Immune Hacks for Surviving the Winter

In this first podcast episode of 2024 Pete chats with his favourite Immunologist Dr Jenna Macciochi.  

January is one of the most challenging times for our immune system and overall health.  In this episode, Pete and Jenna chat about the fundamental basics of great immunity.  

Jenna has a unique capacity to make immunology simple to understand. Throughout this episode you will be given nuggets of advice that can be easily applied on a daily basis. 

A key podcast for your health at this time of the year. 

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Transcript

Peter Williams  0:02  
Welcome, everyone to the first Functional Medicine bite size podcast of 2024. Wow, crazy. So I've got the real pleasure of speaking to an immunologist today, which, given that we are in the back end of the winter is probably going to be pretty important. Dr. Jenna Macciochi . I think I've got that right haven't I Jenna? And now me and Jenna sort of go back quite a long way. I'd probably say at least 10 years. And I first met Jenna, through one of our friends,  Ben Payne, who sort of ferments a lot of foods. And he asked me to come and speak at some stuff that he was doing in North London. And so off, I went, thinking I'd go and do this amazing conversation and blow everyone away with regards to immunology and the microbiome. And then, just before I went on, I got introduced to Jenna. And when I said, So Jenna, what do you do? And she says, Oh, I'm an immunologist. I was like, Christ. I'm going to be absolutely panned here. So I better be careful what I say. But you were very kind I have to say, you were very kind with your with your comments. So so a lot of you might know Jenna, because she she's she's done some really amazing books. And I want to plug it because I think what Jenna is doing, it's I always like the quote from Albert Einstein is that simplicity is the highest form of expertise. And what I think Jenna is doing and continues to do is to take the incredibly complex area of immunology and actually bring it down to real fundamental basics that are super easy to understand. And so I'm going to plug her book because her book's awesome. It's called The Science of staying well. And you've done another one, which I think is "Your Blueprint For Strong Immunity" as well. So I think, you know, I've got to plug these books, because they're just beautifully well written. And, you know, I think sometimes, again, I think there's the skill of clinicians is sometimes well, the lack of skill of clinicians is sometimes we make complex subjects complex. And really, what we should be doing is trying to make complex subjects less complex, so more and more people can understand them. And I think as you say, you do that really well. So, so Jenna, why don't you just give us give us a sort of brief of how you ended up being an immunologist? And then we'll, we'll jump into some sections.

Dr Jenna Macciochi  2:32  
Yeah, I mean, it was kind of serendipitous. I don't think I had the best career guidance early on, I think I would have benefited from maybe being a little bit more informed in my choices. But there we have it. But I was always pulled to figuring out what makes the body go wrong. What keeps us healthy, and immunology just seemed to answer those questions to some degree. It's a relatively new area. So there's still a lot to learn. So that's something that I love about it. Because I feel like I'm always learning. And I think in science, you just always have to approach it with that open mind and be open to things that might seem ridiculous on one level. But once you probe a little bit deeper, you get actually there's a kernel of truth in that.

Peter Williams  3:18  
So didn't you grow up on a farm in Scotland, and your mum was well into foods that that sort of guided you as well, didn't it? 

Dr Jenna Macciochi  3:27  
I mean, we grew a lot of our foods. We weren't particularly wealthy. So it was like the cheapest way to live so that a lot of porridge and turnips were eaten in those days. But yeah, so I really was connected to how food was grown. I knew how hard it was because of, you know, one bad season of weather and you know, your whole crop is wiped out. And that has such big implications. And that always kind of stuck with me. And also, whenever we get sick as children, my mom was just like, it's fixed at the kitchen table, you know, she had all her little herbal concoctions and I really believed that that's where good health started. And I think it went beyond nutrition that and I started to think about food as being connection with people and connection to our culture. And that's something that we love when we travel, like we often want to try the local food and that helps us get a sense of connection to that culture that we're in at that moment. Even things now like we talk about the anti inflammatory diet pattern, like the Mediterranean diet, and it's not just the food, it's the way they eat. It's the cultural aspect as well that's really important in that so I think that really was something I learned in childhood and also you grew up in a farm you see the circle of life, you know, your it was like a cow having a calf over there is another animal that sadly not survived for whatever reason that over there. It's just kind of like very visceral and real.

Peter Williams  4:51  
The Lion King in Scotland brilliant. So I think the key thing is, as you know, I what I would say I think for people in the street also trying to get answers off clinicians is that we're doing the best job we can with just an overwhelming amount of things to think about and take in. So we're, we're always best guesstimating is that I don't think anyone truly knows the answer, because I think it's far too complex. And I think one of the areas where it's just exploded is immunology, particularly with the the advent of you know, bacteria and understanding the microbiome a bit more. Suddenly immunology is is just a probably the area that's for me, it's probably exploded the most. So can we sort of give some kind of basic overview of our immune system, that would probably be probably the place where we could start, and then we can talk over to maybe nutrition, exercise, sleep, some of the fundamental pillars of it? Yes,

Speaker 1  5:50  
I think that's a really good place to start. And it's interesting that you mentioned the microbiome, because I feel like immunology branched off of microbiology, which was the study of microbes. And that that was where we first discovered that microbes made us sick. And we used to think that it was this bad air, you know, people got unwell because of like, because we couldn't use microscopes, because they hadn't been invented yet to see the microbes. Nobody knew what caused people to get sick. So suddenly, when we could see my microbes under a microscope, it was like, oh, you know, that's what's causing cholera or tuberculosis. And so we had this field of microbiology. And then from that, we realised, oh, wait, our bodies have their own system to deal with these infectious challenges. And so then branched off the field of immunology. And that very much took the frame of germs are bad. And the immune system is good. And I think what we've seen in recent years is an evolution to not all germs are bad, in fact, 99% of them won't kill you. And we really need them as our allies, and they're very, I consider them very much part of the immune system part of our defences, because if we don't have them, our immune system can't do its job properly.

Peter Williams  7:03  
Right. So let's dig into this because there's a couple of hypotheses wasn't there? There's the hygiene hypothesis. And then there's the good friends hypothesis, which is that the sort of latest version of what we are, so can you just give us a sort of real sort of layman's sort of understanding of what, what, what what they are? Yeah.

