Dr Jenna Macciochi: So I always think that man flu's real, but women get more autoimmune diseases.
Dr Rupy: Because there's evidence there. Welcome to the Doctor's Kitchen podcast with me, Dr Rupy. This is going to be part two of the fascinating conversation I was having with Dr Jenna Macciochi, who is an immunologist who lectures at the University of Sussex. It's absolutely fascinating, in-depth look at what the immune system is and what immunity and supporting it actually means. If you haven't listened to episode one, I highly recommend you do that before listening to this podcast. Don't forget my first book, the best-selling Doctor's Kitchen is out now. So if you haven't got a copy, make sure you pick it up online or in all good book stores. Let's go back into it. Autoimmunity is a big topic, I feel, these days. What is your impression of why we are seeing increasing rates of autoimmunity across the board? I mean, it's not just coeliac disease we're talking about, it's not just IBD, but everything that I'm seeing, certainly from an anecdotal frontline NHS point of view, it's just going up and up and up. And there are so many different theories, the sanitation, the hygiene hypothesis, and all these different things. It's probably going to be a combination of a whole bunch of things.
Dr Jenna Macciochi: Like whenever I'm teaching at the university, I'm like, nothing in immunology is straightforward. Most questions will be answered, well, it depends. So it's definitely multifactorial. You cannot deny that there is an increase in the prevalence of autoimmune diseases and also allergies, which is just when your immune system is going awry. There's definitely a genetic component to it. In fact, this going back to in the beginning when I mentioned about how we're all genetically very different, there are some genes that predispose you to autoimmunity that actually protect you from things like HIV. So it's really unique. So there's a particular type of compatibility gene that protects from ankylosing spondylitis, which is quite a horrible autoimmune disease. And if you have that gene, you've got a really high risk of getting ankylosing spondylitis. It's not sufficient, but it's a really high risk. But it affects how the HIV virus can proliferate in your T cells and it actually makes you highly protected from HIV. So it just goes to show that the immune system, there's always a compromise. It's like give and take a little bit. So one gene might predispose you to autoimmunity, but it might protect you from something really nasty, which is perhaps why evolutionarily we've held on to it.
Dr Rupy: Yeah, it's kind of like sickle cell, right? If you have the trait of sickle cell, you're protected against malaria because the malaria if when you if you're affected by malarial virus, then your cell will autodestruct.
Dr Jenna Macciochi: Yeah. The other kind of interesting thing about autoimmune disease is that almost 80% of them are in women. So I always think that man flu is real, but women get more autoimmune diseases. Because there's evidence that men seem to suffer for longer with infections, whereas women have much more aggressive immune responses. And sometimes that tips over into autoimmunity. So boosting your immune system again, might not actually be. Most of autoimmune diseases seem to spring up in women around the age 20s, 30s, 40s. And it actually your risk seems to decrease after the menopause. So we know that there's something to do with the hormones. We know that the immune cells have receptors for both oestrogen and progesterone and also testosterone is involved as well. Testosterone seems to be a little bit immune regulating, which is why men don't seem to have an as aggressive immune response. So they're not as good as fighting off infections as women. But it's a really complicated picture. So perhaps regulating your hormones is going to be something that's going to take care of your body and and help with your autoimmune risk. But there are so many theories about...
Dr Rupy: Definitely, yeah. And actually, this is why the science is complex, but sometimes the solution for some people, and certainly there is some evidence to show, is that the solutions just involve putting your body in the best environment possible where you allow your body to operate functionally, optimally. And this is why I'm quite interested in the process of autoimmune protocols and autoimmune diets that are essentially taking out a lot of processed foods, introducing more whole foods. And there are certain ones, you know, there's various shades of grey, right? There's the whole food plant-based diet, there's the whole food paleolithic style diets, there's even a carnivore diet. I don't know if you've heard of that.
Dr Jenna Macciochi: I do, I've met someone who was doing that. I couldn't keep a straight face.
Dr Rupy: I was like, I'm so curious. I want to ask you so many questions.
Dr Jenna Macciochi: I know, and they were a yoga teacher and I was just in the yoga class.
Dr Rupy: Oh wow, a carnivore diet, yoga teacher. That's interesting.
Dr Jenna Macciochi: Quite like vocal about only eating meat.
Dr Rupy: Okay. I just wanted to ask her so many questions, but I didn't. I just, you know, from what we know about carbohydrates and fibre and the need for to feed your microbiota, it just doesn't sound very intuitive for some people.
Dr Jenna Macciochi: I was kind of thinking, come back in in 30 years of only eating meat and then see how things are. You know, she was also like, you know, really early 20s. And I think when I was that young, I could do a lot of stuff to my body and it bounced back because I was young enough to deal with it.
