The Dr. Lam Show
The Dr. Lam Show
How To Cope with Shortness of Breath
Shortness of breath and heart pounding are common and frightening symptoms. It’s important that you see your doctor if you experience this problem, but what happens if they can’t find anything? Here are some often ignored causes of breathing and heart problems and what you can do about them.
1:30 - How do Adrenal Fatigue sufferers describe Shortness of Breath (SOB)
2:50 - When does SOB happen?
4:30 - Adrenaline Rushes and Panic Attacks
6:20 - Postural Orthostatic Tachycardia Syndrome (POTS)
10:40 - Heart pounding and impending doom
12:25 - How to Improve Adrenal Fatigue
14:30 - How to increase parasympathetic response
15:30 - Natural compounds to help with Heart Pounding
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Do you sometimes have trouble breathing, heart pounding and quickening when you stand up too quickly? This can be a very serious problem and it's something that you should get checked out as soon as possible. That means going to see your doctor, but if your doctor really can't find anything and you're still experiencing shortness of breath, then it may be time to look for less obvious causes. That's what we're here to help you do today. This is the Dr. Lam show the place for you to find guidance and practical skills for dealing with adrenal fatigue and associated problems. Please Like and Share the show if you enjoy it, or if it helps you find better health. I'm Dr. Carrie Lam. I'm a specialist in family medicine and preventive medicine.
Dr. Jeremy Lam, MD:Hello, I'm Dr. Jeremy Lam, I focus on holistic and preventative medicine and also have a focus in chronic conditions. Let's look at shortness of breath and how it relates to adrenal fatigue. People with adrenal fatigue, sometimes present a shortness of breath. And they go through this normal workup, even after extensive workup with their lungs and heart, they're given a clean bill of health. That can be pretty frustrating for some people. So, Dr Carrie, how do they describe the shortness of breath?
Dr. Carrie Lam, MD:They describe the shortness of breath as they can't catch a full breath of air, or sometimes they can't take a full deep breath, they try to but feels like it got stuck. Sometimes going up the stairs, makes them breathless, or walking around the block, they feel short of breath. Sometimes this is accompanied by a fast heart rate, but not always. So, they might go home or you they go see their doctor, and maybe they get placed on an inhaler, to help with a breathing mechanism. But that doesn't help the root cause. Inhalers help to reduce inflammation, if you have asthma or COPD, or open up your airways like albuterol, to help you breathe better and help with your wheezing. But it doesn't address the physiologic basis to why that shortness of breath is happening. So why does this shortness of breath happen in adrenal fatigue specifically?
Dr. Jeremy Lam, MD:Well, the exact physiologic basis is unknown but the shortness of breath happens mainly in two situations. The first one is in the setting of adrenal fatigue. When a person is extremely nervous with anxiety, it can sometimes cause shortness of breath, However, this is more associated with panic attack like symptoms, where the person is breathing rapidly, and the intake of air is very slow, and often shallow. That results in a buildup of carbon dioxide, which worsens the shortness of breath. That's a vicious cycle. The other possibility is that those with advanced adrenal fatigue, especially if they're in a catabolic state, then they tend to lose muscle mass. When people with adrenal fatigue are losing muscle mass, they're also losing not only biceps and triceps, but also the intercostal muscles, that hold the ribs together. And those are decompensating and when a person wants to take a deep breath, due to wasting of the intercostal muscles, they are compromised. The ribcage cannot expand normally and cause breathing difficulties. This is what we mean when your body's in a catabolic state, you're losing weight, and have severe fatigue, and become housebound.
Dr. Carrie Lam, MD:When people have adrenaline rushes, very similar to the panic or anxiety attacks, these rushes can come at with any trigger, something simple as opening a fridge door, or having difficulty sleeping at night by feeling breathless or going for a walk and suddenly you get a rush because of the temperature change that makes your breathless as well. We tend to think it's more of a norepinephrine response, but that is not necessarily true. The pounding of your heart and shortness of breath, can be due to adrenal fatigue. And this can be very terrifying, when you can't breathe properly and you wonder if your oxygen saturation, is okay. So, go and see a doctor and make sure the issues like asthma, COPD, emphysema, heart, underlying heart problems, allergies and viruses are all taken care of. Yet, if you continue to feel short of breath, and if you still can't find a solution, then our team can help. Contact our office for a free initial phone call at 714-709-8000 for expert help guidance to support you during this frightening time.
Dr. Jeremy Lam, MD:There's another issue that occurs with adrenal fatigue that may be responsible for shortness of breath. When the adrenal glands are not functioning up to capacity, and it's called POTS, postural orthostatic tachycardia syndrome. POTS is a type of orthostatic intolerance that occurs with rapid heartbeat, over 120 beats per minute. You get other symptoms like low blood pressure. The key is with posture, when a person stands up from a sitting or lying position. And the corresponding symptoms experienced with POTS are so varied in some individuals, that sometimes even the blood pressure may remain constant or even increase.
Dr. Carrie Lam, MD:Other clinical abnormalities that patients with POTS can display are low blood volume, high levels of norepinephrine, especially when you stand up too quickly. They can also feel nauseated, fatigued, and lightheaded, you've been down and you pick something up and you just feel your heart pounding or you get lightheaded like you're about to blackout. Some may get heart palpitations, difficulty concentrating, difficulty sleeping, tremors or fainting spells, difficulty in doing exercise and their circulation might be worse with pain and coolness in their extremities.
