting that my late father suffered with panic attacks.

  4. #4

    Re: Panic Attacks, Brain Acidity, and Lactic Acid

    I remember taking a mind altering drug in my teens and after coming down off of it, I had a dark feeling that lasted all afternoon and it really scared me. It wore off, though. Later on, I started experiencing panic symptoms while I was taking thyroxin for low thyroid. I stopped taking the thyroxin. About a year or two later I underwent minor surgery. I was given sodium penthatol. It made me feel so strange. Scary strange. I woke up later in my hospital bed with a dark feeling. It scared me. I remember driving home feeling strange. Later that day, or perhaps it was a few days later, can't remember, I had an even darker feeling, fell to the couch, and was choking. My ears were roaring. I am not sure what was happening, but it was very physical and I could feel something like a straw sucking something out of my head. I have stayed that way ever since. I also have constant vertigo now. I have had two really bad choking episodes throughout the years, but I try and deal with the barrage of physical things. I am no baby. I was in labor for 12 hours and I elected to go the natural route, so when I say that panic symptoms are unbearably painful, I am not kidding. Not too long ago, I took 5htp for the panic, and it cured the symptoms, gave me back my sense of well being, and took away my tics. It was amazing. but I DO NOT recommend it, because hours later it made me feel like I was taking yet another mind altering drug. Just last week I was drinking milk, lots of it, for the calcium, and I had the most intense panic symptoms I have ever had. It was horrible. So I now agree that panic and lactic acid go together, and that milk is a huge contributor. My question is "How do 5htp, neurotransmitters, and lactic acid, combine to create this problem. What is the chemical process? How do neurotransmitters, 5htp, etc, create lactic acid? Please please let me know. Even if it is theoretical, I still would like to know more. I think you are all on to something. I just would like to know.

    ---------- Post added May 4th, 2011 at 04:59 PM ---------- Previous post was May 3rd, 2011 at 11:50 PM ----------

    Also, I just saw in your notes that neurons are enhanced during this process, so that would explain. I would still like more indepth info. How would this all explain why valiums help? Valiums suppress gaba. I read a lot about how exercise helps panic and anxiety so does that mean that exercise plays a dual role? Of course, there is the aspect of serotonin in this process. How does that work?









    ---------- Post added May 5th, 2011 at 12:36 PM ---------- Previous post was May 4th, 2011 at 04:59 PM ----------

    [QUOTE=dell;186277]I remember taking a mind altering drug in my teens and after coming down off of it, I had a dark feeling that lasted all afternoon and it really scared me. The feeling finally wore off. These drugs affect gaba, and they manipulate serotonin which is involved in anxiety. Later on, I started experiencing panic symptoms while I was taking thyroxin for low thyroid. I stopped taking the thyroxin. Of special note is that bipolar is now known to be caused by hypothyroidism, in many cases. I believe that thyroid imbalance contributed to my anxiety symptoms, but only after I was given thyroxin. Also of note, is that anxiety is said to be caused by an imbalance in t3, t4, and tsh, which play a huge part in thyroid gland activity. About a year or two later I underwent minor surgery. I was given sodium penthatol. It made me feel so strange. Scary strange. I woke up later in my hospital bed with a dark feeling. It scared me. I remember driving home feeling strange. Later that day, or perhaps it was a few days later, can't remember, I had an even darker feeling, fell to the couch, and was choking. My ears were roaring. I am not sure what was happening, but it was very physical and I could feel something like a straw sucking something out of my head. I have stayed that way ever since. I also have constant vertigo now. I have had two really bad choking episodes throughout the years, but I try and deal with the barrage of physical things. I am no baby. I was in labor for 12 hours and I elected to go the natural route, so when I say that panic symptoms are unbearably painful, I am not kidding. Not too long ago, I took 5htp for the panic, and it cured the symptoms, gave me back my sense of well being, and took away my tics. 5htp helps to create serotonin. I am not sure if it crosses the blood brain barrier. It was amazing. I DO NOT recommend it, because hours later it made me feel like I was taking, yet, another mind altering drug. Just last week I was drinking lots of milk, for the calcium, and I had the most intense panic symptoms I have ever had. It was horrible. So I now agree that panic and lactic acid go together, and that milk is a huge contributor. My question is "How do 5htp, neurotransmitters, and lactic acid, combine to create this problem. What is the chemical process? How do neurotransmitters, 5htp, etc, create lactic acid? Please please let me know. Even if it is theoretical, I still would like to know more bout the chemical process by which all of this takes place.

    ---------- Post added May 4th, 2011 at 04:59 PM ---------- Previous post was May 3rd, 2011 at 11:50 PM ----------

    Also, I just saw in your notes that neurons are enhanced during this process, so that would explain. I would still like more indepth info. How would this all explain why valiums help? Valiums suppress gaba. There is serotonin in this process too. How does that work? I was told to drink water to level ph, and when I sweat a lot I sometimes have more anxiety, so that may explain the water concept. Do you agree to drink more water, and perhaps drink bottled instead of tap?




