PTSD and AFS: Is There a Connection?

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

Connecting AFS and PTSDMost people are familiar with PTSD, or post-traumatic stress disorder. Trauma in which you or a loved one are exposed to danger that may lead to serious harm or even death can have both immediate and long-term impacts.

The immediate response to trauma, or acute stress, can lead to confusion, panic, amnesia, agitation, and other mental and emotional states. If the trauma continues, become chronic, or is very severe, about 80% of those exposed will develop PTSD. This anxiety-based disorder is has a significant impact on your life and can become debilitating. Some symptoms include avoiding situations, places, and people associated with the traumatic event; hyperarousal; and reliving the trauma, also called flash-backs.

The anxiety and severe stress associated with PTSD can have other effects on your body as well. PTSD often comes from or leads to chronic stress situations that can cause adrenal fatigue.

Fewer people are familiar with AFS, or Adrenal Fatigue Syndrome. AFS can occur when the body responds to stress from any source with activation of the hypothalamic-pituitary-adrenal (HPA) axis. This results in a cascade of hormones being released to deal with the stress. One of the most important hormones is cortisol, released by the adrenal glands. One of its main purposes is to fight the effects of stress on your body. If the stress becomes chronic, the adrenals become unable to keep up with the demand for cortisol. This sets in motion a number of symptoms that start out as vague and hard to detect but may become severe.

Because the symptoms of AFS are vague, most conventionally trained health professionals either don’t recognize the condition or treat the symptoms individually. This misses the root causes and effects of the symptoms. A better approach is the NeuroEndoMetabolic (NEM) Stress Response model. This approach allows for a more comprehensive assessment and more effective remediation of AFS symptoms. The approach says there are six interrelated circuits or organ systems that respond to stress when you encounter it. Since these circuits are interrelated, what affects one will also affect others. This allows healthcare professionals to determine the root causes and effects of stress.

Causes of PTSD

Any kind of trauma that involves significant fear and emotions that are difficult to process can lead to PTSD. Possibly the most familiar cause is exposure to the trauma of combat. With the recent war in Iraq and the current one in Afghanistan, more and more veterans are being assessed as having the disorder.

But you don’t have to experience combat to have PTSD. Any severe trauma or imminent danger can trigger a stress response. If you witness the death or serious injury of someone nearby, even if they are not related to you, you may develop PTSD. Physical, sexual, or mental abuse can also lead to this condition. A natural disaster of any kind that affects you or a serious illness that hits someone close to you can bring on this type of stress response as well.

Developing PTSD is not a sign of weakness. There are several factors that play a part in whether you develop the condition or not. If you were previously exposed to a traumatic event and then another one occurs in your life, you are more likely to develop the condition. If you are injured during the event or if it is prolonged, the risk of developing PTSD increases. Some personality factors may play a part in your risk of developing this condition. Your gender, your age, and the presence or absence of social supports have an effect on your risk as well.

How Your Body Responds to Trauma

How you respond to trauma depends on several factors in addition to those above. If the trauma is continuous or if you experience several different traumas, your risk of developing PTSD increases due to the way successive traumas reinforce those that came before.

PTSD and TraumaChildren usually respond to trauma in some physical way. They may become constipated, suffer from headaches and stomach aches, develop muscle aches and pains, or faint. Many adults will also develop various physical problems, such as migraines, ulcers, and unexplained pain. Both children and adults can exhibit depression and anxiety.

One response to trauma that both adults and children experience is the body’s fight or flight response. This occurs because the trauma becomes a threat and leads to stress. In this response, the adrenal glands secrete cortisol, the stress-fighting hormone, to deal with the effects of stress on the body.

If stress continues, the brain can become trained, in a sense, to continue stimulating this fight or flight response. This can lead to the hyper-alert state often seen in PTSD. With continued stress, cortisol’s ability to regulate blood sugar levels, your immune system, and depression will be reduced. Some current research has shown that combat veterans with this condition also have a smaller hippocampus, the part of the brain that aids in short and long-term memory.

PTSD and Physical Health

The research into the relationship between this condition and physical health has been somewhat inconsistent. When the research is based on self-reported problems by the person suffering from PTSD, it is clear that the condition has a negative effect on health. But when the research is based on healthcare professionals’ assessment, the relationships between military trauma or sexual assault in adulthood, the development of PTSD, and health problems aren’t as clear. For survivors of natural disasters, the relationship appears to be there, but the correlation is not strong.

It does appear that those who self-report PTSD have a greater incidence of physical health problems than those who do not. This is one aspect of a growing body of evidence that suggests a connection between this anxiety-based condition and significant health problems. Those who have PTSD tend to use medical services more frequently than those who do not have the condition. To date, this finding has been shown in veteran populations only.

physical health and PTSDResearch has not shown a definitive causal relationship between PTSD and physical health issues. Rather, something connected to the PTSD may be the direct cause of poor physical health. However, some research has shown this kind of connection even when these other factors have been controlled. Thus, there does appear to be a connection between PTSD and poor physical health.

One major aspect of this connection appears to be neurochemical changes in the brain that occurs due to PTSD. The kinds of changes that can occur may bring on vulnerability to high blood pressure and atherosclerosis. These two factors are associated with cardiovascular problems that are very frequently found in those with PTSD. Abnormalities in certain hormone functions can also be brought about by these neurochemical changes. These abnormalities in hormone levels can lead to increased incidence of infections and immunological problems that are often seen in those suffering from PTSD.

Another possible connection between PTSD and health issues, particularly cardiovascular problems, can be seen in the anxiety and panic that are often seen in those with this condition. The association between anxiety and cardiovascular problems is very clear through research. The mechanism of this association is not clear, however.

