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Howtoboostyourimmunesystem
Whatcanyoudo?
On the whole, your immune system does a remarkable job of defending you against disease-causing microorganisms. But sometimes it fails: A germ
invades successfully and makes you sick. Is it possible to intervene in this process and make your
immune system stronger? What if you improve your diet? Take certain vitamins or herbal preparations?
Make other lifestyle changes in the hope of producing a near-perfect immuneresponse?
The idea of boosting your immunity is enticing, but the ability to do so has proved elusive for several
reasons. The immune system is precisely that a system, not a single entity. To function well, it requires
balance and harmony. There is still much that researchers dont know about the intricacies and
interconnectedness of the immune response. For now, there are no scientifically proven direct links
between lifestyle and enhanced immunefunction.
But that doesnt mean the effects of lifestyle on the immune system arent intriguing and shouldnt be
studied. Quite a number of researchers are exploring the effects of diet, exercise, age, psychological stress, herbal supplements, and other factors on the
immune response, both in animals and in humans. Although interesting results are emerging, thus far they can only be considered preliminary. Thats
because researchers are still trying to understand how the immune system works and how to interpret measurements of immune function. The
following sections summarize some of the most active areas of research into these topics. In the meantime, general healthy-living strategies are a good
way to start giving your immune system the upperhand.

Adopthealthylivingstrategies
Your first line of defense is to choose a healthy lifestyle. Following general good-health guidelines is the
single best step you can take toward keeping your immune system strong and healthy. Every part of
your body, including your immune system, functions better when protected from environmental
assaults and bolstered by healthy-living strategies such asthese:
Dont smoke.
Eat a diet high in fruits, vegetables, and whole grains, and low in saturatedfat.
Exercise regularly.
Maintain a healthyweight.
Control your bloodpressure.
If you drink alcohol, drink only inmoderation.
Get adequate sleep.
Take steps to avoid infection, such as washing your hands frequently and cooking meatsthoroughly.

Immunity in action. A healthy immune


system can defeat invading pathogens as
shown above, where two bacteria that cause
gonorrhea are no match for the large
phagocyte, called a neutrophil, that engulfs
and kills them (seearrows).
Photos courtesy of Michael N. Starnbach,
Ph.D., Harvard MedicalSchool

Get regular medical screening tests for people in your age group and riskcategory.

Beskeptical
Many products on store shelves claim to boost or support immunity. But the concept of boosting immunity actually makes little sense scientifically. In
fact, boosting the number of cells in your body immune cells or others is not necessarily a good thing. For example, athletes who engage in
blood doping pumping blood into their systems to boost their number of blood cells and enhance their performance run the risk ofstrokes.
Attempting to boost the cells of the immune system is especially complicated because there are so many different kinds of cells in the immune system
that respond to so many different microbes in so many ways. Which cells should you boost, and to what number? So far, scientists do not know the
answer. What is known is that the body is continually generating immune cells. Certainly it produces many more lymphocytes than it can possibly use.

The extra cells remove themselves through a natural process of cell death called apoptosis some before they see any action, some after the battle is

