Inflammation Circuit Dysfunction – Part 3

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


Read Part 1 | Part 2

The Immune System and the Inflammation Circuit

The immune system is vital to a healthy inflammation circuitInflammation is an important component of your immune system. Chronic inflammation is usually the result of infections, an autoimmune reaction to your own bodily materials, or the result of an antigen from the environment, etc. In instances of chronic inflammation, the mediators are monocytes and macrophages, which are components of the immune system. They are leukocytes, otherwise known as white blood cells. Leukocytes, when confronted with a problem, release chemical agents that target that which has caused the inflammation circuit to response.

The problem, however, is that these cells not only target the invaders but your own tissue as well, causing damage. These damaged tissues need constant repair. Chronic infection is also responsible for your body continuously developing new blood vessels.

The repair work completed often causes irritations, and by so doing, results in the inflammatory process being retriggered. If for whatever reasons, this becomes a cycle, your body stays in a constant state of inflammation that, in the long-term, has a debilitating effect.

Modern medicine does not provide a long-term solution to the problem in such cases. At times, certain steroids that suppress your immunity are prescribed. These medications, however, often only provide short-term, symptomatic relief, and do not address the underlying root cause of the problem.

Autoimmune Diseases and the Inflammation Circuit

The inflammation circuit does not necessarily function correctly due to a strong immune system, as the immune system could, on occasion, when overactive, cause autoimmune issues.

When under stress, the immune system finds and protects us against pathogens, triggering an inflammatory response to deal with the problem. The immune system thus attacks and gets rid of any potential dangerous pathogens. An immune system that functions as it is intended quickly gets rid of the danger posed by certain chronic pathogens and infections.

Although a weakened immune system is often responsible for recurring infections, or even those that are difficult to get rid of, it is not necessarily the cause of illness – an overactive immune system may also be responsible.

Under ‘normal’ conditions, your immune system identifies and targets enemy pathogens, while leaving those considered as beneficial alone. At times, however, this is not the case, and the inflammation circuit becomes overzealous, creating an immune response to even normal cells and conditions.

When this occurs, certain antibodies become confused between what they see as a normal cell and what is perceived as a pathogen. It then attacks indiscriminately. The result, when this happens, is that the inflammation circuit is then presented with flare-ups that happen to be consistent with certain autoimmune conditions.

Overactive Immune and Autoimmune Disease

Consider the following where the body can potentially recognize its own cell as foreign and mount an autoimmune type response:

Food sensitivity

Eating a food we are sensitive to can cause inflammation and leads our immune cells to see our tissue as foreign. The immune response is activated to rid itself of such unwanted guests.

Microbiome Imbalance

Our gut is a complete ecosystem on its own, perfectly maintained by beneficial bacteria. When this system is off balance, as in someone who suffers from SIBO (Small Intestinal Bacterial Overgrowth), gastric reflux, H. pylori, irritable bowel, inflammatory bowel disease, catabolic state, or the gastric slowdown in advanced stages of adrenal fatigue, which can mean good beneficial bacteria are replaced by foreign non-beneficial bacteria. Gastric assimilation becomes suboptimal. Foreign opportunistic bacteria and stealth viruses transition from a dormant to active state. This causes the immune system to go into overdrive leading to chronic inflammation.

In this process, the immune system, especially if in a hyperactive state, can become easily confused about who the real enemy is. Attacks are made on the foreign opportunistic bacteria and itself concurrently, leading to various autoimmune diseases.

HPA axis imbalance

The HPA axis is the primary stress regulatory hormonal axis of the body. Cortisol is the main anti-stress hormone. In advanced stages of adrenal fatigue, insufficient cortisol produced leads to rampant systemic inflammation which in turn can contribute or trigger autoimmune symptoms.

