Adrenaline PACER Integrative Behavioral Health Series

Hey there everybody, and welcome to this presentation on adrenaline. This is part of the PACER Integrative Behavioral Health Series and I'm your host, Dr. Donnellice Snipes. In this video, you're going to learn about the functions of adrenaline, causes of imbalance, symptoms of too much or too little, and explore how adrenaline interacts with other hormones and neurotransmitters that impact you physically, affectively, cognitively, environmentally and relationally. So let's talk about the function of adrenaline. This is one of our more basic hormones. So there it's not going to be a really hard thinking presentation today. Adrenaline is one of our main energy hormones, excitatory hormones. It's involved whenever the body is under stress, either cognitive stress or physical stress. So if you are thinking, there's a threat, if you're fear, fearful, if you're anxious, that HPA axis gets activated, or if you're under physical stress because of malnutrition or inadequate sleep or pain or illness. Again, adrenaline is secreted whenever that there is a stress. In order to help that HPA axis with the cascade of events that needs to happen for that fight or flight reaction. Adrenaline increases your heart rate, it increases your blood pressure, it expands the air passages of your lungs. So when you're working out hard, for example, and you're, you start to breathe heavier, you may even notice that you cough a little bit more because you notice that you're a little phlegmy. A lot of times that's because the HPA axis is engaged. It's dumped cortisol and adrenaline. Those air passages are opening up and any gunk that's in there is getting pushed out. So that, you know, can think of that as a good thing. If it happens occasionally and under intense exercise, if it is happening when you're not exercising or as a result of a cold or problems, you know, obviously you need to see a doctor about that. Adrenaline helps redistribute blood to the muscles, maximize blood glucose levels, which means that if you have diabetes, adrenaline can be a friend, but it also can be a foe because it's going to alter, it's going to monkey with your blood sugar levels. It helps reduce pain perception. Think about people who, when they are in under extreme stress, they are able to do things that they normally wouldn't be able to do, or they do things and they don't feel the pain until afterwards. Well, that's partly a function of adrenaline helping reduce that pain perception so you don't get sidetracked by injury or pain and you can fight or flee. And adrenaline also helps increase your attention. Now what it's increasing your attention to is whatever the source of that threat is. So what causes adrenaline to be out of balance? A lot of things, unfortunately. Chronic stress resulting in HPA axis dysregulation. And you learned about that in the video on the HPA axis. When we're under chronic stress and the tissues are regularly exposed to cortisol, glutamate, adrenaline, eventually the, the tissues say, you know, that's too much, I can't run that hot all the time. And they become insensitive or resistant to those hormones. So if you're under chronic stress, you may have an adrenaline rush and really not experience that much out of it. One of the things that just drives me crazy is when I hear people say things like, I can drink as much coffee as I want and it doesn't even phase me. Or worse yet, I drink coffee right before bed because it helps me calm down. And if that's the case, you really need to ask yourself why. Why is it that you're able to ingest a stimulant and it has no effect on you? Is it that you're not noticing the effect, or is it that you've had have ingested it so chronically that you've built up a tolerance to it? Those tissues have become resistant to it, so it's not even stimulating anymore. Ingestion of stimulants, as I said, can be a cause of adrenaline imbalance or inadequate adrenaline or adrenaline not being able to do its job effectively. And glucocorticoid therapy or steroids, including those used to treat autoimmune issues, can result in glucocorticoid resistance. When you are taking high levels of steroids, more than what your body would naturally produce, your body is going to develop a tolerance to those, and it can end up causing glucocorticoid resistance. So your body does not respond the same way when the HPA axis is activated. When you are anxious, angry, grieving, any of those hot dysphoric emotions that causes adrenaline to be secreted. So you can experience high levels of adrenaline in these situations. Additionally, when people have what we call distress, intolerant thoughts or cognitive distortions, so they're thinking of things in all or none terms, or they're personalizing or catastrophizing, or they're using inaccurate threat based schema, so something that may have been a threat when they were six isn't a threat now. But if they're still using that Schema feeling like they're six years old again. Then they may feel scared now, even though they're 26, and they're able to handle it. And just negative perceptions. People who tend to have negative attitudes tend to also have negative affect, which causes that HPA axis to be regularly activated and ultimately potentially to disregulate, which will result in an imbalance of not only adrenaline, adrenaline, but also cortisol and glutamate when you've got too much adrenaline in your system. And that can happen if you drink too much coffee and you're sensitive to it and it just sends your heart rate racing. When you take decongestants, when you're under a lot of stress, you may experience rapid heart rate, high blood pressure, insomnia, and what they call psychomotor agitation, which is a clinical term for