With the start of the winter season and an abundance of viruses circulating in offices, schools and childcare, revisiting our incredibly informative podcast on immunity is timely.
Professor Lesley Braun facilitates a conversation with our four ambassadors, Dr. Adrian Lopresti, Dr. Damian Kristoff, Emma Sutherland and Dr. Michelle Woolhouse, all from different modalities and perspectives looking at immunity.
Key foundational concepts such as holism and interconnectedness, self care and the importance of convalescence are covered as is a deep dive into key herbs and nutrients to support the immune system.
We hope this helps support you and your patients negotiate this winter season, the seriously cold weather, and arms you with some practical prescribing perspectives.
COVERED IN THIS EPISODE
[00:38] Dr. Lesley Braun welcomes the FX Medicine ambassadors
[01:36] Holistic healthcare and naturopathic principles and immunity
[05:55] The bidirectional relationship between stress and immunity
[09:20] Nutrition, absorption and immunity
[12:23] Lesley discusses her research into mechanisms behind the key nutrients and their roles in various aspects of immunity
[14:13] Zinc
[19:21] Vitamin C
[23:24] Vitamin D
[30:13] Andrographis
[32:27] Echinacea
[34:26] Pelargonium
[36:10] Physical activity and stimulating the parasympathetic nervous system
[42:33] Sleep, restoration and recovery
[49:51] The forgotten art of convalescence
[57:22] Ambassadors tips on boosting immunity
[01:06:07] Thanking the ambassadors and final remarks
CLINICAL PEARLS
- Stress has a huge impact on the body’s homeostatic functions and can be both beneficial and detrimental to our health and in particular, our immune health.
- When supporting our immune health, it is important to look at the body as a whole and to treat the person through both diet, lifestyle and psychological measures.
- The key nutrients and minerals to support the immune system are vitamin D, vitamin C, zinc and quercetin.
- Many people present with deficiencies in both vitamin D and C and may require increased levels of vitamin C and quercetin to replenish greater demands due to stress and infection.
- Quercetin works synergistically with zinc to support its absorption inside the cells.
- People that suffer from recurrent infections (sinusitis, recurrent tonsillitis, recurrent otitis media, recurrent coughs and colds) tend to have a deficiency of zinc as it is required to sustain an immune response and is not stored.
- Clients who are iron deficient are likely to be deficient in zinc also.
- Zinc helps to convert beta carotene to vitamin A
- In acute infections, we can use up to 8g of divided doses of vitamin C in a day. Vitamin C has a half life of 6 hours and is best taken regularly in smaller doses throughout the day rather than one large dose.
- Pelargonium interferes with the viral replication of influenza A.
RESOURCES DISCUSSED IN THIS EPISODE
EXPANDED SHOW NOTES: Further Reading and Resources
[PODCAST] The Emerging Importance of Psychoneuroimmunology: Dr Michelle Woolhouse and Professor Craig Hassed
[INFOGRAPHIC] Acute Immunity: Fighting the common cold
[INFOGRAPHIC] Influenza: Acute immune strategies
[ARTICLE] Female reproductive hormones and immunity
[ARTICLE] The bi-directional relationship between immunity and stress
[ARTICLE] Immunity mechanisms of vitamin C and zinc in children
[ARTICLE] Clinically trialled probiotic-vitamin C combination supports child immune health
[RESEARCH] Post-infectious role of zinc and vitamin C in SARS-CoV-2
[ARTICLE] Astragalus: Targets immunity in multiple ways
[ARTICLE] Quercetin and vitamin A: forgotten players in childhood immunity
[ARTICLE] Key herbal medicines for supporting immunity
[ARTICLE] The contradiction of social distancing (Winter FX Medicine Magazine 2021)
Lesley: This is FX Medicine, bringing you the latest in evidence-based integrative, functional and complementary medicine. I'm Professor Lesley Braun, director of Blackmores Institute and editor-in-chief of FX Medicine. The team at FX recognise the importance of having a timely conversation on immunity and the unique opportunity we have to discuss this from different modality perspectives as we've got four fantastic ambassadors; Adrian is our psychologist and his perspective’s on the bidirectional relationship between stress and immunity, Damian is a chiropractor and naturopath and his perspective’s on the role of the spine, movement, and physicality in relation to immunity, Emma bringing in important naturopathic understandings of immunity and herbal medicines, and Michelle bringing in perspectives from an integrative GP approach, and what drives impaired immune resistance, and what are those key nutrients that she goes to.
Before we deep-dive into some key herbs and nutrients for immune support, let's get back to basics and consider the importance of key foundational concepts such as holistic healthcare, interconnectedness, and the naturopathic principles when it comes to immunity.
So, first, I want to talk to Damian. Can you talk us through your thoughts on naturopathic principles and the general role of diet and lifestyle as those foundational elements, and how we also might need to give the body just a bit of a nudge during times of acute illness or significant challenge?
Damian: Thanks, Lesley. It's such a massive topic, and I'm so grateful to be able to talk on the philosophy of what it is that we're trying to do because really, at the end of the day, the foundational elements and the foundational principles of what it is that we actually do are underpinned by this philosophy: how do we approach the human body? And I will draw upon two different philosophies here that dovetail in.
So a naturopathic philosophy of "nature cures,” which I think is so important to remember that we're dealing with nature and the body, and they're not mutually exclusive. They work together all of the time, forever and a day. So that's really important. And the second philosophy that I love to dovetail into that is the chiropractic philosophy which is that “in every single body, there is an innate intelligence that gives to an organisation the ability to heal and to grow and to thrive.” And there's this energy system or organisation system that's always striving to repair and maintain homeostasis and balance.
And I think it's really important that we consider that the foundational things that we can do to improve our health and well-being, with this particular topic, immunity, all revolve around the things we put into our body, whether it be food, whether it be substances, whether it be information, the things that we see and the things that we surround ourselves with. So it's important to consider that we might want to move on a daily basis, regularly. We want to eat really healthy food. We want to drink nice, clean water. We want to be thinking clean thoughts, and we want to be surrounding ourselves with positive, let's say, vibes or positive emotions, positive people to keep us going and keeping us upbeat.
Lesley: Yeah. Thanks, Damian. It is all interconnected. Absolutely. There's no one silver bullet here which is actually what I want to talk to Michelle about because, as an integrative GP, I know you've got a really strong connection with the whole person philosophy and how it all fits together, which I think is unusual for a GP because I think a lot of people see medicine as very reductionist, which I think is completely the opposite way to how you look at things. So, can you talk us through that in relation to immunity?
