Inhaling pleasant Scents during sleep and boost in Cognition

 

Inhaling Pleasant Scents During Sleep Tied to a Dramatic Boost in Cognition

Batya Swift Yasgur MA, LSW

August 08, 2023

Inhaling a pleasant aroma during sleep has been linked to a "dramatic" improvement in memory, early research suggests.

In a small, randomized control trial researchers found that when cognitively normal individuals were exposed to the scent of an essential oil for 2 hours every night over 6 months, they experienced a 226% improvement in memory compared with a control group who received only a trace amount of the diffused scent.

In addition, functional magnetic resonance imaging (fMRI) showed that those in the enriched group had improved functioning of the left uncinate fasciculus, an area of the brain linked to memory and cognition, which typically declines with age.

"To my knowledge, that level of [memory] improvement is far greater than anything that has been reported for healthy older adults and we also found a critical memory pathway in their brains improved to a similar extent relative to unenriched older adults," senior investigator Michael Leon, PhD, professor emeritus, University of California, Irvine, told Medscape Medical News.

The study was published online July 24,2023 in Frontiers of Neuroscience.

The Brain's "Superhighway"

Olfactory enrichment "involves the daily exposure of individuals to multiple odorants" and has been shown in mouse models to improve memory and neurogenesis, the investigators note.

A previous study showed that exposure to individual essential oils for 30 minutes a day over 3 months induced neurogenesis in the olfactory bulb and the hippocampus.

"The olfactory system is the only sense that has a direct 'superhighway' input to the memory centers areas of the brain; all the other senses have to reach those brain areas through what you might call the 'side streets' of the brain, and so consequently, they have much less impact on maintaining the health of those memory centers."

When olfaction is compromised, "the memory centers of the brain start to deteriorate and, conversely, when people are given olfactory enrichment, their memory areas become larger and more functional," he added.

Olfactory dysfunction is the first symptom of Alzheimer's disease (AD) and is also found in virtually all neurological and psychiatric disorders.

"I've counted 68 of them — including anorexia, anxiety, [attention-deficit/hyperactivity disorder], depression, epilepsy and stroke. In fact, by mid-life, your all-cause mortality can be predicted by your ability to smell things," Leon said.

Leon and colleagues previously developed an effective treatment for autismusing environmental enrichment that focused on odor stimulation, along with stimulating other senses. "We then considered the possibility that olfactory enrichment alone might improve brain function.”

Rose, Orange, Eucalyptus…

For the study, the researchers randomly assigned 43 older adults, aged 60 - 85 years, to receive either nightly exposure to essential oil scents delivered via a diffuser (n = 20; mean [SD] age, 70.1 [6.6] years) or to a sham control with only trace amounts of odorants (n = 23; mean age, 69.2 [7.1] years) for a period of 6 months.

The intervention group was exposed to a single odorant, delivered through a diffuser, for 2 hours nightly, rotating through seven pleasant aromas each week. They included rose, orange, eucalyptus, lemon, peppermint, rosemary, and lavender scents.

All participants completed a battery of tests at baseline, including the Mini-Mental State Examination (MMSE), which confirmed normal cognitive functioning. At baseline and after a 6-month follow-up, participants completed the Rey Auditory Verbal Learning Test (RAVLT) as well as three subsets of the Wechsler Adult Intelligence Scale–Third Edition (WAIS-III).

Olfactory system function was assessed using "Sniffin Sticks," allowing the researchers to determine if olfactory enrichment enhanced olfactory performance.

Participants underwent fMRI at baseline and again at 6 months.

Brain imaging results showed a "clear, statistically significant 226% difference between enriched and control older adults in performance on the RAVLT, which evaluates learning and memory (timepoint × group interaction; F = 6.63; P = .02; Cohen's d = 1.08; a "large effect size").

They also found a significant change in the mean diffusivity of the left uncinate fasciculus in the enriched group compared with the controls (timepoint × group interaction; F = 4.39; P = .043; h ² p = .101; a "medium-size effect").

The uncinate fasciculus is a "major pathway" connecting the basolateral amygdala and the entorhinal cortex to the prefrontal cortex. This pathway deteriorates in aging and in AD and "has been suggested to play a role in mediating episodic memory, language, socio-emotional processing, and selecting among competing memories during retrieval."

No significant differences were found between the groups in olfactory ability.

Limitations of the study include its small sample size. The investigators hope the findings will "stimulate larger scale clinical trials systematically testing the therapeutic efficacy of olfactory enrichment in treating memory loss in older adults."

