Detangle by Kinjal

Detangle with Dr Sanat Phatak

Buzzsprout Season 4 Episode 9

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Dr. Sanat Phatak, a clinical immunologist and rheumatologist, joins us for a fascinating deep dive into the complex relationship between our mental state and immune function. We explore the nuanced ways stress impacts immunity—revealing that while chronic stress can suppress certain immune functions, it can paradoxically promote inflammation elsewhere. Dr. Sanat explains that it's a two-way street: inflammation itself can suppress mood and cognitive ability, creating a feedback loop that connects our psychological and physical health.

The conversation illuminates the remarkable concept of "immune memory"—how individual cells remember past encounters with pathogens and respond more efficiently when those threats return. Dr. Sanat suggests this cellular memory system may be even more impressive than neurological memory, evolving earlier and functioning without a centralized organ. This mechanism underpins vaccination and explains why exposing ourselves to a wider variety of antigens strengthens our immune response.

We tackle common misconceptions about "boosting immunity," with Dr. Sanat challenging the notion that immune health works like muscle building. Instead, he emphasizes that balance is key—not too little, not too much—and that consistent sleep, regular exercise, and proper nutrition trump trendy supplements. 

Throughout our conversation, we see how the lines between mental and physical health blur, highlighting the importance of validating patients' experiences and addressing health through an integrated lens. Whether you're curious about how social media affects your immune system or wondering if those "immunity boosters" actually work, this episode offers evidence-based insights that will transform how you think about your body's defense system.

Speaker 1:

Welcome to Detangle, where we untangle the complexities of life one conversation at a time. I'm your host, dr Kinjal Goel, a psychologist and a writer. Our guest today, dr Sanath Fateh, is a clinical immunologist and rheumatologist and a friend whom I have turned to many times with endless queries about the immune system. A collaboration between a psychologist and clinical immunologist could not have come at a better time. I can't wait to get this conversation started. Oh and yes, we have a super rapid fire at the end of the episode, so stay tuned till the very end. Welcome to Detangle, dr Sanath. So good to have you with me today.

Speaker 2:

Thanks for having me Pleasure to be on Detangle.

Speaker 1:

Well, to begin with, let's orient the audience a little bit with your scope of work. Can you list it out for us, please?

Speaker 2:

Sure. As rheumatologists and clinical immunologists, we help diagnose and manage autoimmune and inflammatory diseases. These particularly affect the joints and the connective tissue. So people think of us as doctors treating arthritis, but other autoimmune diseases like lupus also come under our clothing. Essentially, these are diseases where one's own immune system, which is designed to fight germs, which are coming from the outside decides by mistake to attack one's own healthy cells.

Speaker 2:

Such a disease is called autoimmune, and those are the ones that we treat. Just as a disambiguation, let me just tell you what we don't deal with, at least on a primary basis. So most of us don't deal with allergies, although these are immune related diseases. That forms a separate specialty and that is an immune attack against a small foreign antigens. We also usually don't deal with autoimmune diseases in which inflammation is restricted to one particular organ. So there are many such diseases, for example in multiple sclerosis if you've heard of that where there's inflammation and an autoimmune attack only against the brain. Or Hashimoto thyroiditis, the common form of hypothyroidism, where it is only targeted against the thyroid. So those diseases usually go to particular specialists and those don't come to us.

Speaker 1:

Great. So at least now we know what you don't do as against what you do. So why clinical immunology? I mean, what drew you to this field in the first place? It's so niche.

Speaker 2:

In one word I would say complexity. The immune system is very complex and elegant, and the diseases that we treat are subtle, they're multisystemic, they're clinical puzzles. So that's what drew me to them and by its nature it lends itself to a lot of research. So we have a lot of advances in both how we understand diseases, measure diseases and therefore treat disease. Finally, there's a deep human aspect to it, because these are chronic conditions which usually affect people for life, and some of them being children. So it brings in a very deep connection throughout years.

