Healthy Gut Bacteria, Microbiome and Adrenal Fatigue Syndrome – Part 2

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

Read Part 1

Healthy Gut Bacteria

Healthy microbiome and Adrenal Fatigue recovery go hand-in-handThe association between adrenal fatigue and microbiome is more than casual. The microbiome is defined as the entire habitat, including the microorganisms, their genomes (i.e., genes) and their surrounding environmental conditions. Although dysbiosis – a disruption in our microbiome when healthy gut bacteria become imbalanced or altered – is one of the most frequent aggravating factors of issues with the microbiome and Adrenal Fatigue, it is often overlooked.

Adrenal fatigue is a condition describing a weakened adrenal state of function due to stress intolerance. The primary symptoms are fatigue and lack of energy. It represents the neuroendocrine stress response by the body, as it tries to overcome stress by way of the hypothalamic-pituitary-adrenal (HPA) hormonal axis. Routine laboratory tests are usually normal, and sufferers are normally sent home and told nothing is wrong by conventionally trained doctors after Addison’s Disease has been ruled out.

Microbiome and Adrenal Fatigue

There are four stages of adrenal fatigue. In early stages (stage 1 and 2), symptoms are very mild and subtle, and are often passed over, with complaints such as sugar craving, afternoon slump, and exercise intolerance compensated by snacking, napping, and reduced physical activity respectively. Advanced stages of adrenal fatigue (stage 3 and 4) are much more serious and can be incapacitating, with symptoms including reactive hypoglycemia, insomnia, low blood pressure, salt craving, dizziness, heart palpitations, menstrual irregularity, depression, panic attacks, and weight loss. Some are even bedridden requiring ambulatory help.

It is well known that gut pathogens such as Escherichia coli, if they enter the gut, can activate the HPA. However, animals raised in a germ-free environment show exaggerated HPA responses to psychological stress as well. Stress induces increased permeability of the gut, especially at the tight junction, which is the gap between mucosal cells that is usually hard to permeate. As the tight junction becomes more lax, toxins, bacteria, and bacterial antigens cross the epithelial barrier and enter systemic circulation, bringing cellular signals to the brain distally. Locally, mucosal immune response is activated, which in turn alters the composition of the microbiome and leads to enhanced HPA drive. It is clear that healthy gut bacteria must be taken into account when considering these factors that regulate the HPA both locally and systemically.

Research is currently exploring the interactions between gut microbiome and adrenal fatigue syndrome. Our healthy gut bacteria is therefore, directly connected to how well our brain handles stress, and ultimately, adrenal gland function. GI symptoms directly associated with advanced adrenal fatigue include bloating, constipation, food intolerance, gastric discomfort, diarrhea, intolerance to medications and supplements, and paradoxical reactions, just to mention a few. These symptoms usually improve as healthy gut bacteria is optimized. Studies into microbiome and adrenal fatigue may offer new insights into prevention and treatment possibilities.

Avoid intestinal dysbiosis with a healthy microbiome and Adrenal Fatigue plan.Multiple pathways are involved on how dysbiosis can affect healthy gut bacteria. They include systemic GI assimilation slowdown as the body tries to conserve energy, metabolic by-products build up due to liver sluggishness, extracellular matrix congestion, and receptor site damage. Dysbiosis is an unavoidable part of the big picture as normal healthy gut bacteria fails to normalize the body in its attempt to retain homeostasis when dysbiosis is rampant. Excessive inflammation appears to be a major common final pathway pathophysiologically with dysbiosis.

When faced with excessive stress, our body microbiome changes. Studies in squirrels living in a low-stress environment have shown that they harbor healthier communities of microorganisms. In the same squirrels examined two weeks later, studies have found that if stress levels increased, some bacteria that are potentially harmful also increased. The greater the stress in the squirrels, the less bacterial diversity are found, which can be an indicator of poor health.

Bad bacteria overgrowth and resulting GI dysbiosis are prominent clinical challenges as adrenal fatigue worsens to the advanced stages. It can overwhelm and reduce the good bacteria load. When the fungi and bad bacteria overwhelm our intestines, they can stimulate inflammation, which has the direct effect of damaging the gut track locally. If not resolved, systemic inflammation is part of the natural progression as adrenal fatigue worsens. The more bad bacteria are present, the more burden is placed on the adrenal glands to produce more anti-inflammatory hormone cortisol. As further disruption of healthy microbiome and adrenal fatigue symptoms worsen, the body weakens. Eventually, the adrenal glands become exhausted. Cortisol output starts to fall after reaching a peak. As cortisol level falls, inflammation increases. Inflammation is a silent killer. It damages the body even more, thus requiring more cortisol to help repair it. The adrenals are put to work even harder. This forms a vicious cycle in which the body eventually crashes as it runs out of steam. Facing a threat to its survival, the body starts an automatic shut down process of non-essential functions to conserve energy. This is also destabilizing. Without the nutrition reserves or replenishment to be sufficient for what is needed to fight stress, the body enters a state of negative nutritional reserve, creating a vicious cycle of ever lowering energy and ultimately a catabolic state as the body surrenders and assumes a low energy vegetative state as a survival method of last resort. Sufferers become bedridden, with slow GI function, and rampant systemic inflammation driven in part by severe dysbiosis.

