A systems view of biological health

Section 2: Theory

40 : Surviving extremes: Plan A+ and Plan B+

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The polarity of the Krebs cycle continues into emergency survival responses

The first response is to throw energy at the problem

Then is that fails, the fallback response is to turn off the lights

When adaptive stress of any kind exceeds a certain threshold that might indicate a mortal threat – external danger or withdrawal of critical social support, when core body temperature or blood glycogen leaves the normal homeostatic range, when there is deficiency or excess of water, major electrolytes or other nutrition, infection, or whatever – then emergency measures are put in place. This threshold is never a conscious decision – but rather, one made by the non-cognitive adaptive body-mind – which then calls on extraordinary reserves that originate deep in our evolutionary past. The transition from "normal" to "emergency" may be so rapid as to be undetectable. However, if self-reflection has been trained as a skill, even in quite extreme states it will be possible to sense that the body physiology along with the, sensory, attentive, physiological, mental-emotional etc. have entered a much narrower band of possibility[1].

Having said that (i.e. the "decision" to escalate to survival physiology is taken by the non-conscious) - conscious processes still play important roles. The appraisal of possiblemortal threat is taken at a Gestalt level, and is passed up to the conscious mind as an emotion such as fear, anxiety, anger, or foreboding. The conscious level of your being then has a narrow opportunity to notice the rising emotion and to compare it to a cognitive appraisal of the situation. This feedback loop may occupy a little time (seconds, even minutes) or be very fast indeed (less than 0.1 seconds), in either direction. So it is possible with some kind of applied self-awareness to notice "danger" emotions and to also recognise that you are sufficiently in control – in which case there is some kind of tacit acknowledgement of the internal unease, and also a cognitive recognition that the internal response is out of proportion to the real situation. Feeling in-control-enough is one part of feeling safe-enough (or vice versa), and allows for situations that may not what you would wish for in this moment, but are nevertheless manageable. This nuanced management of reactive emotions requires that the speed of the feedback loop is relatively slow – which in turn has three fundamental requirements:

• the situation is actually more safe (even if only marginally) than your immediate gut-level reactive response would indicate. Given this relative safety, then:

• the internal emotive "signal" must be small enough so that you are able to not be immediately caught up by it – i.e it does not takes over ("flood"), and

• you have the wherewithal to be curious rather than reactive, and/or to recognise that the emotive response is even slightly disproportional to the actual situation.

The presence of feedback loops implicitly requires that the conscious / cognitive mind also plays its part in them in the way that has been habituated in your nervous system, as it evolved over the past few million years. If (so far as is possible) the conscious mind does not blindly join into Gestalt-driven responses, then it remains available to regularly re-calibrate the internal body-mind to the reality of the immediate external world. Which in turn requires that your actions are able to settle into the 2-3 second relational state instead of being wholly reactive.

The presence of feedback loops inevitably means that "flooding" – the escalation of a small alarm internal signal such that it seems to occupy the entire body and mind – is quite normal. Many people suffer from regular or even constant "flooding", and like many other things I discuss here, the issue is often both (relatively) simple and non-trivial. The asymmetry of danger-survival-alert responses (fast to onset, slow to recover) means that this recalibration is required many times each day. If re-calibration does not occur, then there is a gradual accumulation of un-calibrated emergency alarm responses that form Gestalts of their own. As their number accumulates through life they are more present in everyday experience and even if each one is quite small they will eventually reach a critical mass and constantly flood the conscious mind with distressing survival emotions.

One aspect of the physiological emergency-survival adaptation is to reduce internal communication so that more attention can be devoted to surviving the immediate situation. When the quantity of internal communication is reduced, this:

• reduces energy expenditure at a small cost of reducing the ability to shift metabolic range, because it also

• increases local autonomy wherever there is less communication

• frees off your cognitive space so it only needs to engage with survival priorities

• prioritises internal states that are more adaptive to the type of danger being faced – whether that is physical or social threat, lack of water or nutrition, thermal regulation, infection or anything else.

Survival-adaptation comes in two and a half phases:

1. Intensify Plan A to A+: yet more energy

"Plan A" escalates beyond its normal limits, releasing far higher amounts of energy whilst placing long-term vegetative (repair, recuperative, digestive, reproductive) functions on hold. In the case of external or social threat this is usually termed "fight-flight". If cortisol accompanies adrenaline (in the case of threat-induced stress) this prepares the immune system to deal with infected bite wounds and temporarily reduces its "interest" in other forms of infection. The iinitial immune response is to flush any external wounds (a short burst of free blood flow) followed by inflammation to encapsulate any infection or tissue injury, leaving it for a safer time when there is spare capacity to deal with it. Other demands are also encapsulated and set aside for future attention. Simply, why spend an iota of energy dealing with a small flu infection when faced with a sabre-tooth tiger? If you survive the tiger, then that’s a good time to deal with the cold.

Metabolic survival emergencies are also dealt with by first "throwing energy at the problem" such as inflammation, sweating, shivering, higher blood pressure, with appropriate changes in peripheral (skin) circulation through vasodilation / vasocontraction. The specific circumstances dictate the initial response physiology, which then determines the details of "Plan B+" - should that become necessary. To take just one example, there are three known responses to peripheral cooling (ignoring responses that occur when core temperatures start to drop), some of which include clanges in mitochnondrial activity. Unpicking all the specific details of possible Plan A+ responses is therefore beyond the scope of this book.

