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How Your Body Is Affected by Stress in the NEM Stress Model

By: Michael Lam, MD, MPH; Carrie Lam, MD; Jeremy Lam, MD

Video is summarized in the article below.

Dr. Michael: So, let us look at how derangement of the NeuroEndoMetabolic (NEM) Stress Response can progress. How it kind of spreads and how to identify some of what these symptoms really mean.

A Typical Case of NEM Malfunction: Jane

Dr. Jeremy: So, let’s discuss a typical presentation of NEM malfunction and clients that we talk to every day.

Jane is a 52-year-old female. She present’s with fatigue, and that’s her main complaint. For the past few years, she’s been needing a cup of coffee every morning, and in that cup of coffee, she puts two tablespoons of sugar.

Though she loves sweets, she gets hungry really quickly after even eating a high carbohydrate meal. She’s also started to notice that she has gained some weight around the belly. She’s now starting to crave some salty foods. Sometimes certain foods don’t agree with her GI system. Sometimes when she bends down to pick up something, she gets lightheaded and has to hold herself steady.

NEM Activation: Early Signs

Dr. Michael: Does this sound like you or sound normal to you? On the surface, it doesn’t sound like much, but if you understand the physiologies that tie this together, this can actually represent the early part of the NeuroEndoMetabolic stress response, which is Activation.

So, signs of increased metabolic demand are plentiful if you look at what’s described by Dr. Jeremy, the sugar craving. That means the body’s requiring you to have more energy. Why? Energy is required to overcome stress as far as the body’s concerned.

Number two, you have central weight gain, especially the muffin tops. Why? The adrenals are focused on retaining the weight in order to slow down and conserve energy, and most of it goes through the central portion of the body. These are metabolically driven events. They are not very intense at first. They’re subtle.

So, you don’t write them off because there’s already the body telling you there’s something wrong inside. They often go unnoticed. This is the Neuroendocrine circuit, by the way. Now, we have been talking so far about the Metabolic circuit as being activated.

Don’t forget that the body is very smart. While the Metabolic component—the Bioenergetic circuit is being activated—the body also activates the Neuroendocrine component, but in a much lesser degree. Now, symptoms can include a little blood pressure instability and mild electrolyte imbalances. Craving of salt and sugar, things like that, but they’re relatively mild. It’s most predominantly metabolic early subtle signs. Dr. Carrie let’s go on.

Jane's Phase 2

Dr. Carrie: So:

As Jane continued at her job, she found that she was getting a little more stressed at work. She’s been having more nervousness and sometimes before she goes to bed at night, she just feels her heart pounding really loudly at night. Despite being very tired, she can’t fall asleep and sometimes wakes up multiple times at night. So, she decides to take some sleepy-time teas or some melatonin to help her get to bed.

Then she goes through menopause, which was actually very rough on her as she had hot flashes, some dry skin, some vaginal dryness, and itching. She tries to get exercise because everyone knows it’s good for you, but it really tires her out even easier. So, she goes to see her doctors, who try to run labs, and everything actually comes back normal.

Dr. Michael: It’s not only about Jane. Males also have the same problem. Libido going down. Reduced exercise capacity. Feeling drained at the end of the day. Some inability to sleep. Feeling a little bit down from time to time. These also are subtle signs. What is that really saying here?

NEM Overdrive: Symptoms Increase

In terms of a NeuroEndoMetabolic stress response, you are now stepping into the second phase of what is called overdrive. Now, as the stress continues, the Neuroendocrine component circuits become more activated. Remember, there are six circuits on the diagram, half is Neuroendocrine, which is the three circuits and the related organ and system components. They become more activated. They become more in demand. They are really going on full speed now, the Neuroendocrine component organs and systems.

So, the Cardionomic circuit is working. That leads to nervousness, for example. Sometimes the heartbeat experiences occasional palpitations. Sometimes you have little skipped beats here and there.

The Neuroaffect circuit becomes more involved, leading to trouble sleeping because the body becomes more wired. Even though you’re tired, you can fall asleep after a little while, but then you tend to wake up, for example.

And the Hormonal circuit becomes more of a problem. So, in a female, it would be the OAT axis imbalances, menopause, as well as fatigue, and in the male, it will be reduced libido and exercise intolerance.

Together, again, you can see there’s a Neuroendocrine component. There is a Metabolic component in the overdrive step, which is phase two, then both are ongoing.

However, the important thing to note in this overdrive phase is that the prominence of the Neuroendocrine component becomes more and more surfacing. So, while the Metabolic component still on the low end of things, is kind of sleepy, it’s just starting to wake up. So, most of the symptoms people complain of in this overdrive phase consist of Neuroendocrine symptoms. So, let’s continue and see how Jane goes on.

Jane Moves Into Phase 3

Dr. Jeremy: So:

Now she has gone to multiple doctors and practitioners who have tried to put her on some medications, some herbs, some glandulars, and some vitamins. She feels better for just a little bit, and then her symptoms start to worsen again. She has had multiple fatigue crashe,s especially after big work events or family events.

