Wednesday, May 23, 2012

Stress and Saliva

You can buy your very own ladder safety poster from Stan's Safety Posters, found here

I received this excellent question from Gill recently:

Incidentally, is saliva production halted when there is major stress?  Have noticed a marked difference, for instance, today I was frightened that I was about to fall off the top of a step ladder and the saliva vanished........When the stressful situation is over, back comes the saliva.

First of all, I was really impressed with Gill's ability to evaluate Sjogren's symptoms AS THIS PERSON WAS ABOUT TO FALL OFF A LADDER.

Wow. That's amazing. See, I would be all flailing around and screaming and just freaking out in general. But Gill? Thinking probably calmly, "Drat. I'm falling off a ladder......Hm. My mouth is really dry right now. I wonder where the saliva went?"

This is the kind of person that I aspire to be. Seriously.

But back to the excellent question: Does stress influence saliva production?

Yep. It sure does.

The production of saliva is controlled by several factors, one being a very complex neurological network, two components of which I'll discuss here. Please note that I'm simplifying things dramatically. It's the only way that my brain can handle this kind of stuff anymore.

The answer to the question lies in describing the sympathetic and parasympathetic nervous systems.  Simply put, the parasympathetic nervous system is responsible for the "rest and digest" functions of the body. The sympathetic creates the "fight or flight" response in a reaction to stimulus outside of the body, such as the stress created by a wobbly stepladder. And the fear that one may be crashing one's body onto a hard surface.

Here's an explanatory graph created by Dr. Sumaiya Khan, found here.

Parasympathetic Nervous System
Sympathetic Nervous System
Constriction of pupils
Dilation of pupils
Stimulation of secretion of saliva
Inhibition of secretion of saliva
Decreases the heart rate, thus, causing a drop in the blood pressure
Increases the heart rate, thus, causing an increase in the blood pressure
Constricts the bronchi and thus, decreasing the diameter of airway
Dilates the bronchi, thus, increasing the diameter of airway
Stimulates activity of the digestive system, like stimulation of peristalsis
Inhibits activity of the digestive system, like inhibition of peristalsis
Stimulates gallbladder secretions
Decreases gallbladder secretions
Contract urinary bladder
Relaxes urinary bladder
Relaxes rectum
Contracts rectum

Note in the second row that the sympathetic nervous system (the one that is triggered as one falls off a ladder) when stimulated inhibits the production of saliva.

The parasympathetic and sympathetic nervous system cannot both be active simultaneously. Dr. Khan explains, "Thus, as can be inferred from the above given table, the responses and effects of both the systems are complementary in nature, rather than being antagonistic. The sympathetic division acts as the accelerator and the parasympathetic division acts as a decelerator of the human body. Thus, these two systems try and maintain the body in a normal state of homeostasis for the maximum possible time. At a time, only one of the two systems are activated in the body, depending on the type of innervation brought about and the hormones released."

In other words, a Yikes-I'm-Going-To-Fall experience will inhibit the secretion of saliva.

So, yes, Gill, acute stress does temporarily halt saliva production. That is, until the parasympathetic nervous system kicks in once the stressful incident has passed, and resumes it's normal messages to the salivary glands to produce saliva.

But wait -- there's more!

The nervous system uses special biochemicals -- or neurotransmitters -- to facilitate stimulus transmission through it's network of nerves. Sjoggies should be particularly interested in the neurotransmitter acetylcholine, which is used by the parasympathetic nerves to send their messages, including the ones that stimulate the production of saliva.

The two most commonly used drugs which increase the production of saliva, Evoxac (civemeline), and Salagen (pilocarpine), are considered cholinergic agonists, which means that the drugs enhance the effects of acetylcholine.

If you take either of these medications, you probably have noticed that they do cause an increase in saliva (if your salivary glands have functioning tissue) but that they do also have side effects, which may include increased sweating and some gastro-intestinal symptoms. This is because acetylcholine is instrumental in these body functions too, and these functions will also increase along with salivation.

If you are experiencing side effects while taking civemeline or pilocarpine, talk to your doctor.

Enough biochemistry for the day. My brain is strained.

See y'all tomorrow.

