Dr. Jeremy: So, let’s jump into how the conventional stress model works.
The conventional stress model is actually represented by the Neuroendocrine system.
So when your body encounters stress, the hypothalamus signals the pituitary to release ACTH, which then goes to the adrenals to release cortisol, which is the antistress hormone. This is called the HPA axis. Dr. Carrie, what happens when you don’t have a properly functioning HPA?
Dr. Carrie: Without this properly functioning HPA axis and adequate levels of cortisol being outputted by your adrenals, your body will not be able to handle stress well because the adrenals also put out epinephrine. When you have a fight or flight response, when you see a bear, when you undergo stress, when you’re taking a test, when you have a boss screaming at you, epinephrine is also being released from your adrenals, and norepinephrine is also released from your brain. So, in the early stages of the stress response, cortisol levels rise. The epinephrine rises and the norepinephrine also rises.
Dr. Jeremy: However, as stress becomes more persistent and it increases in your life, then cortisol output drops as the adrenals are not able to keep up with the cortisol demand.
Dr. Michael: So, now, everything you’ve heard up to this point from Dr. Jeremy and Dr. Carrie is standard physiology that’s taught to us in medical school. So this is how everybody looks at the stress model. However, this stress response model is not able to answer all the questions and all the symptoms.
In my case, and in the people that I see all the time that have adrenal fatigue, they have symptoms that are not explainable by this dysregulation of the HPA axis. So, we know something is missing.
Dr. Jeremy: Some of those questions that don’t really add up in your life could be:
Dr. Michael: So, these are very real because we are not in a theoretical school. We are dealing with real people with real problems. When stress arrives at your doorsteps, it sets off a cascade of responses. Through my research, I finally found the missing piece.
Now, we know that the adrenals are not the only part that becomes imbalanced in a stress response. There are many other circuits and organs and systems that are tied in with the adrenal system, but do get dysregulated or imbalanced with time. This revolutionary new model of looking at how stress affects your body is called the NeuroEndoMetabolic stress response. As you may be able to tell by the name, it’s rather long. We’ll call it just NEM for short. It involves a whole lot more than the HPA. The HPA is only one-sixth of the entire picture.
Let’s look at this diagram that you see. It’s a graphical representation of how the NEM stress response work. In the center is the bullseye or the stress. When stress enters the body, it enters through the center, and it kind of spreads out peripherally. Dr. Carrie let’s go further into what’s going on here.
Dr. Carrie: So, now we’ll dive into the Neuroendocrine component which is on the left side of this diagram. You have the Hormone circuit on the top left, the Cardionomic circuit on the left side, and then the bottom left is the Neuroaffect circuit.
So, let’s start with the Hormone circuit. This consists of the adrenals, the reproductive system and organs, and the thyroid. Dr. Lam talked about it before with the OAT axis, which is similar to this because the ovarian, the adrenals, and the thyroid are all connected to each other. They all produce hormones, and that’s why they’re all part of this Hormone circuit.
When you have a problem going on with this circuit, symptoms like fatigue will come on. Symptoms like estrogen dominance, hair loss, irregular periods, or temperature intolerance, even cramping and bloating before periods can come up.
Dr. Michael: Yes. Most of the conventional approaches to adrenal fatigue or fatigue in general are all focused on this particular Hormonal circuit. To a large degree, that’s correct, but it all depends as we will see. This spreading of the Hormonal circuit when it becomes imbalanced can have ramifications well beyond the Hormonal circuit. For example, we'll next talk about the Cardionomic circuit, which is also frequently disrupted.
Dr. Jeremy: That’s right Dr. Lam. The Cardionomic circuit consists of the adrenals, the cardiovascular system, and the autonomic nervous system.
Now, the adrenals put out cortisol to dampen the epinephrine and norepinephrine’s effects. When the adrenals start to weaken and they can’t keep up with their cortisol demand, then this epinephrine and norepinephrine start to wreak havoc in your body. This can present as heart-pounding or palpitations. You can have lightheadedness. You can crave salt and you can have reactive sympathetic overtone.
