Thanks for joining us for episode 22 of The Ancestral RDs podcast! If you want to keep up with our podcasts, subscribe in iTunes and never miss an episode!

We’re continuing on with the adrenal fatigue theme this week, and today we’ll talk about two very common health concerns that we see in our patients and how they relate to stress: Digestive disorders and autoimmune disease. Kelsey and Laura wrote pretty in depth blogs about these topics that we’ve linked to in the show notes, and today we want to go over these issues for our podcast listeners.

Remember, if you’d like to submit a question for our podcast, or suggest a guest that we should host, CLICK HERE.

Here’s what Laura and Kelsey will be discussing in this episode:

1. How stress can cause digestive problems like leaky gut or IBS
2. How stress fuels inflammation and lowers immune activity
3. How stress causes imbalanced gut flora
4. How stress affects your risk of autoimmune disease
5. The 5 most important steps to managing your stress

Links Discussed:

• Does Stress Cause Digestive Problems?
• Could Stress Be Causing Your Autoimmune Disease To Get Worse?
• Sign Up For The Adrenal Fatigue Email List – Get a free 28 page eBook when you join the list!

TRANSCRIPT:

Laura: Hi everyone. Welcome to episode 22 of The Ancestral RDs podcast. I’m Laura and over there is Kelsey.

Kelsey: Hi everybody.

Laura: We’re continuing on with the adrenal fatigue theme this week. Today we’re going to be talking about two very common health concerns that we see in our patients in how they relate to stress. These common conditions are digestive disorders and autoimmune disease. Kelsey and I wrote pretty in-depth blogs about these topics that we’ll link to in the show notes, but today we want to go over these issues for our podcast listeners. We’re going to start by talking about stress and gut health, which I think a lot of people intuitively understand that stress affects the gut especially just because of the connection to IBS.

Kelsey: Mm hmm.

Laura: But Kelsey is going to go into super deep detail about how stress really actually affects the gut.

Kelsey: Alright, cool. I think you hit the nail on the head with that, Laura. We all kind of know inherently that stress…first of all just stress in general is not good for any part of the body but especially for digestive health. I think a lot of people with IBS or any other digestive disorder tend to kind of hear from their doctors the line that it’s all in your head or you just have to relax, which can be really frustrating to hear. Obviously if you are suffering from physiological symptoms that feel very, very real to you and someone just tells you It’s all in your head, it’s like well come on, that’s not very nice. I think we tend to kind of push the stress aspect to the wayside because of that a little bit. It’s sort of a defense that someone brings that up, we just say yeah right, it feels so real, I can’t even imagine how stress would be causing these incredibly uncomfortable symptoms that I’m experiencing, so I kind of think your wrong.

What I want to remind people before we jump into this in depth is that there really is an aspect of digestive health that relates to stress that you really need to pay attention to. I hope that after I go through some of these different ways that stress affects the digestive system, that you will understand the real physiological impact that the stress response has on the digestive tract so you’ll be more able to justify implementing some of the strategies that we’ll talk about later to reduce stress in order to help yourself heal or feel better with the digestive issues that you are experiencing.

To start off, let’s talk a little bit about intestinal permeability. That’s one of those words that you probably have heard before but maybe you’ve heard it more referred to as leaky gut. I’m not going to go much into really what that means. We have lots of other podcasts and information out there about what it is. But basically you want to think about the gut as really it’s not inside the body technically, it’s actually this tube that goes from our mouth out to our anus. So we have to think about it that way, that’s it’s not really inside. It has to serve as this barrier from what’s coming in our mouth to what actually gets absorbed into the body. We have cells on that tract that usually are pretty close together, and what can happen is that they can spread apart and then there’s this little gap in between. Undigested or partially digested food particles, and bacteria, and things can slip through those cracks where they normally shouldn’t be and that causes a whole host of other issues. That’s just a really quick explanation of what intestinal permeability or leaky gut is. If you want more information on that, literally you can just type it into Google and you’ll find so much information, and I’m sure we’ve probably talked about it on our podcast before too.

Laura: I’d be surprised if we hadn’t.

Kelsey: Yes. What I want to talk about is that stress really has always been known to cause intestinal permeability, but really what that means and what they’ve researched years and years ago is the stress that comes from surgery or trauma. So these really big acute stressors that happen and then go away. We’ve known for a long time that stress in that sense causes intestinal permeability but it goes away as soon as the stressor from the trauma or the surgery goes away as well.

But now, researchers are starting to research the effect of chronic stress on the digestive system, which is really, really intriguing. What they’ve done is usually they’ll use rats because they don’t really want to stress people out to kind of see what happens, but they use rats to study the effect of this long term chronic stress that we are talking about in the sense of adrenal fatigue. What they found is that these mild stressors that go on for a long time, they do have an effect on intestinal permeability. When rats are subjected to some kind of mild chronic stressor, they develop what we call leaky gut. And then when that stressor is taken away, it actually take several days for the intestinal lining to recover, which to me that was the more interesting take away from this study was just that wow, I can’t even remember the last time I went a couple days without stressing out about something. So that is a very intriguing finding they were able to discover with this study and it should hopefully help you determine that stress is really, really important when it comes to intestinal permeability.

Why they think that this happens, when we’re stressed we get intestinal permeability, is that it has something to do with the mast cells in the digestive tract. When you think about mast cells, think about histamine. When we have an allergic type of reaction, our mast cells get what is called degranulated and they produce histamine and a host of other chemicals as a result and that’s why we get all of these symptoms of allergies when this happens. The runny nose, the congestion, inflammation, all of those things are due to the histamine and the other chemicals that are released from mast cells when they become degranulated. That’s exactly what happens when we get stressed is that those mast cells degranulate and they produce histamine and all those other chemicals as well, and that has been shown to lead to intestinal permeability.

We know that these mast cells when they degranulate or become un-stabilized like that, that’s what’s causing, or at least part of what is causing the intestinal permeability. This is a really, really new field of research, the mast cells in terms of everything that they have to do with stress because they’re very involved with that stress response in terms of not only intestinal permeability, but inflammation, our immune system. And we’ll talk about more of this as go on, but I just want you to know that those cells are really, really important when it comes to the stress response and the effects that it has on the rest of the body.

