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Influencing Immunity: Part 1 with Amie Skilton

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Part One: Influencing Immunity with Amie Skilton

In this episode, taken from our live interactive podcast, we're joined by Amie Skilton to dive deep into the dietary and nutrient considerations in optimising immune resilience.

Tune in to learn Amie's top five nutrients for a robust immune system and a deep dive into how sugar, alcohol and sleep can dismantle immunity. 

Interactive video podcasts will be available exclusively to FX Medicine subscribers - and there's only limited spaces available to participate. Already a subscriber? GREAT! Be sure to keep an eye on your email for how to access our live video podcasts or contact us on [email protected]

Covered in this episode

[00:20] Welcoming Amie Skilton
[01:41] Today's topic: Influencing immunity
[03:26] Dietary modifications for maximising immunity
[04:10] An in-depth look at how damaging sugar is to immunity
[17:41] Why vitamin D is so important for optimal immunity
[19:07] Stress suppresses immunity
[20:47] Alcohol impacts immune function
[24:28] Quality sleep influences immunity
[32:29] Amie's top 5 nutrients for immune health
[33:43] Why vitamin C is an immunity hero
[45:59] More on vitamin D
[51:32] Immune 'besties': Vitamin A and zinc
[59:22] How selenium protects immunity
[1:01:57] Mucolytic effects of proteolytic enzymes and NAC
[1:05:16] Last call on questions


Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook and joining me today is Amie Skilton. We'll be discussing how to influence immunity, particularly in this time. 

Just a little bit before we get into it, the 8th BioCeuticals Research Symposium is going digital and will take place over 4 weekends from the 6th to the 28th of June 2020. For more information and to book your tickets, go to bioceuticals.com.au and click on the Education tab. 

I'd like to welcome Amie Skilton. How are you, Amie?

Amie: I'm well. Thank you, Andrew. How are you going?

Andrew: I'm very, very well. Very, very nervous. It's the first time we've done this without having somebody directly opposite me to bounce off. How's things going for you in this particular time in 2020?

Amie: I think everyone's having to make some sort of adjustment, right? For some people, that's been really huge. Certainly, for this particular conversation, it's a shame that we're not opposite one another today but I'm so excited that we can still have this conversation and invite people in to join us at the same time.

Andrew: Yeah, so it's great. It's very exciting, I've got to say. The world of technology, it's pretty awesome. 

So, I guess to start, I think we have to make that ethical line in the sand, if you like. In Australia, we're coming into the winter months. We are going to be talking about what we've always done as practitioners and clinicians, and that is to help our patients through the immune challenges of the winter months, whatever that immune issue would be.

Amie: Yes. Yeah, that's exactly right. Our immune system is an incredibly sophisticated thing. And, in order for it to work its best, there's a lot that we can do to optimise its activity. There's also a lot we do as human beings that can disable and disarm our immune system. We're all human and we'll talk about what those things look like in this conversation but we generally...when there's a time of immune challenge happening is when you want to buckle down and limit as much as possible things that might suppress or disable your immune system and dial up the things we know that it needs to mount an immune response to any pathogen whatever that is, whatever the nature of it is.

But I think the reason we're having this conversation at this particular time is there is a pathogen currently impacting the globe that has quite a unique presentation, a very aggressive and unusual timeline, and appears to have a virulence that is in excess of what we would typically find with a standard respiratory tract virus that we tackled in wintertime, right?

Andrew: Yeah. Having said that, we all need to nourish our immune system. And we need to be avoiding those things which suppress our immune system. Of course, the simplest one that we have and do all the time is dietary intake. 

Amie: Yes.

Andrew: So, I guess to start off, how can we modulate our immune system by dietary inclusion and dietary avoidance?

Amie: So, look, we could probably talk for more than an hour alone on that subject, so let's be honest.

Andrew: Hashtag Professor Lustig.

Amie: Yeah, it’s exactly right. So, in terms of that, we can't go into a lot of detail but there are some key basics that I think most people should be aware of but often aren't. I don't want to sound like the “fun police: here, but if there's nothing else anyone listening here today takes away from our chat is I want you to understand how damaging sugar is for your immune system. 

It actually distils your immune system. Sorry if that's broken anybody's hearts out there. And, look, I enjoy sugar just as much as the next person. I've got my thing that I love, I'm sure we all do. But the truth of the matter is, when we put in refined sugar, particularly glucose I'm talking about on this particular occasion in the study that I'm...

Andrew: Glucose or fructose?

Amie: I'm talking about glucose on this. 

Andrew: Glucose, okay.

Amie: Again, you can split up the different types of sugar and the impact on their body, but glucose specifically is almost molecularly identical to ascorbic acid, which most people know as vitamin C. 

So, look, can I get nerdy on you for just a second here, everyone? I want to explain… We’ll talk about why vitamin C is so crucial for a good immune response in a little bit. But the reason why sugar is so problematic as far as an immune response goes is because eons ago we actually were able to make our own vitamin C in our body from glucose. It was a very simple process of doing that. However, that gene got deleted and scientists have hypothesised that it was deleted because of an abundance of vitamin C-rich food for a period of time.

Here's the analogy I use with my clients. When you first got a smartphone, you downloaded all the games and all the fun apps and all the WizBang Gadgets. And then overtime you worked out there were some you used regularly and there were ones that were taking up space in your phone, so you delete them. The same thing happened with that particular gene and our ability to manufacture ascorbic acid. 

The problem is our white blood cells, which are literally our immune cells, our immunological army, don't know. It's 2020 now and they can't use sugar or glucose in the same way as ascorbic acid, and so they take up glucose preferentially when blood sugar is high or is raised because of a sugar-rich meal, or snack, or Netflix nibbles. And as a result, their ability to tackle pathogens, bacteria for example is reduced by 75%.

Now, no one should or wants to be running on 25% but, in times of good health and it's not a pandemic outbreak, well, you can get away with a few Ferrero Rocher here and there. Not that I'm giving away my favourites.

Andrew: The white or the brown?

Amie: But as far as when something is going around that you don't want to catch, you do not want to limit your immune response down to 25% of its’ capability. And so keeping sugar to an absolute minimum or avoiding it entirely I think is a key element of improving your diet to optimise immunity. 

