Trend #2
The Future of Immune Health: Stop Boosting, Start Balancing
Say goodbye to pop-it, guzzle-it supplements and hello to evidence-backed immune health
By Beth McGroarty
Introduction
When the coronavirus hit, our immunity, understandably, became our obsession: What can I do—now, fast—to strengthen my immune system against this terrifying virus? As 2020 unfolded, we saw immunity become its own lane in wellness—the biggest lane—with a storm of “immune-boosting” foods, supplements, therapies, and programs at travel destinations. Everything in wellness, it seemed, was instantly re-angled and repackaged around “immune health.”
Even with vaccines arriving, because of the trauma of COVID-19 and the growing awareness that this isn’t the last pandemic we will face, immune health will long remain a consumer preoccupation; there’s been a profound mindset shakeup about its importance. So, it remains a major wellness “trend” for 2021, already gracing dozens of 2021 trends lists, with statements like “immunity is the new sustainability.”
So, why are we joining the army of forecasters making immune health a top trend this year? Because the main way it’s being discussed, and the main ways the wellness industry is addressing it, is flat-out wrong. The concept of “immune-boosting” is precisely the wrong way to create a healthy immune system. And while the immune system is one of the most astoundingly complex areas of medicine, the wellness market has led with a storm of trendy, quick-fix “immune-boosting” superfoods, supplements and treatments, which matter far less in creating long-term immune health. The goal of this trend is to lay out the evidence for what needs to matter more if we actually want to make a difference in the world’s immune health, but first, we need to clear up a few things.
“Immune-boosting” = BAD science: There were thousands of articles this year on how to “supercharge” your immune system and thousands of products and experiences that claimed they did that.
But as Dr. Ken Pelletier, professor of medicine at UCSF, explains, “The whole concept that you can ‘boost’ your immunity is nonsense, and with the immune system, ‘more boosting’ is not better at all. ‘Hyper’ or over-activated immunity is when the body attacks itself, the pathway to all kinds of autoimmune diseases. And with COVID-19, we saw how an over-boosted immune system released a cytokine storm that killed people…
“…What we want is immuno-stabilization, immuno-balance. The concept that we need ‘more’ immunity (what so many products and spas promise) is the wrong path. Far too many ‘hyper’ immunity solutions are being marketed when the immune system is something you want to modulate, not crank up to 11.”
This isn’t just wrong terminology, “immune-boosting” solutions give people false security, contributing to our public health crisis. It’s a marketing move by wellness companies and influencers so dangerous that it compelled researchers from the University of Alberta to undertake a study on the disturbing ways it’s playing out on Instagram. They found #immunebooster posts skyrocketed 46% a month after the pandemic started and widespread use of “biomedical jargon” to give unproven “immune-boosting” products credibility.
2020: The year of quick fixes: “Ingestible” immunity dominated the wellness world last year, with an avalanche of immune-boosting supplements and foods pushed on anxious consumers, who, understandably, gobbled them up (the markets exploded). So many sexy products like elderberry-adaptogen tonics in cool, pastel-colored cans or super-herb immunity gummies presented in chic prescription-like bottles.
It’s funny; if you step back and view the current wellness world with fresh eyes (a movement whose DNA was seeking alternatives to Big Pharma), it’s become a world of so much pill-popping and IV drips—increasingly simulating the look-and-feel of traditional medicine. While we’re not arguing that a vitamin D deficiency doesn’t matter for immune health, the wellness market now needs to expand far beyond the pop-it, guzzle-it, do-it-for-a-day mindset if it wants to get real about immune health. Dr. Pelletier: “Your immune system isn’t changed much by any particular functional food, supplement, herb or treatment. These are too simple-minded prescriptions for something so complex.”
2021 – Immunity goes deeper, wider: So, what actually has the most impact in creating a well-modulated, responsive immune system? We worked with Dr. Pelletier and functional medicine leader Dr. Frank Lipman (and read hundreds of medical studies), and, no surprise, many cornerstones are violently anti-trendy (no frog venom or eye yoga here); mostly, they’re the core pillars of wellness: exercise, diet, enough sleep and exercise.
