MY 10 FOUNDATIONAL PRINCIPLES FOR BUILDING IMMUNE HEALTH IN FUNCTIONAL MEDICINE “Laying the foundations for functional wellness”

Over the last decade working in functional medicine (FM), I’ve worked on over 2000 cases with no 2 single cases being identical. All have had their own unique identity, and different combinations of signal inputs & mechanisms behind the dysfunctions, disturbances and disorders. It’s these dysfunctions, disturbances and disorders that eventually over-time have manifested into symptoms, and then went on to develop into health conditions.

Before I go on to talk about the topic of today’s article; I want to give my own evidence-based analogical explanation on the breakdown of health from an FM clinicians perspective based on a decade of clinical experience.

Everyone has a physician inside him or her, we just have to help it in its work. The natural healing force within each one of us is the greatest force in getting well.” HIPPOCRATES 2400BC

One thing that really makes me cringe is when I hear people referring to themselves as healers, like they have some special god-like powers or status. I first made this statement almost 10 years ago, and many times since, but for the purpose of adding context I’ll make it again…

The practitioner, clinician, or physician, are merely middlemen when it comes to the restoration of health, or functional wellness. Nature is the only true healer.” STEVE HAWES 2011 ?

My role as a certified FM clinician, Naturopath, and Nutritional Therapist is to improve patients health outcomes by identifying dysfunction within systems-biology, and restoring functional wellness which is the proverbial ‘middleman’s’ intervention of implementing FM/lifestyle-medicine to help the body get back on the road to recovery. In order to do this it means understanding chronic disease prevention and intervention from a completely different perspective. One that fully integrates the relationship between lifestyle inputs, targeted clinical interventions (“signals“) and the patient’s ability to convert the signals into healthy outcomes, to create real change, offering a complete paradigm shift vs society’s current understanding of the allopathic, symptom focussed model.

The FM/lifestyle-based therapy that I practice mandates a patient-centred philosophy which requires comprehensively assessing the integrated network of body-systems (known as systems-biology) and signals that influence the health of each individual, whilst at the same time recognising that each individual has a different capacity to translate signals, respond to interventions, adhere to instructions, and change behaviours. Clinical success is dependent, in this model, on an ongoing relationship between a highly skilled, engaged clinician & an empowered/educated patient.

Having originally trained as a Naturopath (NP) & Nutritional Therapist (NT) before going on to study & practice FM (a science-guided natural medicine practice, using the most advanced evidence-based functional lab assessments, and focussing on identifying & addressing the underlying causes of disease) it allowed me to refine & construct my own unique way of working by taking the most effective modalities/strategies/therapies from each of my professional qualifications, and from what I had spent years learning from my mentors, and combining them to create a very effective model that is made up of strategies that have had/or have the biggest impact in improving patent health outcomes, and closely align with nature or normal function.

As far as approaching illness and disease from an FM perspective – while the name we give to chronic diseases might depend on the organ system or tissues involved, such as atherosclerosis, osteoarthritis, hepatitis, Alzheimer’s disease, autoimmunity, Type II diabetes or cancer; the chronic dysfunction involved in each of these conditions is ultimately caused by the presence of harmful signals that overwhelm tissues ability to self-heal, or the absence of healthy signals that promote tissue recovery. The FM lifestyle synergy model that I use and promote is designed to protect all tissues and organs from the effect of chronic disease and is described by two layers of resistance against poor lifestyle signals: physiological resilience and metabolic reserve, which I’ve talked about, and written about in the past.

Physiological resilience is something I’ve written about before in previous articles. In essence it’s the capacity of each cell or organ system to withstand the necessary (and immediate) changes that create the rhythm of a healthy organism. The ability of arteries to dilate when bloodflow increases, the ability to quickly dispose of excess glucose after a meal, the ability to increase and decrease cortisol when a stressful situation arises and resolve are just a few examples of physiological resilience.

