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Exercise and the Immune System
Dr. Chris Spooner B.Sc. NDDeMonte Centre for Natural Medicine
November 2007
Dr. C. Spooner
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November 2007
Dr. C. Spooner
Exercise and Infectious Illness
Research Findings– Compared with Non-Athletes, competitive athletes such as competitive athletes such as
distance runners experiences high rates of symptoms of distance runners experiences high rates of symptoms of Upper Respiratory Tract Infections (URTI) during the two Upper Respiratory Tract Infections (URTI) during the two week period after a major competition.week period after a major competition.
– In endurance athletes, the incidence of URTI symptoms increases increases with training volume and intensity.with training volume and intensity.
– The risk of URTI is not elevated and may possibly be reduced in possibly be reduced in moderately active individuals or “recreational athletes”moderately active individuals or “recreational athletes”
– Exercise capacity is reduced during feverscapacity is reduced during fevers
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Dr. C. Spooner
Does Exercise Weaken the Immune System?
What we KnowWhat we KnowMale endurance athletes are more susceptible to URTI for a few weeks more susceptible to URTI for a few weeks
after major competitionsafter major competitions ( Studies for female endurance athletes and other sports have not been conducted)
URTI are most likely to occur in those training either to little or excessivelytraining either to little or excessively
Many immune parameters change with exercise ( WBC, NK cells, neutrophilactivity, decreased IgA)
The only one directly related to URTI incidence is decreased secretory IgA
While may of these alterations are relatively small, it is possible that immune function is compromised by the additive and interactive defects of small changes in several factors
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Dr. C. Spooner
Training and the Immune System
•• Research FindingsResearch Findings
– Compared to non athletes, endurance athletes have suppressed endurance athletes have suppressed white blood cell function at rest and after intense exercise.white blood cell function at rest and after intense exercise.
– In athletes, slightly suppressed natural immunity may reflect a suppressed natural immunity may reflect a normal down regulation of inflammation in response to normal down regulation of inflammation in response to chronic tissue injury due to intense daily exercisechronic tissue injury due to intense daily exercise..
–– Mild suppression of immunity may be a part of the normal Mild suppression of immunity may be a part of the normal physiological response to prolonged periods of intense physiological response to prolonged periods of intense exercise training in endurance athletes.exercise training in endurance athletes.
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Dr. C. Spooner
Exercise Intensity and Immune Function
•• Moderate exercise trainingModerate exercise training has little effect on serum or mucosal Igand antibody, suggesting that such exercise does not compromise does not compromise immunity to URTIimmunity to URTI
• The decline in mucosal decline in mucosal IgAIgA concentration and secretion rate associated with intense exercise training may be related to the with intense exercise training may be related to the high incidence of URTIhigh incidence of URTI among endurance athletes
• Monitoring mucosal IgA and IgM levels may provide a means to identify athletes susceptible to URTI and to assess changes in susceptibility as training intensifies over the season
November 2007
Dr. C. Spooner
Exercise and Antibodies
• Serum Ig level does not change after acute exercise or chronically after moderate exercise training.moderate exercise training.
•• Clinically low serum Clinically low serum IgIg concentrations have been reported in concentrations have been reported in some athletes during intense training periodssome athletes during intense training periods..
• Salivary IgA concentration and secretion rate decrease after decrease after intense brief and prolonged exercise and during periods of intense brief and prolonged exercise and during periods of intense trainingintense training but not after more moderate exercisenot after more moderate exercise
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Figure 10-24
8
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The “Open Window” Hypothesis
• Athletes are susceptible to infection during the extended period of immune suppression after exercise.
• High performance athletes train intensely at least once, and often twice each day for many months.
