Rethinking Autoimmune Disease
Stress Biology, Immune Regulation, and the Role of Lifestyle Medicine
Autoimmune disease is commonly framed as immune dysfunction — a body that has somehow lost the ability to distinguish self from non-self. While this description is not biologically incorrect, it is incomplete. Increasingly, research across psychoneuroimmunology, endocrinology, and lifestyle medicine suggests a more nuanced understanding: autoimmune disease reflects dysregulation across interconnected systems, not an isolated immune failure.
This distinction matters. How we conceptualise illness shapes clinical practice, patient experience, and long-term outcomes.
Immune function is inseparable from nervous system state
The immune system does not operate independently. It is tightly regulated by the autonomic nervous system, the hypothalamic–pituitary–adrenal (HPA) axis, circadian rhythms, and metabolic signalling. These systems continuously assess environmental and internal cues to determine whether the body is safe, threatened, or depleted.
Under conditions of chronic stress, this regulatory balance shifts.
Prolonged activation of stress pathways alters cortisol signalling, increases sympathetic nervous system dominance, disrupts sleep architecture, and promotes low-grade systemic inflammation. Over time, these changes influence immune tolerance, inflammatory thresholds, and tissue repair mechanisms.
Large-scale population studies have demonstrated associations between stress-related disorders and subsequent autoimmune disease, as well as significantly higher prevalence of affective disorders among individuals with autoimmune conditions. These findings support a bidirectional relationship between immune dysregulation and nervous system load, rather than a unidirectional “immune malfunction.”
This does not imply causation in a simplistic sense. Rather, it highlights shared biological pathways — including inflammation, autonomic imbalance, and disrupted recovery — that increase vulnerability over time.
Autoimmunity as adaptation, not attack
From a systems perspective, many autoimmune processes can be understood as adaptive responses that have become maladaptive.
Inflammation, immune activation, and heightened vigilance are protective in the short term. They mobilise energy, defend against perceived threat, and promote survival. However, when the body remains in a prolonged state of threat detection — whether due to psychological stress, physical illness, social adversity, or cumulative life strain — these same mechanisms can begin to cause tissue damage and persistent symptoms.
This framing challenges the language of the body “turning against itself.” Instead, it suggests a body that has been responding appropriately to sustained pressure, but without sufficient opportunity to return to baseline.
For patients, this reframing can be profoundly important. It replaces blame with context and opens the door to therapeutic strategies aimed at regulation rather than suppression alone.
The relevance of lifestyle medicine in autoimmune care
Lifestyle medicine is sometimes misunderstood as behavioural advice layered on top of disease management. In reality, it addresses the biological terrain in which immune processes occur.
Each pillar influences immune regulation through established mechanisms:
Sleep: Sleep deprivation is associated with increased pro-inflammatory cytokines, impaired glucose metabolism, altered pain perception, and reduced immune resilience. Sleep is not passive rest; it is an active period of immune recalibration.
Nutrition (food-first approach): Dietary patterns rich in fibre, phytonutrients, and healthy fats are associated with reduced inflammatory markers and improved gut-immune signalling. This is not about restriction or perfection, but about adequacy, consistency, and nourishment.
Physical activity: Appropriately dosed movement improves mitochondrial function, reduces inflammatory burden, and supports immune modulation. Both over-exertion and prolonged inactivity can worsen symptoms, highlighting the importance of individualised pacing.
Stress management: Chronic stress alters autonomic balance and HPA axis function. Regulation strategies work at a physiological level, not simply through cognitive reframing.
Social connection and meaning: Social isolation and lack of purpose are associated with increased morbidity and mortality. Immune health is influenced by relational and environmental context, not solely by individual behaviour.
From a lifestyle medicine perspective, these factors are not “optional extras.” They are integral to immune stability.
Behaviour change, capacity, and health equity
A critical consideration in autoimmune care is not what changes are recommended, but how they are supported.
People living with autoimmune disease often experience fatigue, pain, cognitive impairment, financial strain, and social isolation. When lifestyle guidance is delivered without attention to capacity, resources, or context, it risks increasing shame and disengagement.