Each of the systems, and thousands more, are like coiled springs or rubber-bands capable of being stretched for a particular physiological purpose, then designed to snapback to their original status, ready for the next physiological challenge. Some systems are stretched and snapback in an instant, such as nerve conductivity, or like blood glucose control. Some follow a circadian cycle, such as the HPA axis, and others a monthly cycle, such as menstruation for example.

When inappropriate or overwhelming signals begin to overpower our physiological resilience, the stretching of that system does not immediately resolve. Perhaps the best example of this is a slow progression of impaired glucose tolerance/insulin resistance, which is sometimes referred to as the “metabolic continuum.” As an example, imbalance blood sugar results in constant “stretching “of the post-prandial glucose which overtime creates eventual change in the fasting state. By the time a patient is deemed to be “Type II diabetic “, their ability to reach normal fasting level is compromised by changes in peripheral insulin sensitivity and pancreatic insulin capacity – a depletion of the metabolic reserve.

Your physiological resilience defines the immediate capacity of cells, tissues and organs systems to respond to changes in physiological need, metabolic reserve defines the long-term capacity of tissues and organs systems to withstand repeated (chronic) changes to physiological needs. It is, in essence, the stored up “reserve “available for each metabolic and organ system to maintain and rebuild its physiological resilience. As with any reserve, it’s capacity is vulnerable to depletion; but also capable of being resupplied, strengthened, and restored.

Without going too much into the science behind another topic, I want to move onto the immune system, and how what I just spoke about ties in to this very important host protective mechanism.

A considerable number of cases I deal with daily in FM practice are immune/autoimmune related, each of which have unique specific mechanisms/signals that affect the host immune system of the individual. Likewise there are specific mechanisms that allow the immune system to function properly, some of which can be complicated in relation to a persons health concerns. This is where working with an experienced natural health professional helps. That being said it’s important to keep in mind the fundamental principles that underpin or exist within those details; those that build and maintain the foundation of a strong immune system will always apply. As more research is published, our detailed understanding of the mechanisms will often change, but these fundamental principles will not. Likewise, strategies for supporting immune-system function vary widely among various healing disciplines and will often need to be tailored to each patient situation. For this reason I believe it’s important to keep in mind the core principles that form the basis of any immune supporting strategy. Here I’d like to outline 10 of those principles in a bite-size format, that I personally follow working in FM practice. I could have gone into way more detail on each of the principles but wanted to keep things as light as possible.

So here they are in no particular order…

MAINTAINING & PROTECTING BARRIER FUNCTIONS

  • Even though the immune system function is often measured by immune cell numbers or cytokine concentrations in the peripheral blood, most of the activity of the immune system occurs within the various tissues and specialised organ/glance that control the interface between our bodies and the outside world. In fact, most immune system cells are found within specialised mucosal membranes that make up the GI tract, respiratory tract, do you know urinary tract and lungs. Generically, this is known as the mucosa associated lymphoid tissue (MALT). The largest portion of this is the gut associated lymphoid tissue (GALT), where is said that 75% of all mature immune cells reside and function. Breaches in barrier function is one of the most potent immune challenges a person can face. This is why protecting barrier function, especially the integrity of the barrier within the intestinal mucosa, is vital for basic immune function and appropriate immune responses. Understanding the integrity of the gut mucosa is one of the hallmarks of FM, and Naturopathic medicine.

CREATE A COMMENSAL-FRIENDLY HOST ENVIRONMENT

  • This support mechanism is closely related with barrier function as friendly commensal organisms reside almost exclusively in the skin or mucosal membranes (mouth, GI, vagina, etc). An environment that allows for the proper number and type of commensal organisms, and is unfriendly to most harmful organisms, is important for overall health and vital for proper immune function. Because so much of the immune system resides in the GI tract, the “training “and maturation of immune system cells is dependent on the interaction with commensal organisms within the gut microflora, which use the protective mucosa like a climbing net to adhere to.