7 comments:

Gill from the other side of the Big Pond said...

Forget the bravery or stupidity of being able to think saliva when falling off a ladder, think "I must shout for help, drat the side of my mouth is glued to my teeth, I must find a way to peel my mouth apart to shout, now how to I hang on for dear life and peel the mouth apart?". Answer - 1. make a ment a mental note to enquire if i am too old/overweight to take an acrobatics course. 2. Hope there is a soft landing preferably in pool of drinking water, life being what it is, drowning could then become an issue....

kd said...

Julia, your posts are always so helpful to me - thank you!

As you know already, I have Sjogren's. When I get stressed (which is what prompted me to go to my PCP in the first place), I IMMEDIATELY end up in the bathroom w/the Big D, I call it. (It also occurs about 20 mins after eating my evening meal also, unfortunately, but the stress trigger can be any time.) Since starting Plaquenil, the joint pain in my knees has improved tenfold, but I have the problem above as strong as ever & new, neuro symptoms in my arms. They are weak, my thumb jerks & twitches, my fingers curl like with RA & elbows ache like I can't shake the hit-in-the-funny-bone feeling ALL day & night - nonstop. Plaquenil doesn't seem to touch any of the gastro or neuro. What's your take on it? Just curious...

Julia said...

Gill: Now, now. My comments may have been tongue-in-cheek, but I actually am seriously impressed by anyone that can think rationally in a stressful situation. Also? I'd bet that you'd ace an acrobatics course.

KD:

Ouch. Neurological issues frequently arise in autoimmune disease. However, there are also other neurological conditions that could cause symptoms similar to the ones that you describe, especially the hit-in-the-funnybone one. read this: http://orthoinfo.aaos.org/topic.cfm?topic=A00069
In regards to your busy busy intestines.....ooo. Know how you feel. Another one of those symptoms that can be caused by a large variety of factors. Looks like you need to have some ongoing discussions with your doctor.

In respect to the plaquenil, while it is generally known to reduce joint pain, malaise, and slow autoimmune activity, generally it can CAUSE more GI issues than cure. For some, it is irritating to the colon and stomach, so while you may have had these issues before you started this medication, I wouldn't expect plaquenil to reduce them.

Good luck with de-mystifying these symptoms! And let us know what you and your health care team decide!

Kelly said...

Even in people without Sjogren's, stress causes noticeable dry mouth. This is why public speakers so often have a glass of water by the podium, and use it frequently, just like Sjoggies. I guess that would be a good way to describe to people what Sjogren's dry mouth is like: that feeling you get when called upon to do a speech in public...only we have it ALL THE TIME!

Early on, right before I noticed consistently dry mouth, I was plagued more by episodic over-production and saliva of an odd consistency. Suddenly I was spitting and/or blowing bubbles while talking. This had NEVER happened to me before and I would have noticed because I talk A LOT. ;-)

I don't have enough saliva for the spitting to be a problem anymore, really. That business of wildly fluctuating levels of saliva production didn't last too long before it settled in to chronic under-production, especially at night.

The bubbles still happen sometimes when I talk. It's very embarrassing, and yes, it's also noticeably worse when I'm under stress and really don't need spit bubbles interfering with my need to communicate some serious thought.

Cary said...

I know i'm behind in my comments but just join the blog and can't stop reading! I did also had an increase in saliva for a while worst while talkinf which i also do 8- 9 hours a day. This turned to very dry mouth, eyes and skin. Its gotten worst under stress specially when I need to discuss with my supervisors, I hate this so much! because they notice and probably think I'm scared.

Anonymous said...

I love your blog!!! This is so informative (really all of it is)... thank you for all that you do!

I started my own blog a few months ago, at www.survivingsjogrens.com

Feel free to take a look, but it's not nearly as impressive as this! Thank you for helping me to feel less alone in this journey...

Anne said...

Don't know where to put this dry mouth tip but under saliva. Worst flare ever last fall (2013) accompanied by the truly "Big D". Began drinking 50% pedialyte 50% kombucha every morning. My mouth and mucosa are so sensitive I can only tolerate one brand and, within that brand, only two flavors; but the combo really seems to help me banish the worst of the dry mouth symptoms in the morning.

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