IMMUNITY STRONG

Chapter One of IMMUNITY STRONG: Boost Your Body's Natural Healing Power and Live to 100 by Robert G. Lahita, M.D., Ph.D. The Basics of the Soul: A Glimpse of Phenomenal “You” I have seen thousands of patients in my practice, in clinical studies, and on my hospital rounds for the past 45 years. All of the people who end up on the other side of my stethoscope are suffering, sometimes very acutely. From the unrelenting pain of a woman with fibromyalgia, to the teen who a day at the beach trigged an underlying life-threatening autoimmune condition we call systemic lupus erythematosus or SLE, to the vibrant 25year-old who suddenly had a stroke, these are all real-life stories that fill my every day. Just as it did from the time I first began my medical career, these people tug at my compassion but their conditions also call to my curiosity. What is this ailment? What causes it? Why is it happening to that particular person? What can I do the alleviate it? The common factor is the immune system or what I call the Biological Soul, the incredible apparatus that can determine our fate. We first must understand how it works in coordination with all of the other organs of the body, before we can begin the task of fathoming how it breaks down and what we can do about it. The Immune System at Work Imagine your body as a huge city. Your immune system is the police department, working every second of every hour of every day. If you get a splinter in a finger, the cops alert you through pain or redness. If you get the flu, the cops alert you by using a fever and an upset stomach. Sometimes, a vaccine is available to keep the disease from even making you ill. Otherwise, there’s a doctor’s visit or medicine is available at the drug store and the immune system goes back to work, waiting for the next “bad guy” to appear. But when a virus first touches your skin or is inhaled, the police have a more intense response with alarms sounding off to protect your organs and, hopefully, make an “arrest.” The origin of the immune system is “stem cells,” which is our name for one of many cells in our body that begin to drive the policing system that originated in our liver before birth. Stem cells complete the training for your immune system at birth and remain ready to protect. They are the origin of what I call the Biological Soul. Your immune system provides two types of protections in the form of “innate response” and “adaptive response.” The innate response is first on the scene, launching into action with a forceful attack on a perpetrator with weapons used to signal a problem. The official name of the signal which causes this response is “alarmin.” The alarmins call together a cellular and chemical response involving as many as two hundred different signals and receptors. I describe it as “a SWAT team,” as it moves quickly to alert the rest of the body. The innate system is the closest thing to “automatic” response. It only knows “foreign” and has no recognition if a culprit is involved. But the response isn’t working solo. In the background is the “adaptive response,” which seeks to determine whether or not the “bad guy” was previously known to the system. This usually kicks into action about three days after the SWAT team is on scenes. It is backed up with millions of T and B cells which are white blood cells we call “lymphocytes.” These are made in the bone marrow from stem cells that are always cruising around in your blood. T cells mature from the thymus (hence the “T”) gland in the neck where enough are produced to work for the rest of your life. These make a direct attack on the invader. B cells got the name from glands in chicken bowels called “the Bursa of Fabritius” (hence the “B”) and there is no comparable gland in the human bowel. They are programmed to clean up after the T cells have attacked the virus. If there is no recognition of the invader, the adaptive response goes all out using other cells of many organs (cells in the liver or the lungs), besides the T and B to eliminate the offender. The remarkable aspect of the adaptive response is it will store the invader’s identification in its genetic database, for use later if there’s another attempt to enter your body. Yes, it’s the police record-keeper of past offences. But if this is a virus never seen before, like the novel Chinese coronavirus, there is chaos because the invaderperpetrator-criminal isn’t seen as such. The coronavirus is one of the many causes of the common cold (another is the rhinovirus). Most viruses are difficult for the immune system to handle. Our bodies natural killer cells (a form of T cell) is dedicated to anti-viral activities through evolution, but even they can be fooled. The bad thing is that we continually get colds, even after infection, which could mean the immunity for this family of viruses could be very fleeting. On the other hand, there is discussion underway about the structure of the COVID-19 virus that its protein spikes make it easier to identify than any other coronavirus. However, it is wily, and with infected people showing no symptoms, COVID-19 is easily transported to other people. When a parasite, bacteria or virus from the outside (we call this an “antigen”), the body reacts by producing proteins (aptly called “antibodies”). I view antigens as criminals who can be thieves or murderers. They are usually not obvious and, in our “city,” the police consider antigens sneaky with the ability to be hidden from view. An example is when an infection enters cells even before the body has a chance to recognize that a breach