The role of diet in the management and prevention of chronic disease is a widely accepted notion, particularly amongst those who are already health conscious. What is perhaps lesser considered, is the relationship between diet and the acute immune system. As we enter into cold and flu season, we explore how what we eat may affect our ability to resist infection. In this week's podcast, Andrew and Dr Mark Donohoe navigate an interesting discussion on the role of diet in immunity, including sugar consumption, eating seasonally and making appropriate fresh food selections.
Covered in this episode
[01:38] Welcoming back Dr Mark Donohoe
[02:17] Sugar and athletes
[06:35] Diet and the gut
[11:22] Locality and feeding the microbiome
[14:50] Eating seasonally
[17:22] Discussing the Mediterranean diet
[19:50] Closing remarks
Andrew: This is FX Medicine and I'm Andrew Whitfield-Cook, and joining me again in the studio today is Dr Mark Donohoe. Mark graduated in 1980 from Sydney Uni, worked around the Central Coast of New South Wales, and this is where his interest sparked with nutritional medicine because patients just weren't fitting into the boxes of diagnoses and treatments. He's one of the uncles of integrated medicine in Australia, and he's been the vanguard for patient health throughout his whole career, and you truly have. So, Mark, welcome back.
Mark: Thank you. Uncool or uncle?
Andrew: You're an uncool uncle.
Mark: I'm one of the uncools of integrated medicine.
Andrew: Mark, we're going to be exploring the role that sugar plays in our immune system response. So, I'm not convinced that acute sugar consumption decreases the immune response. Indeed, there's one reference or a couple of references that I found, one in particular, talking about its use in sports performance and immunity where acute sugar actually improved immunity.
But, certainly, there's a plethora of research which shows that chronic high consumption of carbs and sugar can lead to metabolic issues… well, a sequelae, which then impede efficient immune response in chronic infections.
Mark: Right. I'd separate improved immunity. Improved immunity is a term that bothers me, because sometimes improved immunity is turning down immune responses when inflammation is dominating, sometimes improved immunity is turning up immune responses.
Andrew: Point taken.
Mark: And it's a little bit like good and bad bugs.
Andrew: Yes. Yes, you're right.
Mark: They are, in their context, all good or all bad. There are some known pathogens you don't want around and there are some known states of inflammation that you don't want to see.
But I agree with you. I don't think sugar could be blamed for those acute episodes. Sportspeople are an odd group of people. These are people demanding extraordinary feats from the musculoskeletal reflexes, those types of areas. So you could make an argument...
Andrew: And wear activewear while shopping.
Mark: Well, that's the kind of defect that you get from sugar. I've blamed that for a long period of time, that and the MAMILS, the men, you know, wearing lycra on their bikes. So there are brain defects that obviously go with these kind of consumptions.
But, leaving that aside, I think sportspeople are like finely tuned race cars. You wouldn't put them on the road, that's not how life is lived most of the time. And we do know that if you settle the microbiome, if you manage the microbiome, inflammation recovery, after injury for example, well, you do need a good, vigorous immune response. What you don't need is average immunity. You need neutrophils to get in, you need remodelling, you need quick activity that you can get away with using carbohydrates with a very positive effect.
I think we are moving to the stage with microbiome management, where we may be able to dial up and down things not with probiotics but with dietary manipulation and the appropriate use of carbohydrate loading, for example. See, carbohydrate loading is a thing for, you know, the use and the reclaiming of that afterwards in sports medicine.
So, I would separate the athletes from the rest. I think that their job is to perform at the highest possible level, sustain the injuries and recover from those injuries as quickly as possible. And the inflammation response is critical to that. Having a good, strong, aggressive inflammation response that has not over damaged tissue. Then, the omega-3 resolvins, protectins, the inflammation-controlling molecules of the body getting in to rapidly resolve that does a lot better job than, say, the kind of peptide story that we've had before of manipulation at the peptide level and to try and manipulate hormones around the body.
