Why are laughing and happiness good for fighting Hashimoto’s?

…or for any other complex disease? A patient - scientist perspective

by Dr. Vedrana Högqvist Tabor

Laughing is good for virtually everything. It is an often ignored component of our everyday life. Sharing a laugh makes us happier and better human beings, and science has proven it does improve the overall health. But, is doing a standup comedy show, with a dose of pre-stage stress, beneficial for relieving me of Hashimoto’s symptoms?

Laughter and joy are the main building blocks of my day

One of my goals in life is to laugh and make others laugh. I try to live by it every day. Sometimes it means I will make my husband laugh, the other times it will be a broader audience: at work, dinner or any other social occasion.

With a good joke, there are fewer barriers to cross between the strangers. For me, something as intimate as sharing a moment of joy and happiness is an important milestone when bonding with a person. It allows me to explore the new territory, without asking too many questions, but rather to see the reaction, as well as to expose myself through a couple of jokes or anecdotes.

People that laugh are all so beautiful. They are genuine* and they can feel I am too, even if the story I share is an invented or pimped up version of the events I experienced. After all, I grew up on Monthy Python.

What my friends told me turned out to be true…

(my road to a stand-up gig)

My friends laugh at my jokes, and often tell me I’m funny. I believed them, because trusting people you love is easy. That was step one.

Step two was a pure accident: I bumped into a right venue, and after hearing a couple of performers, I decided to give it a try three weeks later.

On the night, standing in front of the unknown people did bring up questions: “Am I actually funny? As well as “Can I pull this off?

I gave dozens, if not hundreds of talks during my career, but a stand-up is different, it is quick, one needs to be funny and in the moment. There are no massive accomplishments to present, only a joke. I did give a lot of personal and emotional talks, connected to what I do, but I did not tell a funny (non-offensive) anecdote about my husband and family yet. This was an uncharted teritory for me. Making strangers laugh is a challenge, but the reward in a form of a laughter is awesome.

Laughing for health

I have a condition, Hashimoto’s, an autoimmune disorder in which my thyroid became underactive, my digestion became tough on me and I was forced to become a slightly different person: more meticulously tracking my health and habits (off so many beloved things, discovering and starting to love the new opportunities).

When chronic condition descends upon us, it is usually a predominant part of our day, whether tracking of what we did or how we feel, worrying or planning. So, sometimes it is good to relax, enjoy and produce a bit more of feel-good molecules.

What does science say?

Forty years ago Norman Cousins published an account of Adam Smith in the New England Journal of Medicine describing the potential medicinal benefits of laughter (1). Fifteen years ago science seemed to be a bit reluctant in accepting there are healthy aspects of the laughter therapy as the research was lacking sufficient evidence to validate such claims (2).

Today, laughter has been shown to be beneficial to some heart-related problems through opposing stress-induced constriction of blood vessels (causing high blood pressure; reviewed in (3)).

Laughter modifies activity of the immune system (reviewed in (3)).

Research has shown that laughing decreases stress-induced hormones adrenocorticotropic hormone (ACTH), cortisol as well as adrenaline and could possibly buffer the effects of stress on the immune system** (4).

More recent research on laughter and pain showed that more we laugh spontaneously, less pain we feel (well, up to a certain level), which is due to the endorphin action (5). Laughter, through endorphins, creates euphoric states in the person performing too (reviewed in (5)).

What about cortisol and thyroid function?

I have looked into two research studies to understand the connection. The first study, from 2012, reports on people not tested for anti-TPO or anti-Tg antibodies with elevated levels of TSH (over 2.0 uIU/L). The research shows positive correlation between TSH and cortisol(6).

The other study shows an increased cortisol levels in Hashimoto’s patients and researchers suggest it was because the damaged thyroid releases certain molecules (immunoreactive adrenocorticotropic hormone (ACTH)), which induces hyperproduction of cortisol (7). This theory indicates that releasing of cortisol is a consequence of the destroyed thyroid gland, acting to suppress the activity of the immune system. Cortisol protects our tissues from damage inflicted by an overactive inflammatory immune response.

Severe or chronic stress is known to triggering the onset or exacerbations of inflammatory/autoimmune diseases (reviewed in (8)). Serotonin, sometimes called the happiness hormone because it regulates mood and prevents depression, is connected to the hypothyroid state. In the hypothyroid state our body is less responsive to serotonin, but with the increased levels of active TSH → T4 → T3 cascade (when taking medication on time) serotonin activity is restored (9).

Laughing will most likelly not heal Hashimoto’s, but it may well make us feel less of the symptoms, and contribute to lowering down the stress, which in turn lowers down the immune reaction. Breaking the viscious circle with laughter is a good way to go.

The immunology of happiness and stress

Hormones regulate the function of our immune system in a very complex way, and I will here limit myself to review one aspect only.

Research has reported that conditions such as depression, thyroid disorders, as well as many other autoimmune diseases can occur together.

Hormones activate more than one type of immune cells, including T-helper cells (a type of T cell that help the activity of other immune cells). T-helper cells are further divided into Th1 (target intracellular bacteria and protozoa. Th1 overactivation causes Type 4 delayed-type hypersensitivity) and Th2 cells (target extracellular parasites Th2 overactivation will cause Type 1 seasonal allergy, asthma and hypersensitivity(reviewed in (10)).

The delicate balance between Th1 and Th2 is one of the determining factors of the behavior of our immune system. Hormones that are related to stress, such as noradrenaline (NA) and cortisol as well as their counterparts serotonin and melatonin are proven to impact and trigger the activity of our immune system. The balance between the two systems is paramount for a healthy immune system, defending us from the pathogens, but not overreacting towards our own organs or causing allergies such as seasonal hay fever (reviewed in (10)).