I guess, on the flip side of that though, rather than focusing on what you shouldn't be having, I would also be encouraging you just to eat as fresh and whole food as possible. Seasonal and local is always ideal because it's most nutrient-rich. And really getting an abundance of fruits and vegetables as well as, if you eat meat, lean organic meats, wild-caught fish, nuts and seeds, leafy greens. It's honestly not rocket science, and I'm sure if you asked any one of our...

Andrew: Just eat a vegetable.

Amie: Yeah, just eat a vegetable, man.

Andrew: But I do make the distinction, and we need to just do this again and again and again because people continually get caught up or confused in that word, sugar. There are so many different sugars. 

Amie: Yeah.

Andrew: When we're talking about sugar, we're talking about refined sugar and additive sugars, not those that are important to immunity like for instance the mannose, the rhamnose, the galactose. 

Amie: Yes, yes.

Andrew: Things like that. So, we just have to continually make... as to what are we talking about. 

Amie: Yes, absolutely.

Andrew: So, I'm going to ask a little question on that. To what extent does, say, regular intake of fizzy drinks...to what extent does that suppress our immune system?

Amie: So 100 grams of sugar will disable your immune system by 75% for at least 6 hours. 

Andrew: Right.

Amie: Now, it doesn't have to be in the form of a fizzy drink though. A lot of breakfast cereals that people commonly consume are very high in added sugar and refined sugar. And then if they're using skim milk, that's also very high in sugar. If you're having, let's say morning tea, you go for a skim cappuccino and a muffin. That's about 85, 90 grams of sugar right there.

What you look at, if you're examining, say, the standard Australian diet, people are suppressing their immune system breakfast, lunch, and after dinner.

Andrew: Yeah.

Amie: And so are spending almost most of that 24-hour period operating well below what is ideal. Now, that doesn't mean you can't enjoy those things from time to time, or watch the volume or watch the frequency. But the fact of the matter is, if you want to liken...I hate using war analogies and fighting things, but I feel like I can't think of a more fitting one right now on the spot so I'm going to go there.

Let's say you're going into battle against an enemy. In this case, it's invisible but regardless you want your soldiers to be fit, well-trained, armed, and ready with resilience, and longevity, and power, and speed, and agility so that you come out the victor and hopefully without too many casualties. Now, you can't go into battle expecting a good outcome if you are feeding your soul...

Andrew: With a sugar high.

Amie: On a sugar high, yes.

Andrew: A sugar high and a sugar low.

Amie: Yeah, exactly. I just see one question here: 100 grams would disable the immune system by how many minutes? Thanks for your question, Alison. With regards to that, the immune suppression occurs within the first 20 to 60 minutes and the bulk of it lasts for about 6 hours. But it can last up to 8 hours. 

So I think it depends probably on a few things. I imagine women are more vulnerable because we have less muscle mass generally and so our insulin sensitivity isn't quite as good. Of course, if you have got hormonal challenges, insulin/blood sugar balance challenges, other metabolic dysfunction, you could end up in a risky immune suppression at even a lower dose, for a longer period of time. So, yeah, thank you for that question.

Andrew: It's a very telling argument. I think firstly the very telling thing is an army marches on the stomach as you said, but I was thinking comorbidities. I was thinking about those people that are at increased risk of having an immune issue particularly in this light: who isn't diabetic? It's really interesting…"people with diabetes,” is what I should have said. They are at an increased risk of a number of diseases but certainly, during the winter months, they're at an increased risk of pneumonias and things like that.

Let's move on though from dietary indiscretions or dietary modulation. What about things like...I mean working from home, social isolation, which is the new Vogue, it's the new in. Stress. I mean, the stressors placed on us and also we place on ourselves in maintaining health…

Amie: Yeah.

Andrew: …or that are forced on us in this situation. Let's go a little bit into that.

Amie: Well, there's actually some really important elements to touch on there, and I've just seen a question come through about wine as well. But, if you don't mind, I'm going to just answer one other question first on the sugar. 

Hi, Carol. Thank you for your question. The question is: would there be an improvement if someone stops sugar? Will this improve immunity or is it the end of the path? That is a great question. You know what the great thing is? Our body responds very quickly to either positive changes or negative changes. We can see obviously an immediate response with a sugar-laden meal or snack or drink that can last for the rest of the day. But if you don't eat sugar tomorrow and stay off it for the next month, your immune system's going to come back up to speed very quickly, or rather, the sugar-induced suppression will lift.

Now, there's a lot of other things that we will talk about today that are required for optimal immune function. So avoiding sugar is kind of one of the pieces of the puzzle ,if you like, but please know that for anyone who's all of a sudden gone, "Uh-oh, I actually eat quite a bit of sugar. This isn't good. Am I doomed?" No, you're not doomed. 

What I would also just say is, as a side note, stopping sugar immediately is a bit like coming off caffeine and other drugs because sugar acts very much like a drug. I would just encourage you to cut down over this next week, and maybe find healthier, yummier alternatives, and just ease yourself into it. There's no massive panic but, yes, certainly you're not doomed if you've been on a high sugar diet until now.

But going just to your question about... Sorry, did you want to say something?

Andrew: No, no. You keep going.

Amie: No? Okay. And the last sort of question: where does fructose and lactose fit in? Look, all simple sugars are really not great for your body, so I would be limiting them. Although please don't take that as an indication that fructose in the form of whole fruit is a problem. This is refined sugar, sugar that's outside of its normal food source, and that have been added into things. Please don't worry about that. And stevia is fine from that point of view.

Andrew: Of course, there are those instances where fructose in and of itself should be, I'm going to say, minimised, not avoided. If somebody's got, say, for instance fructose malabsoprtion, SIBO, irritable bowel syndrome, and they're sensitive to fructose, obviously you've got to limit that. The FODMAP diet. The low FODMAP diet, forgive me. It's not the FODMAP diet. It's not FODMAP avoidance diet. It's the low FODMAP diet. 

But the other one was people with compromised liver function. I'm drawing particularly here because of the way that fructose is metabolised to the liver first. Whereas glucose is straight into the cells, if you like. 

Amie: Yes.

Andrew: Fructose has to be changed biochemically before it's able to be used by the body.

Amie: Yeah.