Speaker 1:

Wow, I don't think we've ever seen rheumatology from this perspective, but I'm quite intrigued and I think we've all said it at some point. Most of us have believed it as the ultimate truth stress impacts our immunity. Tell me more about this.

Speaker 2:

how far is it true and how can we really know for sure?

Speaker 2:

So that is an excellent question and an exceedingly common belief, and the short answer is yes, that stress does impact your immune system, but the relationship is very nuanced.

Speaker 2:

It cannot be said that high stress worsens the immune system in such a short sentence. So let me start with a caveat that when we are talking about immune function, it is extremely difficult to measure. It is not like, say, thyroid function or metabolic function or pancreatic function, where I have a set of tests to say if my thyroid is doing well or not. To say that the immune system is doing well or not is far more difficult and we'll keep coming back to this. But the problem with measurement is really the problem why we have difficulty in correlating or associating it with anything else. So, coming back to the interface between stress and the immune system, we do know from both human and animal studies that chronic stress can do bad things to your ability to fight infections. So stress that goes on for a long period of time, what we call chronic, chronic stress increases a hormone called cortisol and other such stress hormone, which suppress certain aspects of immune function and therefore your ability to fight infections would be slightly compromised. Okay.

Speaker 2:

Paradoxically, chronic stress also promotes inflammation, which is the immune system keeping on being active without a real cause, without an um, without a foreign organism being around, which is also bad for you. So, um, a couple of things that I would like to stress upon here I like the use of the word stress yeah, in a different, uh, yeah go ahead so, um, a couple of things that I want to stress upon here.

Speaker 2:

Firstly, not all stress is harmful. So acute, short bursts of stress can actually prime the immune system. And we're not talking only about mental stress here, we can even be talking about physical stress, and that leads to the kind of evidence we have from things like acute cold exposure, for example, which improves immune function. Secondly, it is best not to think of it as causative. It's good to think of it as an effect modifier. I've seen many patients tend to attribute the onset of a disease, say, to a particular stressful event. So we've had many people say this came right after a divorce or a death or an exam. And most of us have stresses, but most of us do not get diseases. So it's difficult to say that this was causative, but definitely possibly an effect modifier.

Speaker 2:

And the third thing is that it's a two-way street. It's not just a one-way street that inflammation itself suppresses mood and cognitive ability. So we have diseases in which there is long-term systemic inflammation and you know the feeling when you have fever or you have a viral illness and you can't bring yourself to work or you're not in a great mood. So that's because of inflammation and inflammatory cytokines, which are chemical substances that are secreted by these cells when there is inflammation, do act on your brain and produce this low mood. Some of these diseases have this mood for years, so imagine what you're feeling in a three-day. Viral. People are feeling for years before they get diagnosed and the treatment of the immune system related problems or the inflammation actually improves the mood in itself.

Speaker 2:

So it's a very complex interface.

Speaker 1:

It's two-way, it's not very direct, to say the least you know, this is very interesting because most of us believe that a low mood or intense stress or intense anger or certain personality types will be more likely to be ill or more likely to be chronically ill. What we don't understand is chronic illness can also cause mood disturbances and also to take this forward, there are so many medicines which can alter moods in a good sense, in a controlled sense, and also in a bad sense. So sometimes I tell patients that if you're on long-term medication and you see a mood change, talk to your doctor about it. They might know how to alter the medication. Also, we always believe we are in control and in charge of our moods, but that's rarely the case.

Speaker 2:

Yeah, it might not be something to do with your brain and something completely exterior to it.

Speaker 1:

Right. So what chronic ailments do you see the most commonly that have a strong psychosomatic element? And when you do identify this, what's your next step? I mean, do you have to do counseling yourself? Do you have to prescribe something yourself?

