How to use Heart Rate Variability (HRV) to Manage Autoimmune Disease

Autoimmune diseases are on the rise and comprise most of the chronic disease that we face. Lupus, multiple sclerosis, rheumatoid arthritis, psoriasis, sjogren’s, celiac, type 1 diabetes, and vitiligo, are just some of the growing list (over 100) of autoimmune diseases. They are classically described as an immune system that’s gone “haywire” and the current solution is to suppress the immune system with steroids. That is a symptom based approach and will cause a whole host of other issues. Getting a grip on your immune system can help you manage autoimmune disease and put it at bay. Luckily, we now have a metric (HRV) that tracks your immune system and can be leveraged. 

HRV stands for heart rate variability, and it is the variation in time between your heartbeats. Instead of beating like a metronome, a healthy heart naturally fluctuates in rhythm. For example, if your heart rate is 60 beats per minute, it doesn’t beat exactly once per second, it speeds up and slows down slightly with each breath.

HRV is considered a key indicator of autonomic nervous system balance, reflecting how well your body can shift between "fight-or-flight" (sympathetic) and "rest-and-repair" (parasympathetic) states. Higher HRV generally signals greater resilience and adaptability, while lower HRV may suggest stress, fatigue, or inflammation.

Autoimmune conditions involve an overactive immune system that mistakenly attacks the body. Flare-ups are often triggered or worsened by chronic stress, poor sleep, and systemic inflammation.

Here’s where HRV comes in:

• Indicator of Stress Load: Low HRV often correlates with higher inflammatory markers and greater disease activity.
  
  

• Feedback Loop: Monitoring HRV gives you a real-time view of how lifestyle choices (sleep, diet, stress, exercise) affect your body.
  
  

• Nervous System Regulation: Since the vagus nerve helps regulate immune response, strengthening vagal tone (reflected in higher HRV) may reduce inflammatory signaling.
  
  

So how can we use HRV to modulate the immune system? 

1. Track Your HRV Daily
   Wearables like Oura Ring, WHOOP, Garmin, or Apple Watch can measure HRV. Look for patterns rather than single numbers, what raises or lowers your HRV?
   
   

2. Identify Triggers
   Logging HRV alongside symptoms, diet, sleep, and stress levels can reveal personal flare-up triggers. For example, you may notice that poor sleep or high-intensity workouts drop your HRV before a flare.
   
   

3. Support Nervous System Recovery
   Practices that stimulate the parasympathetic system tend to increase HRV:
   
   

• Deep breathing or meditation
  
  

• Gentle yoga or tai chi
  
  

• Spending time in nature
  
  

• Cold exposure (like a short cold shower)
  
  

• Mindful rest days instead of pushing through fatigue
  
  

4. Balance Exercise Intensity
   Movement is crucial for autoimmune health, but overtraining can worsen symptoms. HRV helps gauge recovery, if your HRV is low, it may be a day for lighter activity.
   
   

5. Collaborate With Us
   We are well versed in using HRV to balance the immune system. Share HRV patterns with us and we can help tailor your treatment plan, stress management strategies, or lifestyle interventions.
   
   

The most powerful aspect of HRV tracking is that it provides objective data. Instead of blaming yourself for a flare or feeling guilty for needing rest, HRV can affirm that your body is under strain and needs care. It shifts the focus from "pushing through" to "listening to your body."

HRV isn’t a cure for autoimmune disease, but it’s a valuable compass. By tracking and supporting your nervous system balance, you can gain better insight into your body’s stress and recovery patterns, helping you manage symptoms, improve resilience, and live with more stability.

Here is an example of what we call the “breathing spin down” to activate the parasympathetic nervous system:

Another potent tool to trigger the parasympathetic nervous system is lymphatic drainage. More on that here.

We put together a free PDF on 35 ways to improve HRV. You can get it here:

How Lymphatic Drainage Can Improve Autoimmunity

There is an acronym, T.I.G.E.R., from the work of Dr. Akil Palanisamy, for the 5 triggers of autoimmune disease. While it’s tempting to blame genetics, it’s really the interplay between your genes and your environment that dictates whether genes are expressed or not. This is termed ‘epigenetics’. 