Andrew: So let's say 30% of the community suffer from nonalcoholic fatty liver disease. I'd love to see that stat in Australia because it's alcohol-related but anyway, people with nonalcoholic fatty liver disease are going to have a compromised ability to metabolise this sugar. What sort of stressors we'll be placing on the body if we don't modulate that sort of sugar? Now, I don't know if avoiding fruit would be the way to go, but maybe minimising fruit?

Amie: Yeah, so tropical fruits like summer fruits tend to be a lot higher in carbohydrates and fructose. And so everyone obviously...I guess maybe we should have said this at the start. You want to optimise your own individual biochemistry. There'll be plenty of people who can eat fruit and it's fine. But if you have got a compromised microbiome or there's other metabolic issues going on and fruit is a bit of a problem, then you can simply aim for the lower glycemic index, things which aren't necessarily seasonal, like berries. But in this case, that's where you need to get your fibre and your vitamin C from, and you can focus more on vegetables. So certainly this is why working with a practitioner is really helpful because they can really help work out what is an ideal immunological blueprint for you. 

But, in and of that, avoiding sugar is always going to be key. And, as you say, this whole working from home and stress and the lack of getting outside is also another key piece of the lifestyle puzzle.

Now, what they’re noticing overseas is that 90% of people who end up on ventilators are critically low on vitamin D. We'll talk about vitamin D in a minute and why you need it to produce your own antiviral compounds, but we get that from the sun in the summer months. Now, we are at an advantage. For anyone listening who's currently in the Southern Hemisphere, we're just rounding out summer here. Autumn has definitely kicked in and our vitamin D levels are about as good as they're going to get. The reason you need to be mindful of what your vitamin D is at this time of year is it gives you a very good indication about whether you have enough stored in your body to get through winter safely or not.

Now, with this whole working from home and only being allowed to leave to go do shopping, if you don't have a backyard where you can get some sunshine, and you live maybe in a more densely populated area where they're really moving people on from beaches and parks quite aggressively, then your opportunity to make what little vitamin D you have left with the UVB left is quite limited. 

So that's a problem but also the stress, the lack of community, the lack of social interaction. Stress is a really built-in tool for our body that was meant to be used very short-term. Adrenaline is a "you're about to die" signal from your body, and it floods you with adrenaline and cortisol and increases your heart rate and all those other things to survive whatever is about to take your life. And you either have the strength and the speed to run away, fight it off, or you die. But either scenario, it's over very quickly. 

But unfortunately, I guess it's more of a modern-day pandemic than the dreaded you know what going around is that we're constantly operating under the influence of adrenaline and cortisol. Now, cortisol, there's a couple of elements to that, but ultimately your immune system gets supressed with stress and with lack of social connection. In fact, babies will die if they're not cuddled enough. That's how crucial and hardwired we are for human touch and connection. Stress management is a really key thing in getting out in nature.

Now, fortunately, we're in a country where you can still be...you're allowed outside to exercise. Twenty minutes is all you need to reduce your cortisol by 30%. That also boosts your endorphins. If you go in the middle of the day, you've got some vitamin D manufacturing happening as soon as you've got your legs and your arms out. That's really important and obviously keeping in touch with people.

The question that was earlier from Michelle asking about wine. A lot of people are drinking more at the moment. Partly it's because of boredom. Partly it's because of stress. Wine and all alcohol actually acts at the GABA receptor and has a temporary, albeit unhealthy, anxiety-relieving effect. Now, white wine has a higher sugar content than red and actually depends on the varietal as well. Obviously, the sweeter wines are higher on sugar. Even if it was sugar-free, alcohol does impact the immune system as well. Now, rest assured I'm enjoying a glass of chardonnay probably every other night, too.

Andrew: I was thinking, "What? Now?"

Amie: Well, actually you can't see my wine glass, can you? So, what I want to say about that is sugar is kind of a blanket “please avoid it as much as possible.” I'm not going to apply quite the same rule to alcohol, but please know that every alcoholic drink depletes zinc, which is important for the immune system. It depletes B vitamins. It affects your microbiome.

Andrew: The gut.

Amie: That's where most of our immune system is. Over time it wears out the GABA receptor. So there are better ways to cope with stress than drinking. There are healthier choices out of alcohol as well. Just to sort of close out the sugar conversation, someone has asked where does fructose and lactose fit in? I think I did cover that already but simple sugars out of the context of the foods they appear in is not great.

Sharon asked about stevia. Stevia is fine. It doesn't have a carbohydrate value and therefore doesn't trigger insulin and can't be taken up into the white blood cells instead of vitamin C. Now, Melanie has asked about vitamin C. I will cover that when we get to vitamin C. 

Honey… Graham, in order to answer your question, how about honey? Honey is a little bit of a grey zone. Honey is high in natural sugars and there's no getting around that that has an impact on your nervous system and your microbiome. It's high in fructose, and we know that fructose brings with it a whole host of other problems. Having said that, honey also has natural antimicrobial, anti-inflammatory and other properties that make it quite useful for sore throats and things like that. So I would limit its use as a culinary item when you're trying to preserve immune function, but I wouldn't say don't use it if you've got a sore throat or post-nasal drip and you're looking to add it to say, an immune-boosting drink with ginger and lemon and things like that.

Andrew: The only other point I'd make about honey is metabolically, if you look at the Hadza tribe during the summer months, they can eat as much as 30% of their calories from honey. Incredibly high. But they're not in a Western society that's sitting on a chair in an office. 

Amie: Exactly.

Andrew: They’re out on the planes chasing or being chased so they're constantly moving.

Amie: If you've exercised, if you eat carbohydrates or sugar, within 20 minutes, you don't even need insulin to get it into the cells. It uses the GLUT4 receptors and so you're not triggering insulin. You're not triggering inflammation. It's a different lifestyle, that's for sure.

Andrew: Totally.

Amie: I suppose we should talk about then vitamin C, do you think?

Andrew: Well, just before we go into that, finishing off lifestyle factors. If it's so important, we always...we say we know them and we just accept that we know them, but we never go through them. How often do we take as a stepwise methodical approach to this with every patient to say, "Okay, how is your sleep"? 

Amie: Yeah.

