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I’M Annemarie Medina, I’m the director of corporate and community relations for the University of Arizona Health Sciences here in Tucson. I’D also like to introduce you to our director up in the Phoenix campus, Caroline Berger

And our executive director Alison Otu Little bit about the University of Arizona Health Sciences, We’re a statewide leader in biomedical research and health professions, training. We include the colleges of medicine in both Tucson and Phoenix, the colleges of nursing pharmacy and the Mel and Enid Zuckerman College of Public Health. We have main campus locations in both Tucson

We also have the growing Phoenix biomedical campus in downtown Phoenix. From these vantage points, Health Sciences reaches across the state of Arizona and the greater Southwest to provide cutting edge health, education, research and community outreach services. As a major economic engine, Health Sciences employs nearly 5,000 people. Has approximately 4,000 students and 900 faculty members and garners over $ 200 million in research grants and contracts annually? We are led by Dr. Michael Dake, who is our Senior Vice President for Health Sciences?

Now we would love for you to follow us on the UAHS social media accounts.

There’S a lot of information about testing tracing reopening out there right now, So you can stay up to date on all of the most recent information through all of our accounts And if you are on social media and you want to help promote our events, we invite You to use the hashtag Wellness, Wednesdays AZ. You can also tag me using my Twitter handle at AMedinaWildcat

So today we’ve got one person who is going to be speaking for about 15 to 20 minutes And then we’ll have chances for you to ask some questions. We do have you all muted, so that everybody can hear, And so, if you’ll just use that chat function down at the bottom of your screen. Just in your questions there and I will make sure to ask the presenter the questions and we’ll get to as many as we can.

We will make sure and send you links to all the resources. You will also get a copy of Dr. Thomson’s slides today, We’ll send you a link to the session video so that you can go back and listen to it again.

And any other things that we have to share with you we’ll make sure and include that.

We’Ll have a lot of information so make sure you check that email. One other thing please take the time to fill out that short, two minute evaluation. We really need that feedback, so we can make sure that our future events have what you want to hear We’re going to record this session today, like I said,

So we’ll give you that link when it comes out. So let me introduce our speaker today. Dr. Cindy Thomson is a professor in health promotion sciences at the Mel and Enid Zuckerman College of Public Health, where she also directs the Canyon Ranch Center for Prevention and Health Promotion.

She holds a doctoral degree in nutrition sciences.

She’S a registered dietitian nutritionist And she co-leads the cancer prevention and control program at the University of Arizona Cancer Center, where she leads a research team whose work focuses on health promotion, with an emphasis on cancer prevention and control. Having a healthy immune system may be more important than ever, particularly as our communities begin to reopen under COVID 19 Immune system plays a vital role in protecting us from infections as well as assuring that we come through infections as quickly as possible. Dr

Thomson will address the role of lifestyle behaviors in promoting a healthy immune response at all ages and also provide us with some guidance for making healthy choices. So I’m very excited to hear from my friend, Dr

Thomson today So welcome Cindy. Thank you.

All right well, thank you all for being here today And I am going to be sharing my screen here And I’d like to thank the organizers for this opportunity to present to you today on immunity. I think one of the important things to keep in mind as we go through this is that the immune system is a very dynamic system And there are a number of components that help us to have a healthy immune response to pathogens that may be introduced.

And so, when we think about the immune system, organs such as the spleen and the thymus, as well as the lymph nodes that are demonstrated here throughout the body, allow us to circulate specific immune modulating cells that protect our body from damaging foreign pathogens. Cancer viruses, bacteria et cetera, So it’s a very complex system. It has thousands of specific cells and responses to these invasive organisms And I’m not going to be able to really review all the complexity of the immune system today. But what I wanted to do is just make you aware that there are a number of factors that we use to measure immune response and to protect our bodies from pathogens.

So today, what we’re going to focus on is lifestyle behaviors and the immune system, And I think what I want to drive home is that there are major drivers of immune response in terms of lifestyle are obesity, diet and nutrition and physical activity, And we’re going to Hit on each of these today, as well as some other factors When I think about the interplay of health, behaviors and immunity, you have this balance between a pro-inflammatory response. That starts when we introduce foods or factors that promote inflammation, And those in general are not good.

The inflammatory response is important in small doses, to keep us healthy, But when it’s in small doses and sustained chronically or when it’s in a very large dose, we end up with a situation that can promote disease. And when you look at this diagram here, what I’ve tried to do is make these circles — these purple circles relative in terms of their size and the degree to which they can drive either a pro-inflammatory response or protect your immunity.

So the major drivers, as I mentioned, are diet and obesity physical activity and then we’re also going to touch on sleep and stress and other exposures. Keep in mind that we are not going to spend a lot of time on obesity today.