Speaker 2:

Or do you have to send them out to a mental health expert and do people really go right now? Right, very pertinent question. Um, many, or actually most, conditions that we treat have a psychosomatic element, and here I'm talking about the fact that they are deeply influenced in how well they respond to medication, how they progress, um, how they present all of that. I'm not saying that the diseases are in quotes, all in the mind, but they are just deeply influenced by the psychosomatic element. And probably the best example of this is fibromyalgia, which is a disease of widespread pain and fatigue, and we know very well that stress and trauma amplify all of these symptoms. But nevertheless, even all other diseases that we treat chronic autoimmune diseases, systemic lupus, rheumatoid arthritis, psoriatic arthritis which are, in a sense, clearly inflammatory, also have a complex interface with emotional stress. So we know, for example, that prolonged emotional stress can trigger flares in these conditions, they can increase pain perception in people with arthritis, they can worsen fatigue and they can reduce the effectiveness of certain medications.

Speaker 2:

And going back to your question about how I would deal with this, so we have excellent experimental evidence that management techniques that deal with the psychosomatic component, like cognitive behavioral therapy or mindfulness, or even yoga for that matter help pain, reduce inflammatory markers, improve how well people function.

Speaker 2:

So it's very interesting to think of how you're dealing with the person as a whole and not with a particular disease or not with a particular process. So if I only think that I'm going to treat inflammation, then disease modifying agents immunosuppressants are going to be enough, but, as we see in clinic, agents immunosuppressants are going to be enough, but, as we see in clinic, that's clearly not the case. We do need a more holistic approach in treating both the psychosomatic component as well as the physical or inflammatory or biological component. Counseling is, of course, very important. There's a limit to how much we can do it. So I would, in theory, like for someone to look at it, measure the amount of psychosomatic stress and how it is influencing the disease, and then help manage it along with it. So it's definitely useful to be a part of a team which does that.

Speaker 1:

So tell me, in the recent past, have you seen any changes in patient compliance? I see this a lot when patients come to me, even referred from other specialists. They don't want to continue on any medication for a long time simply because chat, gpt told them so or Google told them so. And in your case, when you're dealing with lifetime disorders or diseases which need constant management, sometimes the medicine will stop working or you might have to change the dosage. Are patients less compliant now?

Speaker 2:

well, I don't know if there's been any systematic studies to do this, but one has a general perception. I feel one problem is the availability of many other options right so um it's.

Speaker 1:

It's like having the availability of 10 different options within electronics or mobile and coming back hungry from a good buffet, exactly because there are too many options. Yeah, so uh, availability and the possibility of many stimuli is probably what is affecting the medicine world as well and sad, but true so I am so intrigued by this concept that we spoke about the last time we were talking about this the concept of immune memory. I mean, yes, we know that our immune system evolves with us, but memory, I mean, tell me more yeah, fascinating is right.

Speaker 2:

Um. So the immune system has its own version of learning. Let's call it that. It's called immune memory. Okay.

Speaker 2:

And what I mean by that is that the immune system remembers past encounters. These encounters are with pathogens which it has seen. The pathogen is usually a bacteria, virus or fungus, whatever the immune system deems harmful to the body. Okay, how we know it remembers is that because the next time that same pathogen comes, it can respond faster and more efficiently, so better quality antibodies are formed. The cells move there faster, and I won't go into too much detail about the biological mechanisms of this, which are actually very elegant, but this rests mainly with certain types of cells called lymphocytes. There are two types of lymphocytes B and T cells, and within that a subset that is called memory B cells and memory T cells. And these are the ones that remember the specific shape of and protein structure of the pathogen that it's encountered. And once it remembers this, then it forms what we call a clone, a group of cells that is kept away in storage and will be revoked when the pathogen comes the next time.

Speaker 2:

And often I tell my neurologist friends that immune memory is probably more impressive than neurological memory. We all know about neurological memory and of course it's very impressive, but A it evolved before neurological memory. We all know about neurological memory and of course it's very impressive. But? A it evolved before neurological memory, b? Um it rests within individual cells. I keep, I keep teasing them that your organ has a fancy top floor office with windows to the outside. And our organs are not even an organ, they're just cells moving around in here and there like bombay's andabba Wallas.

Speaker 1:

I like the sound of this and yet are so efficient in remembering things.