But with new research and lessons from COVID-19, some things become FAR more important:
Metabolic health: COVID-19 cruelly exposed the connection between metabolic ill-health and immune dysfunction. The number one thing that can strengthen our immunity (personally and as a culture) is to focus relentlessly on sensible, science-backed diets that drive metabolic health (and stop the profusion of trendy, complex ones that don’t).
The microbiome: With an incredible 70% of our immune system headquartered in our “gut,” a healthy microbiome becomes radically more important. An outrageously complex system, researchers are trying to crack the microbiome code, and testing will get better, with AI and machine-learning helping apply your byzantine gut data for personalized nutrition.
Personalized nutrition: Research mounts that the same foods have dramatically different impacts on an individual’s microbiomes and metabolic health. That means far greater urgency for personalized nutrition. We’ll see more advanced and integrated blood marker, microbiome and genetic testing to realize the eternally delayed promise of an evidence-based diet.
We’ll see greater experimentation with:
Intermittent fasting: There’s more research on how certain types of intermittent fasting can “flip the switch” on immune system regeneration. If intermittent fasting has mostly been done in the name of weight loss, more will now embrace it for immune health.
“Positive stress” experiences: Chronic stress is an immune system destroyer, but voluntary “positive stress” experiences—hot/cold; fasting; breathwork; high-intensity, short bursts of exercise—are proven to have a short-term, positive immune effect. Research is underway on whether these “hormetic” stress practices have long-term immunity benefits, and people will experiment.
Deeper programs at travel destinations: Wellness resorts rushed to “immune-boosting” programs in 2020. Now, they will go deeper, more medical, and revolve around interventions that matter more: from gut health to personalized nutrition.
FUELING THE TREND
COVID-19, not the last deadly pandemic: Health experts agree that COVID-19 is hardly the last killer virus and that we may be entering a pandemic era given the way humans live their lives (from factory farming to hundreds of millions of Asians depending on open-air wet markets for food). The World Health Organization recently warned that COVID-19 “might not be the big one…and that the world must prepare for even deadlier pandemics.” Dr. Pelletier: “Right now, there is an unusual virus being transferred from an animal to a human being (a zootic transfer) that’s not a guess; it’s a certainty.” If COVID-19 is the world’s wake-up call to pay attention to immune health, people will increasingly grasp that it needs to be a long-term, front-burner focus.
Metabolic Health = The #1 Immunity Issue to Focus On
COVID-19 laid bare the relationship between immune system health and metabolic health, as globally, people with metabolic health issues (pre-diabetes, diabetes, obesity/weight issues and hypertension) were dramatically more likely to get very sick or die from the virus. As Dr. Lipman puts it: “The COVID-19 epidemic was superimposed on an epidemic of metabolic ill-health (intensely pronounced in the US but growing globally)—and to me, that’s the elephant in the room. If we talk at all about strengthening our immune systems, the #1 issue we must tackle is rampant metabolic ill-health—for our own personal health and as a culture.”
Metabolic ill-health means any out-of-whack regulation of lipids and blood sugar and chronic inflammation. It leads to metabolic syndrome, defined as a cluster of more than three of the following issues: high blood sugar, excess fat around the waist, high triglycerides, hypertension, and poor HDL cholesterol levels. Metabolic dysfunctions lead to obesity (and its related cancers), diabetes, heart disease—and many more conditions.
The stats on metabolic ill-health—and its march from the West to the rest of the world—could fill a book. Worldwide, obesity rates have tripled since 1975; globally, 39% of adults are overweight, and 13% are obese. Diabetes quadrupled since 1980 (now diagnosed in 8.5% of adults, and it’s rising fastest in developing nations). But metabolic dysfunction is bigger and wider than that. It’s estimated that one-quarter of the world’s population (over a billion people) are affected by metabolic syndrome. The US (hit hardest by COVID-19) shows how deep the metabolic health crisis is. Dr. Dariush Mozaffarian, dean of the Freidman School of Nutrition Science at Tufts University, explained to the New York Times that “only 12% of Americans are without high blood pressure, high cholesterol, diabetes or pre-diabetes…horrifying statistics…and poor metabolic health was the immunity-impairing risk factor (the biggest beyond age)…that (makes people) especially vulnerable to the lethal coronavirus.”
