Emotional Immunity Linked to Chronic Disease

Below is the full podcast episode which I encourage you to listen to in my human voice and a modified transcript of the episode.

Background

There is a major mechanism contributing to chronic disease that we constantly ignore or overlook. It’s a root cause of the so-called “surprise diseases” that hit my patients and people I know, even though they thought they were doing everything right. For example a diagnosis of cancer despite no family history or identifiable risks, a heart attack or plaque found on a heart scan at a relatively early age, or perhaps an autoimmune disease…again with no family history or warning signs. In this episode, I’m going to educate you and hopefully persuade you to really take seriously the link between your thoughts and your body. Since this is the first real content episode for Season 2, what I call the Season of Inner Change, it sets a strong foundation for future episodes

A Case Study

Let me introduce you to a quick case study using a pseudonym and changing a few details around, but this represents so many women and men I’m coming across in my clinic and during talks and programs. 

Sheila is a 45-year-old manager at a tech company and mother of two young children. She’s extremely bright and a high performer at work with a large team that reports to her. She is a highly motivated mother of 2 young children, so the minute she punches out of work, she along with her working husband are managing the hectic lives of their kids, and the numerous extracurricular activities, sports commitments, and also the emotional and social needs of one of the children who has mild Autism Spectrum Disorder. Let’s add on top of that her aging parents, where her father has developed early dementia with increased caretaking needs.

Sheila is also an ardent exerciser who makes time to train for 3-4 endurance events a year, while also being extraordinarily disciplined with her diet…practicing intermittent fasting combined with low carb to keto. Over a course of 2 years, Sheila developed Hashimoto’s thyroiditis, an increasingly common autoimmune condition that results in an underactive thyroid, her glucose has crept into the prediabetes range, and by the time she saw me she was recently diagnosed with breast cancer. Sheila has no family history of diabetes, autoimmune disease, or breast cancer, so all of these diagnoses over a short span of time have been what I previously referred to as “surprise diagnoses.” 

The breast cancer diagnosis in particular was the biggest shock given how she not only sees a primary care doctor, but also a functional medicine doctor and has had routine blood tests and extensive lab panels including checking over 50 different biomarkers that that have assessed her gut, her genes, her immune system, and her heart health. She was told by both doctors that she was in excellent health.

I’m not being critical of either of these doctors since they used whatever tools they had at their disposal to help Sheila, but what I do want to share with you in this episode is a common pattern of risk that keeps showing up in my patients, who appear to check off all the right boxes for optimal health and lifestyle habits, but get hit by one or more surprise diagnoses.

I want to emphasize that there’s no health care provider, or special blood test panel that can identify the type of risk we are about to discuss, especially in the early stages.

You are the only one who can detect these patterns and with practice you’ll pick up on them really early. 

Emotional Immunity (EI)

There is a 2 letter acronym that I can’t currently seem to escape no matter where I turn, whether it’s the news or conversations with friends or discussions or meetings at work, and those are the letters A and I for Artificial Intelligence. For this topic I’m going to use a different acronym, which is EI, but this is not Emotional Intelligence, but instead refers to Emotional Immunity. So let’s take a break from AI and focus on EI, since I think this is a simple way for us to understand how thoughts and emotions can drive disease. 

To understand emotional immunity, let’s first break down the immune system using a metaphor. Visualize your immune system as a highly trained security team tasked with protecting a vast and complex piece of property known as your body. Your immune cells—like white blood cells—are the guards, constantly patrolling for invaders, scanning for viruses, bacteria, toxins and even rogue cells that could become cancerous. They use sophisticated communication networks, including chemical messengers like cytokines, to coordinate their defense.

Now, emotions play a crucial role in how this security team functions. Imagine chronic low level emotional stress as a cyberattack on this property.

When stress hormones like cortisol and adrenaline surge repeatedly due to behavioral patterns like emotional suppression, the system meant to protect your body breaks down. 

By the way, I’m not overlooking the other more overt emotions and behaviors like anger, aggression, and excessive Type A egocentric hypercompetitiveness, but at least in my practice emotional suppression is the easily overlooked risk profile which is strongly associated with autoimmune disease (especially in women) and also cancer and cardiovascular disease. So let’s summarize a few of the events happening in the immune system due to persistent emotional suppression and chronic stress at large. 