Speaker 1  7:23  
So the the hygiene hypothesis was the one that emerged first. And this was through looking at the rise in allergies, and basically asking yourself, why is our immune system reacting to allergens when it shouldn't? Oh, it's because we have increased hygiene. So there was this correlation drawn between being very clean, people who lived like myself in farms, which are, you know, you're exposed to more dirt, farm animals, etc, they tend to have fewer allergies and people who are living in the cities and much cleaner environments. But I think the word hygiene was a bit of like a wrong phrasing to use. Because at that point, we didn't really have an understanding of good germs and bad germs, we were still thinking of germs causing infections. And so all hygiene, you've got to wash your hands after you've been to the toilet hygiene, you know, you've got to dispose of tissues that you've used correctly. And, you know, when you've chopped raw meat in the kitchen, kitchen hygiene is important to remove any risk of you know, food poisoning. So hygiene is really the wrong word, it was more that we were lacking exposure to the good friends. So this is where that hypothesis came along much later by Graham Brooks. So he kind of took the hygiene hypothesis and kind of improved it to make it more applicable to what we know now. And the good friends, sometimes they're called the old friends are basically the good microbes in our environment. Because we're surrounded by microbes all the time, we're breathing them in, they're being swallowed, they're passing through our digestive tract where our microbiome sits. And we know that over the past 50/60 years, we've kind of eroded these old friends in that our microbiomes are not as robust as they used to be then they're not informing our immune system of how to do its job properly. And the result is we see a rise in things like allergies, also autoimmune diseases and other kinds of inflammatory diseases.

Peter Williams  9:17  
So you you said that they are informing certainly these bacteria these friendly bacteria are informing our immune system so for many people, they probably might start to think that our talks getting a little bit weird and wacky so can you can you can you explain that because you know this is the I think this is the crux for me as where immunology is exploded is because of the the well, basically what is a human and then, you know, the jobs that our bacteria do for us would be would just be really cool. If you could just sort of sort of clarify that a bit more.

Dr Jenna Macciochi  9:52  
It is a really good point because it is it is kind of interesting, and it's hard to get your head around, you know, we have a few kilogrammes worth of microbes living on and in our body. And these are known as the microbiota. So they're kind of the good friendly microbes. Most of these are in the gut. So that's the highest concentration of these microbes. And actually, most of your immune system is located along the digestive tract, and there's a huge concentration of your immune cells. So they are located along the digestive tract. And then within the digestive tract, you've got all these good, friendly microbes, and so they're in constant communication with each other. And those friendly microbes are doing things like they're helping break down our food properly, so that we get the right nutrients, they're helping us liberate key things from our foods. They're producing things when they break down our foods, things called short chain fatty acids, which actually help our immune system work properly. So it kind of stops it going down the direction of, of allergic disease, or autoimmune disease. So this is what I mean, when the microbes are training and educating our immune cells. And a lot of this happens in childhood, it's kind of setting us up for success, and it continues throughout our life.

Peter Williams  11:06  
So can you can you expand from that as well? Because obviously, we could go to I mean, I suppose How far do you want to go back? Because you could probably trace it, you know through your grandparents and parents, and they are having an influence with regards to your immune system. But maybe, could you maybe give us sort of the story from if Well, I suppose you know, I don't have a go at mums who, who are getting pregnancy ready. But the evidence on mum having a really good microbiome and a really good vaginal microbiome is quite important for for setting up baby. So can you can you just go through that? Because again, I mean, some of this just might seem like just wow, oh, my God, I listened to these two guys on the podcasts. And it was just so weird and wacky. But the reality is, is that a lot of medicine now is like, is that true? Is that really what's happening? So which, and it is,

Dr Jenna Macciochi  11:58  
often when I speak to people, they'll be like struggling with gut issues relating to their microbiome. And the first thing I do is ask them about where it all began, get them to go back to their childhood, because as you said, you're kind of a blank canvas when you're born. And that journey from being inside the the uterus, safe as a little developing baby to entering this germy world where literally every surface is full of germs, like I say they're not dangerous germs, but just you know, environmental germs. It's quite a transition in a short space of time. And so you're, you're what we call seeded with microbes from your mother, when you go down the birth canal. So that kind of sets you up with this initial microbiome that helps protect you from all these other germs that could otherwise make you very sick, because you're so vulnerable at that age. And then we need to fertilise the proper gut microbes to make sure that they flourish like a garden, you plant the seeds, and then you need to fertilise them. And so to do that, that's why breast milk contains prebiotic fibres, designed not to nurture the baby's nutrition, but to actually fertilise the right types of microbes in the gut. So these are two huge events in our life, and early life that really set the trajectory for our immune system. And this is relatively new knowledge. So if you're sitting listening, thinking, Well, I was to ceasarien section, and I wasn't breastfed, or I've had a baby that was ceasarian section, and I couldn't breastfeed, you might be thinking, Oh, my God, I've, you know, I've set set myself up for my child up for a terrible immune system. And it's not about looking back at the things we can't change and feeling bad about it. But it's just appreciating the marvel of science, that this is really an important input for our immune system. And then thinking what can we do, you know, as we get older to maybe improve on that, and there's lots of science evolving in this area, still very early and very fresh. So it's maybe not information you'll get when you go to your doctor or your gynaecologist if you're pregnant. But it's really important to just have on our radar. So

Peter Williams  14:10  
I think it's a really good point, because I think people suddenly feel responsible. And, you know, it is what it is, in many ways. And you know, I've got we've our little ones, well, our youngest one he was C section, whereas our other one wasn't. And he obviously displays the some of the some of the classic conditions that come with that. So can you give an idea of maybe what we should be looking at and how, you know, when we, when we're talking about and also really sort of sort of expand on baby gets to about two or three, doesn't it while that while our immune system is really sort of trying to take shape, so can you just expand on some of the things that you may see in kids that may be related to that? But that doesn't mean to say as I said to you, that doesn't mean to say it was your fault, or you know, you're a bad mum, you know, because I couldn't breastfeed that's not it at all. It's not what we're trying to say.