We could do a whole session on obesity, But maintaining a healthy body weight or losing weight. If you are overweight, is a major approach to controlling inflammation and enhancing your immune response. It is very clear that people who carry excess body fat are –, basically will show a suppressed immune response to disease, And we’ve seen this with COVID and the degree of COVID infection and the severity of infection in people who have obesity or chronic diseases that are Associated with obesity, So weight control is absolutely important.

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We just don’t have a lot of time to talk about that in more specific detail today. So when I think about diet and the immune system, I offer you up this diagram just to present to you the complexity of the number of factors that come into play.

And, given that we have 20 minutes, I’m going to keep this really focused on the primary issues and nutrition exposures that are important, But we could spend again additional time later. For example, I’m not going to hit a lot on omega 3 fatty acids and their anti-inflammatory response, but absolutely that is the factor that we could consider.

I’M going to talk about protein, some of the vitamins and minerals, the bioactives and then last week those of you who were able to weigh in heard about pre and probiotics and dietary fiber and its role in health And then we’ll hit on –. Just emphasize to you that these nutrients are important, but there also are data to suggest that there are a number of whole foods that will promote immune response.

And in fact, we want you to get these nutrients we’re talking about here in the form of whole foods, perhaps herbs and spices more so than trying to focus on supplementation. I also want to point out that the immune system works closely in terms of other processes. Such as damage to DNA or oxidative stress And, as I mentioned earlier, inflammation

This interplay is what enhances our overall health or compromises our overall health. So protein is the building block of the immune system And we have a requirement of 0.8 grams per kilo per body weight per day. Many people say that if you are over the age of 65, you should begin to increase that protein to meet the needs of — related to immune function, as well as protecting your lean mass

There are ways that your clinician can monitor some of your protein levels as well as common immune markers that are measured like white blood cell counts and lymphocytes. That will be affected by a low protein diet And if we think about operationalizing an adequate protein diet. What we want to do is think about what your body weight is, what your requirement might be and then think about distributing that protein across the day. So here I give an example of egg whites. The source of protein is 10 grams, Five per egg white

Lentil soup, Snacks such as yogurt And dinners that include lean proteins such as fish or chicken breast Beans, are another very low cost highly available source of protein for our diets And then low fat, milk

And this is just one example of how you can meet those protein needs.

In addition to protein, we want to promote vitamins A and C. And think about A and C, because they not only enhance your response to any kind of vaccination. For example, if you’re getting a flu vaccine, But also they can help to reduce the duration of an illness or infection, They can reduce the viral load that you’re exposed to

And these also have anti-inflammatory behaviors On the right hand, side. What I’ve tried to do is give you some examples of different sources of vitamin A and C. Vitamin A can be found in animal sources. But you could also get vitamin A by the conversion of beta carotene to vitamin A as shown in the bottom box, And then vitamin C. Some sources are in the upper right hand beyond citrus

There are a number of sources:

And sometimes things like bell peppers and the various colors of bell peppers can give you beta carotene, as well as vitamin C. In terms of vitamin D. We know fairly well that vitamin D plays a role in our immune response, both what we call our innate immune response and our adaptive immunity that develops as we’re exposed to various pathogens.

And so getting a little bit of UV sunlight exposure is important to enhance your vitamin D levels. Obese individuals tend to have greater inflammation, lower immunity, but also lower vitamin D levels circulating. It may be appropriate to talk to your health care provider, about having your vitamin D levels assessed, so that you can decide whether you can address any deficiencies through diet or whether you will need supplementation.

For most people who are deficient, you will need to consider supplementation, But I’ve listed for you here some food sources, including fortified milk, mushroom swordfish salmon, tuna and sardines And the old standby cod, liver oil. If you can get it down. We also know that the minerals in our diet play a role in our immune system, So things like zinc, iron, selenium and copper.

And these are found in low amounts with very low requirements, but in a variety of dietary foods. So anything from seafood to shell, fish to legumes to dried beans and fruits all can help to meet that need for minerals. So I like to also provide what we call bioactives

And bioactives are compounds that are found naturally in whole foods generally plant foods that give color and flavor to those plant foods. So a lot of times we will tell people eat by the rainbow

When you go through the grocery store, fill up that cart with a lot of colorful fruits and vegetables. Look down before you leave the section of the supermarket and make sure that you have lots of colors in order to have a variety of bioactives And bioactives in plant foods can act as antioxidants anti-inflammatories, as well as help our immune cells, migrate and conquer pathogens. That may enter our body When we think about anti-inflammatory foods. That may enhance immune response as well. I’Ve shown you here a table of several different foods that allow us to help better immune response Things like onions and garlic. They contain allicin

Or green teas that contain catechins Or tomato products that contain lycopene, as does watermelon, So there are a number of different compounds in each fruit and vegetable that can help to enhance your immune response.

