Immunity: How does it work and can it be strengthened

THERE IS NO END IN SIGHT TO THE PROMISES OF “STRENGTHENING” THE IMMUNITY WITH VITAMINS , yogurt or magic food supplements – and even those who do not believe in advertising, in the cold season, start talking about “failures” in the immune system and looking for ways to “fix” them. Immunity disorders are explained by a variety of ailments, and experiments with little-studied means designed to improve it are performed not only on themselves, but also on children.

Together with the candidate of medical sciences, a member of the European Academy of Allergists and Clinical Immunologists (EAACI), an immunologist Umar Khasanov and an allergist-immunologist of the Atlas Medical Center Ekaterina Pushkova, we tried to figure out how the immune system works, is it so easy to “undermine it” »And whether it is necessary to try to improve.     

How immunity works

When in advertising we are told about how another new means can increase the “fallen” immunity, it seems that the immune system has an equalizer and it is only important to move the lever in the right direction – but it’s not that simple. According to Umar Khasanov, even a simplified schematic model of the immune system consists of dozens of cell types with almost four hundred different receptors. With the participation of special substances, cytokines, they perform an astronomical number of tasks – from eliminating a splinter in the skin to destroying tumor cells. This system has been forming for millions of years – and it does not work independently, but in close relationship with the nervous, endocrine and other systems of the body. In general, the concept of an equalizer, in which immunity can simply be made “louder” or “quieter”, does not work here.   

In addition, this system is perfectly self-regulated: according to Ekaterina Pushkova, it is not so easy to “break” the immune system by simply drinking some traditional medicine or going outside in cold weather. But the chronic effects of fatigue, malnutrition, constant jet lag, intense stress are factors that can gradually “damage” the immune system and increase susceptibility to infections.

What can really worsen immunity

When the effectiveness of the immune defense is reduced, a person’s tendency to infections increases – and this can be caused by factors that can be quite realistically influenced. One of them is smoking, in which not only the smoker himself suffers. A negative effect has been proven not only with secondary (passive), but also tertiary smoking – the remains of smoke on the skin and clothing can cause an increased propensity to illness in relatives of a smoker. An increased risk of respiratory infections has also been proven for a number of toxic substances, primarily drugs.         

The presence of certain diseases also reduces protection against infections – for example, acute respiratory infections are more common in people with rhinitis and bronchial asthma . Gastroesophageal reflux – a condition where gastric juice is thrown into the esophagus – increases the frequency of laryngitis and pneumonia; if you correct this condition, then the problem will be solved not only with the stomach, but also with frequent infections of the respiratory tract.   

You can often hear about the so-called local immunity – we are talking about the very first immune barrier of the body, that is, the skin and mucous membranes. If the permeability of this barrier is increased, then the risk of infections increases. Local protection is violated if a person has chronic foci of infection (for example, caries), and also because of tobacco and alcohol – they negatively affect the state of the mucous membranes. Pushkova notes that in this case it is incorrect to talk about immunodeficiency, but these factors really contribute to more frequent infections.    

What is immunodeficiency

Immunodeficiency is a real disease, with a clear definition and specific changes in the test results – that is, one cannot talk about immunodeficiency, for example, on the basis of the fact that a person often catches a cold. There are more than a hundred types of immunodeficiency , but in general it is divided into primary and secondary. The primary is genetically determined – that is, a person is born with a mutation of one or more genes important for the immune system. Most often, such an immunodeficiency is found in childhood.   

Secondary immunodeficiency is also called acquired – it can be viral, caused by HIV, or develops due to chronic diseases or their treatment. For example, this happens with cancer or autoimmune diseases, or due to treatment aimed at suppressing the immune system: chemotherapy, radiation therapy, immunosuppressive drugs. 

There are very specific signs of primary immunodeficiency – first of all, these are severe infections that are difficult to treat. For example, these signs include two or more pneumonia per year, more than two months of antibiotic treatment without effect, deep recurrent skin abscesses – a key factor here is the severity of the disease. As Ekaterina Pushkova explains, if a person coughs a little chronically and is not particularly treated in any way, but at the same time goes to work or study, there is no talk of immunodeficiency. In addition, with real disorders in the functioning of the immune system, other manifestations arise – for example, the development of opportunistic infections, that is, caused by microbes that normally inhabit the body and do not cause any reaction in a person with a healthy immune system.   

What does ARVI have to do with it

According to Umar Khasanov, ephemeral promises to reduce the frequency of colds are the wheels of a powerful marketing machine for promoting questionable substances. We are led to believe that colds are a sign of a weakened immune system, when in fact this is not the case. An uncomplicated cold is not scary, it does not need to be treated (and there are no effective remedies for this), and frequent morbidity in children is a normal age-related feature. A child is born with an immature immune system and at first receives antibodies in breast milk, and then “training” and the development of the immune system is largely due to viral infections. SARS is a small price to pay for the fact that we constantly live in close proximity to thousands of viruses.   