Andrew: Now, in this situation, what we're going through, this pandemic issue that we're going through at the moment with increased stressors and totally mucked up sleep, how important is it for us coming into winter?

Amie: It's critical and I know it's easy if you're not in the functional medicine space to think, "What's getting some sleep going to do to protect me against this virus or anything?" But the truth is our bodies, we mistreat them all the time. We cut corners. Human beings are actually quite lazy by nature. We're always looking to improve efficiency and do the bare minimum to get the most results. 

Unfortunately, we have been quite conditioned to just burn the candle at both ends and then look for a magic pill when things fall apart. Unfortunately, you can't out-ninja nature. So if you're going to disable, and damage, and decimate your immune system and fail to nourish your cells, you bet not getting enough sleep is going to increase your risk of catching something. It's going to mean it's going to hit you harder. It's going to take you longer to recover. I know it sounds really pathetic to say, "Please focus on getting enough sleep and quality sleep at the right time of night," as a form defence against something that seems so big and so scary. But it's actually a fundamental piece of the puzzle as far as immune support goes.

Andrew: I think it's really interesting that, no matter how much hooked you are...forgive me. Poor syntax. No matter how hooked you are on Netflix-ing all the time, if you catch a cold or a flu...flu for women, colds for men. You can quite see the severity there. Man cold. But if you catch a cold, the first thing that you want to do is you want to just hibernate and you just want to close off. You want to go to sleep. Don't bother me. You know? You really hunker down for a short amount of time. It's a telling message that we should be doing this.

Amie: Well, so that's nature's way of protecting the rest of your tribe. We're all I guess doing it right now as far as physical distancing goes. But when we're fighting off a pathogen, whatever it is, we produce inflammatory cytokines amongst other chemicals in our body. They play a number of different roles including communicating with the immune system. But part of the fallout, and if anyone's ever had the flu, you'll know what I'm talking about, is pain, stiffness. You become moody, short-tempered, sensitive to light, sensitive to sound sometimes, achy, and very antisocial. It's nature's way of driving you back to your bed because it doesn't want you wasting energy doing stuff when your immune system needs the energy.

And so it's actually very supportive and helpful to do that at the first sign of anything, to rest. Now unfortunately again we have a culture of “soldier on.” In fact, there's a whole advertising campaign for something you can take to do just that, but what you're doing in that particular case is suppressing symptoms but extending...you're making your immune system work really much harder than it needs to. Now, I totally get sometimes you just have to. But in an ideal world, we're supposed to rest so we can recover fully, completely, and quickly as well as avoid giving it to the rest of our family. It's also an external indicator to other humans where we're battling something. When people look sick, you're like, "Oh, just stay over there, will you?"

Andrew: Absolutely. This is the upside of having man flu, we’re like a bear, of sorts. Whereas, my wife being a teacher, the worst thing she sees every winter or any peak of colds and flus, is these really sick parents and really sick kids being sent to school. Just absolute crazy thing but...

Amie: It is. It's very silly. It's a real shame that it's a product of the way society has a cold. I've seen stuff going around about, you know, in our rush to get back to normal, can we at least think about the parts of normal that are worth keeping? And I really think that's one of the old paradigms we need to ditch. I've just seen a question...

Andrew: How many hours of sleep?

Amie: Yeah. How many hours of sleep?

Andrew: Do we need? It's really interesting. This is a whole podcast as well.

Amie: I know. I'm going to try and give you the shortest, simplest answer possible. Ultimately there was a study done that 7.25 hours was the best amount of sleep. 

Andrew: For an adult.

Amie: If you over or undershot that, your risk of dying earlier and comorbidities was higher. Now, I have a particular view of this study. It comes from a chronic illness that I've dealt with. I think if you're sleeping less or more than that, it's an indication that something needs help. Either you're sleeping more because your body needs more rest or you're sleeping less because you lack some fundamental minerals, for example, to initiate and keep the sleep process in place.

Now, I know when I was really sick, I needed about 9 to 10 hours. And if I'd forced myself to get up after 7.25 hours...

Andrew: You have sleep debt.

Amie: ...that would have compromised my health. It would have been very bad for me. So look, aiming for 8 hours in bed is good. If you know you need more or you feel better on more, take it. I wouldn't want to go less than 7. If you're sleeping less than 7, I'd be looking at your glutamate and some other neurotransmitter imbalances that might be happening there.

But the other thing is, because of stress, we often see people with unhealthy circadian rhythms, night owls, for example, staying up late, sleeping in, things like that. We really should be going to bed an hour or two after sunset and waking up around sunrise. That's sort of what you want to be aiming for. And, of course, with artificial light and blue light, that's really interrupting people's natural sleep rhythms, which is why we see all these blue-blocking glasses going on. 

Basically, you want to be able to wake up naturally and feel good, like you're ready to get out of bed. Now, I don't know many people who can say that's how they feel when they wake up. But if that's not how you feel, you're probably not getting enough sleep or the quality of it is poor and you want to look into that.

Andrew: That's one of the big hallmarks. If your sleep is not refreshing you, you need to look into why, and that's given that certain groups like teenagers require a heck of a lot longer sleep. It's insane that we should be going to high school so early, when teenagers need so long a sleep. We always have the light screen issues of course. And of course elderly require less. So there's not one sleep that's good. 

Amie: That’s right.

Andrew: It’s different for different populations but if you are not feeling rested after your sleep, that's the key that you need to look into something.

Amie: Totally, totally.

Andrew: So let's go on now, I guess. Let's look at some of the things that you might use as a clinician. Some of the tools of your profession, and the question's already been asked: vitamin C.

Amie: Yes, okay. All right, we'll start with vitamin C. So there are four, five key nutrients actually that I always take in winter at a moderate to low dose just to support my immune system. These are things I commonly recommend my clients take as well. They are vitamin C, which probably most people are across, vitamin D, which more people are becoming aware of. Vitamin A, which I think is languishing in the back closet a little bit.

Andrew: People are paranoid about it. Yeah, it's crazy.

Amie: And they also don't really understand why it's so crucial. Zinc, I think probably people are across, and selenium which is actually very, very important for Australia, New Zealand, parts of South America, and Asia. I think it has a particular prominent role to play as far as getting on top of the current outbreak as well, but let's start with vitamin C.