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Again, think about that supermarket shopping and the opportunity to have a lot of diversity in the colors and the flavors of the foods and the herbs and spices that you include in your diet. Now, one way to think about getting all of these and for which we have fairly good evidence, is the anti-inflammatory immune promoting Mediterranean diet.

So studies have been done where they’ve, given people, the Mediterranean diet and then they’ve looked to see what happens to their immune response and their inflammatory markers over time And overall, what we find is that, when people eat with a diet, that’s consistent with the Mediterranean diet, They have a protective effect on the immune system.

I don’t have time to go through every food, that’s in the Mediterranean diet, but many of you may be aware that this is primarily plant-based, lean, proteins and very much a diverse diet, eating pattern that integrates a large number of colors as well as flavors. So I want to take a few minutes and hit beyond diet and nutrition and make sure I address the other factors in our health behaviors that are going to inform on how our immune system responds And so, first of all, for physical activity. When we’re physically active. We have an immediate, acute, inflammatory or oxidative stress response.

And some of us might –. Well, that’s not good, But in fact, because it is a very low level response. What this does is actually primes our body to respond to inflammation and oxidative stress later, So it gets the immune system revved up, so that when you do have other sources of inflammation or oxidative stress, you can respond.

In addition, it activates our immune system, along with these other factors. It also promotes mental health, reducing anxiety and stress response.

And we’re going to talk a little bit about stress and immunity in a minute, as well as just in general, reducing our fat mass that can be associated with reduced immunity Now. The other behavior that I wanted to mention is sleep. Sleep does absolutely affect your immune system. Basically, what we want is to have a 24 hour day cycle that aligns with our circadian rhythms, And we know that, if we’re out of alignment in terms of our wake and sleep cycles, we can actually suppress T cell response.

We can increase inflammation, We can reduce the number of effector leukocytes that help to control inflammation And a lack of sleep can increase cortisol levels, which is a known stress, response.

So practice regular sleep hygiene – And here I mean regularity in your sleep, awake cycles,

Try to make sure that every day of the week, you’re getting up and going to bed around the same time Make sure that you are physically active daily, Make sure you have a routine prior to going to bed so that you know exactly –. I’Ve washed. My face I’ve brushed my teeth And get yourself in that habit so that your body gets ready to rest, Avoid light and noise, while sleeping

And anyone who knows me knows that light includes all those bright blue lights from all those electronics that we like to have in our bedroom. Remove those All right stress also affects immunity, So stress increases our heart rate and our blood pressure.

But it also increases stress hormones and suppresses the immune system, including increasing cortisol levels, as I mentioned,

It can also disturb your digestive system. So how do we manage stress Again? We could have a whole talk on managing stress And we have provided guidance in this area in the past, But the main thing is first to have an awareness,

Where is that stress coming from? Is it your job? Is it select people? Is it circumstances? How can you modify some of those factors?

Be physically active throughout the day That will help manage your stress.

It will also help you to sleep better. Although physical activity should probably be two to three hours before sleep at minimum, Think about meditation or prayer or physical activities that help you to meditate or get in a relaxed state such as yoga And then alcohol and high carbohydrate binges in response to stress actually can Be immunosuppressive

So we don’t want to go that direction when we’re under stress

Avoid tobacco and smoking We’ve heard this many times before. For those of you who are having issues with tobacco, I provide for you the federal tobacco free tools for you to quit, And there’s also state quit lines in almost every state in the nation.

In terms of making behavior change, how do you do it? You really want to get serious Set goals. Write them down, Be very specific.

I’M going to go on a walk five days a week at 6:00 in the morning till 7:00. In the morning I’m going to go with my neighbor, I’m going to take a bottle of water, Be very clear And then measure your progress.

Keep a journal or use a monitoring device such as a Fitbit, Make sure that you’re realistic If walking an hour, is way beyond what you’re currently doing set up a realistic goal.

15 minutes then 20 in a few weeks, then 25, a few weeks later, So that you can build self-confidence and self-efficacy to be able to achieve your goal.

In summary, I just want to reinforce how important lifestyle choices and related behaviors influence your immune system. There is no doubt We know that these things are interrelated on many levels. Your immune system functions and drives this when you eat a healthy diet And make sure you realize that your lifestyle is modifiable.

So please take the opportunity to put these recommendations into action. Thank you. Thank you, Cindy. That was really wonderful. That’S a lot of information that you provided.

So, just as a reminder to our listeners that we will be providing that full slide deck for you, so that you will have those links – and you will also have all of those wonderful pictures and things that Cindy provided. So we do have some questions that popped up And one of them was the –. We talk about immune response And we know that sugar tends to be one of those things that really causes inflammation in the body.

So, can you talk a little bit about sugar and the body’s response to that?

