The word immunity has unfortunately become an all-too-common term in our vocabulary, and for good reason. When the pandemic hit, many of the major drug companies created vaccines that offered us “immunity” against this specific virus. Yet, few of us understand that almost all these vaccines work based upon their activating our own built-in systems of defense. It is our very own immunity to these viruses that can make the difference between illness and health. To help clarify what each of us can do to protect ourselves and our loved ones, Pamela Wartian Smith, MD has written Max Your Immunity. Here is a complete guide to understanding and maximizing your natural defenses against various infectious diseases.

Max Your Immunity is divided into three parts. Part One explains how our innate and adaptive immunity systems work. Our innate immunity system is based on our built-in barriers designed to fight or separate us from infectious agents. Our adaptive immunity, also called acquired immunity, is composed of lymphocyte cells that are triggered when a specific pathogen enters the body. These cells learn to identify the invading pathogens and hunt them down. In this section, each component in both systems are clearly identified and explained. Part Two provides ten important things that you can do to increase and strengthen all of these components. And Part Three provides specific nutritional plans to increase your body’s immunity to help defend against the most common health disorders.

By simply having a clear understanding of how our internal defenses work and what we can do to increase our immunity, we can play an important role in maintaining good health. Max Your Immunity can help show you what you need to know to protect yourself and your family.

Pamela Wartian Smith, MD, MPH, MS, is a diplomate of the American Academy of Anti-Aging Physicians and past co-director of the Master's Program in Medical Sciences, with a concentration in Metabolic and Nutritional Medicine, at the Morsani College of Medicine, University of South Florida. An authority on the subjects of wellness and functional medicine, she is also the founder of the Fellowship in Anti-Aging, Regenerative, and Functional Medicine. Dr. Smith is the best-selling author of ten books, including What You Must Know About Vitamins, Minerals, Herbs & So Much More; What You Must Know About Women's Hormones; and What You Must Know About Memory Loss.

