The Fundamental Guide to Your Autoimmune Condition

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

an autoimmune condition can raise many questionsMillions of people have some form of autoimmune condition, and this number is rapidly growing. Prevalence of the disease is 75% more common in women than in men. Autoimmune disease occurs when the immune system begins to attack healthy tissue in the body, thinking it is an invading bacteria or virus. It is thought that because women have a stronger, more reactive immune system than men, they are more susceptible to an autoimmune condition. Autoimmune diseases are classified by the main tissue the immune system attacks. While the conditions often cause systemic issues, usually one main organ system is the target of autoimmunity.

There are many types and progressions of autoimmune diseases, and many have widespread symptoms. It is important to note that discovering you have an autoimmune disease does not mean that there is no hope. Autoimmune diseases vary, symptom to symptom and person to person, so depending on how you manage your condition, there is an opportunity to reclaim your health and your life. However, it is important to understand that the antibodies will usually be present and can flare up from time to time.

The goal is to stay in remission as long as you can by identifying the cause, staying away from triggers, and optimizing your immune system.

Because many different organs can be affected throughout the body, symptoms of each autoimmune disease can vary greatly. The symptoms of an autoimmune disease can often mimic the symptoms of adrenal fatigue. The two conditions are related, and it is important to note the differences between the two, the similarities, and how both can exist in a susceptible body.

Common Autoimmune Conditions

Some common autoimmune conditions include:

Hashimoto’s Thyroiditis – The immune system attacks the thyroid, which decreases the thyroid’s effectiveness and results in hypothyroid symptoms.

Inflammatory Bowel Disease (IBD) – Ulcerative colitis or Crohn’s disease, which includes diarrhea, nausea, and abdominal pain; the immune system attacks the lining of the colon.

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, which causes joint swelling, joint pain, and even changes to bone structure.

Celiac Disease – The immune system is triggered and reacts to gliadin, a component of gluten, which then causes damage to the intestinal lining.

Sjogren Disease – A condition characterized by dry eyes and dry mouth. The immune system attacks the salivary glands and tear ducts. This syndrome can also be seen with other autoimmune conditions.

Raynaud’s Phenomenon – Often a symptom in many other autoimmune conditions, it is characterized by vasoconstriction of the blood vessels supplying the fingers, resulting in white waxy fingers due to cold or stress.

Stages of Autoimmunity

Autoimmune condition stagesThere are three stages to the progression of an autoimmune condition. Stage 1 is a silent autoimmune condition, where antibodies can become elevated, but the target organ has no symptoms or loss of function. Stage 2 is Autoimmune Reactivity, where antibodies are elevated, and the person presents with some symptoms and mild loss of function. However, in stage 2 there is no severe impairment of the tissue associated with the disease. Stage 3 is what most doctors would identify as autoimmune disease, where labs, imaging, and special studies can identify significant loss of function, along with elevated antibodies and significant symptoms.

Conventional medicine usually catches such dysfunction when it’s already too late and in full blown late stages. For example, Addison’s disease is only identified when 90% of adrenal function is affected. By this time, it is very difficult to regain adrenal function.

However, it’s encouraging to know that you can identify your problems well before it reaches stage 3 of autoimmune disease if you are on alert and listen carefully to your body’s signals. When caught early, your body has plenty of chances to rebuild itself, with the right guidance.

What Causes an Autoimmune Condition?

The exact cause of autoimmune disease is unknown, but environmental and genetic factors play a large role in onset and progression. Environmental factors such as chronic stress, toxin/pollutant exposure, immune-reactive dietary proteins, and underlying infections have all been examined as potential triggers for immune dysregulation.

Once the immune system starts to identify its own cells as enemies, it can lead to a loss of self-tolerance, and therefore production of self-tissue antibodies.

Some viral infections, especially with Epstein Barr Virus, Herpes Simplex 1, and Herpes Simplex 2, have been associated with autoimmune disease onset. The bacteria E.coli has also been thought to contribute to autoimmune conditions. The reasons for these infections triggering autoimmunity is unknown, but there are two working theories.

