Immune Health

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    Last Updated: October 6, 2024

    Immune health refers to the body's ability to resist potentially harmful microorganisms such as viruses and bacteria, and includes both innate and acquired immunity.

    Immune Health falls under the Immunity & Infectious Disease category.

    What is immune health?

    Immune health describes the immune system’s ability to heal and preserve bodily function when confronted by infection, injury (wound healing), and even malignancy. Our body relies on multiple levels of defense. These levels include physical barriers (skin and mucous membranes), inflammatory response inflammation, cellular response, and cellular adaptation.[1] Moderation and balance in these different levels of defense are key to optimal immune health. When the immune response is inadequate, this can open the door for infection by harmful pathogens. In contrast, an overzealous immune response could break tolerance of the immune system to ‘self’ molecules in the body, resulting in autoimmune disease. When it comes to immune health, balance is the key.[2]

    How is immune health measured?

    Healthy immune response includes the ability to accurately determine what is harmful to the body, adapt to changes in the environment, manage infections, and retain memory of what foreign cells cause damage.[2] One approach to quantifying immune health is by measuring biomarkers in blood that reflect each of these facets of the immune response. These biomarkers may include: leukocytes, lymphocytes, cytokines, T-cells, natural killer (NK) cells, monocytes, C-reactive protein, and antibodies. An important consideration here is that these biomarkers may be elevated as part of a healthy immune response, for example, to an infection. Concern may be warranted if there is an abnormally high level of inflammatory biomarkers or if they’ve been circulating at a higher than average level for an extended time.[3] [4]

    Beyond blood tests, perceived immune status is a subjective assessment that may be more accessible to those outside of the clinical setting. The Immune Status Questionnaire (ISQ) was published in 2019, and is a validated self-assessment that may help individuals determine if they should seek medical attention, make lifestyle changes, or take further action to improve immune health.[5]

    How does physical activity affect immune health?

    Current research suggests that when it comes to exercise for immune health, moderation, balance, and consistency are key. Moderate exercise has been shown to have numerous benefits on immune health. Although physical activity is a stressor that does incite an immune response, the degree of the immune response and whether it’s harmful or helpful to immune health can be situationally dependent.

    The current understanding is that consistent, moderate to vigorous intensity exercise (<60 minutes in length) is beneficial for immune health and can enhance adaptive immunity, thereby improving protection from community acquired illness and increasing the efficacy of vaccines.[6][7] Muscle contraction is also beneficial to immune health by releasing helpful immune mediators, aiding in lymphatic drainage of waste products, and possibly even diversifying the gut microbiome.[1][8] On the other hand, extreme exercise (especially in the untrained) can be detrimental to immune health. When healing from extreme exercise, the immune system becomes preoccupied and can devote fewer resources to defense.[9]

    Have any supplements been studied for immune health?

    The effects of many supplements on immune health markers have been studied, and the research is ongoing. As of 2022, some of the most frequently studied supplements for immune health include Fish Oil, Vitamin C, Colostrum, Spirulina, Astaxanthin, Reishi, Vitamin D, Vitamin E, Boron, Conjugated Linoleic Acid, and Garlic. Many of these supplements have been studied for their ability to improve immunity by limiting inflammation or by enhancing the body’s defense against damaging compounds, such as free radicals. Two exceptions to this list are Vitamin D and Garlic, both of which are primarily known for their ability to help the body manage or resist infections. A group of supplements that individually have been studied to a lesser degree on this topic, but that collectively present a noteworthy body of evidence, are adaptogens. Adaptogenic plants (such as Eleuthero, Ginseng, Ashwagandha, Rhodiola rosea, and Astragalus) are thought to work primarily through their ability to help the body adapt to stress.[10]

    How can diet affect immune health?