Hopefully that explains to you a little bit about what happens with intestinal permeability when we’re stressed out. Basically as long as you have mast cells in your gut, which all of us do, you will be developing intestinal permeability when you get stressed out. That doesn’t have to be a really strong, acute stressor like surgery or trauma, it can be just these little everyday mild stressors that we deal on an everyday basis.

Laura: Awesome.

Kelsey: Yeah. You can learn more about that too if you check out my article, but that was a pretty good overview there.

Next, we’ll move on to inflammation. If you’ve ever been given a steroid like prednisone to reduce inflammation, this is usually given to those with digestive disorders, something like Chron’s or something like that where they just need to reduce the inflammation and that reduces symptoms, you know firsthand the effects that glucocorticoids can have on inflammation because when you take prednisone, it actually gets converted into prednisolone. I’m not even going to try to pronounce that correctly. But it’s basically a derivative of cortisol and that helps to calm inflammation in the body. Now, inflammation is a completely normal response to trauma. If you think about when you get a cut or you step on something that cuts into your foot or something like that, it gets red, it gets swollen, and it really hurts. All of those are signs of inflammation. What cortisol does is it helps to turn that inflammation off when the healing process is mostly completed.

All of those signs of inflammation, basically what is happening is you’re pushing fluid with healing factors to the area that was damaged and so that’s why all of this inflammation happens because you want it to hurt so that you don’t hurt it even further. The swelling is from all the fluid that collects there that is bringing things to the site, and it gets red because of the swollenness and the inflammation that is going on there. All of those are what happen, and cortisol when it kind of realizes that your body has sent all these healing factors, everything’s going okay, cortisol says alright, we’ve dealt with this situation, we can reduce this inflammation now. That’s at the point when you’ll start to feel like your cut is healing, for example. That’s completely normal in the short term. It’s just how the body works and it’s made that way. So completely fine, completely normal.

But what happens when the HPA axis becomes dysregulated, like we’ve been talking about in a lot of our previous podcasts, is that cortisol starts to get pumped out more and more because we’re really stressed out so the body starts to create more and more cortisol, it’s pumping that out, and what happens then is the body becomes resistant to the effects of cortisol. What that means is that the tissues that are normally absorbing cortisol and kind of listening to the signals that it’s giving, they stop listening basically. When this happens, we become inflamed and then we stay inflamed because the body just isn’t listening to cortisol trying to tell it to stop the inflammation or cool it with that inflammation. So you really need to make sure that your stress levels are under control to also keep inflammation under control.

This is more of an issue with higher cortisol, so right at the beginning of that HPA axis dysreguation, before your cortisol starts to get too low. But basically you want the right amount of cortisol because too high cortisol can cause inflammation, and then if you don’t have enough cortisol, you also can’t shut off that inflammatory response too. So whether you’re resistant, or whether it’s too low and you can’t produce that response and have something to the body to listen to stop that inflammation, either way you’re going to be inflamed. So you want just the right amount of cortisol to make that happen.

Laura: Yeah, and that’s an important thing to remember for when I start talking about autoimmune disease in a little bit. So remember that, guys. You either can have too much cortisol that leads to inflammation, or too little cortisol that again leads to inflammation.

Kelsey: Exactly. Kind of sucks because you really need the right amount and it’s hard to get that these days with a lot of the stressors we’re dealing with on a regular basis. But the more that we can implement in our lives to make that happen, the better and the healthier we’re going to be.

Let’s see, let’s move on to immunity because this actually ties into the inflammation piece as well. Most of our immune system is housed in the gut, which probably for most people comes as a little bit of a surprise. But if you think about tit, it actually makes a bit of sense because like what we were talking about before, the digestive tract is just this tube that gets inundated with bacteria, food particles, anything that’s coming in your mouth, it has to deal with to decide what to absorb or what to get rid of. So it would make sense then of course for a lot of our immune system to be there because it has so much to deal with. What we call gut associate lymphoid tissue or GALT or short, makes up almost 70% of the immune system by weight, and that course like the name suggests is in your gut. We really need that strong defense system there to just make sure that we’re taking in the right things and getting rid of the things that we don’t need.

That tissue, the GALT, it produces an antibody called secretory IgA, which helps to protect us from foreign particles and bacteria. If you have an overgrowth of some kind of bacteria there, your secretory IgA is going to help you fight that overgrowth or infection that’s happening. When we don’t have enough cortisol, we don’t produce enough secretory IgA, so we’re more open to attack from bacteria, or any kind of bacteria, infection, or even just food particles that need to be digested properly before we absorb them. Anything that is there that shouldn’t be there, secretory IgA is going to help protect us from it. If we don’t have enough cortisol and we don’t produce enough secretory IgA, we’re open to attack. Then when we do get an infection, let’s say because you’re cortisol was low, and then as a result of that you’re secretory IgA is low, and you get an infection because you can’t fight it off, that of course causes even more inflammation. And if your cortisol is low, like we said before, you can’t fight that inflammation with cortisol, it’s not there to make that happen. Those two really go together and of course anytime you have an infection or anything in the body that shouldn’t be there, then you’re going to get more inflammation. You need that cortisol to protect you from infection and also to calm down inflammation if something does happen to go on in the body, like you do have an infection or you have a cut, anything like that, you need the cortisol to turn off that inflammatory response.

Okay. We’re going to talk about gut bacteria too which again, ties back to the infection piece here. Chronic stress has been shown to cause something called dysbiosis, which I’m sure, again, we’ve talked about on our podcast multiple times probably. And that’s the imbalance of gut bacteria and it means that usually you have too much bad bacteria and not enough good bacteria, or you have some kind of infection or overgrowth of a particular type of bacteria that shouldn’t be there. But basically when it comes down to it, it’s just an imbalance of the right amount of bacteria that should be there.

Gut bacteria is actually required for the proper development of the HPA axis. What researchers have done is they bred mice to have no gut bacteria to see what happens when, like I said, when they have no gut bacteria and how things develop from there. They wanted to see what would happened with HPA axis if mice did not have the gut bacteria that helps it develop. What happens when they did that, is that the mice produce more ACTH, which is one of the hormones kind of at the beginning of the stress response, and they produce more cortisol as a result of the increased ACTH. You can learn more about that process in our e-book which you can sign up for on MyPaleoRehab.com.

