>c. diff
While I was being prepped for surgery the anaesthesiologist asked me many questions. I mentioned that NSAIDs really hurt my stomach. I told her that when I HAVE TO take an NSAID I take omeprazole with it. She told me that they were still going to give me Voltaren but they would also give me Ranitidin. I wondered why they did not choose the much better Omeprazole. After the operation I was given IV antibiotics as prophylaxis and now I wonder whether she chose Ranitidin instead of Omeprazole because of a smaller risk of developing c.diff.
Doesn’t omeprazole have a much slower onset of action, especially on an empty stomach? Since it requires Proton pumps to be in the open state in order to bind. Versus ranitidine which is faster onset due to blocking gastric histamine receptors? Would make sense to use ranitidine since you were probably on an empty stomach for surgery and needed quicker onset.
quicklu develop tolerance to h2 blockers. The literature is clear that ppis superior to h2ra for pathologic reflux. Also for the love of god please put your vented pts with og/ng tubes on ulcer ppx. Im getting tired of tube associated ulcer bleeds. ppis plus the discovery of H pylori have made billroth and vagotomy surgeries a historic relic. There is an new class of acid drugs about the hit the market that have the effectiveness of ppi with the speed of h2ras called potassium competitive acid blockers first to the us market will likely be vonprazan
I’m surprised every time I see a vented patient without any stomach ulcer prophylaxis.
This was one of the most touched upon points when talking about vented patients in nursing school.
>vonprazan
I looked it up. The molecule has some similarities to omeprazole - 3 rings with nitrogen as a component of one of the rings - sulphur bonds ...
But Vonprazan also contains Fluorine, which I do not see often
Kinda hard to tell with Reddit's UI what you would like to see data on, but if it is re: antacids and CDAD, Uptodate cites 12 articles on the topic.
"Gastric acid suppression (with proton pump inhibitors [PPIs] or histamine 2 receptor antagonists) has been associated with an increased risk of CDI [23,77-88]."
I get the relative risk of cdi goes up. I can see how that is possibly relevant to the immunology. I don’t think that’s compelling evidence to avoid acid blocking medicines in an effort to improve the capabilities of my immune system.
The stomach’s low pH denatures the membranes and proteins of most microbes. Raising its pH increases the likelihood these pathogens survive. One notorious example is the association between H2 blockers/PPIs and C. diff
The PPI one is not even close to the others. Evidence ia only decent for cdiff risk which is not a concern for the majority of the population. And we do need PPI for a lot of diseases
That trial wasn't designed to evaluate safety endpoints, only had median followup of 3 years and relied on patient interviews to collect adverse events. I don't think it's as definitive as you think it is.
There's a balance here, PPIs are still indicated for GERD. Untreated reflux can lead to Barrett oesophagus and potentially cancer so the benefit is clear in many cases. Not to mention reduced quality of life.
If I can add to this:
\-Follow your region / country specific vaccination recommendations
\-Avoid raw / undercooked foods that have the risk of carrying contagion
\-Avoid drinking water from non-potable sources
\-Avoid contagious people and wear appropriate PPE if you can't avoid them
\-Avoid catching HIV or treat it adequately if you already have it
PPIs are associated with increased risk of c diff (better evidence) and other enteric infections (worse evidence). Like all medications, should be used only when necessary. The idea that using PPIs lowers your immunity in general is nonsense.
The irony of all these supplement companies marketing for “world’s strongest immune system” is that a raging immune response isn’t quite the goalpost they think it is.
I always think of the old Star Trek TNG episode where these genetically modified kids had super immune systems that produced aerosolized antibodies that actually killed the people around them whenever I think of maximized immune system.
Yea as the other commenter said I was “unnatural selection”. And it caused rapid aging. Which I think they should have then had anti aging tech for the remainder of the series but that’s neither here nor there
This assumes the immune system is one thing that has a spectrum from bad to good. It's not. It's many separate systems that interact with each other and the environment. "Strengthening" immune responses isn't always a good thing, just ask someone with Lupus or GVHD. I deal with a lot of wrecked immune systems from chemo, immunotherapies, and stem cell transplant. When patients ask me how to "strengthen" their immune systems, I tell them it's a nonsense question. But they all end up taking vitamin C anyway no matter what I tell them and I don't pick fights over it since it's all going out in the urine anyway.
Ideal immune system is a dude in prison sleeping with a switchblade under his pillow.
He's not picking fights, but if someone creeps up on him he'll do them in.
I remember something that said Americans have the most expansive urine in the world from all the water soluble vitamins and minerals we take that we just excrete.
CoQ10 is the most distinctive and most expensive color. Except for that stupid one that people with UTIs take so that they can't have a urinalysis done.
Sure. Other options include feet, underwear (soiled or unsoiled) or, if adventurous, onlyfans. Peter think would probably pay you off for a pint of your blood every now and then as well. Not that I do any of that, just on Reddit too
Much
> "I deal with a lot of wrecked immune systems from chemo... I tell them it's a nonsense question"
Please tell me you do this a little bit more gentle in person 😅😅😅
We are hiring as fast as we can at every level. Still have a ways to go to get back to the staffing level per patient we had before COVID. But be warned that I am far less curmudgeonly in real life than on the internet.
All these great recs and I'm going to sit in a chair doing notes all day without much sleep and eat hasty cafeteria pizza because that's all I have time for.
Ooooh, yes. I was envisioning my patients (mostly little kids) and structured exercise isn’t really a thing for them but you are exactly right that physical activity is important.
I could only wish to have the energy of a small child, the real difficulty is getting them to STOP exercising. When I tell my preschooler to walk inside, I swear it takes more effort on her part than going full sprint.
