Do You Keep Getting Sick? How To Break The Cycle Of Illness

Coming up on this week's episode of the Doctor's Pharmacy.

We're kind of in a challenging moment for human immune systems because we are dealing with things we never had to deal with before.

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Hi, this is Lauren Fein, one of the producers of the Doctor's Pharmacy podcast. If you have been wondering why you or a loved one gets sick all the time, the experts in this compilation episode will guide you on how to rejuvenate your immune system. Our immune systems are under attack because of so many things we face in our modern world, like environmental toxins, fake food, and chronic stress. In today's episode, we feature three conversations from the Doctor's Pharmacy about why creating immune resilience is so important. Dr. Hyman speaks about how senescence of our cells hastens aging and poor immune response. Then he speaks with Dr. Elizabeth Boham about a case study of a young.

Boy who was always getting sick immune system. Let's jump in. How do we optimize our immune function? How do we regulate it? How do we rejuvenate it? It's a whole new concept. rather than immune boosting or immune suppression. How about immune rejuvenation? This is a beautiful way of thinking about how do we regulate our immune system to do what it's supposed to do and not do what it's not supposed to do, which is happening a lot in our culture because we have such an overactive immune system given our inflammatory diet, given environmental toxins, given the changes in our microbiome, given our levels of stress and so on. We all are experiencing immune system dysfunction at some level. So we also wanna understand how inflammation plays a role in aging and how do we regulate the process of getting older without dealing with the consequences of chronic inflammation, which is driving so much of the age-related diseases. I wrote about this a lot in my book, Young Forever. There's a whole concept of a chronic systemic sterile inflammation. It's not inflammation that's coming from getting an infection, but it's this low-grade chronic inflammation that we now refer to as inflammaging. the inflammation that occurs as we age. And that actually accelerates every aspect of aging. So how do we regulate that? How do we understand how to not neglect our immune systems as we get older and make them strong and fit and be able to be resilient and rejuvenate their effect, which is basically diminished as we age. We're less likely to be able to fight infections and cancer. So our immune system is dysfunctional at that level. And at the same time, it actually is causing more inflammation that leads to more autoimmunity and chronic sterile inflammation that leads to heart disease, cancer, diabetes, and dementia. So we have to really understand the way to rethink our immune system to both upregulate our ability to fight cancer infection, but also reduce the levels of inflammaging and autoimmunity that happen as we get older. Now, immuno rejuvenation is a relatively new concept. It was really sort of framed by my mentor, Jeffrey Bland, Dr. Jeffrey Bland, the father of functional medicine, who was a student of Linus Pauling and has, has taken this concept of immediate rejuvenation and, and actually created a whole company around it called Big Bold Health. And just for full transparency, I'm an investor, I'm an advisor. I believe so much in this, in, in the work that Jeff's doing. He's taught me most of what I know in medicine. So we have to think about this a little differently. So today we're going to talk about immuno rejuvenation, what it is, how it happens in the body, and how to turn it on, how do we rejuvenate our immune system? Now, why is the concept of immune rejuvenation better than our conventional approach to immune health? Well, immune rejuvenation essentially trains your immune system to work better at every level. Your immune systems turn over fast, your white cells turn over fast, you build a new immune system regularly, everything comes from your blood and bone marrow, right? So, your hematopoietic stem cells are generating new white cells and all the different types of cells. So, you really need to kind of learn how to build the right immune system and not have it degrade as we age. Now, what happens as we age typically is not immunorejuvenation, but a concept called immunosenescence, which is the aging of our immune system. And that's damage that occurs in our body as a result of a dysfunctional immune system, one that generates more inflammation, that causes aging and less immune support that actually helps you fight infection and cancer. And what happens is you, we develop these cells called zombie cells. They're terrible cells. I wrote about them in my book. It's one of hallmarks of aging. They're also known as senescent cells. And, and what they do is they tend to spread inflammation like a wildfire throughout your body, and they make other cells zombie cells, just like zombies make other people zombies. It's the same idea. And you end up with a lot of these senescent cells running around your body that are causing you to age faster. So how do we deal with them? How do we actually get rid of them? How do we rejuvenate our body to get rid of the zombie cells to make room for healthy new cells? Well, We're kind of in a challenging moment in history for human immune systems because we are dealing with things we never had to deal with before. And the worst is our diet, which is a highly inflammatory diet. Our processed food diet, high sugar and starch diet, high refined oils, lack of enough phytochemicals and medicines in food, anti-inflammatory compounds in food, and omega-3 fats in our diet. We are really having a horrible dietary experience. in America and around the world globally. And we're seeing that effect on driving all the inflammatory diseases, especially obesity. And then there's not just our inflammatory diet, but all the environmental toxins that we have to deal with. And we're also having, you know, increased spread of globalization of microbes through, like we saw with COVID and the pandemic. It happens, you know, one in one country, a thousand years ago, wouldn't get anywhere because you couldn't get anywhere. But now it spreads like a wildfire. So we also have other things like stress, psychological stress, physical stresses, all create stress on the immune system. So this really sets the stage for this chronic inflammatory state and makes us more susceptible to infections, more susceptible to food sensitivities, allergies, and autoimmunity, as well as rapid aging. So the question is, how do we lose the science of immunology, the emerging science of understanding immunorejuvenation, to help the body to reset, to help the body fight this process of inflammation as we age, to help deal with the zombie cells and to basically make our immune systems more resilient. Well, it's the way basically, you know, we do cleaning up of our cells is through killing of the bad cells or they die, and then we have to clean and recycle them up. And this is called autophagy. And this is something I've talked a lot about, but autophagy is simply this process of self-cleaning like a self-cleaning oven where your, your sort of body has this process to kind of gobble up, like with Pacman, little things called lysosomes, gobble up all the old cells or damaged cells or damaged proteins, digest them and break them down into component parts and then reuse them like recycling. And it's quite an amazing process. And we often have a degraded process of autophagy as we age, and there's lots of things we can do to stimulate it. And, and a lot of the ways we can do it actually is through food and through right nutrients in food and through the right phytochemicals in food. So we also have to actually understand how to also rejuvenate our mitochondria because our mitochondria are the energy factories of our cells. They're the place where we make ATP that drives all of our biological processes. So when our mitochondria age, we age and we need to rejuvenate our mitochondria as well. So again, this is like mitophagy is similar to autophagy. It's a process of recycling and getting rid of the old mitochondria. getting, building new ones, and you need a good immune system to do that because any kind of inflammation will cause mitochondrial dysfunction. So, when, when you look at the body's ability to rejuvenate, it's quite remarkable. We have our own built in process of rejuvenation. We have stem cells, we have immune cells that can help us rejuvenate. We can actually activate all these processes, but we have to learn how. So the question is, what can we do to activate our own body's immuno rejuvenation system? What are the, what is the research showing us about how do we cultivate a healthier immune system? Well, there's a few things. Food, right? So food is so important. And so eating an anti-inflammatory diet that's plant rich, that's full of phytochemicals, that has medicinal properties in them that actually can kill some of the zombie cells, can rejuvenate your immune system, can reduce the inflammation is so important. So lots of call for fruits and vegetables. One of the things that I like are prebiotics and polyphenols. And they are in various kinds of foods. One of the most important foods for immune rejuvenation is something called Himalayan Tarter Buckwheat. Now, this is an ancient grain, not even a grain, it's actually a flower. So it's not even a grain, even though it's called wheat, it's not wheat. That's confusing. But anyway, it's grown in the Himalayas and it's got over 132 phytochemicals, many of which are not found anywhere else in nature, and have a powerful ability to regulate immunity. And some of them like Quercetin, we've seen reverse biological age. And some preliminary data, they've shown that using Himalayan buckwheat, we can actually reverse our biological age by rejuvenating our immune system. So really important. Next is stay active. So moving your body, exercise, interval training, really powerful for actually rejuvenating your immune system. Over exercising actually can cause a problem, but the right amount of exercise actually helps build immunity. Also make sure you get the right omega-3 fats because essential fatty acids are so important.

