Nancy Sudak, MD, IFMCP October 8, 2021 KEY LIFESTYLE STRATEGIES TO SUPPORT IMMUNE FUNCTION

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KEY LIFESTYLE

STRATEGIES TO

SUPPORT IMMUNE FUNCTION

Nancy Sudak, MD, IFMCP

October 8, 2021

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ATTRIBUTION

• A considerable portion of this material is curated from the Institute for Functional Medicine

• Excellent resources regarding COVID-19: COVID-19 Functional Medicine Resources (ifm.org)

• Includes free presentations and patient education handouts

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CONTRIBUTORS TO DISEASE

Genetic

susceptibility

Chronic toxic

exposures in air, water, food,

cosmetics

Chronic

insufficiency of vitamins, minerals,

phytonutrients Stress &

trauma

Microbes/

infection

DISEASE

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SOCIAL COVID-19 SUSCEPTIBILITY FACTORS

Racial or ethnic

minority

Limited English proficiency

Housing occupied with high number of people

per room

Household without vehicle

Lack of food access Institutionalized

individuals Disabled individuals

(Karmarak)

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PHYSICAL COVID-19 SUSCEPTIBILITY FACTORS

Preexisting chronic cardiac or pulmonary

disease Hyperglycemia/diabetes

Obesity

• Visceral fat higher in patients accessing ICU

Chronic inflammation

• High cytokine activity

• Upregulated NLRP3 inflammasome

• Bradykinin

Age/immunosenescence

Oxidative stress

• Glutathione deficiency

• Drives cytokine storm

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PREVENTION IS THE TICKET!

• Normal isn’t healthy (CDC)

• 60% of Americans have at least one chronic condition

• 40% have two or more conditions

• 25% of children ages 2-8 have a chronic health condition

• Key underlying factors: tobacco, poor nutrition, lack of physical activity, alcohol use

• Need multi-factor upstream approach

• What supports immune function supports general health and vice-versa

https://www.cdc.gov/chronicdisease/resources/infogra phic/chronic-diseases.htm

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FOCUS ON THE INFLAMMASOME

• Inappropriate hyperinflammatory response underlies severe cases of COVID-19

• Driven by overexuberant cytokine release

• The co-morbidities that portend greater risk are all associated with high basal inflammation

• Serum LDH indicates tissue damage supported by widespread cell death

among monocytes, alveolar epithelial cells and endothelial cells of lungs and kidneys

• Hyperexpression of TNF-a, IL-6 and IL-8 commonly seen in severe COVID (Vora)

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KEY FACTORS: OVERVIEW

Sleep

Exercise Social

Connection Stress

Management Food and

Nutrition

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Food and

Nutrition

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STANDARD AMERICAN DIET (SAD)

• Standard American Diet (=SAD 😢😢) is inflammatory--

sugar, high omega 6:omega 3, unhealthy fats, processed foods (Christ)

• Single highly processed meal leads to 100% rise in IL-6 within 6 hours of eating

• Pesticides can also affect immune function (Gore)

• High intake of omega 6 fats activates series 2 pro- inflammatory compounds

• High intake of fat and CHO stimulates toll-like

receptor inflammatory markers and others (Molendijk)

• Table salt induces pathogenic T helper cells (Th17)

(Kleinewietfeld)

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BALANCING INFLAMMATORY PATHWAYS

• Inflammation is critical for proper immune response

• HOWEVER: prolonged or upregulated release of inflammatory mediators (IL, PG, TNF) can cause morbidity and chronic disease

• Whole foods or Mediterranean diets well studied to reduce inflammation (Bonaccio, Modndijk)

• 9-13 svgs colorful fruits and vegies

• Why so many? Powerful antiviral and immune supportive effects! (Zakaryan)

• 28-35 grams fiber from whole foods

• Fermented vegies/probiotic containing foods

• Low intake of added sugar/salt, high glycemic load

foods, excess fat

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OXIDATIVE STRESS

• Oxidation is the process by which we use the oxygen we breathe for energy production.