Study after study after study reveals how people worldwide with metabolic health issues were exponentially more likely to get very ill and die from COVID-19. The reason, experts like Dr. Mozaffarian argue, is that metabolic health dysfunctions—from high blood sugar to subpar cholesterol profiles—“suppress the immune system…They’re all associated with low-grade, body-wide inflammation…and COVID kills by causing an overwhelming inflammatory response that disables the body’s ability to fight off pathogens.” Creating an immune system that can do its job means focusing far, far more intently on metabolic health—and not just for diabetic or obese people.
This is overwhelmingly a food and diet crisis and has little to do with many new, complex diets (some of which may actually be exacerbating metabolic issues). We’re forced to go back to the ‘70s if we don’t learn its lessons. We must…
Stop consuming so many highly-processed, low-fiber foods shot through with sugar, bad starches, refined grains, and unhealthy fats—all the empty calories that immediately flood our body with glucose.
Eat a far more varied, colorful diet of vegetables, fruits, whole grains, healthy fats (like omega-3s), high-quality proteins, nuts, seeds and legumes— foods that nature manufactures.
Dr. Lipman: “You want to boil it down, stop eating sugar, and starchy and processed foods, if you want a balanced immune system. People are eating way too many garbage carbohydrates (and many are carb-intolerant) for their bodies to metabolize, leading to insulin resistance, then pre-diabetes, then diabetes, obesity and heart disease.” Dr. Pelletier adds: “Only one diet has a preponderance of evidence for its effect on metabolic health and extending longevity: the Mediterranean Diet. If you don’t move to some modified version of a Mediterranean Diet, you’re in the Wild West of wild claims that diets make.” The wellness world needs to stop always chasing the nutritional “new” (this week’s superfood or branded diet) and re-focus on sensible, science-based nutrition for metabolic health. People are confused.
COVID-19 made it crystal-clear that being nutritionally compromised means being immune-compromised.
What an extraordinary amount of work there is to do. There are so many public policy “ideas” that need to turn into action: government subsidies for producing healthy foods (instead of unhealthy ones), taxing and curbing advertising for sugary drinks and killer snacks, giving people on food assistance much bigger healthy food subsidies, making nutritionists central to the healthcare chain, giving doctors more than two hours of nutrition training in medical school, and investing big in nutrition research.
Diet quality correlates inversely with income. We must tackle the issue of food insecurity and food deserts in Black, brown and poor communities, as we saw how their soaring rates of metabolic health issues were a key factor in their experiencing much higher COVID-19 infections and deaths. As Thierry Malleret, economist and founder of The Monthly Barometer, argues: “Addressing food insecurity and inequality will become a big issue in wellness in 2021: We’ll see a flurry of new initiatives, ranging from start-ups and nonprofits that strive to provide affordable, fresh, nutritious meals to simple community gardens. One great example: LA-based Everytable (they just raised $16 million), an ethical company that delivers healthy meals at low prices or free for challenged communities, all paid for by higher prices in wealthier ones.”
The Basics:
Eat a diet full of diverse fiber sources—again, colorful plates full of fruits, vegetables, nuts, seeds and whole grains. Fiber specifically impacts the microbiomes in the digestive walls and keeps pathogens moving through the gut.
Cut way down on any processed (this is key) foods and foods packed with sugar, starch, refined grains and artificial sweeteners.
Stay well-hydrated. Dr. Ross Walton of Imperial College London notes that drinking lots of water is “vastly overlooked” in immunity, as dehydration damages the mucus layer in the respiratory tract that contains important antibodies.
Eat prebiotics regularly, found in numerous fruits and vegetables with fiber and resistant starch. Because your body can’t digest them, they become food for probiotics and other healthy bacteria and microbes. Potent amounts are found in garlic, asparagus, onions, leeks, yams, bananas, artichokes, whole grains and chicory root (the trendy new coffee alternative).
Eat probiotics—fermented foods—daily, as they contain live organisms and bacteria that add healthy microbes to your gut. They include yogurt and kefir with “live cultures,” sauerkraut, miso, tempeh, and kombucha (so wildly popular it’s almost become a whole “economy”).