Important.

And most fish oils are not that great because they process the fish oil in a way that degrades some of the most anti-inflammatory components we call pro-resolving mediators, which are basically like breaks on the immune system. And they also take out a lot of the, the important things like astaxanthin, which is important for inflammation. It is an antioxidant that is found in a lot of the Omega-3 fat containing fish like salmon. So want to make sure you have the right Omega-3s, also you want to fertilize your microbiome. So both polyphenols from colorful plant foods, but prebiotic and probiotic foods are really important. So, and there's a lot of them out there. We've talked a lot about it on the podcast, but we want to make sure you're including pre and probiotic foods. Also, get rid of all the junk, right? The processed food, fried foods, sugary foods, junk foods. These are things that are just driving inflammation and actually worsening your immune system. Also, sleep, really important. If you don't sleep, your immune system's not gonna work well. So seven, eight hours of good sleep, really important. Now, the other thing is that there are positive things that are gonna help you improve your immune system, like stress stressors, for example. We know that a stress isn't always bad, that there are good stresses that activate your body's own healing response. So basically, this kind of stress is called hormesis. And hormesis is the idea that there's a stress that doesn't kill you that makes you stronger. So essentially, some kind of insult, which could be exercise or fasting or a sauna or a cold plunge, and it tricks your body into thinking something bad's happening. And then your body responds by creating a defensive response by activating all its healing and Rejuvenation repair systems. So it's really important, and I think there's a lot of ways to do this. So, and these positive stresses are, are important. They help you become more resilient. So the goal is to become more resilient, more stress resilient, more immune resilient, be able to adapt to a lot. a lot of changes and actually deal with what has to happen. Now, one of the ways we can actually stimulate the process of healing in the body is through sort of plant compounds that they have used and developed to protect themselves. These are the plants own protective defensive mechanisms, and they're called phytochemicals. And when the plants are stressed, they make more of these. They're their own defense system. They're their immune system. so it's great to eat these things because they actually activate your body's own healing system. So when plants have to deal with bad soil or temperature extremes or, or, you know, insects that are trying to fight off or floods or droughts, they create all these incredible molecules that are part of their own defense systems. And, and when we actually eat these, it's like eating a little bit of adversity, and then they activate our body's own healing systems, and it's really powerful now. Dr. Bland has come up with an approach to immune health that I think is quite brilliant because it deals with three key categories of foods and components in our food that can really rejuvenate our immune system. The first are polyphenols from plants, things like quercetin, luteolin, and isperidin, all these bioflavonoids that are found in food that can really rejuvenate our immune system. And they're found in abundance in this Himalayan tartary buckwheat. The second is eating the right amounts of omega fats, Omega-3 fats and, and the right kind. And, and again, I know I'm an investor in Big Bold Health, but they, they've come up with a model of getting fish oil and extracting the Omega-3s from it and keeping the pro-resolve and mediators preventing the degradation is purified. There's no toxins in it. It's cold processed, so it retains all its benefit, and it's quite a different Omega-3 fat. The next is your microbiome. And this is supporting your microbiome through pre and probiotic foods. And actually, Himalayan Tawari buckwheat has these amazing microbiome supporting fibers that are quite amazing. And, and basically you want to make sure you get these from all sorts of foods, not just obviously Himalayan Tawari buckwheat, but omega-3 fats from fish, polyphenols from plants, fibers and pre and probiotics from, from our food. And they basically help us to build our own immune system. So what are the kinds of other positive stressors other than food that we can use to upgrade our immune systems and immunorejuvenate ourselves. Well, first is hormesis. So hormesis is, like I said, this idea that what doesn't kill you makes you stronger. And some of them are pretty simple to do. For example, temperature extremes, hot and cold. So you can do a sauna for 30 minutes at 170 degrees, a regular sauna for 30 minutes, and you can go in and out, cotton cold, hot and cold. Doing that four times a week has enormous benefits for your health and longevity. cold plunge. If you get one, great. You can just fill up your bathtub with cold water or get a big horse trough and fill it with ice and water and go in that. You can even just take cold shower. That also helps rejuvenate your immune system, not overeating and actually having a diet that is, is time restricted can be very important. So donate three hours before bed. Give yourself at least, you know, 16 hours, maybe 12, 14 if you know, thin and you can't tolerate a longer period. But most people can deal with a 16 hour overnight fast. That's eating dinner at six and having breakfast at, you know, 10 in the morning. So it's not, it's not terrible. And it's powerful to actually drive the activation of autophagy, mitophagy and killing some of these zombie cells, rejuvenating your immune system. Do stuff that's also challenges you in other ways, whether it's, you know, learning a new sport, whether it's you know, bike riding or tennis or horseback riding, you know, do something that kind of puts you out of your comfort zone and makes you learn new stuff. I picked up tennis when I was 45, and it was, I'm still learning and I'm still improving and growing. So it's, it's amazing. And also try something crazy, like public speaking. I do it. It's, it's pretty easy for me, but if you're not used to it, it creates a stress in your system. It may actually be a good stress. So try lots of fun stuff. Try do some fun and challenge yourself a little bit both. in terms of the life activities you can do, in terms of optimizing your diet, in terms of making sure you get all the right nutrients from polyphenols and from phytochemicals that are great for your gut microbiome, prebiotic fibers and omega-3 fats. So that's a great way to really think about reshaping your immune system to actually deal with the ravages of aging and inflammaging, but also to boost it so you can actually fight infections and cancer.

