Optimizing Your Immune System
The human immune system does not yield to easy explanation. We have multiple different defenses against foreign intruders, and must limit attack on self. This desired golden mean of immune response illustrates why we can suffer from viral and bacterial infections or from lupus and psoriasis.
The immune system is generally divided into innate and adaptive systems. The innate immune system is less precise, attacking any intruder in a broad manner. This involves multiple immune cell types (neutrophils, NK cells, etc) and the complement system. The adaptive immune system employs a more targeted approach by B and T cells to pathogens, and possesses memory. The memory is why vaccines work, and why we usually don’t catch the exact same infection twice (unless it mutates, which many do).
That is probably enough detail on an entire field that comprises whole textbooks and subtextbooks. A chief take home point is that the immune system is a diverse system, interconnected with many other organ systems, and therefore will not yield itself to a one diet, product, or supplement fix. Though most of us cannot come close to the knowledge of an immunologist, we can take certain measures to ensure our immune systems are optimized against threats.
The following lifestyle and nutritive recommendations are in random order. Some will be more feasible for you, others unlikely to stick. The more you optimize overall health, the stronger your immune system. This includes obtaining ample sleep (7-9 hours per night), eating a nutritious, real food diet (low processed foods, low sugar), minimizing stress, exercising, and maintaining good social connections (albeit at 6 foot distance right now).
Vitamin D
Vitamin A
Probiotics
Selenium
Zinc
Vitamin C
Copper
Iodine
Carbs
Iron starvation
Garlic
Mushrooms
Elderberry
Quercetin
Overall for supplementation I refer people to the Perfect Health Diet Supplements page. At the end of the day, maintaining overall good health, reducing/managing medical problems, vaccinations, plenty of sleep, practicing gratitude and mindfulness, and finally luck will have more effects than a bunch of pills. Compounds and molecules do not exist isolated in nature, but exist in bioactive combinations (vitamin A is defined as: “a group of unsaturated nutritional organic compounds that includes retinol, retinal, retinoic acid, and several provitamin A carotenoids (most notably beta-carotene”). Vitamin C from food may have different effects compared to pill form.
You will make vitamin D with 20 minutes of sunlight exposure (so generally a good idea to supplement in the winter depending on your latitude). Get Vitamin A from eggs, carrots, and orange/red vegetables. Fruits and vegetables will feed your microbiome, but consume Kefir daily for probiotics, it probably lowers the risk of upper respiratory infections. One Brazil nut gives you a day’s worth of Selenium. Oysters (and other shellfish), meat, nuts, and legumes have plenty of zinc, but a supplement once a week can help. Copper comes from eating liver, but also cocoa powder. Iodine from seafood, seaweed, or a pill (a good idea if you don’t eat iodized salt).
The carb or no carb, eating vs fasting question is intriguing – do you starve a fever (bacterial infection), feed a cold (viral)? Decent science behind that idea. Bacterial and fungal infections seem amenable to iron starvation (donate blood and don’t eat much red meat). Several quality studies present data on garlic intake for preventing and treating infection; just roast and eat a whole bulb. Mushrooms and numerous other adaptogens can trigger mild immune response regularly so your body will surmount a strong response but not go overboard when a real pathogen comes along. Elderberry extract may prevent infection by inhibiting viral entry, including in a chicken coronavirus model. Finally, quercetin, found in red wine, onions, green tea, apples, berries, has shown activity against influenza and coronaviruses that cause SARS and MERS.
COVID-19
Now that everyone is running out to buy elderberry syrup and quercetin for COVID-19, let’s address the elephant in the room. The pandemic we are facing is disrupting schools, employment, healthcare, whole economies, and costing human lives around the world. COVID-19 is a force of nature that now has the entire human race united in fighting against it – a bittersweet, rare phenomenon. US citizens are united (mostly), and working with the WHO and many nations around the world to develop best practices for prevention and treatment. The ideal solution involves social distancing, meticulous hygiene, excellent hospital (including critical) care, pharmacologic and ventilatory/oxygenation strategies, and ultimately a vaccine. Hopefully whoever discovers a vaccine shares it widely and makes it affordable for all.
This virus creates a paradox wherein most individuals in a country will either not acquire the infection, or will have only mild symptoms. But we must ask all citizens to act as though they are at great risk of harm in order to protect the subset of people who are most vulnerable. From the above “paradox” link: “Hence one must ‘panic’ individually (i.e., produce what seems to an exaggerated response) in order to avoid systemic problems.”