Speaker 2:

So I feel it is even more impressive than neurological memory, and essentially this is the principle we benefit from when we vaccinate. So when you're vaccinating, you're exposing the immune system in these cells in particular to harmless versions of a pathogen and therefore it builds an immune response.

Speaker 1:

so next time, the or not even next time when that pathogen comes, it's already seen part of it oh, so basically this is supposed to be an involuntary process as we evolve, but as we have now grown in medicine, we have taken some control yeah, and made it semi-voluntary.

Speaker 2:

Yeah, we can harness it using vaccinations and does something.

Speaker 1:

Uh, help us improve this memory. I mean with brain memory, all of us are always talking about how do we get it to work better. So can we improve memory in our immune system?

Speaker 2:

so the more things we show the immune system, the better the memories so like playing in the mud or exposing ourselves Antigen repertoire as we say A wider antigen repertoire that's been seen. The better the immune memory is going to be, the better your immune tolerance is going to be.

Speaker 1:

This is really fascinating. So let's break away the doctor from Dr Sanath Patak and just let me talk to you about yourself for a while. Someone once told me that you should either earn money doing what you love or spend money doing what you love. Apart from medicine, what do you love the most? I mean, what are the hobbies closest to you?

Speaker 2:

I love that sentence. That's a really nice way of putting it. So I'm generally interested in art and design, visual aspects of it and also, maybe, as a creative outlet. So I have a general feeling that there's something very grounding about working with your hands and you know it could be drawing, it could be gardening, it could be sculpture, whatever else, and it's something we as physicians don't get to do too much. Maybe it's a little different for a surgeon, but there's not too much of a creative aspect to being a physician, so I feel that fills in Okay.

Speaker 1:

Very nice. You mentioned fibromyalgia in the previous question, but I have a separate question just for this one, because this has been a point of contention across fields. As a rheumatologist, you must be seeing a large number of patients with this very vague, diffuse, random, distressing pain. I see fibromyalgia being treated as a dustbin diagnosis most times. If it is nothing else, it must be fibromyalgia right. Treated as a dustbin diagnosis most times. If it is nothing else, it must be fibromyalgia right. But is there a definitive way to still diagnose it? Is it a functional disorder? Is it an organic disorder? Does it sit on the fence? Should we just not label it? I mean, what are your thoughts?

Speaker 2:

yeah, perfect. I mean, this is a good time to talk about fibromyalgia and I agree that it sits in on the fence, uh, between what I would say are traditional biomedical silos. You don't really need to think in compartments here, because there is a definite psychosocial component to it. There's a definite inflammatory component to it. We currently understand it as a disorder of how pain is perceived. That's the main thing. Um so how pain is perceived and processed by the entire pain detecting system, which starts at the receptors in your skin or any other organ and then goes up right to the brain and these. This system is overactive. Um so what I or you would perceive as touch, for example, these people perceive as pain. Okay, so think of it as a volume knob turned too high. Even something that is very enjoyable, even music, would sound deafening to your ears or blaring to your ears if the volume knob is turned off. Right.

Speaker 2:

That's the same thing which is going on with the pain system in fibromyalgia okay um, and it's not only pain, it's accompanied by a cluster of symptoms.

Speaker 2:

So there's fatigue, there's unrefreshing sleep, there's brain fog, there's a lot of things. There's soft tissue inflammation that comes up and goes um. It's a whole syndrome. It's a whole syndrome. It's a cluster of symptoms.

Speaker 2:

And talking about the dustbin diagnosis part of it I feel it gets that reputation because there's no blood test which is diagnostic of it and like many other diseases that we treat. So anything that is done in a person with suspected fibromyalgia where workup is concerned is to rule out other similar looking diseases, and there are multiple. So there's there's a disease called polymyalgia rheumatica or osteomalacia, which can come with diffuse pain, and we don't really want to miss those. So the workup really goes to see if we are not dealing with one of those and therefore the blunt investigations are to rule out other diseases more than rule in fibromyalgia. But I mean, I wouldn't call it a dustbin diagnosis because it can be coexistent, for example. So people with rheumatoid arthritis have secondary fibromyalgia.