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Tell us Liz about some of your.

Patients that you've discovered how to actually work with it. Because it's something I also have seen in my practice. People get sick over and over again and you're going to see these people like, why are you always getting sick? And then you start digging and what.

Are the kinds of things you find? What are out of balance? What's out of balance? So for the first person I wanted to talk about, he was a 10-year-old boy and he was coming in because he was getting every cold and flu that was going around, right? So his mom was getting frustrated because he was out of school almost a couple weeks a year, if not more, because he kept getting sick. And she, of course, had to take off work and it was causing some disruption in their house. But she was also really just worried about him. Why was he picking up every cold and flu going around? We, you know, I got a good detailed history from him and he had multiple ear infections as a younger child. So when he was, you know, his first few years of life, even up to five, he was getting lots of ear infections and often treated with antibiotics, right? So he would get an ear infection and he would take antibiotics and then we get another ear infection and he would take more antibiotics. He had a lot of congestion in his in his nose and-: I mean even when he wasn't sick. Even when he wasn't sick, he was dealing with it. And that's an issue we know because when there's a lot of congestion floating around, sometimes it gets stuck, right? So kids that have a lot of congestion in their nasal passageways and their eustachian tubes, more likely for it to get-: More inflammation. They have more inflammation and it's more likely to get stuck and then another infection grows and you get an ear infection, for example.

So he had these recurrent chronic ear infections. So wait, so this is just to break it down a little bit. So what you're saying essentially is that that if you're living a lifestyle or you have food sensitivities or something is causing congestion and inflammation in your sinuses and your nose and your throat, that sets the stage for recurring infections.

Yeah.

Right?

So maybe the treatment isn't to fix the infection, it's to figure out why there's this problem.

Right, because the congestion gets stuck and then it's a breeding ground for a virus or bacteria to overgrow and an infection to take hold and for it not to be able to get out of the system.

You know?

And for him, you know, for him he had these chronic ear infections but now is getting everything. So when he had the chronic ear infections, it's important to note that he was given lots of antibiotics. So for his first five years of life, he was on multiple rounds of antibiotics, two, three times a year, getting antibiotics for these ear infections.

And.

That is something we often see, right? We'll see that somebody gets an infection, right? For this kid it was his ear infection, or for somebody else it might be a urinary tract infection or sinus infection. They are given antibiotics, but those antibiotics get rid of the infection, but they also can get rid of all that good bacteria that's lining the sinus passageways, the digestive system, the bladder area, right?

The microbiome.

The microbiome, right? So, and we know that those good bacteria, they're like the First line of defense. They're like that army on the front line, right? They can say, okay, virus, don't get into my body. Okay, another bacteria, don't come into my nose, right? Those good bacteria are aligning all the passageways in our body so that when.

We- They're part of our defense system.

Huge part of our immune system, huge part of that innate immune system, that immune system that's gonna attack right away when something new or different comes into the body. And so when we've been on a lot of antibiotics in the past, we will often see people whose immune system is not working as well as we'd like it to. So, and I think- so what you're.

Saying is that antibiotics, even though they treat infections, seem to mess up your immune system?

I think they do, yeah, absolutely. I think there's good studies to show that when you get, I mean, sometimes an antibiotic is necessary. But there's definitely been multiple times with lots and lots of people and of course all the antibiotics in our food supply, they're damaging a lot of that good protective good bacteria that are our first line of our immune system. So absolutely. Dr. Then it makes you even more.

Susceptible on the next round. Dr.

Exactly. And that's I think one reason why we see these chronic infections with people because they take the antibiotics but then it gets rid of a lot of the good bacteria. so it's easier then next time for that virus or bacteria to take hold and to become an infection again. And so we see this sort of cyclical thing going on with people. And so I think that's important for us to pay attention to and say, okay, let's step back and say, do we absolutely need to use this antibiotic this time for this situation? And I think as physicians, it's important that we are making that, we're being more careful with the use of antibiotics. But I think that's an area that we see issue with. And I think one reason for him, one of the reasons why he was more susceptible to these colds and flus. But I don't think it was the only reason.

Yeah, what was the other reason?

And I think that that's important to note, right? We always want to find one thing. We always want to say, oh, it's the one reason why somebody's immune system isn't working as well. But many times it's multiple things coming together.

And I just want to stop you for a minute there, In traditional medicine, we were trained to think about the one thing. We call it Occam's razor. What's the simplest explanation that can explain all of it? And we sort of do that a little bit in functional medicine, but the problem with traditional medicine is very reductionist. It's like this is one thing, and the truth isn't body is complex and it's a system, and it's many things.

It's more like a web than a razor. Absolutely. Right, and many times there's 10 different things going on that are contributing to why this person's immune system wasn't working.

So their microbiome, their diet, nutritional deficiencies.

All sorts of things. So for this child, you know, we realized also because of all of this congestion and frequent infections and a lot of ear infections as a kid, I said, well, you know what? Maybe we need to think about some food sensitivities that may be causing a lot of congestion for this kid and putting him at increased risk for these ear infections as a kid and infections now. Because we do know, we do know that dairy, and cow's milk is associated with increased risk of ear infections for some kids.

And also mucus production, congestion. I mean, I know by immediately get running nose and congestion. It doesn't affect everybody by that way, but it does affect a lot of people that way.