Increased intestinal permeability (leaky gut)

Undigested food and immune system activation are part of inflammation circuit dysfunctionWhen food particles cross the gastrointestinal mucosa, inflammation is triggered. Undigested foods are supposed to be inside the GI tract. When it enters the hepatic circulation and the rest of the body, the immune system recognizes this as foreign and every attempt is made to try to attack and neutralize such foreign compounds. The persistent activation of the immune system can lead to immune cells cross-reacting with normal cells to trigger autoimmune diseases.

Heavy metal toxicity and chemical sensitivity

Environmental toxins are everywhere. It is impossible to escapes if one lives in the urban world. Excessive toxins accumulating in our body are triggers of our immune system to work in a hyperactive state to rid our body of such unwanted material. Those who are unable to carry this function naturally and properly can develop symptoms of autoimmune disease.

Chronic and stealth infections

Living in the modern world exposes us to a constant barrage of viruses, fungi, bacteria, and protozoa, etc. Some pathogens tend to stay with us for a long time, in a dormant state. They become activated and flare up when our immune system is weak. These organisms include Borrelia burgdorferi, Babesia microti, Candida albicans, EBV, CMV and many others. The diseases created by these pathogens can lead to hyperactivity of the immune system.

Cross-reactions with normal tissues in the body are not uncommon. Many of these infectious diseases present with symptoms of an autoimmune disorder, such as swelling, joint pain, psoriasis, fatigue, and food sensitivities. Autoimmune laboratory markers may be elevated in blood tests.

Excessive physical or emotional stress

This also lowers the barrier to invasion by a pathogen, triggering our immune system to go into overdrive. It can, therefore, be a conduit that initiates the autoimmune response. In other words, stress worsens any pre-existing clinical or sub-clinical autoimmune disorders.

Stress and inflammation circuit dysfunctionIt is important to remember that such events are uncommon. However, when the body’s immune system is overly active, or in a hyperactive state, the collateral damage can be significant. Sufferers can begin to experience symptoms typical of autoimmune diseases, such as joint pain and fatigue.

With a body inflamed from existing microbiome imbalance, GI tract irritation, or reactive metabolite overload, it is hard to fully decipher for sure if there is a true autoimmune disease (such as primary Hashimoto’s thyroiditis or Lupus), or just symptoms resembling autoimmune disease surfacing when the body’s good cells are attacked in the crossfire.

Laboratory tests such as RA, CRP, ANA titers and anti-TPO antibodies may add to the confusion. They may be normal or borderline high in these situations rather than sky high as with a true primary autoimmune state. Other laboratory studies are generally unremarkable.

Unfortunately, few clinicians are on the alert for this differentiation that depends on a detailed history for proper assessment. When normal or borderline high laboratory tests are accompanied by fatigue, joint pain, psoriasis, gastric discomfort, weight gain, vasculitis and muscle ache, the knee-jerk reaction by physicians is to jump to the clinical diagnosis of autoimmune disease. There is no comprehensive look at the body holistically to look out for a hyperactive immune state as the root cause.

The inflammation circuit is heavily affected by stressRemember it takes two hands to clap. A hyperactive state combined with pathogens perceived as foreign is the worst possible state. However, even if there is no significant pathogen, a body in a hyperactive immune state can cause damage simply by its hyperactivity.

Because clinical presentation is similar, little effort is put to trace the symptoms to the root cause – whether it is primarily pathogen-driven, hyperactive immune state driven, or a combination thereof. Patients are often put on steroids and autoimmune medications. Short-term benefit is common, as the hyperactive immune state calms down from anti-inflammatory properties of corticosteroids.

Long-term use of steroids​ can be problematic as it can reduce our overall immune response and mask the underlying problem of excessive metabolites within a setting of hyperactive immune state being the true cause. There is a slow but gradual deterioration of the inflammation circuit over time as it becomes dysfunctional. A typical example of this is Hashimoto’s thyroiditis.

