Chronic Inflammation and Adrenal Fatigue Part 2
Adrenal Fatigue Basics
An inflammatory response is activated whenever our body is stressed. To control this inflammation so that it does not go rampant, our adrenal glands secrete cortisol, the main anti-stress hormone, which calms the inflammatory process. This balance allows the body to return to a normal state after the inflammation is no longer needed. With chronic stress, however, inflammation persists in your body. The adrenals are put on overdrive to constantly secrete cortisol under the direction of the hypothalamic-pituitary-adrenal (HPA) axis. If stress is unrelenting, our adrenal glands can ultimately become exhausted, a condition known as Adrenal Fatigue. At first, the body simply becomes progressively more fatigued. In advanced stages, common symptoms of Adrenal Fatigue include reactive hypoglycemia, chronic Inflammation, low blood pressure, insomnia, anxiety, depression, heart palpitations, reduced exercise capacity, menstrual irregularities, and low thyroid symptoms. A body in advanced Adrenal Fatigue has a limited ability to control inflammation, leading to a variety of other problems.
Inflammation and the NEM Response
To fully understand the pathophysiology of inflammation, we need to first understand that the body’s overall response to stress is governed by its neuroendometabolic stress response. This response has six major components that help our body maintain homeostasis, which is necessary for long term survival. Here is graphical representation of the components of the neuroendometabolic stress response:
The inflammatory response is one of these key components in how our body reacts to stress. Inflammation works synergistically with other systems and organs to properly react to the situation while maintaining crucial functions.
The most important systems that affect inflammation in your body are the:
- Immune System
- Gastrointestinal Tract
To understand how inflammation affects your body, let’s look at these individual components in more detail.
Immune System and Inflammation
Inflammation is an important part of innate immunity. Innate immunity refers to nonspecific mechanisms that respond to any threat or stressor the body many encounter, as opposed to mechanisms that target specific pathogens.
Acute inflammation is a normal process that helps to protect and heal the body in response to physical injury or infection. However, if your body’s inflammatory response continues for a prolonged period of time, the inflammation is said to be chronic. Chronic inflammation can be the result of an infection, an environmental antigen such as pollen, an autoimmune reaction to the body’s own material, or the persistent activation of inflammatory molecules. Chronic inflammation is primarily mediated by the immune system components known as macrophages and monocytes.
Macrophages and monocytes are both classes of leukocytes, a type of immune cell commonly known as a white blood cell. Leukocytes release reactive oxygen species (ROS) and proteases, chemical agents that destroy whatever has triggered the inflammatory response; however, these agents are indiscriminate and attack not only the foreign invaders but also the body’s own tissues. The damaged tissues must be continuously repaired by replacement of damaged cells, either with the same type of cells or with fibrous connective tissues. Another important characteristic of chronic inflammation is local angiogenesis—the development of new blood vessels. As part of the inflammatory response, the damaged tissues also undergo repair. The affected areas are replaced by new functional cells or fibrous connective tissues; and the site undergoes angiogenesis, building new blood vessels to supply the new tissue with blood. This repair work, although started by your body with the best of intentions, can actually be disruptive, and the irritation it causes can retrigger inflammatory processes. If this cycle repeats itself time after time, the cascade can continue indefinitely and keep your body in a chronic inflammatory state. Chronic inflammation is abnormal and does not benefit the body.
The fact that your immune system is the driver of your body’s inflammatory response to disease is well established. Unfortunately modern allopathic medicine does not provide solutions for long term alleviation of immune- and autoimmune-driven chronic inflammation. Oftentimes, immunosuppressive therapy or steroids are recommended by doctors in order to suppress the immune system response. But while these approaches reduce inflammation, neither addresses the underlying pathology to heal the body.
Until the actual cause of inflammation is addressed, the problem remains and continues to consume resources and destroy tissues.
Inflammation and the Gut
The majority of inflammatory diseases actually begin in the gastrointestinal (GI) tract. A single autoimmune response there can magnify and spread through the body to become a systemic inflammatory reaction.
Your GI tract is a very large and complex organ system with an intricate semi-permeable lining. In fact, the internal surface area of the gut could cover two tennis courts! The permeability of the GI tract lining changes in response to various body functions and chemical reactions. If the hormone cortisol, for example, rises in response to a stressful argument, or if thyroid hormone levels fluctuate due to disruptions in your sleep cycle, the intestinal lining becomes more permeable; the tight junction responsible for holding adjacent mucosal cells together to prevent penetration becomes more lax in response to the those hormones. In this more permeable state, difficult to digest food particles, toxins, and pathogens such as bacteria, viruses, or yeasts have a greater chance of making it past the intestinal wall and into your bloodstream. The invading toxins and pathogens trigger an immune response, which causes inflammation, allergic reactions, and other symptoms we relate to a variety of diseases.
