Why our immune system needs exposure to microbes and the sun
While we are in the midst of mandatory lockdowns around the world for the covid-19 pandemic, I can’t help but think that staying at home inside is probably the worst thing we can do for our immune systems, which has been stated by experts.
I know it’s radical to say this but excessively washing your hands, bathing and sanitizing your homes is not conducive of a healthy microbiome and therefore immune system.
This goes against everything we’ve been taught.
Germs are the enemy right? WRONG!!!!!
I’ve studied the human microbiome extensively and I can tell you that our immune system depends on trillions of microbes that program our immune system to respond properly to real threats. Our intelligent bodies are also equipped with a complex immune system that we don’t even fully understand that naturally protects us against pathogens. Germ theory states that a germ like a bacteria, virus, yeast or parasite can cause a disease; however, we depend on our microbes for nearly all aspects of our health— immune, mental, endocrine, respiratory, digestive, and cardiovascular.
We can thank the vilification of germs thanks to the chemist Louis Pasteur who postulated that one germ causes one disease. He saw bacteria under a microscope and assumed that they were “bad guys” who caused disease and infection. The idea is that a microbe like a bacteria or virus causes a disease and this microbe can be passed from one organism to another. Remember- just because something is present doesn’t mean it’s bad.
Cellular theory developed by French scientist Antoine Béchamp challenged his rival Pasteur’s germ theory. Béchamp hypothesized that germs were not the cause of disease per se but rather the “inner terrain” was the real determinant of health. In other words, microbes have the potential to be dangerous if the host’s (i.e. human´s) overall health is compromised. Although most of Béchamp’s hypothesis was disproved late, he was really onto something. He understood that when our microbiomes and immune system, or “terrain” are in a state of imbalance, disease can arise. Turns out Pasteur was far from a hero and more of a fraud who plagiarized his peers’ work, and rumor has it admitted on his death bed that Béchamp’s terrain theory was correct— it’s not the microbe it’s the terrain. Enter the human microbiome.
What is the human microbiome?
Humans are walking ecosystems. The human microbiome has been called the “forgotten organ” and consists of about as many microbes as human cells [1]. These microbes comprise mostly bacteria as well as viruses, parasites, yeast, archaea and eukaryots [2]. Each human microbiome is as unique as a finger print [3] and is effected by one’s diet, toxin exposure, medicine use like antibiotics, whether one lives in a rural or urban area, hygiene practices, etc [4]. These microbes inhabit primarily our intestinal tract, stomach, skin, mucosal lining of our lungs, vagina, nasal passages and mouth [5].
The microbiota plays a fundamental role in our health and has a role in the development of the immune system and protect us against pathogens [6], maintain the integrity of the intestinal mucosal barrier and synthesize vitamins K and B [7,8]. Immunoglobulin A has an important relationship with intestinal bacteria and binds commensal bacteria to the intestinal mucosa [9].
To maintain good function, metabolism and balance of the microbiome, the community of organisms needs to have a certain level of stability [10], and low microbial diversity has been associated with several diseases such as autoimmune diseases and allergies [11]. So we actually need lots of microbes to be healthy!
In fact, Strachan developed the hygiene hypothesis in 1989 that postulated that viral infections early in life and family size affect the risk of suffering from hay fever and allergic rhinitis [12]. With our growing knowledge about the crucial role the microbiome plays in human health, scientists now believe that increased cleanliness and subsequent lack of proper microbial exposure and viral infections in early childhood can disrupt the human microbiome causing a lack of indigenous microbes and aberrant immune responses such as allergies and autoimmune diseases [5, 13, 14].
How do you increase your microbial diversity? By exposing yourself to microbes that are in your food (probiotics, fermented food, fiber and polyphenols from colorful and antrich ioxdiant foods) and environment (animals, soil, being in nature and not being overly hygienic) [15-22]. Since an estimated 70% of our immune system lies in our guts, so our immune system depends on having a healthy gut microbiome. When we have a diverse and stable microbial composition, our immune system can adequately respond to pathogens— not overreacting which is the case with allergies and autoimmune diseases, and not too little as is the case with sepsis and severe acute infections.
Viruses, exosomes, Toxins oh my!
