The Secrets to Creating a Healthy Immune System

[Music] welcome to the doctors pharmacy that's FA RM Acy a place for conversations that matter I'm dr. Mark Hyman I'm here with an extraordinary man a friend of mine from the Cleveland Clinic we're here at the Cleveland Clinic and we're here for a conversation that you will come to believe really matters now dr. Leonard Calabrese is an extraordinary scientist he's an immunologist he's a Rheumatologist he's leading some of the most important work in the world of how our lifestyle and immune system are connected and what we eat and what we think and stress and our sleep and our food all play a role in how well our immune system works and can fight disease he's he's very inexperienced in virus disease and HIV he's the director of the RJ fast Meyer center for clinical immunology at the Cleveland Clinic which specializes in disease of the immune system he holds joint appointments not only in in infectious disease but also in the Wellness Institute so he's focused on wellness and he's focused his whole career on changing the way we think about how we approach disease in general and specifically immune disease in fact he came to us at the Cleveland Clinic Center for functional medicine and reached out and said hey you're here welcome very few people did that and he with his colleagues have been key partners in helping us think about how do we move this this field forward so welcome dr. Calabresi it's really great to be here mark and been following the the show we've had some incredible people on and flattered to be here and look forward to the chat well you're a giant in this world and I want to start out by talking about how you came to understand that the immune system was connected to our lifestyle and what we eat in our thoughts and beliefs and exercise and so forth how did that sort of a hot moment happen for you because you were trained conventionally okay the nog you learn it's a good question I don't have a soundbite answer but there's a there's a story a time we got stories so you know I'm a clinical immunologist I take care of people with overactive immune systems with immune mediated inflammatory diseases rheumatoid arthritis lupus and vasculitis and and like I also take care of patients with immunodeficiency 2 whose immune system is hypo functioning and when I started this business a number of decades ago you know we had very few tools in the toolbox to deal with us now there are a few stories in medicine as satisfying as the development of biologic therapy attics for immune-mediated diseases and over the past 20 to 25 years the introduction of biologics have transformed patients lives has taken fatal diseases and made them non fatal is taken progressive diseases and made them non progressive and I've been involved in clinical you're talking about drugs like I'm Braille and I'm talking about all of these types of drugs and I was involved in the development of virtually all of them in terms of clinical trials yet at the same time while we're doing this incredible job of controlling disease activity I increasingly recognized that there was not a one-to-one correlation with making people well hmm you know you could control disease activity you could reduce a biomarker yet at the same time you know everybody has the same desire they want to live a life that's well lived you know then that that's wellness and it's in its essence and you know I have a remarkable practice I'm so privileged to be able to run the center and see patients from all over the world coming for rare and unusual diseases and sometimes we identify them you know genetically sometimes we do tremendous therapies for them sometimes you know we we make some progress but I I have always noticed that there's not a single person and if you give them enough time and that's kind of rough thing in medicine these days right who won't ask you the question what else can I do what else can I do and so you know I'd say when my croizon got here kind of stimulated my thinking and this air he's the chief wellness officer wellness officer doing great things with our patient population I started to become more interested in this academically and clinically and I started out by you know creating a one-page handout of what I thought was you know good wellness behavior mm-hmm and it grew to a two-page handout now it's a you know 30 page monograph and have videos in all my exam rooms of recipes and and and everything else that that is going on so there's there there are these two dimensions moving forward now I you know I'd love to get your take on this you know 15-20 years ago the Wellness Science was not robust I mean you know you're a believer you're not a believer but over time tremendous progress in the science of health wellness so you have these two things going on development of targeted therapies robust progress in the area of the immunologic basis of wellness and I've decided to try to put these together in the most high quality highly productive and scientific way possible yeah and you do that with your patients in the clinic I absolutely do it with my patients in the clinic and we want to take it and make it for patients around the world so that's where we're going that's fantastic so there's some fascinating studies looking at this I mean I remember reading one study in JAMA about patients with rheumatoid arthritis and asthma both inflammatory diseases and they had the patients just write in a journal 20 minutes a day now couldn't be you know I went to the grocery store and I walked my dog it had to be about what was happening below underneath the hood and what were your emotional state how are you feeling what was affecting you and they found that it dramatically reduced asthma even by objective measures and even rheumatoid arthritis