Prolonged fatigue and pain are two of the most common causes for patients to come to us. Fatigue and pain can have many different causes and often appear as symptoms alongside a large number of other diagnoses. Often, they also appear together
We work with the following conditions:
In patients suffering from autoimmune diseases, their immune system confuses normal proteins for invaders and goes after them, destroying tissues and organ functions. The reasons for this have been revealed by researchers to some extent – but the insight reveals the complexity behind autoimmune diseases, and many genetic and environmental factors have been identified as contributing causes.
Autoimmune diseases constitute a very large category of disease in which many common conditions belong, such as rheumatoid arthritis, lupus, Crohn’s disease, ulcerative colitis, multiple sclerosis, type 1 diabetes, psoriasis, metabolic diseases and many others. In autoimmune diseases, the immune cells synthesize so-called autoantibodies against the body’s own tissue. The antibodies signal to other immune cells to destroy proteins and fatty acids in the tissue that the body mistakenly sees as invaders. Which tissue is affected determines which disease you are diagnosed with.
Many factors have been shown to cause or increase the risk of autoimmune diseases. The risk of developing autoimmunity is especially high when you have the following 3 risk factors.
1. Genetic susceptibility
2. increased intestinal permeability
3. an external trigger ie. an environmental factor.
These factors – or one of them in isolation – cause most autoimmune diseases. & nbsp; If you suffer from an autoimmune disease, you are at high risk of developing a second or third disease, etc. Individual genetic variations may increase vulnerability to certain diseases. However, diet, lifestyle and other environmental factors help to determine how genes are expressed i.e. & nbsp; whether they are turned on or off. Sometimes it is a genetic variant that causes a deterioration of one or another biological function, only a problem in the presence of a certain kind of burden. The importance of our genes has been downplayed in favor of gut health and a trigger when it comes to the development of autoimmune diseases.
Intestinal permeability or “leaky gut” is a phenomenon that has been shown to be present in all autoimmune conditions where it has been scientifically studied. “Leaky gut” means that the intestinal mucosa has become fragile and permeable. The consequences are numerous. Toxins from intestinal bacteria and larger particles from the diet have been allowed to pass through the barrier, a barrier that normally only needs to allow fully digested nutrients through. This leads to activation of the immune system located inside the intestinal wall. Immune cells start communicating to activate each other and begin to trigger large amounts of proinflammatory molecules. Whole microorganisms can also cross the barrier that has been observed under conditions such as lupus, type 1 diabetes and myalgic encephalomyelitis (sometimes called chronic fatigue syndrome or in short ME / CFS). The phenomenon is called microbial translocation and can cause inflammation and autoimmunity in tissues located far from the intestine. In microbial translocation, the body’s immune system reacts in the same way as an infection. A damaged intestinal mucosa is also less able to absorb nutrients, which in itself can reduce the body’s ability to heal as well as impair the immune system’s ability to function optimally.
There are many potential causes of leaky gut, such as the composition of the intestinal flora, the presence of SIBO, nutritional deficiencies and dietary components such as gluten, casein (milk protein) and other peptides (small proteins) that can be difficult to break down. Lifestyle factors such as stress, lack of sleep, certain pharmaceuticals and a sedentary lifestyle can also contribute to leaky gut.
Often there are several triggers that, along with leaky gut, increase the risk of autoimmunity. An example could be infections. Epstein-Barr is a virus that is particularly linked to autoimmunity. However, many other infections – both viral and bacterial – have been shown to cause an autoimmune reaction. In fact, infections may be the most well-known trigger for autoimmune diseases across medical and scientific conditions. Toxic metals such as mercury, cadmium and aluminum are another category that can play a role in autoimmunity, especially when it comes to neurological diseases.
Autoantibody formation can sometimes be secondary in relation to a tissue or cell damage caused by e.g. Surgery. Proteins from the internal environment of a tissue or cell are exposed, after which the immune system forms autoantibodies against these proteins, which do not normally have to circulate freely.
Medical research has revealed that vitamin D deficiency is a very important factor in the development of all types of lifestyle diseases, including autoimmune diseases.
Each patient with an autoimmune disease has a unique combination of underlying factors that triggered their condition. At the Nordic Clinic, we carefully review each patient’s history and recommend tests and interventions based on their unique symptom picture, lifestyle and contributing environmental factors.
Intestinal health plays a key role in your health and is associated with many chronic diseases and mental well-being.
Intestinal health is central to our overall health and has been linked to diseases such as autoimmune diseases, chronic fatigue and mental health. Irritable bowel syndrome (IBS). IBS is a diagnosis with a high population prevalence. & Nbsp; Common symptoms of IBS are constipation, diarrhea, flatulence, abdominal pain, bloating and nausea. These diseases primarily routinely rule out more serious diagnoses such as celiac disease, ulcerative colitis, Crohn’s and bowel cancer at the gut doctor. If no irregularities are found, the patient is likely to be diagnosed with IBS and is often just sent home with advice to avoid specific foods. IBS is sometimes considered a diagnosis of exclusion and is often used when no symptoms have been found. Symptoms of IBS can vary widely between individuals and are increasingly being questioned by experts in the field of diagnosis as a unit.
Many patients with IBS feel that their doctors do not understand how a limited life with IBS can be. The disease varies in severity from mild to severe. With severe IBS, the symptoms can significantly affect the quality of life. In addition, IBS often goes hand in hand with mental disorders such as depression, anxiety and stress sensitivity. The cause of the compound is inflammation. Inflammation of the intestine leads to inflammation of the brain, with mental disorders as a result. This area has grown into one of the “hottest” fields in medical research. In addition, research points to gastrointestinal problems as one of the main risk factors for a loss of productivity in the workplace. Thus, there are plenty of incentives to dig deeper when encountering IBS symptoms than to make a diagnosis – both for the individual and from a socio-economic perspective.