Contents 

Acknowledgments, vii

Introduction, 1

PART 1
How Your Immune System Works

1. What Makes Up Your Immune System?, 5

2. What Is an Autoimmune Disease?, 17

3. How Is Your Immune System Measured?, 23

4. Does Your Immune System Change With Age?, 27

PART 2
Lifestyle Changes to Strengthen Your Immunity

5. Alcohol: Moderation Is the Key to Health, 33

6. Exercise: Whether You Like It or Not, 38

7. Your Gut: A Healthy Gut Equals a Healthy Immune System, 54

8. Inflammation: Its Effect on the Immune System, 86

9. Sleep: Get a Good Night’s Sleep, 110

10. Smoking: How It Affects the Immune System, 123

11. Stress: Manage Your Stress, 129

12. Sugar: Minimize Your Intake for Healthy Eating, 138

13. Thyroid: Optimize Its Function, 146

14. Water: Stay Hydrated, 164

PART 3
Herbal and Nutritional Therapies for Immune Building

HERBAL THERAPIES

Astragalus, 172

Cordyceps, 173

Echinacea, 175

Elderberry, 176

Garlic, 177

Ginseng, 179

Goldenseal, 183

Glycyrrhizin, 185

Olive Leaf Extract, 189

Oregano, 190

NUTRITIONAL THERAPIES

Arginine, 193

Carnitine, 196

Chromium, 199

Cysteine, 199

Glutamine, 201

Manganese, 203

Selenium, 206

Vitamin A, 208

Vitamin D, 210

Zinc, 212

OTHER NUTRIENTS

Beta Glucans, 217

Carnosine, 219

Colostrum, 220

Glutathione, 222

Sulforaphane, 224

THERAPIES THAT DECREASE INFLAMMATION

Aloe Vera, 226

American Skullcap, 227

Boswellia, 228

Cayenne Pepper, 229

Chinese Skullcap, 232

Curcumin, 233

Feverfew, 235

Fish Oil, 236

Ginger, 237

Green Tea, 238

N-Acetyl Cysteine, 240

Pomegranate, 244

Pycnogenol, 246

Resveratrol, 247

Rosemary, 249

Thyme, 251

White Willow Bark Extract, 252

Conclusion, 255

Resources, 259

References, 263

About the Author, 264

Index, 265

"A guide, written for lay readers, to good lifestyle habits anyone can adopt to better support their own immune system, especially amid threats such as the ongoing COVID-19 pandemic . . . it should be emphasized that Max Your Immunity is absolutely not an anti-vaccination or anti-mask book - it simply focuses on good health habits that work well in addition to vaccination and wearing masks . . . an excellent supplementary resource for personal health and wellness collections, highly recommended."

Introduction Most people have become more interested in their health and even specifically in their immune system with the advent of the COVID-19 virus into the world. How can you build your immune system so that you do not develop this or other infectious diseases? If you do catch COVID19, how do you maximize your immune system so that hopefully you do not have as severe a case of this potentially lethal illness? The immune system is composed of specific cells and organs that ward off invaders. Normally it does a wonderful job of keeping you healthy and preventing infections and illnesses by guarding the body against everyday germs and microbes. Unlike many other parts of your body, where cells of various functions are located in areas that can be easily defined, the distribution of immune cells into various organs is more complicated. A great deal of research has recently focused on understanding the individual cell types within the immune system and identifying interacting cells and the messengers they use to communicate. In this book, Max Your Immunity, you will learn proven therapies to increase your body’s ability to fight off disease. In addition, you will discover how to restore and increase your immunity without developing an overactive immune system. Part 1 of this book discusses the role your immune system plays. How does the immune system work? What are the innate and adaptive parts of the immune system? What are T cells, B cells, natural killer cells, and other cell lines you may not have heard of? What is an autoimmune disease? How is your immune system measured? Does you immune system change with age? All of these questions will be discussed at length in this section of the book. It may surprise you that currently the number-one cause of disease in the United States and most industrialized countries is your immune system trying to protect you. It is all about balance. An overactive immune system leads to an autoimmune disease process. An underactive immune system leads to an increase in infection rate and risk of developing cancer. Furthermore, a varietyof changes are observed in the immune system, which translate into less effective innate and adaptive immune responses and increased susceptibility to infections. The capability to cope with infectious agents and cancer cells resides not only in adaptive immune responses against specific antigens, mediated by T and B lymphocytes, but also in innate immune reactions. Moreover, an age-related decline in immune functions, referred to as immunosenescence, is partially responsible for the increased prevalence and severity of infectious diseases, and the low efficacy of vaccination in older individuals. In short, this section of the book provides a comprehensive reference map defining the organization and balance of the immune system. Part 2 examines lifestyle changes and other considerations that can strengthen your immunity; from managing your stress, to optimizing gastrointestinal health, to minimizing sugar intake and alcohol intake, and a great deal more. Many of the ten keys discussed in this section can be employed on your own without a healthcare provider’s input. It is always best, however, to keep your doctor, or other healthcare professional, updated on changes in diet and other factors that you may implement to help heal and build your immune system. Part 3 reviews herbal and nutritional therapies for building immunity. Research has shown repeatedly that nutritional deficiencies or inadequacies can cause your immune system not to function perfectly. Insufficient intake of micronutrients occurs for many reasons. In addition, new studies have shown that for certain nutrients higher doses may be needed to optimize immune functions, including improving immune defense and resistance to infection. Likewise, many of these nutrients and herbal remedies help to maintain or improve immune function through different modalities of action; for example, inhibition of pro-inflammatory mediators, alteration of antigen-presenting cell function, anti-inflammatory action, modulation of cell-mediated immunity, as well as communication between the innate and adaptive immune systems. To be specific, micronutrient deficiencies suppress immune functions by affecting the innate T cell-mediated immune response and adaptive antibody response, which leads to an imbalance of the immune system. This increases your susceptibility to infections, along with an escalation in morbidity and mortality. Consequently, adequate intake of vitamins and minerals are required for the immune system to function efficiently. Last, extensive sources of scientific studies, academic papers, and books have been used in writing Max Your Immunity. Therefore, you can review the medical literature on your own and also give a copy of this book to your healthcare provider in order to aid all in the worthwhile goal of optimizing your immune system.