Dr. Jeremy Lam, MD:So symptoms of POTS can occur due to different abnormalities. While some of the disorders linked to POTS are known, many of them are yet to be identified as there are different types of POTS. In the setting of adrenal fatigue, the adrenergic driven POTS symptoms is most common, and most sufferers are symptomatic, but they don't fit into the classic definition of POTS and their tests are borderline or normal. And so they're usually given a clean bill of health from cardiologists and neurologists, while they remain clinically symptomatic. We call this subclinical POTS because your symptoms are present, you are experiencing those symptoms, but laboratory tests are normal.
Dr. Carrie Lam, MD:How do people diagnose POTS, do you do a tilt table test, where they put you on a tilt table, and they measure your heart rate? Does your heart rate go up? This is important to our neuroendometabolic stress response, especially the cardionomic circuit, which deals with the cardiac, the autonomic nervous system and the adrenals. They're all tied together in this cardionomic circuit. POTS can be one of the symptoms in addition to the shortness of breath, when epinephrine, norepinephrine, fight or flight response, sympathetic response is just all over the place. POTS is one of the syndromes that can happen when your adrenals are not releasing the right amount of hormones due to stress. Many people have a hard time distinguishing between adrenal fatigue and POTS. Is it some other cardiac issue because many symptoms overlap. So it's very important to get underlying reason for this syndrome since many are reversible, like being able to help with the cardionomic circuit, and NEM. We can help with POTS, doing the breathing exercises, or supporting the adrenals, your sympathetic response by reducing stress, as these will benefit if you have POTS.
Dr. Jeremy Lam, MD:So if you're dealing with shortness of breath and POTS, which can be pretty terrifying, contact our team for a free initial phone call at 714709 1000 for guidance and support during this tough time. And next, let's dive into heart pounding, or really feeling that impending doom in your chest as a lot of our patients describe. Dr. Carrie, can you tell us more about this heart pounding?
Dr. Carrie Lam, MD:So normal people actually don't feel the heartrate, unless you're exercising very hard. It's normal to not feel it pulsating at 70 to 80 beats per minute. However, there are reasons why your heart would start to pound or throb. Physiologically, that means your heart is contracting more. So instead of a regular squeeze, it's squeezing real hard and makes you feel that pound. This is a catecholamine response causing your heart pound is specifically norepinephrine, and epinephrine. Epinephrine is also called adrenaline. Norepinephrine is a neurotransmitter in the brain that releases and affect your whole body. Specifically in your heart, it causes this pounding, throbbing type effect, especially at a higher level than your body needs. Epinephrine is there to make your heart pump faster and get the circulation going to your heart, norepinephrine makes it pound harder. So there are reasons why your heart might be pounding due to this fight or flight response, but importantly you must make sure your heart's not pounding due to structural heart problems.
Dr. Jeremy Lam, MD:So how does this relate with people who have adrenal fatigue? When you think about adrenal fatigue, you think about the adrenal glands needing support, eating to be stronger and healthier, and cortisol being the primary hormone in the adrenal system. The interconnection between the adrenal system and the sympathetic nervous system, releases the norepinephrine and epinephrine like Dr. Carrie said, and this correlation is important. If adrenal system is off track, it activates the on cardionomic system and the autonomic nervous system. This causes the throbbing and surge in the catecholamines. We cannot treat them separately, and that's why it's called the cardionomic and the NEM stress response. It is a combination of both autonomic nervous system and the cardiovascular system. When you trigger one, you trigger all three, imagine a stool with three legs or a chair with one leg will throw the balance. Likewise if your adrenal system is off, then the other two will be off as well and cannot stay balanced.
Dr. Carrie Lam, MD:What can someone do when they're feeling like this? Sudden heart pounding, and they lie in bed or keep still ? The best way is to prevent it. We teach our patients how to prevent it through different ways and mechanisms. And if you already have it, then how to abort and reduce stress. So you can go to a quiet room, do the adrenal breathing exercises the right way, making sure you are activating the parasympathetic response, and not just the sympathetic response. You don't want to overdo it if you're an anxious type. Don't just do deep breathing because it can get worse. Try 70% of our breath using your diaphragm, your belly coming out and in and you want to feel very calm and listen to your body. Given every person is different, if you cannot do 70% of a breath, try 50%. So it's personalized considering what your body can handle and how you can calm down to stabilize the body. Dr. Jeremy, what are other things that people can do when they're feeling this heart pounding?
Dr. Jeremy Lam, MD:For a quick solution, you can try medication including natural compounds that can calm you. Despite prevention being the best way, natural compounds are great for helping the heart pounding like magnesium is calming, same with GABA, or L-theanine all these need to be taken carefully, especially if you're dealing with adrenal fatigue. There may be opposite reactions, depending on how sensitive and how far along you're in adrenal fatigue. So this is not just throw everything and hope that one works, it needs careful titration and understanding of when to stop. Crucially, find the root cause and calm your body down. And so, gentle breathing, keeping calm arms are another one. Ultimately, it's also about preventing stress and the adrenal fatigue from getting worse.
Dr. Carrie Lam, MD:You need to make sure that adrenal glands, the autonomic nervous system, cardionomic circuit, is dealt with, along with the neuro endo metabolic stress response, because only dealing with symptoms does not mean you're getting checked. Find a practitioner who can help you to step back and find the cause rather than just dealing with the symptoms, like shortness of breath, tachycardia, POTS or pounding heart rate along with reducing stress. We can help you and you can call our office at 714-709-8000. We'll start to address and eliminate all these causes and empower you to take control of your life. Thank you for listening to us and we hope that you pick up a lot of valuable information. Please subscribe to the Dr. Lam show for more great content. We hope to see you next week.
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