How Stress Impacts Your Immune System
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Coming up on this episode of The Doctor's Pharmacy. 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.

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Hi, I'm Dr. Mark Hyman, a practicing physician and proponent of systems medicine, a framework to help you understand the why or the root cause of your symptoms. Welcome to The Doctor's Pharmacy. Every week, I bring on interesting guests to discuss the latest topics in the field of functional medicine and do a deep dive on how these topics pertain to your health. In today's episode, I have some interesting discussions with other experts in the field. So let's just trump right in.

- We have to think about this a little differently. So today we're gonna 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 immuno rejuvenation better than our conventional approach to immune health? Well, immuno rejuvenation essentially trains your immune system to work better at every level.

Your immune systems turn over faster white cells turn over fast you build a new immune system regularly Everything comes from your blood and bone marrow, right? So your hemipatic 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

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 we develop these cells called zombie cells. They're terrible cells. I wrote about them in my book. It's one of the hallmarks of aging. They're also known as senescent cells. 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,

um we're kind of in in a challenging moment uh in history for human immune systems because we are dealing with things we never had to deal with before uh and and the worst uh 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 an increased spread of globalization of microbes, like we saw with COVID in the pandemic. It happens 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. It 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, the way basically we do cleaning up of our cells is through killing of hormones.

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 pack

man 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 a lot of the ways we can do it actually is through food and through the 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 or 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, building new ones. And you need a good immune system to do that because any kind of inflammation will cause mitochondrial dysfunction.

So 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 immunorejuvenation system? What are 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 colorful fruits and vegetables one of the things that i like um

are prebiotics and polyphenols and and they are in various kinds of foods one of the most important foods for immune rejuvenation is something called himalayan tartary 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 so it'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 course of 10 we've seen reverse biological age and some preliminary data they've shown that using himalayan terrier 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. 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-resolvent

are mediators, which are basically like brakes on the immune system. And they also take out a lot of 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 prebiotics

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 increasing 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 is not going to work well. So seven, eight hours of good sleep, really important.

Now, the other thing is that there are positive things that are going to help you improve your immune system, like 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 it takes 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 is 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 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 of changes and actually deal with what has to happen

And 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

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

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 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

and asparadin and 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-resolving mediators preventing the degradation it's 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 tartary buckwheat has these amazing microbiome supporting fibers that are quite amazing. And basically, you want to make sure you get these from all sorts of foods, not just obviously Himalayan tartary buckwheat, but omega-3 fats from fish, polyphenols from plants,

fibers, and pre and probiotics 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 go in and out cotton cold hot and cold that doing that four times a week has enormous benefits for your health and longevity uh cold plunge if you get one a great you can just fill up your bathtub with cold water get a buck big horse trough and fill 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 don't eat three hours before bed uh give yourself at least you know 16 hours maybe 12 14 if you're 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 for your immune system. Do stuff that also challenges you in other ways, whether it's learning a new sport, whether it's bike riding or tennis or horseback riding. 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. Uh, and also, uh, 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, uh, do some fun and challenge yourself a little bit, both, um,

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, but also to boost it so you can actually fight infections and cancer.

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Tell us about what you've learned about how do we optimize our lymph system? Because it really is the key to optimal health, longevity, and feeling good. Because, by the way, when your lymph system is full of crap, you feel like crap, right? Exactly.

How have you found that we can enhance our limb system? What are the dietary, nutrient, lifestyle factors and other factors that you've discovered make a big difference? - Well, exercise is a big thing and it's not necessarily extreme exercise, but deep breathing, for example, walking, lifting light weights are all good exercise that will contract the muscles

the muscles and pulse forward the the lymphatics so in the exercise realm i think is very important with your deep breathing with your with your movement to the muscles will will increase lymphatic flow the other thing is plenty of good pure water because you need you know there's a sal gel system there the the lymph can turn kind of sticky like uh

like a gel, and you want to keep it pure and flowing. So plenty of good clean water. As far as foods, the plants and the fruits, I'm not saying that you have to be a vegetarian.

