Super Immunity

Lesson 4:
Introduction to the Immune System
Colds and Flu What We Need to Know

Copyright 2011 Joel Fuhrman, M.D.

Introduction to the Immune System:

Exterior Defenses
Exterior defenses work to keep microbes from entering
the tissues and bloodstream:
First line of defense: intact skin
Respiratory tract cilia, cough reflex
Mucous membranes
Mucous coating
Secretion of anti-bacterial enzymes, immunoglobulins
(antibodies)

Stomach acid
If a pathogen does indeed invade tissue or blood,
additional defenses step in to remove it (the
inflammatory response).

Copyright 2011 Joel Fuhrman, M.D.

Cells of the Immune System (1)

Phagocytes (macrophages, neutrophils) engulf
and remove microbes, foreign material,
cellular debris
Macrophages first line of cellular defense
Neutrophils are recruited to sites of
inflammation, amplify inflammatory response

Copyright 2011 Joel

When macrophages encounter a pathogen, they

produce cytokines to activate other immune cells

Copyright 2011 Joel Fuhrman, M.D.

Cells of the Immune System (2)

Natural killer (NK) cells kill tumor cells and virusinfected cells
Antigen-presenting cells (macrophages, dendritic cells)
activate helper T cells, B cells
T cells:
Cytotoxic T cells destroy infected body cells, tumor cells
Helper T cells - stimulate B cell activity
NK T cells - recruited to sites of inflammation, secrete
cytokines that activate helper T cells, kill tumor cells;
dysfunction associated with autoimmune disease

B cells produce and secrete antibodies

Copyright 2011 Joel Fuhrman, M.D.

What happens when you catch a cold

or flu virus?

Viral particles enters via nose, eyes, or mouth

First, the virus must avoid being trapped in mucus layer and swallowed
The virus must also avoid being trapped in cilia and coughed or sneezed
out
Once the virus enters your tissues, the inflammatory response begins.
If you have been exposed to the virus before, antibodies will bind and
block it from infecting cells
The complement system may destroy it
Macrophages may destroy it
If the virus evades all of these defenses, it begins to infect tissue cells
The virus uses the host cells resources to replicate
The host cell dies, releasing virus which will infect more cells
The inflammatory response continues until the virus is removed
An immunological memory of the virus (antibody) is produced

Copyright 2011 Joel Fuhrman, M.D.

The Common Cold & Influenza

Common cold: caused by a variety of viruses,
primarily rhinoviruses
Influenza: Caused by one of three types of
influenza virus: A, B, or C
The bodys natural responses help to eradicate
the virus

Inflammation: mucus production, swollen

membranes
Cough mobilizes mucous, dead cells, and virus
particles, keeping airways clear and preventing more
serious illness
Copyright 2011 Joel Fuhrman, M.D.

Cold Symptoms vs. Flu Symptoms

Symptoms common to both:
High fever
Headache
Extreme fatigue
Cough, sore throat, nasal congestion (common but
not universal)
GI symptoms (more common in children)

Headaches and muscle aches usually

differentiate flu from other viral illnesses
Copyright 2011 Joel Fuhrman, M.D.

Cold vs.
Flu

Copyright 2011 Joel Fuhrman, M.D.

Common misconceptions
Antibiotics are effective against cold and flu
Green or yellow mucus indicates bacterial
infection
Fevers should be reduced with medication
OTC cold medicines accelerate recovery
Drinking excess fluids
Eating to keep strength up

Copyright 2011 Joel Fuhrman, M.D.

Avoiding exposure to viruses

Most viruses: primarily hand-to-face contact
Public surfaces: door handles, pens, etc.
Avoid touching your face in public places
Keep young children at home childcare settings
are fertile ground for viruses

Influenza: inhalation of airborne virus

(coughing, sneezing)
Avoid exposure to infected people
Copyright 2011 Joel Fuhrman, M.D.

Flu Vaccine

(Review and Summary from Lesson 2)

The CDC recommends flu shots for everyone,
but the flu is not dangerous for healthy people
Strains are guessed at - vaccines can only be
partially effective
Cochrane analysis determined that safety data
for children and elderly are insufficient, and
the benefits of flu shots are marginal
No safety data on long-term repeated
vaccination
Copyright 2011 Joel Fuhrman, M.D.

70% of immune system is in the GI tract!

GI tract is the main route by which the body
contacts the external environment, which is full
of microorganisms and other foreign material
Gut-associated immune cells must be able to
tolerate healthy flora and also mount a protective
response to pathogens
Excess immune response of gut immune cells is
involved in intestinal inflammation e.g. IBD.