The gut microbiome therefore plays a central role in adrenal fatigue. Restoring healthy a composition of gut microbiome and adrenal fatigue treatment should be seen as one in the same. Modulating the gut microbiome should be considered an integral therapeutic technique to adrenal fatigue recovery. Failure to restore a normal microbiome and adrenal fatigue may worsen. This can lead to retarded recovery, frequent relapse, lower threshold to adrenal crashes, frequent infections, the pain of unknown origin, metabolic derangements, brain fog, and depression.

Other Microbiome Related Illnesses

1. Irritable Bowel Syndrome

Irritable bowel can be linked to the microbiome and Adrenal FatigueFunctional bowel disorderliness such as irritable bowel syndrome (IBS) is defined solely by symptom-based diagnostic criteria. Abdominal discomfort or pain as well as altered bowel habits are the main symptoms of the condition. The exact pathogenesis of IBS is likely a confluence of many factors; however, there seems to be a connection between alterations in gastrointestinal flora and irritating inflammation of the gut characteristic of IBS. The gut microbiome is also important in preventing pathogens from flourishing, so an altered healthy gut bacteria may also play a role in allowing colonies of disease-causing organisms to form.

2. Inflammatory Bowel Disease

Ulcerative Colitis (UC) and Crohn’s disease (CD) are both forms of inflammatory bowel disease (IBD). These conditions include recurring chronic inflammation of the gastrointestinal tract. They are, however separate and distinct, with differentiating patterns of symptoms. Crohn’s disease is thought to result from an interaction between the gut’s microbe composition and the body’s genetics. It is defined by chronic segmental gastrointestinal tract inflammation. The symptoms of ulcerative colitis are similar, being inflammation and ulceration of the lining of the colon. However, it is thought that these two conditions are not the result of a single pathogen, but arise from dysbiosis of the gut changing the gastrointestinal microbiome and altering the functional environment; although the exact causes remain widely debated. Studies have found gut microbes to be correlated with the development of IBD, and they are thought to be key factors in mucosal lesion formation. Despite the lack of a clearly defined etiology, the evidence points to a strong connection between gut microbial health and IBD.

3. Colorectal Cancer

The gut microbiome may also have a role to play in the development of colorectal cancer (CRC). Like IBD, no single pathogenic organism has been found for CRC, however some organisms of interest have been identified in studies. Fusobacteria was found in higher numbers in colorectal tumors in one study, suggesting a link between the two. These tumors are often causal of, or at least associated with, persistent and chronic inflammation in the gut, which is also a risk factor for CRC. The link between microbially induced inflammation and CRC has also been highlighted in some other studies. Indeed, it has been established that microbial products can enter barrier-defective colonic tumors, trigger inflammation through a host immune response and, in turn, increase tumor growth.

4. Obesity

Obesity is a complex metabolic dysregulation that develops from a prolonged imbalance between energy intake and energy expenditure. Although lifestyle factors, diet, and exercise contribute largely to the modern epidemic, the gut microbiome plays an important part in the development of obesity.

Fight obesity by improving your microbiome and Adrenal Fatigue diet.Many studies with both mice and human subjects have evidenced strong associations between changes in healthy gut bacteria and the development of obesity. Some studies have shown a flourishing of the microbial genera Firmicutes along with a corresponding drawdown of Bacteroidetes populations in the gut of obese subjects. However, this skewing of population ratios between different microbial families disappeared after weight loss, returning to those seen in the gut microbiomes of lean individuals. This skewed Firmicutes to Bacteroidetes ratio was also observed in mice subjects genetically predisposed to obesity.

Genetic differences that can cause a predisposition to obesity include a greater number of genes coding for phosphotransferase functions that increase the rate of carbohydrate processing, and therefore suggesting it may be easier for these individuals to assimilate energy from sugar rich diets.
Using fecal microbiota transplantation as discussed above, studies have been conducted to introduce microbe populations from both obese and lean mice into mice with microbe-free guts. The results suggest a causal relationship between microbiome alteration and the development of obesity.

5. Type 2 diabetes (T2D)

T2D is principally linked with obesity-related insulin resistance. However, several genetic and some environmental factors are thought to influence the condition. Alterations in the composition of the gut microbiome of adults with T2D in relation to that of healthy control subjects has been noted.