So, my answer to that is, not even sugar is good or bad. Appropriately done, it can enhance sports performance and even rate of recovery. It can make the immune system too aggressive for what you would want for maybe a child in preschool or a young adult who's not got those performance demands, but it's entirely appropriate for the sportsperson. What we also know about sportspeople is, they get degenerative injuries, degenerative changes after the use of those, whether you're talking osteoarthritis, or you're talking about the kind of head injuries from football where there is neurological degeneration. They're often sacrificing their future for a present.
And part of our job in medicine for the good management of high-level athletes is not just to make them perform like monkeys at the moment, but to make sure that in 30 years time, they still function. And that's the downside of that inflammation that rapidly gets you over the infections, gets you back on the football field is the cost you may pay may be a decade down the line and we've got to remember that in tissue protection.
Mark: It is the everything. And so the combination of bugs that we have, and the diet that we eat, and, potentially, the probiotics and nutrients that we take, they combine to give us health and to minimise or maximise inflammation as appropriate for the person. So we're not after a steroid-like, it's not like we're after prednisone for the gut where everything stops and inflammation stops. The gut is a churning mess of microbes. We are in symbiotic relationship with it if we feed it well. It looks after us in a very mysterious way that we're only just getting to understand.
What we do know, right from the start of life is the glycans in human breast milk are incredibly more complex than nearly any other species or any other species identified to date. And so the complexity of an omnivore, of the baby growing up is that they're born with a wide variety of microbes that the breast milk encourages in many directions. The vagina provides the bugs, the growth factors are in the breast milk. That start in life is what we need to maintain, and this concept of glycans, of not separating complex sugars from simple sugars, the variety of those is a diet.
So fresh fruit and vegetables in season, but not all the way through a year. Providing complex carbohydrates or even semi-soluble, or partially soluble fibre that can produce the butyrates and can produce the short-chain fatty acids which so fuel the large intestine. So, what we're using as food that we think of as food but which is fuel for a whole variety of biochemical processes down the gut that breeds up different organisms at different times of the year.
My push for my patients is to get fresh fruits and vegetables in season, to not be scared of it. We see people on candida diets or restrictive diets as though every sugar molecule is equally nasty. The word fructose induces, you know, holding crosses and screaming. But the fructoses and those sugars in season allow the appropriate development of the bacteria for that time of the year. They have their job of triggering the inflammation responses, keeping our body's immune system organised, and keeping the anti-inflammatory responses under control.
I think the simplest answer is, if you keep away as far as plausible from the added sugars to food and even the added salts, going back to what we previously talked about, that if you keep away from those areas and provide fresh fruits and vegetables in season with a moderate amount of meats, if you're so inclined. And if you're not so inclined, making sure that you're very big on the variety of vegetables, vegetable matter and the insoluble fibre or semi-soluble fibre, they are all critical components of breeding up that diversity in the microbiome.
We can't control it, what you can do. I mean, there are doctors around who you know give vancomycin and clear out the gut microbes, there are no bugs left there and we will re-colonise it from the start. We actually don't. What happens is we can put a starter pack in, get someone's poo and put it back there. We can put the starter pack in, but then we just cross our fingers and it's like pressing a reset button on the computer.
Our job though, is to take children from a healthy breastfeeding time, give parents the confidence to say, "This is really important. What I feed my child over the next 10 years is going to define how their cardiac risk factors, cancer risk factors, and other problems occur later in life." And that intensity of focus is what mothers are great at. So, fresh fruit and vegetables in season, the occasional meats, a focus on the, you know, the pulses. People forget about the pulses, the chickpeas, and the lentils, and those kind of things.
Andrew: Chickpeas, underrated protein source.
Mark: They are. And we think of them as “fart foods,” but when you change the microbiome, gas occurs. Microbes go to war. The ones that are there, you know, hold on to their little slime cities and other ones are competing for that position, and you will get fermentation. Something always worth mentioning to patients is when they're doing the right thing, discomfort is not an unusual thing to go through in that transition period. And it should never stop them from… But then people back off and say, "Oh, it must be bad for me," but as the gut microbes sort themselves out, give them three weeks and they're in a whole new state of health.