Dr Jenna Macciochi  15:02  
Yeah, I always see it as like, let's just, you know, marvelled at the science like we produce this breast milk that's actually got something in it to help the microbiome. I mean, I think that's pretty cool. Whether you could breastfeed or wanted to breastfeed or not, I think we can appreciate the human body can do some cool things. But yeah, the first 1000 days they talk about, which is the first a couple of years from conception, in to infant years is really important for sort of setting up the microbiome, which is then setting your immune system on a trajectory. But it's really important that we've talking in averages, you know, we're looking at the totally at ease, where you'll see like 80% of kids went on to develop allergic disease or something if they weren't breastfed, but it doesn't mean that all kids will necessarily go on to develop this. And I think that's really important to stress that we're always talking in averages. And in every study, it's rare that 100% of you know, people tested will show the symptoms, but some things can be important to look out for. So things like eczema very early on, which means the skin barrier is slightly not integral. And if we get some allergens, so for example, peanut into the skin, before that baby has had peanut in the diet, it can lead to a peanut allergy. So this is the dual allergen hypothesis, this is also relatively new information. And actually, we've seen a huge U turn in this in recent years. So we used to be told not to give babies allergens until they were much older. And what we realised was this was driving allergies. So we need to see these allergens early on. So I think the recommendations in the UK is somewhere between four and six months to give the child all the major allergens in a sort of safe and controlled way, unless you're a high risk family and your doctors recommended otherwise. And when your immune system sees those potentially allergenic foods through the gut, then it helps build tolerance to them that will guide you through the rest of your life.

Peter Williams  17:11  
I can't remember that study, I think it was I don't know, it was the pace study. Or maybe I've got the names wrong. But it was it was done by St. Tommy's wasn't it and it was it was doing exactly that it was giving allergenic babies. Peanut allergy babies actually feeding them very small dosages of peanuts. And the and can you can you, I think you're doing this really great explaining about what the immune system does? Is it because it's it's tasting and organising friend or foe all the time, isn't it? And so, you know, I was trying to explain it. It's a bit like you're always an explain this sort of role of tolerance. I try to explain tolerance to my patients as it's like the experienced bouncer on the nightclub door he's been seen and everything. So you know, there might be a couple of students who were a bit pissed, but they're not really going to be any trouble. Exactly. Can you can you just sort of go into that a bit more, because I think it's a really important thing to have their understanding of, you know, and particularly, you know, why the gut's so important, this really important barrier from the outside world?

Dr Jenna Macciochi  18:14  
Yeah. I think that's really important. And the gut is, I mean, it's this huge, long tube. So we're throwing all sorts of stuff in there. Think about what you know, you swallow things that you've breathed in, you might be in a really polluted Street, whatever you've eaten that day, it's all going through the gut. So the gut is this huge sampling system. And as we said, it's got lots of immune cells there. And it's got all your microbiome there. So it's this huge interaction to decide what we're going to respond to? Is it salmonella infections going to make you really sick? Is it just a benign microbe in your environment that might actually be helpful? Is it a food that's something we want to react to like an allergen? Or is it a food that we want to tolerate? And so a healthy gut is able to make those, those different decision points, like you say, it's constantly calibrating so that if your baby's eating all the top allergens, I don't know peanuts, tree nuts, eggs, fish, things like that. It's taking that information and going these are not harmful foods. These are things that are giving me nutrition, so we don't react to them. And sometimes that system goes a bit array, and the immune system makes the wrong choice, and will say, Oh, no, that peanut, that's something actually I think is harmful, even though it's not and it makes that wrong choice and you develop the allergy. And so seeing eczema early on can be a sign that you have what we call atopy. So it's a genetic predisposition to being allergic. And it also means that if you get peanut in through the skin, it's more likely to sensitise you to a peanut allergy because it overrides this tolerance that happens in the gut. So where your immune system sees something whether that's through the gut through the skin can make a big difference to how you react to it.

Peter Williams  20:03  
So, we've talked a lot about how the microbiome are it, I suppose, probably frontline, sort of soldiers or security guards at the border. What else is there? Because obviously, we've got a bit of a frontline, we've got a bit of a back line, we've got messenger cells that tell the rest of the body, there's a bit of a fight on here, let's let's get activated. Can you give us a? And I know this is quite complex? I mean, I struggle with the complexity of it. But can you try and sort of give us the what is the immune system? Apart from sort of, obviously, microbes are a massive part of it?

Dr Jenna Macciochi  20:36  
Yeah, it's a great question. Because sometimes I'll say to people, where is your immune system, and they're like, Hmm, I don't know. And then you really start to think about it, it's because it's everywhere. Unlike other systems in the body, like the respiratory system, you can say, Oh, I know, it's my lungs, the digestive system, oh, I know, where my gut is, the immune system is everywhere. And it's primarily composed of white blood cells. These are not just in the blood, despite the name, they're also in your tissues. So you'll have a lot of them at what I call the body barriers. So under your skin, lining your respiratory tract, lining your digestive tract, anywhere where microbes or things that want to damage your body could get in, so any interface you have with the outside world. And within those white blood cells, there's two types, there's the first line defenders, who are going to be there ready and poised, you know, the minute you inhale some sort of virus, they're ready to respond. And then you have the adaptive immune cells, which take a little bit of time to develop a specific response, but they're much more specific to that germ and give a more powerful and targeted response. But on top of that, you also have lots of immune organs. So this would include things like your lymph nodes, your spleen, your thymus, which is a small gland and the neck, your bone marrow, and these are all connected by the lymphatic system. So the lymphatics are kind of like the circulatory system of the immune system, as it were, but whereas the heart pumps the blood around your body, the lymphatic system isn't pumped around by your heart, it requires you to move your muscles. So you literally need to move the body in order to get your immune system to work.

Peter Williams  22:21  
Great, that brings me on to my expertise, which, of course is all is the exercise science side, which, as you know, I mean, you've beautifully summarised it there. Because, you know, one of the key things here is that what exercise does is not only stimulate blood flow, but it stimulates the lymphatic system to move soldiers around the body more effectively for sure. So that I think that's a great place for us to jump into. So can you because this is I know, You've covered this in your book, but I think it's super, super important. Because this is all free. You don't you just got to do it. And you also get that deeper understanding of how movement it well, you know, I always say to people, I'm pretty sure you cannot have optimal health unless you're moving consistently, because everything is designed to have movement applied to it on a daily basis. And your immune system. Totally is I mean that the studies with no, I'm gonna let you do it. I'm going to I don't want to take this up. So you go and give us an understanding of why moving more often is better for your immune system. 