Dr Rupy: Yeah, yeah, probably. But saying that, autoimmune protocols have been very effective, specifically with regard to inflammatory bowel disease. So there's lots of evidence, or not lots of theories as to why that might be the case. There might be some certain food intolerances, there might be some aspect of the microbial population, how it differs with whole foods. So...
Dr Jenna Macciochi: Yeah, exactly. That's for me, I think that's probably one of the biggest impacts that makes a lot of these protocols successful is depending on a dysbiosis in the patient. So there is a lot of evidence that having a dysbiosis in your microbiome can be a trigger for autoimmunity. So I mentioned that there's genetic component, there's a hormonal component, there's various different environmental things that can be all you're sort of looking to generate the perfect storm of events that are necessary and sufficient to develop an autoimmune disease. And I know that the microbiome is one of those. So if the if the microbiome's perturbed, this could be due to having an infection or antibiotics, for example. Then those bacteria are are going to be producing different things. So we're feeding them, they're eating the food we eat, and they're producing, we call them postbiotics. So it's like your own personalized pharmacy of of molecules from them eating your food. And if the bacteria are a bit off or you don't have the right populations in the right proportions, perhaps there's an absence of those metabolites that they're producing or they're producing different ones. And this is exacerbating an autoimmune disease that you might have. But we're speaking kind of broad strokes because obviously there's so many different autoimmune diseases and there's no one single trigger. It's going to be this kind of perfect storm.
Dr Rupy: Yeah, it's going to be a mixture of your genomics, your nutrition and also your lifestyle. And I think that's probably a good way to sort of segue into talking about food.
Dr Jenna Macciochi: Yes, exactly.
Dr Rupy: Because we are, I mean, there's so many different topics that we could talk about. There's the mitochondrial stuff, there's the hormesis, and I'm fascinated by plant hormetics. I think they're it is a very good metaphor for for how we are as human beings. This whole constant state of balance.
Dr Jenna Macciochi: Yeah.
Dr Rupy: In fact, actually, you've got a really good definition of hormesis on your website. I've been reading your I've been reading your blogs. I think it's great. But would you would you mind talking about what hormesis actually means?
Dr Jenna Macciochi: Yeah, so hormesis is is a really interesting concept and I think it it plays into that the poisons in the dose, you know. A lot of things are good for us, but it depends on how much we're having. You know, too much of anything is probably going to give us some kind of unpleasant symptoms, whether that's exercise or a particular food and you just eat too much of it. Or water. Yeah, exactly. So hormesis is, yeah, this sort of biphasic response where small amounts of something that's quite stressful for the body can actually promote an adaptation to deal with that better. So increasing the resilience, whereas high amounts can just be toxic. And you find that with food in terms of these phytonutrients. So those are things that are part of the plant's defenses that you know, they can't run away. So they produce these chemicals when they're damaged or chopped. I know you've had discussions on the pod before.
Dr Rupy: Yeah, we discussed this with Dr Anita, who's a colleague of ours, she's a gynaecologist, and we talked about phytonutrients and in particular turmeric and how these actually exhibit a mild noxious effect to the body, but an overall resilient compensatory response, which is why it leads to benefits, which I think is I think it's awesome because there's this whole phenomenon of like introducing ingredients into your body to detox or to reduce inflammation. But actually, what these ingredients are doing is the exact opposite in a small amount and it's encouraging your body to actually be more resilient.
Dr Jenna Macciochi: Yes, exactly. And and it's getting rid of these old immune cells that might be going wrong because they're more susceptible to the stress of these phytonutrients that are exhibiting this kind of hormetic stress on our body. So, yeah, I think the power, the interesting thing about phytonutrients is that they're not actually part of our RDA, are they? This recommended daily allowance. We all know that we should have so much vitamin C. But people don't really know about phytonutrients and that's the thing.
Dr Rupy: Of which there are thousands of them as well. And so it's quite hard to quantify. We haven't really studied them as well as we'd like to at this point.
Dr Jenna Macciochi: There's probably one or two that are quite highly studied. You mentioned sulforaphane, which I think is a great example. Turmeric or curcumin, which is the active ingredient. But interestingly, they did some studies with turmeric that had the curcumin removed and they found it still had some of the benefits of the spice. So it shows you it's not just the...