November 2007
Dr. C. Spooner
Open Window Hypothesis of Exercise Induced Immune Suppression
Repetition leading to cumulative, chronic suppression in
1. Mucosal IgA
2. Leukocyte number
3. NK cell number
Exercise Period 1
Exercise Period 1
Exercise Period 1
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Dr. C. Spooner
Inflammation and Immunity
• Down regulation of certain aspects of the immune system may serve as a protective mechanism by limiting chronic inflammation caused by increased levels of training
• Mild immunosuppression may reflect a compromise between the body’s attempts to limit chronic inflammation and maintain immune responsiveness
• Controlling training associated inflammation may prove beneficial in preventing URTI
Colds and FlusTreatment / Prevention
November 2007
Dr. C. Spooner
How to prolong a cold or flu…
• What typical patients do when sick--They get in the way of the immune system:
– Keep eating the SAD, keep working, keep cleaning the house--keep expending energy the body needs to recover.
– OTC meds to inhibit normal processes--antitussives, decongestants, anti-diarrheals, and NSAIDs to lower the fever:
• In all ways the body wishes to excrete the toxins, OTC Meds while managing symptoms, stop that from happening.
The Result The Result The The “cold” lasts 6 weeks, “cold” lasts 6 weeks, instead of 3instead of 3--7 days.7 days.
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Dr. C. Spooner
Fever
“Give me fever and I can cure every disease”.
Hippocrates
November 2007
Dr. C. Spooner
Fever--Physiology
Studies have shown that fevers are beneficialfevers are beneficial and actually INCREASE survival; while suppressing suppressing fevers increase length of illness and fevers increase length of illness and MORTALITYMORTALITY.
Marik PE, Fever in the ICU. Chest 2000; 117:855-69
Mackowiack PA. Concepts of Fever. Arch Intern Med 1998;158:1870-81.
November 2007
Dr. C. Spooner
Fever Effects on the Body
• Enhances neutrophil migration
• Increases metabolic rate—each 1 degree of temperature raises M.R. 7%
• Increases neutrophils production of antibacterial substances.
• Increases interferon production—which causes achiness (which means we should go to bed, as our immune system is more active during sleep).
• Upregulates antiviral and antitumor activity
• Increases growth of T-cells
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Dr. C. Spooner
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Dr. C. Spooner
Cough Meds
"There is no clinical evidence that over-the-counter cough expectorants or suppressants actually relieve cough,“
Richard D. Irwin, MD. panel chairman and pulmonary specialist
Louis-Philippe Boulet, MD, FCCP. Future Directions in the Clinical Management of Cough. ACCP Evidence-Based Clinical Practice Guidelines.Chest. 2006;129:287S-292S.)
Play FairThe Athletes Dilemma!
WADA, OTC meds and Natural Medicines
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Dr. C. Spooner
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Dr. C. SpoonerPage 28Page 28 Page 37Page 37
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Cough Meds
• Irwin, R.S. Chest, January 2006; vol 129: pp 1-25. Richard S. Irwin, MD, FCCP, chairman, cough management evidence-based guidelines committee, American College of Chest Physicians; chief, division of pulmonary, allergy and critical care medicine, University of Massachusetts Medical School, Worcester, Mass. W. Michael Alberts, MD, FCCP, president, American College of Chest Physicians.
• Cochrane Review of OTC Medications for Acute Cough in Children and Adults, 2005, Issue 4. News release, Penn State, July 6, 2004.
• BMJ, Feb. 9, 2002; vol 324: pp 329. William Glomb, MD, medical director, sleep diagnostic services, Children's Hospital of Austin, Austin, Texas.
Effective Alternatives to OTC Medications
November 2007
Dr. C. Spooner
Vitamin C for preventing and treating the common cold
Main results• Thirty comparisons involving 9676 respiratory episodes contributed to a meta-analysis
on common cold duration during prophylaxis. A consistent benefit was observed, representing a reduction in cold duration of 8% for adults and 13.6% for children.
