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Your immune system's designed to protect you from toxins and infections. But it can become overactive leading to inflammation, or underactive leaving you vulnerable to the flu and more serious infections. Immunology expert Leonard Calabrese, MD, discusses what lifestyle choices will keep your immune system functioning its best. 

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How Your Immune System is Affected by Diet, Stress and Exercise with Dr. Leonard Calabrese

Podcast Transcript

Nada Youssef:   Hi, and thank you for joining us. My name is Nada Youssef. I'm your host today. Today we have Dr. Leonard Calabrese, rheumatologist in Cleveland Clinic, and we are talking about your immune system and how it's affected by diet, stress and exercise. But before we begin, please remember, this is for informational purposes only and to not replace your own physician's advice. Thank you so much for coming today.

Dr. Leonard Calabrese: Hey, it's my pleasure.

Nada Youssef:   Can you give a little introduction about yourself to our viewers?

Dr. Leonard Calabrese: Yeah. I am a clinical immunologist here. I head the section of clinical immunology, and we deal with diseases of the immune system. We deal with it when it is overactive, diseases of autoimmunity, rheumatoid arthritis and lupus and a variety of other diseases. We also deal with immune problems when the immune system is under active, immuno deficiencies, such as HIV and congenital, genetic primary states. So we're always trying to find the right balance between overactivity and underactivity, and that's really what immunologic health is conceptually.

Nada Youssef:   Great. Great. Thank you. Okay, well let's go on and start by the first question here. Why should we be concerned about immunological health and what is it?

Dr. Leonard Calabrese: Yeah. Well, you know, health is a concept of being sound in mind, body and spirit. It is the absence of disease. It is a concept of wellness. It is the way that we want to be. I think most of us have the traditional view of being healthy is to be good cardiovascular endurance, of muscle and strength training, ideal body weight, good tone, bone health, etc. But I have a different view that is complementary to this, and that is that central to health, particularly for the 50 million Americans that have immunologic diseases, is to optimize your immune health. That means that your immune system is poised to protect you from danger, infections, toxins, allergens, etc, but it is not overactive causing inflammation from either acute or chronic inflammatory diseases, and it's not under active to leave you vulnerable to infections including colds and flews and a lot of more serious things.

A recent paradigm shift is that we can influence and change our behaviors, diet, exercise, stress modifications, sleep hygiene, and others, to optimize our immune system. If you are one of the 50 million people with immunologic diseases, that's particularly important. If you're just a person who wants optimal immune health, it's good for you, too.

Nada Youssef:   Great. Awesome. Thank you. Okay, well we have Nicole. I have angioedema that is not hereditary, and I was told diet, stress, and exercise affect me. I do know that when I exercise it sometimes doesn't react, but sometimes during a menstrual cycle it flares up. Any advice?

Dr. Leonard Calabrese: Well, let me give you a 30,000 foot view over behavior and optimizing immunologic health. There are five things that we like to tell people, and I write about this a lot and tweet about this, so hopefully you'll be joining me somewhere down the line. The first thing is to eliminate the negatives that drag your immune system down, and those things that are polluting your body, particularly things like smoking, excessive of alcohol, drug, excessive sun exposure without protection. These things are all important.

In addition to that, there are four other additional domains just to give you the big picture of things that we can do behaviorally. We can change our diet to an anti-inflammatory diet, and this is largely going from the standard American diet, called the SAD diet, to a more plant based diet, a more mediterranean diet, eating wholesome and real foods that are available and colorful and fill your plate. My colleague, Roxanne Sukol, here at the Cleveland Clinic has a wonderful blog called Your Health is on Your Plate. I recommend that you fall this for dietary recommendations.

The second thing is exercise, and the relationship between exercise and immunity is what we call a J-curve. Being sedentary makes you vulnerable to ubiquitous infections like colds, flus, etc. Exercising moderately, getting our 150 minutes of moderate to high physical activity a week that can be done in five or ten minute little bundles, will reduce your risk for these. And at the other end is training and training hard, that the sports scientists call overreaching or over-training. That can make you vulnerable, as well.

The third and most important domain for me is to modify stresses and to work on achieving mental and spiritual health. This is something we're all interested in and we can talk more about it as we move along.

Lastly, let's not forget about sleep hygiene. Poor sleep drags the immune system down as it affects our brain and the way we interact, so all of these things are important.

So angioedema and urticaria, yes, they're influenced by particularly the access between the brain and the immune system. You know that some people when they have excessive anxiety can get urticaria and some people it can be brought on by overexertion. You have to find where your place is, and then work on these four domains and optimize what you can do.

Nada Youssef:   Awesome. Very informative. Thank you. And, next to Luanne. Graves' disease. After 20 years without a thyroid and medication changes right and left, what's all of a sudden would make the TSH go off the charts?

Dr. Leonard Calabrese: You know, I can't answer that question about your in particular case, but something has gone wrong. Graves' disease is an autoimmune disease. We produce antibodies against our thyroid. These antibodies influence the function of thyroid cells and lead to some local, regional inflammation.

