The Role of Nutrition in Managing Chronic Illness

Listen to the episode The Role of Nutrition in Managing Chronic Illness hosted by patient advocate Abbie Cornett. In this episode, we'll be exploring how what we eat can directly impact our immune system, energy levels and even our treatment outcomes. Our guest today, Dr. Terry Harville, is a medical director of the Special Immunology Laboratory at the University of Arkansas for Medical Sciences, a consultant for immunodeficiencies, autoimmunities and transplantation and a long-time advocate for holistic whole-person care.  

Transcript

Welcome to today's podcast! My name is Abbie Cornett, and I am the patient advocate for IG Living magazine. This podcast is brought to you by IG Living to give readers the chance to hear directly from healthcare experts on topics that matter to them most.

Abbie: In today's episode, The Role of Nutrition in Managing Chronic Illness, we’ll explore how what we eat can directly impact our immune system, energy levels and even our treatment outcomes.

Joining us today is Dr. Terry Harville, medical director of the Special Immunology Laboratory at the University of Arkansas for Medical Sciences. He is a consultant for immunodeficiencies, autoimmunities and transplantation and a long-time advocate for holistic whole-person care.  Fortunately, Dr. Harville and I talked about this topic years ago at an immune deficiency conference in New Orleans, and I've never forgotten about what he shared on how proper nutrition can truly support healing and the whole person. I'm 

Dr. Harville, thank you so much for joining us today. To get started, can you tell our listeners a little bit about your background and what led you to focus on the importance of nutrition in caring for people with chronic illness and immune deficiencies? 

Dr. Harville: Abbie, thank you so much for inviting me. And as you were just mentioning, this is a very important topic that frequently is left out of the total care of an individual, because we're focusing too much on the medical side and leaving out the other things that are important. When I graduated from college, I went to a program to obtain my PhD in biochemistry and microbiology, and part of what we deal with in biochemistry or the metabolic systems. And so that was a very important part of my learning, as well as teaching. It's what we taught to medical students, taught to dental students, veterinarians. And it helped me more critically understand the importance of all the pathways and all of what's going on with metabolism for maintenance of health and maintenance of life. 

And some of the things that were being discussed and researched back at that time were dealing with such things as the healing of wounds. And so this is back in the early 1970s. And looking at what's going on and what was found to be critical, which has already been known for very long time, is the nutritional status of the animals that were used at that time, but even in individuals. And so, for example, people who had severe burns, the most critical way of helping them heal is adequate nutrition. And so this helped me better understand what was going on. And I worked with a lot of athletes back at that time, and nutrition was critical for maintaining the athletes in peak condition. And so from there, as I got involved with immune deficiencies, it was obvious to me that nutrition and all the facts about metabolism are very important for maintaining the immune system, for allowing healing to occur and having a person remain and be healthy. 

Abbie: You know, I particularly remember the story that you told me about a patient, I believe, and this is years ago, so correct me if I'm wrong, that you'd been brought in to consult with, who had a wound that just wouldn't heal. And through proper nutrition, you were able to help that patient. I don't know if you remember that story or not, but that's what literally caught my attention. 

Dr. Harville: Oh yeah, and that was one of the things I was hoping to be able to talk about today because that was back when I was still in my training for immunology. At that time, this is a patient who others had been following and he had had an open wound of his abdomen. He had common variable immune deficiency and was being treated with IVIG, not having other problems but had a wound of the abdomen that would not heal up. This had been going on for number of years and, so basically, they turned him over to my care to give me a chance to see what I could do with him since others had not been able to get him well. And so when I reviewed the records, the first things I noticed were he was low on iron. The parameters for his blood cells showed that he didn't have enough iron present. His albumin was a little bit low, and he was being treated with the IVIG every three weeks but his trough values were very low. And the perception I had was that he was actually using his immunoglobulin as a protein source and metabolizing it for protein. And he had been treated with antibiotics and the IV oral topical was every day. His mother was washing out the wound with vinegar and saline to try to keep it clean. And it was packed and unpacked and so forth. So all the things you do, and it would never heal up. And so what was going on is he turned 15 and got a girlfriend, and she couldn't, didn't want to be near him in certain ways because of the wound in his belly and the odor that was there. And so he decided he wanted to do something about it. And so I told him, we need to get nutrition in. 

