Feel Better, Live More with Dr Rangan Chatterjee - How to Keep Your Immune System Healthy with Dr Jenna Macciochi #125

Episode Date: September 29, 2020

What does immunity mean to you? In today’s Feel Better Live More podcast, researcher and lecturer, Dr Jenna Macciochi explains that it’s not just about fighting off infection. Our immune systems do not lie dormant, waiting to wage war if bacteria or viruses invade – they play a central and constant role as our bodies’ housekeepers. How do we do that? From empowering nutrition advice to insights into the how our metabolism and immune systems interact, there’s plenty of practical takeaway from this conversation. We discuss the disruptive effects of stress and how cortisol dampens immunity and even reactivates viruses. Having learned this first-hand when chronic stress led to her getting pneumonia, Jenna shares some helpful rituals for reducing the impact of stress in your life. Perhaps most fascinating though, is the idea that the type of person you are can shape your immunity. Jenna explains there are five main personality categories and each of them have specific immunological features. Traits and behaviours typical of each category, such as risk taking, sociability and how we respond to stress, can end up informing how our immune systems develop. As we discuss, ‘It’s more important to know what person the disease has than what disease the person has.’ This is a valuable conversation for anyone who wants to understand more about their immune system, not just to reduce their risk of getting an infection, but also to increase their overall wellbeing and longevity. Show notes available at: https://drchatterjee.com/125 Follow me on instagram.com/drchatterjee/ Follow me on facebook.com/DrChatterjee/ Follow me on twitter.com/drchatterjeeuk DISCLAIMER: The content in the podcast and on this webpage is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

Even if you have the best diet in the world, you know, other things can erode away at your immune system and leave you open. And stress is probably, it's the one thing that we don't take seriously. We think of it as being psychological and the causes can be psychological, they can be physical, they can be emotional, but they're always biological because stress chemistry is real. Hi, my name is Rangan Chatterjee. Welcome to Feel Better, Live More. Hey guys, welcome to the podcast. This is episode 125. So for much of the year so far, many of us have been thinking about our immunity, but what exactly does immunity mean to you? On today's episode, I talk to the researcher and university lecturer, Dr. Jenna Machoke, who explains that the immune system is not just

about fighting off infection. You see, our immune systems don't just lie dormant, waiting to wage war if bacteria or viruses invade. They actually play a central and constant role as our body's housekeepers. So how do we actually keep our immune systems in shape? Well, in today's conversation, you are about to find out. Jenna explains how our diets can impact our immunity and explains how our metabolism and immune systems interact with each other. She explains the disruptive effects of stress, how it can dampen our immunity and even reactivate viruses. Like all of us though, Jenna is a human being and she knows full well the science on stress and immunity, yet she discovered that there is no better teacher than personal experience.

When a few years back, she found that the chronic stress in her life led to recovering from a severe pneumonia. Jenna reveals what she learns from going through this traumatic experience and she shares some helpful rituals for reducing the impact of stress in your life. But this conversation is not just about nutrition and stress. What I found incredibly fascinating is the idea that the type of person you are can shape your immunity. Jenna explains that there are five main personality categories and each of them have specific immunological features. Traits and behaviours typical of each category, such as risk-taking, sociability and how we respond to stress, can end up informing how

our immune systems develop. As you're about to hear, it's more important to know what person the disease has than what disease the person has. This is a valuable conversation for anyone who wants to understand more about their immune systems, not just to reduce their risk of getting an infection, but also to increase their overall well-being and longevity. so to increase their overall well-being and longevity. We do get a little technical at times, but I still think you will find this conversation well worth navigating and do stay tuned until the very end for some practical tips that I think will really, really help you. Now, without further ado, here is my conversation with the wonderful Dr. Jenna Machoke. Your day job is about a subject that is really close to my heart, immunology. Now, I did a BSc honours degree in immunology at university. So I've always been fascinated with it. But I don't think I realised back then just how important it is

for every single one of us. You know, pretty much every chronic long-term health complaint stroke condition that we have, in many ways, the immune system plays a central role and i don't think people realize that no no why do you think that might be i mean when i was an undergraduate and learning about the immune system it was through the lens of infection protection and that kind of is a historical thing you know from maybe over 100 years ago when the first kind of ties were made between these white blood cells and susceptibility to infection. And we've just always maintained this lens through which we look at the immune system as protecting us from infection. And then suddenly you start to dive into the field of immunology and you realize it's not just protecting us from infection,

it's doing a whole array of other things. And I kind of like to move away from that military analogy we often have about the immune system as going out to battle off the germs, because most of the time it's not doing that. Most of the time it's kind of like your housekeeper, you know, it's just taking care, it's working hard, it's learning from your environment inside and outside, and it's processing all that information, and it's working hard it's it's learning from your environment inside and outside and it's processing all that information and it's maintaining the kind of status quo in your body yeah i like that i think a lot of us do think um still to this day that oh if i get cold symptoms in november my immune system in inverted commas kicks in yes to fight it off exactly but the immune system is constantly

running it's constantly working yeah right now as we sit here it's working hard it's involved in so many processes you know like cells in your body have a finite lifespan so eventually they die and they have to be disposed of and special immune cells are removing those and keeping things tidy they're repairing damage when it happens even if there's no infection so last year i broke my arm but i didn't rip the skin open there was no infection getting in there but there was still signs of my immune system working hard to to knit that all back together yeah so it's it's sensing it's a real kind of uh it's like a mobile brain, I think. It's very dynamic and it's listening, integrating all these signals from our

environment, from insiders, and then producing the appropriate response to kind of keep things in balance. Yeah. And what's fascinating for me is that, and I hope we get into this today, is that it's not something passive that we have no influence over. There is a lot that we can do, a lot of it quite simple stuff that can positively impact how our immune system works. Yes. And I know you've basically done a fabulous job of summarizing it in your book, Immunity, The Science of Staying Well, which is well worth a read, I think, for anyone who's interested in learning more about the immune system and how they can use the lifestyle to help them. So well done on such a great job. Thank you.

So let's sort of dive in some. Should we start with food? Yeah, yeah, exactly. I think that's a good place to start i actually put the food chapter at the end because i was really sick of seeing you know the whole immune boosting food supplement whatever being pushed on you know the media social media everything so i was kind of like people are gonna want to open a book about immunity and expect to see on like the first page vitamin c does this to your immune cells so take a vitamin c supplement or eat these vitamin c

rich foods and i kind of just wanted to emphasize it's not that simple you know and and almost um make people look at the other aspects of lifestyle first before you dive into food i i just want to i i love that you did that um it's what I did in the four pillar plan my first book I thought I'm not people are expecting this will start with food I'm not going to start yeah I'm going to start with stress because I think that's what no one's thinking about yeah but then I'm interested so you did that in your book but when the book came out yeah and you started to write you know articles or read a PR in newspaper columns yes I bet you or I'm going to guess what were they wanting you to say oh definitely yeah

it was all about you know my book came out in March which was you know COVID pandemic you know going through the roof so all of the press and publicity was you know how can we make ourselves invincible to covid what what supplements can we take to be invincible and i'm gonna let everyone down and say well you know nothing's going to make you invincible because from the dawn of time we've always had this battle with with germs you know like they're trying to infect us we're trying to keep them out we just cohabit this earth together so there's always going to be infection and a pandemic's an unfortunate situation but it's a very real one yeah i mean i'd love people just to sit with what you said there which is we all cohabit this earth together us and the bugs

you know it's it's really quite profound that you know it's not i think humans have we've we've often felt i think particularly in the times that i've been around on planet Earth, that we kind of know best and we can dominate everything around us. But I think we're learning, well, Mother Nature is pretty powerful and has been around a long, long time. And there's a certain ebb and flow and a certain dynamic. We are not the only living species in the world there's animals there's bugs and bugs as no no doubt we'll get into yeah bugs are not all bad there's a lot of bugs yes exactly very good 99 of them won't hurt us and they're everywhere they're you know right now as we're sitting here there's there's bugs even in the air we breathe and they're not you know causing us harm so most of them are good but there's the obvious ones that

come along and um you know side swipe you like um SARS-CoV-2 has yeah as a sort of reminder a stark reminder that yeah infection protection is really important yeah and i think i think the the thing i would sort of reiterate to people is what i think the last few months have highlighted for us is that looking after your immune system is really important yes and i would say i've said it's a lot in the press like taking care of your immune system is for life. It's not just for COVID. You know, suddenly everybody's really interested in it. There's lots of marketing of immune boosting products. You know, all of the supermarkets and pharmacies were sold out of vitamin C supplements at the start of the lockdown.