Exciting but Preliminary 

Commenting for Medscape Medical News, Donald Wilson, PhD, professor of child and adolescent psychiatry and of neuroscience and physiology, the Child Study Center, NYU Langone Medical Center, New York, said that multiple studies have "demonstrated that problems with sense of smell are associated with and sometimes can precede other symptoms for many disorders, including AD, Parkinson's disease, and depression."

Recent work has suggested that this relationship can be "bidirectional" — for example, losing one's sense of smell might promote depression, while depressive disorder might lead to impaired smell, according to Wilson, also director and senior research scientist, the Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, who wasn't involved with the study.

This "two-way interaction" may raise the possibility that "improving olfaction could impact non-olfactory disorders."

This paper "brings together" previous research findings to show that odors during bedtime can improve some aspects of cognitive function and circuits that are known to be important for memory and cognition — which Wilson called "a very exciting, though relatively preliminary, finding."

A caveat is that several measures of cognitive function were assessed and only one (verbal memory) showed clear improvement.

Nevertheless, there's "very strong interest now in the olfactory and nonolfactory aspects of odor training and this training expands the training possibilities to sleep. This could be a powerful tool for cognitive improvement and/or rescue if follow-up studies support these findings," Wilson said.

Front Neurosci. Published online July 24, 2023. Full text

Sleep Dysfunction and the Microbiome

 

Sleep Dysfunction & the Microbiome: Emerging Treatments

Sleep is a dynamic process that affects every system of the body, and the interplay of different environmental and lifestyle factors influences sleep quality and architecture.1 

Recent research suggests that some of these factors may influence sleep via the microbiota-gut-brain axis, both directly and indirectly.1-3 What is the connection between lower sleep quality and quantity and a dysbiotic gut microbiome? What emerging interventions targeting the microbiota-gut-brain axis may be beneficial for the treatment of impaired sleep patterns?

From a young age, microbial communities within the body interact with the sleep-wake cycle in a complex manner.1The gut microbiome, which produces a variety of metabolites and compounds with neuroactive and immunomodulatory properties, including short-chain fatty acids, secondary bile acids, and neurotransmitters, may affect brain function and behavior through the microbiota-gut-brain axis.4 These microbial products are also involved in sleep physiology.3 While the mechanisms underlying the microbiota-gut-brain axis are not fully understood, some evidence has suggested that neuroendocrine, immune, and metabolic pathways may regulate interactions.3

Growing evidence reports a positive correlation between sleep efficiency and the diversity of the gut microbiota from childhood through adulthood.3 For example, a recent study of 143 largely Caucasian children ages 3-4 found that children with a high total nighttime sleep duration (average 9.48 hours), greater sleep efficiency, and less time awake at night showed a higher relative abundance of Bifidobacterium and Bacteroides.5 Both bacteria have been linked to sleep-related neurochemicals in previous studies, such as serotonin and its precursors tryptophan and gamma-aminobutyric acid. In the 2022 study by Wang et al, five taxa showed greater abundance in children who had shorter night-time sleep duration, less sleep efficiency, and longer waking time, including Blautia, Coprococcus, and other Lachnospiraceae.5

Evaluating individuals with healthy sleep quality, a 2020 pilot study of 28 young adults by Grosicki et al found higher proportions of the abundance of Blautia and Ruminococcus (belonging to Firmicutes), lower proportion of Prevotella(belonging to Bacteroidetes), and higher ?-diversity of the gut microbiota among individuals reporting superior sleep quality.6 Researchers hypothesize that sleep quality may be positively correlated with the ratio of Firmicutes/Bacteroidetes and microbial diversity.3,6

A 2021 cross-sectional pilot study found that adult short sleepers have different microbial composition, such as an increased abundance of the bacteria Pseudomonas (0.14% vs. 0.08%) in feces and a lower abundance of Sutterella(0.38% vs. 1.25%) compared to normal length sleepers.1,7 Interestingly, Sutterella has been associated with lower relative abundance in patients with depression and may play a role in the microbiota-gut-brain axis.7 Several other studies indicate that a lower sleep quantity and quality are associated with a dysbiotic gut microbiome characterized by a lower microbial diversity, an increase of pathogenic microbiota, or the loss of beneficial microbes.4,8-9

Sleep-Related Disorders & the Microbiome

 OBSTRUCTIVE SLEEP APNEA (OSA)

OSA leads to fragmented night sleeping and daytime sleepiness due to episodes of obstruction of the upper airway; it is accompanied by repeated sleep fragmentation and forced awakening from sleep due to airway collapse.1,3Studies suggest that those suffering from OSA may have a prolonged N1 stage and a shortened REM sleep stage.3