The extra cells remove themselves through a natural process of cell death called apoptosis some before they see any action, some after the battle is
won. No one knows how many cells or what kinds of cells the immune system needs to function at its optimumlevel.
Scientists do know more about the low end of the scale. When the number of T cells in an HIV/AIDS patient drops below a certain level, the patient gets
sick because the immune system doesnt have enough T cells to fight off infection. So there is a bottom number below which the immune system cant
do its job. But how many T cells is comfortably enough, and beyond that point, is more better? We dontknow.
Many researchers are trying to explore the effects of a variety of factors from foods and herbal supplements to exercise and stress on immunity.
Some take measures of certain blood components like lymphocytes or cytokines. But thus far, no one really knows what these measurements mean in
terms of your bodys ability to fight disease. They provide a way of detecting whether something is going on, but science isnt yet sufficiently advanced
to understand how this translates into success in warding offdisease.
A different scientific approach looks at the effect of certain lifestyle modifications on the incidence of disease. If a study shows significantly less disease,
researchers consider whether the immune system is being strengthened in some way. Based on these studies, there is now evidence that even though
we may not be able to prove a direct link between a certain lifestyle and an improved immune response, we can at least show that some links arelikely.
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Ageandimmunity
Earlier in this report (see Cancer: Missed cues), we noted that one active area of research is how the immune system functions as the body ages.
Researchers believe that the aging process somehow leads to a reduction of immune response capability, which in turn contributes to more infections,
more inflammatory diseases, and more cancer. As life expectancy in developed countries has increased, so too has the incidence of age-related
conditions. Happily, investigation into the aging process can benefit us all no matter what ourage.
While some people age healthily, the conclusion of many studies is that, compared with younger people, the elderly are far more likely to contract
infectious diseases. Respiratory infections, influenza, and particularly pneumonia are a leading cause of death in people over 65 worldwide. No one
knows for sure why this happens, but some scientists observe that this increased risk correlates with a decrease in T cells, possibly from the thymus
atrophying with age and producing fewer T cells to fight off infection. Thymus function declines beginning at age 1; whether this decrease in thymus
function explains the drop in T cells or whether other changes play a role is not fully understood. Others are interested in whether the bone marrow
becomes less efficient at producing the stem cells that give rise to the cells of the immunesystem.
Researchers at the University of Arkansas are looking at another aspect of why the immune system seems to weaken with age. They studied cell death in
mice. They conducted an experiment to compare the lifespan of memory T lymphocytes in older mice with those of younger mice and found that the
lymphocytes in older mice die sooner. This suggests that as the lymphocytes die off, the elderly immune system loses its memory for the microbes it is
intended to fight and fails to recognize the microbes when they reappear. The body thus becomes less able to mount a vigorous immuneresponse.
A reduction in immune response to infections has been demonstrated by older peoples response to vaccines. For example, studies of influenza
vaccines have shown that for people over age 65, vaccine effectiveness was 23%, whereas for healthy children (over age 2), it was 38%. But despite the
reduction in efficacy, vaccinations for influenza and S. pneumoniae have significantly lowered the rates of sickness and death in older people when
compared withnonvaccination.
Yet other researchers are looking at the connection between nutrition and immunity in the elderly. A form of malnutrition that is surprisingly common
even in affluent countries is known as micronutrient malnutrition. Micronutrient malnutrition, in which a person is deficient in some essential vitamins
and trace minerals that are obtained from or supplemented by diet, can be common in the elderly. Older people tend to eat less and often have less
variety in their diets. One important question is whether dietary supplements may help older people maintain a healthier immune system. Older people
should discuss this question with a physician who is well versed in geriatric nutrition, because while some dietary supplementation may be beneficial
for older people, even small changes can have serious repercussions in this agegroup.

Whataboutdiet?
Like any fighting force, the immune system army marches on its stomach. Immune system warriors need good, regular nourishment. Scientists have
long recognized that people who live in poverty and are malnourished are more vulnerable to infectious diseases. Whether the increased rate of disease
is caused by malnutritions effect on the immune system, however, is not certain. There are still relatively few studies of the effects of nutrition on the
immune system of humans, and even fewer studies that tie the effects of nutrition directly to the development (versus the treatment) ofdiseases.
There are studies of the effects of nutritional changes on the immune systems of animals, but again there are few studies that address the development