MAINTAINING APPROPRIATE HYGIENE PRACTICES

  • In the historic battle between human health and infectious disease stands the appropriate role of personal and community hygiene practices. Changes in personal hygiene practices, water and sewage facilities, quarantine of infectious individuals in similar practices have saved countless lives. Where these practices are less common throughout developing nations, infectious disease are still common and devastating. Ironically, the modern trend towards a highly sanitised environment in developed countries has led to a host of other immune related an infectious disease related dilemmas. The overuse/abuse of antibiotics over the past half-century have led to a variety of antibiotic-resistant organisms difficult or nearly impossible to treat, even in healthy subjects. Likewise, the so-called “hygiene hypothesis” predicts children with little or no access to “germs” during the early stages of immune development will have adverse or inappropriate immune response such as higher levels of autoimmune or atopic conditions.

AVOIDING ANTIGENS & ALLERGENS IN ADULTHOOD

  • This advice appears basic but it is fundamentally associated with a phenomenon of immune system ageing known as immunosenescence. Of course, ageing affects all systems of the body, and the immune system is by no means an exception. The changes in immune system function that result from ageing have been well characterised. As we age, our main system appears less able to adapt new strategies when encountering new antigens, and it appears to become more vulnerable to immune related disorders. The elderly seem to be especially vulnerable to seasonal infectious agents, chronic inflammatory diseases and, of course, malignantly transform cells not removed from the immune system before multiplying. There are many ways to build a stronger immune response and increase the metabolic reserves our immune system relies on every day. However, it is clear that avoiding unnecessary exposure or purposely avoiding antigens and allergens may be a prudent way to Stay healthy and avoid episodes of critical illness. Well the hygiene hypothesis may explain the need for appropriate antigen/allergen exposure is in children, this is not a strategy for improving immune health in the elderly.  In essence, immunosenescence can be described as a loss of a new “reserve” on the one hand, and a loss of a new discretion on the other hand, meaning that while most measurable features of the immune system decline over time, some may actually increase, such as an autoantibody production or inflammatory upregulation. These changes create increase susceptibility to infectious diseases, poor immunisation response, and increased risk of cancer and several autoimmune conditions. Likewise the increased levels of inflammation, sometimes called “inflammaging” mediates a number of well-known chronic diseases. Another example  is newborn babies  that have an immature immune system and vulnerable to infectious agents. The immune system begins to mature with appropriate interaction with antigens and is enhanced by changing microflora in the gut through adolescence and adult hood.

BUILDING MICRONUTRIENT & ANTIOXIDANT RESERVE

  • One of the hallmarks of modern day nutrition is the connection between specific nutrient deficiencies in disease susceptibility. There’s no question that when we are deficient in one or more vitamins and/or minerals, our body has a reduced capacity to fight off various diseases. However, the notion that there is a connection between micronutrient deficiency on one end, and optimal immune levels of micronutrient intake on the other is often under appreciated by most. Put another way, in many cases, especially individuals with immune challenges or immune-related illnesses, the recommended daily intake (RDI) suggested for particular vitamins or minerals may not be a sufficient to provide optimal levels of immune-supporting micronutrients. The body does have the ability to store some minerals and fat soluble vitamins, however,  immune challenges can quickly deplete the reserve of these critical micronutrients when in high demand, leaving an individual vulnerable. An experienced FM clinician can help advise a patient on specific micronutrients that may be depleted during immune challenges, or based on a full analysis of the patients lab data, can suggest appropriate natural therapeutic agents that can improve health outcomes. An active or challenged immune system produces a wide range of oxygen radicals as a natural consequence of mounting a strong defence. It’s critical that these oxygen radicals are swiftly neutralised by strong network of antioxidants. While many micro nutrients are vital to the anti-oxidant reserve (vitamin C, E, selenium etc) building antioxidant reserve requires manufacturing adequate glutathione levels, which means trans-sulphuration as part of the methylation process must be running smoothly and balanced, as well as triggering appropriate regulation of antioxidant response element modulated genes.