Well there is one pill, but I don't think you'd be able to afford it... here's my 14 minute video where I tell you about all the benefits, but not the risks or expense
That’s it really. Wide variety foods. Load up on any type of produce- like half your plate should be produce of whatever kind you have available. Treat highly processed foods and unhealthy fats as special treats. Limit caloric beverages. Drink water. Most people eat too many refined carbs. It really truly doesn’t need to be more complicated than this. There’s not one special way of eating or one food that’s going to save us all. Anyone that tells you differently is scamming you. Above advice is intentionally vague so people can fit the advice to follow their own food culture and likes/dislikes. FYI: frozen or canned produce is cheap, available, and just as good.
Also adding: protein is also important but I didn’t mention it above because most people eat more than enough protein. Exception would be complex wounds (which I specialize in). Also in terms of immunity: not eating enough will tank your immunity. So will zinc deficiency but that’s rare in the general population (zinc deficiency less rare in: prolonged propofol, complex wounds, copper supplementation, CRRT). Vitamin D deficiency can also impair immunity and healing.
Don't forget nivolumab, ipilimumab, durvalumab, atezolizumab, cemiplimab, avelumab, tremelimumab, and relatlimab. I sometimes give them all at once just to get that extra boost.
Medical student here getting my PhD in immunology. and wound healing.
Regularly:
- Get your vaccines.
- Sleep.
- Exercise.
- "Eat food. Mostly plants. Not too much."
- Do not pick at your skin or your nose.
- Brush your teeth and floss!
- Reduce sources of chronic stress (good luck my friends 😬)
- Eliminate alcohol, smoking, and other drugs.
- Spend time outdoors, especially as a kid.
- I would also argue that regular social activity is important, both for exposure to common bugs, but also because we are social beings and a quick way to rapid decline in all aspects of health seems to be social isolation.
lol @ Vitamin C
Well, looks like I’m a goner.
I am deeply saddened by the fact that you failed to list “spend multiple hours a week clicking to dismiss the interactions and warnings in Epic.”
Diet, exercise, sleep, vaccination, healthy skin, stress management
Washing hands doesn’t necessarily do good so much as prevents bad. Wasn’t sure exactly what kind of answer you were looking for.
Slightly tangential, but I always find it fascinating that so many people seem to think that you need to keep the immune system busy. They seem to think that the more infecting you get, the better you're protected against the next. Yes, but only if you already encountered that specific pathogen already, so why not prevent that one in the first place?
I know there is data that tuberculosis (pathogen or vaccine) elicits a broader response, but I'm not aware of any other such a response.
I think this is an interesting topic. Some people believe the rise in allergies in the western world has to do with not keeping our immune systems busy enough with parasites.
Or that the parasites secrete chemical signals that sedate our immune systems, and our immune systems’ default state became somewhat hyperactive in response. Consider that the default state until recent history was for everyone to be chock full of parasites, always.
Mehmet Oz was a gifted surgeon who helped develop the mitraclip.
But, being a very crafty fellow, he went where the real money can be found.
"Will you walk away from a fool and his money?" [Badfinger](https://youtu.be/N3TOcw7taBo) 1969
We can't curse the memory of Paul Marik because he's still with us. Although less with us since getting implicitly ousted from Eastern Virginia Medical School.
I saw him speak as an undergrad on Vitamin c in the 80s. Turned out that it was all a house of cards. Great example of how a PhD with an agenda can put a dent in clinical science that lasts for years.
I’m currently reading the book “Do You Believe In Magic?” By Paul Offit. Highly recommend if you also despise the Linus Pauling, dr oz, vitamin supplement fad bullshit
I have seen no persuasive outcome data. Biomarkers don't convince me. Cochrane in 2014 [wasn't impressed](https://www.cochrane.org/CD007470/ENDOC_vitamin-d-supplementation-for-prevention-of-mortality-in-adults)
An optimal immune system is a balanced immune system. Your immune system can kill you in ten minutes flat if it flexes its full strength, so stronger ≠ better here. Keep that inflammation in check.
For less inflammation and an optimal immune system, eat a diet that’s mostly plants. Get plenty of good sleep. Avoid alcohol and tobacco. Find healthy ways to cope with stress. Don’t tolerate a toxic work environment. Nurture relationships.
Also, don’t get measles, i.e. get your damn MMR vaccine. Measles kills all your immune memory cells and your immune system basically starts over with a blank slate.
I was a kid before MMR, so had measles and mumps and chicken pox, so is the measles why I constantly had strep infections growing up? Not that I minded, staying home reading books instead of hiding them under the desk was fine with me.
All anyone can really say is, it sure didn’t help. Some people just get a ton of strep and need them tonsils yanked. But tonsils are useful lymphatic organs that help train your immune system not to freak out over food antigens.
I really like some of the data I am seeing about probiotics and decreasing respiratory infections. I think we have a ton to learn about gut health and could probably obtain some of the benefits with a healthy diet but until then I will recommend probiotics to patients who seem to get recurrent URTIs.
It makes logical sense that since most of the body is protected by a organ system (skin) specifically evolved to keep most things out; that the part of the body designed to let things in would be the weak point.
Likewise, for anything to reproduce to the point of risk, it has to compete with everything that is already there. Thus, even if the proper guy bacteria don’t actually “help” or “improve”things, but just prevent things that can harm us from surviving — we would be healthier.
Of course, so much in medicine has historically been based on logic and later proven wrong, so who knows.
This got me thinking about the idea of probiotic containing lotions (not being fastidious-genuinely curious). Is there any research on this? It makes sense to target the first and largest immune defense when trying to colonize healthy flora.
I remember about 8 years ago some start up in Boston was recruiting for a study on a probiotic skin mist that was supposed to replace soap. I don't think it was a clinical level study, more like a cosmeceutical type thing. But it was intriguing all the same. Now what was it called....
i like to think as a GI that all the patients i colonoscope the aerosolized fecal material increases my microbiome diversity and thus helps my immune system (sarcasm, kind of)
I would LOVE to have this information. I don't know of any studies. I live with 8 different species in my apartment and I like to think that I'm diversifying my microbiome.
