In this segment of the "Medicine Health with Dr. Paul Anderson" series, Dr. Anderson explains why chronic infections may persist by focusing on factors that suppress or block immune function. He first examines medically induced immune problems, detailing how steroids, certain anti‑infective drugs, and biologic/targeted therapies (used in oncology and autoimmunity) can dampen immune responses, mask infection symptoms, and create opportunities for opportunistic infections. He emphasizes the need for careful dosing, tapering, and concurrent monitoring when these medications are prescribed. The discussion then shifts to physical and lifestyle contributors to immune inhibition, such as chronic sleep deprivation, high‑sugar diets, sedentary behavior, and other concurrent illnesses. Dr. Anderson advises patients and clinicians to adopt a top‑down, comprehensive assessment approach—testing for hidden infections, working with specialists, and addressing lifestyle factors—to improve immune competence and enable chronic infections to resolve.
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What you meant to me. Welcome back to Medicine Health with Dr. Paul Anderson, and today we're talking about why won't my chronic infections resolve? And there's a lot of answers to that. In this section, what I want to talk about are things that sideline or suppress or slow down or otherwise mess with your immune system's function. So in other sections, we've talked about things like other infections, co-infections, superinfections, etc. And those certainly are a problem. But what if we go beyond the level of other infections not allowing your chronic infection treatment to work? And then we get to what if my immune system is suppressed or slowed down or inhibited or blocked And this is happening more and more and more than really we've ever had in the history of humanity because of many factors that we can get right into here. Now, there's a number of ways we can get at the immune system. And it can be one big thing, but a lot of time it's a bunch of little things. And so, you know, just like with chronic infections interfering, a lot of times, you know, it's one other infection, sometimes it's 10 other infections. Well, with immune blockade or immune inhibition, etc., there's a number of ways that that can happen to us. So big category we'll talk about will be medically induced immune problems. Then another big category are more physical or body function reasons for immune issues that go on. So what we'll do here is first take a look at what would be the medical conditions that would cause a problem. Okay. So when we're thinking about that, one that's very common would be the use of steroids. Now steroids, a lot of people have heard of things like prednisone or maybe dexamethasone or beta methasone. Steroids tend to end in -sone, -zone, or -onide. Those tend to be steroid drugs. And there's a lot of good reasons to give people steroids. Now, there are, you know, you have to put a caveat on that because every drug has a side effect. And, but if you are going to keep having a seizure because your brain's inflamed and you have no other option, steroids are part of the management there. If you have an orthopedic problem and your joint swells up and there's no other management, steroids are a piece of that. If you get a vasculitis where you can go blind from vasculitis or have many other problems, sometimes steroids are very critical there. Now, they're a two-edged sword because usually the stronger that a drug works in one direction, the more side effects you get in the other direction. And one of the problems that steroids have really is that they block the initial sequence of chemistry that tells our immune system to wake up and do something. So if I am on steroids and I have an infection I'm exposed to, I'm more likely to exhibit no symptoms of the infection till it's really blowing pretty hard in my body. And so this is one of the problems where if you're, for instance, managing somebody somebody and they have an inflammatory problem that might kill them, but they also have an infectious problem and you give them steroids, you generally go also and you give them things to deal with the infection too. Because I've actually seen cases where the inflammatory part of the problem was treated heavily with steroids and then there was a, let's say, a fungus or something like a coccidiomycosis or something. And that doesn't effectively get treated. And so the steroids push the immune system down, so this, you know, inflammation gets better and the, you know, the infection just goes crazy. I've also seen people develop pneumonias and all sorts of other things when this has happened. So it's not without a cost. Well, steroids— people are on steroids for many reasons. We talked about pain, orthopedic problems. Allergy is a big one, acute allergies, other immune problems. autoimmunity, et cetera, et cetera. So what you want to think about there is if your healthcare provider has prescribed steroids for you, do not go off of them. Going abruptly off of steroids can actually kill you. So you would never want to do that. But you want to be informed about, you know, why do I need this? Is this the right dose, et cetera? And normally, not in all cases, but normally we healthcare providers have some sort of plan where we're going to taper the steroids down. or off at some point, or at least to a very low level, because the lower the steroids go, the less immune suppression. But at most steroid doses that are required to, you know, shut down inflammation for most things, you're also shutting your immune system down. So steroids are a big one. There's also some anti-infective drugs that are a little sidelining to the immune system. Now, what often happens with these is that the prescriber may give a covering drug or treatment to cover the immune suppression from the other one. So sometimes you might be getting a, you know, sort of a backup medication to help you out there. But there are some times where anti-infective treatment will create more of an opening—
Excuse me.
