Stress and Autoimmunity

What I Wish I’d Known About Stress And Autoimmune Disease

I see and treat many people with autoimmune disease in my functional medicine practice.

I’m also an autoimmune patient (Hashimoto’s gal here) and frequently lecture about Hashimoto’s, autoimmunity, and the gut-immune connection.

So, I’ve been aware of the role that stress plays in autoimmune disease for some time.

However, I always considered stress more of a contributing versus a causal factor, like the straw that breaks the camel’s back.

I’ve also observed and experienced how stressful situations can cause autoimmune flares.

Most of the literature supports this viewpoint, showing a connection, but that stress alone likely isn’t enough to cause autoimmunity.

However, new evidence, coupled with clinical observations and some self-exploration, has forced me to shift my beliefs about the significant role stress plays in autoimmune disease.

I’m now convinced that stress can and does play a massive role in the development of autoimmune disease and can begin very early in life.

In this article, I’ll share this new evidence plus fascinating facts on how stress and trauma impact the immune system, autoimmunity, gut health, and more.

We’ll also dive a little deeper and examine the energetic and psycho-emotional factors behind chronic stress and trauma and how that may be linked to increased susceptibility of autoimmune disease.

I admit the topic of energetic or bioenergetic medicine is not my area of expertise — but I’m feeling compelled to learn and share more about it.

Before We Get Started Let’s Address An Elephant In the Room

We’re talking about stress today, but not within the context of reducing a person’s very real symptoms to “just stress.”

I cannot tell you how many people (especially women) come to my practice because their symptoms have been dismissed as the result of “just stress.”

I think that’s B.S. quite frankly.

What we’re talking about today is how stress and trauma cause real health conditions within the body, specifically autoimmunity.

The Basics Of The Stress-Immune Connection

Nearly everyone has experienced the stress-immune connection.

Whether it’s a cold sore popping up after a stressful trip, coming down with a cold or flu after a fight with a loved one, or experiencing an autoimmune flare when your toddler floods your house (that was my life last year!) stress can wreak havoc on an otherwise strong immune system.

Those are examples of how acute stressors impact our immune system.

Chronic stress is another ballgame, with potentially serious long-term consequences for immune system function.

When we experience stress, our bodies produce hormones like cortisol and adrenaline.

This entirely natural and helpful process preserves life by triggering our fight-or-flight response. Without it, humankind would have never survived.

The problem is when we experience chronic stress, those same stress hormones designed to protect us in small amounts can negatively affect the balance of immune cells (such as lymphocytes, white blood cells, and natural killer cells) and cytokines (proteins involved in the immune and inflammatory response). 1

Cortisol can lead to suppressed production of white blood cells, resulting in a condition called leukopenia, which increases the risk of infections and other health problems.

This is why medications like prednisone (a steroid) are often prescribed to suppress the immune system in those with autoimmunity.

Additionally, stress can cause and/or contribute to:

In other words, chronic or prolonged stress can lead to an overactive immune response, which can result in chronic inflammation and tissue damage, also known as: autoimmunity.

New Findings About Stress and Autoimmune Disease

As I mentioned in the introduction, we’ve known about the link between stress and autoimmunity for some time.

Specifically, in functional medicine, we see stress as part of the autoimmune triad—three factors that create autoimmunity:

#1: Genetics: If your mother, for example, has Hashiomoto’s, there’s a greater chance you will have it too.

#2: Environment: It has long been known, but often ignored, that environmental triggers like toxins play a central role in the development of autoimmune diseases. Research now shows the role environment (including various toxins and stress) and epigenetics (how the environment affects gene expression) play in autoimmune risk.2 3 4

#3: Intestinal hyperpermeability (aka gut health): Until recently, genetics and environment were believed to be the only causes of autoimmunity. However, about ten years ago, physician and researcher Dr. Alessio Fasano proved that when intestinal barrier function is compromised, the body’s ability to regulate the immune response becomes imbalanced. 5

I discuss this in more detail in: The Functional Medicine Solution For Autoimmune Disease.