has occurred. This is the issue with COVID-19, a stealthy non-living menace that can use our cells to propagate. These antigens operate like organized crime syndicates and fool the immune system to block its functions at every turn. In most cases the immune system can over-react and get so excited that there is an ability to react with tissues that aren’t foreign. The immune system might attack kidney calls, or heart cells, or in the worst case, cells that line the blood vessels. When our own immunity suddenly believes itself is the criminal, we call this “autoimmunity.” Luckily, this isn’t common and most “criminals” are stupid and readily caught within the body. But others are resourceful, and as we have seen with the recent pandemic with COVID-19, they are brilliant. Many of us believe that the actual way that autoimmunity develops and produces the hundreds of diseases related to Lupus, Multiple Sclerosis, and even Rheumatoid Arthritis is through this stealthy, but effective, viral infection. As earlier noted, B and T cells are key actors after the SWAT team, which operates after “antigen presenting cells” (or APC) begin to work. I see the APC’s as police commanders within the body carefully located in certain organs and always at the ready to give orders. The B cells mature and use plasma cells to produce Y-shaped proteins that usually mark the antigen for destruction. Once that takes place, T cells recognize the infected cells as a criminal that has entered protective space and produce “cytokines” (which are chemicals sent by the T cells and possible other immunity-related cells) that are designated to destroy the perpetrator. If successful, we begin to feel better. In the case of an organ transplant, things are a bit different. The immune system recognizes a new lung or kidney as a foreign-based threat, because the T cells are using the same genetically driven protection system for the original organ. There’s a degree of “acute rejection” in every transplant in the first three weeks after these procedures which are treated with immunosuppressive medication (which used to treat lupus, asthma and rheumatoid arthritis to name a few). These medicines allow the immune system time to accept an antigen in the form of a donor organ. These are moments when the immune system is tricked and releases an increased number of cytokines that destroy its own cells instead of, yes, the perpetrators. We call this “a Cytokine Storm,” It depletes, or greatly reduces, T-cells in a patient and also results in massive degrees of autoimmunity. Everything is rejected, including the heart, lungs, kidneys and the brain. This is why we continue to hear stories of someone with COVID-19 taking a sudden turn for the worse and going from making plans to leave the hospital to being on a ventilator the next day and, in many cases, dying. It is the biological equivalent of a body insurrection and is very difficult to control, even with immunosuppressive drugs. One of my first introductions to the power of cytokines was Parker, an 18-year old male who suffered from the cytokine storm. His lungs were filled with fluid, his liver and kidneys were failing, he had a high fever and a significant lack of red blood cells (anemia). His immune system was turning on itself by producing defensive antibodies to almost every protein in his body. Because of his age he survived, but not without many sleepless nights for me. He was treated by literally shutting down his immune system with immunosuppressive drugs (used in cytokine storms and that can also be used to treat lupus, asthma and rheumatoid arthritis to name a few) as he was near death. In the same way the immune system rejects a new organ, we were facing his immune system essentially rejecting his entire body. We are seeing the cytokine storm as the most prominent cause of death in the COVID-19 pandemic. I call it the “maximal provocation” of the immune system; put another way, there’s nothing worse. Autoimmunity, as noted, is treated with the friendly use of anti-cykotine drugs. One example is found in cases of severe eye disease where the patient is treated similarly by an infusion (yes, injected) of man-made proteins (which are called a “monoclonal antibody”) that will block a specific cytokine and allow a person to see, and avoid total blindness. We’ve seen the immune system tricked with many viruses, among them HIV. During the 80’s treating patients, we saw rare Kaposi’s Sarcoma cancers, as a result of a sudden loss of what are called Helper T-cells. We learned the virus tricked the immune system by replacing these cells that would normally fight off HIV (CD4 T-cells) with those infected by the virus but remained hidden as it occurred. The Role of Genetics It is common knowledge that our genes can increase the chances of developing specific diseases such as diabetes and heart disease. The always-active T cells can be blamed as they use a specific receptor protein to identify their roles in the immune system. These receptors are very important to define the roles of the T and B cells in circulation. Among the many things these receptors do is help distinguish “foreign” from “self.” Historically, the inheritance of these markers on T cells either allow or prevent foreign invaders from proliferating within the body. There are clearly mechanisms that make a person susceptible to infections like TB, Strep, Staph, or even COVID-19. I and others have wondered why perfectly healthy people succumb to an infection that is otherwise harmless. Moreover, blood relatives often succumb to innocuous infections leaving