Most replayed moment: Can you really boost your immune system? | Professor Daniel Davis

0:00Hello, and welcome to Zoe Recap, where each week we find the best bits from one of our podcast episodes to help you improve your health.

0:10Today, we're talking about the immune system. It's one of the most important systems in our body, and it's also one of the hardest to understand. You can't see it, you can't feel it working, and there's no simple way to measure whether it's strong or weak. But when it fails, we certainly notice. Everywhere we look, supplements and superfoods promise to boost our immune system. But how many of these claims are actually supported by science? Professor Daniel Davis joins me to explain how our immune system truly works, and what the evidence says is the best ways to support it.

0:46The immune system is very complicated. I'm sure people are very aware of the importance of your immune system in fighting off all different kinds of infections. It's also important in preventing us from succumbing to other kinds of illnesses, cancer, and all sorts of other problems that could arise in our health. It's inherently complicated because it has to fight off all different kinds of possible infections, including infections that have never before existed in the universe. A new type of virus could arise at some point, and our immune system has to be able to fight that.

1:19So the immune system is there to fight off things that are potentially dangerous, but not attack any normal part of your healthy body. And to some extent, every single cell of you is part of your immune system, because almost all the different types of cells that make up the human body actually have some ability to know when they are infected with a virus, for example, or when they are turning cancerous. So most cells of the body have already some inbuilt sensory mechanism to detect when they themselves have a problem, and they could signify to other bona fide immune cells that they have a problem.

2:04So all of your body is part of the immune system. I mean, one thing I heard really clearly was that not only does it have to be incredibly good at attacking sort of these bad things outside, but it needs to be really smart at recognizing whether this is actually part of my body, so it mustn't be attacked. I'm interested that you mentioned that just in the summary. Is that a very important part of what it needs to do in order to be healthy? Absolutely, because you will know that there are any number of products and ideas telling you how to boost your immune system.

2:39And on the face of it, that sounds quite a simple thing that we want to be doing. But having just told you the complexity of what the immune system has to do, a layer of depth in the idea of boosting the immune system is immediately apparent. What does that actually mean? If you just somehow boost the ability of your immune system to be very active and start fighting things, then you don't want to do that because it would inadvertently start attacking things that are part of the normal, healthy body, and that would then cause you problems in itself.

3:09So it's important that we understand the complexity and the nuance in what the immune system has to be able to achieve, because already we're at the point where some of the soundbites and clickbait you might come across for do this one thing to boost your immune system. Already now we could be questioning, what does that actually mean? I don't want to just boost my immune system in a very general way to make it more active. I need it to be restrained in some situations because I don't want the immune system to react against my own body or things that are not particularly harmful to me, like would happen if your immune system started reacting against food or something and gave you an allergic reaction.

3:48One of the things I thought of as you were describing this like not reacting to things that are normal in the environment is seasonal allergies or hay fever. And I'm probably thinking about that because I get this now regularly, which I never did as a kid. Is that an example of like my immune system? You know, I mean, sometimes we belittle allergies because they're not spoken about in the same way that cancer is because allergies are not really a top 10 cause of death. But the number of people who get allergies, you just mentioned you get allergies, I get allergies, hay fever as well. And it's 2 billion people. So allergies are incredibly important and by and large, they are the outcome of our immune system reacting against something that is not particularly harmful, like it could be pollen as an example.

4:30But there are many different types of allergies, of course. So just even that knowledge in itself hopefully means that thinking about the complexity of the immune system means it's all about having the immune system react to things that are truly dangerous, but not overreact against things that are not really a problem for the body. There's another side to that as well, which is that when you do get a genuine infection, a virus infection, let's say, and your immune system has to deal with that. So that involves a heightened state of our immune system.

5:03The particular cells in your body that are good at fighting that virus have to multiply a number. You might experience a fever depending on what type of infection it is. But then, again, you don't want your body in that heightened state of immune activity because that would put it at risk of overreacting against something that's not harmful. So a lot of what we're talking about in good immune health is keeping the immune system balanced rather than, you know, utterly boosted in some way. And I get the impression that maybe we don't come back to balance as much as perhaps we're designed to.

5:37I mean, you talked about the allergies, 2 billion people with allergies. I just remember my grandparents sort of telling me that almost nobody had allergies when they were growing up. I don't know if that's true. Are we, like, coming back to normal in the same way that we are meant to? It's a very hard question to answer. I mean, the number of people diagnosed with allergies has been increasing. And some of that could be that we're better at recognising allergies than we used to be. It could be true that we are more susceptible to certain kinds of illnesses we used to be. And again, another reason for that might be that we're living longer on average.

6:10As we age, our immune system changes. Some autoimmune diseases do tend to arise more as we age. So there are many factors in the increasing prevalence of an immune system problem. In terms of allergies, one of the things that you might be thinking about is the effect of our microbiome. And there's this general idea that perhaps being exposed to something like a less hygienic environment or to microbes when we're younger trains our immune system to be better at dealing with allergies. So that comes from wonderful and pioneering research by Gordon Strachan at St. George's Hospital in South London.

6:50We're not too far from where we're speaking right now. And he made the observation that large families, the younger siblings tend to develop less allergies or less hay fever. And he had the idea that perhaps in a larger family, especially a younger sibling was more exposed to infections when they were younger because the older, the other people in the family might get infections. So you have this idea that perhaps an exposure to germs when you're younger somehow protects you against allergies. And he called that the hygiene hypothesis, which probably many of the listeners will be somewhat familiar with.

