Adrenal Recovery: A Necessary Step to Overcoming Autoimmunity
Alan Christianson ND
web page drchristianson.com
During the introduction it was mentioned that one of the things Dr. Christianson overcame from when he was a child was Cerebral Palsy. He now enjoys his unicycle. These are my notes from the interview in The Thyroid Summit 2017, for more information visit Dr. Christianson’s web page.
Early on my first chapter of life from birth to age 12 I had pretty bad coordination, couldn’t do sports, couldn’t really run, couldn’t do anything properly. For whatever reason I was an early reader I was engrossed in my books and space science and somewhere around age 12 I realized that wasn’t enough I had to be able to move. I was obese and experiencing social pressure from that and it forced me to start picking up health books. I started doing what they said and thought wow, these things actually work. It was pretty wild because I had seen doctors about my health quite a bit. But nothing they directed me towards with the medications they gave me had as big of effect as doing the things I found in books, the diet and exercise. I thought wow, there must be a huge gap for me to figure this out I’m just a kid, and this is beyond what the doctors told me. So that led me to focus on that all along, how could I learn more, how could I improve these things.
Imagine a few things that fit in your back that are the size of a few tick-tacks and they make over 57 substances. These various substances they regulate every facet of our health, one of the top tears of their rolls is to control the immune system and to control inflammation. Along with that they also control blood sugar, our bodies fluid and electrolyte balance, our other hormones as well, they also regulate how all the other hormones work within our system. But inflammation is a big one, what happens is that when delicate rythyms are disrupted in some way that’s when the body can no longer compensate. At any given point in time our immune system has some number of stressors, be they irritants in the intestinal tract or nutrients that are lacking, allergens or minor infections that we’re struggling with. When things work well all these things that trigger inflammation can be managed, and the adrenals can control with adaquite amounts of cortisol and it can be kept in check. One of the chains in that cycle that could be broken by it’s own internal regulation of inflammation, when that’s no longer operative, then the sum total of inflammatory triggers can become overwhelming. At that point the immune system really shifts how it works, when it’s healthy it’s working more like a system of barriers or blockades, and just keeping out foreign things and breaking them all down right at the border. When inflammation is overwhelming the body is not controlling it, the adrenals are not keeping up, then the immune system does more specific targeted attacks. The problem is those targeted attacks can end up becoming targeted attacks against things that belong inside of us, things that are safe and some combination of events is how we feel autoimmune disease develops. Once it gets going it takes less to maintain it than it does to perpetuate it. The positive side we have been learning recently is that we thought in the past that once we have these reactions going they would keep on going no matter what happened. But the good news as of late is that if you can identify and see what the perpetuating factors are, that in most cases, the whole autoimmune cascade can be calmed down and reversed. Helping to heal the adrenal glands can be a key part of that.
With autoimmune thyroid disease the big thing is realizing it’s a process it’s not a state, so someone is not stuck being hypothyroid. Their bodies in a process of creating stress on the gland, once you can really tease apart what the triggers are, what are the factors that are causing the body to do that, it can greatly improve. Thyroid disease is by and large Hashimoto’s, many have some vague awareness of that the term, and oftentimes the person will say I have thyroid disease but I don’t have Hashimoto’s. There is really no clear way to say you really don’t have Hashimoto’s. There are tests for thyroid antibodies but as many as 40% of people that have Hashimoto’s never have measurable antibodies, so that doesn’t really rule it out. Being aware of that as a trigger can also be cleared through ultrasound. I’m a real big fan of those for thyroid disease, being current and having an ultrasound done, many never have. The side benefit is that that can also help detect and manage early thyroid cancer, which is the fastest increasing type of cancer in North America today. Imaging is one step that is often missed it can show when someone does have Hashimoto’s, and once we know that they do then we want to see what those causes are.
The thyroid gland is a real concentrator, it’s devised to concentrate iodine, which it should. But the drawback with that mechanism is that a lot of wastes that are really not serving it also get concentrated. We see things like lead, prochlorate, BPA plastic residues, mercury, those belong with the list of about 250 known endocrine disruptors that bioacummulate within the thyroid. The cycle is that some genetic susceptibility, perhaps some family history of thyroid disease. Then they have exposure to compounds that build up in the gland and then there’s stress on the immune system. If the adrenals no longer manage that stress then the immune system see’s the thyroid with these foreign substances as something that doesn’t belong in the body, and the tissues become attacked and the cycle can then perpetuate. The toxins are present in the glands, they’re generating free radical stress. And they themselves become the tissues that they are within and become the target for the immune response. Those tissues can be proteins and other building blocks that the thyroid uses for forming cells, for responding to it’s regulating hormones or for generating it’s hormones internally.
