Stress & Autoimmunity

Why Chilling Out Can Help Your Health

This post is about a book dedicated to how stress affects the body on a biological level- Why Zebras Don’t Get Ulcers by Robert Sapolsky. Though it’s technical, it’s really written for the layperson. It delivers amazing detail that you can actually understand without making you feel like a narcoleptic. I found it on Neil de Grasse Tyson’s favorite books list, so I figured it had to be promising. He covers depression, chronic stress, and even my subject of interest- autoimmunity. The latest research on POTS is revealing antibodies that seem to be unique to the condition, leading some to suspect that maybe it’s autoimmune (at least for some etiologies) or that it’s perhaps revealing an aspect of the interesting and complex connection between the immune and neurological systems that is still poorly understood.

The fact is that stress can be excessively inflammatory, and can trigger or make autoimmunity worse by enhancing an already over-active immune system. We don’t know what POTS or MCAS are yet, so we can’t call them autoimmune, and though they may present through similar modalities there’s a good chance it’s a more complex [neurological] problem. It is a fact that many patients do have other comorbid autoimmune conditions, so reducing stress may reduce your risk of forming these other debilitating autoimmune diseases. What is clear is that POTS and MCAS symptoms can be triggered by stress, and that these conditions cause excessive stress on person in many physical and emotional ways. It does also seem fair to claim that our immune responses are already dysfunctional due to our dysautonomia, making stress reduction seem that much more difficult, yet that much more important.

This book inspired me to zen my life as much as possible. It’s a lot easier to respect and adhere to advice (like reduce your stress exposure and get plenty of sleep) when you really understand why you should. The consequences make more sense and feel more real.

Managing Stress

Sapolsky wraps up the book with a great chapter on managing stress. He believes in the 80/20 quality of stress management- where 80% of the stress reduction comes from the first 20% of effort. Sounds amazing, right?

Here are some of his key take-away’s:

• When dealing with catastrophe like a chronic illness, it’s been shown that those who use denial tend to fare better. He suggests trying to find promise of improvement in even the most stressful situations, but warns not to ignore the possibility that things may get worse. Hope for the best, but let a small part of you be ready for the worst.
• People who deal with stress best seek control over the present stresses, not ones that have already happened or uncontrollable future problems. Classic AA type advice.
• Finding accurate information to help predict stressors can significantly reduce stress, because you can gain some control. This helps with some caveats… Extremely bad news is only going to increase your stress, as will an overload of information. For example, learning about your triggers for your health flares can help you avoid them and manage the symptoms better. Also, learning that your disorder can ebb and flow can give you some hope.
• Exercise can boost mood and blunt stress for a few hours and up to a day. Regular aerobic exercise is best. Seems like common knowledge now. Of course this is a huge challenge for those with POTS or MCAS, who can have moderate exercise as a trigger. Doctors do encourage us to get exercise, because it’s proven to help our condition significantly. It can feel impossible, but start what you can whether it be walking to the mail box or just 5 minutes on a reclined bike.
• Meditation done on a daily basis for about 15 minutes or more a day does seem to blunt the stress response. This is one of the most effective ways my therapist has helped me learn how to cope. It’s empowering to feel some peace by just being in the moment that’s happening right now. It’s something you can actually do, even if the rest of your life and body is out of control. I’ll take it.
• Find social support and affiliation with the right people. Don’t mistake socializing as the same thing. You need to feel connected and have a sense of belonging to improve your well-being. Those that do can cope better and statistically live longer.
• Regularly use outlets for frustration. Find what works for you whether it be writing furiously, playing a violent round of Grand Theft Auto, or meditating on a beautiful yoga mat.

The Details: How Stress Relates to Autoimmunity

Within the first 30 minutes of the onset of physical or psychological stress your body pumps out stress hormones like glucocorticoids and epinephrine, and your immune system actually becomes enhanced in many ways. More immune cells are put into your circulation, lymphocytes are quicker to respond, many of those immune cells are shunted to your skin, and more antibodies are released into your saliva. Your body is preparing for battle, and your immune cells are being put to the front lines.

After about an hour of stress exposure, a healthy immune system rebounds back to its normal baseline. If you can’t produce enough glucocorticoids, or if your immune and inflammatory cells are less responsive to those glucocorticoids, your immune systems doesn’t ramp back down. Instead it remains high, putting you at risk for autoimmunity. Imagine getting stressed repeatedly and your immune system isn’t brought back to normal each time. Your immune system is heightened as your new normal, priming it to start attacking parts of your own body. Sapolsky also explains that lots of transient stress even with a normal rebound response can still trend upward, ratcheting up immune function over time… again increasing the risk for autoimmunity.

For these reasons, it seems obvious why stress also worsens existing autoimmune conditions. Stress enhances an already over-active immune system. Your immune system just gets to attack you harder.

Fact: Autoimmune and inflammatory conditions likely cause depression.

Cytokines are small proteins that act as messengers between immune cells, and there are different kinds. Sapolsky connects depression to cytokines that reach the brain, where they stimulate corticotropin releasing hormone (CRH), which begins a cascade of the stress response, mediating anxiety. Cytokines are also proven to interact with norepinephrine, dopamine and serotonin systems. These interesting connections have been made, but the exact pathways and details are still being investigated and researched.