POTS Page 4

  But the limbic system is also immensely vulnerable to events that occur in the ‘body-mind’ connection. For, as I have just mentioned, the limbic system does not just receive our outer experience but also our inner experience and, as such, it is also affected deeply by events that are happening to and in the body. The main claim that I am making in this regard is that the limbic system can be deeply affected by physical traumas to the body itself. There are many kinds of physical trauma which the limbic system could register as traumatic, such as:

  - an intrusive physical trauma on the body, as in a violent physical assault; a serious surgical operation or a difficult pregnancy [i.e. limbic system crisis induced by injury)

  - a severe illness which is so severe that, from the brain’s point of view, the illness is a ‘traumatic event’. Common examples are mononucleosis and Lyme disease, but it could be any severe illness [i.e. limbic system crisis induced by illness]

  The hardwired state of crisis I am discussing comes about because the limbic system ‘reads’ - via the ‘body-mind’ connection - the distress signals ongoing in the body during one of these traumas (such as a severe viral illness) and enters a state of profound crisis as a result. Indeed, depending on the severity of such a ‘triggering event’, it is biologically possible for the limbic system to enter a state of hardwired and perpetual crisis. This state of crisis has far-reaching neurological effects and knock-on effects on the entire body (as we shall see), for, as mentioned above, things work two ways. A distress signal from the body is ‘sent up’ to the limbic system via the nervous system, affecting the limbic system and changing, in turn, the signal that the limbic system ‘sends back down’ to the body via the nervous system. Indeed, this complex receiving and emitting of signals is best understood as a kind of ‘signal loop’.

  If it seems strange or unlikely that the limbic system might be affected by these kinds of events, then there are a few points to consider. In the case of a viral illness, remember that the limbic system is deeply involved, in its protective role, whenever we have an illness. The initial viral illness involves, of course, the virus running its course and during this time our limbic system’s survival signals become stronger and highly active as part of an effort to defeat the illness. But say the effects of the viral illness on the body are so severe that, long after the virus itself has left the body, the brain itself remains in a traumatic state as a result of the signals it received during the illness. It remains stuck, in other words, in the ‘survival mode’ which it was in during the illness itself: the brain still believes it is necessary to protect the person from the physical difficulties it sensed from the virus. This is because the ‘distress signals’ that the body was sending up to the brain during the illness were so severe that the brain redoubled its efforts at protecting the person concerned, and, thanks to neuroplasticity (a concept we shall consider later on and which concerns the brain’s ability to change in response to experience), the brain remained ‘stuck’ in this highly protective mode after the virus had run its course. The brain remained stuck, in other words, in survival mode. Likewise, the effects a difficult pregnancy can have on the brain are not as yet understood, even though it is currently recognised, as Brooks, McCully and Cassaglia write, that pregnancy ‘…increases sympathetic nerve firing and decreases…parasympathetic activity’.[25] In such a case, the difficulties of the pregnancy could also leave the brain stuck in a traumatic, self-protective state. Culturally speaking we tend to be myopic about the full range of ways that the limbic system can be affected by events, only really aware of the ways in which the limbic system can be affected by psychological events (as in the case of PTSD). Biologically speaking, however, it stands to reason that distress signals emitted via the nervous system to the limbic system during a severe illness could act as a kind of ‘internal trigger’ that would also force the limbic system to enter a state of perpetual crisis.

  In emphasising these ‘physical’ traumatic triggers, however, I am not discounting the role that psychological traumas may play in the development of limbic system impairment. However, in these cases, as with PTSD, the person concerned also has no ‘choice’ in the matter. For, at a psychological level also, the limbic system operates in automatic and primitive ways. It experiences an event and the chemical response it creates as a result happens with no conscious effort on the part of the individual: it is all automatic. No one, indeed, would choose to have PTSD. The war veteran who experiences constant flashbacks does not ‘choose’ to do so: rather his or her limbic system entered a state of hyper-vigilant crisis automatically in response to the experiences of the horrors of war. The rational part of their mind knows that the original traumatic danger is no longer present but the limbic system has remained stuck in a traumatic state thanks to a maladaptive and automatic neuroplastic response. In any event, the point is that it is possible that psychological traumas - whether on their own or in addition to physical traumas - may contribute to the development of limbic system impairment too. Having made these distinctions, however, I also note that the distinctions between ‘physical’ and ‘psychological’ trauma can also break down quite easily. Every trauma has both physical and psychological components, although it is helpful to categorise some as being more physical than psychological and vice versa. Of course, psychological and physical limbic system traumas might also combine, creating a ‘perfect storm’ of trauma. Similarly, traumas do not always need to be acute, relating to one specific incident in time. Rather there could be a series of traumas over several years, each one leading to a more hyper-sensitive limbic system, with a final trauma occurring as the catalyst for a state of total limbic system trauma.