No one develops IBS for no reason. There is a lot of research that shows what triggers IBS symptoms. Many of these reasons are also easy to clarify by testing. The following factors have been identified as possible causes of IBS symptoms:
In the Nordic Clinic, we have a holistic approach to IBS. We work with diet and lifestyle as well as different types of laboratory samples to identify infections, SIBO and other imbalances in the intestinal flora. If necessary, we can look at the stress hormones as well. Many of our patients experience mild symptomatic relief when treatment is underway.
Intestinal bacterial overgrowth (SIBO) is one of the most common diseases we address at Nordic Clinic. While the large intestine contains high levels of microorganisms (bacteria, fungi and parasites), the small intestine is usually sparsely “populated” by microbes. Several different factors can contribute to an abnormal increase in the number of microbes within the small intestine. Examples of this are excessive antibiotic use, a sugary diet ect. Consequences of SIBO can be air and stomach pain, chronic diarrhea or constipation, decreased nutrient uptake, indigestion, inflammation and increased permeability of the intestinal mucosa ”(also called“ leaky gut ”). This list of symptoms is often led to a diagnosis of irritable bowel syndrome. irritable -IBS. In the long run, SIBO can cause inflammation systematically in the body and has been identified as an underlying or contributing cause in a number of clinical conditions.
At Nordic Clinic, we have extensive experience in laboratory tests and treatment of SIBO. SIBO can occur as a result of the growth of methane and hydrogen producing microorganisms and when we suspect SIBO we can use a laboratory sample where the two gases are measured in the patient’s exhaled air. Individual treatment is prescribed based on a test result and the overall symptom picture. Then, we reevaluate the patients’ symptoms. Often the patient has to take a test again to ensure that the treatment has the desired effect.
Inflammatory bowel disease (IBD) is a group of conditions that include the autoimmune diseases colitis ulcerative and Crohn’s diseases. The understanding of IBD has grown, thanks to research. It is now known that the potential causes of these diseases are many and can vary between different patients. Factors that researchers have been able to identify are diet, stress, cesarean section, use of antibiotics and nutritional deficiencies and other aspects of our modern lifestyle. First of all, there are some abnormalities that have been found in several different factors that affect the function of the intestine and the composition of the intestinal flora in these patients. Examples are bacterial or fungal infections, SIBO, imbalances between different groups of intestinal bacteria and reduced amounts of essential fatty acids produced by good bacteria. Due to the underlying causes of IBD varies between individuals, treatment must be individually tailored.
Har din læge informeret dig om, at du har risiko for at udvikle type 2 diabetes? Oplever du en konstant følelse af stress, en mangel på energi til motion, og vågner du træt på trods af tilstrækkelig søvn? Er diffuse symptomer begyndt at dukke op, som begrænser din dagligdag? Dette er alle tegn på noget ikke fungerer. Eller måske er dit mål at leve et langt og sundt liv, og du vil gerne lære hvordan du kan forbedre dit helbred og din performance? Vi støtter dig igennem din rejse hen til et bedre helbred.
En kvart del af Danmarks voksne befolkning konsumerer en diæt så usund at de har risiko for tidlig død på grund af sygdomme, som hjerte-kar-sygdomme, type 2 diabetes og kræft. Derudover har faktorer så som stillesiddende livstil, stress, dårlig søvn og en mangel på fysisk aktivitet en altafgørende indflydelse på helbreddet. Vores Functional Medicine personale kan hjælpe dig med at forhindre og forbedre sygdom.
Individualiseret sundhedsplaner for at hjælpe dig med at nå dine mål succesfuldt. I dag leder mange mennesker for såkaldte ”quik-fixes” til deres sundhedsproblemer, bruger kun farmaceutiske lægemidler og efterlader hele ansvaret for deres helbred til en læge. Desværre, er der ingen genveje som kan forvente at rette op på sundhedsproblemer i et langt perspektiv og hvert individ skal tage ansvar for deres eget velvære.
Vi ser ofte det kræver en grad af nye livsstilsændringer for at forhindre og/eller mindske kroniske tilstande. Dog, kan en etablering af nye rutiner og vaner være en stor udfordring for mange. Hos Nordic Clinic tilbyder vores sundhedspersonale konsultationer hvorledes din diæt, livsstil og rutine vurderes samt analyseres. De tager din situation, symptomer og dine evner i betragtning og giver nogle skræddersyet anbefalinger til dig. Vedholdende ændringer kræver viden, mål og en plan. Sundhedspersonalet giver dig support og giver værktøjer til dig, for du kan opnå dine individuelle sundhedsmål. At tage ansvar for dig selv er dog en forudsætning, for at nå både kortsigtede og langsigtede mål.
Når du samarbejder med os, vil vi sende dig et spørgeskema inden vores første konsultation. Det er din unikke symptomhistorie og en vigtig brik i puslespillet om at forstå din case. Vi kigger på dit spørgeskema ved første konsultation i detalje og vil altid anbefale dig individuelt hvad passer præcis til dig og din situation med et objektivt perspektiv for at blive enige med dig om hvordan vi griber din tilstand an.
Vi tilbyder individuelle konsultationer baseret på dine behov. Det bedste er at booke et forløb over flere måneder, da det kræver tid at ændre livsstil og at gøre det alene kan være udfordrende. Vores personale kan motivere dig og give dig den rette support i din sundhedsrejse for et optimalt vedvarende resultat.
Kontakt os på info@nordicclinic.com for mere information om tider og priser.
Få et overblik over din sundhed og hvad livsstilsændringer kan gøre med de rette livsstilsændringer der vil gavne dig mest.