I fully admit to a rollercoaster of emotions related to the COVID-19 pandemic. I do find, and someone has already studied this, that the more news I read, the worse I feel. News stories slant toward the negative – fear sells in media. Unfortunately, this happens to actually be the most terrifying global threat to humanity since the early HIV epidemic, 1957 Flu, or perhaps the Cold War. Grave respect for this virus will save lives, and anyone who casts it off as just like influenza has decided to ignore experts.
But right now let’s focus on the positives: What can we do proactively to protect ourselves and loved ones from this virus? The first step as mentioned is hand and overall hygiene, along with social distancing. We visited my mom and stayed in her front yard with >6 feet separation, and actually stopped at a few other houses to see people. Be creative in distancing from others without completely isolating yourself.
The next steps would be sleep, stress management, optimizing medical problems, eating a healthy diet, and maintaining at least a light exercise regimen. Continuing to exercise with long walks, bodyweight workouts at home, or any other form of activity will elevate your mood and your immune system. As far as supplements, opinions differ. Some have concern for Vitamin D (might increase ACE2 levels), while others believe Vitamin D could save lives. The most balanced approach would be to supplement vitamin D if your levels are low (below 40). Hint: most people are somewhat deficient during the winter, depending on distance from equator. Vitamin C similarly could be the key to treating COVID-19, or could predispose one to an exaggerated immune response (cytokine storm). I would suggest obtaining ample vitamin C from food, but in the spirit of moderation, avoid large doses of pill form. Finally, elderberry extract could prevent viral entry, but you may want to cease supplementation if you develop symptoms. Certain herbal formulations are being used in China to prevent infection, this article summarizes these efforts and cites impressive data from SARS and H1N1 avian flu. For one of the most balanced, referenced guides I have found, consult this document. No sources seem to question the safety of these effective supplements: quercetin, Zinc, garlic, Kefir/probiotics, reasonable intake of vitamin C and A.
None of these recommendations should be taken as medical advice, but it should not be controversial to state that healthy food and gentle supplementation could at least marginally impact immune function. Do your own research, and please reply back with ideas and suggestions. I have to thank all of the people (pretty much everyone I know) who send articles, especially my wife, Mateo, Dan, Jacob, Suzanne, and various group text participants. The memes and lighthearted links are as important as the scientific ones!
Be Positive
Remember, the whole world is working together on this problem, and the intelligence and creativity of the human race boasts amazing accomplishments in the past few hundred years. We are testing medications like chloroquine and hydroxychloroquine, various antiviral drugs and HIV specific ones, azithromycin, serum from people who have recovered from the infection, and working hard at vaccine development.
Pollution is down in many large geographic areas, we are using the Internet to network more wisely, we are developing telehealth models, and we are spoiled with free content from the NYTimes, most medical journals, and mindfulness apps: Tricycle, Ten Percent Happier, and Headspace. Some news media have gone the optimistic route. Start with this piece from the highly respected metadata expert John Ioannidis, who offers hope for a lower mortality rate, and asks for more data to inform our responses and attitudes. Two different Nobel Laureates believe the pandemic will die down in each location reasonably quickly. We might have less influenza deaths this year, and there is certainly less traffic during the social distancing. Many of us are getting to spend more time with our immediate family, a sometimes challenging but in the grand scheme a precious opportunity. SARS-CoV-2 is easy to clean off of surfaces, and will likely (hopefully!) struggle to infect us as weather becomes more warm and humid. We have the choice to work together, to harness altruism instead of panic.
None of this is meant to be insensitive to the very real monetary, physical and emotional health effects of this pandemic. But each day, you can choose where to focus your attention and energy. Focus on what you can control, take charge with resolve to make a difference. I know I cannot save lives of patients in Spain and Italy, but with our local and national leadership, we can learn from what is happening around the world to save patients here in the US and share what works. We can shift focus away from partisan politics and act as a united citizenship with renewed civic virtues. We can look across the hallway, street, or social media sphere, and see someone who is dealing with the same anxiety and concern that we are.
Thank you to everyone acting in the best interests of your communities. And a special thanks to the healthcare workers risking their own well-being to help patients. If you need one more uplifting read, proof that humility, wisdom, and hope can cross paths with pure competence in one (Louisville) physician, read this.
