How to Do An ‘Immune System Audit’ This Autumn: Interview with Renowned Expert, Author, and Nutritionist Dr Jenna Macciochi
A member of our research team sat down with renowned nutritionist and author Dr Jenna Macciochi to talk about the surprising correlation between a healthy immune system and a healthy mind.
‘Immunity’ – a term we once heard mostly in biology class and yoghurt campaigns –garnered a new wave of public interest during the Covid-19 pandemic. Google Trend research shows that searches for phrases like ‘immune boosting’ skyrocketed in February 2020.
Finding oneself interested in health and wellbeing during the global spread of an infectious virus makes sense. However, the immune system is so complex that content on the subject is ripe for misunderstanding and misinformation. For example, even the notion of ‘boosting’ or ‘balancing’ our immunity is scientifically inaccurate.
With a cold winter fast approaching, we wanted to help our readers obtain a deeper and more scientifically grounded understanding of the immune system and how you can effectively look after your own. To that end, we had the opportunity to sit down and chat with renowned expert Dr Jenna Macciochi.
Our interview was as thought-provoking as it was insightful. While you can find the full transcript below; you can also click here for a list of various articles within which we elaborate on specific issues and points raised during our conversation.
Molly: Hello! I hope you are doing well. Firstly, thank you so much for being here and agreeing to share your knowledge with us. I just loved your book and found it so enlightening. Right at the start of the introduction, you wrote that ‘I’m driven to question what makes modern life tell us is healthy, yet makes our immunity go awry.’ That is such a concise way of phrasing the confusion many of us feel when we try to become healthier versions of ourselves. Could you elaborate on that and what exactly those modern life unhealthy aspects are?
Hi Molly, thank you for having me and yes, sure! I started thinking about this when I wrote my first book before the Covid-19 pandemic. At that point, I felt like everybody looked at the immune system as something to protect us from infection. But I thought it does so much more than that; it is not just about infection protection. I wanted to elevate the general understanding that, you know, we live somewhere like Europe where we have public health measures, routine vaccinations, and antibiotics. We are not dying of the infectious diseases that our great grandparents faced.
However, we are dying of other stuff and getting sick earlier in life. We might be living longer, but we are not living better, and it is because our immune system is just going wrong slowly over time. It is releasing this unwanted inflammation that now seems to underlie every chronic health condition.
I realised it’s not the infectious but non-infectious diseases that seem to be the most prevalent.
So, I was thinking that we are getting sicker, yet we have all this knowledge and tools and policies for our health, so what is going wrong? I was really curious about this, and I started to think about what the immune system needs to go right. The answer, of course, is a whole variety of inputs. We tend to focus on diet and think to ourselves, “oh I can eat my way to a healthy immune system”, but that’s only one piece of the puzzle. The immune system is chronologically developing across your life that is ever-changing in response to your environment.
However, it seems like we just don’t live in a world that is responding or giving us these inputs. For instance, compared to 100 years ago, most of us live very sedentary lives, looking at computers for long periods, which we know isn’t good for our immune system.
Then, we have our diet where we tend to lean towards convenience food, and fewer people cook at home than ever before. We also have toxic food environments, and by this, I mean that there is a constant bombardment of messaging that we need to eat, snacks, and convenience food. It is everywhere, which wasn’t the case even 20 or 30 years ago.
Then, in our environments, we use a lot more products in our home, and we tend to think we need to remove every germ possible, even though 99% of the germs around us are actually helpful, and our immune system needs exposure to them. In reality, we need to be digging in the dirt and having exposure to healthy soil and healthy contact with green spaces and natural environments, yet we’re becoming less and less able to do so.
Then we have the mental health component - our immune cells have receptors on their surface for all the different neurotransmitters – dopamine, serotonin, and a whole mix of different chemicals that imprint on our immune system what different emotions we are experiencing. We know that there is an epidemic of mental health issues that have been rising and further exacerbated by things like the pandemic, which directly impacts our immune system.
So, you know you can be very healthy in our modern world – you eat all the right fruit and vegetables, you go to the gym and all the rest of it, but you might just be missing out on some of the components because it’s hard in this day and age to obtain them all. It is difficult to avoid sitting at a computer all day, scrolling social media, or eating fruit and veg grown locally with those good microbes on the surface. All these little things are making it harder and harder for us to look after our health and wellbeing.