More developed Hashimoto’s, the one that predominantly all of us experience, is ruled by Th1 organ inflammation [Hashimoto’s starts as Th2-driven disease, which happens in the early stages of the disease, can be long before the diagnosis] (reviewed in (10)).

The inflammation, as a consequence of autoimmunity causes the damaged tissues to produce molecules called inflammatory cytokines (substances produced by certain cells of the immune system and having an effect on other cells, increasing inflammation). These molecules play a significant role in the development of depression. They reach our brain from the site of injury (e.g. from the thyroid gland in Hashimoto’s) through the blood vessels and when they reach the brain, it recognizes them as signs of illness. This in turn activates another complex network within our brain*** and causes changes in the way it processes signals and the uses the energy. This new brain behavior changes the function of other glands in our bodies and blocks the activity of certain molecules whose function is to protect us from all the ongoing inflammation (including changing the barrier of our intestines, changes in our bacterial flora, and triggering the massive intestinal immune response) (11, 12, 13).

There is emerging evidence that stress or other negative psychological attributes may have an effect on the disease course (11, 12, 13).

“Sickness behavior”

Our body and our immune system have co-evolved and adapted to provide us the best defense against many pathogens in our environment. As a result, the way our body fights any “enemy” results in many physiological changes, named sickness behavior.

Sickness behavior is a set of actions caused by infection and inflammation (a hallmark of autoimmune diseases). Most prominent sickness behaviors are: depression, changes in appetite, fatigue, sleepiness and lack of energy or enthusiasm. There are probably many more.

Sickness behavior’s main evolutionary purpose is to conserve the energy resources the body has and focus on fighting back the infection. Some researchers even go as far to speculate that depression is an evolutionary psychological byproduct of early mechanisms that geared energy spending on fighting infections, in order for us to survive (12).

Before we started with the modern day hygiene practice and the discovery and use of antibiotics, sickness behavior would be necessary for our survival, and the development of depression seems to be an acceptable byproduct of that process (12, 13), but today this is not necessarily the case.

Today we should have the ability to fight the autoimmunity-caused sick behaviors with a multitute of treatments, and some of them might be…well, doing a stand-up comedy show.

How do I feel afterwards?

I feel great, relieved and thankful to all of my friends that came to support me. I did not use any ways to quantify the immediate before and after, but I intend to continue doing stand-ups now and then, and see how they impact me through a long-term.

If your goals in life are similar to mine: laugh and make others laugh, I do recomend trying something like what I tried, it will not result in a flare-up, but maybe in a lift-up of your spirits and your health.

Notes

*The fake or forced laughter can be recognised easily, and I do not talk about that type of laughter in here.

**The problem of this study is a very small number of participants (n=10) and all of them were male

***The more correct term woud be central nervous system (and our brain is the biggest and the most complex component of it).

References

1 Cousins, N. Anatomy of an illness (as perceived by the patient). N Engl J Med295, 1458–1463, doi:10.1056/NEJM197612232952605 (1976).

2 Bennett, H. J. Humor in medicine. South Med J 96, 1257–1261, doi:10.1097/01.SMJ.0000066657.70073.14 (2003).

3 Hasan, H. & Hasan, T. F. Laugh yourself into a healthier person: a cross cultural analysis of the effects of varying levels of laughter on health. Int J Med Sci 6, 200–211 (2009).

4 Bennett, M. P. & Lengacher, C. Humor and Laughter May Influence Health: III. Laughter and Health Outcomes. Evid Based Complement Alternat Med 5, 37–40, doi:10.1093/ecam/nem041 (2008).

5 Dunbar, R. I. et al. Social laughter is correlated with an elevated pain threshold. Proc Biol Sci 279, 1161–1167, doi:10.1098/rspb.2011.1373 (2012).

6 Walter, K. N. et al. Elevated thyroid stimulating hormone is associated with elevated cortisol in healthy young men and women. Thyroid Res 5, 13, doi:10.1186/1756–6614–5–13 (2012).

7 Agha-Hosseini, F., Shirzad, N. & Moosavi, M. S. The association of elevated plasma cortisol and Hashimoto’s Thyroiditis, a neglected part of immune response. Acta Clin Belg 71, 81–85, doi:10.1080/17843286.2015.1116152 (2016).

8 Silverman, M. N. & Sternberg, E. M. Glucocorticoid regulation of inflammation and its functional correlates: from HPA axis to glucocorticoid receptor dysfunction. Ann N Y Acad Sci 1261, 55–63, doi:10.1111/j.1749–6632.2012.06633.x (2012).

9 Bauer, M., Heinz, A. & Whybrow, P. C. Thyroid hormones, serotonin and mood: of synergy and significance in the adult brain. Mol Psychiatry 7, 140–156, doi:10.1038/sj.mp.4000963 (2002).

10 Martino, M., Rocchi, G., Escelsior, A. & Fornaro, M. Immunomodulation Mechanism of Antidepressants: Interactions between Serotonin/Norepinephrine Balance and Th1/Th2 Balance. Curr Neuropharmacol 10, 97–123, doi:10.2174/157015912800604542 (2012).

11 Bonaz, B. L. & Bernstein, C. N. Brain-gut interactions in inflammatory bowel disease. Gastroenterology 144, 36–49, doi:10.1053/j.gastro.2012.10.003 (2013).

12 Madeeh Hashmi, A., Awais Aftab, M., Mazhar, N., Umair, M. & Butt, Z. The fiery landscape of depression: A review of the inflammatory hypothesis. Pak J Med Sci 29, 877–884 (2013).

13 Dantzer, R. Cytokine, sickness behavior, and depression. Neurol Clin 24, 441–460, doi:10.1016/j.ncl.2006.03.003 (2006).

Vedrana Högqvist Tabor