    Diet can impact most physical functioning, so it’s no surprise that it can also play a role in immune health. Similar to the ways supplements have been studied, the focus has been on the ability of nutrients to either reduce susceptibility to infection or to enhance healing through modulating inflammation and oxidation. Current research suggests that when part of the diet, plant-based compounds such as flavonoids may reduce incidence, duration, and severity of upper respiratory infection.[11] Foods like blueberries and grapes tend to be high in flavonoids (anthocyanidins and flavonols), which have antioxidant properties that may enhance immune health. Beyond flavonoids and their antioxidant capacity, complete plant-based diets, such as the Autoimmune Protocol and vegan diets, are full of phytochemicals, fiber, vitamins, and minerals, all of which can contribute to immune health.[12] Alterations in the gut microbiome may also play a role in immune health,[13] which could explain why diets that include probiotic-rich foods, such as Kefir, have potential immune-enhancing effects

    What other factors affect immune health?

    Stress exposure, sleep, and metabolic health all have both distinct and overlapping effects on immune health. Sleep has a profound effect on the immune system, and consistently getting enough of it can improve the ability to fight off infections (or avoid them altogether) and increase the efficacy of vaccines.[14] Excessive stress (either psychological or physiological) can have positive or negative effects on immune health, depending on the type of exposure. For example, temporary stress from exercise or public speaking can have positive effects on immune health,[15] while chronic stress exposure can impair immune health by limiting the ability of the immune system to fight off infections and/or increasing the risk of autoimmune disease.[16] Metabolic health — in particular the ability of the body to regulate blood sugar levels — also plays a significant role in immune health, since impaired blood sugar control and insulin resistance have widespread negative effects on the immune system.[17]

    Examine Database: Immune Health

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    Frequently asked questions

    What is immune health?

    Immune health describes the immune system’s ability to heal and preserve bodily function when confronted by infection, injury (wound healing), and even malignancy. Our body relies on multiple levels of defense. These levels include physical barriers (skin and mucous membranes), inflammatory response inflammation, cellular response, and cellular adaptation.[1] Moderation and balance in these different levels of defense are key to optimal immune health. When the immune response is inadequate, this can open the door for infection by harmful pathogens. In contrast, an overzealous immune response could break tolerance of the immune system to ‘self’ molecules in the body, resulting in autoimmune disease. When it comes to immune health, balance is the key.[2]

    How is immune health measured?

    Healthy immune response includes the ability to accurately determine what is harmful to the body, adapt to changes in the environment, manage infections, and retain memory of what foreign cells cause damage.[2] One approach to quantifying immune health is by measuring biomarkers in blood that reflect each of these facets of the immune response. These biomarkers may include: leukocytes, lymphocytes, cytokines, T-cells, natural killer (NK) cells, monocytes, C-reactive protein, and antibodies. An important consideration here is that these biomarkers may be elevated as part of a healthy immune response, for example, to an infection. Concern may be warranted if there is an abnormally high level of inflammatory biomarkers or if they’ve been circulating at a higher than average level for an extended time.[3] [4]

    Beyond blood tests, perceived immune status is a subjective assessment that may be more accessible to those outside of the clinical setting. The Immune Status Questionnaire (ISQ) was published in 2019, and is a validated self-assessment that may help individuals determine if they should seek medical attention, make lifestyle changes, or take further action to improve immune health.[5]

    How does physical activity affect immune health?

    Current research suggests that when it comes to exercise for immune health, moderation, balance, and consistency are key. Moderate exercise has been shown to have numerous benefits on immune health. Although physical activity is a stressor that does incite an immune response, the degree of the immune response and whether it’s harmful or helpful to immune health can be situationally dependent.

    The current understanding is that consistent, moderate to vigorous intensity exercise (<60 minutes in length) is beneficial for immune health and can enhance adaptive immunity, thereby improving protection from community acquired illness and increasing the efficacy of vaccines.[6][7] Muscle contraction is also beneficial to immune health by releasing helpful immune mediators, aiding in lymphatic drainage of waste products, and possibly even diversifying the gut microbiome.[1][8] On the other hand, extreme exercise (especially in the untrained) can be detrimental to immune health. When healing from extreme exercise, the immune system becomes preoccupied and can devote fewer resources to defense.[9]

    Have any supplements been studied for immune health?