Thank you, that is so interesting because, as you mention, we tend to think about it in such binary terms of things like 'germs bad, clean good', but it is so much more nuanced than that. I also love that you mentioned this, as it's one of my favourite aspects of your book – that eye-opening moment when you realise the immune system does so much more than just fight off infection. You've already touched on this, but in chapter five, you mention a Hippocrates quote – 'it is far more important to know what person the disease has than what disease the person has.' Could you elaborate on that and explain what exactly the immunity-brain axis is?
Yes, well, it basically means that, for example, you can almost have two people with the same condition, say, two people with rheumatoid arthritis. This is an autoimmune disease wherein the immune system's gone wrong, and it is attacking the body. However, each individual's journey to develop these symptoms and manifest that disease will be quite different. There's a whole mosaic of different reasons that precipitate that disease, which can be different in different people. Then, how that person embraces their diagnosis and deals with it going forward can affect the outcome. We know from scientific literature things like mindset, a good sense of self and wellbeing all make a difference in your ability to recover. For example, it's things like even though you have a chronic disease, you feel very happy and content because you live in a nice area, you have family and a support network, you enjoy your work, and you have things in your life that will give you that positivity.
We even know from people in hospitals who have operations that if they are given a nice environment to recover in, they will recover better and faster than someone in a noisy and busy hospital ward with no views of nature or things like that. So, there are a lot of individual factors, which is good news because it means we have a lot of control over how we progress through any health challenges that come up. For instance, adopting a certain mindset and working on those tools can genuinely help you recover.
That is fascinating! It really brings home the message of how interconnected we are with our environment – even to the point where noise can impact your physical recovery. It also raises interesting questions and thoughts regarding our modern world. For instance, we tend to think of ourselves as so isolated and 'in our own worlds', but that is, in reality, a complete myth. In that same line of thought, you touch on the link between inflammation and depression in your book when you write that "certain neurological disorders might be caused by a malfunction of the immune system." Could you elaborate on this point?
Yes, absolutely, this is really interesting. There was this separation of the mind and body that occurred at a certain time in medicine, and it is only very recently that we have started to realign these two fields. For centuries, it was almost like psychiatry was ‘over there’ or ‘across the border’ where you don’t need a stethoscope or white coat, and you’re just dealing with the mind. Then, on the other side, you had the other medical professions who were dealing with the physical element. However, on both sides, it was as though we had no space or recognition of the cross-fertilisation between the two fields.
However, this is changing. For example, recently, there were studies done on people who struggle with both depression and inflammatory diseases. The researchers initially thought, well, if you’re diagnosed with a chronic inflammatory disease like an autoimmune disease, then it’s likely you’re struggling with depression because you’ve been told you have a chronic lifelong condition, which is obviously difficult. However, when they were completing the study, what they actually found was that the levels of depression were linked to the levels of inflammation in the body. Specifically, participants who were experiencing a flare in their condition had raised levels of inflammation, and their depression worsened because of that physical interaction between the inflammation and the brain.
So, then they started giving participants anti-inflammatory drugs in clinical trials, and for a subset of patients with mood disorders, their symptoms improved with the intervention of anti-inflammatory drugs. With this, we started to realise that unwanted inflammation in the body can have a direct impact on the brain. To note though, inflammation is in itself useful - it is what our bodies use to get rid of infections in the body - but when we have constant low levels of inflammation due to various lifestyle factors like our diet, then it can directly lead to mental health issues. What’s more, this helped us realise that it is because the inflammation is acting on the brain directly and making you change your behaviour. For example, if you think about the last time you had a really bad flu, for example, you probably didn’t go about your normal life doing the same things you normally do, you were probably a bit socially withdrawn, had changes to your sleep pattern, changes to your appetite, you might have felt very tired and so on.
All of these physical symptoms are caused by the inflammation in your body acting on your brain telling your brain to change your behaviour to allow your body to heal from the infection. It’s called sickness behaviour, and it’s a very specific characteristic of being unwell. Poignantly, depression has a lot of parallels to sickness behaviours because when someone’s depressed, they might feel socially withdrawn, fatigued, struggling to sleep, not able to do normal activities and so on. So, yes, it is a really fascinating area of research.
Wow, that is really interesting and such a powerful piece of data for combating the mental health stigma because it just immediately makes you think that, you know, you would never go about your day with a fever or flu and think, ‘wow, what’s wrong with me’ in the same way that people do with mental health issues like depression. It is super interesting too because inflammation is one of those buzzwords that go around but we don’t really know what it actually means.
Yeah, it’s one of the weapons that the immune system uses.
