Autoimmune Disease and Adrenal Fatigue Syndrome – Part 3

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

Read Part 1 | Part 2

Autoimmune Disease and the NEM Stress Response

An autoimmune disease stress responseFrom a big picture perspective, an autoimmune disease and a disrupted stress response can affect almost every system of the body. The NeuroEndoMetabolic (NEM) Stress response regulates your body’s overall response to stress and thus, plays a unique role in both mediating immunity and maintaining the health of metabolic and inflammatory processes. Autoimmunity and Adrenal Fatigue are closely linked to both these processes. Disruption in the NEM stress response, especially the detoxification and inflammatory circuits, creates a suitable environment for the progression of an autoimmune condition, as well as amplifying any existing adrenal and endocrine stress response issues.

It is important to remember that your body reacts to stress in a holistic way via the NEM stress response. When discussing autoimmune conditions 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 the inflammatory circuit, metabolic circuit, and detoxification circuit. Under stress, ideally all three processes function synergistically to get your body ready for action by producing stress hormones, cleansing your body of unnecessary toxins, boosting your metabolism, and reducing inflammation. However, if an imbalance or issue with one of these processes exists, chronic stress can have repercussions on your entire body.

The triad specifically involved with the inflammatory circuit is the GI tract, microbiome, and immune response. These three aspects play a role in how inflammation affects autoimmunity, GI distress, food allergies, and response to infection. Studies have shown that a high-fat diet can alter gut flora, leading to increased intestinal permeability and lipopolysaccharides (LPS). Absorbing large amounts of LPS—a negative byproduct of bacteria—can cause increased endotoxemia, which triggers inflammation in the gut and can lead to metabolic and autoimmune disorders. Certain food additives have also been found to alter the tight junction permeability of intestinal cells and are therefore associated with the rising incidence of autoimmune disease. Some examples of auto immunogenic additives include gluten, emulsifiers, organic acids, nanoparticles, and microtransglutaminase (MTG) found in meat glue.

When your gut microbiome is functioning correctly, nutrient absorption and your immune response work together to protect your body from invading bacteria and viruses and to digest food. In turn, the immune system is downregulated, metabolism functions normally, and excess reactive metabolites are cleansed from the body. However, dysfunction of the GI tract absorption process, imbalances in the microbiome, or an overactive or hyperactive immune response to digested food tend to cause issues and throw the NEM system out of balance.

Autoimmune Disease and Gut Health

An autoimmune disease and gut healthDiet and GI health are integral parts of both autoimmune remission and Adrenal Fatigue recovery. The GI tract, microbiome population, and immune system work together to maintain healthy nutrient absorption, stave off invading bacteria and viruses, and excrete toxins. Billions of bacteria live in the GI tract to aid digestion and also to fight foreign molecules that enter the body. When microbiota encounter something they cannot fight, inflammatory signals are sent to trigger increased production of NF-kB—a proinflammatory signal that communicates with other parts of the body to increase inflammation. If this situation becomes chronic or your intestines become damaged due to previous immune responses and the presence of unchecked NF-kB, your body may trigger an immune response when one is not necessary. NF-kB is also known to activate the breakdown of intestinal cell tight-junctions, leading to increased intestinal permeability, a syndrome also known as leaky gut. Leaky gut occurs when there is damage to the lining of the intestine that allows unintended proteins and particles through. The intestine lining normally acts the an initial barrier of the immune system, keeping toxins and bacteria out of the bloodstream. The lining also aids in the absorption of essential nutrients, vitamins, and minerals. When damage occurs or inflammation increases, the barrier becomes less selective about what can stay in the gut and enter the body. In response, your body may try to compensate by increasing the attack on what it perceives to be invading toxins regardless of how benign they may be. In addition, due to an increased immune response and leakiness, your immune system may begin to respond more and more frequently to anything that crosses over from the GI tract, which presents more opportunities to react to similar nutrients and healthy cells throughout the body. To halt these effects, it’s important to address your leaky gut and GI tract dysfunction. A number of strategies can be used to manage the immune system such as removing triggers, re-introducing beneficial bacteria, making nutritional changes, and managing your lifestyle. Natural compounds with GI supportive properties include DHEA, glutamine, and pantethine.

Once the GI tract, microbiome, and immune response are balanced again and functioning synergistically, the NEM Stress response may normalize. The process is long, and in many cases, requires ongoing management. However, once the system is addressed holistically, managing an autoimmune disease and Adrenal Fatigue are much easier and we can better understand why the body might be plagued by these conditions, moreover, why certain supportive methods may be incredibly helpful.


Autoimmune Disease and AFS Relief

Meditating for calming an autoimmune diseaseAutoimmune diseases and AFS are interrelated and in many cases, may even overlap. Although it’s difficult to pinpoint the exact cause of either, managing symptom can be similar. Lifestyle modifications are important and since increasing cortisol levels helps with autoimmune issues, exercise is often recommended to manage an autoimmune condition. If you’re also suffering from Adrenal Fatigue, make sure to start exercising gradually. For example, why not try making long walks and meditation a priority in your life to relax the body and also manage cortisol levels.

Diet plays a big role in managing an autoimmune condition. A number have studies have investigated low-inflammatory diets and autoimmune protocol diets, which aim to eliminate common trigger foods such as dairy, gluten, corn, and sugar. These diets can be difficult to follow but they are often a crucial part of your recovery. Lowering sugar and caffeine intake can also help Adrenal Fatigue recovery since they affect cortisol levels, so avoiding excess amounts is often a helpful step towards recovery.

