Commusings: When Your Body Attacks Itself by Dr. Sara Gottfried

Dear Commune Community,

We know that trauma can lead to depression, PTSD and other mental disorders.

Trauma also manifests in the body — often furtively. We can’t always put the thumb of a diagnosis on it. We’re mysteriously ill. We have gastrointestinal issues, chronic headaches, joint pain, profound fatigue … but the provenance of these symptoms are not obvious. Some autoimmune diseases like MS or rheumatoid arthritis are easier to identify and label. But autoimmunity is very bio-individual and can manifest in ways that escape modern medical classification.

In her new book, The Autoimmune Cure, my dear friend, Dr. Sara Szal Gottfried, untangles the effects of trauma and its relationship to the psycho-immune-neuroendocrine systems (PINE). I am thrilled to feature the opening of the book in today’s Commusing.

Sara provides actionable methods and praxes to regulate our stress response and unwind negative emotional patterns that lead to discomfort and disease – including diet, holotropic breathwork and psychedelic-assisted therapy.

Got questions? Hit me at [email protected] and follow me on the IG @jeffkrasno.

In love, include me,
Jeff

• • •

When Your Body Attacks Itself

Excerpted from Dr. Sara Szal Gottfried's new book, The Autoimmune Cure

Radha, whose name is Sanskrit for “devotion,” is a forty-seven-year-old nutritionist and mother of two. She had suffered for years with chronic illness: irritable bowel syndrome (IBS), chronic fatigue syndrome, and fibromyalgia, which involves widespread muscle pain and discomfort, accompanied by fatigue, sleep disruptions, and poor memory and mood.

Years before, she’d had a hysterectomy and partial ovary removal to alleviate chronic pelvic pain from endometriosis, fibroids, and adenomyosis. After these surgeries, she was struggling with perimenopausal symptoms, metabolic syndrome (including prediabetes and abnormal lipids), fatty liver, high levels of inflammation and was overweight.

When Radha came to see me, she was desperate for help and answers. She was frustrated that she’d suffered for so long without any true relief. Not only did she still have uncomfortable symptoms of fatigue and pain, but she didn’t have any answers as to why she struggled with these chronic illnesses.

Any previous treatment she had didn’t fix the underlying issue—or it led to other, new health problems. It was like a crazy-making game of medical Whac-A-Mole with no hope in sight.

She was tired of it.

As I reviewed Radha’s chart and history, something jumped out at me—a pattern began to emerge. As a personalized medicine doctor, I take a deep dive into my patients’ story, and there was something interesting that I’d noticed about my patients who struggled with potential autoimmune issues, like Radha. In her case, the potential autoimmune conditions were IBS and fibromyalgia.

What is autoimmunity?
It’s when your body’s immune system—a protective system that’s designed to attack invaders to keep you healthy—attacks normal, healthy tissues in the body. In other words, your body attacks itself.

The more I worked with patients who had autoimmune issues—and battled my own—the more clearly I could see a powerful, underlying connection: trauma was often a potential trigger for autoimmune conditions.

If I went back far enough in the patient’s history, more often than not I would find some form of trauma.

This hunch of mine bears out in the statistics and research. For instance, trauma has a known association with a greater risk of fibromyalgia. More than 71 percent of people with fibromyalgia meet criteria for post-traumatic stress disorder (PTSD).¹

Approximately 84 percent of fibromyalgia patients suffered one or more traumatic events prior to the onset of pain. They report traumatic events throughout their lives, including childhood and adolescence, such as emotional abuse and neglect, sexual abuse, and physical abuse. While fibromyalgia is not a classic autoimmune disease, it is nevertheless a case of the body attacking itself.

Radha had left an abusive marriage a decade prior to our first session. Interestingly, Radha’s chronic conditions—the IBS, chronic fatigue, and fibromyalgia—had almost disappeared after her divorce and thanks in part to the daily spiritual practices she developed afterward: mantra, chanting, sound healing, humming, toning, restorative yoga, moving meditation with walking her labyrinth, and affirmative art.

When I began working with Radha, even though she had resolved some of the ways that her body attacked her own tissues, she still had metabolic, immune, and hormonal drift in the wrong direction. Our goal was to address the stress-related dysregulation in her physiology and cool her inflammation so that her body was less likely to develop autoimmunity. At five foot four inches and 163 pounds, she had a body mass index of 28, with significant visceral fat in her abdomen perhaps serving as a protective shield from her trauma, though also driving more inflammation.

Fast-forward three years later.

Her weight is healthy at 127 pounds with a BMI of 22, her fatty liver and prediabetes are gone, and her inflammation is vastly improved, as are her lipids. She is mostly free of pain, and there is no sign of self-attack of her tissues, even after the tragic death of her beloved father one year ago.

Radha is now much happier in her life and work. She has more energy to keep up with her teenaged daughters and is often mistaken for a sister rather than a mother. She looks ten years younger than when I first met her.

I will let her describe her experience in her own words:

“Toxic stress from past experiences became biologically embedded in my anatomy and physiology, where I was swimming in a soup of inflammation and dysregulation. This altered my ability to respond to and rebound from stressors in a healthy way. Most days I am pain-free. If I allow stress to dysregulate and derail my thoughts and choices, my fibromyalgia and fatigue will peek through the curtains as though to say, are you welcoming us back? And occasionally I surrender to the symptoms because the stressor is overwhelming, like my father’s recent passing. But most days I say no and redirect my thoughts and choices moving back to pain-free, energetic existence.”

Inside the body, trauma can behave like a home intruder, trespassing into your body’s own physiology to wreak havoc and rob you of energy, protection, and agency. Depending on your vulnerabilities, trauma exposure may show up as heart disease, high blood sugar, depression, or another condition, like autoimmunity.