Evidence suggests that intermittent hypoxia may result in changes to the gut microbiota, including increased Firmicutes richness and decreased Bacteroidetes richness, as well as decline in ?-diversity.3,10 A 2020 pilot study in children with OSA showed a significant decrease in gut microbial diversity compared to healthy children and an increase of inflammation and gut barrier disruptor–related strains.1,3,11 In 2019, Ko et al found gut microbial dysbiosis, in varying degrees, in adults with OSA-hypopnea syndrome.1,12 Specifically, short-chain fatty acid–producing bacteria was decreased and the level of interleukin-6 was increased compared to controls.1,12

More recently, a 2023 prospective case control study of 48 Chinese adults age 18-65 found that the severity of OSA was related to differences in the structure and composition of the fecal microbiome.13 Enriched Fusobacterium, Megamonas, and Lachnospiraceae_UCG_006 and reduced Anaerostipes was found in patients with severe OSA. Enriched Ruminococcus_2, Lachnoclostridium, Lachnospiraceae_UCG_006, and Alloprevotella was found in patients with high intestinal barrier biomarkers. Lachnoclostridium and Lachnospiraceae_UCG_006 were the common dominant bacteria of OSA and intestinal barrier damage. Fusobacterium and Peptoclostridium were independently associated with apnea-hypopnea index. The dominant genera of severe OSA were also associated with glucose, lipids, neutrophils, monocytes, and BMI.13

INSOMNIA

A range of psychiatric and inflammatory disorders as well as metabolic syndromes are comorbid with insomnia.2,14Marked changes in gut microbiota diversity and composition was found by Liu et al in 2019 among 10 chronic insomnia patients compared to 10 healthy controls.1,15 A later study by Li et al observed a decrease in microbiome diversity in acute and chronic insomnia patients, with greater effects on bacterial diversity found in patients with disordered sleep.1,13 These individuals also show an increase in the inflammatory cytokine interleukin-1?.13 Both of these studies noted that an increase of Bacteroidetes phylum could be a biomarker to identify insomnia.1

A 2022 multiomics analysis reveals that the composition and structure of gut microbiota and metabolism in insomnia patients differs from healthy controls.14 Compared to healthy controls, the relative abundances of Lactobacillus, Streptococcus, and Lactobacillus crispatus were significantly increased in people with insomnia. (Lactobacilli possess several health-ameliorating attributes, including alleviation of chronic diseases, immune system stimulation, pathogen protection, and nutritional physiology.)14 Five metabolic pathways in patients with insomnia differed between the two groups as well, including glycerophospholipid metabolism; glutathione metabolism; nitrogen metabolism; alanine, aspartate, and glutamate metabolism; and aminoacyl-tRNA biosynthesis.15Researchers also found that IL-1? levels were significantly higher in insomnia patients while TNF-? was significantly reduced; the changes in the level of IL-1? and TNF-? were associated with some specific bacteria and metabolites, such as Prevotella amnii, Prevotella buccalis, Prevotella timonensis, and Prevotella colorans.15

Clinical Applications: Microecological Therapy

A novel treatment strategy referred to as microecological therapy has emerged, featuring several potential interventions targeting the gut microbiota to improve sleep quality and quantity.3 The targets of this therapy include regulating the abundance of specific bacterial groups, microbial metabolites, intestinal barrier function, and host immune response. Evidence suggests that microbiota manipulations like dietary interventions and the use of probiotics may be beneficial for the treatment of impaired sleep.3

PROBIOTICS

Although probiotics are transient visitors, they play a role in shifting the overall balance of the microbiome, modulating the immune system, and decreasing inflammation.18 Consuming probiotics in foods or supplements may encourage colonization of commensal organisms over time.18 Studies suggest that probiotics may improve sleep latency, sleep quality and duration, sleepiness upon wakening, and recovery from fatigue.19-21

A 2023 systematic review and meta-analysis of six studies showed significant improvement in sleep quality of 343 healthy adults with mild to moderate stress as an effect of daily consumption of L. gasseri compared to controls (-0.77, 95% CI -1.37 to-0.16, P=0.01).21 In addition to the cumulative beneficial effect shown using the PSQI global score, four of six studies reported a statistically significant positive effect of L. gasseri on sleep quality as indicated by at least one of the Pittsburgh Sleep Quality Index component scores (sleep latency, duration of sleep, sleep disturbance, and daytime dysfunction due to sleepiness).21