The same goes for viruses. I wrote a previous blog post in which I question whether all viruses really cause disease and the role exosomes play in the manifestation of disease symptoms. In fact, about 10% of genes are viral in nature. I highly recommend watching this presentation by Dr. Andrew Kaufmann who discusses the shoddy science surrounding the covid-19 pandemic and the potential role exosomes could be playing. I don’t claim to know what’s really going on or what’s really causing so many people to become sick, but I believe it’s time we start digging beneath the surface to see if what we’re being told is absolute truth.
I’d also be remiss if I didn’t mention the elephant in the room— chronic illnesses are a far bigger issue than any infectious disease like covid-19. I don’t mean to downplay the number of deaths and severe cases of covid-19, but it’s deterring us from waking up to the fact that there are diseases that are killing billions worldwide and the number of deaths from covid-19 don’t come even close.
17.9 million people die of cardiovascular disease worldwide which accounts for 31% of all deaths.
The prevalence of type 2 diabetes has risen from 108 million in 1980 to 422 million in 2014 and can cause several health complications like blindness, kidney failure, and stroke.
Obesity has almost tripled since 1975 and 1.9 billion adults are overweight, 650 million of whom are obese. Like type 2 diabetes, obesity is preventable with diet and lifestyle changes.
Cancer is the second leading cause of death globally. Approximately one third of deaths from cancer are due to the 5 behavioral and dietary risks: high body mass index, low fruit and vegetable consumption, lack of physical activity, tobacco use, and alcohol use.
Autoimmune diseases consist of more than 100 chronic illnesses in which the immune system erroneously attacks the tissues of an organ or organ systems. Their prevalence has increased over the past 30 years, especially rheumotoid arthritis, endocrinological and gastrointestinal diseases like crohn’s, ulcerative colitis and celiac. It is also believed that autoimmune diseases are caused by a genetic predisposition and environmental triggers.
1 in 7 people are hungry worldwide, and hunger causes 3.1 million deaths a year which is about 45% of deaths in children under five.
Most of the critical covid-19 patients suffer from immune dysregulation or are immunocompromised, so when their body does come into contact with a seemingly harmless microbe it creates a cytokine storm which is an overactive immune reaction that causes inflammation and can be fatal.
Environmental and lifestyle factors play major roles in contributing to cancer, autoimmune diseases, diabetes, obesity and cardiovascular disease , yet no one wants to talk cleaning up all the persistent chemicals in our soil, the excessive use of cancerous pesticides like glyphosphate, air pollution, poor water quality worldwide and even in cities in Detroit, the rise in processed food consumption, etc. That’s because these are complex issues to solve that require billions of dollars. It’s way easier to try to kill one”bad” germ than to tackle multidimensional issues that are affecting human health way more than any infection.
What if germs don’t cause disease?
As our understanding of the vital role the human microbiome plays in our health grows, several well-cited books have been written over the past decade that debunk the theory that germs are bad. It’s too much to go into now, but the general gist is that when we are overly hygienic and abuse antibiotic use, our beneficial microbes disappear and our health suffers. I highly recommend checking out the following books on this topic:
Missing Microbes by Martin Blaser MD
The Good Gut by Justin Sonnenburg and Erica Sonnenburg Ph. D
What Really Makes You Ill by Dawn Lester and David Parker
Let Them Eat Dirt: Saving Your Child from an Oversanitized World by B. Brett Finlay Ph.D and Marie-Claire ARrieta Ph.D
The Mind-Gut Connection by Emeran Mayer, MD
The Wild Life of Our Bodies by Rob Dunn
The Symbiont Factor: How the Gut Microbiome Redefines Health, Disease and Humanity by Richard Matthews
An Epidemic of Absence: A New Way of Understanding Allergies and Autoimmune Diseases by Moises Velazquez-Manoff
I know it sounds totally radical and against everything we’ve been taught but maybe what appears to be an infection from a “bad” germ is really caused by a natural physiological process, a toxic substance or a weakened immune system caused by an imbalanced microbiome that causes an improper immune response like a cytokine storm, allergies or autoimmune diseases. Is there really one cause for disease? I would say not always. The human body is far too complex for that, yet we live in a society that fears dirt, nature and microbes because we have been programmed to believe they are our enemy when in reality our health depends on them.
Germs being deemed as “bad” is part of human nature's desire to control and conquer. The love of polarity like good and bad, life and death, rich and poor, barbaric and civilized is a major aspect of humans' dense energy that prevents us from not living in a constant state of suffering.