The T stands for toxins. According to Dr. Palanisamy, this is the biggest of the 5 triggers. Examples of toxins are microplastics, heavy metals, pesticides, etc. The lymphatic system is a vital part of your immune system. It consists of a network of vessels, lymph nodes, and lymph fluid, which work together to remove toxic substances. Unlike the cardiovascular system, the lymphatic system doesn’t have a central pump (like the heart). Instead, lymph fluid moves slowly through the body via muscle contractions, breathing, and manual stimulation [1].

Manual lymphatic drainage (MLD) is a specialized technique that encourages the natural flow of lymph fluid. Practitioners use light, rhythmic strokes to stimulate lymph nodes and vessels, helping the body eliminate metabolic waste, toxins, and excess fluid. Here’s how it works:

• Enhances toxin removal: MLD facilitates the movement of interstitial fluid, helping remove cellular waste and foreign substances more efficiently [2].
  
  

• Reduces inflammation: By improving drainage and tissue oxygenation, MLD may help reduce local inflammation, which is a key factor in many chronic conditions [3].
  
  

• Improves circulation: Boosted lymphatic flow can enhance microcirculation, contributing to better tissue repair and immune defense [4].

Autoimmune diseases occur when the immune system mistakenly attacks the body’s own tissues. Conditions like lupus, rheumatoid arthritis, and Hashimoto’s thyroiditis involve chronic inflammation and immune dysregulation.

A sluggish lymphatic system may contribute to autoimmune symptoms in several ways:

• Toxin accumulation: Poor lymph flow can lead to a buildup of cellular waste and toxins, which may trigger or worsen immune responses [5].
  
  

• Inflammatory feedback loop: Chronic inflammation can impair lymphatic function, and in turn, a congested lymph system can perpetuate inflammation [6].
  
  

• Immune cell trafficking: The lymphatic system is essential for transporting white blood cells. Dysfunction in this system may impair immune regulation [7].
  
  

By promoting detoxification and reducing inflammation, lymphatic drainage may help break this cycle and support the body's natural immune balance. Supporting the body’s natural detox pathways is an essential step toward immune health, especially in the context of autoimmune disease. Lymphatic drainage offers a gentle, non-invasive way to stimulate detoxification, reduce inflammation, and stimulate the parasympathetic nervous system.

References

1. Gashev, A. A. (2010). Physiology of the lymphatic system. Colloquium Series on Integrated Systems Physiology.
   
   
   

2. Foldi, M., Foldi, E., & Kubik, S. (2003). Textbook of Lymphology: For Physicians and Lymphedema Therapists. Elsevier.
   
   
   

3. Bakar, Y., Tugral, A., & Keklik, S. (2014). Effects of Manual Lymph Drainage on Pain and Health-Related Quality of Life in Patients with Fibromyalgia: A Randomized Controlled Trial. Journal of Manipulative and Physiological Therapeutics, 37(2), 117–123.
   
   
   

4. Zawieja, D. C. (2009). Lymphatic biology and the microcirculation: past, present and future. Microcirculation, 16(7), 643–654.
   
   
   

5. Dietrich, L., et al. (2020). Impaired lymphatic drainage promotes tissue inflammation and autoimmunity. Nature Immunology, 21(12), 1456–1468.
   
   
   

6. Kataru, R. P., et al. (2019). Lymphatic Dysfunction in Chronic Inflammatory Diseases. Current Opinion in Immunology, 61, 97–103.
   
   
   

7. Randolph, G. J., et al. (2017). The lymphatic system in disease processes and immunity. Cell, 170(4), 807–821.
   
   
   

An Overview of Autoimmune Disease

Autoimmune disorders were once thought to be uncommon, but they currently impact 3%–5% of the world's population, with autoimmune thyroid disease and type 1 diabetes mellitus being the most common. Some are organ-specific, such as Hashimoto's thyroiditis, and others that involve multiple organs, such as systemic lupus erythematosus (SLE). It currently affects over 80 million people (1 in 5 people), which makes it more impactful than diabetes, heart disease, and cancer combined. This is the biggest threat to western culture. 

The immune system's ability to recognize “foreign” antigens was first proposed in the early 20th century. However, until the early 1950s, it was not widely accepted that an immune response could be developed against “self” antigens. Paul Ehrlich identified nearly a century ago the immune reactivity against one's own body, which he named “horror autotoxicus” and is today recognized as autoimmunity. Therefore, autoimmunity is characterized by abnormal lymph responses to pathogens.

