How a Faulty Sympathetic Response Can Lead to AFS and POTS

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM

Stress triggers the sympathetic responseWhen you submit your body to an extreme stressful workout of any kind, you get an adrenaline rush, your heart rate goes up beyond normal, you start sweating excessively, you could encounter muscle burn, and your blood pressure shoots up. What happens, physiologically, is that your body’s sympathetic response is triggered, and hormones, specifically norepinephrine and epinephrine, are released in large amounts. The release of these hormones activates what is known as the ‘flight or fight’ response. Both are necessary for aerobic exercise to proceed. However, the degree of activation of the sympathetic response is dictated by the degree of stress the body perceives itself to be in.

The Sympathetic Response Identified

There are two parts to the human nervous system, the voluntary nervous system and the autonomic nervous system. The voluntary nervous system has to do mainly with our movement and sensations, for example walking, talking, or touch.

The autonomic system, on the other hand, controls parts of the body that function automatically, such as digestion, blood, pressure, and heart rate. The nerves in this system are linked to all our major organs and glands, and this serves to determine their activity.

There are five branches of the autonomic system. Among them are the parasympathetic branch and the sympathetic branch.

The parasympathetic branch of the autonomic nervous system is concerned with healing, regeneration, and nourishing. It deals with rebuilding the body and eliminating waste. Organs that play a role in this function include the stomach, intestines, pancreas, and liver.

The sympathetic branch, on the other hand, is the body’s defense mechanism. It is responsible for the body’s ‘fight-or-flight’ response, which is also known as its sympathetic response. The hypothalamic–pituitary–adrenal (HPA) axis forming part of the autonomic system is directly responsible for this response in the body.

During a sympathetic response phase, energy is used for protection, meaning that rather than being used for the elimination of waste or nourishment, it is used to prepare the body for defense. An adrenalin rush is typical at this time. Although, initially, you might feel good and as if you can conquer the world, once the energy is used up, you feel depleted and fatigue sets in.

Adrenal Fatigue and the NeuroEndoMetabolic (NEM) Stress Response

The adrenal glands are responsible for the secretion of epinephrine (adrenalin). They also produce cortisol. These three hormones enable us to cope with any given stressful situation, whether it is physiological or psychological in nature.

Epinephrine increases the heart rate, serves to focus your attention, and provides a surge of energy to prepare you for fight or flight.

Cortisol is a steroid hormone that combats stress. It’s impact on the body is not felt as immediately as is that of epinephrine and norepinephrine; it takes minutes, rather than nanoseconds, before its effect is felt.

The secretion of these hormones, produced by the adrenal glands, is directly the result of the HPA-axis, and its particular functionality.

Under normal conditions, a stressful situation is of short duration. The sympathetic response shuts off when it is no longer needed, and the autonomic system is once again in balance. In other words, the sympathetic and parasympathetic branches are once more in harmony. After the sympathetic system is done protecting the body, the parasympathetic system can then direct energy back to nourishing, healing, and cleansing the body.

What triggers your sympathetic responseThe problem arises when stress carries on for a long period or is increased. The adrenal glands are tasked with producing ever higher quantities of hormones, until such time as they are no longer able to do so. Adrenal fatigue sets in.

Once the adrenal glands are not able to function at their optimal levels, the body’s NeuroEndoMetabolic (NEM) Stress Response sets in. The NEM response is automatic. Other avenues are found to produce the hormones needed to combat the stressful situation.

There are four stages of adrenal fatigue. The first stage, which includes feelings of alertness and intermittent tiredness, slowly progresses until, if unchecked, the fourth stage is reached. Symptoms at this time are devastating and include depression, stress, lack of a sex drive, insomnia, anxiety, and weight loss. Sufferers are bedridden and can no longer cope.

Other symptoms typical of those with adrenal fatigue include symptoms that are associated with dysautonomia, which is also known as Postural Orthostatic Tachycardia syndrome (POTS). These include the occurrence of diabetes, an abnormal heart rate, blood pressure problems, lightheadedness, and rheumatoid arthritis, amongst other conditions.

This stage sees the body no longer able to produce the needed hormones in sufficient quantities in order to heal itself or cope with any stressful situation. Once this stage is reached, recovery is slow and laborious.

Postural Orthostatic Tachycardia Syndrome (POTS)

Any illness that is directly related to a dysfunction of the autonomic nervous system is known by the collective name of dysautonomia. Postural orthostatic tachycardia syndrome (POTS), also called postural tachycardia syndrome, is a subset of dysautonomia. POTS is a condition where, when you go from a sitting position to an upright one, your heart rate increases disproportionately. This sudden, drastic increase in heart rate is known as tachycardia.

Interestingly, the majority of POTS patients (between 75 and 80 percent), are females who are of menstrual age. A small portion develops the condition during pregnancy. Males who develop POTS are usually in their early to mid-teens. The condition normally arises for them during a growth spurt or after either a bacterial or a viral infection. Approximately twenty-five percent of POTS patients are disabled by their condition.