Yep. And he was willing to say, okay, I'm gonna, the kid, he was ready to say, I wanna stop getting sick all the time. And so he was willing to go off to do an elimination of dairy from his diet. And so that is one of the things we really focused on and we worked on. And it really did help. His congestion decreased. He wasn't getting as sick as much. But we did more than that because we also realized that he, you know, I did some nutritional biomarkers. I realized he was a little low in zinc, which is, you know, not uncommon to find, you know, so I.

Recommended- Zinc is so important for your immune function. In fact, in COVID-19, they're finding they're actually treating patients with zinc because it helps to interrupt the viral replication and the viral binding to this sort of cells and insertion into the host DNA. So I think it's really interesting to see that, you know, just even in this crazy horrible infection of COVID-19, we're going back to basic principles of what's required to help the immune system, zinc.

And vitamin C, which are being used intravenously in studies. Yes. And so for him, you know, we added in like 20 milligrams of zinc and 500 milligrams of vitamin C a day. And that was very helpful too to help him break this cycle. In addition, we found out that he had some elevated levels of heavy metals. So his lead was a little bit high. He was living in a home, he'd grown up in a home that was built in the early 1920s, or so, so it had more just lead in the water and in the walls of the house. So, it had been refurbished, but it's still, you know, his lead levels were higher than we'd like them to be. And we know, right, what we know about heavy metals, we know that high levels of lead are really a problem for both the neurological system and the immune system. But I think we also know that, you know, low levels can result in people's immune systems not working optimally.

And also mercury lead also affects interrupt the gut. So they interrupt the gut function, can cause leaky gut, growth of bad bugs in there.

So you've got other reasons for this. Dr. Yes. Right, that's true. That's very true. So we also, not only did we pull away dairy from his diet, we put him on a really good probiotic because he had been on so many antibiotics in the past. And probiotics, there's really interesting studies on how well they help the immune system. I mean, we need to do a lot more research here and figure this out a lot more. But they can really help with breaking some of the cycles for people who are chronically getting sick.

I remember this study I read years ago, it was a pregnant women who took antibiotics, I mean, who took probiotics, compared to another group that didn't. And the women who took the probiotics during pregnancy, their offspring had dramatically less eczema and asthma and allergies because the mothers took it. So same thing when you give it.

To kids, it also helps dramatically.

With these problems?

Yeah, absolutely. And can help improve the functioning of the immune system for some kids in certain situations. And then of course we gave him that zinc and vitamin C, but then I put him on a detoxification protocol. I really helped with getting these heavy metal levels down. We did a protocol that had multiple different components in it, but that was because we tested and we found that his heavy metals were a little bit high. So we worked to really bring them down with with glutathione, liposomal vitamin C, some binding agents, things that help supported the detoxification system in his body. And that comprehensive approach really helped his immune system improve and it helped him get out of that cycle of getting sick two to three times every winter. And I think it's really fun to watch and see that because we can see the results.

I hear there's somebody else, I'll talk to him. I don't get sick anymore. My sinus is I don't get the, this is the first year I've gone without having antibiotics for my sinus infections. I know, right? It's just so simple. I remember this kid who just reminded me of this story when I was in the emergency room years ago. And I was working Mercy Hospital in Springfield, Mass. And this woman came in with her toddler who was probably like maybe about two years old. And it had just so many ear infections, one after the other, after the other. And I said, well, when did this all start? And she's like, well, he was about a year old. I said, what happened is your role. I switched him from breast milk to regular milk. And that was like, and this is before I knew about functional medicine or anything, I was like, oh, well that's interesting. Why don't you take him off dairy and see what happens? And the kid was fine.

So I think sometimes it's sort of.

That simple, but I think often it's more comprehensive because one, you change his diet, you optimize his nutrient levels, and you also went a little deeper to look at his detox deoxification and his mental burden, which was also a factor. So you did diagnostic tests that can help pinpoint these issues and you can really create a precision approach to each individual. So this is his problem, but there may be somebody else who might have a different reason for their immune system not working. I think it's really important to understand that we at the Ulta Wellness Center and in functional medicine take a very different lens at looking at these chronic problems and say, what is the cause? How do we get rid of the cause? and why isn't the body working properly? And when I learned functional medicine, one of my mentors was a guy named Sidney Baker who's sort of a Yale pediatrician, just brilliant guy. And he was incredibly good at taking incredibly complex ideas and simplifying them into a few principles. And one of the most important principles that guys meet every day still today is a very simple question. question is, what do you need to get rid of in your body that's making it unhappy? And what does your body need to get in order to get healthy?

Yes.

So what are the things that are the problems that cause disease? And what are the missing factors that you need to have a resilient system? And so this is for the immune system. I was saying, so this kid, it was, he had too much Dairy that was bugging him. He had too many metals or bugging him. So you got rid of those things, and then you added in the things the body needed to function. You need to add it in the probiotics. And you add in the zinc and the vitamin C, and the body knows what to do. It's like when you take out the bad stuff, you put in the good stuff, it's just that simple. And sometimes it's a tough job to figure out what the bad stuff is that you need to get rid of and what the good stuff is that you need to get. And that's where the real meat of functional medicine is, is being able to.

Investigate those things properly.

And we don't learn that in medical school.

Medical school.

So, functional medicine, we learn how to dive deep into being an expert in what are the things that cause disease and how do you create a healthy human.

And I think that's really the power of supplements. Sometimes people are like, oh, what do supplements matter? Multi, is this helpful? Is this helpful?

Expensive urine.

Yeah, but when you can identify what deficiencies people have or because of their genetics they need more of. Right? When you can really specialize and give a personalized program for somebody, it makes a world of difference. You know, I remember in my undergraduate degree in nutrition and they were like, oh, you know, don't bother with supplements. You know, it was really food first kind of a program. So I never took supplements. I remember the first time I took a multivitamin, I was like, whoa, this is amazing. And it was a good quality one with good methylated B vitamins. I had so much more energy because I needed that extra methylation because of my genetics, right? So when you specialize and give a personalized approach, it really makes a huge difference for people. So key, so key.

So we see recurrent ear infections, recurrent sore throats, recurrent colds and flu. We also see recurrent sinus issues, which are very similar. But you had a case of a woman with chronic bladder infections.