Copyright 2011 Joel Fuhrman, M.D.

Immune Cells and Organs in the GI Tract

Copyright 2011 Joel Fuhrman, M.D.

Healthy Bacteria
Healthy bacteria = probiotics = intestinal
microflora
95% of the cells in the human body are
healthy bacteria in the human GI tract
Perform functions vital to our health
Healthful diet is key to maintaining healthy
flora
Antibiotics kill bacteria indiscriminately
Copyright 2011 Joel Fuhrman, M.D.

Functions of Healthy Bacteria

Supplement the
digestive process to
break down food
Produce vitamins (B
vitamins, K)
Process fiber
Produce colon cancerprotective SCFA

Protect against
overgrowth of
pathogenic bacteria,
yeast
Strengthen immune
function
Produce nutrients that
prevent weight gain

Copyright 2011 Joel Fuhrman, M.D.

Effects of Pathogenic Bacteria, Yeasts

Produce toxic substances including
carcinogens
Harbor a reservoir of bacterial invaders to
create serious future infections
Produce digestive disturbances
Promote immune system dysfunction
Promote autoimmune inflammatory diseases
Promote weight gain
Copyright 2011 Joel Fuhrman, M.D.

Immune cells of the GI tract attack foreign

microbes, but not microflora

Copyright 2011 Joel Fuhrman, M.D.

Antibiotics
90% of antibiotics are prescribed inappropriately
Study: more than half who seek physicians care for
cold symptoms leave with a prescription for antibiotic
Adverse reactions common 140,000 ER visits/year
Risks:

Non-Hodgkins Lymphoma in children

Breast cancer in women
Commonly prescribed to pregnant women birth defects
First year of life risk of asthma, allergies (more than half
of babies prescribed antibiotics during first year)

Disruption of healthy bacteria

Copyright 2011 Joel Fuhrman, M.D.

Antibiotic Resistance: A Growing Threat

Over 100,000 deaths/year caused by hospital
acquired antibiotic-resistant infections
Antibiotics kill off non-resistant bacteria,
leaving resistant bacteria to replicate
Antibiotics cause bacteria to mutate relatively
quickly to develop resistance
Repeated use of antibiotics sets the stage for
recurrent and increasingly serious infections
Copyright 2011 Joel Fuhrman, M.D.

How Antibiotic Resistance Spreads

Antibiotic-resistant genes released in the form
of plasmids (pieces of DNA)
Plasmids picked up by other bacteria
These bacteria are now protected from
antibiotics

Copyright 2011 Joel Fuhrman, M.D.

Common Cold and Flu Remedies

Most options provide temporary relief of
symptoms, but come with risks and do not
promote recovery
The symptoms are the bodys natural healing
actions
Suppressing symptoms can only prolong the
illness
To recover, allow the body to do its job:
Rest
Eat well
Do not interfere!

Copyright 2011 Joel Fuhrman, M.D.

Cough Medications
Coughing is part of your bodys natural
response to viral infection
Dextromethorphan (OTC cough suppressant)
does not work and causes insomnia
Codeine is also not effective
Hydrocodone mildly effective, but has
serious side effects
Its a good thing that cough suppressants
dont work!
Copyright 2011 Joel Fuhrman, M.D.

Antihistamines
Histamine is a natural part of the immune
response:
Vasodilation increased blood flow to infected area
Endothelial permeability allow neutrophils to enter
the area and phagocytose virus particles

Analysis of 35 trials: no evidence that

antihistamines significantly improve cold
symptoms or accelerate recovery
Antihistamines do induce sleepiness
Copyright 2011 Joel Fuhrman, M.D.

Fever Reducers: Ibuprofen and Aspirin

Fever is beneficial elevated body temperature
increases immune cell production and activity
Fever reduction may slightly reduce discomfort,
but is preventing the body from fighting the virus:
Prolongs illness
Prolongs contagious period

NSAIDs associated with cardiovascular events

Copyright 2011 Joel Fuhrman, M.D.

Fever Reducers: Acetaminophen

More toxic than ibuprofen
Only effective for 4-5 hours
Can cause liver damage in recommended
doses
Acetaminophen overdose is a significant cause
of death in children
Associated with cardiovascular events

Copyright 2011 Joel Fuhrman, M.D.

