Why HPA dysfunction/adrenal fatigue can cause gut dysfunction

[Beyond]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1966574/pdf/brmedj02907-0037.pdf

Low steroid hormones can be a factor or directly the cause in malabsorption/leaky gut for some. I find this especially interesting since my 17-ketosteroid urine panel came back very defficient.

This is most intriguing in the context of CFS, since is well established that some form of HPA dysfunction is happening, normally found in tests as hypocortisolism.

Now, when trying to fix your gut problems caused by HPA dysfunction (affecting thyroid and adrenals) is a bit of a catch 22 since you need certain nutrients etc to be taken, and oral are the most readily available. Having the GI compromissed after years of oxidative/nitrosative stress, hormonal decay and chronic inflammation oral supplementation seems not the best. So, the best is either sublingual or IV. Or micellized.

Tying this with methylation, some people have found that methyation treatment greatly improved gut. This could be due to it gradually restoring glutathione which while depleted was causing the HPA misfiring. Not only that but both b12 http://annals.org/article.aspx?articleid=688366 and folate http://annals.org/article.aspx?articleID=686628 can cause and reverse leaky gut/malabsorption. Their defficiency can, however, be the consequence of malabsorption too. Is good to have in mind all possibilities since is well known that we are all different.

Personally I think both adrenal, thyroid, gut and methylation treatment together should give the best outcome but doing all these at the same time means an amount of monthly expense that someone "chronically" ill rarely can afford.

So is matter of everyone discovering what is the most dysfunctional system for them and start with that.

 

[MeSci]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1966574/pdf/brmedj02907-0037.pdf

Low steroid hormones can be a factor or directly the cause in malabsorption/leaky gut for some. I find this especially interesting since my 17-ketosteroid urine panel came back very defficient.

This is most intriguing in the context of CFS, since is well established that some form of HPA dysfunction is happening, normally found in tests as hypocortisolism.

Now, when trying to fix your gut problems caused by HPA dysfunction (affecting thyroid and adrenals) is a bit of a catch 22 since you need certain nutrients etc to be taken, and oral are the most readily available. Having the GI compromissed after years of oxidative/nitrosative stress, hormonal decay and chronic inflammation oral supplementation seems not the best. So, the best is either sublingual or IV. Or micellized.

Tying this with methylation, some people have found that methyation treatment greatly improved gut. This could be due to it gradually restoring glutathione which while depleted was causing the HPA misifiring. Not only that but both b12 http://annals.org/article.aspx?articleid=688366 and folate http://annals.org/article.aspx?articleID=686628 can cause and reverse leaky gut/malabsorption. Their defficiency can, however, be the consequence of malabsorption too. Is good to have in mind all possibilities since is well known that we are all different.

Personally I think both adrenal, thyroid, gut and methylation treatment together should give the best outcome but doing all these at the same time means an amount of monthly expense that someone "chronically" ill rarely can afford.

So is matter of everyone discovering what is the most dysfunctional system for them and start with that.

Interesting paper - thanks, @Beyond. Just had a quick read so far.

It was a small study, and I note that the subjects were underweight, which is the case in some ME patients, whilst others have the opposite problem, plus some being underweight in the early stages and then overweight.

A lot of findings do look relevant to ME, such as nocturia, although some have polyuria much or most of the time. Electrolyte imbalance/deficiency is another, although probably typical in malabsorption/diarrhoeal conditions.

Some people with ME have also found benefit from taking steroids, although there are many ways in which steroids can improve symptoms (notably by reducing inflammation, which the study refers to, and in the case of autoimmunity, reducing immune activity) but of course it's not safe to take them long-term.

The study also says "It is likely that intestinal mucosal damage accompanying steatorrhoea of long duration is permanent and incapable of being reversed by steroid therapy." Being an optimist, I refuse to believe that it is permanent!

I note that the authors refer repeatedly to the relationship between hormonal abnormalities and intestinal dysfunction as 'an association' and I don't think that they established any causality, e.g. A causes B, B causes A, or C causes both.

I find this bit particularly interesting:

"the adrenocortical hormones, secreted in response to pituitary stimulation, exert considerable anabolic activity, and are potent regulators of carbohydrate, fat, protein, and electrolyte metabolism. Thus would the pituitary-adrenal mechanism be activated whenever minor deficiencies of these essential factors occur-a likely possibility with any gastro-intestinal lesion of sufficient severity to impair absorption. The longer the duration and more severe the intestinal lesion the greater will be the demand for adrenocorticoids.

Should the limit of pituitary responsiveness be surpassed by excessive or prolonged demands, anterior pituitary exhaustion will occur."

plus the text that follows it.

This is the same type of mechanism described for 'adrenal fatigue', for example in response to chronic stress that leads to chronically-increased cortisol production followed by a drop in production.

My own illness started during a period of malnutrition when I could not afford to eat properly, as well as extreme stress and over-exertion.

On the next page they refer to 'A vicious circle'.

It would be interesting to see whether symptomatic improvements arising from a leaky-gut diet are accompanied by improvements in adrenocortical/pituitary function.

I did a search for the paper to look for later papers citing it, and the PubMed page is here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1966574/

Not much there, so I did a search for 'pituitary' in the ME Research UK database and found these:

http://www.ncbi.nlm.nih.gov/pubmed/1659582

http://www.ncbi.nlm.nih.gov/pubmed/21549189

and there are others but I must get on with some other things like my tax return!

 

[Beyond]

Hypocortisolism in CFS:
http://ajp.psychiatryonline.org/article.aspx?articleID=174711

Good points @MeSci I too tend to hypothetize than improving the gut directly would improve "adrenal fatigue" as well. These systems are so interconnected than treating one is treating the other, because they all are causes and consequences in the chain/cascade of events that lead to losing body homeostasis. As you have noted, the original cause is often some kind of acute or prolonged stress, which I suppose is coupled with a genetic predisposition.

 

[caledonia]

In my experience, treating the gut only helped the gut.

However, methylation treatment has helped both my gut and adrenals. So according to this article, it is possible that methylation treatment helped the adrenals which helped the gut, instead of directly.