Dr Rupy: It's not just one thing, yeah. And I think we've we've done the same thing with resveratrol that you find in grape and red wine and you know, some studies show it does have a benefit, others don't. And it's really about getting back to eating whole as much as possible because your humble apple will have pectins and it will have quercetin and a whole bunch of other phytochemicals that we probably haven't even discovered yet that leads to ultimate benefits, which is why eating an apple a day, I don't want to spend the rest of that line, but you know, it's it's really important. So, going to food and specific ingredients, there isn't actually one specific set of ingredients really, it's just about eating, unfortunately, the rainbow.
Dr Jenna Macciochi: So I have my kind of key things that I like to focus on because people love to ask me like, how do I boost my immune system? And it's always things like vitamin C, vitamin E. And of course, your immune system needs, as I said before, it needs all of the the macronutrients. It needs proteins, fibre, carbohydrates, fats, but it also needs all of the micronutrients, the vitamins and minerals that that you know, you've we all know about and you have the recommended daily allowance for.
Dr Rupy: And you find in a general balanced diet actually. That's what I find. Most people are hitting their RDA for a lot of things. But it's the phytonutrients that we don't have an RDA for that may lead to the health optimization.
Dr Jenna Macciochi: Yeah. And there's little to no evidence for supplementing with vitamins and minerals to, for want of a better word, boost your immune system better than it's already at baseline. Vitamin and mineral supplements protect from diseases of deficiency. So if you're deficient, they will protect from that. But I think they've kind of been boosted up to some kind of, you know, gold status where they offer some extra benefits in high amounts. And some of the the studies are quite interesting because it actually shows that eating a diet rich in vitamin E, for example, is associated with a lot of health span and and health benefits in the long term. But vitamin E supplements at certain doses are actually quite toxic. So it shows you that the dietary context is really much more useful than a supplement on its own. So there's very little evidence to supplement unless you're plugging specific holes in your diet or you know that you're deficient in things for your your vitamins and minerals.
Dr Rupy: And when you think about what a diet looks like that is high in vitamin C and E, for example, you'll realize, you know, that's dark leafy vegetables, it's lots of citrus fruits, it's nuts and seeds, which are really good sources of other sorts of minerals like zinc and magnesium and so it's no wonder that the dietary component is so much more efficient and beneficial than just isolating one particular element of the diet and supplementing it.
Dr Jenna Macciochi: Exactly. It's like that multi-pronged approach. There's been numerous attempts to try and put sulforaphane in a capsule. Yeah, and it's just not really proved very well. I mean, I think there was a guy in in the US that works quite a lot on sulforaphane and he looked at a lot of the supplements that were out there and tested them and it's so hard to capture the bioavailability and put it in a pill and have that shelf stable form that you can take, opposed to getting it fresh from cruciferous vegetables. It's just there's real problems with like bioavailability. And there's also been numerous studies of, you know, things like garlic. So garlic's quite known for being a good treatment to, it's got kind of antiviral properties. And so people make garlic supplements, but there's a lot of studies showing that these can be quite toxic because they have to go through the liver and you don't quite know what dose you should be aiming for when you're randomly buying a supplement opposed to just putting some garlic in your cooking. I think this is one of the things I love about your cooking is that you make variety from like from quite a minimum amount of things because you're introducing a lot of herbs and spices and they all contain phytonutrients. So you're kind of jazzing up real basic staples that you might have in your cupboard and just tipping over the edge to to give them that extra bit of nutrition.
Dr Rupy: Yeah, that's a little boost. Yeah, yeah. And I think I read on one of your blogs and it's something I've come across before in some studies about crushing garlic and allowing it to sit for about 10 minutes so it increases the concentration of allicin.
Dr Jenna Macciochi: Allicin, yeah. Yeah, so I think it's these little tips and tricks. Like there's a reason that we crush garlic, you know. A lot of it is just it's intuitive or it's old wives' tales and I love kind of exploring the science of that and just kind of bringing that to the surface. And things like turmeric, you know, I'm sure if I walk down the street in London, I can get myself a turmeric latte, but will the will that be very bioavailable? Will any of it actually get into my blood? Or if I make a curry tonight and I throw in lots of black pepper, lots of like coconut milk and different spices, that's how you're meant to have turmeric in a meal and the bioavailability is so much better than, you know, a capsule or, you know.
Dr Rupy: Are there any other standout herbs that along side ginger and garlic and onion that that stand out in terms of an immunological sort of...
Dr Jenna Macciochi: No, I think it's it's for me, it's it's the phytonutrients and it's the fibre. So the fibre is having that direct effect on the microbiome. They are the ones that are really instructing your immune system to get that right balance. They're producing this whole cacophony of different nutrients as they digest your food. So you've got to give them the right stuff and they're going to produce the right things. And they can measure them in the blood now. I know that there's numerous studies looking at these sort of postbiotics, the things the bacteria are producing. And you know, they're going all over the body and having an effect on it. So I always think it's fibre, it's phytos, and then the right fats. So those are my kind of three things that I'm big on.