And so what we told him to do was swallow an NG tube. And so he made that sort of a game and told him to act like a sword swallower. And so every evening, he would swallow an NG tube down. His mom would put up 6,000 calories of protein mix (Ensure). And that would go in overnight. What he found out when discussing with him, basically his nutrition was a six pack of Pepsi and a bag of Doritos a day. So he wasn't getting any substantial nutrition. Within a month, the whole wound had healed up and everything had gotten better. And that was a clear-cut indication that without appropriate nutrition, you just can't heal up. 

The other things that are important in there for people to recognize is if you're low on iron, your red blood cells get first dibs on the iron that you have in your body. Neutrophils and macrophages require iron, mitochondria require iron, mitochondria being the energy source for all your cells. And macrophages monocytes important for not only for killing microorganisms, but for wound healing. And if they don't have a sufficient amount of iron, they can't do their job for healing of wounds. So iron is so critical for you to be able to maintain not only your ability to fight infections, but be able to heal up your wounds. And so that was something early in my immunology career that really, really indicated to me that you've got to be looking at somebody's nutrition to make sure their immune health is in good shape. 

Abbie: That is just fascinating. That story stuck with me for years. And we often think of medications, therapies and infusions as the main part of a patient's treatment. And you've said that without proper nutrition, these treatments may not be as effective. Can you explain why nutrition is so important? We've learned why nutrition is important, but why is it especially important for people with chronic illnesses or a compromised immune system?

Dr. Harville: One of the things that we don't think about ,and frequently physicians and even nutritionists aren't considering, is that people with a chronic illness are actually requiring more calories and their immune system is burning up more calories trying to fight the disease processes occurring. And so, since people who are immunocompromised or ill may not be doing much activity, their basal metabolic requirement rates are being taken as though it's an individual without a problem who's not very active. And so, therefore, they're being undertreated regarding their nutrition, their vitamins minerals and other items because they're not being compared to the right comparator. And so you need to be comparing more to someone who's actually burning up calories and is very active so that you can maintain your immunity in a more robust state for it to be able to fight off infections. 

Abbie: Well, and definitely you need the extra nutrition if you're fighting an infection or you need the extra calories if you have a fever or anything. I mean, that only makes sense for healing. For patients living with immune deficiencies, you've covered iron a little bit, but what are some of the most important nutrient deficiencies you see? Vitamin D, zinc, and I know you've talked a little bit about iron, and how those deficiencies can affect the patient's immune function or increase their risk for complications. 

Dr. Harville: That's a very important point, and I wish it was so simple as saying these are the obvious items. Because what happens is if you measure the items, frequently they're going to be in the normal range or they may be at the low end of normal range where they're not being perceived as being abnormally low. Things like this are always an issue. As a separate and aside, for example, a person's IgG level is borderline and so the physician says you're OK because it's not too low and yet the person is having constant infections associated with the antibody deficiency. And so you end up having to individualize for the person rather than simply looking at the test value itself. And, you have to look at what the symptoms are and the features. And in general, what I can say is based on our clinical evaluations of patients over the years, is all of the vitamins that support mitochondrial health are water or critical. So these are basically all the B vitamins. And, when someone is ill, the mitochondria are not able to carry out their function to their best ability. And so, all the B vitamins need to be supplemented even though if you test for them and they may be in the normal range of things. 