Oh, this is so common. I mean, this is This is something we see all the time. And we know that at least 50% of women get one urinary tract infection in their lifetime, but lots and lots of women get many, many more. And a percentage of women have recurrent bladder infections to the point where they're put on antibiotics for prevention. They might be taking an antibiotic every time they have intercourse.

I remember that. I learned about that in medical school. I'm like, wow, that's such a bad idea.

Because let's go back to the microbiome, right? We've got microbiome, we've got all that good bacteria that lines our urethra and our bladder. And so that when we take antibiotics all the time, that is killing off some of those good bacteria, just allowing that bad bacteria to get back in there again, right? So it's really, we've got to work to break the cycle with women all the time. all the time with the chronic urinary tract infections. It's something I see so often in my practice.

Part of the reason women get it is of the anatomy. They have a very short distance between their outlet of their bladder and the vagina and then their bladder, it's very short, whereas man, it's a lot longer, it's harder for the bacteria to migrate up there and then it gets easily affected by hygiene and sex and de-hydration.

The most common cause of a urinary tract infection is the E. coli bacteria, which comes from our gut. And so there's, like you said, there's not a lot of distance between where the stool is coming out and the urethra and the bladder. So it's not an, you know, it's a common thing that we see, but there's a lot we can do to prevent that bacteria from taking hold. So this woman, she was a 40-year-old woman who had had bladder infections, you know, her whole adult life, and was at the point where she was she was needing to take an antibiotic every time she had intercourse. And really that was impacting so many other things. Now she was getting yeast infections and she was, you know, and her digestion was getting off. And so we were like, okay, we've got to get to this underlying, we have to work to break this cycle of chronic infections. And, you know, there's a lot of cool things that really help with stopping that cycle of recurrent bladder infections. I mean, you talked about some of the basics, right? making sure you're drinking a lot of water, you know, urinating frequently, peeing after sex, peeing before and after sex, right? Yeah, wiping from front to back, wearing cotton, I mean all the basics, but then there's some stuff that really is helpful, you know, to help break the cycle. And one of those things are the probiotics. There's been a lot of really interesting research showing that there's certain forms of probiotics, the lactobacillus rhamnosus and the lactobacillus reuteri, which are good bacteria for the urinary tract system, right? Like those bacteria you want to have a lot of in the urinary tract system. And that when there's good levels of those bacteria, you know, things are going to work better there. You might not be as high risk of getting some of those recurrent infections.

She's always trained that your whole urinary tract system is sterile, but you're saying there is a microbiome in the urinary tract.

Absolutely. Absolutely. And so you can take these probiotics, you can take them by mouth. We often will have compounding pharmacies mix them and you can apply them vaginally too, make it easier for the-: Infections and recurrent issues. Yep, and help those good bacteria climb up the urethra and into the bladder. But taking them by mouth is also helpful to create that nice microbiome or help replete the nice microbiome in the bladder area. we know that, that cranberry, you know, we've heard forever that cranberry is really helpful because it has a substance that prevents the bacteria from sticking to the bladder lining. So cranberry is really great. I, you know, I often don't want to give people to drink too much cranberry juice because it's high in sugar, but you can get powders of cranberry, and there's capsules of cranberry that can, that can be used.

And D-mannose is another substance. But you can. unsweetened cranberry juice.

Yes. Right?

Yeah.

Unsweetened cranberry concentrate. That stuff is sour, but it really works. You can take a quarter cup of that. Yep. You mix a little water and then drink it. There's no sugar and it really works. And people can do it every half hour, every hour, two hours, depending on the, you know, and it'll really help break the cycle. If they don't want to take antibiotics, I've had a lot of women who just trying to break the cycle and we give them things like cranberry. concentrate or cranberry supplements.

And there's another one you were just mentioning, D-mannose. Yeah, I was gonna mention also that other place to put the unsweetened cranberry concentrate is in seltzer water. It's yummy that way. Yeah, that's right. But the D-mannose is also another substance that prevents the binding of the bacteria to the bladder lining, so it's less likely to stick. And they've done studies showing that two grams of D-mannose can be as effective as antibiotics for prevention of a urinary tract infection. So both cranberry and D-mannose can be used for prevention and then if somebody's starting to have symptoms, they can really increase the amount that they're using to sort of stop that infection from coming on. So I think those can be really helpful as can the probiotics.

And we use herbs too sometimes. We try to avoid people getting antibiotics.

Yeah, yeah. I mean, the couple things you wanna watch for, right? If you get a fever, if you see any blood in your urine, if you get any back pain, if it's not getting better, or you really work with your doctor on this because they can, those infections can become serious for some people. And then they can go up to.

Your kidneys, which is bad.

Yeah, in certain situations. But some of those things can be really helpful for breaking the cycle. And I think that's important. And I worked with her with this one patient, we added in some cranberry and D-mannose, She was taking it on a regular basis, but then she also took it after intercourse. She took it frequently when she was starting to feel some sensation, like an infection might be coming on. We worked to make sure she was drinking lots and lots of water so her urine was more dilute.

You changed her diet, too, right?

We got rid of, I mean, she was on a little too much sugar. Why sugar bad? Because it can feed the wrong bugs in the body, right? it can feed the yeast, it can feed bad bacteria, and that is, you know, and also-- you- can feed viruses too. Absolutely, right? Because we know that when blood sugar is too high, that the immune system doesn't work as well, right? So for all those reasons, we cleaned up our diet, we pulled in a lot more of the good healthy vegetables that are rich in phytonutrients, that are anti-inflammatory and can help support the immune system. We helped her get off of the chronic antibiotics she was using because that is one of the best ways to help break the cycle of getting more and more infections. Yeah, so powerful.

Just to recap, we've had a couple of cases, one of recurrent ear infections and colds and sore throats and flus and other bladder infections. This really applies to anybody whose immune system is not working, who tends to get sick more often, who gets sinus issues. The treatments are sometimes slightly different, but we look we look differently at this with the lens of functional medicine. We look at diet, we look at food sensitivities, we look at the gut where 60% of your immune system is. We look at your nutritional levels like vitamin D. I mean, if your vitamin D level is low, you're much more likely to get the flu. And if your vitamin D levels are optimal, you can reduce the flu by 40 to 70%. Just that alone. We look at zinc levels and levels of your overall nutritional status.