symptoms by objective measures and there's a woman named Candace pert who studied neuro immunology there's a whole field of psychoneuroimmunology at the NIH National Institute of Health and he found that the immune system was listening to her thoughts she calls this molecules of emotion can you tell us more about that you at such a incredible area so you know everyone everyone it's well accepted that stress is bad for your immune system you mean classic chronic stress you know acute stress run from the saber-tooth Tiger that's really good chronic stress of my job my life the environment politics and the world is is bad hmm we are now starting to appreciate that the opposite of that the immunology of joy can be immunological II potentiating and you mentioned a very nice example I call this the immunology of gratitude mmm-hmm gratitude has wide-ranging biologic effects there's a recent study done at UC San Diego that showed that patients with asymptomatic echocardiographic Lee documented a congestive heart failure with six weeks of gratitude journaling could improve ventricular function your heart pumps better and faster if you're great grateful right so you got a hold in your heart it's exactly let's take this a couple a couple of steps further we go on there's a there's another condition which is the opposite which is stress induced heart failure broken heart broken heart I had literally had a patient with a broken heart he was healthy otherwise and he went into heart failure after his wife died sure and through using various modalities around stress and energy medicine we only get it better we think that that's the basis of you know of vudu deaths yeah you know you're petrified yeah your heart so it's all neck do GU toxin be right so the the immunology of joy there's been some tremendous work in this it's such a great phase the immunology of joy yes so some people Cohen from Carnegie Mellon has done such beautiful work looking at resistance to respiratory viruses and the effects of hugs hmm and did this elegantly control study where they measured social interactions the amount of touching that goes on in a person's life and then actually inoculated all the people in the study for with cold virus and then measure their antibody responses and clinical things and hugging was an important and significant clinical variable even though the hug people were more exposed to viruses you know yeah they were protected so I mean a small example that's great so hugs so you won't get sick yeah that's why when Lenny ever comes to see me we always hug each other right I is the only doctor at Cleveland Clinic who gives me a hug it's pretty amazing that's good Fulvio DaCosta from London who's going to be visiting us and in May where my immunology summit which has been going on for 16 years is actually going to start out full half day on the immunology of wellness who does experimental work on the immunology of joy and he actually has animal models mice take mice and let him live in his little home take another set of mice and put them in a dirty cage and they get all upset and take the other set of mice and you put them in the ritz-carlton house and you pet them the our immune systems shift yeah so you know we don't know how to quantify this but it certainly fits with our models that in those behaviors of diet exercise sleep and stress we want to move our affect in a more positive manner and I see this every single day that you know sometimes we see immunologic diseases that we just can't we can't do anything about with targeted therapy and we have to deal with it you know bio behaviorally and people have to they haven't they have to be empowered to do this and that's where I think that you know you guys have been doing this for your whole career and you know but 20 years ago you were the Wellness guys we were over here all right you're over here this is alternative therapy right I'm trying to bring immunologic strength wellness and immunologic health building to the mainstream of people some of the people that you're interviewing on the show yeah who deal with immune mediated inflammatory diseases every single day so you know we're shifting the curve a little bit you said it was really important before you said before wellness was sort of a nice idea that we all believed in but didn't have a lot of data now you're saying there's a lot more data and I saw a study recently where they literally injected cold viruses into people's nose and they looked at stress questionnaires that's some work of Sheldon Cohn incredible and they found that those who scored high on the stress questionnaires got colds and then ones didn't even when they injected the cold buyers right in their nose that's right so what kind of data are you seeing around stress and wellness diet I just gonna go through it I want to spend a little time digging in because it's such a compelling area and I think your work is so important and you're such a great voice for this well you know it will knock these down one at a time but you know one of the interesting things that that has happened here is that you know a decade ago I felt very comfortable talking about this these topics to the wellness community and you know translating it for them but it's taken a bit longer and only in the past five years am I now trying to take to the Airways literally and in the scientific literature to bring it to my immunology colleagues so it's a shift and the day to speak for itself let's just take one disease so take rheumatoid arthritis so okay so for for the Audience rheumatoid arthritis most common cause of inflammatory arthritis you know a hundred years ago inexorable terrible illness the great Sir William Osler the greatest physician of the of the past century said when he saw a patient with that disease walk