But basically if you have more ACTH, you’re going to produce more cortisol as a result because they’re all signaling hormones to at the end kind of tell your body to produce more cortisol. What means when you’re producing lots ACTH and lots of cortisol, it means that the HPA axis is in overdrive basically. That’s not good because as we’ve discussed before too, when the HPA axis starts to pump out more and more cortisol, it’s getting stressed out more and more and activated more and more often, that eventually causes what we call HPA axis dysregulation, which is something we absolutely do not want if we can avoid it.

What happens is, like I said, no gut bacteria means no proper development of the HPA axis. What that meant in this particular study is that the HPA axis was in overdrive. When mice are colonized with the gut bacteria from normal mice…so first they had no gut bacteria which caused HPA axis dysregulation…but then when they colonized those same mice with gut bacteria from normal mice, the effect was partially reduced. They didn’t produce quite as much ACTH and cortisol. The HPA axis was not quite as in overdrive as it was before, so it was partially reduced. But then when they gave them a specific probiotic, the effect the completely reduced. It just goes to show that you really do need the right bacteria in the gut to make sure that your HPA axis is functioning properly.

I think this is something that a lot of us just don’t think about because it kind of seems crazy that the gut and our mind, our brain would be talking so much and really feeding off of each other, but they do, so you need to recognize that that happens. And like we talked about before, you need to make sure that any gut issues that you’re dealing with like dysbiosis, like small intestinal bacterial overgrowth, any kind of parasite or infection, they need to get dealt with too because as long at there’s something going on in the gut that shouldn’t be there, that’s going to have a negative effect on your HPA axis. It goes both ways. Any changes in the HPA axis, so if you developed HPA axis dysregulation irrespective of anything going on in the gut, that would in turn affect your gut bacteria negatively. And the same goes for the other way around. Anything that’s going on with your gut bacteria negatively is going to effect the HPA axis negatively.

Hopefully that makes sense. It’s a little confusing and like I said, I think it’s just something we don’t think about all that often because it seems a little crazy that those two things that are very far apart in the body would be communicating so much, but they absolutely do.

Laura: Well, it’s definitely a chicken and the egg situation where you don’t necessarily know what comes first. And there may be in one person that the stress came first, and then in the other person the gut issues came first.

Kelsey: Exactly.

Laura: Like you were saying, one can cause the other and vice and versa. I’m curious, do you remember which specific probiotic the mice were given?

Kelsey: I don’t off the top of my head actually, but very good question. I’ll look that up as you talk about your autoimmune stuff and I’ll bring that back to everybody so they can hear what that is. Also just as a reminder, everybody can take a look at these studies if you go to the original article, I link to all of them that I talk about here.

Laura: Yeah, I would just be curious because sometimes when they do tests with specific probiotics, it’s because they’re testing to see if the probiotic can actually help with something like HPA axis dysregulation.

Kelsey: Right.

Laura: I would be really curious to see which one that was.

Kelsey: Here it is. I got it. It’s bifidobacterium infantis.

Laura: Oh, okay. That’s a pretty typical one.

Kelsey: It is, yeah. This is something that’s in a lot of over the counter supplements these days for probiotics, so not all that hard to get your hands on.  Again, this is mice so we can’t completely just say of course it can have the exact same effect on humans, but it does go to show that there really is a strong effect of having good bacteria in the gut on the HPA axis.

Laura: I’ve found that a lot of the bifido strains tend to the be the most well tolerated by people.Even people with histamine intolerance or SIBO, they tend to do better with the bifido strains than even the lactobacillus strains which are commonly put together.

Kelsey: Yeah.

Laura: There may even be supplements that only have B.infantis in it, or maybe they just have a combination of a couple different bifido bacteria which I would think would be possibly helpful in the HPA axis issues.

Kelsey: Yeah, absolutely. That’s something to consider especially I would say if you think that maybe the gut bacteria problems came first, I would definitely consider first of all figuring out the gut bacteria issues, so treating any sort of infection, anything like that. But then in terms of a probiotic supplement, you may want to try bifido bacterium infantis if that would make sense for you.

Cool. Alright. Lastly here that I want to talk about the effects that stress have on pain. This one I think is really fascinating because this boggles my mind for some reason, but it does make sense. What they’ve found with people with gut disorders is that they tend to have lower pain thresholds. Basically their symptoms increase with stress and reduce when they’re relaxed. A lot of people that deal with digestive disorders can probably agree with that. When you’re stressed out you just tend to have more symptoms. When you’re relaxed and let’s say you’re on vacation and things are really easy, symptoms tend to be better as long as you’re kind of eating on the same diet that makes you feel best at home too.

Researchers are starting to believe that this is due to again, those mast cells in the gut. They think that because they’ve done studies on those…I think this one was done with IBS where they gave people mast cell stabilizers, pharmaceutical intervention that stabilized the mast cells and their symptoms got a lot better. I bring this up to kind of tie back to this whole thing with the mast cells because it seems to be from looking at all these different effects that stress has on the gut, that role of the mast cell in the gut is huge and the more that you are destabilizing those mast cells so they produce the histamine and all the other chemicals that they’re producing, the more you’re going to get the effects of intestinal permeably, inflammation, all these things that we talked about today.

We’ll talk more about exactly what you can do about this later in the show. But to me, it’s very, very clear that the more that you can lower your stress just by implementing stress management techniques, the less degranulated mast cells that you’ll have. They’re more likely to be stable and not cause all these reactions. They’ve actually done research on that to show that those stress management techniques, things like meditation, tai chi, they’ve done studies on all sorts of techniques with a lot of different digestive disorders and they’ve shown that symptoms are reduced when people start to implement a stress management routine, which is great. It just goes to show that you don’t have to take a medication to reduce some of these effects. You don’t have to go on a mast cell stabilizer or anything like that. You can also do this naturally as well just by managing your stress in your everyday life.

Laura: Yeah, especially because those mast cell stabilizers can cause side effects. Don’t they cause drowsiness and that kind of thing?

