Stress Triggers Autoimmune Diseases: Fact or Fiction?

Young woman with hand pain from arthritis.

Source: Yurii_Yarema/Shutterstock

Why do 80% of patients with autoimmune diseases, like lupus, rheumatoid arthritis, thyroiditis and multiple sclerosis, report that their symptoms first appeared after a period of extreme stress? On first blush, this association seems counter intuitive. When one is stressed, large amounts of the stress hormone cortisol are pumping through your body, and cortisol is amongst the most potent anti-inflammatory hormones your body makes. Logically, when you are stressed, your immune system should be tuned down – not turned up as in autoimmune diseases.

Without data, physicians often considered this an imaginary association. Compounding the problem is that autoimmune diseases occur in females of all species at a 2 to 10-fold higher rate than in males. Not helping was the centuries-long dismissal of many illnesses in women as “hysteria.” In fact, the word hysteria is derived from the Greek for uterus or womb: “hystéra.”

I even attributed the perceived association to coincidence – that is, until I developed inflammatory arthritis and Hashimoto’s thyroiditis after a period of prolonged stress. I began to wonder what could account for the connection. I had been a long-distance caregiver for years when my mother was dying of breast cancer, and before that when my father died after a long decline from a Parkinsons-like dementia. In that same period, I went through a divorce, moved to a new house, and, as a whistle-blower, I was experiencing a great deal of stress at work. In sum, I was carrying the load of 5 of the top major life stressors: caregiving, loss of loved ones, moving, divorce, and work stress. Could stress indeed have triggered my autoimmune disease?

I had a large family history of autoimmune diseases. My grandmother had lupus, my mother thyroiditis and late-onset rheumatoid arthritis, and two cousins had autoimmune diseases. I naturally attributed my arthritis and thyroiditis to my genes and I do have the gene linked to a mild form of mixed connective tissue disease. But genes are only part of the story.

In the arthritis-prone rats that I was studying at the National Institutes of Health we found that many genes each with small effect contributed to their susceptibility to a whole host of autoimmune diseases — the pattern of which depended on the environmental triggers to which they were exposed. Bits and pieces of streptococcal bacteria triggered inflammatory arthritis that looked for all the world like human rheumatoid arthritis. Spinal cord protein triggered multiple sclerosis, thyroid protein triggered thyroiditis, and so on. I discovered that those rats had a blunted hypothalamic-pituitary-adrenal axis response – the brain’s hormonal stress response. They didn’t make enough cortisol to shut off inflammation as soon as it began, unlike their high stress response cousins who, when exposed to the same triggers, shut of inflammation promptly and were resistant to those same autoimmune inflammatory diseases. So why would stress, where cortisol is high, trigger these illnesses?

Lock and key.

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It turns out the amount of stress hormone floating around isn't the only thing that tunes down inflammation. For cortisol to have its effects, its receptors on immune cells also need to be functioning well. It’s the old lock and key phenomenon. If the hormone is the key, it needs to fit into the locks – those receptors on immune cells, to turn off inflammation. Chronic stress impairs those locks. It reduces the number of stress hormone receptors and makes the remaining ones resistant to cortisol’s effects. So even if there is plenty of cortisol around, there aren’t enough receptors available for it to unlock. Think of a keyhole filled with bubble gum. No matter how many keys you throw at it, the door won’t unlock. To make matters worse, chronic stress also increases the amount of a dummy, inactive form of the cortisol receptor, so that much of the cortisol that could have turned off inflammation is sucked up and stuck on the dummy receptor. Less is available to bind to the active form of the receptor, thus reducing the hormone’s anti-inflammatory effects.

When I developed inflammatory arthritis and thyroiditis, it certainly was related to the dose of genes I had inherited that made me prone to these illnesses. But it was no coincidence that I developed those illnesses when I did, after a period of prolonged, unrelenting stress.

So, given how much is stacked against us biologically when we are chronically stressed, what can we do about it? You can’t get rid of your genes, and you can’t get rid of stress. The prevalence of autoimmune diseases is increasing worldwide. This has been attributed to increasing exposure to environmental triggers such as pollutants, poor diets, and to stress.

If you are amongst the estimated 1 in 10 people worldwide or 10 million people in the U.S. with autoimmune diseases, you can be aware of the impacts of chronic stress on your immune system and take action to do what is possible to shift your stress response when it is getting out of hand.

One way to do this is to engage in the 7 domains of integrative health: restorative sleep; activities that reduce stress, like meditation, yoga or Tai Chi; being in green environments and nature; fostering positive relationships; eating a healthy anti-inflammatory Mediterranean diet; getting adequate amounts of exercise and engaging in spiritual pursuits. If these all seem daunting, don’t try all of them at once. Choose one to work on to start. And don’t try to do it on your own. A health coach or integrative medicine practitioner can help guide you through the rough spots and help you keep yourself the healthiest you can be.

This doesn’t mean ditching the anti-inflammatory or disease-remitting drugs you’re taking. Engaging in these activities can help your body receive the greatest benefit from those drugs by reducing the overdose of stress hormones that accompany stress. I did it and it helps me modulate my symptoms whenever my stress load gets out of hand.

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