References

Introduction

Cunningham-Rundles, S., et al., “Mechanisms of nutrient modulation of the immune response,” Jour Allergy Clin Immunol 2005; 115(6):1119-28.

Weiskopf, D., et al., “The aging of the immune system,” Transpl Int 2009; 22(11):1041-50.

Wintergerst, E., “Contribution of selected vitamins and trace elements to immune function,” Ann Nutr Metab 2007; 51(4):301-23.

PART 1

Chapter 1: What Makes Up Your Immune System?

"Cytokine" in Stedman’s Medical Dictionary, 28th Ed., Wolters Kluwer Health, Lippincott, Williams & Wilkins, 2006.

Badawi, A., “Hypercytokinemia and pathogen-host interaction in COVID-19,” Jour Inflamm Res 2020; 13:255-61.

Brodin, P., “Human immune system variation.” Nat Rev Immunol 2017; 17(1):21-9.

Castillo, J., "Plasma cell disorders,” Primary Care 2016; 43(4): 677–91.

Chen, W., “Tregs in immunotherapy: opportunities and challenges,” Immunotherapy 2011; 3(8):911-14.

Harwood, N., et al., “Early events in B cell activation,” Ann Rev Immunol 2010; 28(1):185–210.

Kurosaki, T., et al., "Memory B cells,” Nat Rev Immunol 2015; 15(3):149–59.

Liu, Q., et al., "The cytokine storm of severe influenza and development of immunomodulatory therapy," Cell Mol Immunol 2016; 13(1):3–10.

Mehta, P., et al., “"COVID-19: consider cytokine storm syndromes and immunosuppression," Lancet 2020;  395(10229):1033–034. 

Orange, J., “Natural killer cell deficiency,” Jour Allergy Clin Immunol 2013; 132(3):515-25.

Randolph, H., et al., “Herd immunity: Understanding COVID-19,” Immunity 2020; 52(5):737-41.

Ruan, Q., et al., "Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China," Intensive Care Med 2020; 46(5):846–48.

Shelly, A., et al., “Impact of microbiota: A paradigm for evolving herd immunity against viral diseases,” Viruses 2020; 12(10):1150.

Terunuma, H., et al., “Potential role of NK cells in the induction of immune responses: implications for NK cell-based immunotherapy for cancers and viral infections,” Int Rev Immunol 2008; 27(3):93-110.

Tisoncik, J., et al., “Into the eye of the cytokine storm," Microbiol Molecular Biol Rev 2012; 76(1):16–32.

van den Broek, T., “The full spectrum of human naive T cells,” Nat Rev Immunol 2018;  18(6): 363–73.

Vignali, D., et al., “How regulatory T cells work,” Nat Rev Immunol 2008; 8:523-32.

Vivier, E., et al., “Functions of natural killer cells,” Nat Immunol 2008; 9(5):503-10.

Vivier, E., et al., “Natural killer cell signaling pathways,” Science 2004; 306(5701):1517-19.

Wong, J., et al., "Current and future developments in the treatment of virus-induced hypercytokinemia," Future Medicinal Chem 2017; 9(2):169–78. 

Chapter 2: What Is An Autoimmune Disease?

Cooper, G., et al., “The epidemiology of autoimmune diseases,” Autoimmune Rev 2003; 2(3):119-25.

Fasano, A., “Leaky gut and autoimmune diseases,” Clin Rev Allergy Immunol 2012; 42(1):71-8.

Rosenblum, M., et al., “Treating human autoimmunity: Current practice and future prospects,” Sci Transl Med 2012; 4(125):125.

Smith, D., et al., “Introduction to immunology and autoimmunity,” Environ Health Perspect 1999; 107(Suppl 5):661-65.