    :

  5. #5

    Re: Panic Attacks, Brain Acidity, and Lactic Acid

    Sorry... I did make a mental note to re-read that article but haven't had time yet. But I will say that the role of the various neurotransmitters in anxiety, stress, mood regulation, and mental illness is still not well understood, so many of your questions can't yet be definitevely answered. Add to that the complexity of the endocrine system, which is rather tighjtly integerated with the neurotransmmiter system, and all of this becomes complex enough to make your brain hurt.

    As for water, in most areas of the world tap water is fine, although you may prefer the taste of bottled water.

  6. #6

    Re: Panic Attacks, Brain Acidity, and Lactic Acid

    One more question. Please answer as soon as you can. Theoretically, do you think that lactase would help panic attacks or make them worse? At first I thought it would help, but now I think it would hurt.




  7. #7

    Re: Panic Attacks, Brain Acidity, and Lactic Acid

    I'm not a biologist or an endocrinologist or a physician but I know of no reason to expect that it would do either, truthfully. Just because something can mimic anxiety or panic doesn't mean it's the root of that particular symptom or disorder.

    Let me give you an example from my personal experience. I am prone to anxiety myself, dating back to when I was a child and first began experiencing what the doctors then called paroxysmal atrial tachycardia (PAT), basically a racing pounding heart beat. This isn't a heart condition - repeated EKGs throughout the years have always been normal. Eventually, I determined that this was my physical manifestation of an anxiety reaction.

    Earlier this year, in January or February, I began experiencing a sort of fluttery sensation, kind of a heart palpitation, which was very familiar to me since during childhood, adolescence, and the first part of m,y adult years this was the primary precursor to one of my PAT attacks. Consequently, I assumed that I was experiencing more anxiety than normal and needed to take steps to address that, despite the fact that I could not identify any reason for increased anxiety in my life.

    As it happens, I had an appointment in March with my family doctor and he ordered the usual blood tests. A short while later, I received a call informing me that my potassium levels were low and that I needed to start taking a potassium supplement. Now, approximately 3 years earlier, I had changed the medication I take to manage hypertension and further research revealed that a known "side-effect" of this medication is to leach potassium out of the body, so that's why all of a sudden the potassium was low when it had never previously been an issue my whole life. Looking further into the symptoms of low potassium, I learned that one of the symptoms was exactly the "fluttery heart" thing I had been experiencing. Once I started taking potassium, this symptom disappeared within a couple of weeks.

    Now it sure felt like anxiety but in the end it had nothing to do with anxiety. Should I conclude that I had never had an anxiety disorder at all? No, clearly, because I've had blood tests frequently throughout my life and I had never previously had a problem with low potassium but I certainly had symptoms of anxiety from about the age of 6 or 7.

    I would suggest that the same is probably true for lactic acid or lactose. It's an example of why it is dangerous to infer causality from correlation.

  8. #8

    Re: Panic Attacks, Brain Acidity, and Lactic Acid

    This is amazing information! Lactic acid lowers blood pH, yet hyperventilation actually causes a LOWER blood pH (respiratory alkalosis) and also messes with the O2/CO2 balance in the blood. From the "Hyperventilation Wiki":

    "It can result from a psychological state such as a panic attack, from a physiological condition such as metabolic acidosis, or can be brought about by lifestyle risk factors or voluntarily as in the yogic practice of Bhastrika. It often occurs together with labored breathing, which, in contrast, can also be a response to increased carbon dioxide levels."

    But back to lactic acid: I have suffered from not only agoraphobic/phobia-specific anxiety but exercise induced anxiety attacks. Attacks while stair climbing, weight lifting, roller blading - anything that involves exertion. I always thought the exercise-induced panic was due to a phobia of heart problems or elevated heart rate. But even when I am feeling confident and strong and having a super "in the zone" workout, sometimes that panic sensation washes over me. And when I do exert, I normally go at it with considerable effort. So I would not doubt it at all that my lactic acid levels are up when exercising. Also, another factor in general 'blood pH' health is common acidosis. (Myself, I've actually been diagnosed with gout a ways back which is a direct result of acidosis or so they say.) High blood acidity combined with lactic acid levels increasing during exercise could theoretically result in an even lower (more acidic) blood pH.

    This is fascinating and something that should be researched further; especially for those of us who still get that "whole body anxiety" feeling. That "feeling" invariably leads to a panic attack when our usual techniques at breaking the panic cycle fail us. I have a handful of panic attacks each year. One or two at most result in a hospital visit. The others, I am able to "land the plane" for - bring myself down to a calm state. But one thing is for certain: if acidosis is a contributing factor, people with panic should investiage this phenomenon. With physiological and blood chemistry factors working against us, it's possible all of the "exposure therapy" and ativan in the world won't alleviate that initial panic response that triggers the entire panic cycle.

    Thanks so much for posting this. Opening any new door towards recovery and healing is always an exciting moment.

    Cheers,
    Big Ben
    Last edited by bigben70; June 17th, 2011 at 01:00 PM. Reason: Spelling/grammar

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