MAINTAINING & BUILDING CELLULAR (MITOCHONDRIAL) ENERGY

  • When the immune system is under attack, every bit of the metabolic reserve available for energy can be quickly depleted, leaving the patient exhausted and even lethargic, which is part of the classic illness syndrome. When our cellular energy reserves are depleted due to poor diet, stress, strenuous exercise, slow short sleep duration, issues with digestive function or infection, or just the inability to perform other critical metabolic function such as detoxification, the immune system can be easily overwhelmed. In addition, recent studies have shown that mitochondria are critical to the function of both the innate and adaptive immune systems, participating in anti-viral signalling and antibacterial activities.

MAINTAINING ADEQUATE DETOXIFICATION CAPACITY

  • Another important area of metabolic reserve that directly impacts immune function is liver function, and more specifically, detoxification capacity. When liver function and detoxification capacity are functioning appropriately, removing exogenous and endogenous toxins, a significant burden is reduced/removed from internal immune and GI functions. However, slow or incomplete detoxification allows for cell damage and GI irritation that can exacerbate immune system inflammatory responses, deplete nutrient resources, and create opportunities for additional immune-related vulnerabilities. Based on my experience, most patients can benefit from appropriate detoxification protocols. Patients with immune system challenges may greatly benefit from annual or semi-annual detoxification protocols that allow them to systematically remove allergens and toxins from their diet and use targeted nutrients known to upregulate both phase 1 and phase 2 liver detoxification enzymes. These will usually boost glutathione & antioxidant levels as well. As much as detoxification is an important function of the body, many individuals may not be at the stage to detoxify right off the bat. Restoring functional wellness occurs in a specific order, and each person may have a different order of operation depending on their health situation. In order to detoxify safely, and effectively, the body must have a number of functional systems in check, and operational. Practitioners that go straight in and put everyone on heavy detox protocols shows lack of real skill & experience.

DIMINISHING STRESS & CORTISOL-INDUCED IMMUNE SUPPRESSION

  • Stress in general, and cortisol specifically, is a powerful inhibitor of the night immune response. Cortisol was known as one of the most potent endogenous anti-inflammatory molecules, where is inflammatory mediators such as IL – six and TNF – alpha are strong triggers of the HPA axis. While these compensate reactions are critical for healthy immune and stress responses, chronic stress can lead to long-term immune suppression and autoimmune susceptibility.

REDUCING CHRONIC INFLAMMATORY TRIGGERS/MEDIATORS

  • Inflammation is one of the core functions of the innate immune system and is vital to healthy immune response. However, inappropriate or chronic inflammatory signalling is the hallmark of almost every chronic disease, and the appropriate modulation of inflammation is critical for a healthy immune system. Once the body is comprehensively assessed by the FM clinician, there are many ways which they can help a patient modulate their inflammatory responses without pharmaceutical intervention.

USING IMMUNE-MODULATING AGENTS TO CREATE BALANCE & STRENGTHEN IMMUNE FUNCTION

  • While the foundation of immune support is in building metabolic reserve, there are a number of ways to specifically enhance immune function using agents generally referred to as immune modulators. These agents vary in their mechanisms, but are mostly derived from plants or fungi. Herbs, botanical extracts, medicinal mushrooms, glycoproteins etc, are just a few tools that can be used in certain applications by a knowledgeable FM clinician to balance the immune system. Some of these agents are antimicrobial, anti-viral, antifungal, or antiparasitic; while other agents act to stimulate or modulate immune cell function.

I hope this article has given you some insight into considerations when it comes to supporting immune system function. Obviously, there’s more complex layers that are beneath everything I’ve written about which is where an experienced FM clinician is required to connect the dots, and construct meaningful functional wellness restoration programmes that have the best chance of improving patient outcomes. A large number of patients that come to work with me have wasted 10 years of their life taking the DIY approach – consulting with Dr. Google to no avail. I get messages daily from people all over the world, who’ve been wresting with ill health for years, looking for help. Every day spent sick, is another day wasted where one could be taking steps to feeling well again.

If you are looking for an experienced guide to help you uncover the underlying mechanisms behind your health issues then feel free to book a free 30 minute pre-screening consult to see if we are the right fit to work together.

Thank you for your attention.

*By Steve Hawes