People’s Pharmacy: Are there drugs to take the edge off public speaking?

Q. I have a crippling fear of speaking in public. Nothing I’ve done has worked to overcome it. Are there any medications for this?

A. Doctors sometimes prescribe a beta blocker such as propranolol or metoprolol for performance anxiety. Such drugs have been Food and Drug Administration-approved for high blood pressure and heart problems but not stage fright.

They work in part by blocking the effects of adrenaline (epinephrine) on the body. When people are under stress, they might experience symptoms such as sweating, tremor, dry mouth, rapid pulse, shallow breathing and a tight throat.

Musicians, athletes, public speakers and test takers have been known to take beta blockers to calm the jitters. Sadly, though, there are not many well-controlled trials to test this class of medicines for stage fright.

Some people might react to beta blockers by developing insomnia, disorientation, asthma and impaired performance.

If your doctor prescribes a beta blocker for public speaking, make sure to test-drive the drug beforehand. You might also consider cognitive behavioral therapy or a group such as Toastmasters to overcome your anxiety.

Q. When my hemoglobin A1c hit 13, I realized I needed to make some changes. I started eating a high-fat, low-carb and moderate-protein diet. Within days, my blood sugar dropped to normal.

At my next appointment, my doctor, who had been planning to put me on insulin, took me off my oral diabetes medicine completely. (I’m so grateful to have a doctor who listens.)

My blood sugar remains well-controlled. I am not on a keto diet. I have up to about 100 grams of carbs a day but almost all from vegetables, no grains. The only fruit is berries. My fats are from avocado oil, coconut oil, meats, full fat dairy, eggs, olive oil and chocolate.

My last lab tests all were within normal range, and the cholesterol numbers are impressive. The HDL is no longer low.

I don’t understand why some people say that it’s difficult to stick to such a diet. I’ve never enjoyed food so much.

A. Some people with diabetes do extremely well on the type of diet you describe. A three-month-long study in Denmark demonstrated lower HbA1c and blood sugar among people following a carbohydrate-reduced and high-protein diet (Diabetologia, November).

The control group followed a conventional diabetes diet. You can learn more about diabetes and diet, as well as medications, in our eGuide to Preventing and Treating Diabetes. Look for it in the Health eGuides section of peoplespharmacy.com.