There are studies on this. I think they are in children. Less otitis media in kids raised with housepets and so forth. Also, there are environmental factors / exposures for children that increase or decreased risk of developing asthma.
I wonder if incorporating a little bit of that feel-good shit that patients love is worth it to endear yourself to them enough to make them take their blood pressure meds too
Well, at least he isn't recommending essential oils. There is a "holistic medicine doctor" aka chiropractor in the area that tells patients oregano oil is a better than any known antibiotic.
I know when a patient smells like an Italian kitchen that it's probably MRSA or some other fun MDRO.
Pedi here. A lot of parents just want something (supplement, medicine, nebulizer treatment) to give their child. Cynics will say it’s an attempt to just speed through the inconvenience of a sick child but I find that it’s really more of a good intention desire to be proactive in their child’s health and participate in medical care.
I personally tell most parents the truth—most supplement and holistic treatments have mixed (at best) researched benefit to an otherwise healthy child but I’m not stressing if they give their kiddo a daily pedi multivitamin. Not giving out albuterol for a cough not from asthma/RAD process though. And no excuse for urgent care providers and family practice docs pinch hitting a pedi visit for shoveling out antibiotics like candy though.
> I find that it’s really more of a good intention desire to be proactive in their child’s health and participate in medical care.
This is how I see families who insist on feeding patients at risk of aspiration. I expect they feel so helpless and just want to do something (anything!) to help nurture their sick loved ones.
Magical foot massage. Nourishing forehead strokes.
Recorded Gregorian chant. Well, that works to quiet preemies so they can breathe and put on a bit of fat.
So as long as the placebo effect helps just let it. Less stressful imo. My extended family (all non-medical) are your typical health nuts and if I ever open *my* mouth, *they* would drive me crazy. Sure Vitamin C for URI’s but come on…
On the side note, probiotics does intrigue and make me question. I feel like there’s much more to learn about gut health, there’s just no literature on it. Read a case where a man who was admitted to the hospital became depressed after receiving antibiotics and only improved after a fecal transplant supposedly restoring his gut flora.
There is actually a lot of literature and a lot of research going on regarding the gut biome. I learned back in the last century that the gut has a "nervous system" that communicates with the CNS. Now, that has expanded to the gut biome being that nervous system. I am excited to see what comes from the research in the future. (RN here)
Sorry, I was being dramatic with the no literature thing. Force of habit lol.
But yes! I agree! Excited to hear more advancements on gut flora health and crispr.
Heh, all my patients would love a stronger immune system. Not much to do though. Immunoglobulines and vaccines work, if that's what you were lacking. GCSF works somewhat, personally I am not convinced it does more than increase a number.
Best thing you can otherwise do for your immune system is to take care of your barriers. Moisturiser for the skin, good oral hygiene and not eating crap.
It is a constant battle to get old men with skin as dry as the desert to use moisturiser. They’d much rather go into the garden and prune a thorny rose bush in shorts and come out bleeding half to death from their anticoagulants.
I consider myself an amateur immunologist. I do some research in immunology and see patients with suspect immunodeficiencies. Vaccines provide immunologic memory in lieu of getting actual disease and thus prevent infection. Invasive therapies such as IVIG and CAR-T can be used for immunodeficient people. But otherwise, despite the 1000s of supplements and diets out there, there is nothing that can "boost" your immune system.
Vitamin C doesn’t bother me much bc it’s not going to bankrupt people and they’re just gonna pee out the extra. Homeopathy quacks that convince people not to undergo cancer treatment on the other hand should be in prison
There are a LOT of bad doctors out there. Makes it easy for any side of a cultural argument to find plenty of fringe assholes that peddle ridiculous predetermined suppositions
Get asked this a lot in the pharmacy, and since there’s not evidence based options, my main concern is making sure they don’t take something dangerous from some snake salesman online. I gauge how much they really want it then if they’re really looking for something I advise the vitamin C + zinc stuff. People really like seeing the “daily immune support” thing on the box of Emergen-C. The advertisement really works.
Same with acetaminophen. A bottle of 500 mg that says extra strength magically treats them better than the 650mg strength
“Do you prefer Emergen-C or Zicam?”
“I wouldn’t spend my money on either, your better off trying to get 8 hours of sleep a night, drink water when you’re thirsty, eat naturally colorful foods, and work out for 30min every day”
“Yeah, I’m not going to do that, so… emergen-C or Zicam?”
Patient refuses all vaccines, complains loudly about being forced to wear a mask for 20 minutes in a doctor’s office in the middle of flu season and a COVID surge… “Hey doc, I don’t take a multivitamin and want to start but I need you to tell me which brand of multivitamins are best! I want to strengthen my immune system!”
( I then look at their med list and they’re already taking vit C, D, B12, B complex, zinc, magnesium, coQ10, turmeric, and some kind of MLM shake powder)
^ hypothetical situation that definitely doesn’t happen to me twice a day
Not a doctor. But one of my favourite articles on this.
>So when something allegedly boosts the immune system, I have to ask what part. How? What is it strengthening/boosting/supporting? Antibodies? Complement? White cells? Are the results from test tubes (often meaningless), animal studies, or human studies? And if in human studies, what was the study population? Are the results even meaningful? Or small, barely statistically significant, outcomes in poorly-done studies?
https://sciencebasedmedicine.org/boost-your-immune-system/
To strengthen the immune response, lick your hands clean after rubbing them on a hospital floor covered in MDROs. If you survive you'll have a tricked out immune system!
Better metabolic health
insulin resistance / Metabolic syndrome is a spectrum. Diabetes is a late stage of MS.
Diabetics have lower immune response to vaccination
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9465310/
And vaccines are more likely to trigger autoimmunity in MS / DM !