But it's something that we should all have been thinking of before COVID because it's for the long game. You know, immunity is really entwined with how we age. So, you know, if you want to live a long and healthy life, we are as a population living much longer than the generations before us. But we're not necessarily living better. we're not necessarily living better so if you want to you know i don't necessarily want to live forever but i want to be able to enjoy my years and feel well and not be sort of burdened with chronic disease and we can't bulletproof ourselves but there's definitely things we can do now that that are for the long game and when i wrote the book it was before we knew about um the current coronavirus pandemic so i was really hoping to try and get people

thinking about the long game for their health yeah well you know i'm sure in many ways people if they weren't going to take it seriously before are really going to now so that would be our hope so in terms of the things people can do yeah uh if we if we sort of dive into diet and food then exactly um what are some of the things that people can do to help their immune system yeah well i mean there's sort of ones that people often think about which is vitamins and minerals and we have a whole selection of essential we call them micronutrients so the vitamins and minerals that we need to function and if you're deficient in any of those you you will impair your immune system. And I think that there's certain ones that are highlighted. So vitamin A, the B vitamins, vitamin C, vitamin D, vitamin E. But you could sort of say

that taking more than you need if you're not deficient isn't going to make your immune system work better than it already does at its baseline. But the sort of subclinical deficiencies in our populations are not really clear. It's very hard to measure. You know, if somebody has an overt deficiency in vitamin D, you would see it clinically as rickets. But if they're subclinically deficient, that would sort of fly under the radar. And being subclinically deficient is would sort of fly under the radar and being subclinically deficient is in one micronutrient is often a sign that there's other micronutrients that might not be quite at the right levels for people who i just want to clarify for people that subclinical so you know a lot of people used to getting blood tests and there's a normal range

and often if you are with you know out with that normal range you will be it was said you are deficient yeah um but we're learning more and more like b12 for example is a prime example for me the normal range is so big yeah you know it's something like you know 200 ish to 700 or 800 depending on what lab you're in but for some people who are at 250 although it's technically normal actually they're symptomatic with it like they can have um you know they can have all sorts of things fatigue they can have confusion they can have muscle aches and i really think medicine i would say has been quite black and white for a number of years i think we need to evolve a little bit to go there's optimal yeah you know there's normal there's abnormal but there's

also optimal yeah and and and i think i think that's just a really important concept for people to grasp yeah and i you know um if you're if you know have problems with any of these micronutrients the vitamins and minerals it's going to impact your immune system so it's not so simple as saying i'll take a vitamin c supplement and that's going to make me more invincible so it doesn't quite work like that um the other thing about the micronutrients is if we're low in any of those, it can actually increase oxidative stress in our body. So this is kind of the balance between oxidants and antioxidants.

And what we've actually come to realize is this can affect how badly an infection causes us symptoms. So if you're in a more oxidative state, so your imbalance of antioxidants to oxidants is out, that bug, if you catch an infection like coronavirus, for example, it can cause a much worse pathology in you. And it can also cause that virus to be under a greater pressure to mutate to become more virulent so let's let's take a winter flu for example a winter flu type virus that we are exposed to are you saying then that the state of your immune system at that time potentially can influence whether you actually get sick with that infection yeah or whether you fight it off with no problem and how sick you get and whether you the environment that your body provides when that infection is inside you can

shape how that infection behaves how that virus might be under a more pressure to mutate or more likely to mutate because of the the environment of your body which is really... Is this why you can have 10 people in the same room with the same person with, let's say, a cold virus coughing all over 10 of them, but not all 10 will get symptoms of the virus, will they? Yes, exactly. And we've known this for a really long time, but I think coronavirus and the current pandemic has really kind of put that under the microscope because people are like why are some people getting really really sick and others have no symptoms and this is quite commonly seen with infections that we have this huge diversity of how we respond now you mentioned oxidative stress and this balance between the oxidative stress and the antioxidants and one of you we could just make that super clear

for people so what is oxidative stress exactly so we have um oxidative like things that are are produced when uh like byproducts of of our cells normally working um things in our environment various different things can can cause that oxidative stress in our body. And then we have our own internal antioxidant systems. We have the micronutrients, vitamins and minerals that support production of antioxidants. And we also get antioxidants from food. And we kind of need this to be in balance. So we don't want to completely extinguish the oxidative side. And we don't want to have too few antioxidants because they both play roles in

different ways. And just being alive and functioning and going around your day today is going to increase oxidative stress, isn't it? Because it's a normal, it's like all these things you want it, as you say, it's a balance. You want that, but you want enough going on in your lifestyle to balance that out. Is that what we're saying? Yes, I think that's a good way to put it. And oxidative stress is something that our immune cells do when they're fighting an infection because they want to make our body's environment very hostile to the infection. So they produce all these kind of reactive oxygen species, like free radicals and stuff to try and fight off infections and make that environment hostile

and then you have the antioxidants going to quench that and bring things back to normal once you no longer need to be fighting the infection so is this why it's a good idea to eat antioxidant rich foods because it helps with this balance exactly and a lot of the minerals and vitamins in our diet are sort of co-factors in all of the processes that are involved in achieving this balance. And then you have all the kind of phytonutrients. So these are plant chemicals that are not considered in the recommended daily allowance. Like we don't have a sort of reference amount that you should be taking and has 20 odd thousand of them recorded so far. So they're kind of the things that plants use as their own defense system because they cannot run away when a little, you know, insect comes along and tries to bite it. So they'll produce their own little chemicals, phytochemicals that will try and make it hostile. And when we eat these, they help our own internal antioxidant systems and they also have their antioxidant properties themselves so that's why we should focus on like a plant-rich diet and most of these phytonutrients are found in the pigments of different plants so something

i do with my kids is that we talk about eating different colors and you know red fruits and vegetables we have leafy greens orange fruits and vegetables um yellow then even like the browns and whites like cauliflower and those kind of things um and the purples and the blacks you know the real that are found in berries and kind of trying to eat from a whole range of these foods rather than focusing on one particular phytonutrient like curcumin and turmeric so that's one that we commonly see in sort of wellness arena that people take um supplements of this and i think the most sort of basic thing that you should think about is that they work in concert like an orchestra so you don't want to isolate one particular phytonutrient or antioxidant and put

it in a pill and take it because you might actually be removing some of its power because it's not being consumed in situ of all the other phytonutrients and parts of your diet that help with that digestion and absorption so i think food first is what everyone should be thinking of when it comes to their immune system trying to get your nutrition from foods so that you're not deficient in any of the micronutrients which are the vitamins and minerals and then getting all these phytonutrients which are kind of like the icing on the cake to really umish our immune system. And they have their own natural antioxidant properties. Some of them are antimicrobial, antibacterial, anti-inflammatory, and they're often considered longevity compounds. So we know that we don't need a certain amount to be able to function, but we know that

over the course of a lifetime, they're very important for longevity. So, you know, food first seems really simple. And if you have a chronic condition or some underlying health problem, then you might, that might not be an approach that works for you. But I think that is the best thing that we can sort of aim for. I think that's a nice approach. It's saying, look, there may be some value in some supplements at some time, depending on your state of health, but let's get the basics right first. Let's focus on food first. And it's the pattern of your diet. It's the consistency. It's not what you ate this morning, but what did you eat all week? What did you eat all month? You know, maybe you had a few meals that were not the best but if the majority if the pattern overall is is strong then I think that's that's what you need to be looking at

rather than getting stressed about every meal being perfect yeah that's a very empowering message I think for people because you know we are living in stressful times people do sometimes struggle with energy or motivation to you know cook that perfect meal that they want to but your approach is saying look that's okay right don't beat yourself up yeah if now and again you have a meal that isn't let's say what you would ideally have okay fine maybe enjoy it you know exactly guilty about it yes but try to make most of your meals as much as possible yes exactly you know natural minimally processed foods i would like i think so one of the one of the tips you're saying is colors focus on different colors yep exactly rather than maxing out on one color you're saying

go for a variety and the other thing is you know, when you focus on food first, it's conveniently packaged up with other things that your body needs. And one of the key things that is often not linked to your immune system, but I'd say it's like massive for the resilience of your immune system is fiber. And potions and whatever are not full of fiber, but the fresh produce is full of fiber. And people might be thinking, why is fiber important for your immune system? Because your gut bugs, the microbiota at the interface of your digestion and the rest of your body are one of the key educators of the immune system. And again, this is something that's probably exploded in the field of immunology in the last 10-15 years if you do not so if you take an experimental animal model where the animals have a reduced or a minimal collection of good bacteria in their gut their immune system doesn't develop and they're very impaired in how they can respond and heal. And even things like, you know, protection from cancer because our immune system is the main cancer surveillance system.

So these bugs are helping to educate and teach and mature our immune system. And this happens potentially in utero before we're born but predominantly when we enter the world because we go from a relatively sterile there is some evidence that there may be some bugs in the placenta but we go into this hugely germy world and suddenly our immune system has to cope with that because you know it's um it's got all these receptors on it to to detect pathogens as being problematic so it has to learn to tolerate those because you know most of the bugs around us are safe and harmless and we need them because they're helping us and that's actually how the immune system develops isn't it it is by exposure to the environment around it to the

bugs around it to sort of give it that sort of ongoing education so it starts to learn oh i respond to this i don't need to respond to that exactly i often say that you know the immune system's made it's not born there's maybe a percentage in the genetics that we inherit but then it's made it's built throughout our life and it changes throughout our life so that's a lovely idea it's made not born we can we can build and we can sort of develop it the way we want to if we give it the right inputs yeah and i i often think about the inputs as a way to shape the immune system and I was trying I was working on a talk the other day and I was trying to make a slide of all the inputs

some that we can control some that we can't that are shaping our immune system from birth and then this became a really busy messy slide because there was too much to put on there but yeah a lot of it happens in childhood. And in some ways, I find that quite daunting as a mother. And you think, well, you know, there's sort of first three years, I would say, is when you're being colonized by all these good bacteria. And there's huge changes going on in the immune system during that time. And there's this sort of interaction happening. These bacteria, they help protect the gut barrier to keep it very nice and tight and stop any bacteria going into the body because they're only good bacteria if they're in the

right location. So they're not meant to cross over the gut and enter our body because then they become a problem. over the gut and enter our body because then they become a problem. But one of the biggest things that they're doing to help our immune system is they're eating our food. And I often think your diet's only as good as your microbiota in your gut because they are the interface. They're eating your food. They're helping you to produce these vitamins and minerals from your diet but they're also producing these post biotics and people might have heard of prebiotics and probiotics but post biotics are basically the metabolic waste of the bugs in your gut so they're producing stuff that is their kind of you know

waste product of eating your food like short chain fatty acids is the classic one i i used to work on these when i lived in switzerland um and looking at how they influence um inflammation in the gut and beyond so short chain fatty acids are kind of a metabolic byproduct of the the bugs in your gut and they directly bind to the immune cells at that site. And they help educate them and teach them to tolerate anything that you're throwing down your mouth, because we're not supposed to react to that, because it should be benign things that are going in there. But they have to help strike that balance that if you did get some kind of food poisoning, they also can identify the bad bugs.