Chicken Soup
Hot soup may temporarily lesson nasal
symptoms
Does not shorten duration of infection, may
prolong suppresses mucous flow and WBC
movement
Eat lightly when you have a cold. Have
vegetable soup instead.

Copyright 2011 Joel Fuhrman, M.D.

Humidified Air/Steam Inhalation

Not effective for accelerating recovery
Not effective for reducing wheezing or
coughing

Copyright 2011 Joel Fuhrman, M.D.

Drink Plenty of Fluids

No scientific basis
Avoiding dehydration is important
Extra fluids (beyond replacing losses) have no
benefit, may even be harmful
Drink when thirsty

Copyright 2011 Joel Fuhrman, M.D.

Nasal Saline Irrigation

May improve symptoms in people with
chronic sinus infections
No beneficial effects for acute viral infections

Copyright 2011 Joel Fuhrman, M.D.

Homeopathic Remedies
Homeopathy: like cures like
Popular homeopathic cold remedy
Oscillococcinum found to be ineffective for
preventing infections and accelerating
recovery

Copyright 2011 Joel Fuhrman, M.D.

Vitamin C
Review of 30 randomized trials found that
daily vitamin C supplementation does not
reduce incidence of infection
Vitamin C taken during illness also shown to
be ineffective
May be of value for people who do not
consume enough vitamin C
If you eat adequate fruits and vegetables,
additional vitamin C will not add any benefit
Copyright 2011 Joel Fuhrman, M.D.

Echinacea & Other Herbal Remedies

Studies have found Echinacea to be ineffective for
reducing symptoms and length of illness
When taken preventively, some studies reported
benefit; larger, higher quality studies did not
Other herbal remedies (andrographis, ginseng,
astragalus, golden seal, juniper, pelargonium)
May have mild immune-stimulating, antihistaminic
effects that lesson symptoms
Limited scientific data, no evidence of major illnessshortening or preventive effects
Not sufficiently tested in rigorous trials

Copyright 2011 Joel Fuhrman, M.D.

Garlic
Insufficient evidence thus far that garlic
affects incidence or symptoms of the common
cold
However, recall from our previous lessons that
garlic and onions are immune-enhancing
foods, and should be eaten regularly.

Copyright 2011 Joel Fuhrman, M.D.

Resveratrol
A phytochemical found primarily in red grape skin
and peanuts, plus other colorful produce
May have anti-inflammatory and anti-aging
effects in humans preliminary evidence
Anti-cancer effects in cell culture and animal
studies
Antiviral effects in animal studies against HSV,
HIV, varicella-zoster, influenza
Supplementation is likely beneficial
Copyright 2011 Joel Fuhrman, M.D.

Zinc

Zinc deficiency increases susceptibility to infection

Absorption may be low or inadequate from plant-based diets
Evidence that zinc supplementation is beneficial for cold, flu,
other infections:
Decreases pneumonia incidence
Maternal supplementation reduces likelihood of infant
infections
Reduces duration of flu symptoms
Cochrane analysis
Reduces severity and duration of cold symptoms when
taken upon start of symptoms
When taken regularly (for at least 5 months), 2/3 reduced
likelihood of colds
Avoid zinc deficiency
Copyright 2011 Joel Fuhrman, M.D.

Vitamin D

Produced by the skin in response to sunlight

Not present in most foods
Acts as a hormone
Deficiency associated with increased flu risk
Study: children given vitamin D supplement
then exposed to flu virus had reduced
incidence of viral respiratory infections

Copyright 2011 Joel Fuhrman, M.D.

Elderberry Extract
Has antiviral effects
Evidence that black elderberry extract can
shorten duration of flu
Elderberry flavonoids increase monocyte
defensive function, inhibits virus adhesion to
cells which inhibits replication

Copyright 2011 Joel Fuhrman, M.D.

Review of Cold/Flu Remedies

Likely a waste of your time:
Vitamin C
Chicken Soup
Humidified air/steam
Nasal saline irrigation
Echinacea

Likely helpful:
Zinc
Vitamin D
Elderberry and berry
flavonoids
Caloric restriction

Copyright 2011 Joel Fuhrman, M.D.

When it is appropriate to call

the doctor:
Rapid breathing
Breathing with grunting or wheezing sounds
Labored breathing (in a child, with rib muscles
retracting)
Abdominal pain (more common in children)
Changes in behavior or mental status
Persistent diarrhea or vomiting (more common in
children), especially if unable to hold down
sufficient fluids
Persistent fever above 103 degrees for 3 days
Copyright 2011 Joel Fuhrman, M.D.