Event 1: Overactive Security Team Response

If the guards become overly reactive, they start attacking friendly citizens—your own cells—leading to a higher risk of autoimmune conditions. There are no studies proving causation, but lots of associative and mechanistic studies to support this connection. For example, you’ll find multiple studies showing how chronic stress, emotional suppression, and conditions like anxiety and depression increase the levels of pro-inflammatory cytokines like IL-6 and TNF-alpha, which contribute to autoimmune disorders. Again, the cytokines are the chemical messengers that immune cells use to heighten the security response.

Apart from autoimmune disorders, emotional suppression can trigger a slow burning fire of inflammation in the body that’s linked to other common conditions like heart disease, diabetes, and neurodegenerative disorders which don’t fall directly in the bucket of autoimmune disease, but the immune system plays a central role in the development of these conditions also.

Event 2: Underactive Security Team Response

If the guards become exhausted or distracted, they fail to detect and eliminate threats, like infections and circulating cancer cells which need to be cleared daily to reduce our risk of cancer. We call this function immune surveillance and there is a specific highly trained security team of assassins called natural killer or NK cells who are in charge of this immune surveillance, especially the removal of cancer cells, and studies show that emotional suppression, chronic stress, and conditions like depression lower NK cell activity. 

Event 3: Weakened Walls (aka Gut-Brain-Immune Axis)

Just like we have our NK cells as part of our immune surveillance squad, our Gut is a physical wall that keeps out invaders and highly flammable substances like LPS or Lipopolysaccharide, which is an endotoxin that can sneak into the bloodstream under conditions of chronic stress and emotional suppression, leading to increased systemic inflammation and immune dysregulation.

These changes can alter the profile of our gut bacteria, making it more pro-inflammatory and less protective, and potentially leading to or contributing to a host of digestive conditions like IBS, IBD, SIBO, and leaky gut which is more technically referred to as intestinal hyperpermeability. Endotoxins like LPS can also infiltrate our brain via the blood brain barrier, causing neuroinflammation which may be a contributing factor to neurodegenerative disease….thus the term Gut-Brain-Immune Axis. 

Just to summarize, Emotional suppression is an echo chamber where your bottled up emotions resonate and vibrate internally and transmit these potent signals to your immune system which might either hyperespond in certain areas, contributing to autoimmunity and chronic inflammation, and/or weaken in others, like the compromised NK cell assasins that protect us against cancer. Like the compromised gut wall barrier, where invaders can now enter the blood and invade the brain and other key organs.

The abundance of research connecting our emotions and the immune system is so strong that there is a special field of research called psychoneuroimmunology. 

Emotional Suppression vs Rumination

Let’s imagine your thoughts and emotions as movies playing inside your head…what I refer to in lectures as Headflix…and you have a remote control in your hand. 

Rumination is repeatedly hitting rewind and then replaying a distressing scene in your mental movie.

You keep obsessively focusing on the negative emotions and thoughts, analyzing them over and over, but not finding a solution or resolution. You’re stuck on replay, unable to move forward. For example, let’s say I have a conflict with my Doug, a hypothetical manager at work. When I wake up at 3am, I rewind to the Doug episode in my Headflix and push play. I do the same thing when I get up in the morning and brush my teeth, on my drive to work, and maybe multiple times throughout the day and night. I might have more than 1 episode I like to ruminate on, like maybe something about my body or health…let me rewind to the “I hate my body” episode and hit play over and over. 

Suppression is like hitting the skip scene button so you  fast forward past uncomfortable Headflix content. 

I’ll avoid or deny the conflict I’m having with my manager Doug or a family member, so I’ll keep hitting fast-forward so I don’t have to deal with those uncomfortable sensations and emotions. You’re essentially pretending those scenes don’t exist., but the content has just been buried deep and continues playing in the background. 

Persistent and habitual rumination is a major precursor to anxiety and depression, so it’s a risk just like emotional suppression.

I call rumination pre-anxiety or pre-depression….similar to how prediabetes is a precursor to diabetes. I did a podcast episode on rumination in Season 1, Episode 4 here and also wrote up a very popular blog post here on rumination where you can learn more. 

Know that both patterns often co-exist and have similar and cumulative impact on our immune system which is connected to all other body systems….and of course the impact on our mental health. Rumination is hitting the replay button over and over and even turning up the sound and zooming into scenes to make it even more dramatic and possibly traumatic than the original event.

Suppression is reflexively hitting fast forward to skip scenes, but the scenes don’t disappear. Instead they get magnified internally and send even stronger signals to your immune system. Remember you can fool the outside world with your calm, pleasant demeanor, but you cannot fool your body. 

