An Autoimmune Condition and Adrenal Fatigue Syndrome – Part 3

By: Dr. Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM

Read Part 1 | Part 2

An Autoimmune Condition and the NEM Stress Response

An autoimmune condition stress responseFrom a big picture perspective, an autoimmune condition and a disrupted stress response can affect almost every system in the body. The NeuroEndoMetabolic (NEM) Stress response regulates our body’s overall response to stress plays a very unique role both in the mediation of immunity and the health of metabolic and inflammatory processes. Autoimmunity and adrenal fatigue is linked very closely to both these processes. When there is a disruption in the NEM Stress Response, especially the detoxification and inflammatory circuits, the situation is created for progression to an autoimmune condition, as well as amplification of any issue already with the adrenal and endocrine stress responses.

It is important to remember that the body reacts to stress in a holistic fashion by way of the NEM stress response. When discussing an autoimmune condition and adrenal fatigue, we tend to focus on the metabolic component, one of two major components of the NEM stress response. The metabolic component is made up of inflammatory circuit, metabolic circuit, and detoxification circuit. Under stress, ideally all three of these processes function together to create stress hormones, cleanse our body of unnecessary toxins, boost our metabolism, and decrease inflammation to ready our body for action. However, under chronic stress, if there is an imbalance or issue with one of the processes, it has repercussions on the whole body.

The triad involved specifically with the inflammatory circuit is the GI tract, microbiome, and the immune response. These three aspects play a role in how inflammation affects autoimmunity, GI distress, food allergies, and infection response. Studies have shown that high-fat feeding can change the gut flora, leading to increased intestinal permeability and lipopolysaccharide (LPS) absorption. LPS are negative byproducts of bacteria, so absorbing large amounts of it can cause increased endotoxemia that triggers inflammation in the gut and lead to metabolic and autoimmune disorders. Certain food additives have also been found to change intestinal tight junction permeability, associating itself with the rising incidence of an autoimmune condition. Some examples of auto immunogenic additives are gluten, emulsifiers, organic acids, nanoparticles, and MTG (microtransglutaminase) which can be found in meat glue.
When functioning correctly, the gut microbiome, nutrient absorption and immune response all work together to protect our body from invading bacteria and viruses and digest food accordingly. In turn, the immune system is down regulated, metabolism functions normally, and the excessive reactive metabolite toxins are cleansed from the body and excreted. If, however, there is a dysfunction in either the absorption process of the GI tract, an imbalance in the microbiome, or an overactive or hyperactive immune response to digested food, issues tend to occur and throw the NEM system off balance.

Autoimmune Disease and Gut Health

An autoimmune condition and gut healthDiet and GI health is an integral part of both autoimmune remission and adrenal fatigue recovery. The GI tract, microbiome population, and immune system work in coordination to maintain healthy nutrient absorption, stave off invading bacteria and viruses, and excrete toxins. The GI tract has billions of bacteria living in it to aid in our digestion. These microbiota also help to fight foreign molecules in the body. When there is something the microbiota cannot fight, inflammatory signals are sent to trigger increased production of NF-kB. NF-kB is a signal that communicates to other parts of the body to increase inflammation. If this happens chronically, or there is damage to our intestines because of previous immune responses and unchecked NF-kB running around, our body may start triggering an immune response in unnecessary situations. NF-kB is also known to activate intestinal Tight-junction breakdown, leading to increased intestinal permeability, a syndrome also known as leaky gut. Leaky gut occurs when there is damage to the intestine lining that allows unintended proteins and particles through. The intestine lining is normally the first immune barrier to keeping toxins and bacteria out of the bloodstream. The lining also aids in absorbing nutrients and essential vitamins and minerals. When there is damage or increased inflammation to this barrier, it becomes less selective on what may stay in the gut, and what may enter the body. To respond, our body compensates with increasing our immune system attack on what is perceived as invading toxins, regardless of how benign it might be. Also, with increased immune response and leakiness, the immune system begins to respond to more and more that crosses over from the GI tract, which gives it more of an opportunity to react to similar looking nutrients and healthy cells throughout the body. In order to relieve the immune system in this case, it is important to address the issues of the leaky gut and dysfunctional GI tract. There are many management strategies such as removing triggers, re inoculation of beneficial bacteria, nutritional changes, and lifestyle management. Natural compounds that have GI supportive properties include DHEA, glutamine, and pantethine.

Once the GI tract, microbiome, and immune response are once again in balance and functioning together, the NEM Stress response may be able to normalize. This process is long, and in many cases an ongoing management process. However, once the system is addressed holistically, it makes management of an autoimmune condition and adrenal fatigue easier to grasp, and helps us understand why the body might be plagued by both conditions, and why certain supportive methods might be incredibly helpful.

Autoimmune Disease and AFS Relief

Meditating for calming an autoimmune conditionAutoimmune diseases and AFS are interrelated and overlap in many situations. While it is difficult to pinpoint the exact cause of either, the symptom management of both are similar. Lifestyle modifications are important. Since an increase of cortisol helps with autoimmune issues, exercise is often recommended to help manage an autoimmune condition. If also suffering from adrenal fatigue, be sure to keep exercise slow at first. Make long walks and meditation a priority in your life to help relax the body, but also manage cortisol levels.

