Jolting System May Be What Autoimmune Patients Need to Counter Chronic Effects
September 03, 2004
Dallas Morning News
DALLAS (KRT) -- The brain and the immune system are at times like members of a dysfunctional family. Sure, they're close. They depend on each other. But under stress, one can drive the other to self-destruction.
Perhaps few people feel this more than the millions who already have a love-hate relationship with their immune systems. People who suffer from any of a host of autoimmune diseases rheumatoid arthritis, multiple sclerosis or psoriasis, to name a few can feel the pressures of stress literally in their every move.
Scientists who study the interplay between the brain and immune system are trying to help people with autoimmune conditions buffer themselves from the mental backlash of daily life by studying the effects of proper rest, stress management and other coping strategies. And one idea may be surprising: Fighting stress with stress.
"The key to chronic stress is acute stress," says Dr. Andrew Miller of Emory University School of Medicine. He believes that short bursts of benign stress - a scary movie, say - may actually be good for you.
But where the immune system is concerned, he and others point out, no answer is simple. The immune system is one of the body's most intricate operations, run by the chemical cross-talk between nerve cells, hormones from the brain and glands throughout the body. Troops of cells in the blood can quickly storm and retreat.
In autoimmune disease, something goes awry, and the system designed to attack outside threats starts to attack itself. The target varies by disease. In arthritis, it's the joints. In multiple sclerosis, it's the central nervous system.
Then on top of this comes stress, which can wreak havoc on even a healthy immune system. Human beings evolved in a world of mostly short-term threats, like an attacking bear. In modern life, the most menacing bear usually comes out of the stock market. Stress resonates at a sustained, yet unpredictable pitch. Fight or flight has become cope or mope.
Stress excites a trigger in the brain called the HPA axis. "HPA" stands for hypothalamus, pituitary gland and adrenal gland. It is the key relay that translates mental stress into physiological action. When you feel stressed, the hypothalamus in the brain fires a chemical signal to the pituitary gland, which then sends another signal to the adrenal glands. The adrenal glands (where the name "adrenaline" comes from) start pumping out a variety of substances that talk to the immune system and the rest of the body. One of the key substances is cortisol.
Cortisol is a potent compound that affects systems throughout the body. It raises blood sugar and works with adrenaline to increase heart rate, for example, readying the body for the stressful situation. It also sends a "message received" signal back to the brain, so the hypothalamus and pituitary don't stay all atwitter. And when things operate as they're supposed to, cortisol calms the immune system.
Thus, a paradox: Stress leads to cortisol, and cortisol can control a raging immune system - which is just what someone with arthritis wants.
"You would think that stress would tend to suppress the disease," says Dr. Esther Sternberg. A rheumatologist by training, Dr. Sternberg now directs the Integrative Neural Immune Program at the National Institute of Mental Health.
Yet that's not how people who have autoimmune conditions say they feel. Under stress, their conditions often get worse. And it's not just perception. For example, one study published earlier this year from researchers at Arizona State University found that people with rheumatoid arthritis have higher amounts of a naturally occurring inflammatory substance during stressful periods.
"What happens in chronic stress," says Emory's Dr. Miller, "is that cortisol doesn't work anymore." Prolonged stress affects either the production of cortisol, or the body's ability to respond to it. Some scientists believe the system may simply burn out. For whatever reason, the immune system loses a key chaperone.
What might help, he believes, are short-term stressors that would give the body a blast of cortisol. As evidence to support this idea, he points to a study of multiple sclerosis patients in Tel Aviv. The study happened to take place in 1991 during the first Gulf War, when Israel came under fire from Scud missile attacks. Researchers were surprised to find that the patients reported an improvement in their symptoms. According to a review published last year, this is the only study that has found multiple sclerosis symptoms actually improving under stress.
"The question for us is, why is chronic stress different?" says Dr. David Mohr of the University of California, San Francisco. Mohr, who studies the effects of stress among people with multiple sclerosis, concludes, "the short answer is, we don't know."
Researchers, including Miller, emphasize that cortisol isn't the sole cause of all things good and evil in the immune system. And its ultimate role in the exacerbation of autoimmune disease is still under study. The immune system has several kinds of soldiers, depending on the threat, and cortisol isn't the only colonel. There is even evidence suggesting that gender makes a difference, that men's and women's bodies don't respond to stress in the same way.
"You don't have just one thing going on in the body at the same time," Sternberg says. Which means there's no one thing to advise people with autoimmune conditions, but a host of possibilities that might help. "Listen to your body," she says. "Listen to your body because everyone is different. Different people will have different reactions to different kinds of stresses."
Pacing yourself is also important for people with autoimmune conditions, she says, because of its contribution to stress relief. So is moderate exercise. "You need more sleep than most people," she says. "There's nothing wrong with that."
By mastering stress, people with autoimmune conditions may feel like they have more control over their health. However, UCSF's Mohr cautioned that patients shouldn't feel like they have failed if their disease flares up. "This type of information should never be used by patients to place blame," he says. "These aren't diseases that people cause by themselves."
WHAT'S AN AUTOIMMUNE DISEASE?
Millions of Americans suffer from autoimmune diseases, which occur when the immune system begins to attack targets within the body. For reasons that are unclear, these conditions affect women more than men. Many autoimmune conditions are rare. Here are some of the more common diseases, and the area targeted:
- Rheumatoid arthritis (joints)
- Crohn's disease (intestine)
- Multiple sclerosis (central nervous system)
- Type 1 diabetes (pancreas)
- Lupus (connective tissue)
- Psoriasis (skin)
- Grave's disease (thyroid)
For more about autoimmune disease:
The National Institutes of Health offers general information at http://www.niaid.nih.govublications/...mmune.htm#what
The American Autoimmune Related Diseases Association has details about many such conditions, advice on coping, research and other information at :: American Autoimmune Related Diseases Association, Inc ::