How 'boosting' your immune system increases inflammation and 4 ways to support balance instead | Dr Giulia Enders

Introduction

0:00Welcome to Zoe Science and Nutrition, where world-leading scientists explain how their research can improve your health.

0:13It's 3am and you're wide awake, streaming nose, sore throat, and the distinct feeling that your body has let you down. But what if it hasn't? What if the sneezing, the runny nose, the fever, all of it, is actually your body doing exactly what it should? And what if the symptoms we spend so much energy suppressing are in fact the whole point?

Julia Ender's Book

0:36That's the idea at the heart of Julia Ender's new book, Organ Speak. Julia is a gastroenterologist and an author whose previous book, Gut, sold 8 million copies and helped convince the world that gut health was worth taking seriously. Now she's turned her attention to the whole body and the remarkable language it uses to communicate with us. Today, she joins us to completely reshape how we think about illness, immunity, and what it means to feel well. By the end of this episode, you'll know whether to reach for a decongestant the next time you have a cold,

1:09why boosting your immune system might be a very bad idea, and which simple habits genuinely do keep your immune system in balance.

Quickfire Questions

1:17Julia, thank you so much for joining me today. Thank you for having me. So we have a tradition here at Zoe where we always start with a quickfire round of questions, and we have these very strict rules. You can say yes or no, or if you have to, a one-sentence answer. Okay. Does drinking Coke increase your risk of rheumatoid arthritis? Yes, it does. Is boosting your immune system a good idea? Not necessarily, no. Does a runny nose help you recover from a cold?

1:49In a way, yes, it does. Can poor sleep harm your immune health? Yes, definitely. And finally, what's one fact about the immune system that just blows your mind? That it is actually comparable to consciousness and far more connected than AI networks are. It is, in a way, cellular intelligence at work and at its best.

Rethinking the Immune System

2:14Whenever I get a cough or a cold, I immediately feel like my body is letting me down. Like, it's a failure, I'm failing, and my immune system is not doing what it should. And I was really struck that in your new book, you're sort of completely reversing that way of thinking. You wrote a previous book that was called Gut that was a huge hit. There were about, I think, 8 million copies sold. But particularly for me, I actually read that book at just the time that I met my co-founder, Tim Spector.

2:46And at that point, I knew nothing about the microbiome. I knew very little about the gut. And your book helped convince me, basically, that Tim was not mad, that the gut health was really important, the microbiome was really important. And so this thing was really credible.

Gut Health and Microbiome

3:02What first drew you to this topic of gut health? It was, at first, a very personal experience. I had a skin disease, and the doctor would prescribe me, you know, corticosteroid creams, and it would make it better for a little bit, but then it'd just come back. And I thought to myself, well, I'm in this body for, I think, another, like, 70, 80 years, maybe, and I know nothing about it. And this is a bit odd, isn't it? I should know more. So I started reading and trying to find ways to, you know, get my skin healed back up again.

3:33And then during that time, I read about the gut, and I was completely blown away. It's so intelligent, it's so versatile, and it mediates so many important processes. So then I studied medicine, and every time the gut came up, I was there, you know, I really listened. And then I thought, more people should know all these things. They're so helpful and also interesting and sometimes funny. And, well, then that really tipped it off. And so clearly, you know, that took you all the way through. You became a doctor. You became a gastroenterologist.

Expanding Beyond Gut Health

4:03But in your latest book, Organ Speak, you've sort of expanded to other parts of the body. So you've sort of cheated on the gut a little bit here. What's inspired you to do that? It was the work in the hospital. After I finished my studies, I went to work in a hospital specialized on gut disorders. And after a while, I just had to come clear and face reality, which, you know, meets you there in the hospital, which was, I'm not a good doctor if I only focus on the gut. I'm missing out on all these connections, on all these other things that influence the gut.