every doctor scratching his head. In our city example, the marker is a genetic guide or police manual that determines how you respond to invaders, probably going back generations to an early great grandmother or grandfather. Once the recognition occurs, there is a flurry of communications via chemicals informing the lymph nodes and millions of other cells within the immune system of capture and arrest. This is done through the communication of the cytokines and chemokines (which are proteins that attract white blood cells to infected areas) working together to destroy microbes belonging to the bad guys. If we study infections around the world, we often see a propensity for those inherent to a person or a family. There could be something genetic called inborn errors of immunity that are not immediately apparent until a major infection like a novel coronavirus enters the system. Or one could be susceptible to an infection like TB or Cholera depending on where you live (it’s prominent in slums in Delhi and refugee camps in southern Syria. Nature and Darwinian adaptation might also play a role in this process. For example, the susceptibility to malaria, one of the world’s deadliest infections, was overcome by a simple genetic error called sickle cell disease in people of African heritage. This is where their blood took on a sickle shape that prevented the malaria organism from infecting red blood cells. Politics, Gender and Sex There is perhaps no more interesting area within immune diseases than the role of gender and sex. It is often said, “you can pick your gender, but not your biological sex.” If you wish to be a man or a woman, you can change your clothes, inject some hormones and maybe have gender altering sex surgery, but you will always be a man or a woman as far as your cells are concerned. That goes for the immune system as well. It is apparent long before the news about men with COVID-19 dying sooner than women with the virus, that women and men handle infections and organ transplants differently. In fact, this might be the one reason why women’s life spans are so much longer than men. They have special aspects of their genetic makeup which I believe has to do with having a baby and the potential benefits that it offers. Those benefits exist even if a woman doesn’t have a baby. Which is testament to the effects of the XX genotype, rather than the process of pregnancy. We’ve seen women having more adverse reactions to vaccinations than men. Women have a pair of X chromosomes while men have an X and a Y. Estrogen and testosterone have different effects on cells within the immune system. We all know that selection of gender is a personal option, but it has no effect on genetic directed immunity. However, it does have effects on the immune response itself, which is in part influenced by sex hormones, meaning that flooding yourself with estrogen as a man trying to become a woman has consequences for immune reactivity that we are beginning to appreciate. There are suggestions that hormones could be used as therapy to enhance immune function in homosexual people, transsexuals, or in people with severe infections. We know that it is used in cancers of the breast or prostate, as examples. But our biological sex is a major determinant for everything else: cell types, response efficiency, antibody character, and probably sensitivity to those cytokines and chemokines. Putting It Together Let me give you two examples of infection, one with bacteria and one with a virus. Let’s begin with a simple infection in someone who is healthy. A 54-year-old woman named Mabel presented with a simple abscess of intestine that resulted from what we call a diverticulum or a bulge in her intestine. A fragment of stool, an undigested peanut or something else lodges itself in the diverticulum leaving organisms within the bulge (also called “outpouching) with no place to go. A collection of pus or large numbers of bacteria and lots of responding white cells form a small round mass called an abscess. There is pain and swelling as bacteria enter the wall of the intestine and then the bloodstream. The innate response (the SWAT team) responded once there was even a suggestion of a problem and they are familiar with bowel organisms, since this person had multiple episodes of minor inflammation over many years and her mother had the same condition. The adaptive response, all too familiar with these bowel bacteria, mounts an all-out fight of the organisms encapsulated in the abscess. After being present for at least four days, all hell breaks loose: antigens are being presented to specialized cells to carry the antigens to Tcells which inform B- cells and copious amounts of antibody is being made, all to ward off the infection and protect the body. Neutrophils, the most common white blood cell that assist the T-cell fight accumulate and carry special enzymes and set up the bacterial capture and emit the required chemical assistance to the immune system as it swarms the scene. Cytokines communicate with the lymph nodes around the bowel and within the bowel itself there are pockets of lymphocytes. Chemokines allow cells to enter the area and they facilitate the inflammatory process and keep channels of communication open. The abscess grows as the response grows. There is fever, pain, and probable bowel obstruction due to swelling and a bowel that is in shock, as all resources come to the aid of the patient. Fifty years ago, there might be death, because the infection and the response could become catastrophic and something called sepsis (infection of