But you should have the majority thinking about plant-based, you know, diet like, you know. I call it plant-rich. Yeah, plant-rich we want to call it. And green leafy vegetables, ginger, turmeric, spices, things like that will always make – we have a recipe guide I had. We had –

made there that is all lymphatic stimulating. So you keep the polyphenols. For example, in olive oil, polyphenols of olive oil are very important. And that's one of the things that we look for in pure virgin olive oil is the polyphenols.

So you have green leafy vegetables, you have herbs and spices, you have onions, garlic, things like that will all increase lymphatic flow. And then certainly the idea of stress modification to suppress the epinephrine and ACTH and stuff like that.

which constricts the flow. So these things in spirituality, doing yoga and meditation and things like that, get the lymphatic flow going. Yoga is called like an internal massage. The plans of the yoga are to increase the massage of the internal organs. So those are the things you can do.

And there's a whole, you know, we have a chapter on meditation and yoga. We have a chapter on exercise and a whole bunch of recipes that you can use. And we tasted some of them and they're pretty good, aren't they, Mehmet? Yeah.

We try. Yeah. So I think those epigenetic, those are things you can do to change your gene, you know, change what the genes produce. And it's important to do that when things we have control of because and once we understand why we're doing it, I think we will apply it more fervently and we'll have better control of our health.

Yeah. You mentioned yoga, and I think yoga is one of those things that's sort of underappreciated for its effect on lymph flow. And I created a detox program years ago, and I work with a yoga teacher to create a lymph yoga program to actually help move lymph through the body. There's twisting, there's bending, and all the massaging you do. It's really one of the most powerful tools, I think, aside from just walking and regular exercise, but it really can be a powerful back

And you mentioned the spices and the polyphenols. We don't use them much in this country. It's just amazing to me. Most of our food is so awful and bland. It's flavored with salt, sugar, fat, additives, and chemicals. I just got back from Turkey, where you're from, Mehmet, and I went to the Spice Bazaar in Istanbul. It was just like an incredible kaleidoscopic

bonanza of colors and spices. And I brought some of them back with me that are just used every day as part of their cuisine. And we don't do that here. But those cultures really have understood the role of these things in our diet as health promoting factors.

And the olive oil you mentioned, you know, I was where your dad, I guess, had an olive oil orchard. And I was being schooled on the ways in which you have to actually maximize the polyphenol content because most people, when they pick olives, they shake the tree and then it like falls to the ground and they pick them up and then they smush them and they get olive oil.

They have them handpicked. Every olive is handpicked so it doesn't hit the ground and start to become acidic and loses polyphenol content. So, I mean, we have such an amazing world we live in with all these tools, with all these foods, with all these spices, with all these potential therapies that we don't take advantage of that help enhance our health. And I think that

If people just pay a little attention to what does mess up their limb system and what enhances their limb function, their health and their life will be a lot better, right? - Yep, yep, yep.

So do you have a daily like limp practice or how do you think about incorporating into your life? I mean, there's so many things you have to do, right? Eat right, meditate, exercise, but how do you start to make simple changes that could help people say, okay, I'm gonna do this 'cause this is- - Well, at my age, I'm limited to walking three miles an hour for a mile or two in the mornings.

And then I lift five pound weights just to get them so I can play golf with this guy. Otherwise, he tries to embarrass me. You know, what do you mean? He's not he's not competitive. He's just be clear. Dad is 84 years old.

And for any golfers out there, he shot his age two weeks ago. Oh, wow. And then that was the warm-up. The next weekend, we played, my dad and I, against my two brothers-in-law, and we beat them, which is unheard of. Wow. And dad, as he hit the winning putt,

winked at them with great joy in his eyes. So I knew that was the win. - I might achieve hitting my age when I'm maybe 140. - Exactly, like most of us. - I'm not very good at golf. Well, that's what it is. - Mark, can I ask, the thing is that these common ailments that you're talking about that Dad was listening through, I mean, they exist.

because we don't have good solutions for them, right? So we had a great solution for libido and there are some pharmaceuticals obviously that we can start using now, especially for women. But the Chinese say, you know, goji berries, nuts, Siberian ginseng, you know, they have their own game plan. Lychee berries, which are, you know, lychees that Prudence sort of reminds you of something. It looks like testicles. But things like sleep, the Chinese use congee. They use a lot of congee, which is a grain, but they also use massage and the main,

Tip for massage, you need to stimulate lymphatic flow, which dad showed and others have proven. You massage your feet, you stimulate thoracic duct lymph flow.

