Navigating Autoimmune Part 2: How Stress Impacts Disease
- Chris Rhoades
- Mar 28, 2024
- 8 min read
Updated: Apr 10, 2024
How chronic stress impacts autoimmune disease and what you can do about it.
Background
When I was first diagnosed with UC I put a stressful amount of time and energy into diet. I researched the best dietary approaches, why they were effective, and ultimately created a blend of AIP and low-FODMAP. I was in denial that I had an auto immune condition and was fully convinced based on reading some articles that diet alone could heal all my "woes". Turns out diet alone won't heal my autoimmune disease.
I was not a good patient for my first GI doc. He prescribed me with a 180 day taper of Budesonide in addition to mesalamine. It took me 2 agonizing weeks to start it. I was hanging on to hope that miraculously I would wake up and my newfound diet modifications would cut the increasingly-worse-by-the-hour flare symptoms. I did not want any "big pharma" flowing through my body.
Reluctantly I gave in. And low-and-behold my flare quickly got under control. But my stubborn ass couldn't just accept that. So I tapered myself off the Budesonide after sometime between 60-100 days. At my follow up with the Doc he was a bit taken aback that I did not do exactly what he prescribed and left a note in MyCharts.
"Strongly recommend against discontinuing the medication for ulcerative colitis at this time. Significant amount of patients could rebound with pancolitis. And this may need aggressive medication to treat as mesalamine and budesonide may not be effective at the time. Patient feels that diet and curcumin have helped." - Dr Anonymous
I can tip my hat to that. But what the "patient feels" was unfortunately short lived. My next flare started 4 months later and peaked 3 months after that and landed me in the ER for a 2 day stay with a high dose prednisone IV, nutrients for my deficiencies and a high dose prednisone pill to-go. I took a 7 week leave of absence from my own business. I was in the worst physical and mental condition of my life.
I share this because I didn't realize at the time how stress impacts autoimmune disease. I don't know what others experience in their IBD journey but no one at any time in traditional medicine told me I would experience extremely elevated levels of stress right before and during the onset of all my disease flare-ups. Deaths of loved ones, social media slandering of my businesses, expanding locations, closing a location and laying everyone off, a miscarriage with my wife.
So lets talk about stress.
Chronic Stress and Autoimmune Diseases Aren't Friends
No, they are mortal enemies. As people who have an autoimmune disease, we need to understand the basics of how detrimental long term stress is to the body. And to understand the impact of chronic stress we need to know how the stress response system should work.
The stress response system in the body involves a complex interplay between various physiological processes and organs. Here is a cliff-notes version of our stress response:
Perception of Stress: The process begins with the brain's perception of a stressor. This can be anything perceived as a threat, whether physical, emotional, or psychological.
Hypothalamus: The hypothalamus, a small region at the base of the brain, plays a central role in initiating the stress response. It releases corticotropin-releasing hormone (CRH) in response to perceived stress.
Pituitary Gland: CRH stimulates the pituitary gland, another small gland located below the hypothalamus, to release adrenocorticotropic hormone (ACTH) into the bloodstream.
Adrenal Glands: ACTH then travels through the bloodstream to the adrenal glands, which sit atop the kidneys. In response to ACTH, the adrenal glands release stress hormones such as cortisol and adrenaline (also known as epinephrine).
Cortisol: Cortisol, often referred to as the "stress hormone," plays a key role in the stress response. It helps regulate energy metabolism, suppresses non-essential bodily functions like digestion and immune response, and mobilizes glucose for immediate energy.
Adrenaline: Adrenaline triggers the "fight or flight" response, rapidly increasing heart rate, dilating airways, and redirecting blood flow to vital organs like the muscles and brain.
Sympathetic Nervous System (SNS): Adrenaline also activates the sympathetic nervous system, which is responsible for the immediate physiological changes associated with stress, such as increased heart rate and blood pressure.
Parasympathetic Nervous System (PNS): The stress response is balanced by the parasympathetic nervous system, which promotes relaxation and recovery once the perceived threat has passed.
Feedback Loop: Once the stressor is no longer present, feedback mechanisms help regulate the stress response, returning hormone levels and physiological functions to baseline levels.
These components work together in a coordinated manner to mount an appropriate response to stressors, helping the body adapt and cope with challenging situations. However, chronic activation of the stress response system can have detrimental effects on health over time. You are telling your brain that you are still not safe. So the stress response never shuts off. Then starts the "side effects" of chronic stress:
Hormonal Imbalance: Prolonged stress can disrupt the balance of stress hormones such as cortisol and adrenaline. While acute stress triggers a temporary surge in these hormones, chronic stress can lead to prolonged elevation or dysregulation of cortisol levels, which may contribute to metabolic imbalances, weight gain, and immune system suppression. Additionally, constant activation of the sympathetic nervous system can lead to sustained high levels of adrenaline, which may contribute to cardiovascular issues like hypertension.
Immune Suppression: As noted above chronic stress can suppress the immune system, making individuals more susceptible to infections and exacerbating inflammatory conditions. Have you ever noticed when you're stressed and don't sleep well you develop a cold? Prolonged elevation of cortisol levels can interfere with immune cell function and decrease the body's ability to fight off pathogens and heal injuries.
Inflammation: Dysregulated stress responses can contribute to chronic inflammation throughout the body. Elevated levels of stress hormones can promote the release of pro-inflammatory molecules, exacerbating inflammatory conditions such as arthritis, asthma, and autoimmune diseases.
Cardiovascular Effects: Chronic stress is associated with increased risk factors for cardiovascular disease, including elevated blood pressure, heart rate, and cholesterol levels. Sustained activation of the sympathetic nervous system and elevated levels of stress hormones can contribute to arterial damage, atherosclerosis, and increased risk of heart attacks and strokes.