Yeah, which is so enlightening. Actually, on that note, like what you said about stress in your book, inflammation is not in itself bad; it just becomes problematic when it becomes chronic and long-lasting. Could you elaborate on why chronic inflammation is so prevalent these days?
Yeah, so people often ask me what is causing this chronic inflammation, and the answer is a lot of things. It could be years of poor diet, it could be numerous rounds of antibiotics, it could be gut issues, it could be medications you’ve had to take, it could be stress or anxiety from your job or life events. It’s kind of like you need to do an audit of your life and really sit down and look across different parameters. So, you know, thinking about your diet and gut health, exercise, and activity levels, thinking about your stress and social and emotional wellbeing, thinking about your environment and what you’re exposed to, e.g., do you live in a very polluted area? Do you sleep well? I always say try to do a little audit of all of those elements, and you’ll start to realise, ‘ah, okay, this issue is the one I need to work on most, this is probably contributing most to the inflammation that I don’t want in my body’ and so on.
Ah, amazing. That is such a useful tip and actually perfectly leads into my next question which was what are your thoughts on the impact of loneliness on our immune system?
The loneliness question is really interesting because there are scientific studies that have been done on this, and this was way before the pandemic, but then I think they became extra relevant during it. Essentially, throughout history and for millions of years, human beings evolved to rely on each other. Generally, we are social as a species, we live in communities, and that is kind of hard-wired into our DNA. We do better in communities because different people in that community will have different diverse roles and contribute different skills and attributes, and that’s kind of why we’re all different.
So, imagine generations ago living in a very tight-knit community; if somebody got sick with a virus, chances are lots of you are going to get sick with that virus because you’re all in close contact. So, when you have a strong sense of community and you’re not feeling lonely, your immune system is really turning on your viral defences because it knows that by being in a community and not being lonely, it is increasing the chance of getting sick.
However, when you are feeling lonely, your immune system turns that off because it is telling your brain, ‘well, you are not part of a community and thus not likely to be in contact with people.’ It is not going to keep those antiviral defences really high when it doesn’t need to because that costs your body energy and resources.
But then, when we look at our modern world, many of us are lonely yet surrounded by people. Millions of people worldwide are getting on buses and undergrounds exposed to viruses yet feeling lonely. As a result, their immune system is like ‘well, your lonely, so you’re not likely to come into contact with people, so we’re going to switch off those antiviral defences’ even though – in reality - you need them now more than ever because you’re living in these busy places, it’s just not a community like our ancestors would have known.
Wow, yes, thank you, that is so succulently put. I remember once reading a study that chronic loneliness increases your mortality rate to the point of being a heavy smoker, but I never quite understood why or how, so thank you very much for clearing that up. What a paradox of our time; we are so interconnected and yet so isolated.
I come from a psychotherapeutic background and was very interested to know the link between inflammation and mental illness. Obviously in psychotherapy you learn that childhood trauma plays a role in spiking stress levels and activating fight or flight and I was wondering if you could elaborate on the impact of trauma on our immunity-brain axis?
Well, from what we know in the research, the link between trauma and the immune system is from studies done on people who have undergone adverse childhood events (ACEs). These are traumatic events that happen in childhood, and we know that if children undergo traumatic events in early life, it actually sets up the trajectory of their health into adulthood.
Specifically, these individuals have enduring changes in how their nervous system responds – particularly in the stress axis – to life events. It is almost like it has recalibrated and has a different threshold, so people are much more stressed much more easily and maybe stressed out without even realising it.
ACEs also impact the immune system and how the immune system responds because it is so interlinked with that stress axis. So, I think that’s why if you’re working with adults who have a range of health issues – whether it’s an actual clinical diagnosis of a disease or just that they’re not feeling great – and struggling with certain issues, it’s really important to dive into the possibility that there could be a childhood trauma which is having a significant effect on their nervous system. All too often, we carry around these unresolved issues inside us and don’t even realise that they are contributing to our present-day pain.
So, that’s kind of one piece of evidence that helps us know that trauma is linked to the immune system.
Then, if you experience trauma as an adult, the effects are still going to be apparent on the immune system, but it might be much easier for you to make that mental link because you think, “okay I went through this huge life event that was very traumatic and now I feel terrible much later, my energy is destroyed and I’m getting sick all the time.” But when it happens in childhood, we don’t really make the connection so easily which means what we consider ‘normal’ could actually be a highly stressed-out state of being, we just were too young to truly observe the difference, and now it is normal to us.