Dr Rupy: What kind of what are your favourite types of fats?
Dr Jenna Macciochi: So fats, definitely minimizing like the trans fats. We know these are not good for us. I guess I I really think about the omega-3, omega-6 ratio and how those work. So I used to work on resolution of inflammation and chronic inflammation. And the omega-3s and omega-6s get incorporated into the the cell membranes and they they can hang around for quite a long time. So if you think of what you're consuming in your diet, you know, three, four months down the line, that might still be inside your cell membrane. So it's kind of always good to have a long-term picture. And omega-6s are important, but they help us, they help our immune cells to really produce those inflammatory responses that help get rid of infections and fight the the various bugs that are around us. So they are important. And then the omega-3 fats switch to resolution. So inflammation is a cyclic process. We have the the firefighting part and then there's an actual active switch that comes only when you have that first part that promotes resolution. And resolution is active. We we tend to kind of forget about resolution. It's like that just passively happens at the end of an infection. But the omega-3s are really important and they kind of mitigate and offset the omega-6s. But if you have a diet that's quite high in omega-6 fats, the omega-3s don't really get a look in. So you really have to work on boosting the omega-3s and then reducing the omega-6s to find the ratio.
Dr Rupy: And when you actually when you concentrate on whole sources of fats and and whole foods really, you're going to get that natural ratio, which is either equivalent or one to four, I believe, which is what we've evolutionarily been adapted to. It's the introduction of industrial oils, processed foods, poor quality fats essentially that put us up in the omega-6, which is still important, like you've you've really glad you pointed that out because a lot of people are just very fearful of omega-6, but it's very important for our stress response. But it's just focusing on whole foods, you'll naturally get that balance.
Dr Jenna Macciochi: Yes. Yeah, exactly. And yeah, I think that's a really really important point. So yeah, I'm big on the omega-3s and I think where you get them from is is yeah, kind of interesting as well. Like fish and you have to think about the sort of environmental impact of that and the vegan sources, it's a little bit harder for our body to get those. So maybe...
Dr Rupy: I recommend them algae sources. There's some really good sources of omega-3 in the long chain format, so EPA and DHA that you can get from algae. But they're a little bit more expensive and less easy to find as well, I find for for certain people. But you can get them online these days.
Dr Jenna Macciochi: Rather than I I feel like over the years when they've started to focus on particular nutrients and the immune response, we we kind of we know vitamin C is important. It's not like the magic bullet, but it kind of didn't yield a lot of useful information to focus on individual vitamins or nutrients. And so they started to look at dietary patterns and this is where we really see the Mediterranean style diet, lots of antioxidants. And it sort of depends where you live as well. If you have a stressful life in a big city, you're exposed to a lot of pollution, you might have a greater need for antioxidants. And again, food is the best source of these because if you take too many in a supplement, it can actually be pro-oxidant. So you have to be very careful.
Dr Rupy: A lot of people don't realize that about how vitamin C has a pro-oxidant effect and that's actually how it may elicit some of its benefits as well. But taking in an isolated format, which is very unnatural in terms of its amount, may lead to some side effects as well.
Dr Jenna Macciochi: Exactly. Yeah. So yeah, the the fibre, the phytos and the good fats. Taking care of your microbiome. There's some evidence around prebiotic probiotics, but I think again that's kind of muddy waters because we all have a different starting point with so you couldn't suggest one particular probiotic that's going to help. I think we're not there yet, but that's that that's an emerging field. There's definitely some evidence of antibiotic use actually making you more susceptible to infection long term. So, this I think is something that's it's quite topical because everyone's trying to be a bit more careful with antibiotic use. And it's interesting that using antibiotics might actually end up to you being more susceptible to infection long term. So hopefully that we can steer and start to change that as people are more careful in prescribing those.
Dr Rupy: This is something I talk to a lot of my patients about actually, about how unnecessary use of antibiotics, which a lot of people want still, can actually put them in a worse state down the line. What's your opinion on pre and post pro probiotics during antibiotic use? Do you have a position on that?
Dr Jenna Macciochi: Yeah, there's definitely some studies looking at that and there's particular strains that they've tried to pinpoint. I just feel like because we're all unique in our diversity, it's kind of if you want to take a probiotic that might be suggested to be helpful, go for it. Perhaps it's a bit of placebo effect, but I think it's probably worthwhile. I think doing all that you can to preserve your microbiome. So feeding it the right things, having a good pattern of eating. Particular soil-based probiotics, so the ones that have a bit more of a a shield that help them get down into the large intestine seem to be more useful. And I think if it's available to you, then it's perhaps useful to to do that.