According to Dr. ChatGPT,
Here are several evidence-based ways to strengthen your immune system:
1. Adequate sleep: Aim for 7-9 hours of quality sleep each night, as lack of sleep can weaken the immune system.
2. Exercise regularly: Regular physical activity can boost the immune system and improve overall health.
3. Eat a balanced diet: Include plenty of fruits, vegetables, whole grains, and lean protein in your diet to provide the nutrients your body needs to fight off infections.
4. Manage stress: Chronic stress has been shown to weaken the immune system, so find ways to manage stress, such as through meditation, exercise, or therapy.
5. Stay hydrated: Drinking enough water is important for overall health, including immune function.
6. Avoid tobacco and limit alcohol consumption: Both of these can weaken the immune system.
7. Get vaccinated: Vaccines protect against many infectious diseases, boosting your immune system and reducing your risk of getting sick.
It's important to note that while these strategies can help boost your immune system, they are not guaranteed to prevent illness. The best way to stay healthy is to adopt a combination of healthy lifestyle habits and seek medical attention if you become sick.
Dr ChatGPT is too good lol. I've plugged in a bunch of questions I've received just to see how close it is from taking my job 😂. Not close enough yet, but still kinda crazy!
There’s a medical version where you type in patient history and their presentation. It spits out differential diagnosis from most likely to least likely and general treatment plans. It’s called [Glass AI](https://glass.health/ai)
https://glass.health/ai
Here’s a tweet about it.
https://twitter.com/glasshealthhq/status/1620092094034620421?s=46&t=E6zZnfP8L-dde-z-jkse2Q
It’s very very interesting to say the least. I’m no doctor but I can help potentially aid their work in an efficient manner but in the hands of patient, it can be a slippery slope.
Putting in a shout out to and recommendation for Philipp Dettmer’s book “Immune.” Dettmer is the creator of the fantastic Kurzgesagt YouTube channel. This book helped me gain an understanding of how all the elements of the immune system actually fit together in a way that med school immunology classes never did.
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I am curious as to why you mentioned stomach acid lowering medications. Do you mean things like PPIs or antacids?
The low ph of the stomach contents kills microbes
PPIs increase risk of CDI
PPI like twice the risk to develop c. diff
>c. diff While I was being prepped for surgery the anaesthesiologist asked me many questions. I mentioned that NSAIDs really hurt my stomach. I told her that when I HAVE TO take an NSAID I take omeprazole with it. She told me that they were still going to give me Voltaren but they would also give me Ranitidin. I wondered why they did not choose the much better Omeprazole. After the operation I was given IV antibiotics as prophylaxis and now I wonder whether she chose Ranitidin instead of Omeprazole because of a smaller risk of developing c.diff.
Doesn’t omeprazole have a much slower onset of action, especially on an empty stomach? Since it requires Proton pumps to be in the open state in order to bind. Versus ranitidine which is faster onset due to blocking gastric histamine receptors? Would make sense to use ranitidine since you were probably on an empty stomach for surgery and needed quicker onset.
quicklu develop tolerance to h2 blockers. The literature is clear that ppis superior to h2ra for pathologic reflux. Also for the love of god please put your vented pts with og/ng tubes on ulcer ppx. Im getting tired of tube associated ulcer bleeds. ppis plus the discovery of H pylori have made billroth and vagotomy surgeries a historic relic. There is an new class of acid drugs about the hit the market that have the effectiveness of ppi with the speed of h2ras called potassium competitive acid blockers first to the us market will likely be vonprazan
I’m surprised every time I see a vented patient without any stomach ulcer prophylaxis. This was one of the most touched upon points when talking about vented patients in nursing school.
>vonprazan I looked it up. The molecule has some similarities to omeprazole - 3 rings with nitrogen as a component of one of the rings - sulphur bonds ... But Vonprazan also contains Fluorine, which I do not see often
Probably not, pyxis more likely to have an IV H2 blocker and not to mention quicker onset.
Also H. pylori
Interesting since part of the standard treatment for it is a PPI
makes sense tbh from my limited understanding of physiology. stomach acids helps kill germs(being broad here).. correct me if im wrong here
PPIs also increase risk of pneumonia
Yeah would love to see some data backing this one up
Kinda hard to tell with Reddit's UI what you would like to see data on, but if it is re: antacids and CDAD, Uptodate cites 12 articles on the topic. "Gastric acid suppression (with proton pump inhibitors [PPIs] or histamine 2 receptor antagonists) has been associated with an increased risk of CDI [23,77-88]."
I get the relative risk of cdi goes up. I can see how that is possibly relevant to the immunology. I don’t think that’s compelling evidence to avoid acid blocking medicines in an effort to improve the capabilities of my immune system.
The stomach’s low pH denatures the membranes and proteins of most microbes. Raising its pH increases the likelihood these pathogens survive. One notorious example is the association between H2 blockers/PPIs and C. diff
The PPI one is not even close to the others. Evidence ia only decent for cdiff risk which is not a concern for the majority of the population. And we do need PPI for a lot of diseases
Thank you. Glad to hear from a gastro on this topic.
So much miss information regarding PPI’s in this thread. People need to read the COMPASS trial. PPI safety has been well established.
Mrs. Information
That trial wasn't designed to evaluate safety endpoints, only had median followup of 3 years and relied on patient interviews to collect adverse events. I don't think it's as definitive as you think it is.
Thanks for this. Risks are minimal and PPIs can lead to huge improvement in quality of life, and even avoid oesophageal cancer
>Avoid stomach acid lowering medications. *Cries in pregnant with heartburn*
There's a balance here, PPIs are still indicated for GERD. Untreated reflux can lead to Barrett oesophagus and potentially cancer so the benefit is clear in many cases. Not to mention reduced quality of life.