Walsh, S., et al., “Autoimmune diseases: A leading cause of death among young and middle-aged women in the United States,” Amer Jour Public Health 2000; 90:1463–66.

Wang, L., et al., “Human autoimmune diseases a comprehensive update,” Jour Inter Med 2015; 278(4):369-95.

Chapter 3: How Is Your Immune System Measured?

Bieber, K., et al., “Insights how monocytes and dendritic cells contribute and regulate immune defense against microbial pathogens,” Immunobiology 2015; 220(2):215-26.

Brodin, P., “New approaches to the study of immune responses in humans,” Human Genet 2020; 139(6-7):795-99.

Brodin, P., et al., “Human immune system,” Nat Rev Immunol 2017; 17(1):21-9.

Chaussabel, D., et al., “Assessing the human immune system through blood transcriptomics,” BMC Biol 2010; 8(84).

Gregersen, P., et al., “Recent advances in the genetics of autoimmune disease,” Annu Rev Immunol 2009; 27:363-91.

Orange, J., “Natural killer cell deficiency,” Jour Allergy Clin Immunol 2013; 132(3):515-25.

Pearce, E., et al., “Dendritic cell metabolism,” Nat Rev Immunol 2015; 15(1):18-29.

Schroeder, H., et al., “Structure and function of immunoglobulins,” Jour Aller Clin Immunol 2010; 125(2 Suppl 2):S41-S52.

Vivier, E., et al., “Functions of natural killer cells,” Nat Immunol 2008; 9(5):503-10.

Vivier, E., et al., “Natural killer cell signaling pathways,” Science 2004; 306(5701):1517-19.

Zhernakova, A., et al., “Detecting shared pathogenesis from the shared genetics of immune-related diseases,” Nat Rev Genet 2009; 10:43-55.

Chapter 4: Does Your Immune System Change With Age?

Bruunsgaard, H., "Decreased natural killer cell activity is associated with atherosclerosis in elderly humans,” Exp Gerontol 2001; 37(1):127–36.

Gibson, K., et al., "B cell diversity decreases in old age and is correlated with poor health status," Aging Cell 2009; 8(1):18–25.

Ginaldi, L. et al., "Immunosenescence and infectious diseases,”Microbes Infection 2001; 3(10):851–57.

Ginaldi, L., et al., “The immune system in the elderly: III Innate immunity,” Immunol Res 1999; 20(2):117-26.

Hakim, F., et al., "Immunosenescence: deficits in adaptive immunity in elderly,” Tissue Antigens 2007; 70(3):179–89.

Hazeldine, J., et al., “The impact of ageing on natural killer cell function and potential consequences for health in older adults,” Ageing Res Rev 2013; 12(4):1069-78.

Kale, A., et al., “Role of immune cells in the removal of deleterious senescent cells,” Immun Ageing 2020; 17:16.

Lord, J., et al., "Neutrophil ageing and immunesenescence,” Mech Ageing Dev 2001; 122(14):1521–35.

Pangrazzi, L., et al., “T cells, aging and senescence,” Exp Gerontol 2020; 134:110887.

Solana, R., et al., “Innate immunosenescence: effect of aging on cells and receptors of the innate immune system in humans,” Semin Immunol 2012; 24(5):331-41.

Strout, R., et al., "Immunosenescence and macrophage functional plasticity: dysregulation of macrophage function by age-associated microenvironmental changes," Immunol Rev 2005; 205:60–71.

Uyemura, K., et al., "The frail elderly: role of dendritic cells in the susceptibility of infection,” Mech Ageing Dev 2002; 123(8):955–62.

Weng, N., "Aging of the immune system: How much can the adaptive immune system adapt?" 2006; Immunity 24(5):495–99.

PART 2

Chapter 5: Alcohol

American Cancer Society 2020.

Barr, T., et al., “Opposing effects of alcohol on the immune system,” Prog Neuropsychopharmacol Biol Psychiatry 2016; 65:242-51.

Bhatty, M., et al., “Alcohol abuse and streptococcus pneumoniae infections: Consideration of virulence factors and impaired immune responses,” Alcohol 2011; 45(6):523-39.