Causes: Molecular Mimicry

The first theory involves molecular mimicry. Molecular mimicry is a way the virus or bacteria might try to escape the immune system. In a normal immune system, the virus presents itself, the immune cells recognize it as foreign material, and the immune system attacks it. In molecular mimicry, the virus is able to disguise itself to look like healthy tissue (by attaching to proteins and sugar complexes that healthy cells have on their surface). The immune system doesn’t recognize the invading virus at first, so the infection can spread. Eventually, the immune system catches on, but because the virus mimicked healthy tissue, the body is now susceptible to mistaking healthy tissue for a virus and attacking it instead.

Autoimmune condition, viruses and bacteria.A very 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 it to create antibodies against it. Since gluten has been shown to cross-react with the gut and pancreatic islet cells, the antibodies against gluten actually damage the body’s own cells, leading to an increase of gut diseases and possible diabetes.

Causes: Microbiome and Gut Health

The second theory involves gut health. Studies have shown that people with type 1 diabetes and rheumatoid arthritis have less healthy gut bacteria and oral microbiota. Since many immune cells are located in the gastrointestinal tract, it is logical that an unhealthy gut can lead to abnormal immunity. E.coli infection damages gut health and can contribute to this.

Maintaining healthy gut microbiota and a healthy intestinal lining is important for overall health. When infected with E.coli, gut microbiota is thrown out of balance, which affects how the body absorbs and manages nutrients. This dysregulation can damage the intestinal lining, which causes the immune system to attack the healthy tissue of the gut. This can result in issues such as IBD, inflammatory bowel disease. While having an unhealthy gut might not cause autoimmunity in everyone, if the body is genetically predisposed, it might be enough to cause a reaction.

Causes: Genetics

Genetic factors play a role how immune cells are structured. There are many ways immune cells function, one of these is via the MHC, major histocompatibility complex, which are a set of proteins involved in cell recognition. A slight genetic problem with this complex, combined with an environmental trigger, can be enough to tip the body into an autoimmune condition.

The genetic link, however, is not as simple as one protein code and one gene. There are many factors and issues that can be linked and studied. An example of the complexity is to look at how autoimmune diseases play out in a family. Often, when a disease is genetic, it is passed down to children. However, autoimmune diseases are unique because different autoimmune conditions can occur. If one person in the family has Hashimoto’s thyroiditis, another member of the family might have SLE (lupus). While the genetics prime the body for an autoimmune disease, environmental factors determine the course of the disease.

When you have an increased risk of an autoimmune disease, it does not necessarily mean you will get that disease, unless it is triggered by a situation or condition of the body. If environmental factors and existing conditions of the body are favorable towards an autoimmune disease, it will be easier to trigger one. In some cases, the body can be genetically predisposed to an autoimmune condition, but environmental factors are never strong enough to progress to a disease.

Autoimmune Diseases and Adrenal Fatigue

an autoimmune condition and adrenal fatigue/Adrenal Fatigue Syndrome (AFS) is a condition directly related to the hypothalamic-pituitary-adrenal (HPA) hormonal axis. This axis is the pathway that manages the response to stress and the release of cortisol. Stress can be an external event or an underlying condition of the body. AFS is a condition that can surface when the adrenals are overtaxed and become exhausted. The clinical presentation is wide and varied. Symptoms can include fatigue, exercise or stress intolerance, insomnia, metabolic disturbances, frequent infection, heart palpitation, hypoglycemia, and many others. The effects of a weak adrenal system can be felt throughout the body.

Autoimmune Disease Progression as a Cause of Adrenal Fatigue

While there is no clear cause of an autoimmune condition, there are many factors come into play when examining the etiology of the disease. These include a genetic predisposition and an array of environmental factors, from stress or infection, to issues with the immune system. Often overlooked and seldom considered is the role the adrenals play in this.

The adrenal glands are located just above the kidneys and control the production and release of the hormone cortisol. When under physical or emotional stress, the hypothalamus acts on the anterior lobe of the pituitary gland, which triggers many hormone pathways including the ACTH to signal the adrenals to produce cortisol. After sufficient amounts of cortisol are produced, cortisol acts on the hypothalamus and turns the signal pathway off.

If, however, cortisol production is not sufficient, the pathway is not able to turn off, and the upstream hormone ratios are out of balance. This puts pressure not only on the adrenal glands but also on the upstream glands, such as the anterior pituitary, which controls many other hormone regulations. These include the thyroid hormone response, bone growth, and sexual development. Hormone and cortisol imbalances have been associated with a higher incidence of an Autoimmune condition, including Systemic Lupus Erythematosus, and Hashimoto’s Thyroiditis.