    The effects of many supplements on immune health markers have been studied, and the research is ongoing. As of 2022, some of the most frequently studied supplements for immune health include Fish Oil, Vitamin C, Colostrum, Spirulina, Astaxanthin, Reishi, Vitamin D, Vitamin E, Boron, Conjugated Linoleic Acid, and Garlic. Many of these supplements have been studied for their ability to improve immunity by limiting inflammation or by enhancing the body’s defense against damaging compounds, such as free radicals. Two exceptions to this list are Vitamin D and Garlic, both of which are primarily known for their ability to help the body manage or resist infections. A group of supplements that individually have been studied to a lesser degree on this topic, but that collectively present a noteworthy body of evidence, are adaptogens. Adaptogenic plants (such as Eleuthero, Ginseng, Ashwagandha, Rhodiola rosea, and Astragalus) are thought to work primarily through their ability to help the body adapt to stress.[10]

    How can diet affect immune health?

    Diet can impact most physical functioning, so it’s no surprise that it can also play a role in immune health. Similar to the ways supplements have been studied, the focus has been on the ability of nutrients to either reduce susceptibility to infection or to enhance healing through modulating inflammation and oxidation. Current research suggests that when part of the diet, plant-based compounds such as flavonoids may reduce incidence, duration, and severity of upper respiratory infection.[11] Foods like blueberries and grapes tend to be high in flavonoids (anthocyanidins and flavonols), which have antioxidant properties that may enhance immune health. Beyond flavonoids and their antioxidant capacity, complete plant-based diets, such as the Autoimmune Protocol and vegan diets, are full of phytochemicals, fiber, vitamins, and minerals, all of which can contribute to immune health.[12] Alterations in the gut microbiome may also play a role in immune health,[13] which could explain why diets that include probiotic-rich foods, such as Kefir, have potential immune-enhancing effects

    What other factors affect immune health?

    Stress exposure, sleep, and metabolic health all have both distinct and overlapping effects on immune health. Sleep has a profound effect on the immune system, and consistently getting enough of it can improve the ability to fight off infections (or avoid them altogether) and increase the efficacy of vaccines.[14] Excessive stress (either psychological or physiological) can have positive or negative effects on immune health, depending on the type of exposure. For example, temporary stress from exercise or public speaking can have positive effects on immune health,[15] while chronic stress exposure can impair immune health by limiting the ability of the immune system to fight off infections and/or increasing the risk of autoimmune disease.[16] Metabolic health — in particular the ability of the body to regulate blood sugar levels — also plays a significant role in immune health, since impaired blood sugar control and insulin resistance have widespread negative effects on the immune system.[17]

    How does stress (and rest) affect immune health?

    When it comes to the immune system, the effects of stress cannot be overlooked. The immune system interacts with our hormonal regulation and our nervous system in ways that we’re only beginning to understand. In fact, some of the same biomarkers that are used to evaluate immune health (such as C-reactive protein and interleukins 6 & 8) are also considered to be biomarkers of chronic stress.[18] Although exposure to certain types of stress can be healthy (exercise, adverse circumstances that make us stronger and more resilient), our stress-response is not designed to be activated all the time, and if it is, that can have negative effects on immune health. Chronic stress-induced increases in the hormone cortisol can suppress the immune system’s ability to fight off infection.[1] Environmental stressors, such as pollution, may have similar immune-suppressing effects too.[19] Some stress may be unavoidable, so getting adequate rest/recovery and managing the stress response can also be an effective approach for improving immune health.[20] Mindfulness meditation may also improve immune biomarkers through managing the stress response.[21] Similarly, immersion in nature and natural environments (like forests), also may enhance immune health, possibly through stress reduction.[22][23] More high-quality evidence is still needed on many of these interventions, but based on what we know, any activity that optimizes our relationship with stress is likely to improve immune health in turn.