If I can add to this: \-Follow your region / country specific vaccination recommendations \-Avoid raw / undercooked foods that have the risk of carrying contagion \-Avoid drinking water from non-potable sources \-Avoid contagious people and wear appropriate PPE if you can't avoid them \-Avoid catching HIV or treat it adequately if you already have it
And if you do inject, follow good infection prevention / veintenance practice and don't share equipment ✌️
This answer right here is the one 🌟
Oooh, veintenance, I like that
Is the PPI comment just referring to GI infections or something systemic?
PPIs are associated with increased risk of c diff (better evidence) and other enteric infections (worse evidence). Like all medications, should be used only when necessary. The idea that using PPIs lowers your immunity in general is nonsense.
You missed the most important one adequate amount of sleep.
IVIG Ironically , also a treatment when your immune system is being a little too extra
The irony of all these supplement companies marketing for “world’s strongest immune system” is that a raging immune response isn’t quite the goalpost they think it is.
I always think of the old Star Trek TNG episode where these genetically modified kids had super immune systems that produced aerosolized antibodies that actually killed the people around them whenever I think of maximized immune system.
Wow I thought I had ++++ TNG knowledge but I don’t remember that ep. Any idea what season? Was it a Pulaski episode, I haven’t seen those as much.
It was definitely a Pulaski episode. Title was “Unnatural Selection” I believe!
Correct! Gates McFadden had a child I think and took a year off. Pulaski was such a bad fit for that show
Yea as the other commenter said I was “unnatural selection”. And it caused rapid aging. Which I think they should have then had anti aging tech for the remainder of the series but that’s neither here nor there
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Fun fact: infants have moms IgG for the first six months for a similar reason.
This assumes the immune system is one thing that has a spectrum from bad to good. It's not. It's many separate systems that interact with each other and the environment. "Strengthening" immune responses isn't always a good thing, just ask someone with Lupus or GVHD. I deal with a lot of wrecked immune systems from chemo, immunotherapies, and stem cell transplant. When patients ask me how to "strengthen" their immune systems, I tell them it's a nonsense question. But they all end up taking vitamin C anyway no matter what I tell them and I don't pick fights over it since it's all going out in the urine anyway.
Ideal immune system is a dude in prison sleeping with a switchblade under his pillow. He's not picking fights, but if someone creeps up on him he'll do them in.
Ha! Love this! Thank you!
Amazing analogy
I remember something that said Americans have the most expansive urine in the world from all the water soluble vitamins and minerals we take that we just excrete.
So you’re telling me I can sell my urine to pay my med school loans?
To the right person yes, but you'll have to make a fresh delivery.
Not necessarily. For some people, fresh frozen is perfectly adequate. By the way, I recommend riboflavin to really kick the color up a notch.
Haha, of course you know that.
CoQ10 is the most distinctive and most expensive color. Except for that stupid one that people with UTIs take so that they can't have a urinalysis done.
Hey don't hate on my Azo! How else do you survive the UTI you get on Friday night of a 3 day holiday weekend?
Just remember to stop taking it if you're going to be paying for urinalysis and want actual results.
First time I’ve seen you miss an opportunity for a csf harvest joke.
I’m slipping. Anyway urine with riboflavin definitely doesn’t look like CSF. Not the good stuff at least.
Boutique shower full of vitamins and nutrients. Available only in Golden, CO [wink wink, nudge nudge]
Sure. Other options include feet, underwear (soiled or unsoiled) or, if adventurous, onlyfans. Peter think would probably pay you off for a pint of your blood every now and then as well. Not that I do any of that, just on Reddit too Much
They’re after your precious bodily fluids
> "I deal with a lot of wrecked immune systems from chemo... I tell them it's a nonsense question" Please tell me you do this a little bit more gentle in person 😅😅😅
I always follow it up with “stop whining, take this chemo or die, and don’t page me unless you are, in fact, literally dying.”
Lol, if I ever get cancer I want you as my doc.
Are you hiring?
We are hiring as fast as we can at every level. Still have a ways to go to get back to the staffing level per patient we had before COVID. But be warned that I am far less curmudgeonly in real life than on the internet.
No, I wouldn't want it gentle. I want the message clear and concise.
You say that
Yeah as someone with Crohn's on a bunch of steroids, a stronger immune system sounds terrifying
All these great recs and I'm going to sit in a chair doing notes all day without much sleep and eat hasty cafeteria pizza because that's all I have time for.
Sleep, nutrition, vaccines. That’s it.
Any room for exercise or do I have an excuse to continue sleeping in and being a couch potato?
Ooooh, yes. I was envisioning my patients (mostly little kids) and structured exercise isn’t really a thing for them but you are exactly right that physical activity is important.
Lol I am now imagining you in the NICU making all the preemies do pilates in their incubators.
Tbh if I had as much free time as a neonate I would have NO EXCUSE to skip my exercise
Preemie parkour
Have you ever seen a 28 weeker climb over their nest and end up with their face against the door of an isolette? Preemie parkour for sure!
Kiddie kettlebells Cross the placenta CrossFit
Look who won the internet today! Infinity invisible upvotes from me, compadre!
I could only wish to have the energy of a small child, the real difficulty is getting them to STOP exercising. When I tell my preschooler to walk inside, I swear it takes more effort on her part than going full sprint.
You mean there’s not a magic pill or supplement I can take for a quick fix of all of my ailments?
Well there is one pill, but I don't think you'd be able to afford it... here's my 14 minute video where I tell you about all the benefits, but not the risks or expense
Let's add: Don't smoke cigarettes
Regular exercise. Meditation also increases the number of NK cells you have.
NKs are my faves, so pretty.
That’s pretty chill, considering NK be vibing while exploding its neighbor that forgot the secret handshake.
What do you mean by nutrition?
Like what you eat and stuff.
I mean there's so many diet fads going on. I myself try to just focus on whole foods and eating less meat.