On the other hand, no one is talking about the major health impact pharmaceuticals have on our health and the more than 128,000 deaths they cause in the U.S. alone. Moreover, pharmaceutical companies are masters at covering up, misinterpreting or manipulating data related to drug interactions and constantly lie about drug safety [24].
If you’re skeptical about what I’m saying, I highly recommend you read any one of the books I’ve mentioned above, especially Missing Microbes.
Dr. Kelly Brogan said, “When we can individually and collectively acknowledge that medicine is a personal belief system, we will finally be free to practice embodiment according to our own truth.”
Perhaps it’s time to reframe our concept around germs and immune health.
Why aren’t the health experts talking about cheap and effective ways to support immune health?
I think the main reason many health experts and institutions are not pushing for natural and inexpensive ways to improve immune health is modern medicine takes a reductionist approach to treating the human body and ailments. Instead, we should be taking a systems approach to human health because our bodies work through an interconnected web of systems and no organ or system of the body works in isolation. Our body is incredibly intelligent and our immune systems want to support us so that we stay in a state of homeostasis. Harsh drugs, antiobiotics, antivirals and dare I say vaccines can disturb our body’s equilibrium.
Here are some proven natural vitamins, minerals and antioxidants that support our immune system effectively with little to no side effects:
vitamin A [25, 26]
vitamin C [26, 27]
Vitamin D [23, 28]
Vitamin E [29]
selenium [30]
zinc [31]
antioxidants from food and liposomal glutathione and PQQ [32-35]
a diet high in whole foods that’s naturally high in vitamins, minerals and antioxidants that support immune health
microbes- food and environment as previously discussed. Get dirty and eat your fruits, vegetables and fiber.
Instead many governments want to push vaccines and expensive pharmaceuticals rather than getting back to basics- good food, water, relationships and a healthy microbiome. That’s because it’s easier to pinpoint an “enemy” such as a virus or bacteria so that we can wage a war against it rather than digging deep and finding the root cause to our complex health problems and immune dysfunction. That’s why obesity, cardiovascular disease, cancer, mental health issues and autoimmune diseases are on the rise.
“A root cause approach would also uncover the myriad of toxins that are in our water, soil, food, cosmetics, furniture, clothes, pesticides and environment that are major contributors to our health problems. That’s a way bigger problem to tackle that has trillions of dollars invested in major corporations owned by the top 1%. But killing a virus. Yeah, you bet modern medicine is all over that because it appears to be the easy approach and it makes us feel like we are more in control.”
I’m not about to get into a debate for or against vaccines, but what I am saying is that it’s like many doctors and scientists have seemed to have forgotten that all humans are equipped with an intelligent immune system that’s perfectly capable of managing an infection if the person is healthy. The problem is that most of us aren’t healthy and few are willing to tackle these issues because they seem beyond our control and the fabric of capitalism and many societies depend on the survival of these major corporations— or so we are made to believe.
Moreover, few are talking about the millions of deaths worldwide caused by hunger and chronic diseases such as heart disease and diabetes. That’s because the pharmaceutical companies profit far more from pushing vaccines and drugs than educating the public about how to eat well, exercise and support their immune system. This is because these diseases are multifactorial and can't be reduced to one “bad germ” like a virus or bacteria. It requires a more systems biology approach than a reductionist view of health and medicine.
In the case of respiratory diseases like covid-19, we already know that people with diabetes, cardiovascular disease, cancer and those who are immunocompromised are far likely to have severe cases of the disease [37]. This is because diabetes [38, 39], obesity [40], all weaken the immune system and therefore increase susceptibility to infection like pneumonia [41]. Moreover, chronic inflammation can also lead to cardiovascular disease [42] which can create a viscous cycle of inflammation and weakened immune system.
The role Vitamin D plays in immune health
Humans are becoming less and less in touch with nature. In fact, since the beginning of civilization humans have wanted to conquer nature and dominate rather have a symbiotic relationship with it. We rarely go outside and get dirty, we over sanitize our bodies and our homes, doctors and the agricultural sector have abused the use of antibiotics to the point that the rise in antibiotic resistant bacteria is on a dangerous rise [36], and we fear being out in the sun because of the risk taking of getting skin cancer. Many go from their home to the car to work and back home without barely going outside for days. Humans are afraid to be wild, but are we really any healthier being “civilized” with all the scientific and technological advances we’ve created?