Cortisol, produced by the adrenal glands, is extremely important in supporting the body in times of stress. It has an especially important role in immune system suppression. Cortisol down-regulates the immune response. Autoimmune disease is the result of the immune system overreacting to a stimulus, and beginning to attack healthy tissue over time. Usually, the body has checks and balances in place. When the immune system is on overdrive, cortisol is able to down-regulate it and bring the immune response back into balance. This is how the body normally works.

However, excessive stress on the body puts a strain on the adrenal glands and alters the balance of hormones along the way. This can lead to adrenal fatigue.

The progression of an autoimmune conditionAdrenal fatigue and the circumstances that cause it are a perfect storm for triggering an autoimmune condition. In advanced adrenal fatigue, cortisol levels are diminished. When the levels are diminished, cortisol is not available to effectively downregulate an overactive immune system, so the immune response can progress unchecked from stage 1 to stage 3. The body becomes inflamed. It should come as no surprise that people who have weak adrenal function are predisposed to an autoimmune condition.

Likewise, if your body is genetically predisposed to autoimmune reactivity, and there is an environmental trigger, cortisol is usually able to keep the response low and managed. If, however, you are also suffering from adrenal fatigue, your cortisol levels are not able to regulate your immune system, and it is much more likely to lose self-tolerance. This scenario is the perfect opportunity for an autoimmune disease to arise, show symptoms, and worsen.

While adrenal fatigue does not directly cause autoimmune disease, it is important to understand the relationship between cortisol and immune system management.

Adrenal Fatigue as a Result of an Underlying Autoimmune Disease

As mentioned above, AFS can be the result of chronic stress on the body. This can be due to an external stress, such as a stressful work environment, relationship, or economic situation. However, it can also be due to an underlying stress on the body such as a chronic infection or disease, such as autoimmune disease.

The HPA pathway is triggered when our body encounters a stressful stimulus. Usually, this stimulus is short lived. The hypothalamus signals the pituitary to release hormones which affect the adrenal glands to produce the hormone, cortisol. Cortisol then travels throughout the body to respond to the stimulus. This includes activating sugar reserves to give the body energy and releasing neurotransmitters, such as norepinephrine, to keep the brain on alert. Epinephrine is also released to ready the body for the ‘fight or flight’ response.

Cortisol and other glucocorticoids also manage the inflammatory response. They are able to upregulate anti-inflammatory signals and downregulate proinflammatory chemicals. The result is suppression of the immune system.

In an autoimmune condition, the immune system tends to be working on overdrive. This is especially true if one is in a hyperactive immune state. Because the body is a network of chemical signals, the increase in the immune system causes a high demand for cortisol and glucocorticoids. This activates the HPA axis, and the demands on the adrenal glands become huge. If this demand is chronic, the adrenal glands are not able to keep up with the cortisol output needed to regulate the immune system. A heightened immune state may be due to primary autoimmune condition or foreign objects being placed into the body, such as breast implants, over a long time. Your body's reaction to foreign object can trigger classic autoimmune condition symptoms, such as fatigue/The body’s reaction to such foreign object can be negative. It can trigger an autoimmune response with all the classic symptoms of autoimmune disease such as fatigue, joint pain, anxiety, and brain fog, just to name a few. Removal of such objects may give temporary relief and reduction of symptoms. This welcomed relief, however, is often short lived. It is often followed by worsening fatigue and adrenal crashes. Without proper fortification of the adrenal glands ahead of time, the immune heightened state which the body has been accustomed to continues unabated. When combined with preexisting adrenal weakness with low cortisol output, the heightened immune response can trigger increases in reactive metabolites which in turn can lead to adrenal crashes.

Eventually, adrenal fatigue sets in because cortisol production from the adrenal is insufficient to meet the demand needed to calm the heightened immune system response.

Whether it’s autoimmunity that causes AFS, or AFS that weakens the immune response, it is important to see that both can affect each other and create a vicious cycle if not corrected. Unfortunately, conventional medicine often misses the adrenal connection.

A Hyperactive Immune State

Regardless of whether autoimmunity is the cause or result of AFS, it is clear that a healthy immune system is a necessary part of the body’s defense system.