Michelle: Yeah, absolutely. I mean, I find immunity such a fascinating topic for discovering holism and what whole person care is all about because really I say the immune system is almost like the roving security system that goes around the body. And what's so fascinating about it is it's so bidirectional with the cells of the immune system, and how it interrelates to the gut, and how it interrelates to the brain, and how it interrelates to every single cell of the body.
And what's beautiful about whole-person care is that, when we break it down to various different parts and we look at improving all of these different parts, the beauty, when you build it back up again, is that the whole is greater than the sum of its parts. And that's really important to understand as we're working towards better immunity, is that there's such a profound kind of leap towards wellbeing once we start having a more positive effect towards whole-person care.
And what I see sometimes in my patient load, because of the marketing and I guess the influences that we have in modern-day culture, is that people seem to reduce down things, thinking that the gut health is more important than sleep, diet is more important than exercise. And so looking at whole-person care, we're bringing everything into this soup and really giving it equal positioning so that we can work together to get a real sense of whole-person care.
Lesley: I love that idea of putting everything into the soup. It's kind of like making a big, healthy minestrone soup or something, isn't it?
Michelle: Pie. That’s right. Yeah, everything goes in.
Lesley: Yeah, yeah. And, look, I also really liked the fact that you said there's no one thing that really dominates, which is why I actually wanted to ask, Adrian, your view from a psychologist's perspective, because occasionally I hear about people that say, “All you need to do is think positive. Just have positive people around you.” I don't think it's that simple. Can you tell us your view on how stress fits into the picture particularly in relation to immunity?
Adrian: Yeah, I mean, Lesley, I think if it was as simple as positive thinking, that would be great. We’d just come up with some affirmations that we could say every day and we'd all be healed, but unfortunately, that's definitely not the case. And certainly, we know that there's a significant bidirectional relationship between stress and immunity.
And when I talk about stress, I'm really referring to a person's physical or emotional response to demands or pressures of daily life. So it can be related to environmental or social stressors, but also it can be related to physical stressors that might then trigger our stress response in the body.
And what the research shows around stress is that, it really depends. Different types of stresses have different effects on the body and different immune enhancing or immune depleting effects on the body. So, stress can be acute. It can be chronic. It can be episodic. And the severity varies over time.
And while acute stress can actually...some of the research shows that acute mild stress can enhance your immune system. It's that chronic stress that often goes on that can have a suppressive effect on our immune system, might actually have a pro-inflammatory effect on the body. And that's something that we really need to consider when we think about stress and its effect on the body.
Lesley: I think it's a really important point because I know there's a whole strain called psychoneuropharmacology, which is really looking at the role of the brain and perception of stress and what it does in the body as well as how you can nudge that into different directions. And I also really liked the thinking that you had around chronic stress because I think a lot of people don't realise, and particularly as we've been going through lockdown after lockdown, there's burnout. There's long-term stress people are dealing with, which probably has this impact that people aren't recognising enough on their ability to mount a great response to whatever challenge is around them, including infections.
Adrian: Absolutely. What's interesting with the research is that the type of stress really does make a big difference. And even how we perceive the stress can have a big influence on us too. So if we have what we call a “locus of control,” we have an internal locus of control. If we believe that we can control the stress, there are things that we can do to manage the stress, it's not so damaging on our health. But if we have an external locus of control, meaning that we can't control it, the situation has got to do with external environment and therefore we're helpless in managing it, then that really has significant ramifications on our mental and physical health.
Lesley: Yeah, so I think there's a lot of people feeling that way at the moment. I know there's somebody who I was hoping to see in Sydney within the next few weeks who's living in Perth, and we're kind of joking that we don't know when we're going to see each other. And I can only imagine for so many people around the country how difficult it is to make plans, and these things are out of your control. And, yeah, it just complicates everything.
Emma, you've got a great saying and it is, “You can't prescribe your way out of a bad diet.” I love that. So what's our naturopathic understanding of the importance of food and nutrition when it comes to the immune system and when you're under fire and you've got to really make sure you're bulletproof?
Emma: Yeah, thanks so much, Lesley. Your immune system, it doesn't act in a silo. It's closely aligned with many body systems as Michelle mentioned, but particularly the digestive system. We know that over 70% of immune cells reside within the gut. And immune cells have increased requirements for nutrients like zinc, and vitamin D, vitamin C, but this relies on an individual to not only consume a nutrient-rich diet, but most importantly, to be able to extract the vitamins and the minerals and phytochemicals found in their food.
And so many drivers can impact the absorption of nutrients, factors such as stress, enzyme levels, inflammation, dysbiosis. And from that naturopathic perspective, working on those underlying factors is crucial for immune health. And as I say to so many of my patients, you really can't supplement your way out of a bad diet. And a wholefood, nutrient-dense diet in combination with optimal absorption is one of the best defences that we have to preventing and, I think, to minimising viral infections.
Lesley: Yeah, it's so important. You know, one of the vitamins you mentioned is vitamin C, a particular favourite of mine. And a lot of people don't realise that you can lose 100% of the vitamin C content of your food by the way you cook it, because vitamin C is so sensitive to light and to heat. And I know when I was in practice and people used to tell me, “I had lots of veggies,” and I said, “Well, how did you prepare them?” “I boiled them up in a huge soup." “Well, I don't know how much vitamin C was left in there.” So I think that also just understanding how to prepare food is so important.
Emma: Yeah, and it's the quality of the food, it's how you prepare it. The intention is the energetics of what is going on when you're preparing that food. Are you eating that food in a state of stress or are you calm and relaxed? There really is a multitude of factors. But if we think of it a bit like a spider's web and if we just start to make small tweaks from various different angles, the synergy of that can make a huge impact on that nutritional template.
Lesley: I thought it was really interesting when you said, also, eating when you're stressed or when you're relaxed because we know fight, flight, and fright or freeze, that we're just not getting the blood supply to the gut when we are stressed. And so therefore our imaginary absorption's not going to be as good either.
Emma: Yeah. I mean, I have many patients come to me and they might be eating a purely organic diet and doing all the right things on paper. But then when we dig down it's the absorption factor that is the missing link. So, it's very important to look at that.
Lesley: Yeah. Like all of you, I've been asked by a lot of people, what should I be taking right now? And what's the best things I should be looking at? So, I have been doing a bit of desktop research through all the medical databases and trying to be really systematic about it. And so I've been doing some research into the mechanisms behind the key nutrients and their roles in various aspects of immunity, especially obviously in relation to respiratory viral conditions. And ultimately what I was trying to find was the ideal nutritional components that had multiple mechanisms of action and could also work synergistically and were really safe.
So when you think about it, the ideal component should be able to display a bunch of different mechanisms. And ideally, the first one would be to strengthen our first line of defence, so the natural barriers of the nose and throat lined by epithelial cells, making sure it's nice and strong. Moderating our immune response, when a virus does enter into the body, that it has a direct antiviral activity of relevance. That it moderates inflammatory responses, and ideally it also reduces the tissue damage, which is caused by excessive free radicals, which tend to form through the whole immune response.