While you may think you’re fine – that the trauma or toxic stress you’ve experienced isn’t a big deal – the body may not agree.

Time and again, I see people who disregard their trauma, yet their body tells a different story, one of physiological dysregulation that may persist and even cause disease until the underlying forces are addressed. It was true for Radha, and it was true for me.

Broadening the Definition of Trauma
Because trauma can have such insidious, pervasive, and corrosive effects on the body, mind, and spirit, it’s essential that we learn to detect it. That can be easier said than done, both because many of us are culturally taught to ignore or deny our experiences and because trauma can show up in many ways, some obvious and some not so obvious.

You can think of trauma that persists as an unresolved stress response.

I learned a lot about the stress response in my medical training and career. The classic process is that when you’re exposed to stress, your body releases adrenaline and cortisol, and then you either take care of business (fight-or-flight, i.e., mobilization toward protection or escape), or you get stuck (freeze, fright, fawn, faint, i.e., incomplete mobilization), meaning you may keep experiencing the original stressor over and over, as if the trauma were still occurring in real time.

Some experts consider stuck, or unresolved, trauma to be a chronic freeze state. Physician and bestselling author Gabor Maté describes trauma as a restriction or constriction in the body and the mental capacity of a person to respond in the present moment from the authentic self.

When you get stuck, it can lead to downstream consequences like psychological overwhelm and helplessness, immune problems, neurological difficulties, and hormonal imbalances from the excess adrenaline and cortisol. The immune problems are especially of concern because they may lead to autoimmune conditions, where the body attacks its normal tissues.

I did not learn enough about trauma and unresolved stress responses in my medical training, nor in my twenty-five years of practicing medicine. Yet, as I embarked on my own healing journey and started to ask my patients routinely about trauma, I was surprised to discover how many people were on that stuck path.

I, too, was stuck.

It’s taken me a few decades to realize that the reason I have struggled so much with toxic stress and cortisol is because I was addicted to my body’s own stress hormones, trapped in a self-perpetuating loop, in near-constant flight mode, sometimes freeze or fawn, almost never fight.

I developed addictive patterns with behaviors that release dopamine, like overworking and overfunctioning in relationships. I craved high-pressure situations and felt bored if there wasn’t a lot of tension at the workplace or home. I had a chronic pattern of high conflict in my relationships. I had trouble relaxing and sitting still—I was always on the go. I constantly overscheduled myself.

All this, combined with porous boundaries, led to near perpetual cycles of saying yes, then feeling depleted. Until, that is, I started to see the cycle, get help, and change it. It was only in the last few years that I realized this was no way to live.

It’s not normal to thrive or succeed in chaos, to stay so busy most of the time, to have trust issues, to feel guilty about resting, or to be so self-reliant that I don’t ask for help even when I am completely beyond my capacity.

It’s exhausting and accelerates aging. It robs you not just of healthspan but also joyspan. But to change what was a subconscious, autonomic process, I had to see and then consciously address it.

I had to stop the flight. And that required naming it: trauma

Autoimmunity May Be the Ultimate Expression of Trauma
Trauma triggers dysregulation in the body in some but not all people. While it’s true that not all people with autoimmunity have a history of trauma, most do. Autoimmunity is the root cause of one hundred chronic illnesses experienced by men and women alike, and women suffer at higher rates.

The big idea of my new book—the pattern that I kept seeing in my patients and myself—is that trauma is so often a trigger for autoimmune disease.

When we look at cases of autoimmune disease with root cause analysis, we consistently find a perfect storm of three factors: genetic susceptibility, increased intestinal permeability (a condition in which a person’s gut allows more water and nutrients through the cells, i.e., they leak), and a trigger.

The trigger can be and often is trauma. For trauma to trigger, it does not have to be cataclysmic “big T” trauma; it can be just as easily subtle, quiet, minor, or insidious “little t” trauma.

Once I connected trauma and autoimmune disease in my own healing journey, and began to see staggering results with my patients, I knew I needed to share my work with readers everywhere who are frustrated and suffering. This includes suggestion on eating, sleeping, therapy, supplement, and alternative (think MDMA or low-dose naltrexone, maybe even orgasmic meditation) protocols for people who want to reset their immune systems and heal autoimmune disorders that come about from a variety of triggers, with a focus on trauma.

While I’ve figured out a lot that is right for my health and for the health of others over my career, I’m an eternal student with plenty to learn in terms of being more present and creating healing and wholeness. This journey – described in and motivated by this book – has intertwined learning and healing.

As each aspect of myself and my trauma came into the light, I would learn how to release my imperfections, which in turn would teach me to become more present in my wholeness. The act of writing this book is a part of this learning-healing cycle, and I offer it as an invitation to learn together so that we can heal together. 

Sara Gottfried, MD, is a Harvard-educated physician-scientist and a clinical assistant professor in the Department of Integrative Medicine and Nutritional Sciences at Sidney Kimmel Medical College, Thomas Jefferson University, where she serves as the Director of Precision Medicine at the Marcus Institute of Integrative Health.

Her clinical focus is performance-based and personalized care of executives and professional athletes. She is the New York Times best-selling author of four previous books about the interface of mental, physical, and spiritual health, including Women, Food, and Hormones and The Hormone Cure.

1. I. Gardoki-Souto et al., “Prevalence and Characterization of Psychological Trauma in Patients with Fibromyalgia: A Cross-Sectional Study,” Pain Research and Management (2022).

From The Autoimmune Cure by Sara Szal Gottfried, MD. Copyright © 2024 by Sara Szal Gottfried. Reprinted by permission of Harvest, an imprint of HarperCollins Publishers. All rights reserved.