In a group of 94 healthy medical students from Japan studying for national exams, researchers found that sleep latency prolongation was less in the intervention group that received Lacticaseibacillus casei strain Shirota.4,19 EEG measurements also showed that, as the examination approached, the time spent in NREM stage 3 sleep was reduced in the placebo group but maintained in the intervention group. In this double-blind, randomized, placebo-controlled trial, researchers also found a reduction of the mean Pittsburgh Sleep Quality Index (PSQI) score, indicating improved sleep quality among the intervention group compared to the placebo group.4,19 

In a 2018 randomized crossover study, 40 adults aged 20-64 consumed either Lactobacillus helveticus or placebo for four weeks.4,20 Sleep efficiency was measured as the total time spent in REM and NREM sleep divided by the total time from sleep onset to awakening. The researchers found that sleep efficiency significantly improved in the intervention group compared with placebo, including improved sleepiness on awakening, onset and maintenance of sleep, dreaming, and recovery from fatigue. It is important to note that the intervention group also received theanine, which has stress-reducing effects, while the placebo group did not.4,20

MEDITERRANEAN DIET

Nutritional imbalances are potential contributors or causes of several chronic conditions, and nutrition-based interventions are fundamental components of many therapeutic strategies used to combat chronic illness and restore optimal health. These personalized treatments may include therapeutic food plans like the Mediterranean diet, a plant-based, antioxidant-rich, unsaturated fat dietary pattern that has been consistently associated with lower rates of disease and total mortality.22 Studies indicate that greater adherence to the Mediterranean diet may be associated with adequate sleep duration and with several indicators of better sleep quality. For example:

• In 2018, Castro-Diehl et al found that a Mediterranean-style diet was associated with adequate sleep duration and fewer insomnia symptoms.23,24 This cross-sectional, multi-ethnic study of 2,068 adults with atherosclerosis found that compared with individuals who currently reported a low aMed score, those with a moderate-high aMed score were more likely to sleep 6-7 vs. <6 hr/night (p <0.01) and less likely to report insomnia symptoms occurring with short sleep (vs. no insomnia or short sleep alone; p <0.05). An increase in aMed score over the preceding 10 years was not associated with sleep duration or insomnia symptoms. However, compared with those with decreasing aMed score, individuals with an unchanging score reported fewer insomnia symptoms (p ?0.01).23,24

• In a 2019 cross-sectional study of 1,314 Southern Italian adults, a higher adherence to the Mediterranean diet was associated with a higher likelihood of adequate overall sleep quality (highest vs. lowest quartile, OR=1.82, 95% CI: 1.32, 2.52).25 Interestingly, in a sub-analysis of this study, researchers found the benefit of the Mediterranean diet on sleep latency was observed in normal and overweight individuals (highest vs. lowest quartile of adherence score, OR=2.30, 95% CI: 1.49, 3.54) but was not evident in the obese (highest vs. lowest quartile of adherence score, OR=1.12, 95% CI: 0.33, 3.79).22,25

• In a 2021 cross-sectional study of 2,169 Costa Rican adults (1,600 men and 569 women), the association between sleep duration and adherence to the Mediterranean diet differed between men and women. In women only, a lower adherence to the Mediterranean diet was associated with shorter sleep duration, a finding that researchers say was primarily driven by lower consumption of fruits, vegetables, and legumes.26 However, the literature is inconsistent regarding whether associations between sleep and diet are gender based. For example, a 2020 study conducted among young adults 21 to 30 years old found that men with lower fruit and vegetable intake had a higher risk of insomnia as compared to women.26,27

Functional Medicine Considerations

Taken together, these studies illustrate the important connection between the gut microbiome and sleep patterns. Screening patients for sleep disorders is encouraged as a regular practice in functional medicine, and there are a range of effective lifestyle interventions for patients suffering from poor sleep. A close working relationship between clinician and patient can help identify sleep troubles early on so that they may be targeted with behavioral and lifestyle therapies to prevent or reverse further damage.

References:

1. 1) Wang Z, Wang Z, Lu T, et al. The microbiota-gut-brain axis in sleep disorders. Sleep Med Rev. 2022;65:101691. doi:1016/j.smrv.2022.101691
2. 2) Sen P, Molinero-Perez A, O’Riordan KJ, et al. Microbiota and sleep: awakening the gut feeling. Trends Mol Med. 2021;27(10):935-945. doi:1016/j.molmed.2021.07.004
3. 3) Han M, Yuan S, Zhang J. The interplay between sleep and gut microbiota. Brain Res Bull. 2022;180:131-146. doi:1016/j.brainresbull.2021.12.016
4. 4) Haarhuis JE, Kardinaal A, Kortman GAM. Probiotics, prebiotics and postbiotics for better sleep quality: a narrative review. Benef Microbes. 2022;13(3):169-182. doi:3920/bm2021.0122
5. 5) Wang Y, van de Wouw M, Drogos L, et al. Sleep and the gut microbiota in preschool-aged children. Sleep. 2022;45(6):zsac020. doi:1093/sleep/zsac020
6. 6) Grosicki GJ, Riemann BL, Flatt AA, Valentino T, Lustgarten MS. Self-reported sleep quality is associated with gut microbiome composition in young, healthy individuals: a pilot study. Sleep Med. 2020;73:76-81. doi:1016/j.sleep.2020.04.013
7. 7) Agrawal R, Ajami NJ, Malhotra S, et al. Habitual sleep duration and the colonic mucosa-associated gut microbiota in humans—a pilot study. Clocks Sleep. 2021;3(3):387-397. doi:3390/clockssleep3030025
8. 8) Matenchuk BA, Mandhane PJ, Kozyrskyj AL. Sleep, circadian rhythm, and gut microbiota. Sleep Med Rev. 2020;53:101340. doi:1016/j.smrv.2020.101340
9. 9) Simkin DR. Microbiome and mental health, specifically as it relates to adolescents. Curr Psychiatry Rep. 2019;21(9):93. doi:1007/s11920-019-1075-3
10. 10)  Zhang X, Wang S, Xu H, et al. Metabolomics and microbiome profiling as biomarkers in obstructive sleep apnoea: a comprehensive review. Eur Respir Rev. 2021;30(160):200220. doi:1183/16000617.0220-2020
11.  11) Valentini F, Evangelisti M, Arpinelli M, et al. Gut microbiota composition in children with obstructive sleep apnoea syndrome: a pilot study. Sleep Med. 2020;76:140-147. doi:1016/j.sleep.2020.10.017
12.  12) Ko CY, Liu QQ, Su HZ, et al. Gut microbiota in obstructive sleep apnea-hypopnea syndrome: disease-related dysbiosis and metabolic comorbidities. Clin Sci (Lond). 2019;133(7):905-917. doi:1042/cs20180891
13.  13) Li Q, Xu T, Shao C, et al. Obstructive sleep apnea is related to alterations in fecal microbiome and impaired intestinal barrier function. Sci Rep. 2023;13(1):778. doi:1038/s41598-023-27784-0
14.  14) Rastogi S, Singh A. Gut microbiome and human health: exploring how the probiotic genus Lactobacillusmodulate immune responses. Front Pharmacol. 2022;13:1042189. doi:3389/fphar.2022.1042189
15.  15) Wang Q, Chen B, Sheng D, et al. Multiomics analysis reveals aberrant metabolism and immunity linked gut microbiota with insomnia. Microbiol Spectr. 2022;10(5):e0099822. doi:1128/spectrum.00998-22
16.  16) Liu B, Lin W, Chen S, et al. Gut Microbiota as an objective measurement for auxiliary diagnosis of insomnia disorder. Front Microbiol. 2019;10:1770. doi:3389/fmicb.2019.01770
17.  17) Li Y, Zhang B, Zhou Y, et al. Gut microbiota changes and their relationship with inflammation in patients with acute and chronic insomnia. Nat Sci Sleep. 2020;12:895-905. doi:2147/nss.s271927
18.  18) Mazziotta C, Tognon M, Martini F, Torreggiani E, Rotondo JC. Probiotics mechanism of action on immune cells and beneficial effects on human health. Cells. 2023;12(1):184. doi:3390/cells12010184
19.  19) Takada M, Nishida K, Gondo Y, et al. Beneficial effects of Lactobacillus casei strain Shirota on academic stress-induced sleep disturbance in healthy adults: a double-blind, randomized, placebo-controlled trial. Benef Microbes. 2017;8(2):153-162. doi:3920/bm2016.0150
20. 20)  Nakagawa M, Yamamoto H, Kawaji M, Miura N, Wakame K, Endo T. Effects of lactic acid bacteria-containing foods on the quality of sleep: a placebo-controlled, double-blinded, randomized crossover study. Funct Foods Health Dis. 2018;8(12):579-596. doi:31989/ffhd.v8i12.572
21.  21) Chu A, Samman S, Galland B, Foster M. Daily consumption of Lactobacillus gasseri CP2305 improves quality of sleep in adults – a systematic literature review and meta-analysis. Clin Nutr. 2023;42(8):1314-1321. doi:1016/j.clnu.2023.06.019
22.  22) Scoditti E, Tumolo MR, Garbarino S. Mediterranean diet on sleep: a health alliance. 2022;14(14):2998. doi:10.3390/nu14142998
23.  23) Qi X, Ye J, Wen Y, et al. Evaluating the effects of diet-gut microbiota interactions on sleep traits using the UK Biobank Cohort. Nutrient 2022;14(6):1134. doi:10.3390/nu14061134
24.  24) Castro-Diehl C, Wood AC, Redline S, et al. Mediterranean diet pattern and sleep duration and insomnia symptoms in the Multi-Ethnic Study of Atherosclerosis. Sleep. 2018;41(11):zsy158. doi:1093/sleep/zsy158
25.  25) Godos J, Ferri R, Caraci F, et al. Adherence to the Mediterranean diet is associated with better sleep quality in Italian adults. 2019;11(5):976. doi:10.3390/nu11050976
26.  26) Gupta K, Jansen EC, Campos H, Baylin A. Associations between sleep duration and Mediterranean diet score in Costa Rican adults. 2022;170:105881. doi:10.1016/j.appet.2021.105881
27.  27) Jansen EC, She R, Rukstalis MM, Alexander GL. Sleep duration and quality in relation to fruit and vegetable intake of US young adults: a secondary analysis. Int J Behav Med. 2021;28(2):177-188. doi:1007/s12529-020-09853-0