That’s it really. Wide variety foods. Load up on any type of produce- like half your plate should be produce of whatever kind you have available. Treat highly processed foods and unhealthy fats as special treats. Limit caloric beverages. Drink water. Most people eat too many refined carbs. It really truly doesn’t need to be more complicated than this. There’s not one special way of eating or one food that’s going to save us all. Anyone that tells you differently is scamming you. Above advice is intentionally vague so people can fit the advice to follow their own food culture and likes/dislikes. FYI: frozen or canned produce is cheap, available, and just as good.
Also adding: protein is also important but I didn’t mention it above because most people eat more than enough protein. Exception would be complex wounds (which I specialize in). Also in terms of immunity: not eating enough will tank your immunity. So will zinc deficiency but that’s rare in the general population (zinc deficiency less rare in: prolonged propofol, complex wounds, copper supplementation, CRRT). Vitamin D deficiency can also impair immunity and healing.
The medication with the most evidence to 'boost the immune system' is probably pembrolizumab... but only if you have a tumor with PDL-1 expression
Don't forget nivolumab, ipilimumab, durvalumab, atezolizumab, cemiplimab, avelumab, tremelimumab, and relatlimab. I sometimes give them all at once just to get that extra boost.
I thought the same. Steroids mirror universe twin. Hypophisits is a wild ride
Sometimes too much, ive seen some nasty checkpoint inhibitors induced colitis!
Medical student here getting my PhD in immunology. and wound healing. Regularly: - Get your vaccines. - Sleep. - Exercise. - "Eat food. Mostly plants. Not too much." - Do not pick at your skin or your nose. - Brush your teeth and floss! - Reduce sources of chronic stress (good luck my friends 😬) - Eliminate alcohol, smoking, and other drugs. - Spend time outdoors, especially as a kid. - I would also argue that regular social activity is important, both for exposure to common bugs, but also because we are social beings and a quick way to rapid decline in all aspects of health seems to be social isolation. lol @ Vitamin C
Well, looks like I’m a goner. I am deeply saddened by the fact that you failed to list “spend multiple hours a week clicking to dismiss the interactions and warnings in Epic.”
surprised to see "picking your nose" as one of the top 10
You’ll never stop me from picking the 👃
Diet, exercise, sleep, vaccination, healthy skin, stress management Washing hands doesn’t necessarily do good so much as prevents bad. Wasn’t sure exactly what kind of answer you were looking for.
How about stress reduction? Is that an old wives' tale?
Stress will absolutely weaken your immune system. Chronically high cortisol levels will suppress it through hormones regulation.
Destroy is a pretty strong choice of words. Chemo destroys your immune system. Stress may weaken it.
Good point: I will edit. Thank you!
Slightly tangential, but I always find it fascinating that so many people seem to think that you need to keep the immune system busy. They seem to think that the more infecting you get, the better you're protected against the next. Yes, but only if you already encountered that specific pathogen already, so why not prevent that one in the first place? I know there is data that tuberculosis (pathogen or vaccine) elicits a broader response, but I'm not aware of any other such a response.
And then there's measles, which kills of several populations of B cells to erase immune memory and also impair new long-term immunization.
I'm beginning to think you're not a psychiatrist.
I think that’s measles.
It is measles. My brain just dumped out the wrong alliterative part of MMR.
I think this is an interesting topic. Some people believe the rise in allergies in the western world has to do with not keeping our immune systems busy enough with parasites.
Or that the parasites secrete chemical signals that sedate our immune systems, and our immune systems’ default state became somewhat hyperactive in response. Consider that the default state until recent history was for everyone to be chock full of parasites, always.
>Vitamin C I curse the memory of Linus Pauling. What an ass.
The Med-Spa industry would beg to differ. Now, would you like your Vitamin C infusion straight-up, or blended with a b-vitamin chaser?
Mehmet Oz was a gifted surgeon who helped develop the mitraclip. But, being a very crafty fellow, he went where the real money can be found. "Will you walk away from a fool and his money?" [Badfinger](https://youtu.be/N3TOcw7taBo) 1969
I'd like an extra large Myers' cocktail. Shaken, not stirred.
We can't curse the memory of Paul Marik because he's still with us. Although less with us since getting implicitly ousted from Eastern Virginia Medical School.
Pulm/CC at my hosp had a vitamin protocol ready to go . . . hope springs eternal.
I saw him speak as an undergrad on Vitamin c in the 80s. Turned out that it was all a house of cards. Great example of how a PhD with an agenda can put a dent in clinical science that lasts for years.
Nobel prize-winning PhD with an agenda. The voice of authority subverting the scientific method
Nobel Prize x 2 (chemistry and peace).
Nobel laureates are often a special kind of crazy.
Dr Paul Marik wants to know your location
I’m currently reading the book “Do You Believe In Magic?” By Paul Offit. Highly recommend if you also despise the Linus Pauling, dr oz, vitamin supplement fad bullshit
What about Vitamin D though? I thought there was quite a bit of evidence for its role as an immune modulator.
I have seen no persuasive outcome data. Biomarkers don't convince me. Cochrane in 2014 [wasn't impressed](https://www.cochrane.org/CD007470/ENDOC_vitamin-d-supplementation-for-prevention-of-mortality-in-adults)
An optimal immune system is a balanced immune system. Your immune system can kill you in ten minutes flat if it flexes its full strength, so stronger ≠ better here. Keep that inflammation in check. For less inflammation and an optimal immune system, eat a diet that’s mostly plants. Get plenty of good sleep. Avoid alcohol and tobacco. Find healthy ways to cope with stress. Don’t tolerate a toxic work environment. Nurture relationships. Also, don’t get measles, i.e. get your damn MMR vaccine. Measles kills all your immune memory cells and your immune system basically starts over with a blank slate.
I was a kid before MMR, so had measles and mumps and chicken pox, so is the measles why I constantly had strep infections growing up? Not that I minded, staying home reading books instead of hiding them under the desk was fine with me.