Diagnostic Dilemma

I gave you a very simplistic overview of the impact of emotions on the immune system, which alone is an incredibly complex system. Immunology was a tough topic in medical school. I also mentioned how emotions impact virtually every other major system in the body and then these biological systems interact with each other.

Now let me ask you a question. Do you think there’s a simple blood test or imaging test we can do that would uncover the chronic immune system dysfunction that led to Sheila’s breast cancer or let’s say Susan’s autoimmune disease or Vinay’s heart attack at age 42 despite fairly normal standard labs? A C-reactive protein or highly sensitive C-reactive protein test is NOT sufficient.

At this time we do not have any blood panels or tests available to diagnose emotionally driven cancer, autoimmune disease, cardiovascular disease, neurological disease, etc.

You can pay extra money to get your genes checked, your gut bacteria checked, or do one of these commercially available blood panels that test 100+ different biomarkers, but the intricate processes and communications that are taking place at the cellular level (activity of T-cells, B-cells, cytokines, etc.) at this time cannot be measured. 

Think of chronic inflammation or any immune system dysfunction that contributes to chronic disease as undetectable flickering flames which only become detectable once these flames spread and manifest as a visible cancerous or precancerous tumor, an autoimmune condition, or a plaque in the coronary arteries that presents as heart disease, or shows up as plaque on a screening coronary artery calcium scan. These are the family of so-called surprise diseases that manifested much earlier, due not just to diet and exercise where all the emphasis tends to be, but also from chronic thought patterns and their resulting emotions.

Now if a test like the hsCRP comes back elevated, then that is a potential signal, but I wouldn’t be falsely reassured if that test and all the others come back normal. Surprise diseases happen because we neglect how persistently emotions activate our immune system, and how these complex and continuous processes cannot be detected with our relatively simplistic diagnostic tests that barely scratch the surface of the EI or Emotional Immunity network. 

What Next?

You might be eager for some key tips and practical strategies to address these smoldering flames of inflammation. I’ll cover these in more detail in future episodes and they won’t be unfamiliar to most of you…breathing, meditation, journaling, etc. Many of you have been exposed to these practices and have a ton of apps loaded on your phone, but are resistant to doing these things. Why is that? Maybe you’re not thoroughly convinced that invisible thoughts inside your head can directly cause disease. Food and exercise are much more tangible and palpable than thoughts and emotions.  

The purpose of this episode is for you to understand that there is a definitive interplay between your thoughts, emotions, and the immune system, that is a major driving factor for common and uncommon diseases that can occur even if your annual physical exam, standard labs and even extensive consumer lab panels with a 100 different biomarkers and genetic tests are all normal. Even if my patients are intermittent fasting and exercising regularly and doing a little breathing and meditation here and there.. I’m still haunted by so many cases in my clinic, among friends, family, neighbors, and coworkers who present with silent disease despite checking off many of the usual lifestyle strategy boxes. 

It’s much easier to eat less, fast longer, and train harder, than to spend a little time each day in silence observing your thoughts and emotions, and releasing them so they don’t continue to fuel your immune system.

It’s easier to just work more hours, micromanage your kids and your daily life, or spend countless hours on screens consuming mostly nonsense. I’m not judging you..I’m judging us, because I’ve done all those things and recognize that those modern day activities are numbing agents to some of our past and present stressors and trauma. 

As a doctor, it’s easy for me to justify seeing more patients or recording more podcast episodes or Instagram reels as a service to others, but I also know that these activities can be forms of what I call “noble distractions,” where I’m not watching cat videos on Youtube but I’m still avoiding confronting some deeper personal truths and inner and outer conflicts. 

Maybe you’re an entrepreneur or work for a company with a noble mission, which is an easy way to log in countless hours of noble distraction to cover up the pain of your childhood, your prior marriage, the death of a loved one, or some difficult relationship you haven’t fully processed. 

Look at some of those painful past or current experiences right now for just a moment and see how the sensations and feelings in your body shift, maybe subtly, maybe more significantly. Even the most subtle palpable shift is magnified inside of you several fold, and transmitted to your immune system and other bodily systems. Being more in tune with these subtle shifts means you can recognize and break the patterns much earlier. These subtle shifts can’t be picked up by any blood or imaging tests, so you are the only one that can train yourself to be more self aware, and not habitually numb yourself with distractions, including noble ones. 