Now “postbiotics” are hitting 2021 wellness trends reports, with mega-food-company ADM arguing that they’re the future. They are defined as “the “waste” of gut microbes after the process of fermentation (also living in some fermented foods or made by inactivating a probiotic). Because postbiotics are not live (like prebiotics), they may be much easier (no refrigeration needed) to roll into more supplements and foods/beverages. Research is in the early days.
With COVID-19, research on the microbiome’s outsized relationship to human immune function will only heat up, and researchers argue that while they’re getting a stronger understanding of who the microbiome key “players” are, they’re still struggling to identify which components are essential to overall health and immunity. There are only 10,000 public microbiome samples available, so it’s like genome testing’s early days. While the evidence-based approaches today seem basic, consumers will increasingly get the connection between gut and immune health, and they will embrace both the basics and new experiments.
The Future: New Urgency for Personalized Nutrition
Metabolic and microbiome health are the huge forces in determining immune health, and the strategies above are evidence-based, if generic. But scientists agree that each person has different nutrition needs because of their individual genetics, biochemical processes, and microbiome—all together determining what nutrients you do well with and struggle to process. It’s a completely different way of looking at nutrition: Instead of pushing certain foods for their healthy ingredients (vitamins, minerals, etc.), it switches the focus to the person and how their body ultimately responds to that food. Personalized nutrition through testing has been a huge focus for years, but with the metabolic health crisis that is COVID-19, there is far more urgency in getting diet right down to the unique person.
Important studies, such as one from Israel’s Weizmann Institute of Science, find that bodily response to all foods is dramatically individualized: People who ate identical meals had huge differences in the rise of blood glucose levels. A crucial new global study from PREDICT, the world’s largest research project on how individuals respond to food, found—to researchers great surprise—that genetics play a minor role in specifically shaping your microbiome (identical twins share 34% of gut microbes; unrelated people share 30%). And that while a version of the Mediterranean Diet is generally better for metabolic health, that “the same diet in two different individuals does not lead to the same microbiome…or metabolic response.” They can be wildly different. They also found strong links between particular bacterial species in the microbiome and metabolic risk factors for conditions such as diabetes and obesity, with the researchers concluding that creating an individualized diet that adjusts the community of organisms living in our gut would optimize overall health and immune function.
Dr. Lipman: “The personalization of nutrition is absolutely the future because the more we use current nutritional genetic tests in combination with key blood biomarker tests, we really are picking up what people’s weaknesses are and can plug them with more precise lifestyle changes, foods and supplements. Microbiome testing is in its infancy, but getting all three tests right will take metabolic and immune health to the next level.”
Dr. Pelletier elaborates: “The gold standard for personal nutrition is that three-part testing. Liken it to a house. Genetic tests reveal the blueprint (what your body is designed to do). Blood tests show how the house is built (what your body actually does with the blueprint). And blood tests need to go beyond the standard 15 in a physical, to more like 100 blood subfractions, including immune markers and hormonal markers. Third is microbiome testing, the byproduct of living in the house. This tri-partite testing, a project we’re working on at the UCSF School of Medicine, can give an individual’s complete biochemical profile to provide an objective, personal nutrition plan—down to whether you should avoid walnuts and eat almonds.”
One difficult walnut to crack is how the new wave of direct-to-consumer microbiome testing companies apply all their mountains of gut data, given, as The Lancet says, “there is no consensus regarding what comprises a healthy biome and…the microbiomes of healthy people vary as much as their fingerprints.”
Dr. Pelletier says that the Holy Grail of personalized nutrition—integrated genetic, complex blood marker, and effective microbiome testing— is maybe three to five years away. But there is a whole lot of market activity trying to put together different pieces now.
At-home microbiome testing company Viome gives scores for measures such as metabolic fitness and inflammation levels and recently added RNA testing to try to understand how a person’s genes are expressed. Rootine uses a DNA test and a special blood test aimed at determining how nutrients function in your body to see how your genetics and biochemistry impact your nutrient absorption. The interesting start-up MYX Health is an at-home blood testing company (using one-prick bloodspot tech) to test lipids, hemoglobin (average level of blood sugar over the last months), and inflammation (hsCRP)—and soon cortisol, melatonin and vitamin D levels—to deliver personalized nutrition, exercise and sleep recommendations. So many examples…and it’s not surprising that most work on the model of selling people (often expensive) personalized supplements, meals, and prebiotics and probiotics.