Kelsey: Mm hmm.

Laura: Taking those medications every day or over the long term wouldn’t really even be an option for most people. I would say the stress management practice would be really important for those people because like you said it’s a way to stabilize the mast cells naturally and no side effects.

Kelsey: Exactly.

Laura: In fact, you feel usually more energetic.

Kelsey:  Yeah. I love when that’s the conclusion that we can take away from this is that you can do this really easily naturally as long as you put in the work to make it happen. Like I said, we’ll talk a little bit more about the strategies there later in the show today, but just know there is a lot you can do about it. And I know it kind of sounds crazy when you start to add up all these effects that just something as simple as stress can have on your digestive system, it sounds really intense. A lot of people when they hear this kind of stuff, they get overwhelmed and just think, there’s nothing I can do about this, I don’t know. But what we’ve seen here is that there really is something you can do about it and it’s pretty simple. You don’t have to go crazy with these stress management techniques. Just few minutes every single day is enough to really start to manage your stress. Even if you just can do that, I’m sure that your symptoms would get better.

Laura: Yeah, and I think our whole point with doing these podcasts is not to freak people out, but to make them realize how important stress management is.

Kelsey: Right.

Laura: Because oftentimes people get wrapped up in the diet and the exercise and they don’t remember that stress management is just as important as those other two typically focused on side of things. I don’t want people to hear what we’re saying and just feel discouraged, or feel that they’re causing their own health issues, or anything like that, but we want you to take a look at what you’re doing with your daily life to see if there’s anything that you can cut out of your life that’s causing stress to see if there’s anything that you can add into your life that can help reduce stress.

Kelsey: Right.

Laura: There’s so many different things that could be a factor in your stress levels. A lot of times when I talk to clients about this kind of stuff, they are putting more stress on themselves about certain things than they even need to.

Kelsey: Mm hmm.

Laura: Sometimes it takes a little bit of an objective opinion about it where I’ll say well this something that’s really important, or do you find that you don’t have an option to stop doing this activity? Or a lot of times it’s moms with kids and their kids have something going on that’s causing them stress.

Kelsey: Right.

Laura: They feel, but my kid has to do this, and it’s not really necessary to do all this stuff people do that cause them stress. So trying to figure out where you can reduce stress in your life is going to be important. We’ll definitely talk about that a little bit at the end of the podcast where we discuss the methods for reducing stress, but just wanted to make sure that people don’t feel discouraged by what we’re talking about.

Kelsey: Don’t get freaked out. There’s a lot you can do, so don’t worry about it. Alright. Want to move on to autoimmunity now, Laura?

Laura: Yeah. Like I had mentioned in the intro, and I’m mostly speaking for myself here, but I would guess that Kelsey has a similar situation that the majority of our patients either have some kind of digestive issue or some kind of autoimmune issue. Would you agree with that, Kelsey?

Kelsey: Yes, absolutely.

Laura: I mean there’s definitely people that don’t fall into those two categories, but I would say those are the most common issues we see.

Kelsey: Mm hmm.

Laura: And I think the reason we see those people so much is because a lot of people go on a Paleo diet expecting to have their issues just completely disappear because they’ve seen these amazing testimonial stories about people going on a Paleo diet and losing 100 pounds, and completely getting over their autoimmune disease, and eliminating their IBS, or whatever kind of issues people have been able to overcome with a Paleo diet, we see a lot of people that have not had that level of success.

Kelsey: Right.

Laura: I do think that the gut health problems and the autoimmunity issues are what typically don’t respond 100% to a Paleo diet. That’s why I think talking about stress being such an important component is really important because a lot of people will just do the diet, they don’t realize that there’s something in their life that’s really stressful for them, and they’re not dealing with that, and they’re expecting the diet to make up for that, and it can’t.

Kelsey: Mm hm.

Laura: That’s why we want to talk about these two primary issues. Autoimmune disease is a little bit tricky because in general, scientists and doctors don’t know for certain what causes certain people to develop autoimmune disease. There’s evidence that supports a couple potential triggers. Genetics susceptibility is one of the most common things that we can look at as far as what would trigger someone’s…I shouldn’t say trigger…what would predispose someone to an autoimmune disease. A lot of times when I have clients with autoimmunity, I’ll look at their family history and I feel like 9 times out of 10 they have a family member with autoimmune disease.

Kelsey: Mm hmm.

Laura: So there is some level of genetic susceptibility. There’s also potential environmental triggers that can affect autoimmune disease. There is obviously a lot of stuff in our food these days that can potentially cause autoimmune disease since we’re eating things that humans were not designed to eat. But I would say one of the most common controllable causes is chronic stress. It’s really interesting because I don’t know if that’s necessarily something that a lot of doctors recognize how much stress can play a role in the development of autoimmune disease.

Kelsey: Right.

Laura: But there’s so many patients that come to me that their autoimmune disease was triggered after some super stressful event or they had a bunch of chronic stress going on and they started to develop the symptoms. Maybe somewhat of a hypothesis on my part, but I feel like the evidence that I’ve seen has definitely supported it and my clinical experience has shown that to be that to be true.

I want to talk about how chronic stress can affect your autoimmune disease risk. Now this also related to the severity of the disease, so if you have an autoimmune disease, chronic stress can definitely make it worse. If you don’t have an autoimmune disease and if your mom has an autoimmune disease, or one of your family members has it, and you’re worried that there’s a chance that you might develop an autoimmune disease, then dealing with your stress as much as possible is going to be really important for prevention.

Interestingly stress has been blamed for a lot different diseases. Obviously Kelsey just went over the digestive side of things really in depth. But there’s other things like heart disease, cancer, infertility, and obesity just to name a few that have also been correlated with chronic stress. The more we learn about stress, the more we understand how important it is to manage it so that we can reduce our risk of chronic disease in the future.

