The NEM Stress Continuum Response – Part 1

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

The stress continuum and your doctorOne of the greatest challenges in clinical medicine is the clinician’s ability to take clues from the body presented as signs and symptoms and translate that to a diagnosis that accurately reflects the underlying pathology. Once a proper diagnosis is made, a solution is relatively straightforward for the most part. The most challenging cases are often those which appear to defy conventional medical logic, cannot be compartmentalized, and where laboratory tests appear to be normal or insufficiently strong to pronounce a straightforward verdict. This is where the stress continuum response comes into play.

For example, it is relatively easy to make a diagnosis of diabetes if the fasting blood sugar is over 140 mg/dl (normal under 125 mg/dl) and the HBA1C exceeds 7.0 (normal under 6.5 mg/dl) What about those who are otherwise normal but with a slight hypertensive history, a positive family history of diabetes, and generally in good health, but have fasting blood sugar of 120 mg/d; and HbA1C of 6.3 mg/dl? In the past, these factors were considered “normal”. Patients were sent home. In recent decades, research has shown that many chronic diseases exist in a continuum of ranges, like the stress continuum, from mild to severe – whether it be diabetes, chronic fatigue, depression, hypertension, autism or even Alzheimer’s’ Disease. The compartmentalization approach of “all or nothing” is an incomplete thought process when it comes to such conditions because it is too simplistic a view of how a diseased state affects the body.

Until recently, fibrocystic breast disease, endometriosis, uterine fibroids, and PCOS were thought of as independent entities. We now know they are all an expression of the same underlying condition called estrogen dominance. It is clear that chronic disease does not exist in a vacuum. The progression, whether it be classified in stages, phases, or steps, all point to the same psychological construct, that disease and conditions are progressive in nature. Autism has now been renamed Autism Spectrum Disorder, for example.

Such progression have been discussed earlier in great detail with regards to Adrenal Fatigue Syndrome, where the body progressively advances through various symptoms from stages one through four as the condition worsens. Each stage of the condition presents with different but overlapping symptoms. Reversal and recovery efforts are necessarily different because in each stage, the body’s underlying health and response may be very different. Using the same approach, regardless of what stage a sufferer is in, is a sure recipe for failure. In fact this is a common clinical mistake and accounts for the majority of clinical and self navigation errors.

Various organ components and internal biological circuits are involved in the body’s overall stress continuum response. Yes, it is way more than the adrenal glands and sympathetic nervous system that is involved. While the adrenals are an important anti-stress regulatory center, the body has additional systems in place concurrently. Indeed, such systems appear complex and convoluted on the surface. However, on deeper study, one can see that there is a logical and systematic holistic response available to the body to help restore harmony. Focusing on a single organ or system dysfunction can blind us to the big picture. This narrow focus is a common clinical mistake.

The big picture is the stress continuum responsesLet us accept that the body is seldom (if ever) wrong. It is us who have failed to see the forest because we are so focused on the trees. Our specialization has blinded us at a time when we need to be a generalist. If we are able to let go of our pretenses and look from afar at the big picture, it is crystal clear that the body’s staged NEM stress continuum response is a defense system masterpiece fortified with redundancy to ensure survival of our species. Symptoms can range from annoying to downright unpleasant and incapacitation can even result ultimately, but these are the body’s only ways to alert us of a problem within.

Our body, when it comes to handling stress, is far more wise and comprehensive we think. Multiple systems and organs are involved. This is in stark contrast to our myopic vision of assigning it only one system such as the hypothalamic-pituitary-adrenal (HPA) hormonal axis, for example. As far as the body is concerned, the fact is that no single organ or system can fully do all that is necessary, all by itself, in times of stress. Overcoming stress is a team sport, requiring each player to contribute to the overall success. The body’s orchestration of the neuroendocrine and metabolic components and their circuits simultaneously and collectively is miraculous and amazing – to say the least.

The proper assessment of the NEM stress continuum response requires that we first understand that our body’s response to stress spans a continuum from mild to severe, with different responses at each point of the spectrum. Secondly, we need to know that the body uses and place different emphasis on its neuroendocrine component and its metabolic component, depending on the stage of stress. Understanding these two fundamental concepts is the first step towards the healing process.

NEM Response Continuum

Fatigue and low energy is a physician’s office most frequent complaint and accounts for more than fifty percent. Our body’s built in NEM stress response is activated when stress arrives on our doorstep.

