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immune status in BFS

PostPosted: June 1st, 2014, 7:07 am
by Yuliasir
dear twitchers,
is there anybody who did a test in which detailed picture of immune status is established (immunogram)?

it is not a standard test and ususally it is performed for HIV community :))) so I doubt any of us had it, but just in case

I am asking about that becasue I read a blog of HIV+ person and he noted and confirmed by self experiment that excersises like 10 km velo per day and a diet to decrease weight resulted in significant decrease of CD4 and generally causes decrease in immune status ;)
becasue BFS seems to be somehow related to immune system status and becasue many of us are dedicated sports persosn and also use diets - well, who knows! it might be interesting to see if therer is a relationship :)))

Re: immune status in BFS

PostPosted: June 3rd, 2014, 5:42 am
by Little Lost

I haven’t been here for a while as we have moved down south into England, so been a bit busy. I would just like to say sorry if I have not answered any of the recent PMs, I am sorry, not meant to be rude just been losing my mind in a sea of removal boxes.

However saw this post last night and you did have to mention the immune system….like red rag to a bull for me, so I wanted to answer this one, though again these are just my thoughts. Not really about immunostatus in BFS just about testing, and the immune system in exercise.

As you probably know the immune system is dynamic, it displays constant fluidity to respond to an ever changing molecular hostile environment. It is therefore hard to predict what is going on at any particular point of time by using any single blood test. If you imagine the immune system as a feature length film a really long one, like Lord of the Rings trilogy length.`, and you take just one still frame from it ( i.e. a single blood test at time X), it is like trying to work out the whole plot from that one still photograph. It is even harder if your one photograph turns out to be a picture of a bloody tree. It is often just not possible.

Some private clinics will offer Th1 vs. Th2 profiling; However the old notion of 2 types of CD4+ helper cells i.e. Th1 and Th2 is now expanding as in the last few years there has been so many new subsets of CD4+ T cells described, Th17, Th3, Tfh, Foxp3 regulatory CD4+ cells, and probably more on the way. Cytokine profiling of Th1 and Th2 is more complex now as there is much cross over in the cytokines they can produce, so not so black and white Th1 or Th2 as it used to appear to be. Also functionality rather than quantity of the cells differs from patient to patient and from condition to condition. So immune profiling is a bit like trying to catch smoke. I feel it has its place when taking together with other clinical and serological evidence, but in isolation not the best of tools, so watch before you spend your money.

The test you describe is slightly more extensive covering more parameters at that specific time point ( i.e. like having 20 photos of the film rather than 1 or 2). They often involve serial testing in an individual to compare changes over time, and try to establish if any trends are apparent. Again though these tests need to be interpreted with care and by a clinical immunologist and as part of a clinical picture. The tests are useful to monitor patients known conditions or suspected conditions. In HIV status they can look to see how function is decreasing or increasing over time. Kind of prognostic rather than diagnostic.

Next concerning exercise and depleting CD4+ numbers.

As I said the immune system is dynamic and large scale studies have clearly demonstrated that the effect of exercise on the immune system strongly depends on the type and duration of work out.

So there is this thing called the “ Excercise induced immunosuppression hypothesis “ Also called the J curve or open window relationship .

In this the current evidence suggests that exercise of “moderate intensity” is beneficial and a boost to the immune system ( protective), it enhances certain components of the immune system, including CD4+ numbers, and also increases their ability to proliferate and respond to antigens. Importantly it also promotes effective immunoregulatory cells, so prevents too much inflammation, so overall a good balance is achieved. Clinical studies seem to support this. Moderate exercise is beneficial both psychologically and immunologically. Fantastic get out the skipping ropes and be at one with your immune system…all is well in the world …ah but hang on and read on, for there is more to tell ( a dark side)… what if you get a bit carried away and start to exercise like superman on speed….something different happens.

In stark contrast ultra endurance exercise, or periods of intensive training (such as training hard for a competition or in the run up to a marathon…appears detrimental to the immune system. This type of exercise causes periods of marked immunosuppression and depleted CD4+ T cells, and such sessions leaves the immune system down and out ( only for approx 24hrs after the session), but enough to open a window of time for infections to come flooding in unchallenged.

The evidence for this is quite clear. Athletes training for tournaments are more susceptible to upper respiratory tract infections and reactivation of herpes viruses. One third of marathon runners will come down with a respiratory infection within 2 weeks of completion. If you exercise hard while you are sick you tend to have a longer recovery time and are at greater risk of complications. If people with bronchitis continue to exercise hard, they often quickly progress to chronic bronchospasms and secondary bacterial infections. Healthy adults have approx up to 5 respiratory infections a year and elite athletes (who contrary to the stereotype are actually far from healthy) have many many more…..put the skipping ropes down now YOU HAVE HAD ENOUGH !!!!