Vitamin D, as you were mentioning, is very important. Vitamin D can be low in individuals or may appear to be in the normal range. But still we know that taking extra vitamin D is not harmful and very helpful for helping to keep the immune system in a more regulated state. And one of the things where we know this is very critical has been due to COVID. And what has been found is that many people who are having more problems with COVID actually have low vitamin D levels. But even people who have what appear to be vitamin D in the normal range benefit from taking a couple thousand units of vitamin D twice a day. And that helps the immune system function more in an appropriate manner for people with diseases like that. So, the bottom line, or the things that are important, are the items that help support mitochondrial function. So these are going to be the B vitamins (B1, B2, B6, B12), folic acid, alpha-lipoic acid and carnitine. And these types of things can help individuals with immune problems to have their immune system work at a better rate because if they're mitochondria are supported, then their immune system is in better support. 

Abbie: That makes complete sense. This is not a question that we talked about before, but I know personally that certain medications can make you feel depleted or cause other problems, one of them being steroids. What do you recommend for patients who are on long-term steroid doses or antibiotic doses? 

Dr. Harville: Sure. Well, one of things that, as we mentioned before, was getting the nutrition in. So we have a patient, we're using just a typical over-the-counter type of protein supplementation. But what individuals can do who are on chronic medications that can interfere with their body is they can alter the way their metabolic processes work, can interfere with such things as the way the pancreas works. So we know that glucose metabolism goes off when you're on corticosteroid therapy. Corticosteroids also cause depletion of the protein in your muscles. And so fatigue and having weakness due to corticosteroids is very important. And so basically what happens is you start catabolizing the protein in your muscles as part of your energy source. And so it's altering the way your glucose metabolism is working, and you're consuming more of your protein. So I always suggest that people take amino acid supplementation where the amino acids themselves, you're not having to do anything to break them down, it's actually feeding your microbiome in your gastrointestinal tract. So you're keeping your microbiome happy. 

And then amino acids can be directly absorbed into your body for direct utilization rather than having to undergo some form of digestive process. And there are what we call essential amino acids, which are, we have basically 20 amino acids that are found in our body. And for humans, 10 of them, about half are essential amino acids. And there are many essential amino acid mixes available that contain the appropriate distributions of the different essential amino acids. 

And I'll just name those real quick for people. There's a group that's called BCAA amino acids. These are a type of, one of the better sort of biochemical terms, are called aliphatic amino acids, or they're more similar to a fat-like substance than other things. And that's leucine, isoleucine and valine. Then we have a group of amino acids that have different structures. And these are threonine, phenylalanine, tryptophan, methionine and histidine. And so these are the essential amino acids that we cannot make. We have to get these from a dietary source. And these can be obtained from a variety of dietary sources. Plant sources tend to provide most of them very well. So beans, for example, and a variety of beans can provide you with a good source of these amino acids. 

But for people who are on chronic medications like corticosteroids, I suggest that they take a supplement of these. And generally, 15 grams of these is sufficient for most people. If somebody is doing more activity, or is a larger person, then maybe 30 grams. And so for an athlete, for example, we'd recommend 30 grams of the essential amino acids a day to provide them with the rebuilding source of amino acids to keep their muscles built back up. And so these are very critical for that. Another one that is important is glutamine. And when you go to a metabolic table and you have all those pathways, when you focus in on the very center, you find amino acid glutamine. And glutamine can be directly converted to what's called alpha-ketoglutarate, which goes into what's called the TCA cycle (tricarbic silicic acid cycle) mitochondria, which is the way we generate energy. And so this amino acid can directly go there. And as it circulates through the body, it can be directly used by the heart and the brain as an energy source for help. 

Abbie: Right. You’re tapping my college classes and I’m thinking about this: Remember the whole energy cycle.

Dr. Harville: It's amazing how these things work. Because of the fact that we're on things like corticosteroids and we're taxing the mitochondria, we tend to generate an increased amount of oxidative metabolites that are damaging to the body. When our immune system is active, the way we kill microorganisms is by generating oxidative reactive oxygen species that kill the microorganism. Well, they also damage our tissue when they're released by our cells. And so we have endogenous mechanisms, estedestine finite, and we have the other components that dismutates and so forth, that are there to try to help control the reactive oxidative species products to prevent excessive damage to tissues. 