Key Questions to Identify if You’re At Risk

Sheila’s  personality profile is that she is a selfless mother and team player at work who always puts others’ needs above her own. She rarely says “NO” to family members, coworkers, friends or neighbors and as a result, all these people habitually reach out to her for some form of help or support. Between the pressures of home, work, her community, and society at large, how much time do you think Sheila sets aside for complete rest and introspection? Sheila actually has some deep traumas from childhood, her marriage isn’t ideal, but instead of trying to address these factors, she numbs herself with the noble distractions of work, motherhood, and the incessant pursuit of fitness. Does this resonate with you? It definitely resonates with me.

I’ve numbed myself over the years with some combination of work, parenting, fitness obsession, or other pursuits which feel productive and worthy, but are often just masquerading something deeper inside.

Even meditation has been commercialized to some degree where you might be chanting mantras or doing a specific breathing protocol on the surface, without looking deeper inside to address the real triggers that are fueling your immune system. 

Modern day Western meditation, mindfulness, and yoga have mostly been manipulated to become practices that make you more energetic and productive so you can make more money or build a better body, but not necessarily more introspective and reflective. I’m not diminishing the value of these practices, especially if they are truly done in the way they were originally designed, but do understand that they can be more subtle numbing agents that still suppress the root triggers for immune system overactivation. 

If you can learn these practices and combine them with true introspection and reflection, something we will address in more detail in future episodes, you will become much more self aware. I’ll explain in future episodes how meaningful introspection and reflection is very different from emotional suppression and rumination. For now, I’d like you to recognize how some of your daily routine habits are numbing agents, and these include your laundry list of noble distractions. Ask yourself the following questions to see if you might be at risk:

1. Have you been called selfless by others?
2. Do you have trouble saying no and drawing boundaries?
3. Do people constantly rely and depend on you? Do you maybe rely and depend on others depending on you since they provide a welcome distraction from your own pain and suffering. If so, this is actually co-dependence.
4. Are you averse to conflict and more prone to peacekeeping and people-pleasing?
5. Do people perceive you as being persistently pleasant, nice, and/or “in control?” Excessive nicety and pleasantness can be masks that hide emotional suppression
6. Are you obsessive about some combination of work, fitness, parenting, or even a hobby you might take a bit too seriously?
7. Is sitting in silence challenging or even unbearable, with a strong urge to get on a screen or just do something around the house? If so, ask yourself what you are hiding from or what it is about you that you can’t stand to be with in silence
8. If someone were to ask you, like a healthcare provider….if stress was an issue…would you answer “no” or claim it was “mild” or “under control” despite you juggling countless responsibilities? This is a common characteristic where high levels of stress just start to feel normal like putting your hand on something really hot until your hand becomes numb to the point that you can’t even feel that the flesh on your hand is burning.

The above answers might indicate signs of emotional suppression leading to an overactivation of EI, again Emotional Immunity, which causes immune system dysfunction, making you prone to chronic disease that is often undetectable until that low level simmering inflammation burns into a full blown fiery disease. This episode is the first step in making you aware of the mechanism of EI and hopefully will motivate you to keep asking yourself the important questions and identifying your habitual triggers, so you can make the necessary changes to prevent surprise disease and live a more balanced and meaningful life. 

Also please recognize that this key shift in the way you approach life will be an important model for your own children to follow.

Our kids are going to continue to spend more time on screens and less time in nature with live humans…I see that trend only getting worse with the emergence of AI…this is a recipe for more emotional distress, envy, suppression, etc.

Many of us are the children of parents who had addictions to work, to status and achievement, to substances and other behaviors. Our kids now have instant access in their pockets to gaming, gambling, porn, envy-generating social media, and unlimited entertainment. They will continue to shift away from self and towards these activities, and the endless noble distractions we impose upon them in the form of academic, athletic, and professional achievements. We have the ability to break that intergenerational pattern so future generations suffer less. We need to teach them and model behaviors they may not pick up right away, but might pick up later.

My father forced me to listen to his readings of the Bhagavad Gita every Thursday morning and spent thousands of hours sharing spiritual teachings with me as a child and teenager, encouraging me to spend time meditating. I resisted and rebelled against all of that and now only in my 40s and 50s am I reading and rereading almost every book he handed down to me and my brother, going over his underlines and highlights. 

Our kids need us more than ever…not just to provide a roof over their head, food on the table, to shuttle them to school and their countless activities….not as academic and professional counselors trying to shove them into what we think is the right college or job, but instead to teach them to approach life in a way that allows them to feel less pressure and more freedom so they aren’t stuck…constantly hitting that replay or fast forward button.