not being able to sit still. You feel like you're going to crawl out of your skin and you're fidgety all over the place. That is often an indication of high levels of adrenaline. When you have anxiety and irritability, that is a sign that your adrenaline levels are high, that that HPA axis is highly active. Cognitively, when your adrenaline levels are high, your body is in that fight or flight mode, and you may have racing thoughts, especially as they relate to whatever that threat is. So, for example, if you go to the doctor and you have to get blood, blood work done because the doctor thinks something might be wrong, your anxiety may go up because you start worrying about what's going wrong. When your adrenaline goes up and your anxiety goes up, your thoughts may start racing about what the possible things could be and going to catastrophic places. So it's important to recognize that adrenaline doesn't only affect us physically, it affects us affectively. It affects our emotions and our thought processes when we are experiencing high levels of adrenaline, when we are under high levels of stress, not only do we have racing thoughts, but it's also harder to learn things that are not related to escaping from that threat and to remember things. So your memory usually goes to pot because your brain says, now's not the time to devote energy to forming memories. Right now we need to focus on fight or fleet. Those are the direct effects. Indirectly, when your adrenaline levels go up, environmentally, you may be more sensitive to things in the environment if your adrenaline levels are high. If your stress levels are high, you may be more edgy. So when the dogs bark, it may feel a lot more intrusive or overwhelming than when your adrenaline levels are not high. So adrenaline makes us more Hypersensitive to stimuli in the environment and interpersonally, a lot of times when our adrenaline is up, we tend to be more irritable and have difficulty with our patients. Now the exception to this is when your adrenaline, adrenaline is up because you are doing adrenaline laden activities like riding a roller coaster or riding a, you know, know, motorcycle or something that is designed to give you, quote, an adrenaline rush. That adrenaline rush is your body's response to a threat. But the way you interpret it is not with anxiety or irritability, it's more with euphoria. I mean, your brain sees you at the top of that, at the top of that roller coaster and sees it going down and goes, that this is not good. The primitive brain says roller coasters are bad ideas, but our higher order brain can talk it down and go, no, this is fun, this is a rush. So adrenaline can go up in situations in which people are engaging in, in those adrenaline laden activities. Some people who have resistance to adrenaline and typically need more stimulation may actually engage in some of those high risk activities in order to get that adrenaline rush. When you don't have enough adrenaline, think depression. When you don't have enough adrenaline, which is an excitatory neurotransmitter, you're going to often feel fatigued. You may have low blood pressure, decreased appetite, cravings for salt. Adrenaline helps balance salt levels and fluid levels in your body. And you may experience low blood sugar. When adrenaline is dumped or secreted, it causes blood sugar to be dumped. So if adrenaline, if you don't have enough adrenaline, then you may not be triggering enough blood sugar to get released into the system effectively. People with low levels of adrenaline experience depression and apathy cognitively. They have foggy head, they have difficulty with attention. You know, they just have a hard time really staying focused environmentally. When people are, have low levels of adrenaline, when they're fatigued, when they're exhausted, when they are experiencing. And a, a term we'll talk about later in the course is adrenal fatigue, which is not a medical diagnosis. But when people's tissues start to become resistant to the effects of adrenaline, they may experience a lot of these symptoms that look a lot like clinical depression. And environmentally, they may withdraw from being around other people. They may not have the energy to get up and clean. Um, they may be less sensitive to environmental stimuli. It's just like that. They just don't care. And interpersonally, when you're depressed and fatigued and just not feeling well a lot of times it's hard to have the energy to nurture relationships. If you don't even have the energy to get up and take a shower. In terms of other neurotransmitters, adrenaline doesn't interact with as many as some others. So, you know, that's an interesting little point, but we do want to go through some of them. Serotonin, which. There are different types of serotonin receptors. One type of serotonin receptor increases blood pressure and appetite and those sorts of things. The other type reduces and helps us feel calmer. There is no known interaction. When adrenaline goes up, it doesn't seem to affect serotonin at all. But norepinephrine, which is one of our main focus chemicals, adrenaline is synthesized from norepinephrine. So if you've got low levels of norepinephrine, you're probably going to have low levels of adrenaline. Acetylcholine causes the release of norepinephrine and the synthesis of adrenaline. So if acetylcholine levels are low, then norepinephrine is not going to get released. So there's no option to even make the adrenaline. So acetylcholine imbalances can contribute to low levels of adrenaline. Um, and certain antipsychotic medications, certain psychotropics and certain other medications do affect levels of acetylcholine. So it's important to notice if, when you. Somebody starts taking a medication, if they start