Israeli company Day Two is doing important personalized nutrition work to change how diabetes and obesity are prevented and managed. The company is founded by the researchers who conducted the Weitzman Institute of Science study above, and they use advanced microbiome and other clinical tests, then apply their AI and machine-learning algorithm, to give people super-specific food recommendations via their app. It’s being proven to work without people having to cut carbs or calories (huge). It just won the 2020 Roche Diabetes Care Innovation Contest. There is no reason its microbiome-testing-based personal nutrition solution couldn’t be applied to everyone. Another scientist-driven company to watch: Zoe Global, that uses microbiome testing combined with the data from the important PREDICT studies, to deliver personalized food plans via an app.
High-quality personalized nutrition has been pricey, but as testing prices fall (a whole genomic profile should be $100 soon) and digital solutions rise, it will become far more in reach. Integrated genetic, blood and microbiome testing will become incredibly important in the next few years. Imagine evidence-based nutrition (crazy thought), with no more wars between more carbs, no carbs, keto and paleo—but a diet based on you.
Crucial – Sleep & Circadian Health
Piles of evidence show that getting enough sleep (6–9 hours a night) is central to immune health, but as Dr. Lipman points out, it’s often forgotten. Dr. Pelletier: “When the biorhythms induced during sleep are disrupted, the immune system cycles are destabilized, so the sleep-deprived are more susceptible to viruses and flus, etc.”
Countless studies reveal how sleep and our circadian rhythms (impossible to extricate) exert a powerful influence on all kinds of immune function and how too little sleep over time creates a persistent production of pro-inflammatory cytokines (chronic inflammation) and overall immunodeficiency. Sleep improves T-cell production (white blood cells that kill infected host cells) as well as natural killer cells, white blood cells that play a major role in rejecting virus-infected cells and tumors. Sleep, in essence, lets the immune system do its work (just as it’s a bedrock of metabolic health).
Sleep has become a cultural obsession and a whole “economy” worth tens of billions of dollars. If we’re not sleeping, it’s not for lack of spending: on the smartest mattress, on sleep tonics and CBD, on meditation apps that read us “sleep stories.” Last year, one of our top wellness trends was about how the whole focus really needs to shift from “sleep” to “circadian health” because most of the generic sleep solutions—and our modern lives where we take in light and dark at the wrong times—defy the facts of circadian biology. With the pandemic, it’s even more important to realize that our magnificent, light-timed circadian rhythms control almost every system in our bodies, including our immune and metabolic systems. We must get good sleep for immunity, but only solutions that have the timing of light at their center can right our circadian rhythms and our sleep. Read more here.
Crucial–Exercise
The evidence that regular exercise benefits the immune system is incontrovertible—no matter your age, your condition, and even if it’s just walking 10 minutes a day. Regular exercise is shown to significantly lower inflammation; contractions of skeletal muscle produce proteins called myokines, which fight infection and increase the power of the immune system’s natural killer cells; and moderate exercise is linked to lower rates of respiratory infections from viruses. Studies show that high-intensity exercise for more than 75 minutes at a time can compromise the immune system, so a mix of low- and high-intensity exercise is best.
Toolbox: Intermittent Fasting for Immune System Regeneration
Intermittent fasting has been a big diet trend for years, mostly with an eye to weight loss. A very comprehensive review of the clinical trials in the New England Journal of Medicine lays out the mounting evidence for intermittent fasting’s positive impact on preventing so many health issues: diabetes, obesity and weight problems, various cancers, high blood pressure, and cardiovascular disease. Experts increasingly agree that giving your body a rest from the constant barrage of meals and snacks (the modern diet, but not how earlier humans ate), not only has profound metabolic effects (the body eats up its store of fat, ketones and glucose), it causes deep cellular repair and renewal.
We predict more people will now embrace intermittent fasting for immune strength. There has recently been more research into how intermittent fasting—and just what kind—impacts our immune system. Dr. Valter Longo, director of the USC Longevity Institute, has been the leader in exploring fasting’s impact on immune function. Back in 2014, he and his colleagues at USC found that a cycle of fasting over six months (2–4 day fasts at 200 calories a day) had a pretty incredible impact. During each fast, the body broke down a high volume of dormant (and damaged) white blood cells, and when participants ate again, it triggered the immune system to produce all-new white blood cells. A fasting cycle essentially “flipped the switch,” they said, on powerful immune system regeneration.
