How to boost your immune system

Excerpted from The Truth About Your Immune System, a Special Health Report from Harvard
Health Publications
What can you do?
On the whole, your immune system does a remarkable job of defending you against disease-causing
microorganisms. But sometimes it fails: A germ invades successfully and makes you sick. Is it possible to
intervene in this process and make your immune system stronger? What if you improve your diet? Take
certain vitamins or herbal preparations? Make other lifestyle changes in the hope of producing a near-
perfect immune response?
The idea of boosting your immunity is enticing, but the ability to do so has proved elusive for several
reasons. The immune system is precisely that a system, not a single entity. To function well, it requires
balance and harmony. There is still much that researchers dont know about the intricacies and
interconnectedness of the immune response. For now, there are no scientifically proven direct links
between lifestyle and enhanced immune function.
But that doesnt mean the effects of lifestyle on the immune system arent intriguing and shouldnt be
studied. Quite a number of researchers are exploring the effects of diet, exercise, age, psychological
stress, herbal supplements, and other factors on the immune response, both in animals and in humans.
Although interesting results are emerging, thus far they can only be considered preliminary. Thats
because researchers are still trying to understand how the immune system works and how to interpret
measurements of immune function. The following sections summarize some of the most active areas of
research into these topics. In the meantime, general healthy-living strategies are a good way to start
giving your immune system the upper hand.


Adopt healthy-living strategies
Your first line of defense is to choose a healthy
lifestyle. Following general good-health guidelines is
the single best step you can take toward keeping
your immune system strong and healthy. Every part
of your body, including your immune system,
functions better when protected from environmental
assaults and bolstered by healthy-living strategies
such as these:
Dont smoke.
Eat a diet high in fruits, vegetables, and
whole grains, and low in saturated fat.
Exercise regularly.
Maintain a healthy weight.
Control your blood pressure.
If you drink alcohol, drink only in moderation.
Get adequate sleep.
Take steps to avoid infection, such as
washing your hands frequently and cooking

Immunity in action. A healthy immune system
can defeat invading pathogens as shown above,
where two bacteria that cause gonorrhea are no
match for the large phagocyte, called a neutrophil,
that engulfs and kills them (see arrows).
Photos courtesy of Michael N. Starnbach, Ph.D.,
Harvard Medical School
meats thoroughly.
Get regular medical screening tests for people in your age group and risk category.
Be skeptical
Many products on store shelves claim to boost or support immunity. But the concept of boosting immunity
actually makes little sense scientifically. In fact, boosting the number of cells in your body immune cells
or others is not necessarily a good thing. For example, athletes who engage in blood doping
pumping blood into their systems to boost their number of blood cells and enhance their performance
run the risk of strokes.
Attempting to boost the cells of the immune system is especially complicated because there are so many
different kinds of cells in the immune system that respond to so many different microbes in so many ways.
Which cells should you boost, and to what number? So far, scientists do not know the answer. What is
known is that the body is continually generating immune cells. Certainly it produces many more
lymphocytes than it can possibly use. The extra cells remove themselves through a natural process of cell
death called apoptosis some before they see any action, some after the battle is won. No one knows
how many cells or what kinds of cells the immune system needs to function at its optimum level.
Scientists do know more about the low end of the scale. When the number of T cells in an HIV/AIDS
patient drops below a certain level, the patient gets sick because the immune system doesnt have
enough T cells to fight off infection. So there is a bottom number below which the immune system cant
do its job. But how many T cells is comfortably enough, and beyond that point, is more better? We dont
know.
Many researchers are trying to explore the effects of a variety of factors from foods and herbal
supplements to exercise and stress on immunity. Some take measures of certain blood components
like lymphocytes or cytokines. But thus far, no one really knows what these measurements mean in terms
of your bodys ability to fight disease. They provide a way of detecting whether something is going on, but
science isnt yet sufficiently advanced to understand how this translates into success in warding off
disease.
A different scientific approach looks at the effect of certain lifestyle modifications on the incidence of
disease. If a study shows significantly less disease, researchers consider whether the immune system is
being strengthened in some way. Based on these studies, there is now evidence that even though we
may not be able to prove a direct link between a certain lifestyle and an improved immune response, we
can at least show that some links are likely.