Dr Rupy: It's a conversation I have very often with patients who come into the emergency department and I often give some antibiotics and I talk to them about the a few things that anything that nurtures their microbiome will be likely be beneficial for them, if not to protect them against the potential negative impacts of having antibiotics. So optimizing sleep, reducing your processed and convenience foods and sugar, increasing your whole foods, particularly with a focus on prebiotic fibres, so chicory, artichokes, garlic, onion.
Dr Jenna Macciochi: Exactly. It's not just one type of fibre, is it? You've got so many different bugs in there. I I see a lot of prepared foods that have added fibre and it's only going to be one or two types and that's not really I don't think that's a good message to give to people that they should, oh I've got my fibre for the day. You should really be thinking about different sources.
Dr Rupy: It's the whole sources and the ones that we probably haven't even discovered yet because this this is an emerging field and so you're a huge advocate of lifestyle as well as the foods and nutrition and stuff. So this is really important from the perspective of immunity as well. So we've talked a bit about stress and how that might have a negative impact on immunology or your immune system. Are there any certain practices that you like to talk about or practice yourself?
Dr Jenna Macciochi: The reason that I got into kind of looking beyond nutrition was I kind of felt like it was just one leg of the chair. Like you can have the best diet in the world and everything else is not right and you're still going to be impacting your immune system. And I think stress is a massive one. So we've we've mentioned a little bit about that. And then the other areas that I kind of got interested in was sleep and exercise. So exercise is is fantastic, I think for all round for health benefits. But there's something quite unique about the exercise and the immune system in terms of health and longevity. And this is a personal area that I'm really passionate about because we're living longer but we're not necessarily living well. And I personally want to not necessarily live to be 100, but I want to be active and I want to see my family grow up. And so I'm really quite interested in longevity. And I think it was last year or the year before, there was a really fantastic study where they looked at 70-year-old cyclists. So they're all around 70 and they're in a cycle club. So they were active cyclists and they compared them to sedentary 20-somethings. And what they found was there's this process that starts to decline in immunity from age 20. So we have the thymus gland, which is located in the neck, and this is responsible for producing the T cells of the immune system, which are like the master controllers. And from around age 20, your thymus gland actually starts to shrink and we call it thymic involution. So that's quite a scary thought because you know, from 20, those T cells are just declining. And what they found was when they were looking at these sedentary 20-somethings and the really active 70-year-olds, when you're using your skeletal muscle, like the cyclists were, and you're maintaining a muscle mass into old age, those muscles are producing a very particular molecule, IL-7. So this is actually stimulating the thymus gland and stopping it from shrinking. And they had much better thymus capacity than the sedentary 20-somethings.
Dr Rupy: That's fascinating. I'll have to link to that paper on the show notes for sure, but yeah, I'm definitely going to give it a read.
Dr Jenna Macciochi: Yeah, Professor Janet Lord in Birmingham University. I think one of the professors on the paper was actually the in the cyclist club. So yeah, a little bit biased there. I wonder where they got the sedentary 20-year-olds from. Yeah, exactly. But I think movement is so important. So not only maintaining muscle mass and the muscles are producing something that's slowing down the aging of your thymus gland, slowing down the decline in our immune system. But movement is activating your lymphatic system. So I think we haven't mentioned the lymphatics yet, but that's the the sort of super highways of the immune system. So it's it's like a circulatory system like your blood, but instead of the where the blood is relying on the heart to pump it, the immune system of the lymphatics relies on movement to to move it around. And by moving your lymph fluid through the lymphatics, you're distributing the cells to all the different parts of your body so they can perform a kind of surveillance function. So they're going to be moving to the lymph nodes, to the gut, to the lungs. So they're protecting and and they're constantly on guard. And so movement, any kind of movement, walking is going to get that going.
Dr Rupy: Just as you were talking there, I just had this image of like essentially the evolution of man essentially walking across the plains. We're moving, we're sleeping adequate amounts. We're eating whole natural foods that are minimally processed and we're also eating within that time period as well because we probably wouldn't have been eating in the middle of the night either. And that really is a metaphor for how to boost our immune system.
Dr Jenna Macciochi: Exactly. For want of a better word.
Dr Rupy: To essentially improve and support our immune system. Which I think we've pretty much summed up in like a whole bunch of different we've been talking for ages. So we've got this new part of the show where we do rapid fire questions. I took a poll from social media, a whole bunch of questions were generated and we're just going to give you 10 seconds to answer.