So, you know, 20 years is a long time and one of the things that I talk about in my monographs and my blogs is the influence of aging on immune system. And I hate to break this to everyone, but as we age, everything kind of goes downhill. We're not as strong as we were. Our kidney function slightly declines. Our cardiovascular function, our brains tend to slow down. Our immunologic systems age, as well. And this is an area of recent and intense interest because this aging process, the aging of the immune system, is influenced by a variety of factors, some of which are under behavioral influence. So, particularly, chronic stress, PTSD, and beyond, this all can influence our immunologic aging. Being good to ourselves, those domains I talked about, has the capacity to slow immunologic aging.

Nada Youssef:   Okay, great. I know we should always be healthy, eat right, sleep, exercise. Is there a certain age that we should be doing something different, or should we just continue on?

Dr. Leonard Calabrese: Well, I think it's a lifelong process, and I don't actually ever use the word diet. I like to have a healthy eating style. I think that the one thing that is hardest for my patients, and when I talk to people in public, is the notion of mental and spiritual health. There are many roads to this and I'll just mention a few. Being stressed has been show to suppress the immune system. If you're a caregiver to someone with a terminal disease or a caregiver for someone with dementia, it's terribly stressful and our immune system is worn down. Well, there's no simple answer to these situations.

There are buffers for stress and immunity, and the ones that I like to talk about are the ones that I engage in myself, and that's mindfulness, meditation. So mediation, everybody's familiar with this. This has been around for 2500 years. This is espoused by many Eastern religions and has spiritual, religious connotations. Well, it's been Westernized and there are techniques that you can engage in that don't require you to be a monk, that don't require an hour a day, that don't require a day of silence, that require no religious or spiritual connotations. And we have found that periods of meditation as short as 15 minutes can have a calming effect. Right now we're steadying, actually, the genetic changes influenced by that. There's a program available at the Cleveland Clinic called Stress Free Now on our website. Just Google Stress Free Now Cleveland Clinic, you can come to it. It's a very inexpensive lifetime subscription, and it is guided. Actually, it was the program that let me break through in my own mindfulness meditation habits.

Nada Youssef:   Great. Great. Okay, well the questions keep coming in. We have Jan. How much sleep should I be getting each night to keep my immune system healthy?

Dr. Leonard Calabrese: This is a ... interesting and complex area, and of the areas that I talk about, this is one that I think has the least hard data in terms of sleep hygiene and immune function. But we're vulnerable to lack of sleep throughout our lives, particularly when we're younger and we're more active and we have things to do. This relates to children, adolescents, teenagers and young adults, as well. Everyone says that, "Oh, I only need this and I only need that amount sleep." If you take the ... try to draw this curve and you get right in the middle of it, somewhere between seven-and-a-half and eight-and-a-half hours is probably a sweet spot. I need a little bit more than that, and there are other people who say, "Oh, I only need six hours of sleep," etc.

But there's so much to this area of sleep hygiene and how do we correct this? A few points that try to go to bed at the same hour every night. Wild swings of going to bed at 1 and going to bed at 10:30 don't help. Make your bedroom a place for sleeping. TVs and this and bright lights. Dark spaces, comfortable surroundings, cool environment, very helpful.

I find it kind of interesting, if you go online there's so many apps and devices to help people sleep. Sleep is natural, and I like to approach it naturally. What's wrong with a quiet, dark room that's cool and inviting and comfortable? I don't think we need to totally reinvent this. But some people have genuine sleep disorders ranging from hypersomnolence and narcolepsy to people that just have intrusion on their sleep, can't fall asleep, can't stay asleep. There are consultants and people who deal with that.

Nada Youssef:   Great. Let's see. Darren. Are there vitamins that I could take to help me with stress?

Dr. Leonard Calabrese: The whole topic of vitamins and immunity is very interesting. In my writings and blogs, I do not advocate vitamins, in general. I advocate a diet of real food, colorful food that has all the daily requirements for vitamins and also has all the additional nutrients and flavonoids that are found in genuine, plant-based eating.

Now, I'm assuming that we're not talking about vitamin deficiency, and so for a person who's eating a healthful diet, a mediterranean diet, a plant-based diet, there's really no need to supplement. There's a few small exceptions along the way, and there's much writing on this. Who is ... wants to add anti-inflammatory supplements, omega-3 fatty acids in the form of fish oils. There's good evidence that that can actually treat certain conditions like arthritis. It has a very small cardioprotective effect. But as we add these on, there are side effects, dyspepsia. There are anti-inflammatory supplements, curcumin and others that I think have very small effects. An anti-inflammatory diet is more important.

I do feel vitamin D has a special place. Being even modestly deficient in vitamin D can detract from our immune system, and I have no problems with anyone taking up to 2000 units of vitamin D a day. The actually recommended does in a diet is still a moving target, but there are some good data to show that supplementing it might be able to reduce colds and flews.

Nada Youssef:   So more whole foods, less processed. Plant-based.

Dr. Leonard Calabrese: Yes, and so the good question that often follows this, you know, should I eat organically or should I not eat organically?