So vitamin C plays so many roles in the immune system, so I'm going to give you just a bit of a highlights reel. First of all, it has a role in stimulating the production of white blood cells. Giving vitamin C helps you make more soldiers. More soldiers, bigger army, better outcome in battle, right? It stimulates white blood cell function and so it allows your soldiers to move quicker, move faster, be more effective in their approach to clearing pathogens for you as well. It also helps natural killer cells do their activity. Lymphocyte proliferation. We also know that low lymphocyte levels seem to be a key factor in the severity of how people respond to this current virus. So vitamin C plays an important role there.

There are a couple of other things though that I love about vitamin C. One of which is it actually speeds up white blood cell activity. It boosts your immune system in the vein of your soldiers can move faster and quicker. But I think the most important thing about vitamin C that most people don't know is vitamin C actually stops your white blood cells from killing themselves in battle. So here's the analogy. Gosh, I’m using a lot of war analogies here. I'm sorry, everyone.

Andrew: It is a war.

Amie: I'm a military kid, all right? Unfortunately, it's in the DNA. Our white blood cells engage in chemical warfare. So many of the approaches that our immune cells or your immune soldiers take is by spewing out really toxic chemicals to kill off the bad guys: the virus, the bacteria, the fungi, whatever it is, the parasite, the protozoa. Unfortunately, those chemicals can actually destroy the white blood cell as well.

Now, here's where it gets really interesting. So, as human beings, we produce oil in our skin. This hydrolipid film is a chemical barrier for us to protect us against environmental stressors. White blood cells actually secrete vitamin C across their cell membranes to do exactly that. As it's spewing out all of these chemicals to kill off pathogens, it doesn't destroy itself in the process, which is why white blood cells actually concentrate vitamin C at least 80 times more than you find in the bloodstream. Now, if you're actually fighting something off, we can see that go up to 150 times the concentration of what you find in the blood. So they are so hungry for vitamin C.

Now, if you're well and you're not fighting anything, you don't need a lot and you can probably get it from your diet if you eat well. But, if you're battling something, you need to put a lot more in as a therapeutic intervention in order to have your white blood cells be able to do their job without blowing up in the process. That's how vitamin C is so crucial.

Now, Helene's asked about dosage. Again, this is really something that needs to be determined by your practitioner because there are a few people who can't manage high doses of vitamin C. It also depends on your gastrointestinal health. It also depends on the form of vitamin C. But generally a safe dosage for health maintenance would be between 1,000 and 2,000 milligrams a day. And I find my clients, if they're fighting off a cold or a flu, can take 5,000 to 10,000 milligrams in a day without it affecting their bowel function, really showing that their immune system is sucking that up. 

The key I think though is to use a pH buffered vitamin C so something that's pH neutral. Ascorbic acid on its own is very acidic and will give you heartburn and potentially inflame your digestive tract. If you are taking doses above 1 to 2 grams, as in you're fighting something off, you have to do it in divided doses throughout the day. Did you want to add anything else to that?

Andrew: That divided doses. I find we always like convenience and it's to our detriment on so many occasions but particularly the intake of nutrients, including vitamin C but also things like magnesium, where we really need to look at the adverse event that's going to happen from a massive dose of that nutrient. We know well vitamin C and magnesium. And if we would only just take them in smaller divided doses, you just don't have that issue. Now, I get there's the vitamin C flush. I understand that's a challenge. What's really interesting to me is just how much people can often tolerate when they are in the midst of an infection versus when they're not in that infection. It's quite interesting.

Amie: Yes. Well, so just for everyone listening, I shared earlier a link to a podcast that you and I did about how sugar disables the immune system. So anyone wanting to dive into that research and understand how it works, you're welcome to scroll back up at the end and grab that link or you can find that on FX Medicine on the podcast. I've literally just shared a link though on the vitamin C flush so you can understand how that's done.

And, Adam, thank you for your comment. Adam shared a message in the chat saying you can test your threshold, which is exactly what the vitamin C flush does. It allows you to saturate your tissues and identify at what point you reach tissue saturation, and then you can obviously...there's a titrated down sort of post-flush dosing that you can follow. I actually do the vitamin C flush at the beginning of every winter, myself, and it is something that I do often recommend where it's appropriate for clients who are battling a virus or infection of any sort as well.

What's interesting is an old tutor of mine got SARS back early 2000s, a bird flu, whatever it was.

Andrew: Oh yeah, H1N1.

Amie: Please do not try this at home, anybody. I swear on everything, you're going to be in trouble if you do. But I want to share this anecdote just as an illustration of how incredibly intelligent the body is. So in times of good health, you can probably tolerate 5 to 10 grams of vitamin C before it gives you diarrhoea. Especially if you take it in divided doses, your body continues to suck that up. In fact, scientists estimated we would have produced around 10,000 to 15,000 milligrams a day anyway when we used to have that ability. 

However, when people are unwell, you can take a lot more and your body just sucks up like a sponge. This person was able to tolerate 180,000 milligrams in a 24-hour period with no loss of bowel tolerance.

Andrew: Is that oral?

Amie: Oral.

Andrew: I have to achieve that. No, don't do this at home.

Amie: Do not try this at home. You will pass your pancreas in the toilet, okay? But this guy was very sick and his body was able just to suck it up at an extreme rate. Now, that’s the only time I've ever heard of that, so I would stick to doing a vitamin C flush or your practitioner's recommendations. However, Jane has just asked about liposomal vitamin C for COVID, and I just want to say that especially if you've got gastrointestinal issues, liposomal C could be a really good choice for you, because it's absorbed through the mucosa in the mouth. You can't do a vitamin C flush with it. You can't assess your tissue saturation with that, but it is a very effective way of getting vitamin C into your system and also allow it to stay in your cells a lot longer. That's another option, absolutely.

Andrew: Just a little point on that, though. There is no data on which form of vitamin C for COVID. 

Amie: No, no.

Andrew: There is no data on any vitamin C for COVID-19 so please put this in the context of generality. Please don't think this is a specific treatment. That is really not a responsible track to take. There's also the point of intravenous vitamin C. I've got to say, if somebody's really sick, I'm a fan of referring them to a GP who does intravenous vitamins. And not just vitamin C but also accessory nutrients: vitamin B groups and zinc and possibly magnesium as well.