Furthermore, when the intestinal lining is repeatedly damaged due such recurring “leaks”, the microvilli cells of the gut lining start to break down and are rendered unable to process the nutrients and facilitate the work of enzymes vital to proper digestion. Digestion becomes impaired and nutrient absorption becomes problematic, preventing proper energy and nutrient intake from food.The diminished nutrient intake capacity further degrades the health of the body, making it even more susceptible to disease.
This situation can become quite serious, leading to severely debilitating conditions. The immune system can become overburdened, allowing pathogens and toxins to cycle through your bloodstream, where they can affect joints, muscles, connective tissues, nerves, and even other organ systems. Leaked toxins entering our blood stream from the gut can enter the brain, causing inflammation and resulting in depression. It has been also been shown that many of the inflammatory diseases we suffer from are gut mediated but do not present as gut issues. For example, gluten sensitivity can be primarily, and at times exclusively, a neurological disease. In other words, some people show gluten sensitivity because of problems with their brain functions, despite having no gastrointestinal problems whatsoever. No organ is spared when the gut is inflamed. Without a healthy gut, it is impossible to feel vibrant and healthy. The many symptoms associated with these issues are referred to collectively as leaky gut.
In addition to the gut itself as a source of inflammation, there is also the microbiome—trillions of microbes that live in and on your body, including within your gut— which can also play a role in inflammation.
Microbiome and Chronic Inflammation
You may think of your body as a single organism, but in reality, your body harbors trillions of commensal microorganisms that are intricately tied to maintaining homeostasis and functional balance within your body. The relationship is so intimate that the human body can be considered a metaorganism; interactions between the human host and its resident microbes are a critical part of its development and function. These populations of microbes and the environment they live in and help to keep healthy are collectively known as the microbiome.
When your internal microbiome is disrupted by illness, stress, or antibiotic medications, the composition and functionality of the microbiome is altered, a state known as dysbiosis. Dysbiosis is involved in several metabolic and inflammatory diseases, and is thought to be connected to many more.
If your gut microbiome is altered due to mass dieoff of microbial populations from antibiotic medications, normal gut functions may be negatively affected by the limited functional capacity of the remaining gut microbes. In addition, the reduced population size creates a vulnerable niche which other, less beneficial bacterial or fungal organisms may colonize. These other organisms are often detrimental to your gut health, producing toxins and irritating the gut lining; this can, in turn, have implications for all of the other systems in your body, as discussed above.
Systemic Signs of Chronic Low Grade Inflammation
Unlike acute inflammation, which causes localized redness and swelling of a particular affected area, chronic inflammation effects are more diffuse and systemic. They also develop and affect the body over longer periods of time Signs and symptoms include:
- Food sensitivity
- Autoimmune disease
- Frequent infections
- Stealth infection
- Leaky gut
- Small intestine bacterial overgrowth
- Irritable bowel disease
- Pain of unknown origin
- Inflammatory bowel disease
How to Evaluate Inflammatory Conditions
Since inflammation is commonly mediated by the gut, proper evaluation of an inflammatory condition often starts with the gastrointestinal tract. There are seven common areas that should be considered when looking at causative factors for gastrointestinal dysfunction that has produced chronic inflammation. They are listed below, along with key triggers within the category of evaluation:
- Diet: alcohol, gluten, casein, processed foods, sugar, fast food
- Medications: corticosteroids, antibiotics, antacids, xenobiotics
- Infections: H. pylori, yeast or bacterial overgrowth, viral or parasitic infection
- Stress: increased cortisol or catecholamine levels
- Hormonal: thyroid, progesterone, estradiol, testosterone
- Neurological: brain trauma, stroke, neurodegeneration
Common laboratory indicators of chronic inflammation include elevated:
- C-reactive protein levels
- white blood cell count
- sed rate
© Copyright 2016 Michael Lam, M.D. All Rights Reserved.
Thank you, Dr. Lam, for all your work to aid those who suffer from AFS and for providing a guide. You give me hope that if I listen to my body and give it what it needs, I may one day recover. Most doctors prefer to treat patients where there is less of an unknown. I personally, am extremely thankful for the work you do!