5 Important Tools
for a
Robust Immune System

Dr. Al Danenberg Nutritional Periodontist

December 13, 2020 [printfriendly]


Image by Bruno /Germany from Pixabay

I’m obsessed with getting it right.

From all the research I’ve read and from my personal cancer journey, there is one fact that stands out above all: A robust immune system is critical for wellness.

It’s vital for healthy people; it’s vital for sick people; it’s vital for all who want to be proactive as well as those who are reactive.

A robust immune system is the ticket for fighting diseases arising from external and internal sources. It protects us from pathogens as well as our own cells which become cancerous.

I’m fixated on recreating my robust immune system and evaluating my success along the way. And I’ve assembled a toolbox – my biological measuring tools. It includes 5 biomarkers which tell me what I need to know. I’ve used these measurements to guide me on my journey to a healthier immune system.

You also can use these tools to assess your progress and success.


5 Important Tools

#1. Healthy Gum Tissue

Your mouth can tell a lot about the health of your immune system. One prominent sign is the gum tissue around your teeth. It should never bleed unless it is cut. Never!

If you were to scrub your nails with a nail brush, you should be concerned if the cuticles around your nails started bleeding. Similarly, when you brush your teeth with a toothbrush, you should be concerned if you see any bleeding. The gums are as tough and protective as are your cuticles.

However, if you have a compromised immune system, the gum tissues may become inflamed or infected (i.e., gingivitis). They then may bleed when you clean or rub them. They even may bleed spontaneously. This is a strong indication that your immune system is not functioning ideally.

An excellent method to determine if you have bleeding gums around any tooth is to use a TePe Easy Pick. This is a small, silicone brush used to clean between the teeth at the gum line.

If you see any bleeding when using the TePe Easy Pick around any tooth/gum area in your mouth, you have some form of gum disease. This suggests that you have a compromised immune system.

Here are two pictures demonstrating how to use the TePe Easy Pick between teeth at the gum/tooth margin.


#2. Ketone Breath Meter

Metabolic flexibility is necessary to support a responsive immune system. And ketosis is part of being metabolically flexible.

I want to be in ketosis 6 days a week and then cycle into a carb-burning mode on the 7th day. The benefits of ketosis and carb-cycling are documented in the medical literature. Travis Christofferson summarized the unique qualities of ketones in his book, Ketones: The Fourth Fuel.

To help me gauge my ketone levels and document how well I’m doing, I researched three options.

  1. Urine ketone strips are easy and inexpensive. But they are not accurate once your body begins to utilize its blood ketones efficiently and effectively.
  2. Blood ketone levels can be monitored with finger sticks using a blood ketone meter. The readings are accurate, but I would need to prick my finger several times a day, every day. Not for me! I don’t know about you, but it hurts when done repeatedly. Another drawback is that it only gives a static picture at that moment in time.
  3. A ketone breath meter recently came on the market that has clinical research to support its efficacy. It’s was created and is sold by MyBiosense. This meter is unique because it registers acetone levels that are blown out in the latter part of the exhale, which is called Deep Lung Sampling. The readings correlate to the mmol/L of blood ketone levels. Using this device, I can monitor my ketone levels as often as I want with no finger sticks! And the data is stored in the MyBiosense App on my phone for me to review.

My goal is to average a ketone level between 1.5 – 2.5 mmol/L per day while in ketosis. On my “carb” day, my ketone levels will drop below 0.5 mmol/L that day.


#3. Standard Deviation of Glycemic Variability

Glycemic variability is the up and down variations in blood glucose level. It indicates the efficiency of insulin to make glucose available as a fuel or to store it appropriately. If insulin is not effective, glucose levels will get out of control leading to diabetes and various forms of metabolic dysfunction.

Various medical papers have shown that the standard deviation of glycemic variability directly correlates with the risk of chronic disease and cancer. It is inversely correlated with the robustness of the immune system.

I want my glycemic variability to be as low as practical.

I could take finger sticks frequently using a glucometer to register my moment-in-time blood glucose level. But that would not give me a running graph 24/7. It certainly would leave me with painful fingertips. I prefer not.

However, a continuous glucose monitor (CGM) by NutriSense is a device that is worn for two continuous weeks. The CGM inserts a microfiber into the interstitial tissues and attaches to an inconspicuous area of the body with an adhesive. It is painless to insert and wear. But it registers glucose levels every 5 minutes, 24/7. The data is transferred to a NutriSense App, which calculates the standard deviation.