Vitamin A, right?

Vitamin A, yeah. so we really take a deep comprehensive look and is there something else that's destabilizing your immune system? Are there toxins like in this little boy that might be just destabilizing the immune system? So we really create a model of a real clear diagnosis through history, a dietary analysis, detailed testing if needed. It's a little bit different than when you get a traditional doctor. It looks at these sort of root causes and then we kind of apply the method of restoring health. So we remove the bad stuff like you remove yeast and you remove the bad foods and the inflammation, dietary factors, maybe dairy, whatever it is. And then you add in all the things that need to rejuvenate the immune system. And it's some of the things we didn't talk about like sleep and moderate exercise and stress reduction and the whole foods diet and getting off of processed foods and sugar. These are so simple and they're so profoundly effective. in terms of rejuvenating immune system?

It's well accepted that stress is bad for your immune system. I mean, classic chronic stress, you know, acute stress, run from the saber-toothed tiger, that's really good. Chronic stress of my job, my life, the environment, politics, and the world is bad. We are now starting to appreciate that the opposite of that, The immunology of joy can be immunologically potentiating. And you mentioned a very nice example. I call this the immunology of gratitude. And gratitude has wide-ranging biologic effects. There's a recent study done at UC San Diego that showed that patients with asymptomatic echocardiographically documented congestive heart failure with six weeks of gratitude journaling could improve ventricular function.

Your heart pumps better and faster if you're grateful.

Right. So you got to open your heart, essentially. It's exactly. Let's take this a couple steps further.

By the way, before you go on, there's another condition which is the opposite, which is stress-induced heart failure.

Broken heart.

Broken heart. I literally had a patient with a broken heart. He was healthy otherwise. and he went into heart failure after his wife died.

Sure.

And through using various modalities around stress and energy medicine, we were able to get it better.

We think that that's the basis of, you know, of voodoo deaths. Yeah. You know, you're petrified and your heart. So it's all connected. That's a good point.

Voodoo toxin.

Right, right, right. So the immunology of joy, there's been some tremendous work in this.

It's such a great phase, the immunology of joy.

Yeah, so, Some people, Cohen from Carnegie Mellon has done such beautiful work looking at resistance to respiratory viruses and the effects of hugs and did this elegantly controlled study where they measured social interactions, the amount of touching that goes on in a person's life and then then actually inoculated all the people in the study with a cold virus and then measured their antibody responses and clinical things, and hugging was an important and significantly clinical variable. Even though the hug people were more exposed to viruses, you know, they were protected. So, I mean, a small example.

That's great. So, hugs so you won't get sick. That's why when Leni ever comes to see me, We always hug each other. I was like, all right.

It's therapeutic, right?

It's the only doctor at Cleveland Clinic who gives me a hug. It's pretty amazing.

That's good. I want to be known for that. Folvio DeQuista from London, who's going to be visiting us in May, where my immunology summit, which has been going on for 16 years, is actually going to start out full half day on the immunology of wellness. who does experimental work on the immunology of joy. And he actually has animal models. Mice, take mice and let them live in his little home, take another set of mice and put them in a dirty cage and they get all upset and you take the other set of mice and you put them in the Ritz Carlton house and you pet them and their immune systems shift. So, you know, we don't know how to quantify this but it certainly fits with our model that in those behaviors of diet, exercise, sleep and stress, we want to move our affect in a more positive manner. And I see this every single day that, you know, sometimes we see immunologic diseases that we just can't, we can't do anything about with targeted therapy. And we have to deal with it, you know, biobehaviorally. and people have to, they have to be empowered to do this. And that's where I think that, you know, you guys have been doing this for your whole career. And, you know, but 20 years ago, you were the wellness guys. You were over here, all right? You're over here. This was alternative therapy. I'm trying to bring immunologic strength, wellness, and immunologic health building to the mainstream of people. some of the people that you're interviewing on the show who deal with immune-mediated inflammatory diseases every single day. So, you know, we're shifting the curve a little bit.

Well, what you said was really important before. You said before wellness was sort of a nice idea that we all believed in but didn't have a lot of data. Now you're saying there's a lot more data. And I saw a study recently where they literally injected cold viruses into people's nose and they looked at stress questionnaires.

That'S the same work of Sheldon Cohen.

Incredible, and they found that those who scored high on the stress questionnaires got colds and the ones didn't, even when they injected the cold virus right in their nose. That's right. so what kind of data are you seeing around stress and wellness, diet? Let's just kind of go through it. I want to spend a little time digging in because it's such a compelling area and I think your work is.

So important and you're such a great voice for this. well, you know, we'll knock these down one at a time. But one of the interesting things that has happened here is that a decade ago, I felt very comfortable talking about these topics to the wellness community and translating it for them. But it's taken a bit longer, and only in the past five years am I now trying to take to the airways, literally, and in the scientific literature to bring it to my immunology colleagues. So it's a shift. And the data speak for itself. Let's just take one disease. Let's take rheumatoid arthritis. So, okay, so for the audience, rheumatoid arthritis, most common cause of inflammatory arthritis, you know, 100 years ago, inexorable, terrible illness. The great Sir William Osler, the greatest physician of the past century said when he saw a patient with that disease walk in the front door, he would walk out the back door. Even when I was a resident and fellow, we had very little to offer. Steroids and steroids were just in the dawn of them. Today we know so much more about this. So we have large studies. Who gets rheumatoid arthritis? Well, there's a genetic predisposition. You have the genetic makeup, but not everybody that carries the gene gets the disease.

So they have- But not everybody who has the disease has the gene.

Exactly, but most do. So we have hypothesized for a long time that there are environmental influences, so gene plus environment. And that environment may be external, could be your own behaviors. Big studies like the Women's Health Study that have looked at you know, 100,000 women for decades have found that if you take people, women who are predisposed to rheumatoid, it's many autoimmune diseases are female predominant.

More, yeah, mostly.

Yes, and you look at certain variables, diet, okay? And if you, you know, just to make this understandable, if we take the dietary range here from over here, the standard American diet, sad diet.

Yes.

