Post Bacterial and Post Viral Fatigue in Adrenal Fatigue Syndrome

By: Michael Lam, MD, MPH

A look under a microscope for Post Viral FatigueThe invention of the microscope in the 1800s was a scientific milestone that has led to revolutionary advances in medicine. It helped with the discovery of bacteria and parasites later in the century, which eventually led to the invention of antibiotics in the early 1900s. However, these inventions have also initiated our undoing in recent years. Drug-resistant superbugs have started surfacing due to persistent over medicating. Since the discovery of microscopic organisms, the medical establishment has found many controversies regarding the involvement of bacteria in conjunction with or as a cause of other medical conditions aside from infection. For example, the bacteria, Helicobacter pylori, were in only recent decades shown to be a cause of stomach ulcers, having previously been rejected by the medical community. Lyme disease is currently facing a similar situation, with differing views on the degree of its prevalence and associated diseases such as chronic fatigue that is seemingly unrelated at first glance. We are entering a new era in which infections play a causative role in multiple disease entities other than infection including post bacterial and post viral fatigue.

Infectious States

When a microorganism invades an individual, physiologic changes such as fever, elevated white blood cell count, and positive x-ray findings typically manifest in post viral fatigue. This is what we commonly call an active infection, and most agree that antibiotic treatment is required for this post viral fatigue. Sometimes lesser symptoms present themselves and exist over a longer period of time in the case of post viral fatigue such as enlarged lymph nodes, fatigue, persistent cough, and low-grade fever. Patients with these subtle signs and symptoms fall classically in a state of subclinical infection, and would still be treated with antibiotics.

Another level below sub-clinical infection is known as the carrier state. At this state, the organism is still in the patient’s body but is controlled by the immune system. This means that the patient is not suffering from any physiologic symptoms at the time, but may in the future when their immune system weakens or falters. For example, patients who once suffered from chickenpox as a child may see the virus come out of hiding as shingles when they become an older adult as their immune system weakens.

There is another level below the carrier state known as the stealth level that is recently coming to the forefront. At this lowest level, microorganisms are normally undetectable by regular laboratory tests or by the immune system. They exist in the body unrecognized as a negative foreign entity. The body, therefore, does not mount an active defense response. The organism is still active however secreting toxins in minute amounts. These toxins affect the bodies’ physiology and generally weaken the body, allowing other organisms to invade opportunistically. Recurrent sinusitis and Post Viral FatigueCommon signs and symptoms of post viral fatigue are extremely subtle and often have no apparent connection to what is generally acceptable as signs of infection. They include worsening allergies, recurrent sinusitis, autoimmune disease, chronic diarrhea, brain fog, rash, anemia, delayed inflammation, food intolerance, and hormonal imbalance. A patient presenting with these symptoms of post viral fatigue will typically visit many doctors over time. These visits seldom lead to anything definitive, as medical findings are typically not significant, laboratory tests are normal and at best marginally positive. The clinician is baffled and the patient is commonly diagnosed as having anxiety or depression and put on medication for such conditions.

Stealth Pathogens

Common pathogens that can present themselves in the stealth state of infection include Candida, giardia, EB virus, Borrelia (causes Lyme Disease), various hepatitis viruses (causing hepatitis A, B, C and E), and H. Pylori (causing gastric discomfort and ulcer).

Other less common pathogens that are linked to stealth infection include mycoplasmas, a highly pleomorphic microorganism. This is a common cause of walking pneumonia. There are many species of these very dangerous organisms. They exist in a physical state somewhere between bacteria and virus. Detection is therefore very difficult. In their stealth state, toxins are released slowly and consistently. The body’s immune system is worn down slowly as it tries to neutralize toxins constantly. Traditional allopathic antibiotics are usually ineffective. In fact, mycoplasma may be the end result of aggressive but failed medical therapeutics giving rise to their opportunistic infection.