Get your copy of Viruses and Disease
Have you ever wondered whether you are truly protected from infectious diseases
ranging from the common cold to more deadly threats like rabies or bird flu? When
you travel, are you protected from the many infections abroad? Are you up-to-date on
the new adult vaccines? This report describes the most up to date information on
infectious disease and how to protect yourself from everything from stomach flu to
HIV/AIDS.


Age and immunity
Earlier in this report (see Cancer: Missed cues), we noted that one active area of research is how the
immune system functions as the body ages. Researchers believe that the aging process somehow leads
to a reduction of immune response capability, which in turn contributes to more infections, more
inflammatory diseases, and more cancer. As life expectancy in developed countries has increased, so too
has the incidence of age-related conditions. Happily, investigation into the aging process can benefit us
all no matter what our age.
While some people age healthily, the conclusion of many studies is that, compared with younger people,
the elderly are far more likely to contract infectious diseases. Respiratory infections, influenza, and
particularly pneumonia are a leading cause of death in people over 65 worldwide. No one knows for sure
why this happens, but some scientists observe that this increased risk correlates with a decrease in T
cells, possibly from the thymus atrophying with age and producing fewer T cells to fight off infection.
Thymus function declines beginning at age 1; whether this decrease in thymus function explains the drop
in T cells or whether other changes play a role is not fully understood. Others are interested in whether
the bone marrow becomes less efficient at producing the stem cells that give rise to the cells of the
immune system.
Researchers at the University of Arkansas are looking at another aspect of why the immune system
seems to weaken with age. They studied cell death in mice. They conducted an experiment to compare
the lifespan of memory T lymphocytes in older mice with those of younger mice and found that the
lymphocytes in older mice die sooner. This suggests that as the lymphocytes die off, the elderly immune
system loses its memory for the microbes it is intended to fight and fails to recognize the microbes when
they reappear. The body thus becomes less able to mount a vigorous immune response.
A reduction in immune response to infections has been demonstrated by older peoples response to
vaccines. For example, studies of influenza vaccines have shown that for people over age 65, vaccine
effectiveness was 23%, whereas for healthy children (over age 2), it was 38%. But despite the reduction
in efficacy, vaccinations for influenza and S. pneumoniae have significantly lowered the rates of sickness
and death in older people when compared with nonvaccination.
Yet other researchers are looking at the connection between nutrition and immunity in the elderly. A form
of malnutrition that is surprisingly common even in affluent countries is known as micronutrient
malnutrition. Micronutrient malnutrition, in which a person is deficient in some essential vitamins and
trace minerals that are obtained from or supplemented by diet, can be common in the elderly. Older
people tend to eat less and often have less variety in their diets. One important question is whether
dietary supplements may help older people maintain a healthier immune system. Older people should
discuss this question with a physician who is well versed in geriatric nutrition, because while some dietary
supplementation may be beneficial for older people, even small changes can have serious repercussions
in this age group.
What about diet?
Like any fighting force, the immune system army marches on its stomach. Immune system warriors need
good, regular nourishment. Scientists have long recognized that people who live in poverty and are
malnourished are more vulnerable to infectious diseases. Whether the increased rate of disease is
caused by malnutritions effect on the immune system, however, is not certain. There are still relatively
few studies of the effects of nutrition on the immune system of humans, and even fewer studies that tie
the effects of nutrition directly to the development (versus the treatment) of diseases.
There are studies of the effects of nutritional changes on the immune systems of animals, but again there
are few studies that address the development of diseases in animals as a result of changes in immunity.
For example, one group of investigators has found that in mice, diets deficient in protein reduce both the
numbers and function of T cells and macrophages and also reduce the production of immunoglobulin A
(IgA) antibody.
There is some evidence that various micronutrient deficiencies for example, deficiencies of zinc,
selenium, iron, copper, folic acid, and vitamins A, B6, C, and E alter immune responses in animals, as
measured in the test tube. However, the impact of these immune system changes on the health of
animals is less clear, and the effect of similar deficiencies on the human immune response has yet to be
assessed. But the research at this stage is promising, at least for some of the micronutrients.