    What is the role of metabolic regulation in immune health?

    Maintaining metabolic health is another important factor for having a healthy, well-functioning immune system. Under resting conditions, immune cells such as lymphocytes burn a combination of proteins, fats, and glucose for energy. During an active immune response, much of the fatty and amino acids that are utilized as fuel under resting conditions are instead used to synthesize proteins and lipids required for cell growth, causing an increased reliance on glucose metabolism for fuel.[24] The flexibility required to undergo this whole-sale metabolic shift from oxidative metabolism under resting conditions to glycolysis when the immune system becomes activated is an important factor for immune health. There is mounting evidence that immune cell function tends to suffer when “metabolic flexibility” is impaired.[25]

    Healthy regulation of glucose homeostasis is key to ensuring adequate glucose supply to the cells and tissues that need it. When glucose homeostasis is impaired, the body is less able to maintain blood sugar levels within a healthy range, which can have negative effects on immune health. Many of the effects of impaired glucose homeostasis on immune health have been brought to light through research on type 2 diabetes (T2D): people with T2D are less able to fight off invading pathogens.[17] Hyperglycemia (abnormally high blood sugar) can also impair the immune response by affecting the immune system’s ability to induce[26] or resolve[27] inflammation. Glucose is a reactive molecule that causes chemical modifications to proteins if it is allowed to accumulate to toxic levels in the blood.[28] Animal studies have suggested that hyperglycemia may promote autoimmunity through the chemical modification of major histocompatibility complex (MHC) class II proteins in immune cells,[29] which play a role in sensing and responding to foreign pathogens. While further studies are needed to confirm these findings in humans, in the animal model, autoimmunity targeted a protein associated with cholesterol transport and atherosclerosis, suggesting a possible explanation for the connection between diabetes and atherosclerosis risk.[30]