Dr Jenna Macciochi  23:28  
Yeah I think people don't always make the link with the immune system. You know, you've got all this sort of public health messaging about movement. And when I talk to people now, it's everyone's thinking about it as a tool to lose weight. Yeah, nobody's really thinking, Oh, it's a tool to like, give me this really robust body well into my later years. So hopefully, we can keep trying to change that narrative. Because like you said, it literally does make your immune system work. It's making that lymphatic flow move around the body, it's allowing your immune cells to perform a surveillance function. So they're able to move around the body look out for things untoward. And that doesn't just include infections, that also includes damage and repair that needs to happen. And it also includes potentially cancererous cells, because your immune system is the main cancer defence system. So that is really, really important critical thing. I think what some people don't realise is, you know, you might say oh but I'm physically active because I go to the gym three times a week, but you're literally sedentary, from nine to five, and being sedentary can't be out done by an hour in the gym in the evening. It's about moving more throughout the day. 

Peter Williams  24:39  
Totally agree with you. There were two studies in particular that were done just before the turn of the century in Holland, and they looked exactly that. And what they certainly proved is that if you're going to go to gym three times a week and you're not going to do anything else, you might as well just be sort of moving around all day because you get more benefits from it. So absolutely key on that. And again, that's something that I nail in to everyone all the time. The other thing I would say on that is that I totally, again, agree with you that unfortunately, people use exercise as a modality to lose weight. And if you're using it as the only modality to lose weight, you're gonna have to do a lot of exercise for that to work. But everything else, it's, it's the real deal. For sure.

Dr Jenna Macciochi  25:23  
Exactly, and I just think when you look at how humans are built, on our two legs and our limbs, and you look at our evolution, and how our things like our metabolism works, all of that, you just say, Oh, we're just meant to move more, we're meant to move more often. And we're meant to move in lots of different ways. And, you know, it's something that I just can't emphasise enough. When I had my kids, I realised I couldn't go to the gym when I wanted when they were babies suddenly thrown into parenthood. And you don't have that luxury of just going out for a run when you've got two babies at home. So I had twins. And that's when I realised that movement had to take a different form, I couldn't just wait until I could get an hour to run out to the gym. And I just had to build it into my day. And that's something that was a really positive thing of having children, because I suddenly that luxury was taken away from me. And so I really would challenge anyone who struggles to get to the gym to just find a way to build it into their day. If that means keeping a kettlebell next to your desk, just getting up and doing some swings every, you know, 20 minutes. I don't know what it looks like. But

Peter Williams  26:36  
it could be my Instagram, because that's basically what it is, here's exercise of the day off you go. And then there's a tick the box on something like like that,

Dr Jenna Macciochi  26:44  
like break it down into 10 minute exercises, totally, end of the day of like, Oh, I've done a full workout, but I just had to spread it out. And the other thing that exercise does, is it's really important for taming unwanted inflammation. So inflammation is a response of your immune system to fight off something. It's why you feel sick when you have the flu, because that inflammation is making your body very hostile to the germ to get rid of it. But because of the way we live our lives, we have kind of a low and slow burn of inflammation that we know can really build up over the decades and precipitate and a lot of age related diseases and unpleasant symptoms. And we know that short bursts of exercise can be quite inflammatory and that short term in a good way that it's almost then driving up those antioxidant pathways. And we know that inflammation is very oxidative. So exercise is the anti oxidative counterbalance to that. So that's another really, really important thing. And I would say one of my favourite aspects of immune health and exercise is really to do with longevity. So there's a lot of chat about longevity and health. And I think that from my research, we know that the immune system ages not at the same rate as your chronological age, so you could be 70. But your immune system could be the same as someone who's 40. Or it could be the same as someone who's 90 depending on how you've looked after your body. And one of the key inputs into the ageing rate of your immune system is exercise, and specifically of exercise, it's your muscle mass. So for anybody out there who's like me in your 40s, you're going to start having to really think about how you're going to hang on to your muscle mass as you get older, because if we don't use it, we lose it. And when we use our muscles, we produce things called Myokines which are really rejuvenating for the immune system. So they're sort of anti ageing for your immune system. Which is why when you're then in your 70s you can have the immune system of a 30/40 year old and you'll be less susceptible to all those nasty winter germs and things that often are the things that strike elderly people down much more seriously.

Peter Williams  29:14  
That was just heaven for me, because it's it's literally everything that that's the beauty of what we found with exercise now it's just I think you you I mean what I liked about you Jenna, you're really good on the research isn't it? There's research and research and there's a lot of crap out there for sure. And there's a lot of crap regards to longevity and I don't see a lot of that that actually really sits solidly with the science there are two aspects for me that really do the VO2max your fitness number one, number two is well probably runs with it is the amount of muscle mass that you're gonna carry into older age. The rest is a bit of umming and ahhing for me and definitely I think you know a lot of the I mean even mean even the argument about you know, you need to make sure that you are and again, I don't want to get make this complex, but I think it's quite an important point for some people is that, you know, they're trying to restrict the mTOR pathway. And the reality whether I'm trying to do most people who are probably have low muscle mass is I'm trying to stimulate the mTOR pathway, because I want to build a bit of muscle tissue so that, you know, they've got enough to get them through through later ages. And can you just give us an understanding as well on that, because one of the key things is that that muscle becomes a key part of your immune system, particularly when you're older. And I think about, you know, sometimes people go spend a long time in hospital and they're bedridden. So can you just expand on that as well?