Speaker 2:

People with other diseases have secondary fibromyalgia and it is important to recognize that. So, for example, if a person with rheumatoid arthritis has many swollen joints and I treat them, the joint swelling goes away and yet you see people still having pain. Is that pain? Is having that pain incorrect? No, there's a discordance between what I see in that patient. So there's no swollen joints, I feel the person is doing well. The person does not feel they're doing well, they feel that they're still in pain and this is when it's probably that there's secondary pain sensitization or secondary fibromyalgia. And if we don't recognize that, then they are not going to be happy. Their concerns are not met, their functions have not improved and we've not done our full job right.

Speaker 2:

Validating is just as important as treating absolutely completely, and the pain is real pain is always real the pain is real, so I would not attribute hierarchies to functional pain or organic pain it doesn't matter.

Speaker 1:

I love the sound of this. I think this is so important because usually this bifurcation is what causes problems. So let's talk about mental health in men. In medicine, how prevalent is burnout, anxiety, depression? How often do you see your colleagues seek help? Are there enough avenues for patients I mean for patients who are doctors or do we need to generate specially curated spaces for this?

Speaker 2:

Yeah, that's a huge problem, I feel, because what I feel is we only see the tip of the iceberg. We have times in our lives, during training, which are extremely exhausting physically and mentally, and the general um, the general way of going about it is just keeping on going face it.

Speaker 1:

Yeah, be strong yeah, yeah, exactly.

Speaker 2:

Um, and then you see these small examples of burnout or suicides and those are unfortunate and those are probably just the extreme tip of the iceberg and, um, yeah, at least when I was training, I didn't see any very easily available routes to getting help. Um, it would definitely.

Speaker 1:

I'm sure it's the same now, hopefully a little better, but it would definitely be more welcome I think what is happening with psychology and with counseling, in india at least, is we have done our bit in raising awareness, but we haven't really helped solve the problem. So if somebody asks me where do we go, I don't have answers because we don't have enough qualified professionals yet. So people are now more aware that they need help, but when they go out to seek seek help, they hit that dead end and say, okay, now what? So then there's a lot of quackery, there's a lot of people.

Speaker 1:

So we need to cross that border now. We need to start educating people.

Speaker 2:

So there's an infrastructure.

Speaker 1:

Yeah.

Speaker 2:

Education becomes limitless.

Speaker 1:

Correct, and we need more and more people who are well qualified in all these fields.

Speaker 2:

Right.

Speaker 1:

It's not the same. I mean, like medicine, even psychology has various upsets and we need more trained people absolutely, I completely agree so you know, I heard something beautiful recently. A person is always seeking something personal, even through professional pursuits. What is it that you're looking for through your encounters?

Speaker 2:

oh, that's a very interesting question. Um, for me, I think it's the stories. I mean, every person has a story, be it a patient. Meet someone who's accompanying a patient, meet someone who I meet outside. It helps one understand that what we are dealing with is not a disease but a person, and how they interact with the disease is a story in itself, and how they interact with the disease is a story in itself and, for that matter, I feel we as doctors have a huge privilege because people come out with stories to us and we get to have the opportunity of listening to such things. So I'm grateful to that.

Speaker 1:

That's such a beautiful way of putting medicine into perspective. It's actually a whole collection of narratives, stories. Some stories are organic, they have been built on their own. Some stories have so many components like a patient going to four different doctors and then coming to you will have a little bit, a little angle, a little paragraph of a story from somebody else. So sometimes they need to learn, sometimes they need to unlearn and you get to be a part of that process.

Speaker 2:

So important to recognize that we were taught, for example, to ask separately what a patient's concerns were, and it often happens that their concerns and our concerns are completely different. We are thinking of how to suppress the immune system and how to get these joint inflammation in my field, but in anybody else's field it will be different. But if I ask a patient, sometimes their concern is is this cancer? Because my grandmother? And unless I felt with that concern, my job is only half done right and they won't be hearing anymore.