And then I was thinking about, “Okay, what about the role of diet? And are there just a bunch of nutrients that we know most people are suboptimal because either they're not getting it through their diet or they're cooking it up to the point where there's nothing much left, or for other reasons?”
So after quite a few hours of research, I uncovered four absolute heroes that meet nearly all of these criteria. And no surprises to anyone, they were vitamin C, of course, vitamin D, zinc, and quercetin. And quercetin might be a new one for some people.
Michelle, you and I talked about these before, and I know they were no surprise to you. Can you tell us a bit about them?
Michelle: Oh, absolutely. I mean, I'm going to start with my top favourite that has basically transformed my whole clinical practice, and that is zinc. And I'm equally a great fan with vitamin C, but we'll get to that in a second.
So zinc is just such an important coenzyme, and I noticed like... I was looking over the weekend at what the latest statistics are in terms of how many people have suboptimal zinc status. And, research came in at around 50%. I've seen women of child-rearing age, around that late teen, up until their 40s or so having up to around...76% of women at that age group having a deficiency in zinc. And I've seen it time and time again in clinical practice as well.
And also for those that suffer from recurrent infections. So often, people that have sinusitis issues or recurrent tonsillitis, recurrent otitis media, recurrent coughs and colds tend to have a deficiency of zinc because we require so much of it to sustain that immune response. And of course we don't store zinc in any particular way. So we do need a regular amount of zinc that's taken in.
And so as Emma said, if you're eating when you're stressed, and if you're not secreting enough acid in your stomach, it's very difficult to get that amount of zinc in because you require zinc to form hydrochloric acid and you require hydrochloric acid to absorb zinc. So we've got a vicious cycle there going even from that absorption perspective that Em was talking about before.
But zinc is a super coenzyme. So it is an antioxidant. It supports the epithelial lining to help protect against pathogens even entering into the body. It's antiviral in its own right. I remember, as I first studied nutritional medicine, looking up a well-known textbook back in my era, mentioning zinc being an excellent antiviral but is rarely used these days. As antibiotics came into fashion, zinc really fell from favour. And it's really, really important for protecting that free radical cytokine storm that we see, particularly for people that have quite significant illness and then when it reaches into a whole-body effect.
So zinc is definitely a favourite. And what I notice about zinc in terms of dosages is, like, we'll often look at...you know, I've got patients that are carrying excessive weight or, men that are big men, muscly men or men that are over 100, 150 kilos, whatever, we have to look at the amount of zinc per kilogram per day. And that's really important because I've found that sometimes I've had to supplement 100 to 150 milligrams of zinc for people that have been under chronic infections to almost get it up to a certain level. And that's really important to understand. And when you've got a level of zinc, just maintaining that level on a day-to-day basis is really important.
Zinc is really synergistic and works quite closely with vitamin C and quercetin in the body. So quercetin, which we'll talk a little bit more about, which is kind of, like, quite new to many of the listeners, is such a fantastic adjunct to use with zinc from an immune perspective because quercetin helps zinc to get inside the cells, which is where we kind of need it. So that's a really important factor as well.
Lesley: Zinc is also one of my absolute favourites. And, like you say, there's so much suboptimal nutrition when it comes to zinc. I remember reading that after iron deficiency, zinc deficiency was the number two most prevalent metal deficiency in the world, just everywhere.
Michelle: In clinical practice, I see it everywhere. And also if you're iron deficient, which we know is super prevalent, you are really likely to have a zinc deficiency as well. So, when you've got one deficiency, you need to start looking for other deficiencies. And I have to say, in Western medicine, we're not looking enough for zinc deficiency. And it's a really, really common problem. The other little thing that I love that... You can tell that I really love zinc.
Lesley: Me, too. We could talk all day.
Michelle: I'm going to get onto vitamin C, but I just have one more thing. One of the critical things, vitamin A is also probably, if we were going to list it, it'll be number five, but zinc actually helps to convert beta-carotene to vitamin A. And so when you're zinc deficient, even if you're having adequate levels of beta-carotene, which come from our yellow and orangey fruits and vegetables, you really need that level of zinc in order to convert it to vitamin A, which is also super important for immunity.
So, yeah, if I haven't impressed upon you the importance of zinc, but I want to also talk about vitamin C as well, which is almost like the immune powerhouse nutrient. I mean, there's not much that vitamin C doesn't do. It's just such a vital protector for the prophylaxis of infection but also in the treatment phases of viral infections as well. And I was fascinated to read some of the recent research on the utilisation of vitamin C in the ICU arena. And, you know, even some of the influences of using... They tested patients in the ICU and found that 50 odd per cent of them were deficient in vitamin C even if they were given intravenous nutrients.
Lesley: Wow.
Michelle: So utilising, I guess, the way we utilise vitamin C in chronic infections, or acute infections, or septicemia, or even chronic stress is really important to remember that we're using it up so much. So we're needing to replenish it so that we've got a storehouse of it so that we can use it to continue to fight infections and as immune protection.
Lesley: You know, Michelle, one of the things that we found in the hospital with vitamin C is a lot of people who are diabetic and not having a lot of fruit. And so they tended to be low on vitamin C. We also know people who smoke cigarettes, cigarette smokers, it increases their demand for vitamin C beyond what you get through your diet. And as you rightly say, vitamin C gets flushed through the body pretty quickly. So a lot of people think, “Oh, I'll take one big dose in the morning,” but you've actually got to take smaller doses throughout the day to really make sure you're protected with vitamin C for as much as possible.
Michelle: Absolutely. Its half-life is around six hours. And factors like quercetin or alpha-lipoic acid help to recycle vitamin C. So they're natural recyclers of vitamin C, which are useful as adjunctive nutrients to go alongside it. But, yeah, you're absolutely right. Vitamin C doesn't have a long half-life. We've got to get it regularly and often. And particularly in acute infections, even sipping on it all day is really useful.
On a practical level, looking at the... The more the body is under stress, the more the digestive system can absorb, which is great news. So in acute infections, we can use doses up to 8 grams a day. We've got to obviously watch for the gastrointestinal effects of that, the gurgling, the loose bowels, and all of that kind of other factors that many people are aware of. But when those requirements are up, in high fever states or acute infections, you will absorb a lot more vitamin C than you ordinarily would.
Lesley: Yeah, yeah. And I think also what you pointed out was that the immune cells draw on vitamin C stores. So you can imagine that when you're fighting an infection and your immune system's really mounting a strong response, it's going to be just gobbling up that vitamin C. So replenishing regularly is going to be important.