Diet is a large part of managing an autoimmune condition. There are many studies done around low-inflammatory diets, and the autoimmune protocol diets which aim to eliminate common trigger foods such as dairy, gluten, corn, and sugar. While these diets can be difficult to follow, they are often a crucial part of recovery. Low sugar and low caffeine will also help with adrenal fatigue recovery management. Caffeine and sugar affect cortisol levels, so avoiding these in excess are often helpful steps in recovery.

Supplements can also be helpful both in adrenal fatigue recovery and autoimmune symptom management. The supplement selection is as vast as the presenting symptoms, so it is most important to target the underlying cause. However, while managing the underlying cause of stress and immune response, supplements can help in supporting the body throughout recovery.

Omega-3s found in fish oil are extremely beneficial in managing chronic inflammation. Chronic inflammation has been associated with heart disease, metabolic disease, and autoimmune conditions. Fish oil helps to down regulate chronic inflammatory processes by blocking NF-kB. Other supplements that can block NF-kB are turmeric and resveratrol. However, it is important to consult with an experienced physician before starting these supplements by yourself because those with adrenal fatigue might have more sensitivity to higher doses of supplements and should not self navigate if advanced.

Vitamin D, Vitamin A, and Glutathione have also been shown to increase T regulatory cells, which are important immune cells that can signal to increase or suppress T Helper cells, the fighters in your body. Getting good sleep and controlling blood sugar also decreases the stress on the body and improves immunity through decreasing TH17, the inflammatory T cell that amplifies NF-kB.

The body has two ways to fight infection, one through T cells, which is TH1 mediated, and the other is through B cells, which is TH2 mediated. TH1 works through natural killer cells and cytotoxic T cells directly destroying the antigen when it encounters it. Supplements that increase TH1 function are echinacea, astragalus, maitake mushrooms, glycyrrhiza, pomegranate, and melissa officinalis. TH2 works through B cells which make antibodies to tag antigens so that Natural killer cells can find them more efficiently and store it up for memory. autoimmune condition and natural solutionsFoods that can increase TH2 function are green tea, grape seed, antioxidant extracts from goji/acai berries, resveratrol, and flavonoids. It has been found that people are genetically dispositioned to be more TH1 or TH2 dominant. Therefore someone who is TH2 dominant might not feel good when taking the TH1 supplements like echinacea. And vice versa, someone who is TH1 dominant might not feel good when drinking green tea. So it is important to evaluate your own body’s disposition to see how your symptoms are before taking large amounts of these supplements.

Another important way to prevent further triggers is to aid in gut health and improvement. Glutamine has been specifically shown to be helpful with leaky gut, when intestinal permeability has been compromised. Glutamine helps to rebuild the intestinal barrier and prevent bacteria, toxins, or foreign material leaking through the intestinal wall into the body to trigger an immune response. This relieves the immune system and improves gut function. Those with AFS may not tolerate this amino acid which also have metabolic stimulatory effect.

Pantethine, also known as vitamin B5, also helps with leaky gut in improving both gut motility and intestinal repair. Pantethine causes contraction of the gut wall, as well as stimulates movement of blood, and therefore nutrient transfer, surrounding the intestine. Pantethine is the precursor to coenzyme A which also works to support adrenal function. Coenzyme A helps provide building blocks for the adrenal glands to produce the glucocorticoids the body demands in adrenal fatigue. Pantethine works best alongside administration of Vitamin C.

There are many other supplements like plant sterol, DHEA, pregnenolone that can be helpful. As well, lifestyle modifications that can be made to support adrenal function and help in managing an autoimmune diagnosis. It is best to seek support from your healthcare provider before embarking on a management plan for recovery. It is also essential to understand the fine balance between autoimmune conditions, adrenal fatigue, and the importance of cortisol, microbiome, and gut health. All of these must be examined and explored holistically in order to effectively reach a state of balance. These conditions are not static, so it follows that supporting the body to help manage the conditions is not static either. The processes are dynamic and fluid, so in order to effectively address all the processes involved, a multisystem support plan must be in place. Under the setting of adrenal fatigue, nutritiolnal supplements may exhibit paradoxical reactions, with opposing clinical outcome rather than that normally experienced. The weaker the adrenals, the higher is such risk. Self navigation is therefore not recommended.


autoimmune condition contributing factorsAutoimmune diseases are on the rise in the United States. While there is no understood single cause of autoimmune disease, there are many contributing factors, such as environmental impacts, genetic predisposition, and underlying conditions in the body. One of these conditions that is gaining attention is leaky gut syndrome as the permeability of the intestine walls is compromised and foreign material is able to pass into the body triggering a full immune response, which in turn can be the tipping point to causing an autoimmune reactivity. Autoimmune disease can be a result of AFS, and adrenal fatigue can also be the result of an autoimmune condition. While on the surface this can be confusing and frustrating, it makes sense because of its relationship to cortisol. Cortisol down-regulates the immune system. If the immune system is dysfunctional, as in situations of low cortisol levels in advanced adrenal fatigue, autoimmunity is more likely to occur. Genetic factors also play an important role, especially for those who have a hyperactive immune state. An autoimmune condition is inflammatory by nature and generate unwanted reactive metabolites that can overtax the HPA hormonal axis, resulting in adrenal fatigue and low cortisol state. Looking from the NeuroEndoMetabolic (NEM) Stress Response system point of view, it should be clear that recovery from autoimmune conditions should focus on removing the root cause while supporting the adrenals by tackling the gut triggers, reducing inflammation, and helping the immune cells work alongside a balanced cortisol level.

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© Copyright 2017 Michael Lam, M.D. All Rights Reserved.

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