Nada Youssef:   Right.

Dr. Leonard Calabrese: The difference between organic and non-organic food, if you're eating a good healthy diet, mediterranean diet, plant-based diet, organic versus non-organic production, there's really very little difference in the nutrients in the food, vitamins, minerals, composition, all the additional flavonoids and other compounds that influence our immune system. The big difference is that organic foods are devoid of the pesticides and toxins that can be in commercially produced food. You know, there's a yin and yang for this. A lot of people would like to eat organic, but there are costs involved and if you can't afford organic, eat non-organic. But I would do is look for the lists that are published online for those food products that carry the most toxins, and it's published every year called the dirty dozen, and things such as fresh berries this year, peaches. If you can afford it, go for those and go for the rest as much as you can.

Nada Youssef:   Great. Awesome. And we have Anne. Does rosacea have its cause primarily in stress, and is linked in any way to autoimmune disease?

Dr. Leonard Calabrese: Yeah. Rosacea is a very common problem. For those of you who aren't familiar it's a red rash on the cheeks. It's quite common. It's often confused in our clinic, people think that they have a disease called lupus, which can do something similar, but it's quite distinct. In its mild form, it's not cosmetically disturbing, but it can get severe and people suffer with rosacea. The cause of it is actually poorly understood. There are immune factors and vascular factors that contribute. Dilation of the vessels, the release of what we call vasoactive substances and inflammation in this lesion.

I know of no specific data on immunologic health access and rosacea, in other words, controlled trials of mindfulness meditation or exercise, etc. But I would strongly encourage, after you've had adequate diagnosis and conservative medical treatment, to try adopting an anti-inflammatory mediterranean diet and to examine, in the context of something like Stress Free Now or something equivalent, how your stresses are playing out because that can lead to know, you know, when you're excited or mad you can become flushed. Those are the kind of things that can influence different types of rashes. Remember, your brain and your immune system are one. They're totally one, and as you work on your mental and spiritual health, your immune system will come around.

Nada Youssef:   Okay, and then we have Javier. Does stress really trigger MS?

Dr. Leonard Calabrese: You know, there are some data for many immunologic diseases. I do not believe that stress alone is an adequate trigger for virtually any diseases, other than some allergic and vasoactive reactions where we can demonstrate this, and diseases like Raynaud's phenomenon, where people's hands turn blanche, often can occur with emotional upset. As with other immune-mediated inflammatory diseases, we call them IMIDs, these are diseases with shared pathways, multiple sclerosis, rheumatoid arthritis, inflammatory bowel disease, celiac disease, cirrhosis, etc, all of them involve a combination of genes, those that you're dealt, that you're born with, and then the influence of the environment itself. I can't speak directly to MS in many of these regards, but I suspect there are as rich data as there are for many other IMIDs that the same domains that we're talking about it can influence it. But stress alone isn't adequate without the right genetic background.

Nada Youssef:   Great. And I will give you one more question and I'll let you have the floor. I have Stan. I have RA and I'm on drugs to weaken my immune system. As we go into a cold and flu season, are there things I can do to keep myself healthy?

Dr. Leonard Calabrese: That's a great question, and one that I actually field virtually every day. First of all, having rheumatoid arthritis today is, you know, there are so many excellent therapies and I'm sure your rheumatologist is prescribing them, and they do affect your immune system. So you have all the more reason to engage in a program to make yourself immune strong, as we like to say. So for you, an anti-inflammatory diet, even more potent vitamin Di in the doses that I've already discussed. Moderate exercise. Can't emphasize this enough.

Let's just take a break here and talk about exercise for a second. Many people think, "I'm not doing anything. I'm never going to do 150 minutes a week." We have a philosophy, we call it instant recess. We believe that everyone can engage in moderate exercise. If you're doing nothing, we encourage people to start with two or three minutes a day. Just get up and walk once an hour. There have been some recent studies that show that walking five minutes an hour five times a day is better than going to a gym and hitting the treadmill for a half an hour, in terms of your overall health. We do it in our own work. Myself and my nurse practitioner and my admin, we like to take these brief walks and we know that it works and my patients are walking literally with me in a figurative sense. So do that. We've been at some meetings, instead of just taking a break we'll do some kind of calisthenics and standing yoga. Engage.

Work on your stressors and sleep hygiene. All we can do is to optimize our immune system, and it does help.

Nada Youssef:   Great. Well, that's all the time that we have for today, but before I let you go is there anything else you would like our viewers to know?

Dr. Leonard Calabrese: No. You know, we've engaged in a series of articles with US News on immunologic health and I've been posting them on my Twitter line. Please follow me on Twitter. We have a wealth of information that we put out regularly on immunologic health, and we want you all to be immune strong.

Nada Youssef:   And Dr. Calabrese's Twitter handle is @LCalabreseDO. We'll also put it in the comment section. For more health tips and information, make sure you keep following us on Facebook, Instagram, Twitter and Snapchat, one word ClevelandClinic. Thank you so much for watching.


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