Bykov, I., et al., “Effect of chronic ethanol consumption on the expression of complement components and acute-phase proteins in liver,” Clin Immunol 2007; 124(2):213–20.

Choudhry, M., et al., “Impaired intestinal immunity and barrier function: A cause for enhanced bacterial translocation in alcohol intoxication and burn injury,” Alcohol 2004; 33(3):199–208.

Cook, R., “Alcohol abuse, alcoholism, and damage to the immune system: A Review,” Alcohol Clin Exp Res 1998; 22(9):1927-42.

Cook, R., et al., “Ethanol and natural killer cells. I. Activity and immunophenotype in alcoholic humans,” Alcoholism: Clin Experiment Res 1997; 21(6):974–80.

Cook, R., et al., “Loss of the CD5+ and CD45RAhi B cell subsets in alcoholics,” Clin Experiment Immunol 1996; 103(2):304–10.

Coronado, G., et al., “Alcohol consumption and the risk of breast cancer,” Salud Publica Mex 2011; 53(5):440-47.

Curtis, B., et al., “Epigenetic targets for reversing immune defects caused by alcohol exposure,” Alcohol Res 2013; 35(1):97-113.

Deandrea, S., et al., “Alcohol and breast cancer risk defined by estrogen and progesterone receptor status: a case-control study,” Cancer Epidemiol Biomarkers Prev 2008; 17(8):2025–28.

Domínguez-Santalla, M., et al., “Increased serum IgE in alcoholics: Relationship with Th1/Th2 cytokine production by stimulated blood mononuclear cells,” Alcoholism: Clin Experiment Res 2001; 25(8):1198–1205.

Dorgan, J., et al., “Serum hormones and the alcohol-breast cancer association in postmenopausal women,” Jour Natl Cancer Inst 2001; 93(9):710–15.

Dumitrescu, R., et al., “The etiology of alcohol-induced breast cancer,” Alcohol 2005;35(3):213-25.

Fan, S., et al., “Alcohol stimulates estrogen receptor signaling in human breast cancer cell lines,” Cancer Res 2000; 60(20):5635–39.

Frydenberg, H., et al., “Alcohol consumption, endogenous estrogen and mammographic density among premenopausal women,” Breast Cancer Res 2015; 17:103.

Gao, B., et al., “Liver natural killer and natural killer T cells: Immunobiology and emerging roles in liver diseases,” Jour Leukocyte Biol 2009; 86(3):513–28.

Ginsburg, E., et al., “Effects of alcohol ingestion on estrogens in postmenopausal women,” JAMA 1996; 276(21):1747–51.

Hankinson, S., et al., “Alcohol, height, and adiposity in relation to estrogen and prolactin levels in postmenopausal women,” Jour Natl Cancer Inst 1995; 87(17):1297–1302.

Happel, K., et al., “Acute alcohol intoxication suppresses the interleukin 23 response to Klebsiella pneumoniae infection,” Alcoholism: Clin Experiment Res 2006; 30(7):1200–07.

Holguin, F., et al., “Chronic ethanol ingestion impairs alveolar type II cell glutathione homeostasis and function and predisposes to endotoxin-mediated acute edematous lung injury in rats,” Jour Clin Invest 1998;101(4):761–68.

Jaruga, B., et al., “Chronic alcohol consumption accelerates liver injury in T cell-mediated hepatitis: Alcohol dysregulation of NF-kappaB and STAT3 signaling pathways,” Amer Jour Physiology Gastrointestinal Liver Physiol 2004;287(2):G471–G479.

Jerrells, T., et al., “Role of activated CD8+ T cells in the initiation and continuation of hepatic damage,” Alcohol 2002; 27(1):47–52.

Joshi, P., et al., “The alcoholic lung: Epidemiology, pathophysiology, and potential therapies,” Amer Jour Physiology Lung Cell Mol Physiol 2007;292(4):L813–L823.