She has constant heart pounding. Sleep is not improved, even with over-the-counter sleep aids. Her brain fog starts to settle in more, and she has a really hard time concentrating. She becomes even more sensitive to supplements, sometimes actually having the opposite reaction. Such as, she was taking vitamin C and instead of it making her feel better, it actually crashed her, and she was on the coach for a week.

She’s now unable to smell certain perfumes, and she gets headaches from just even walking by someone who has really strong perfume. Or even just filling up gas in a gas station, she also gets headaches. She’s also tried limiting her diet to gluten-free and dairy-free foods, and yet still her GI symptoms are not improving.

Dr. Michael: This is not only limited to Jane. In fact, I went through much of what you described with Jane. This is no joke. This is not funny because it is very debilitating. I was in bed for weeks and couchbound. But look at what is really going on physiologically.

NEM Exhaustion: Health Declines Rapidly

If you look at the NeuroEndoMetabolic stress response, you’re now entering the exhaustion phase. So, if stress is not well controlled and it continues to attack you, then the entire NeuroEndoMetabolic response enters what we call the exhaustive phase. This is after the activation and the overdrive phases.

In this exhaustion phase, it is perhaps the most alarming, because it is the point that the velocity of the declining health enters its maximum speed. Frequent crashes are very common. You will not be able oftentimes to go to work. You can be couchbound. Just getting up and walking around the block can be problematic.

Medical Support Often Fails

So, this is very problematic, and this is where most people finally decide to visit their healthcare professional, which is a good thing. However, this is also the beginning of one of the most dangerous parts of the journey, because of well-intentioned, heroic efforts that turn out badly. Not because the health professional is not well-intentioned, but because they don’t understand there are two components. So, the tendency is to just focus on the Neuroendocrine by propping up what we call the adrenal side, without attention to the metabolic side. So, crashes can become more debilitating.

It’s best that both the Neuroendocrine and the Metabolic component problems surface and rise to the top. Now the symptoms can become so convoluted that most practitioners just give up.

Dr. Carrie: I remember you had a lot of these symptoms when you were going through this, right?

Dr. Michael: That’s the biggest challenge--how to sort it out. We are logical creatures. We tend to try to figure out what is wrong. But when so many things are coming at you—an inability to sleep, feeling wired, nauseated, feeling lightheaded—and your doctor tells you everything is fine. So, you’re just simply confused. That’s what happened to me.

How NEM Exhaustion Affects You

Dr. Carrie: From the Neuroendocrine perspective, the body enters this state of hormonal dysregulation beyond the HPA axis. If it’s a female like Jane, the OAT axis can become disturbed. You might have irregular periods, irritability, cramping, hot flashes, cyclical symptoms may worsen. Their thyroid issues may also not improve and might actually worsen, despite medications. Their fatigue now goes throughout the day.

Then you have the Neuroendocrine derangements that also become more severe in the Cardionomic and the Neuroaffect symptoms, like daily adrenal crashes. Your heart starts pounding consistently throughout the day. They bend down, they pick up something, they get lightheaded. They have nervousness or mood issues, and inability to sleep despite using sleep aids.

Dr. Michael: Perhaps the most devastating part is the emotional, because with this convolution of symptoms… I was lucky because my wife—who’s a registered dietitian—helped me to kind of decipher all this, because she knows about chemical reactions that go on, but most people are not so fortunate. Most healthcare providers are not in tune. Most of the family members—despite their good intentions—have no idea. They think it’s all in your mind, but actually, it’s not.

Dr. Jeremy: That’s right. That can be really tough on a person and actually increase your stress and worsen your condition as well.

The Vicious Cycle

Dr. Michael: Yes. So, it actually becomes a vicious cycle because when you have more stress that’s unresolved, your mental state becomes confused. You can become discouraged. You become frustrated and you become almost down. The body then continues to get worse because when you have these negative emotions, it actually compounds the problem and drives the NEM response into the last stage. Which is?

NEM Exhaustion Worsens

Dr. Jeremy: That’s right. It’s still in exhaustion. From a metabolic perspective, the body can experience these kinds of symptoms such as increasing food sensitivities. You find yourself getting sick more often and you have a lowered immune system. You have multiple chemical sensitivities. You have paradoxical reactions to supplements and medications that should be helping you, but they’re making you worse. You’re really unable to handle detoxes, and your body just enters a catabolic state.

The NEM Continuum

Dr. Michael: Now, remember, even in this exhaustive phase, it’s a continuum. Some people are in the early part of the exhaustion. Some people are in the middle. Some people are in the tail end. The symptoms can range so much because not everybody has all the symptoms. It really depends on how weak you are and which component and which system is imbalanced, and that’s usually the first one to come out.

© Copyright 2020 Michael Lam, M.D. All Rights Reserved.

© Copyright 2001-2021 Michael Lam, M.D. All Rights Reserved.
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