But I always suggest people take N-acetylcysteine, NAC, because that helps to slow down the oxidative damage that can be occurring, especially when your mitochondria are being overworked and when you have infections where your immune system is generating a live oxidative species. And we found that 600 milligrams three times a day seems to be sufficient. And one of the good things about NAC is it passes in the blood brain barrier, and so it helps promote brain health. And so it's one of the mainstays we use to help treat people with long COVID because it helps reduce the oxidative damage in the things that are detrimental that are occurring in the brain. And so once again, it helps our gastrointestinal tract. It helps the bacteria that are present to not be damaged by all the oxidative processes that are occurring. They themselves generate oxidative metabolism for their own growth and health, and by giving the additional N-acetylcysteine, it keeps them healthy rather than them getting sick and creating more damage in our GI tract. And, so these are very helpful.

And I also suggest people consider taking arginine. Arginine is metabolized in nitric acid, and nitric acid is very critical for maintaining vascular integrity. It helps cause our vessels to loosen up, it helps blood flow better, it helps reduce hypertension and so you get better blood flow to tissues, your heart, lungs, gastrointestinal tract and brain, once again. And so arginine, again, can be very useful for helping people. So that's a series of them. 

Another one that is very interesting are the omega-3 fatty acids. And these not only once again help with what's going on in the gastrointestinal tract, but they help throughout the body, especially the brain. And, recent studies were showing that omega-3 fatty acids, getting enough of those in, can slow down, possibly even prevent the progression of dementia and may be helpful. 

Abbie: I read an article on that the other day that I found. We're big into diet and nutrition around here, but I'd read that and I was like, OK, we're gonna up the omegas. 

Dr.  Harville: Right. And just yesterday, it came out that one of the factors noted in women with Alzheimer's disease is that their omega-3 fatty acid levels are too low. 

Yeah, and so basically, the bottom line there is that what I suggest, based on the studies, is you have to read the label. And the major ones that provide the benefit are called EPA and DHA. And the EPA DHA you need 2,000 milligrams of those a day. And when you look at a typical omega-3 fatty acid, the label will say 1,000 milligrams. Then when you read the label, it says you've got 300 or 360 EPA DHA. So for the typical omega-3s, where it says 1,000 or 1,200 milligrams, generally it means you have to take about seven of the capsules a day to get the 2,000 milligrams of EPA DHA. I suggest people divide those up in whatever is comfortable for them to take. And unfortunately, the pills are relatively large. And so if you search, you can find some of the mini pills that are 2,400 milligrams, and you only need to take four of those a day to get the level of EPA DHA in. And so that seems to promote brain health, GI tract and other things. 

Abbie: You mentioned a number of times GI tract. And I remember when I first got involved with IDF (the Immune Deficiency Foundation) and was first having some real health issues is no one really mentioned gut health. And now there are so many studies on gut health, and they actually talk about how your gut is one of the major players in your immune system. So, could you explain a little bit to our listeners what the relationship between the gut microbiome and the immune system is and how proper nutrition can play a role in maintaining a healthy gut? And then, explain a little bit about probiotics and if they can make a difference for people managing chronic inflammation and/or autoimmune symptoms. I know that's a big question. 

Dr. Harville: No, but it's something that if we, not to pick on any type of physician, but if you specialize in a certain area, you will tend to focus on that organ and want to deal with the items that are associated with it and maintain what's going on with it. 

And because of that and because of the time we can spend with patients and so forth, we forget about everything else that's involved with what's going on. And what we've discovered is the microbiome, the bacteria in our gastrointestinal tract, shape our immune system. And so we have to live in a symbiotic relationship. We have to live a commensal relationship, because if our immune system started attacking the bacteria that live in our gastrointestinal tract or our skin, then we'd be creating inflammatory bowel disease and damage to our skin, for example. And even the microbiome in our mouth. If we started attacking it, we'd end up with sores and ulcers and problems. 

And so what we've learned is that the microbiome, the bacteria that are present in our gastrointestinal tract, will contain viruses that are not harmful, bacteria that are not harmful, fungal organisms and even certain types of what we consider parasites that are not harmful for us. And so a whole range of organisms that live in our intestinal tract that helps our immune system to know what it should attack and what it should not attack. 

