Autoimmune Disease and Adrenal Fatigue Syndrome – Part 1

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


An autoimmune disease can raise many questionsMillions of people are diagnosed with some form of autoimmune disease, and the number is rapidly growing. Prevalence of the disease is 75% more prevalent in women than men. Autoimmune disease occurs when the immune system thinks healthy tissues of your body are invading bacteria or viruses and begins to attack them. Women are thought to have a stronger, more reactive immune system than men, which is why they may be more susceptible to autoimmune conditions. Autoimmune diseases are classified by the main tissue the immune system attacks. While the conditions often cause systemic issues, there is usually one main organ system that the autoimmune system responds to.

There are many types of autoimmune diseases with differences in their development or progression, which results in widespread symptoms. It’s important to note that an autoimmune disease diagnosis does not mean there is no hope. Autoimmune diseases vary from symptom to symptom and person to person, so depending on how you manage your diagnosis, you may have the opportunity to reclaim your health and your life. However, it’s important to understand that antibodies are usually always present and may flare up on occasion.

The goal is to stay in remission as long as possible by identifying the cause, staying away from triggers, and optimizing your immune system. Because many different organs throughout the body may be affected, symptoms of each autoimmune disease can vary greatly. Moreover, symptoms often mimic those of Adrenal Fatigue. Although the two conditions are related, it’s important to recognize the differences between them, as well as similarities, and how both can exist in a susceptible body.

Types of Autoimmune Disease

Some common autoimmune conditions include:
Hashimoto’s Thyroiditis – the immune system attacks the thyroid, thereby decreasing its effectiveness, resulting in hypothyroid symptoms;

Inflammatory Bowel Disease (IBD) – ulcerative colitis or Crohn’s disease, whereby the immune system attacks the lining of the colon causing diarrhea, nausea, and abdominal pain;

Systemic Lupus Erythematosus (SLE) – characterized by joint pain and swelling, a butterfly rash across the face, inflammation of mucous membranes, and other symptoms;

Rheumatoid Arthritis – the immune system attacks the joint space, specifically in the fingers and hands causing swelling, joint pain, and even changes to bone structure;

Celiac Disease – the immune system is triggered and reacts to gliadin, a component of gluten, causing damage to the intestinal lining;

Sjogren Disease – a condition characterized by dry eyes and dry mouth, wherein the immune system attacks the salivary glands and tear ducts, and can also be associated with other autoimmune conditions;

Raynaud’s Phenomenon – often a symptom in many other autoimmune conditions, Raynaud’s is characterized by vasoconstriction of blood vessels that supply the fingers resulting is white waxy fingers at the onset of cold temperatures or stress.

Stages of Autoimmune Disease

Autoimmune disease stagesThere are three stages in the progression of an autoimmune disease. Stage one is the silent autoimmune disease, during which time antibodies may become elevated, however, the target organ shows no symptoms or loss of function. Stage two is known as Autoimmune Reactivity, characterized by elevated antibody levels and the some symptoms present as well as mild loss of function. However, in stage two, no severe impairment of tissue associated with the disease occurs. Stage three is what most doctors would identify as an autoimmune disease, at which point labs, imaging, and special studies are able to identify significant loss of function along with elevated antibodies and significant signs and symptoms of the disease.

Conventional medicine usually catches immune dysfunction in the advanced stage when it’s already too late. For example, Addison’s disease is only diagnosed when 90% of adrenal function has been affected. At this point, it’s very difficult to regain function. However, it’s encouraging to know that you can identify your problem well in advance of stage three of an autoimmune disease if you’re alert and listen carefully to your body’s signals. If the signs are caught early, your body will have the opportunity to rebuild itself under the right guidance.

What Causes Autoimmune Disease?

The exact cause of autoimmune diseases is unknown, however, environmental and genetic factors are known to play a large role in the onset and progression of the disease. Environmental factors such as chronic stress due to external factors or an underlying condition, toxin/pollutant exposure, immune-reactive dietary proteins, and underlying infections have all been examined as potential triggers of immune dysregulation. Once the immune system starts to identify the body’s own cells as enemies, this may lead to loss of self-tolerance, and therefore, production of tissue-attacking antibodies.