There are studies of the effects of nutritional changes on the immune systems of animals, but again there are few studies that address the development
of diseases in animals as a result of changes in immunity. For example, one group of investigators has found that in mice, diets deficient in protein
reduce both the numbers and function of T cells and macrophages and also reduce the production of immunoglobulin A (IgA)antibody.
There is some evidence that various micronutrient deficiencies for example, deficiencies of zinc, selenium, iron, copper, folic acid, and vitamins A, B6,
C, and E alter immune responses in animals, as measured in the test tube. However, the impact of these immune system changes on the health of
animals is less clear, and the effect of similar deficiencies on the human immune response has yet to be assessed. But the research at this stage is
promising, at least for some of themicronutrients.
So what can you do? If you suspect your diet is not providing you with all your micronutrient needs maybe you dont like vegetables or you choose
white bread over whole grains taking a daily multivitamin and mineral supplement brings health benefits of many types, beyond any possibly
beneficial effects on the immune system. Taking megadoses of a single vitamin does not. More is not necessarily better. Researchers are investigating
the immune boosting potential of a number of differentnutrients.
Selenium. Some studies have suggested that people with low selenium levels are at greater risk of bladder, breast, colon, rectum, lung, and prostate
cancers. A large-scale, multiyear study is currently in progress to look at the effects of combining selenium and vitamin E on prostate cancerprevention.
Vitamin A. Experts have long known that vitamin A plays a role in infection and maintaining mucosal surfaces by influencing certain subcategories of T
cells and B cells and cytokines. Vitamin A deficiency is associated with impaired immunity and increased risk of infectious disease. On the other hand,
according to one study, supplementation in the absence of a deficiency didnt enhance or suppress T cell immunity in a group of healthyseniors.
Vitamin B2. There is some evidence that vitamin B2 enhances resistance to bacterial infections in mice, but what that means in terms of enhancing
immune response isunclear.
Vitamin B6. Several studies have suggested that a vitamin B6 deficiency can depress aspects of the immune response, such as lymphocytes ability to
mature and spin off into various types of T and B cells. Supplementing with moderate doses to address the deficiency restores immune function, but
megadoses dont produce additional benefits. And B6 may promote the growth oftumors.
Vitamin C. The jury is still out on vitamin C and the immune system. Many studies have looked at vitamin C in general; unfortunately, many of them
were not well designed. Vitamin C may work in concert with other micronutrients rather than providing benefitsalone.
Vitamin D. For many years doctors have known that people afflicted with tuberculosis responded well to sunlight. An explanation may now be at hand.
Researchers have found that vitamin D, which is produced by the skin when exposed to sunlight, signals an antimicrobial response to the bacterium
responsible for tuberculosis, Mycobacterium tuberculosis. Whether vitamin D has similar ability to fight off other diseases and whether taking vitamin D
in supplement form is beneficial are questions that need to be resolved with furtherstudy.
Vitamin E. A study involving healthy subjects over age 65 has shown that increasing the daily dose of vitamin E from the recommended dietary
allowance (RDA) of 30 mg to 200 mg increased antibody responses to hepatitis B and tetanus after vaccination. But these increased responses didnt
happen following administration of diphtheria and pneumococcalvaccines.
Zinc. Zinc is a trace element essential for cells of the immune system, and zinc deficiency affects the ability of T cells and other immune cells to function
as they should. Caution: While its important to have sufficient zinc in your diet (1525 mg per day), too much zinc can inhibit the function of the
immunesystem.

Herbsandothersupplements
Walk into a store, and you will find bottles of pills and herbal preparations that claim to support immunity or otherwise boost the health of your
immune system. Although some preparations have been found to alter some components of immune function, thus far there is no evidence that they
actually bolster immunity to the point where you are better protected against infection and disease. Demonstrating whether an herb or any
substance, for that matter can enhance immunity is, as yet, a highly complicated matter. Scientists dont know, for example, whether an herb that
seems to raise the levels of antibodies in the blood is actually doing anything beneficial for overallimmunity.
But that doesnt mean we should discount the benefits of all herbal preparations. Everyones immune system is unique. Each persons physiology
responds to active substances differently. So if your grandmother says shes been using an herbal preparation for years that protects her from illness,
whos to say that it doesnt? The problem arises when scientists try to study such a preparation among large numbers of people. The fact that it works
for one person wont show up in the research data if its not doing the same for a largergroup.
Scientists have looked at a number of herbs and vitamins in terms of their potential to influence the immune system in some way. Much of this research
has focused on the elderly, children, or people with compromised immune systems, such as AIDS patients. And many of the studies have had design
flaws, which means further studies are needed to confirm or disprove the results. Consequently, these findings should not be considered
universallyapplicable.
Some of the supplements that have drawn attention from researchers arethese:

Aloe vera. For now, theres no evidence that aloe vera can modulate immune response. Because many different formulations and compounds have