Check out this easy to understand infographic about the immune system and inflammation circuit triggers

Autoimmune Thyroiditis

The thyroid system is often one of the organs most vulnerable to dysfunction from a hyperactive immune state as the body’s inflammation circuit is put into overdrive. The thyroid glands control the overall metabolic rate and are responsible for our body temperature regulation. Slight changes in thyroid function can result in fatigue, weight gain and feeling cold on the hypothyroid side and anxiety and heart palpitations​ on the other extreme.

One of the most frequent complaints that bring patients to their doctors is fatigue and lack of energy. Standard medical workup usually consists of a complete metabolic panel to evaluate thyroid function. In a hyperactive immune state, anti-thyroid autoantibodies (also called anti-thyroid antibodies) that target one or more components of the thyroid may be activated. The most significant one being anti-TPO antibodies. It is present in roughly 90 percent of Hashimoto’s thyroiditis, 10 to 20 percent of nodular goiter or thyroid carcinoma, and 75 percent of Graves’ disease. Clinicians often make the diagnosis of Hashimoto’s thyroiditis based on laboratory test showing anti-TPO antibodies in a clinical setting of fatigue and low energy.

Also, it should be noted that 10 to 15 percent of normal individuals can have a higher level anti-TPO antibody titer. They do not have primary autoimmune disease like those mentioned above. The high titer can be secondary to a hyperactive immune system when our inflammation circuit is on overdrive. These patients can be mistakenly diagnosed as having clinical or subclinical primary Hashimoto’s thyroiditis. Thyroid replacement is often started. Little consideration is given to alternative causes such as inflammation circuit overload.

When symptoms of fatigue improve with thyroid replacement, physicians are misled into thinking they were on the right track, especially if thyroid laboratory studies start to normalize. More often than not, high anti-TPO antibody count may not normalize totally, but fatigue may improve. Doctors are at a loss, but since the patient is feeling better, no further investigation is needed. In other words, normalizing TSH, free T4, and free T3 gives the physician a false sense of compliance.

A persistent high rT3 or anti-TPO titer is disregarded as important in such circumstances. Little attention is placed on investigating whether or not symptoms are caused by a hyperactive immune state trigger by inflammation circuit dysfunction that is clinically accompanied by fatigue that comes from adrenal burnout. Because thyroid replacement tends to help increase energy and normalize laboratory tests, there is little interest or need to further consider other differentials until this approach stops working. The entire focus of therapy is on primary thyroiditis alone as a presumptive diagnosis.

Make sure to check your thyroid if you have inflammation circuit dysfunctionWithout resolving the underlying root cause of a possibly hyperactive immune state and concurrent adrenal fatigue as a secondary cause of symptoms resembling autoimmune disorders, many sufferers will continue to need an ever larger dose of thyroid replacement to keep laboratory numbers normalized and sustain energy over time. This can play out over decades.

Many who started on T4 replacement eventually have to advance to combination T4/T3 formulas and ultimately to the most potent T3 replacement to maintain the same energy flow. They feel terrible inside, often wired and tired, only to be told all is well.

In other words, thyroid slowdown symptoms are treated as an autoimmune issue based on lab tests and symptoms when in reality, it represents a body in trouble with the inflammation circuit. Thyroid replacement merely covered up the symptoms in such cases. A holistic approach should be deployed to fully comprehend the root cause and effect a comprehensive long-term recovery plan.

Conclusion

The inflammation circuit is part of the NeuroEndoMetabolic (NEM) stress response deployed by the body to overcome stress. Excessive and dysregulated inflammatory response can wreck your body, leading to a host of conditions and undesirable symptoms. Conventional medicine’s approach to this problem is by way of suppression of symptoms. This can worsen the situation over time. Autoimmune diseases and hyperactive immune state are frequent consequences. Understanding the body from a holistic standpoint is needed to fully comprehend the clinical significance because of the systems-wide reunification when a body is overly inflamed.

Read Part 1 | Part 2

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


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