Sock Doc 16: Your Immune System Part 3 – Role of Mental Stress, Supporting The Immune System For Vaccines, Boosters and Your Body, Athletes Who Get Sick A Lot, and More

January 28, 2022


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Dr. Steve Gangemi, The Sock Doc, is a natural health care doctor who founded and practices at Systems Health Care, an integrative wellness center in Chapel Hill, NC. Steve is also a longtime endurance athlete and is a wealth of knowledge for athletes looking to optimize wellness.

This is Part 3 of our 3-part series on the immune system and how you can get healthier and stronger immune function. If you’ haven’t yet go back and listen to Part 1 & Part 2 first. On this episode we tie it all together and cover mental stress, neurotransmitters, nutritional protocols to support your immune system in general and before/after vaccines, the question of vaccines/boosters and individual responses and approaches, athletes who seem prone to getting sick and more…

Part 1

Role of mental stress on immune function

  • How tangible is the effect of mental stress on immune function? How can we better check and monitor or stress levels? 
  • Triangle of health: Structural, chemical, mental/emotional, e.g. this shows how mental stress can be just as detrimental as other types of stress.
  • Gut-brain connection:
    • Nearly all serotonin made in your gut and this affects how we feel.
    • Up to 55% of dopamine is made in the gut as well and this affects our emotions and how we feel.
  • When we’re injured or sick for a long time there’s a lot going on- we can get angry etc and this can be tied into HPA axis, cortisol, etc., and affect mood and emotions.
  • Chinese medicine meridians
    • Meridians affected by emotions and vice versa.
    • Emotional turmoil can affect organs.
    • Liver is affected by or contribute to anger and frustration, lung correlated with grief, kidney/ low back pain with fear.
  • The journey of healing is never over, what better time to address our mental and emotional health?

Neurotransmitters and their role

  • Neurotransmitters are chemical messengers that transmit signal from one nerve cell to another, or muscle or a gland.
    • Eg histamine, to some degree, it’s a neurotransmitter
  • Most people think of serotonin as the thing that “gets you to the race”, whereas dopamine “gets you to win the race.”
  • Neurotransmitter levels can go both ways: If you’re someone who’s always in a funk for no specific reason, you could actually create a serotonin imbalance which could then affect gut health (motility, etc)- it’s not always about something else outside or a gut issue in itself that is causing deficits and imbalances in neurotransmitters.
  • If you’re anemic or having hormonal issues (sex hormones, stress hormones), or even blood sugar regulation—these issues could influence neurotransmitter dysfunction.
  • An ongoing cycle:
    • WBC are thought to tag neurotransmitters as they’re being made and there’s a memory that’s created.
    • If you’re overwhelmed with an infection and neurotransmitters are imbalanced, your body can get an imprint of that and tag WBCs. This can impact how immune system then affects emotions even after the infection!
    • Eg if serotonin levels are not functioning properly, the immune system gets an imprint and then after the infection is cleared, you can kind of get stuck in a similar pattern as when you were sick/imbalanced- i.e. serotonin symptoms of depression.
    • Receptors aren’t being activated properly due to the imbalance.
  • How to fix neurotransmitters or get out of a rut/cycle as mentioned above?
    • Starts with diet.
    • Check exercise, stress, breathing, cortisol levels (are they through the roof? this matters).
    • Check gut health- are you making them, and enough?
  • SSRIs: they can help but they don’t help your body make more neurotransmitters; instead, they help what you do have stay active; i.e. they can help but not fixing root cause.
  • So a lot of people aren’t making sufficient amounts- goes back to methylation (and folate, B12, et- methylated nutrients), iron/anemia, gut health.
  • Women end up on meds more than men, tied into hormonal issues and even more incidence of iron/anemia etc.
  • Fix/control what you can fix: diet, exercise routine, etc. These things are often at the root cause. Work on 2 sides of the triangle.

Nutritional protocol to support Th1/Th2 and vaccine support

  • Refer back to Part 1 for a more detailed rundown of the Th1/Th2 responses in the immune system.
  • Th1 is supported by astragalus, olive leaf, vitamin A, vitamin D.
  • Covid specific: What is helping includes elderberry, astragalus, A, D, zinc. 
  • Th2 is supported by OPC from grape seed phytosomes, and we’re seeing that this has been really helpful to support the Th2 response from a vaccine or otherwise.
  • OPC info:
    • OPC is showing to be helpful to support your body when getting the vaccine.
    • This compound is found naturally in apples, raw chocolate, blueberries, strawberries
    • We recommend Thorne brand of OPC.
    • You can take OPC in advance or after the shot; so far we know more about it when taking it after the shot.
    • When taking after the shot – if using Thorne, take 3 capsule 3x a day for 3 weeks, and this helps with immune overstimulation that happens.
  • Vaccine can lead to an overabundance of Th2 cells.
  • Th2 supported by antioxidants—helpful foods and nutrients include: tomatoes, carrots, watermelon, quercetin, onions, kale, resveratrol, green tea extract.
  • But sometimes the food form isn’t enough and supplements really help for a bigger boost. 
  • Are vaccines throwing off our Th1/Th2 balance? it seems like it results in being Th1 deficient with heavy Th2.
  • Vaccines and breakthrough covid infections, what’s going on here? Or is it just that the immune system is very overwhelmed from these interventions, etc?