Like Candida and Borrelia, mycoplasmas in its regular state can cause low-grade gastrointestinal tract infections and dysbiosis as well as the ability to attack the entire body. No organ system is untouched. These stealth capable pathogens have also been linked as a cofactor to chromosomal aberrations, and other unexplained and complex illnesses, including chronic fatigue syndrome and a variety of autoimmune illnesses. For example, autoimmune thyroiditis has been linked to GI overgrowth of the opportunistic organism Yersinia enterocolitica; Kelsiella has been associated with ankylosing spondylitis; Campylocbactor has been linked to Guillain-Barre syndrome; Chlamydia has been tied to multiple sclerosis, and Cirtobactor a suspect in rheumatoid arthritis.

Small Intestine Bacterial Overgrowth

The small intestine is also referred to as the small bowel and acts as a bridge between the stomach and the colon, or the large bowel. The small intestine digests food and absorbs it into the body. The small intestine, or bowel, has three different parts: the duodenum, which is where food empties into from the stomach, the jejunum and the ileum, which both absorb various nutrients and empty food not fully digested into the colon or large intestine.

Human Intestines and Post Viral FatigueThe human gastrointestinal tract, which includes the small intestine, contains bacteria under normal conditions. The quantity of bacteria varies, with the colon having the greatest amount and the small intestine having the least amount. The colon contains different types of bacteria than would benormally found in the small intestine. A condition known as small intestinal bacterial overgrowth (SIBO) occurs when an abnormally large quantity of bacteria is living in the small intestine and the types of these bacteria are more in line with the types of bacteria that usually exist in the colon.

Small intestinal bacterial overgrowth (SIBO) also goes by the name small bowel bacterial overgrowth syndrome (SBBOS). The cause of this condition may be malfunctioning intestinal muscles or nerves or perhaps an obstruction of some sort or some other intestinal dysfunction. People with SIBO display the following symptoms:

  • Abdominal pain
  • Bloating
  • Gas
  • Constipation
  • Diarrhea

When the condition or post viral fatigue becomes advanced it can cause weight loss along with vitamin and mineral deficiencies. Certain patients with irritable bowel syndrome may develop similar symptoms due to SIBO. The recommended treatment for SIBO is antibiotics or probiotics and sometimes both are prescribed and used in combination.

If SIBO is not treated promptly, the symptoms can become chronic and last on and off for months and even years. Sufferers can have no symptoms for a period of time and then suddenly experience resurgence out of the blue for no known reason. The common causes usually turn out to be a diet high in sugar, along with stress. If someone has co-infections of Candida and Lyme, along with the Epstein Barr virus, this can weaken the body’s immune system, which invites bacteria in the small intestine to take hold. This raises the toxin levels, which causes the symptoms to become even more severe.

The natural progression of this condition, along with aging, can cause the person to become debilitated with continued weight loss, chronic diarrhea, and malabsorption.

Stealth Infection and Inflammation

Let us look at how stealth infection destroys the body slowly and quietly.

The body’s immune system starts developing at birth by remembering each individual organism it encounters. Every organism has a unique molecular fingerprint found on its surface. Once identified, the body triggers and activates an inflammatory reaction as a defense mechanism. Inflammation is defined as four distinct signs, heat, redness, pain, and swelling. This process is usually brief and contained. However, in the case of stealth infection, the inflammatory reaction is lowered but not totally suppressed. It persists at a very mild simmering level. This results in the ambiguous symptoms and lack of objective findings found in these patients along with normal laboratory findings despite extensive medical workups.

There are varieties of proposed theories suggesting how stealth organisms are able to go undetected. Biofilms are aggregates of microorganisms covered in a polymeric substance, also known as slime, made up of extracellular substances. One theory supports, it is this slime that helps the organism navigate under the radar as it is made up of parts of the human body. Chronic Inflammation and Post Viral FatigueAnother theory suggests that certain organisms have deficient cell walls. This means that the organism lacks the identifiable molecular fingerprints typically found on the surface and as such, are not recognized by the immune system. A third theory proposes that plasmids, shareable DNA, are transferred between organisms, allowing them to disguise themselves with molecules that can change depending on the situation. These plasmids can be shared between different species, allowing for even more genetic variation and masking. Regardless of which theory, a simmer inflammatory response is the body’s common pathway at the end.