Keshavarzian, A., et al., “Leaky gut in alcoholic cirrhosis: A possible mechanism for alcohol-induced liver damage,” Amer Jour Gastroenterol 1999; 94(1):200–07.

Kwan, M., et al., “Alcohol consumption and breast cancer recurrence and survival among women with early-stage breast cancer: the life after cancer epidemiology study,” Jour Clin Oncol 2010; 28(29):4410–16.

Laso, F., “Chronic alcohol consumption is associated with changes in the distribution, immunophenotype, and the inflammatory cytokine secretion profile of circulating dendritic cells,” Alcoholism: Clin Experiment Res 2007;31(5):846–54.

Lau, A., et al., “Antigen-presenting cells under the influence of alcohol,” Trends Immunol 2009; 30(1):13–22.

Lew, J., et al., “Alcohol and risk of breast cancer by histologic type and hormone receptor status in postmenopausal women: the NIH-AARP Diet and Health Study,” Amer Jour Epidemiol 2009; 170(3):308–17.

Li, C., et al., “Alcohol consumption and risk of postmenopausal breast cancer by subtype: the women's health initiative observational study,” Jour Natl Cancer Inst 2010; 102(18):1422–31.

Lopez, M., et al., “Modification of lymphocyte subsets in the intestinal-associated immune system and thymus by chronic ethanol consumption,” Alcoholism: Clin Experiment Res 1994; 18(1):8–11.

MacGregor, R., et al., “Effect of ethanol on functions required for the delivery of neutrophils to sites of inflammation,” Jour Infect Dis 1988; 157(4):682–89.

Mandrekar, P., et al., “Inhibition of lipopolysaccharide-mediated NFkappaB activation by ethanol in human monocytes,” International Immunol 1999; 11:1781–90.

Mandrekar, P., et al., “Inhibition of myeloid dendritic cell accessory cell function and induction of T cell anergy by alcohol correlates with decreased IL-12 production,” Jour Immunol 2004; 173(5):3398–3407.

Meyerholz, D., et al., “Chronic alcohol consumption increases the severity of murine influenza virus infections,” Jour Immunol 2008; 181(1):641–48.

Minagawa, M., et al., “Activated natural killer T cells induce liver injury by Fas and tumor necrosis factor-alpha during alcohol consumption,” Gastroenterology 2004; 126(5):1387–99.

Molina, P., et al., “Focus on: Alcohol and the immune system,” Alcohol Res Health 2010; 33(1-2):97-108.           

Moss, M., et al., “The role of chronic alcohol abuse in the development of acute respiratory distress syndrome in adults,” JAMA 1996; 275(1):50–4.

Muti, P., et al., “Alcohol consumption and total estradiol in premenopausal women,” Cancer Epidemiol Biomarkers Prev 1998; 7(3):189–93.

Nagy, L., et al., “Stabilization of tumor necrosis factor-alpha mRNA in macrophages in response to chronic ethanol exposure,” Alcohol 2004; 33(3):229–33.

Nelson, S., et al., “Alcohol, host defense and society,” Nat Rev Immunol 2002; 2(3):97-113.

Nelson, S., et al., “The effects of acute and chronic alcoholism on tumor necrosis factor and the inflammatory response,” Jour Infect Dis 1989; 160(3):422–29.

Pan, H., et al., “Chronic ethanol consumption inhibits hepatic natural killer cell activity and accelerates murine cytomegalovirus-induced hepatitis,” Alcoholism: Clin Experiment Res 2006; 30(9):1615–23.

Perlino, C., et al., “Alcoholism, leukopenia, and pneumococcal sepsis,” Amer Rev Resp Dis 1985; 132(4):757–60.

Prakash, O., et al., “Hepatitis C virus (HCV) and human immunodeficiency virus type 1 (HIV-1) infections in alcoholics,” Front Biosci 2002; 7:e286–e300.

Pritchard, M., et al., “Role of complement in ethanol-induced liver injury,” Adv Experimental Med Biol 2008; 632:175–86.