4:33I realized after a while that there was a group of my patients with irritable bowel syndrome where they would sleep poorly. And I would repeatedly hear this when I was questioning them in the beginning. And so I got into reading about the brain and sleep, for example. And I realized, oh, there is a part of sleep that is really important for pain threshold and how much pain we feel. So this could influence it. And also the gut homeostasis and how everything is repaired during the night. In the body, everything is connected. And in research, we always try to, like, tidy it up and separate it all to have, like, good, nice and clean results.

5:05But you can't do that in the hospital because, you know, there the human is built back together again. So, yeah. And then there were other things like people coming in with belly aches or even appendicitis more often when the air quality was poor in the city I was working in. And we had that often because we had lots of cruise ships coming in. It was Hamburg. So, you know, I started reading about the lung and air quality. And this is sort of, like, how I took off. And things kept piling up and made me want to say something again. Like, that felt with the first book.

The Immune System's Purpose

5:35So how has that experience changed the way that you think about, I guess, health and disease? The way I see the body now, I think, is a bit more sophisticated. Suddenly, I started to have this respect for all the things. Why are they put in this place? What are they especially good at? And how can I actually make use of that in my day-to-day life and really have, like, a more cooperative and appreciative relationship to these organs? And this has made me, I think, more appreciative. But it has also, like, drastically changed what I think I am and what others are.

6:08And I think it's also important to just see this miraculous, crazy thing of being alive sometimes. Just let it shine through a little bit. That has done that to me. I love just hearing the enthusiasm, but also, you don't sound like a typical doctor. Like, I feel like a typical doctor does, like, carve this up into pieces, try and identify the one bit that's broken, and then say, okay, this is the thing that we need to do in order to... And that's important, too. And I need to do that, too, at times. But it took me some time to get to this other thinking.

6:38That's actually why it took me quite a while to write this book. I really had to learn a different way of thinking, also a bit more associative, I'd say. When we feel ill or not able to perform as we expected, we often say things like, my body's broken or I'm damaged. What's your view of that approach? It's almost always wrong, even with horrible diseases. And I'm not saying the body doesn't make mistakes. The body definitely does make mistakes. It's human, after all. But the way we often describe it is like it's broken or stupid or dumb or aggressive, even.

7:11With the immune system, you'll often hear in a doctor's office, you know, your immune cells are attacking your own body. And it sounds, in a way, a bit stupid and aggressive and unnecessary. But what we know from research since the 90s is a very different picture. It's more that the immune system is trying to keep you safe all the time. And it's really all it's there for. That's its whole purpose of existence. And it does so eagerly. And sometimes, for example, when it experiences a horrible cold or something happening or notices your body is really not doing well or other genetic factors also, then it can go overboard a bit with that.

Autoimmunity and Overprotection

7:45It can be overprotective. They want to do their best, but they're doing something that's not so beneficial. And that's happening a lot of the times when it comes to autoimmunity. And to see it like that is not only a nice story. It's also accurate to the research we have. But it's also helpful to the way people see themselves and treat their body when they have this disease. Why does it matter? Why is there anything wrong with having this approach that says, like, my body is letting me down? Well, let me give you just the example I had with this when I really understood this.

8:15And I had a patient and we diagnosed her with a chronic inflammatory bowel disease. And she had been in our hospital a few years earlier where she had a really severe EHEC infection. So that's a toxic E. coli strain that is very dangerous. And she said, oh, I have such bad luck. It's always the gut and it's like acting up and doing all these horrible things. Of course, she was sad. That's not a good diagnosis to get. And I went in there in the afternoon and I said, I wanted to just talk to you about it again for a few minutes. You've had this really severe infection a few years ago.

8:47And it is something that the immune cells see and witness and they do form a memory. And when they have been through something like this, they are more likely to react with autoimmunity and maybe attack gut bacteria that aren't bad after all. Just because they've seen something so dreadful, so horrible, almost going wrong. And now they're just being over careful. And while they're doing that, they're attacking all these things that when they just look a bit funny, they go off. So it is not convenient. It is not a good thing. But it is them really now being overly, you know, attached to you and trying to secure you.