And they help our developing immune system as we develop after birth to grow up and develop into a more mature immune system to protect us from specific pathogens. And so one of the things that has happened, and it’s maybe a little bit of a digression, is that what we've done is we've gone from being more primitive humans where we'd be exposed to non-cooked food and pathogens in the environment that our immune system would have to start responding to immediately after birth, that we sterilize the baby, we keep them sterilized away from everything for three months or so, because that's how long mothers can usually stay away from a job, and now we throw them into a daycare center, so there is a cesspool of microorganisms that they've never been exposed to. And we are preventing our immune system from developing normally. And suddenly we shock the immune system into trying to get it to catch up to where it's supposed to be. And what this does is lead to autoimmune diseases and lead to allergies and allergy type problems because our immune system hadn't gone through its appropriate pathogen exposure and development against pathogens, as well as to non-pathogenic microorganisms. Years ago, one of my friends, a gastroenterologist, and I were discussing this, and we were saying, probably the best thing we should be doing to babies these days is start feeding them dirt after they're born. 

Abbie: When you say you digress, there used to be a television show called “The Two Fat Ladies” and it was two older British women who rode these little mopeds. It was a cooking show and, one day, one of the women had a really bad cold. She said to the other one, don't you ever happen to get the sniffles? And the other one's like, darling, I grew up drinking water from the Ganges. I haven't been sick a day in my life. 

Dr. Harville: Exactly. 

Abbie: And was just, was so funny because it's so true. She's like, I was exposed to so much when she was growing up in India that she literally never got sick. And I found that a fascinating comment. The question, though, that I want to ask and a lot of our patients will want answered, is so many of us are on large doses of antibiotics off and on throughout our lives. And sometimes every week, unfortunately. And we know that that really messes up the gut microbiome. What can patients do to support their gut health while they're on antibiotics? And I know probiotics is an easy answer, but what does that look like? 

Dr. Harville: Sure. And just to go one step further there, my son for his undergraduate project, we did a project where we looked at the effects of a probiotic on the microbiome. And we did this to make the experiment very controlled. We basically took an off-the -shelf probiotic that would contain a variety of different important microorganisms that are part of the microbiome that are critical for a microbiome to function. We grew them up in culture and treated them with different doses of acetaminophen. Acetaminophen, Tylenol, is horrible for a microbiome. Yeah, acetaminophen is very toxic to the microbiome. And so the point being there, it's not just antibiotics that we take. Because we know that those are specifically killing bacteria, but we don't think about the other things that are also potentially harmful to the bacteria because of the toxic metabolites that they generate. So, acetaminophen is a very toxic for the microbiome. 

And so, we're hoping to do other studies with people to show the alterations in microbiome. And so, the point being is you don't necessarily need to be just on antibiotics, but just any of the things that we take daily, even other toxic things that come in. Again, not wanting to go too far off on a tangent, when foods we buy are monitored for specific toxins that might be generated. And so there are toxins generated by specific molds that are very dangerous and can cause liver failure. They're called aflatoxins. And so, unfortunately, when we harvest grains and so forth, and they're stored, the molds and fungi can grow up and create aflatoxins. And so what you do is these are being monitored, and you basically mix up the different grains and items to reduce the level of aflatoxins down to what's considered to be safe by the FDA levels. But they're not absent. And so every time we eat any food, we're eating things that are toxic in many ways. And they may be from other microorganisms, they may be from pesticides, they may be from the herbicides — all these types of things that we're doing in our modern farming, our modern way of generating food. And so, all of these things can damage the microbiome. 

Abbie: So for patients who want to support gut health, do you recommend they take probiotics or manage it through diet with foods that are higher in probiotics? You know, kimchi and sauerkraut and a number of other items. 

