What is Dysautonomia?
Dysautonomia applies quite often to fibromyalgia patients. The term dysautonomia describes a delayed, inappropriate and exaggerated autonomic nervous system response to an external or internal stimuli that has long passed. The autonomic nervous system (ANS) or the primitive and unconscious part of our mind controls every aspect of our internal organs and their functions.
The Autonomic Nervous System (ANS)
ANS consists of two major components, namely the sympathetic and the parasympathetic. The sympathetic nervous system of the ANS initiated organ functions such as: increase heart rate, increases smooth muscle tone of the bowel (decreases bowel motility i.e. tight bowel or constipation), decreases blood flow and increases the blood pressure (increases constriction of the smooth muscle of the blood vessels wall), constricts the pupil, etc. The parasympathetic nervous system however does exactly the opposite. The end organs depending on the different stage of its assigned function initiates nervous signal to the ANS which will respond with either sympathetic or parasympathetic nervous signals increasing or decreasing the activities or functions of the end organs. In harmony and balance, internal organs' nervous signals to the ANS (afferent impulse) are perfectly matched by the outflow of sympathetic or parasympathetic nervous signals (efferent impulse) to the organs. These organs then perform optimally and efficiently which reflect externally as health and wellness of the individual.
Denervation of Nerve Endings in Fibromyalgia
Nerve endings and their end organs in fibromyalgia behave as if "denervated". Denervation is a physiological term used to describe when a nerve to the organ is cut and how the organ responds to stimulation. It consists of 4-phased responses that differ from a normal organ: 1. "Super-duration response", 2 "Hyper-excitability", 3. "Increased susceptibility", 4. "Super-reactivity". Initially the organ does not respond to any of the stimulation until a higher than normal threshold is reached. Once the threshold is reached, the organ responds maximally. Any further stimulation will cause significantly more response and the response is exaggerated. The organ behaves with a delayed all or nothing response. This is the basic law of Cannon described in physiology concerning the responses of any denervated organs.
The organs of fibromyalgia patients respond as if they are denervated. The smooth muscles within the organs of fibromyalgia patient do not stretch well and the nerve endings that conduct the signal to the brain or the central nervous system is often delayed. In combination these factors produce a denervation effect on many of the organs. I will use an example, panic attack - what is often considered to be an attack of no known etiology, to illustrate the delayed action of the nerve endings and the secretion of stress hormone from the organs. When a normal person is under stress, the stress responses begin. Both mental and physical stress triggers the production of stress hormones from the adrenal gland and from the central nervous system. These hormones have a tendency to increase the heart rate, cause jitteriness or nervous energy, increase breath rate, and cause a sense of urgency that things need to be accomplished. Hormones are secreted in response to stressful conditions of various types.
Stress Hormone Dysfunction in Fibromyalgia
The organs of fibromyalgia patients do not secrete the stress hormones appropriately. When they are under stress, the stress hormones are not released during the stressful period. They just keep working, utilizing normal energy and feeling exhausted from the whole ordeal. Eventually the ordeal is over, they get to go home to rest (super-duration). Any additional physical activity or any mental activity causes the threshold level to be reached and the stress hormones begin to be dumped into the body (hyper-excitability). The patient experiences a rapid heart rate, a sense of urgency, and shortness of breath. Adrenaline begins to circulate in the body and the patient feels hot, cold or sweaty. Because the person is not doing anything stressful at that particular moment and can see no significant precipitating factor to elicit this type of response, the patient may become more fearful. The patient begins to hyperventilate and the heart rate goes up faster, inducing extra adrenaline to be secreted and the other stress hormones to be released rapidly (super-susceptibility). Eventually the patient reaches a point of extreme panic (super-reactivity) and are often brought to the Emergency Room for work up and to be treated with various medications and sent home with usually negative findings.