Unfortunately, in a small number of people, the immune system can operate in a hyperactive state, well beyond the normal overdrive that it initiates to handle pathogens or insults. This can lead to serious consequences. Sufferers in this category are uniquely faced with a clinical situation where symptoms of autoimmune conditions exist but laboratory tests are not supportive. These sufferers are nevertheless told they have autoimmune disease. However, without focusing on the root cause, a positive clinical outcome is elusive. In the presence of AFS, the clinical picture can be very confusing.

Consider how the immune system works under stress. The immune system is able to detect pathogens that may become active when the body is under stress. To protect the body, an inflammatory response is initiated to help neutralize any pathogens that may take this opportunity to surface. The immune system’s job is to attack and neutralize a myriad of active and potential pathogens simultaneously. Flare-ups of co-infectious states (such as H pylori and Lyme Disease) and chronic pathogens (such as candida, EBV) will be automatically squashed if the immune system works properly.

Most people think of a weak immune system as the cause of recurrent infections. This is certainly true. On the flip side, few are aware that a hyperactive immune state can also be problematic. It is, in fact, a key factor in the formation of the perfect storm that leads to inflammation circuit dysregulation.

an autoimmune condition and your immune systemThe body’s immune system tends to be very well designed, and cells are trained to recognize and target the enemy while avoiding ‘friendly fire’ and an autoimmune condition. In some people, however, a hyperactive immune system, well beyond an overload state, can generate an immune response that is more than what the body needs. It can be too much. Certain antibodies, for example, can experience a cross-reaction between outside and internal real and perceived pathogens, creating a rampage of ‘friendly fire’, where normal cells are attacked along with pathogens. This can cause a flare up of symptoms consistent with autoimmune-type conditions. In other words, a hyperactive immune system can trigger symptoms resembling an autoimmune condition.

It is important to remember that such events are uncommon. However, when the body’s immune system is in a hyperactive state, the collateral damage can be significant. Sufferers can begin to experience symptoms typical of an autoimmune condition, such as joint pain and fatigue. When the body is already inflamed from existing microbiome imbalance, GI tract irritation, or reactive metabolite overload, it is hard to decipher if there is a true autoimmune disease (such as primary Hashimoto’s thyroiditis or lupus), or just symptoms resembling an autoimmune condition surfacing.

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 very high as they are in a true primary autoimmune state. Other laboratory studies are generally unremarkable. Unfortunately, few clinicians are on the alert for this differentiation, which 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 an identification of autoimmune disease. There is no comprehensive look at the body holistically to discover if a hyperactive immune state or AFS could be involved.

Patients are often put on steroids and autoimmune medications. Short-term benefit is common, as the hyperactive immune state calms down due to the anti-inflammatory properties of corticosteroids. However, long-term use of steroids can be problematic as it can reduce the overall immune response and mask the underlying problem. Often this is excessive metabolites in a setting where a hyperactive immune state is the true cause. There is a slow deterioration of the body, especially the inflammation circuit of the NeuroEndoMetabolic (NEM) Stress Response. Over time it becomes dysfunctional. One organ that is most easily affected is the thyroid.

Autoimmune Thyroiditis

The thyroid gland is one of the organs most vulnerable to attack by a hyperactive immune system, leading to low thyroid function. Symptoms of hypothyroidism are also prevalent in advanced AFS. In addition, primary thyroid dysfunction also needs to be considered to properly identify the condition. Deciphering which thyroid condition is present is important because recovery approaches are very different for each.

The thyroid gland controls the overall metabolic rate and is responsible for the body’s temperature regulation. Slight changes in thyroid function can result in fatigue, weight gain, and feeling cold on the hypothyroid side. Anxiety and heart palpitations occur on the other extreme.

an autoimmune condition and the thyroidOne of the most frequent complaints that brings people to their doctors is fatigue and lack of energy. The standard medical workup is usually 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 type is the anti-TPO antibodies. They are present in roughly 90% of Hashimoto’s thyroiditis, 10-20% of nodular goiter or thyroid carcinoma, and 75% of Graves’ disease. Clinicians often believe they have identified Hashimoto’s thyroiditis based on laboratory tests showing anti-TPO antibodies in a clinical setting of fatigue and low energy.

It should also be noted that 10-15% of normal individuals can have a high-level anti-TPO antibody titer. They do not have a primary autoimmune disease like those mentioned above. The high titer can be secondary to a hyperactive immune system when the inflammation circuit is on overdrive.

