Freak Outs and Ice Packs: Women, Autoimmune Conditions, Inflammation, and Stress

Monday, March 09, 2015 by Meg   •   Filed under Physical Health and Emotion

Stress and the immune system have a relationship as complicated as Common Core math (so I’ve heard). In the short term, acute stress — or the kind you get running from a tiger —  boosts immune function and improves our ability to fight off illness and infection. Escaping from a tiger only to die of an infection would have been a bad evolutionary move and would surely have pissed off even the most chill cave man. 

So, if you’re going to the jungle gym and want to make sure you don’t catch a cold from those germy, monkey-bar-climbing heathens, make sure to be in full-on panic mode by pretending there’s a tiger behind a tree. Plus, what a fun game for the kids!

“Dude…your mom is whack.”

It’s the long term, chronic stress that does us in. That initial immune burst after run for your life is great. But when we can’t come down after it, say because instead of a tiger it’s a pile of paperwork, our stress stays at a lower but ultimately constant level. When that happens, our body starts producing more than the chemicals needed for fight and flight and things go a little haywire.

Okay, okay, a lot haywire.

We’re haven’t really evolved to the point where we can handle the never-ending demands of work and home (to read more aboout that, check out Why Zebras Don't Get Ulcers). Even our tendency towards social isolation is a problem because it triggers stress in social species. Socially isolated mice end up with worsening autoimmune conditions, complete with increases in all the chemical markers for those issues5. And the solitary offices, the constant worry about sending junior to college, how we’re going to pay the car note and why we’re SO DAMN TIRED….these we face everyday. 

Womp womp.

Autoimmune Conditions and Women

Autoimmune conditions occur when your immune system decides that healthy cells are foreign invaders and attacks them. Autoimmune conditions — such as fibromyalgia, rheumatoid arthritis and inflammatory bowel disease — affect around 8% of the population but a whopping 78% of cases are women19

Seventy. Eight. Percent. Holy fuck, ladies.

This may be because we respond differently to stresses on the body. Whether from vaccination, trauma or infection, women produce more antibodies and a specific immune response that is T helper (Th)2 predominant19. The main thing to take away from this is that the diseases we get tend to be those that are related to these antibodies. When we have too many, or they get confused, we are more likely to have problems because our cells are badasses and there are a lot of them. They go after your thyroid (or other areas) like a clan of Real Housewives from New Jersey with frying pans and Gucci bags.

I might be misrepresenting that show, but from the one I saw while flipping through the channels this seems pretty accurate.  

Okay, so we produce more of these antibodies than our male counterparts which helps us attack infection. But we don’t only produce these antibodies in response to an actual “foreign invader germ” roaming through our bloodstream. We are also more sensitive to other types of stress, including that from the environment. 


Stress, Inflammation and Autoimmunity

Stress and inflammatory autoimmune diseases are closely linked2,3 with hundreds of studies finding connections3. Stress triggers thyroid autoimmunity issues including Grave’s disease3, skin diseases such as psoriasis, vitiligo, blistering diseases and eczema7. Stress also suppresses immune system functioning9,10, increases the susceptibility to infection and cancer10, and makes asthma, allergic reactions and pretty much all autoimmune conditions worse10

But the why behind this is not well understood. Usually, the suppression of the immune system should lead to less inflammation and less autoimmunity, not more. If you hurt your arm and have an infection, you’d expect swelling and heat as your immune system gets to work. If your immune system isn't working you’d expect the wound to fester and not heal. Less swelling, less inflammation. So why would the immune suppression caused by stress be any different? 

There are a few theories, all of which are probably true on some level.

The first holds that oxidative stress, or that chronic kind, increases inflammation, and leads to cell death, including cells that emulate serotonin, a chemical that plays a huge role in both depression and pain reception. And oxidative stress also triggers the activation of certain genes such as those linked to borderline and bipolar conditions, psychopathy and depression. So stress turns on genes that lead to depression, while killing cells that would protect you from it. It’s a double whammy of  bullshit. 

That oxidation and cell death thing might be why stress makes mood disorders and autoimmune conditions worse4, but there might be more. 

Stress also alters the immune system response through either the nervous system or the endocrine system by releasing hormones and other chemicals. And neuroendocrine hormones secreted in response to stress lead to immune dysregulation and ultimately to autoimmune disease8. This may also explain why those exposed to extreme stress and trauma are at a higher risk for autoimmune diseases and cardiovascular issues later on6.

Okay, so lots of cell death from stress hormones, lots of not being able to regulate hormones and lots of turning on genes that trigger depression and other issues. But still…why the inflammation? 

Time to check in with our buddy, cortisol. 