So that's very hard to even connect those two structures. How do your feet affect lymphatic flow in your chest? On the other hand, the Chinese do acupressure and acupuncture in the feet, and they can stimulate parts of the brain that coincide with that spot. So there are clearly connections between parts of our body that we don't understand with the traditional Western model that you and I, all three of us, participated in. It doesn't mean they're not right. We haven't discovered them yet. We will one day, but why wait?

No, it's so true. It's so true. I think the ways in which these ancient systems have developed models for maintaining health and optimizing health and creating health is so foreign to how the three of us were trained in medical school, which was find the disease, kill the disease, and then move on. Just that was it.

And it's exciting that you both sort of are coming at this in a different way that help us sort of understand a new way of dealing with some of the challenging conditions that we suffer from. And I think, you know, fatigue is another one that people have. And I think fatigue is probably really connected to limb flow because fatigue is connected to the toxic burden and to inflammation and oxidative stress. And if your lymph is not working, it's hard to function with that.

And a hot bath will also stimulate lymphatic flow most likely. It also happens to be the foundation of traditional Chinese medicine treatment of depression and fatigue. So if you Google, right, if everyone listening now to buy a computer, Google, why am I?

it will auto complete so tired it would do it I mean that's amazing the first time right but why am I sounds like a philosophical a spiritual quest you know why am I will auto complete on Google so tired of towards Austin you know because yeah that's the number one thing we search you have uh

come upon the lymph system as one of those critically foundational systems that has to function in order for us to be healthy. And when it's not, we age quickly. So, Dr. Lamont, tell us about how you came to understand that this is true, that it's not just about our cardiovascular system or neurologic system or musculoskeletal system, that there's this whole other system in there that's pretty much ignored and we don't really have a lot of treatments for.

but that actually responds to a lot of things that you talk about in your book that are available to everybody. So tell us, how did we sort of miss this and why were you interested in lymph system and how it impacts every aspect of their health? I mean, you've called it the secret river of health. What do you mean?

Well, you know, when we were doing the heart transplants back, way back when then, we took, I was involved in the first five and they became very personal friends because we stayed with them for months. We didn't know what the heck was going to, what to expect, what was going on. So within a short period of time, we had given these people good, healthy hearts with wonderful blood vessels.

And within a short period, a year or two, year and a half, they developed, all died from galloping atherosclerosis. Their vessels had turned to 90-year-old vessels. And it was not only a professional failure, but a personal loss. And so it always stayed in the back of my mind. And when I left Houston, I was chief at Temple University School of Medicine, and we had a

professor of pathology there, Betty Lausch, who was interested in foam cells. So we got together and did a project on rhesus monkeys. We ligated their lymphatics from their heart, and sure enough, they developed early atherosclerosis. So I always kept this in the back of my mind, and I'd observe when we did coronary bypasses, we'd have sclerotic little white vessels following along the veins.

And so I biopsied them and they were sclerotic lymph vessels and they were not there in the aortic valve or the mitral valve with no coronary disease. So, but it's so hard to measure the lymphatics. You can't measure a level of something or it's a low pressure system. You can't, it's very difficult. So consequently for many years,

Nobody really did a whole lot. Up until the last 10 years or so, there was nothing really said about the lymphatics. But in 1981, I wrote a paper. I figured the best paper I knew was the sciatothoracic surgeons. I should have been in some other journal because the surgeons weren't too interested in what

But we showed that there was reverse cholesterol transport, the relationship with the lymphatics was important. And that's how the actual cholesterol got out of the arterial wall into the venous system to the liver by way of the lymphatics. And that was, you know, 40 years ago.

So your blood circulation and your lymph circulation are connected and they're interacting and moving things around like cholesterol all the time.

If one's not working, the whole system kind of breaks down. The whole beauty of the lymphatic system is that it is responsible for re-regulating our fluids because we lose about 10% or 15% of our fluid outside our vascular system into our interstitial or this tissue between

the cells. So we have to get that back in. The lymphatics are responsible for getting it back in. The lymphatics are responsible for getting every fat molecule back into the system. They're responsible for getting large proteins.