These patients can be mistakenly told they have clinical or sub-clinical primary Hashimoto’s thyroiditis. Thyroid replacements are often started. Little consideration is given to alternative causes such as inflammation circuit overload. When symptoms of fatigue improve with thyroid replacement, physicians are mislead into thinking they were on the right track, especially if thyroid laboratory studies starts to normalize. More often than not, the high anti-TPO antibody count may not normalize totally, but fatigue improves. Doctors are at a loss, but since the patient is feeling better, no further investigation is taken. In other words, normalizing TSH, free T4, and free T3 gives the physician a false sense of complacency. A persistent high rT3 or anti-TPO titer is disregarded in such circumstances.

Little attention is placed on investigating whether or not symptoms are caused by a hyperactive immune state, which is often triggered by inflammation circuit dysfunction, accompanied by fatigue and adrenal burnout. Because thyroid replacement tends to 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 mistakenly on primary thyroiditis alone.

Without resolving the root cause of a hyperactive immune state and concurrent adrenal fatigue as secondary causes 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 considered to be an autoimmune issue based on lab tests and symptoms when, in reality, they represent a body in trouble with its inflammation circuit. Thyroid replacement merely covers up the symptoms. A holistic approach should be deployed to fully comprehend the root cause and effect a comprehensive long-term recovery plan.

Steroids: Friend or Foe

an autoimmune condition and steroidsIn addition to or in place of thyroid replacement therapy, one of the first methods for autoimmune disease management is administration of oral glucocorticoids. While this is a valuable short-term solution, there are many issues with taking steroids long-term as immunosuppression.

One issue is a decreased immune system, which makes the body more susceptible to common diseases such as a yeast infection, cold, or flu. Other issues include triggering the onset of Cushing syndrome, which can be the result of chronic glucocorticoid use. Cushing syndrome symptoms include a rounded, reddened face, fat accumulation, and decrease in bone density. To avoid Cushing syndrome, it is important to use glucocorticoids under the supervision of a health care provider and avoid using steroids as a long-term solution.

It is important to avoid chronic steroid use in managing an autoimmune disease while maintaining effective cortisol levels. It is easy to overburden the adrenal glands when you have an autoimmune condition. In proper autoimmune management, the adrenal glands should be supported to function effectively, promoting sufficient cortisol levels and managing the immune response, while removing the triggers for a hyperactive immune state.

An Autoimmune Condition and the NEM Stress Response

From 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 the body’s overall response to stress. It plays a unique role, both in the mediation of immunity and in the health of the metabolic and inflammatory process. Autoimmunity and adrenal fatigue are linked 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. This can also amplify any issue already present 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 the inflammatory circuit, metabolic circuit, and detoxification circuit. Under stress, ideally, all three of these processes function together to create stress hormones, cleanse the body of unnecessary toxins, boost the metabolism, and decrease inflammation to ready the body for action. However, under chronic stress, if there is an imbalance with one of these processes, it has repercussions for the whole body.

An autoimmune condition stress responseThe triad involved specifically 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 infection response. Studies have shown that high-fat feeding can change the gut flora, leading to increased intestinal permeability and lipopolysaccharide (LPS) absorption. LPSs are negative byproducts of bacteria, so absorbing large amounts of them can cause increased endotoxemia that triggers inflammation in the gut, leading to metabolic and autoimmune condition.

Certain food additives have also been found to allow intestinal tight junctions to become more permeable by bacteria, which is associated with the rising incidence of an autoimmune condition. Some examples of auto-immunogenic additives are gluten, emulsifiers, organic acids, nanoparticles, and the MTG (microtransglutaminase) found in meat glue.

When functioning correctly, the gut microbiome, nutrient absorption, and immune response all work together to protect the body from invaders and digest food. At the appropriate time, the immune system is downregulated, the metabolism functions normally, and the excessive reactive metabolite toxins are cleansed from the body and excreted. If, however, there is a dysfunction in the GI tract’s absorption process, an imbalance in the microbiome, or an overactive immune response to digested food, issues tend to occur and throw the NEM system off balance.

Autoimmune Condition and Gut Health

Diet 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 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 the intestines because of previous immune responses and unchecked NF-kB is running around, the body may trigger 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 intestinal lining, allowing unintended proteins and particles through. The intestine lining is normally the first immune barrier to keep 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 of what stays in the gut and what enters the body. The body compensates launching an immune system attack on what it perceives as invading toxins, regardless of how benign they might be. Also, with increased immune response and leakiness, the immune system begins to respond more and more to the material that crosses over from the GI tract. This trains the immune system to react to similar looking nutrients and healthy cells throughout the body.