Quinton, L., et al., “Effects of systemic and local CXC chemokine administration on the ethanol-induced suppression of pulmonary neutrophil recruitment,” Alcoholism: Clin Experiment Res 2005; 29(7):1198–1205.

Rao, R., “Endotoxemia and gut barrier dysfunction in alcoholic liver disease,” Hepatology 2009; 50(2):638–44.

Rao, R., et al., “Recent advances in alcoholic liver disease. Role of intestinal permeability and endotoxemia in alcoholic liver disease,” Amer Jour Physiol Gastrointestinal Liver Physiology 2004; 286(6):G881–G884.

Reichman, M., et al., “Effects of alcohol consumption on plasma and urinary hormone concentrations in premenopausal women,” Jour Natl Cancer Inst 1993; 85(9):722–27.

Rohan, T., et al., “Alcohol consumption and risk of breast cancer: a cohort study,” Cancer Causes Control 2000; 11(3):239-47.

Romeo, J., et al., “Moderate alcohol consumption and the immune system: A review,” Brit Jour Nutr 2007; 98(Suppl 1):S111–S115.

Sander, M., et al., “Suppression of interleukin-6 to interleukin-10 ratio in chronic alcoholics: Association with postoperative infections,” Intensive Care Med 2002; 28(3):285–92.

Seitz, H., et al., “The relationship between alcohol metabolism, estrogen levels, and breast cancer risk,” Alcohol Res Health 2007; 30(1):42–3.

Shuper, P., et al., “Causal considerations on alcohol and HIV/AIDS: A systematic review,” Alcohol & Alcoholism 2010; 45(2):159–66.

Singal, A., et al., “Mechanisms of synergy between alcohol and hepatitis C virus,” Jour Clin Gastroenterol 2007; 41(8):761–72.

Singletary, K., et al., “Effect of ethanol on proliferation and estrogen receptor-alpha expression in human breast cancer cells,” Cancer Lett 2001; 165(2):131–37.

Siu, L., et al., “Hepatitis C virus and alcohol,” Seminars Liver Dis 2009; 29(2):188–99.

Spies, C., et al., “Effects of ethanol on cytokine production after surgery in a murine model of gram-negative pneumonia,” Alcoholism: Clin Experiment Res 2008;32(2):331–38.

Starkenburg, S., et al., “Early alteration in leukocyte populations and Th1/Th2 function in ethanol-consuming mice,” Alcoholism: Clin Experiment Res 2001; 25(8):1221–30.

Suzuki, R., et al., “Alcohol intake and risk of breast cancer defined by estrogen and progesterone receptor status–a meta-analysis of epidemiological studies,” Int Jour Cancer 2008;122(8):1832–41.

Szabo, G., et al., “A recent perspective on alcohol, immunity, and host defense,” Alcohol Slin Exp Res 2009; 33(2):220-32.

Szabo, G., et al., “Acute alcohol consumption inhibits accessory cell function of monocytes and dendritic cells,” Alcoholism: Clin Experiment Res 2004; 28(5):824–48.

Szabo, G., et al., “Focus on: Alcohol and the immune system,” Alcohol Res Health 2010; 33(1-2):97-108.

Szabo, G., et al., “Reduced alloreactive T-cell activation after alcohol intake is due to impaired monocyte accessory cell function and correlates with elevated IL-10, IL-13, and decreased IFN gamma levels,” Alcoholism: Clin Experiment Res 2001; 25(12):1766–72.

Tang, Y., et al., “Effect of alcohol on miR-212 expression in intestinal epithelial cells and its potential role in alcoholic liver disease,” Alcoholism: Clin Experiment Res 2008; 32(2):355–64.

Wagner, F., et al., “Ethanol inhibits interferon-gamma secretion by human peripheral lymphocytes,” Jour Stud Alcohol 1992; 53(3):277–80.

Watson, R., t al., “Alcohol, immunomodulation, and disease,” Alcohol Alcohol 1994; 29(2):131-39.