Dr Jenna Macciochi  30:38  
Yeah, exactly. We do lose muscle mass over time, unless we're working hard to mitigate that. And I think that I concur with all that you say about the longevity medicine, I think it's really trendy at the moment. But I don't know that there's much substance beyond like the things that you mentioned VO2Max, you know, keep being active and have that cardio aspect, get your heart rate up, and then muscle mass, which is to mitigate that age related muscle decline, which we will all experience and you may see it in your elderly grandparents, that they tend to shrink, and particularly if they have a fall and have to go to hospital. That's something that happened to my grandfather, I literally saw it before my eyes he, he also lived on the farm with us in Scotland, he maintained living alone in his in his cottage on the farm, he was 95, he climbed on his roof to clean his chimney because he still had a coal fire. He fell off the roof, but he landed on the flat roof of a garage. But no bones were broken. But he was badly enough injured that he went to hospital and they were like, Oh, my goodness, this man should not be living on his own, he needs, you know, round the clock care, even though he'd been quite happy until this incident. But within a few weeks of being in hospital, he was completely bedridden, he'd become incontinent, because they just put a catheter in because they couldn't be bothered to get him up to the well I don't know, if they can be bothered, it didn't have capacity to get him up. And he's his muscle mass shrunk, and he could never walk again. And that was in a few weeks, because in your 90s, you just cannot keep that a hold of the muscle mass if you're not using it. And this is what happens to so many elderly people, you know, you just trip over and you hurt your knee and then suddenly you're sitting on the sofa while you're recovering. And then you've lost so much of your ability to move. So I think you have to build that bank, not only of muscle, but your ability to move your body in lots of different ways like to reach up high and get something and you know, bend down low, get off the floor when you've been playing with grandkids, like all of these different factors so that you can have a life that you enjoy and all that social wellbeing comes in, because you can go and do the activities you like anything that nurtures your immune system in other ways.

Peter Williams  32:55  
So thank you for understanding my, my Instagram page again, because it's totally, but you know what, that's the beauty of it is that someone who you who gets it gets what we're trying to do with that and gets the importance of mobility, stability, strength, you know, what are you going to do when you fall? And it's not a question of, you're not going to fall? It's a question of, does your brain work quickly enough so that you don't have more dramatic outcomes from the falls and it's coming?

Dr Jenna Macciochi  33:24  
For you actually, on that, what is it, is it the human condition that we're kind of resistant to hearing that information? Because I find people are like, Yeah, but still just want to look good and burn calories. And I don't know if it's because I'm speaking to women in the 40s, who've been conditioned to think that you exercise to burn calories to look good. Not that exercise is going to give you a long healthy lifestyle, is there's a real like, resistance to hearing that information and making the changes.

Peter Williams  33:54  
So what I would say on that I think that's age led for someone who's just got into their 50s Now, well I've been in it for a while is that you definitely recognise mortality once you're over 50 Rather than when you're in your 40s. And you still think you're the best thing since sliced bread. Yeah, so I would, I would say I would say that's purely the case because everything changes from there and then just that realisation of your mortality. It's like, you know, I've got a I've got a 15 year old who said, you know, he's pretty big and strong, you know, as a rugby player. And he's already you know, it's like holy shit, you know, he's, you know, there's a He's strong. Yeah, so you realise your mortality a bit more on that one and then you start realising you know, same thing I mean, my grandma she she had neck of femur fracture, which again, you don't really survive it or, you know, you're probably going to the statistics on that are pretty horrible. And, you know, falling is one of the, unfortunately one of the biggest causes of early mortality once you're over your 60s. And so, yeah, Jenna, I just think again, it's that you know, we need people like you to teach people about the importance of somebody's fundamental basics past, you know, aesthetics. So, you know, I've got no problem with, you know, people doing stuff to look good, because, you know, they're probably still engaging in that muscle mass. But, you know, as you get older, you know, you've got to start thinking about, you know, mobility, stability, how quickly can I move, you know, from from from, you know, not getting myself in trouble from a fall. Anyway, let's, let's move on. That was brilliantly said, we're both on the same page on that one. Because also, I think one of the key important things is, is which you tie to is the mental health aspects, and sort of dissociate genomic aspects of you know, how that influences your immune system. So again, I know you've covered this in your book, but could you give us the sort of summary? Yeah,

Dr Jenna Macciochi  35:47  
this is something that I thought about a lot. I think, when I embarked on the first book, I was kind of centred around the big levers of diet and exercise. And when I started looking into the literature, I was like, Oh, those are the least interesting parts, it's all the other psychosocial stuff that's actually interesting. And so the other areas that I think that people should start to have an awareness, or bringing awareness to when they're considering the health of their immune system is that the people that they spend time with the environments that they frequent, and the relationships they have, and their own sense of mental well being, their own levels of stress, I think these are really hard things for people to grasp. And some of it might feel very out of their control, you might have a really stressful job. In an environment that's very noisy, or uncomfortable, or stuffy or no natural light, you might feel that you don't have any agency over your stress levels, because they're driven by many outside factors. But just really thinking about stress as a biological response, you know, we think about it in our head, and, but when we can start to tune into having that interception of our body does your heart rate increase, when you start thinking about some things stressful, that you're anticipating your sleep might suddenly go off, you might not be able to focus, you might lack concentration, or you feel clammy, there's a lot of physical manifestations. And that's driven by these chemicals under the hoods that are creating that stress response all due to what you're thinking in your head. And it might be due to very real circumstances. But our immune cells have receptors on the surface for stress chemistry, and that's deliberate throughout our evolution, we've evolved that mechanism, because when there's stress, that means there could be danger could be risk of getting injured or damaged or infected, you know, you get a wound. And so we need to have the immune system going right, I'm on red alert, there's a stress coming up. So actually a very short term stress Improves Your Immune System. But when that stress is more than just a single incident for a few hours, and it's kind of low and slow every day, that's when it's almost like you're accelerating and braking at the same time. And that's not nothing's working properly, you're no longer responding to the stress chemistry in the right way. And one area where this is really important is in autoimmune diseases. And often when I speak to people with autoimmune diseases, they want to change their diet to improve their symptoms, but they haven't considered the impact of stress. You know, when we wake in the morning, we have this rise and stress chemistry to make us feel a week. So we have to not think of all stress as being bad, but it's got a it's got to function, it's got a purpose. And that is helping get rid of old, tired and potentially malfunctioning immune cells, and leading to the release of fresh new ones. So that that daily kind of ritual of waking with the sun. At the same time, every day, having that nice routine is clearing out old immune cells bringing in fresh ones, and the ones that are old and tired, could malfunction could drive things like autoimmune diseases.