In research they have identified upwards of more than a dozen different antibodies that could be involved with attacking the thyroid, they are not all available for testing. The other wildcard is that antibody tests do not perfectly represent immune response. There is many examples to where once the process of blood draw is done and the blood is taken outside the body, and looked at how it responds in the laboratory, it won’t work in the same way. We see this with allergy tests, antibody tests relative to infection, and it’s also true for antibody tests for autoimmunity so false negatives is quite common.
Most people think of adrenal fatigue, or adrenal dysregulation, and what’s happening is the adrenal glands are not making cortisol in a good rhythm. We contrast this from adrenal disease, the main two being Addison’s or Cushing’s. Adrenal disease is where the glands are not doing what they’re told, they are basically making way too little hormone in the case of Addison’s, even though the body is asking to work. Or they are making way too much hormone in the case of Cushing’s. Even though the body is not telling them to do that we see this via a hormone called ACTH. The cycle is the pituitary gland releases ACTH when we want the adrenals to make more hormone. When someone has Addison’s they have very low cortisol but we see that their ACTH levels are high. So what’s happening is the brain, the pituitary is yelling at the adrenals to work but they can’t make what the body is asking them to make. That’s not occurring with more garden variety adrenal fatigue or adrenal dysregulation. In those cases when you look at ACTH it’s not elevated, the adrenals may be underperforming but it’s really not their fault. It’s not because they can’t, it’s not because they’re broken, they’re not really fatigued. It’s more a matter of this whole system of which they are a part which we call the hypothalamic-pituitary axis. The whole system is down-regulating as an attempt to slow the bodies activity. There is a point where there is a chronic load of stressors, or inflammation, the body tries to do something like a hibernation or a rest and regenerate cycle. It’s a strategic effort that the body can then down-regulate the adrenal, and sometimes even down-regulate thyroid hormone that could be a strategy to calm itself. Many who have not got that distinction have thought that if cortisol is low, then we could just have the patient take cortisol medication in some form to raise it back up again. Sometimes that does give boosts of energy, but it’s really working in opposition to the bodies goals and the bodies own internal strategies. Your body is trying to give you the message that you need rest and recovery. It’s what happens when there is adrenal fatigue, your body is intentionally diminishing the capacity for energy output just to protect itself.
Let’s say we don’t care about health and all we care about is productivity. There is more and more data emerging that if we take less time for productive tasks, but we’re more on during the time that we’re available for that, we tend to be more effective than just slogging away for hours and hours spinning our wheels. The other big distinction is that with the glands not working right it’s not always a matter of cortisol being diminished. So when the rhythm get’s thrown off sometimes it’s a matter of the timing being disrupted. When the glands are really healthy they make the cycle of cortisol where we make a bunch in the morning and shut it off at night. We are learning that’s critical for the immune system that we need to have almost like a wave of cortisol coming and hitting the beach and receding and then washing away. That’s part of how the membranes respond properly to cytokine’s and these other messages of inflammation. When the cortisol exposure happens at the wrong time, or if it happens more continually to it, that’s when the immune system is shifting over to that mode of targeted attack as opposed to like blanket defense. That’s the cycle of triggering autoimmune response, once we see that timing disrupted. That can happen in different ways. Some can make too little cortisol across the day, some can make it in the office at times they should, and some can constantly over-produce it.
If there are obvious disrupters, don’t do that, avoid what is throwing your cycle off. Light seems to be very powerful as an agent of healing and an agent for disrupting it. We hear more and more about being away from screens for the last few hours of the night, that’s a really important step. On those same lines red light exposure in the last few hours at night is extremely helpful in regaining the bodies regulation. You can get a red bulb easily and have a reading lamp that uses a red light, and toward your last hour of evening have no other lights on. What happens is that the sun as it passes though the atmosphere the angles change throughout the day, at sunset there is a more red hue to the light, and at dawn it’s the opposite there is a more blue hue. We learned now our brains are acutely aware of those subtle shifts of wavelength, they really know what time of day it is based on those how those light patterns play out. In the modern world we’re not exposed to those same patterns that much, to help us we have to reproduce those by getting red light exposure in the evening is one simple step. I am a huge fan of getting bright light exposure first thing in the morning. A lot of research has shown it seems that about a half hour of exposure within a half hour of waking is the formula for most people to help get their rhythm back again. The light indoors is never enough intensity without a special light. There is a light box that generates 10,000 lux intensity, and that’s enough where it can mimic that signal of the sun and get your bodies rhythm off to the right start for the next 24 hour cycle.