7 ways to build a healthier Immune system

 I love sharing articles from people I respect and admire in the health field. 

Here is an article written by Dr Robert Silverman that is excellent and will help you navigate a healthier lifestyle and Immune system.

Enjoy!!

7 ways to build defenses against illness and disease when patients ask how to build a strong and healthy immune system

Robert Silverman, DC January 3, 2023 <https://www.chiroeco.com/how-to-build-a-strong-and-healthy-immune-system/

The immune system has a difficult job. Its primary focus is to protect and keep you healthy from foreign invaders. It’s always walking a tightrope between being hypervigilant and not being vigilant enough. By supporting it — with proper nutrition, healthy lifestyle choices and nutritional supplements — you allow your immune system to rejuvenate and maintain its delicate balance. But how to build a strong and healthy immune system, and why does it matter?

A weakened immune system can leave patients vulnerable to infectious diseases, autoimmunity and chronic illnesses. And they don’t have a backup immune system if they choose to neglect the one they have.

Thankfully, there are many safe, effective avenues when patients ask how to build a strong and healthy immune system.

Here’s what I recommend.

1.    Eat better for a stronger immune system

Stronger immunity starts with a better diet and good gut health. Begin by saying no to gluten, processed foods, sugar, dairy and artificial sweeteners. Likewise, avoid deep-fried foods and foods cooked in pro-inflammatory vegetable oils.

Avoiding these foods is the basis of an anti-inflammatory diet. Removing them from the diet reduces cellular stressors, inhibits inflammatory signals from the immune system and promotes healthy gut microbiota. A diet high in sugar, for example, can damage your immune system; more specifically, sugar can damage the immune cells in the gut.

The healthiest diets focus on nutrient-rich whole foods, lots of plants and limited processed foods. The Mediterranean and plant-forward diets are anti-inflammatory in addition to their other benefits. Research has found that eating a Mediterranean-style diet leads to a healthier gut microbiome with more beneficial bacteria, along with lower inflammation and better blood sugar control. A healthy gut microbiome is also associated with a lower risk of illness, including COVID-19.

Detect and avoid food sensitivities

Detecting and avoiding food sensitivities can be a game changer for patients when it comes to immune health. Food sensitivity is an immune-based reaction to food that elevates inflammation. Undetected food sensitivities can lead to chronic inflammation, possible autoimmunity and a compromised immune system. Treating and avoiding food sensitivities can make a dramatic improvement in immune system function.

Environmental toxins such as lead, acrylamide, BPA and many others can enter the body and interact with the immune system, causing detrimental immune activation or suppression. A semi-annual quality detoxification program will help rid the body of toxins. At the same time, patients should work to reduce exposure to environmental toxins.

Focus on hydration

Staying well-hydrated aids in maintaining a properly functioning immune system. A good rule of thumb is to drink three-quarters of your body weight in ounces, spread throughout the day. Drinking water improves overall immunity and helps the body eliminate some pathogens naturally. Avoid fruit juices, alcoholic beverages, soda and other sweetened beverages. Stick to plenty of filtered water, organic coffee, black tea, green tea and mild herbal teas.