Infections, particularly those involving the Epstein Barr virus (EBV), Herpes Simplex 1, and Herpes Simplex 2, have been associated with the onset of autoimmune disease. The bacteria Escherichia coli (E. coli) is also thought to contribute to autoimmune conditions. The reason these infections may trigger an autoimmune condition is unknown but there are two working theories.

The first theory involves molecular mimicry, the method a virus or bacteria may use to evade detection by the immune system. In a properly functioning immune system, if a virus is presented, your immune cells recognize it as foreign material and attack it. In molecular mimicry, a virus is able to disguise itself as healthy tissue (by attaching to proteins and sugar complexes that healthy cells in our body have on their surfaces). At first, the immune system doesn’t recognize the invading virus, allowing the infection to spread. Eventually, however, the immune system catches on but because the virus is mimicking healthy tissue, your body is now susceptible to your immune system attacking actual healthy tissue. Autoimmune condition, viruses and bacteriaAn important example of molecular mimicry is the cross reactivity of gluten with gut cells. Studies have shown that gluten, found in most wheat products, can be viewed as a foreign object by the body, inducing your immune system to create antibodies against it. Since gluten antibodies have been shown to cross react with gut cells and pancreatic islet cells, antibodies against gluten actually damage the body’s own cells leading to an increase in gut diseases and the possibility of developing diabetes.

The second theory involves gut health, which can be damaged by E. coli. Studies have shown that the gut bacteria and oral microbiota of people with both Type 1 Diabetes and Rheumatoid Arthritis are less healthy. Since many immune cells are located in the gastrointestinal tract, it seems logical that an unhealthy gut leads to immune deficiencies.

Therefore, maintaining healthy gut microbiota and a healthy intestinal lining are important to your overall health. Infections with E. coli throw our gut microbiota out of balance, which affects how you absorb and manage nutrients in your body. This type of dysregulation can sometimes damage the intestinal lining causing the immune system to attack healthy gut tissue, and can result in a number of issues including IBD. Although having an unhealthy gut may not cause an autoimmune condition in everyone, unless your body is genetically predisposed as we’ll discuss, it may be enough to cause a reaction.

But let’s not forget about our genetic makeup. Genetic factors affect how the immune cells are structured and immune cells can be formed and function in many different ways. Major histocompatibility complex (MHC) is involved in the cell recognition function. A slight genetic alteration leading to a problem with this complex combined with an environmental trigger can be enough to tip the body towards an autoimmune condition. The genetic link, however, is not as simple as one protein code and one gene since numerous factors can be linked. As an example of this complexity, just look at how autoimmune diseases play out in a family. When a disease is hereditary, it is passed down generations through genes, however, autoimmune diseases are unique. If one person in the family is diagnosed with Hashimoto’s thyroiditis, another member of the family may potentially be diagnosed with systemic lupus erythematosus (SLE). Genetics prime the body for an autoimmune disease, but environmental factors determine the particular type of disease.

An increased risk of an autoimmune disease does not necessarily imply your body will develop that disease unless it is triggered by a certain situation or condition in the body. If environmental factors and existing conditions in the body are favorable to a certain autoimmune disease, it’s much easier to trigger. In some situations, the body may be genetically predisposed to an autoimmune condition but environmental factors are never strong enough to allow the disease to progress.

Adrenal Fatigue

An autoimmune disease and adrenal fatigueAdrenal Fatigue Syndrome (AFS) is a condition directly related to the hypothalamic pituitary adrenal (HPA) hormonal axis. This axis is the pathway that manages our response to stress and the release of cortisol. Stress can be an external event or a result of some underlying condition in the body. When the adrenals are overtaxed and become exhausted, AFS can surface and the clinical presentation can vary widely. Symptoms may include fatigue, exercise and stress intolerance, insomnia, metabolic disturbances, frequent infections, heart palpitations, and hypoglycemia. The effects of a weak adrenal system are therefore felt throughout the body.

Read Part 2 | Part 3

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


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