Mark: And so that persistence is important, shepherding people through the first couple of weeks of changes of such diets because once you've got a dominant growth, it is like the Middle East down there. They hold on with great intensity and changing it is a very difficult thing to get through, but once done is most rewarding because it maintains itself after that time.
Andrew: It was an interesting point that Jeff Leach made when he was talking about his experience with living with the Hadza tribe in Africa. There I go, you're on apples and I go “Hadza tribe.” And he was talking about the bellies of the children especially are usually protruded, not from Kwashiorkor, from protein deficiency, but actually from fermentation of good bacteria. And yes, they farted a bit.
Mark: But they fart in the open, where in schools there are certain downsides to getting that farting happening. Did you know we fart 24 times a day? A healthy person farts...Oh, sorry, 48 times a day. Twice an hour is the average. And if you hold it in, as I do inside consultations where it's inappropriate to, the amount of gas that forms there is really, really quite significant. And so the outdoor life is what we used to have where you can fart anywhere.
Mark: Burping was quite acceptable anywhere, and now we have the social customs which hold it in.
Andrew: We have changed ourselves so much, haven't we?
Mark: We have. I think you should become a Hadza. I think that you should go back and be an honorary Hadza and I should grow apples in Tasmania.
I would also say that what we focused on with the Mediterranean diet, we always think of it as cardiovascular disease reduction…
Andrew: Much more.
Mark: But it is much, much more than that. And I think the missing factor that we often talk about is siestas and those kind of things are part of it. The eating, sleeping, that kind of cycle of life where we have our quiet times in the afternoon, they've disappeared in our modern world. School goes on, work goes on and we can't do that.
But the Mediterranean diet provides that diversity of glycans, it provides the polyphenols, it provides the fats. And so what we do see is, when people are left to themselves and they got a diversity of foods, they sort out pretty rapidly what diminishes inflammation, what optimises cardiovascular disease recovery, and it's exactly the same as initiating a good microbiome management.
Now, this will vary from culture to culture. You cannot transpose the Mediterranean diet to China, to, you know, Middle Africa, Sub-Saharan Africa. They have diets which are ridiculously different, well-adapted to their own environment, and their health is dependent upon their own microbes. So we have a job to be sensitive to the culture and the cultures, so the culture the person comes from, what's the traditional cultures? Where do they get their microbes in that area?
Our fascination with soy comes from a different group of people and their low breast cancer is from soy and we transpose it and say, "Soy is everything.” And that's a mistake for a Western kind of origin, Greek, and Italian, and Irish, and all those. We have potatoes. We don't like potatoes because potatoes provide this swift carbohydrate, but let them cook and cool, and you've got a resistant starch.
Andrew: That’s right.
Mark: And a resistant starch does a lot of good for you. So, Irish people probably learned this before the English came and poisoned our crops with this fungus, but we've unlearned it. We've learned to live from packages and the packages do not suit the good health of people.
The conspiracy theorist in me says the drug industry and the food industry are so closely intertwined with each other, that what's the downside of having foods that induce inflammation that sell drugs, that cause depression that sell drugs, that raise cholesterol that sells drugs? And I know that's a conspiracy theory, I don't think they do it for our harm. But, hey, what's the downside of profiting from the very things you've removed from your food and the problems you've caused with our supermarket life?
Mark: I do.
Andrew: ...grow your own carrots?
Mark: There are, you know, in my area around Sydney, there are a couple of the markets that are open every single week. There's living foods stalls in there. There are organic vegetables in there, and people get a surprise that not every vegetable is available all the time, not every fruit is available all the time. When you get this, you are naturally drawn into the story and the story of organic food production and appropriate local food production and ecology. We are part of the ecology of our planet.