Within a short time the same process will be repeated. These cycles will continue until all the stress hormones are exhausted from the adrenal glands and from the central nervous system. Then the cycles will stop so that the body can regenerate all of the stress hormones. If these patients will later again experience another stressful condition until the delayed threshold is reached, the panic attach cycle will repeat itself. Therefore dysautonomia of the hormonal stress response elicits what many times people consider to be panic attacks of unknown etiology.
Dysautonomia and Negative Effects on GI Tract
Dysautonomia affects the GI tract of fibromyalgia patients in various ways. The GI tract within our body serves two major functions. The two functions are to digest the food and propel the waste from the body. The urge to eat is influenced by both the external and internal stimuli. In the external environment the sound, the smell, the visual image of food, the time of the day, the occasion, all stimulate the person's urge and appetite and the need to eat. Internally many things happen to cause the appetite to increase, including the time of day, the release of hormones and the glucose level. The hormonal level of insulin also directly affects glucose level. In women hormonal influence is well known to affect the sense of well being and increase the appetite.
How the ANS Controls Digestion
The autonomic nervous system controls every aspect of digestion and propulsion of food. When food is put into the mouth, saliva is secreted to begin the very first process of digesting food. After the foods are chewed properly, swallowing is initiated, the autonomic nervous system then takes over and causes the esophagus to dilate and contract and slowly propel the chewed food particles into the stomach. Every aspect of food digestion and propulsion, after the conscious act of swallow, is an unconscious or autonomic nervous function. The stomach begins to move more actively and secretes acid and enzymes, further digesting the food and propels the food down the GI tract. The GI tract also begins to move more actively and secrete all types of digestive juices or enzymes to further break down the food into essential nutrients that can be easily absorbed. As these digested foods are propelled down the GI tract, the nutrients are absorbed through the mucosa into the body.
The autonomic nervous system also controls many GI reflexes. For example, early in the morning, drinking a cup of coffee or eating breakfast will stimulate and initiate the gastroenteric reflex directly down the GI tract so that the urge to defecate is almost immediate. The autonomic nervous system helps the body digest food and excrete waste.
FM Patients and Digestive Difficulties
Fibromyalgia patients often have difficulty with digestion. To understand the problem we need to look into the working mechanisms of our GI tract. In addition to propel and digest food the GI track has to protect us from some of the harmful effects of spoiled food or toxins that occasionally may come with the food we ingest to the stomach. If we eat something that is toxic to our body or "disagrees" with us, the first thing that happens is that the entire GI track shuts down. We do not feel well and experience bloating of the stomach. The stomach lining and the GI tract produce a watery secretion to dilute this toxin. When the threshold is reached, and if the food is in the upper part of the GI tract, reverse peristalsis occurs, and we regurgitate or vomit the food. Quite often we feel better because the toxic material is removed from the stomach. If the food has passed through the stomach, we experience GI discomfort, bloating, gas, pain, and sense of doom. The bowel becomes irritated from the toxic material and produces secretions to neutralize the toxins. The autonomic nervous system initiates painful movement down the spastic and tight bowel leading to diarrhea, which propels all the toxins out of the body. Almost everybody has experienced this type of GI track reaction to bad or "toxic" food that we occasionally partake.
For fibromyalgia patients, these unpleasant functions are experienced in normal instances. For example when eating food, fibromyalgia patients may not secrete sufficient saliva. The mouth is too dry while they are eating, but may produces saliva after they finished eating. The response of the saliva glands to food stimuli within the mouth is delayed. Once the food is washed down, the stomach responds quickly to the food as if the food is somewhat toxic. The stomach slows down and does not secrete sufficient gastric acid and enzymes to neutralize the "richness" of the food. They then begin to experience a bloated feeling, gurgling sensations within the stomach, and a painful gas and bowel movement as the not well digested food slowly and forcefully moves from the stomach to the GI tract. Rich food with high oil and fat content heighten this type of problem, commonly described as dyspepsia after eating.
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