Dr. Michael: Interestingly, you can do a million-dollar cardiac workup and most of the time it’s going to come back normal, and you will be told that your heart is functioning perfectly, but somehow, you’ll feel it’s just not quite right there. You feel a little breathless. Sometimes when you’re at rest you can feel the heart thumping, but you’re feeling fine. You are healthy from the outside, but it’s just your cardionomic.
Why it’s cardionomic? It’s because of the cardiac system plus the autonomic nervous system. They all intertwine. Imbalance of this circuit can really ruin your life.
Dr. Carrie: So, then we’re going to go into the Neuroaffect circuit, which consists of the autonomic nervous system, the brain, and the microbiome. A lot of your neurotransmitters like serotonin, dopamine, and GABA, they’re made in the gut with the help of your microbiome. So, when you have a leaky gut, you’re also going to be having a leaky brain.
Symptoms of neuroaffect issues can be mood instability. You’re feeling sad, jittery, or you’re feeling some anxiousness, wired and tired, problems falling asleep or even staying asleep, and troubles concentrating.
Dr. Michael: Yes. The gut is actually also called the second brain for that reason Dr. Carrie. We see so many people that once we are able to rebalance this particular circuit, they actually feel brand new.
The reason is that the gut controls—to a large degree—the brain’s function, by providing the precursors of the neurotransmitters that go from the gut through our system to the brain. From the brain, the pieces of the precursors are put together into neurotransmitters and hormones. From there, they come back down to the rest of the body.
So far, we have seen that the conventional model of the HPA axis only covers—they have one very small part of the overall stress response, the Neuroendocrine component which has the three circuits that we mentioned. And the hormonal part, the HPA axis part, is only one out of the three.
However, as we said, what is the other missing piece? It is now being discovered by our research that the second piece is the Metabolic component. This Metabolic component consists of three circuits. These circuits are the Bioenergetic circuit, the Detoxification circuit, and the Inflammation circuit.
Dr. Jeremy: Now, a healthy Metabolic component defends our body against stress in many ways. One of the ways is it reduces the body’s toxic load. Other times it makes sure that we have a steady supply of glucose that goes to our brain so that we’re alert when we’re fighting stress. Another way that it helps our body deal with stress is it decreases inflammation in our system.
Dr. Michael: So, a weak Metabolic component causes an imbalance in our overall internal structure. It’s almost like a spiderweb. It’s perfectly symmetrical in its own synchronized chaos within, but if you kind of upset one part of it, then you’re not going to feel good.
A weak Metabolic component can lead to congestion of the extracellular matrix, or what we call the interstitium, and can slow down the detoxification process, so you always feel kind of toxic, so to say. It reduces nutrient delivery, so the nutrients cannot get to the right place at the right time at the proper speed. You, therefore, have inflammation. Your body physically can be kind of draggy. Let’s take a look more at each of these metabolic circuits Dr. Jeremy.
Dr. Jeremy: Right. The first circuit of the Metabolic component is the Bioenergetic circuit, which is comprised of the thyroid, the pancreas, and the liver.
So, one of the signs of early bioenergetic derangement is sugar cravings, which happen all the time. We really overcome this by just snacking frequently. This is kind of just brushed off by conventional medicine.
Another sign is central obesity and central weight gain. That’s a sign of Bioenergetic circuit dysfunction. Also, if your weight is fluctuating a lot, then that is also a sign that your Bioenergetic circuit is malfunctioning.
Dr. Michael: Yes, so the Bioenergetic circuit is actually activated very early on when stress arrives at your doorstep. We just don’t pay attention to it. It’s socially acceptable as you say. Donuts, coffee, sweet things, simply is a masking mechanism of what the Bioenergetic circuit is telling us.
Now, let’s talk about the Detoxification circuit, Dr. Carrie.