Evidence from behavioural science consistently shows that small, supported, person-centred changes are more sustainable than large, unsupervised overhauls. Models such as health coaching, group consultations, shared decision-making, and social prescribing align well with the needs of people managing chronic illness.
Importantly, this approach acknowledges health inequalities and avoids framing lifestyle factors as moral choices. Instead, it positions them as modifiable influences shaped by environment, access, and support.
Lived experience as clinical insight
My own experience of autoimmune disease has reinforced what the science increasingly reflects: the body speaks long before it collapses.
In retrospect, my diagnosis was preceded by years of heightened stress, poor recovery, emotional suppression, and nervous system overactivation. Medication was essential and stabilising. But long-term recovery required addressing the conditions that shaped my immune response in the first place.
This is not a rejection of medical care. It is an argument for integration.
Lived experience adds depth to clinical understanding, particularly in conditions where symptoms fluctuate, outcomes are unpredictable, and recovery is non-linear.
Moving toward a more integrated model
Autoimmune disease cannot be reduced to immune malfunction alone. It reflects the interaction between biology, behaviour, environment, and lived experience over time.
Lifestyle medicine does not offer a cure. What it offers is a framework for reducing physiological load, restoring regulatory capacity, and supporting long-term resilience.
For clinicians, this perspective encourages curiosity rather than blame.
For patients, it offers context rather than condemnation.
And for both, it provides a more humane and biologically coherent story to work from.
How I Work
My work sits at the intersection of lifestyle medicine, nervous system education, and lived experience of autoimmune disease. I support people to understand how stress physiology, sleep, nourishment, movement, and recovery interact with immune health — and how to work with these systems in realistic, compassionate ways.
Rather than pursuing quick fixes or rigid protocols, I focus on person-centred support that builds capacity over time. This often includes education, guided self-inquiry, and practical behaviour change strategies that respect individual circumstances, health inequalities, and the realities of chronic illness.
My aim is not to override symptoms, but to help people reduce physiological load, restore regulatory balance, and develop a more sustainable relationship with their health.
Research and Further Reading
The perspective outlined above is supported by a growing body of evidence across psychoneuroimmunology, epidemiology, and lifestyle medicine:
Stress-related disorders and autoimmune disease
A large Swedish population-based cohort study demonstrated an increased risk of autoimmune disease following stress-related disorders, supporting shared biological pathways between chronic stress and immune dysregulation.
Song, H. et al. (2018). JAMA.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6583688/Mental health and chronic inflammatory conditions
Analysis of over 1.5 million UK participants found significantly higher prevalence of affective disorders, including anxiety and depression, among individuals with autoimmune and inflammatory diseases, highlighting bidirectional relationships between immune and mental health.
Mudra Rakshasa-Loots, A. et al. (2025). BMJ Mental Health.
https://pmc.ncbi.nlm.nih.gov/articles/PMC12161381/Sleep deprivation and inflammation
Experimental and observational studies show that insufficient sleep is associated with elevated inflammatory markers such as IL-6 and CRP, impaired immune regulation, and increased pain sensitivity.
Ballesio, A. et al. (2025). Journal of Sleep Research.
https://onlinelibrary.wiley.com/doi/10.1111/jsr.70099Dietary patterns and inflammation
Systematic reviews indicate that whole-food dietary patterns rich in fibre, plant diversity, and healthy fats (e.g. Mediterranean-style diets) are associated with reductions in inflammatory biomarkers and improved immune signalling.
Koelman, L. et al. (2022). American Journal of Lifestyle Medicine.
https://www.sciencedirect.com/science/article/pii/S2161831322005312Exercise and immune modulation in autoimmune disease
Evidence suggests that appropriately dosed physical activity can reduce inflammatory burden, improve mitochondrial function, and support immune regulation in conditions such as rheumatoid arthritis, while over-exertion may exacerbate symptoms.
Li, Z. et al. (2023). Frontiers in Immunology.
https://www.frontiersin.org/articles/10.3389/fimmu.2022.1089621/full
Recent 2025 research highlights "neurogenic inflammation," where the nervous system releases neuropeptides that directly trigger immune cells. In my opinion, this confirms that treating the mind is literally treating the tissue. Mental calm isn't just a feeling; it's a biochemical necessity.