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    21. ^Black DS, Slavich GMMindfulness meditation and the immune system: a systematic review of randomized controlled trials.Ann N Y Acad Sci.(2016-06)
    22. ^Andersen L, Corazon SSS, Stigsdotter UKKNature Exposure and Its Effects on Immune System Functioning: A Systematic Review.Int J Environ Res Public Health.(2021-02-03)
    23. ^Stier-Jarmer M, Throner V, Kirschneck M, Immich G, Frisch D, Schuh AThe Psychological and Physical Effects of Forests on Human Health: A Systematic Review of Systematic Reviews and Meta-Analyses.Int J Environ Res Public Health.(2021-02-11)
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    28. ^Singh VP, Bali A, Singh N, Jaggi ASAdvanced glycation end products and diabetic complications.Korean J Physiol Pharmacol.(2014-Feb)
    29. ^Clement CC, Nanaware PP, Yamazaki T, Negroni MP, Ramesh K, Morozova K, Thangaswamy S, Graves A, Kim HJ, Li TW, Vigano' M, Soni RK, Gadina M, Tse HY, Galluzzi L, Roche PA, Denzin LK, Stern LJ, Santambrogio LPleiotropic consequences of metabolic stress for the major histocompatibility complex class II molecule antigen processing and presentation machinery.Immunity.(2021-04-13)
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    3. White Blood Cell Count - Selmi C, Leung PS, Fischer L, German B, Yang CY, Kenny TP, Cysewski GR, Gershwin METhe effects of Spirulina on anemia and immune function in senior citizensCell Mol Immunol.(2011 May)
    4. Low-density lipoprotein (LDL) - Park HJ, Lee YJ, Ryu HK, Kim MH, Chung HW, Kim WYA randomized double-blind, placebo-controlled study to establish the effects of spirulina in elderly KoreansAnn Nutr Metab.(2008)
    5. Low-density lipoprotein (LDL) - Szulinska M, Gibas-Dorna M, Miller-Kasprzak E, Suliburska J, Miczke A, Walczak-Gałezewska M, Stelmach-Mardas M, Walkowiak J, Bogdanski PSpirulina maxima improves insulin sensitivity, lipid profile, and total antioxidant status in obese patients with well-treated hypertension: a randomized double-blind placebo-controlled studyEur Rev Med Pharmacol Sci.(2017 May)
    6. TNF-Alpha - Hee Jung Park, Hyun Sook LeeMonocyte chemoattractant protein-1 polymorphism interaction with spirulina immunomodulatory effects in healthy Korean elderly: A 16 week, double-blind randomized clinical trialNutr Res Pract.(2017 Aug)
    7. Natural Killer Cell Activity - Nielsen CH, Balachandran P, Christensen O, Pugh ND, Tamta H, Sufka KJ, Wu X, Walsted A, Schjørring-Thyssen M, Enevold C, Pasco DSEnhancement of natural killer cell activity in healthy subjects by Immulina®, a Spirulina extract enriched for Braun-type lipoproteinsPlanta Med.(2010 Nov)
    8. Natural Killer Cell Content - Artur Juszkiewicz, Piotr Basta, Elżbieta Petriczko, Bogusław Machaliński, Jerzy Trzeciak, Karolina Łuczkowska, Anna Skarpańska-StejnbornAn attempt to induce an immunomodulatory effect in rowers with spirulina extractJ Int Soc Sports Nutr.(2018 Feb 20)
    9. Interferon Gamma - T K Mao, J Van de Water, M E GershwinEffects of a Spirulina-based dietary supplement on cytokine production from allergic rhinitis patientsJ Med Food.(Spring 2005)
    10. White Blood Cell Count - Kianbakht S, Ghazavi AImmunomodulatory effects of saffron: a randomized double-blind placebo-controlled clinical trialPhytother Res.(2011 Dec)
    11. TNF-Alpha - Hajieh Shahbazian, Armaghan Moravej Aleali, Reza Amani, Foroogh Namjooyan, Bahman Cheraghian, Seyed Mahmoud Latifi, Sara Bahrainian, Ataallah GhadiriEffects of saffron on homocysteine, and antioxidant and inflammatory biomarkers levels in patients with type 2 diabetes mellitus: a randomized double-blind clinical trialAvicenna J Phytomed.(Sep-Oct 2019)
    12. White Blood Cell Count - Perche O, Vergnaud-Gauduchon J, Morand C, Dubray C, Mazur A, Vasson MPOrange juice and its major polyphenol hesperidin consumption do not induce immunomodulation in healthy well-nourished humansClin Nutr.(2013 Mar 26)
    13. Interleukin 6 - Buzdağlı Y, Eyipınar CD, Kacı FN, Tekin AEffects of hesperidin on anti-inflammatory and antioxidant response in healthy people: a meta-analysis and meta-regression.Int J Environ Health Res.(2022-Jun-28)
    14. Interleukin 6 - Lorzadeh E, Ramezani-Jolfaie N, Mohammadi M, Khoshbakht Y, Salehi-Abargouei AThe effect of hesperidin supplementation on inflammatory markers in human adults: A systematic review and meta-analysis of randomized controlled clinical trials.Chem Biol Interact.(2019-Jul-01)
