Healthy diet, exercise key in general care for PI

While treatments for primary immunodeficiencies vary, proper nutrition, regular exercise, appropriate amounts of sleep, and stress reduction benefits people with all types of primary immunodeficiency (PI) diagnoses, said Dr. Elizabeth Wisner in her “General Care for Individuals with PI” IDF forum.

An assistant professor of clinical pediatrics at Louisiana State University Health Sciences Center, New Orleans, and Children’s Hospital, New Orleans, Wisner described simple but effective steps persons with PI can follow in their lives to support their immune system and work towards staying healthy.

The importance of nutrition cannot be understated, said Wisner. To stay healthy, we need:

• Macronutrients like protein, fat, and carbohydrates that provide the structure of immune cells and help conduct immune cell signals.

• Micronutrients like vitamins and minerals that also help conduct immune cell signals.

• Antioxidants, including vitamins A, E, C, beta-carotene, minerals, and co-enzymes that counteract free radicals, which are atoms that can damage cells.

• Phytochemicals like colors and flavors in plant-based foods that offer anti-inflammatory, anti-cancer, antioxidant, and anti-UV effects.

Vitamin A is particularly important because it supports the structure and function of the mucosal cells of the eyes, lungs, and gastrointestinal tract. A lack of vitamin A can impair B and T cell response, cause loss of structure/function of cells on mucosal surfaces leading to impaired resistance to infections (particularly in the gastrointestinal tract), and diminish innate immunity. Vitamin A can be found in leafy green vegetables, sweet potatoes, carrots, liver, kidney, egg yolk, and butter.

Vitamin D deficiency is common, especially in the elderly. Vitamin D is important in helping phagocyte function, limiting inflammation by T cells, and promoting wound healing. Vitamin D can be obtained through sunlight on the skin, a diet including certain fish and orange juice and milk fortified with vitamin D, and supplements.

When it comes to immune boosters, such as probiotics, multivitamins, and echinacea, Wisner said studies remain inconclusive about their effectiveness.

“I get asked this question all the time - what can I take or what can I give to my child to prevent illness? The quick answer is that there really isn’t anything that’s been shown consistently to boost the immune system,” she said.

If you eat a well-balanced diet, you probably don’t need extra vitamins, and you can get probiotics naturally through foods like sauerkraut, kimchee, aged cheese, and yogurt, explained Wisner.

Just as people with PI need to be sure to eat enough healthy foods, they should also avoid overeating. Overnutrition causes weight gain and health problems.

In the U.S, more than two-thirds of adults and nearly one-third of children are overweight or obese. As a result, the rates of chronic diet-related diseases have risen, said Wisner. Half of the adults in the U.S., about 117 million, have one or more preventable chronic diseases such as cardiovascular disease, high blood pressure, type 2 diabetes, and poor bone health.

Overnutrition and obesity promote inflammation, stimulate the immune system causing autoimmune problems, result in poor wound healing, and increase susceptibility to respiratory and gastrointestinal infections.

“It’s very important to remember that overnutrition and obesity affect immunity and that creates a very pro-inflammatory state,” said Wisner.

Wisner recommends visiting choosemyplate.gov to learn about dietary guidelines suggested by the U.S. Department of Agriculture. The guidelines offer science-based advice on what to eat and drink to promote health, reduce the risk of chronic diseases, and meet nutritional needs. Fruits and vegetables should comprise most of the plate, and grains and proteins make up about a quarter.

“When people think of being on a diet, for instance, it seems very restrictive, but we can have fun foods and enjoy meals that don’t fit all these criteria. It’s all about a balance and a way to incorporate this into your daily life so that you aren’t fluctuating so much,” said Wisner. “Be forgiving with yourself and find something that works for your lifestyle.”

Along with proper nutrition, exercise is key to maintaining the immune system. Exercise is linked to a lower risk of upper respiratory infections, and yoga in healthy populations has been proved to increase IgA in saliva and decrease cortisol, lowering stress. It increases lean body mass, and muscle and bone strength, promotes physical health, fosters psychological well-being, increases self-esteem and capacity for learning in children, and can help manage stress.

“Exercise may also contribute by promoting good circulation, allowing cells and substances of the immune system to flow freely and do their job more efficiently,” said Wisner.

All age groups benefit from exercise and Wisner described in detail how much is necessary for babies, toddlers, teens, and adults. She recommends visiting health.gov/moveyourway for exercise suggestions.

Getting the proper amount of sleep is another key ingredient to maintaining a healthy immune system, said Wisner.

“Remember that sleep often affects your ability to fight off infections and when you do have an active infection you can realize that because your body demands more sleep, you’re fatigued so it does take a toll on your immune system,” she said.

Finally, Wisner urged listeners to reduce stress in their lives. Stress suppresses the immune system, increases susceptibility to disease, impairs healing, increases blood pressure, increases fatigue, and can cause anxiety, depression, sleeping difficulties, and decline in cognitive functioning.

Solutions to reduce stress include deep abdominal breathing, mindful meditation, progressive muscle relaxation, prayer, yoga, guided imagery, and keeping a gratitude journal.

“I do recognize that having a chronic disease itself is a major stressor so it’s really important to focus on reducing stress,” said Wisner. “Find something that works for you and be consistent.”