Immunity

Silent Signs and Symptoms

When you experience acute inflammation, the symptoms are pretty obvious: redness, heat, swelling and pain, all localised to the site of the injury or infection – like a sprained ankle or sore throat. But the symptoms of chronic inflammation are a bit more subtle and sometimes not even there at all. Signs that chronic inflammation is manifesting in your body include:

 Erratic moods, anxiety and depression (inflammation affects your entire body, including your brain)

 Pain (one of the key features is often painful, stiff or achy joints)

 Fatigue (inflammation places demands on your body, messes with your stress response and muddles up hormonal balance; it makes sense that your body is telling you to hit the sofa rather than the gym)

 No symptoms at all, but ‘just not feeling right’ (while symptomless chronic inflammation might seem pretty chill, it can still lead to all the risks and complications of chronic inflammation with symptoms)

There aren’t, unfortunately, any standardised tests to measure chronic inflammation. A simple blood test can measure a liver chemical – C-reactive protein (CRP) – which, as part of the immune system, rises in response to inflammation. The result can help your doctor devise a strategy to lower your levels. However, the test doesn’t show where the inflammation is or what is causing it.

When chronic inflammation symptoms do present themselves, they can manifest in a variety of ways, many of which can be mistakenly attributed to a lingering common cold or something else (hence chronic inflammation being so tough to nail down). Doctor visits are often related to the negative effects of stress or just feelings of being not quite right, unexplained or ongoing fatigue or niggling aches, pains or rashes. The red flags of chronic inflammation are often only acknowledged once severe symptoms that we can no longer ignore have taken hold.

While those symptoms all sound pretty awful, there’s worse news: chronic inflammation has been linked to some very serious health issues down the line. Seemingly unrelated conditions like heart disease, type 2 diabetes, autoimmunity, allergy, some forms of cancer, and even neurodegenerative diseases like Alzheimer’s share this deep immunological link.11 This is because if it is continually ‘rescuing’ (i.e. fighting over a long period of time without resolution), your body’s inflammatory response, left unchecked and unresolved, is universally damaging to your healthy cells, tissues and organs, which, in turn, leads to damaged DNA, tissue death and internal scarring. Chronic inflammation may be a recently observed phenomenon, but many of the related diseases are themselves not new. They are the same cluster of wear-and-tear diseases of ageing, but rates are increasing dramatically. And now they are happening more aggressively and at younger and younger ages in individuals living in industrialised countries who follow a Western lifestyle. But they are relatively rare in populations who adhere to more traditional diets and lifestyles, with environments and social stressors starkly different from those typically present in today’s modern Western world.12

The idea that chronic inflammation – constant, low-level immune-system activation – could be at the root of many non-communicable diseases is a startling claim, requiring extraordinary proof. But is it cause or consequence? The details are still being fully worked out. The pathways of inflammation are complicated, difficult to define and manipulate, making unpicking the details challenging. But in 2017 a large-scale human clinical trial of more than 10,000 patients in 39 countries examined the effects of inflammation in heart disease. Researchers found that the immune system’s inflammatory response is uniformly damaging and causal in the process, killing people by degrees.13 For some conditions it appears that inflammation is a causal factor in this modern malaise. Until we accept that – and take action to change it – we will not be able to fight these lifestyle illnesses effectively.

The Drugs Don’t Work

True, anti-inflammatory drugs exist. There are many types, including non-steroidal anti-inflammatory drugs (NSAIDs), many of which are available as common over-the-counter non-prescription drugs – ibuprofen, for example. These are powerful medications for a whole variety of acute pain problems, and when taken for a few days or a week they are very safe for most people. But they are not without their side effects. The Food and Drug Administration added new warnings about NSAIDs in July 2015. NSAIDs must be used cautiously in people with heart conditions and cardiovascular problems since recent studies have demonstrated taking prescription NSAIDs for just one week can increase the chance of heart attack or stroke in these patients,14 not to mention the suite of more common side effects, including damaging the delicate lining of the digestive tract. And, alarmingly, they actually interfere with the resolution of inflammation, hindering the natural course of the healing process that our bodies are designed to do so well. In fact, these treatments may bring symptomatic relief, but a little-known fact is that they have minimal effect on chronic inflammation. Inhibiting these crucial resolution pathways over the long term induces physiologic dependence, which has been shown to produce a rebound effect, paradoxically promoting chronic inflammation further through a compensatory mechanism.15,16 Constant use actually worsens some of the problems that people hope to ameliorate by taking these drugs. Arthritis is a prime example. NSAIDs provide short-term symptom relief, but long-term use accelerates disease.17 This is why, and studies confirm this, that when it comes to chronic inflammation, the side effects might outweigh any benefits.

So when is it OK to take NSAIDs, and when is it not OK? This is a complex and controversial topic. If you have been prescribed these drugs, then you must follow your doctor’s orders. Prescriptions aside, these drugs are ubiquitous and available without prescription, so now there’s no guidance or accountability, and people are taking them for every imaginable pain or ache, even for emotional stress. They must be used with an eye towards the delicate balance that has allowed our species to survive this long. We need to start looking to better long-term ways to manage chronic inflammation, some of which we will explore in the upcoming chapters. I’m optimistic that holistic approaches to managing chronic conditions won’t negate NSAIDs but may reduce how many we need to take.