feeling symptoms of depression to examine, you know, what neurotransmitters and what hormones does that medication act on and what are the known side effects. Glutamate is one of our other main excitatory neurotransmitters that's released when the HPA axis is activated. It doesn't directly affect adrenaline, but when glutamate goes up, adrenaline goes up. GABA down regulates the HPA axis and reduces adrenaline. So when GABA levels go up, adrenaline goes down. Endorphins are actually increased in response to adrenaline because endorphins help with pain suppression. So when our adrenaline goes up, the endorphins are secreted to help us, you know, not feel pain and be able to escape the threat. Dopamine is also increased because dopamine is a precursor to norepinephrine. And norepinephrine is broken down to make adrenaline. So you have to have dopamine to be able to make the norepinephrine acetylcholine to trigger the release of norepinephrine and the synthesis of adrenaline. So if any of these neurochemicals are out of balance, not just the adrenaline. If any of these neurochemicals are out of balance, you may not have appropriate levels of adrenaline. And finally, your endocannabinoids inhibit adrenaline in low doses, but may increase adrenaline at high doses. Your endocannabinoids are your natural cannabis receptors, if you want to overly simplify it. So when people take things like marijuana, cannabis, CBD oil, it acts on those endocannabinoid receptors. At low doses, it may help calm people down, but. But at higher doses, it can increase, increase adrenaline levels and anxiety and heart rate and those sorts of things. In terms of other hormones, what we just talked about were your neurotransmitters. In terms of other hormones, cortisol is triggered when adrenaline is secreted. So cortisol, glutamate, norepinephrine, and adrenaline are all secreted when that HPA axis is triggered. Thyroid hormones are also increased when adrenaline is released in the short term. If the HPA axis is functioning properly and there's a response to a threat and then it downregulates itself, then adrenaline in the short term increases the availability of thyroid hormones in order to increase the ability of the body to metabolize foods and things for energy. Now, in the long term, if that cortisol levels remain high for too long, cortisol actually inhibits the effect of the thyroid hormones in the long term. So thyroid people with a dysfunctional HPA axis that goes on for, you know, know, weeks or months or years can start evidencing symptoms of hypothyroid initially. Again, this is if the HPA axis is working like it's supposed to, testosterone is reduced. And it's important to recognize the reason for this is that the body says, you know what, there's a threat. This is not time to procreate. So testosterone is actually reduced in response to adrenaline and cortisol. Now, if the person. The caveat here is if the person is in a situation where there's a competition and they're excited about the competition, then testosterone levels may go up, especially in men. But if it is a threat and it's a stressful, unpleasant situation, testosterone levels usually go down. DHEA is a steroid that's converted to testosterone and. And estrogen. So if testosterone is reduced in response to adrenaline, you're not going to have enough. But if people don't have enough dhea, then they're not able to make the testosterone and estrogen that they need. Oxytocin is not directly in the scientific literature. There's you know, not much that talks about the direct relationship to adrenaline, but we do know that, interestingly, oxytocin, which is our bonding hormone, may increase in response to social stress and to reward bonding. So it encourages you to reach out and connect with other people and have loving relationships, but it also increases when there's a perception of threat to prompt you to protect your family and your friends. Progesterone may block the effects of excess adrenaline. So making sure in, in people that their estrogen, progesterone and testosterone levels are at the right, in the right balance is really important because when people do have excess adrenaline, progesterone can go in there and kind of blunt the effect so they don't get overly revved up. And estrogen, like testosterone, is often reduced in response to HPA axis activation and the presence of adrenaline. So we do want to recognize that testosterone and estrogen in threat situations can typically go down. Progesterone may block the effects of excess adrenaline. It may, you know, go up a little bit when adrenaline levels go up, but that relies on the gonadal, hypothalamic, pituitary, gonadal axis to be working effectively. Interventions, physical interventions. Good nutrition is going to be a foundation of just about everything that we talk about. The amino acids phenylalanine and tyrosine are the building blocks of the fight or flight hormones and require B6 for synthesis. You can find tyrosine in soy products if you're a vegetarian or a vegan. Chicken, turkey, fish, peanuts, if you can eat those, almonds, avocados, bananas, milk, cheese, yogurt, cottage cheese, lima beans, pumpkin seeds and salad, sesame seeds. So it is possible to get tyrosine in your diet pretty easily, no matter what type of special diet that you're on. Sleep is really important if the HPA axis is not functional, if it is revved up, if chronically excited and starts to cause problems with glucocorticoid resistance and adrenaline resistance, then you're going to have problems with the availability of adrenaline. Sleep is really important. We know that sleep deprivation hyperactivates that HPA axis. Exercise can be helpful at modulating the HPA axis and helping people find productive avenues for some of that