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with immune function. In a study with 50 older adults cell activity). Furthermore, those who are socially isolated
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assigned to either a control or tai chi/qigong group for five have heightened response to stressors. Older individuals
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months, the group assigned the activity had improved may be particularly at risk for the effects of loneliness if
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antibody response to an influenza vaccine that was their immune system is already compromised. 94,95
administered within the first week of intervention. Excessive social interaction may confer either immune
Furthermore, a systematic review of 15 studies on yoga benefit or harm through increased exposure to potential
found that it can lead to a pattern of inflammation pathogens depending on whether or not conflict or stressors
downregulation, including lower IL-1beta, TNF-alpha, are present. 91,93 There is the viewpoint that an individual
and IL-6, as well as enhancements in immunity. The who is socially interacting with others may, in fact, have the
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authors concluded, “These results imply that yoga may be potential for greater antiviral immunity, although much is
implemented as a complementary intervention for determined by the individual’s environmental exposures,
populations at risk or already suffering from diseases with toxic burden, and even genotype. Interestingly, during
an inflammatory component.” bouts of increased inflammation, as during illness, there is
Due to the constraints brought on by the COVID-19 some instinctual inclination within most people to socially
pandemic, exercise may need to be adjusted to fit a home- withdraw. The amygdala region of the brain is part of this
based schedule. Suggestions include stretching, walking sickness-induced social withdrawal process and may even
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in nature, stair climbing, chair squats, and even simple be protective by encouraging retreat from threatening
yoga poses since they require no equipment. There are images. Therefore, it may be important to personalize
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many online offerings through apps and the internet to exposure to social influences depending on the
engage in classes if more interaction is desired. circumstances, including the current state of health or
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Furthermore, this time of social distancing may be optimal illness.
for being in nature to experience the therapeutic effects The converse of social isolation is to have support and
(referred to as Shinrin-yoku, or forest bathing), such as an connection, which can come through a variety of means,
increase in NK cell activity, physiological relaxation, such as family and friends, community, and spiritual or
immune recovery, and a decrease in stress. Dr. Steven religious practices. Overall, research indicates that
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Blair’s quote from Dr. Ken Powell, “Some activity is better individuals who feel this sense of interconnection, either
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than none, and more is better than less,” seems to be horizontally with other people or vertically through a
particularly relevant during these times of quarantine and sense of something greater than themselves, have favorable
the resulting risk of increased sedentary behavior. Ideally, gene expression, decreased stress, increased antibodies,
30 minutes of physical activity every day, or a total of and better health outcomes. In a study of over 8 000
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150 minutes weekly, should serve as a guideline for most adults, greater social engagement and cohabitation were
individuals. associated with lower C-reactive protein, fibrinogen, and
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white blood cells. In a study of 155 adults, a positive
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Social Factors/ Connection relationship was found between sociability and salivary
secretory immunoglobulin A, an essential feature of
Overall Recommendations: Social connections are mucosal immunity.
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important to consider and evaluate with patients as part of The sum of the research on connection and the
their health status. In some cases, interactions with others immune-inflammatory response is mixed as this
will be supportive, and in other instances, there may be connection appears to be influenced by several factors,
conflict or stress. For immune health, the focus should be including the response of the individual and their
on reducing exposure to interactions perceived as hostile preferences, personality, and health state, as well as
and non-supportive and, at the same time, on emphasizing whether or not there is conflict or stress in the interactions.
and encouraging time with others who are positive However, if there is a sense of supportive connection
or affirming. For those people who may be lonely or through the social network, it appears that immune
isolated, such as the elderly, as well as those who may be at markers can be favorably influenced.
increased risk of immune compromise, providing ideas for
regular social connection may be helpful for establishing a Summary
routine. Ideas might include participating virtually in local In general, lifestyle interventions can be an effective
community events or in a religious or spiritual group. means to help patients regain their locus of control during
times of uncertainty like those experienced in a pandemic.
Social relationships are a significant determinant of Substantial research indicates that certain dietary patterns
immune health. The absence of these essential and lifestyle patterns offer viable options for improving
relationships, collectively referred to as social isolation, overall health, especially by reducing inflammation. The
loneliness, bereavement, and/or conflict, has been anti-inflammatory effects of foods and aspects of how one
implicated in the upregulation of proinflammatory chooses to live may, in turn, favorably influence and
processes 91,92 and reduced immune functionality (e.g., NK support immune system function as a preventative

Minich—Nutrition & Lifestyle Practices for Strengthening Host Defense Integrative Medicine • Vol. 19, No. S1 • Epub Ahead of Print 59