So, we’ve known about the triad of autoimmunity for about a decade and research continues to emerge.

stress causes

Until recently, I underestimated the role that stress plays within this triad.

Like many integrative functional medicine doctors, I used to put gut health as the primary focus in treating autoimmunity.

And it worked really well, most of the time.

However, as I started digging deeper in the pathology of autoimmunity, stress kept coming up again and again—which challenged what I thought I knew about primary causal factors.

This inspired my recent article, Why HPA Axis Dysfunction May Be More Important Than Gut Health.

But, it wasn’t until I saw the results of a large-scale Swedish study that I really shifted my thinking.

This study entitled: “Association of Stress-Related Disorders With Subsequent Autoimmune Disease” was published in the Journal of the American Medical Association (JAMA).6 Researchers observed 106 464 exposed patients with stress-related disorders, with 1 064 640 matched unexposed persons and 126 652 full siblings of these patients and ran from January 1, 1981, to December 31, 2013.

So, this is a lot of people being observed over a long period of time.

Researchers sought to answer the question: are psychiatric reactions induced by trauma or other life stressors associated with subsequent risk of autoimmune disease?

After years of observational research, scientists determined that exposure to a stress-related disorder was significantly associated with an increased risk of subsequent autoimmune disease compared with matched unexposed individuals and with full siblings.

Although this was an observational study and more research is needed, the scope and detail in which it was conducted were enough to shift my stance about correlation versus causation.

There’s a saying in functional medicine: “Genes load the gun, and environment pulls the trigger.” 

This means your genetic predisposition to a disease or disorder doesn’t mean it will manifest…

…unless something environmental triggers it.

This is where functional medicine doctors roll up their sleeves and do various functional lab tests to identify what may be triggering disease.

I offer many of these tests and have been able to help many people as a result.

However, based on the results of that Swedish study, I’m now looking much more closely at how stress and trauma play a central role in my patients with autoimmune disease, in addition to the functional labs.

I’ve discovered that patients who are willing and able to identify and address their emotional triggers or traumas (and this happens in its own time, way, and season for everyone) get better much faster.

To be clear, this doesn’t mean we’re not also addressing food sensitivities, gut health, heavy metal toxicity, mold/mycotoxins and other triggers.

This work remains essential to addressing the root causes of autoimmunity.

However, it has shown me how powerful prioritizing stress, trauma, and pyscho-emotional work is in addressing the root cause of autoimmunity.

Now that I’ve made my case, let’s look at the stress and autoimmune connection from a more energetic/psycho-emotional perspective.

Trauma, Stress, And Autoimmunity From An Energetic Psycho-Emotional Perspective

Before we get started I want to state that I’m not a psychologist, psychiatrist, or mental health professional.

I’m also somewhat new to the whole energetic psycho-emotional side of healing.

I’ve become interested in it due to what we’ve discussed so far and also my own personal journey to healing.

In other words, I’m sharing as I’m learning…which is pretty much what we do in medicine.

So, here’s what I’ve learned so far that has helped my patients and me.

Healthy early childhood attachments to parents or caregivers are critical to developing a true and authentic sense of self, safety, value, confidence, and mental/emotional resilience. 

They also form the basis for healthy adult decision-making, coping (including how we handle stress), and relationships (among other things).

If you were lucky enough to be part of a family that understood attachment and responded to your needs throughout your life, chances are you handle stress, trauma, and grief a lot better than someone who did not have that growing up.

I’m summarizing a huge topic into just a few sentences, but it’s a critical piece to begin to understand within the context of the next two points I’ll mention.

For more information, I’d recommend watching or reading Gabor Mate’s lectures and books, such as “The Myth of Normal” and “Hold Onto Your Kids Why Parents Need To Matter More Than Peers”, on the topic of attachment.

Trauma, even small seemingly insignificant traumas in childhood, adolescence, and adulthood, can contribute to a lifetime of chronic stress if not addressed.

Nearly all of us have unresolved trauma in our lives.

This may even be things we’ve laughed at or even trivialized, such being bullied (either obviously or subtly), not feeling accepted for who we are, or having unresolved grief.