• ROS (contain only a single oxygen bond) naturally created as a function of energy production

• ROS are highly reactive, damaging

atoms/ions/molecules with one unpaired electron that targets fats, proteins and DNA (the aging process)

• Oxidative stress is an imbalance between the

natural production of free radicals (ROS) and our body’s antioxidant system

• Antioxidants from whole foods scavenges ROS and prevents cellular damage

• Oxidative stress cytokine storm perpetuate one

another in a loop of upregulated inflammation

and cellular damage

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Causes of oxidative stress

• Smoking

• Processed foods

• Alcohol consumption

• Pollution

• Toxins

• Radiation

• Grilling, frying, high temp cooking

Ways to reduce oxidative stress

• Regular exercise

• Stress management

• Food (Halvorsen)

• Herbs/spices

• Nuts/seeds

• Chocolate

• Vegies/fruits

• Antioxidant supplements

• In moderation: red wine, coffee

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ROLE OF THE MICROBIOME

• 70% of immune system is located in GI tract

• Dietary fibers from whole plant-based foods is fermented by bacteria for energy and SCFA production

• High fiber diets improve gut barrier fx by increasing SCFAs

• Dietary diversity is critical for a healthy gut ecology (polyphenols)

• Downregulate TNF, NF-kB, AA, TLR; inhibit oxidative stress (Yafoufi)

• Microbial diversity associated with less metabolic dysfunction (Cotillard)

• Fermented foods (yogurt, kimchi, miso, sauerkraut) can provide healthy microorganisms for these processes

• Specific strains of microorgs may affect specific viruses

(Yamamoto; Yamane)

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Stress

Management

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STRESS

• Acute and chronic stress can suppress immune function and increase susceptibility to illness (Segerstrom)

• Can alter wound healing and exacerbate AI dz, allergy, asthma (Agarwal).

• Implicated in morbidity/mortality of cancer, HIV, IBD (Marshall)

• Increased risk of viral infection (Klein, Aich)

• Brief mental stress in healthy adults can lower T-reg cell function (Freier)

• Mechanisms

• SNSEpi/NETranscription factorsSynth of inflammatory cytokines

• Activated HPA axis increases cortisolLong-term lowering of inflammatory cytokines needed to fight infection

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STRESS

• Allostasis ( general habituation over time)

• Common to fail to recognize stress as a primary driver impairing well-being

• Inability to regulate emotional states and labile

mood are associated with immune suppression and viral shedding (Horn, Strachan)

• The good news: stress management reduces infection and severity of infection

• Multiple studies show mind-body practices benefit immune regulation (decreased NF-kB, improved CTRA) (Buric)

• Upreg of genes that support neutrophil fx and downreg of inflammatory mediators but not immune suppression (Li)

• MBSR reduced post-stress inflammation (TNF-a

and IL-8) compared to controls (Rosenkranz)

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MEDITATION

A group of techniques, most of which started in Eastern religious or spiritual traditions. In

meditation, individuals learn to focus their

attention and suspend the stream of thoughts that normally occupy the mind. This practice is believed to result in a state of greater physical relaxation, mental calmness, and psychological balance. Practicing meditation can change

how a person relates to the flow of emotions and thoughts in the mind.

--Nat’l Center for Complementary and

Integrative Health

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MEDITATIVE PRACTICE: MANY FORMS

• Mindfulness meditation (MBSR)

• Transcendental meditation

• Focused attention

• Effortless presence

• Loving kindness

• Mantra meditation

• Guided meditation

• Qi Gong

• Yoga

• Progressive relaxation

• Repetitive prayer

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THE RELAXATION RESPONSE

• The relaxation response is a physical state of deep rest that changes the physical

and emotional responses to stress and the opposite of the fight or flight response.

• Shifts toward parasympathetic dominance

• Timeless book: The Relaxation Response,

by Dr. Herbert Benson

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EMOTIONAL FREEDOM TECHNIQUE

(TAPPING)

Tapping on acupressure points deactivates stress response

Combining with meditation enhances effectiveness

Effective for acute and chronic anxiety and PTSD

Can be very helpful for any condition:

pain of any nature, low mood, fatigue, insomnia, lack of motivation, food issues

Resources:

The Tapping Solution App

www.eftuniverse.com, www.coursesforlife.com

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Sleep

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SLEEP

• Sleep has a MAJOR influence of immune regulation and inflammatory signals.