Dr. Harville: That's it. Right. So even trying to take a diet where you're trying to eat all the right things, unfortunately, our modern world is full of things. And as you know, the PFAs and these forever plastics, so all of these are toxifying our gastrointestinal tract constantly. And so I recommend taking some form of probiotic that contains a mixture of microorganisms that have very selective bacillus and very streptococcal species, and they'll be listed on the label. And I personally take a couple of them twice a day because of not only my concern about the things I'm ingesting that are interfering with my normal microbiome activity, but also I'm wanting to keep down any pathogens I come in contact with seeing patients so that I'm not spreading pathogens from patient to patient. And I'm trying to replenish my flora with the bacteria that are not harmful. 

The caveat here is that sometimes taking these, because we're taking them orally, from our stomach through our small intestines is supposed to be sterile. We don't have microorganisms growing there except in a pathogenic scenario. So for example, helicobacter pylori growing in the stomach will cause ulcers and cause problems. And bacteria in the small bowel will cause what's called small bowel overgrowth and can end up causing us to have chronic diarrhea and other problems with appropriate absorption of our foods and items and can cause further damage. And so since we take these things orally rather than from below, they have to pass through us to get to the colon where we want them to grow up and replenish. And so, occasionally, people will develop what's called small bowel overgrowth. And so if you're taking a probiotic and you start feeling more sort of fullness, belching type of things, gassiness in your intestines, brain fog, then you're probably having bacterial overgrowth. You should be checked for that. And you probably need to stop the probiotics until that diminishes. And if you restart probiotics, take less of them and see, or switch to something else to see if it can replenish your colon growth and not grow up in your small bowel. 

There have been reports of people who have had problems taking probiotics. These have not been patients with immune deficiencies. These have been patients with cancer. They have been on a lot of chemotherapy that has greatly replenished their immune system, particularly the neutrophils and macrophages, monocytes. So you don't have those to control any bacteria that might be trying to leak in through your intestines. And one other thing that happens with the chemotherapy is it causes your gut to be leaky so that more bacteria can leak in. And so people with immune deficiency, for the most part, their gut is not leaky enough to create a problem. But there are many physicians and immunologists who say, do not take a probiotic if you have an immune deficiency. And they're doing it because they're concerned that the gut is leaky and the bacteria could leak through, create a problem. And the reality is that there's been no evidence of that. 

Abbie: I was going to say, what my immunologist always says whenever I'm on antibiotics, prescribes probiotics. 

Dr. Harville: Absolutely. And I think that people should be on them period, whether you have an immune abnormality or not, because our world has changed from when we were getting this naturally many thousands of years ago. 

Abbie: Yes. You know, there is no doubt our world has changed. My daughter came home the other day with a big article on “don't leave plastic water bottles in your garage. Don't leave them in the car anywhere where they get warm because it causes the plastics to break down.” And I hadn't even thought about that. 

Dr. Harville: Direct sunlight or warmth bleaches the plastics out. The UV light  will bleach the plastics out. 

Abbie: Well, I'd stocked up on a bunch of water because we relocated to a place where there's hurricanes and she's like, no, like, OK. 

Dr. Harville: Yeah, well, store them in your attic. Well, no, it may get too hot there.

Abbie: Yeah, so before we wrap up, what advice do you have for patients and their caregivers who want to make nutrition a bigger part of their overall care plan? And what are some of the practical ways they can work with their healthcare team? Is it asking for lab testing, getting help from a dietician, tracking what they eat? What would you recommend? 

Dr. Harville: I wish there was a single simple answer. Obviously, the things I'm telling you are from my experience, and other physicians have a different opinion about things. You always need to talk to your physician about your specific health problems and, hopefully, they will be able to guide you in a manner that can provide you with the help you need. So that's one of the first things I would start with.

If you're not getting answers you need there, you can find physicians who specialize in nutritional advice and get a second opinion. A nutritionist, as you mentioned, is always a good place to go. But you need to have nutritionists who deal with patients who have problems. 

And so, if a nutritionist is strictly looking at you from the standpoint of as a normal individual, where you're starting from what would be normal metabolism, then you're not going to be getting the right nutrients, the right replacement, the right things you need. You need to deal with nutritionists who deal with people who have chronic illnesses. Unfortunately, there's not many that do. 