There are many breeds of intermittent fasting (the daily 8 hours of eating/16 hours off; 5 days eating, 2 days off; and new “fast mimicking diets” where you halve (or so) calorie intake for 5–7 days in an ongoing cycle). Three studies from 2019, summarized in Cell, provide some evidence that different forms of fasting have different—sometimes opposite—impacts on the immune system. One study (on humans and mice) found that the most common kind of intermittent fasting (daily, in this case, 19 hours off eating) led to significantly lower inflammatory markers in the blood. The second study (on mice) indicated that reducing calorie intake by half for a week led to significantly increased protection against infections and tumors. The third, though, (on mice) discovered that repeated 2-day, water-only fasts actually lowered immune response.
The researchers at Cell argue that it’s studies like these that mean we really need to get rid of the generic term “intermittent fasting” and study specific fasting methods to understand their impact on health and the immune system.
If people want to take cues from these studies to strengthen their immune system, embracing the shorter, daily fasting windows or a fasting-mimicking diet may be the way to go. The latter involves eating between 800–1,100 calories a day for 5–7 days a month (plant-based carbs and grains, nuts and seeds—nutrients that specifically “trick” the body into thinking it’s fasting without the agony of a water-only purgatory). Dr. Longo offers a fast-mimicking, home delivery meal service called Prolon.
More research is ahead: Dr. Longo’s team’s upcoming trials will test whether fasting interventions can make a virus less infectious and whether they impact the efficacy of the flu and COVID-19 vaccines.
There’s too much rising evidence that forms of intermittent fasting belong in the immune health toolbox. As Johns Hopkins researchers summarized, our cells respond to fasting by switching on “antioxidant defenses, DNA repair…mitochondrial biogenesis and down-regulation of inflammation.” We say “toolbox” because while intermittent fasting is safe for most healthy people, it’s not generic advice: Some people struggle with it, and it can be wrong for people with certain health conditions.
Two Types of Stress & Their Opposite Immune Impact
For decades, researchers have been studying the two types of stress—short-term and long-term—and their opposite impact on immunity. A meta-review of 300 studies concludes that short-term stressors (the physiological fight-or-flight response evolved by our ancient ancestors) elicit positive changes to the immune system, such as bursts of cortisol that lower inflammation. Bad, chronic stress happens when we activate that fight-or-flight system for months on end—as Dr. Pelletier puts it, it’s all those stressors that are “not immediate, identifiable or resolvable” —whether a year-long pandemic or eternal job stress.
Chronic stress is an immune system killer: It makes every aspect of immunity go downhill. It causes more inflammation; decreases your body’s white blood cells that fight infection; disrupts the microbiome; and is associated with cell aging, early mortality, and shortened telomeres, as well as higher rates of heart disease and diabetes. Managing stress, whether through exercise, meditation, or by spending time in nature, has to be part of any meaningful immune-health program.
In Toolbox: Voluntary “Positive Stress” Experiences
The evidence shows that short-term stress significantly boosts immune response short-term. A Stanford study showed that when rats were subjected to mild stress, it caused a “massive mobilization of several key types of immune cells into the bloodstream and then onto the skin and other tissues”—with researchers arguing that short-term stress experiences could be a key intervention in preparing people’s immune readiness for surgery or a vaccine (and we have a big vaccine coming!).
Positive stress (or “eustress” or “hormesis”) is radically different in its psychological and physiological effects than chronic stress because, as Dr. Pelletier puts it: “You’re the voluntary initiator of the stressful experience and you know it will end—whether it’s taking an ice bath, intermittent fasting, or bursts of high-intensity exercise. These periods of short, intensive stress have a positive immune effect because your body ramps up by burning blood sugar and body fat and then starts to feed on junk, aberrant cells, called autophagy.” Studies show that manageable cycles of stress enhance psycho-biological resilience to oxidative damage. Dr. Lipman adds: “We’ve now found that shorts bursts of hormetic stress positively impact the longevity genes–from mTOR to MPK-1.”