So what can you do? If you suspect your diet is not providing you with all your micronutrient needs
maybe you dont like vegetables or you choose white bread over whole grains taking a daily
multivitamin and mineral supplement brings health benefits of many types, beyond any possibly beneficial
effects on the immune system. Taking megadoses of a single vitamin does not. More is not necessarily
better. Researchers are investigating the immune boosting potential of a number of different nutrients.
Selenium. Some studies have suggested that people with low selenium levels are at greater risk of
bladder, breast, colon, rectum, lung, and prostate cancers. A large-scale, multiyear study is currently in
progress to look at the effects of combining selenium and vitamin E on prostate cancer prevention.
Vitamin A. Experts have long known that vitamin A plays a role in infection and maintaining mucosal
surfaces by influencing certain subcategories of T cells and B cells and cytokines. Vitamin A deficiency is
associated with impaired immunity and increased risk of infectious disease. On the other hand, according
to one study, supplementation in the absence of a deficiency didnt enhance or suppress T cell immunity
in a group of healthy seniors.
Vitamin B2. There is some evidence that vitamin B2 enhances resistance to bacterial infections in mice,
but what that means in terms of enhancing immune response is unclear.
Vitamin B6. Several studies have suggested that a vitamin B6 deficiency can depress aspects of the
immune response, such as lymphocytes ability to mature and spin off into various types of T and B cells.
Supplementing with moderate doses to address the deficiency restores immune function, but megadoses
dont produce additional benefits. And B6 may promote the growth of tumors.
Vitamin C. The jury is still out on vitamin C and the immune system. Many studies have looked at vitamin
C in general; unfortunately, many of them were not well designed. Vitamin C may work in concert with
other micronutrients rather than providing benefits alone.
Vitamin D. For many years doctors have known that people afflicted with tuberculosis responded well to
sunlight. An explanation may now be at hand. Researchers have found that vitamin D, which is produced
by the skin when exposed to sunlight, signals an antimicrobial response to the bacterium responsible for
tuberculosis, Mycobacterium tuberculosis. Whether vitamin D has similar ability to fight off other diseases
and whether taking vitamin D in supplement form is beneficial are questions that need to be resolved with
further study.
Vitamin E. A study involving healthy subjects over age 65 has shown that increasing the daily dose of
vitamin E from the recommended dietary allowance (RDA) of 30 mg to 200 mg increased antibody
responses to hepatitis B and tetanus after vaccination. But these increased responses didnt happen
following administration of diphtheria and pneumococcal vaccines.
Zinc. Zinc is a trace element essential for cells of the immune system, and zinc deficiency affects the
ability of T cells and other immune cells to function as they should. Caution: While its important to have
sufficient zinc in your diet (1525 mg per day), too much zinc can inhibit the function of the immune
system.
Herbs and other supplements
Walk into a store, and you will find bottles of pills and herbal preparations that claim to support immunity
or otherwise boost the health of your immune system. Although some preparations have been found to
alter some components of immune function, thus far there is no evidence that they actually bolster
immunity to the point where you are better protected against infection and disease. Demonstrating
whether an herb or any substance, for that matter can enhance immunity is, as yet, a highly
complicated matter. Scientists dont know, for example, whether an herb that seems to raise the levels of
antibodies in the blood is actually doing anything beneficial for overall immunity.
But that doesnt mean we should discount the benefits of all herbal preparations. Everyones immune
system is unique. Each persons physiology responds to active substances differently. So if your
grandmother says shes been using an herbal preparation for years that protects her from illness, whos
to say that it doesnt? The problem arises when scientists try to study such a preparation among large
numbers of people. The fact that it works for one person wont show up in the research data if its not
doing the same for a larger group.
Scientists have looked at a number of herbs and vitamins in terms of their potential to influence the
immune system in some way. Much of this research has focused on the elderly, children, or people with
compromised immune systems, such as AIDS patients. And many of the studies have had design flaws,
which means further studies are needed to confirm or disprove the results. Consequently, these findings
should not be considered universally applicable.
