Archive for April 2022

Boost your immune system

Strengthen your immune system and fight off disease

How can you improve your immune system? 

On the whole, your immune system does a remarkable job of defending you against disease-causing microorganisms. But sometimes it fails: A germ invades successfully and makes you sick. Is it possible to intervene in this process and boost your immune system? What if you improve your diet? Take certain vitamins or herbal preparations? Make other lifestyle changes in the hope of producing a near-perfect immune response?

What can you do to boost your immune system?

The idea of boosting your immunity is enticing, but the ability to do so has proved elusive for several reasons. The immune system is precisely that — a system, not a single entity. To function well, it requires balance and harmony. There is still much that researchers don’t know about the intricacies and interconnectedness of the immune response. For now, there are no scientifically proven direct links between lifestyle and enhanced immune function.

But that doesn’t mean the effects of lifestyle on the immune system aren’t intriguing and shouldn’t be studied. Researchers are exploring the effects of diet, exercise, age, psychological stress, and other factors on the immune response, both in animals and in humans. In the meantime, general healthy-living strategies make sense since they likely help immune function and they come with other proven health benefits.

Immunity in action

A healthy immune system can defeat invading pathogens as shown above, where two bacteria that cause gonorrhea are no match for the large phagocyte, called a neutrophil, that engulfs and kills them (see arrows).

Your first line of defense is to choose a healthy lifestyle. 

Following general good-health guidelines is the single best step you can take toward naturally keeping your immune system working properly. Every part of your body, including your immune system, functions better when protected from environmental assaults and bolstered by healthy-living strategies such as these:

Don’t smoke.

Eat a diet high in fruits and vegetables.

Exercise regularly.

Maintain a healthy weight.

If you drink alcohol, drink only in moderation.

Get adequate sleep.

Take steps to avoid infection, such as washing your hands frequently and cooking meats thoroughly.

Try to minimize stress.

Keep current with all recommended vaccines. Vaccines prime your immune system to fight off infections before they take hold in your body.

Increase immunity the healthy way

Many products on store shelves claim to boost or support immunity. But the concept of boosting immunity actually makes little sense scientifically. In fact, boosting the number of cells in your body — immune cells or others — is not necessarily a good thing. For example, athletes who engage in “blood doping” — pumping blood into their systems to boost their number of blood cells and enhance their performance — run the risk of strokes.

Attempting to boost the cells of your immune system is especially complicated because there are so many different kinds of cells in the immune system that respond to so many different microbes in so many ways. Which cells should you boost, and to what number? So far, scientists do not know the answer. What is known is that the body is continually generating immune cells. Certainly, it produces many more lymphocytes than it can possibly use. The extra cells remove themselves through a natural process of cell death called apoptosis — some before they see any action, some after the battle is won. No one knows how many cells or what the best mix of cells the immune system needs to function at its optimum level.

Immune system and age

As we age, our immune response capability becomes reduced, which in turn contributes to more infections and more cancer. As life expectancy in developed countries has increased, so too has the incidence of age-related conditions.

While some people age healthily, the conclusion of many studies is that, compared with younger people, the elderly are more likely to contract infectious diseases and, even more importantly, more likely to die from them. Respiratory infections, including, influenza, the COVID-19 virus and particularly pneumonia are a leading cause of death in people over 65 worldwide. No one knows for sure why this happens, but some scientists observe that this increased risk correlates with a decrease in T cells, possibly from the thymus atrophying with age and producing fewer T cells to fight off infection. Whether this decrease in thymus function explains the drop in T cells or whether other changes play a role is not fully understood. Others are interested in whether the bone marrow becomes less efficient at producing the stem cells that give rise to the cells of the immune system.

A reduction in immune response to infections has been demonstrated by older people’s response to vaccines. For example, studies of influenza vaccines have shown that for people over age 65, the vaccine is less effective compared to healthy children (over age 2). But despite the reduction in efficacy, vaccinations for influenza and S. pneumoniae have significantly lowered the rates of sickness and death in older people when compared with no vaccination.

There appears to be a connection between nutrition and immunity in the elderly. A form of malnutrition that is surprisingly common even in affluent countries is known as “micronutrient malnutrition.” Micronutrient malnutrition, in which a person is deficient in some essential vitamins and trace minerals that are obtained from or supplemented by diet, can happen in the elderly. Older people tend to eat less and often have less variety in their diets. One important question is whether dietary supplements may help older people maintain a healthier immune system. Older people should discuss this question with their doctor.

Diet and your immune system

Like any fighting force, the immune system army marches on its stomach. Healthy immune system warriors need good, regular nourishment. Scientists have long recognized that people who live in poverty and are malnourished are more vulnerable to infectious diseases. For example, researchers don’t know whether any particular dietary factors, such as processed foods or high simple sugar intake, will have adversely affect immune function. There are still relatively few studies of the effects of nutrition on the immune system of humans.

