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Just Say "No"

Just Say "No"

It is no secret that chronic stress is an immunosuppressant. Sixty years ago Dr. Selye first discovered that when rats were subjected to a variety of sustained disagreeable circumstances, their thymus glands atrophied.

What kinds of stress suppress our immune systems? Both physical and psychosocial stress subdues our immune function. Stress will reduce the production of new lymphocytes, stifle their release into the circulatory system and accelerate the death of pre-existing lymphocytes already in circulation at the onset of the stressor. Stress will significantly reduce the production of new antibodies to an infectious microbe.

Circulating glucocorticoids (cortisol secreted from the adrenal glands) are mostly responsible for this stress-induced immunosuppressive phenomenon. In the 1960s, researchers measured the size of the thymus as a method of evaluating stress because this gland's size shrinks under the influence of increased corticosteroids in the bloodstream. The thymus gland matures T-Cells and thymus tissue is almost entirely made up of new cells. Glucocorticoids halt the formation of new lymphocytes shrinking the gland. Glucocorticoids also stop the release of chemical messengers, specifically interleukins and interferons which guide the immune response. Circulating lymphocytes become less reactive to infection. T-Cells migrate to storage tissues under the influence of increased glucocorticoids, making cell-mediated immunity much more disturbed than humoral immunity. Glucocorticoids can actually poison lymphocytes to death. It is postulated that glucocorticoids trigger lymphocyte suicide pathways but the precise mechanism remains obscured.

Other sympathetic nervous system's hormones such as beta-endorphins and corticotropin releasing hormone both somehow play a role in immune suppression. Recent scientific work suggests that their impacts are much more significant than previously recognized.

Under repetitive episodes of acute stress or one long episode of chronic active stress, why would the body deconstruct its immune system? In the midst of stress, our bodies pour energy into the disassembly of the pre-existing immune operation, our glandular tissues become atrophied and thousands of individual cells are destroyed. For years, scientists have searched for some reasonable explanation for our self-destructive behavior under stress. When an answer was discovered, it was not what researchers had expected.

Within the first few minutes of stress, the body does not uniformly suppress immunity. Some aspects actually enhance. The parts of our immune system that will allow us to respond better to the stressor will boost. More immune cells are secreted into the bloodstream to infiltrate tissues that may have been injured in our response to the stressor. T- and B-Cells become more sensitive to interleukins and interferons. Mucous membranes initially secret more IgA antibodies. When we are exposed to any stressor, our initial response is to put our immune system on high alert. Some of these amplified effects are mediated by the secretion of glucocorticoids (cortisol).

If the stressor lasts longer than sixty minutes, the prolonged glucocorticoid secretion and sympathetic nervous system activation begins to have a detrimental effect. If the stressor ends in less than an hour, everything returns to where it was prior to the stressor in the first place. It is only in those circumstances when our major stressors continue over long periods of time that our immune system reduces its functionality, sometimes as much as forty to seventy percent of baseline. In the case of a short-lived stressor, the recovery phase begins when the action phase finishes. It is only in the last few years that researchers recognized that what they observed after a brief stress (less than an hour's duration) was recovery: immune reactions that initiated to return the system back to normal.

Why it is important to bring a heightened immune system back to its pre-stressed baseline? Because too much of a great thing is not a great thing. It turns out that if your body remains on a heightened immune reactivity after the stressor is gone, the risk for autoimmune disease greatly increases. Epinephrine (adrenaline) is the hormone/neurotransmitter that heightens the immune system initially. High levels of glucocorticoids are needed to offset the immune stimulating effects of epinephrine. If for some reason the glucocorticoid levels are inadequate to restore normal immune function, the chances of our immune system attacking self increases greatly.

Scientists have evaluated strains of rats and chickens that spontaneously develop autoimmune diseases as they mature into adulthood. They all have a defect in their glucocorticoid regulation. They either have lower levels of circulating glucocorticoids in their bloodstream during their recovery phase compared to normal controls or their cells are less responsive to circulating glucocorticoids in their recovery phase compared to normal controls. This phenomenon has been shown to be consistent with patients suffering from autoimmune diseases, especially rheumatoid arthritis. I suspect it is probably similar for many human autoimmune events.

However the subject of autoimmunity is complex. One of the most time honored treatments of autoimmune disease is to prescribe "steroids" - massive amounts of synthetic glucocorticoids - to dramatically reduce the immune system's vicious attack on its self. A serious side effect of suppressing the immune system is that it is unable to defend the self against real pathogens or infectious threats. Over the years, I have observed that patients with autoimmune diseases and extreme stress over prolonged periods of time have less symptoms. Oddly enough, when their stressors are relieved, their symptoms seem to get worse.

On the other hand, I have treated hundreds of patients with stable symptom-free autoimmune diseases who experience an acute episode of unexpected stress. Their condition flairs. It seems clear that stress is probably the most reliable factor in worsening an autoimmune disease and repeated episodes of stress increases someone's risk of developing an autoimmune disease.

By now, you should be pretty confused about autoimmune disease. And I think you recognize why most physicians typically dismiss complaints by patients who have autoimmune diseases, doctors are confused too. We need our immune system since our world is filled with microbes just lurking to get into our bodies and wreak havoc for their benefit. On the other hand, many of us do not take care of ourselves good enough to keep the immune system from over-activating. Many patients suffer from over-dramatic lives, ever present psychosocial stress encouraged by a lack of appropriate boundaries in family and personal relationships. They seek the approval of everyone they encounter.

When was the last time you said "No" to someone with an over burdensome request? In many cases, I think "No" is a better treatment than "Steroids" for autoimmune diseases. If you have an autoimmune disease, just say "No". "No". Again. And again. One more time.

I bet you feel better already.


Posted by Amanda Sanders at 9:01 AM
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