So they help create an environment that's what we call tolerogenic. So it's encouraging tolerance of the food that you're eating. And there's a very kind of dynamic interaction between these bugs and the immune cells. And I'd say what happens in the gut is not just staying there. This influence, this sort of tolerogenic influence

of things like short-chain fatty acids is also being absorbed into your bloodstream and helping regulate the immune system at distal sites from the gut as well. It helps make T regulatory cells, doesn't it? Yes, exactly. I mean, you mentioned the term peacekeeper. I think the first time I read that, I think it was in a nature paper in 2014, I think. I think I used that in one of my slide decks. It's where it calls them our peacekeepers. Yeah. I think for the first time when I saw it in prints, which is kind of what they are really.

And I sort of, yeah. I mean, I really think a lot of people talk about gut health these days but i don't think people understand the immune system that's linked to it you know they think the gut is separate but i i often teach uh doctors about this triad between our diet our in uh our gut bugs and our immune system and how they all sort of cross talk oh definitely yeah there's bi-directional communication between you know diets and gut bugs system and how they all sort of cross talk oh definitely yeah there's bi-directional communication between you know diets and gut bugs diets and immune system and gut bugs and immune system together it's like this so you know if you if you make certain dietary choices you're

going to improve the health of your gut bugs which is going to improve the health of your immune system yes exactly just empowering right because we can do something about that yes exactly and i think as a nation we're not eating enough fiber and also fiber in the uk has a really bad like image problem i think like most people i think come on let's give it some pr yeah if i was to ask my husband what he thinks fiber is he's not in any kind of medical nutrition wellness field he'd um in fact the other day he came home with some crackers that said he's like look they say they've got added fiber and i was like okay because we kind of think of it as being like

you know those bread breakfast cereals like cardboard with the big fiber logo on it and um or fiber as being one thing but again it's the diversity different bugs need different forms of fiber and we find it in all the plant-based foods so it's not just the fruits and vegetables nuts and seeds legumes beans pulses and and whole grains and it's about trying to bring in the diversity i think in the last few years there's a publication about the sort of trying to get 30 different plant-based foods into your diet because it's per week yeah because it's about the diversity but also it's that includes i think lentils and nuts yeah you know and you know i think it's very achievable yeah once people have it in their mind exactly yeah to do

it and they're very common in in traditional diets i remember growing up you know my mom would would add lots of different um grains and beans and pulses to spin things out as she put it so that you could make a dish go a lot further and so now that's something that i do as well yeah wonderful advice um so far, we've said that lots of different colours, lots of different diversity of plants is going to help your gut microbiome, it's going to help your immune system. Eating less is also something that might be helpful, right? Yeah. helpful, right? Yeah. Just taking a quick break to give a shout out to AG1, one of the sponsors of today's show. Now, if you're looking for something at this time of year to kickstart

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our diet so the protein carbohydrate and fats into energy and building blocks that our cells can use and people might hear things about metabolic rate or i've got a good metabolism these kind of things that people say um and you know metabolism and the immune system are really intimately entwined and i don't know why it's taken us so long to figure that out because immune responses are energetically very costly you know there has to be sort of triaging of resources to be like right we're going to fight this infection and turn on all the inflammation turn on all the antibody producing and all those molecules that are being produced and the proliferation of immune cells that takes a lot of resources so it

needs energy it needs building blocks is this why we feel tired when we're fighting an infection because the body's diverting resource yes to making all that stuff exactly and you might find that you need to kind of build yourself back up again after you've been sick um particularly if you've been sick for quite a long time or if you have an ongoing illness your nutritional needs might be very different from somebody who doesn't have that. So immunometabolism is the field that's trying to understand how metabolism can shape immune responses and vice versa. So this happens at the level of the individual immune cell, but also can happen in the environment of a tissue and an environment of our whole body.

And this is something that there's not really any kind of absolute concrete understanding yet in this area. But we know that when an immune cell is fighting an infection, it goes through a metabolic switch. And it goes from being in this kind of resting state to suddenly sucking up lots more glucose

to fuel proliferation. The immune cells are making armies of themselves. Building antibodies requires, you know, the building blocks of proteins. All of this kind of thing is happening. And that metabolic switch is known as the warburg effect this is also what's happening to cancer cells but immune cells do this when and it's perfectly normal when they're fighting an infection or fighting any kind of um problem and then it's switched back off and the

immune cells go back to normal and they're they don't have this huge need for metabolites anymore. But what people are starting to wonder is, can the overall environment of a body influence the metabolic switches inside our immune cells and switch them on aberrantly when they're not needed? So we know that diabetics with poorly controlled blood sugar, so they have elevated blood sugar in their body, this creates an environment that causes some of our immune cells like neutrophils to not work so well. So it affects, so immune cells have nutrient sensing switches inside them, so they can sense

what nutrients are available. And they're taking in that information and then that affects how they can work. Now, what is not known is can we feed someone different macronutrients, proteins, carbs, or fats, and influence how their immune system is working? So can you switch unwanted immune responses off or on based on the different macronutrients that your body's metabolizing. I think this is where the field of immunology is going to be headed in terms of treating chronic diseases. Because we know that people with chronic diseases like metabolic syndrome, type 2 diabetes, heart disease, or people who are carrying too much visceral fat that the whole environment of their bodies is metabolically different and this might be causing the immune cells to act abnormally and

become more pro-inflammatory for example wow super interesting yeah a lot of research to come in that area exactly and i think we just don't know enough to say specifics yet but i think that's you know for so long we've been focused on the micronutrients but actually it's the macronutrients so you could adjust someone's diet give them different proportions of protein fat and carb to maybe alter their metabolism and alter immune cells that were going wrong so somebody who had a chronic inflammatory disease we could kind of steer that around it's incredibly exciting isn't it on the other side of it what you said about eating less um another thing that i bring up in the book because i wanted to

get people away from just thinking about you know a vitamin supplement for their immune system is that the immune function is impacted by overnutrition and undernutrition. So if you're not eating enough, or you're eating too much, this is going to send your immune system awry. And I should context that by saying, if you're doing that consistently. And then we have this field of research coming out about fasting and immune function. and I remember being at conferences decades ago and they were talking about fasting and how it would regenerate all sorts of parts of the body it was kind of mind-blowing and now we kind of see it more in the mainstream and we

have all these kind of forms of different diets and this again is causing metabolic switches in the body that then when you go on to refeed after someone has had a period without food you get increasing in growth hormone you get production of fresh new immune cells from the bone marrow um and the stress of the lack of eating kind of causes some of the older immune cells and ones that might be more likely to malfunction to be deleted so you're kind of replenishing your immune system and we start to see in experimental models of autoimmune disease that this is you know highly therapeutic yeah it's fascinating that it's not necessarily just what we're eating it's how much or how little it's are we fasting are we not fasting all these kind of different components that all play I guess they all play a role in the signals the

body is receiving because I guess that's all it is isn't it the immune system is trying to interpret the signals and sort of going okay what does that mean is it is it sort of safe or is it unsafe do I need to take action yes or can i just stay calm exactly everything we do even our thoughts our words our sleep our stress they're all giving a signal in some ways our immune system exactly is do i need to respond or is it okay exactly yeah it's always yeah it's that simple isn't it at its core yes yeah yeah it's it's this decision making that's ongoing and constant and integrating all these different inputs to decide and i think the thing with the sort of so-called western diet that that you know we talk about as being having a negative impact on our health.