Why do these “little things” matter? Because the body keeps score.

In other words, even if you’ve convinced your rational self that these things are no big deal, your body has internalized that trauma. This can create a chronic stress alarm that never really goes away. 

It just gets louder and louder until you can’t ignore it anymore because it manifests as a physical or emotional symptom.

Remember all the ways stress impacts the immune system? Stress based in trauma works the same way.

So, imagine having that alarm going off since childhood. If your attachments weren’t optimal, you may not have felt you could get help from your parents or caregivers; or maybe you tried but didn’t get the help you needed, so you had no choice but to internalize it.

It’s no stretch of the imagination to suggest that this could create a significant cascade effect.

From an energetic medicine perspective, it is believed that when our sense of self and safety is compromised due to lack of attachment and/or trauma, it can negatively impact our root chakra.

The root chakra, also known as Muladhara, is located at the base of your spine and is connected to your sense of safety and security.

It comes from the Sanskrit words: Mula, meaning “root,” and Adhara, meaning “support” or “base.”

The root chakra is the first energetic system to develop, and intimately connected to the health of our immune system.

Ayurvedic practitioners, reiki healers, and yogis will tell you Root chakra deficiency is common in adults and children.

New to energetic medicine? Here’s a quick crash course (we’ll cover more in future articles).

Many traditional systems of healing rely on an understanding of the physical, emotional, and energetic body to address disease and imbalances, including:

  • Traditional Chinese Medicine (Qi)
  • Ayurvedic medicine (Prana)
  • Homeopathy
  • Shamanic medicine

Sound therapy, healing touch, reiki, acupressure, craniosacral therapy, specific chiropractic modalities, and even yoga are considered energy medicine forms.

Is there science to back this stuff up?

There is. Energetic medicine is a vast topic. However, there is research validating things like the meridian systems in Traditional Chinese Medicine, Qi gong, meditation, biofeedback, bioenergetic analysis, healing touch, reiki, and many other forms of energy medicine.7 8 9

I’ve provided a couple of links above and will probably do a future article with more detail.

stress autoimmune disease

What To Do About Stress And Your Immune System

If you’ve read up to this point and are thinking, “Hmmm, it sounds like I may have some mental and emotional work to do,” or “Wow! I think this may be what’s been missing from my autoimmune strategy” congratulations!

As I’ve stated over and over, I truly believe the stress and trauma piece is a critical missing link in re-balancing our immune response, overall health, and happiness.

And if you’ve read to this point and are thinking, “This all sounds a little weird and doesn’t resonate with me.” That’s okay too.

As I said, there are many ways to approach autoimmunity within the autoimmune triad. Everyone has different environmental triggers, and if the stress/trauma piece doesn’t ring true, there are many other effective ways to help you heal.

Ultimately the goal is to signal your primitive/ survival brain that you are safe. This is critical because your body can’t begin to heal until your primal brain knows it is safe.

The hustle culture of overworking, undersleeping, over-caffeinating and skipping meals, followed by mind-numbing TV and alcohol does the opposite.

Healing the nervous system helps us to become more flexible and adaptable to changes in our environment and stressful situations. This helps us to fully recover after the trigger has been removed and fosters a sense of safety vs overwhelm and anxiety.

This requires that we focus on the vagus nerve and the parasympathetic arm of our autonomic nervous system which oversees rest and digest (and a vast array of other bodily functions). Many of us live in a chronic state of sympathetic dominance – where flight or flight starts to feel like the norm.

It is also helpful if we focus on embodiment practices.  Many of us learn to use dissociation as a coping skill due to trauma. Embodiment, on the other hand, helps us get back into our physical body to create healing through mindfulness, mind-body connection, self-awareness, self-regulation, and cultivating self-acceptance.

The goal is to reconnect with and learn how to listen to the body’s signals again.

Here are some ways that you can help your nervous system achieve feelings of safety:

All of these things can help bring a deep sense of safety and security. Try not to get overwhelmed by them — as always, this is about progress over perfection and small changes that add up over time. It’s also a great time to practice what James Clear calls habit stacking – “one of the best ways to build a new habit is to identify a current habit you already do each day and then stack your new behavior on top.”