Michelle: Yeah, and I think this is a concept that's missing from Western medicine in many ways, the utilisation of nutrients under either a stress response, as Adrian mentioned, or acute infections, or... We recognised that we need more nutrients in things like pregnancy and lactation, but we don't actually recognise that we need more nutrients as a general rule in things like acute infections.
So, I think it's a really, really important factor to understand that the body needs it. It's mounting a defence, and it can be really helpful with managing the cytokine storm. It can mop up and help transform the inflammatory pathways at the end of the infection as well.
Lesley: Now vitamin D is quite different because we've got zinc, quercetin, vitamin C, they're all antioxidants as well as having a lot of effects that meet that criteria. Vitamin D is a bit different. Do you want to tell us about that and how it fits in?
Michelle: Well, it's a prohormone for one and we make it in terms of sun exposure. It's remarkable how common vitamin D is deficient. We've got people working indoors, I think also since the lockdowns and the pandemic, a lot more people not commuting and not even going out for lunch. And so we're getting a lot more inside time. And so we're seeing a lot of vitamin D deficiencies in clinical practice, which is quite incredible.
It supports both the innate and the endogenous immunity. So it inhabits the inflammatory cytokines, particularly interleukin 6 and interleukin 8 and 12, and it helps the regulatory function of the T cell. So it's really important for that innate immunity, and we can see quite a significant impact on immune and susceptibility of infections when we've got a deficiency in vitamin D. And so we have to really look out for that. So adequate sun exposure is obviously a key importance.
And I just wanted to mention to some of the clinicians that might be listening is that on the SunSmart app, if you put in your sun type, it will tell you how much sun exposure that you require to get the adequate levels of vitamin D. And so now there's some fantastic little apps that you can give to your patients that can help them to define how much vitamin D they need.
And I think also for a lot of the people that are of dark-skinned origin, even your Mediterranean, Asian, Indian, Sri Lankan, African, background, they are commonly, commonly deficient in this country of vitamin D. And we really have to look out for that issue, particularly in terms of their immunity if they're living in a colder climate where their skin, I guess, has not evolved to live in this type of indoor, clothes on, beanies on kind of environment.
Lesley: Yes. No, I understand. I've got a daughter. She's a redhead and she jokes she only needs to go out for two seconds and she's got her dose.
Michelle: That’s right, for sure.
Lesley: The other thing I've been reading about vitamin D is, in terms of supplementation, there's a few ways of doing it, and people who are suboptimal are going to get the best response to supplementation, but whether it's a daily dose or a high dose every now and again which... How do you use vitamin D? How do you prescribe it?
Michelle: Yeah, it’s a great question actually. I mean, I think it depends on the patient. Like, we know that we can give quite large doses because it does store within the body. So that's a great thing to know. We don't have to get a daily dose. So we've got a storage element within the body, which is really important. So you can give higher doses that might suit the patient.
I met quite some patients that just feel like they can't sustain even a twice daily dose. So sometimes we will give 50,000 international units once a week or even, larger amounts once a month. It depends on the patient. And so for nursing home patients or people that just don't have access or agency really, we can give larger doses infrequently to make sure they've got adequate storage of vitamin D.
But on a general rule, it's generally given as a twice-daily dose. I'll often suggest to take it with a meal with some level of healthy fat like an avocado, an egg, or some yoghurt just to help with the absorption of vitamin D. And you can access it through things like egg yolks, and salmon is quite high in vitamin D. So improving diet can sometimes be beneficial, too.
Lesley: A number of years ago, we did a study with cardiac surgery patients at one of the hospitals here in Melbourne, and we used 2,000 international units a day, so one capsule of a thousand in the morning and one at night. It took about six weeks to really move the dial. So it does take time. That's what I learnt from that study.
Michelle: I think it does take time, and often I can see it for even longer than that. It's taken 6 months, 12 months for some people. Perhaps maybe they've got a genetic deficiency that impacts their ability to convert vitamin D, or there might be some other factor going on. I also have suspicions in terms of diet quality. If people have got a very, I guess, diet that's very low in antioxidants, a very poor diet quality, they may be using up their vitamin D quite a lot. And so they'll often—this is just a clinical observation—tend to have a higher need for vitamin D. So I often keep that in mind as well. And obviously things like if they're having recurrent infections or utilisation of vitamin D to try and keep the body healthy is going to be another factor to look at as well.
Lesley: And I'm guessing you're tracking all of that with blood levels as well. So you can really titrate the dose for the individual.
Michelle: That's right. That's right. I mean, there's lots of I guess... We don't really know what the ideal dose is. Some people say it's over 50. Some people say it's over 75. Some people say it's over 100. And I think, interestingly, we used to say it was 75 and some labs are saying 50. And so we will often see things lower and lower and lower over time. Like, being in practice for 20 years, the blood levels tend to get, less and less.
Ferritin is another example, where we used to say over 50 or even over 80 was great, and now, in some labs, it's saying over 20 is adequate. So I've noticed over 20, 23 years of clinical practice, that is the case. So I like to aim for around 100. So that I absolutely know they've got adequate stores at times of infection going into the future so that I can really feel comfortable with the level of vitamin D from an immune perspective.
Lesley: And I think vitamin D is one of those really super safe ones anyway.
Michelle: Oh, super safe. Yeah. I think they had a clinical mistrial where they were giving 600,000 international units daily for months, and there was no ill effect. So, I'm not suggesting for one minute for people to do that, but the fact of the matter that they used really high doses as a mistake, and it was not found to be particularly toxic at all.
Lesley: Oh, an accidental toxicological study.
Michelle: Right, exactly.
Lesley: Oh, thanks for that. And, you know, there's some fantastic herbs out there as well. I know we've been talking nutrients, but there are certainly some really useful and powerful herbs as well. So, Emma, I've no doubt you've been asked a lot about this in your practice. I mean, my favourites are Andrographis echinacea, even pelargonium in this situation, but I'm really keen to hear what you think of those. And have you been using them?
Emma: Yes, extensively, although I've got to give a caveat. I do not use Andrographis as a liquid herb because my patients cry too much. So that's always in a tableted form, because it is so very bitter. But it is one of the first herbs that I think of for acute viral infections, because if you get the dose right, within three days, an upper respiratory tract infection can change. It can shift. And the mechanism of action for Andrographis is its got many. It's antipyretic so it'll bring down a fever, anti-inflammatory, antiviral, immune modulating, and it also provides symptomatic relief. So it's got so many different mechanisms.