Some of the supplements that have drawn attention from researchers are these:
Aloe vera. For now, theres no evidence that aloe vera can modulate immune response. Because many
different formulations and compounds have been used in studies, comparing the results is difficult.
However, there is some evidence that topical aloe vera is helpful for minor burns, wounds, or frostbite,
and also for skin inflammations when combined with hydrocortisone. Studies have found aloe vera is not
the best option for treating breast tissue after radiation therapy.
Astragalus membranes. The astragalus product, which is derived from the root of the plant, is marketed
as an immune-system stimulant, but the quality of the studies demonstrating the immune-stimulating
properties of astragalus are poor. Furthermore, it may be dangerous.
Echinacea. An ocean of ink has been spilled extolling echinacea as an immune stimulant, usually in
terms of its purported ability to prevent or limit the severity of colds. Most experts dont recommend taking
echinacea on a long-term basis to prevent colds. A group of physicians from Harvard Medical School
notes that studies looking at the cold prevention capabilities of echinacea have not been well designed,
and other claims regarding echinacea are as yet not proven. Echinacea can also cause potentially
serious side effects. People with ragweed allergies are more likely to have a reaction to echinacea, and
there have been cases of anaphylactic shock. Injected echinacea in particular has caused severe
reactions. A well-designed study by pediatricians at the University of Washington in Seattle found
echinacea didnt help with the duration and severity of cold symptoms in a group of children. A large 2005
study of 437 volunteers also found that echinacea didnt affect the rate of cold infections or the progress
and severity of a cold.
Garlic. Garlic may have some infection-fighting capability. In laboratory tests, researchers have seen
garlic work against bacteria, viruses, and fungi. Although this is promising, there havent been enough
well-designed human studies conducted to know whether this translates into human benefits. One 2006
study that looked at rates for certain cancers and garlic and onion consumption in southern European
populations found an association between the frequency of use of garlic and onions and a lower risk of
some common cancers. Until more is known, however, its too early to recommend garlic as a way of
treating or preventing infections or controlling cancer.
Ginseng. Its not clear how the root of the ginseng plant works, but claims on behalf of Asian ginseng are
many, including its ability to stimulate immune function. Despite the claims of a number of mainly small
studies, the National Center for Complementary and Alternative Medicine (NCCAM) considers there have
been insufficient large studies of a high enough quality to support the claims. NCCAM is currently
supporting research to understand Asian ginseng more fully.
Glycyrrhiza glabra (licorice root). Licorice root is used in Chinese medicine to treat a variety of illnesses.
Most studies of licorice root have been done in combination with other herbs, so its not possible to verify
whether any effects were attributable to licorice root per se. Because of the potential side effects of taking
licorice and how little is known about its benefits if any for stimulating immune function, this is an
herb to avoid.
Probiotics. There are hundreds of different species of bacteria in your digestive tract, which do a bang-
up job helping you digest your food. Now researchers, including some at Harvard Medical School, are
finding evidence of a relationship between such good bacteria and the immune system. For instance, it
is now known that certain bacteria in the gut influence the development of aspects of the immune system,
such as correcting deficiencies and increasing the numbers of certain T cells. Precisely how the bacteria
interact with the immune system components isnt known. As more and more intriguing evidence comes
in to support the link that intestinal bacteria bolster the immune system, its tempting to think that more
good bacteria would be better. At least, this is what many marketers would like you to believe as they tout
their probiotic products.
Probiotics are good bacteria, such as Lactobacillus and Bifidobacterium, that can safely dwell in your
digestive tract. Youll now find probiotics listed on the labels of dairy products, drinks, cereals, energy
bars, and other foods. Ingredients touted as prebiotics, which claim to be nutrients that feed the good
bacteria, are also cropping up in commercially marketed foods. Unfortunately, the direct connection
between taking these products and improving immune function has not yet been made. Nor has science
shown whether taking probiotics will replenish the good bacteria that get knocked out together with bad
bacteria when you take antibiotics.