Neurochemical Changes in Those With PTSD

Research at the University of Minnesota and the Minneapolis VA Medical Center has shown significant changes in the brains of veterans suffering from PTSD. This research showed a definite miscommunication among various parts of the brain in those with this condition.

Many of these changes occurred in the hippocampus, an area of the brain involved with organizing memories and moderating learned responses, like contextual fear conditioning. Studies have shown children with PTSD to have a hippocampus that functions poorly. Adults with this condition have been found to have a significantly smaller hippocampus than adults who don’t suffer from the condition.

Another brain structure implicated in PTSD is the amygdala. This part of the brain is associated with how people learn about fear. In people with this condition, the amygdala appears to be overly active. This suggests the possibility of oversensitivity to fear stimulation.

PTSD and neurochemicalsWhen the amygdala is affected by PTSD, one result is an oversupply of norepinephrine. This neurochemical is involved with stimulation of the emotional reactions of the amygdala, setting the stage for those with PTSD to have heightened emotional responses.

Research indicates the HPA axis is disrupted in those who have PTSD. This kind of disruption seems to put the person into a state of continuing false alarm regarding threats to their person. This would keep the HPA axis and its end result stimulated. The end result is stimulation of the adrenal glands to secrete cortisol to fight the effects of stress. There is also scientific speculation that this continuing stimulation of the HPA axis can lead to damage to the hippocampus in people with PTSD.

Another neurochemical that is affected by PTSD is cortisol. Dysregulation of cortisol in people with this condition leads to hypoglycemia. This low blood sugar condition stimulates the hypothalamus, a brain region dealing with hormone production, to believe the brain is being deprived of its essential nutrient, glucose. This then stimulates the adrenal glands to produce more adrenaline, increasing the stress symptoms characteristic of PTSD.

The Effects of A Neurotransmitter Imbalance

Your body operates best when hormones and neurochemicals like neurotransmitters are in balance. Stress upsets that balance. Chronic stress interferes with the production, regulation, and control of neurotransmitters.

There are generally two categories of neurotransmitters: inhibitory and excitatory.

Serotonin, glycine, and GABA are some of the inhibitory neurotransmitters. They increase sleep and raise self-esteem. With too few of these chemicals, you may feel angry and unable to sleep, among other symptoms.

The excitatory neurotransmitters include the catecholamines (adrenaline, noradrenaline, and dopamine) and glutamate. Low dopamine levels can lead to feelings of fatigue, decreased sex drive, and difficulty with short-term memory. Low levels of noradrenaline lead to depression, increased risk of developing a dependency on caffeine and other stimulants, and decreased motivation. Too much noradrenaline can lead to panic and insomnia.

Under significant stress such as is found in AFS, catecholamines can increase. These excitatory neurotransmitters prompt your body to release inhibitory neurotransmitters like GABA and serotonin. This is an effort to calm down the body when it’s under the influence of catecholamines. If stress continues, your body demands more of these inhibitory neurotransmitters. Eventually, your body becomes habituated to them and the production of these inhibitory neurotransmitters is reduced. Anxiety, inability to sleep, and depression result.

Modalities to Help Your Body Rebalance

There are several options available to help you manage PTSD. However, if you have AFS as well, it is best to see a specialist. In addition to meditation, yoga, and other self-care techniques to manage stress and reduce anxiety, supplements, and other methods can be used to support and rebalance your neurotransmitters. Proceed with these cautiously though.

Under the conditions of a dysregulated HPA axis, your body is more sensitive to the symptoms of AFS. 5-HTP is often given to bring about some relief from these symptoms. This increases serotonin levels in your bloodstream. Your adrenals then respond with increased cortisol to balance the serotonin. If you have AFS in the early stages, this can worsen your condition because the level of cortisol in your system is already high.

PTSD support supplementsAt times, glutamine is given for help with AFS symptoms. While glutamine is an important nutrient for gut health, its benefit in a setting of AFS is not so clear. Glutamine can increase glutamate, an excitatory neurotransmitter. This is a negative thing for those with AFS because of the flood of adrenaline and noradrenaline already in the system. Adding this neurotransmitter can trigger adrenal crashes and increased fatigue. Glutamate also reduces the release of cortisol. In advanced AFS, cortisol levels are already low and this simply lowers the level even more. Increased cortisol levels are needed at this stage of AFS for recovery.

If you take 5-HTP, glutamine, and L-theanine, you may experience a paradoxical effect. These substances should raise GABA and reduce the anxiety common with advanced AFS. One of the effects that may occur is an increased risk of adrenal crashes and increased excitation rather than inhibition. The reason for this is unknown.

In order to regain balance in your neurotransmitters, the pathway that is unbalanced must first be discovered. Experienced clinicians can figure this out from a detailed history taking.

Nutritional supplements can be used in this effort. Amino acids, vitamins, and minerals along with adaptogenic herbs like maca and rhodiola can be helpful, but only if used properly and under good guidance. Improper use can worsen AFS. Glandulars can play a supportive role as well. Electromagnetic therapies, biofeedback, liver decongestion, and various detox procedures to enhance your body’s ability to self-heal and rebalance power can also help.

© Copyright 2018 Michael Lam, M.D. All Rights Reserved.

Dr. Lam’s Key Question

PTSD leads to brain chemistry changes. Significant changes in the hippocampus and amygdala lead to negative influences on hormones. An oversupply of norepinephrine leads to continual excitation of the body. Cortisol is decreased, leading to a demand for more cortisol at a time when your adrenals are depleted.