An autoimmune condition and gut healthIn 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 it is an ongoing management process. However, addressing the system holistically makes managing an autoimmune condition and adrenal fatigue easier and explains why the body might have both conditions and why certain supportive methods might be incredibly helpful.

Autoimmune Disease and AFS Relief

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

Foods and Supplements for Autoimmunity

Diet is a large part of managing an autoimmune condition. Many studies have been done on low-inflammatory diets and autoimmune-protocol diets that 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. Caffeine and sugar affect cortisol levels, so avoiding these in excess is often helpful in recovery.

Supplements can also be helpful both in adrenal fatigue recovery and autoimmune symptom management. It is most important to target the underlying cause of symptoms. However, while managing the underlying cause of stress and immune response, supplements can help support 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 downregulate 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, because those with adrenal fatigue can be sensitive to higher doses of supplements and should not self-navigate, especially if their adrenal fatigue is 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.

Another important way to prevent autoimmune and adrenal fatigue triggers is to improve gut health. Glutamine has been shown specifically to help leaky gut and compromised intestinal permeability. Glutamine helps rebuild the intestinal barrier and prevent bacteria, toxins, or foreign material from leaking through the intestinal wall into the body, triggering an immune response. This relieves the immune system and improves gut function. Those with AFS may not tolerate this amino acid, which also has a metabolic stimulatory effect.

Foods high in vitamin B5 are part of the diet to help autoimmune conditionPantethine, also known as vitamin B5, helps with leaky gut by improving both gut motility and intestinal repair. Pantethine causes contraction of the gut wall and stimulates movement of blood. This improves 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 vitamin C.

There are many other supplements like plant sterol, DHEA, and pregnenolone that can be helpful as well. Lifestyle modifications can also support adrenal function and help manage autoimmunity. Another consideration is your individual type of immune system.

TH1 or TH2 Dominance and Autoimmunity

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 lemon balm.

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. Foods 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 disposed to be more TH1 or TH2 dominant. Therefore someone who is TH2 dominant might not feel good when taking the TH1 supplements like echinacea. Likewise, 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 they affect you before taking large amounts of these supplements.

Considerations for Managing Autoimmunity

It is best to seek support from your healthcare provider before embarking on a plan for recovery. It is also essential to understand the fine balance between autoimmune conditions, adrenal fatigue, and the importance of cortisol, the microbiome, and gut health. All of these must be examined holistically in order to effectively create a plan to reach a state of balance.

These conditions are not static, so it follows that a plan for supporting the body to manage these conditions is not static either. The processes are dynamic and fluid, so to effectively address all the processes involved, a multisystem support plan must be in place. With adrenal fatigue, nutritional supplements may lead to paradoxical reactions, with outcomes opposite what is normally experienced. The weaker the adrenals, the higher the risk. Therefore, self-navigation is not recommended.


Autoimmune condition contributing factorsAutoimmune diseases are on the rise in the United States. While there is no single known cause of an autoimmune condition, there are many contributing factors, such as environmental impacts, genetic predispositions, and underlying conditions in the body.

One of these conditions is leaky gut syndrome. When the permeability of the intestine walls is compromised and foreign material is able to pass into the body, it can trigger a full immune response, which in turn can be the tipping point that causes autoimmune reactivity.

An autoimmune condition can be a result of adrenal fatigue, and adrenal fatigue can be the result of an autoimmune condition. While on the surface this can be confusing, it makes sense because of the relationship with cortisol. Cortisol downregulates the immune system. If the immune system is dysfunctional, autoimmunity is more likely to occur. In someone with low cortisol levels due to advanced adrenal fatigue, sometimes this takes place.

Genetic factors also play an important role, especially for those who have a hyperactive immune state. An autoimmune condition is inflammatory by nature, generating unwanted reactive metabolites that can overtax the HPA hormonal axis. This can result in adrenal fatigue and a low cortisol state.

From the NEM Stress Response perspective, recovery from autoimmune conditions needs to focus on removing the root cause while supporting the adrenals. By tackling the gut triggers, reducing inflammation, and helping the immune cells function via balanced cortisol levels, improvement is possible.

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

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