Speaker 1:

I'm sure you get this question a lot, but let's do this for the sake of the listeners here. How badly do you think social media and extra screen time is affecting us in terms of immunity? There's been so much discussion about people getting more and more sedentary. You know so many causes, but they all lead to social media and people are falling prey to more and more diseases. People are falling prey to viruses over and over again. Do you see this?

Speaker 2:

Great question, and I've often heard this question being asked by a parent, especially when their child is a patient. Maybe, with a little hint of suggestion, that is social media they want me to say social media is bad for the immune system. Is social media they want me to say social media is bad for the immune system and um?

Speaker 2:

I don't think there is any direct link here, but there are many indirect links. So, for example, social media we know that um the more engaged you are with social media, the more likely you are be sedentary. And um we also know indirectly that physical activity is better for the immune system. So being sedentary, being inside four walls, is actually putting you at a slightly higher risk for infections. Right.

Speaker 2:

One of the main things that social media does is sleep disruption, and sleep is sacrosanct for a good immunosuppressant, immunological response. So, um, and you know that right, you um go somewhere, you party for two days late at night and on the way back you're getting an infection. We all know that that's what social media is probably also doing is, um, getting down your sleep cycles. And thirdly, like we said, chronic stress. So we do know that prolonged social media exposure has low-grade emotional dysregulation it's probably the comparisons news fatigue, overstimulation and that chronic stress is going to suppress the cortisol response and reduce your immune response. So, yes, it's quite likely that chronic stress is going to suppress the cortisol response and reduce your immune response. So, yes, it's quite likely that social media is harming you, your immune system, and it'll be very interesting to do some studies of this very interesting because this emotional dysregulation that you talk about is very important in our field of work right when you look at people who have.

Speaker 1:

You know. You're scrolling down instagram and one moment you see this cute sheep and then you're smiling. And the next moment you see a war-torn area and then, suddenly, you're feeling empathy, and then the next one you're feeling scared. So so many emotions impact you. You don't know how to regulate them because you're not allowed to regulate them.

Speaker 1:

Right at the end of it, you don't know whether you're rested or more tired absolutely completely okay so I have a question which I have been trying to get answers to, but I'm sure there are no clear answers yet. But have you seen any rise in viral infections since covid? I mean as a lay person, I feel. Earlier there used to be a flu season, even when we were younger and we would say, oh, there's a nasty viral all around and people are getting it, but now it seems to be all the time. I mean, everywhere you look, people are falling sick and repeatedly sick. So what's your take? Are viruses getting stronger? Are we getting weaker?

Speaker 2:

Well, I mean, there's a few nuances to this. There's a couple of things we know. Anywhere where there's been systematically collected data, we don't see a rise in the incidence or virulence of viruses, course, okay. But we do know that the autoimmune diseases or inflammatory diseases are. You are at a higher risk for a certain period of time after a covid infection. Okay, this is known for multiple autoimmune diseases, like rheumatoid arthritis or vasculitis, where you are at about two to three times a higher risk for about a year or two after a COVID infection. Okay, I also feel that we know better now, we monitor better now we are a little more careful, we pay attention to our symptoms better after COVID, after the entire world has been reset to think about viral illnesses, yeah.

Speaker 2:

And it's probably also a function of this improved surveillance within the community that we feel I see these quotation marks in improved.

Speaker 1:

I mean, is hypervigilance good for us or is it bad for us? Where are we headed?

Speaker 2:

Well, I have no answer for that. Okay, let's address the elephant in the room.

Speaker 1:

This is one thing which I know all my listeners want an answer to Is there a way to genuinely boost your immunity? I mean, there are innumerable health influencers out there asking you to take this, take that, this shot, that shot shot. Drink this, don't drink this, but tell me, does anything truly help? Is something really worth doing?

Speaker 2:

this is where I start to get unpopular, so let me digress a bit here about the ideas of no immunity and boosting immunity in general. So, as I said, as we said first that measurement is difficult.