Normal range adaptation also includes "peak states" – euphoria, awe, reverence, altered transcendental states, exhilaration, enchantment, lightheartedness, profound peace, serenity, gratitude, satisfaction, pleasure (etc.). Most of these are mediated by small concentrations of endorphins (peptides arising from endogenous opiates) and cannabinoids (EOC’s). The presence of adrenaline and noradrenaline changes the effect of EOC’s from pleasure to numbness. Plan A+ responses tend to be accompanied by a loss of interest in the body and more interest in sensory information from the outside world. If you are in a fight, an awareness of the nuances of the space between your toes or the specific energised sensation in muscles is superfluous to requirements. "Armouring" (a contraction of Titin in the more superficial muscles and of connective tissue in the skin) includes both hardening and some degree of numbness – because it’s more sensible to not feel the pain of any injuries when your’e still fighting!

2. Fall back to Plan B+: hibernate

If the escalated "Plan A+" is inadequate in any way – i.e. is overwhelmed – then "Plan B+" takes effect – in other words the Krebs wheel starts to turn backwards. In this case, production of EOC’s is ramped up, which changes the meaning of adrenaline/cortisol and sets the body-mind on a trajectory some way towards hibernation (though this end-point has been very rarely documented, except in a few cases of hypothermia). Here energy is conserved. Thus, deep sleep or even coma or "organ failure" (the turning off of unnecessary metabolic load) is not unusual in extreme situations. Hibernation induces profound self-healing to occur – and so it is not unusual for people to sleep or even go into a coma for a few days in the case of severe injury or infection. However, if there are pre-existing high adrenaline-cortisol levels (from any preceding threat-induced "Plan A+"), this may prevent the kinds of heightened self-repair or deep immune response available in true hibernatory states. In this case the body continues its "Plan A+", with any repair work going into the pending tray, encapsulating infections and tissue repair "for later".

With the opioids comes dissociation, numbness, reduced circulation in extremities (to conserve heat in the core), sleepiness and eventually comatose states. Energy is removed from muscles and musculo-skeletal connective tissue (to varying degrees) – creating a disengaged floppy state. This may be very minor and display as submissive social responses, or be more physical – and be evident as exhaustion, floppiness, lassitude and sleep.

Plan B+ involves the abandoning of high-energy processes as a an initial stage of energy conservation – so the cortex is the first thing to be dumped, and people in Plan B+ are not very good at thinking clearly[2]. For everything except hyperthermia the next obvious contender is peripheral circulation (skin, then hands & feet, then legs & arms). Communication used for coordination of metabolism is also a drain on energy and attention. The obvious initial place to reduce or simplify connection is between the already loosely coupled three major compartments. The reduced communication through the Vagus Nerve causes a loss of fine-tuning of everything, and one place that is visible is in RSA and HRV[3]. The reduction in Vagal activity should be considered to be a deliberate adaptation strategy – equivalent to you burning toast in the kitchen and deciding to temporarily leave a telephone conversation, intending to resume it when everything is well again. In this case the Vagus Nerve equates to the telephone line.

Hibernation physiology is a slow tick-over that metabolises fats rather than sugars. Since fats are "eaten", they produce water, and so there is less need for hydration. Some cellular Mitochondria themselves may shut down ATP production and enter a vegetative reverse-Krebs cycle.

Plan C (or A++): throw everything to the wind

If "Plan B+"is in turn overwhelmed and failing because bodily energy reserves are approaching the bottom of the tank (as in late-stage hypothermia) then there is a dead-cat-bounce "Plan C" in which a vast amount of energy is released in a last ditch attempt to survive. The mental confusion during hypothermia results in utterly suicidal behaviour. The fact that there is a "Plan C" means that either it once did enhance survival at one time in our evolution, and/or that it is effective in some non-hypothermic life-threatening situations – perhaps the extreme fever seen in some responses to infection.

Experiencing Plan B+

In real time, Plan B+ often results in some degree of sleepiness or mental confusion – so people who have an infection may sleep for days. This was observed in many amputees during the Crimean war, a time before anaesthetics and painkillers were available – where they would go into a coma with apparently major organ failure. But in reality the organs were simply switching off to provide more resources to heal the body. Eventually the amputee would die painlessly or would awaken with the limb stump already well on the way to healing. Usually life is less extreme than this (!) and there is a vast spectrum of dissociation / loss of embodiment that may often be a numbness so small as to be imperceptible – except that injuries do not heal or muscles, ligaments and tendons in the body adopt a sub-optimal balance. Dissociation (and resultant lassitude) in some muscles and connective tissue places abnormal load on other parts of the musculoskeletal system – which then often become painful. Therefore the vast majority of musculoskeletal pains and strains are in healthy tissue and the actual problem lies in whatever reason they are doing more than their fair share of work – i.e. in the muscles and tissues and proprioceptors that are dissociated and febrile.

The presence of elevated endogenous opioids and cannabinoids results in a numbness of the body – which can then feel as if there are no feet or legs (like walking around on glass stilts), or the feeling self-presence gains an unreal, wraith-like or cardboard-like quality – or as Bilbo Baggins noted "like thinly buttered toast". This is termed "de-personalisation" – classically described as "through a glass, darkly". The external world may also fall into this pit of unreality, and feel alien or like a Hollywood backdrop in which nothing is what it seems to be or solid or reliable – "de-realisation". Dissociation may be big (as described above) or so small as to be normal and unremarkable, and for most people it is usually the latter. A loss of the ability to experience the body as being fully solid and responsive frequently induces some degree of loss of confidence, followed by an increase in anxiety or depression or both. These symptom patterns are so common in the Western world as to be almost normal. The fact is that low to high level dissociation is endemic in Western cultures. And particularly so in big cities where the wall-to-wall noise and close-crowding create a background physiological stress, thus reducing adaptive capacity for everything else.