in the front door he would walk out the back door yeah even when I was a resident in fellow we had very little to offer sterols and and steroids were just in the dawn of them today we know so much more about this so we have studies the who gets rheumatoid arthritis well there's a genetic predisposition you have the genetic makeup but not everybody that carries the gene gets the disease so they hand on everybody who has the disease has the gene exactly but most do so we have hypothesized for a long time that there are environmental influences so gene plus environment and that environment may be external could be your own behaviors big studies like the Women's Health Study that have looked at you know hundred thousand women for four decades have found that if you take people women who were predisposed to rheumatoid it's a many autoimmune diseases or female predominant more MO yes and you look at certain variables diet okay and if you you know just to make this understandable if we take the the dietary range here from over here the standard American diet sad diet yes and over here let's just call it the prudent diet and and at the end we would peg this as a vegan diet the further you go down toward a healthy diet the more plant-based you become statistically for each quartile for each quarter of dietary health you statistically lower the likelihood of developing rheumatoid arthritis particularly when you're young and active it's it's an unbelievable and stepwise regression hmm and you know so we know that diet can be a tremendous influencer once you have the disease once you have the disease looking at dietary composition we know that patients that eat fish twice a week will have statistically and and I'm not talking about trivial improvements palpable lower disease activity than people who are non fish eaters and in fact just eating any fish in your diet in these cross-sectional studies have suggested that it contributes to soap composition healthy fats things that we can dig into a little bit later so this is this is hugely important so we can take people who are you know genetically predestined to this and modify their risks early on and once they have a disease actually can make contributions to lowering diseases what are the kind of dyes precise precision blotting fish what would be the dietary recommendations you'd give to some with an inflammatory disease or rheumatoid arthritis you know so my my recommendations are to well ultimately you know I'm very happy with someone who has achieved a semblance of what we would recognize as the Mediterranean diet I'm very happy with people who have achieved you know becoming either total vegans or close to that very good data coming out now that paleo diet also can have some anti-inflammatory effects and p-goon diet you know I sell beans you know so you know people are not coming to me so what's different for people who come to see you and people come to see me so people are coming to see me are coming to have their disease sorted out there looking for the most advanced targeted therapies and they're looking for a little extra people coming look to you are looking how to rearrange their lives and do this so I have a very slow and stepwise process might scare away if you told me you know if you can do meatless Monday I'm very happy let's start and then and the one thing that we know in amid diseases it's not a foot race it's a marathon so I'm gonna be seeing people for years and decades and many diseases is immune mediated yes amatory disease so rheumatoid planetary bowel disease so we try to we try to take the low-hanging fruit and try to make little modifications and then over time I'm so impressed that that you know people can make meaningful progress so that in the dietary aspect I'm I'm I encourage you know real food get rid of the junk plant-based mono saturates I have no problem with protein as long as it's high-quality yeah and and I think there's a place for it so that that's where we start with people yeah step to the exercise yeah I am I I became it by the way for people maybe not realize but sixty percent of your immune system is right underneath the lining of your gut so it's there because you're exposed to foreign molecules from food and bugs and your immune system is the first line of defense and so when that system gets disrupted and you get one call a leaky gut it creates a lot of inflammation and so changing your diet has a huge impact on there working on your inner garden your gut microbiome plays a big role yeah you know I'm glad you brought that up and a diving into the science just a little bit you mean the the microbiome which is connected to every organ system in our body and you've talked about it extensively on this show is critical in both the development and the function of our immune system I mean you know if you're born with a sterile gut and you your immune your immunodeficient and we know that from animal models we know it from people we know a lot about and you just know I had dr. Hazen on the shows studied this in the most you know robust scientific way possible you know we know what healthy microbiome kind of looks like you know diverse and rich you know we've yet to dial it in to this organism that organism so you know we know that good diets that you know people that eat real food you know usually have a more diverse and rich microbiome and that supports immunologic health I'm reluctant to tell people you know Carl Sagan used to say you know that extraordinary claims require extraordinary data right and so you know we don't know how to reduce it to that crystallised eat this do this one thing it's probably much more complicated than that but we do know that prudent diets versus sad diets a huge sure effect under a more functional medicine we often people on elimination