9:22And she had a bit of teary eyes. And I think for her it was way better to learn it that way. And also when we look at all these additional therapies that are now being researched more and more when it comes to autoimmunity, different diets, you know, relaxation techniques, or, you know, all kinds of different things for autoimmunity, it's all like a to-do list if you don't see it from the right angle. But if you see it from the angle that the immune system is constantly checking on your body, how you're doing and adjusting its aggressiveness according to that, then all these things make sense because they give the signal and communicate to your immune cells,

9:54oh, I'm actually doing good. Are you saying that your immune system is perhaps overprotective some of the time? It's checking on you and figuring out how aggressive it needs to be. And if in fact it's on more than it should be, and this is your example with these sort of autoimmune situations where it's sort of attacking something that isn't actually bad. If you can just somehow calm yourself down, like be more relaxed, then potentially you're sort of sending messages to your immune system that maybe it can also be a bit more relaxed,

10:25and that can genuinely change the way in which it interacts with, you know, whatever's triggering it and setting off this sort of autoimmune response.

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11:16To be very clear, you cannot heal an autoimmune disease by just relaxing. That would be insane. There's always multiple causes and influences on diseases. Usually it's multifactorial, you know. But one factor is also an interaction of the nervous system with the immune system. Those two communicate. And we know those routes through good medical research. And there are these studies with relaxation techniques, stress influencing the cause of autoimmune diseases. So it is one factor that we can influence.

11:47But there's also other factors. Like, as I said, maybe a viral disease has tipped it off in the beginning, or you're genetically more likely to develop autoimmunity because you lack certain signals or structures, or have a little less of cells that calm the immune system down usually. So there's always multiple factors. But one of them is also your body being in a good state and your immune system noticing that. I think that's fascinating because I feel like I was brought up thinking that is all crazy Californian woo-woo to think that, like, your mental attitude could have any impact on your body.

12:19I was definitely brought up with a very big divide between, like, the mind and the rest of your body. I think most of us were. And this is just what happens when research has the luxury of being more differentiated. Lots of research that I look at now is, you know, suddenly there's a gut-liver axis, there's a liver-brain axis, there's immune system-brain axis, there's a, you know, all these axis that are now being called that, they're basically just saying, oh, now we have the luxury to see all these finer connections and influences as well. It's also a paradigm shift because we've had this time of, you know,

12:51separating everything in science. And we had to because everything was so, you know, before that, medieval times and everything being a bit more like a story time or, you know, mystical. And then we said, no, let's separate it and be very rational. And in order to research it, we have to really divide it up and look at the singular pieces. And I think now we're actually doing an interesting step. We're now connecting those pieces that we were so eager of separating in the first place. I find this an interesting time in medicine. My wife says I'm a terrible patient.

13:21That whenever I am sick, I catastrophize. I'm like, I'm going to be sick forever. It's terrible. I also complain immensely about the fact that my body is letting me down. Why am I feeling like this? I can't do everything I want, which I think is learned behavior from my upbringing. What should I be doing instead? The nice thing about being sick, or well, it's not a nice thing, but it's the good to know thing, I would say, is that all these things you're experiencing, for the most part, don't come from the germ

13:52that's infecting you, the sore throat, the runny nose, the cough, the fever even. The microbe or the virus doesn't do that. It's not coming from the infection? No, because it would really like to live there unnoticed. And that would be the best case for it if no one bothered, and it could just be there and do its thing. But who bothers is our immune system. It's saying, oh, I don't like the way this special microbe is treating my cells. I'm against that. I don't think it's a good match. So we should, you know, divide this up here.

14:23And in that case, it'll start popping some of the throat cells to get those out that have the virus in, and then protecting the cells around to not get the virus from the virus spreading. It'll induce little wounds doing that. And it'll make the nerve cells more sensible with all the inflammation. So that's where your sore throat comes from. Or also the runny nose is a mechanism where when there's an infection or a bacteria or virus noticed in the cells, the immune system will trigger the blood vessels to become porous.