I would say that autoimmune disease is another class of disease that has definitely a correlation with chronic stress and it has been studied for its relationship to chronic stress. Impaired HPA axis responsiveness…which is essentially the same thing as HPA axis dysregulation, it just means that your HPA axis is not responding appropriately to stress, that can mean that it’s over responding or under responding…but this issue has been shown to influence a bunch of different inflammatory and autoimmune diseases. That includes things like rheumatoid arthritis, inflammatory bowel disease, so that’s beyond even just IBS and SIBO, that goes into things like Chron’s disease and colitis which is an actual autoimmune process. It also affects multiple sclerosis, Sjogrens syndrome, Graves and Hashimoto’s thyroiditis, asthma, and dermatitis. Which asthma I don’t think is necessarily an autoimmune disease, but it’s definitely an inflammatory disease. And dermatitis can be related to a lot of different things like eczema or psoriasis, which those two are definitely autoimmune related.

As you can see, a lot of the different autoimmune diseases are related to HPA axis issues. For example, inflammatory bowel disease, which would make sense based on what Kelsey just talked about, but it can go into things like joint issues, skin issues, and thyroid issues, that kind of thing. A lot of studies have shown that about at least 80% of patients report uncommon emotional stress before their disease has presented. So that’s those autoimmune disease right before those diseases start to become an issue, up to 80% of patients have reported stress before that happens. Also the stress of having an autoimmune disease is actually known to cause disease exacerbation. Just like we talked about in the digestive section, this is a vicious cycle. Stress can cause autoimmunity, and autoimmune disease exacerbates your stress levels, which then make the disease worse. Again, getting your stress under control whether you have an autoimmune disease or you’re concerned you might develop one is really important.

One of the theories that scientists have come up with for an increased risk of inflammatory disease due to chronic stress is that stress results in that glucocorticoid receptor resistance that Kelsey talked about, so essentially you have so much cortisol that you become cortisol resistant and that results in that failure to down regulate the inflammatory response. I know this is a little bit of an overview of what we’ve already talked about, but it’s important to remember.

Kelsey: This stuff is complicated. I’m sure people appreciate hearing it more than once.

Laura: Yeah. Knowing what’s going on is important. It’s not as important as doing something about it, but it’s always good if you have a really good understanding of what’s happening so that making the decisions to do certain lifestyle changes, diet changes, that kind of thing actually has a scientific background for why you’re doing it.

Like I said, the chronically elevated cortisol leads to cortisol resistance and that impairs the body’s ability to control inflammation, so inflammatory diseases develop. Kelsey talked about the digestive ones. Autoimmune disease is definitely an inflammatory disease as well. Interestingly, levels of cortisol actually tend to be low in patients with autoimmune disease despite the higher levels of systemic inflammation. Normally if somebody has high levels of inflammation, you also see high cortisol and that’s because as Kelsey explained before, cortisol is a hormone that is used to regulate inflammation. When you have high levels of inflammation, cortisol is released by the body to help bring some of that down so it’s not causing any excessive damage to your body. But when you see someone with an autoimmune disease, they tend to have low cortisol even though they have this high level of inflammation.

Stress and HPA axis dysregulation, which you guys may know better as adrenal fatigue, but we like to talk it about it as HPA axis dysregulation because that’s the more official scientific term, but that issue has been studied as a trigger for rheumatoid arthritis in a lot of different studies. Rheumatoid arthritis is an autoimmune disease that affects over 1.5 million U.S. adults and it’s more common in women than men. It’s a pretty common issue and it’s especially common in older women. Both daily minor stressors and major traumatic life events have been found to affect the risk of that disease. But interestingly, it was the mild daily stressors that are actually considered to be a greater risk factor because those are what lead to the cortisol resistance and uncontrolled inflammation.

Kelsey: Interesting.

Laura: Yeah. So a major traumatic life event, I think the reason that that is associated with the kickoff of the symptoms is because if somebody’s already got a lot of chronic stress, they’re already becoming cortisol resistant and then they have that major life event and that is what kind of sends somebody into more full blown adrenal fatigue, HPA axis issues.

Kelsey: Mm hmm.

Laura: Even though a major traumatic event tends to be a trigger, it’s not the most important trigger. It’s those mild daily stressors that are more important for preventing cortisol resistance and autoimmune disease development.

Studies have also shown a significant HPA axis involvement in multiple sclerosis, which we also call M.S. The interesting thing with M.S. is that there is both hyper and hypo activity of the HPA axis seen in patients with severe symptoms. Hyper means high activity, and hypo means low activity. As we were saying before, these patients would either have high cortisol, low cortisol, cortisol resistance is probably involved with both of those. According to this research, HPA axis is generally activated in Multiple Sclerosis, but patients with a hypo active HPA axis are the ones that have particularly severe M.S. and more active lesions. This impaired activity also increases the M.S. patient’s risk of depression and it just generally exacerbates symptoms and it causes progression to go more rapidly. Even though the high cortisol is seen in some patients with M.S., it’s actually the low cortisol that is associated with more severe M.S.

Okay, now let’s talk about autoimmune thyroid disease. Adrenal stress and HPA axis dysregulation not only impacts the development of autoimmune thyroid diseases like Hashimoto’s and Graves’ disease, but it can also actually imitate hypothyroidism thanks to its effects on the conversion of T4 to T3, it also reduces TSH, and can suppress thyroid receptor site sensitivity among other things.

Kelsey: Yeah, I think that’s really common.

Laura: Mm hmm. And we see a lot of patients with adrenal issues that also have thyroid issues. I strongly believe that it’s the relationship to how it affects the autoimmunity of the thyroid.

Kelsey: Mm hmm.

Laura: Of course it can also just suppress the conversion of T4 to T3. Even if somebody doesn’t have an autoimmune thyroid issue when they have adrenal stress issue, they can have hypothyroid symptoms because of the way that it affects that conversion. Also the suppression of the receptor site activity is also a really big deal. Essentially we’re reducing the amount of active T3 hormone and we’re also decreasing the amount of sensitivity that the thyroid receptor sites have. It’s making the little hormone that you do produce way less effective. That’s why it causes those thyroid symptoms.

Also another interesting thing that the T4 tends to get converted into reverse T3 more in people who are highly stressed. Whenever you get your thyroid tested and you get that full thyroid panel that also includes free T4, free T3, and reverse T3, if your free T3 is low and your reverse T3 is high, a lot of times that is due to stress. That’s one of the big reasons why practitioners will order that test because you may have normal T4, you may have normal TSH, you may even have normal T3, but if you have high reverse T3, that actually affects your thyroid function just from a symptoms perspective.