Another caution is that the quality of probiotic products is not consistent. Some contain what they say they
do; some do not. In a 2006 report, the American Academy of Microbiology said that at present, the
quality of probiotics available to consumers in food products around the world is unreliable. In the same
vein, the FDA monitors food packages to make sure they dont carry labels that claim the products can
cure diseases unless the companies have scientific evidence to support the claims. Does this mean
taking probiotics is useless? No. It means the jury is still out on the expansive health claims. In the
meantime, if you choose to take a probiotic in moderation, it probably wont hurt, and the scientific
evidence may ultimately show some benefit.
The stress connection
Modern medicine, which once treated the connection between emotions and physical health with
skepticism, has come to appreciate the closely linked relationship of mind and body. A wide variety of
maladies, including stomach upset, hives, and even heart disease, are linked to the effects of emotional
stress. But although the relationship between stress and immune function is being studied by a number of
different types of scientists, so far it is not a major area of research for immunologists.
Studying the relationship between stress and the immune system presents difficult challenges. For one
thing, stress is difficult to define. What may appear to be a stressful situation for one person is not for
another. When people are exposed to situations they regard as stressful, it is difficult for them to measure
how much stress they feel, and difficult for the scientist to know if a persons subjective impression of the
amount of stress is accurate. The scientist can only measure things that may reflect stress, such as the
number of times the heart beats each minute, but such measures also may reflect other factors.
Most scientists studying the relationship of stress and immune function, however, do not study a sudden,
short-lived stressor; rather, they try to study more constant and frequent stressors known as chronic
stress, such as that caused by relationships with family, friends, and co-workers, or sustained challenges
to perform well at ones work. Some scientists are investigating whether ongoing stress takes a toll on the
immune system.
But it is hard to perform what scientists call controlled experiments in human beings. In a controlled
experiment, the scientist can change one and only one factor, such as the amount of a particular
chemical, and then measure the effect of that change on some other measurable phenomenon, such as
the amount of antibodies produced by a particular type of immune system cell when it is exposed to the
chemical. In a living animal, and especially in a human being, that kind of control is just not possible,
since there are so many other things happening to the animal or person at the time that measurements
are being taken.
Despite these inevitable difficulties in measuring the relationship of stress to immunity, scientists who
repeat the same experiment many times with many different animals or human beings, and who get the
same result most of the time, hope that they can draw reasonable conclusions.
Some researchers place animals into stressful situations, such as being trapped in a small space or being
placed near an aggressive animal. Different functions of their immune systems, and their health, are then
measured under such stressful conditions. On the basis of such experiments, some published studies
have made the following claims:
Experimentally created stressful situations delayed the production of antibodies in mice infected
with influenza virus and suppressed the activity of T cells in animals inoculated with herpes
simplex virus.
Social stress can be even more damaging than physical stress. For example, some mice were
put into a cage with a highly aggressive mouse two hours a day for six days and repeatedly
threatened, but not injured, by the aggressive mouse a social stress. Other mice were kept in
tiny cages without food and water for long periods a physical stress. Both groups of mice
were exposed to a bacterial toxin, and the socially stressed animals were twice as likely to die.
Isolation can also suppress immune function. Infant monkeys separated from their mothers,
especially if they are caged alone rather than in groups, generate fewer lymphocytes in response
to antigens and fewer antibodies in response to viruses.
Many researchers report that stressful situations can reduce various aspects of the cellular immune
response. A research team from Ohio State University that has long worked in this field suggests that
psychological stress affects the immune system by disrupting communication between the nervous
system, the endocrine (hormonal) system, and the immune system. These three systems talk to one
another using natural chemical messages, and must work in close coordination to be effective. The Ohio
State research team speculates that long-term stress releases a long-term trickle of stress hormones
mainly glucocorticoids. These hormones affect the thymus, where lymphocytes are produced, and inhibit
the production of cytokines and interleukins, which stimulate and coordinate white blood cell activity. This
team and others have reported the following results:
Elderly people caring for relatives with Alzheimers disease have higher than average levels of
cortisol, a hormone secreted by the adrenal glands and, perhaps because of the higher levels of
cortisol, make fewer antibodies in response to influenza vaccine.
Some measures of T cell activity have been found to be lower in depressed patients compared
with nondepressed patients, and in men who are separated or divorced compared with men who
are married.
In a year-long study of people caring for husbands or wives with Alzheimers disease, changes in
T cell function were greatest in those who had the fewest friends and least outside help.