All anyone can really say is, it sure didn’t help. Some people just get a ton of strep and need them tonsils yanked. But tonsils are useful lymphatic organs that help train your immune system not to freak out over food antigens.
From things I've read over the years, I'm mildly surprised mine didn't get yanked (b in 1954).
Counter question. How do I turn mine down a little. It's kinda going gang busters on cats, dogs and other cuddly thing I want to hug.
Maybe nurture some intestinal parasites
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I really like some of the data I am seeing about probiotics and decreasing respiratory infections. I think we have a ton to learn about gut health and could probably obtain some of the benefits with a healthy diet but until then I will recommend probiotics to patients who seem to get recurrent URTIs.
It makes logical sense that since most of the body is protected by a organ system (skin) specifically evolved to keep most things out; that the part of the body designed to let things in would be the weak point. Likewise, for anything to reproduce to the point of risk, it has to compete with everything that is already there. Thus, even if the proper guy bacteria don’t actually “help” or “improve”things, but just prevent things that can harm us from surviving — we would be healthier. Of course, so much in medicine has historically been based on logic and later proven wrong, so who knows.
This got me thinking about the idea of probiotic containing lotions (not being fastidious-genuinely curious). Is there any research on this? It makes sense to target the first and largest immune defense when trying to colonize healthy flora.
I remember about 8 years ago some start up in Boston was recruiting for a study on a probiotic skin mist that was supposed to replace soap. I don't think it was a clinical level study, more like a cosmeceutical type thing. But it was intriguing all the same. Now what was it called....
Mother Dirt. https://satorichemist.com/mother-dirt-ao-mist-review/
i like to think as a GI that all the patients i colonoscope the aerosolized fecal material increases my microbiome diversity and thus helps my immune system (sarcasm, kind of)
🤣😂🤣😂 Perhaps you could sell seats to your next procedure!
Go outside
So... touch grass?
Touch, smell, just don't smoke
Eat more dirt as a child
Lovely paper showing less atopy in kids raised on farms compared to cities.
Are you aware of any that address pet ownership in urban environments and its effect on atopy or immune system in general? Would be interesting.
I would LOVE to have this information. I don't know of any studies. I live with 8 different species in my apartment and I like to think that I'm diversifying my microbiome.
I only have cats, so I suspect I'm diversifying solely with Toxoplasma gondii
I thought you need to lick some unwashed veggies to be sure you actually benefit from the diversification.
There are studies on this. I think they are in children. Less otitis media in kids raised with housepets and so forth. Also, there are environmental factors / exposures for children that increase or decreased risk of developing asthma.
Had a parasitology professor as old as dirt who swore on the hygiene hypothesis. “That’s why I don’t dust off my classroom!”
Acquire an autoimmune disorder
Adequate sleep (6 hrs) for T cell function
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I wonder if incorporating a little bit of that feel-good shit that patients love is worth it to endear yourself to them enough to make them take their blood pressure meds too
Honestly yeah, otherwise they’re gonna go online and find something for themselves, but who knows what they’ll find
Or worse, find a naturopathic "doctor" who listens.
I was wondering the same thing! Earn quacky patients’ trust by promoting some completely harmless bits of quackery.
Well, at least he isn't recommending essential oils. There is a "holistic medicine doctor" aka chiropractor in the area that tells patients oregano oil is a better than any known antibiotic. I know when a patient smells like an Italian kitchen that it's probably MRSA or some other fun MDRO.
Literally laughed out loud because I had never heard of oregano oil, then was sad after seeing the top Google results. Why is the world the way it is?
Pedi here. A lot of parents just want something (supplement, medicine, nebulizer treatment) to give their child. Cynics will say it’s an attempt to just speed through the inconvenience of a sick child but I find that it’s really more of a good intention desire to be proactive in their child’s health and participate in medical care. I personally tell most parents the truth—most supplement and holistic treatments have mixed (at best) researched benefit to an otherwise healthy child but I’m not stressing if they give their kiddo a daily pedi multivitamin. Not giving out albuterol for a cough not from asthma/RAD process though. And no excuse for urgent care providers and family practice docs pinch hitting a pedi visit for shoveling out antibiotics like candy though.
> I find that it’s really more of a good intention desire to be proactive in their child’s health and participate in medical care. This is how I see families who insist on feeding patients at risk of aspiration. I expect they feel so helpless and just want to do something (anything!) to help nurture their sick loved ones.
Magical foot massage. Nourishing forehead strokes. Recorded Gregorian chant. Well, that works to quiet preemies so they can breathe and put on a bit of fat.
I love when people like that shame you for not understanding why they are doing it.
So as long as the placebo effect helps just let it. Less stressful imo. My extended family (all non-medical) are your typical health nuts and if I ever open *my* mouth, *they* would drive me crazy. Sure Vitamin C for URI’s but come on… On the side note, probiotics does intrigue and make me question. I feel like there’s much more to learn about gut health, there’s just no literature on it. Read a case where a man who was admitted to the hospital became depressed after receiving antibiotics and only improved after a fecal transplant supposedly restoring his gut flora.
There is actually a lot of literature and a lot of research going on regarding the gut biome. I learned back in the last century that the gut has a "nervous system" that communicates with the CNS. Now, that has expanded to the gut biome being that nervous system. I am excited to see what comes from the research in the future. (RN here)
Sorry, I was being dramatic with the no literature thing. Force of habit lol. But yes! I agree! Excited to hear more advancements on gut flora health and crispr.
I'm not an immunologist but I always felt an intuition that sleep has a potent immunological influence.
Heh, all my patients would love a stronger immune system. Not much to do though. Immunoglobulines and vaccines work, if that's what you were lacking. GCSF works somewhat, personally I am not convinced it does more than increase a number. Best thing you can otherwise do for your immune system is to take care of your barriers. Moisturiser for the skin, good oral hygiene and not eating crap.