Modern science has come to the conclusion that uncomplicated ARVIs indicate diseases of the immune system extremely rarely. The structure of the immune system is such that if the slightest “failure” appears, it will result in a series of bacterial complications – frequent pneumonia, skin infections, purulent otitis media and sinusitis, – cancer and autoimmune diseases . So, frequent uncomplicated colds are not a reason to contact an allergist-immunologist, it is enough to visit a pediatrician, therapist or family doctor. 

Is it true that carriers of viruses have reduced immunity?

In Russia, it is difficult to find a person who has not been tested for herpes viruses; the idea of ​​their detrimental effect on the immune system is deeply rooted in the public consciousness. They say that a frequently ill child or adult needs to exclude hidden infections – namely, find, for example, cytomegalovirus, Epstein-Barr virus, herpes simplex virus and “cure”. On the Internet, you can find hundreds of dissertations and articles on the effect of these viruses on the immune system, but on the English-language resources everything is much more modest, and the information dates back mainly to the nineties of the last century.

In particular, on the international professional resource UpToDate, only one small paragraph is devoted to the effect of viruses on the immune system with reference to a 1990 publication. In short, in the laboratory some influence of viruses on immune cells was indeed noted – but this is of practical importance only for people with already seriously impaired functioning of the immune system. For healthy people, evidence of harm absent , and, for example, the Control Center and Prevention of diseases is not recommended to diagnose such viral infections everyone. This simply does not make sense: it is difficult to find a person who would not be infected with them, but they are extremely rare “guilty” of all troubles, from insomnia to frequent colds.       

How vaccines affect immunity 

Immune defense is divided into congenital and acquired: congenital is aimed at fighting a lot of things, but the acquired one is specific, that is, it is aimed at specific foreign substances. Acquired immunity appears when the system has already “got acquainted” with the pathogen. And although in general all these processes work, sometimes there is simply not enough time for the cells to “work” effectively: infections such as tetanus can lead to irreversible complications or death in a short time. It was in order to “acquaint” the immune system with the pathogen (in the most attenuated form) or its components in advance that vaccination was invented . 

Vaccination is a gentle and safe way to “train” the immune system; subsequently, when faced with a threat, the protection will work and protect the person, if not completely, then at least from the consequences that threaten life. Khasanov notes that in countries with developed medicine, the vast majority of patients with primary immunodeficiencies are vaccinated quite calmly – the vaccination schedule may differ, but not significantly. That is, even for children born without a significant part of the immune system, vaccination is important and must be timely – and it’s definitely time to forget about contrived medications like snot.

Do I need to drink immunomodulators and vitamins 

More than four hundred over-the-counter “immunomodulators” are registered in Russia – but, according to experts, they do not have any significant effect on the immune system. Of course, there are drugs that are really active in relation to immunity, but these are already drugs for the treatment of serious diseases prescribed by a doctor (for example, high doses of interferons are used in the treatment of multiple sclerosis ). The side effects of such drugs are also pronounced – for example, allergic processes or a condition that resembles the flu (flu-like syndrome). 

It is often said that large doses of vitamin C can help reduce the frequency and duration of acute respiratory viral infection – but in larger studies proved that preventive reception of vitamin C, although it may slightly shorten the duration of illness in healthy people, does not affect the frequency and severity of colds. A lack of vitamin C is really bad for the immune system, but nowadays it is difficult to earn a deficiency. This also applies to other vitamins and microelements: if there is a proven deficiency of them, then it needs to be corrected, but this does not mean that vitamin deficiency should be sought in everyone who often catches cold. If, nevertheless, a deficiency of vitamins has developed (and this happens, for example, in vegetarians or people with intestinal absorption disorders), then it should be treated according to certain clinical guidelines, and not independently selected multivitamins. 

And yet how to strengthen it

No matter how much we would like to find a magic pill to strengthen the immune system, there are no such funds yet. Moreover, although modern medicine has learned to suppress the immune system (for example, in autoimmune diseases), there is still no way to safely stimulate it. And you don’t need to do this – and in order to get sick less often, it is enough to follow boring recommendations: lead an active lifestyle, eat a variety of foods, get the necessary vaccinations and not start chronic diseases. It is worth remembering that the quality of immune protection is negatively affected by alcohol, tobacco smoke and smog – therefore, you need not look for a remedy that will “spur” the immune system, but normalize your lifestyle and regimen. 

local_offerevent_note July 4, 2021

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