Det at prioritere ens eget helbred er en super investering til sig selv. Ca. 50% af befolkningen lider af en eller anden form for symptomer og det virker til trenden er opadgående desværre. Hos Nordic Clinic er det vores topprioritering at stoppe den trend og gøre et forsøg på at forebygge og forberede sundheden generalt hos befolkningen. Så få et sundhedstjek for at forstå din krop bedre og tage de rette livsstilsændringer som redskab kan gøre underværker for din velvære og forbedret tilstand. At blive en bedre version af dig selv.
Et sundhedstjek betyder vi kigger på patientens sundhed og vaner. Alle symptomer bliver nedskrevet i spørgeskemaet og vores journal notater. Patienter bliver spurgt om deres kost, stressniveau, træningsvaner, søvnmønstre og sociale forhold. Så vi får et overblik over hele personen.
Et sundhedstjek kan nemt blive kombineret med livsstilscoaching. For mere information kan du kontakte:t info@nordicclinic.com
This article was originally published as a guest editor post at foodpharmacy.se
By: Graeme Jones, clinical physiologist and CEO at Nordic Clinic Stockholm
Published: 20/05/2020
Nothing makes it more depressing than making it to your holiday destination after a crazy period of work and suddenly becoming sick. That sucks. It happened to me on a recent trip to Israel and I was not happy with my immune system. But was it my fault? Had I pushed myself too hard? What has stress got to do with our ability to fight infection?
Our health is dependent on our ability to cope with the environment. This requires the integration of many systems within the body to help maintain homeostasis. Our stress and immune responses both play an integral role in this process. While the stress response helps us cope with factors in our external environment, the immune response helps us cope with factors, primarily damage and infectious agents, within our internal environment.
Given that both systems are crucial to our survival, they cannot function autonomously from one another. In fact, they are fully integrated with one another via the nervous and hormonal systems. Generally speaking, the nervous system provides rapid yet quickly fading responses while the endocrine system produces slower acting, yet prolonged responses.
This is an important concept because the effects of stress on the immune system, and vice versa, are dependent on whether the response is acute or chronic. We are well-equipped to deal with acute stress or acute immune activation, but not chronic forms of either. Unfortunately, when stress or immune function is chronic, it can break us down over time. Guess which version of stress most of us suffer from? Of course, it is the chronic version.
Image (6)
Effects of chronic immune activation on the stress response
The sickness response is a prime example of how the immune system affects stress. Inflammation from immune activation alters behavior, producing a state of social withdrawal, depression, anxiety, lethargy, loss of appetite, sleepiness and failure to concentrate. Essentially, activation of the immune response partitions resources towards fighting infection and away from adapting to the external environment. So this explains at least why I become even more of a social hermit when I am unwell.
Over the short term this also works out well for people around me. Social withdrawal decreases the spread of infection within groups. Decreased physical activity and activation of the stress response partitions limited energy resources towards fighting an infection or healing an injury. As a result, there is quick resolution of the infection and a return to normal. Perfect, thank you immune system.
But if inflammation becomes chronic, this sickness behavior becomes persistent (1, 2). Alterations in both the nervous and endocrine (hormonal) systems set in, altering physiology to promote both depression and fatigue. Many aspects of our modern lifestyle promote this chronic state of inflammation. Factors such as poor diet, sedentary behavior, obesity, poor sleep, and chronic stress – all factors discussed in this blog series. Have I mastered most of these factors? Yes, but one – chronic stress. I am a long way from mastering it (open admission here). It is perhaps no surprise as I, like most people, are never taught how to manage and deal with emotions and stress as a child so how can we expect to be masters as adults.
Chronic inflammation contributes to disruptions in physiological well-being but severe infection can also alter our stress-response long term. Studies show that infection early in life impairs stress resilience in mice (3) and that sepsis in adult humans is a significant risk factor for the development of stress-disorders such as post-traumatic stress syndrome (4). Studies like these certainly show how much of a bi-directional relationship this is and remind me of the importance to try and look after my stress and immune system.
Effects of Chronic Stress on Immune Function
Just as chronic activation of the immune system promotes a maladaptive stress response, chronic stress does the same to the immune system. During the acute response to stress, activation of the sympathetic nervous system causes the release of short-acting stress hormones called adrenaline and noradrenaline. These mobilise resources towards fight or flight within seconds. For example, someone jumps out from behind a door to scare you – the reaction you feel is the action of adrenaline and noradrenaline.
During the response to a prolonged stressor, such as constant impending work deadlines, the endocrine hormone cortisol is released from the adrenal gland to promote a more prolonged response, from hours to days. Cortisol has a powerful effect on our physiology; it makes our stress response stronger by making us more sensitive to adrenaline. It also acts as a strong anti-inflammatory, depressing immune function so that resources are partitioned towards surviving the threat from our environment.
But did you know, when stress is acute, this entire process makes the immune system more efficient (5). Inflammation is kept in check while immune cells flock to areas where pathogens are likely to slip in. The response to regular exposure to acute stressors is immune-enhancing. This is why exercise is good for the body – it is a short term acute stressor.
Unfortunately, when stress is chronic, lasting days, it impairs immune function (5). Continuous exposure to cortisol promotes a form of cortisol resistance where both the anti-inflammatory and immune trafficking effects are lost. It also promotes factors that increase inflammation such as hyperglycemia (high blood sugar) and may promote autoimmunity (when our immune system attacks healthy tissue) due to persistent inflammation. Yes, you can get diabetes from stress.
Early life stress can also be problematic to both the stress response and immunity (6). Early life stressors that are either prolonged or very traumatic, such as sexual abuse, have a way of re-wiring our stress response, making us more sensitive to stressful experiences later in life. Furthermore, adults with early life stress have higher levels of inflammatory markers and viral reactivation of the Epstein Barr Virus than healthy controls. Also, when comparing the desired immune response to vaccination (which is antibody formation) in chronically stressed caretakers to that of control individuals, the carers response was severely blunted. (7) This points to a significant effect of the psychosocial environment on our ability to fend off infections.