the blood) would occur to kill the patient. Those were the days when, depending on the age of the patient and overall condition, the infection would overcome the immune system and the patients could die. Today, a surgical opening of the abscess and use of antibiotics assist the immune system to overwhelm the infection, avoiding sepsis or infection of the blood. During this pandemic of COVID-19, deaths aren’t predictable, but it is obvious that in some people the availability of cytokines, cell types with certain receptors, cascades of antibodies, and immunological genetics, are causes of patient death. The body’s immune system is influenced by many factors, a bad heart, chronic obstructive lung disease, bad asthma, and, of course, age. You might be a young 25-year-old male with no risk factors but also have a genetic predisposition to the virus infection that can result in death. During this viral infection, our SWAT team responds (innate response) but the virus hijacks normal cells in the lung, the heart, the kidney and other organs like the bowel. There are specific receptors that the virus has learned to use in humans when it jumped from one animal species to another; one theory is it originated in a Chinese boomerang bat. But whatever the origin, the virus is a hidden criminal which multiplies using normal cells as a shield and a reproductive machine all rolled into one. The immune system response is robust as usual with the SWAT team going to the problem area(s), while cytokines transmit messages as white cells, along with specific cells that absorb bacteria (what we call “phagocytes”) respond as do natural killer T cells all to produce massive degrees of inflammation in an effort to alert the body something is wrong. There is rioting in the lung, fluid is extruded, and cells abound producing a layer that oxygen cannot cross. We see an increased fever and breathing is difficult because the normal function of the lung cells is destroyed. The virus has fooled the immune system and oxygen is unable to travel through fluid. In addition, multiple mini-clots clog the vessels of the lung, and finally life stops. The virus does not want the host to die but wants to use the host to pass itself on to another host; however, in an altruistic manner defined only by nature, we die to prevent that transmission. Enter the Biological Soul “The Question is not what you look at, but what you see.”—Henry David Thoreau, Walden Pond The Biological Soul isn’t taught in medical school. But each of us has heard the advice about the importance of looking at “the big picture” when dealing with life. If you’re stressed by divorce, or your job, or finances, or your teenage child wants to get a tattoo, that will affect the classic definition of one’s soul: how you look at you and the world. And this affects how well your immune system handles “the bad guys” trying to bring a virus or the flu or cancer. Your diet will do the same, as does watching Netflix for half the day instead of having a routine of daily exercise. Of course, genes and gender have a role and it all affects how you live your life outside of the hospital. Corliss a young Black woman was pregnant with her first child. She had systemic lupus erythematosus (SLE). Her immune system was attacking her body, the process we call autoimmunity, while she was a teenager. It could be something that happens more often than not when the immune system is tricked by a virus, but with lupus no virus is known to cause this disease. She had skin lesions, pain from an inflamed heart and lungs and was facing the fact SLE can be lethal during pregnancy. When any of the staff, including me, spent time with Corliss during treatments, we saw and heard only her kindness and concern for the world and her role in it. Defying the odds of losing her baby, she gave birth to a healthy baby girl. I believe that this was the Biological Soul at work. After Corliss left the hospital, a number of our staff members continued to exchange phone calls and emails with her. We learned that this baby was an exceptionally gifted child who was reading by age 3, writing by age 4 and went on to excel at school. By the time her daughter was a teenager, Corliss died of her illness. Despite the physical challenges of her life, Corliss had remained positive and I believe that had transferred to the fetus in her womb, touching both mother and daughter. We all have immune systems that add to our lives or terminate life in a matter of hours; but the relationship between the spirit, the mind and the body which comes together in the Biological Soul has a power that is remarkable. In another example, I treated Patricia, a 30-year-old Caucasian woman suffering from rheumatoid arthritis (RA), stiffness and severe pain. In our talks, Patricia said she was “in pure hell” for about seven hours after waking up and felt she was always in slow motion. These are standard symptoms of RA which is caused by the immune system mistakenly attacking the body, in this case the joints. Patricia told me there have been moments when she feels fine, and that’s during the nine months of pregnancy. She has three young girls and says her husband is wonderful and the family helps her through the constant swelling and pain. She was always saying “I want to be pregnant all the time” because that is when the arthritis disappears. This happens because the Biological Soul protects an expectant mother through nausea, anxiety, and stress during pregnancy. It is also protects the fetus, which because of its own genetic makeup, has an immunological advantage. Pregnancy