With shift work that applies to more and more people, in the last book I wrote I talked about how there is this huge obesity crisis that’s effecting the globe. Around the time the obesity crisis was beginning back in 1980 one of the big global shifts was that we had much more connections of global economy. There was more people that were working on schedules that were not the schedules they’re living within. Upwards of 30% of the work force around that time was not working on a schedule of what we call bankers hours. In terms of how to manage that for someone, those that cannot change it, I would consider changing the career, the health effects of that is huge. If you really can’t there is two paths to take, it depends on how many days per week you’re doing shift work. If the majority of your days are shift work, you’re sleeping odd times of day, then the best thing is to construct your daily rhythm around that schedule. Let’s say you wake up at 8 in the evening for your shift, get exposed to bright light. If it’s not available outside then use a light box to where it’s a few above you, ideally, for about a half hour within that first hour after waking. In the morning let’s say you’re going to bed at 8am after the shift, the trick would be then that last hour to spend as much time in darkness as possible, with the exception of red light. For those who are working the majority of days per week, even the days you’re not working, you want to construct your circadian hygiene around your body schedule not the schedule of sunlight. Those who work fewer days of shift work, the best thing is to just stay on a typical schedule for your body cycles. And then work during the hours you’re working, then the other days do try to mimic the typical cycles you would do otherwise. It’s tough on the body, by doing steps that improve circadian hygiene like that those things help. But you are always swimming upstream, it is always a stressor on the body, it is hard on the system.
With diet I encourage first and foremost to be off of gluten, off of things that have the binding proteins. Some can also have the binding issues with dairy and eggs, we have gluten from wheat and casein from dairy and albumin from eggs, cutting those out. Cutting sugar out, avoiding the GMO’s, there is so many pro-inflammatory triggers in the diet that can disrupt the adrenals. Consuming these on a continuous basis the body has a hard time managing that. I was looking at the sheer number of things that disrupt that circadian cycle, how delicate it is. And I realized it’s not possible for someone to change all those factors, we can’t live in a cave. I started thinking about some other rules that cortisol has, and one of the big rules is managing blood sugar. I thought about data on how macronutrients effect cortisol, and how the ratio of carbs in the diet can skew it. And how that might be a leveraging point, a tool we could use to reset this. I did some testing with myself and a lot of others in a trial where we did a 30 day timeframe. Shifting all carbs, and carbs themselves are loaded things. You want to think about the right one’s and reasonable quantity, it’s easy to have too much of any type. Amongst the carbs that someone was to have, to shift them more towards the evening.
Here’s the logic, carbs raise the blood sugar, they cause an insulin response. And in doing so that suppresses cortisol so early in the day that’s actually bad, but later in the day that could be some benefit. You want cortisol lower at night to allow for that rhythm, for that immune response to help prevent autoimmunity, but also for the sleep cycle for melatonin to be produced. So more carbs in the evening and less cabs earlier in the day. That creates almost like a trellis that the cortisol can gravitate back towards. The trial that we did we thought about in terms of the cortisol rhythms. But it was among those who had very persistent struggles with weight loss, those who had at least 5 diets not work for them in the last several years, and had several pounds to loose. We did tests on all of them showing their cortisol rhythm in various ways, we did blood, urine and hair studies, and we redid those things a month later. It wasn’t perfect, but I tried to get everyone to not introduce too many variables. You guys get what we’re going for, but I don’t want you to start meditating if you don’t already. I don’t want you take up yoga, go on adaptigens, I don’t want there to be a lot of changes, just the diet. I want to see just how this could work, more or less just the isolation of the cortisol rhythm.
What we saw was that there was an overall 54% correction of the cortisol rhythm, and it was not always in the same direction. People who were flatlined tended to move up, their cortisol level in the morning raised. Others had high cortisol constantly, and they tended to have their nighttime cortisol lower more than the daytime cortisol. Wherever someone started out it had a large effect moving them back toward homeostasis. Some of them were lucky to do follow-ups longer time frames, 6 months out. We saw that those results moved further toward the right direction, they really seemed to persist with them as well. We looked at a combination of factors, we saw that there was a clinical change in the cortisol rhythms. It was very pronounced and prominent, and to be really precise we has a substantial weight loss, and waist loss the most dramatic. We averaged an over 2 inch waist reduction, up to 5 inches in 30 days. What we are learning is the visceral fat, that’s an organ that’s very involved with this cortisol rhythm. When cortisol is interrupted the body goes into a survival mode, in which case more and more of that fuel goes into the visceral fat for survival and famine. As the body was less in that state then that visceral fat could be drawn upon for energy. In terms of autoimmunity and immune response, once we learned that visceral fat is like a ticking time bomb, a pro-inflammatory organ. It’s a beautiful shift when the body is able to need less of that and start to break it down.
