Stress and Lupus

Posted by Elaine Moore Mar 11, 2007

In systemic lupus erythematosus (SLE) , Graves’ disease, and related autoimmune disorders, stress contributes to disease development and disease flares. At a cellular level, stress directly affects immune, nervous, and endocrine cells, causing the production of autoantibodies, immune complexes, and pro-inflammatory cytokines.

Effects of Stress

Stress is not always inherently harmful. Stress causes us to respond to certain events such as danger, deadlines, new life circumstances, and work pressures. At times, stress invokes creativity and help us find novel solutions. In addition, stress triggers the fight or flight response, which alerts our hypothalamic-pituitary-adrenal (HPA) axis to secrete hormones that help us respond. During stressful times, stress hormones, primarily insulin and cortisol, along with several pro-inflammatory chemicals, tend to rise dramatically.

When stress is chronic, such as the persistent stress of working at an unrewarding job, the HPA axis malfunctions. It begins to secrete a constant stream of stress hormones. Increased levels of stress hormones lead to metabolic syndrome, characterized by aging, increased intra-abdominal body fat, high cholesterol, elevated glucose and increased risk of autoimmune disease.

The Mind Body Connection

Psychoneuroimmunology (PNI) is the scientific study of the interrelationship between the immune, endocrine, and nervous systems. Whatever affects one system trickles down to the others as the three systems work together to maintain health (homeostasis). The nervous system and endocrine system cells are collectively known as neuroendocrine cells, their organs neuroendocrine organs.

Neuroendocrine transmitters respond to physical and psychological stress, including the stress generated by stimulants and refined sugars. In response, these neurotransmitters send signals to the immune system so it too can respond. Over time, the immune system weakens. The weakened, ineffective immune system cells respond to chronic stress by unleashing pro-inflammatory cytokines and autoantibodies in their frenzied efforts to help protect us.

Stress Reduction Techniques

Stress reduction techniques include dietary changes; dietary supplements; exercise programs such as Pilates, yoga, tai chi, and walking; biofeedback, meditation and other forms of energy healing. Adequate rest is also essential for coping with stress, and the recommendation for patients with lupus is 8-9 hours of sleep each night. In terms of diet, avoiding refined sugars can help lower insulin levels, and avoiding caffeine, particularly in coffee and sodas, reduces the effects of stress. A study conducted at Duke University showed that the effects of morning coffee consumption exaggerate the body’s stress hormones and increase stress hormone levels throughout the day.

What to Avoid

It’s important to avoid known or suspected allergens. In autoimmune diseases, exposure to allergens stimulates an already erratic immune response. It’s also important to avoid industrial chemicals, chemical cleaning agents, and processed foods. Patients with lupus should avoid alfalfa, zinc, tyrosine, phenylalanine, tryptophan and 5-hydroxytryptophan. Defects in amino acid metabolism seen in lupus contribute to toxicity. Patients with autoimmune thyroid disease should avoid excess dietary iodine, especially avoiding processed foods.

Supplements That Reduce the Effects of Stress

• Antioxidants: 400-800 IU vitamin E, 10,00 IU vitamin A, 200 mcg selenium, 1000-3000 mg vitamin C are all used to combat the effects of stress. A study conducted in ultramarathon runners showed that using 1500 mg of vitamin C daily for 7 days before a marathon, on the day of the race, and for two days after the race, caused significantly lower post-race cortisol levels. Another study showed a reduction in cortisol levels in people subjected to psychological stress who used 3000 mg vitamin C daily.
• Essential oils: Fish oils, which contain omega-3 fatty acids, evening primrose oil, flaxseed oil, and other oils rich in EPA, DHA, and GLA are recommended to reduce levels or pro-inflammatory chemicals generated by stress. The recommendation is for 2250 mg EPA, 500 mg DHA, and 250 mg of other omega-3 essential fatty acids daily.
• Hormones: DHEA, using 50 mg daily for men and 15-25 mg daily for women.
• Digestive Enzymes: Bromelain and pancreatic enzymes are used to reduce the effects of stress caused by dietary antigens and plant lectins.
• Herbal Adaptogens: Herbal adaptogens have long been used in Asia and Europe as immunomodulators autoimmunedisease.suite101.com/blog.cfm/immunomodulators and to relieve the effects of stress. The three most important include:

1. Rhodiola rosea, using one 250 mg capsule, which fights fatigue, reduces the effects of stress related to excess sympathoadrenal system activity such as that caused by stimulants, sleep deprivation and long-term stressors, increases mental and physical performance. In addition, Rhodiola prevents adrenal burnout and the effects of adrenal depletion caused by nutrient deficiencies, high intake of starchy and sugary foods and chronic stress.
2. Ginseng, either Panax ginseng (Korean, Chinese or Asian ginseng), Panax quinquefolium (American ginseng) or the closely related plant Eleutherococcus senticosus (Siberian ginseng) help restore immune system health and protect against the effects of physical and psychological stress.
3. Ginkgo biloba, using 60-120 mg twice daily of a standardized extracts helps reduce the effects of stress and increases blood circulation to the kidneys, which is beneficial for patients with lupus.

• Anti-inflammatory Herbs: Anti-inflammatory herbs include turmeric, ginger, green tea, and devil’s claw. These are used to reduce pro-inflammatory cytokines generated by stress. Dr. Balch recommends using teas made from skullcap, hops, passionflower or valerian to reduce stress.
• Probiotics: Probiotics have been found to enhance immune function, inhibit chronic inflammation, and improve inflammatory conditions with an autoimmune component such as Crohn’s disease. Dr. Perricone recommends the addition of kefir, a fermented, probiotic milk drink resembling a liquid yogurt from the Caucasus Mountains in the former Soviet Union.
• Phosphatidylserine: The phospholipid compound phosphatidylserine is an essential part of the cell membrane. Studies show that using 300-800 mg phosphatidylserine daily can reduce elevated cortisol levels related to mental and physical stress.
• Patients on corticosteroids benefit from 1500-2000 mg calcium, 500-1000 mg magnesium, and vitamin D to help prevent bone loss.
• Overcoming emotional eating related to stress can be accomplished with several nutrients including pinolenic acid, conjugated linoleic acid, wild oat extract, and green tea extract.

Resources:

Lupus: A Patient Care Guide for Nurses and Other Health Professionals, National Institutes of Health, May 2001, Revised September 2006, accessed March 1, 2007.

James Balch, Prescription for Natural Cures, Hoboken, NJ: John Wiley & Sons, 2004.

Elaine Moore, Autoimmune Diseases and Their Environmental Triggers, Jefferson, NC: McFarland and Company, 2002.

Nicholas Perricone, Dr. Perricone’s 7 Secrets to Beauty, Health, and Longevity: The Miracle of Cellular Rejuvenation, New York: Ballantine Books, 2006.

Nicholas Perricone, The Perricone Promise, Look Younger, Live Longer in Three Easy Steps, New York: Warner Books, 2004.