But if you're looking at the research, the main bioactive is the andrographolide component. And it's got this incredible dual action. So, firstly, it's been shown to inhibit the viral entry to cells by binding to hemagglutinin and neuraminidase receptors on the cell membrane. So these are the receptors that a virus will bind to. So andrographolide can prevent that or reduce that. And then, secondly, it reduces viral replication within the cell itself. And that's been seen in the literature in regards to influenza A, Epstein-Barr, I think hepatitis C and a couple of other viruses. So it is such a useful herb but, yes, I definitely use it in a tableted form.
Lesley: Yeah, I think that's the thing with herbs, aren't they, that either they can be incredibly powerful but compliance can be an issue when they don't taste good.
Emma: Yeah. And, look, I always tell my patients when I give them liquid herbs, “This is going to taste terrible. You're going to be crying out my name in anger each morning, but they work,” and this is what we see.
And looking at echinacea, I mean, as a herbalist, this has been one of the most well-researched herbs I think globally. And the mechanism of action for this is it's immune modulating, anti-inflammatory, and antiviral, but it really works by increasing the response of natural killer cells and other immune cells. And it blocks the action of some viral proteins. So it seems to almost attenuate the response of macrophages to an immune stimulus. And, yeah, the research on echinacea is just fantastic.
Lesley: Yeah, yeah. Look, it's been one of those...it's been around for a very long time. And, you know, more and more research is coming through to understand it better. And incredibly safe as well. And I like the fact with echinacea, it's available in lots of different forms, so liquids and solids. And in fact, I know when I used to work in one of the pharmacies we used to recommend echinacea as a liquid tincture, because really good liquid tincture can have that local anaesthetic effect as well, which is nice.
Emma: Yeah, absolutely. It can be quite incredible. And looking at the research, a randomised double-blind placebo-controlled trial—so, this was a good one—showed that adults who took 2,400 milligrams of echinacea daily for 4 months and then they increased the dose to around 4,000 milligrams of echinacea at the first sign of a cold, but they had 59% fewer cold episodes and 26% fewer days with cold symptoms than the people taking the placebo. So echinacea is such a wonderful, wonderful herb and its safety profile is fantastic.
Lesley: We used to have a lot of people at work, particularly in childcare or in schools or places where there's lots of infection going around, using it and starting around Easter so that they would become a little bit more bulletproof by the time winter hit.
Emma: Yeah. I have a lot of nurses that use echinacea, patients of mine. So, yeah, similar demographic in that way.
Lesley: Yeah, like, when you know you're going into somewhere where it's just going to be everywhere. One of my absolutely favourite herbs, it's a herb called pelargonium, which I don't think enough people know about. I mean, I love the story of it. It came from South Africa. It was used by a number of the tribes there way back in the day for really serious respiratory illnesses like TB was brought to the UK, eventually was studied again in Germany. A PhD student I think in the 1970s discovered it, had another look at it, and, wow. Wow, it's amazing. Tell me what you know about it.
Emma: Yeah, I do think it's amazing, and it is a very undervalued herb so far here in Australia, so I'd love to see more clinicians making use of it. I mean, the mechanism of action for pelargonium is it modulates the immune system. It's antiviral. But the thing that I love the most is that it's really helpful for symptom relief.
So when you're looking at the research, a 2019 meta-analysis of 6 randomised controlled trials showed that pelargonium, it not only reduces symptom severity but also—and this is the part I really love—accelerated recovery, which, look, in the real world, it means that adults get back to work and kids get back to school more quickly. So I find that absolutely fascinating. And research shows that pelargonium interferes with the viral replication of viruses like influenza A. So I would absolutely highly encourage any practitioners out there who are qualified in herbal medicine to really start utilising pelargonium more.
Lesley: And we've got it on standby here all the time. Oh, look, thank you so much for that.
Look, talking about holism and, you know, we've talked a bit about diet, we've talked a little bit about nutrition, our key components, vitamin D, zinc, quercetin, vitamin C, some great herbs, Andrographis, echinacea, pelargonium, but we know there's more we can do.
So, Damian, I want to throw to you to talk us through movement and physical activity and how this might affect immune function.
Damian: Thanks, Lesley. Listening to Michelle and Em, I'll tell you what, what a wealth of knowledge those two are. Gosh, I'm going to be rewinding this podcast and listening to it myself. It's unbelievable. Thank you so much for your insights.
I think it's really important for us to consider what we're wanting to achieve. When somebody is fighting an infection, what's the body wanting to do? Is the body wanting to hammer and tongs, work 24/7, take emails, phone calls, answer SMS, text messages, be available all the time 7 days a week? Or is it wanting to rest, digest and heal? And really it's a bit of a leading kind of intro for myself here. We're wanting to rest, digest and heal. So we're wanting more parasympathetic activities. So we're not wanting to go and smash out a triathlon. We're not going to want to go and do an iron man event, or maybe head on down to the local CrossFit gym and do a WOD. I’m not doing the workout of the day today. Not when we're trying to get on top of our immune system.
So we've got to work out what the body is trying to do. So in a state or a time where the body's mounting an immune response, certain hormones are circulating through the body in certain states at which the body will do a better job and, listening to Michelle before, when she said when the body's in stress. And it's a great thing to just to consider that when the body is in stress and it's fighting an immune challenge or it's mounting an immune challenge, really it's moving in the direction of a parasympathetic approach to management of itself.
So you're looking for parasympathetic stimulation. So you're wanting to do easy walks, 30 minutes a day, exposure to the sun, take your sunglasses off for those short periods of day, those short bursts, 30 minutes, just to walk at a pace that you could chat but not sing at. You don't want to be singing. You want to be kind of chatting at, it’s a nice little pace. And doing that on a daily basis in the sun, provided it's not raining and not stormy outside.
But there's other things that you can do to bring yourself into parasympathetics, which is very important from a chiropractic perspective and a movement perspective, and that is to lie on a posture pole, get yourself a foam roller, lie on the posture pole in a crucifix kind of position with your legs out straight, the posture pole running straight down your spine with your arms out stretched to the side, and then breathing deeply into your stomach. This has been shown to bring your body back into parasympathetics. And this is a really great way to stimulate that rest, digest, heal mechanism that the body wants to get into when it's trying to mount an immune response.
I think there's some really easy, simple things to be mindful of, but really you don't want to burn yourself out. You don't want to create a situation where your body's requiring extra nutrition to repair your muscles because you've gone too hard. You really got to deliver the nutrition to the immune system, and you're looking to just move into parasympathetics, resting, sleeping, moving appropriately, and give yourself that opportunity to heal as quickly and rapidly as you can.
Lesley: So I think what I heard, Damian, is we're not soldiering on. We're being kind to ourselves.
I also found it really interesting when you were talking about the roller. So I've started doing yoga. And as a part of every single class, we put the bolster up under our back and do that similar positioning. I'd never realised that's what it's doing.