How Stealth Pathogens Attack – Post Bacterial and Post Viral Fatigue

Pathogens capable of leading stealth infectious states range from bacteria, fungus, virus, to mycoplasma. Almost any pathogen that has been able to survive the onslaught of strong antibiotics of the past century has the potential capability to attack the body using the stealth mode in addition to their regular mode like post viral fatigue. Unfortunately, this is frequently overlooked. The alert to the stealth infectious state of many pathogens remain vastly under-estimated and under-appreciated within the medical world. The stealth infectious process puts the body on a slow-motion train crash that can wreck the body beyond repair before final discovery. It is important to recognize that just because a pathogen is not detected by current laboratory technology does not mean it does not exist or cannot do harm.

Once these stealth capable pathogens enter the body, they can be ever present, even though common signs of infection such as fever, diarrhea, or cough are absent. Strong antibiotics can bring relief of acute symptoms and reduce toxic load temporarily. Even when the laboratory titer has cleared us of an acute infectious state whereby we are pronounced cured by infectious disease specialists, these pathogens can still be omnipresent within our eco-system in minute amounts. By operating in the stealth mode, they evade detection while continuing to destroy healthy cells, slowly but surely. Fortunately, Mother Nature has provided us with an excellent built-in defense system, and that is why most stealth infections are neutralized without our knowing and this process usually goes on unnoticed for decades.

At their stealth state, pathogens release toxins very slowly as the main mechanism of attack. The process is so slow that it can escape even the most sophisticated laboratory detection available. Post viral fatigue is very hard to detect. In their mildest state, therefore, stealth infection, like post viral fatigue, is hardly noticeable at all. As the stealth infection gathers steam, mild clinical symptoms may surface and be treated more as a nuisance to normal daily living. A person may be totally normal other than some unexplained joint pain or occasional food intolerance. As the infectious process and post viral fatigue becomes more serious, moderate fatigue, headache, and reduced exercise capacity may become evident. Often these are simply written off as signs of aging. This is why such infectious states usually go unnoticed until the damage is severe and well entrenched. Unfortunately, sooner or later, the body gradually runs out of steam to defend itself as we age or becomes weak due to other reasons. When this happens, though slowly, the body enters a state called toxic overload.

Toxic Overload and Post Viral Fatigue

Overload and Post Viral FatigueEarly signs of toxic overload include malaise, brain fog, joint pain, nervousness, tingling, dizziness, insomnia, headache, gastric upset, and delayed food sensitivity that seems to be innocuous and even written off as part of the aging process. Symptoms of stealth infection escalate slowly over years and decades. If left unabated, toxin accumulation can lead to severe anxiety, chronic pain of unknown origin, severe fatigue, irritable bowl, and recurrent colds and flu. No system is spared, but organs most exposed to attack include the liver and adrenal glands. As toxic overload increases inflammation, the body’s compensatory response is to produce more cortisol, the anti-inflammatory hormone. This production is controlled by the adrenal glands. Chronic stealth infection can gradually lead to overworked adrenals. Cortisol output first rises but eventually falls after being unable to keep up with the ever-increasing demand to neutralize toxic overload. Adrenal Fatigue Syndrome surfaces as cortisol depletion sets in. With compromised adrenal function, the anti-inflammatory response is further lowered, and the toxic overload worsens. As the adrenals weaken, the liver is also under tremendous stress. Stealth toxin attacks healthy cells and causes cell death. As healthy cells die, they have to be metabolized and quickly removed from the body. This is the job of the liver. Long-term sufferers of stealth infection invariably are burdened with increased liver workload if not properly fortified. Those already afflicted with a history of liver insult from past illness such as hepatitis, weak constitution, poor lifestyle habits including excessive alcohol or medication use including the very popular statin type of cholesterol lowering medications and certain antibiotics are particularly vulnerable. If the stealth infection is not controlled early on or with aging, the liver will eventually weaken over time. Unfortunately, liver enzymes will continue to be unremarkable during this entire process.

