Dear Dr. Roach: Would you please clarify what it means to be immunocompromised? Is it the same as having an immune disorder? If a person has an autoimmune disorder, are they considered immunocompromised, or would they have an exceptionally robust immune system?
As people age, their immune systems weaken. Would an autoimmune disease become less severe with age? Do allergies become less severe with age? — J.C.
Answer: Immune disorders include both immunodeficiencies and autoimmune diseases. An ideal immune system would keep you protected from all infections (bacteria, viruses, fungi, protozoa and others) and would kill any cancers. It would never mistake part of the body for an invader. Unfortunately, as good as our immune systems are, they aren’t quite perfect.
We sometimes simplify that “immunocompromised” is having too little of an immune system, while people with an autoimmune disease have too much of one, but it’s more complicated. Most people with immunodeficiencies have “holes” in their immune system so that they are susceptible to certain germs, but they may be perfectly good at fighting off others.
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People with very severe immunodeficiencies, where they are very immunocompromised, may be at risk from practically any pathogen. Sadly, people with severe immunodeficiencies are also at increased risk from many cancers, since cancers are often, and usually, stopped by the immune system.
Unfortunately, people with autoimmune diseases are not protected against infections and cancers. Worse yet, treatment for autoimmune diseases, although effective at relieving the symptoms of the autoimmune disease, usually put a person at a higher risk for certain infections and cancers.
Allergies, like autoimmune diseases, are immune and inflammatory responses that are more forceful than optimal. It is often, but not universally true, that they decrease over time. Some autoimmune diseases, such as Type 1 diabetes, are much more likely in young people, while others, like Hashimoto’s thyroiditis, are more common in older people.
Scientists often find it frustrating to see advertisements for products to “strengthen” the immune system. The immune system should be perfectly balanced; too much activity in the immune system is very dangerous, as anyone with lupus or a hundred other autoimmune diseases knows.
Dr. Roach writes: A recent column on different diets led to many letters from disappointed people about how their particular diet choice was not considered the best choice. (One person sent me a seven word letter: “Can you say, ‘Go vegan or die’?”) Based on their feedback, I wanted to make a few points.
One is that in any style of diet, there are healthier and not so healthy choices. A diet consisting entirely of Oreos, vodka and cigarettes is technically vegan. A healthy diet contains mostly plant foods and has a high degree of diversity, including different types of vegetables such as greens, roots and legumes; whole grains; nuts and seeds; fish; and small amounts of red meat.
Some people are allergic to or just don’t like some healthy foods, and that’s OK! Eating what you love is important, and most people can find foods that they love that are really healthy.
You can have the things you love that aren’t so healthy in small amounts — and not so often. Ultra-processed foods are in the list of foods that “aren’t so healthy.”
Another is that the amount of food you eat is ideally connected to the amount of exercise you get. Eating large amounts of food but getting no exercise is not ideal. Diet can never be looked at in isolation.
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