which is eliminating inflammatory foods an anti-inflammatory diet things like gluten and dairy can be an issue processed food obviously eating more Whole Foods plant rich foods is really key so that's sort of what you're saying absolutely yeah yeah all right so next topic would be you said exercise exercise so I've been interested in exercise and immunity for decades actually it's probably one of the first areas of behavior immunity that I became interested in and it's a it's a it's a complex area to talk so over the past many years I try to invite world leaders in all of these areas to my centre to visit and last year we had David Neiman who is one of the undisputed leaders in this field and you know I do believe in what we call the J curve of exercise that people who are sedentary people who are sedentary are immunocompromised and we know this both from the laboratory and the risks of you know the kind of the canary in the coal mine that we measure usually is respiratory illnesses and how many normal and how many do you get well being a couch potato is bad for your immune system it is definitely bad for your immune system as well as virtually every other system in your body but I'm looking from the lens of immunologic we just talk about heart disease and things like that but this is it yes you this is this is this is it the thing that you can do to demonstrate immunologic enhancement is moderate exercise and you know moderate exercise is still a moving target and you know if we look at the guidelines which have been recently revamped only in the past of a couple of months you know walking is an incredible form of immunologic strength building and we actively endorse and what we talk to about our patients is just like with the diet tell me where you're at in this spectrum of exercise or you the couch potato and you work in a cubicle and you're sitting there all day long you're doing nothing or are you you know training for ultra marathons at the other end the where you are we try to move people down a bit at a time and Betsy and I my nurse practitioner world's best nurse practitioner we talk to our patients about instant recess that's what we call them we say you know if you're totally sedentary just get up and start moving and now I'm copying you so in my immunological 'its for the past two years I invite our head yoga teacher from the Cleveland Clinic Judy who comes and we do yoga at all the sessions so first time I did this at a scientific meeting these guys are like what oh my god they wait it and now it's like so popular yeah so anyway we we start moving the needle down to moderate exercise there still is some data and there's some controversy that's recently been added into this you know the middle path is very strong for health and wellness and you know you can too much of something is often as bad as not doing it yeah and there have been a lot of epidemiologic evidence that show people who are ultra exercise of yeah can actually do harm in and like marathon runners and and beyond now we can't remember ultra marathon runners you know and it's not think it's coincidental and I'm sure you've seen this in your practice I've seen many people who have developed you know what we would recognize now is chronic fatigue syndrome who had started out as very high endurance athletes and then something has fallen apart and you just wonder in your head of whether this was a predisposing factor but we get people moving so there was a very interesting study done at the University of Colorado in the last about 18 months where they experimentally took a group of people who work at a sedentary job cubicle sit there all day long and they randomized them to you get to go to a gym and come in a half-hour late and you do 30 minutes on the treadmill versus yoo-hoo all you have to do is for five hours during the day get up and walk around five minutes out of each hour five minutes out of each hour and then they measured a number of outputs and while they didn't do immunologic function they looked at vitality well-being mood etc the people who won where the people were just getting up and move walking around yeah you know you don't need a step counter there 10,000 steps all of that stuff that my croizon talks about and that our whole enterprise engages and you know it's I think it's good for your body it's good for your brain and it's clearly good for your immune system so it's just a small bit of data and similar to what we talked about from the Nurses Health Study in on diet there been several large epidemiologic studies to show that people who carry the predisposition to rheumatoid arthritis who are more physically active will have a lower incidence of actually developing the disease over a lifetime so you've got to two areas that you know that there's clearly enough data for so many reasons you know already vascular health emotional well-being an immunologic string so what happens to our immune system when you're exercised not not like the ultra marathoners and I know you've written about this where you see even even clinical studies looking at ultra marathoners versus regular folks their immune system is different their oxygen stress is more what what is actually happening when you exercise your immune system it's actually still relatively poorly understood if you divide it into two two types of studies one of the studies where you can do it in a lab and come in and you know get on the do a an exhaustive stress test or cycle till you've hit the oxidation wall and you're you know hit your aerobic capacity there it's not surprising that all types of things happen to your immune system you have trafficking of immunologic cells you have elevations of inflammatory cytokines those are the mediators that cause inflammation and redistribution of lymphocytes