excess adrenaline and cortisol when they feel stressed. Sunlight is super important at helping to regulate the circadian rhythms, and relaxation and meditation have been shown to reduce cortisol and adrenaline levels as well as increase GABA and serotonin levels in the brain. It's also important that people reduce stimulants, including nicotine and caffeine, which would trigger the release of adrenaline. If they are experiencing HPA axis dysfunction or symptoms of low levels adrenaline, or if they even notice that they're not their body's not responsive to the stimulant anymore, that's a clue that, you know, they've probably overdone it and they may need to think about detoxing affectively. Happiness will run counter and to HPA axis activation. Encouraging people to do things that make them happy, that help them feel content and give them, giving them tools or helping them develop tools to handle unpleasant emotions. Cognitively helping people address cogn stressful cognitions and cognitive styles will help reduce the unpleasant thoughts that that trigger the unpleasant emotions that trigger the HPA axis activation. Environmentally, one of the biggest triggers of that HPA axis is a threat. And a threat means a lack of safety. So making sure people feel emotionally, cognitively and physically safe wherever they are is a huge step. I am a big proponent of feng shui for arranging environments to reduce natural stress. For example, being able to see all entrances and exits of a room and if you can't do it easily just by sitting there strategically placing mirrors so nobody can sneak up on you. There are some primitive parts in our brain that actually do feel a little bit of stress when, when there is a possibility of being, being surprised or being startled. So that can take off some of that unnecessary distress sites. Helping people create environments that look pleasing to them, whatever that looks like. If they want, you know, navy blue walls, more power to them, whatever they can do to make their environment feel safe and welcoming and calming, music sounds can be helpful. They found that music can either increase or decrease adrenaline. Obviously, you know, hardcore metal intense music is likely to increase adrenaline levels, increase that HPA axis which is why people listen to it when they work out instrumental music or calming music or not loud ruckus intense music can reduce cortisol and adrenaline levels in people. They've also found that acoustic nature sounds have been shown to significantly reduce adrenaline levels in people who were stressed out. Encouraging people to consider getting those little. They're not expensive white noise machines that have different sound sound. So some days they can listen to a thunderstorm, other days they can listen to the beach waves, whatever they want to listen to. But they have found that that's helpful. They can try it out without buying anything by just going to YouTube. YouTube has a lot of videos or soundtracks, whatever you want to call them, that are multiple hours in length that people can put on while they're working to see what sounds, what nature sounds, what work best to help them feel calm and relaxed. Rose oil, lavender, bergamot, chamomile and valerian have all been shown to decrease adrenaline levels in people. And that's just inhaling it, that's not putting it on, it's definitely not ingesting it in any way. Just inhaling those essential oils is associated with significant reductions in your stress hormones. Black pepper increases levels of adrenaline. Now, it's important to look at or have people talk with their doctor about the causes of their low levels of adrenaline. If it's due to HPA axis dysfunction, then pepper may not help them feel energized at all because their synapses are just not responsive to the adrenaline anymore. But for people who are just, they have a functioning HPA axis and they're just feeling kind of sluggish. Essential oil of black pepper has been shown to help people feel more energized and increase adrenaline levels. And finally, interpersonally or relationally, developing supportive relationships can go a long way to helping people buffer against stress and reduce their adrenaline levels. Because they feel more connected, those oxytocin levels are higher and they feel less isolated, they feel more protected. Adrenaline, which also is called epinephrine, is synthesized from noradrenaline or norepinephrine, which is synthesized from dopamine that is created from tyrosine. So if there's a breakdown anywhere in that system, then you may not have the correct balance of those neurotransmitters. Adrenaline is secreted in response to physical or emotional stress or threat and works with norepinephrine, glutamate and cortisol to support the fight or flight response. Adrenaline may increase the levels of dopamine to help you focus on fighting or fleeing, which has been thought to underlie some of the motivation of quote adrenaline junkies. When people have that adrenaline surge, remember dopamine. Dopamine goes up as well as endorphin levels, so you don't have as much pain and people can get addicted to that rush. As a part of the stress response. Adrenaline opposes gaba, serotonin and the gonadal hormones in, in most part, excess adrenaline often looks like anxiety or anger. A person is in that fight or flight stage the only time, the only exception to that is if they're engaged in those adrenaline laden activities in which it may present as extreme euphoria. Inefficient adrenaline due to chronic stress or extended use of steroids often presents like depression and may include symptoms of hypotension and and slow heart rate, or bradycardia, which can contribute to reduced oxygenation throughout the body and compound their fatigue.