•• A subgroup of six trials involving a total of 642 marathon runneA subgroup of six trials involving a total of 642 marathon runners, skiers, rs, skiers, and soldiers on suband soldiers on sub--arctic exercises reported a pooled RR of 0.50arctic exercises reported a pooled RR of 0.50
Conclusions• The failure of vitamin C supplementation to reduce the incidence of colds in the normal
population indicates that routine mega-dose prophylaxis is not rationally justified for community use, but evidence suggests that it could be justified in people evidence suggests that it could be justified in people exposed to periods of severe physical exercise or cold environmeexposed to periods of severe physical exercise or cold environments.nts.
Douglas RM, Hemil H, Chalker E, Treacy B. Vitamin C for preventing and treating the common cold. Cochrane Database of Systematic Reviews 1998, Issue 1. Art. No.: CD000980. DOI: 10.1002/14651858.CD000980.pub3
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Dr. C. Spooner
Vitamin E
• Vitamin E may influence the production of inflammatory mediators such as prostaglandins, leukotrienes and oxygen radicals, which enhance cytokine release
• While not directly antiviral, Vitamin E supplementation prior to exercise may help to limit post exercise inflammation which can contribute to chronic immune suppression
November 2007
Dr. C. Spooner
Zinc
• Certain forms of zinc release ions that are thought to directly inhibit viruses in the nose and throat.
• The immune system does not function properly if you don't have enough zinc in your body. 1-2
• Zinc is commonly deficient in the diet, especially among children and senior citizens, nutritional zinc supplementation may certainly be useful for those who get sick easily.
• A 1-year, double-blind study of 50 nursing home residents found that zinc supplements as compared to placebo reduced rates of infection. 159
• More than ten other studies performed in developing countries have found that zinc supplements at nutritional doses can increase resistance to respiratory and other infection in children. 5-6,157
• Note: With zinc, more isn't better; once you do have enough zinc, getting extra won't help, and might even hurt.
November 2007
Dr. C. Spooner
Reducing Cold Duration Using Ionic Zinc (zinc gluconate):Reducing Cold Duration Using Ionic Zinc (zinc gluconate):
0
20
40
60
80
100
0 1 2 3 4 5 6 7
Days
%
Zinc Gluconate(23 mg)Placebo
Eby GA, Davis DR & Halcomb WW. Reduction in Duration of Common colds by Zinc Gluconate Lozenges in a Double Blind Study. Antimicrobial Agents and Chemotherapy, 1984, vol 25, no 1, pages 20-24.
P = 0.008 day 1P = 0.0005 day 7
N=41
N=39
Total daily zinc = 207 mg
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Dr. C. Spooner
A few properties of zinc
• High-dose zinc = 50 to 300 mg per day of ionic zinc.
• Ten times serum – broadly antiviral.
• Antirhinoviral – Korant, 1974
• Astringent, and drying in common colds (nasal application – Merck, 1901).
• Zinc lozenges releasing ionic zinc are astringent & drying.
• Non-ionic zinc at physiologic pH is useless in biological systems & colds.
November 2007
Dr. C. Spooner
Zinc Supplements Zinc Supplements –– The good, the badThe good, the bad…
•• UsefulUseful– Ionic zinc: zinc chloride, zinc acetate, zinc gluconate, zinc
sulfate
•• UselessUseless– Non-ionic zinc: zinc oxide, zinc orotate, zinc oleate, zinc
sterate
November 2007
Dr. C. Spooner
Echinacea
•• Until the 1930s, Until the 1930s, echinaceaechinacea was the number one was the number one cold and flu remedy in the United States.cold and flu remedy in the United States.
• It lost its popularity with the arrival of sulfa antibiotics.
• Ironically, sulfa antibiotics are as ineffective against colds as any other antibiotic, while echinacea does seem to be at least somewhat helpful.
•• In Germany, In Germany, echinaceaechinacea remains the main remedy remains the main remedy for minor respiratory infections.for minor respiratory infections.