Chronic HPA axis activation can also cause a shift in the balance between TH1 and TH2 cytokines. Our listeners may or may not be familiar with that term. It’s something that’s very common in the autoimmune community where you’re looking to balance out your TH1 and TH2 cytokines. If they’re imbalanced, this can cause a multitude of inflammatory and autoimmune conditions, and this will depend on the individual’s particular dominance of either type of cytokines. There are a couple of lists out there that people can see, and I linked to them in the article that I wrote. But for example, if somebody is TH1 dominant they’re going be more prone to Type 1 Diabetes, M.S., Hashimoto’s, Chrons disease, Sjogrens, Celiac, that kind of stuff. Rheumatoid arthritis is there as well. Then if you’re TH2 dominant, those are more correlated to things like Lupus, eczema, sinusitis, asthma, allergies, ulcerative colitis. It’s kind of interesting that each type of cytokine has its own associated autoimmune disease.

The chronic HPA axis activation can disrupt that balance between the two. This is an effect that has been demonstrated in mice. Again, we can’t necessarily test that in humans, but if we can show it in mice, then there’s reason to believe that it’s possibility happening in humans. There are some herbs and different types of medications that can help resolve the imbalance, but it is pretty clear that if you are not prioritizing your stress, then the imbalance between the two cytokines is not necessarily going to resolve.

Kelsey: Right.

Laura: I think that all the information out there about how to balance your TH1 and TH2 cytokines is really helpful, but I would say that somebody needs to make sure that the stress management side of thing is kind of the number one priority at that point. Once they get that under control, that’s when you can start adding in those herbs that can help resolve that balance issue.

I know I kind of flew that information. The good news is I did write an article about it.  So if you want to read it, it’s available on my website and we’ll link to it in the show notes. But ultimately, the point was to show the various different types of autoimmune diseases that have been shown to have a correlation to HPA axis issues whether that be over-activation, under-activation, cortisol resistance, all of that stuff.

I would say that anyone that has an autoimmune disease definitely needs to be addressing stress and that’s why we want to talk the things you can do to help deal with stress. I know we talked about a couple of these in past podcasts. We’ll briefly go over them and we’ll also link to our e-book on adrenal fatigue and HPA axis dysregulation. That way if you want to download that, there’s a little bit in depth recommendations there. We’ll just go over a quick little summary of a couple of the things that we mention in that book.

Kelsey: Cool.

Laura: When I wrote this article, I put in the diet as being the number one thing to do. That’s because for autoimmune disease, I wouldn’t necessarily tell someone to skip going to at least a Paleo diet if not an autoimmune Paleo diet to help with the autoimmune issues.

Kelsey: Mm hmm.

Laura: I mean as much as stress is important, we don’t want completely miss the diet side of things. I would say that the autoimmune protocol is a really good idea for people have autoimmune disease. Eliminating foods on its own is not enough to heal you from the HPA axis dysregulation. I don’t think that just cutting out a bunch of foods is what’s going to help you. In fact, one of the things that we talk about in our program which is called “Paleo Rehab: Adrenal Fatigue” we talk about why eliminating foods can actually lead to worsening of these adrenal issues.

Kelsey: Right, you need to take them out if they need to be taken out. Otherwise, if you can tolerate them, it’s always to good have them in your diet just to have variety and make it less stressful for you mentally to be on a restrictive diet.

Laura: Right. I would recommend people start with the autoimmune elimination protocol and give that at least 4 to 6 weeks of doing the elimination diet, and then systematically reintroduce foods so that they’re not avoiding foods for no reason. That is a pretty in depth topic in itself for autoimmune disease. Even for gut issues, Kelsey wouldn’t you say that there’s the same issue with gut issues where like say they’re on a low FODMAP diet, and then they go to a SCD diet, and then they go to a GAPS diet, it’s like they’re just removing so many foods out of their diet and then that can actually its own issues.

Kelsey: Yeah, I actually think it’s a huge problem in digestive disorders. It’s because people see all these great testimonials like you were talking about before, like oh all of my symptoms went away as soon as I did this particular diet. So they just try these diets one after another or stay on something really, really restrictive for a long time. That has a really significant impact on your stress level, your HPA axis activation. For anything honestly, anything, you want to be the least restrictive that gets you the most results. I think that’s a really good rule to go by just like I said, for any condition that you’re dealing with, you never want to overly restrict things that it’s not making any difference for you. The more variety the better.

Laura: We often find that people who are over restricting types of foods end up under eating even by accident. And under eating is a stressor in itself.

Kelsey: Right.

Laura: If you’re trying to deal with stress and you’re trying to be on this autoimmune diet and you’re under eating constantly, that’s just going to be further triggering these issues. You don’t want to be under eating either calories, or fat, or protein, or even carbohydrates, which that’s probably the most common that we see in both autoimmune and digestive issues patients. You need to make sure you’re providing your body the nutrition it needs to not only heal from these issues, but also to keep your stress low.

Kelsey: Right. Alright. The next thing to think about here is to engage in mind/body activities on a regular basis. I talked a little bit about that before when we talking about digestive issues, and how the mast cells start to degranulate when there’s too much stress going on, and how they start to stabilize when you incorporate mind/body activities into your lifestyle. This is something that I would say probably the majority of people could do more of. We are just under so much stress and so much pressure that our ancestors and maybe even our grandparents or parents just didn’t have to deal with. So we need to take that into consideration and try to incorporate some stress management on a regular basis in our life.

Laura: Mm hmm.

Kelsey: If you think about all of the different things are pulling us in a million directions and kind of causing this pressure, I mean we’re seeing horrible things on the news half the time, we’ve got our laptops, our smartphones open pretty much 24/7, so you’re getting notifications one after the other, all this stuff that you’re seeing from your friends on Facebook like how their life is so great or Pinterest, all these things just really, they just put so much pressure on us to live perfectly. That’s really tough for all of us to live up to and it puts this pressure, this stress on us that really just wasn’t there before. Just think about even, like Laura and I are about the same age, so our parents didn’t really necessarily even grow up until later with computers and Facebook and all that kind of stuff. It’s just not something, that pressure that they had to deal with that we unfortunately are so exposed to today.