Aloe vera. For now, theres no evidence that aloe vera can modulate immune response. Because many different formulations and compounds have
been used in studies, comparing the results is difficult. However, there is some evidence that topical aloe vera is helpful for minor burns, wounds, or
frostbite, and also for skin inflammations when combined with hydrocortisone. Studies have found aloe vera is not the best option for treating breast
tissue after radiationtherapy.
Astragalus membranes. The astragalus product, which is derived from the root of the plant, is marketed as an immune-system stimulant, but the
quality of the studies demonstrating the immune-stimulating properties of astragalus are poor. Furthermore, it may bedangerous.
Echinacea. An ocean of ink has been spilled extolling echinacea as an immune stimulant, usually in terms of its purported ability to prevent or limit
the severity of colds. Most experts dont recommend taking echinacea on a long-term basis to prevent colds. A group of physicians from Harvard
Medical School notes that studies looking at the cold prevention capabilities of echinacea have not been well designed, and other claims regarding
echinacea are as yet not proven. Echinacea can also cause potentially serious side effects. People with ragweed allergies are more likely to have a
reaction to echinacea, and there have been cases of anaphylactic shock. Injected echinacea in particular has caused severe reactions. A well-designed
study by pediatricians at the University of Washington in Seattle found echinacea didnt help with the duration and severity of cold symptoms in a
group of children. A large 2005 study of 437 volunteers also found that echinacea didnt affect the rate of cold infections or the progress and severity of
acold.
Garlic. Garlic may have some infection-fighting capability. In laboratory tests, researchers have seen garlic work against bacteria, viruses, and fungi.
Although this is promising, there havent been enough well-designed human studies conducted to know whether this translates into human benefits.
One 2006 study that looked at rates for certain cancers and garlic and onion consumption in southern European populations found an association
between the frequency of use of garlic and onions and a lower risk of some common cancers. Until more is known, however, its too early to recommend
garlic as a way of treating or preventing infections or controllingcancer.
Ginseng. Its not clear how the root of the ginseng plant works, but claims on behalf of Asian ginseng are many, including its ability to stimulate
immune function. Despite the claims of a number of mainly small studies, the National Center for Complementary and Alternative Medicine (NCCAM)
considers there have been insufficient large studies of a high enough quality to support the claims. NCCAM is currently supporting research to
understand Asian ginseng morefully.
Glycyrrhiza glabra (licorice root). Licorice root is used in Chinese medicine to treat a variety of illnesses. Most studies of licorice root have been done
in combination with other herbs, so its not possible to verify whether any effects were attributable to licorice root per se. Because of the potential side
effects of taking licorice and how little is known about its benefits if any for stimulating immune function, this is an herb toavoid.
Probiotics. There are hundreds of different species of bacteria in your digestive tract, which do a bang-up job helping you digest your food. Now
researchers, including some at Harvard Medical School, are finding evidence of a relationship between such good bacteria and the immune system.
For instance, it is now known that certain bacteria in the gut influence the development of aspects of the immune system, such as correcting
deficiencies and increasing the numbers of certain T cells. Precisely how the bacteria interact with the immune system components isnt known. As
more and more intriguing evidence comes in to support the link that intestinal bacteria bolster the immune system, its tempting to think that more
good bacteria would be better. At least, this is what many marketers would like you to believe as they tout their probioticproducts.
Probiotics are good bacteria, such as Lactobacillus and Bifidobacterium, that can safely dwell in your digestive tract. Youll now find probiotics listed on
the labels of dairy products, drinks, cereals, energy bars, and other foods. Ingredients touted as prebiotics, which claim to be nutrients that feed the
good bacteria, are also cropping up in commercially marketed foods. Unfortunately, the direct connection between taking these products and
improving immune function has not yet been made. Nor has science shown whether taking probiotics will replenish the good bacteria that get knocked
out together with bad bacteria when you takeantibiotics.
Another caution is that the quality of probiotic products is not consistent. Some contain what they say they do; some do not. In a 2006 report, the
American Academy of Microbiology said that at present, the quality of probiotics available to consumers in food products around the world is
unreliable. In the same vein, the FDA monitors food packages to make sure they dont carry labels that claim the products can cure diseases unless the
companies have scientific evidence to support the claims. Does this mean taking probiotics is useless? No. It means the jury is still out on the expansive
health claims. In the meantime, if you choose to take a probiotic in moderation, it probably wont hurt, and the scientific evidence may ultimately show
somebenefit.