Autoimmune Conditions and Cortisol

We usually see cortisol as the bad guy, revving us up and making us all panicky like a big jerk. But it also helps with metabolism and reduces inflammation by influencing the immune system1, which is a pretty critical thing for those with autoimmune issues. If cortisol is too low, our immune system plummets and other bodily systems get even more out of whack, including the ones that regulate neurotransmitters like serotonin (remember that one is critical in both pain and mood disorders). You end up with a big soup of symptoms, where the severity is based on the interaction between them and how low (or high) certain chemicals are. As one example, in a study of those with fibromyalgia, those who had depression, fatigue and sleep disturbances had lower cortisol levels than those without those issues. And the lower their cortisol was, the more tender and painful points they had on their body1. This suggests that if you are suffering from this set of symptoms, getting screened for lower cortisol might be beneficial, particularly because it can be treated. Some choose to take cortisol supplements or supplements which enhance adrenal functioing overall, but check with your doctor about the best way to raise your cortisol levels as not everyone requires hormonal supplementation for this particular issue.  

Though not everyone has precisely the same set of symptoms, those with autoimmune conditions may all share some common ground as far as the things that alleviate stress and inflammation. 

Autoimmune Conditions and Reducing Stress: 

Find support. Isolation increases stress responses, effects the immune system and makes mental health conditions worse. Even the female stress response involves secreting oxytocin to get us to connect with one another (more on Tend and Befriend here). Find one way to reach out every day, whether it’s sending an email (okay), calling a friend (better), or getting together for a girl’s night slumber party complete with wine and a bunch of movies starring Ryan Gosling (best).

“Hey girl…how can you be stressed looking at these abs?” 

Mindfulness and meditation have been show to improve psychological well being, improve immune function and reduce overall inflammation12. (Find more on how to practice mindfulness here.)

Decrease stress by getting help around the house, saying, “No,” to favors you don’t have time for and picking your battles. Not everything is of equal importance. It might be important to have clean clothes, less so to have them in the drawers. If your kids want wrinkle free pants, they can put them away. Give less fucks about things that don’t matter. Order out for sushi or plan fruit, eggs and toast for dinner so you can rest (or meditate). And if you can swing it, consider hiring someone to help, even if it’s a neighborhood kid to come in and do the floors once a week. Every little bit helps. 

Exercise. Exercise has been shown to do all kinds of great things from decreasing stress to regulating the hypothalamic-pituitary-adrenal (HPA) axis, a system involved in stress responses. And those with certain autoimmune issues do have some variation on the HPA axis over the course of the day that is related to the severity of their symptoms20. Regulate that axis: get outside and go for a walk. If you can exercise with a friend, even better. (Read more about the HPA axis and exercise here.)

Improve Overall Health

Nutritional supplements might be beneficial, particularly if you are vitamin or mineral deficient (as most Americans are). In some cases, proper supplementation can improve immune response, decrease allergies and inflammation and increase quality of life for those with allergies and asthma11. While a blood test is the best way to figure out exactly what you need, a multivitamin can get you started. Try this one

Natural Remedies for Autoimmunity. All of the following have been shown to reduce inflammation in autoimmune conditions. There are hundreds of studies so I cherry-picked some of the best. (You can purchase these supplements by clicking on the words.) 

  • Ginger 13,14
  • Turmeric15
  • Omega-3s17
  • Boswellia 16,18
  • Magnesium
  • Essential oils such as Carlina acanthifolia  Cordia verbenacea (Boraginaceae) and Gaultheria yunnanensis (Ericaceae) have been found to reduce inflammation18, but they are mostly rainforest herbs and are thus difficult to get. The same study found Rosmarinus officinalis, AKA Rosemary possesses similar anti-inflammatory properties. You can get rosemary essential oil here. 

Get professional assistance. Whatever you’re struggling with, a professional can help you to work through the physical and emotional issues that come with having an autoimmune condition and reduce stress. 

Stress and immune issues is a two way street; just as stress can trigger or worsen autoimmune disease, the disease itself can cause more stress. Nothing like chronic pain to make you a little testy. Hell, most men can’t even deal with a runny nose without hiding in bed whining all day.  (I'll see your "man cold" and raise you childbirth, fellas.)

Take it slow, make small changes where you can and try to reduce your stress to a manageable level to give yourself the most pain free days. If you need support from other people who are suffering, check out the American Autoimmune Related Diseases Association on Facebook, or try one of the NeuroTalk forums for autoimmune conditions. You might also like The Autoimmune Epidemic and Living Well with Autoimmune Disease: What your Doctor Doesn't Tell You That You Need to Know

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Topic-Relevant Resources

Why Zebras Don't Get Ulcers
Primatologist/biologist Robert Sapolsky on stress and your brain. Good stuff.

Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer
Economic exploration of the American healthcare system, and why it may be making us sicker and poorer.

Why Do I Still Have Thyroid Symptoms (when my lab tests are normal)
Exploration of the causes and effects of thyroid malfunction on mental health and other body systems

Living Well with Autoimmune Disease: What Your Doctor Doesn't Tell You...That You Need to Know
Overview on the theories of autoimmunity and healthy living tips to reduce symptoms

The Autoimmune Epidemic
One of my favorite reads on the topic, The Autoimmune Epidemic is packed with useful information on the diseases themselves and on ways to treat them.