Zhang, P., et al., “Alcohol abuse, immunosuppression, and pulmonary infection,” Current Drug Abuse Rev 2008; 1(1):56–67.

Zhao, X., et al., “Acute alcohol inhibits TNF-alpha processing in human monocytes by inhibiting TNF/TNFalpha-converting enzyme interactions in the cell membrane,” Jour Immunol 2003; 170(6):2923–31.

Zisman, D., et al., “Ethanol feeding impairs innate immunity and alters the expression of Th1- and Th2-phenotype cytokines in murine Klebsiella pneumonia,” Alcoholism: Clin Experiment Res 1998; 22(3):621–27.

Chapter 6: Exercise

Abbasi, A., et al., “Changes in spontaneous and LPS-induced ex vivo cytokine production and mRNA expression in male and female athletes following prolong exhaustive exercise,” Exerc Immunol Rev 2013; 19:8-28.

Abbasi, A., et al., “Exhaustive exercise modifies different gene expression profiles and pathways in LPS-stimulated and un-stimulated whole blood cultures,” Brain Behav Immun 2014; 39:130-41.

Agha, N., et al., “Exercise and the regulation of immune functions,” Prog Molecul Biol Translational Sci 2015; 135:355–80.

Allen, J., et al., “Exercise alters gut microbiota composition and function in lean and obese humans,” Med Sci Sports Exerc 2018; 50(4):747-57.

Baek, K., et al., “Exercise training reduces the risk of opportunistic infections after acute exercise and improves cytokine antigen recognition,” Pflugers Arch 2020; 472(2):235-44.

Booth, F., “Lack of exercise is a major cause of chronic disease,” Compr Physiol 2012; 2(2):1143-211.

Braun, L., and Cohen, M., (Eds.) Herbs and Natural Supplements. 4th Ed. Australia: Elsevier, 2015.

Brolinson, P., et al., “Exercise and the immune system,” Clin Sports Med 2007; 26(3):311-19.

Cass, S., “Alzheimer’s disease and exercise: A literature review,” Curr Sports Med Rep 2017; 16(1):19-22.

Clark, A., et al., “Exercise-induced stress behavior, gut-microbiota-brain axis and diet: a systematic review for athletes,” Jour Int Soc Sports Nutr 2016; 13:43.

Duggal, N., et al., “Can physical activity ameliorate immunosenescence and thereby reduce age-related multi-morbidity?” Nat Rev Immunol 2019; 19:563–72.

Gleeson, M., “The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease,” Nat Rev Immunol 2011; 11:607-15.

Gleeson, M., Exercise, Nutrition and Immunity. In Calder, P, Yaqoob, P., (Eds.), Diet, Immunity and Inflammation. Cambridge: Woodhead Publishing, 2013; pp. 652-685.

Hackney, A., “Hypogonadism in exercising males: Dysfunction or adaptive-regulatory adjustment?” Front Endocrinol (Lausanne) 2020; 11:11.

Janssen, J., “Impact of physical exercise on endocrine aging,” Front Horm Res 2016; 47:68-81.

Lavie, C., et al., “Sedentary behavior, exercise, and cardiovascular health,” Cir Res 2019; 124(5):799-815.

Mackinnon, L., “Chronic exercise training effects on immune function,” Med Sci Sports Exerc 2000; 32(7 Suppl):S369-76.

Mackinnon, L., “Special feature of the Olympics: effects of exercise on the immune system: overtraining effects on immunity and performance in athletes,” Immunol Cell Biol 2000; 78(5):502-09.

Martin, S., et al., “Exercise and respiratory tract viral infections,” Exerc Sport Sci Rev 2009; 37:157–64.

Matthews, C., et al., “Moderate to vigorous physical activity and the risk of upper-respiratory tract infection,” Med Sci Sports Exerc 2002; 34:1242-48.

Mehta, N., et al., “Exercise as a countermeasure for latent viral reactivation during long duration space flight,” FASEB Jour 2020; 34:2869–81.

Narula, N., et al., “Exercise and inflammatory bowel disease,” Can Jour Gastroe ...