  In general, is not so important how the limbic system enters a state of crisis more than the fact that it does so. Whatever the nature of the trigger, however, it is essential to remember that the person affected has had no say in the matter. The limbic system responds to events in automatic ways and according to its own primitive biological laws - whether that trauma was more physical or more psychological. For these reasons, I refer to any trauma that is capable of tipping the limbic system into crisis as a trauma ‘broadly understood’. This includes the possibility of the traumatic trigger being psychological, physical or a combination of both. It also includes the possibility of it being sudden and acute or insidious and building up over a longer period of time.

  The Anatomy of the Limbic System in Crisis: What Changes Actually Take Place

  The brain is highly ‘neuroplastic’, that is to say its structure is highly malleable or changeable, especially in response to experience. (We shall consider the science of ‘neuroplasticity’ in more detail in chapter four). The way in which the brain responds to trauma is no exception. Let us now consider how the limbic system can change in response to the kind of traumatic or ‘triggering’ events discussed in the last section, including physical traumas (such as a viral illness), crushing psychological traumas, or a combination.

  Upon the occurrence of the initial trauma (broadly understood), the distress signals (either internal or external) cause the normal limbic system’s neuronal circuits to be broken apart aggressively and disorganised. In this way, the old generally ‘calm’ neuronal programming in the limbic system is replaced by new, highly fearful brain circuitry which see their job to be the avoidance of any further threat. This highly self-protective neuronal circuitry becomes ever more self-protective and ever more sensitive as time goes on.

  The effects of limbic system trauma can be divided into two categories: direct neurological effects and knock-on effects on the health of the body.

  To consider the direct neurological effects first, what can primarily be observed is damage to the limbic system’s role in perceiving stimuli - both internal and external. Thus, the more the limbic system enters a crisis state, the more likely it is that common stimuli will also begin to be perceived as ‘too much’. Loud sounds startle, bright light can give migraines and the scent of chemicals is
suddenly perceived by the brain as more powerful than before or even as noxious. The sense of smell of a person with limbic system impairment can actually change drastically (interestingly the limbic system used to be referred to as the ‘rhinocephalon’ or ‘centre of the nose’, given its role in processing smell). As time goes by and the brain becomes more and more hypervigilant, it is possible for this sensitivity to become extreme. For example, it may be impossible to tolerate light at all. Chemical exposure may lead to anaphylactic shock. It is even possible to develop sensitivity to electro-magnetic frequencies. Similarly, the perception of internal stimuli can also go wrong. In particular, the pain centres of the limbic system become overly active, leading to perceiving pain and tenderness in all aspects of the body. These direct neurological changes as a result of a trauma to the limbic system lead to a kind of ongoing neurological nightmare.

  However, these direct neurological changes also lead to knock-on effects on the health of the body. This is because of the role of the hypothalamus in sending a ‘signal’ to the entire nervous system via the HPA axis. How the nervous system behaves depends entirely upon the ‘quality’ of this signal. When the limbic system is in crisis, the HPA axis is constantly ‘firing off’ and constantly sending out messages for adrenalin to be released. The result is that the parasympathetic nervous system (the rest and digest system) is no longer given permission to do the work it needs to do, with widespread disastrous results. Energy production falls, the body is unable to receive nourishment as a result of impaired digestion, the thyroid suffers as do the hormone, immune and endocrine systems. Hopper describes the vicious cycle that ensues as follows:

  “A limbic system impairment is psychoneuroimmunological (PNI) in nature, which means it involves psychological processes as well as the nervous and immune systems of the body.…the brain gets ‘stuck’ in an unconscious state of chronic emergency that perpetuates illness and inflammation. This typically involves the central nervous system, the musculoskeletal system, and the endocrine system.”[26]

  A limbic system impairment really is a two-fold problem, therefore. The sufferer must contend with the direct neurological effects of the crisis as well as the knock-on effects on the health of the body as a result of the compromised nervous system as a whole. The problem, however, is that medical research into what are in fact limbic system impairments has tended to miss the root cause, focussing instead on treating the secondary, ‘knock-on’ health effects on the body and on assuming that the root cause of the condition will be found amongst these secondary effects. This is the equivalent of studying a tree’s branches for signs of disease when actually the tree’s problems may actually be located in its roots.

  Summary of a Limbic System in Crisis

  In conclusion to this section, you need to remember the following four points:

  the brain, especially the limbic system, is very vulnerable to experience and its structure changes in response to life’s events. This is particularly true of traumatic events, where ‘traumatic’ is understood broadly to include physical traumas (such as a virus or pregnancy), crushing psychological traumas or a combination.

  The limbic system enters a resulting hardwired state of crisis either via the body-mind or mind-body connection (or both) and this can cause widespread negative (and hardwired) structural changes in the brain.

  The first kind of adverse effect of this change concerns the limbic system’s ability to perceive stimuli: the faculties of sound, light, and smell are all adversely affected and become hypervigilant, sometimes extremely so.

  The second effect of limbic system impairment is on the body. When the limbic system is in crisis, the HPA axis is constantly emitting a crisis signal, which leads the nervous system, in turn, to malfunction, with the sympathetic branch dominating, leading to widespread changes in energy production, the endocrine and hormonal systems and many others essential aspects of the body’s health.

