We do it with our cars. We do it with our air conditioning systems. We do it with our lawns. This time of year, those of us with a proactive mindset take measures to preempt any predictable problems associated with seasonal change. Most of us, however, don’t think much past flu shots when it comes to helping patients get through the cold and flu season without illness. I perceive that this is mainly because most of our practice habits are ruddered by what economist John Kenneth Galbraith calls “conventional wisdom.”
One of the most pivotal books I’ve read since graduating from medical school in 1985 is Galbraith’s The Economics of Innocent Fraud. While not a medical book, the education this book gives you on the folly of “conventional wisdom” will likely have more impact on how you practice than any book you’ve read to date.
Mr. Galbraith, one of the greatest economists of our age, describes conventional wisdom as “… opinions that, while not necessarily well-founded, are so widely held among the rich and influential that only the rash and foolish will endanger their careers by dissenting from them.” Early examples include the beliefs that the Sun revolves around the Earth, and that the Earth is flat. A few centuries ago, dissention from these beliefs could cost a person his life.
More recent medical examples of conventional wisdom include our 50-year belief that non bio-identical hormone replacement was beneficial for women. Results from the Women’s Health Initiative revealed that hormone therapy with Premarin and Provera actually increased deaths from heart attacks, strokes, Alzheimer’s, and breast and colon cancer.
Conventional wisdom becomes “standard practice” through the repeated expression of views that serve the interests of those professing them. It gains strength and validity from the frequency with which these views are expressed. To use our hormone replacement example, gynecologists have been the last specialty to retire use of synthetic/animal-derived hormones, in part because for so many practitioners, these products were a mainstay of their practices.
Similarly, we must not rely exclusively on the conventional wisdom of the CDC and other government authorities to instruct us on what to tell our patients about staying well this winter. A February article in the Archives of Internal Medicine reports that although influenza vaccination among the over 65 age group increased from 15% to 65% between 1980 and 2001, influenza-related mortality increased in this age group during the same period. I contend that by following conventional wisdom on how to “prevent” infectious diseases, we now have more chronic diseases than ever in the history of mankind. This is the opposite of our objectives as physicians.
Our understanding of the immune system has changed drastically over the last 2 decades. This new information tells us that the immune system is fundamentally involved in the genesis and progression of most chronic diseases including heart disease, rheumatic disease, cancer, diabetes, Alzheimer’s and osteoporosis. In most people, we can effectively and dramatically improve immune function via simple, non-toxic interventions such as dietary changes, exercise, and nutritional supplementation. We are remiss in our pledge to the Hippocratic Oath if we don’t make our patients aware of these approaches.
A quick review of the current knowledge of immune system function will facilitate our understanding of the power we have at our disposal. First, let us to acknowledge the inherent power of the immune system. It keeps us well for the most part, even though our bodies are inhabited by more microorganisms than human cells, and we’re constantly exposed to potentially pathogenic organisms. On the other hand, it has the power to kill us with amazing speed as evidenced by things like transplant reactions, asthma, and some food allergies.
Between these two extremes are various illnesses mediated in large part by the immune system and its chemical signals. The emerging peer reviewed literature suggests that maintaining the integrity and balanced functioning of the immune system is essential for maintaining overall good health. The practices involved in winterizing the immune system will give us a good start toward that end.
Epidemiological studies show that while many may get sick or even die during infectious outbreaks of influenza or other infectious diseases, many people go through flu season, malaria outbreaks and even HIV infection without manifesting symptoms of disease. Such is the potential of the human immune system.
There are some basic tenets of optimizing immune function. These include maintaining skin integrity, avoidance of first and second-hand tobacco smoke, keeping alcohol consumption to a moderate level, and staying well-hydrated. These basic preventative measures are particularly important for those more likely to be immune compromised.
The next tier of immune defense involves the mucous membranes lining the respiratory, gastrointestinal, and renal systems. Good levels of vitamin A are critical to maintaining the optimal activity of local macrophages on mucosal surfaces. When macrophages on these surfaces encounter pathogens, they physically engulf and digest them. The digested pathogenic proteins, now antigens, are then “regurgitated” up to the macrophage cell membrane and attached to the major histocompatibility complex.
