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Stress as a Trigger of Autoimmune Disease

Autoimmune diseases are a rare and poorly understood group of diseases, affecting  approximately 5% of Western population. Dr. Betty Diamond defined autoimmune disease in an article in the New England J. of Medicine (2001) as “a clinical syndrome caused by the activation  of T cells or B cells, or both, in the absence of an ongoing infection or other discernible cause.”  Almost all research papers on the topic of etiology start by saying that there is a multifactorial  group of causes, including genetic, hormonal, some environmental and immunological factors.  Despite the known causes, at least 50% of autoimmune diseases can be attributed to “unknown trigger factors.” And, that is where stress as a trigger fits in. Stress can affect immune function  in individual ways. Subjects of many retrospective studies have identified that they experienced  an unusual amount of emotional stress prior to onset of an autoimmune disease.

The bad news is that not only can stress trigger the onset of disease, the autoimmune disease  itself can then cause significant stress in the patient. This sets up a vicious cycle. As the stress  builds up, the major stress hormones are released, in particular, cortisol. The overproduction of cortisol and failure of the nervous system to regularly reduce it leads to immune dysregulation,  which ultimately results in autoimmune disease by the changing of cytokine production.

Cytokines are little proteins that help control the immune system and inflammation response.  Immune dysregulation is when your body can’t tell the difference between healthy cells and the  invaders that should be attacked. In most cases of immune dysregulation, the person is living  with an overactive immune system with joint pain and stiffness.

Since stress is so actively involved as both a trigger and a response to autoimmune disease,  effective treatment of autoimmune disease should thus include stress management and  behavioral intervention to prevent stress-related immune system imbalance. That brings us  back to some thoughts on the role cortisol plays in the autoimmune patient.

Cortisol is essential to the production of steroids. In fact, all steroids are initially derived from cortisol. And, since steroids are often prescribed in the treatment of autoimmune disease, high  levels of cortisol are helpful in reducing the symptoms of autoimmunity. When the levels are  low, however, it is likely to aggravate autoimmune disease symptoms. Addison’s disease is a  rare condition in which your adrenal glands do not produce enough cortisol.

Effective treatment of stress in the case of autoimmune disease requires a serious look at the  patient’s life situation in terms of what kind of stressors (psychological, physical, or emotional  stress), how the stress is affecting the body (overproduction or underproduction of stress  hormones), and how that person best reduces daily stress. Then set up a daily routine and  follow it slavishly.

Stress and Your Immune System During the Pandemic

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Keeping our immune system strong has always been important. However, it has become critical in this age of a 2-year pandemic. While this pandemic appears to be winding down, who knows what might be waiting in the wings.

When we are stressed, our immune system’s ability to fight off antigens is reduced making us more susceptible to infection. How does this happen? The stress hormone, corticosteroid, works to suppress the immune system by lowering the number of lymphocytes. Corticosteroid  can also increase active immunosuppressive mechanisms, like regulatory T cells. Chronic stress  dysregulates immune function by increasing proinflammatory responses.

There is a big difference between chronic stress and short-term stress. Short-term stress is the  fight-or-flight response lasting minutes to hours. It is a response to an immediate threat. The healthy nervous system will self-regulate by reducing the effects of the fight-or-flight response  as soon as the immediate threat is gone. Research has shown the value of short-term stress as  a way of mobilizing bodily resources and stimulating immune activity. One particular set of studies done at Stanford University School of Medicine by Dr. Firdaus Dhabhar tracked the paths of key immune cells in response to short-term stress in rats. The hormones that were  triggered enhanced the rats’ immune responsiveness during the fight-or-flight response. Their  findings paint a better picture of how our minds influence immune activity.

Chronic stress, or long-term stress, can suppress our immune system. People with weak  immune systems need to pay particular attention to their stress and to ways to systematically reduce it. Signs of a weak immune system include:
Frequent colds or infections
Digestive problems
Delayed wound healing
Skin infections
Fatigue
Blood Disorder or an autoimmune disease

Anxiety and its side-kick, chronic stress, are especially harmful to the immune system. If you  recognize that your nervous system reacts quickly with an anxiety or stress response, it is time  to pay attention to ways to reduce your stress. A busy mind that never stops or a busy schedule or chronic worry all can lead to chronic stress. One of the most effective ways to manage the  problem is to take frequent breaks during the day to stop the mental activity and consequent  cortisol production. As a great teacher once said when asked what is the best way to reduce  stress: “breathe!”

How Long is Your To-Do-List?