Addison’s disease is pretty much Hashimoto’s of the adrenals, there is a real strong parallel. We know about Addison’s disease being present when there is exceedingly low cortisol, typically close to none, that can be measured through blood and urine. These tests are not consistent enough for picking up adrenal dysregulation, but they are efficient enough for picking up adrenal disease. Most anytime that’s measured the cortisol is just negligible, and there is various things that cortisol does in terms of managing blood pressure, electrolytes, blood proteins. We see many of those other markers abnormal as well, and that is saying that the rules of cortisol are not really being carried out properly. Along with that we will see often measurable antibodies against the adrenals, there are adrenal antibody panels that are part of diagnosing Addison’s disease. There can also be on imaging tests a visual atrophy of the glands themselves, they can be found to be smaller and broken down. We contrast that with Hashimoto’s because Hashimoto’s has two variants. There is one that’s more atrophic where the gland does get destroyed, and one that’s more goitrogenic where the gland gets large and lumpy. With Addison’s disease it’s more an atrophic variant with a simple breakdown of the glands. Unlike adrenal dysregulation, in this case the body really wants cortisol but it’s not getting it, so it often is a matter of cortisol replacement. With Addison’s disease it often is a critical matter of maintaining glucocorticoid function. I have had some with Addison’s who have successfully taken the steps to heal their immunity and manage other facets of their health. I’ve been able to generate adequate amounts of cortisol, that’s not always the case though.
When it is managed thoroughly, in terms of still looking at the triggers of autoimmunity, and taking all the other stress off of the adrenals so they can be healthier. Then those with Addison’s disease can at least do much better with cortisol replacement therapy, and have fewer side effects from that, and have a better reflection of their health come back again. There does come a point that where, even if the autoimmunity itself has been calmed down that the number of times that a cell can divide and repair itself, unfortunately it’s finite. If the glands have been beaten so badly they may have just burned out, all their possible numbers of replication, even if the assault is gone they may not be able to make more tissue.I always think that trying to see what’s the body’s intent, what it’s strategy is, and then trying better to fulfill that strategy is the most direct path to health.
I eluded to the fact that glucocorticoid replacement is critical. There have been clinical trails on different types of glucocorticoid replacement therapy and cortisol has a lot of different rolls it manages, mineral, blood sugar, blood pressure as well. Oddly enough, cortisol is not always the best replacement for cortisol. There have been studies looking at cortisol or hydrocortisone, which is a slightly different molecule versus using things like synthetics like prednisone or dexamethasone. The drawback about taking cortisol pills you’re exposed to pretty high levels of an anti-inflammatory in the intestinal tract. The drawback is this is the kind of anti-inflammatory that has a bad side to it as well in that it inhibits tissue repair. So taking it as a pill on a daily basis it can work like an antibiotic. It can make to where we see the same type of vilus-atrophy and damage, especially to the upper intestinal tract. Some papers have suggested that Dexamethasone may be one of the more efficient glucocorticoid, and still giving the mineralcorticoid benefit but without having that villus atrophy and less tendencies toward fluid retention. There have been some clinical trials in which people have been on dose equivalencies of hydrocortisone versus the same similar dose of prednisone. Or the same dose of dexamethasone and looking at just symptoms and side effects, the synthetics seemed to be better tolerated and they could be used in very small dosages. Like half a milligram per day versus twenty milligrams per day for hydrocortisone or cortisol.With autoimmune conditions as some stressor, or some trigger, of inflammation persists for long periods of time, then the body can actually down-regulate or become decompensated.
Supplements for dysregulation need to be individualized for each person. But there are some homeostatic adaptogens that are the most regulatory, and probably have the least risk of pushing cortisol too far or either direction. One would be reishi or ganoderma, which is a medicinal mushroom. Quite a bit of data about it buffering the stressors both in terms of down or up regulating cortisol output. Another is lemon balm, that’s a really unique compound in the sense that it’s not a sedative, it does a real good job for maintaining and improving mental focus. But it’s very effective for diminishing the stress response and lowering anxiety, lowering that type of response without being an excessive sedative. The last one I would put in that category would be theanine, which is an amino acid derived from tea. And also similar in that it can buffer and downregulate the body’s over-response to stress without causing cortisol’s suppression to where it does run low. These are my top three for general usage.
The information contained on this site is for educational purposes only and should not be used as a substitute for diagnosis or treatment from a licensed physician. It is essential that you discuss with your doctor any symptoms or medical problems you may be experiencing.
M. Scherker medical researcher