Victor Brick, CEO of Planet Fitness Growth Partners and chairman of the John W. Brick Mental Health Foundation, points out that if human biology and immunity evolved around constant, short-term stresses (we experienced them constantly to survive), we’ve completely lost that in modern life, where we sit at desks and expect the temperature to always be tuned to 72 degrees. He argues that we need to push ourselves outside of our modern comfort zones: experience cold and heat, bolt up the stairs instead of taking the elevator, feel hunger—push the envelope a little bit further every day to build physical, mental and immune resilience—and that it should be a bigger part of wellness programs.
People now seem to be intuitively seeking voluntary, boundary-pushing stress experiences. It’s a trend that has really ramped up during COVID-19, perhaps because we feel helpless against an uncontrollable virus and seek more extreme challenges to build up our ability to “fight anything.” We see it in fitness, with the continued rise in high-intensity interval training (HIIT), which made a bunch of 2021 fitness trends reports.
Cold and hot (and contrast) experiences will boom further in wellness, from cryotherapy to the cold-water surfing mania to more infrared sauna experiences (at destinations and in the surge in home infrared sauna blankets/mats, like those from HigherDose). Wim Hof, and his method of combining extreme cold experiences with “push-the-limit” breathwork, has moved beyond biohacker-god-status to the mainstream—and more resorts like New Tree Ranch in California are making the Wim Hof Experience a centerpiece wellness experience. At Sweden’s new Arctic Bath Hotel and floating spa, you experience hot/cold therapy in the wild: jumping into the open-air plunge pool’s icy waters after sweating in wooden sauna huts. We’ll see new technologies at wellness resorts around contrast therapy: If the Finns always take a roll in the snow post-sauna, TechnoAlpin Snow Rooms (now coming to spas) will make the experience “dry” and more comfortable by bringing snowfall indoors.
A poetic (and huge) recent trend: wild, cold water swimming, with people jumping in all over the world—and more wellness destinations, such as the UK’s Armathwaite Hall Hotel & Spa, launching new wild swimming packages. Six Senses Resorts is looking to add a menu of positive stress programming, such as HIIT, new hot/cold experiences, and fasting.
We know that positive stress temporarily “boosts” immune response. But does it have a long-term effect on our cellular biology and immunity? We may soon learn more, as UCSF has just undertaken the first human clinical trial, testing whether short-term positive stresses (from breath-holding methods to hot/cold exposure) could have a lasting impact on the immune system, metabolism and mental wellbeing. Lead researcher, Elissa Epel, PhD, posits a “stress paradox,” that these short-term stressors could prevent/reverse the ravages of chronic stress. In 2021, we predict more people, and more wellness destinations, will embrace that “stress paradox” and experiment with positive stress approaches with an eye to immune strength.
In Toolbox: Immunity Foods & Supplements
We don’t go in-depth on all the functional foods and supplements (from elderberry to echinacea to mushroom adaptogens) being marketed specifically for immunity because they’ve been covered to death all year. While some definitely reside in the “immunity toolbox,” we’ve tried to show how the evidence doesn’t support the wellness market “leading” with them if the goal is true immune health. That doesn’t mean the market isn’t exploding: 60% of global consumers now seek immune-focused food/beverages, and the market is forecast to hit $24 billion by 2023.
The medical debates around “immunity-boosting” supplements are a minefield. US coronavirus czar Dr. Anthony Fauci was vocal this year about how most “do nothing”—excepting vitamins D and C. Most doctors agree that vitamin D deficiencies (so widespread) weaken the immune response, and a recent study showed how vitamin D deficiencies were linked with significantly higher rates of COVID-19 infection.
Dr. Pelletier notes that vitamins B6 and E have immune-stabilizing effects and that there’s research that (very trendy) adaptogens (from ginseng to the mushroom reishi) have special biochemical constituents that stabilize body functions such as the immune system. “When you eat all the ‘immune-boosting’ foods and supplements, you’re giving your body the opportunity to pick and choose from nutrients likely to have immune-modulating effects, but they’re not ‘magic.’” Dr. Lipman is more bullish: “I’ve always been a proponent of supplements, and now more so; they’re a good insurance policy. The three key immune-modulating supplements I’m using are vitamin D, NAC (which replenishes the powerful antioxidant glutathione), and the anti-inflammatory compound quercetin.”