I think this is a key in this pro-antioxidant argument. They say that orally it's an antioxidant and, if you give it intravenously, it's a pro-oxidant. We've got to get away from this thinking. The body has elegant feedback mechanisms and control mechanisms, if we would only support them. If you want to give extremely high doses of one single nutrient whether that's oral or IV, I think you're going to go down a really dark road. 

If we think about the redox companions of all of these things, we need to really think about history as well. We used to use the oxidised form of CoQ10. Why? It was the only one available. Did it work? Yep. Is there research? Absolutely. But now we've got the reduced form.

Amie: The ideal form, yeah.

Andrew: I take this point, but that's also within the cell. If you take a pill of the reduced form orally, what happens to it going through the liver, absorption. The lacteals absorb it into the circulation, and finally to the cell. So there's always this progression of what happens to that nutrient from having it in a pill, putting it in your mouth, and getting into the tip of your finger or your lungs. So I guess the point I'm making is, don't rely on any one vitamin to be a hero. It won't work.

Amie: No, no. It's a useful tool but, if you have failed to give your body the other nutrients that it requires for immune function, it's really not going to have a huge impact. Although having said that, there are three clinical trials using IV vitamin C over in China. One is using 6 to 12 grams a day. One is using 12 to 24. These aren't particularly high doses although they're at the upper end obviously, for infection. Reports are saying that, as the vitamin C is entering the blood vessels, the actual respiratory distress is lessening in real-time. It is a great intervention, but we can't overlook all the other nutrients that your immune system needs as well. We probably should talk about them, too, huh?

Andrew: Just a point that you refreshed in my mind, and that was the work done by Paul Marik with intravenous vitamin C with sepsis. Never use just vitamin C. It was always vitamin C, B1, and corticosteroids. There was also a trial done at Monash University in Australia, and it was negative. Failed. Look at the dose that was used. Too high, not soon enough, and not frequent enough. I think it's really interesting. We've got to look at the actual trial. I'd love to speak to Paul Marik about this. He was using it for sepsis, not infections, but you've got infections by that stage. We're talking about organ shutdown. But it's really interesting, isn't it? Lower dose more frequently is better.

Sorry, Amie. You were going to...what other nutrients we're going to speak about? Vitamin D, we brought up that.

Amie: Vitamin D. We can see a huge difference in the way this is playing out in the Southern Hemisphere versus the Northern Hemisphere. One of the most obvious elements of that of course is season and that, in the Northern Hemisphere, their vitamin D levels are the lowest they'll ever be. They're horribly low over winter. In Australia, even though we're quite a sunny country, even in summer, 25% of Australians are deficient. In winter, 75% are deficient in vitamin D. That's actually by the current standard definition of vitamin D deficiency, which I actually consider to be medically negligent.

Andrew: Too low.

Amie: Yeah. So 50 nanomoles per litre...

Andrew: Fifty is too low.

Amie: ...is basically the threshold. If you were to see your doctor, if they're not trained in nutritional medicine or functional medicine, if you were 51, or 55, or 49, 50, they'll be like, "Oh, you're all right," when you're definitely not. Because we know that, if your levels fall below 75, you are twice as likely to get a respiratory tract infection than if they're above 75. If they're below 50, you are three times at risk. And so looking at Professor Michael Holick's work, anything less than 85 is heading towards the danger zone. According to his research, we want to finish summer at 125, 150 in order to get through winter appropriately.

Now, the reason it's so important for immunity, most people know vitamin D is good for your bones. It puts calcium into your bones. In actual fact, vitamin D does a bazillion other things, regulating genes and all sorts of stuff. But our body uses it to produce antimicrobial peptides. They're called AMPs for short. We've got two halves of the immune system. You've got the innate immune system which is non-specific. It's a bit of a bush bashing part of your army, if you like. They're not very sophisticated...

Andrew: The berserkers.

Amie: ...and aggressive, yeah. And then you've got the adaptive part of the immune system which come in with...they're the second responders. They're a bit more sophisticated and specific. Now, AMP is a part of the innate immune system, so they're not specific against viruses. Although what we do know is looking specifically at the lungs and respiratory tract infections. Our lungs produce a compound called cathelicidin LL-37, and it's an antiviral compound that is specific against influenza A, several other strains of influenza, and respiratory tract viruses in general.

Now, if you have sufficient vitamin D in your body, your immune system at the lining of the lungs where the virus might show up can instantly produce its own antiviral compounds. Knowing that even by that definition of 50 nanomoles per litre or less, three-quarters of our population in winter are low. It's probably similar for the Western countries up in the Northern Hemisphere. We are just wandering into battle unarmed. 

For you and I… I work indoors, I'm also studying and so I'm kind of trapped inside 6 or 7 days a week. Even though I'm not sun-shy and I'm not sun-sensitive, I struggle to manufacture enough vitamin D in summer to get through wintertime. This is a problem for most people. We have full-time jobs or full-time activities, and this is one of the most significant things we can do for ourselves in the winter, or even right now to support our immune system.

Andrew: Yeah, and of course we get vitamin D for free from the sun. I think it's really interesting though when we talk about the UVB rays from the sun, the first message that we need to get across people is how do we make vitamin D. And you only make it when the sun is overhead…

Amie: That’s right.

Andrew: …between the hours of 10 to maximum. In winter, we're reducing that range because of course, the sun is lower in the sky.

Amie: In fact, sometimes you can make none.

Andrew: That's exactly right. Indeed, the next thing that you need in your skin to make vitamin D or pre-vitamin D from 7-dehydrocholesterol is heat. If it's cold, even if it's light, you're not going to be making much vitamin D. The message is you need to be making sure that you have enough vitamin D early on in the piece, to see you through the winter lull.

Amie: Yes, yes. Totally. I'm mindful. We've only got 10 minutes left.

Andrew: Whoa.

Amie: I know.

Andrew: We can talk.

Amie: I think we're going to have to do a second one to talk about herbs but I also want to be able to cover off vitamin A, zinc, and selenium before we let people go.

Andrew: For vitamin D, the research was showing smaller, more regular doses were better than lump doses.

Amie: Yes, it is. Yes, you're right. Absolutely right. It seems to be better utilised by the immune system given that...