In terms of the health impact of these experiences, traumatic events can result in cortisol, adrenaline, and noradrenaline essentially becoming dysregulated, and our immune cells are very, very sensitive to these chemicals, particularly cortisol. I mean, we treat inflammatory conditions with corticoids because we know it turns off the immune system. So, when you have circulating cortisol, you are basically telling the immune system to stop. It’s important to understand that, in the body, there’s always a triaging of energy and resources, and the immune system is quite costly to run. So, turning off the immune system in times of stress is what your body does so as to put all of those resources into the stress response.
So, when that is happening in the short term, it’s fine, but when it’s long-term and chronic then it can really take its toll on our immune system.
Ah, that is so interesting and makes so much sense as to why people get sick during stressful times; thank you. Also, the idea that the body is endlessly doing a cost analysis with energy is so fascinating and goes back to what you were saying about the myth of balancing your immune system.
And I suppose, what would your advice be to someone who struggles with trauma-related depression or anxiety and wants to make sure their immunity is as strong as possible? (i.e., can they minimise symptoms via various immunity-focused habits assuming they are also receiving adequate mental health treatment)?
One of the first things would be to be kind to yourself. We know from scientific evidence that self-compassion is linked to lower levels of unwanted inflammation which is going to be good for our mental health and our physical health. So, try to be more compassionate with yourself, above all else.
For example, when you wake up in the morning and you think to yourself, ‘oh I haven’t done this and I’m terrible at that and I can’t cope with this,’ try to change that narrative to ‘okay this is where I’m at now, but I can be kind to myself about it.’ And actually, self-compassion is a better motivator for change than anything else. You know, when we beat ourselves up and say, “oh I’m so rubbish at everything,” it doesn’t really motivate us to make the changes we want to make so practising that self-kindness (which won’t come naturally to many people, it will take time) is a really good starting point.
Second, try to make all the changes as small as possible. You know how often do people wake up on a Monday morning and think, ‘I’m going to eat perfectly, I’m going to exercise perfectly, I’m going to do all the stuff that I need for my health perfectly.’ Then, they get to lunchtime and they’ve had a terrible work meeting and a phone call that’s triggered them, and then something else and something else and they just walk to the fridge and eat all the food that they know is not serving their body well and they don’t want to go to the gym later because their tired and they’ve set themselves too huge a goal. But, if you try to just get yourself to adopt tiny incremental changes like ‘this week, I’m just going to add more vegetables to my meals.’
It doesn’t matter what it is or how much it is but just try to get into the habit of making your meals healthier or getting into the habit of being more mindful when you’re eating so that you’re digesting them better which is great for that gut-brain axis. Just really small things you can do so that when you’re having a bad day it doesn’t matter so much because the habits have become automatic.
Specifically, you don’t need to invest the necessary motivation anymore because you’re just in the habit of doing it. Getting more steps into your day, walking instead of taking the bus, whatever it is. Developing those habits is what’s going to be so useful because it takes away some of the mental load and reliance on motivation.
However, remember it’s a 360 approach and diet is only one leaver that you can pull. You’ve also got to look at the other leavers and go back to what I said at the beginning – try to do a bit of an audit of your life and ask yourself; what area am I struggling with the most? Is it that you're stuck at your computer all day and just get up from your computer at the end of the day and feel drained from the screen? If yes, can you find ways to break that up e.g., getting up and moving or gardening even just for 10 minutes per day? It just has to be really small, but it adds up and over time, you never know how far you can go.
Amazing Jenna, and I love that idea that being kind to yourself can help your mental health. Thank you so much; I am so grateful and excited to share your insights!
Dr Jenna Macciochi
Dr Jenna Macciochi has 20+ years of experience as an immunologist. Her work focuses on the interplay between nutrition, lifestyle, and our immune systems. Her career is as extensive as her knowledge; she is a lecturer at Sussex University, a personal nutritionist, fitness instructor, TEDx speaker, an Editor at Scientific Journals, and a Fellow of the Higher Education Academy. In 2009, she was awarded a prestigious Presidential Fellowship to combine her personal interest in nutrition with the study of the immune system.
Dr Macciochi is also a regular contributor to various print and online media platforms, as well as regularly appearing on TV shows such as BBC HealthCheck UK. In 2020, she published her bestselling debut novel entitled, Immunity: The Science of Staying Well (2020).
Follow her on Instagram or Twitter for more tips, tricks, and insights into how to stay well.
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