It may seem like a question with an obvious answer: what is immunity? In reality, it's as complex as our very own immune systems. These days, the term "immunity" has been closely associated with COVID-19. You may have heard a variety of questions bandied about in the last several months: how do we achieve herd immunity? How soon can we find a vaccine so that we can become immune to the virus? How do I boost immune system to keep myself from getting sick?
All of these questions play into our overall understanding of immunity and how vital it is to the survival of mankind. Upgraid's co-Founder, Helene Rutledge, has a great deal of experience in this field and she shares her insight in this piece recently published in Thrive Global.
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The COVID-19 pandemic has brought health and wellness to the forefront of everyone’s mind, on both a personal and societal level. However, in the 24/7 onslaught of COVID news, there has been a range of questions, direction and even publications that show a misunderstanding of real science, especially as the guidance of experts has evolved, to outright misinformation. Unfortunately, in times of fear, many consumers are vulnerable to try solutions that are at best ineffective and at worst downright harmful, chasing protection, or “immunity” from infectious disease. In today’s healthcare space, when it comes to the topic of immunity, knowledge and protection are kicked to the curb. The root of this dilemma comes from businesses capitalizing on consumer fear for the purpose of making a profit.
The first question we need to ask is, “What exactly is immunity?” Part of the problem is the broadness of the term. For example, WebMD defines immunity as simply “protection from disease.” Stedman’s Medical Dictionary provides a more complete definition: inherited, acquired, or induced resistance to infection by a specific pathogen. The confusing part to a layperson is that the immunity is situational in two ways: (1) the specific disease and (2) individual risk factors.
The specific disease is important to understand immunity contextually. Recently, the 2011 movie Contagion has been trending since our current outbreak, prophetically referencing fomites and the perils of face touching. Disease-causing microbes vary greatly in transmission routes, contagiousness, duration and severity of symptoms, mortality rates, and long-term health impact. For novel pathogens, early stages of the epidemic are often unclear without the Hollywood satisfaction of finding a Patient Zero. Finally, just as scientists start to profile the disease, it is possible for microbes to mutate to new forms, confusing the diagnosis and containment of spread. For each specific infectious disease, there is a perfect storm of conditions that allows it to thrive and these conditions will define which individuals are in the highest risk groups to contract it.
Individual risk factors are both genetic and controllable. For example, Sickle Cell Disease is an inherited blood disorder that impairs the functioning of the spleen, which is part of your immune system, and puts anyone with the Sickle Cell gene at higher risk. The disease has no cure so people with this disease, like anyone who is immunocompromised, must turn to the controllable factors to do everything possible to stay safe from infection.
Since the plagues of the Middle Ages, isolation has controlled pathogens. Unfortunately, back then it happened because entire villages would be wiped out by disease and burned by newcomers who found the gruesome scene. Globalization has also brought the opportunity for global pandemics with isolation to become possible after the novel agents have been identified. By that point, transmission to multiple locations has likely occurred. And as we have seen with COVID-19, large scale sheltering-in for many months is difficult to maintain on both a social and economic level. Since some spread is inevitable, especially in densely populated areas, isolation is effective mainly on reducing the impact to healthcare systems and only a temporary measure.
Despite these invisible invaders, humans have avoided extinction because of our incredible immune systems. In this case, it is true that whatever doesn’t kill you makes you stronger – by producing antibodies that fight this specific pathogen next time around. Some diseases, like measles, create enough antibodies so that you can only have one episode in your entire life.
A key controllable way to reduce your risk of infection is through induced resistance, in which you can create antibodies without having to suffer the serious symptoms of a disease. Vaccines do this by inducing a mild reaction in the body – enough to stimulate the production of antibodies but not enough to cause serious symptoms. The immunity granted by antibodies, whether by contracting a disease or getting vaccinated, varies depending on the pathogen. Some microbes mutate rapidly and when they change form, your body no longer recognizes them and needs to build up new antibodies to match the microbes. This is why the seasonal flu vaccine is different every year and actually, the best guess by epidemiologists to predict the prevalent strain.
Vaccination benefits both the individual and society; widespread vaccination can promote herd immunity and with time, virtually eliminate infectious diseases. Herd immunity is when enough people in a population have been vaccinated or recovered from disease so that transmission slows significantly or stops. The benefit is that the vulnerable who cannot be vaccinated are protected by the rest of the “herd.” However, even once herd immunity is established, it can break down if pockets of people are not vaccinated. In fact, smallpox is the only disease that has been entirely eradicated.
The very first vaccine for smallpox was developed in 1796 and it took until 1980 for the World Health Organization to declare complete elimination. Many serious diseases like polio have been kept at bay through widespread vaccination but could return if rates drop. There are rampant misconceptions leading to the “anti-vax” movement where people are refusing to vaccinate their children. In many cases, it is an exaggeration of the small percentage of side-effect risks without considering the jeopardy to herd immunity. The World Health Organization clearly advocates full vaccination programs and organizations like Vaccines Today provide a forum for education and conversations with consumers to help foster understanding and allay Fears.
Lifestyle factors can also impact your risk of contracting an infectious disease. When you let your body get run down it compromises the immune system. Getting enough sleep, eating a healthy diet, drinking enough water and getting regular exercise are all common sense habits to help bolster your immunity. Recently, however, more attention has been paid to the impact of your emotions and the hormones they trigger on the complex ability to resist infectious disease. Stress and anxiety typically lower resistance, but can also temporarily fend off a disease if they trigger the release of cortisol, the “fight-or-flight” hormone. Counterintuitively, often people get sick after the stress has passed, which is known as the “let-down effect.”