It's just really tasty. And we just want to eat it all the time. It's salty, it's sweet, it's delicious. It's everywhere. We can quickly override any lack of hunger cues just to eat. We kind of pathologize being hungry. It's like you're not ever allowed to be hungry. You have to have 10 snacks in your bag in case you might not be able to reach some food. And then we have millions of incidences of eating across a huge portion of our waking time. And part of the research I was involved in several

years ago was looking at postprandial inflammation. So when we eat, there's an inflammation, a subtle inflammation that happens in the body. And this is quite normal. We have plenty of checks and balances in place to keep that in check. And actually dietary fiber is one of the best ways to kind of seal that up again and prevent that from happening, as is having a period of time without food in between meals. So eating enough and the right things at one meal that you do not need to eat then till the next meal is actually quite good for overall gut health, but the whole body health. I'm sort of super fascinated by this research as well. And, you know, not only do many of us eat too much, we eat too often in the day. And as you just said there, you know, the act of eating is inflammatory so that's a response to eating is that your body will become inflamed as you say nothing to worry about it's sort of that's part of the process but i guess you know and you know i know uh sachin panda's done a lot of look at this professor panda um and i think when when he started his app

in 2015 i think it's called my circadian clock i i can't remember the figures off hands but it's something like 20 30 years ago most people were eating three times a day in the us i think you can probably infer in the uk as well and And then in 2015, when he was measuring and people were inputting into the app, I think the top 10% of people were eating 15 times a day. And it was, you know, so that, if you think about that, let's say I'm eating 15 times a day. And let's say in theory, it is all whole food right it's all nice uh health what

what is considered yeah you've got to be careful with the language but what is considered sort of helpful foods for our health you do have to ask the question is eating them 15 times a day helpful that's that's like 15 bouts of inflammation whereas if you had the same sort of food over you know it's not a perfect analogy but three times a day over five days you're still getting 15 bouts of inflammation but that's over the whole week yeah as opposed to in just one day and i i really do think societally culturally there's a problem with how much we're being encouraged to eat even healthy foods like you can buy healthy snacks here and healthy snacks there but you're you're sort of

inflaming yourself each time and i don't know what would you make of that yeah no i think that's a real uh issue i think it's not well enough understood in the scientific community to really translate into a kind of clear health message for people but from the research i was involved in and from work like what sachin panda has done and others i definitely think we need to look at the incidence of eating as well as um you know the the stretch of time that we're eating. I think some of the studies show that we're spending 18 hours a day eating. It's just like the whole time we're awake. And I don't think that we are designed to cope with that on a long-term consistent basis. You know, going back to the traditional diets, you know, my grandparents weren't eating all day, every day um because that just wasn't how it was

constructed in different cultures or eat in different ways but certainly it's not common to eat all the time and i i want to fuse the tradition with the modern life somehow because i think that's the key that we need we can't go back to times gone by but we can bring bits that we've left behind and kind of integrate it into what we have to work with right now somehow when i i find a very effective and powerful recommendation i use in my patients is uh to try not to eat for 12 hours and every 24 hours so uh you know basically eating all your food within a 12 hour window uh which you know really was the norm for pretty much yeah everyone maybe 30 40 years ago i mean yeah you know we we might stop eating at 8 p.m and maybe we wouldn't have breakfast till

late i mean i'm not talking about an extreme fast i'm just saying i said i think it's quite i certainly know when i uh managed to stick to that consistently, I sleep better, I feel more energetic. And I think there really is this idea that, you know, you need time for the body to regenerate a little bit. If your gut is constantly having to use up energy to constantly digest food,

that's going to impact your immune system. It's going to impact, you know, the resource it has for something else right yes exactly there's um you know the the gut lining as well there's a kind of um uh it's energetically costly because it's there's a turnover of those cells quite regularly and things like the short-chain fatty acids we mentioned earlier that are produced when our gut bugs digest fiber they are really nurturing to the growth of and repair of the cells that line the gut barrier. And those are kind of the interface cells between what's going on in the gut and what's being put in the bloodstream that could

exacerbate that inflammation. And we know that certain things like saturated fats, high fructose diets, fiber-poor diets, as well as other things like stress and extreme exercise can alter the integrity of that gut barrier and exacerbate this sort of inflammation that you see postprandially. And I know that some of the work that Tim Spector recently published looked at postprandial inflammation and looked at also people's microbiomes and found that the same food did vastly different things in

different people which is why we have to kind of have a bit of intuition of our own bodies and how we're feeling how do we feel after we eat and not you know just be eating something because our friends are eating it. I know we have our kind of eat well guide and the public health messages, which are kind of good to give the whole population a safety net against certain diseases. But I guess we don't all have access to personalized nutrition, but we all have a very personal response to food. And we can't just say

don't eat that because that's inflammatory it might be in you and it might be not the same in me yeah it's it's you know as an ideology like these public health guides it's tricky actually because i get what you're saying i get what the idea is to give a bit of a safety net. And I guess the way I sort of feel more these days is, have we sort of disempowered individuals by doing that? Sort of by saying, this is the way one should eat. When it's kind of, it's always been passed down, hasn't it? From, you know, parents to child, from grandparents to grandchild. It's like, this is how you eat and you know I'm not expecting an answer from you appreciate you know you're a lecturer and you may not wish to get drawn into this but I'm just sort of sharing my perspective is I sort of get that but I think

we've lost touch with ourselves like definitely I think you know the conversation I had this morning here was with someone called Pippa Grange, who is an amazing psychologist. She works with the England football team. She's, you know, all kinds of high powered business. But we were really talking about kind of intuition, but spending time understanding yourself and really sitting with how you feel. So making that relevant to what we're talking about, this idea that trying to tap into, oh, when I eat this sort of meal, oh, I've got more energy. I sleep better. My gut feels better. I actually personally think, and this is probably different from 10 years ago as a doctor, probably evolved the more patients I see, but I sort of feel that's I think where the power lies for people is

to yeah get a bit of guidance understand some principles but then sort of within those principles kind of figure it out for yourself like experiment and see how you feel there's no there's no better tool than actually figuring out yourself hey when I eat that I get bloated afterwards I don't sleep well but when I don't have that or I have this I feel fine I think that is very powerful but I think half the problem is with many people are too busy to actually tune into how they're feeling definitely I think that's something I've learned as I've got older but I can definitely see how there was points in my life when I was too busy to really yeah you know and I I'd be eating on the go years ago when I lived in London

and that just became really normal. And I remember speaking to my great-grandmother and she was like, in our day, it was, you know, it was unheard of to eat and be on the bus or be walking around. You sat down to eat and she was outraged by all the young people eating on the go and just kind of got a point because now i just avoid eating on the go because i i don't like how i feel you know as rushed and i'm not really chewing my food properly it's mindless eating it's not a very nice environment sitting on a bus or somewhere i just wait till i get to the other end and given that's not always possible but i think we have become you know we definitely pathologized feeling hungry like yeah most of us are not going to

keel over we don't snack in between our next meal or maybe maybe you might keel over because your blood sugar balance has kind of gone awry because you've exactly because you're metabolically sort of i don't like the term broken so much but because there's there's some sort of yeah dysfunction there metabolically that we can hopefully fix but that may be why you need to eat every two hours yes yeah maybe if the the metabolism is working more obviously you wouldn't need to you need a nudge gently back to the right position but we embark on these really extreme diet changes overnight and then we feel awful for days and then we go back to how it was because

it's you know we just need little gentle nudges really well let's get some more practical things um i think you've really helped people understand the immune system how important it is so food so far it's been potentially think about how often you're eating how much you're eating how you're eating but also this diversity you did mention saturated fats um let's just quickly go through the macronutrients then like yeah because there was a really nice bit in the book about protein and immunity which i found really interesting um but saturated fat is is a very hot topic of conversation and uh how can i put it the twitter diet wars yes definitely you're clear

i do these days i'm just like okay i'm over it really i don't find it particularly helpful um but also when we talk about saturated fat there's so many different types of saturated fat it gets quite a nuanced discussion but i wonder if you could let's talk about protein maybe we can talk about fats and carbs and actually yeah how you see them impact in the immune system exactly so i think carbs is the quality and the quantity so these are where we're getting the fiber to feed our microbiota so So thinking of that diverse colorful produce that we're trying to eat 30 different plant foods and over the course of a week. Carbohydrates are fueling our immune responses. And then protein, I think protein malnutrition is probably globally one of the

biggest factors that has a negative impact on our immune system because it's it's protein breaks down into amino acids and these are the building blocks to make so many other proteins in our bodies and the immune system is a huge sink for that because it needs you know antibodies are made from protein so we need protein for the fabric of our immune system exactly yeah and i think you know that's probably one of the key things as i said globally that impacts our immunity uh what's sort of less understood is which particular amino acids these building blocks of proteins are more or less important for different aspects of the immune system and i think that's something we'll see coming out in

the next few years under this kind of immunometabolism field um i think you beautifully addressed animal versus plants uh in the book where you said you know animal proteins are typically more complete yeah but plant-based proteins a lot of cultures have actually learned how to combine them yeah to give you that completeness and i thought that was very inclusive in a very empowering way because people you know people these days are choosing to eat in very different ways and of course choosing how you eat is a very modern it's quite a privileged phenomenon in the first place to be able to choose exactly which to follow yeah um but i thought it was really nice how you did that yeah what are some of those examples of combining so i think um i think rice and beans

yeah and you find these in sort of different uh cultural diets as well and the complete proteins the complete proteins are the ones that contain all of the amino acids that are considered essential we cannot make them ourself and then there's certain amino acids that we can make ourself and there's some that are conditionally essential so in certain situations they become essential so most animal products tend to um you know generally speaking contain all the essential ones whereas most plant products tend to only contain some or other of them but you can piece them together and i think anyone who's switching out all animal products for plant-based protein sources should really