Peter Williams  38:59  
And it's not one of the roles of the thymus gland is that it sort of does the morning. It says, Are you normal? Or aren't you normal? Isn't that one of its roles? And then if it seems sort of dysfunctional, sort of immune cells, it's sort of it takes them out of out of out of circulation? I mean, that's super cool, isn't it?

Dr Jenna Macciochi  39:18  
Super cool. It's really cool to think that the reason that you wake up and feel like you want to leap out of bed is because you've had this morning, it's called the cortisol awakening response. Yes. Like, you know, your body's going, boom, time to get up. Here's a burst of energy from cortisol in a good way. And we're also going to get rid of anything, we don't need trash, all those wonky immune cells, and then we've got space for fresh ones, but I think what happens these days is that nobody's really having that strong. sleep wake cycle, our sleeps eroded because we're stressed or we're staying up too late. We don't have that lovely cortisol awakening response anymore, like we should do. And so we just tend to Everything gets a bit burnt out and not working properly.

Peter Williams  40:03  
And as you said, Is that so so in my understanding if you don't have a robust enough cortisol punch, and again, here's the thing, isn't it? Is that too little is no good, too much is no good. And I think this is the key thing. So I always sort of, I also dread the people with a little bit of knowledge because it makes them dangerous. And they say, oh, you know, cortisol is terrible. But the reality is, is that it's probably the most essential hormone as far as I look at everything, and life is going to look pretty horrible. If you don't have much cortisol, that's for sure. And can you just talk about cortiso's anti inflammatory role as well, because I know you want to talk about sort of that leading into that autoimmune aspect.

Dr Jenna Macciochi  40:46  
Yeah. So it's, it's, you know, imagine, like you said, cortisol is really, really important, because it's important for survival. If I was standing out on the street, and there was a car coming out of nowhere, I would need a burst of cortisol to pump some blood sugar, some sugar into my blood, so I could run to safety and sharpen my mind so I could get out of the way and be safe. And at the same time, you want to dampen any inflammation, because that's not important right now you need to motivate yourself to safety. So if you have a head cold, and you're stressed, you're not going to deal with the cold, because your body's like, No, I'm, I've got to be stressed. I've got to be red alert for this over here. So you know, when your doctor prescribes cortisol based drugs are a hydrocortisone cream. That's basically the same chemical structure as what is in your body when you release that stress chemistry to take away any inflammation to suppress the immune response.

Peter Williams  41:44  
And what about long term problems with that? Yeah, exactly. You must see that all the time I do Yeah,

Dr Jenna Macciochi  41:50  
over the long term, then your immune systems not going to be able to work properly. So it's really, really like, in the short term, it has a function, when it's outside of the realms of what's functional, then it's going to suppress your immune system. Yeah.

Peter Williams  42:06  
And just to be clear to everyone, we see loads of patients who are on those sort of anti inflammatory led drugs. And usually it's pretty essential, based on where they are with their condition. I think we're, I think medicine needs to get better is that there's got to be some degree of plan, also running alongside it, because there comes a point where those drugs become start to become the problem and start to create more problems longer term. So that would that would be definitely my call on that. You can't just have someone on a medication that said, sometimes the medication absolutely hits the spot. Yeah,

Dr Jenna Macciochi  42:43  
exactly. And I always think of it as you know, we have to get control of a person's condition. And then when we want to keep control, then we might want to dial different levers. And that might, in the best case scenario, be able to reduce the medication. Yeah. So I've seen that with people with things like rheumatoid arthritis. Yeah,

Peter Williams  43:06  
absolutely. I think that's the way you've got to do it for me, for sure. And I suppose that also leads into my view on antibiotics, you know, it's exactly the same thing is that, you know, it's some stage for some person, it's going to be absolutely essential that they're given antibiotics, because you've tried everything else, and it's just not working. Yeah. So great. But you've got to run something alongside that. So can you just because I think this is actually, again, another really important clinical pearl. So can you just give us this sort of overview with regards to look, there's no doubt they're incredibly effective drugs, no doubt about that. I mean, probably one of the most successful and drugs that we've had. But they are overused. But what are the what's the sort of potential long term consequences to the microbiome with antibiotics?

Dr Jenna Macciochi  43:58  
Yeah, I mean, it's, it's starting to get traction in terms of awareness now. And I know a lot of people are starting to question their GP. If they're prescribed, I think it's really a precautionary approach. So if you go through to your GP with some kind of infection, often they won't even check if it's bacterial. Yeah. And particularly in the case of kids, but they just want to give you the antibiotic as a precaution. And that's fine if there's not a sort of longer term impact. But I think what we've learned is that since antibiotics were introduced, and I think this was in the 1940s, and that correlates beautifully with the rise in allergies and autoimmune diseases and inflammatory diseases. And obviously, that's a correlative approach to the data. So it's not necessarily a driver. But we also know that allergies, autoimmune diseases, inflammatory diseases, are all the diseases that have their roots in what our microbiome is doing. And that goes to our earlier part of our conversation because the microbiome is teaching and educating our  immune system. So if you're damaging the microbiome, your immune system is more likely to go array, and lead to these these conditions and different immune disorders. The challenge is when we're looking at research that different studies will show different things with regards to what impact antibiotics have on the gut biome. And obviously, again, you're looking at one sample population of people, you're giving them all antibiotics, or you're looking before and after antibiotics. And in some ways, it's really hard to predict, I think how how a person's immune system or how a person's microbiome is going to deal with that challenge. And it might depend on the frequency of antibiotics, the type of diet and lifestyle that person has. I just think we should avoid them unless strictly necessary, and that people should feel empowered to maybe push back and challenge the GP. And also, ask the GP or pharmacist or seek some nutritional support and how to perhaps deal with the potential collateral damage. Because antibiotics are just nuking all the bacteria good and bad. So they're not differentiating between the good ones you want to keep, and the bad ones you want rid of.