Manage and Reduce your Stress Levels – Stay Healthy
Both the stress and immune response are important for our survival. The stress response helps promote adaptation to external stressors while the immune response helps respond to internal stressors. Successful adaptation to either type of stressor is contingent upon the proper partitioning of resources to overcome it.
Throughout our evolutionary history, our exposures to both stress and infection have been acute. You get exposed to infection or stress, you adapt, and you move on. Therefore, we are well-equipped to deal with acute stress and infection. But chronic stress and infection are a different matter; we are not well-equipped for either.
Unfortunately, our modern existence presents challenges as both can become chronic. Chronic stress, particularly psychological stress, impairs our immune function making us more susceptible to infection. Furthermore, aspects of our modern life create chronic inflammation, promoting chronic stress. These two aspects of our modern lifestyle feed into one another, making us more susceptible to stress and infection.
You find the other articles in the 7 part series “For king and country – Tend to your immune system” here:
Part 1: Your Immune System is Everything
Part 2: The Surprising Connection between the Gut Mocrobiome and Infections in other Organs
Part 3: Sunshine – the Forgotten Booster of Joy, Calm and Immune Resilience
Part 4: Go to Sleep and Get Moving – Your Immune System Will Thank You
Part 5: The Wester Diet – How Processed Diets Fail to Support Vital Immune Functions
References
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6658985/
2. https://link.springer.com/chapter/10.1007/978-3-030-16996-1_6
3. https://www.sciencedirect.com/science/article/pii/S0889159118304409
4. https://www.ncbi.nlm.nih.gov/pubmed/25760659
5. https://aacijournal.biomedcentral.com/articles/10.1186/1710-1492-4-1-2
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465119/
7. https://www.ncbi.nlm.nih.gov/pubmed/18040814
This article was originally published as a guest editor post at foodpharmacy.se
By: Graeme Jones, clinical physiologist and CEO at Nordic Clinic Stockholm
Published: 11/05/2020
Having grown up in the UK, I’m certainly no stranger to the western diet. I spent the best part of 23 years eating that way until I really began to study and understand the basics of nutrition. Sometimes I wonder how I survived.
Looking back over those years eating white pasta, bread, pizza, fries, crisps, candy, fast food and ready-made meals, whilst drinking various brands of soda also prompts some interesting questions. Like how has it impacted my immune system and my brain function? And would I have excelled more in school, in sports, and at work as I got older, had my diet been different?
As we have discussed in this series so far, many different lifestyle factors impact on how our immune systems work. In my last blog, we covered the importance of sleep and exercise in maintaining a strong, robust immune system. Unfortunately, we often take for granted these essential health factors.
Diet in the Age of Coronavirus
Diet is another important cog in the wheel of human health and immune function. However, most people think primarily about the quantity of what we eat, rather than its quality. Many of us seem to believe that as long as we maintain a certain weight, we can eat what we want and consider ourselves healthy. It’s very easy to associate being overweight with being unhealthy – it’s another thing to accept that what you enjoy eating may not be good for you.
The western diet is becoming increasingly common among industrialised nations. Highly palatable and energy dense, it is often blamed for the increase in obesity and type 2 diabetes in the western world. But aside from calories, there are other aspects of this diet that may have negative effects on the immune system.
Now, more than ever, people are beginning to take their immune health seriously. In the age of COVID-19, where an infectious and, to some, deadly pathogen is freely circulating, people are taking notice. And what we find is that diet, and the western diet in particular, can have a significant impact.
Training Your Immunity
There are two separate but integrated wings of our immune system.
The first, known as innate immunity, acts as the initial response. It signals that the walls have been breached and helps identify invaders, but it doesn’t provide a targeted response to them.
The second response, the adaptive immune system, provides the specific immune response you’re looking for – it targets the invader and removes it.
Both wings of the immune system are critical to forming a proper immune response. We know that long-term immunity – the immune system’s memory that prevents you from constantly being re-infected by the same pathogen – is controlled by the second part, the adaptive immune response.
But new research suggests the first part – innate immunity – is capable of memory too. It’s called trained immunity and it is affected by diet.
Your Immunity Memory
When challenged by a trigger, such as an infection, cells of the innate immune system remain on high alert for a period of time. That way, if they are exposed to a second inflammatory stimulus, they can respond rapidly and strongly.
Trained immunity is established through what’s called epigenetic re-programming of innate immune cells. This basically means our environment is teaching these vital immune cells how to act.
This type of memory isn’t as long lasting as the adaptive immune response to something like measles. But it does persist for months and can intensify the inflammatory response to later infections.
Remember, we want our immune system to react to infection, and this includes inflammation, but we don’t want it to overact and continue for too long.
Impact of the Western Diet
While trained immunity has obvious benefits, there does appear to be a major problem, and a recent paper identified the western diet as a trigger for it.
Mice fed a western diet had increased systemic inflammation that reversed when returned to a normal chow diet. But when these mice were exposed to other immune triggers during the normal diet, the innate immune response was heightened (1).
It turns out the innate immune system had been re-programmed by the western diet. The “sterile” inflammation caused by foods found in the western diet was sufficient to re-program the innate immune system.
As a result, mice fed the western diet continued to experience increased inflammation in response to immune triggers even after switching back to a chow diet.
Image source (1)
Western v Mediterranean Diet
There are many different parts of the western diet that may promote this re-programming either directly or by altering intestinal permeability (2). Increased intestinal permeability occurs when the tight junctions of your digestive system wall, which normally act as a strong barrier to stop bacteria getting into your bloodstream, become too wide. This is also known as leaky gut. The components of the western diet that can cause this include:
The Mediterranean diet is essentially the opposite of the western diet in these dietary components. Unsurprisingly, it is also associated with healthier ageing and better health outcomes. So the conclusion seems clear – avoidance of a western diet is crucial to maintaining a healthy immune system.