make sure they get some sort of nutritional advice to ensure that they're not lacking in any of these amino acids and study traditional diets i guess or traditional cultures there is a lot of kind of ancestral wisdom there that we've known as humans before that yeah we've sort of forgotten maybe it's the human condition you know like when our parents try and tell us stuff and we're like no we'll do it anyway um and then we're like oh yes they were right that's what they were trying to tell us yeah i think we all know that exactly yeah So what's the deal with fats then? So fats, I think for a long time, we kind of thought of fat as one thing,

but it's not. It's lots of different things. There's the unsaturated fats. So there's the mono and the polyunsaturated fats. So olive oil is probably the best example of a mono unsaturated fat. And there's lots of epidemiological research around why it's important for health. And it has lots of these phytonutrients that I mentioned earlier included in it. And my own personal bias because of my hybrid Italian family is like, you know,

olive oil is life. So it's all that I use. And yeah, hold my hands up to that um so it's it's something that's um really important to include uh in your diet i think people get afraid of cooking with olive oil but it's for the short-term sort of home cooking it's been shown to be stabilized by the presence of these phytonutrients so it's it's a good healthful oil to use. And, you know, people have been using it for millennia and it's associated with some of the most healthful diets in the world, like the Mediterranean region. Then the polyunsaturated fats are kind of interesting because you have the omega-3 and the omega-6. So some people might be familiar with these. Omega-3 supplements are quite popular now. And I would say if you're not eating oily fish,

then you should really think about an omega-3 supplement because they're making up the cell membranes of our cells, but their immune system is using these as a resource to produce different molecules that it uses to do its job. And this includes production of inflammation, but also resolution of inflammation. And resolution of inflammation was something that was really neglected in the field for a long time. It's only maybe 10 years ago that we started to understand, oh, it's an active process. Inflammation just doesn't go away by itself. Simply the act of having inflammation in the body, having the presence of certain inflammatory cell types causes the switch to the next phase cell membrane to produce pro-resolving molecules that help dampen down this and and heal and repair the the body that is super fascinating so

you know we were saying at the start that inflammation is a normal process you know it's but it's it's meant to be short-lived so it's meant to be there to help you fight something like a broken ankle, sorry, sprained ankle, you don't get red, hot, swollen for a few days and then it resolves. The chronic inflammation, the chronic unresolved inflammation that's behind type 2 diabetes,

high blood pressure, a lot of cases of depression, all kinds of autoimmune diseases is a sort of chronic unresolved inflammation and you're saying that omega-3s help to resolve inflammation yes which is which is you know it's quite nice actually be able to draw a direct sort of thing so oh that's going to help me you know in colloquial terms switch it off i guess to a certain degree and you have to also consider

whatever stimulating the inflammation in the first place needs to be somehow removed or contained as well there's a lot of studies in things like heart disease depression i think probably um rheumatoid arthritis is one that springs to mind because there's you know dozens of um clinical trials now that show that high doses of omega-3 is really beneficial to the overall um patient's quality of life and you know their pain and disease management but yet the NICE guidelines are still not suggesting that we treat people with this it It's still that they're welcome to explore something like a Mediterranean diet. So for me, rheumatoid arthritis is the one that holds the strongest evidence, but it's just challenging to get that into clinical practice, I think.

There's also things like allergies where omega-3s, the evidence is really quite mixed, but we have a sort of picture appearing where what the mother is eating when she's pregnant and the fish, which is a great source of omega-3s, is really important to help prevent allergies in the unborn child. So again, not a really strong clinical message yet, but I think that's something that we're going to see coming out in the next few years yeah and i think you know this is one of the big problems at the moment is with how information is communicated um we can easily get overexcited by certain things but at the same time i also think we put the brakes on a lot of things as well of course we often need more evidence but i also think sometimes with some things when the risk of harm is low we should really be starting to think about well look

and when you when for example we say mixed evidence that implies well some evidence is suggesting it may work and some are suggesting it's not so it could be that in certain populations it works brilliantly exactly and in other populations it doesn't work at all but no we're going to have a global recommendation that you don't do it because we don't have the evidence yeah i just don't think it's i really think we need to think about a better way sometimes to communicate some of this with the public it's really hard especially you know the thing with pregnant women and and fish because there's mixed messages about how much fish pregnant women should mercury because of

mercury but yet we we're starting to see a picture where having omega-3s are really important during pregnancy but pregnant women might decide to not eat fish at all during pregnancy rather than the kind of gray area of you're allowed so many portions, but not this fish and only so many times a week. And in which case, then maybe a supplement would be suitable, but that's not, again, it's very difficult to communicate this kind of information into very clear public health messages. In terms of saturated fats, you have written about this in the book. I think you cover it really well um as i say there's lots of different kinds of saturated fats and i think sometimes i

find it confusing in the literature as to it's a specific type or they often it's an animal study with a high sucrose high saturated fat diet so you can one might be confusing sort of the high sugar and the high fat diet combination and i sort of think some people seem to be okay with a little bit of saturated fat in the context of a natural sort of more traditional diet and i think that's where and as you yourself said at the start it's very hard when we just go to individual yeah nutrients and try and say good or bad exactly it's kind of a lot more nuanced yeah before we get back to this week's episode i just wanted to let you know that i am doing my very first national uk theater tour i am planning a really special evening where I share how you can break free from

the habits that are holding you back and make meaningful changes in your life that truly last. It is called the Thrive Tour. Be the architect of your health and happiness. So many people tell me that health feels really complicated, but it really doesn't need to be. In my live event, I'm going to simplify health and together we're going to learn the skill of happiness, the secrets to optimal health, how to break free from the habits that are holding you back in your life, and I'm going to teach you how to make changes that actually last. Sound good? All you have to do is go to drchatterjee.com forward slash tour and I can't wait to see you there.

This episode is also brought to you by the Three Question Journal, the journal that I designed and created in partnership with Intelligent Change. Now journaling is something that I've been recommending to my patients for years. It can help improve sleep, lead to better decision making and reduce symptoms of anxiety and depression. It's also been shown to decrease emotional stress, make it easier to turn new behaviours into long-term habits and improve our relationships. There are of course many different ways to journal and as with most things it's important that you find the method that works best for you. One method that you may want to consider is the one that I outline

in the three question journal. In it you will find a really simple and structured way of answering the three most impactful questions I believe that we can all ask ourselves every morning and every evening. Answering these questions will take you less than five minutes, but the practice of answering them regularly will be transformative. Since the journal was published in January, I have received hundreds of messages from people telling me how much it has helped them and how much more in control of their lives they now feel.

Now, if you already have a journal or you don't actually want to buy a journal, that is completely fine. I go through in detail all of the questions within the three-question journal completely free on episode 413 of this podcast. But if you are keen to check it out, all you have to do is go to drchatterjee.com forward slash journal or click on the link in your podcast app so we do know that saturated fat can be something that causes the gut barrier to open up

can be something that causes the gut barrier to open up more than other foods. And that in itself can cause this transient post-eating inflammation. But we also know that eating it in the context of a fiber-rich diet is going to kind of counterbalance that. And I think no food is just 100% saturated fat. Every food has a mix of different nutrients. So we're not just eating saturated fat every food has a mix of different nutrients so we're not just eating saturated fat on its own um but you can eat foods that are higher or lower in saturated fat and for some people it may be beneficial to eat a lower saturated fat diet for other healthy people maybe

it's not even something that needs to be on your radar because your overall pattern yeah is quite balanced and then it also comes down to doesn't it like what's your current state of health so if you have for whatever reason had a lot of insults to your body whether it's stress poor diets inadequate movement insomnia maybe you work night shifts for 20 years or whatever maybe at that point maybe the gut is a little bit more leaky than um than we would call physiological or normal or optimal maybe in that context foods can start to become problematic on the background of that compared to someone who's got their their health and their microbiome yeah in a completely different states yeah exactly i've really i so strongly feel that that nuance is getting lost in health communication i really think it gets lost on social media a lot of the

time where things have become black and white and it's like and i don't know i i i am heavily influenced by my experience as a clinician seeing patients i've just realized that it's very hard to say one thing for sure that is applicable in every single situation yeah yeah and i guess that's where you know we're not going to be able to deliver personalized diets to everyone but we can help sort of nurture intuition and yeah and steer people towards the helpful i i thought for you to be a very small part of this discussion we spent a long time on food so i think overall pattern lots of diversity yeah um you know we've covered a few things there uh depending how long we've got i'd love to talk about stress emotions um the idea of hormesis hot stress cold stress these are really interesting so

um i mean i don't know which one do you want to go yeah i don't know i mean i guess i start by saying i'm a natural stress head i don't know why, but I get stressed very easily by things that I probably shouldn't. I think my husband's opposite end of the spectrum. So sometimes he's like, why is she getting so worried about things that she doesn't need to worry about? So it's always on my radar because I know that if I let it run away with me, I will start to feel the detrimental effects of stress. In one way? I think the biggest example was the time I gave myself pneumonia, which is kind of embarrassing, but I was very stressed. I wasn't someone who grew up understanding what boundaries were.

isn't someone who grew up understanding what boundaries were maybe that was my generation but I'm I'm someone who like I enjoy what I do so I get excited about projects I take on everything I say yes to everything so like that sounds amazing that sounds amazing then I have to realize I have job I have kids I have to have downtime I need to spend time with family and friends you know all the other life admin and life load that comes with it. And it was a couple of years ago I got a cold. My husband got the cold as well. My son got the cold. My daughter didn't, which probably could have another tangent about why, even though we're all coughing on her.