like t-cells and b-cells I've always said well I would expect that that's just stress and your immune system is moving to stress the more important question is if you take a person who's sedentary and a person who has moderate activity in person who is an ultra-marathoner do their immune systems differ by what we have traditionally measured T cells and B cells and inflammatory cytokines and the like and the answer is there's very little difference that we can detect and my response to that is is that you know we have very poor tools yeah we're just now you know we're looking with we're looking with an eyeglass instead of a telescope we're looking at the same techniques that we looked at you know forty years ago where in the next five years we'll be looking with you know what we recognize as ohmic technologies where we're looking at the entire cloud of data of how your genes are functioning and how your your proteome and metabolism of that work is starting to be done right now and I look forward to seeing more of it that's pretty exciting so it's eating right exercise a slug about stress because I think the data is pretty clear that stress is not good for your immune system but that the active managing stress or actually doing things that help reset your stress response actually can help your immune system and it's really the the conversation about molecules of emotion it really is I think that this is the most exciting area going on in immune behavioral science right now and the data that are being generated are you know pretty impressive so let's just talk about let me back up and give you a just a magic minute on on triggering the immune system so you know we have this immune system here it's designed to defend us from all types of dangerous signals we traditionally think of that as external signals such as you know infections and it certainly does all that there is another set of danger signals that we are just now starting to understand and you brought up the term psychoneuroimmunology and ah ah okay it is it is and it's your your psyche your nervous system and your immune system and you know we don't know what stress levels were you know two hundred five hundred five thousand years ago but we do know that today living in this world stresses are different you know you've got you know you're carrying your phone in your pocket I had to turn it off when I came in here and I'm probably already getting nervous about how many emails are standing up while I'm having this nice conversation with you the you know the exigencies of modern life are complicated add to that the environmental stresses you know we're living in a world where you know the temperature is rising pollutants are are bombarding our body those are dangerous signal yeah and so there is a tonic level of stress there that I think is probably new in the industrial age processing that is our brain it by and large and the brain can send signals to the body that promote inflammation you know inflammation is good when you cut your finger it's bad when you have it for ten years so the immune system is triggered by stress to generate accelerated inflammation which contributes to all these immune mediated and Planetary diseases that we're talking about you know contributes to acceleration of aging and that includes aging of the immune system and we have this great term called immuno senescence you know you're me sound good it does not sound good right so so all of this is going on dying of your immune system is what it means that anyway right so with that as a background the question is you know what the heck do we do about it yeah and all the science is really good about what happens to immune system under stress it's not it's not just an ideal stress is bad for you it's actually mapped out pretty well it's it's it's mapped out in in incredible detail and we can look at people who have mood disorders we can look at people who are caregivers for patients with cancer or dementia we can look at people with PTSD we can look at all of these populations and there's profound perturbation of their immune response so how do we move that needle how can we do that well you know there are a variety of techniques but the ones that have been best studied surround the use of mindfulness meditation mm-hm and I'd like to just take a couple minutes to talk yes this with you because I know that you're a great practitioner and so for those in your audience who are many of our well familiar with this the the cognitively based mindfulness based stress reduction developed by Jon kabat-zinn 2530 years ago has been the standard-bearer of research of research and you know I give unbelievable credit to his pioneering efforts and all the data that's been generated for this but as you know this is pretty demanding stuff and you know day of introduction you know you know you have quarterly stressed is hard work for CBC tea I wouldn't be stressed mindfulness based stress reduction yes sorry mindfulness very stress reduction so I've been asking the question for the past number of years whether lower doses of mindfulness hmm can have beneficial effects on all the domains that MBSR has had effects on all right it's only an hour twice a day maybe there's like a different ducky there so you know we have a program that develops at the Cleveland Clinic stress free now and stress free now has been used in multiple settings and we published in scientific literature you know when you know hundreds of engineers have taken this people from Colin centers that are all stressed out that 15 minutes four times a week appears to lower stress levels minutes twice every 15 minutes four times a week seems to be a sweet spot which is you know that's doable we've also developed a program which you can get on your app called stress free now