Andrew: And it's for free.

Amie: Yeah, and the sun is for free, and it has a lot of other benefits as well. So let's talk about zinc and vitamin A. They do a couple of things together that are really important as a pair, as well as having their own individual benefits. So they are immune “besties” when it comes to epithelial health. The epithelium is not just the lining of your lungs, nose, and throat but also the lining of your gut, bladder, genitourinary tract in general, and your skin actually. 

They work together to maintain the integrity of that tissue and the health of that tissue. And so, if you're low on either one of those, your skin health isn't that good, your skin's immune system isn't that good, and the same applies for your gut and of course your lungs and your respiratory tract tissue.

Diving in more specifically to what they do individually, vitamin A is key to be able to produce antibodies. Now, a lot of people use the word antibodies but don't really understand what it means. Now, antibodies relate to the adaptive immune system or the more sophisticated second responders. What it means your immune system has been presented this pathogen, has kind of made a bit of a 3D copy of it, and also matched whatever chemical your body needs to produce to destroy it. Meaning that next time the bad guy shows up, they're all over it. They know exactly how to shut that down much more quickly, so quickly sometimes you don't even know you've been exposed or at least your immune response is nowhere near as full-on as the first time you got sick with it.

Now, in order for that to happen, in a way that you have a sufficient antibody response and an effective antibody response, you need sufficient levels of vitamin A, which you can only get from animal foods. Now, in times of good health, again we can take pre-vitamin A in the form of carotenoids, fruits, and vegetables. But the conversion of beta-carotene into vitamin A is very low because of course vitamin A can be toxic if you're not using it up. 

So in terms of an acute immune response, it's usually something we need to supplement with. It's particularly something you want to look out for for anyone who's vegetarian or vegan who are relying on beta-carotene foods to provide that precursor, not perhaps realising that their immune system may not be able to produce enough retinol in times of defence, when the defence requires it.

If someone's low in vitamin A, we see their antibody response start to fail. If they're low in vitamin A, we also see the number of natural killer cells go down. We see cytolytic activity go down, meaning your soldiers are not as good at killing off the bad guys as they normally are. We also see greater epithelial damage. And I want to make a point about that because we know, with this current virus, we're seeing bilateral interstitial pneumonia. We're also seeing extreme inflammation in the tissue of the lungs as well as coagulopathies and other things. But we know that vitamin A is really important along with zinc to preserve the epithelial tissue. It helps to repair it quicker, but also limits the damage that's done when you inhale a pathogen that impacts that tissue.

Of course, there are upper limit considerations particularly for women of child-bearing age, people with liver challenges, anyone who's been on Roaccutane. This is something you want to be advised a dosage on through your own functional medicine practitioner, but it is absolutely crucial part of the immune toolkit alongside zinc. Before I dive into zinc, did you want to share anything else on vitamin A or are you happy for me just to carry on?

Andrew: Just very quickly, the para.… Many people, many practitioners included, are paranoid about vitamin A, including I was. It's really bad syntax. I was, too. So, one of the other points about vitamin A is the International Vitamin A working group with the World Health Organization. If anybody's interested in that work, they can look that up, the IVACG group. It states that it is safe for a pregnant woman to take as much as...jeepers, I can't remember the IU now. Anyway, it was higher than the supposed safe level, and that was including supplementation. Anyway, look up the IVACG working group.

The other thing is vitamin A is used for making neurotransmitters as well. Isn't that interesting about the stress response and things like that?

Amie: Yeah, totally. Zinc, by the way, is required to deliver vitamin A around the body. If you're low in zinc, vitamin A gets stuck in the liver and of course, can cause liver damage as a result. So zinc is required to produce retinol-binding protein and that is the transporter that delivers vitamin A everywhere else you need it. 

But, in addition to that, zinc has direct antiviral properties. It is really important for normal development and function of both B cells, T cells, neutrophils, macrophages. In fact, the innate and the adaptive immune system require it to function properly.

Of course, it's important for mucus membranes, for epithelial tissue health, but what we know is zinc deficiency actually decreases our ability to mount an immune response particularly to viruses. We have reduced thymulin, reduced enzyme and transcription factor activation. We know that lower zinc levels increase your susceptibility to infection. And by the way, zinc is depleted rapidly when you're stressed and everyone is really worried about what's going on. Not just getting sick, but there are of course lots of other things that are coming along with our response and guidelines to what's happening, and that is going to be further weakening people's immune response.

Andrew: You can look up the prevalence of zinc deficiency in the Australian diet by looking up on FSANZ, the Food Standards Australia New Zealand. It goes through various age groups and their deficiency of intake. We've got an extremely old continent. Of course, there's no zinc in the soil so of course there's no zinc in the food. 

Amie: Yeah.

Andrew: It’s interesting how so many people, orthodox practitioners will say, "If you eat a good balanced diet, you don't need vitamin supplements, da, da, da." "If you..." One is, who does? The second one is, look at the stats.

Amie: Well, also we're talking about using them therapeutically here, as opposed to just maintaining the RDA or the status quo when your health is good. There's a big difference there, and a fundamental gap in some areas of education. 

The last thing I'll say about zinc is that it blocks RNA polymerase, which is the enzyme that allows viruses to replicate and spread throughout your body, and it's interesting that one of the medications that they are currently using is a zinc ionophore which increases the zinc uptake into the cell. Now, I'm not saying that's its only mechanism of action, but we know that zinc has an antiviral effect once it's inside the cell. By boosting that, it can have obviously an increased result. So, zinc is pretty key.

The last nutrient I'll touch on is selenium. Now, selenium is probably...again, you know, we could talk about any one of these nutrients for an hour and still not have a complete conversation. So I'm going to keep it quite brief because we've got just a couple of minutes left. But, two things. 

Obviously selenium-dependent enzymes are used to produce glutathione and glutathione is a key nutrient. I can see someone asked about that earlier. We won't be touching on that today but we can cover that in the next episode. And so in terms of antioxidant defences to help preserve and protect the immune system, it's crucial but here's actually the ultimate important thing that selenium is...I think we need to be really mindful of our intake.