When was the last time you are wild berries, go dirty without immediately washing yourself, gazed at the stars, was aware of the phase of the moon, observed how nature changes with the seasons or listened to your natural circadian rhythm depending on the season and hours of light there are in a day?
I published a peer review article a few years ago about the role sun exposure and vitamin D levels play in immune and microbiome health [23]. Vitamin D is known as the sunshine vitamin because we humans are one of the few species that has to synthesize it from sun exposure. Thanks to the development of supplementation, sun exposure is no longer necessary. However, there are correlations between the prevalence of autoimmune diseases and countries that are at higher latitudes. This is because vitamin D plays a crucial role in our immune health. Interestingly, vitamin D has recently been shown to interact with our gut microbiome, and adequate serum D3 levels have been associated with a beneficial bacteria in our guts. Moreover, our gut microbes also interact with vitamin D receptors in our intestines which regulate our immune system.
So the moral of the story is the more hygienic and germophobic we are and the less we are outside exposed to the sun the weaker our immune systems are likely to be.
What does this all mean?
Humanity as we know it is at a turning point. When this pandemic blows over, we can decide to return to our regular routines and what we believe to be normal life, or we can demand change to fill the gaps in our society’s systems.
It’s also a critical time to question the fear mongering narrative we’ve been fed by the corporation-controlled and bought out media and think about what our truth really is. It’s ok to feel fear. It’s our human nature, but the problem is when we live in fear and our blinded by it. How can we use our fear as a tool of transformation to guide us closer to our truth?
We can’t pretend to know what’s truly going on, and I don’t think conspiracy theories are going to get us anywhere right now other than deepen our fears, and aim certainly not going to sugar coat our current situation with rainbows and unicorns. To me it seems this pandemic is another example of how humans are trying to control the uncontrollable variables in their lives by waging a war— The war on drugs, the war on terrorism, the war on germs in our bodies and environment, the war on immigration, and now the war on coronavirus.
I know this is an unorthodox viewpoint, but maybe we should stop “fighting” illnesses and “germs” and instead take a holistic approach to health and disease. There’s nothing to fight especially because it implies that those who have “lost the battle” against whatever disease or illness didn’t “fight hard enough.” Maybe health is more about surrendering our illusion of control and that we can cheat death and play God— the control of germs through excessively hygienic practices (I’m looking at you hand sanitizer) like the abuse of harsh chemical cleaners, antibiotics, antivirals, etc, control of disease through pharmaceuticals that have severe side effects, the false believe that if we can control our lives using scientific and technological advancements it will bring us utopia and better health (spoiler: it hasn’t yet), the control over our environment and belief we are more powerful and wiser than Mother Nature, the control over what people are supposed to believe about germs and the immune system using fea tactics, the control over religion, and most importantly the control over life and death itself through imposing fear on basically everything from germs to terrorists.
“At what expense will we surrender our human rights and liberties to give us a false sense of control over life and death while we still continue to live in fear? Is the goal of humanity to live as long as possible although our quality of life and that of our planet suffers?”
Is long-term social distancing and strict lockdowns the only answer?
Are we really any healthier given the advances in medicine like antibiotics, antivirals and immune-modulating drugs? Sure, life expectancies worldwide have more or less increased over the years, but what is our quality of life like during our final decade or so of life? Is being in chronic pain and fear worth it? More people are dealing with chronic illnesses than ever before and the sharp rise in antibiotic-resistant bacteria is a real health threat, which again challenges the idea that we have to “fight” germs rather than healing the “terrain” to restore homeostasis. Is being in a state of chronic fear and stress worth it? We know psychological stress negatively affects our immune system [43].
Maybe what we all really need now is to hug and shake hands more, get dirty more, deeply connect with people instead of isolating ourselves and surrender to the fact that everyone’s death is inevitable. I don't believe death is the end. It's coming home to the eternal beings that we all are. Charles Eisenstein eloquently says here and here that over time we've become more concerned with security rather than living a beautiful life. He goes on to further say that no one is counting the number of people who die well but instead look at helping a person stay alive regardless of their quality of life is seen as a success. We're indeed becoming more and more separate from nature and each other due to the fear of germs and not being safe.
I’ll be damned if we come out of this process the same as when we started. We are being forced to face our traumas and fears and come out changed for the better with a new outlook on life itself. That’s the hope I’m holding for us humans at least.
Sources
Ursell LK, Metcalf JL, Parfrey LW, Knight R. Defining the Human Microbiome. Nutr Rev. 2012; 70(Suppl 1): S38–S44.