There is some evidence that various micronutrient deficiencies — for example, deficiencies of zinc, selenium, iron, copper, folic acid, and vitamins A, B6, C, and E — alter immune responses in animals, as measured in the test tube. However, the impact of these immune system changes on the health of animals is less clear, and the effect of similar deficiencies on the human immune response has yet to be assessed.

So, what can you do? If you suspect your diet is not providing you with all your micronutrient needs — maybe, for instance, you don’t like vegetables — taking a daily multivitamin and mineral supplement may bring other health benefits, beyond any possibly beneficial effects on the immune system. Taking megadoses of a single vitamin does not. More is not necessarily better.

Improve immunity with herbs and supplements?

Walk into a store, and you will find bottles of pills and herbal preparations that claim to “support immunity” or otherwise boost the health of your immune system. Although some preparations have been found to alter some components of immune function, thus far there is no evidence that they actually bolster immunity to the point where you are better protected against infection and disease. Demonstrating whether an herb — or any substance, for that matter — can enhance immunity is, as yet, a highly complicated matter. Scientists don’t know, for example, whether an herb that seems to raise the levels of antibodies in the blood is actually doing anything beneficial for overall immunity.

Stress and immune function

Modern medicine has come to appreciate the closely linked relationship of mind and body. A wide variety of maladies, including stomach upset, hives, and even heart disease, are linked to the effects of emotional stress. Despite the challenges, scientists are actively studying the relationship between stress and immune function.

For one thing, stress is difficult to define. What may appear to be a stressful situation for one person is not for another. When people are exposed to situations they regard as stressful, it is difficult for them to measure how much stress they feel, and difficult for the scientist to know if a person’s subjective impression of the amount of stress is accurate. The scientist can only measure things that may reflect stress, such as the number of times the heart beats each minute, but such measures also may reflect other factors.

Most scientists studying the relationship of stress and immune function, however, do not study a sudden, short-lived stressor; rather, they try to study more constant and frequent stressors known as chronic stress, such as that caused by relationships with family, friends, and co-workers, or sustained challenges to perform well at one’s work. Some scientists are investigating whether ongoing stress takes a toll on the immune system.

But it is hard to perform what scientists call “controlled experiments” in human beings. In a controlled experiment, the scientist can change one and only one factor, such as the amount of a particular chemical, and then measure the effect of that change on some other measurable phenomenon, such as the amount of antibodies produced by a particular type of immune system cell when it is exposed to the chemical. In a living animal, and especially in a human being, that kind of control is just not possible, since there are so many other things happening to the animal or person at the time that measurements are being taken.

Despite these inevitable difficulties in measuring the relationship of stress to immunity, scientists are making progress.

Does being cold give you a weak immune system?

Almost every mother has said it: “Wear a jacket or you’ll catch a cold!” Is she right? Probably not, exposure to moderate cold temperatures doesn’t increase your susceptibility to infection. There are two reasons why winter is “cold and flu season.” In the winter, people spend more time indoors, in closer contact with other people who can pass on their germs. Also the influenza virus stays airborne longer when air is cold and less humid.

But researchers remain interested in this question in different populations. Some experiments with mice suggest that cold exposure might reduce the ability to cope with infection. But what about humans? Scientists have performed experiments in which volunteers were briefly dunked in cold water or spent short periods of time naked in subfreezing temperatures.  They’ve studied people who lived in Antarctica and those on expeditions in the Canadian Rockies. The results have been mixed. For example, researchers documented an increase in upper respiratory infections in competitive cross-country skiers who exercise vigorously in the cold, but whether these infections are due to the cold or other factors — such as the intense exercise or the dryness of the air — is not known.

A group of Canadian researchers that has reviewed hundreds of medical studies on the subject and conducted some of its own research concludes that there’s no need to worry about moderate cold exposure — it has no detrimental effect on the human immune system. Should you bundle up when it’s cold outside? The answer is “yes” if you’re uncomfortable, or if you’re going to be outdoors for an extended period where such problems as frostbite and hypothermia are a risk. But don’t worry about immunity.

Exercise: Good or bad for immunity?

Regular exercise is one of the pillars of healthy living. It improves cardiovascular health, lowers blood pressure, helps control body weight, and protects against a variety of diseases. But does it help to boost your immune system naturally and keep it healthy? Just like a healthy diet, exercise can contribute to general good health and therefore to a healthy immune system.

Graves Disease, Thyroid Eye Disease, and COVID-19

COVID-19 has caused disease in close to 500 million people worldwide, according to the World Health Organization. While the airways are its primary target, SARS-CoV-2 may enter many organs via the protein angiotensin-converting enzyme 2 (ACE-2).  ACE-2 is highly expressed in thyroid cells, and COVID-19 has been reported to cause thyroid dysfunction both during and after infection with SARS-CoV-2. COVID-19–related autoimmune thyroid manifestations include Graves’ disease and thyroid eye disease (TED), although COVID-19 can lead to multiple other thyroid dysfunctions.