Clinical experience has shown us that the body’s NEM stress response is designed to be graded and activated in sequential steps as stress increases. This make perfect sense. The body will not ring multiple alarm bells to warn us of impending danger when only one or a few will do to resolve stress in situations when it is mild – such as having a late night out. The body, however, will relentlessly ring multiple alarm bells available if the fire of stress is rampant and out of control – such as when there is a loss of a loved one or traumatic accident. Different responses are thus activated to match the level of stress perceived by the body. This is good design.

The two major components of the NEM stress response, the neuroendocrine and the metabolic responses, are activated in sequential fashion when exposed to stress.

Stage 1 – NEM Stress Continuum Response Activation:

the stress continuum keeps us on alertWhen stress is mild, the body’s metabolic response (consisting of the metabolism, detoxification, and inflammation circuits) is engaged automatically in an auto-regulation process, as the first line of defense. Stress induces a demand for more energy. This can be accomplished by increasing metabolism. The body does exactly this. Extra energy generated keeps us on alert mentally and physically – ready to escape the threat of stress – whether it be physical or emotional. Our body’s becomes inflamed as part of this response and protection process. The purpose is to remove unwanted and harmful stimuli (including damaged cells, irritants, or pathogens) quickly and begin the healing process. Stress induced free radical damage are quickly and automatically removed by our detoxification system. Reactive metabolites are kept to a minimum, well within the capability of the body to store and handle. The three metabolic circuits collectively help to quickly restore the body back to equilibrium or homeostasis, working within their capacity behind the scenes. Symptoms are mild if any. A sense of tiredness may be experienced, but generally contained with a bit of rest as the body’s metabolic response kick in.

Signs of increased metabolic demand are plentiful if one looks closely. Sugar craving, a early symptom of metabolic derangement, can be overcome with donuts and sweet food. Exercise intolerance is blamed on aging, and food sensitivities viewed as hereditary are passed on.

The neuroendocrine circuits are also activated in this stage, but at a much lesser degree as the metabolic circuits carry out the burden of the work. The HPA axis is on standby waiting to be called into action. The sympathetic nervous system is put on standby. Occasional heart palpitations are passed over as normal after a typical medical work up. Mild insomnia is resolved with over the counter sleep aids. Brain fog is passed over as insignificant.

The neuroendocrine component of this stage incorporates symptoms physiologically consistent with Adrenal Fatigue Stage 1, also referred to as Alarm Reaction. The dominant overall anti-stress response rests with the metabolic auto-regulation component of the NEM stress continuum response.

The NEM response is able to return the body to normal function if and when stress arises in this stage. This is the way the body is designed. Our life continues normally as stress subsides and hopefully stay away. Most people do not even realize they have passed this stage unless it is in retrospect.

Stage 2 – NEM Stress Continuum Response Overdrive:

As the assault of stress increases, the workload burden on our metabolic circuits increases as well. The three metabolic circuits – metabolism, detoxification, and inflammation – go into overdrive. If stress is unrelenting, these circuits eventually reach their maximum workload in this stage. Further burden triggers metabolic dysregulation, evidenced by dyslipidemia and central obesity, for example.

As our metabolic circuits get close to or reach capacity in this stage, the marginal benefit decreases. Metabolic dysregulation may begin if the metabolic circuits are not given proper rest and rebuilding time. The body recognizes this and calls upon the neuroendocrine system into action – as stage 2 progresses. Unwanted weight gain can be caused by the stress continuumThis work is the responsibility of the HPA hormonal axis. Starting in the brain and ending in the adrenal glands, the anti-stress hormone cortisol output rises and reaches its peak as the HPA axis is put on overdrive to help the metabolic circuits which are reaching maximum capacity. The HPA axis will drive more cortisol output from the adrenal glands to reduce inflammation and generate energy from within. With regard to neuroendocrinological factors, the body is in stage 2 of Adrenal Fatigue Syndrome, also called Resistance Response.

Clinical symptoms of fatigue in this stage are mild to moderate. Fatigue becomes more frequent. Weekends can be spent at home recuperating. Strong willed sufferers will continue to demand top performance from their body as they refuse to slow down and rest. Many start to come home drained after a full day’s work. This process can go on for years or decades. The body’s nutritional reserve reduces as its resiliency starts a subtle downhill pattern.

Read Part 2

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

Stress continuum
Stress continuum