Incidence of type 2 diabetes (T2D) is rising in numbers parallel to obesity, and the environmental factors that are linked with T2D risk include diets high in carbohydrates and altered healthy gut bacteria. Low-grade inflammation is witnessed in T2D patients; diabetic mice and humans that have raised plasma levels of lipopolysaccharide (LPS), the membrane component of Gram-negative bacteria, which has been proven to impair glucose metabolism in mice. Germ-free mice have lesser macrophages in their adipose tissue and increased glucose metabolism compared with colonized mice.

6. Atherosclerosis

Atherosclerotic plaques are hardened, thickened sections of the arterial wall resulting from accumulating white blood cells and adhesion of cholesterol to said wall. The thickening of the blood vessel wall is known as atherosclerosis, and it is often the cause of serious health events such as heart attack or stroke. Microbes from the genera Chryseomonas, Veillonella, and Streptococcus have been detected in these plaques, and they also exist in the oral cavity and the gut. Studies have demonstrated that patients who had experienced an atherosclerotic event had higher levels of Collinsella and lower levels of Eubacterium and Roseburia in their gut microbiome than healthy control subjects did.

7. Miscellaneous

Multiple digestion issues can be reduced by maintaining healthy microbiome and Adrenal Fatigue recovery.Mention the terms leaky gut, Small Intestine Bacterial Overgrowth (SIBO), food sensitivities, bloating, and autoimmune disease, and our mind seldom paints a picture of microbiome imbalance as a possible culprit. Yet it should be clear from the above discussion that the microbiome can play an important role in such disease pathology. While we are still in the early phases of research, evidence is mounting that symptoms associated with dysbiosis can reach far and wide, including symptoms that often appear unrelated to the microbiome. Unhealthy microbiome and adrenal fatigue have a variety of symptoms and vary among individuals. The variation in symptoms of unhealthy gut microbiome and adrenal fatigue makes diagnosis difficult. The symptoms include, but are not limited to,pain of unknown origin, rise of autoimmune conditions, food intolerance, food allergies, migraine headaches, blurry vision, metabolic slowdown, insomnia, depression, anxiety, and brain fog.

Tips to Improve Your Microbiome

Here is the approach to regaining a healthier microbiome by reducing inflammation, improving assimilation, and restoring healthy flora.

  • Avoid antibiotics. Antibiotics can actually have deleterious effects on the healthy gut microbiome and adrenal fatigue sufferers should use caution as well. Broad spectrum antibiotics especially are damaging as they inflict indiscriminate damage to swathes of microbial populations, and can disrupt the functional balance of the microbiome. As a result, more discerning health professionals may focus on narrow range antimicrobials as opposed to classic broad spectrum antibiotics unless there is no choice.
  • Take prebiotics and probiotics as needed. Prebiotics and probiotics are becoming increasingly popular. Prebiotics are particular nutrients that help beneficial microbes in our healthy gut bacteria to thrive and grow, helping to keep the gut microbiome healthy. For example, fibrous foods, fermented foods, asparagus, garlic, and onion. Use of the oral probiotic cultures to restore the gut microbiome has led to promising results in treatment of intestinal disorders like UC and obesity. While it can be argued that oral probiotic doses do not provide enough microbial numbers to fully influence the colon populations, it may be that these microbes impose their influence through complex means. These can include production of an antimicrobial or a modulation of your immune system. Researchers have also suggested that higher doses of one type of bacteria might not be as important as ingesting a variety of microbes. One should not get carried away with ingesting the highest concentration of probiotics. More is not necessarily better. This is especially true for those with adrenal fatigue, because they can trigger adrenal crash as well as constipation. The ideal dosage matches the body’s need with the ability of the body to clear it from the system once utilized.
  • Focus on food components proposed to benefit healthy gut bacteria. Living microorganisms known as “probiotics” commonly found in such foods as yogurt, kefir, and kimchi, nondigestible carbohydrates (e.g., dietary fiber found in fruits, vegetables, and whole grains), and secondary plant metabolites such as flavonoids (found in brightly colored fruits, vegetables, and red wine). Not all such food can be tolerated if one is in advanced adrenal fatigue. When treating unhealthy gut microbiome and adrenal fatigue, one must start slowly. Continuously measuring and adjusting the balance of the right amount, or titrating, is extrememly important.
  • Add natural antifungals to your regimen. These include garlic and olive leaf extracts. Those with advanced adrenal fatigue need to be very careful as these compounds can trigger an adrenal crash.
  • Eat spinach to help your microbiome and Adrenal FatigueEat more spinach. Fresh vegetables are an important source of good bacteria to aid in treatment of unbalanced gut microbiome and adrenal fatigue syndrome. The leaves of the spinach plant are estimated to harbor more than 800 different species of microbes. These are microbes that cannot be sterilized or removed from the plant by washing, because they’re actually inside the leaves. Therefore, having access to this kind of microbial diversity through the things that we eat is probably very important.
  • Take fermented herbs that help the liver metabolize toxic compounds to inert molecules for excretion, such as milk thistle.
  • Make your diet more alkaline and plant based to increase pH of the body. This is an essential part in treating unhealthy gut microbiome and adrenal fatigue syndrome.
  • Avoid inflammation triggers such as gluten, wheat, dairy, corn, processed food, sweets, and excessive carbohydrates. A Western style diet – high in sugar and fat – has less of the protective benefits of plant foods and simultaneously provokes other metabolic disruptions and contributes to gut dysbiosis and inflammation.
  • Take digestive enzymes with all your meals to help with digestion. However, keep in mind that excessive enzymes can cause diarrhea. When treating unhealthy gut microbiome and adrenal fatigue, to begin slowly. Start with small doses and increase as tolerated.
  • Take high quality mercury free anti-inflammatory omega 3 oils with a high concentration of EPA/DHA. Omega 3 oils aid the body in healing body microbiome and adrenal fatigue.
  • Fecal microbial transplantation (FMT), more commonly known as fecal transplant, is another strategy used to improve and fortify the gut microbiome. Fecal transplants from a donor individual with a healthy gut can introduce healthy populations of beneficial microbes where they may be dwindling, or even absent, in the GI tract of the individual receiving the transplant. For example, difficult cases of Clostridium difficile infection that seem resistant to ordinary treatment are effectively addressed by FMT, with high remission rate. Those with adrenal fatigue usually do not do as well if the underlying stressors are not removed, and in fact, often trigger relapse after a brief period of success.