Franzosa EA, Huang K, Meadow JF, Gevers D, Lemon KP, Bohannan BJM, et al. Identifying personal microbiomes using metagenomic codes. PNAS. Jun 2015; 112(22)
Human Microbiome Consortium. Structure, function and diversity of the healthy human microbiome. Nature. 2012; 486: 207-214.
Cho I, Blaser MJ. The human microbiome: at the interface of health and disease. Nature Reviews. 2012;(13).
Thum C, Cookson AL, Otter DE, McNabb WC, Hodgkinson AJ, Dyer J, et al. Can Nutritional Modulation of Maternal Intestinal Microbiota Influence the Development of the Infant Gastrointestinal Tract?. Journal of Nutrition. 2012; 142: 1921–1928.
Alonso VR, Aguilar FG. El sistema inmune de las mucosas. El Probiótico. 2014.
Ramakrishna BS. Role of the gut microbiota in human nutrition and metabolism Journal of Gastroenterology and Hepatology 2013; 28 (Suppl. 4): 9–17.
Gilbert JA. Our unique microbial identity. Genome Biology. 2015; 16(97)
Human Microbiome Consortium. Structure, function and diversity of the healthy human microbiome. Nature. 2012; 486: 207-214.
Morgan XC, Huttenhower C. Chapter 12: Human Microbiome Analysis. PLOS. 2012; 8(12).
Strachan DP. Hay fever, hygiene, and household size. BMJ (1989) 299:1259–60. doi: 10.1136/bmj.299.6710.1259
Proal AD, Albert PJ, Marshall TG. The human microbiome and autoimmunity. Curr Opin Rheumatol (2013) 25:234–40. doi:10.1097/BOR.0b013e32835cedbf
Schnorr SL, Candela M, Rampelli S, Centanni M, Consolandi C, Basaglia G, et al. Gut microbiome of the Hadza hunter-gatherers. Nat Commun (2014) 5:3654. doi:10.1038/ncomms4654
Perlmutter D. Brain Maker: The power of gut microbes to heal and protect your brain for life. Little, Brown and Company. New York. 2015. pp. 11, 33, 190, 191, 206.
García- Mazcorro JF, Garza-González E, Marroquín-Cardona AG, Tamayo JL. Caracterización, influencia y manipulación de la microbiota gastrointestinal en salud y enfermedad. Gastroenterología y Hepatología. 2015.
De Felipo C, Cavalieri D, Di Paola M, Ramazzotti M, Poullet JB, Massart S, et al. Impact of diet in shaping gut microbiota revealed by a comparative study in children from Europe and rural Africa. PNAS. 2010; 107(33): 14691-14696
Bäckhed F, Fraser CM, Ringel Y, Sanders ME, Sarto B, Sherman PM,et al. Defining a Healthy Human Gut Microbiome: Current Concepts, Future Directions, and Clinical Applications. Cell Host & Microbe. 2012; 611-622.
Clemente JC, Pehrsson EC, Blaser MJ, Sandhu K, Gao Z, Wang B. The microbiome of uncontacted Amerindians. Science Advances. 2015; 1(3).
Zeng J, Li YQ, Zuo XL, Zhen YB, Yang J, Liu CH. Clinical trial: effect of active lactic acid bacteria on mucosal barrier function in patients with diarrhoea-predominant irritable bowel syndrome. Alimentary Pharmacology and Therapeutics. 2008; 28, 994–1002.
Puddu A, Sanguineti R, Montecucco F, Viviani GL. Evidence for the Gut Microbiota Short-Chain Fatty Acids as Key Pathophysiological Molecules Improving Diabetes. Hindawi. 2014.
Dueñas M, Muñoz-González I, Cueva C, Jiménez-Girón A, Sánchez-Patán F, Santos-Buelga C, et al. A Survey of Modulation of Gut Microbiota by Dietary Polyphenols. BioMed Research International. 2014.