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Breathe. Let go. And remind yourself that this very moment is
the only one you know you have for sure.” Oprah

My mother used to be famous for telling our family: “It’s hard work having a good time.” I was  remembering that as I sat nursing a bump on the head from forgetting to duck under an open  cabinet door while rushing around setting up camp this weekend. At the same time, I was thinking about writing this column and wondering what to write about.

We used to laugh when mom said “it is hard work having a good time” but the more I live life,  the more I realize the truth of it. Life seems to be all about hurrying to DO things. We seem to  try to pack in as much as we can into each day. The more we put into the schedule, the more stressful the day becomes. For one thing, nothing ever goes as quickly or as easily as we plan,  thanks to things like traffic, the weather, the unexpected phone calls or unplanned things we  simply have to deal with. The meeting we planned doesn’t happen because the Zoom connection was bad, or the other person forgot, or they had an emergency or something.

Life in the fast lane. There is an explosion in one part of the world, and it is world news within  the same hour. What precautions do you take to erase some of that stress daily? Or, do you just let it build up until you realize you are exhausted.

How long is your To Do List? The busier we are the more we think we can add to the daily To Do List. After all, we are very fast and efficient at getting things done. Or, at least, that is what we  tell ourselves.

To change this pattern, you have to be conscious of (aware of) so much from minute-to-minute  in your day. Start by becoming aware of not over-booking yourself and not underestimating  how long it takes to do things. That is a tough one for most of us. If you are honest with yourself, you will recognize that you underestimate most everything from how long it takes to  drive to work to how long it takes to write that report. I spent years estimating my drive to the  office from Mandeville to Metairie was 30 minutes. It is and always has been 40 minutes – even  with no traffic or bad weather.

And, most important, I will bet that none of you think about putting a real break into your To- Do-List, a period where you can just BE for a few minutes, breathe, stretch, drink some water,  and STOP THINKING! Why not put the paper down and take a few minutes right now to just BE.

Stress Solutions

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Today’s Pregnant Woman Has More to Manage

That the birds of worry and care fly over your head, this you
cannot change, but that they build nests in your hair, this you can prevent.
~ Chinese proverb

A friend who was about to become a grandmother for the first time told me of her fears about her daughter’s pregnancy. The doctor was concerned about an early or premature delivery. My  friend confided to me that she was worried that this had something to do with her daughter  being a Type A personality and continuing to work long hours at her job. “Could someone under  that much pressure,” she asked, “expect to have a normal baby?”

My friend wasn’t worried about whether her daughter’s child would have ten fingers and toes,  two eyes and ears, and a nose. She wondered about the baby’s disposition, ability to rest, and  overall health and wellbeing. Intuitively, my friend understood what research is now  confirming:  too much stress during pregnancy, if not properly managed, can affect the baby’s  development in a number of ways. Stress, for example, is now recognized as a primary factor in preterm birth as well as a number of other later childhood problems.

The notion that modern generations are busier and handle more tasks at the same time than  past generations is not only supported by research; it is common sense. While we may not need to plow the fields and do the wash by hand, we are juggling more variables, processing more  information, and facing increasing psychological demands as our society becomes more  technologically advanced. In our fast-paced lives, things change around us rapidly. Change itself is a significant cause of stress because when something in our environment changes, we are  compelled to change our behavior. And changing our behavior can be an emotional event often accompanied by fear, anxiety, and even anger.

One of the things my friends’ daughter did when she became pregnant was to examine lists of  physical and mental symptoms of stress like the one below. This was the first exercise she did  to become more aware of her reactions to the day’s events. These aren’t the only symptoms of  a stressful lifestyle, but hopefully you will find this exercise helpful to help you recognize when  your tension is mounting.

Considering that many people have a misperception of how well they are handling the rising  stress in their lives, how well do you know yourself? Do you find yourself. .?

__ Holding your breath under tension               __ Rapidly shaking your foot while sitting
__ Now and then taking a sudden deep sigh    __ Being very fidgety or irritable
__ Having a racing heart or sweaty palms         __ Jumping to loud or unexpected noises
__ Clenching or wringing your hands                 __ Trembling all over

 

Stress Solutions

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Exercise Reduces Stress and
Lengthens Your Life

The first thing that drops out of your schedule when work bears down is exercise.
And, once it is out of your daily routine, it may be days or weeks before you notice
it is missing. I don’t know about you but during this 6-month period of isolation or
quarantine, I have completely loss my exercise routine. It started with our health
clubs closing. Yet, this has been a very stressful period. We need to redouble our
efforts to put exercise back into our schedules.