Part 2, Listener Questions

Suzanne asks:

Based on your latest podcast I would love to hear Steve’s thoughts on how to support your immune system to prepare for Covid booster shots. (Perhaps I should search his sight first for more information.) I recently had mine not sure how I feel about it but each time I’ve had a pretty significant response. The second go around I actually got shingles. I do you have underlying autoimmune condition (Raynaud’s) I don’t consider it severe enough to be a concern with the vaccine. Perhaps I am wrong. it’s hard to know what the right thing is to do these days. There just isn’t enough information available to make a solid decision. Im trying to good for my  community and I have potential high exposure at my job as a massage therapist. Ugh!

Intellectually I agree with science and vaccines. But my gut disagrees.

What we say:

  • Discussing the value and validity of trusting your gut and intuition. 
  • Don’t lose your intuition, this means we lose our own compass.
  • Being in alignment and true to yourself, our purpose, etc.
  • Uncertainty or indecision affects large intestine (going back to Chinese medicine).
  • If an autoimmune condition is present that should be a red flag when deciding to get a vaccine.
  • IL-4 is the predominant cytokine of the Th2 response and when you combine that with TGF-beta, this leads to a Th9 response, which is another pathway in which someone develops autoimmunity. 
  • If we provoke the Th2 pathway excessively (can happen with allergies, asthma, parasites, vaccines) you’re more susceptible to developing or worsening autoimmunity.
  • Shingles is a sign that immune system set off, this condition is the reactivation of the virus for many of us (as it lives dormant in us usually), and the Th1/Th2 imbalance at play in leading it to surface.
  • What about “mild” autoimmune cases or those in remission from autoimmune conditions? 
    • If it’s present and an issue, even minor, that is considered a risk factor.
    • Remission is another issue and a deep question.
  • Recent data indicates that the vaccine may only diminish transmission/reduce exposure for 3 weeks.
  • The vaccines for covid aren’t lasting very long but what they are doing is hoping to reduce severe cases.
  • What about natural immunity? Herd immunity? And helping to end the pandemic.
  • Typically vaccines don’t last as long as natural immunity for many viruses (i.e. viruses other than covid).
  • And with covid we just don’t know everything yet for one reason: time.
  • So bottom line: how do we prepare and support my immune system for a better Th2 response when getting a vaccine or booster?
    • If you want to get the booster and more shots going forward: support immune system, A, D, OPC are high on the list to support.

Emily asks:

Just discovered endurance planet a couple of weeks ago and have been gobbling up the episodes. Thanks for your important perspective on the whole person not just the performer. I am striving for balanced and health-focused marathon training if such a thing is possible.

I’m a mother of two and my kids and marathoning are my joys.

I’m a 4x marathoner and have progressed from 3:20 (2014) to 2:56 (2019) with a baby born in 2016. My second was born March this year.

Nothing inspires me like the marathon and I overperform at it relative to my other distances. I know I should probably take a season or two to run shorter distances but whenever I do that I often lose motivation and don’t enjoy myself.

I’m a huge fan of building up to 100km weeks I like to hold for about 10 weeks each cycle. My workouts are fairly light — I rarely go to the well and focus on threshold and hills for power— and love the long run.

However every build my limiting factor is illness. I have mild asthma that flares up with respiratory infections. When I train and race through these infections, I know I potentially damaging my lungs by prolonging the infection and exacerbating my asthma symptoms. I’ve worked with a naturopathic doctor in the past and I’m not sure the supplements help if I only take 3 days off instead of waiting for the illness to subside. I usually get very antsy about losing fitness. I have taken up to a week off but find it very difficult. I am getting better with a meditation practice and improved perspective at listening to my body.

I’ve moved to a new area and made fast friends with other runners also running marathons this spring. I promised myself I’d put health and family first but am so tempted to run Boston 2022 for social reasons and to do what I love. Somehow I still qualify from 2019. I have not run it before. It feels “right” but daunting.

My first race post partum (8 months post partum) was to be this weekend (nov 8). I didn’t line up because my two sons got ill earlier this week and I got sick beginning Thursday. Scratchy throat, dry cough keeping me up at night, and runny nose. Not major but I’m just not interested in it developing into an upper respiratory tract infection so I DNSed. So far asthma feels controlled.

I’ve been running 60k a week with little strain and lots of enjoyment and think I could easily build to 85k and maybe 90-95 by January.


My baby sleeps better than my first but sleep and diet are definitely some areas I could improve. When babys not teething or unwell I usually get 4-5 hr stretches once 3-4x a week. My partner works shift but for the next few months will have all weekends off which will allow me to train with friends for every long run on Sundays. It’s much less stressful than my normal training cycle where I sometimes and doing my 35k long runs at 7pm.