Four months after the passage of Hurricane Andrew in Florida, people in the most heavily
damaged neighborhoods showed reduced activity in several immune system measurements.
Similar results were found in a study of hospital employees after an earthquake in Los Angeles.
In all of these studies, however, there was no proof that the immune system changes measured had any
clear adverse effects on health in these individuals.
Get your copy of Vitamins and Minerals
About half of all Americans routinely take dietary supplements. The most common
ones are multivitamin and multimineral supplements. This report explains the
evidence behind the benefits and safety profiles of various vitamins and minerals. It
also includes the recommended minimum and maximum amounts you should
consume, as well as good food sources of each.



Does being cold make you sick?
Almost every mother has said it: Wear a jacket or youll catch a cold! Is she right? So far, researchers
who are studying this question think that normal exposure to moderate cold doesnt increase your
susceptibility to infection. Most health experts agree that the reason winter is cold and flu season is not
that people are cold, but that they spend more time indoors, in closer contact with other people who can
pass on their germs.
But researchers remain interested in this question in different populations. Some experiments with mice
suggest that cold exposure might reduce the ability to cope with infection. But what about humans?
Scientists have dunked people in cold water and made others sit nude in subfreezing temperatures.
Theyve studied people who lived in Antarctica and those on expeditions in the Canadian Rockies. The
results have been mixed. For example, researchers documented an increase in upper respiratory
infections in competitive cross-country skiers who exercise vigorously in the cold, but whether these
infections are due to the cold or other factors such as the intense exercise or the dryness of the air
is not known. Theyve found that exposure to cold does increase levels of some cytokines, the proteins
and hormones that act as messengers in the immune system, but how this affects health isnt clear.
A group of Canadian researchers that has reviewed hundreds of medical studies on the subject and
conducted some of its own research concludes that theres no need to worry about moderate cold
exposure it has no detrimental effect on the human immune system. Should you bundle up when its
cold outside? The answer is yes if youre uncomfortable, or if youre going to be outdoors for an
extended period where such problems as frostbite and hypothermia are a risk. But dont worry about
immunity.
Exercise: Good or bad for immunity?
Regular exercise is one of the pillars of healthy living. It improves cardiovascular health, lowers blood
pressure, helps control body weight, and protects against a variety of diseases. But does it help maintain
a healthy immune system? Just like a healthy diet, exercise can contribute to general good health and
therefore to a healthy immune system. It may contribute even more directly by promoting good circulation,
which allows the cells and substances of the immune system to move through the body freely and do
their job efficiently.
Some scientists are trying to take the next step to determine whether exercise directly affects a persons
susceptibility to infection. For example, some researchers are looking at whether extreme amounts of
intensive exercise can cause athletes to get sick more often or somehow impairs their immune function.
To do this sort of research, exercise scientists typically ask athletes to exercise intensively; the scientists
test their blood and urine before and after the exercise to detect any changes in immune system
components such as cytokines, white blood cells, and certain antibodies. While some changes have been
recorded, immunologists do not yet know what these changes mean in terms of human immune response.
No one yet knows, for example, whether an increase in cytokines is helpful or has any true effect on
immune response. Similarly, no one knows whether a general increase in white cell count is a good thing
or a bad thing.
But these subjects are elite athletes undergoing intense physical exertion. What about moderate exercise
for average people? Does it help keep the immune system healthy? For now, even though a direct
beneficial link hasnt been established, its reasonable to consider moderate regular exercise to be a
beneficial arrow in the quiver of healthy living, a potentially important means for keeping your immune
system healthy along with the rest of your body.
One approach that could help researchers get more complete answers about whether lifestyle factors
such as exercise help improve immunity takes advantage of the sequencing of the human genome. This
opportunity for research based on updated biomedical technology can be employed to give a more
complete answer to this and similar questions about the immune system. For example, microarrays or
gene chips based on the human genome allow scientists to look simultaneously at how thousands of
gene sequences are turned on or off in response to specific physiological conditions for example,
blood cells from athletes before and after exercise. Researchers hope to use these tools to analyze
patterns in order to better understand how the many pathways involved act at once.