#4. Alpha Diversity of Gut Microbiome

The gut microbiome is made up of about 38 trillion microbes. Our body only has about 30 trillion human cells. We are more “microbial” than “human”!

Many studies have been published describing the variety of species in the gut. These medical papers clearly demonstrate that the greater the diversity and numbers of specific microbes, the healthier the immune system. [1],[2],[3]

A measurement including (1) the diversity of various microbial species in the gut and (2) the number of each of these species is called “Alpha Diversity”. It is generally reported as a percentile compared to the microbial ecosystem in a population of metabolically healthy individuals.

BiomeFx is a stool test marketed by Microbiome Labs and evaluated by CosmosID. Among the many biomarkers reported in this test, Alpha Diversity stands out to me as one of the most significant results.


#5. Blood Level of Vitamin D

Recently, blood levels of Vitamin D have been widely reported as important in the fight against the COVID-19 virus.[4] Previous to the Pandemic, much research has been published emphasizing the importance of adequate levels of Vitamin D to assure a robust innate and adaptive immune function.[5], [6],[7],[8]

Vitamin D is reported to …

  • Prevent excessive expression of inflammatory cytokines
  • Increase the “oxidative burst” potential of macrophages
  • Stimulate the expression of potent anti-microbial peptides, which exist in neutrophils, monocytes, natural killer cells, and in epithelial cells lining the respiratory tract where they play a major role in protecting the lung from infection
  • Affect the action of T cells, key players in adaptive immunity

My Personal Results

#1. Healthy Gum Tissues:

My gums do not bleed. I use the TePe Easy Picks every day.

If you have bleeding gums, you need to address your diet, the health of your gut microbiome, and your oral hygiene techniques. You also need to seek the services of a general dentist or a periodontist (a dentist specializing in periodontal disease).


#2. Ketones:

I stay in ketosis with my animal-based diet 6 days a week. My highest mmol/L while in ketosis has been 2.8; the lowest on those days has been 0.5. My average for 6 days running is 1.5. On my cycle day out of ketosis, I eat between 100 – 150 grams of carbs for that day, and my ketone reading drops to an average of 0.3.


#3. Glycemic Variability:

In July 2020, I wore the CGM from NutriSense for two weeks. My average standard deviation of glycemic variability for that time period was 10. Here is a table showing ranges and their interpretations:


#4. Alpha Diversity:

My Alpha Diversity was reported in the BiomeFx stool test I took in August 2020. The results indicated my Alpha Diversity was in the 98th percentile. That meant that 98% of metabolically healthy individuals had less variation of species and numbers of individual microbes than I had.


#5. 25 Hydroxy Vitamin D:

My last blood test for 25 Hydroxy Vitamin D was in 6/2020. At that time, my blood level was 89 ng/mL. and I was taking 5,000 IU of Vitamin D3 daily. I have reduced that dosage to every other day, and I’ll have another test shortly. As a cancer patient, I want to keep my Vitamin D level between 60-80 ng/mL.


Bottom Line

A robust immune system is our internal armed forces to fight the fight. My ultimate goal is to make my immune system as robust as I can. The 5 important tools I described will guide me along my path and document my success. They also will confirm that I am remaining where I want to be.

I firmly believe that my cancer journey has been as successful as it has because I have significantly improved my immune system along the way. You may find that my 5 Important Tools will help you monitor your journey to a stronger and more responsive immune system.


[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6906406/

[2] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200728

[3] https://www.frontiersin.org/articles/10.3389/fmicb.2016.00455/full

[4] https://articles.mercola.com/sites/articles/archive/2020/12/11/do-vitamin-d-supplements-help-prevent-respiratory-tract-infections.aspx?ui=baff764f733a1f4f602b56b0683839cc74ea77293ab586e40b1b7b0b93d42111&cid_source=dnl&cid_medium=email&cid_content=art1HL&cid=20201211&mid=DM744365&rid=1032114513

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3166406/

[6] https://health.ucsd.edu/news/releases/pages/2018-06-15-greater-levels-of-vitamin-d-associated-with-decreased-risk-of-breast-cancer.aspx

[7] https://www.mdpi.com/2072-6643/12/4/1140

[8] https://www.mdpi.com/2072-6643/12/5/1248



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CGM & My Cancer Journey

Dr. Al Danenberg Nutritional Periodontist

August 9, 2020 [printfriendly]


CGM on Dr. Al's arm
CGM on Dr. Al’s arm


When I was interviewed by Dr. Paul Saladino, we discussed the benefit of continuously monitoring my blood glucose levels. Dr. Saladino recorded a Podcast prior to his interview of me that was devoted to continuous glucose monitoring.