Presentation of antigens activates the T-cells to swarm like killer bees and attack any pathogens with that same antigen signature. T-cells also activate B-cells to make antibodies to that antigen, thus ensuring that the next response to an invasion is facilitated by antigen-specific antibodies and complement. This immune cascade is facilitated by a complex of chemicals signals, including: super oxide anions, interferon, prostaglandins, leukotrienes, and metalloproteinases.
Vitamin A is derived from dietary carotenoids such as beta carotene, but only if adequate levels of thyroid hormone are present. In the absence of adequate thyroid hormone, beta carotene builds up in the blood causing the palms and soles of the feet to display the yellow hue of beta carotenemia.
You should suspect hypothyroidism in a large proportion of your patients, as it is very prevalent and under-diagnosed. Current blood tests are not adequate to measure nuclear transcription underwritten by T3.The best we can do is to look for the phenotype of that transcription by doing a good clinical assessment. My website www.drfitt.com has an extensive list of symptoms that will make it easy for you to predict whether thyroid replacement is justified.
Assuming normal thyroid function, encourage your patients to eat plenty of deep-colored yellow, orange, red and green vegetables such as spinach, pumpkin, peppers, tomatoes, red grapefruits, and cruciferous vegetables. Sometimes, though, supplementation is necessary. For example, an acute viral infection can be mitigated by giving 100,000–300,000 IU/day vitamin A for 3–5 days, then stopping to avoid toxicity from this fat soluble vitamin.
While we do have to watch the doses carefully, the risks associated with vitamin A are overstated and far outweighed by the benefits. The Women’s Healthy Eating and Living (WHEL) study showed a 43% reduction in risk of cancer recurrence in women with the highest versus the lowest blood carotenoid levels. Furthermore, new research by physiologist Charles Stephenson, PhD and his team at the Western Human Research Center showed that NHANES III participants who tested high in CRP had lower than normal retinoic acid levels.
Another powerful and easily accessible immune modulator is vitamin C. Susan Ritter, MD at the University of Texas studied the lymphocytes of patients before and after supplementation with one gram of vitamin C daily for two weeks. The number of peripheral blood NK cells (especially potent against viruses) increased after two weeks of supplementation with vitamin C. The number of T-cells remained the same, but they were more active following vitamin C supplementation, and produced more gamma interferon and less immune-suppressing interleukin 4 and 10.
This study corroborates reams of prior studies showing the immune boosting power of vitamin C. Contrary to popular wisdom, however, fruit juices are not a healthful source of vitamin C, as they are loaded with fungus-promoting sugar. Superior vitamin C choices are whole citrus fruits, bell peppers, jalape?o peppers and acerola cherries. Vitamin C performance is enhanced by the bioflavonoids that naturally occur in fresh fruits and vegetables. If you do recommend a vitamin C supplement, be sure it includes flavonoids by encouraging the use of food-source vitamin C products.
Just as important as amplifying immune performance is making sure that resident pathogens are not hampering immune cell function. Though conventional wisdom would have us believe viruses represent the most important challenges to the immune system, in reality it appears that this dubious honor goes to yeasts.
The September 1999 issue of Mayo Clinic Proceedings contains the report of a group of ENT specialists headed by David Sherris, MD. They studied 210 patients with sinusitis who did not respond to antibiotics. They discovered fungus in 96% of the patients, and identified 40 different fungi, with an average of 2.7 kinds per patient. Using antifungals, they were finally able to clear the infections. Again, conventional wisdom holds that less than 10% of all sinusitis is fungus-related. The data prove otherwise.
Sherris’ group established a compelling paradigm that bacterial infections follow after fungi have already weakened the immune system. We physicians have continued to use antibiotics for sinusitis not because of well-founded science, but because of conventional wisdom and rote habit.