Peter Williams  46:13  
So I what I usually say, Well, again, a lot of the times they are given out, and it's probably not bacterial. But I get why. And so it is a complete mismatch there. But I do think the GPs are covering the bases on that. So you know, fair enough, it's not a perfect science. But I always say look, if we're going to run if if you're going to go on the antibiotic, which is not a problem, because maybe actually, we've tried everything, and it's just not working. So that's definitely the right thing to do, you've got for me, you've got to at least run some kind of gut microbiome sort of programme alongside it for a period of time. So that's sort of standard standard care in our practice on that side. And you may be doing a little bit of guesswork, because it's, it's nine, as I said to you, you know, what I think would be really good. And I'm going to change subject here, because I think what's really super important is that, you know, you go on social media, someone will say, you know, here's, here's a study, and here's the result of that study, and everyone thinks that that study is completely appropriate to them. And I think just that deeper understanding of what does that mean to an individual? You know, I just think that's super, super important, because actually, it might have no relevance to you at all. Or actually, it might be absolutely spot on for you. So can you just, can you just break that down a little bit? Because I think we say when you get an individual study that comes in, and then suddenly it's, it's in the news, and then suddenly some say, and then your patients are saying, you said X, Y and Zed on this? And I'm like, Listen, you know, you are not that study. So can you get can you get a try and just explain how, you know, an individual may or may not relate to that study that's been done.

Dr Jenna Macciochi  48:01  
Yeah, it's a real challenge for for the general population. And I would just say on that, you know, especially with social media, that information can transfer so quickly, you know, from the press release going out, to, you know, 3 million hits on Instagram with people talking about it. And then you speak to like, I don't know your neighbour one day, and they're like, Yeah, but avoid this, I'm worried about that of my life. And, and I think that, I don't know, you need to have a certain training to be able to interpret the science properly, which the lead public are not expected to have, because that's not their job. And so there's a real responsibility that we have in communicating it. And I often try and put it to people like this, like one study is really interesting. And sometimes I share one single study on my social channels, that I think is really interesting. I'm always really careful to try not fear monger. But I we have to look at the body of evidence and then apply it with clinical context. So you know, it's fusing together the body of evidence, which means all of the studies in that area, and how similar they are and what population they looked at, and what parameters they measured and didn't measure with the individual in front of you and their individual story and narrative. And the science is the beauty of putting those two things together. I think

Peter Williams  49:27  
the challenge is probably the art of it rather than that.

Dr Jenna Macciochi  49:31  
That's the phrase that art and science of it is, is that which I think is missed when you read a headline because journalists, and I work with lots of wonderful journalists, but they want to have a engaging headline. So the caveat caveat doesn't apply to these people. This was only done in mice this week. You know, that doesn't work for a headline, it's going to be boom, x plus y equals cancer or you know, it's going to be really powerful. And so I always just really encourage you able to cast a critical eye. You know, people will say to me Oh, but I've heard this or I was told that by who? What did they mean? What do they know about you and your health? Where's the source of the information? critique to me is how we drive science forward. So critique isn't being critical. It's not personal. It's not me saying, Oh, your studies rubbish, because I don't like you. It's me saying, let's dig into this. No study is perfect. Every study has gaps. It's all driving it forward. So I'm just, I'm always telling people just try and be a bit critical. Just try and cast that critical eye on information before you just take it as gospel and start to internalise it.

Peter Williams  50:39  
And you do that, probably better than anyone I've seen on Instagram, when you do your cuz you've done a few. And they're just, I'm almost like, right, there's the template for me, because you do that incredibly well. And I know that's a slightly, you know, I think there's a I think there's a slightly defensive aspect to sort of not coming out with a big, big statement. But the reality to that is that is because no one really knows. So you know, so So if anyone wants to have a look at Jenna's Instagram, she will, she will occasionally and probably probably this probably about two or three a month where you've looked at a few studies. And you've sort of broken them down over as you flick through what you've written. Yeah, you do that you do that brilliantly well. So as I say, I've looked at Jenna's Instagram, because she, she really does, you're very good at. Okay, so this study is quite exciting. But what does it really mean? And how can we translate this to the individual and again, you know, I can remember this stuff, it's a little bit like, the old Vitamin E story about vitamin E, you know, may create early mortality or increase your cancer risk, but then, when you look at all 10,000, other studies that have been done showing the opposite, then you're like, Okay, so, you know, where do we go with this? And, you know, what sort of vitamin E did they use? And what was the quality and all this sort of stuff. And and, as I said, is, if you really do need to be a literally, a reader, a reader of science to, you know, that needs to be your job to fully understand exactly, I mean, I think I'm okay at reading papers, but I know there's a naivety to, to me reading them as well, because I mean, I'm not a statistician. So you know, I don't

Dr Jenna Macciochi  52:17  
know what you mean, it's a constant learning, and also, just appreciating our own biases. Because we all have them and sometimes we really want to find studies that confirm what you want to believe, like, I've had this conversation with people who have dietary preferences, so they don't eat a certain foods. So they'll show me 10 studies that show that food is bad, and it's like, okay, we can go and find 10 More that show that it's not bad. And the overall pattern of the diet is more important. But we all have these biases. And so I think that's really important to try and have an awareness of and try and objective, it's not always possible, but it

Peter Williams  52:55  
is, just to let people know is that I don't know anyone who I would be, I would be cautious of people who pretty much think they know exactly what you should be doing. Because I think anyone who's really been in this game for quite a long time, the more you know, the less you're like, Well, you know, maybe we can have sort of, there's a there's a pathway where you can go down and we'll see what see where we end up. So, you know, I think

Dr Jenna Macciochi  53:18  
everything with the immune system starts with, it depends.