is an amazing time for the immune system. It represses what is normal cell reactivity or perceived violation of her immune response in her body so that fetal cells can increase, and it can grow. Those “violations” are simply that she is growing a baby in her womb that contains half of the genome of the father. If we transplanted a kidney into mom, she would reject it, but not the baby. The fact that the baby has a different genetic burden is good for the pregnancy. If the baby were genetically related to the mother (as in some closed societies or as a result of incestuous co-mingling), the baby would be miscarried or worse. Genetic dissimilarity is good for the Soul. We see this a lot with pregnant women. there are numerous cases of the Biological Soul preventing migraines or making the mother-to-be feel more focused. The Biological Soul enhances life and ensures the miracle of normal birth. A third example of the Biological Soul at work is 35-year-old Greg who came to the hospital complaining of fever, nausea, pain all over, diarrhea and a rapid pulse. He was healthy, active and ate well, but upon admission, he tested positive for COVID-19. The amount of oxygen in his blood (“pulse oxygenation”) was normal (97%) so Greg was sent home to self-quarantine for 14 days, as had become the standard set by the Centers for Disease Control and Prevention across the country. Six days later he was back in the ER, gasping for breath and coughing. The amount of oxygen in his blood had dropped to 70% and had to be attached to a ventilator pushing pressurized air into the lungs (called a BiPap). I was concerned that having COVID-19, this would lead to his having to be intubated (a tube is placed in the windpipe) to breathe for him. That’s exactly what happened as he lost consciousness. With the machine breathing for him, a chest x-ray revealed a “white out” in both lung fields (a lack of air and which shows up on the x-ray as the obliteration of air space). It was clear a cytokine storm was the cause as his immune system sensing a problem was suddenly attacking his organs. Concerned now about blood clots forming; he was given blood thinners and was injected with steroids that have proven to shut off the immune system. It should be noted these are different than to the steroids you read about involving illegals use by athletes to improve performance (they take anabolic steroids). After two weeks in a comatose state, the ventilator was removed and Greg slowly regained consciousness and began rehabilitation at home. He recovered from COVID-19 for which he is grateful and is willing to live with a shortness of breath. In talks before and after rehab, GH of about his spiritual desire to show the coronavirus wasn’t going to take him as one of its victims and he had things to accomplish. But quietly, the Biological Soul was already at work, independent of Greg’s knowledge, connecting all of his organs to communicate once again. Yes, his life almost ended but with the assistance of medicine at exactly the right time to steer his immune system in the correct direction, the Biological Soul was back on track. There is a condition called homeostasis, which is when the body is humming along like a well maintained sportscar. In such cases, every organ is communicating with every other organ. There are “biomes” (organisms with a specific job in the body but work together to support the immune system) and provides efficiency when an unwanted virus/parasite/bacterium appears. The heart, brain and kidneys are of paramount importance to the Biological Soul. The liver serves to metabolize all nutrients and on tap to provide the Biological Soul with just the right amount of energy and vitamins to assure good health. Everything is in sync. While it is always protecting the body, external threats, metabolic influences (alcohol, drugs, etc.), and a host of other factors have proven to interfere with the workings of the Biological Soul. In my years talking with, learning about, and treating patients, I see a complex, almost divine presence in all of us, of which we are unaware. The interaction of our various vital organs and the immune system are a major part of a grand design, which we are only beginning to understand. The complexity of the system and the way in which protects us is rarely appreciated. What should be obvious as a result of current events is this system’s beauty, its commonness between us, the vital role that it plays in our lives, and its ability to rob us of life despite its good intentions, and maybe protect others in the species. Someone once said blood is red in all of humanity, but the Biological Soul is more than blood. There’s no difference whether we are black, brown or yellow, poor or rich because we all have immune systems that add years to our lives or terminate life in a matter of hours. Within each of us, our Biological Soul determines the length of our life. This intricate and marvelous system which can work in concert to prolong our lives also has its limitations that we are beginning to understand and sometimes control, which we will discuss in the next chapter. As is the case with each of who believe a spiritual soul will continue to exist after death, the Biological Soul which is responsible for our day-to-day existence ends when we die. It shows us time and time again how precious and fragile life really is--each of us can come to an end with a simple bacterium, or a novel virus. We must respect the awesome beauty of its design and appreciate the sacred aspect of this internal system that protects us, The Biological Soul.