Supplements can be helpful both in Adrenal Fatigue recovery and managing autoimmune symptoms. The available selection of supplements is as vast as the symptoms, therefore, it’s important to target the underlying cause. So, as you progressively manage the underlying cause of stress and your immune system response, supplements may help by supporting your body throughout the recovery process.

Chronic inflammation has been associated with heart disease, metabolic disease, and autoimmune disease. Omega-3 fatty acids found in fish oil are extremely beneficial in managing chronic inflammation. Fish oil helps to down-regulate chronic inflammatory processes by blocking NF-kB. Other supplements can also block NF-kB such as turmeric and resveratrol. However, it is important to consult an experienced physician before starting any supplement program, particularly those suffering from the advanced stage of Adrenal Fatigue, since you may be more sensitive to higher doses of supplements.

Vitamin D, vitamin A, and glutathione have also been shown to increase T cells, important immune cells that can increase or suppress the activity of T Helper cells, the fighter cells of your immune system. Getting a sufficient amount of quality sleep and controlling blood sugar levels can also minimize the stress on the body and improve immunity by decreasing the number of TH17 cells, inflammatory T cells that amplifies NF-kB.

The body has two ways of fighting infection: via TH1-mediated T cell activation or through TH2-mediated B cell activation. TH1 works via natural killer cells and cytotoxic T cells, which directly destroying antigens when they encounter them. Many supplements are known to increase TH1 function including echinacea, astragalus, maitake mushrooms, glycyrrhiza, pomegranate, and Melissa officinalis (lemon balm). TH2 works directly through B cells, which produce antibodies that tag antigens so natural killer cells can find them more efficiently and store them in memory. Autoimmune disease and natural solutionsSome foods can increase TH2 function including green tea, grape seed, antioxidant extracts of goji/acai berries, resveratrol, and flavonoids. People are genetically predisposed to being either more TH1 or TH2 dominant. Therefore, someone who is TH2 dominant may not feel good due to taking TH1 supplements like echinacea, whereas someone who is TH1 dominant may feel worse from drinking green tea. So, it’s important to evaluate your own body’s disposition and to determine your symptoms before taking large amounts of a particular supplement.

Another important way to prevent further triggers is by improving gut health. Glutamine has been specifically shown to help with leaky gut, a condition that occurs when intestinal permeability is compromised. Glutamine may help rebuild the intestinal barrier and prevent bacteria, toxins, or foreign materials from leaking through the intestinal wall into other parts of your body where they may trigger an immune response. This can provide relief for the immune system and improve gut function. Those suffering from AFS may not tolerate glutamine supplements, which can also have stimulatory effects on your metabolism.

Pantethine, also known as vitamin B5, can also help with leaky gut by improving both gut motility and intestinal repair. Pantethine causes contraction of the gut wall and stimulates movement of blood—and therefore, nutrient transfer—around the intestine. In addition, pantethine is a precursor to coenzyme A, which supports adrenal function. Coenzyme A provides the building blocks of the adrenal glands allowing them to produce the glucocorticoids demanded by your body in Adrenal Fatigue. Pantethine works best when taken alongside vitamin C.

Many other supplements like plant sterol, DHEA, pregnenolone can be helpful and in addition to lifestyle modifications can be used to support adrenal function and help manage an autoimmune diagnosis. It’s best to seek support from your healthcare provider before embarking on a recovery plan by yourself. Understanding the fine balance between an autoimmune disease and Adrenal Fatigue, as well as the importance of cortisol, the microbiome, and gut health, is essential. All of these components must be examined and holistically explored to effectively reach a state of balance. These conditions are not static, so managing these conditions cannot be static either. Each management process must be dynamic and fluid in order to effectively address the dynamic processes involved, moreover, a multisystem support plan must be put into place. Under the clinical setting of Adrenal Fatigue, nutritional supplements may exhibit paradoxical reactions, presenting the opposite clinical outcome to what is expected or normally experienced. The weaker your adrenals, the higher the risk of paradoxical reactions, therefore, self-navigating the recovery process is not recommended.



Autoimmune disease contributing factorsAutoimmune diseases are on the rise in the United States. While there is no understood single well-understood cause of autoimmune disease, there are a number of contributing factors, such as environmental impact, genetic predisposition, and any underlying conditions already present in your body. One of the conditions gaining a lot of attention lately is leaky gut syndrome. This occurs when permeability of the intestine wall is compromised and foreign materials are able to pass into other parts of the body where they can trigger an immune response. This, in turn, may be the tipping point that leads to an autoimmune reaction.

Autoimmune disease can be the result of AFS, however, Adrenal Fatigue may also be caused by an autoimmune condition. On the surface, this may seem confusing and frustrating, but it does makes sense when you consider on the cortisol connection. Cortisol downregulates the immune system and if your immune system is dysfunctional, as in the case of low cortisol levels associated with advanced Adrenal Fatigue, autoimmunity is more likely to occur. Genetic factors also play an important role, especially in those who have a hyperactive immune system. An autoimmune condition is inflammatory by nature and generates unwanted reactive metabolites that can overtax the HPA hormonal axis resulting in Adrenal Fatigue and chronically low cortisol levels. From the NeuroEndoMetabolic (NEM) stress response system point of view, treatment of autoimmune conditions should clearly be focused on removing the root cause while supporting the adrenals by tackling gut triggers, reducing inflammation, and helping the immune cells work alongside balanced cortisol levels.

Read Part 1 | Part 2

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

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