1. Protect your mornings. The brain is in a unique state of being more open to healing and regulation upon awakening, so take advantage of this!

  • No phone for at least an hour. I tell my patients to ignore their phone and social media upon awakening and instead take advantage of this time to set up an intention for your day. Journaling encouraged!
  • If you have young children at home, I highly recommend waking before they do (if possible) so that you can carve out a few minutes of peace before the screaming baby, toddler, or teenager is asking for you.
  • Get some morning sunlight! This is great for your nervous system and your sleep cycle.
  • Practice some visualization, meditations, mantras, prayer, gratitude, and/or breath work (more on this below).

2. Eat regular meals and focus on protein. Goodbye to intermittent fasting, and hello to 20-30 grams of protein within 1 hour of waking.

If you don’t have an appetite in the morning, that might be cortisol talking — but once you get into the habit of eating breakfast, it will likely become easier.

Remember: the goal is to remind your survival brain that resources are plentiful and all is well here. 

Also be sure that you are drinking enough water (maybe even add electrolytes).

3. Make meditation part of your routine. There are so many resources out there! Find your favorite and figure out how to make this a part of your daily routine, even if it’s just 5-10 minutes a day (this is a great replacement for the time you might spend spend scrolling social media). Here are some of my favorites at the moment:

4. Breath work. Focus on belly breathing and longer exhalations vs. inhalations. This only takes a minute and can be done anytime, anywhere.

  • My favorite is the 4-2-6 breath. Breath in for a count of 4, hold for 2, and out for a count of 6. Do this in 3 cycles.
  • Othership also has an app for guided breath work.

5. Spend time in nature and get natural sunlight. Getting away from screens and into our natural environment is so important, and getting natural morning sunlight is also very powerful. This is likely one of the reasons many of us feel better on vacation!

You can make this a part of your daily routine at home by regularly walking your dog, gardening, hiking, biking or just playing outside with your kids.

This is also a way to practicing grounding – this is through direct contact with the earth via gardening, walking around barefoot or swimming in natural water.

6. Weight training. Generally speaking, those healing from autoimmunity and/or chronic stress should avoid super-strenuous cardio and HIIT because it can signal to your survival brain that the lion is chasing you. However, regular exercise is super important for reducing stress, improving sleep, supporting blood sugar, and overall well-being. Top of the list is strength training because lifting heavy things can be great for calming the nervous system. Check out Madeline Moves and Nourish Move Love.

Side note: A weighted blanket can provide a similar nervous system benefit. However, I do want you to exercise too!

7. Take time to relax and slow down. I’m wired for productivity so this has to be intentional for me. Alone time is especially important for busy moms and dads. Do something every day to refill your cup! You deserve to rest.

  • Read
  • Journal
  • Color
  • Cook
  • Drink a cup of tea
  • Take a walk or hike
  • Enjoy a warm bath

8. Sleep for at least 8-10 hours per night while you’re healing. Getting optimal sleep is essential to resetting your stress response (and this is different than rest).

  • If you have trouble sleeping, talk to your doctor or healthcare practitioner about ashwagandha, melatonin, l-theanine, magnesium, or other natural sleep aids.
  • Getting natural morning sunlight and avoiding screens at night can also help reset your circadian rhythm.
  • Heart Rate variability can also affect sleep, which is where HeartMath comes in handy for tracking your stress response via your nervous system.
  • The Oura ring is great for tracking quantity and quality of sleep (P.S. Try this link and you might get you $50 off).

9. Prioritize connections and community. Did you know the effects of loneliness or social isolation have been compared to smoking a pack of cigarettes a day? In other words, being and feeling surrounded by people who care is equally important as eating right and exercising for healing and long-term health. Yes, COVID made being anti-social appear “normal”, but that doesn’t mean it was ever healthy long-term, nor should it continue. Make an effort to build community. It is so important.