And over here, let's just call it the prudent diet. And at the end, we would peg this as a vegan diet. The further you go down toward a healthy diet, the more plant-based you become. Statistically, for each quartile, for each quarter of dietary health, you statistically lower the likelihood of developing rheumatoid arthritis, particularly when you're young and active. It's an unbelievable and stepwise regression. And, you know, so we know that diet can be a tremendous influencer. Once you have the disease, once you have the disease, looking at dietary composition, we know that patients that eat fish twice a week will have statistically, and I'm not talking about trivial improvements, palpable lower disease activity than people who are non-fish eaters. And in fact, just eating any fish in your diet in these cross-sectional studies have suggested that it contributes to this. So composition, healthy fats, things that we can dig into a little bit later. So this is hugely important. So we can take people who are, you know, genetically predestined to this and modify their risks early on and once they have the disease, actually can make contributions to lowering disease activity.

What are the kind of diets, besides for example, eating fish, what would be the dietary recommendations you'd give to someone with inflammatory disease or rheumatoid arthritis?

You know, so my recommendations are to, well, ultimately, you know, I'm very happy with someone who has achieved a semblance of what we would recognize as the Mediterranean diet, I'm very happy with people who have achieved, you know, becoming.

Either.

Total vegans or close to that. Very good data coming out now that Paleo diet also can have some anti-inflammatory effects and Pegan diet, you know, I tell you know, so, you know, people are not coming to me. So what's different for people who come to see you and people come to see me. So people who are coming to see me are coming to have their disease sorted out. They're looking for the most advanced targeted therapies and they're looking for a little extra. People coming to you are looking how to rearrange their lives and do this. So I have a very slow and stepwise process.

It might scare them away if you.

Told them to go to a meatless Monday. I'm very happy Let's start. And the one thing that we know in IBD diseases, it's not a foot race, it's a marathon. So I'm gonna be seeing people for years and decades.

IBD diseases is immune-mediated inflammatory disease.

So rheumatoid, inflammatory bowel disease. So we try to take the low-hanging fruit and try to make little modifications and then over time, I'm so impressed that you know, people can make meaningful progress. So that in the dietary aspect, I encourage, you know, real food, get rid of the junk, plant-based monosaturates. I have no problem with protein as long as it's high quality. Yeah. And I think there's a place for it. So that's where we start with people.

Yeah.

Step two, exercise. I became.

By the way, for people, maybe not realize, but 60 of your immune system is right underneath the lining of your gut. So it's there because you're exposed to foreign molecules from food and bugs, and your immune system is the first line of defense. And so when that system gets disrupted, and you get what we call a leaky gut, it creates a lot of inflammation. And so changing your diet has a huge impact on there, working on. inner garden, your gut microbiome plays a big role.

Yeah, you know, I'm glad you brought that up and diving into the science just a little bit. I mean, the microbiome, which is connected to every organ system in our body, and you've talked about it extensively on this show, is critical in both the development and the function of our immune system. I mean, you know, if you're born with a sterile gut and you're immunodeficient, and we know that from animal models, we know it from people. We know a lot about, and you just, you know, I had Dr. Hazen on the show, studied this in the most, you know, robust scientific way possible. You know, we know what healthy microbiome kind of looks like, you know, diverse, and rich. We've yet to dial it into this organism, that organism. So we know that good diets, people that eat real food, usually have a more diverse and rich microbiome and that supports immunologic health. I'm reluctant to tell people, Carl Sagan used to say that extraordinary claims require extraordinary data. and so we don't know how to reduce it to that crystallized, eat this, do this, one thing. It's probably much more complicated than that, but we do know that prudent diets versus sad diets, a huge effect on the In the frame of functional medicine.

We often people fall on elimination diets, which is eliminating inflammatory foods and anti-inflammatory diet. Things like gluten and dairy can be an issue, processed food obviously, eating more whole foods, plant-rich foods is really key.

So that's sort of what you're saying.

Absolutely. Yeah. All right, so the next topic would be, you said exercise.

Exercise. So I've been interested in exercise and immunity for decades actually, probably one of the first areas of behavior and immunity that I became interested in. And it's a complex area to talk. So over the past many years, I try to invite world leaders in all of these areas to my center to visit. And last year we had David Nieman, who's one of the undisputed leaders in this field. And, you know, I do believe in what we call the J-curve of exercise, that people who are sedentary, people who are sedentary, are immunocompromised. And we know this both from the laboratory and the risks of, you know, the kind of the canary in the coal mine that we measure usually is respiratory illnesses and how many is normal and how many do you get?

Being a couch potato is bad for your immune system.

It is definitely bad for your immune system as well as virtually every other system in your body. But I'm looking from the lens of immunologic strength.

We just talk about heart disease and things like that, but this is a whole new view.

This is it. The thing that you can do to demonstrate immunologic enhancement is moderate exercise. And, you know, moderate exercise is still a moving target. And, you know, if we look at the guidelines, which have been recently revamped only in the past couple months, you know, walking is an incredible form of immunologic strength building. And we actively endorse, and what we talk to about our patients, is just like with the diet, tell me where you're at in this spectrum of exercise. Are you the couch potato and you work in a cubicle and you're sitting there all day long, you're doing nothing, or are you, you know, training for ultra marathons at the other end? No matter where you are, we try to move people down a bit at a time. And Betsy and I, my nurse practitioner, world's best nurse practitioner. We talk to our patients about instant recess. That's what we call. And we say, you know, if you're totally sedentary, just get up and start moving. And now I'm copying you. So at my immunologic summits for the past two years, I invite our head yoga teacher from the Cleveland Clinic. like Judy, who comes and we do yoga at all the sessions. So the first time I did this at a scientific meeting, these guys are like, what?

What's going on here?