Damian: Yes, it's a really beautiful stimulator of the parasympathetic nervous system. It's a great thing. It's a mechanism that we talk about in terms of people who are really highly strung and stressed, and they're sitting down to go and eat a meal, and they're still thinking about all the work that they haven't done, let alone the conversations that they've had with people that might've upset them through the day.
A great thing to do before they sit down to a meal, again, to activate the parasympathetics, which is again, rest, digest and heal, is to lie on this posture pole or a bolster or something that kind of stretches your thoracic spine out to give yourself that opportunity to take in some deep breaths to really trigger the parasympathetic nervous system. It's such a simple, little, biomechanical, neurological trick that I think more people could actually access and tap into to get a great result from.
Lesley: I'm actually having this funny visual of people having bolsters in their office space and lying down on the floor behind their desks and doing it just to chill.
Damian: Yeah, it's my dream office. Sounds amazing, Lesley. I think that'd be really great. That'd be great. If we could switch ourselves from that sympathetic dominant state, which many people are really going to move towards a parasympathetic balanced approach, where at times of the day when you need to be sympathetic, you can be sympathetic, but at times of the day when you need to be parasympathetic, you can move yourself towards parasympathetics. We'll not only get a better rest at night, we'll have better dreams, we'll wake up more refreshed. We'll have that better REM sleep, which is restorative. There's so many positives and upshots to moving towards parasympathetics. And movement is a big part of that, and opening up your thoracic cage is such a significant component to making sure that happens efficiently.
Lesley: Now, one of the things I wonder about with movement, like you were talking about walking to the point where you can talk so you're not out of breath but you're walking with a little bit of pace. When people listen to music as well, do you find that that has an amplifying effect or there hasn't been much research on it?
Damian: Yeah, I don't know about the research on that, Lesley. That is a great question, but I think that, again, you're kind of going with music that's calming and soothing. Now for one person, calming and soothing, I think we've all seen that TV commercial with a man with a beard meditating and he's listening to punk rock or whatever it is. And then there's somebody else listening to Beethoven or Pan Flutes By the Ocean by Ken Davis. You know, there's all different types of approaches that we'd all use, but you're looking to get music that will stimulate your senses to the point that it would calm you and relax you. And if that is hard rock, heavy metal, death metal, whatever it is, then good for you. But I suspect that it's probably something that's probably going to move your brainwaves in a direction that's probably a bit more calming and soothing to the brain as opposed to something that's a bit more excitatory.
Lesley: Yeah, look, perfect segue to talk to Adrian. Adrian, you've probably got a view on music, but also I'm really keen to talk to you about sleep as well and restoration and recovery from that perspective too. Adrian, what's your suggestions here?
Adrian: Yeah, absolutely. I mean music, I mean, certainly there's research around music, and it's a positive effect or potentially positive effect on the immune system. And definitely the type of music does make a difference. And you've got your relaxing soothing music, which is, as Damian talked about, kind of putting you into parasympathetic mode. And then you've got music that's pleasurable and engaging but may not necessarily turn on that parasympathetic response. So really music is definitely something I recommend as they're engaging in moderate exercise when they're healing from an illness.
From a sleep perspective, I mean, sleep is really potentially another stressor or an activity that's soothing. So it really depends on the quality of sleep. So we know that research around insomnia, even sleep apnea, if the people are suffering from insomnia or sleep apnea, they have greater levels of inflammation going on. If you measure markers like C-reactive protein, it increases that. And concerningly, there's also research showing that inconsistent sleep is associated with high levels of inflammatory biomarkers and particularly in women. And this is really concerning obviously for breastfeeding mums and parents with young children, who their sleep is varying significantly from night to night.
So that's something that people really do need to think about, and we know that acute sleep loss can have a negative impact on the immune response, but it's certainly that chronic sleep problem that is really concerning and is associated with lower immune response. It increases our risk of depression and anxiety and other mental health disorders. It increases our risk of suffering from cardiovascular disorders, metabolic conditions, and all those various diseases that are linked with poor sleep.
Lesley: One of the things I'm also wondering about is, if you start to find a way to have better sleep, does it actually have an impact on those other things? So, for example, you're talking about poor sleep over time having a detrimental effect on immune function. Are you suggesting that if you can improve your sleep, that'll have a beneficial effect there too?
Adrian: Definitely. I mean, if we think about people that aren't sleeping and what will happen during the night for them, so if they're not sleeping, they're staying up during their night. They may be stressing about the fact that they're not sleeping. And we know that if you're thinking about a negative event or you're thinking about a stressor, that then triggers our cortisol response. It has a significant effect on our sympathetic nervous system. So you've got the fact that you're not sleeping, then you've got thinking about the fact that you're not sleeping, and that then exacerbates it. And then you're staying up through the night. And what are you potentially doing? Or, maybe you're snacking on high sugary foods.
So then that's happening during the night. And then all the metabolic responses associated with that and then potentially weight gain and insulin resistance. And then you're waking up in the morning and feeling unrefreshed. Because you're feeling unrefreshed, you're not going to go for that walk in the morning or that exercise in the morning. So you're probably becoming more sedentary because you're feeling so tired.
And then what do you do? You might use caffeine or stimulants to help you boost your energy during the day. And then just the fact that you haven't slept means that if there is a stressor, you're going to be more hypersensitive to a stress that occurs during the day. So you're feeling unrefreshed, you're feeling tired. You get told off at work, or there's a major deadline going on. Now you're going to be even more hyperactive or hyperresponsive to that stress that occurs.
So definitely the reverse happens and your sleep improves. You're feeling more settled. There's a whole bunch of lifestyle factors that occur. Your mindset changes. And certainly some of the research is indicating that we see a change in a whole range of different hormones and pro-inflammatory mediators.
Lesley: Wow. So poor asleep has got such a strong cascading effect on so many other factors. And when you put it like that, really it makes me think about why aren't we talking about sleep a lot more.
Adrian: It's definitely something that we do need to ask about when we're seeing our clients and asking about sleep and how do they manage sleep and what's their sleep hygiene. And I encourage anybody to, if they're working with their clients, to just really understand the importance of sleep. Certainly assess for it. There's plenty of useful checklists and questionnaires that people can quickly give. And then really knowing about good sleep hygiene, because while there is several supplements, nutraceuticals, herbal ingredients that may help improve sleep, ultimately, the research shows that it's our behaviours that are the most important.
So cognitive behaviour therapy for insomnia, some of our sleep hygiene practices, and caffeine intake, and what we do before we go to bed and all those different things are really things that we can recommend to clients. And if they can engage in five or six small changes in their sleep hygiene routines or their sleep routines in the evening, they can have a significant cumulative effect and improve their sleep over time.