The importance of aerobic exercise was brought back to mind when I saw this
article in Psychoneuroendocrinology (2018). Dr. Eli Puterman is a professor in the
University of British Columbia’s school of kinesiology and lead author of the
article. The study was focused on showing how aerobic exercise can reduce
stress in family caregivers; however, the results generalize to all of us. In fact, a
much earlier paper on exercise and the length of “telomeres” was done at U. of
California. The bottom line is that Puterman’s study proved that exercising at least
3 times a week for about ½ hour over a 6-month period can slow down cellular
aging, which was measured by telomere length.

Telomeres are regions at the end of chromosomes that are active during cell
division. Simply put, telomeres protect the ends of chromosomes. Telomere
length is one of the most commonly used markers of aging. Telomerase is the
enzyme that adds DNA to the ends of the chromosome. Exercise can induce
apparent telomere growth or lengthening. That translates into longer life and/or a
more healthy and active life.

Dr. Puterman’s study design took a group of 68 men and women who were
inactive and stressed caretakers of a family member with dementia. They
randomly assigned the subjects to a supervised aerobic exercise intervention
group vs a waitlist control group for 24 weeks. The exercise routine was 40
minutes of exercise 3 – 5 times per week or 120 minutes/week of aerobic
exercise. The waitlist control group did not change anything in their usual activity
schedule.

The two groups did not significantly differ in telomerase activity across time, but
they had significantly different telomere length changes across time. Of course,
the exercise group also charted significant body mass index reduction and
increased cardiovascular fitness. Oh, and they reported a significant decrease in
perceived stress levels.

Aerobic exercise is also known as cardio. It includes brisk walking, running,
cycling, hiking, dancing, swimming, and kick boxing. (I added that last to make
sure you were awake.) If your choice of aerobic exercise is walking, you need to
step up the pace and also the length of time you walk. The key is to get your heart
rate up. You should notice your breathing, but you should still be able to carry on
a conversation. An Australian study indicated that walking briskly for 30 minutes
five days a week can improve aerobic fitness. But even walking for 10 minutes
three times a day is as beneficial as walking for 30 minutes one time a day.

Happy Trails to each of you during this Pandemic. Stay healthy.

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Puterman, Eli, Weiss, Jordan, Lin, Jue, et al. Aerobic exercise lengthens telomeres and reduces stress in family caregivers: A randomized controlled trial – Curt Richter Award Paper 2018. (2018). Psychoneuroendocrinology, 98, p.245-252

Stress Solutions

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One Simple FDA Approved,
Non-Drug Therapy
That Reduces Stress AND
Blood Pressure

RESPeRATE is actually the first medical device that has been
clinically proven to lower blood pressure AND stress. And, if
you don’t have high blood pressure, it is still a very effective
and easy to use method to reduce your cortisol levels and
relieve tension due to stress.

What is RESPeRATE? It is a small device that was originally
designed for pilots and other people that needed to reduce their
blood pressure but could not afford to take medication because
of their job or other health issues. This gadget is like a
“breathing coach” because all the work of reducing stress and
blood pressure is done by helping you reduce and calm your
breathing such that you spend 5 to 10 minutes a day (or more)
in slow gentle breathing.

RESPeRATE does the work of matching your breathing and
then gradually slowing it down and lengthening your
respirations until you get into a “therapeutic range.” Once you
reach that range, it keeps you there with a soft chiming to
signal intake of air and exhalation

The kit contains the RESPeRATE device, an elastic belt that
goes around your diaphragm and plugs into the device, and
earphones to allow you to hear the gentle tones that signal the
timing of your breathing. The cost is minimal, and the company
allows for it to be purchased in 3 easy installments.

Many of our patients promise that they will practice breathing
techniques for relaxation, but we all know how easy it is for
such promises to be put off until tomorrow. RESPeRATE helps
with the routine of doing the breathing exercise and it is a
pleasant 10 minutes that can easily become a habit. The same
benefit can be gained by the “doctor” who prescribes the
method.

It is fair to say that breathing is one of the most important
exercises one can do for your health – physical and mental.
The research indicates that daily use for 3 to 4 weeks is all it
takes to significantly reduce blood pressure. The stress
reduction and improved sleep are “side-effects.” Check out the
website for more information on how to order and for
information on the “Clinical Proof.” www.resperate.com

Stress Solutions

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Tapping Reduces Cortisol by 43%

That is what Dr. Peta Stapleton on Bond University in Australia found when she replicated Dawson Church’s 2012 cortisol study. In the original study, Church et al examined salivary cortisol levels in 83 subjects who were randomly assigned to either an emotional freedom technique (EFT) group, a psychotherapy group (SL for Sympathetic Listening) or a no treatment group (NT). The EFT group had a 50-minute session of tapping with a certified EFT coach. The NT group waited 50 minutes in the waiting room and the SL group had a 50-minute session with a licensed therapist. Cortisol was assayed just before and 30 minutes after an intervention. Emotional distress was assessed using the Symptom Assessment-45 to measure the subject’s level of anxiety and depression. The EFT group measured a significant decrease (p<0.03) in mean cortisol level (-24.39%) compared to a decrease of -14.25% in the SI group and -14.44% in the NT group.