• Enhancement of sleep during an infection is assumed to feed back to the immune

system to promote host defense (Besedovsky)

• Impaired sleep linked to short term and chronic illness (DM, CHD)

• Risk of infection is higher in individuals who sleep less than 6-7 hours/night (Prather)

• ICU patients can have prolonged

recovery from sleep deprivation (Pisani)

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SLEEP

• Sleep is restorative and anti-inflammatory and should be considered a fundamental element of personal health (Irwin).

• Analysis of cell types and cytokines during nighttime immune activity suggest that

sleep strengthens adaptive immunity (Irwin

& Opp)

• Sleep is important for vaccine effectiveness

(Zimmerman)

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SLEEP

• Quality and quantity are critical—7-8 hours

• Make sleep a priority you will not compromise

• Set a regular bedtime and associated rituals

• Refrain from using devices late at night

• Sleep in cool dark room

• Limit caffeine and alcohol

• Allow 3 hours before last meal and bed

• Gentle yoga before bed

• Meditation before bed (Insight Timer is free and fantastic)

• High quality essential oil blends can be helpful

• Consider CBT-I

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Exercise

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EXERCISE

• Moderate regular physical activity improves immunity

• Movement promotes oxygenation, circulation of blood and nutrients, elimination of waste from cells

• One effect of pandemic for many individuals is sedentary lifestyle, which ironically can impair host defense

• Isolated exercise does stimulate rapid cellular changes to stimulate immune function, but regular

exercise has more sustained

effects (Dimitrov, Nieman)

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EXERCISE—WHAT CAN YOU START NOW?

• ACSM advises 150 mins of moderate aerobic activity per week

• Less than that is better than nothing!

• 30 mins a day 5 days a week is a reasonable goal

• Do not overdo

• Outdoor exercise in clean air has additional benefits—

Shinrin-yoku (Hansen)

• Preliminary reports of yoga and tai chi/qigong supporting immune activity

• So many options—choose the most fun!

• Walking, jogging, stair climbing, chair squats, yoga

poses, yardwork, dancing, hand weight routines,

online programs, aps.

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Social

Connection

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SOCIAL

CONNECTION

• Social isolation, loneliness, bereavement and conflict implicated in proinflammatory immune response and

increased viral susceptibility (Leschak)

• Being in a sick state increases sensitivity to social threat

(Eisenberger)

• Individuals who are lonely or socially disconnected tend to show higher levels of

proinflammatory cytokines

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SOCIAL CONNECTION

• Individuals who feel interconnection with people or higher meaning/purpose have

favorable gene expression, decreased stress, increased antibody responsiveness, better health (Holmes)

• Translates to lower CRP, fibrinogen, WBC activation (Walker)

• Personal variability

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SOCIAL CONNECTION

• Reduce exposure to hostile/toxic/non- supportive influences

• Devote time to positive/affirming people

• Routine connection such as community events, religious/spiritual/intellectual

gatherings, positive family interaction,

volunteerism

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HEALTH BENEFITS OF LAUGHTER

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• Decreases stress hormones

• Activates internal reward systems

• Anti-inflammatory effects

• Improves short term memory

• Eases depression and anxiety

• Forms social bonds

• Immune system effects—increased

secretion sIgA, NK cell activity (Ryu,

Bennett)

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ADDITIONAL CONSIDERATIONS

• As clinicians, walking the talk is critical

• All of these lifestyle approaches take some

commitment; having a buddy to whom to

be accountable and to share challenges

can be helpful (and an antidote to social

isolation)!

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REFERENCES

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Besedovsky, L., Lange, T., & Haack, M. (2019). The Sleep-Immune Crosstalk in Health and Disease. Physiological Reviews, 99(3), 1325–

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Bonaccio M, Pounis G, Cerletti C, et al. Mediterranean diet, dietary polyphenols and low grade inflammation: results from the MOLI-SANI study. Br J Clin Pharmacol. 2017;83(1):107-113. doi:1111/bcp.12924

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REFERENCES (CONT)

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REFERENCES (CONT)

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REFERENCES (CONT)

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REFERENCES (CONT)

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