7:23That does also correlate with studies of children growing up on farms. One particularly careful study or a group of studies, if you like, has looked at different communities in the USA. And one group essentially lives nearer to where animals live and the environment where animals are. And they are less likely to develop allergies than another farming community that tends to use mechanical farming tools and live further away from where the animals live. So that again fits with this idea of the hygiene hypothesis that more of an exposure to germs does somehow train your immune system to protect you against allergies when you're older.

8:02But as we've said right at the outset of this podcast, everything is very nuanced and complicated. And there could be other explanations to those farming data. For example, unprocessed milk also is used in farms, which may also have some protective benefit. We understand very little about what that is. From my perspective as a scientist, I've kind of been trained to kind of hear something and then think of like 10 other explanations of why that might be true rather than the one that I've just been told. And it's exactly the case in this, that there's lots of possible explanations for how growing up on a farm may influence the onset of allergies.

8:36And the bottom line is, we don't know enough about the details of how that works to give us an actionable outcome. And it's particularly difficult because I couldn't take dust from an animal house on a farm and somehow expose children to that to see what happens. Because you would be exposing healthy children to something that we understand very little about and is even potentially dangerous. And that just isn't ethically possible to do.

9:06So it's very hard to do the experiments to find out what is it. Is there some important ingredient to the environment of growing up in a farm that helps train our immune system? And right this very minute, we don't know enough detail to make this an actionable thing that leads to any advice. So we have to be very careful about explaining what the results are, what the experiment is. I'm pretty confident I speak for myself, but also for most of our listeners who say, okay, I'd like to talk about some practical advice. Could we maybe start with whether there are any immune boosting supplements that would really support my immune health?

9:43The consensus view probably best comes from, as obvious as it sounds, the sort of basic guidelines that you would get from, you know, medical establishment. As kind of unsatisfying as kind of unsatisfying as that sounds, that's probably where the consensus is. The best established example, or one of the good examples, would be vitamin D supplements during the winter. For people living in the UK where it's certainly not as sunny as it might be in other parts of the world, that's the recommendation of the UK government, for example. And it is true that in a clinical trial, vitamin D supplements did reduce the chance that people with an average of 67 were susceptible to autoimmune disease.

10:24That reduced the chance they get an autoimmune disease by 22%. So vitamin D levels are important. So that would be an example of a supplement that is recommended, for example, by the UK government. And are there any others that you would be recommending? Or are you, this is back to your light, you don't want to really boost it and you've already thrown vitamin C out the window? There are established cases of vitamins being important. Vitamin A is very important, for example. But most people would be getting that level of vitamin A they need, for example, through a normal varied diet.

10:58And so it wouldn't be the case that you need to supplement. So the one thing where I would say will affect your immune health, and you can do something about it perhaps, is long-term stress. A lot of the data that we've talked about, a lot of the experience we've talked about are things coming from correlations between things. But with stress, we've taken that to another level. We've taken it to a kind of molecular level understanding of what happens, so that we do understand in detail how stress very directly affects your immune health.

11:31When your body senses some threat, it goes into this fight-or-flight response. So a signal, your hypothalamus will react to this perception of an issue and send the message to pituitary gland, send the message to adrenal gland, produces adrenaline and cortisol stress hormones. Those stress hormones get your body ready in a state of action to deal with the threat. And as part of that, they quieten down other body systems that aren't so important for dealing with that moment.

12:07And that includes your immune system. So when cortisol levels are high, your immune system is quietened down. So for a short period of time, this is entirely fine in a fight-or-flight response. So your example here is like, I've seen a lion, I need to run away. It's like, forget about fighting a cold. All you need to do is escape this lion. So it's all focused on that. We'll deal with the cold later. Let's run now. But if that persists, stress, of course, can be long-term.

12:37If you're changing job, getting divorced, any number of reasons. Running Zoe. Running Zoe, yeah. Your immune system can be suppressed for a longer time. And then that does correlate with more and more susceptible to infections. So that's true. That's not just one of these myths. Like, if you're under stress for a long period of time, you are more susceptible to infection. Yes. That has been proven in multitudes of ways. And what makes us really know that that's not just a correlation is because we can do

13:07very precise experiments. For example, if I just add cortisol to immune cells in a lab dish, they will be less good at killing cancer cells. So that kind of molecular level analysis of how this plays out makes us confident that this is a process that is genuinely true. And it's not a kind of something else going on that stress correlates with something else and the immune system correlates with something else. So that gives us confidence in that being an actual thing. Now, here's the kicker in this, though.

13:39Everything I'm coming at you with is always more complicated. Right this minute, from everything we've said, stress, long-term stress can affect your immune health. It seems like I should do things to relax. Tai Chi, jigsaw puzzle, coloring, whatever it is you might do to relax, to not be stressed in the long term. However, it hasn't actually been proven unequivocally that practices that reduce stress improve your immune health.

14:09Everything would point to that being true. And it is proven that, for example, practicing Tai Chi does lower your cortisol levels. That is proven. But what's not proven is that those practices will protect you against infectious diseases. And that, again, comes back to this really important message that the experiments are really hard. On balance, it seems to me very clear that stress affects your long-term health and doing things to not get stressed, if you can, is important. If you were going to give me and the listeners a specific one or two things that we could just

14:42start doing straight after we stop listening to this call, what would they be? One, try to avoid where you can long-term chronic stress. Two, every time you see something that feels like you've just been let in on a new secret to what's going to improve your immune health, be a little bit skeptical and think about, well, what was the experiment they did? When you think of a gut supplement, what comes to mind?

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16:19Thanks for listening and see you next time.