14:54And through these porous cells, suddenly the fluids from the bloodstream enter the tissue. And that's good because the immune cells can come with that. They can go to the place where the infection is happening through those pores, and they get there, get to the trouble spot. But also all the liquids that are coming out of the blood are then creating this swelling and runny nose. And the runny nose will expel whatever is there, just like diarrhea does expel a bad germ, or coughing does expel, you know, viruses in a load so that you don't all have to fight them.

15:25You're just, you know, getting rid of them, have fewer of them after. And fever is also a way of the immune system really driving up its own temperature of the body with the help of the brain to then have the virus or bacteria feel uncomfortable with this changed temperature. And also tell other immune system cells that are further away, oh, we're activating this higher temperature mode, so we might all get a bit engaged here. So if these symptoms of, let's start with the cold maybe, if the symptoms of the cold are like my immune system doing its job right,

15:58should I be taking any medicines that might interrupt this? This is debated, and there's data on multiple aspects. And for the very first question, which is, should I take something like anti-inflammatory drugs when I have a cold? Some research say don't because it might prolong the cold for another 24 hours, an estimate, and others say, oh, do, because it doesn't really change anything, but you'll just feel better. Some things are a really good idea, for example, decongestant nasal spray,

16:29because they'll actually, when it gets too bad with the nose and you can't breathe and eat and sleep, then really you should take some before it spreads to the ears, because the ears go through the same channel and if it's all swollen up, they can't really air and clean out and so then they'll have a problem soon. So the decongestant nasal spray, if you use it right, not too much, don't overdo it, don't take it too long, then it's a really good thing to do when you're being sick. But when it comes, for example, to things that tone down the gut when you have diarrhea, like Lopramid, for example, is the usual thing you take on travels

16:59or something, then you should really think twice because, as I said, diarrhea will expel the germs out and help the gut to get rid of them so they don't infect any more cells or less at least. And when you then take something that just stops the motion of the gut and just lets everything brew and lay around, then that's not a good idea and we have data showing that it elevates your risk of post-infectual irritable bowel syndrome and also like having a bit more pain and like trouble after an infection. So if you really

17:30need to take it because you just have to get on that plane or you're starting to be dehydrated and it gets really bad, then go ahead. But if it's not so necessary and you could just really have your gut sorted out for half a day or a day in the hotel room, then you might want to go with that, for example. And it's a mix out of both for anti-calf medicine because in the very beginning, calf is similar to diarrhea where it really gets out some of the viruses and germs by coughing them out. But later on, it oftentimes will fuse

18:00into a more of like irritated calf where just the immune cells and the cells in the airways are so sensitive. Every piece of dry air or a little particle that you breathe in will then irritate them and make you calf unnecessarily. And in that case, you can then grab the medicine. You know, I would, you know, put it in these categories. I'd like to ask about the painkillers because that was less clear to me. So let's say I'm thinking about taking paracetamol, Tylenol. Yeah. What on balance is that likely to do? And since the data is not really clear on that, I think everyone can still pick

18:31their choice and also depending maybe on how bad it is. If it's so bad that, for example, you can't really sleep and sleep is very important for healing or you just have to like get through the day, then I'd say go ahead. Often you have this like paracetamol, ibuprofen as sort of like your twin drugs you can take. Are you as relaxed with the ibuprofen as you are with the paracetamol? It's a freedom of choice, I would say at this point. I don't have a preferred one to advise and people usually have one so they say I react better to that

19:02and that and then I would always go with this. I was thinking back to what you're saying before about like rethinking the immune system. I tend to think of the immune system as being sort of permanently at war. Like it's constantly fighting against all these things in our environment in order to keep ourselves safe. Like is that the right way to think about it with like all our latest understanding of what's going on? Well, yes and no. There is this part of the immune system that really has to do all these things

19:32to keep unwanted microbes and stuff out but then it's also in a way kind of old-fashioned to be honest because we've had this research about like invaders and killer cells and so on in like times of the first and second world war heavily influenced by the war lingo and partly it fits what's happening there but for some other parts and actually quite large parts it's not and we have known like for a few decades now that the immune system is also really trying to keep us safe through other routes than just war