There isn’t a pill, cream, balm, rub, or powder that gives an immediate immunity fix. It’s rather the adoption of these healthy habits over time as a preventative mindset that helps reduce the chances of developing some serious chronic conditions (like Type-2 diabetes).
What we’re seeing during the COVID-19 pandemic is testament to the need to reduce the prevalence of underlying conditions and comorbidity. If your body is already fighting something else off, it can’t be as effective. If COVID-19 starts to take hold in the body, other less healthy areas start to become stressed and or fail. Although even healthy people without chronic conditions can contract the disease, we’re seeing higher death rates with the unhealthy and underprivileged who don’t have access to the same type of preventive healthcare.
Achieving immunity is a multi-layered and complicated objective. Yet, why do so many products claim to deliver this benefit? It’s because of two main problems in our current system: (1) the regulatory classification and rules and (2) bad actors who are looking to profiteer rather than help.
Nutritional supplements are particularly under fire for making claims about immunity. The Dietary Supplement Health and Education Act of 1994 (DSHEA) is responsible for that little statement you see that says that supplements are not intended to diagnose, treat, or cure any disease or condition. These products are for generally healthy people looking to “supplement” their diet with vitamins, minerals, and botanical extracts for health benefits that they are not getting from their food. People often confuse the other statement, which is a disclaimer that the FDA has not reviewed the claims supplements make, with meaning that the products are not regulated. In actuality, the supplement manufacturer is responsible for substantiating that the product is safe and the claims they make are valid. The FDA does not “approve” supplements, but monitors the market and can take action if manufacturers are not in compliance with the laws. In addition, the Federal Trade Commission (FTC) can punish a manufacturer for false advertising and recent class action suits have been an effective deterrent against misleading Claims.
Understanding this structure of “self-regulation,” the FDA and FTC can’t possibly monitor every product. So if supplement claims sound like miracle cures, it is likely that it is a “bad actor” or a manufacturer who either does not know the regulations or is willingly violating them. Both are problematic since ensuring the quality of an ingested product should not be left to a novice in the field or an unscrupulous business that could sell adulterated ingredients.
Unfortunately for consumers, it is a case of caveat emptor, or “let the buyer beware.” Yet, there are some high quality supplements that are safe and do as they claim. So to avoid the entire category would be unfortunate because of individuals or companies who put profit over people. Customers have to do their homework and a good method is to look for proof of legitimacy from certifications like NSF, USP, Organic, or endorsement by individual professionals or organizations. It’s imperative to research the work and the reputation of the company. Simply put, customers must not get clouded by the silver bullet or quick fix language, especially in regards to immunity.
So, can any supplement support immunity claims? The answer is, not so much. Any of the legitimate claims are very limited and the best real outcomes to hope for are reducing the length and severity of symptoms of seasonal cold and flu. With the expectation set that there is no such thing as broad prevention of infection, three ingredients commonly purchased for “immunity” do have some benefits. If you have deficiencies in your diet, you are at increased risk of infection and a supplement can help in this situation. In fact, most people should consider taking Vitamin D. Somewhere around 40% of Americans are Vitamin D-deficient and most don’t know it.
One of the best natural sources is from sunshine and as humans spend more time inside and correctly apply sunscreen to prevent skin cancer, the unintended consequence is that the beneficial rays of light that provide Vitamin D can’t get through. Another benefit of Vitamin D is that it aids in the absorption of calcium into the blood, necessary for strong bones and teeth.
Two other useful supplement ingredients related to immunity are Vitamin C and zinc. Both of these can have benefits, but have unfortunately been overhyped and misused. Since Vitamin C is water soluble, for many years megadosing was thought to be a safe way to fight off seasonal cold and flu, with the thought that the body would just expel whatever was not needed. Besides the waste of money, according to the Mayo Clinic, high doses could have negative side effects including diarrhea, nausea, vomiting, heartburn, abdominal cramps, headache, and insomnia. Likewise with zinc, taking too much zinc has similar side effects to taking too much Vitamin C, but ironically taking too much over long periods of time can have the opposite effect and reduce immunity, according to the National Institute of Health (NIH). Yep, this is complicated stuff.
Recently, the Natural Product Association (NPA) has proposed that the supplement industry work together to solicit the FDA on a common way to talk to consumers about Immunity claims for Vitamins C, D, and Zinc. Clearly, there are benefits, but what products and how much to take depending on each person’s unique body is too complicated for many consumers. Finally, doctors aren’t even a good source of advice on Nutritional Supplements since the Medical School curriculum provides minimal, if any specific guidance on overall nutrition, let alone supplement products.
The COVID-19 pandemic has shined a light on the inadequacies of our current healthcare system, and the mindset change that is needed towards preventative health to avoid chronic, lifestyle-induced conditions. Hopefully the good that can come from the pain and losses of life and livelihood can lead to fundamental changes for a better future for us all.
In summary, Immunity is complex and no supplement or vitamin can keep you 100 percent clear of getting sick, especially getting COVID-19. Consumers have a responsibility to do their research and to listen to credible sources for information in a rapidly changing environment.
Until there is a vaccine, your best defense is to stay healthy. Finally, it is important to remember that we are interconnected as a society and what one person does can be essential to the health and wellbeing of others. When the vaccine is ready, get vaccinated. The life you save could be your own and if everyone does this for each other, we all play a role in controlling disease.