What is the link between stress and autoimmune diseases?

From type 1 diabetes to rheumatoid arthritis, autoimmune conditions affect around one in 10 of us, and can be difficult to live with. But how much of a role does stress play in these conditions, and how can we tackle it head on?

Our immune system is trained to attack viruses and bacteria, to help us bounce back from norovirus or fight the flu, but sometimes things go awry. Rather than fighting dangerous cells, the body’s immune system can get confused and mistakenly attack healthy tissues, and even organs, in the body instead.

When this happens, it creates an autoimmune disease, and there’s a whole range of these, including: Crohn’s disease (where the immune system attacks the digestive system); multiple sclerosis (where the immune system attacks the myelin sheath, the protective covering of nerve fibres in our central nervous system); and psoriasis (where the immune system attacks healthy skin cells).

There’s more than 80 different types of autoimmune disease, as noted by Bupa, and they vary in both symptoms and severity. While these might be separate conditions, research has tried to identify commonalities, since we know individuals who have one autoimmune disease are more likely to have another. In fact, a quarter of autoimmune disease patients have a tendency to develop new autoimmune diseases. So, could the connection be stress?

Does stress cause autoimmune disease?

Autoimmune diseases have many different causes (and, for some patients, the exact cause may not be known), but studies have shown that stress could be linked to their development. One 2023 study, published in International Immunopharmacology, found that chronic stress instigated rheumatoid arthritis and psoriasis, while another 2022 paper, in the International Journal of Environmental Research and Public Health, which was focused on Crohn’s disease patients, discovered that the higher the person’s stress levels, the greater the likelihood of their autoimmune disease flaring up and causing symptoms.

It works the other way too, in that these conditions themselves cause us stress. “There is a bidirectional relationship between stress and autoimmune diseases, in that stress has an impact on these illnesses, and, equally, this group of illnesses causes stress in affected individuals,” says Dr Victoria Froome, a therapist supporting adults and young people through life’s challenges.

There’s scientific evidence to back this up, such as a study from the University of Cambridge and King’s College London, published in Rheumatology in 2023, which found that more than half of patients with autoimmune conditions experienced mental health conditions like anxiety and depression, and yet the majority are rarely, or never, asked about these symptoms.

But why is this? “During periods of acute or chronic stress, the body releases higher levels of cortisol and adrenaline, which can dysregulate the immune system,” explains Dr Katie Barge, a chartered doctor of psychology. “In people with autoimmune conditions, this can exacerbate an already sensitive system, e.g. increased joint pain and fatigue in rheumatoid arthritis, or skin flare-ups of psoriasis.”

How to manage your stress levels

With the awareness of a possible connection between autoimmune flare-ups and stress, the important question then becomes: what can we do about it?

Work on regulating your nervous system

“I encourage people to focus on nervous system regulation as much as possible; these are simple, consistent practices that signal safety to the body,” psychologist Dr Katie Barge says.

“This could include regular, gentle movement (like swimming and walking), or micropractices like grounding (keeping your feet on the floor, or noticing five things you can see, feel, or hear), or body scans.”

Mind-body intervention

“The NHS advocates five steps to mental wellbeing. These are also known as ‘mind body interventions’ (MBIs), and include areas such as breathing exercises, physical exercise, learning new skills, giving to others, and connecting with others,” says Dr Froome. “There is evidence from trials in the UK that these MBIs can lead to reduced inflammatory markers, and increased anti-inflammatory markers, and, vitally, an improvement in wellbeing after only 12 weeks.”

Exercise

Ever felt less stressed after exercising? There’s a reason why. “Physical exercise not only reduces stress through cortisol levels, but increases the levels of endorphins – which are our natural feel-good hormones,” says Dr Froome. “And it doesn’t need to be high intensity exercise – walking, swimming, and yoga can all be beneficial.”

Sometimes stress is unavoidable, but exercise can actually help the way we deal with it. Research from 2014 in Frontiers in Physiology even reports that regular exercise can make us more resistant to acute stress, and improve our ability to tackle it. Of course, we know exercise can help many other parts of our health too – a 2022 study in Lupus Science & Medicine, for example, found it can help with fatigue in those who have the autoimmune disease Lupus.

Eat to support your stress levels

Stress management isn’t just about movement, it can be what’s on your plate, too. Certain foods – such as proteins – can help us tackle stress. Our central nervous system needs the amino acids that can be found in protein foods, and a reduction of one of these, called tryptophan (found in foods like chicken, eggs, and cashews), has been found to increase anxiety levels, as noted in Nutrients in 2021.

We also know that vitamin B12 can help with stress as it supports the nervous system, so tucking into foods rich in this vitamin (like nutritional yeast, fish, and dairy) can help. Finally, magnesium is also linked to stress; it’s involved in reactions that regulate the body’s stress response, and low magnesium is often observed in individuals with stress. You may not need to supplement though, as dark chocolate, nuts, and leafy greens are all great sources of magnesium.

While tackling stress head on through exercise, diet, and mind-body interventions are great ideas, the relationship between stress and autoimmune disease isn’t the same for everybody. Although it can be an important underlying factor in autoimmune disease, there are others, so there’s no guarantee it will always stop a flare-up in its tracks.

“The definitive causes of autoimmune diseases are multifactorial, with stress, although playing such an important role, being only one of these factors. Other triggers include environmental factors and genetic factors,” explains Dr Froome. If in doubt, it’s always important to speak to your GP or medical professional, who will provide you with the most up-to-date information on your autoimmune disease.

Stress management remains important for all of us, and potentially even more so for those navigating autoimmune diseases and other conditions. And while seeking methods to address your stress might not be a magic solution to all that ails you, it can still offer some much-needed relief – and that’s one less thing to worry about.