Manage blood sugar

When asking how to build a strong and healthy immune system, controlling patients’ blood sugar is essential for peak immunity. The glycemic index diet is one of the best dietary approaches for controlling blood sugar. It focuses on foods that have a low impact on your blood sugar.

For example, the glycemic index is a way to rank carbohydrates by their effect on blood glucose levels. Low GI (1 to 55) foods are mostly whole, unprocessed carbohydrates such as fruits, vegetables and whole grains. High GI (above 70) foods, which can send your blood sugar soaring, are mostly sugary foods and processed carbohydrates such as white bread and pasta. A low GI diet helps keep your blood sugar at a healthy level and enables you to maintain good metabolic health, including good insulin sensitivity.

When metabolic health is good, the immune system functions optimally.

Consider intermittent fasting

Intermittent fasting, or time-restricted eating with a 14- to 16-hour fasting period, allows patients’ immune systems to rejuvenate through autophagy and mitophagy. The rejuvenation process reprograms the immune system, leading to improved immune balance and better immune resilience. Autophagy also plays a crucial role in gut health. It maintains intestinal homeostasis and allows for the interaction between the gut microbiota and the innate and adaptive immune systems.

In addition, intermittent fasting helps maintain intestinal barrier integrity, which improves overall immunity. Some evidence suggests that people who follow a time-restricted eating pattern experience fewer complications from COVID-19.

Make clean eating a priority

It’s been said that eating organic isn’t a trend; it’s a return to tradition. The many chemicals we’re exposed to through our food can damage our immunity. Make clean eating a priority by choosing organically grown produce, grass-fed meat and pasture-raised poultry and eggs whenever possible. Organic bone broth is a great way to get vital minerals such as calcium into the diet.

The immune system needs to get plenty of omega-3 fatty acids to function well. Choose wild-caught SMASH fish: salmon, mackerel, anchovies, sardines and herring. Avoid processed vegetable oils; use extra-virgin olive oil, avocado oil, coconut oil and macadamia nut oil for cooking instead.

I strongly recommend a plant-forward diet for patients that is high in organically-grown fruits/vegetables, raw nuts/seeds and quality clean proteins. This diet is high in the fiber needed to support gut health. In addition, a plant-forward diet is high in polyphenols and plant compounds such as quercetin and resveratrol, which are powerful antioxidants. Polyphenols improve gut health and activate the immune system. Foods high in polyphenols include vegetables, berries, herbs and spices, dark chocolate, nuts, olives, coffee, and green and black tea.

In a recent study of almost 3,000 health care workers worldwide, those who followed a plant-forward diet had a 73% lower chance of becoming ill with moderate-to-severe COVID-19 than their colleagues who didn’t follow these diets. If they followed a plant-based or pescatarian diet (eating fish/seafood but no other animal foods), their chances of moderate-to-severe COVID-19 were 59% decreased compared to those who didn’t follow these diets.

2.    Manage stress

Ongoing stress can sharply reduce immunity by raising cortisol levels and causing inflammation. Recognizing that stress affects patient health is the first step to reducing it. Once one acknowledges their stressors, various techniques are available to help cope. Some of my patients find meditation, mindfulness and yoga very helpful; others prefer to work out or spend time on a relaxing hobby. No one approach is better than any other; the key is to find a stress reduction technique (or more than one) that works and to use it regularly.

I often see a real improvement in immune systems when my patients take stress reduction seriously. They get sick less often, reduce their joint and muscle pain, and have less systemic inflammation.

Chronic stress often occurs with chronic sleep loss. The two feed on each other, causing inflammation, hormonal imbalances, digestive problems and decreased immunity. More on the importance of sleep is below.

3.    Patients need to get sufficient sleep

Sleep is the silent superpower. It enables immune systems to function efficiently and effectively. While patients sleep, the body repairs itself and removes toxins and waste. At the same time, their levels of immune cells rise naturally. A growing body of research shows that getting 7-8 hours of quality sleep daily is essential for the immune system to reboot.

4.    Exercise regularly

Regular exercise is one of the key pillars when patients ask how to build a strong and healthy immune system . One of the easiest ways to improve immunity is by getting regular, moderate exercise for 30-60 minutes a day. Exercise reduces inflammation and stimulates immunity by improving the circulation of immune cells and antibodies in the body, which makes it easier for the immune system to detect and respond to potential threats.

As with sleep, make daily exercise a top priority for patients, especially if they have a job or lifestyle that means they spend more than a few hours a day sitting. As I tell my patients, sitting is the new smoking.