Peter Williams  53:24  
We're not sure. So we're totally flying through this. So um, I know, I'm gonna put this out early January, but the thing or the reality is, there's gonna have to be a part two pretty quickly, because we've literally flew through this, we're nearly up to the hour. So I just want to, I just want to maybe just briefly jump into sleep, and then I'm gonna have to ask you to come on again, because this is good stuff, isn't it? I mean, you know, we're sort of really going through some great stuff here for everyone. So let's talk about sleep and immunity. And let's talk about if you're not getting a decent night's sleep, you're on a hiding to nothing, but some of the mechanisms that drive that and why it's so important. Yeah,

Dr Jenna Macciochi  54:03  
yeah. So sleep is really important. We touched on this earlier when I mentioned about, you know, the cortisol awakening response. And that ties into the fact that we're just circadian beings. You know, it's wired into our DNA that we wake in the sunrise and we sleep with the sunset, and we have different cues in our body that are flicking different genetic switches. So we do best when we have that rhythm. So your your sleep is really important for a well functioning immune system. So you wouldn't be getting that quality and quantity of sleep. But equally when we are sick, it in turn will give us poor sleep. So think of the last time you had a cold or flu or fever, that in turn erodes your sleep. So there's a two way crosstalk between the immune system and sleep. And I think that we can underestimate what I call the trickle down effect of poor sleep. So that is, if you've had a bad night's sleep, you wake up you probably I have poorer blood sugar control, you probably reach for the wrong foods, because you feel a bit groggy, you have more caffeine than normal, you know, you just have mood disturbances. So, you know, when you're offered a healthy lunch versus a really unhealthy lunch, you sort of feel a bit like more pulled to the unhealthy. So there's this real kind of trickle down effect of poor sleep, but I think people don't often realise, but not getting enough sleep fundamentally will affect your immune system. And it's hard to say how much an individual needs, we sort of roughly say, like seven to nine hours, I think some people might need more, if you're training for a marathon and you're running, you know, a lot of kilometres a week, or, you know, you have some other life events, or you're healing or recovering from an accident, you might need more. But there's a kind of a study where he did mathematical modelling. And they looked at the percent of catching a cold, depending on how much sleep you've had. And obviously, when you leave the house, go to work commute on the bus in the office, go to the gym, you're surrounded by lots of potential cold and flu viruses, particularly at this time of year in winter. But your chances of catching a virus over and above any other lifestyle factor seem to trickle down to sleep. So if you have less than seven hours, you're nearly 20% more likely to catch a cold. If you've got six hours, you're about 23% more likely to catch a call. But once you get less than five hours of sleep, you're almost 50% more likely to catch a cold than if you've had a really good eight hours sleep.

Peter Williams  56:34  
And what is it what is it that gets reduced on that is it sort of there are certain aspects of the immune system maybe natural killer cells or, or something that is just maybe not produced enough. I mean, I was looking at sleep as you know, this is where you bring everything back into the repair shop to be ready for the next day. And so you know, if you're not getting enough, you can't do that. Yeah,

Dr Jenna Macciochi  56:57  
that's a really good way of looking at it, your immune system really switches gears during sleep versus during the day. And that just reflects the fact that humans are meant to be active during the day. So that's when we're moving around, we're more likely to come into contact with infections, we're more likely to incur an injury that we need to you know, an inflammatory response to heal. So the immune system has to be on that kind of alert during the day. And then at night, it's like, okay, it's more of a housekeeping mode. It's like healing and repairing, correcting damage recovering from anything that you've had. And so if you don't get that recovery time, then everything's like, well, we're starting a bit on the backfoot. Today, we're not as well recovered, we're not as well, best set up to protect you. So it's kind of it seems to be more important than the other factors in predicting the likelihood of catching a cold at least. So that's really important at this time of year, you know, we've still got a few more months of winter to go.

Peter Williams  57:56  
All right, well, we're on the hour. But I'm rather hoping you're gonna come on pretty quickly, again, because I sort of purposely left this section out, which was nutrition, because we could, you could literally do weeks on end on that one. And I thought, you know, what, that I would just sort of dominate the sort of the second after Christmas sort of immune function with regards to foods because they have such well, like everything, they have a really strong effect, you know, and, again, we're going to see it with, we're gonna see across social media in the press, you know, the 10 immune foods that you need to have for, you know, for strong immunity, that's going to, that's going to be something that's coming up. Obviously, you've wrote a book on that as well. So we will definitely plug that one. Okay, so I am going to so I am going to ask you for for four fundamental tips for the man and woman on the street on basic, basic, I mean, how do we use the word is it should be its word, I think the way you describe immune, you know, you don't want to you don't want to, is it a strong immunity? Is it a tolerant immune system? I mean, what are you optimally looking for?

Dr Jenna Macciochi  59:07  
I mean, to be honest, I had a bit of a battle with publishers on the second book, because they said strong immunity and that was kind of a compromise on my side, because I don't think it's the most accurate framing. Yeah, I agree. Also, because it you know, they have to come at it from a commercial aspect and find out what people what would resonate. And so when you look at the different titles and how are phrasings and how people understand them, if it had been more of my nuanced title, people probably wouldn't even pick it up. Exactly. Yeah, it was a little bit but it's still one of my regrets day when I

Peter Williams  59:47  
Yeah, you can't have it all kids if you can't have it all.

Dr Jenna Macciochi  59:51  
A strong immune system is basically a resilient one that's you know, getting sick is inevitable because we live in a germy world but being able to recover well. and control unwanted inflammation. And even if you have a chronic disease, I think being able to manage it well through all the different tools and modalities like some of which we discussed today. I think that's really important as well, being able to have a strong subjective sense of well being. That's really important. All right,

Peter Williams  1:00:19  
ThAll right what a brilliant place to end as I say, this will go out pretty much my first one in the new year, and I'm totally going to get you on for that nutrition side. So, Janet, thank you so much. I think everyone's going to be super tough with this one. There's just so many golden nuggets on this and I'd like to thank you personally because I always look at your certainly your IG posts because they're always rock solid. The way you break down good studies, you do that really well. And as I say you encourage a sort of deeper thought process with regards to just because there's one study that's been clear doesn't mean to say that that's the way we should go forward. And I think we need more of that. I think social media is terrible. And you know, as you will know, your patients I mean, sometimes you spend the first half an hour just trying to listen to their belief systems and you know, their belief systems are probably half of the problem of why they're sick is because they're doing everything completely wrong, but they believe they're doing the right stuff because they've seen something on social media that says I should be doing x y and Zed and you're like God I'll have to break this down really gently so that they they don't think I'm just having a go with them. Jenna, thank you so much. That was awesome. Thanks

Dr Jenna Macciochi  1:01:28  
Thanks for having me. Cheers.

Transcribed by https://otter.ai