other infections to come in. So it's sort of a selective immune suppressive device. So that happens not uncommonly. And then the area that's literally multi-trillion-dollar part of the pharmaceutical industry, it's the biggest area of drug development anywhere in the world. And that is your biological or targeted medications. Now, biological drugs or targeted medications tend to be used in oncology, so with cancer patients, and also in autoimmunity. Now, there are many other reasons they might be used, but those are the 2 big areas, autoimmunity and cancer. The upside of a biological drug is that it literally targets something as a process in your body to slow it down or to modulate its immune function or many other things. The downside is that a lot of the things that they're targeting with the biological drug are things that are immune switches or triggers, and downstream then you might not provide an immune response that would be useful and helpful. So sometimes the, you know, the side effect of being on a biological drug is that you have to have more immune surveillance. You need to watch what's going on. We have had clinically people, say, with an autoimmune disease who are on a biologic drug and their autoimmune disease is much better, things are working way better, but then they start having chronic infectious problems and we go and we test them for chronic infections. And we've had people where, again, their primary autoimmune condition being treated by the biologic drug is you know, almost asymptomatic, but they have opportunistic infections of many types. We've had patients where they've had, you know, 1 or 2 fungal infections, 3, 4, 5 bacterial infections, potentially a few viruses and other stuff as well, and no symptoms at all of those infections. And that's simply because the biological drug is doing such a good job putting a lid on the immune system that you wind up having— you know, more growth of these other infections, but your immune system isn't responding, so you get no symptoms. They might feel fatigued or something, but basically you get no symptoms. So that's something really to keep track of and look at. What I usually recommend to people who are on long-term steroids or biological medications, or maybe even a long-term, say, anti-infective therapy, such as, you know, treatment for tuberculosis or something, is that you, you do kind of do an assessment of what else is going on, maybe do some other testing for infections and work with somebody to treat them and work with somebody to work on your immune system and your immunology. But you need to keep in mind that especially on steroids and biological drugs, You may not feel sick, you may not feel as sick, okay, because the symptoms of the infections that you have are being pushed down, masked over by the medications that you're using there. So that is very, very important to keep in mind as well, and you should monitor, you know, those things with your healthcare provider or another healthcare provider who's doing your chronic infection work. It's also really common that we have people with 2, 3 things going on at once. They may have chronic infections and autoimmunity, and you're juggling between what to do with each one so you get enough treatment in that area. Now, the other thing is beyond the drug world of drug inhibition of immunology, et cetera, is your physical body. And so areas that decrease our immune function. One is lack of appropriate sleep. Your immune system recharges a lot at night while you're asleep. There's a whole lot of other benefits. You know, if you deprive people of sleep long enough, they will literally die. Well, if you chronically are sleep deprived, you will be chronically immune inhibited. There's also things like your diet, and that could be a whole bunch of things. We need a whole program just to on the diet, but there are diets that are better and worse for immune function. Basically, the more sugar and insulin activity, the worse for immunity. Movement of your body, the more you exercise, the more you move, the better your immune function will work. And then there's other illnesses. Maybe your immune system is being suppressed because you have a number of other things, you know, kind of like the co-infection model, only in this case it's maybe other illnesses that are going on. So this is why you need someone looking top-down at, you know, what's happening with you. All right, well, that's our section. We've got to get off here for this segment where we're talking about why won't my chronic infections resolve, and this segment has been on things that suppress or block your immune system. We'll be right back.
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