And they got better. And I took no time off. And they got better and I took no time off. I was working every evening to finish deadlines on various projects. And I wasn't sleeping well because I was going to bed a bit wired from working and not able to switch off my brain and thinking about what I had to get done tomorrow because I had other deadlines and other things. And I'm going to work and I had this awful hacking cough. This is pre-COVID, so definitely wasn't COVID.

And I was starting to hide it from my colleagues and my family. I was trying to pretend that I was fine. I was just feeling awful. My chest was rattling and then I just couldn't get out of bed one day and I couldn't take care of my kids. I feel quite emotional talking about it, actually, because I was just there.

I just literally, I've never had the sort of bone rattling, chesty cough, fever. And I was in bed for three weeks. And, you know, all of those deadlines, my job, my kids, I couldn't do any of it. And I just ignored a cold and I kept on going anyway. And I was so stressed. And I didn't stop and recognize that I was stressed. And the trickle down effect it was having on all the other behaviors that I was engaging in, like my sleep and everything. And that was, you know.

I mean, a very powerful story. And thank you for opening up and sharing it. I can it's so yeah it's very emotional um so that's your immune system getting completely flawed so what's going on there i mean let's break that down you were overworked overstressed not sleeping well and all those things are impacting your immune system yeah so what what is going on i think that one of the most interesting things was i was probably eating pretty well because i love cooking and it's part of my thing that i i enjoy doing so that in itself is just evidence that even if you have the best diet in the world know, other things can erode away at your immune system and leave you open. And stress is probably the one thing I know that is something that you've written about a lot.

And it's the one thing that we don't take seriously. We think of it as being psychological and the causes can be psychological. They can be physical, they can be psychological they can be physical they can be emotional but they're always biological because stress chemistry is real the things that are being produced in our body that give us that stress response um that is having a really real impact on our body and I've come to really start to think about how I can make stress a positive in my life because ultimately it's the thing that gets us out of bed in the morning it gives us to get up and go to go and do things um and what I've been learning about my own journey is when you reflect on events you describe them as stressful if they were negative but you describe them as something else if they worked out you know well for you so as a society we we think of stress as being um a negative thing but if you uh there's

experiments that have been done where they take groups of students before presentation and they're being told to recite kind of positive affirmations or or negative affirmations about what they're about to do and this has a huge impact on their stress chemistry but also there's a trickle-down effect on your immune system because stress is you know designed to save your life so you're about to be hit by a bus you're going to run for your life you're you're you know within seconds you're switching on that um adrenaline response to mobilize you to safety then we have cortisol one of the key stress hormones that's going to keep you running keep you going it's going to pump glucose into your bloodstream so you've got instant energy to to go and take yourself from safety that's all energetically costly and that's saying well you've got a cold

but we're going to stop fighting the cold right now because we need to save your life so turn off the immune system and turn on all the other stuff that needs to save your life so cortisol um is is sort of like the off switch for protecting ourselves and then it really dampens our immune system and that's okay if it's for you know a series of hours but when it's hours and days and months and over the it's for you know a series of hours but when it's hours and days and months and over the long term then you're constantly kind of running running on empty yeah it's i mean i'm glad you shared your story and i'm glad you're making a point to this because i think in health and wellness in general there is you know i'm a big fan that food is important i think there

is far too much focus on foods at the expense of other factors as well and many people frankly their diet is good enough and trying to make a five percent improvement in their diet they're much better off trying to address their stress levels or their sleep quality getting it getting an extra half an hour sleep a night yeah it's probably going to do them more good than tweaking their diet by an extra five percent exactly and i really think we've got the balance wrong and i think that's also because the way we talk about stress and how we see it in society and our food you can see that it's on your plates right you can see food you can see the choice exactly but you know you mentioned that i mean that was a pneumonia i'm you know my dad who who i spent 15 years caring for dad when he was you know he was a uh he was a he was a

consultant doctor in this country um but he you know he worked stupid hours right he had a he did two jobs he had a full-time job as a consultant he also worked nights four days a week in another sort of medical job so for 30 years my dad only sat three nights a week which and you know when dad was I think in his sort of mid to late 50s he suddenly got unwell he'd never been unwell before and boom all our lives changed he came down with l, kidney failure, and then that was 15 years of dialysis. That was me moving back to the Northwest. It's really impacted my whole adult life. And I now, the more I delve into research and the impacts of stress on your immune system, the impacts of sleep deprivation on your immune system, but also emotions and things like anger and pent up stuff. I'm like, well, of course my dad got

lupus. Right. And someone might say to me, oh, you can't prove that. Okay, sure. But I don't need to, like in my head, I don't have to prove that to anyone. I know looking at my dad's life, that that sort of lifestyle, and I love my dad, I love what he's done for the family right so I understand he was doing what he felt he had to do to give us a great life and he has but it came at a cost and as you said before there is a cost to the immune system doing what it does there was a cost and I think in my dad's cost chronic stress chronic insomnia I am convinced led to his lupus yeah um now and there's so many anecdotes that i hear all the time of people saying there was a stressful event or there was something that happened or i lost a partner or you know and and that was a turning point in my health started to

decline and nothing else changed but the stress i i do a timeline with my patients right and and i can tell you when people come down with an autoimmune illness when you go back into the whole history and again i'm skewed by my patient populations this may not be applicable to everyone but in my patient population when i do a timeline it is amazing how many times within six months of them getting symptoms some significant life stressor happened could have been a lost job bereavement breakup it's almost like stress can sometimes not only be a contributor sometimes it can be the trigger trigger yeah everything else was waiting there and it has all the the trickle-down effects as well when i'm stressed like i said before i wasn't sleeping

very well because there's a trickle-down effect and you're more likely to engage in negative behaviors so most people when they're stressed they might say oh i'm just eating really badly because i'm stressed it's a major kind of driver of um you know these negative behaviors that are then you're in a sort of vicious cycle of things and at the moment people are beating themselves up that they put on weight during this pandemic and i really want to sort of say with heartfelt compassion to people you really don't have to because um that there's a study from about 10 years ago which showed that you know maybe 80% of us change our eating behavior in response to stress and it's

roughly I think it's roughly 45% of us eat more and 35% of us eat less yeah I could imagine that I've got friends who say when I'm stressed I can't eat yeah and then there's other people who eat too much is the way yeah so of course in one of the most stressful months, you know, a few months, and certainly my lifetime and many people's lifetimes, well, of course, there's going to be a certain population who are wired to use food to soothe their stress. Yeah. I know I've heard you talk about before that stress impacts the microbiome, the gut bugs, but it also impacts the stress the cortisol receptor

doesn't say it's yes yeah it's kind of like you're you're constantly revving your engine but you've got your foot on the brake at the same time and it's you know we have ways and means of switching off the stress response but that circuit gets worn out a little bit when it's constantly at play and everything just starts to get off balance from then. And because, you know, our immune cells have receptors for all of the different hormones, stress chemistry, they're being influenced by that as well. It's influencing the production of fresh new immune cells from the bone marrow. So things like cortisol can have a sort of dampening effect on that. And there's this concept of the immunological space. I'm not sure if you've heard of this, but we only have so much space in our body for immune cells. And over your lifespan,

your immune cells proliferate when we see an infection, or we sort of gather up more and more immune cells until it becomes full. And we kind of have to wait for the old ones to die off before our body can produce fresh new ones. And older immune cells are more likely to go wrong. So we need to have a way of getting rid of the old ones and bringing in the new ones. And so this kind of balance can be really interrupted by being stressed out all the

time is there anything you do yourself having experienced the negatives of burning the candle at both ends you're really trying to say yes to everyone and do everything the hardest lesson yeah getting pneumonia yeah when you couldn't do anything. What have you, as an immunologist yourself, but also as a human who's susceptible to the same pressures as all of us, what have you changed? I've tried to be a bit more open because I hate seeing in the wellness sphere people looking like their life is perfect. And I just think we all get it wrong.

Even, you know, my colleagues were like, how on earth do you end up letting yourself get pneumonia? Like, it's so stupid. Even though I'm like, what is that, letting yourself? Like, come on, you should know better. I went on a bit of a journey to just look at what helps stress. And some, I obviously went into the research, first of all, just being a scientist. And what I found was, you know, there's sort of cultural aspects to our immune

system and what I mean by that is you know um I was writing about this the other day like the act of writing stuff down like disclosing stressful events or traumatic events is is seen as being very cathartic and good for our health but what we don't realize is this is through a sort of Western perspective. And in some cultures, writing is actually more stressful because it becomes visual on the page. Somebody might read it, even if you know it's private, and that can be more stressful. And it can alter the stress chemistry, can also alter things like their immune cells and how well they're working and how many colds and flus they're likely to pick up that year. So when I think about the current pandemic and how we know that certain populations are more susceptible to severe COVID, so the black and minority ethnic groups, and instantly we try and

look at the biology of why is that and then we realize that it could be cultural things the stress of um not having you know living up to sort of cultural norms of how you live your lifestyle or not having the cultural norms of how you relieve your stress or what a support network looks like it can be quite stressful for people. That is one of the most interesting things I've heard, Janet. It's like, you know, I'm a huge fan of journaling. I think journaling can help so many people.