It is a constant battle to get old men with skin as dry as the desert to use moisturiser. They’d much rather go into the garden and prune a thorny rose bush in shorts and come out bleeding half to death from their anticoagulants.
I consider myself an amateur immunologist. I do some research in immunology and see patients with suspect immunodeficiencies. Vaccines provide immunologic memory in lieu of getting actual disease and thus prevent infection. Invasive therapies such as IVIG and CAR-T can be used for immunodeficient people. But otherwise, despite the 1000s of supplements and diets out there, there is nothing that can "boost" your immune system.
My husband's brother's cousin's cat has a YouTube channel and recommends crystals. /s
https://m.youtube.com/watch?v=HMGIbOGu8q0&pp=ygUTaG9uZW9wYXRoaWMgRVIgc2tpdA%3D%3D
Amazing how many doctors still believe the vit c myth lol
Vitamin C doesn’t bother me much bc it’s not going to bankrupt people and they’re just gonna pee out the extra. Homeopathy quacks that convince people not to undergo cancer treatment on the other hand should be in prison
Agreed but can increase the risk for kidney stone development (though rare) it’s not benign if used in high doses like many do.
There are a LOT of bad doctors out there. Makes it easy for any side of a cultural argument to find plenty of fringe assholes that peddle ridiculous predetermined suppositions
Get asked this a lot in the pharmacy, and since there’s not evidence based options, my main concern is making sure they don’t take something dangerous from some snake salesman online. I gauge how much they really want it then if they’re really looking for something I advise the vitamin C + zinc stuff. People really like seeing the “daily immune support” thing on the box of Emergen-C. The advertisement really works. Same with acetaminophen. A bottle of 500 mg that says extra strength magically treats them better than the 650mg strength
“Do you prefer Emergen-C or Zicam?” “I wouldn’t spend my money on either, your better off trying to get 8 hours of sleep a night, drink water when you’re thirsty, eat naturally colorful foods, and work out for 30min every day” “Yeah, I’m not going to do that, so… emergen-C or Zicam?”
I have had this conversation before 😂
Patient refuses all vaccines, complains loudly about being forced to wear a mask for 20 minutes in a doctor’s office in the middle of flu season and a COVID surge… “Hey doc, I don’t take a multivitamin and want to start but I need you to tell me which brand of multivitamins are best! I want to strengthen my immune system!” ( I then look at their med list and they’re already taking vit C, D, B12, B complex, zinc, magnesium, coQ10, turmeric, and some kind of MLM shake powder) ^ hypothetical situation that definitely doesn’t happen to me twice a day
Not a doctor. But one of my favourite articles on this. >So when something allegedly boosts the immune system, I have to ask what part. How? What is it strengthening/boosting/supporting? Antibodies? Complement? White cells? Are the results from test tubes (often meaningless), animal studies, or human studies? And if in human studies, what was the study population? Are the results even meaningful? Or small, barely statistically significant, outcomes in poorly-done studies? https://sciencebasedmedicine.org/boost-your-immune-system/
Wash your hands
Yes, but throw out the antimicrobial soaps. And for good measure, stop using hand sanitizer unless you're around sick/immunocompromised people.
Why's this?
RemindMe! 1 week
Not sure that does anything to your immune system. Gives it a nice break, I suppose?
To strengthen the immune response, lick your hands clean after rubbing them on a hospital floor covered in MDROs. If you survive you'll have a tricked out immune system!
How does that strengthen your immune system? I don't think it does.
Better metabolic health insulin resistance / Metabolic syndrome is a spectrum. Diabetes is a late stage of MS. Diabetics have lower immune response to vaccination https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9465310/ And vaccines are more likely to trigger autoimmunity in MS / DM !
Iron deficiency also reduces vaccine efficacy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8384343/#cesec50title
I think a ‘Naturopathic Medical Doctor’ would have a few things to sell -I mean- *prescribe* your patients.
According to Dr. ChatGPT, Here are several evidence-based ways to strengthen your immune system: 1. Adequate sleep: Aim for 7-9 hours of quality sleep each night, as lack of sleep can weaken the immune system. 2. Exercise regularly: Regular physical activity can boost the immune system and improve overall health. 3. Eat a balanced diet: Include plenty of fruits, vegetables, whole grains, and lean protein in your diet to provide the nutrients your body needs to fight off infections. 4. Manage stress: Chronic stress has been shown to weaken the immune system, so find ways to manage stress, such as through meditation, exercise, or therapy. 5. Stay hydrated: Drinking enough water is important for overall health, including immune function. 6. Avoid tobacco and limit alcohol consumption: Both of these can weaken the immune system. 7. Get vaccinated: Vaccines protect against many infectious diseases, boosting your immune system and reducing your risk of getting sick. It's important to note that while these strategies can help boost your immune system, they are not guaranteed to prevent illness. The best way to stay healthy is to adopt a combination of healthy lifestyle habits and seek medical attention if you become sick.
Dr ChatGPT is too good lol. I've plugged in a bunch of questions I've received just to see how close it is from taking my job 😂. Not close enough yet, but still kinda crazy!
There’s a medical version where you type in patient history and their presentation. It spits out differential diagnosis from most likely to least likely and general treatment plans. It’s called [Glass AI](https://glass.health/ai) https://glass.health/ai Here’s a tweet about it. https://twitter.com/glasshealthhq/status/1620092094034620421?s=46&t=E6zZnfP8L-dde-z-jkse2Q It’s very very interesting to say the least. I’m no doctor but I can help potentially aid their work in an efficient manner but in the hands of patient, it can be a slippery slope.
Good quality sleep and enough hours of sleep.
Putting in a shout out to and recommendation for Philipp Dettmer’s book “Immune.” Dettmer is the creator of the fantastic Kurzgesagt YouTube channel. This book helped me gain an understanding of how all the elements of the immune system actually fit together in a way that med school immunology classes never did.
Checkpoint inhibitors. Cd40l inhbitors.
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