16 year old female with Panic Attacks and OCD
A 16 year old female with concerns of fatigue, panic attacks, and OCD came into the clinic. She was having panic attacks about 3 times per day, daily anxiety, and OCD with hand-washing. She was already following a gluten-free, dairy-free, egg-free diet.
A normal day's meal schedule consisted of:
Breakfast: GF cereal or GF frozen waffles
Lunch: Typically she would not eat lunch and only snack throughout the day. If she did eat, it would be a granola bar or chips.
Dinner: Dinner is a family meal typically cooked by her parents which included a meat, veggie, and starch. Many times it would have pasta.
Sweets: Every day after dinner she has dessert. She loves ice cream, chocolate, and cookies.
Beverages: She drinks water and coffee daily.
Exercise: She was not exercising at the initial visit because she was having anxiety about "increased heart rate".
Lab testing showed fasting blood sugar at 40, and post-prandial blood sugar at 60.
Hypoglycemia needs immediate treatment. For many people, a fasting blood sugar of 70 milligrams per deciliter (mg/dL), or 3.9 millimoles per liter (mmol/L), or below should serve as an alert for hypoglycemia.
Signs and Symptoms of hypoglycemia can include:
Looking pale
Shakiness
Sweating
Headache
Hunger or nausea
An irregular or fast heartbeat
Fatigue
Irritability or anxiety
Difficulty concentrating
Dizziness or lightheadedness
Tingling or numbness of the lips, tongue or cheek
Post-prandial blood sugar refers to blood sugar after eating. In non-diabetic individuals fasting plasma glucose concentrations are between 70 - 110 mg/dl. Blood glucose levels peak about 60 min after the start of a meal, and rarely exceed 140 mg/dl, and return to preprandial levels within 2–3 hours. [source: American Diabetes Association]
Treatment Plan:
1. Increase protein at each meal. The goal is 15grams per meal with initial focus on breakfast, as it is best to start the day with protein rich meal.
Some ideas for breakfast include:
- Smoothie- based protein powder base.
* Good combos- peanut butter, banana, cocoa powder, hemp seeds and almond milk.
* Mango, avocado, spinach, date and protein powder
* Mix the protein powder in almond milk and drink
- Breakfast burritos- refried beans, guac, and salsa or potato, chorizo and bell peppers.
- Apple slices and unsweetened peanut butter
- Pork breakfast sausage with veggies into a hash
2. Coffee- Do a trial of no caffeine for 3 weeks.
1 Month Follow Up:
At the 1 month follow up she was having protein shakes for breakfast, a salami sandwich with GF chips for lunch, snacking on granola bars or chips, and dinner stayed the same. She cut out coffee and is only drinking water.
Retesting blood sugar showed fasting glucose in 60-70 range, and post-prandial in 70-80 range.
Panic attacks reduced to 2x per day and energy was improving.
Anxiety and OCD symptoms were the same.
Treatment Plan:
1. Focus on adding protein and to snacks and adding in healthy fats at least 2 times per day.
Examples of healthy fats:
- Nuts/seeds: cashews, tamari almonds, roasted pumpkin seeds
- Meat: Turkey avocado roll ups
- Almond crackers with salami and olives
2. Do not go longer than 2.5 hours without food
2 Month Follow Up:
She is having protein smoothies with blueberries and almond milk for breakfast, salami sandwich with cashews for lunch or a turkey cucumber roll up, and hummus with carrots. Snacks include apple with peanut butter, sunflower seeds, and cashews.
She reports NO panic attacks.
Energy levels continue to improve.
Daily anxiety is improving.
OCD is unchanged.
She says "I can now tell the difference between panic attacks and low blood sugar."
Her fasting blood sugar range is 60-83, and postprandial blood sugar is 70-90.
Treatment plan: Next step is to focus on adding in more fiber!