So what is it exactly? The definition is when the immune system mistakenly attacks healthy, functioning parts of the body. The tissue attacked and the symptoms that develop determine the name of the disease. There are 80 types of autoimmune disease that we know of, and there is speculation that there may be 100’s of types. Any body part can be affected. 

Autoimmune disease is characterized by four components:

1. An imbalance between effector T cells (turns on defense, and regulator T cells (turns off defense).

2. Defective elimination of self-reactive immune cells

3. Chronically alert immune system

4. Widespread inflammation

There are 3 stages:

1. Antibodies, no symptoms or tissue damage

2. Antibodies, symptoms, no tissue damage

3. Antibodies, symptoms, tissue damage

What are the causes? We commonly ask, is it nature or nurture? The answer is, yes. It’s both; it’s an interplay between genetics and environmental exposures, otherwise known as epigenetics. This is a good time to introduce the idea of the exposome. The exposome refers to the totality of exposures from a variety of external and internal sources including chemical agents, biological agents, or radiation, from conception onward, over a complete lifetime.

A good acronym for this is TIGER, which is from a book by Akil Palanismy

T: toxins

I: infections

G: gut health

E: eat, what to eat or not eat

R: rest and rebalance

TOXINS:

Toxins can include heavy metals which could be from seafood or dental amalgams. It can come in the form of plastics (which interfere with cytochrome P450, an important part of detoxification). When you start to pay attention to how much plastic we touch and put in our mouth, it’s frightening. From the water bottles, to take out food (including plasticware), our toothbrush bristles, the lining on paper plates and cash register receipts, etc. It’s even worse when you heat up plastic in ready to go foods. It’s not just the BPAs, but also a ‘forever’ chemical called phthalates. Chemicals such as nail polish remover, detergents, cleaning products, and fragrances can all initiate an inflammatory reaction. Last, but not least, pesticides such as glyphosate can be highly inflammatory. 

INFECTIONS:

Certain infections can trigger autoimmune responses. For example, some viral infections may initiate autoimmune reactions in genetically predisposed individuals. Tick borne illness and viruses such as Epstein-Barr are highly associated with autoimmunity. 

GUT HEALTH:

Our bodies contain more bacterial cells than human cells, so it would maintain that the health of our gut microbiome would greatly dictate the health of the entire organism. The gut is a semi-permeable membrane, similar to our skin. There is a protein called zonulin that holds the barrier together. There are many things that can affect this protein and allow the gut to be more permeable, allowing larger molecules to pass through such as food particles. The immune system recognizes this as a threat and starts to attack. Toxins, oxidative stress, psychological stress, antibiotics, NSAIDs, and additives from processed foods can all negatively affect the membrane. 

EAT: 

This is a big one. Many people develop food sensitivities, intolerances, and allergies from specific foods. This can be due to the pesticides, weakened immune system, molecular mimicry, or gut dysbiosis. Unfortunately, our food supply is not what it was even a few decades ago and it’s damaging our health. 

REST AND REBALANCE:

This is the lowest hanging fruit, and somehow the one that gets missed the most. It’s somewhat cultural; we are grossly sleep deprived. Our go-getter culture and stress is partly to blame. But it also has to do with disrupted circadian rhythms, too much blue light exposure, and not enough sunlight. It’s also a mindset shift. So many of our athletes and clientele try to solve a stress issue by adding more stress, when what they really need is recovery. If this is you, we have a free ebook on sleep optimization here.

To hear what you can do about autoimmune disease, listen to our podcast:

Frozen Shoulder and Dupuytren’s Contracture

Frozen shoulder (adhesive capsulitis) and Dupuytren’s contracture share a similar pathology. Inflammation leads to changes in the connective tissue and it ends up severely limiting range of motion. Is there a link between the two? Both have been associated with endocrine disorders such as Hashimoto’s thyroiditis and diabetes (Cakir et al., 2003).

Dupuytren’s contracture affects the palms of the hand. Nodules develop and a cord-like structure becomes prominent causing the ring finger and sometimes the pinky finger to curl. Often this ends up in a surgery to release the tissue. Researchers have found that the nodules are comprised mostly of immune cells and it is now being suggested that Dupuytren’s contracture is caused by a T-cell mediated autoimmune response (Walthall et al., 2021).

Frozen shoulder is a painful condition that affects the capsule of the shoulder. The tissue becomes stiff and movement is limited. When you search for the cause, you will consistently find that diabetes and thyroid disease are associated with it. Perhaps there is an underlying culprit that causes all of these problems. 