Thestressconnection
Modern medicine, which once treated the connection between emotions and physical health with skepticism, has come to appreciate the closely linked
relationship of mind and body. A wide variety of maladies, including stomach upset, hives, and even heart disease, are linked to the effects of emotional
stress. But although the relationship between stress and immune function is being studied by a number of different types of scientists, so far it is not a
major area of research forimmunologists.
Studying the relationship between stress and the immune system presents difficult challenges. For one thing, stress is difficult to define. What may
appear to be a stressful situation for one person is not for another. When people are exposed to situations they regard as stressful, it is difficult for them
to measure how much stress they feel, and difficult for the scientist to know if a persons subjective impression of the amount of stress is accurate. The
scientist can only measure things that may reflect stress, such as the number of times the heart beats each minute, but such measures also may reflect
otherfactors.
Most scientists studying the relationship of stress and immune function, however, do not study a sudden, short-lived stressor; rather, they try to study

Most scientists studying the relationship of stress and immune function, however, do not study a sudden, short-lived stressor; rather, they try to study
more constant and frequent stressors known as chronic stress, such as that caused by relationships with family, friends, and co-workers, or sustained
challenges to perform well at ones work. Some scientists are investigating whether ongoing stress takes a toll on the immunesystem.
But it is hard to perform what scientists call controlled experiments in human beings. In a controlled experiment, the scientist can change one and
only one factor, such as the amount of a particular chemical, and then measure the effect of that change on some other measurable phenomenon, such
as the amount of antibodies produced by a particular type of immune system cell when it is exposed to the chemical. In a living animal, and especially in
a human being, that kind of control is just not possible, since there are so many other things happening to the animal or person at the time that
measurements are beingtaken.
Despite these inevitable difficulties in measuring the relationship of stress to immunity, scientists who repeat the same experiment many times with
many different animals or human beings, and who get the same result most of the time, hope that they can draw reasonableconclusions.
Some researchers place animals into stressful situations, such as being trapped in a small space or being placed near an aggressive animal. Different
functions of their immune systems, and their health, are then measured under such stressful conditions. On the basis of such experiments, some
published studies have made the followingclaims:
Experimentally created stressful situations delayed the production of antibodies in mice infected with influenza virus and suppressed the activity of
T cells in animals inoculated with herpes simplexvirus.
Social stress can be even more damaging than physical stress. For example, some mice were put into a cage with a highly aggressive mouse two
hours a day for six days and repeatedly threatened, but not injured, by the aggressive mouse a social stress. Other mice were kept in tiny cages
without food and water for long periods a physical stress. Both groups of mice were exposed to a bacterial toxin, and the socially stressed
animals were twice as likely todie.
Isolation can also suppress immune function. Infant monkeys separated from their mothers, especially if they are caged alone rather than in groups,
generate fewer lymphocytes in response to antigens and fewer antibodies in response toviruses.
Many researchers report that stressful situations can reduce various aspects of the cellular immune response. A research team from Ohio State
University that has long worked in this field suggests that psychological stress affects the immune system by disrupting communication between the
nervous system, the endocrine (hormonal) system, and the immune system. These three systems talk to one another using natural chemical messages,
and must work in close coordination to be effective. The Ohio State research team speculates that long-term stress releases a long-term trickle of stress
hormones mainly glucocorticoids. These hormones affect the thymus, where lymphocytes are produced, and inhibit the production of cytokines and
interleukins, which stimulate and coordinate white blood cell activity. This team and others have reported the followingresults:
Elderly people caring for relatives with Alzheimers disease have higher than average levels of cortisol, a hormone secreted by the adrenal glands
and, perhaps because of the higher levels of cortisol, make fewer antibodies in response to influenzavaccine.
Some measures of T cell activity have been found to be lower in depressed patients compared with nondepressed patients, and in men who are
separated or divorced compared with men who aremarried.
In a year-long study of people caring for husbands or wives with Alzheimers disease, changes in T cell function were greatest in those who had the
fewest friends and least outsidehelp.
Four months after the passage of Hurricane Andrew in Florida, people in the most heavily damaged neighborhoods showed reduced activity in
several immune system measurements. Similar results were found in a study of hospital employees after an earthquake in LosAngeles.
In all of these studies, however, there was no proof that the immune system changes measured had any clear adverse effects on health in
theseindividuals.
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Doesbeingcoldmakeyousick?