Dr. Stapleton replicated the original Church study almost exactly. However, her results were even more dramatic. The EFT group reduced cortisol after 1 hour of EFT by 43%. There were 53 subjects in this study randomly assigned to one of the three groups. The Symptom Assessment-45 was again used to assess psychological distress. Salivary cortisol assessment was performed 30 minutes before the intervention and 30 minutes after.

Cortisol is considered to be an important biological marker of stress. EFT or acupoint stimulation is shown to be an effective method to reduce stress-related cortisol in a person. In an experimental situation, this is “interesting” and often that is all that happens with a reader who has an interest in stress reduction. In a real life situation, however, where someone has a history of not dealing well with stress, finding a short, easy to apply method that reliably reduces the amount of cortisol circulating in their body, the importance cannot be over-stated.

Creating a list of people who have a history of “not dealing well with stress” is an important first step. These are people who for some reason tend to hold the stress producing situation in their minds and continue to think about it, such as people who are more likely to have anxiety disorders like GAD or PTSD. The list should also include people who because of their physical condition, such as being pregnant, do not want to maintain high levels of cortisol in their blood.

An important second step as clinicians is for us to introduce them to various techniques to help them reduce their stress related cortisol. The Tapping Solution is possibly NOT the best technique. That remains to be seen. However, it is surely experimentally proven to reliably reduce cortisol and it is easy to do.

It might make a good tool for your therapy box if you see and treat people with anxiety.

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Stapleton, P., Crighton, G., Sabot, D., and O’Neill, H.M. (2020). Reexamining the effect of emotional freedom techniques on stress biochemistry: A randomized controlled trial. Psychol Trauma.doi: 10.1037/tra0000563 (epub ahead of print.)

Church, Dawson, Yount, G., and Brooks, A.J. (2012). The effect of emotional freedom techniques on stress biochemistry: A randomized controlled trial. J Nerv Ment Dis., 10, 891-6.

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Sleep – More Important
Than Ever

Research says the average American misses 200-300 hours of needed
sleep each year. This is known as a sleep debt.

Studies suggest that healthy adults have a basal sleep need of seven to
eight hours every night. Where things get complicated is the interaction
between the basal need and sleep debt. For instance, you might meet
your basal sleep need on any single night or a few nights in a row, but
still have an unresolved sleep debt that may make you feel more sleepy
and less alert at times, particularly in conjunction with circadian dips,
those times in the 24-hour cycle when we are biologically programmed
to be more sleepy and less alert, such as overnight hours and midafternoon.

What do obesity, chronic high stress, heart disease, diabetes,
hypertension, and depression have in common? If you guessed sleep
deprivation, my hat’s off to you.

While there is no “magic number” of hours that we should sleep, it is
now firmly established that you cannot lose weight if you do not sleep a
solid 7-8 hours a night.

Cortisol is not the only factor that inhibits weight loss but it is a big one.
Some physicians are willing to flatly state that you cannot lose weight if
you do not get to bed early and get a solid 7 or 8 hours.

What getting a good night’s sleep can do for you:

  1. A good night’s sleep has a positive effect on your blood pressure,
    meaning that for most of us it goes down at night. If your hours of sleep
    are interrupted or too short, your blood pressure may never fall low
    enough.
  2. Insulin resistance is reduced by good sleep. Dr. Michael Breus, a
    psychologist and sleep specialist, emphasizes the fact that even short-term sleep loss (being awake for approximately 36 hours) can cause
    blood glucose levels to be higher than normal.
  3. A routine schedule for sleeping will help your body keep its internal
    biological clock running smoothly. You will be more alert, with good
    reaction time and physical ability, in other words, less accident-prone.

How psychologists can help
Many psychologists are focusing on sleep habits in the patients they are
treating. A study in the Journal of Clinical Sleep Medicine, looking at
adults with insomnia, found that more than 85% of the study sample
who completed 3 or more sleep-focused treatment sessions were able to
nod off faster and stay asleep longer. A 6-month follow-up revealed that
those patients who had 3 or more sessions spent significantly less
money on health care and had fewer doctor visits – compared to the 6
months before their therapy sessions focused on sleep habits. The
weekly therapy sessions included relaxation exercises and education on
topics such as activities to avoid doing 2 hours before bedtime (like
exercise, heavy meals, and smoking).