for healers and I designed this program God knows we need it you know that we're talking about burnout and all the stresses of this so I you know I I couldn't stand the thought of trying to tell some neurosurgeon yes and meditate for an hour a day to reduce the stress it probably cut me over the head right right so so not wake you up with a scalpel we're introducing this smaller dose so now with this so we know that it reduces stress so now we have a study that is going on we just launched it and we're getting scores of people interested in participating we're doing it within our own system so we're taking stress free now for healers this low-dose meditation right that can be used on your app to be used at your workstation computer and we're going to take nurses who are undergoing occupational stress and over a six-week period we're going to study them but the primary endpoint is not going to be reducing their stress the primary endpoint is we're going to look at how this affects how their genes function so we're doing what would we call next-generation sequencing yeah we're looking at the entire function of the genome a very hi-tech analysis very high-tech analysis in and then we're looking at all these interleukins vomitorium all the inflammatory molecules that the immune system and it'll be the largest study done of its type none has been done the health care setting none has been done with this low dose and we just are so excited about working with this and I will tell your audience so if you're interested in in following this work along and my kind of world view on this you know follow me on Twitter yes Elle Calabrese do and I would you know get my wild and wacky view of the immune system and behavior but this is where we want to go we want to plumb that and Mike Rosen and I have had this discussion he thinks that we should be looking at six minutes of mindfulness meditation I don't know that the answer is but that's where our studies are going to be going in the future so it's a big one it is true you know there's and there's other people have done some work on this at the Chopra Center they looked at with it with very sophisticated analysis of immune system of gene expression in the brain effects of meditation they found this dramatic lowering of inflammation improvement of the immune system improved stem cell production proved gene expression just simply by dealing with this really simple technique of stopping breathing sitting doing nothing which most of us never do so you know one of the there's an incredible work going on in that area there's an investigator at UCLA Stephen Cole who was founded this area that Marisa social genetics yeah and basically shows that there is a pattern of gene expression this all has to do with epigenetics yeah you know how our genes work not just the genes that were inherited in is that if you take people who are stressed out regardless of whether it's you know caregiver PTSD or psychosocial issues they have a conserved abnormality of how their genes function in other words there's a fingerprint of this gene perturbation in disruption and it is highly inflammatory and it affects both the amount of inflammation that we're putting out as well as the way our body defends us against viral infections so there's an MMO yin-er if you're on signature and this thing and so this is now being plumbed and actually dr. Cole's going to be doing the gene analysis for our study so we're very excited about it but this is behavior yeah genes immunity it is it is all there and well we don't have all the answers we know that we need to modify this we already have tools in the in the toolbox to do it so that leaves the last thing we do before before we yeah and I want to before you finish on this one I'm gonna get the last thing which is sleep okay great great about sleep the last thing yeah okay so you know what's what's fascinating is that the the immune system responds in that way to stress reduction and in this whole world of social genetics there's a there's a concept that I I thought I came up with but I clearly probably didn't which was over 10 years ago with this idea of socio genomics which is how our social connections and our social contacts influence gene expression and I just sort of thought cuz I because I realized that you know with obesity as well it was warm and infectious disease it was contagious because people who were overweight who had friends overweight were more like I mean people were more likely to be overweight if they had friends overweight than if than if their family was overweight and so I was like what these social connections are really important and then I made these studies where they looked at people who had different quality of relationships if he were in a social interaction that was uplifting that was loving that was heart centered connected that actually improved your gene expression and reduced inflammation and did all these wonderful things and bad interactions did the opposite so the idea of just hugging everybody that's like gonna help your immune system and reduce inflammation and improve your gene expression right yeah and it proves your autonomic function - yeah and all of the above you know the the immune system just - we started talking a little bit about epigenetics so just to you know set that stage again you know you inherit your genes from your parents but how your genes actually function it has to do with a lot of things that after you're born and that's a behavior diet exercise etc so there have been studies done in the past few years mark davis from stanford leading immunologist did this incredibly detailed study of twins and looking at immune function and they looked at monozygotic twins that means that you're absolutely identical twin and then dizygotic where you