Nutrient Density – Your Immune System’s Best Friend
Our immune system’s memory and pathogen fighting abilities are crucial to staying healthy (3). One reason some get severely ill and even die from infections that others beat, is malnutrition. It’s well known that malnutrition is a primary cause of immunodeficiency (4) and that it’s linked to increased severity of infectious disease (5). When malnourished children die, the cause is almost exclusively of infectious origin. While severe malnutrition might lead to alarming rates of infection susceptibility primarily in developing countries, nutritional status is a continuum on which we all find ourselves. Nutrient deficiency at any level might lead to functional impairment. An optimally working immune defence requires a wide range of molecules such as vitamins and minerals to perform its job. While virtually all known micronutrients have a role to play, vitamin A, D, C, and zinc stand out as the most well documented. So what do they actually do? Micronutrients are important for basic biological functions such as binding receptors, regulating how our genes are used, enabling enzymatic reactions and modulating inflammation (3). Not only do processed foods lead to increased inflammation, they’re also notoriously infamous for their often disastrously low nutrient density.
In summary, staying away from hyperpalatable, energy dense, beige, no-need-to-chew-foods in favour of unprocessed foods rich in nutrients, fibre and colour ‒ that our ancestors would actually recognise as edibles ‒ is a fool-proof and side-effect free strategy for vibrant health and vital immune functions. It might even save your life.
You find the other articles in the 7 part series “For king and country – Tend to your immune system” here:
Part 1: Your Immune System is Everything
Part 2: The Surprising Connection between the Gut Mocrobiome and Infections in other Organs
Part 3: Sunshine – the Forgotten Booster of Joy, Calm and Immune Resilience
Part 4: Go to Sleep and Get Moving – Your Immune System Will Thank You
References
1. https://www.cell.com/cell/comments/S0092-8674(17)31493-9
2. https://www.ncbi.nlm.nih.gov/pubmed/31747581
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019735/
4. https://pubmed.ncbi.nlm.nih.gov/18419494/
5. https://pubmed.ncbi.nlm.nih.gov/25475887
This article was originally published as a guest editor post at foodpharmacy.se
By: Graeme Jones, clinical physiologist and CEO at Nordic Clinic Stockholm.
Published: 01/05/2020
One thing I have realised over the last 15 years working in Functional and lifestyle medicine, is that what I thought I was doing well at in regards to sleep and exercise, I clearly was not. Turns out even at a grand old age of 37, I am fitter and healthier than I was in my 20’s, and my numbers continue to get better over time as I optimise my routines. As one example, over the last 16 months I have managed to improve my deep sleep by a WHOLE hour whilst sleeping the same amount of time! But what is the link here between, exercise, sleep and the immune system? Why is the immune system so important?
The immune system plays an important role in protecting us from infectious agents. There are several layers to this process:
Furthermore, there are 2 separate responses called innate immunity (we are born with) and adaptive immunity (our immune system learns). Innate immunity is the first response, creating inflammation and signaling that there’s a problem. But innate immunity is general and does not have memory. The adaptive immune response, on the other hand, swings into action after the innate response. It targets the specific invader and provides memory so that reinfection does not occur.
Lifestyle plays an important role in optimal immune function. Two critically important lifestyle factors that create a strong, robust immune system are sleep and exercise. Both affect all aspects of immunity, and as such, should be part of any plan to optimise immune function. When patients attend Nordic Clinic and report immune system dysfunction, one of the first lifestyle factors I consider is sleep, so let’s review some connections between this strange state we spend a whopping third of our life in.
Sweet Dreams, Sweet Defence
Sleep and the immune system share a reciprocal relationship. On the one hand, immune activation drives changes in sleep believed to play a role in promoting a healthy immune response. On the other hand, poor sleep quality and duration has a negative impact on all aspects of immune function.
Sleep deprivation negatively impacts the innate immune response by driving chronic inflammation1. One of the causes of this increase in inflammation is bacterial invasion into the blood and body from the intestinal microbiome, following a decrease in the barrier integrity.2 This impairs immunity as both the creation and resolution of inflammation are active processes. Chronic inflammation not only damages pathogens, but also the tissues they infect.
Messengers called cytokines can drive up inflammation and lower it. Lighting the fire of inflammation without putting it out through the release of anti-inflammatory cytokines towards the end of infection leads to collateral damage to tissues. This is the mechanism behind the cytokine storm, which increases mortality during infection. In that regard, the pathogen doesn’t kill you, the response of your immune system does, and it seems sleep could be an important player in helping to regulate the response of the immune system.
Sleep also plays an important role in adaptive immunity. T cells are the soldiers of adaptive immunity, carrying out the marching orders by targeting infectious agents. They do this by sticking to pathogens and infected cells and killing them. During sleep, T cells become more “sticky” and are better able to stick to pathogens and kill them3.
In line of this, two studies found that sleep was an important predictor of immunity toward the common cold. The study showed that participants who slept less and had poorer sleep quality had a dramatic increase in their likelihood of developing cold symptoms when researchers deliberately infected them with rhinoviruses. The risk was as much as 5.5 higher.4,5 Also, according to another study, those who sleep less than 6 h per night were at significantly greater risk of developing pneumonia compared to those sleeping 8 h per night.6
Image source8
Move That Body – Put Your Guard up!
Exercise has many different mechanisms through which it promotes healthy immune function. First and foremost, regular exercise decreases systemic inflammation, both independently and through decreases in fat mass7. At high levels, body fat functions as an endocrine (hormonal) organ that secretes inflammatory cytokines into the bloodstream. That’s why the obese and type 2 diabetics see more frequent infections.