Things like when you have a leaky gut and you have, say, casein or gliadin, the only way it can get away from the sampling mucosa is to go through the lymphatics and get tested by a dendritic cell to see if it's good, bad, or ugly. And that's what it's all about. And if we don't have the lymphatic system, it just doesn't happen.

So essentially what you're saying is when you have all these molecules that run around your blood and then they go out in your tissues and your body has to clean it up and then it has to check that if it's okay or not and it gets back into your lymph system and your blood system, then you can kind of regulate it. So it's very difficult to measure anything because it's a very low pressure system.

So we can't measure like the arterial wall pressure or the lymphatic pressure. The flow depends completely on the motion of exercise, what your muscles are doing, squeezing them, the arterial pulsation and its own innate pulsations. It has its own pulsation, it has smooth muscle in it. It has sympathetic and parasympathetic nerves. So it sends signals all throughout the body

to have a general inflammatory response. And then the important thing, it has to shut off that inflammatory response. And if it doesn't shut it off, you get autoimmune or chronic inflammation. And that's what we're facing in a pandemic now.

Yeah, I want to get more into its functions, but for those of you who don't know what it is, I'd love, Jerry, for you to explain what is actually the lymph system? Where is it? How do we find it? What does it look like? What does it do? Give us sort of a background because I

I think most people understand it. You have a liver and a kidney and a brain, but where's the lymph system? - That's exactly, that was the problem in fact, that it really deserves, it's a system that deserves, but it's always used as an appendage to something.

It says, oh, the lymphatics are with cancer. They think a lot of people, it gets attracts attention because of the cancer. But it's a system of its own that is usually lies between the artery and the vein, the lymph channel does. But we don't, when we was in medical school, we didn't talk about the lymphatic, we talked about nerve artery vein. That was the neurovascular bundle.

But the lymphatics are in there and they have to, if they go into spasm, they are not clearing the toxins. They're not sending the messages of the immune system. They're not getting the signals of protein and fat that will send messages out to the body. And then the messages aren't going back that shut off

you know that shut off the inflammatory response the beginning the response you want it's in no acute inflammation is is a good thing it get it kills everything inside it also attacks the other the normal tissue as its getting rid of the toxins but at some point it we have to send in

cells and proteins to come in and stop that inflammation. And if it's delayed, there's more damage in the area.

So everything that causes it to delay is caused by the lymphatic system not either being stagnant, not getting good water supply, not being pulsatile, being dilated or being constricted. For example, if you smoke cigarettes, you will get sclerosis of the lymphatic systems and

and you know cortisol release does it and adrenal release does it so over the long haul that's why stress and stress creates problems and what's interesting to me is we always say when we do these studies you say oh look what people do better if they exercise they do better if they if they have stress management they do better if they eat a lot of vegetables and fruits

point of fact is all those three things increase lymphatic flow the exercise goes to the thoracic duct and you breathe the diaphragm sweeps it up it's got one-way valves and it makes the the fluid go into the venous system and to the liver polyphenols and flavonoids are strong lymphogobes i mean they they suppress inflammatory markers they they do a wonderful things and that's why

We know that vegetarian type plant-based diet is helpful. In the same way with stress modification. If you're relaxing your body, you're not secreting the hormones that will cause sclerosis of the lymphatic vessels.

So it's interesting to me that all these, all the three things that increase lymphatic flow are things that will help every chronic degenerative disease. And so, but it gives you an understanding. And if you get that understanding, you'll be more apt to do what you're supposed to do because it's not a mystery. Then why does this happen? Because you can explain what happens with lymphatic flow when you do these things. Hmm.

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. - You gotta open your heart, essentially. - Exactly. Let's take this a couple of 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 voodoo deaths. - Yeah.