Clark A and Mach N (2016) Role of Vitamin D in the Hygiene Hypothesis: The Interplay between Vitamin D, Vitamin D Receptors, Gut Microbiota, and Immune Response. Front. Immunol. 7:627. doi: 10.3389/fimmu.2016.00627
Light, D. W., Lexchin, J., & Darrow, J. J. (2013). Institutional Corruption of Pharmaceuticals and the Myth of Safe and Effective Drugs. The Journal of Law, Medicine & Ethics, 41(3), 590–600. https://doi.org/10.1111/jlme.12068
Penkert RR, Jones BG, Häcker H, Partridge JF, Hurwitz JL. Vitamin A differentially regulates cytokine expression in respiratory epithelial and macrophage cell lines. Cytokine. 2017;91:1–5. doi:10.1016/j.cyto.2016.11.015MLA
Romieu I. Nutrition and lung health. INT J TUBERC LUNG DIS. 2015. 9(4):362–374
Carr AC, Maggini S. Vitamin C and Immune Function. Nutrients. 2017;9(11):1211. Published 2017 Nov 3. doi:10.3390/nu9111211 ; Aimee L. Webb, PhD, Eduardo Villamor, DrPH, MD, MPH, Update: Effects of Antioxidant and Non-Antioxidant Vitamin Supplementation on Immune Function, Nutrition Reviews, Volume 65, Issue 5, May 2007, Pages 181–217, https://doi.org/10.1111/j.1753-4887.2007.tb00298.x
Christopher E Taylor, Carlos A Camargo, Jr, Impact of micronutrients on respiratory infections, Nutrition Reviews, Volume 69, Issue 5, 1 May 2011, Pages 259–269, https://doi.org/10.1111/j.1753-4887.2011.00386.x
Lewis ED, Meydani SN, Wu D. Regulatory role of vitamin E in the immune system and inflammation. IUBMB Life. 2019;71(4):487–494. doi:10.1002/iub.1976; Aimee L Webb et al, 2007
Steinbrenner H, Al-Quraishy S, Dkhil MA, Wunderlich F, Sies H. Dietary selenium in adjuvant therapy of viral and bacterial infections. Adv Nutr. 2015;6(1):73–82. Published 2015 Jan 15. doi:10.3945/an.114.007575
Wang L, Song Y. Efficacy of zinc given as an adjunct to the treatment of severe pneumonia: A meta-analysis of randomized, double-blind and placebo-controlled trials. Clin Respir J. 2018;12:857–864. https://doi.org/10.1111/crj.12646
Rahman I, MacNee W. Oxidative stress and regulation of glutathione in lung inflammation. European Respiratory Journal Sep 2000, 16 (3) 534-554
Robert Rucker, Winyoo Chowanadisai, Masahiko Nakano. Potential Physiological Importance of Pyrroloquinoline Quinone. Alternative Medicine Review Volume 14, Number 3 2009
Calliandra B. Harrisa Winyoo Chowanadisaia Darya O. Mishchuka Mike A. Satrea Carolyn M. Slupskyab Robert B. Ruckera. Dietary pyrroloquinoline quinone (PQQ) alters indicators of inflammation and mitochondrial-related metabolism in human subjects. The Journal of Nutritional Biochemistry. Volume 24, Issue 12, December 2013, Pages 2076-2084
Sinha R, Sinha I, Calcagnotto A, et al. Oral supplementation with liposomal glutathione elevates body stores of glutathione and markers of immune function. Eur J Clin Nutr. 2018;72(1):105–111. doi:10.1038/ejcn.2017.132
Aslam B, Wang W, Arshad MI, et al. Antibiotic resistance: a rundown of a global crisis. Infect Drug Resist. 2018;11:1645–1658. Published 2018 Oct 10. doi:10.2147/IDR.S173867
Zhang et al. Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy. 2020. https://onlinelibrary.wiley.com/doi/full/10.1111/all.14238
https://www.sciencedirect.com/science/article/abs/pii/S1043661818309459?via%3Dihub
Milner JJ, Beck MA. The impact of obesity on the immune response to infection. Proc Nutr Soc. 2012;71(2):298–306. doi:10.1017/S0029665112000158
Corrales-Medina VF1, Musher DM, Shachkina S, Chirinos JA. Acute pneumonia and the cardiovascular system. Lancet. 2013 Feb 9;381(9865):496-505. doi: 10.1016/S0140-6736(12)61266-5. Epub 2013 Jan 16.
Fernández-Ruiz, I. Immune system and cardiovascular disease. Nat Rev Cardiol 13, 503 (2016). https://doi.org/10.1038/nrcardio.2016.127
Thornton LM, Andersen BL. Psychoneuroimmunology examined: The role of subjective stress. Cell science. 2006;2(4):66–91.