Sherris’ work and other research suggest yeasts are involved in a wide range of diseases previously attributed to bacteria and viruses. Dr. Martin Schroder and colleagues at the Howard Hughes Medical Institute showed how normally benign, ubiquitous, single celled forms of Candida morph into pathogenic filamentous fungi that then invade tissue spaces. They reported in the December 2000 issue of Genes and Development on how a gene called UPR (unfolded protein response) fails in a nitrogen-poor environment. This gene normally transcribes a protein that keeps C. albicans in its single- celled form.
Schroder’s research dovetails with findings published in the Journal of Endocrinology (McAllister RM, et al. J Endocrinol. 2005; 185: 111–119) showing that thyroid status determined the ability of cells to produce nitric oxide, an important source of nitrogen. Gradually decreasing thyroid function with age partly explains why immune function wanes with age. Compromised immune surveillance due to hypothyroidism is increasingly being linked to a wide variety of age-related diseases from diabetes and heart disease to cancer.
It would appear that yeast pave the way for viral and bacterial infections, and they do so by producing toxins that inhibit macrophage function. If these pivotal soldiers in the immune system are knocked out then a key component of the immune system’s pathogen recognition system is compromised. Conventional medical thinking holds that fungal infections are a result of immune compromise. It turns out they are a major cause of it.
How do you keep your patients free of pathogenic fungi? Diet is key. A diet high in simple carbohydrates and refined grains provides the nutrient that yeast crave most: simple sugars. Their favorites, according to Medical Mycology and Human Mycoses, by Beneke and Rogers, are: glucose, maltose, sucrose, and galactose, the primary sugars in our high-carb dairy-rich diets.
Plants produce phytochemicals to serve as their immune systems. By encouraging your patients to eat more fresh produce and legumes while reducing their sugar, grain and pasteurized dairy intake, you’ll go a long way in helping them winterize their immune systems.
My research reveals that the most potent of these plant antimicrobials are compounds found in spices, something our ancestors seemed to have learned by observation. Spices contain a wide range of powerful antimicrobials that are becoming popular with food producers because of their potency and lack of toxic side effects.
Garlic and oregano are two of the most powerful sources of these broad spectrum biocides. Dr. Ron Culter and his team at the University of East London demonstrated that allicin, a compound found in garlic, was highly effective against 30 different strains of MRSA. A paper from the Proceedings of the International Plant Genetic Resources Institute International Workshop on Oregano list the following pathogens as being susceptible to essential oils found in certain species of oregano: Aspergillus niger, Aspergillus flavus, Campylobacter jejuni, Clostridium sporogenes and Botulinum, Pseudomonas syringae, and ECHO9 Hill virus. Other researchers have shown that the phenolic isomers carvracol and thymol have very potent fungicidal activity against a wide range of Candida species, including C. albicans.
In addition to having superior broad spectrum antimicrobial effects, an article in the Journal of Agricultural and Food Chemistry (2004; 52: 4026–4037) showed oregano to have a very high oxygen radical absorbance capacity (ORAC), and that it is a stronger antioxidant than vitamin E.
Have patients look for oregano products that have a high content of these two potent natural germ fighters, and keep them on hand in case they do happen to get an infection this winter.
Studies with zinc show it to be mitogenic for T cells, simulating thymus function (Amer J Clin Nutr. 1981; 34: 88–93). Mild antimicrobials such as Echinacea and Goldenseal have inconsistently shown immunostimulatory effects. No significant toxicity is associated with either, so no harm for patients to give them a try. There are also preparations of juices from dark berries that have shown clinical benefit.
In addition to possessing some antimicrobial activity, these have the added benefit of delivering saccharide molecules that act similar to military counter measures. When a pilot realizes a heat-seeking missile has been launched at him, a counter measure is to release a flare in hopes that its heat signature will be picked up by the missile. Yeast, viruses, and bacteria attach to our cells via various saccharide moieties. Sugars such as those contained in elderberries and cranberries attract the microbes in a similar manner, allowing them to be flushed out of the system. This is the reason for mucus production during infections; the immune system is launching countermeasures!
Obviously there are other things that can be added to these recommendations. The important point, though, is to begin thinking outside the rather narrow box of conventional medical wisdom on how to prevent infections. Hopefully, I have given you some information that will help you do so.