If we’re going to embrace immunity-focused functional ingredients and supplements, more need to be doctor-created and evidence-based. For example, The Well’s Cleanse is a 15-day program that Dr. Lipman designed as a targeted immune pack and program because it “cleans out the gardens” by combining whole-foods nutrition and supplements for metabolic and microbiome health—combined with health coaching.
“Immunity Travel” Will Evolve
It would be impossible to paint the global picture of the number of wellness resorts that have rolled out immunity retreats and programs and how different they are. But it’s clear that “immunity travel” is becoming its own category (like mindfulness or weight loss) in wellness travel. In the pandemic’s early days, many moves felt more like add-ons: whether Equinox Hotels putting “Immune Protect” supplement packs in their minibars or so many resorts serving up “immune-boosting” menus and immune drips/IVs. Destinations are now going much further—and more medical—in their immune health programming and programs designed to help people recover from COVID-19. Yes, there’s still a whole lot of “immune-boosting” language, even though more programs are focusing on approaches that align with the right concept: immune system balancing.
Germany’s medical-wellness destination Buchinger Wilhelmi’s new Immunity+ program has fasting and microbiome health at its core but also includes a battery of diagnostic testing to assess everything from guests’ metabolic to immune system profiles to prescribe a personalized plan. Sangha Retreat by Octave Institute in China has a new program using medical testing for everything from metabolic to immune to sleep health to prescribe an immune-strengthening treatment and nutrition plan. Resorts are also going deep to help people who have had COVID return to health, such as Lanserhof’s program using a whole arsenal of tests and medical-wellness approaches (German, Austria, London).
The Financial Times recently explored what they see as a whole new type of wellness destination focused on “molecular medicine,” whose goal is to build “bioresilience…at the level of the cell”—to delay aging and enhance immunity. “Bioresilence” looks to be a 2021 buzz-concept. London’s BelleCell offers a slate of tests (DNA, metabolic, microbiome, telomere) to create tailored wellness, nutrition and immune health regimes and use futuristic, biohacking tech like IV laser therapy (an energy medicine) and hyperbaric oxygen chambers to target the immune system. Hyperbaric oxygen therapy (breathing in nearly pure oxygen in a pressurized chamber) is an interesting technology to watch: A new study from Tel Aviv University showed that three months of regular treatments led to up to a 38% increase in telomere length in the DNA of immune cells and a decrease of up to 37% in old, deteriorating immune cells, indicating a reversal in aging and immuno-senescence processes.
But whether a program at a wellness travel destination is explicitly designed for immune health, because the pillars of wellness (healthy eating, sleep health, stress-reduction, exercise) are the very pillars for immune resilience, more people will seek wellness travel in general.
The Future
Immune health is not a “trend” and must stop being subject to the “what’s next” fast-fashion mechanism that rules the wellness space. People’s perception of the “wellness industry” has undergone seismic shifts in 2020: There’s growing fatigue with nonsense, more people seek solutions grounded in evidence, and there seems to be a new energy—even an aspirational vibe—around going “back to wellness basics” as true preventative medicine. Immune health is a category where the wellness world simply cannot mess around; the public health consequences are too big.
After a long year, people are more aware that their immune health is a holistic affair, that food and the microbiome health are lynchpins, and that “slow” rather than “hyper” immune health strategies are the difference-makers. People will keep gobbling trendy immunity quick-fixes in trendy bottles…but they’re ready for more.
The medical world, after the lessons of COVID-19, will be much more focused on metabolic and microbiome health, with investment in new research and technologies in these areas ramping up intensely. We expect more breakthroughs in understanding the microbiome’s and diet’s complex and powerful impact on the immune system and how to apply that knowledge to develop innovative therapies, testing platforms, and personalized nutrition models. Research labs and start-ups are busy, whether Stanford’s Microbiome Therapies Initiative or Predict, undertaking the world’s largest scientific nutrition studies with epidemiologists from major research organizations such as Harvard, King’s College London and Sweden’s Lund University.
A wellness industry newly focused on the hard—and fast-evolving—immune science could extend and save many lives. And help its own reputation on the way.
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