20:03and fighting. It is keeping us safe through for example cooperating with good microbes which is a very important part because if they take up a lot of room there's not so much room left for bad germs to land you know it is saving a lot of energy by not initiating unnecessary inflammatory reactions by tolerating and just you know nurturing tolerance in order to have just microbes sitting there that don't do anything bad that they are okay maybe sometimes they're a bit funky but that's not a problem and all of this

20:33it can only do because it constantly asks us how we're doing gets to know us all the time is curious and learning and builds a memory and you know has all these experiences an immune system in our old age is educated and very different than one in the younger ages where it will just inflame and have a fever right away and in an older age it'll say oh I know this buck I don't even care to you know inflame anything or have a fever it's gone or something yeah in your book you use this term the microbe cloak can you explain

21:03what this microbe cloak is and what you mean by that well what is a cloak the fun thing is you can change a cloak right you can take it off and then you can put another one on and if it's raining you might want to use a waterproof one and if it's really light out you might want to lose a very light nice one or something you know and this is the cool thing about bacteria and what actually our relationship with them is because let's be real from like those millions billions of bacteria that are out there very few make us sick with viruses it's the same thing

21:33each time we breathe we'll breathe in hundreds thousands of viruses and they won't do anything to us because they just really don't care to infect us to get the full picture you would have to say they must have have other jobs and it can't be their main job to make us sick and really it isn't and when you look at bacteria their main job numerically speaking just mathematically is really borrowing some of their unique features like giving them to us for free in you know exchange for maybe living on us

22:04for a couple of minutes hours or years and that is a nice thing because we can interchange them like a cloak as I said if we go to another country and there's suddenly a weird new food that we're eating oftentimes on that food sitting ready to digest some of the fiber or particles are already bacteria and while we digest we keep them for as long as we need them and when we go back to our country then you know after a while they're gone because we don't need them anymore and this happens also on the skin where there's bacteria and microbes that will produce

22:35antibiotics that will then fight other bacteria trying to get into their space so this is what I mean by cloak we have all these microbes sitting us and micromanaging our surfaces I love hearing you talk about that to what extent is that just randomly happening and to what extent is our immune system sort of actively managing this the immune system is definitely there to pull some strings I'd say and I love this one paper

23:07where they had people put their hands into a jar of bacteria I think it was E. coli that they put their hands in and of course then the hand is full of bacteria and then they retest after a while and they see that most of the bacteria are gone and this is also because well the skin bacteria and then our immune system and cells producing antibacterial substances so you know the body takes care of quite a few things if you let it and give it the time and of course they have to work together the immune system will allow the bacteria when it sees that the cells are okay

23:38so if there's a bacteria in the gut for example and it's producing short fatty acids that really nurture our gut cells and the gut cells are actually feeling better and they have more fuel and energy and they look healthier so to say then the immune system will be like oh whatever's going on there I'm not getting in it because it seems like it's a good deal this basically happens every day every second in our gut all the time also with foods if we're eating that or that and then the immune system says oh we had some peanut but you can be here if you don't do anything damaging

24:09but then microbes sometimes do the opposite they do damage our cells and then the immune system will get a bit nosy it'll be like what's going on here call some colleagues of mine we'll check it out and then we'll all share our opinion and then decide whether we start an inflammatory reaction for example so should we think about our skin and our gut microbiome as part of our immune system absolutely and I think it's scientifically correct now and regarded as such and so how does our immune system tell whether

24:39this is a good microbe and I want it as like an extended part of my immune system or this is like a bad microbe and I need to try and get rid of it there is different immune cells and there's different ways of how they look at us and some will go with very basic ground rules like they'd say if there's a leakage of intracellular liquids like you know the plasma of the cell basically running out because the cell is damaged a cell wall was damaged by a microbe

