Stress Hormone – How Does Cortisol Affect Autoimmune Diseases?

Introduction

In today’s fast-paced lifestyle, stress has become an inseparable part of daily life. Its physiological marker is cortisol—a hormone that, in appropriate amounts, serves protective functions, but when chronically elevated, can lead to serious health consequences. Particularly intriguing is the relationship between cortisol and autoimmune diseases, the prevalence of which is steadily increasing in Poland.

Scientific research increasingly points to a strong link between chronic stress and the development or exacerbation of autoimmune diseases. In this article, we will explore the mechanisms through which cortisol affects the immune system and discuss stress management strategies that can help control the symptoms of autoimmune conditions.

What Is Cortisol and What Is Its Natural Role in the Body?

Cortisol, often referred to as the "stress hormone," is produced by the adrenal glands in response to signals from the hypothalamus and pituitary gland. This glucocorticoid performs key functions in the body:

• Regulates the metabolism of carbohydrates, proteins, and fats

• Maintains proper blood pressure levels

• Controls the sleep-wake cycle

• Modulates immune responses and inflammatory processes

Under normal physiological conditions, cortisol secretion follows a circadian rhythm—its levels peak in the morning, helping us wake up and prepare for daily activities, then gradually decline, reaching their lowest point at night.

However, in situations of threat or stress, the body triggers the so-called "fight or flight" response, during which cortisol levels spike sharply. This adaptive mechanism, which in prehistoric times increased survival chances by mobilizing the body for rapid action, becomes problematic when stress persists over time.

The Mechanism of the Stress Response – What Happens in Our Body?

The stress response is a complex process involving the nervous and hormonal systems. When the brain interprets a situation as threatening, the hypothalamic-pituitary-adrenal (HPA) axis is activated:

• The hypothalamus releases corticotropin-releasing hormone (CRH)

• CRH stimulates the pituitary gland to produce adrenocorticotropic hormone (ACTH)

• ACTH prompts the adrenal glands to secrete cortisol

Elevated cortisol levels lead to a series of physiological changes:

• Increases blood glucose levels by enhancing gluconeogenesis

• Raises blood pressure and accelerates heart rate

• Suppresses digestive, reproductive, and growth processes

• Modulates immune system activity

In the short term, these changes are adaptive and aid survival. The issue arises when stress becomes chronic, and cortisol remains elevated for extended periods.

Cortisol and the Immune System – A Two-Way Relationship

The relationship between cortisol and the immune system is highly complex. On one hand, cortisol acts as an immunosuppressant, inhibiting excessive immune responses and inflammation. This is why synthetic glucocorticoids are used to treat autoimmune diseases.

On the other hand, chronically elevated cortisol levels can disrupt the natural regulation of the immune system, paradoxically promoting the development of autoimmune conditions.

A key mechanism here is glucocorticoid resistance, which develops under chronic stress. Immune cells become less responsive to cortisol, leading to:

• Imbalance between Th1 and Th2 lymphocytes

• Increased production of pro-inflammatory cytokines

• Reduced apoptosis of activated lymphocytes

• Disruption of immune tolerance to self-antigens

These changes create an environment conducive to autoimmune processes, where the immune system attacks the body’s own tissues.

Autoimmune Diseases Linked to Stress

Epidemiological and clinical studies have demonstrated a connection between chronic stress and an increased risk of developing or worsening several autoimmune diseases, including:

Hashimoto’s Disease and Thyroid Disorders
Chronic stress can affect thyroid function both directly and indirectly. Cortisol inhibits the conversion of thyroxine (T4) to the more active triiodothyronine (T3), leading to symptoms of hypothyroidism even when basic test results appear normal. Additionally, immune dysregulation can exacerbate autoimmune thyroiditis (Hashimoto’s disease).

Rheumatoid Arthritis (RA)
Patients with RA often report that periods of heightened stress precede disease flare-ups. Studies show that chronic stress increases the production of pro-inflammatory cytokines like IL-6 and TNF-α, which play a key role in RA pathogenesis.

Inflammatory Bowel Diseases
Stress affects gut barrier permeability, potentially increasing the immune system’s exposure to antigens from the intestinal lumen. This mechanism is significant in the pathogenesis of Crohn’s disease and ulcerative colitis.