Lesley: You know, Adrian, I used to have such problems with sleep. I still do from time to time. And I found the three things that really helped was, first of all, not taking my multivitamin in the afternoon because all those B vitamins can really activate. The second one was having a journal on the side of the bed. So if I woke up with just thoughts going round and round that I felt I had to hold onto till the morning, I could jot them down and go, 'Right, I've let it go. It's there,' and I go back to sleep. And the third one was a cool room. Being in a cooler environment completely just broke the cycle. It was fantastic. It's so simple.
Adrian: Yeah, it's some of those things that are... It doesn't have to be rocket science. There's not a whole range of magical solutions. There's just some of those simple things that people can do. And it just really means people just take stock and just kind of question, “Oh, what am I doing that might be impacting on my sleep? What are some things I'm doing in the evening?” because it's not just about what you do before sleep. It's also what you do during the day to prepare yourself for sleep. So those are the things we also need to really take into consideration.
And unfortunately with sleep with many things in life, if you try harder, you do better. But when it comes to sleep, if you try hard to fall asleep, you generally do worse. So it's more about just doing the right things. And as one of the consequences of doing the right things is that your sleep will then become better.
Lesley: You know, you remind me of something one of my kids said once. We were learning meditation at home, and they said, “I'm going to do the best meditation ever.” I'm going, “No, not with that attitude.” Thank you for that.
Look, I think that sleep, restore, recovery. We've been hearing a lot about that. And, Emma, we talked earlier and you were mentioning the importance of convalescing. And, again, it's something that we don't talk about that much anymore. Is this something you talk to your patients about?
Emma: Yeah, I call it the “forgotten art of convalescing.” And, look, it's really about surrendering to being still, to letting go of that need to be busy and to really take the time to nourish the body with easily digested, nutrient-dense foods, such as that global favourite, the chicken soup. And what I've noticed clinically is that if people convalesce properly, they have a much more efficient recovery, and they have less chance of relapsing down the track. And I highly encourage it in my patient demographic.
But people find it challenging to be able to stop and give themselves permission. So as a clinician, often I will say to them, “I give you permission to do nothing for four days,” and you've really got to be quite firm with patients sometimes on this front.
Lesley: Now, I'd imagine that's quite hard for a lot of people. It would be very unnatural.
Emma: Exactly. That's right. They're so busy doing that being still can be challenging.
Lesley: And, Michelle, is this something you talk to your patients about? And how do they respond if you did?
Michelle: Yeah, I actually do talk a lot about convalescing because I agree with Emma wholeheartedly. It is a forgotten art. And I think, in many ways, it actually is quite natural for us. Like, if we can learn to read the body, so it's really important.
So when the body does get sick or even mentally unwell, Adrian will probably know about this, like, we actually have a sickness effect of the body. So that inflammatory response that we do get when we're unwell is actually meant to help the body to rest, and to not feel like doing anything, and to feel sick and apathetic and unmotivated. So it's really important to remind patients that that's actually quite a normal process of being sick, so that kind of helps them give themselves permission like Em said, because they do require... a lot of patients are so familiar with being busy.
But in many ways, it's an unfamiliar sense to rest. Like, we have this internal pressure in ourselves and also from the society that we live in. And I think really as a culture, we really need to look at the ways in which we respect convalescence and respect rest. And I think in other cultures, like in Italy and in Finland, they actually have words that express, and I don't know the words, but it's like the joy of doing nothing, you know? I think as a culture here in Australia, we could actually do with a little bit of the joy of doing nothing, and I know FOMO is a massive thing for lots of people, but there's a new way of expressing that, which is JOMO, which is the joy of missing out. So really celebrating the fact that we're missing out on something vital, than just lying and watching the clouds go by can be really important.
But the other thing that I'd really like to say is expectation, as well. So, as we were talking about sometimes with viral infections, you can get a post-viral fatigue issue. And we suspect a lot of the mechanisms, but I'm not sure really we've got a body of evidence that says, “This is exactly the people at risk of something like a post-viral fatigue syndrome.” And so we have to be really careful for patients that experience that because expectation is really important.
And so pneumonia is another classic example. I'll often see pneumonia in clinical practice. And from what I witnessed, it takes months to fully get that vitality back after a significant pneumonia. And that allows people to actually give themselves a break and not push themselves so hard. So their expectation is in line with the way that their body is healing from an innate perspective. And I think that does wonders for them to just sit with that sickness mentality or that innate sickness mentality to help them to heal long-term. So I think convalescence is, yes, definitely a forgotten art and one that needs to come back quickly.
Lesley: Well, I was going to ask you about, one of the things you were talking about was that tiredness that comes when you're fighting an infection. So there's that fatigue, and I guess the way you've put it is that some fatigue is actually really helpful and we should embrace it and just recognise it's our body saying slow down. Just let it do what it needs to do and don't do anything else. But I guess we're hearing a lot about ongoing fatigue, like you said, a post-viral syndrome where it's just lasting beyond where we believe it should be. And then it becomes a problem.
Michelle: Well, it does become a problem, A, because we don't know how to convalesce effectively, and also it just leads to a whole different way of building up the body. So, for example, if people have been under chronic stress and then get a significant viral infection, are they at more risk potentially? If they're nutritionally deplete, if they've got poor sleep, as Adrian was talking about, and they have challenges in mounting that immune response, if they've got depression, or significant sympathetic overdrive, or an inability to engage in that parasympathetic nervous system, they're possibly more likely to suffer from the effects of fatigue.
So this kind of brings in that whole aspect of looking at patients from that holistic perspective. And for patients to look at themselves at all the different areas in their life that potentially might be creating the risk factor for more prolonged fatigue. And I think, in our society, we have a society that reveres stress. We revere the people that can sleep four to six hours and get up and keep going in the morning, the ones that are doing triathlons on the weekends and getting their nutrients from super shakes, etc., etc. I mean, we all know that kind of drive in our community for striving and more and more and more.
And I think that sometimes some of our stresses are actually quite hidden. You know, there's a lot of stressed people that actually don't even know that they're stressed, and that's an important revelation for some people that might be having a post-viral fatigue issue to really look at themselves from a holistic perspective. And, I mean, one of my favourites, the forefather of Western medicine, Hippocrates, said disease is either a matter of time, letting time and the innate immunity get you through an illness, or it's a matter of opportunity.
And I think for that post-viral fatigue, sometimes it can act as an opportunity for people to look at themselves holistically and assess their lifestyle. And we have this opportunity to rebuild them nutritionally, emotionally, psychologically and from a more wholesome lifestyle perspective. And that can then equate to a longer experience of health and vitality hopefully in the future.