    15. White Blood Cell Count - Ishikawa H, Saeki T, Otani T, Suzuki T, Shimozuma K, Nishino H, Fukuda S, Morimoto KAged garlic extract prevents a decline of NK cell number and activity in patients with advanced cancerJ Nutr.(2006 Mar)
    16. TNF-Alpha - Nantz MP, Rowe CA, Muller CE, Creasy RA, Stanilka JM, Percival SSSupplementation with aged garlic extract improves both NK and γδ-T cell function and reduces the severity of cold and flu symptoms: a randomized, double-blind, placebo-controlled nutrition interventionClin Nutr.(2012 Jun)
    17. Nitric Oxide - Mau Bhattacharyya, G V Girish, Soumendra K Karmohapatra, S A Samad, Asru K SinhaSystemic production of IFN-alpha by garlic (Allium sativum) in humansJ Interferon Cytokine Res.(2007 May)
    18. White Blood Cell Count - Jensen GS, Patel D, Benson KFA novel extract from bovine colostrum whey supports innate immune functions. II. Rapid changes in cellular immune function in humansPrev Med.(2012 May)
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    37. White Blood Cell Count - A Juszkiewicz, A Glapa, P Basta, E Petriczko, K Żołnowski, B Machaliński, J Trzeciak, K Łuczkowska, A Skarpańska-StejnbornThe effect of L-theanine supplementation on the immune system of athletes exposed to strenuous physical exerciseJ Int Soc Sports Nutr.(2019 Feb 15)
    38. Heart Rate - Kimura K, Ozeki M, Juneja LR, Ohira HL-Theanine reduces psychological and physiological stress responsesBiol Psychol.(2007 Jan)
    39. White Blood Cell Count - Spiller GA, Dewell ASafety of an astaxanthin-rich Haematococcus pluvialis algal extract: a randomized clinical trialJ Med Food.(2003 Spring)
    40. White Blood Cell Count - Chen JT, Kotani KEffects of Astaxanthin on Liver and Leukocyte Parameters in Healthy Climacteric Women: Preliminary DataJ Med Food.(2017 Jul)
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    45. Tuberculosis Symptoms - Ganmaa D, Giovannucci E, Bloom BR, Fawzi W, Burr W, Batbaatar D, Sumberzul N, Holick MF, Willett WCVitamin D, tuberculin skin test conversion, and latent tuberculosis in Mongolian school-age children: a randomized, double-blind, placebo-controlled feasibility trialAm J Clin Nutr.(2012 Aug)
    46. Low-density lipoprotein (LDL) - Zittermann A, Frisch S, Berthold HK, Götting C, Kuhn J, Kleesiek K, Stehle P, Koertke H, Koerfer RVitamin D supplementation enhances the beneficial effects of weight loss on cardiovascular disease risk markersAm J Clin Nutr.(2009 May)
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    49. Interleukin 5 - Barker T, Martins TB, Hill HR, Kjeldsberg CR, Henriksen VT, Dixon BM, Schneider ED, Dern A, Weaver LKDifferent doses of supplemental vitamin D maintain interleukin-5 without altering skeletal muscle strength: a randomized, double-blind, placebo-controlled study in vitamin D sufficient adultsNutr Metab (Lond).(2012 Mar 9)
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    55. TNF-Alpha - Kelley DS, Taylor PC, Nelson GJ, Schmidt PC, Ferretti A, Erickson KL, Yu R, Chandra RK, Mackey BEDocosahexaenoic acid ingestion inhibits natural killer cell activity and production of inflammatory mediators in young healthy menLipids.(1999 Apr)
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    95. TNF-Alpha - Josep Bassaganya-Riera, Raquel Hontecillas, William T Horne, Mikki Sandridge, Hans H Herfarth, Richard Bloomfeld, Kim L IsaacsConjugated linoleic acid modulates immune responses in patients with mild to moderately active Crohn's diseaseClin Nutr.(2012 Oct)
    96. TNF-Alpha - Smedman A, Basu S, Jovinge S, Fredrikson GN, Vessby BConjugated linoleic acid increased C-reactive protein in human subjectsBr J Nutr.(2005 Nov)
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    113. Interleukin 6 - Federico Soriguer, Carolina Gutiérrez-Repiso, Elehazara Rubio-Martin, Francisca Linares, Isabel Cardona, Jaime López-Ojeda, Marta Pacheco, Stella González-Romero, Maria J Garriga, Ines Velasco, Piedad Santiago, Eduardo García-FuentesIodine intakes of 100-300 μg/d do not modify thyroid function and have modest anti-inflammatory effectsBr J Nutr.(2011 Jun 28)
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    118. Upper Respiratory Tract Infection Symptoms - Hall H, Fahlman MM, Engels HJEchinacea purpurea and mucosal immunityInt J Sports Med.(2007 Sep)
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