25:09for example and this is a typical pattern where some sort of immune cell will go there and be like whoa why is there you know a cell leakage what happened here and it'll create attention and it'll catch other immune systems cells going there and they will then with their way of looking at cells see if something's wrong other cells for example will attach to special receptors where there's always a tiny piece of protein showing what the cell has been doing throughout the day and if this protein suddenly is weird like one that are

25:39actually in virus made and not the cell itself then those immune cells will say oh something's really wrong here and other immune cells will have just receptors for typical patterns of microbial walls so they'd say hmm this is usually not a good microbe that I have learned you know to form this receptor against to notice it so there's very very different ways of immune cells asking us and ourselves the questions how are you doing and then there's this conversation that all of these immune cells have with each other

26:10let's say all of these types are alarmed at the same time oh then it's really going down because then they're super sure that something's wrong like with the viral infection for example but if just one of them is alerted and it'll ask all the others and they're like no no you're maybe just a bit panicky everything here seems fine for us then other immune cells will tone it down and not initiate an inflammatory reaction so there's really this ongoing discussion and debate and researchers looking at that like Aaron R. Cohen

26:40this is why I said in the beginning describe it really more as a way of consciousness because in consciousness in the brain we network all these cells to create you know a neural network that is capable of suddenly saying I am well or I am worried and the immune system just does exactly that it connects cells that all have a different way of perceiving information and then they will say oh I'm not well I need an inflammation here so let's initiate that and then they have a go at it so you're saying

27:10it's almost like my immune system is making these decisions like a conscious thinking thing well yes because it is a nice term to throw around consciousness but what do we base it on we base it on how much information is connected and summarized into one for example with artificial intelligence we say about 150 million connections are made to create AI saying you look handsome or something you know and so when you look at the immune system and the amount of cells and then the number of connections that are made between all of these cells

27:42it is much more than 150 million so it's actually way more complicated than AI and with that number actually it gets much more close to the connections forming consciousness in the brain so this is why you can confidently say it is quite similar to that process that's really cool I think I'm definitely coming away from this like with a sense of how complex it all is I'd like to come back to something you said a bit earlier because you said that the immune system can be sort of set too high and attack innocent targets what happens

28:12what are you describing and why does that happen? There's certainly the time when it just has an inflammatory reaction towards something in a wound for example that's usually good but even there it can sometimes go overboard a bit like when everything's already done and you're healing up sometimes it overcompensates but then you have it also in things like allergies or autoimmune disease and when I hear people say these things like or promote supplements and like everything's just targeted for having a stronger

28:44and stronger and stronger immune system I say oh I think you don't have the whole picture because it's really not about just having the strongest army on the planet but it's about having a balanced one if you had like security personnel around you and they were stoked up all the time almost like on cocaine be super aggressive and super strong then this might lead to some risky situation you really want them well balanced and really analyzing the situation well before they overreact so this is I think the same for the immune system and if you have all these substances to stimulate it

29:15or let's just say sugar because sugar gives all the energy to produce more and more and more immune cells and with more more can go wrong and sugar also gives it a signal to maybe be a bit more pro-inflammatory because it can afford it studies show that over 20 years or so if people regularly drink soft drinks with lots of sugar in them then they just have a higher risk of having as you said rheumatoid arthritis for example and so you don't want it on overdrive you don't want it doing too much you want a balanced

29:46immune system and of course I want to really be clear there's other ways to get those diseases it's not people's fault or having too much sugar that will then lead to them for sure to get this disease so people have genetic disposition there's environment like air pollution all these things can also lead to that so it's not the only cause but it's just one aspect you might want to be careful with because it pushes it in a wrong direction and there's other ways when I think people say well should I not at all strengthen my immune system now and here I would

30:17also interfere and say no no oftentimes it's about not weakening it because for example chronic stress really weakens it because the body uses all this energy for problem solving for ruminating and then it takes it away from for example sleep and forming ripe good immune cells that regulate the immune system so when there's a cold season and everyone around you is sick you might as well strengthen it with some substances I'm okay with that you know but for the most part it's about knowing a bit about it like having a balanced body supporting it not weakening it

30:47I think for many people when they're thinking about the immune system they immediately go