Psoriasis and Skin Disorders
The link between stress and psoriasis flare-ups is well-documented. Cortisol influences keratinocyte proliferation and Langerhans cell function in the skin, potentially intensifying inflammation.

Multiple Sclerosis (MS)
Animal studies and clinical observations suggest that chronic stress may worsen neurodegeneration and demyelination in MS, likely by disrupting cytokine balance and increasing blood-brain barrier permeability.

Diagnosing Cortisol Level Imbalances

If chronic stress and cortisol dysregulation are suspected to contribute to health issues, appropriate diagnostics are recommended. Common methods for assessing HPA axis function include:

• Serum cortisol measurement (preferably in the morning)

• Salivary cortisol testing (to assess circadian secretion patterns)

• Dexamethasone suppression test (to evaluate feedback mechanisms)

• 24-hour urinary cortisol measurement (to assess total production)

Interpretation of results should account for factors such as time of day, medications, and overall health status, making it essential to consult an experienced specialist.

Stress Management Strategies for Autoimmune Diseases

Stress management is a vital component of a comprehensive approach to treating autoimmune diseases. Effective strategies include:

Relaxation and Meditation Techniques
Regular practice of mindfulness meditation, Schultz’s autogenic training, or Jacobson’s progressive muscle relaxation can lower cortisol levels and improve immune parameters. Studies show that an 8-week Mindfulness-Based Stress Reduction (MBSR) program reduces inflammatory markers and enhances quality of life in autoimmune patients.

Physical Activity Tailored to Abilities
Moderate, regular physical activity helps regulate cortisol levels and boosts resilience. Particularly beneficial forms for individuals with autoimmune diseases include:

• Yoga

• Tai chi

• Swimming

• Outdoor walks
  Exercise intensity should be adapted to individual capabilities and disease progression.

Healthy Eating Habits
An anti-inflammatory diet rich in antioxidants, omega-3 fatty acids, and probiotics can mitigate the effects of chronic stress and reduce autoimmune activity. Limiting simple sugars, which can exacerbate inflammation and disrupt cortisol regulation, is advisable.

Sleep Hygiene
Sleep disturbances and elevated cortisol create a vicious cycle that can worsen autoimmune symptoms. Consistent sleep and wake times, avoiding blue light before bed, and creating a restful environment can significantly improve sleep quality and cortisol regulation.

Psychological Support and Psychotherapy
Cognitive Behavioral Therapy (CBT) helps identify and modify thought patterns that amplify stress responses. Acceptance and Commitment Therapy (ACT) teaches how to live fully despite chronic illness and its limitations.

Pharmacological Methods for Cortisol Regulation
In cases of significant HPA axis disruption, pharmacological intervention may be warranted, though it should only be undertaken under strict medical supervision. Options include:

• Plant-based adaptogens (e.g., Rhodiola rosea, ashwagandha) – herbs that modulate the body’s stress response

• Melatonin – regulates circadian rhythm and indirectly affects cortisol secretion

• Antidepressants – in justified cases, some SSRIs can normalize HPA axis function

• Magnesium and B-vitamin supplements – support nervous system health

Summary

The connection between cortisol and autoimmune diseases is a fascinating area of research that sheds new light on the pathogenesis of these conditions. While chronic stress and cortisol dysregulation are not the sole causes of autoimmune diseases, they can significantly influence their development and progression.

A holistic treatment approach—incorporating pharmacotherapy, stress management techniques, nutrition, and physical activity—offers the best outcomes for symptom control and improved quality of life.

Individuals with autoimmune diseases should remember that while we can’t always eliminate stressors from our environment, we can learn to manage our stress responses effectively. This skill can become a powerful tool in combating illness.

Bibliography and Additional Sources

• Straub RH, Cutolo M. Psychoneuroimmunology of the rheumatic diseases. Arthritis Rheum. 2018;70(1):6-15.

• Chrousos GP. Stress and disorders of the stress system. Nat Rev Endocrinol. 2019;15(7):374-390.

• Stojanovich L, Marisavljevich D. Stress as a trigger of autoimmune disease. Autoimmun Rev. 2017;16(12):1219-1226.

• Elenkov IJ, Chrousos GP. Stress hormones, Th1/Th2 patterns, pro/anti-inflammatory cytokines and susceptibility to disease. Trends Endocrinol Metab. 2015;10(9):359-368.

• Selye H. The stress of life. New York, NY: McGraw-Hill; 1956.