Laura: Yeah, the way I hear described is that we compare our behind the scenes to people’s highlight reels.

Kelsey: Oh yeah. That’s a perfect little thing there. That’s exactly right.

Laura: You’re seeing everyone’s posts on Facebook and that kind of thing showing all this amazing stuff that they’re doing and people start to feel guilty or feel like they’re missing out on things. I actually just recently read a really interesting article on I think it was in The New York Times and they were talking about how actually unplugging from the social media, and the internet really, but social media especially is really important for helping to deal with that kind of stuff because it’s just one of those things that people start to think they’re missing out on social trends, and news, and information like that if they’re not keeping up with all the information that’s getting shared on Facebook.

Kelsey: Right.

Laura: But they’ve actually found that people actually end up being way happier if they’re not kind of plugged in all the time to those things.

Kelsey: I can so believe that.

Laura: Yeah.

Kelsey: It’s like even just thinking about it now too, even for me and I’m sure for a lot of people our age, it’s like it’s almost like the things you do in your life, you’re sort of thinking, okay, how can I post this to Facebook or post this to Twitter because you want to show you’re highlight reel too obviously.

Laura: Mm hmm.

Kelsey: It makes you feel bad and then you’re not even necessarily present half the time in the fun things that you’re doing because you’re trying to capture it to post it. It’s not a good thing. Anytime you can unplug and get rid those kind of pressures, the better off you’re going to be. That’s really why engaging in these mind/body practices is so important now because they just help to manage all the stress that we do have that we can’t get rid of because let’s be honest, we can’t get rid of every single stressor that’s going on in our lives. Anything that you can reduce or get rid of, like Laura said, maybe unplugging once and a while from social media, things like that, or even just like making a rule for yourself that you’re not going to take all these pictures and post them to Facebook when you’re out with friends that should be enjoying their presence.

Anything like that where you can reduce the amount of stress or pressure that you’re dealing with, definitely do it, but also know that there are some things that we simply can’t get rid of. And for those we really want you to incorporate some kind of mind/body practice which could include things like meditation, yoga, breathing exercise, tai chi, chi gong. There are so many out there so it’s really just about picking one that you really like and implementing it on a regular basis. I tend to tell people to do it every single day if they can just because it doesn’t have to be a long amount of time that you’re doing it, but the regularly you implement these things, the better the results and the more exponential those results go overtime.

Laura: Mm hmm.

Kelsey: Even though one hour of meditation probably sounds like it would be great for you, I’d rather see someone do a few minutes every single day rather than just once a week doing an hour of meditation, if that makes sense.

Laura: Yeah, an hour sounds a little intense. I don’t think I could handle that. We meditated in my yoga class this morning. I think that might be why I’m a little bit foggy today. I just want to go like take a nap.

Kelsey: Yeah, right.

Laura: I think it’s really important to try a couple of different strategies. For example meditation, if you don’t really enjoy straight up mediating, then that doesn’t mean you can’t do any of things.

Kelsey: Right.

Laura: That’s one of the reasons why I do yoga because I feel like poses actually help get my mind focused because if I’m just sitting there, I start to like go through my to do list, that kind of thing, which that’s just a symptom that I really need this kind of stuff. But just try a bunch of different things and just see if there’s something that ends up getting you to the point where you feel like you not only do you enjoy it but that’s it’s actually helping reduce stress. We talk about more organized mind/body practices, but you could even do things like say you’re an artist and you enjoy painting, then paint every week or something and use that as a stress management practice.

Kelsey: Right.

Laura: Maybe taking your dog for a walk is a stress management practice and making sure you do that every day is important. We talk about mediation and yoga and things like that because it’s got a lot of evidence and it’s actually designed to help with stress, but it’s not the only thing that you can do. We talk a lot about this stuff in our program and we give out free resources, well I shouldn’t say free because the program’s paid, but the resources themselves, a lot of them are free so that way you can get started on some of these practices and test the waters and see do I like this? Is this something I actually want to continue? Then if you find something you really like, then you can always get more involved with it.

Kelsey: Cool.

Laura: Alright. Let’s talk about exercise really quick. Exercise is one of those interesting double edge swords when dealing with stress and HPA axis issues. We usually like to recommended regular moderate exercise for the majority of people because this is been shown to reduce stress, uplift depression, even it’s been shown to improve your HPA axis’ response feed. They’ve even studied how it affects the HPA axis. Unfortunately on the flip side of that, over-exercise, which we’ve also called over-training in the past, this can actually impair your HPA axis function, which causes systemic inflammation, immune dysfunction, and increase risk of depression or anxiety and other mental health issues. It’s really interesting how exercise can either improve your mental health and stress levels, or it can actually makes things a lot worse if you’re over-exercising.

I cannot say what’s an appropriate of amount of exercise is for every person because everyone has different levels of tolerance when it comes to physical activity. What I would say is that for someone with adrenal fatigue or autoimmune disease that over exercise would actually be more dangerous than not exercising enough, so you have to be really careful. Err on the side of caution and avoid any heavy duty, hardcore training regimens like long distance running, and when I say long distance I’m not talking about a couple miles here and there, I mean like marathon training and that kind of thing.

Kelsey: Mm hmm.

Laura: Cross Fit and other boot camp style workouts. Again, Cross Fit is one of those unfortunate things that some gyms are really good at keeping people around their comfort zone, maybe just a little bit outside of their comfort zone, whereas other gyms they will just throw these ridiculous workouts at you and it doesn’t matter where your comfort zone is.

Kelsey: Right.

Laura: I’m not saying that you shouldn’t do Cross Fit if you have autoimmune disease, but I would be very cautious and consider either cutting down on how many days you do it, balancing it out with something like yoga, or maybe taking a break from it if your autoimmune disease symptoms are being flared up.