So what is going on… why this exercise induced immunosuppression during periods of intensive training.

1: Take away our society (i.e. the whole sports recreation exercise thing) and strip us back to basic animals. If we as animals in the wild were HAVING to run with the intensity and endurance, that some people do nowadays for recreation , i.e. miles upon miles of bike riding, followed by cross country sprinting, condensed training for marathons day upon day etc etc…in the past this level of exercise would mean we are living in a stressed environment. Yes we were born to run but not too much.

In simple terms (sorry if this is a bit kid school), our body has a fixed energy budget.

Total Energy = A + B + C. For talking and simplicity sake let’s say A is exercise, B is digestion, and C is the immune system. However during periods of physical stress the value of A (exercise) has now greatly increased. For the equation still to balance the body has to compensate so the values of B and C must decrease. So the more energy you spend on exercise the less left for funding the digestive tract and the immune system. (the immune system can get sick, I love that paradox). So too much exercise may be detrimental because it shuts down other physiological processes in order to provide you with energy for the physical activity, thermoregulation etc that you need. Remember this only happens at prolonged intensive levels, not moderate. (Moderate you can talk but not sing).

So some people may look at the equation above and say easy….the solution is obviously i.e. we can increase the starting value of total energy. That will allow us to train at high intensity faster and for longer and still maintain a healthy immune system….it is not that simple. Some healthy adults often think they can do this, i.e. get used to high intensity exercise, increase their exercise times to crazy levels, become tolerant, but here is the crux, there is a limit to how high an energy budget a normal human can have. Yes training can make you work more efficiently (better VO2max etc), you can change the diet, and you can increase fitness but all only to a point. None of us can change our energy budget that much, there is always a ceiling as to how fast on a cellular level we can metabolise and get rid of waste products. There is often an unseen debt, at the expense of the immune system. People argue that we were built for running; we came out of trees and evolved to running after prey and scavenging. However we didn’t live very long back then.

So how do we get into this precarious immunosuppressed state after intense exercise? Well one of the things that happens is the protective CD4+ T cell numbers decrease in our blood during intense exercise, and there are a few reasons for this. Firstly damage to the muscles induces their recruitment out of the blood into the muscle tissue. Raised serum levels of creatine kinase, aspartate amino tranferase, ( i.e. biochemical indicators of exercise induced tissue damage), cortisol and catecholamines cause many of the remaining CD4+ cells to apoptosis (shrivel up and die). Couple this lack of protective CD4+ cells with the dried up non functioning mucus of the upper resp tract ( i.e. from sustained heavy mouth breathing), then it is not hard to see why the respiratory infections, sore throats etc are common. There is also some evidence to say that the level of immunosuppression may be enough to promote tumour formation, but that is over very prolonged periods.

As you said the HIV person had decreased CD4+ cells and I presume he will not have been exercise intensively, so why the loss. Well sadly no matter how well antivirals are working you can never compare the immune system of an HIV infected individual to a health person. Even in those whose virus is controlled and practically undetectable, it is there doing massive damage. HIV doesn’t just infect CD4+ T cells; it exists in other CCR5 bearing cells. They use CD4+ counts but these people are never close to true immunological health. Their immune system has to be artificially balanced through antivirals and does not have the same fluidity I talked about earlier. Many HIV patients have undetected lung damage that can result in less circulating oxygen, resulting in greater muscle damage. Their energy budget is low to begin with so probably even moderate exercise will reduce their T cell count and may take longer that the 24hr for it to recover. This is known and there are clear clinical guidelines on optimum exercise regimes for HIV infected individuals.

Hope this answers something but probably nothing as it is a bit long winded and I probably lost readers miles back as boredom set in.

Tons on exercise and the immune system but here is a good all round bit of reading.

Re: immune status in BFS

PostPosted: June 3rd, 2014, 9:48 am
by Yuliasir
Thanks for extensive post and explanations!
I actually meant that there are many very dedicated sports people here (and marathon and halfmarathon runners too), so probably some of them may 'thank' their BFS issues to the training :)))
other lazy personsl like me have to 'thank' to something else :)))

Re: immune status in BFS

PostPosted: July 4th, 2014, 5:31 pm
by Nytviolet
I'm a perfect example. Back in 1996 I was training for a 10k, lifting weights to exhaustion and playing tennis 2-3x per week. THAT is when the BFS came on with a vengeance, leaving some nerve damage in its wake. Walking, swimming, or mild yoga, stretching is all I would recommend after what happened to me. Our society puts so much emphasis on getting the perfect physique, that we often "blow a circuit" so to speak. That's my experience anyhow. Hugs