Thyroid disease is triggered by autoimmune disease. Type 1 diabetes is an autoimmune condition, and there is an established connection between type 2 diabetes and autoimmune disease. Patients with diabetes have altered function of immune cells and have reactive autoantibodies. There is a hypothesis that the inflammation of diabetics is attributable to autoimmune disease (de Candia et al. 2019).

It looks like autoimmune disease may be the common root cause. If that was so, you’d find an increase in the incidence of Dupuytren’s contractures with people that have frozen shoulder. That’s exactly what the evidence found. A study in 2001 (Smith et al.) found that in a sample of 58 patients with frozen shoulder, 30 also had evidence of Dupuytren’s contracture. That’s over 50%. This was compared to another study that found that Dupuytren’s contracture was over 8 times more likely in those with frozen shoulder.

Autoimmune disease is complicated but there is strong evidence that it comes from vitamin D deficiency and something called molecular mimicry. If you want to read more on this, read this blog here. Diabetic patients show an altered number and function of immune cells, of both innate and acquired immunity. Reactive autoantibodies against islet antigens can be detected in a subpopulation of patients, while emerging data are also suggesting an altered function of specific T lymphocyte populations, including T regulatory (Treg) cells. These observations led to the hypothesis that part of the inflammatory response mounting in T2D is attributable to an autoimmune phenomenon.

Proper nutrition and diet has way more implications than just weight loss. Processes like autoimmune disease and its sequelae are something that can happen over decades of poor food choices. This may be why it’s difficult to detect that certain foods may not be right for you. They can be like a slow poison. Getting clear on what diet works best for you may have consequences that are far reaching.

Want to get your vitamin D levels checked? Click the button below to find out more. Make sure to use the code DPT30 for 30% off.

References:

de Candia P, Prattichizzo F, Garavelli S, et al. Type 2 Diabetes: How Much of an Autoimmune Disease?. Front Endocrinol (Lausanne). 2019;10:451. Published 2019 Jul 4. doi:10.3389/fendo.2019.00451

Cakir M, Samanci N, Balci N, Balci MK. Musculoskeletal manifestations in patients with thyroid disease. Clin Endocrinol (Oxf). 2003 Aug;59(2):162-7. doi: 10.1046/j.1365-2265.2003.01786.x. PMID: 12864792. 

Smith SP, Devaraj VS, Bunker TD. The association between frozen shoulder and Dupuytren's disease. J Shoulder Elbow Surg. 2001 Mar-Apr;10(2):149-51. doi: 10.1067/mse.2001.112883. PMID: 11307078.

Walthall J, Anand P, Rehman UH. Dupuytren Contracture. [Updated 2021 Nov 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526074/

Autoimmune Disease, Vitamin D Deficiency, and Molecular Mimicry

Autoimmune disease is a condition where the body’s own immune system attacks its own tissues. The types of tissues that are attacked determines the type of autoimmune disease that develops. There are hundreds of versions of autoimmune disease including type 1 diabetes, rheumatoid arthritis, graves disease, hashimoto’s disease, lupus, multiple sclerosis, crohn’s disease, celiac disease, inflammatory bowel disease, psoriasis and the list goes on and on. 

When you search for the cause of most of these autoimmune diseases on mainstream medical websites, you’ll commonly see that the cause is unknown, or ‘idiopathic’ which is medical terminology for - we just don’t know. Well there are a few signals from evidence based research that are giving some major clues. In this article, I want to review a few of these clues: vitamin D deficiency, molecular mimicry and non-nutritive amino acids.

Vitamin D deficiency

Vitamin D plays a critical role in absorption of calcium to keep our bones and teeth strong. This is a well known relationship. Vitamin D has other critical roles as well. It has strong anti-inflammatory, antioxidant, and antifibrotic properties. It also modulates the immune system. Several studies, including this literature review have found an inverse correlation between vitamin D and autoimmune disease. There are two main sources of vitamin D, sunlight and food. In food, it is mostly found in animal sources. Some mushrooms contain vitamin D. If you are vegetarian and live north of Georgia or L.A., it will be very difficult to get adequate vitamin D levels and supplementation may be helpful. Epidemiology studies confirm that autoimmune diseases such as multiple sclerosis are indeed seen at higher levels in northern latitudes. 