Both short and longer duration exercise also increase immunosurveillance. Exercise functions as an acute stressor, and damage to tissues puts the innate immune system on alert by increasing white blood cells. In addition, the lymphatic system which distributes these cells to tissues is almost entirely dependent on muscular contraction to distribute white blood cells. As a result, you have more immune cells that are patrolling the entire system more frequently8. Exercise literally puts more guards on patrol!
Finally, regular exercise helps prevent the age-related decline in immune function called immunosenescence9. As we age, the immune system shifts, causing an increase in chronic inflammation AND a decrease in adaptive immunity. This change causes the elderly to be more susceptible to infection, and have a harder time fighting one off when infected.
Regular exercise training, particularly aerobic exercise, helps put the brakes on immunosenescence (the gradual deterioration of the immune system with age). As a result, those who maintain exercise as a habit throughout life are better able to mount an immune response when infected as they age.
Also, the benefits of exercise for health at large are well known. In support of this, a recent study found that those who take 8 000 or 12 000 steps a day have a dramatic decrease in all-cause mortality compared to those who take 4 000 steps a day (51 and 65% lower risk of death over ten years, respectively.)10
Taken together, one cannot overstate the importance of behavioural factors such as sleep and exercise for health. Chronic sleep deprivation and a sedentary lifestyle are new phenomena considering the history of mankind. To honour our biology, we’d better get moving and go to sleep.
You find the other articles in the 7 part series “For king and country – Tend to your immune system” here:
Part 1: Your Immune System is Everything
Part 2: The Surprising Connection between the Gut Mocrobiome and Infections in other Organs
Part 3: Sunshine – the Forgotten Booster of Joy, Calm and Immune Resilience
References
This article was originally published as a guest editor post at foodpharmacy.se
By: Graeme Jones, clinical physiologist and CEO at Nordic Clinic Stockholm. (Thanks to Annie Pettersson, Nordic Clinic’s Researcher, for her contribution to the article)
Published: 23/04/2020
I moved to Sweden from the U.K. and arriving in April I was met with an interesting sight. As soon as the sun popped out, people would pose like statues, their faces facing the sun and their eyes shut. Leaning onto walls in the middle of the street, on top of a bridge, at the bus stop. I wondered what the hell are they doing? It took but one year of darkness, and the upcoming April I was standing there like the rest of them.
Our worship of the sun isn’t limited to its role as a symbol for the coming of summer, nor to the fact that it’s essential to our survival by bringing life into plants and animals, that we eat. I believe many with me can agree that they simply feel good when they’re exposed to the sun. As we shall see, there are several reasons for this.
Until now it hasn’t been problematic for our species, evolutionary speaking, to be dependent on sun exposure for important biological functions, since indoor life is a new phenomenon and a lack of sun exposure hasn’t been an issue for the vast majority of mankind. Humans colonised the far northern hemisphere some 4 000-30 000 years ago (depending on location), but that’s not considered very long in evolutionary terms. Also, those populations were exposed to the sun half of the year, whereas us modern Homo sapiens tend to spend a huge chunk of our time indoors in the summer as well. Let’s have a look at how we’re affected by those golden rays.
The Sunshine Vitamin
The most well-known effect of sun exposure is vitamin D production. It’s a hormone-like cholesterol derivative that we can also get through our diet (fatty fish mostly, like salmon). Vitamin D is not actually made in our skin, but a precursor is produced from cholesterol with ultraviolet B (UVB) exposure, which then travels to the liver for modification and is transformed into the active form called calcitriol, mainly in the kidneys. This molecule controls the use of hundreds, maybe thousands of genes, a whopping 3% of our genome. (1, 2) Many of these genes are involved in optimising our immune system by 1) helping it fight infections and cancer and 2) keeping the immune system under control by preventing it from overreacting, thus limiting autoimmune disease. (2)
The importance of this molecule cannot be stressed enough. Vitamin D deficiency correlates with virtually every type of immune-related disorder there is (including cancer, autoimmune disease, cardiovascular disease, metabolic disease and depression) where the link has been investigated scientifically. Also, vitamin D is essential for mineral balance and to avoid osteoporosis, a serious disease causing weakening of the bones. These conditions are more common in people self-reporting to stay out of the sun, and/or who live further away from the equator. Correlation studies warrant caution: a mere epidemiological association does not imply causation. However, the observed connection between vitamin D and chronic disease and inflammation is supported by experimental evidence – a higher level of evidence. This means that disease risk, symptoms or clinical markers have been shown to improve in humans or animals that get vitamin D or are exposed to UV radiation. (2, 3, 4)
Nitric Oxide – The New Kid On the Block
When UVA hits our skin, nitric oxide (NO) is made. NO has traditionally been viewed as a free oxygen radical, a damaging molecule. But NO also has important functions in relaxing and dilating our blood vessels. Some researchers suggest that UV-induced NO has the same effect. In accordance, NO from sun exposure seemingly leads to a reduction in blood pressure, according to some pioneering studies. Formation of NO is the reason beetroot juice and arginine supplementation can be so powerful in alleviating hypertension. Further, some researchers suggest that NO can kill infectious microbes and tumor cells, promote wound healing, and also works as a neurotransmitter. Early studies support the idea that many of the positive effects we see of sun exposure is not, in fact, vitamin D dependent, but can be attributed partly to NO. (5, 6)
Endorphins and Serotonin Relieve Stress and Pain and Enhances Mood
Sun exposure has been linked to a heightened mood, relaxation and reduced tension. When skin cells are exposed to UV radiation, beta-endorphins get released into the blood, possibly in levels that affect our brains and well-being. Beta-endorphins are formed by neurons and exert stress-reducing and pain-lowering effects. Our nervous system also produces serotonin, a production which is increased with sunlight exposure of the skin and the eyes. Serotonin is a neurotransmitter that has many effects, including increasing a sense of calm and joy. Fibromyalgia sufferers report lower pain after UV radiation, and depression is also improved by sun exposure. The mood boost and analgesic effects might be partly due to beta-endorphins and serotonin, and partly to vitamin D. (1, 7-9)
A Lack of Daylight Impairs Circadian Rhythm
Exposure of the eyes to light also affects melatonin secretion. Melatonin is our sleep hormone, usually secreted at a specific daily rhythm, with low levels at daytime and a peak around midnight. When and how much is influenced by the amount of exposure to light during the day. Our circadian rhythm is very important not only for sleep, but also for our metabolic health and our risk of cancer and cardiovascular disease. Melatonin is also an antioxidant with anti-carcinogenic effects. (1, 10)
Sun Exposure Lowers Our Risk of Suffering and Death
You may find this subheading somewhat provocative. However, it is essentially true. As we’ve learned, sun and vitamin D lowers risk of inflammatory conditions of all thinkable kinds. Furthermore, many skin conditions (eczema, vitiligo, psoriasis and more) improve upon sun exposure or UV therapy, through many suggested mechanisms. Also, the risk of a long list of cancer types is seemingly lower in those who are exposed to more sun. (3, 10, 11) The risk of a long list of cancer types… Please take a moment to contemplate this fact.