Numerous studies show that almost all forms of regular exercise give you the same fitness and immunity benefits. When we exercise, antibodies and white blood cells circulate throughout the body faster, making it easier for the immune system to detect and respond to potential threats. Running or jogging, walking at a good pace, exercising along with a video, practicing yoga and performing resistance exercises are all excellent choices. The key is to do some form of exercise regularly for at least 30 minutes per day, 5-6 days per week.

A single 30-minute session of weight resistance training, for example, will boost a patient’s lymphocyte count. They will see the payoff in stronger muscles, better body composition and better overall fitness. Sufficient muscle mass allows for a better immune response in most people. Patients probably won’t get sick as often with minor illnesses like colds — and research shows exercise can reduce inflammation and cut the risk of autoimmunity and chronic disease.

A 2021 study of nearly 50,000 COVID-19 patients found that consistently inactive patients were more than twice as likely to need hospitalization or die compared to those who consistently met physical activity guidelines. Compared to patients who only did some physical activity, those who were consistently inactive were 20% more likely to need hospitalization and 30% more likely to die.

5.    Improve patient body composition

Excess body fat creates systemic inflammation and reduced immunity; metabolic disorders increase inflammation and further reduce immunity.

A key finding from the pandemic is that being overweight and obese are significant risk factors for severe infection. People of any age who are overweight or obese are much more likely to get infected with COVID-19. If they do get sick, they are more likely to get severely ill and need a lengthy recovery period. Overweight or obese people with metabolic disorders such as metabolic syndrome or Type 2 diabetes are even more likely to get seriously ill.

The pandemic has been a wake-up call for many of my patients to work on losing weight and improving their diets. They now realize how being severely overweight or obese can affect their immunity and understand how significant weight loss and a better diet are to enhancing their immune systems.

6.    Pair with chiropractic care

As we are well aware, chiropractic care can improve the body’s function in a multitude of ways. Include advanced nutrition and physical modalities training in your practice armamentarium, paired with your vast knowledge of the body and synergistic treatments that can also allow the central nervous system to perform optimally and improve immune system function.

Low-level laser therapy

I believe that low-level laser therapy (LLLT), also referred to as non-thermal laser therapy, is the most versatile health care modality of the current century. Research has shown it provides beneficial effects for a wide array of health conditions, such as musculoskeletal injuries, vagus nerve stimulation, gut restoration/health and improved immune function.

LLLT can stimulate and balance the immune system and reduce inflammation. Laser therapy enhances microcirculation of the blood and lymph, which can aid immunological adaptation and strengthen the immune system.

7.    Boost patient immune health with supplements

Eating a well-balanced, plant-forward diet low in sugar and processed foods is key to strong immune health. However, eating well may not always be accessible for patients in today’s fast-paced, fast-food society. They sometimes need more of a vitamin, mineral or nutrient than they can realistically get from their diet.

Depleted cells in the body may not be repleted sufficiently by food alone. That’s why I often recommend specific dietary supplements as an addition to a healthy diet. Supplements can provide good nutrient status and nutrient stores. This status provides balanced immune system function, which will provide a strong defense against pathogens.

Vitamin D, for example, is necessary for strong immunity. Vitamin D mostly comes from exposure to sunshine, but we spend 90% of our lives indoors. A daily supplement is the best way to ensure you get enough of this vitamin.

Top five supplements for immunity

My top five daily supplements synergistically stimulate, balance and support both the innate and the adaptive immune responses:

Daily multivitamins with minerals: Vitamins A, C, D and the mineral zinc are needed to build the many enzymes for immune cells to produce cytokines and antibodies efficiently.

Omega-3 fatty acids: Omega-3 fatty acids help lymphocytes produce cytokines and chemokines that direct the immune response.

Vitamin D3 with vitamin K2: Taking vitamin D3 with vitamin K2 helps ensure the calcium transported by the vitamin D is absorbed by bones where it’s needed most.

Pro-resolving mediators (PRMs): PRMs help limit acute inflammation and promote resolution after an immune response.

Prebiotics and probiotics: Prebiotics support the growth of beneficial bacteria in the gut, while probiotics aid in modulating the immune system by providing beneficial bacteria to the gut’s ecosystem.

Today more than ever, building a strong immune system is essential for vibrant health. We now have many effective modalities for helping patients strengthen their immunity. As our understanding of the gut microbiome and other aspects of immunity expands, we can successfully target our treatments to meet individual needs.

If history is to repeat itself, there will be other health pandemics. But we can learn something from the past: The first and most controllable line of defense against illness is our own immune system. When considering how to build a strong and healthy immune system, instead of only reacting to sickness, a proactive approach to immunity can help reduce the risk of illness — and possibly even prevent it.