So if you have developed osteoporosis or have cracked some teeth, this is a sign of vitamin D deficiency. If you have a type of autoimmune disease as well, this just may be the underlying mechanism. 

Molecular Mimicry

Molecular mimicry is the idea that the shape of some molecules in the body can be similar enough to other molecules that the body wrongly incorporates a foreign molecule into our cells. It’s a case of mistaken identity. Under normal circumstances, the immune system patrols around like a security guard, and when it sees something that doesn’t belong there, it attacks it. This is a good thing and is how our body handles bacterial or viral infection. There certainly is a link between viral infection and development of autoimmune disease, where the immune system appears to be ‘overactive’. 

However, there is another proposed mechanism for autoimmune disease development and molecular mimicry. This comes from food sources. First, a thank you to Dr. Ken Berry for illuminating these examples. Amino acids are important building blocks for protein synthesis. We have essential and non-essential amino acids. The difference being that essential amino acids are something our body cannot produce and requires food to get it. There is another class of amino acids that is less well known, called non-nutritive amino acids or non-protein amino acids. There are over 600 of them and they all come from plants. This includes phytates, lectins, and oxalates just to name a few. 

The problem with these amino acids is that they are shaped like some of the amino acids that we are supposed to build proteins with. Canavanine is one of these amino acids. Structurally it looks like L-arginine and when the body is replicating cells, it can wrongly use canavanine instead of L-arginine. Now the newly produced cell looks different to the immune system and will attack the cell. Foods that are high in canavanine that we know of include legumes (beans), and alfalfa sprouts. There have been several studies that found an association between alfalfa and development of Lupus, and although not conclusive, it certainly is an interesting relationship that should be further explored.

Another example is of a non-nutritive amino acid that wrongly is incorporated into our bodies is azetidine-2-carboxylic acid. This is found in beets, chives, shallots, onions, garlic, and leeks, and it looks like proline. Proline is involved in collagen synthesis so a diet high in azetidine-2-carboxylic acid may inhibit production of collagen. 

So if you are tired of not getting any answers about your autoimmune disease, it’s not a bad idea to get your vitamin D levels checked. I highly recommend a company called Let’s Get Checked. Here is their vitamin D test. It is sent to your house and you take your own sample, then send it in. You get your results within 3-5 days. 

You may want to consult a dietician and consider an elimination diet. There are diets such as the autoimmune protocol (AIP) or the Wahls Protocol that many people have found success with. 

References:

Elaine M.L. Tan, Lasse Ryhänen, Jouni Uitto, Proline Analogues Inhibit Human Skin Fibroblast Growth and Collagen Production in Culture, Journal of Investigative Dermatology, Volume 80, Issue 4, 1983, Pages 261-267, ISSN 0022-202X,

Giuseppe Murdaca, Alessandro Tonacci, Simone Negrini, Monica Greco, Matteo Borro, Francesco Puppo, Sebastiano Gangemi, Emerging role of vitamin D in autoimmune diseases: An update on evidence and therapeutic implications, Autoimmunity Reviews, Volume 18, Issue 9, 2019, 102350, ISSN 1568-9972,

Jun Akaogi, Tolga Barker, Yoshiki Kuroda, Dina C. Nacionales, Yoshioki Yamasaki, Bruce R. Stevens, Westley H. Reeves, Minoru Satoh, Role of non-protein amino acid l-canavanine in autoimmunity, Autoimmunity Reviews, Volume 5, Issue 6, 2006, Pages 429-435, ISSN 1568-9972

Rojas M, Restrepo-Jiménez P, Monsalve DM, Pacheco Y, Acosta-Ampudia Y, Ramírez-Santana C, Leung PSC, Ansari AA, Gershwin ME, Anaya JM. Molecular mimicry and autoimmunity. J Autoimmun. 2018 Dec;95:100-123. doi: 10.1016/j.jaut.2018.10.012. Epub 2018 Oct 26. PMID: 30509385.

Wood, H. Latitude and vitamin D influence disease course in multiple sclerosis. Nat Rev Neurol 13, 3 (2017). https://doi.org/10.1038/nrneurol.2016.181

Yukihiko Saeki, Katsuhiko Ishihara, Infection–immunity liaison: Pathogen-driven autoimmune-mimicry (PDAIM), Autoimmunity Reviews, Volume 13, Issue 10, 2014, Pages 1064-1069, ISSN 1568-9972,