November 2007
Dr. C. Spooner
Vitamin C
• Numerous studies have found that vitamin C supplements taken vitamin C supplements taken at a dose of 1,000 mg or more daily can modestly reduce at a dose of 1,000 mg or more daily can modestly reduce symptoms of colds and help you get over a cold faster.symptoms of colds and help you get over a cold faster.50,51,10050,51,100
• One study suggests that vitamin C can enhance the effect of standard cold treatments, such as acetaminophen. 109
• Note: In most of these studies, participants used vitamin C In most of these studies, participants used vitamin C throughout the cold season, and found that when they throughout the cold season, and found that when they developed colds, the colds were less severe. developed colds, the colds were less severe.
• Many people use vitamin C for colds in a different way: they only begin taking it when cold symptoms start. Relatively few studies have evaluated this approach. 53,109
November 2007
Dr. C. Spooner
Garlic
• Individuals using garlic were almost two-thirds less likely to catch cold than those receiving placebo.
• Furthermore, participants who did catch cold recovered about one day faster in the garlic group as compared to the placebo group.
November 2007
Dr. C. Spooner
Green Tea
• A gargle made from green tea extract has shown promise for preventing influenza.156
• In a double-blind, placebo-controlled study, Individuals who gargled with tea extract were less likely to develop influenza than those using the placebo.
• In addition, another double-blind study found preliminary evidence that oral consumption of a green tea extract might help prevent both colds and flus.163
November 2007
Dr. C. Spooner
Glutamine
• There is some evidence that the supplement glutamine help prevent post-exercise infections.78-83
•• 5 g supplemental glutamine taken at the end of exercise in 15 5 g supplemental glutamine taken at the end of exercise in 15 endurance athletes resulted in a significant decrease in endurance athletes resulted in a significant decrease in infections among treated athletes.infections among treated athletes.8484
• Only 19% of the athletes taking glutamine got sick, as compared to 51% of those on placebo. Echinacea has also shown a bit of promise for this purpose.160
November 2007
Dr. C. Spooner
Echinacea
• There are three main species of echinacea: Echinacea purpurea, Echinacea angustifolia, and Echinacea pallida.
• A mixture containing all the parts of E purpurea above the ground (flowers, leaves, stems) has the best supporting evidence for effectiveness in treating colds and flus;147
•• Echinacea has shown promise for reducing the symptoms and Echinacea has shown promise for reducing the symptoms and duration of colds and aborting a cold once it has started. duration of colds and aborting a cold once it has started.
Some Closing Thoughts
November 2007
Dr. C. Spooner
Exercise and the Immune System:Major Points.
• Exercise alters many aspects of the immune system in both positive and negative directions, the implications of which are unclear.
• Exercise influences the immune response at both the cellular level as well as the organism level.
• There is a dose-response relationship between the amount of exercise and a specific immune response–– Duration, intensity and to a smaller extent fitness determine Duration, intensity and to a smaller extent fitness determine
the response of a particular immune parameterthe response of a particular immune parameter
• There are inconsistencies that cannot yet be fully explained
November 2007
Dr. C. Spooner
Exercise and Infectious Illness
Applications– Athletes should not be expected to perform to the usual
standards during fevers, and attempting to do so may be detrimental to their health
– Athletes and their coaches should consider ways to modify training volume and intensity to avoid excessive exercise that may increase susceptibility to URTI
– Regular moderate exercise can be shown to reduce risk of URTI. The health of inactive individuals may be enhanced by a physically active lifestyle
November 2007
Dr. C. Spooner
Summary
• Exercise intensity effects the immune system –– Duration, intensity and to a smaller extent, fitness determine Duration, intensity and to a smaller extent, fitness determine
the effect on the immune systemthe effect on the immune system– Control inflammation with diet, healthy fats, and antioxidants – Be proactive and support the immune system with nutrients such as
Vitamin C, Glutamine,
• When Colds and Flus strike, listen to your body and try therapies such as Zinc and Echinacea.
• Susceptibility to URTI is a reflection of the how your body is handling stress