And now it's like so popular. So anyway, we start moving the needle down to moderate exercise. There still is some data and there's some controversy that's recently been added into this. you know, the middle path is very strong for health and wellness, right? And you know, you can, too much of something is often as bad as not doing it. And there have been a lot of epidemiologic evidence to show people who are ultra exercisers can actually do harm. Like marathon runners and beyond, now you have ultra marathon runners. You know, and it's not, I don't think it's coincidental, and I'm sure you've seen this in your practice, I've seen many people who have developed, you know, what we would recognize now as chronic fatigue syndrome, who had started out as very high endurance athletes, and then something has fallen apart. And you just wonder in your head of whether this was a predisposing factor, but we get people moving. So there was a very interesting study done at the University of Colorado in the last about 18 months, where they experimentally took a group of people who work at a sedentary job, cubicle, sit there all day long, and they randomized them to you get to go to a gym and come in a half hour late and you do 30 minutes on the treadmill versus you who all you have to do is for five hours during the day, get up and walk around five minutes out of each hour. five minutes out of each hour. And then they measured a number of outputs. And while they didn't do immunologic function, they looked at vitality, well-being, mood, et cetera. The people who won were the people who were just getting up and moving.

Walking around.

Yeah, you know, you don't- you- need.

A step counter, the 10,000 steps.

All of that stuff that Mike Roizen talks about and our whole enterprise engages in. You know, it's, I think it's good for your body, it's good for your brain, and it's clearly good for your immune system. So it's just a small bit of data. And similar to what we talked about from the Nurses Health Study on diet, there have been several large epidemiologic studies to show that people who carry the predisposition to rheumatoid arthritis, who are more physically active, will have a lower incidence of actually developing the disease over a lifetime. So you've got two areas that there's clearly enough data for so many reasons. Cardiovascular health, emotional well-being, and immunologic strength.

So what happens to your immune system when you exercise? Not like the ultramarathoners, and I know you've written about this where you see even clinical studies looking at ultramarathoners versus regular folks, their immune system is different, their oxidative stress is more. What is actually happening when you exercise your immune system?

It's actually still relatively poorly understood if you divide it into two types of studies. One of the studies where you can do it in a lab and come in and do an exhaustive stress test or cycle till you've hit the oxidation wall and hit your aerobic capacity. It's not surprising that all types of things happen to your immune system. You have trafficking of immunologic cells, you have elevations of inflammatory cytokines, those are the mediators that cause inflammation, and redistribution of lymphocytes like T-cells and B-cells. I've always said, well, I would expect that. That's just stress and your immune system is moving to stress. The more important question is if you take a person who's sedentary and a person who has moderate activity and a person who is an ultramarathoner, do their immune systems differ by what we have traditionally measured, T-cells and B-cells and inflammatory cytokines and the like? And the answer is there's very little difference that we can detect. And my response to that is that, you know, We have very poor tools. We're just now, you know, we're looking.

With an eyeglass instead of a telescope.

We're looking at the same techniques that we looked at, you know, 40 years ago, where in the next five years we'll be looking with, you know, what we recognize as omic technologies, where we're looking at the entire cloud of data of how your genes are functioning and how your proteome and metabolome. So some of that work is starting to be done right now. and I look forward to seeing more of it.

That's pretty exciting. So eating, right, exercise. Let's talk about stress because I think the data is pretty clear that stress is not good for your immune system, but that the act of managing stress or actually doing things that help reset your stress response actually can help your immune system. And it's really the conversation about molecules of emotion.

It really is. I think that this is the most exciting area going on in immune behavioral science right now. And the data that are being generated are, you know, pretty impressive. So let's just talk about, let me back up and give you just a magic minute on triggering the immune system. So, you know, we have this immune system here. It's designed to defend us from all types of dangerous signals. We traditionally think of that as external signals such as infections, and it certainly does all that. There is another set of danger signals that we are just now starting to understand, and you brought up the term psychoneuroimmunology. Mouthful. It is, it is. your psyche, your nervous system, and your immune system. And we don't know what stress levels were 200, 500, 5,000 years ago, but we do know that today, living in this world, stresses are different. You're carrying your phone in your pocket. I had to turn it off when I came in here and I'm probably already getting nervous about how many emails stacking up while I'm having this nice conversation with you. The exigencies of modern life are complicated. Add to that the environmental stresses. We're living in a world where the temperature is rising, pollutants are bombarding our body. Those are danger signals. and so there is a tonic level of stress there that I think is probably new in the industrial age. Processing that is our brain by and large, and the brain can send signals to the body that promote inflammation. Inflammation is good when you cut your finger, it's bad when you have it for 10 years. So the immune system is triggered by stress to generate accelerated inflammation, which contributes to all these immune-mediated inflammatory diseases that we're talking about. Yeah. Contributes to acceleration of aging, and that includes aging of the immune system. And we have this great term called immunosenescence. you know, your immune system.

Does it sound good?

It does not sound good, right. So all of this is going on.

Dying of your immune system is what it means in English.

That's right. So with that as a background, the question is, you know, what the heck do we do about it? Yeah.

And I think the science is really good about what happens to your immune system under stress. It's not just an idea. Stress is bad for you. It's actually mapped out pretty well.

It's mapped out in incredible detail, and we can look at people who mood disorders, we can look at people who are caregivers for patients with cancer or dementia, we can look at people with PTSD, we can look at all of these populations and there's profound perturbation of their immune response. So how do we move that needle? How can we do that? Well, you know, there are a variety of techniques, but the ones that have been best studied surround the use of mindfulness meditation. And I'd like to just take a couple minutes to talk about this with you, because I know that you're a great practitioner. And so for those in your audience who are many of are well familiar with this, the cognitively based mindfulness based stress reduction developed by Jon Kabat-Zinn, 25, 30 years ago has been the standard bearer of research. Of research. And, you know, I give unbelievable credit to his pioneering efforts and all the data that's been generated for this. But as you know, this is pretty demanding stuff. And, you know, day of introduction, you know, you have- Course, he's stressed.

Is hard work.

Eliot said, if I had enough time for CBCT, I wouldn't be stressed. Mindfulness-based stress reduction. I'm sorry, mindfulness-based stress reduction. So I've been asking the question for the past number of years whether lower doses of mindfulness can have beneficial effects on all the domains that MBSR has had effects on. All right.

So you need an hour twice a day. Maybe there's like a different dose.

Maybe there's so, you know, we have a program that develops at the Cleveland Clinic, Stress Free Now. And Stress Free Now has been used in multiple settings and we've published in scientific literature, you know, when, you know, hundreds of engineers have taken this, people from call-in centers that are all stressed out, that 15 minutes four times a week appears to lower stress levels.

15 minutes twice a week.

15 minutes four times a week seems to be a sweet spot, which is, you know, that's doable.

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