Findings are not unanimous (research seldom is) but overall, studies of different types point toward a protective role of sun exposure and/or vitamin D levels when it comes to cancer. These studies involve both observational and experimental studies. One review concludes: “The UVB–vitamin D–cancer hypothesis has considerable supporting scientific evidence from a variety of study types: geographical ecological, observational, and laboratory studies of mechanisms, as well as several clinical trials. At this time, the general public and individual physicians can spend more reasonable time in the sun and use vitamin D3 to prevent and treat many cancers.” (11)
Vitamin D is also associated with a lowered all-cause mortality. The risk of death is inversely correlated with the concentration of vitamin D in the blood, up to a certain level. Vitamin D deficiency is not only a risk factor for increased mortality per se, but vitamin D supplementation may also reduce mortality. (1)
Overall, the diverse effects of the sun on our health is striking. I wouldn’t be surprised if new, currently unknown mechanisms of sun-derived biological effects will be uncovered in the years to come. Caution is warranted: consensus is that we strictly must avoid burning the skin, and be moderate regarding our sun exposure. UV radiation also degrades folate, so please ensure sufficient folate intake during the summer months. (1, 2) However, if you’re staying out of the sun to protect yourself from skin cancer, you might want to rethink your strategy and consider your health on the whole. Also, if you’re trying to replace the sun with vitamin D supplementation, be aware of the many other benefits you miss out on. Maybe you’ve heard of the classic ladder of basic human needs. Perhaps it’s time we update that list to air, food, water, shelter, and sun.
If you want to talk to me more about any part of this article, please contact me on info@nordicclinic.se or read more here on our website.
You find the other articles in the 7 part series “For king and country – Tend to your immune system” here:
Part 1: Your Immune System is Everything
Part 2: The Surprising Connection between the Gut Mocrobiome and Infections in other Organs
References
This article was originally published as a guest editor post at foodpharmacy.se
By: Graeme Jones, clinical physiologist and CEO at Nordic Clinic Stockholm.
Published: 15/04/2020
Extensive research is currently underway looking at the role that the gut microbiota – all the microorganisms in the intestinal tract – plays in overall health. As we’ll learn in this article, there is a link between the gut flora and immune health. But let’s start with the connections found between gut microbiota and brain health.
In the early stages of gut microbiome research, scientists linked gut health to brain health through a major communication ‘highway’ called the vagus nerve, which travels from the digestive tract to the brain (think of it like a direct telephone line). This nerve, which influences everything from our mood to our immune response, digestion and heart rate, exerts a relaxation effect – it slows your heart rate, decreases blood pressure, improves your mood and coordinates digestion. “Sign me up for more of that”, I hear you say, “can I install a second telephone line?” Well no, sorry, but we can stimulate it through various techniques – more on that later. That is why it has been the target of treatment for major depression, post traumatic stress disorder and inflammatory bowel disease, amongst others. It has also shown as a conduit through which the gut microbiota mediates effects on the brain. So our digestive bacteria ‘talk’ to our brain through this direct ‘phone line’? Bullseye!
With the continuous and alarming escalation of dementia worldwide and no pharmaceutical cure in the pipeline (many pharmaceutical companies have just completely dropped the development of Alzheimer’s medication), of great interest are further reports that the microbiota play a role in the pathogenic cascade of both Parkinson and Alzheimer diseases (1). With all this research, it has led to a commonly accepted term called the gut-brain axis, but we are now discovering this was barely a scratching of the surface. While scientists were digging into this axis, they discovered many more communication ‘highways’ or ‘axes’, where information travels back and forth to coordinate a whole host of activities in the body. Some of these bi-directional axes include:
Could these billions of bacteria living in our gut play a role in how distant organs and tissues function? Yes, it seems! The vagus nerve ‘direct line’ is only one part of this puzzle, so let’s dive into some of the other communication tools these sneaky little bugs use in our intestinal tract.
Our microbes mobile phone equivalent
If we think of the gut bacteria influencing the vagus nerve as a sort of ‘old school direct telephone cable line’ to the brain, then what other methods of communication can they use across the different axes? By-products produced by the microbes in our intestines are called microbial metabolites and they are released from the gut. They include two key metabolites called secondary bile acids and short-chain fatty acids. Think of these like using a mobile phone network instead of a direct line to communicate with different tissues. The first, bile acids, break down and aid absorption of fat from our diet whilst the second, short-chain fatty acids, are produced by beneficial bacteria when we eat fibre and make their way to the brain. This is one of the reasons why a high fibre diet could be very important for brain health.