I really like people to stick to exercise that makes them feel energetic. I also like to make sure that my patients get adequate rest in between the exercise they’re doing, so not exercising 7 or even 6 days a week. You really need at least 2 rest days a week. Also just listening to your body. If you’re doing an exercise that you think you can handle and you’re getting injured a lot, if you’re not sleeping well, if you’re waking up super sore than just consider cutting it down because that can definitely get you into that HPA axis dysregulation situation.

Kelsey: Yeah. That’s just so common I think unfortunately just because of kind of because of our society, just people want to push themselves so hard when it comes to exercise. That really can be detrimental and it often seems like it’s the smart choice because how could exercise be bad for you? But in some people especially with adrenal fatigue, autoimmune diseases like Laura mentioned, and I would say also the same goes for digestive concerns, more is not always better in this case. You really just want to make sure that you are doing it appropriately for you, your body, and your condition.

Laura: Mm hmm. Okay. Let’s cover the last two steps really quick. I know we’re going a little long today, but I guess it wouldn’t be much longer than the last two. Of course like I had mentioned, all of this information is available in our free e-book. Again, check the show notes to download that and you’ll be able to read into more detailed information about these. But Kelsey, do you want to talk a little bit about sleep?

Kelsey: Yeah, sure. I’m sure most people can understand that sleep is just vital to our health to our health and wellbeing. They’ve actually researchers have shown that sleep restriction actually activates the HPA axis and then of course alters the production of ACTH and cortisol as a result of that activation. Sadly, about 30% of us get less than 6 hours of sleep a night. This is not something that just affects a small portion of us, it’s a lot of us. And that’s just less than 6 hours, there’s probably even a bigger percentage that get between 6 and 7, which is still fairly detrimental. You want to try to aim to about 7 to 9 hours of sleep per night. This depends on the person, so if you are someone who is dealing with adrenal fatigue or autoimmune diseases, any kind of condition that’s stressful for the body, you’re probably going to want to get more sleep on the end of that spectrum, so more like 8 or 9 hours rather than 7 or so. Anyone who’s really trying to heal, I would say you want to be more towards the 8 or 9 hours of sleep every night. But again, this will just depend on you and kind of where your body is at with sleep and how much it needs currently. This can change overtime too.

Laura: Mm hmm.

Kelsey: The thing here too is that your body’s clock, your circadian rhythm is really connected to the HPA axis too. That system is driven by light and dark exposure, and that also controls the HPA axis. You an think about cortisol kind of that you need the most cortisol in the morning to wake up and then it slowly dissipates over the course of the day to nighttime when we don’t need it because we’re sleeping. It is very much related to the time of day, and that of course is affected by light and dark cycles, and when we’re sleeping, when we’re awake. Anytime that you’re messing with circadian rhythm, your also messing with the HPA axis. That would affect people who are doing shift work, anything like that where you’re either going to bed really early or really late, that’s all going to have a negative effect on the HPA axis.

Try to go to sleep at the same time every day if possible, even if it is at an altered time. But generally you want to get 7 to 9 hours, and like I said, 8 to 9 would be better for those dealing with any kind of health condition. And just make sure you’re sleeping in a cool, pitch dark room, limiting your light exposure at nighttime, and trying to get some light exposure right in the morning so that you can kind of reset that circadian rhythm.

Laura: Yeah, that’s stuff is really important. I feel like as much as we know already about circadian rhythms, I think we’re just going learn as time goes on.

Kelsey: Yeah.

Laura: And you had mentioned shift workers, and I honestly feel like shift working is really bad for circadian rhythm issues.

Kelsey: It is.

Laura: But even people that just stay up too late, like if you’re staying up until 1:00 in the morning watching TV and then going to bed, that is going to be affecting your circadian rhythm.

Kelsey: Absolutely.

Laura: Shift working is the extreme example, but there are a lot of people out there that are not on a healthy circadian rhythm cycle.

Kelsey: Exactly.

Laura: Alright. The last thing I wanted to mention about how to deal with stress, this is something that I think a lot of people don’t really think about as being part of their health pursuit, but building social connections and having a healthy social life. A healthy social life is more important to adrenal health and autoimmunity then many people may realize. Research has actually shown that a good social support network has many physical and mental health benefits. A strong social connection can help you feel less lonely, isolated, or inadequate, and it can help you deal with stress better.

Make sure you have at least a few deep relationships in your life, and if you don’t, consider new ways to cultivate friendships. If you have your own family, you can focus on strengthening those relationships and trying to address any negative interactions that are happening regularly. If you don’t have your own family or if you’ve moved to a new city and you live far away from your friends, your parents, and your siblings, and that kind of thing, just try to get out of your house and find a community of like-minded people to get involved with. This is something that we focus on in the program pretty deeply where talk about all the different ways you can start building a community of people that you can spend time with, that you can build relationships with.

I think that when people are having health issues, especially something like autoimmune disease, even with your digestion, sometimes people end up isolating themselves because they just don’t want to deal with the symptoms. But making sure that you are maintaining a social life is actually really important during either adrenal issues, autoimmunity, gut issues, really any health issues I think could be exacerbated by social isolation. So just want to make sure that you’re not removing yourself from all of relationships in your life when you’re trying to deal with your health issues. Maybe it’s not because you’re trying to deal with your health. Maybe it’s because you are working too much or you just don’t prioritize social connections and you’re staying at home watching TV instead of meeting up with friends. Just think about if that’s something that needs to be worked on and like I said, we have a couple of ideas in our e-book, we have a bunch of ideas in our program about how to deal with that. But either work on your current relationships, or work on building new ones.

Kelsey: Alright. This was another long one.

Laura: Yes.

Kelsey: Hopefully that one was helpful for everyone to hear. Obviously stress has a huge impact on a lot of different things and today we just focused on two, digestive issues and autoimmune conditions. But know that this kind of applies to a lot of things in the body and that’s just why it’s so, so important to really manage your stress as much as possible. Like we were talking about with all these ideas to do that, you can find even more in depth information about how to manage your stress in our free e-book. Land then if you’re interested in signing up for our program, you can do that when it launches April 28^th.

Laura: Yes. Thanks for joining us everybody. I apologize for rushing so much through. I was trying to fit this under an hour and it looks like we just went over. Anyway, we’ll look forward to seeing you again in two weeks and we hope you enjoy the rest of your week.