Mental Health Issues: Chronic stress is a significant risk factor for the development of mental health disorders such as anxiety, depression, and post-traumatic stress disorder (PTSD). Dysregulation of stress hormones and neurotransmitters can affect mood regulation, cognitive function, and emotional well-being, leading to persistent feelings of distress and maladaptive coping mechanisms.
Digestive Problems: Prolonged stress can disrupt digestive processes, leading to symptoms such as abdominal pain, diarrhea, constipation, and gastroesophageal reflux disease (GERD). Stress-related changes in gut microbiota composition and motility can exacerbate gastrointestinal disorders like irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD).
Once the dysregulation has begun it's all too easy to get into a vicious cycle where worsening symptoms create more stress leading to further worsening symptoms, more stress, symptoms, etc. So what can we do?
The Good News Is We Can Learn To Manage Stress!
Breaking free from the vicious cycle requires a multifaceted approach that addresses the underlying causes of stress and the ways in which it manifests in your life. It's not for everyone but my method of choice in these scenarios is to grab a notebook or open a fresh document on my computer and dig in!
Step 1: Self-Assessment and Reflection
Identify Stressors: Make a list of specific stressors in your life, both major and minor. Consider work-related pressures, relationship issues, financial concerns, health problems, and any other sources of stress. Here are some cue's if they are helpful:
Reflect on Symptoms: Take some time to reflect on the physical, emotional, and behavioral symptoms you're experiencing that may indicate chronic stress. This could include things like headaches, irritability, changes in appetite or sleep patterns, and difficulty concentrating.
Explore Patterns: Look for patterns or recurring themes in your stressors. Are there certain situations, people, or environments that consistently trigger stress for you?
Step 2: Stress Reduction Techniques
Deep Breathing: Practice deep breathing exercises to help activate the body's relaxation response and reduce feelings of stress and anxiety. Try inhaling deeply through your nose for a count of seven, holding for a count of four, and exhaling slowly through your mouth for a count of eight. Or try -4-4. I'm personally enjoying Wim Hof's breathing method.
Mindfulness Meditation: Incorporate mindfulness meditation into your daily routine to cultivate awareness of the present moment and reduce rumination on past or future stressors. Focus on your breath, bodily sensations, or the sounds around you to anchor yourself in the present.
Progressive Muscle Relaxation: Practice progressive muscle relaxation to release tension and promote relaxation throughout your body. Start by tensing and then slowly releasing each muscle group, starting with your toes and working your way up to your head.
Physical Activity: Engage in regular physical activity to help reduce stress hormones and increase endorphin levels. Choose activities you enjoy, whether it's walking, cycling, dancing, or yoga, and aim for at least 30 minutes most days of the week. It's even better outside where you can connect with nature and the beauty around you.
Healthy Coping Strategies: Identify healthy coping strategies that help you manage stress in a constructive way. This could include journaling, talking to a friend or therapist, practicing creative expression, or engaging in hobbies and activities that bring you joy.
Step 3: Lifestyle Changes for Long-Term Stress Management
Prioritize Self-Care: Make self-care a priority in your daily life by scheduling time for activities that nurture your physical, emotional, and mental well-being. This could include getting enough sleep, eating a balanced diet, staying hydrated, and taking breaks when needed.
Set Boundaries: Learn to set boundaries to protect your time, energy, and emotional well-being. Practice saying no to commitments that overwhelm you or detract from your overall quality of life.
Practice Time Management: Develop effective time management skills to help you prioritize tasks, set realistic goals, and manage your workload more efficiently. Break tasks down into smaller, manageable steps and delegate responsibilities when possible.
Cultivate Supportive Relationships: Surround yourself with supportive friends, family members, and colleagues who provide encouragement, empathy, and practical assistance when needed. Foster meaningful connections and prioritize spending time with those who uplift and energize you.
Engage in Stress-Reducing Activities: Incorporate stress-reducing activities into your daily routine to help you unwind and recharge. This could include spending time outdoors, listening to music, or engaging in creative pursuits. I have found peace and positivty from gratitude journaling. It's a great way to start the day.
Practice Relaxation Techniques Regularly: Make a habit of practicing relaxation techniques regularly to help maintain a more stabilized stress response system. Set aside time each day for activities that promote relaxation and stress relief.
Seek Professional Help if Needed: If chronic stress persists despite your efforts to manage it on your own, don't hesitate to seek support from a mental health professional. Therapy or counseling can provide valuable tools and strategies for addressing underlying issues and improving stress management skills. I enjoy and find talk-therapy very useful.
I'm hoping this framework is useful! I found out that stress really did play a big role in my disease pathogenesis with some assistance from a prescription. When I experienced a flare in the first few months of 2023 I reached out to my PCP to discuss going on an anti-stress/depressant/anxiety medication. I went into that conversation knowing I wanted to try Wellbutrin due to its ability to not only help the mental game but also clinically proven to lower one of the major inflammatory markers associated with chronic inflammation called TNF-𝛂 (tumor necrosis factory - alpha). Within days of going on this medication my flare stopped and didn't return until a series of back to back to back stressful events that I did not respond well to.
For most of my young adult life I thought I "thrived on stress." I loved to push it to the limit in every area I could. Useful when growing a business. Detrimental to pretty much everything else. As they say, screw around and find out.
We must continuously learn and adapt our approach to healing and understanding our individualized diseases to get better. It's not up for any doctor to decide. Your health is your choice!
If you would like me to expand on any aspect of stress, or have any questions please let me know in the comments. Subscribe to receive updates on new articles and hopefully a newsletter - at some point!
With appreciation,
Chris
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