Gut-Immune Axis
As we are discovering, these gut microbes have different communication channels they can pull on to talk to the different tissues. Since the gut microbiome also has a powerful effect on the immune system via the gut-immune axis, might this whopping 2 kg of microbes living in our intestines help modulate infection risk in some of these other tissues? Let’s look at some of these connections.
The Heart
Myocarditis is inflammation of the heart and typically occurs due to viral infection. Using mouse models of autoimmune myocarditis, researchers have discovered that modulating the gut microbiome may be a novel target for improving outcomes (2).
Another paper found that excessively activating immune cells in the gut exacerbates myocarditis in mice, progressing to mortality (3). Additionally, T cells (an important part of our immune defence system) in humans with myocarditis were more reactive to Bacteroides thetaiotaomicron (a common bacteria found in the gut) than those from healthy controls. This data implies that mortality from myocarditis may be partly regulated by the state of the microbial ecosystem in the gut.
Lung infections
Viral respiratory infection severity often worsens with secondary infections that may arise from the gut. A study in mice found that influenza A infection causes changes in the gut microbiome that, upon transfer to healthy mice, impairs defense to pneumococcal infection (4). Pneumococcal infection is caused by a type of bacteria called streptococcus pneumoniae, which can affect the lungs – now you know why it is called pneumonia. This means that in mouse models, getting the flu can cause changes in the gut bacteria and this subsequently decreases defence to a lung infection.
In older humans it has been shown that antibiotic treatment alters immunity to vaccination by decreasing specific influenza antibodies (5), meaning antibiotics may decrease our ability to fight influenza viruses as we get older. Interestingly, treatment with antibiotics increased the inflammatory response through loss of secondary bile acids (which I talked about earlier in this article) created by members of the gut microbiome.
Bloodstream infections (BSI)
For decades, some brave souls in medicine have been pushing for more research into whether ‘leaky gut’, describing the translocation of bacteria from the intestine into the bloodstream, actually occurs. The standard medical establishment has viewed this as quackery, until research has slowly caught up actually showing this can and does happen under various disease states and circumstances such as type II diabetes, high fat diets and alcohol consumption, to name a few. At Nordic Clinic, where we deal with patients who suffer from chronic health conditions, in subsets of patients we can often test and find they have resident bacteria from the oral and digestive cavity present in the bloodstream!
One of the most severe and worrying conditions I can think of is sepsis, where the body’s response to infection causes injury to its tissues and organs. Several studies have successfully used tests to show bacterial and fungal toxins from the gut present in the bloodstream, mostly in patients with this condition (7). And intestinal barrier dysfunction, where the digestive tract becomes hyperpermeable (a better term for ‘leaky gut’), is thought to contribute to the development of multiple organ dysfunction syndrome in sepsis (8).
Enhanced levels of bacterial toxins are also found in patients with obesity and metabolic syndrome (9,10) which might indicate bacterial translocation from the gut lumen into circulation as a consequence of intestinal barrier function failure causing ‘leaky gut’. As I say time and time again, looking after your metabolic health is so important for gut health and vice versa.
Middle Ear Infections in children
Many parents I am sure can relate to spending hours at the doctor’s surgery for their child’s ear infections. It is caused by bacteria that travel and make their way from the upper part of the throat, through canals (called Eustachian tubes), to the middle ear. Symptoms include fever, earache, and occasionally the eardrum may perforate, discharging pus into the ear canal.
Antibiotics are often prescribed for acute middle ear infection, although they have only a modest effect on reducing symptoms. Moreover, excessive antibiotic use leads to antibiotic resistance (a very worrying side-effect of use), making them less effective for these and other possible future infections. Consequently, preventing acute middle ear infection is highly desirable over treatment. According to Cochrane Reviews website, whose work is internationally recognized as the benchmark for high-quality information about the effectiveness of healthcare, probiotics may prevent ear infections in children not prone to it (11). This suggests there is a possible link between a substance (probiotic bacteria) that modulates the gut microbiome and the prevention of ear infections.
Urinary Tract
UTI (Urinary Tract Infection), is one of the most common types of infection affecting over 150 million people yearly (12). A recent study found that digestive tract abundances of Escherichia and Enterococcus (families of bacteria that live in the gut) are associated with future development of Escherichia and Enterococcus urinary tract infection, respectively, independent of clinical factors like gender (13). These microbes do not seem to discriminate between the sexes, and the gut seems to be the ‘headquarters’ from which infection can possibly arise.
Reduce the risk of infection by cultivating a healthy gut microbiome
By various methods, our gut microbes are able to communicate with a whole variety of tissues, organs and glands. A large body of research evidence is growing demonstrating how important it is to have optimal gut health, function, bacterial balance, and a robust intestinal barrier to ensure a reduced risk of many other types of infection, syndromes and diseases. A viable strategy may be that we all should be monitoring our gut microbial communities on a yearly basis, like we do with our cars as they age – it is always more effective to prevent rather than cure.
Infection has and will continue to happen to all of us, it is an inevitable part of being alive in this biodiverse ecosystem we call Earth. However, we can possibly reduce our risk of infection, or infection being very problematic, by cultivating our own healthy gut microbiome ecosystem and improving the gut-immune axis. How to actually do this is a large topic in itself to save for another future blog post.
If you want to talk to me more about any part of this article, please contact me on info@nordicclinic.se or visit www.nordicclinic.se or www.nordicclinic.com to read more.
References
High level educational webinar about oestrogen detoxification, laboratory testing and how to optimise with lifestyle changes, dietary changes and nutritional supplements. For professionals.