inherit you know one for ternal towards maternal twins and basically showed that 70 percent of the immunologic function and that has to do with everything from T cells and B cells in these inflammatory cytokines and responding to vaccines and stuff like that is acquired yeah and if you start looking at social different in identical twins yes it's different in identical twins again that's you know you know who goes on to lives the loving healthy life and who goes on to be you know a crack addict they're not gonna look the same when they're if they both make it to their seventy years old right and so that's very interesting on the other hand studies that have looked at immune systems in children who are twins they're very similar you know so you start out the same but then your genes start functioning differently by how you actually live your life yeah and that's what we're all talking about here it's fabulous really fast all right last subject sleep now recently we had a expert come to Cleveland Clinic you gave Grand Rounds with him it was fascinating to listen him talk about the effect of sleep and sleep deprivation and quality of sleep on the immune system so can you share with us what those key findings are on sleep because we're all they're all sleeping so much less than we did we have so niang's into Rupp sleep you know we're used to sleep nine hours a night now the average is seven or even less in this country and we're living in chronically to sleep deprived air era and also people have insomnia and disrupted sleep yeah so our visitor was dr. Michael Irwin from UCLA I consider the the leading figure in sleep immunology and I've been I've been thinking about this for the past year and and trying to design how to study it in the amid population and and the immune mediated immune mediated or diseased population and I've been I've been commenting on this and and actually tweeting this I think sleep isn't is the new frontier in immunology it's something that is you know we know less about than all of these other areas yet it is so powerful and it is linked in to virtually everything you know some of the data on sleep and health are are so strong that you know that if you if you sleep less than seven hours and and the lower sleep the worse and if you sleep far more than nine hours all cause mortality it looks like patients with terribly bad serum lipids and cholesterol I mean it's it it is a it is a dominant factor so if you sleep too much or too little yes no to too much and it actually quite complicated because now you have to you know sick people may be sleeping but I gotta my wife because she loves to sleep a lot I actually so I actually I felt I really asked him a lot about that he made me feel a little bit better but the the lack of sleep is is huge and and you know people have been writing about it and been talking about it what has been shown is that sleep is a very potent kind of master switch of the immune system and if you interrupt people's sleep and and deprive them of sleep and they do this experimentally you go into the sleep lab and they just stop you from sleeping for the first four hours then they let you go to sleep your inflammatory markers start rising dramatically and those inflammatory markers are coming from your brain and and because that is the neuro psycho immunologic limb and what does that do those inflammatory markers then contribute to musculoskeletal pain when you have pain you sleep you know you go to bed with a stiff neck you don't sleep very well so all of these things are together add to that our biologic clocks are circadian rhythms you know you are you or you're hardwired to sleep a full night's sleep you know your cholesterol your cortisone levels you know rise in the morning and fall during the night hormone goes all of these things are going on so sleep is invested in every one of these so you know when I talk to people in my practice and I talk to me you know it's easy to talk about at least talk about diet we can you know people know what you're talking about and people know about exercise you can measure that and you envision that but sleep is it's really a tough one to modify you know if you don't sleep good you know what do I do and we have a fabulous online program at the clinic called go to sleep yes that is a cognitive behavioral program that and it's available to everybody rights available on go to sleep please type in Cleveland Clinic go to sleep and you'll go to sleep you'll find it and and that has been published in peer review and the science of it is good and so we are incorporating all of these things and and maybe in our closing comments you know I'd like to tell you a little bit about immune strength yeah so sleep is so key and you know I I remember being a resident or even working as a family doc during delivery staying up all night working in the ER that you have to get sleep deprived you're sore and achy it feels like you have fibromyalgia what you do you know I really think that that is an experimental model yeah I mean is that universal because I don't know if everybody else was experience but I would have it it's very common actually studied it's actually been studied at looking at tender points in physicians post call and you're more tender see I lived in California during my residency in Northern California and Sonoma County and we had a residency that was very enlightened it was a family practice residency one of the residents was a union negotiator and he negotiated the getting off of call after 30 hours instead of 36 hours so you would get off at noon after call and then I would drive up to this hot springs because I was so sorting I would job for the hot springs on my wife and we like soak in the hot sauce in the hot springs just to kind of get rid of that I wish trains it was