Improving Immunity – A View From a Lifestyle Medicine Physician

Covid-19 is all over the news now and everyone is overwhelmed and concerned about getting afflicted.  A natural question asked is how to improve our immunity to fight this disease which has no cure?

This afternoon, a close friend asked me if Vitamin C, Vitamin D and Vitamin K2 along with some other herbs like “Amla” or Indian gooseberry will improve immunity. “What about elderberry?” was another question.   She knew that I am board-certified in Lifestyle Medicine and Internal Medicine.  As I was answering her question, I realized that she was under the impression that all lifestyle medicine physicians do is work with supplements and herbs in addition to prescribing medications. My jaw dropped and I was taken aback.  I came to the realization that the term lifestyle medicine is misleading for many.

I told her the primary goal of my practice is to recommend a lifestyle to my patients after assessing their baseline health, family, work, habits and diet in order to help prevent or mitigate chronic medical conditions.  This form of medicine uses evidence-based research to improve the choice of foods, physical activity, sleep, and ways to deal with stress physically and mentally. Lifestyle medicine in my practice complements Internal Medicine and I believe it makes it more practical, reduces unwanted medications and makes good health achievable for years to come.

Coming to my friend’s question about boosting immunity, I would definitely not recommend anything bottled on a shelf or available online. Supplements or ‘immune boosters’ as they are advertised, don’t work and they give a false sense of security; they may have side effects and interact with other medications.  Eating a well-balanced diet, rich in vegetables, fruits, lentils and beans provides all the nutrients we need.  Therefore, I do not recommend nutritional supplements if the goal is to improve immunity. For more information on this topic, refer to the blog written by NIH director Dr Francis S Collins⁸. 

However, immunity, just like wellbeing and health, cannot be boosted just by eating right.  Our current understanding of good health is a balance of both physical and mental wellbeing.  Similarly, to achieve optimal immunity to fight infectious diseases like Covid-19 and many others, we need to balance our lifestyle, eat well, get adequate sleep, decrease mental agitations, be socially connected and be physically active. 

Immunity also is affected by certain negative behaviors such as:

• Smoking⁵and excessive consumption of alcohol which makes the body more susceptible to infections
• Lack of sleep and abnormal sleep regimen⁷which disrupts the natural circadian rhythm, affecting diurnal rhythms and homeostasis
• Loneliness and Isolation³which acts as a long-term stress and induces the fight or flight response, causing a low-grade chronic inflammation, slightly high white blood count and decreased anti-viral substances⁴that are formed in the body

During a pandemic like Covid-19, social distancing is strongly recommended and needs to be adhered to in order to reduce the rate of spread of the disease.  It is also very important to follow the CDC guidelines like frequent handwashing, restricting social gathering and eliminating non-essential outings and travel during this crisis.   Adhering to these rules unfortunately has the potential to worsen the loneliness epidemic²and the constant updates and news from around the world on the disease may also cause anxiety.  All these have negative effects on our immunity. Therefore, it is important to ensure the continuance of the key Lifestyle Medicine principles⁶during these times to ensure optimal immunity.

What are the key Lifestyle Medicine principles?

• Adopt a well-balanced mostly whole food plant-based diet
• Get adequate sleep with consistent bedtime
• Engage in physical activity
• Learn to mindfully destress
• Reduce and eventually eliminate smoking and moderate alcohol consumption

 Research¹has also shown that meditation provides immediate relief to stress and over time, boosts immunity after a period of regular practice.  

 References

1. https://health.clevelandclinic.org/how-mindfulness-training-can-help-you-achieve-immunologic-health/
2. http://sitn.hms.harvard.edu/flash/2018/loneliness-an-epidemic/
3. https://www.nhs.uk/news/mental-health/loneliness-may-affect-the-immune-system/
4. https://www.npr.org/sections/health-shots/2015/11/29/457255876/loneliness-may-warp-our-genes-and-our-immune-systems
5. https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/pdfs/fs_smoking_overall_health_508.pdf
6. https://www.health.harvard.edu/staying-healthy/how-to-boost-your-immune-system
7. https://www.mayoclinic.org/diseases-conditions/insomnia/expert-answers/lack-of-sleep/faq-20057757
8. https://directorsblog.nih.gov/2019/04/16/study-finds-no-benefit-for-dietary-supplements/