Almost every mother has said it: Wear a jacket or youll catch a cold! Is she right? So far, researchers who are studying this question think that normal

Almost every mother has said it: Wear a jacket or youll catch a cold! Is she right? So far, researchers who are studying this question think that normal
exposure to moderate cold doesnt increase your susceptibility to infection. Most health experts agree that the reason winter is cold and flu season is
not that people are cold, but that they spend more time indoors, in closer contact with other people who can pass on theirgerms.
But researchers remain interested in this question in different populations. Some experiments with mice suggest that cold exposure might reduce the
ability to cope with infection. But what about humans? Scientists have dunked people in cold water and made others sit nude in subfreezing
temperatures. Theyve studied people who lived in Antarctica and those on expeditions in the Canadian Rockies. The results have been mixed. For
example, researchers documented an increase in upper respiratory infections in competitive cross-country skiers who exercise vigorously in the cold,
but whether these infections are due to the cold or other factors such as the intense exercise or the dryness of the air is not known. Theyve found
that exposure to cold does increase levels of some cytokines, the proteins and hormones that act as messengers in the immune system, but how this
affects health isntclear.
A group of Canadian researchers that has reviewed hundreds of medical studies on the subject and conducted some of its own research concludes that
theres no need to worry about moderate cold exposure it has no detrimental effect on the human immune system. Should you bundle up when its
cold outside? The answer is yes if youre uncomfortable, or if youre going to be outdoors for an extended period where such problems as frostbite
and hypothermia are a risk. But dont worry aboutimmunity.

Exercise:Goodorbadforimmunity?
Regular exercise is one of the pillars of healthy living. It improves cardiovascular health, lowers blood pressure, helps control body weight, and protects
against a variety of diseases. But does it help maintain a healthy immune system? Just like a healthy diet, exercise can contribute to general good health
and therefore to a healthy immune system. It may contribute even more directly by promoting good circulation, which allows the cells and substances
of the immune system to move through the body freely and do their jobefficiently.
Some scientists are trying to take the next step to determine whether exercise directly affects a persons susceptibility to infection. For example, some
researchers are looking at whether extreme amounts of intensive exercise can cause athletes to get sick more often or somehow impairs their immune
function. To do this sort of research, exercise scientists typically ask athletes to exercise intensively; the scientists test their blood and urine before and
after the exercise to detect any changes in immune system components such as cytokines, white blood cells, and certain antibodies. While some
changes have been recorded, immunologists do not yet know what these changes mean in terms of human immune response. No one yet knows, for
example, whether an increase in cytokines is helpful or has any true effect on immune response. Similarly, no one knows whether a general increase in
white cell count is a good thing or a badthing.
But these subjects are elite athletes undergoing intense physical exertion. What about moderate exercise for average people? Does it help keep the
immune system healthy? For now, even though a direct beneficial link hasnt been established, its reasonable to consider moderate regular exercise to
be a beneficial arrow in the quiver of healthy living, a potentially important means for keeping your immune system healthy along with the rest of
yourbody.
One approach that could help researchers get more complete answers about whether lifestyle factors such as exercise help improve immunity takes
advantage of the sequencing of the human genome. This opportunity for research based on updated biomedical technology can be employed to give a
more complete answer to this and similar questions about the immune system. For example, microarrays or gene chips based on the human genome
allow scientists to look simultaneously at how thousands of gene sequences are turned on or off in response to specific physiological conditions for
example, blood cells from athletes before and after exercise. Researchers hope to use these tools to analyze patterns in order to better understand how
the many pathways involved act atonce.
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