But if you're journaling and you're worried that someone's going to see what you've written, well, that's a whole different experience. Yeah. And what's interesting is you're saying that your immune system senses that and alters what it does based upon that perception. Exactly. Which is kind of mind-blowing, isn't it? It's mind-blowing, but then it also, it can either be frustrating for people or empowering

because it basically means everything we do, the thoughts we think, the emotions we feel yeah and you've got this lovely bit i think i've probably got it open here you know as above so below emotional roots of disease and it's page 160 of your book like i really like what you put there and how um you know you know and you you sort of say much of the medical community remains skeptical yeah but there's piling evidence that virtually every ill from the common cold to cancer and heart disease is influenced positively or negatively by a person's emotional and mental states and you're saying we can no longer ignore this connection it's just the hardest thing to study because you know it's subjective it's it's fuzzy it's it's it's not any of that hard

but if you ask any like the the experienced clinicians who i'm friend with friends with um we all get it because we've seen it now i get there's a there's often a disconnect between what we see clinically and what we're able to study and quantify yeah but i gotta tell you you know you see this all the time and you sort of you summarize i think what was what was the quote it's far more important to know what person that is it what what person the disease what was the quote yes so it's more important to know what person the disease has and what disease the person has so it's kind of who is the person first and foremost and there's a really interesting yeah yeah there's a really interesting study that um it looked at

sort of these five major personality types so they are kind of roughly divided into like openness to experience conscientiousness extrovertedness agreeableness and neuroticism so in psychology terms are kind of ways that we can be categorized based on our personality and each of these personality types have specific immunological features and one of the most interesting thing is that um some of them are more likely to be pro-inflammatory and have higher levels of c-reactive protein which is a marker in the blood for for inflammation um and things like being neurotic and um being uh sort of less introverted it can affect the inflammation in our body it's because i guess we're all very different. We're all on a sort of spectrum of different personalities, but that's evolved from maybe different roles you might play within a community.

is known to prime the body for becoming damaged because maybe anger preceded violence. And throughout our evolution, we've like, okay, if you're angry, something might happen that might damage you. So we need to prime parts of our immune system to prepare for that. You know, you mentioned anger and it's something I wrote about,

I feel, in version five is the importance of forgiveness. There is good research on forgiveness. A guy called Fred Luskin's done the stanford university i think forgiveness trial or research that i can't remember the exact name yeah his research is incredible and i i shared in my last story about one of my patients who had high blood pressure and which, you know, to make it relevant to our conversation, you know, high blood pressure is a chronic, non-communicable illness that, you know, will have chronic inflammation playing a role in some way. And you know what? She had changed her lifestyle. I was, you know, I was doing this stuff. I try and talk about food and movement and sleep you know what it wasn't budging and it

was to do with um you know basically her um her husband of many years had cheated on her and they had split up and it was only once she started practicing forgiveness right that her blood pressure started going down it was incredible and so that's a look that's an anecdotal story from my clinic but it really i think it does stand uh firm and consistent with the research that is out there in terms of if you're holding on to resentment and anger that will influence your biology and your immune system exactly and maybe that is culturally what we see dividing different groups and how they deal with illness as well because they may feel marginalized i think social status is also really important i know that in the animal kingdom being lower down the pecking order can be quite stressful for an animal and that can be seen in its its blood chemistry but also for us

humans um and i think that's you know something that we see playing out with the sort of lower socioeconomic um demographics are worse hit by some of these lifestyle related diseases yeah they may have more stressful lifestyles and but we always we put it down don't we to oh less access to good food more stress and of course i think those play a role but what if it's also related to status as it is in the animal kingdom what you know that's something i hadn't probably given as much thought to, and it's probably not as common a narrative. It's where do you, I guess it's, you know, in many ways, it's do you feel your life has purpose? Yeah.

Do you know, how do you see your life? What's the meaning behind it? Because that as well in itself has a huge amount of research suggesting, you know, if you feel your life has meaning and value, you tend to have a happier and healthier life yeah i mean another piece of research that came across recently was comparing um samoan individuals to european individuals with um epstein-barr virus which is a virus that almost all of us harbor but when we activate our stress chemistry um this can be actually a sign that the virus uses to allow itself to reactivate and and cause problems and we know in the western culture that being of a lower socioeconomic status means that you're more likely to experience

viral reactivation but in the Samoan culture um being on a lower socioeconomic status has a totally different impact on the stress chemistry that actually meant it was the people in the higher socioeconomic bracket that were worst affected by latent viral reactivation. And this is just, you know, they used the viral reactivation as a readout, an empirical way of measuring the immune system changes. But in different cultures, you know you and we never think about this in medicine i mean what's that like for you as a scientist and as a lecturer these are the kind of yeah these would be these would be perceived as a kind of softer yes yeah aspects of health and science but it's you know that data is data right exactly we need to bring it together a lot of the data is actually quite old now, but I guess it's just been parked there.

And we have this real kind of biomedical model where we focus in on one cell type and what is that cell doing? And it's really reductionist. And then we could try and piece the jigsaw together. And we kind of need to fuse it with the anthropology and be like, okay, now how do we bring these two fields together?

Because that's the only way we can tackle i think where we're at yeah with our health and and you know you sort of you really beautifully bridge it throughout the book all these different components emotions food movement sleep stress yeah you know you've got a nice section on supplements as well which you probably won't be able to get into today um and the joy of the table so the joy of the tabola which is an italian phrase for enjoying being at the table and linking what we were talking about earlier with food to emotions you know make your table a joyous place to be because endorphins from enjoying being at your table with your family, your friends, or even on your own and just enjoying

the meal. Endorphins can alter the function of our immune cells because they have receptors for those on them. So those feel good hormones that actually helps nurture things like the Tregs, the regulatory T cells. So bringing the food together with the emotion and enjoying that that's so so important yeah we haven't had a kitchen for the last four months so we've had no table no joy but we've still been trying to cobble together as a family

you know little meals on the floor and it's just you know what i'm so delighted to hear you speak about these things because i think these are things we've missed in health advice yeah it has been too reductionist you know eating at a table with you know your community your tribe has kind of always been a part of human culture and i think in if you sort of extend the argument that you're making it's kind of like well you could potentially eat the same food feeling stressed out and lonely yeah and the same food might have a different response if you're eating it with good friends when you're feeling relaxed and calm. I'm convinced of it.

You know, one thing I've observed clinically, maybe for two, three years now, a lot of people these days are reacting or perceive themselves as reacting to foods. Yes. And I think what's really interesting for me is, and I think I really got this in the year preceding me writing the stress solution because i thought well if stress changes your uh your guts and your gi tracts in your digestion significantly as it does well are they actually reacting to the food or are they reacting to the fact that they're eating in a stressed state i think this has even been shown with gluten as the nocebo effect yeah which i don't know people say this all the time i go on

holiday i can eat the bread it doesn't make me feel bloated but the bread at home must be somehow different maybe it's different but also you're different you're in a different frame of mind when you're on holiday and you're eating and you're chewing your food as you look at the lovely vista and you're just feeling more relaxed and that's affecting your digestion this stuff matters yeah people think you know when i i really don't i hardly pretty much don't drink anymore um but when i did i used to remember that i'd go on holiday and like you know a glass of red wine would affect my sleep in the UK or you know I'd feel a bit groggy the next day but I found when I was on holiday I could have a glass or two with dinner I felt nothing yeah I thought this is stress this is like there's no like stress load on my life

I'm sort of chilling with my wife and my kids and there's a beach yeah so it's not bothering me but if your life is chronically overly busy, you're stressed out the whole time, not only are you going to get sick more or potentially, you know, you're going to be able to not tolerate various things. You're not going to be able to manage those insults as well, right? Exactly. I call it the food prison. You know, I see so many people who are so stressed about eating the perfect diet

that that's just eroding their health never mind what they're eating being being helpful um but i guess you know you asked me earlier about what i do to manage my stress and i think it's my it's still my learning curve but it's just on my radar now that i'm i'm i'm always experimenting i'm learning how to say no. I think having boundaries was one of the biggest things I learned as an adult. Why are we not teaching kids this in school? And saying no is okay. And there's a time and a place for projects.

If I want to get involved and it can't be now because that compromises my time as a mother or my time spent with family or my time just, you know, being on my own or doing the things that nurture my day then I have to say no and let go of that and I guess that's like you know the catharticism of writing or some ways of you know putting a narrative to what's stressing us out has a release to it and that you can feel that you know like a big physiological sigh that your body is making when you're like okay and once the decision's made you move on from it i've said no to that it's sad and i wish i could say yes but i don't

think about it the next day when i've moved on and other things are you know it's very freeing actually you know something I've struggled with for years and it's I'm getting much better at it but it's it feels good yeah you half the time I used to say yes and stuff and then I would just be stressed out but why did I say yes I've got to do this I've committed now they're advertising it they don't and I'm getting much better at nipping it in the bud yeah sauce yes Yes. You know, but it's taken a lot of work. Oh, yeah. I had to learn the hard way.