Viruses mutate rapidly in selenium-deficient hosts. What that means is human beings that are low in selenium are wonderful incubators to allow viruses to mutate into new stronger evolved versions of themselves. China is completely devoid of selenium in their soils, and Australia and New Zealand are also mostly selenium-deficient soils. We're not either taking a supplement to maintain the RDA or we're actively eating three Brazil nuts a day or other selenium-rich foods, we are actually part of the problem, to be honest. We are providing an environment...I mean obviously sugar, vitamin C, zinc, and all that other stuff but we're providing an environment that allows a virus to mutate rapidly.

We now know, well, as of three weeks ago, there were eight different strains of SARS-CoV-2 going around. In a week or two, I'm sure there's going to be more. That is a natural process but it is accelerated when a virus infects a human being who doesn't have sufficient selenium levels. And so I think, as much as all of the other things we're doing for each other, staying home, wearing masks, washing our hands, this is another thing that we can turn our attention to that will support humankind as far as getting out of this quicker goes.

Andrew: Before we wrap up and just to handle everybody's questions, Amie, we cannot do justice if we don't cover really quickly, the not just antioxidant ability but the mucolytic ability of things like NAC. 

Amie: Yeah.

Andrew: The other key thing that I'd just like to say a few words on, what about the mucolytic effect and anti-inflammatory effect of things like proteolytic enzymes?

Amie: Okay. So, with regards to any respiratory tract infection actually, we have mucus produced. The mucus is a result and has properties...there are numerous, but one of them is to try and wash away the incoming pathogen. But of course, that clogs up our airways and makes it difficult to breathe. 

In the case of COVID-19, we're seeing massive mucus plugs in the lungs. So anything that supports the fluidity of the mucus and reduces the risk of sticky, thick mucus is, of course, worth considering. I stocked up on NAC and already have proteolytic enzymes in the cupboard for that very reason because they are both very powerful as far as the mucolytic properties go, especially NAC or N-acetyl cysteine.

For that reason, it's something you want to be very cautious using ongoingly. However, it's something that you should have in your natural medicine cupboard for cold and flu anyway, because it helps to clear the airways more effectively and it's absolutely something I think is worthwhile having especially right now.

Andrew: Yeah. I think included in the proteolytic enzyme activity is dampening inflammation which is key to any chronic respiratory infection. 

So Amie, I think we're done. I mean, as you said, there are so many intricacies of this. We haven't gone into the dosage per day, per month of vitamin D for instance. Go 5,000.

Amie: That's well, that’s what I take. In winter, I go 5,000 to 10,000.

Andrew: There's no data in there for less than 10,000 IU showing toxicity unless there's sarcoidosis or something, that’s Reinhold Vieth. 

But I'd like to thank you so much for taking us through what you have done today. 

Amie: Pleasure.

Andrew: I know that you've got a personal expertise in this because, as you say, you have a health condition which you manage and so you really are clued up on the issues of immunity. I thank you so much for taking us through and sharing your expertise tonight on FX Medicine.

Amie: Thank you so much, Andrew. It was a real pleasure. It's very nice, I think, to be able to share with people practical, and effective, and safe extra strategies to support themselves. And obviously everything we've said here today applies to your regular wintertime lurgies as well. I sure hope everyone got something out of it for themselves, and we look forward to seeing you on the next one to talk about the herbs, hey?

Andrew: All right. Can I just ask before we go? Is there any more questions that we have to address?

Amie: Let me scroll up. Most people are still here, so I will just have a look and see if there's anything else we can answer for people as it relates to these nutrients. Couple of comments on vitamin A levels. Helene asked, as far as NAC goes, powder or tablets? I have powder because that way you can up and down the dose for all family members. But if you want to take it in a tablet or capsule form, it doesn't impact its efficacy in any way. It just limits your ability to adjust the dosage. The enzyme name...oh, sorry. What were you going to say?

Andrew: Sorry, I was just going to say there was this brilliant one from Germany that I once saw, and the only problem of course with the German nutrients that you get, they're really great, and then you see that they've got acesulfame in them.

Amie: Ah.

Andrew: Why didn't you put stevia?

Amie: There are some good ones available in Australia, actually. I ordered some from Melbourne. And then the proteolytic enzymes. So there are lots of different enzymes that have proteolytic activity, and you can often find them in digestive enzyme formulas as well. They will usually have something that ends in “-ase.” So, -ase indicates that it's an enzyme and it will usually say “protease" or “proteases,” but papain from papaya and bromelain from pineapple are also proteolytic enzymes. You can often find those in a supplement form in combination with other proteases or just on their own. Any last questions?

Andrew: Can I just cover? If anybody wants further information of course on any of these nutrients, if you want any of the trials that have been mentioned or some of the research articles, please contact us at [email protected]. Drop us a line also on our social media platforms.

One last thing I did want to just cover, and I know we're going overboard but maybe we can cover what herbs are of specific use. Indeed where we have to be a little bit cautious of using too much of certain herbs. What do you think?

Amie: Look, I'd love to but that's going to be another 60 minutes. 

Andrew: Yeah, 60 minutes.

Amie: I’m noticing everyone saying they loved it and they want to do another one.

Andrew: Great, let's do the herbs next time.

Amie: I'll invite people to join us again. There's been lots of other great questions. People have talked about the gut microbiome, omega-3s. Yes, they're all things that we couldn't talk about today. Someone else has also mentioned zinc and the way that it might interfere with other minerals being absorbed. This is again another reason why you need to see your practitioner who is trained in nutritional medicine because there are a lot of nuances.

Andrew: Absolutely.

Amie: Having said that in the context of an acute infection, let's say I came down with a really bad cold, I would dial up my zinc amongst the other things to a therapeutic level for 1 to 2 weeks. Now that's not going to have a major impact on, say, my iron levels overtime. But certainly, if you're taking low dose throughout the winter months, which I also do, then the timing and the nature of those minerals all needs to be covered for sure.

So, yes, let's do another one on herbs. We'll send the invitation out and I also noticed, for anyone who we missed in the chat, we will send out the show notes with the replay and include all of the links and evidence that we touched on today, so you can actually go and have a look at the studies, look at the sources, and get a deeper understanding of why we've talked about what we have today.

Andrew: In the meantime, we're going to try and out-ninja nature. Thank you, Amie, for joining us.

Amie: Good luck with that. See you, everyone.

Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.




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