How POTS Affects the Body

When in a resting position (i.e. lying down), approximately a quarter of your blood is in the chest cavity. Upon standing up, however, a large portion of this blood flows out of the chest into the abdomen and legs due to the force of gravity.

In order to ensure an adequate supply of blood to the brain and prevent fainting, the sympathetic nervous system is activated automatically, and norepinephrine is released by the brain. This is an example of a sympathetic response.

Your sympathetic response can release norepinephrineAs this hormone makes its way to the heart and peripheral blood vessels, the heart rate is increased due to blood vessels narrowing. In so doing, the blood flow to the brain is increased, preventing a faint.

Many POTS-associated symptoms are due to the inability of the blood moving to the brain in a timely manner.

Epinephrine also plays a part, as it is mainly released when your body is in a stressful situation. Its job is to ensure the supply of blood to the brain, which is necessary for survival. Once a stressful situation is over, heart rate and blood pressure return to normal.

In some instances, however, the activation of the sympathetic response and the feedback mechanisms fail. There is no normalization of blood flow to the heart and brain. POTS symptoms tend to surface, such as a lowered blood pressure and rise in the heart rate.

Symptoms Associated with POTS

POTS is a collection of a wide variety of symptoms affecting all systems and organs. Certain people have fewer symptoms than others do. These symptoms include:

  • Lightheadedness/dizziness upon standing
  • Constant fatigue/lethargy
  • Heart palpitations
  • Anxiety
  • Gastrointestinal problems such as vomiting, constipation, diarrhea, cramps, bloating, nausea
  • Brain fog
  • Hypoglycemia
  • Headaches – both vascular and migraine
  • Shortness of breath
  • Visual problems

Added to this, many clinical results for POTS tests are either inconclusive or borderline. POTS is often mislabeled as anxiety due to a constant over-release of the hormones epinephrine and norepinephrine.

The majority of POTS patients have a large variety of symptoms. The correct determination would require a study of the entire picture in order to form a proper clinical understanding of the problem.

Illnesses that are frequently associated with this particular condition include:

  • autoimmune disease
  • fibromyalgia
  • viral illnesses
  • mitochondrial diseases
  • mast cell disorders
  • adrenal disorders
  • chronic fatigue syndrome
  • stress disorder
  • panic attacks
  • inappropriate sinus tachycardia
  • type 1 diabetes
  • Lyme disease
  • irritable bowel syndrome

This disorder has a widespread effect on the autonomous nervous system.

A Comparison Between POTS and Advanced Adrenal Fatigue Syndrome (AFS)

The cardiovascular symptoms as related to POTS closely correspond to those of AFS. Both are tied to an excess of epinephrine, and this is even more true for a type of POTS known as subclinical hyperadrenergic POTS.

About twenty to thirty percent of POTS patients fall into the hyperadrenergic POTS group. It is characterized by high levels of norepinephrine while in a supine position, with much higher levels once in an upright position. It is caused by an uptight sympathetic nervous system. This type of POTS is also associated with sensitivity to light, sensitivity to medications, adrenergic urticaria, and intolerance towards stress. This strongly ties into symptoms of AFS.

The body of someone in a more advanced stages of AFS is in a constant state of alarm due to high levels of norepinephrine and epinephrine. While epinephrine is crucial for survival, large quantities of the hormone over a prolonged period have negative consequences. The system most at risk is the cardiovascular system.

Therefore, those who are at an advanced stage of AFS have symptoms that mimic subclinical hyperadrenergic POTS. Conventional medicine, however, seldom recognizes this.

Recovery Tips for POTS and Advanced AFS

Symptoms associated with POTS can cause a sympathetic response

  • Do not start a nutritional supplement program without proper consideration and having a mastery recovery plan in place. Improper use of nutritional supplements can worsen subclinical POTS and trigger adrenal crashes.
  • Consult a medical practitioner to rule out whether you have primary POTS.
  • Focus on the underlying metabolic imbalance and allow the body to heal itself by means of nutritional programs instead of drugs.
  • Irritable bowel symptoms should be stabilized by means of probiotics to facilitate food assimilation from the gut.
  • Antibiotics need to be avoided as they upset internal flora and pH.
  • Adrenal Breathing Exercises enhances the parasympathetic tone and reduce the sympathetic tone.
  • Aggressive detoxification needs to be avoided as it can trigger POTS.
  • Use medication if the body fails to respond and no other choice is available.

Both POTS and AFS are conditions related to an unbalanced ‘fight-or-flight’, or sympathetic response, often due to too much stress. However, with care and natural medicine methodology, it is possible to begin to rebalance the sympathetic response.

© Copyright 2017 Michael Lam, M.D. All Rights Reserved.

Sympathetic response