Yeah. But I started feeling like I was doing everything badly. And when you start to feel like you're being a bad parent, probably I wasn't. But in my mind, I wasn't doing what I wanted to do. And that, I think, with my kids, I just, that had to be a firm line that I couldn't ever cross again. Wow. Now, you mentioned eating, and you said that, you know, there's some studies that our immune system operates differently if we're eating in company, feeling joy, feeling happy. That reminds me of something else I read in your book about,

it's something to do with, you were giving a list of strategies to people but it was about you know like walking whilst listening to music it was about putting two senses in together i that oh i found really interesting could you expand on that yeah that this is it's really interesting actually so this was um data that was generated in the 1980s of some scientists who were trying to disprove research that had come out of Russia around that time about conditioning. So the classical example of conditioning is Pavlov's dogs. Most people will be aware of that. But these experiments they had done where they had looked to try and condition the immune system. And so the scientists

were like, this can't be right. You know, we're going to redo the experiments much more stringently and see if it is really what it makes out to be. Can you condition your immune system with various rituals and routines? And what they did was they used an animal model experiment and they gave the animals a sweet solution to drink.

And one group got the sweet solution that also had a particular chemical inside it that would modulate antibody responses. So they could measure the antibody responses in the blood and see if there was an effect effect happening some kind of readout tangible piece of data that they could observe um so the mice were given these this sugar solution with this chemical for a period of time and after a while when they just gave the sugar solution on its own they got the same effect happening to the immune system. So it's kind of like a placebo effect. It's like you expect something, the mouse expected this effect to take place in its body on some kind

of subconscious level, because it was so used to that happening, that the effect happened anyway, even without the chemical presence to actually cause the modulation to the immune system. And people have been scratching around to try and understand the mechanism. And I think the best we've come up with is the placebo effect. There's some part of us that we don't quite understand that embodies things. And when there's a response expected, the biology changes. And we can start to pair things together. So what you're referring to in the book is like the kind of little stress relieving rituals, like, you know, playing your favorite music whilst you're doing something like taking a nice bath

or having a particular scent being in the room while you're doing something else and eventually then you just can play that music and you start to feel the same relaxed feeling that you do when you're in a nice warm bath even without taking the bath yeah you know it makes me think about you know if your home is or has been a stressful place, then, you know, that it kind of works that you may come into that and your body may start to almost, the immune system might sense that and go, okay, this is a stressful place and react, even if nothing stressful happens. But then you can also flip it. And, you know, I'm a huge fan of ritual and sort of daily practices that even if they only take five minutes, they can be very powerful. And I think when I hear that, I think of a morning routine and I think, what if someone, you know, can design their ideal

morning routine? Let's say it was five, 10 minutes, you know, but if maybe a minute or two of breathing, you know, three or four minutes of some light movement practice. And then let's say five minutes of reading a positive book. For example, I mean, that's, you know, in the stress solution, I write about the three M's of a morning routine, mindfulness, movement and mindset. I think you can create one that lasts an hour, you can create one that lasts five minutes. But the point I'm trying to make is, if someone started doing that in the same room let's say they lit a candle yeah in the room did that that even on a day when they're a little bit busy or they haven't quite they can't quite switch off and they just you know sat there with their coffee with the candle on yes maybe

that will also condition their immune system the other way and go hey things are okay because he's got the candle on i don't know it's quite it's quite empowering now all the senses kind of integrating so it might be particular scent that you're burning there might be particular song or playlist that you always play when you're doing those uh activities for your morning routine and then the morning you wake up and you're just tired and you don't want to do your movement you just want to sit and enjoy a tea but you're in that room with that space and you still may be reaping the benefits of the meditation and the movement that you would normally do and i think routine as a human being we just seem to be anchored by routines for me especially becoming a mother it's been it's been hugely

important so much so that now I can buffer the lack of routine more because I can circle back to a really strong routine that I've built over time and I think when we went into lockdown this year everything kind of got off kilter and we haven't we're living in a building site basically at the moment so it's stressful the routine is is shock you know your shot has really done a number on us but i think having been someone who needs routine particularly as a bit of a stress head it didn't take long for us to find a new rhythm uh it's being at home and that's anchoring i think that's i i love the way you the way you say certain things you said you know we can build a routine like you can build your immune system yeah it's a very empowering words yeah build means

we can do that right it doesn't mean it's fixed exactly we've got some agency over that yeah um it's really interesting as you know as I mentioned right at the start this is you know day one in the new studio yeah and gareth who's videoing and sitting there in the corner um we've been talking about you know how do we create a stress-free space that allows a really deep authentic vulnerable conversation to happen yeah and you know it's not quite ready yet you know bringing plants in is one thing you know um we're gonna probably have a candle on or some sort of you know a nice scent yeah you know my my dream is because my this podcast is all about authentic conversation it's not interviews it's conversation i want um someone like you to walk in and within, you know, I almost want to program it so that people feel calm and they want to open up and actually, do you know what I mean? Yeah. I think you've done a really good job already, but also I think that what you give

off as a person really helps. So the way people's eyes feel relaxed you know when we're angry we like narrow our eyes or if we're feeling quite negative or stress and then we pick that up when we're sort of reading the body language and so if somebody has a sort of relaxed disposition that's going to be interpreted by the other person and make them feel at ease as well so and interpreted by our immune systems yes exactly as this is a safe environment it's all about all of those millions of inputs that are going in yeah every minute of every day and our immune systems reading those shaping and responding jenna look i've really enjoyed this chat there is so much more to discover that we've not got in seattle like hot and cold and supplements which is it's all there in the book for people that are interested in movements and how that impacts

the immune system but but i really enjoyed thank you for opening up and people hear this conversation and they want to sort of interact with you are you sort of um you know are you active online do you like interacting with people online and if so where can they find you yeah i mean i i'm on uh instagram mostly that's sort of the easiest place to find me that's kind of my um internal monologue where i uh i don't know like to post about things that i've been researching and doing and also a bit of kind of general mom life and a little bit of what's going on at home um as well i'm sort of on twitter on a professional capacity so that's mostly like publishing research and interacting with academics um and then i have a website too which is just my name which is drjennamachocky.com

fantastic um so jenna as you know this is called feel better live more um when we feel better in ourselves we get more out of our lives so we covered a lot of different um topics today a lot we didn't cover as well i wonder if you'd mind finishing off by giving the listeners and the viewers some really practical tips if they're inspired by what they've heard and i want to say yeah i like that i want to take steps today yeah to start improving my immune system have you got some of the top tips that you can share with them yeah i would say shut out the noise the noise of social media the noise of marketing the noise of messages and just kind of messages and just kind of write down or find a way to to to um distill down you know what it is about your day-to-day that you think is is making you feel a bit a bit like not yourself um because

we're bombarded with so much and when i speak to people i realize i'm in a very privileged position because of the virtue of my field and that I work in that I know a lot but other people who are with no background at all in this are very confused and it's very confusing um and go with what we talked about you know step away from the supplements and just lay out on the table how is your diet how many times a day are you eating are you overeating are you stress eating are you consistently getting all of the relevant vitamins and minerals that you need, but also good quality sources of carbohydrates and proteins and including good quality fats in your diet? diet is not the only way to shape your immune system. You know, we have movements, stress, all of the different things in our life. And your immune system is always changing. As we grow older, it changes. You know, don't really focus on one solution because health is

complex. There's a lot of different inputs going into it. Your immune system is the foundation of your health. And so it needs to have all these kind of different areas targeted. So you can have the perfect diet, but like me, stressed out of your head and then end up with pneumonia, don't do as I did. But take care. Take care of the whole sort of 360 of your health. And it's about balancing, not boosting your immune system.

Yeah, wonderful advice. I want to thank you for, you study a lot of immunology you do a lot of research you also take the time to communicate it to the public and i think that's such a valuable thing if we get scientists like you yeah trying to communicate what you know to help educate people i think it's a wonderful thing so thank you for doing that thank you for making the journey up today no problem and we'll see you again soon thank you thank you for having me that concludes today's conversation i really hope you enjoyed it please do remember that inspiration and ideas are not enough in and of themselves. You have to take action if you want to create change. The health of your immune system is super, super important. So my advice would be

keep things simple and think about one thing that you can take from today's show and implement into your own life. Now, please do let Jenna and i know what you thought of today's show on social media and go to drchastity.com forward slash 125 to see all the show notes for this episode if you get value from my weekly podcasts please do share them with your friends your family and your work colleagues in fact it's a really beautiful thing to do for someone else, to share an episode of my show with them that you think will really, really help them. I think it's a great gift to give someone. And in many ways, it's a simple act of kindness, which has benefits not just for the other person, but for you as well. So do have a think about which people in your life

would benefit from this episode and send them a link along with a personal message. Don't forget, each episode is also available to watch on YouTube if your friends and family prefer videos as opposed to audio podcasts. If you want to learn more about my take on our immune systems and what we can do to help them, please do take a look at my first two books. The Four Pillar Plan is available all over the world. It's got a different title in America, How to Make Disease Disappear. And my second book has the same name everywhere. It's called The Stress Solution. They're all available in paperbacks, eBooks, and as audiobooks, which I am narrating. A big thank you to my amazing wife, Vedanta Chatterjee,

for producing this week's podcast. And to Richard Hughes for audio engineering. Have a wonderful week. Make sure you have pressed subscribe and I'll be back in one week's time with my latest conversation. Remember, you are the architects of your own health. Making lifestyle changes always worth it it because when you feel better you live more i'll see you next time