Dr Jenna Macciochi: Oh, pass.
Dr Rupy: 10 seconds to answer each one. We'll just keep it brief. I know we're probably not going to be able to keep it brief. We'll try and aim for 10 seconds.
Dr Jenna Macciochi: We'll try. Try and rein in the tangents.
Dr Rupy: Okay, fine. This is probably going to be a complicated one to start off with, but should we be aggressively treating fever with over-the-counter medications in when we've got a simple viral illness?
Dr Jenna Macciochi: Oh, controversial. No. Let the fever do its thing. If it's going on more than a week, go see your doctor. Fever is productive.
Dr Rupy: That is really interesting. Changing tides in in the information.
Dr Jenna Macciochi: Definitely, yeah.
Dr Rupy: Because I don't think even a lot of doctors are aware of this information that, you know, aggressively treating pyrexia, A, this is I mean, the spiel that I give to a lot of patients, particularly young children who have, you know, very worried parents and they want to aggressively get rid of any fever whatsoever. Don't doesn't actually lead to positive outcomes. But as, you know, we've just learned today about adults, you know, that actually might lead to worse outcomes, right?
Dr Jenna Macciochi: Yes, exactly. So reducing the fever might mean you're sick for longer. So, you know, going to the the pharmacy, getting all those over-the-counter meds for however many, however much money you spend just so you can struggle through work, it might mean you're just like sick for longer. And I think we should respond to the sickness behaviours. So that's what we call the effect of these immune mediators when we're sick, actually having on the brain and telling us to retreat, go and sleep, go and rest. You might not feel like doing anything and and writing out the fever and that's the quickest way to get well because most of these colds and flus are self-limiting. Unless you have an underlying health condition.
Dr Rupy: Exactly. Yeah, and that's when you need to get help and you need to, you know, certainly take something from your doctor and be directed by your physician. But certainly, I think listening and becoming the expert of your own health where your brain is telling you, you know what, I need to I need to rest, I need to relax and...
Dr Jenna Macciochi: Exactly.
Dr Rupy: Definitely. Okay. Elderberry, is it worth the hype?
Dr Jenna Macciochi: Oh. No, I I did look into this quite a while ago and a lot of the studies were funded by the companies that make elderberry syrups. So it arises suspicion. But I do think anything that's a bit comforting and rich in in phytonutrients is going to be useful. So it doesn't necessarily have to be that, but anything, yeah.
Dr Rupy: Anything. Any berries or, you know, a lot of it's like a panacea to make you feel better, you know.
Dr Jenna Macciochi: Yes, yes, it's not just one thing.
Dr Rupy: It's a placebo effect. It's going to be... Yeah, yeah. Okay. On that note, Jewish penicillin, does that have an effect?
Dr Jenna Macciochi: Well, yeah, there's something about something that they find in chicken soup. So the just to clarify, Jewish penicillin is a rich broth of chicken soup and veggies and and yeah, it makes you feel absolutely amazing. The L-carnosine, which is found particularly in chicken stock, so it's unfortunately not in the vegetarian version, combined with the fact that it's warm and soothing. So the steam is is helping clear the nose and it's going to have all those nice vegetables inside. They actually affect your immune cells and what they're doing. So there are studies on that.
Dr Rupy: That's fantastic. That's good. I I actually put a medicinal broth as a recipe in my first book, The Doctor's Kitchen.
Dr Jenna Macciochi: It's the first thing I go to when I get sick. Like my mom's recipe.
Dr Rupy: That's great. I add like star anise and clove and garlic and all these different things and it's just I mean, it tastes wonderful. And the steam actually, because the the the reason we're more prone to viruses in winter is because it's cooler and the air inside our nose is a bit cooler and they prefer that. So our temperature going up, but also steaming bowl of soup and you're inhaling the steam, it makes it a bit more uncomfortable for the viruses and it helps your immune cells work a bit better. So...
Dr Rupy: That is a top tip. That's a great. Because I am aware of that, the rhinovirus at the back of your throat thrives at a low temperature, which is why you see them more in winter. There's a whole bunch of different theories out there. It's very interesting.
Dr Rupy: Okay, loads of people are asking about quick ways to boost immunity, but as we've probably gathered, it's not as simple as that.
Dr Jenna Macciochi: Get enough sleep most of the time. Eat well most of the time. Sleep well most of the time. And it's normal to get the odd infection. It's, you know, we live in a microbial world. But when it's, you know, more than you might think is normal, maybe go see your doctor.
Dr Rupy: Is there a way to completely cease a cold if you have one or do you just have to roll with it?