  These are serious neurological changes even if they are not, as yet, the subject of the serious neurological study they deserve. In fact, despite the study of the limbic system in medical school, it is often assumed that its disorders must necessarily belong to the realm of psychology. This is a tragic mistake as it ignores both the role the limbic system, through its connection to the nervous system, necessarily plays in overall health and the fact that ‘non-psychological’ events can adversely impact limbic system function through the ‘body-mind’ connection. As a result, many with limbic system impairment who present to their doctor will find that their myriad of symptoms are treated individually, as if each symptom were happening of ‘its own accord’, rather than receiving a treatment plan for the root cause of all the symptoms. Worse is the fact that some medical professionals, given the intense anxiety patients with limbic system trauma often understandably feel, will dismiss these patients as suffering from psychosomatic complaints, rather than a genuine brain-malfunction, the development of which the individual had no say in. Indeed, I will have more to say countering any suggestion that limbic system impairment is ‘psychosomatic’ at the end of this chapter.

  What POTS Really Is

  We are now in a position to come to the crux of this book: to understand what POTS really is. Be prepared to change what you thought you knew about POTS: it is not primarily a cardiac problem, the result of being unfit, or the inability of the body (somehow or other) to deal with the effects of gravity, as is sometimes suggested.

  Here we go:

  POTS is a Form of Limbic System Dysfunction.

  In other words, POTS is caused by a limbic system in crisis along with the knock-on adverse effects on the body that involves, following a traumatic event, broadly understood to include physical traumas (such as a viral illness) or psychological traumas (or both).

  And now I’m going to attempt to spell out exactly how.

  Explaining POTS: What is Really Going On

  In chapter one, I discussed the two ‘schools of thought’ on the origins of POTS, the ‘deconditioning argument’ and the ‘NET protein’ deficiency argument. I will state my position on both right now, and then expand: deconditioning is not the cause of POTS, although it does play a secondary role. The NET, or Norepinephrine Reuptake Transporter protein, hypothesis, however, is the one which points to the true origins of POTS, and it is the key pre-existing finding in medical research into the condition which can be explained as a direct result of limbic system impairment.

  Why?

  There are three reasons:

  The cause of NET deficiency has been shown not to be genetic, therefore it must be caused by some other reason. NET cannot become deficient just ‘because it feels like it’.

  Norepinephrine and Adrenalin are the same substance.

  When the Limbic system is in crisis, the HPA axis is always active and adrenalin is being released nearly all the time.

  Taking these three points, I will now explain by using an example how the limbic system in crisis leads to NET deficiency.

  The POTS patient suffers from some kind of ‘traumatic’ event (broadly understood), such as a viral illness, surgery or difficult pregnancy. Long after this event has occurred, the brain of the POTS patient remains ‘stuck’ in limbic system trauma thanks to a maladaptive neuroplastic response to that trauma. This response came about as a result of intense distress signals the brain received during that trauma. The patient’s brain thus enters a highly self-protective state: sensory perception changes and the patient becomes sensitive to light, sound and smell. The HPA axis works overtime, sending alarm messages to the adrenal glands which, in turn, send out adrenalin all the time. If you are a POTS patient, consider right now whether the feeling of adrenalin regularly ‘firing off’ is a familiar one to you. This is evidence that the origin of the problem is neurological.

  Now, for quite some time, the NET protein just about manages to deal with the job of recycling all this excess adrenalin. After all, that’s what it has been designed to do. When adrenalin is in the
blood stream, NET gets on with storing and recycling it. But what about when there is simply too much of the hormone around? What happens to the NET protein when it becomes ‘overwhelmed’?

  My main thesis is that at a certain point NET becomes no longer able to cope: it breaks down and ceases to work properly. In much the same way that a fatigued muscle has a ‘breaking point’ beyond which it can no longer do its work, so too does NET have a ‘breaking point’ after which it can no longer deal with its primary task of recycling adrenalin. There has simply been too much of the hormone and for too long. Once it breaks down, the NET protein has become deficient. It is no longer ‘strong enough’ to do its job and keep blood vessels constricted in the way they should be upon standing. Likewise, it is no longer ‘strong enough’ to recycle all of the adrenalin it should be able to recycle. The result, as we have seen in chapter one, is twofold: that the blood vessels remain wider than they should be upon standing and the heart must beat faster to compensate so as to maintain blood flow over a larger area and, secondly, that more and more adrenalin spills out into the blood stream and makes contact with the heart, causing it to beat faster still. You cannot hold the plank position forever and, likewise, the NET protein, although it has been designed to recycle and make use of adrenalin, will reach a point where there is too much adrenalin ‘washing over it’ for it to be able to perform this task. In short: the NET protein is primed to transport and recycle all available adrenalin but when there is a huge amount of that hormone available all the time, the NET protein eventually becomes exhausted and unable to function properly.