This starts with healthy and nourishing relationships at home. For example, if you’re married or have a partner, that relationship can (and should) be a source of support. One thing to consider, if this feels comfortable for you, is to ask your partner to hold you and tell you that you are safe. This can help calm your nervous system and remind your primal brain that you are safe and secure.

Spending pure fun time with your children, nieces, nephews, grandchildren, etc. is also an incredible way to share in the gift of security, love, joy, innocence, and relaxation.

It’s also super important to connect with the community and cultivate friendships outside your home.

10. Try Adaptogens. Adaptogens are herbs that have been used for centuries to help people adapt to stress and increase energy. Several studies have shown that they positively impact the immune-neuro-endocrine-system and HPA axis. Some of my favorites include:

  • Ashwagandha
  • Rhodiola
  • Schisandra
  • Tulsi (Holy Basil)

11. Take Psychobiotics. These specific strains of probiotics and prebiotics have been shown to help promote emotional well-being via their benefits to the gut microbiome (there’s that gut-brain connection in action again!).

My favorites right now are Zenbiome and DUAL, both by Microbiome Labs.

12. PEMF Therapy. PEMF therapy uses low-frequency electromagnetic fields to promote healthy cellular functioning and communication. Research has shows that regular use may inhibit activation of the sympathetic nervous system and decrease the excitability of the nervous system with stress.

I use my favorite grounding mat almost every single night (a great place for meditation and breath work).

13. Sonic Resonance Therapy. Sensate is a little device that sits on the chest and emits precisely engineered sound waves directly into the body, sending a powerful, stress-alleviating signal directly to the autonomic nervous system.

I’m just getting into this myself, and excited to see how it helps!

14. Heart Rate Variability (HRV) training. HRV training is a form of biofeedback that works through activation and calming of our autonomic nervous system. HeartMath is a favorite!

15. Dynamic Neural Retraining System (DNRS): Several versions of this training program are designed to help get to the root cause of an overactive stress response by retraining your brain. This is all about neuroplasticity or “Limbic Retraining”. I typically recommend The Gupta Program.

16. Seek out energy medicine and other hands-on techniques. Many of us have experienced deep relaxation during massage therapy, so you may already know what this feels like to some extent. These therapies can help release stored trauma, emotional and physical tension. Some of my favorite techniques for healing the nervous system include:

  • Reiki
  • Craniosacral Therapy
  • Acupuncture
  • Lymphatic massage
  • Abdominal message

17. Last (but definitely not least!) consider working with a professional therapist, especially someone specializing in trauma therapy. I’d venture to say that all of us could benefit from this type of work. I’ve had the best experiences with therapists who also do somatic or energy work, such as reiki or craniosacral therapy.

Your therapist can advise you on the best modalities for you, but medication assisted trauma therapy may be another option to look into.

Closing Thoughts On Stress And Autoimmunity

I’m the type of person that’s insatiably curious. I’m also not afraid to adjust my thinking when I learn something new…

…and discovering new science on the stress-autoimmune connection has been game-changing for me and my practice.

I hope it will help you on your journey to better health and wellness too.

If you resonate with this article and would like some help working on that stress-autoimmune piece, we’d love to get to know you better!

For those in my tri-state area of practice (Colorado, Michigan, and Texas), click here to learn more about our functional medicine approach and how to apply to become a patient.

For everyone else, I’d love to stay connected via Instagram or through our monthly newsletter.

Are you motivated to get started balancing that stress-autoimmune connection right now?

Choose a few tools from the list in the previous section and commit to them. It’s impressive how small actions can create incredible results when we’re consistent.

I’d also recommend checking out my other articles on a functional medicine approach to autoimmunity, Hashimoto’s, HPA axis dysfunction, and gut health.



About Dr. Maren

Christine Maren D.O., IFMCP is a board-certified physician and the founder of a virtual functional medicine practice in Colorado, Michigan, and Texas.  She is best know for her work in thyroid, gut and reproductive/ preconception health. Dr. Maren is board-certified by the American Board of Family Medicine and is an Institute for Functional Medicine Certified Practitioner (IFMCP)

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