Dr Jenna Macciochi: I think you've got to roll with it. I think this cold is a self-limiting infection in in normal healthy adults and again, tune into what your body is telling you to do. It's probably not telling you to go to work or go to the gym or do any of those things. It's probably making you feel like you don't want to see anyone, you want to lie down and rest and, you know, that kind of thing. So...
Dr Rupy: Is there a role for daily probiotics?
Dr Jenna Macciochi: Well, we don't know if they're working in everyone because we all have a very different starting point and our microbiomes very different. So if you're throwing in a probiotic, whether your body is actually going to make space for that or not. But we do know that they normally only work during the time you're taking them. They don't often set up residence in the body. So if you are taking something and you feel like it's serving you well, then carry on. It's up to you.
Dr Rupy: I think it's really down to the person. And personally, I don't take a probiotic every day, but I do make sure I get a whole bunch of different prebiotics. Because prebiotics feeding that huge immense population of trillions of different bugs is probably going to have the biggest effect rather than taking an isolated supplement.
Dr Jenna Macciochi: Yeah, when I think about my diet now, I kind of think about I'm eating for my bugs as well. I'm like, you know, what what do they want?
Dr Rupy: I think it's a very good perspective. It's kind of like, what do they want?
Dr Jenna Macciochi: Exactly, because our digestion is actually quite basic and then the bacteria are digesting a lot of it for us and liberating a lot of the nutrients for for us. So your diet could be amazing, but your your microbiome's not all there because of, you know, past antibiotics or whatever and you wouldn't be getting the best out of your diet. So it's worth kind of, you know, as a long-term strategy, really trying to nurture that, I think.
Dr Rupy: Do we have to completely ban sugar to improve our immunity?
Dr Jenna Macciochi: Oh, that's a tricky one. Yeah. I think you've got to think about overall dietary pattern. As I mentioned before, we know fructose has quite a dramatic effect on the gut barrier, that's a fruit sugar. But that can be quite easily counteracted with lots of fibre in the diet. Which you naturally have in a whole piece of fruit. Yeah, if you're eating fruit. Yeah. So you kind of have to think about how you're eating overall. The active part of the immune system that's fighting infection, so we have sort of the active and the more regulating part, it is very glycolytic, so it it loves sugar, it uses that to fight an infection. That's not to say that eating sugar is going to cause that, but when you already have an infection, there is actually some evidence, you know, the old adage of feed a cold, starve a fever. Because a fever is a much more aggressive immune response, they did do some experiments to look at that and they found that the reason that you might want to not eat when you have a fever is to maybe just tap the brakes on the immune system because you're just withholding the glucose and and maybe that's stopping it being too aggressive and stopping you feeling really, really sick. So but again, that's, you know, over a very short frame of time. Not a long-term thing. So yeah, think about the whole picture with sugar.
Dr Rupy: It's going to be the whole picture. Yeah, no, definitely. I'm not a... I think it's I think it's we run the risk of demonizing one particular macronutrient and I just think it's it's quite short-sighted and you know, sugar is one of the most important molecules in the body, glucose and there's different monosaccharide forms. So...
Dr Jenna Macciochi: I also think, you know, at this time of year, it's it's it's sharing fun times with colleagues and friends and family and that's tapping into the endorphins, which is also important for your immune system. If you're stressed about trying to avoid sugar when we're, you know, you're literally walking down the street with Quality Street and hot chocolates and mince pies, then, you know, that stress is not, you know, you have to sort of look on balance what's more important.
Dr Rupy: If somebody is on immunosuppressant medications, what should they do to support their immune health?
Dr Jenna Macciochi: I think definitely find out if you've got any gaps, any deficiencies in any of the key vitamins and minerals. I think vitamin A and vitamin D are quite important for the threshold of the immune system. Again, taking care of the diet, you might have a little bit more need for things like vitamin C, but it very depends on if you're deficient or not. And one of the best ways actually to avoid infection is good hygiene and and staying out of places where you know there's going to be infection. People kind of underestimate that, but yeah, that's probably a real key thing to avoid it. And and movement, so getting the lymphatic flow going and really good sleep because sleep really is detrimental to the natural killer cells. These are our real viral and fighting cells that we have in the immune system. So...
Dr Rupy: We haven't talked about sleep actually, but there is a question about how sleep impacts immune health.
Dr Jenna Macciochi: Yeah, there's massive changes happen when we sleep in our immune system, which is really, really cool. We have quite quite a lot of inflammatory cytokines go up in the blood, but the cells go down and a lot of new cells are being produced and redistributed. And there's a lot of drainage of of all the tissues and the lymphatics. So it's really quite an important restorative time, particularly if you've been sick, giving yourself time to rest and and get that sleep is really important.