Abbie: I think that's so important because so many people here, when they hear the word nutritionist, they think immediately of weight loss. And that is not what this is focusing on. This is about getting proper nutrition to care for the body. 

Dr. Harville: That's correct. And not many deal with immune deficiency patients because there's not many centers that have enough patients with immune deficiency to have nutritionists specialize in that. But what you would deal with are the nutritionists who deal with the patients with cancer, that receive chemotherapy for cancer who are requiring all these additional things similar to what somebody with an immune problem needs to have.

One has to be really careful about doing Google searches and ChatGPT. While these can provide you with good information, one of the problems with these is also what's called hallucinations. Because they go in and just gather the information; they can't tell whether the information is true factual information or is false information that somebody's putting forward. 

And one of problems with nutrition, with vitamins, with supplements is this is a largely unregulated industry. The FDA doesn't regulate it. And so most items are being sold by testimonial. And somebody is trying to make money off of it. And so they're telling you all the good sides of things and they're giving testimonials, right, not the bad side at all. And all the testimonials say is, you know, “I started taking this thing and I couldn't walk for 10 years and now I'm able to run marathons.” And it seems too good to be true because it probably is too good to be true. And, another example is, they'll be, “If you use these patches on your feet at night, it will draw out all the toxins from your body.” And that's nonsense. That's absolutely fictitious. And it's a total waste of money. And that doesn't hurt. 

Abbie: I like the ones that say if you take this supplement, your hair will grow over like two inches a month. I'm like, no, it won't.

Dr. Harville: Right. And so I wish that there was more of this. In the IG Living column, we've mentioned some of these things previously. Right now, we're dealing with COVID because that's so important. And when I finish COVID, it might be a good time to go back to this since this is very topical, and I'm hearing this from other people, too. 

Maybe I'll go back and write some more again on some of these things, specifically on the items that we're utilizing for different aspects of things. So, it’s fair to do a ChatGPT or Google search, but don't take it as gospel.

Abbie: No, because I've taken classes recently on hallucinations and some of them actually are pretty significant in how they can be harmful. So definitely, it's fine to do it, I consider that a starting place. If you're going to do that, consider it a starting place and do more research. 

Dr. Harville: Absolutely. Look at the things, be critical rather than believing upfront. Be critical of all the things. Talk to others. There are the Immune Deficiency Foundation through others. Go to Abbie's column where she answers the questions in IG Living. Ask questions that people like me can write specific answers to the questions. 

These are ways that you can get things that more apply to you. One of the dilemmas that we have is some people, because of where they live, are not readily able to have an immunologist or other people who are more aware of what's going on nearby. And it makes it difficult. The Internet, though, does allow you to get into other groups with immune abnormalities. It allows you to be able to chat with others, to ask questions, find out what others do. And that's a good start for anyone. But always be, do things with a little bit of criticism so that you can be scrutinizing the items so that you can do what's right for you. 

Abbie: You know, Dr. Harville, I want to thank you again for being our guest today. I knew years ago that when we had that conversation, I wanted to dive a little bit deeper into it. And this is the first opportunity I've had. And your insights remind us, or me particularly and our listeners, that nutrition isn't just about calories or weight. It's about how nutrition supports the body's ability to heal, fight infections.

We're so grateful to have had you here, and we look forward to continue the conversation in the future. Thank you so much. 

Thank you again for joining us today. Additional information regarding this podcast can be found on our website at www.igliving.com. If you have a question that was not answered, please contact me at acornet@igliving.com. 

Look for the next IG Living podcast announcement on our website for the opportunity to submit your questions. 

IG Living Advocate is a copyrighted production of IG Living magazine, published by FFF Enterprises — the only magazine dedicated to the immune globulin community, including those living with chronic illness and their caregivers.

Disclaimer: The views and opinions expressed by the guest speaker are their own and do not necessarily reflect the views of IG Living magazine, FFF Enterprises, or its affiliates.