Dr. Carrie: Right, the Detoxification circuit consists of the liver, the interstitium, and the immune system. During the later stages as the body starts to accumulate a lot of toxins, whether it’s from the environment, whether it’s what you’re eating, the detox circuit starts to break down, causing the body to become very hypersensitive to triggers.
They are unable to maybe tolerate certain foods. They’re unable to tolerate certain supplements or medications, and they might have symptoms like paradoxical reactions.
Something that you think would be good for you as a supplement, for example, magnesium, which is supposed to calm you down. It actually has a paradoxical reaction, and it actually makes your hyper. Or even supplements like vitamin C or Bs, which are supposed to help you, might actually overstimulate you.
Dr. Michael: Also, medications can have an exaggerated effect for example… even over the counters. Let’s say antihistamine. One person would be kind of calm and zoned out for three or four hours. You may have an extended effect lasting a whole night for example.
So, these are reflections of a body that’s unable to breakdown the metabolites well. As a result, the metabolites can accumulate in the body and causes a chain of cascading decompensation, which is a fancy phrase for saying that your body is basically overloaded with toxins.
Dr. Carrie: I like the analogy like you have a full cup of water and you want to add more water in. Water is great for you, but if you add it in, everything’s going to overflow. So, then all your symptoms are going to come out, even though you need to have that water.
Dr. Michael: Okay, very good. Next.
Dr. Jeremy: Our last circuit is the Inflammation circuit, and it consists of the immune system, the GI tract, and the microbiome.
Now, Inflammation circuit derangement also happens early on, and this can appear with food sensitivities. You’re finding yourself reacting more, having more diarrhea or constipation, reacting to gluten, to nuts, or to just different foods that you really shouldn’t be allergic to. Bloating and irregular stool patterns also start to appear such as alternating between constipation, loose stool, and diarrhea.
Some people might have underlying bacterial overgrowth in their gut. Also, this can increase the intestinal permeability and lead to toxins going through the GI tract into the bloodstream that really shouldn’t be there.
If you have autoimmune problems that are just underlying in the background, then this can add to further complications in the Inflammation circuit and really make things hard on your body and on your health.
Dr. Michael: So, now you can see why the Neuroendocrine system is only part of the stress response. Many of you, if you really pay attention, will realize you see the symptoms that were talked about earlier by Dr. Jeremy and Dr. Carrie. These are subtle. You don’t think about it until the point that it really causes you to be not feeling very well.
For most of us, the problem is that we don’t pay attention to these. So, we don’t know how to interpret them. We don’t realize those are actually body signals; feeling draggy, feeling impending doom, migrating discomfort that kind of moves around, a brain fog. All these are not things that are significant in and of themselves, but if you collectively look at it, it’s like the body is not happy. It’s too many things going on. It’s like a house with little fires everywhere. There’s smoke, but there’s no big fire. Most people say, “Well, there’s no fire.” But there’s smoke. So, you know something is going on.
In summary, we have this NeuroEndoMetabolic stress response picture that you see. On the one side is the Neuroendocrine component which has the three circuits and the six systems. On the other side is the Metabolic component which also has the three circuits and the six systems.
So, if you are working only on adrenal fatigue by only focusing on the adrenal—which is part of the Hormonal circuit—you can see that there are five other circuits that are already deranged that are not being taken care of. So, if you have some progress from just working on the adrenal side, it’s because you are just basically stimulating the body and patching it, and you are basically subduing the other parts of the circuit.
The other circuits go on continuing to be imbalanced, but no one’s taking action. Over time, even though if you have an adrenal system or Hormonal circuit that is recovering, you have the other five circuits that continue to be deteriorating. Therefore, long-term recovery is simply impossible.
That’s what happened to me because I went through what I thought was the normal recovery process, and I didn’t understand why I hit the wall, why I only improved to a certain degree, and I regressed backward, why I kept having recurrent crashes, why my food sensitivities didn't improve. These are the missing links that I’ve discovered. They, as you can see now, all fall into the Metabolic component which we have overlooked.
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