Lesley: Look, I'm going to start wrapping up. It's been just wonderful talking to all of you again, and I'm going to go around the room and ask each of you what are your top three, maximum five, things that you'd recommend to people to support them to fight the good fight, fire up their immune system in the right way, and also help them with recovery. So I'm going to start with Damian. Damian, what are your top tips?
Damian: I feel like I'm Steven Bradbury here. It's like sliding through with all the wisdom, and I'm going to come through as the winner. But I take vitamin C and zinc every day, and I can't go past it. I love it. I think it's fantastic. I love to get outside in the middle of the day and have a little walk. So that's the sort of thing for me that obviously I've given that as advice and I do it as well. It's really important for me to help maintain my health and wellbeing to just get a little stroll in there and also keep my vitamin C and zinc levels up.
But I love also, at the end of the day, after a big day of adjusting where I'm hunched over, you know, so if I'm hunched over, I'm in that fight or flight posture. I'm in that posture where my shoulders are forward, I'm hyperventilating, I'm not actually breathing well to actually lie on a bolster or on my posture pole, we've got a postural pole. I will lie on that, and stretch out my chest, and try to flatten my thoracic spine to just open everything up to take me out of that fight or flight kind of posture. And that kind of practice, those three things for me, they're pretty much non-negotiables and that's what I do on a daily basis. So I would recommend that to anybody.
Lesley: And they sound pretty easy to do as well.
Damian: Not hard, not hard. Pretty simple.
Lesley: And, Adrian, your top tips.
Adrian: Yeah. Before I get into that, I've got an opportunity to show off my really poor Italian skills. So the joy of doing nothing is il dolce far niente. So the joy of doing nothing.
Lesley: Sounds good to me.
Adrian: All right, so in terms of my tips, I mean, I think one of the things is certainly around engaging in positive activities. And we know that that is associated with improved immune health. And interestingly there's actually a study, the term was coined emodiversity, and that's really around having a whole range of different positive emotions. You know, it's emotions like joy and happiness. And what the research showed is that the more emodiversity that you had, the greater the impact on anti-inflammatory mediators.
So for people to really think about not just positive experiences and feeling good, but if they can kind of increase the diversity of experiences by engaging in a whole range of different topics, and activities, and around people, that's going to have a really positive effect on their overall health.
And the other thing really I suppose it's just more recommendation for practitioners is we know that how we see the world and how we see our health is going to have a really positive or negative effect on our mental health and our physical health. And there's lots of research showing that people with greater... well, some research, sorry, not a lot, but there's some research showing that people who have greater optimism have reduced levels of inflammation.
So as practitioners, I think it's really important for us to increase the sense of optimism in our clients to show them that there really are effective lifestyle, psychological, dietary, nutraceutical, phytoceutical options to help normalise inflammation, and we can provide some sensible information, showing them that there's a whole range of things that they can do to restore themselves to better health. And that's through us developing a really trusting relationship for us to give them sound and reliable information. I think that's really important for us as practitioners.
Lesley: And I think it goes back to what you were talking about earlier, the locus of control. It gives people something they can control as well.
Adrian: Yeah, definitely. So if we can do that, and we can, and people walk out going, “Actually there's things I can do to improve my wellbeing,” they're going to certainly be far better equipped. And one of the things in a lot of the research we see is that the placebo effect is just astounding. And that placebo effect is often around expectations and belief and hope. And if we as practitioners can do that and instil hope in our clients, it's going to be really helpful.
Lesley: Michelle, what are your top tips?
Michelle: This is so hard, Lesley.
Lesley: I know.
Michelle: I agree with everything Damian said and everything Adrian just said. But if I was going to add anything, I mean, I think, looking at the person as a whole, looking at yourself as a whole is really important. And managing stress, whether it's internal stress such as, from a poor diet, from poor nutrition, from gut dysbiosis or poor gut health, and also things like are we living a life that is according to our values, is it aligned with what we want is all really important for internal stress. And then external stress. We're doing too much. We're working too hard. Have we given up our leisure time? These are all the factors that can help us to really come into ourselves and get a sense of vitality that no one can really take from us.
Adding in, I mean, nutritional medicine has been such, I guess, a frontier for me. It's really important to my practice, is looking at those key nutrients. As you mentioned, your vitamin C, vitamin A, vitamin D and zinc are all such profound micronutrients and vitamins for the immune system, but they also have aspects in terms of anti-inflammatory, antioxidants. It's like this global effect that they work synergistically with each other.
And the other thing is exercise, getting out into nature. We are natural beings. Nature is where we probably, most of us feel most alive. And we have become more solitary through lockdowns, more isolated, trapped in our homes for some people. So getting out in nature is such a fantastic healing modality on so many different levels. So I think it's really, really important that we have a great relationship, and it can teach us so much in such a subtle way.
And the other lovely thing that I always say to my patients is "Everything in moderation, even moderation itself.” So having that real balance and testing our boundaries from time to time.
Lesley: And, Emma, is there anything left to say? I'm sure you've got something to add.
Emma: Oh, there's always more to say, isn't there? Look, I think the consistency of small actions really pays off in the long run. What I see is so many people go too hard, too fast with health changes, and then they find it all so overwhelming that nothing is maintained. So just focusing on some small strategic things, like maybe ensuring you have a nutrient-dense lunch on a daily basis, maybe making sure you're hydrating well, or sleeping well. But making small actions is always my number one tip for anyone that wants to make health changes, and definitely seeking the advice of a qualified health professional, because health is too important to guess. And I know a lot of clinicians will be listening to this podcast and they too need to ensure that they are seeing a health professional for guidance and for help and support along the way.
And the last one is to think, "How do I eat the rainbow on a daily basis?” So taking it back to that very granular level of food as medicine, thinking what is one small item that I can add to my meal to increase the nutrient density. And it could be something as simple as you're chopping a tiny bit of parsley on your eggs in the morning, or throwing some toasted seeds on your salad, or even just adding one extra vegetable into your dinner. But there's always one item that you could easily add to a meal to upregulate that nutrient density. So small, regular, consistent changes is what I'm always focusing on.
Lesley: Thank you, Emma. I know there's been a lot of research showing that if you just make a small little change but you keep it consistently going, it has a huge impact. Yeah, it's so important.
Emma: Absolutely.
Lesley: Look, I just want to say a very big thank you to Damian, Michelle, Adrian, and Emma. It's been an absolute pleasure talking to you about immunity in a viral world, where we are today. There's so much we can do. And I'm really hoping that the clinicians who've been listening to us are going to go away with some renewed energy and a couple of tips and maybe some new ways of talking about things with their patients as well. So thank you very much, everyone.
Don't forget, you can find all the show notes, transcripts and much more at the FX Medicine website. I'm Prof Lesley Braun. Thanks for joining us.