The learning to forsake convenience, quickness, packages, and high cost and to go for something else which is real food and fermented foods which bring their own microbes that re-organise our little systems, it becomes a story that becomes a lifestyle, that becomes something you transfer to your children who are grateful. I'm now 40 years into medicine. I'm seeing the grandchildren of people who I saw a long, long while ago, and it is within their nature to have that kind of a diet because mom and grandma encouraged it. It's really grandpa and dad, but...
Andrew: He was normally saying, "Have this alcohol at the table here."
Mark: He was drinking on the side. But that transference is the most rewarding thing that I've seen in my healthcare management. When you see the parents learn, they teach their children. Their children grow up healthier than their parents ever were, and now you see the grandchildren, who still complain, "Why can't I go to parties? Why can't I eat all this?" The answer is, occasionally, you can. You can push the boundaries. But if that becomes your lifestyle, you'll get a microbiome which does not facilitate good health. And I think our encouragement as doctors is change the patterns and behaviour. I'm also huge on sleep, sleep, and sleep. Getting sleep right and getting eating right.
Andrew: Getting restful sleep.
Mark: Yeah, restful sleep and eating well, and my estimate is that we would have half of our medical disease problems taken away from us. That we would have people maintaining themselves on just the right side of disease. They may not be brilliantly well but they're well enough to go about their lives. And I think that's our job as doctors, however much we hate it. The area is to get them back to their own self-managed life and healthcare and not dependent on the drugs that we can give them to the quick and easy answers.
Mark: I have not invested in that area. You know, I give people online resources and here's the Mediterranean diet and here's whole foods and living foods areas. I think I've passed the time with books.
Andrew: Because we've carbohydratalised the Mediterranean diet with huge amounts of pasta, and that's just not the traditional...If any of our listeners know of a publication that takes people through the true traditional Mediterranean diet or indeed, a true traditional un-bastardised, Westernized approach to it, can you please let us know on fxmedicine.com.au?
Mark: I also do think that those Mediterranean diets are only one part of our story. I think that we're inventing or re-inventing the diet, and the microbiome story is, in effect, a return to the future. The future is the past.
Mark: The exciting lessons of the microbiome are not what strain you can put in and what does what. The exciting lessons are the traditional knowledge, the mothers, the keepers of what is grown. The farmers were in fact the healthcare providers throughout the history of humans, at least the last 10,000 years. And that what we're learning is what we can gather, what's in the soil, what's around us and our part in our own world.
We are not the dominant organisms that uses up the world. We're finding out what happens with global warming, with lack of biodiversity, species loss. But at a very personal level, it's happening on the family side. That until we are congruent with our own environment, eat the foods that we have evolutionarily developed with, then, of course, we're going to have disease because we are handling molecules in amounts that we were never, ever capable of handling.
And there's a natural selection. What's the future if we keep going down the path we are? The sugar eaters that survive will be what's left. Then you will have the loss of the human biodiversity, because inflammatory diseases, cardiovascular disease, they’re big killers. But they do not respond well to the diet that we have right at the moment. So I think the future is that we learn to go back to the past and what biodiversity of food means, is that we get resilience. When we get resilience, we keep away from doctors.
Andrew: I have the utmost respect and admiration for how you take such seemingly complex, well they are complex, concepts and you bring them back to a very personable level which your patients can then use to help regain or maintain their health. So, Dr Mark Donohoe, thank you very much for joining us on FX Medicine.
Mark: Pleasure as usual. Thank you very much.
Andrew: This is FX Medicine and I'm Andrew Whitfield-Cook.
Other Podcasts with Mark include
- The Microbiome: Beyond the Gut
- The Forgotten Organ: Adrenals
- Methylation: What Is It and Who Is Affected?
- Reducing Cardiovascular Risk
- 2015 BioCeuticals Symposium Review
- Iodine: More than just for thyroid
- Unravelling Detoxification
- Probiotics as medicine
- Pyroluria & Methylation
- The Hibernating Thyroid
- Decoding Health Media: Beyond Hype and Headlines
- Digestion, Biodiversity and Wellbeing