Avoiding Snake Oil and How to Get the Best from Your Immunity

By now you should be getting the picture: immunity is more than those symptoms you feel when the seasonal winter lurgy rolls around. Immunity is the river that runs through every aspect of health and wellbeing. In my experience as an immunologist, it is so central to our wellbeing – survival, even – that its inner workings offer key lessons for living better. It keeps us alive. But it can also make us sick. We can no longer ignore the fact that our fast-paced, over-consuming, unrelenting lives are slowly eroding the balance of this carefully crafted system.

In my line of work I’ve heard it all. From chicken soup for the sniffles to copper bracelets for arthritis. Old-wives’ tales, traditional beliefs and the positively bizarre. Each generation has their own ‘snake oil’ concoctions, potions or rituals promising miraculous cures and good health. Many are flawed or completely miss the mark, some are foolhardy and others downright harmful. That’s not to say all alternative remedies are ineffective. Often, they seem to work for the people who promote them but may not be appropriate or are perhaps even dangerous for others. And, certainly, most won’t be enough to keep you healthy all the time. For some, the biology of belief is enough. By this I mean the placebo effect, which is a wondrous thing. It shows us the immense power of our minds and the beliefs we hold, even though the impact that mindset can have on health is one of the least understood concepts in medicine.

On the other side of this coin is the rise of ‘wellness’. This surging trend has ushered in a wave of enthusiasm for preventative self-care, but also propelled a cascade of misleading messaging, hyperbolic claims and a shift away from science. As we saw with the anti-vaccination movement that evolved from a discredited article in The Lancet, misinformation, compounded by confirmation bias, spreads faster and deeper than the truth. This means misguided choices and misspent money, both of which have the potential to compromise our health.

Everyone wants to hear the tactical. They would have me tell you what to do each day, which superfoods to eat and which supplements to take. So what’s causing me to go against the grain and urge you to cast a critical eye upon all the messages of ‘wellness’? To disregard the powerful marketing aimed at having you ‘boost’ your immunity? Some argue that ‘the science just hasn’t caught up yet’. But it never will. Because that’s just not how science works.

PLACEBO EFFECT

A placebo is anything that seems to be a ‘real’ medical treatment – but isn’t. It could be a pill, an injection or some other type of ‘fake’ treatment. What all placebos have in common is that they do not contain an active substance meant to affect health. They are used in clinical trials to determine the effectiveness of a new drug. Sometimes a person can have a response to a placebo, either positive or negative. For instance, the person’s symptoms may improve or they may have what appear to be side effects. These responses are known as the ‘placebo effect’. Your mind can be a powerful healing tool when given the chance. The idea that your brain can convince your body a fake treatment is the real thing and thus stimulate healing has been around for millennia. Now science has found that in the right circumstances, a placebo can be just as effective as traditional treatments.

I don’t want to focus on lamenting times gone by or chastising the latest superfood. Life has moved on, and our health is better in some ways than it was in past generations. But I can’t help but wonder if we have thrown the baby out with the bathwater? This book is not about quick fixes and cure-all remedies. For many, a mindset shift from sick-care to self-care means we’ve become more intentional about our diets, nutrition, exercise and lifestyle as they relate to health. As the evidence builds, conventional medicine can no longer afford to ignore its place either. It may be the best we have against the uncontrollable surge of NCDs that now plague our modern lives. Several scientific studies explored in the following chapters demonstrate that sustaining certain positive lifestyle choices lowers risk, and that those already diagnosed can have their treatment effectively reinforced by shifts in habits and the provision of strong support networks.

SOLVING THE PUZZLE OF BETTER HEALTH

Health, both physical and mental, starts and ends with your immune system – the guardian control centre behind all other body systems. Ultimately, the immune system seeks peace with the environment. Your goal is to create one that doesn’t require your immune system to lose its natural balance.

Like the brain, the immune system is a learning system. It evolved to anticipate inputs from our environment. We can no longer ignore the fact that our fast-paced, over-consuming, unrelenting lives distort these inputs and are slowly degrading the balance of this carefully crafted system. Despite the fact that our world has changed – or, more correctly, because of that – it’s more important than ever that we anchor ourselves to the things that came so intuitively to our ancestors yet present the greatest challenge in our modern-day 24/7 culture. For example, a sensible lifestyle, getting enough sleep, exercising regularly, eating healthy foods and cultivating the mental bandwidth to adapt and self-manage the constant pressures of modern life. The future is not conventional medicine or alternative medicine – it’s a fusion of modern medicine with the intuitive tools of our great-grandparents.

For those of you who are curious about the forces within that can determine your wellbeing outside of your doctor’s realm, but are nervous to venture into the sphere of Dr Google and online influencer quackery and tired of being told to juice celery, this book makes no claims for quick-fix cures but will provide you with knowledge and direction. Understanding immunity can help you navigate the long game for health. Instead of boosting your immune system: support it. Honour its finely honed balance – one that is so essential to feeling healthy and living well. In the following chapters I will share my own personal tips and tricks, teaching you how to incorporate modern versions of ancient traditions into daily life. Think of these as lifestyle tweaks and changes backed by science. This is in no way prescriptive, nor a magic bullet to health. Quite simply, it is a gentle nudge in a better direction.

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