fantastic so you have laid out a world that is so different than I learned in medical school around how to deal with inflammatory and immune diseases which is not only using medication but using what we eat and how much we exercise in the quality of our exercise how we think about stress our minds and how they affect our immune system and tools we can use sleep and how that affects all of it and these is these are powerful tools they're not they're not small in terms of the effects especially when you add them all up together so your work is pretty amazing so tell us about what you just mentioned so what we're trying to do so when I talk to my colleagues who are immunologists who take care of your monologic diseases the image and I asked them like well are you why here's the data why aren't you doing this hey I don't I don't I'm not comfortable I'm confident that I know the science because it hasn't been discussed be I don't have time see I don't have the skills to interact with patients and D even if I wanted to do this I don't know who to send them to yeah you know I'm afraid of alternative medicine I want people to stay with me too you know so I can manage the disease but I'm all for wellness so we have developed a program that is about 50% built that we call immunological it is an online program working with the Wellness Institute 10 weeks with an e coach and we have these fabulous coaches so you're not alone it's a PC based but also will be portable and over the first eight weeks you are introduced to our stress free now program the one that I've told you that we're studying molecularly to go to sleep program which is highly effective for this a modification of our good foods to go and we're designing an exercise program patients you come into this because you're interested in immunologic strength so there'll be specific programs you have rheumatoid arthritis you psoriasis you have multiple sclerosis and you will learn that you have a disease of the immune system behavior affects your immunity you have the power to change this and the way that it's going to be monitored is that when people come in we're going to measure all types of quality of life measures using many of the things that we use in our clinic all online all you know highly confidential and and self-explanatory they'll have access to my monograph on immune health and then halfway you'll you'll see your progress in global health global mental health global sleep global fatigue pain and then depending upon the disease will actually look at disease activity measures that can be done through patient reported outcome anything so what we want to do is build this and I'm doing this with Elaine honey who work as you guys and yeah my my right arm and then we're gonna use this as a platform for study I mean big time study this is phenomenal so immune strength and then it's not ready yet it is not ready but we're probably in the in the next six months it'll be done and then school only or is it for now yes everybody disseminate it to the world I'm not just a Cleveland Clinic yeah but for anybody beyond and and we're so write that down everybody immune strength for it it's six months Google it's gonna be you know this is built by immunologists but with collaboration of people in the wellness world and what makes it different from all the other messages is it's a story of immunological Powerman there are fifty million people that have immunologic diseases and you know we want them to understand that their immune system is not totally you know out of control they can do a lot about it this is tremendous I'm just sort of marveling here because what you're talking about is a total paradigm shift in how we think about medicine it's not only about treating the disease it's about the science of creating health and it's a very big paradigm shift and yes you're right your colleagues none of us were trained in how do you create a healthy human we don't know we don't know how to do it we don't how to talk about it we don't know the science about it but it's there the science is there so what you're saying essentially is that food is medicine that exercises medicine that's meditation is medicine that sleep is medicine and that where we haven't been using these tools properly in healthcare and now we can and in a place like Cleveland Clinic this is such a pioneering advance I applaud you Lenny and and just continue your work and help us understand how we can actually great healthy immune systems because we all need that well I want to thank you for having me on the show and for all the great work and that you guys have done in functional medicine because you've really kind of challenged some of us to think a little bit differently to have open minds which is amazing so I would say I would say anybody wants to learn about the immune system what's really on the cutting edge they should definitely follow you on twitter give us that handle again Elle Calabrese do al Calabrese do ok great it's great I'm always retreating this stuff so you might see that as well you've been listening to the doctors pharmacy that's FA RM Acy a place for conversation that matters and I think this conversation matters to all of us well thank you for being here dr. Lenny and if you like this podcast please leave a review wherever you listen your podcasts share with your friends and family on Facebook and Twitter and social media and we'll see you next time on the doctors pharmacy [Music]

Channel: Mark Hyman, MD

Views: 120,339

Keywords: immune system, autoimmune, immunodeficiency, disease, Dr. Mark Hyman, Mark Hyman MD, rheumatology, Leonard Calabrese, Cleveland Clinic, genetics, Wellness, joy, gratitude, the doctor’s farmacy, podcast, health

Id: g8M--oV1qv8

Length: 52min 50sec (3170 seconds)

Published: Wed Feb 27 2019