Presentation of patients with new TED to a prominent chain of Indian eye hospitals had increased 25% during the first 2 years of the COVID-19 pandemic.

This observation poses enticing questions

Is there a link between COVID-19, thyroid autoimmunity, and its complications (including TED)? 

Could COVID-19 vaccination and thyroid autoimmunity be connected? 

Might these observations be influenced by COVID-19 public health measures and delays in seeking healthcare? 

Or are these findings purely coincidental and unrelated to the COVID-19 pandemic?

Understanding Graves Disease and TED

To address these questions, we must review our understanding of how Graves disease and TED occur. Graves disease is an autoimmune disorder of the thyroid caused by stimulatory thyroid-stimulating hormone receptor antibodies, leading to hyperthyroidism.

Graves disease is the most common cause of hyperthyroidism and affects > 1% of the US population.

TED is the most common complication of Graves disease that occurs outside of the thyroid gland. TED causes a variety of eye signs and symptoms that can negatively affect patients’ quality of life, be disfiguring, and in rare cases threaten vision.

The exact events that trigger thyroid autoimmunity are not known; however, we believe a complex interplay between genetic and environmental factors occur, including:

Genetics: Genes with polymorphisms predisposing to Graves disease include human leukocyte antigens (HLA), particularly class II genes for HLA-DR; TSHR; CLTA-4; CD40; and PTPN22.

Age: Graves disease has a low incidence in childhood, rising thereafter until the age of approximately 50 years, after which the incidence plateaus or decreases slightly.

Sex: Women have an approximately five times higher risk for Graves disease than men.

Race: Black persons and possibly Asian persons/Pacific Islanders have higher rates of Graves disease, at least in the United States.

Cigarette smoking: Cigarette smoking is a clear environmental risk factor for the development of Graves disease and TED.

Two other possible triggers for Graves disease are stress and infection.

Stress and Graves Disease. Stress has been implicated as a trigger of Graves. Other autoimmune diseases have also been suggested to have increased risk after stressful events. 

One theory of how stress could cause Graves disease in susceptible people is by releasing hormones, including catecholamines and cortisol, that shift the immune response toward antibody production that is pathognomonic of Graves disease. 

Psychological stress imposed by a global pandemic is therefore a potential (although unproven) trigger for Graves disease and TED.

Infection and Graves diseaseInfection with such bacteria as Yersinia enterocolitica and Helicobacter pyloriand by viruses including parvovirus, Epstein-Barr virus, and hepatitis C virushave also been proposed to cause Graves disease.

One hypothesis for this link is that the hyperinflammatory disease state associated with COVID-19 triggers a series of immune responses in genetically susceptible individuals, leading to activation (or reactivation) of Graves disease and TED. 

Most cases have occurred in middle-aged women, the prime demographic for developing Graves disease. 

The smoking status of these individuals has not been reported.

Reactions Induced by Adjuvants?

Thyroid autoimmune phenomena have been reported after both inactivated and messenger RNA COVID-19.

Graves disease and/or TED have been reported to occur days to weeks after receipt of either a first or second dose of vaccine. Investigators have questioned whether these reactions may represent an autoimmune/inflammatory syndrome induced by adjuvants (ASIA). 

Adjuvants in vaccines are used to enhance the immune response using a reduced amount of antigen, thus creating an extended and lasting immune response. 

Potential mechanisms by which adjuvants disrupt the ‘immunologic balance’ of the host include molecular mimicry (similarities between foreign and self-antigens), excessive cytokine production (promoting inflammation), and defective immune regulation (by regulatory T cells). Association does not necessarily imply causation. Given the sheer number of people being diagnosed with COVID-19 worldwide every day, it is inevitable that some patients seeking medical attention for respiratory symptoms (or other COVID-19 complications) may have preexisting Graves disease and/or TED.

Reassuringly, cases of postvaccination ASIA leading to thyroid autoimmunity appear to be exceedingly rare, although there is potential for underreporting of cases or a lack of awareness among clinicians.

COVID-19 restrictions, lockdowns, and stay-at-home orders have also led to delayed healthcare-seeking behavior. 

“This has been observed across a spectrum of disease, including medical emergencies (eg, acute coronary syndrome), and surgical emergencies (eg, acute appendicitis), and in cancer care. “

Abnormal thyroid function is associated with more severe TED. 

Any delays in diagnosis of Graves disease and timely commencement of antithyroid therapy will undoubtedly contribute to more severe disease at presentation.

COVID-19 has presented the world with many challenges, not least in deciphering causation from association. 

However, the pandemic also presents opportunities for us to ask questions and then learn more about disease processes in many organs. 

The anecdotal data from India regarding recent TED presentations is one such example. 

With additional high-quality data, we will be able to definitively address the roles of stress, infection, possibly vaccination, and behavioral adaptations to the public health responses in the development.