Dr Rupy: Which is why I suppose when you get circadian rhythm disruption from travel or from night shift work, and there's loads of questions about night shift workers as well, why that actually might lead to recurrent infections or a general sort of fatigue and the whole plethora of other things that are happening.
Dr Jenna Macciochi: It's really interesting actually when you start to look at circadian rhythms in the immune system, it's like maybe about 80% of the immune system genes are under circadian control, but not all of them. And it's there's a lot of work to try and unpick what aspects of the immune system are and are not under circadian control and why that might be. So it's definitely emerging and we know that circadian disruptions leaves you open to infection.
Dr Rupy: Should I take vitamin D to improve my immunity?
Dr Jenna Macciochi: Yes, well, again, vitamins to sort of plug deficiencies. So it is likely if you live somewhere like where we are now in the UK, that in the winter, you might get deficient in vitamin D. I think it's worthwhile getting checked. Vitamin D is really important to the immune system. And not in a boosting fashion, but it actually regulates and and you know, keeps the brakes on the immune system. So it could be worth supplementing if you think you're deficient. But it works hand in hand with so many other things. So it needs vitamin K as well and it needs magnesium. So you kind of make sure you're getting those other factors into your diet. Interestingly, vitamin K is mostly produced by our microbiome. So make sure you're feeding the microbiome. You can see how it's like a whole cascade of events.
Dr Rupy: It always comes back down to the microbiome. I remember I was meant to be doing my nutrition medicine master's paper. One of the essay options was vitamin D and discussing the role for vitamin D supplementation in the UK. And I chose not to answer that because it is so broad. And I only had 1200 words. And it's so broad to go into all the different pleiotropic effects of vitamin D because it's not a vitamin, it's a hormone. It's a master regulator of hundreds of different genes and you like you can't even begin to imagine how important this thing is.
Dr Jenna Macciochi: The immune cells, most of them have vitamin D receptors on them. So they're directly responding to vitamin D and then it's really changing their behaviour and stuff. So yes, if you think you could be deficient, I think it's one that it's very hard to get from diet with vitamin D.
Dr Rupy: Dr Jenna, this has been a mammoth session.
Dr Jenna Macciochi: I know.
Dr Rupy: I think it's been the longest pod we've had and we're not even halfway through all the different things we should be talking about. We need to talk about inflammation in more detail, brain, lymphatics, all those are different things.
Dr Jenna Macciochi: We can do a part two.
Dr Rupy: We'll have to do a part three, four, five. Just indulge me because I could talk about the immune system all day, every day. So...
Dr Rupy: Well, your passion certainly comes through. It's been an absolute pleasure and we'll catch you another time.
Dr Jenna Macciochi: Yeah, thank you very much.
Dr Rupy: That was a fascinating two-part episode with Dr Jenna talking about everything to do with immunity. We still need to go into loads of other subjects, so we're going to have to get her back on the show to talk about brain health and inflammation and what role the immune system has in that. To summarize what we talked about in terms of improving your immune health, again, getting lots of different colours into your diet. These release different sorts of polyphenols that have plant hormetic effects, a biphasic response whereby a little stressor actually encourages your body to produce an anti-inflammatory response and thus support your immune system. Nuts and seeds are fantastic sources of all the different minerals like zinc and selenium, as well as vitamin E that are very necessary components of your immune system. Fibre, fibre, fibre. She's a very big supporter of the notion of getting different types of fibre into your diet. So pulses, beans, legumes, loads of different recipes that you'll find on thedoctorskitchen.com, as well as in my book, The Doctor's Kitchen and Eat to Beat Illness as well. Jewish penicillin is a thing, as we've found out. Sulforaphane is something that you'll find in dark green leafy vegetables, particularly brassica vegetables. So Brussels sprouts, broccoli, rocket, cabbage, all these different delicious foods that I will teach you how to make delicious meals out of. And quality fats are very important, particularly omega-3 that you'll find in wild fish, also algae sources if you're vegan, and you can supplement those as well that give you good amounts of EPA and DHA, as well as nuts, seeds, and lots of other marine plants as well. You can find Dr Jenna at drjennamacciochi.com, also on Twitter @DrMac and on Instagram @drjennamacciochi. She's got some great articles on her website. I highly recommend you check those out and they will be on the show notes on thedoctorskitchen.com. Make sure you subscribe to The Doctor's Kitchen podcast and give it a five-star review. It really does help people find the podcast. You will find the information useful. Check out thedoctorskitchen.com for the show notes and I will see you next time.