Speaker 2:

So how do you know somebody's immunity is low, or how do you know somebody's immunity is high, or how do you know that you need to boost immunity is the main question here. Um, I just did this exercise for the last couple of months where I asked patients I mean, many people say that I feel my immunity is low and I need something to improve it and I asked them what you mean by allowing it. Um, what do you mean? What does that mean? I mean those words don't mean anything to me. So what does it mean to you when some people say I'm falling sick regularly, I'm getting colds and viruses all the, and some people say I'm falling sick.

Speaker 1:

regularly I'm getting colds and flu and viruses all the time.

Speaker 2:

Some people say I'm just tired by the end of the day. Some people say I can't think properly, brain fog, cognitive fatigue. So any question in which the answer to it is so vague it really is difficult to answer. I mean, it is not the role of your immune system to keep you feeling sprightly. But just the fact that you are feeling fatigued at the end of the day does not mean that you have a low immunity or you need an immunity booster. So that is the first thing. The second thing is that immune health is not like a muscle, so that the more you work out, the more weight you lift, it'll get keep getting bigger and bigger and stronger and stronger, and that's going to be better for you. So it's not like going to the gym there's no immune gym yeah, it seems like an analogy, though, okay uh, because here we need balance, because too much is also bad.

Speaker 2:

All the diseases that we treat, really all autoimmune diseases, are where the immune system is not weak, it's actually acting too much it's an overactive system when it shouldn't, and it's doing things which it shouldn't, do it with self-tissue.

Speaker 2:

So it's a system where, of course, too little is bad, but too much is also bad. So, more than strengthening or boosting, what we really need to improve is balance, and we're talking about food and nutrients. So, like all cells of the body, the immune cells need food, need nutrition, need macronutrients, macronutrients and if there is a deficiency then of course they're going to be compromised, and we know that. So if from malnutrition studies, from countries in which malnutrition used to be or is currently prevalent, immune responses are lower, their ability of fighting infections are more compromised than someone who is more nutritionally replete. But most of the immune boosters that are often touted they are usually antioxidants they usually fall in that particular group.

Speaker 2:

I mean there are some others and of course they support general health. They will also support your immune cells, and if your immune cells are lacking in certain nutrients, then they will replenish those. But are they going to improve a certain aspect of the immune system? Are they going to reduce inflammation when it is not needed? Are they going to improve a particular immune response to when it is needed, like especially when a bacteria comes in? We don't have enough evidence for that okay, you're still not that unpopular because you stay.

Speaker 2:

You stayed on the diplomatic side but I mean, I can tell you from an evidence point of view what we know. There's some things to improve immune health um tell me those as I said, sleep is one exercise, isn't?

Speaker 1:

that is going to make me unpopular so, so simple things are always the ones that you know people don't want to do, because simple equals consistency.

Speaker 2:

Exactly. I was just going to say that we need to depend on consistency and lifestyle choices Rather than quick fixes. There's no magic.

Speaker 1:

Now you're unpopular. Now I agree with you. So let me ask you a question that I ask all my podcast guests. It's my favorite question on this show. You a question that I ask all my podcast guests. It's my favorite question on this show. We've all heard of a physical first aid box.

Speaker 1:

You know, somewhere you might keep your antiseptics, painkillers, band-aids for those minor cuts and bruises, when you don't really need a doctor to have a look at it absolutely, but if you have to have an emotional first aid box, something which will make you happy the minute you open it and you know, if you have those days when you're emotionally run down and you need a pick-me-up, what would you put in it?

Speaker 2:

oh, and that's a lovely metaphor. I just love this question and for me, I feel what works is humor. Okay, uh, my grandfather was a very well-known physician and, um, I mean to everybody else he would be this um, serious man, but um, at home he had a huge collection of joke books which I keep, which I keep for myself these days, and my mother used to make me read BG Woodhouse when I had an exam on the site, on, so something like that. You know, something which brings in silliness, lightness, brings down the seriousness of things Calvin and Hobbes, those kind.

Speaker 2:

So, humor I feel is going to be in my first eight books.