- Petrified, and your heart. So it's all- - That and fugu toxin. - Right, right, right, right. So the immunology of joy, there's been some tremendous work in this. - And it's such a great phase, the immunology of joy. I just love that. - 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 actually inoculated all the people in the study with cold virus

and then measure their antibody responses and clinical things. And hugging was an important and significant clinical variable. Even though the hug people were more exposed to viruses, they were protected. So I mean, a small example. - That's great. So hugs so you won't get sick. That's why when Lenny ever comes to see me, we always hug each other. - Absolutely. It's therapeutic, right? - He'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. Fulvio De Quista 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 that

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, their immune systems shift. So 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 wanna 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, bio-behaviorally 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 were 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 other 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, uh, stress and wellness diet? Let's just kind of go through it. I want to spend a little time digging in. Cause,

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, we'll, we'll knock these down one at a time. But you know, one of the interesting things that, that has happened,

here is that, you know, a decade ago, I felt very comfortable talking about this, these topics to the wellness community and, you know, 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. 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 to- Or 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 100,000 women for decades have found that if you take people, women who are predisposed to rheumatoid, many autoimmune diseases are female predominant. More, yeah, mostly. Yes. And you look at certain variables here.

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, the 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, the

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 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 the soap 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 genetically predestined to this and modify their risks early on. And once they have the disease, actually can make contributions to lowering disease activity. - So what are the kind of diets, besides, for example, adding fish, what would be the dietary recommendations you'd give to someone with an 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 people, you know, so, you know, people are not coming to me. So what's different is,

for people who come to see you and people who 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. - Yeah, might scare him away if you told him to go to the-- - You know, if you can do Meatless Monday, I'm very happy, let's start. And the one thing that we know,

Imit diseases, it's not a foot race, it's a marathon. So I'm going to be seeing people for years and decades. Imit diseases is immune mediated. Yes. Inflammatory disease. So rheumatoid, inflammatory bowel disease. So we try to, we try to take the low hanging fruit and try to make little modifications. And then over time, I'm so impressed that, that you know, people can make meaningful progress so that in the dietary aspect, I'm, I'm, I'm,

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. And I think there's a place for it. So that's where we start with people. Yeah. Step two, exercise. I'm...

- 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 your 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 shows, studied this in the most, you know, robust scientific way possible. You know, we know what a healthy microbiome kind of looks like, you know, diverse and rich.

We've yet to dial it in to 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. - Evidence, right. - 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 immune system. - And in the frame of functional medicine, we often people 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 next topic would be, you said exercise. - Exercise.

So I've been interested in exercise and immunity for decades, actually. It's 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

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. - And we just talked 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 moderate exercise is still a moving target. And if we look at the guidelines, which have been recently revamped, only in the past couple months, 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 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 it. And we say, you know, if you're totally sedentary,

Just get up and start moving. And now I'm copying you. So in my immunologic summits for the past two years, I invite our head yoga teacher from the Cleveland Clinic, 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 is 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. 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 we have people, ultra marathon runners. 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, etc.,

The people who won were the people who were just getting up and moving. Walking around. Yeah. You need a step counter, the 10,000 steps. All of that stuff that Mike Roizen talks about and our whole enterprise engages in. I think it's good for your body. It's good for your health.

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 nurse's 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 different

that there's clearly enough data for so many reasons. - Yeah. - Artivascular health, emotional wellbeing, and immunologic strength. - So what happens to your immune system when you exercise? Not like the ultra marathoners. And I know you've written about this where you see even clinical studies looking at ultra marathoners 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 are the studies where you can do it in a lab and come in and do an exhaustive stress test or cycle until you've hit the oxidation wall and hit your aerobic capacity. There, 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 we have very poor tools. We're just now...

- We're looking with an eyeglass instead of a telescope. - We're looking at the same techniques that we looked at 40 years ago, where in the next five years, we'll be looking with 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 conversation

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, you know, 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. And it's your psyche, your nervous system, and your immune system. And, you know...

We don't know what stress levels were, you know, 200, 500, 5,000 years ago, but we do know that today living in this world, stresses are different. You know, you've got anxiety.

you know 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 are stacking up while i'm having this nice conversation with you um the um you know the exigencies of of modern life are are complicated add to that the environmental stresses you know we're living in a world where

You know, 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 stress.

inflammation, you know, 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. - Doesn't sound good. - It does not sound good, right. So all of this is going on. - It's like 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?

And of all the- - And I think the science is really good about what happens to your immune system under stress. It's not just an idea, oh, 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 have

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.

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