Stealth Mode to Active Mode

If the stealth infection is uncontrolled, the body will eventually be bathed in a sea of toxins unable to be cleared by the liver in timely fashion while the pathogen’s toxin influx continues unabated due to lack of neutralizing cortisol as Adrenal Fatigue sets in. This one-two punch is a time-tested tactic for stealth pathogens to gain the upper hand on the body. A vicious cycle follows as the body gets weaker with time and eventually succumbs. As the body surrenders, fatigue becomes extreme and one can be incapacitated. The regular active mode of infection we are familiar with now resurfaces and gains prominence. Only now will the laboratory test be remarkable, when the damage is well entrenched. Unfortunately, the conventional medical wisdom is to administer strong antibiotics. Upon exposure to antibiotics, the pathogens enter the stealth mode as a shield for self-preservation. When the antibiotic is withheld, active infection returns with a vengeance and toxic titer resurges. Another round of antibiotics will be recommended. The cycle repeats. With each round, the body becomes weaker from internal damage caused by the antibiotic as its efficacy is reduced. Resistance to antibiotics develop and after a few rounds of trying various antibiotics to no avail, the patient is abandoned as medical intervention has been exhausted.

Breakdown Speed

Body constitution and Post Viral FatigueHow long can the body sustain the insult of stealth infection before breaking down? The stronger the body, the more dormant the infectious state and less symptomatic one will be. Conversely, the weaker the body, the more aggressive the stealth infection will be and the faster the breakdown. This tug-of-war between the body’s defense system involving the adrenals and the liver can go on for decades, depending on the body’s constitution and the external environment. At every opportune moment, however, the stealth pathogen will try to reassert itself. There can be no end in sight in this merry-go-round, and that is why stealth infection is so hard to recognize, manage and overcome. One can feel good for weeks or months after a lot of hard work to control the stealth toxin, only to fall quickly with the smallest mistake in lifestyle or nutritional mishap. It comes as no surprise that many with chronic infection such as systemic candida, chronic hepatitis, and Epstein-Barr will find periods of relative symptom free stability when the stealth infectious state is under control alternating with periods of significant clinical symptoms when the pathogen goes on a rampage. In fact, such recurrent roller coaster rides are classic signs and alerts of underlying stealth infection. The triggers for resurgence can include a diet high in hydrogenated fat or sugar, emotional stress, surgery, menstrual cycle irregularities, overexertion, excessive sex, inadequate sleep, or inadequate water intake. During the resurgence, laboratory tests continue to be unremarkable but the sufferer can be incapacitated.

Read Part 2 Now!

© Copyright 2014 Michael Lam, M.D. All Rights Reserved.

Dr. Lam’s Key Questions

Viruses could attach themselves anywhere in your body. Keeping your body healthy with the right supplements, lifestyle, and diet would help to keep your immune system strong so that you don’t catch the “common cold.” There are supplements such as Virapax, Liponano C, Vitamin D that can help to keep the immune system strong and preventing the flu or cold.

Prevention is key. Take any supplements before you have the cold or somebody around you is sick. Virapax, Liponano C, Zinc or Vitamin D. These are all available at

A look under a microscope for Post Viral Fatigue
5 - "Dr. Lam,"
Dr. Lam,

I have taken your supplements for 17 months now and I am recovering very well from AFS. I work full time, can do 90 minutes of power yoga, dance at a concert, have sex, go on a camping trip, etc. Crashes are rare and recovery is very fast. I have rebuilt my lost collagen, but not muscle mass. I am weak from not doing intense exercise.