Read Part 1
© Copyright 2016 Michael Lam, M.D. All Rights Reserved.

Microbiome and Adrenal Fatigue


  • Peggy Miller says:

    Thank you for your article. I have been under your care a few years ago and healed nicely. I have referred many people to you for their adrenal needs. I have recently contacted the worst case of bronchitis the doctor has ever seen and have been put on a strong antibiotic that I take in the morning once a day. I am consuming fermented foods and taking a 30 billion probiotic pill at night. Once I am done with the antibiotic what can I do to rebuild my gut and repair the damage the antibiotic has done.

  • Elena says:

    How often should a fecal transplant be administered in order to be effective?
    What can be done to improve the microbiome in the colon if takng probiotics do not reach it?

    • Dr.Lam says:

      First, fecal transplant is a consideration after all have failed. Frequent transplant does not necessary mean it will be successful. If probiotic is not helping, you need to study why first of all. Is the kind of probiotic, the delivery, the dosage, other underlying issues. There is much to investigate.

      Dr Lam

  • Donna says:

    I was told I had IBS about 40 years ago. I had an attack a few years ago of lymphocetic colitis. It was discovered when all other tests were negative and I had a colonoscopy with biopsy. I was never given a diet to follow other than try to stay away from foods causing celiac. I am always bloated and have gained weight since then. I cannot seem to lose it. I have also been diagnosed with adrenal fatigue and I take supplements for that. Is my issue gut dysbiosis or do you have any ideas? Thanks Dr. Lam!

  • Mary Kay Gould says:

    Well done Dr. Lam! Thank You! Many probiotics do not get through to the small intestine where a lot of bad bacteria can hide. I know I have yeast overgrowth and take oregano oil, olive leaf, etc. But I am never sure if I am taking the right strain of probiotics. What brand is going to get through?

    • Dr.Lam says:

      There are many brands and many different approaches when it comes the debate on whether multi strain is better than single. Because every one is different, what works for one person may not work for another. A detailed history is needed to narrow down the choices generically speaking as to what is required. For example, some with yeast do better with probiotics with good yeast embedded, while others do not. Seeing your doctor is key to avoid trails and errors.

      Dr Lam

      • Tom says:

        For yeast/lack of good flora/fauna try 3 lac, Lepiclol healthy bowels psylium with prebiotics, use of hci stomch acid supplements with all meals and give up meat.
        i had candida ( looked 6 momths pregnant bad) for years and it was these things that got me on the road to recovery. It seems it will never completely go but its 90% under control using these things, give it a try! Be careful with 3lac, it was so effective for me that if if i took too much i got a die off reaction, so build up dose.i realized to give my bowels the best chance i had to give them a fighting chance by limiting they’re work load. So started with the above treatment years ago but then last year went onto 2 liquid meals a day ie proper balanced, vegetable, protein and resistant starch balanced smoothie, using keffir in them, also drinking kombucha and then eating a normal solid one in the evening for a couple of months. It worked wonders. I then gave up meat as my joints were getting really bad whenever i ate it, that in turn seems to have deflated my whole body, which must include my bowels as i look and feel totally differnt.i am now trying to add a probotoic to see if that helps at all, but that as Dr Lam says will be a case of trial and error…