Yeah so I mean it can get complex. I think there are a few things to consider. One is if you’re obese obesity is going to trump the diet, the sugar, whatever factor Sugar is particularly problematic when you’re using it to address stress, Because, when you’re under stress, you’re, more likely to drive up your cortisol levels as well as your blood sugar levels,

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And so you want to think about when you’re consuming sugar and why you’re consuming sugar And make sure in particular, you’re restricting sugar intake when you’re in that stress level. The other thing I would say is that if you are someone who has healthy blood sugar control, sugar is less of a problem. It’S particularly problematic if you’re someone who’s pre-diabetic or have had problems creeping up in terms of elevated fasting glucose – And this happens with aging

This happens with weight gain So be aware that, And I think I’ll stop there. I mean, I think we don’t want to say you can never eat sugar.

Sugar is evil and it’s going to kill you

That is not the case. It’S just you want to integrate it into a very healthy diet. Overall, OK, great. Can you address the role alcohol plays on cancer recurrence, particularly breast cancer Yeah, so we — some of you may be aware. The American Cancer Society actually just last week published the new cancer prevention guidelines.

And I had the opportunity to work on those guidelines And this time when we came out, we did not say alcohol is OK in moderation, The recommendation is actually to avoid alcohol And the reason is that alcohol is a carcinogen, No matter how we cut it. It is a carcinogen

And there are data from the Nurses’ Health Study coming out of Harvard that suggests. Even a few glasses of alcoholic beverages a week can increase your risk of breast cancer, So this would be particularly important if you have a family history of breast cancer. If you are someone who does not have a history, we still know that one in nine women are going to be diagnosed with breast cancer in their lifetime.

So it’s clearly a modifiable factor that we can control. If you want to drink — I mean that is a choice that we can all make.

Then I think the important thing is to drink small amounts, avoid binge drinking and do so with the minimal frequency that is reasonable for your lifestyle. Great, Do you recommend red meat as a protein choice? You will see in the guidelines that certainly I would not recommend processed meat, So anything like bacon, baloney. Those kinds of processed meats absolutely would not.

Red meat – I think the data are not as strong, But they are compelling enough that we have asked people to restrict their red meat intake to no more than twice a week And there’s actually a gram amount. I think the important thing when you do select red meat should you select red meat, is to pick red meat. That is extremely lean.

So, instead of a T bone steak, maybe a flank steak.

And then, when you eat it, it is a small portion on the plate that is dominated by vegetables and other healthy foods Right OK.. Can you get enough turmeric through cooking without using it every day or should you take a supplement? So turmeric is tricky Because I think it’s one of those things that — when I think about to turmeric and other spices. I think the idea should be to use a number of different spices and mix it up.

So turmeric is not the only anti-inflammatory spice; It has gotten a lot of attention. The truth is that a lot of the supplements — – we have Dr. Janet Funk at the university who’s, measured the turmeric in supplements, And many of them are mislabeled in terms of the true exposure that you get

In addition, much of the turmeric is not digested in a way that it can be metabolized in use to reduce inflammation. So fresh turmeric is best With frequency, but mix it with other herbs and spices that have a lot of anti-inflammatory properties as well.

Ok, any advice on the best foods or supplements for reducing anxiety, Wow

I — Other than sugar. I would want to evaluate that on an individual basis, Truthfully as a dietitian, I would love to say, there’s a magic pill, But to me the best therapy for anxiety is physical activity. Honestly

You will feel the responses immediately and they will persist. They don’t go away When you feel that anxiety get going, Even if you can’t go outside and walk even things like trying, a yoga move or jumping jacks or lifting some weights, or something Just expending energy.

Because anxiety is that kind of fight or flight, And so if you can use that energy in some effective way, it will help the anxiety tremendously Great Well Cindy. We have a lot more questions And I just want the listeners to know that we will –. I will send all the rest of these questions to Cindy and she will provide answers to them.

And so we’ll include that as part of the follow up email, But thank you so much Cindy for joining us today.

It was a fantastic presentation, A lot of really great information, And so we really appreciate you joining us today and taking the timeout

So I’m going to go back to sharing my screen here, All righty, So we want to thank you all for joining us today and especially thank our presenter Dr. Cindy Thomson. Please remember the follow up. Email,

Include everything in there, including the recording the slides, Make sure you fill out that survey for us. We really appreciate it Also be sure and tell a friend And don’t forget to sign up for Wellness Wednesdays next week.

Cindy talked about the importance of sleep And next week we’re going to feature Dr

Michael Grandner, the director of Sleep and Health Research Program at the University of Arizona He’s going to discuss how to get a better night’s sleep. How to have more energy during the day – And we know, as Cindy mentioned stress, has a huge impact on our ability to obtain a restful night of sleep.

And so this is really a timely topic for all of us, So we hope you will join us.

And. Until then, on behalf of all of us at the University of Arizona, Health Sciences be safe, be well and, of course, always bear down. Thank you..

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