My naturopathic doctor has me trying out an elimination diet for 4 weeks because I also had iron deficiency and low hemoglobin through my pregnancy. I’ve had chronic anemia and needed to supplement on and off for a decade and we suspect a gut issue. I got iron infusions due to my pregnancy January 2021.. We are eliminating alcohol, dairy, gluten, and added sugar for 4-6 weeks and adding a probiotic. A decade ago I had an eating disorder but I truly feel released from it. I can eat a variety of foods without issue now, fuel very well when I train in particular, and know I need to eat nutrient dense food and put away the junk. I eat about 70/30 whole to processed foods.


  1. Is it foolish to train for a respectable Boston (I’d love to run sub 3:15) given my current lifestyle of young kids, less than ideal sleep, and susceptibility to illness?
  2. What is your thinking on training through mild illness or maintaining fitness without overall stressing the body or is total rest required?
  3. Any other tips for runners prone to illness? Nutrition, supplements, or lifestyle? It’s complicated for supplements bc I am breastfeeding and plan to continue for another 6 months most likely.

I love marathoning but also know I may need to be patient.

Much thanks.

What we say:

  • The concept of “runners who are prone to illness”—the key here is, we shouldn’t be prone to illness. It’s ok to get sick on occasion but it’s how those illnesses affect us (severity, duration, etc). But if you find yourself catching everything, especially as an athlete, there is a clear imbalance between health and fitness, and something needs to change.
    • If the training is too much and heavily weighted in one’s life, i.e. having a negative effect on ability to recover or stay balanced, then that will show itself in the illness and allergies, etc. 
  • Aerobic system is dependent on iron; iron is tied with T-reg cells.
  • And vitamins A, D, copper, glutathione—these all needed for T reg cells.
  • Iron helps make superoxide dismutase, which is a powerful antioxidant right up there with glutathione.
  • So back to the training, is it worth it? Is it foolish? Yes but….
    • We’ve all done dumb things like training and racing when we were sick and prolonging that illness.
  • Thorne article and facts on the J curve with exercise, with more that we discussed in Part 2 of this series.
  • Fit but unhealthy? Refer to Maffeotone/Laursen article.
  • We also discuss more on fit but unhealthy in this podcast.
  • More tips and considerations:
    • Athletes are a bit stubborn and tend to train/race even when worn down and/or sick.
    • Also, in being a mom, is your ability to parent and show up for your kids negatively affected?
    • Total rest isn’t necessary, you don’t have to quit running. 
  • Asthma resources by the Sock Doc:
    • Better understanding of asthma
    • Asthma and athletes
    • The idea here is: What if you can make your lungs stronger and not just manage the deficiency? So you can train and race and get rid of this condition and catch fewer respiratory infections.
    • With medications, how are these affecting you, what is the mechanism taking place? Important to dive deeper on this.
  • Last word: The races will always be there… it’s ok to hold off on having to everything right now.

Comments (5)

  • Todd C Kushner says:

    In this episode, Tawnee mentioned that she had recently read a study pointing to the importance of following one’s intuition. Can you post a link to the study? I am very interested in learning more. Love the podcast; I listen most Saturdays on my long run.

  • Allie Green says:

    I appreciate Dr. Gangemi’s option on vaccines but I did not think the podcast was very balanced on such an important topic.

  • Ken says:

    I would like to see Dr. Gangemi’s source for the vaccines causing a predominantly Th2 immune response in patients. From what I have read, the mRNA vaccines lean strongly towards the Th1 response.

    • TawneePrazak says:

      Hi Ken, from Steve: Hey Ken – thanks for the article and yes, at least from their findings, they do discuss a more specific Th1 shift in the mRNA. However, there is more in the fine details. For example, they discuss the vaccine associated enhanced respiratory diseases (VAERD), a Th2 response, in the alum adjuvant group and that “it is important to keep this phenomenon in mind.” To that statement I will say that the study was published a year ago in February 2021, and I don’t see how they could accurately study the effects on humans (we know there was no time to do that) and also since then there have been various reports of aluminum and other adjuvants in vaccines causing a host of immune “responses.”
      I also suspect that the Th1 response discussed in the study is due to the pro-inflammatory effect caused by the vaccine. They note that there is a TNF response which is highly inflammatory, and by the way, many immunologists don’t consider it a Th1 cytokine like this study notes. Of course Th1/Th2 responses are always happening concurrently, but vaccines produce a spike in antibodies as a Th2 response. Actually, it’s not uncommon for a Th1 response to be followed by a Th2 response as the Th2 is needed to make IL-10, which is a powerful anti-inflammatory. So we might ask if this Th1 inflammatory vaccine-induced response is then overwhelmed by a much greater, and longer lasting, Th2 response?
      One of the linked references,, says “a single immunization with a high vaccine dose (30 μg) appeared sufficient to promote an elevated humoral response in mice…” (humoral responses are Th2) and that “Our study demonstrated that the bona fide Tfh cells induced by SARS-CoV-2 mRNA vaccines had a mixed Th1-Th2 functional profile” and that there was a “superior ability of SARS-CoV-2 mRNA vaccines to promote GC responses.” These Germal Center responses are B cell – humoral (Th2) responses – of the adaptive immune system.
      Hope that helps, or maybe brings up more questions that need to be answered. I sure don’t think there’s a lot of definitive research on this topic.

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