Speaker 1:

How fantastic. I can almost see it. I can see the image of that Calvin and Hobbes book right there smiling at you when you open it.

Speaker 2:

Absolutely.

Speaker 1:

Okay, let's get into a rapid fire round now. No thinking, no retakes. Do this really quick. Your favorite book.

Speaker 2:

I like murder mysteries, so I like murder mysteries, so Agatha Christie maybe your favorite movie character. I like animated movies and I feel my favorite ones are from Kung Fu Panda, oh how nice.

Speaker 1:

I love those your biggest pet peeve. Late nights and anything that disturbs sleep.

Speaker 2:

The one thing that you believed in but no longer do, relying on only logic and relying on only science sometimes, especially in medicine.

Speaker 1:

Wow, that's deep.

Speaker 2:

Your most prized possession I have an old diary of my great-grandfathers. He just written down something like accounts and things which is so cool to look at how nice.

Speaker 1:

It's actually priceless, these little things, handwritten, handmade yeah well, before we come to a close and have our final comments, do you have any question for me as a psychologist?

Speaker 2:

yes, thank you for that opportunity and um I would like to know what you feel has been a major breakthrough which has come in from research in your field that has changed how you look at patients I think um one of the most interesting, I would say I wouldn't call it the most major, because there's so many big things happening. Yes.

Speaker 1:

Is you know, is that people have now started paying enough attention to a physician's personality when treating a patient. For me, this is the most fascinating bit that happens.

Speaker 1:

Yeah, you know those few minutes when a patient feels that they are at the center of attention. They don't understand that what is coming from across the table is equally important. So how that physician has lived or you know, is living their life will impact how they hear the answers. That's fascinating. More likely to oversell anxiety or stress. Might be more likely to take something seriously, might be more likely to respect a patient's perspective and not not out of spite or not out of anything conscious, but this is a very subconscious level of working. I've known physicians were so good with body language because they picked it up along the way and there were instances which made them learn.

Speaker 1:

This was not textbook so when a patient comes to me, I always ask who is your referring doctor? Not to put them in a box, but to try and understand that, yes, this is what this doctor has seen and felt. For example, there's a very senior cardiologist who is brilliant at his work, but he is extremely hard-pressed for time. So he needs to save a life and move on, and that is his perspective on patients. Right, you're living. Good for you. If you're dying, I'm going to save you. But for him, when he sees stress as part of the whole ecosystem and he needs to send the patient to a mental health professional, he's very likely to say oh, it's nothing, it's just stress. So in his mind, mind, what has he said? Listen, you're not dying, you're going to be okay, it's not an emergency, I need to take care of somebody who might actually be dying, and so it's nothing, it's just stress. What the patient has heard is it's not real exactly, yeah you're wasting my time, don't it's yeah, it's not acknowledged.

Speaker 1:

and when these patients come to me I need to help them undo that damage. And is it anybody's fault? No, but is it the physician's personality? Yes, I mean, even with endocrinology, how a patient is going to be seen. You know these doorknob moments that are doctors who will ask certain questions and get certain answers. It's fascinating to me yeah.

Speaker 1:

Yeah, and I can go on about it, because the biopsychosocial model still misses the physician in it and you could just have a bad day or you could be having a migraine when you're treating a patient and you could be short on patients, but that completely changes your outcome. And you're human, so we need to also recognize doctors as humans. Right, we don't want AI to treat us, but we don't want to recognize real doctors as humans, so I don't know what exactly we're trying to do.

Speaker 1:

Well, this has been amazing, amazing. We have spoken so many times about the immune system, about ups downs I mean, I've asked you all these questions in my own way at some point. But I'm so glad we could consolidate this and bring this out for the audience, because it's going to be like a little handbook, you know a toolkit and bring this out for the audience because it's going to be like a little handbook.

Speaker 3:

You know a toolkit which people can use Absolutely. I love it, Thank you.

Speaker 1:

So well. I hope this reaches out to a large audience, and I hope we can come back with questions too, if we have any, once the episode is out. So we're looking forward to this. Thank you so much, thank you.

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