Continuous Glucose Monitoring

I’ve done some personal research, and I learned a bunch. The Continuous Glucose Monitor (CGM) is a device that will monitor glucose on a continuous basis. Although diabetics may know about this device and its data collection, the CGM is definitely not just for diabetic patients. You will learn much about your body if you know how your body is dealing with glucose. Carbohydrates in your diet and also gluconeogenesis, which is the natural generation of glucose from non-carbohydrate sources, affect the levels of blood glucose. Control of glucose through effective insulin sensitivity is critical for weight control, longevity, quality of life, and overall wellness and immune support.

The CGM is a small device that works through a tiny sensor inserted under the skin, usually on the arm. The sensor measures the interstitial glucose level, which is the glucose found in the fluid between the cells. It does not directly test the glucose in the circulatory system. However, the glucose levels in the interstitial fluid will lag the levels of glucose in the blood. The sensor tests glucose every few minutes.

CGM attached to skin


My Experiment

I acquired the CGM made by NutriSense. This company provides the CGM to the general public. The device attaches to the skin with an adhesive. Believe me, there is no pain when you attach the device to your arm. A small pin-prick, and then it’s done. The transmitter in the CGM wirelessly sends the information to the NutriSense App that you download on your cell phone.

This is important: Some older cell phones are not compatible with the CGM. You must have an iPhone 7 (or newer) or an Android with a Near-Field Communication (NFC) chip.

Here is a 24-hour graph of my glucose levels on Saturday, 7/25/20. The red dots are morning coffee at 5:45AM, lunch at 11:40AM, and dinner at 4:15PM:

Dr. Al’s 24-hour glucose 7/25/20


By scanning the device with your mobile phone that already has an active NutriSense App, the data will be transmitted to the App. The App will give you “push” notifications to remind you to scan at least every 8 hours should you forget.

The data is also transmitted to NutriSense where a dietician can help you understand the interpretation of the recorded data. You’ll understand how your glucose is changing in real time and in response to all types of variables, such as food, exercise, stress, and sleep. The App also calculates the variability of the glucose readings which is recorded as a Standard Deviation (SD). The CGM device works for two weeks; then, the device becomes inactive. You simply remove it from your arm and discard it. It can be thrown away in your trashcan.


Glycemic Variability

Glucose levels in the blood fluctuate. As I mentioned, this is known as glycemic variability (GV). I also stated that glucose levels in the blood will lead glucose levels in the interstitial tissues. Glycemic variability measured by the CGM refers to the swings in glucose levels in the interstitial tissues that occur throughout the day. The SD of glycemic variability is the biomarker that interests me.

If a person were only to take a glucometer reading at the start of a meal, an hour later, and maybe another hour after that, these readings would never show spikes between those readings. Also, you would have to prick your finger to get these readings each time – not for me.

Certainly, it would never be possible to know the glucose spikes and swings occurring during the remainder of the day or night. In other words, there would be no way to evaluate a person’s glycemic variability throughout the day unless it was measured continuously. That is what a Continuous Glucose Monitor is designed to do.[1]


Blood Glucose and Cancer

In 2018, a study showed that glycemic variability could promote both local invasion and metastatic colonization of pancreatic ductal adenocarcinoma.[2] Other studies have shown that high levels of blood glucose can raise the prevalence and mortality of many different types of malignancies.[3]

In another study published in 2019, researchers discovered that a large degree of glycemic variability created a high risk of future cancers among people without diabetes. The authors summarized that it would be wise to maintain a low level of glycemic variability for the prevention of future malignancies.[4]


Blood Glucose and the Immune System

In addition, a study published in 2018 suggested that increased glycemic variability would compromise the immune system by increasing proinflammatory cells as well as reducing the number of suppressive regulatory T cells and protective NK cells. The end result would be a higher susceptibility to infections compared to individuals with a low level of GV.[5], [6],[7],[8]


Glycemic Variability and Other Systemic Effects

The SD of glucose fluctuations is highly correlated with metabolic health. As I stated, a high standard deviation is a measure of high glycemic variability, which affects the risk of cancer and the robustness of the immune system. Some of the reported signs and symptoms of a high GV are:

  • low or fluctuating energy levels
  • intense food cravings, particularly for carbohydrates
  • poorly regulated hunger cues
  • risk of cardiovascular disease[9],[10]
  • oxidative stress
  • vascular damage
  • peripheral neuropathy
  • increase susceptibility to influenza[11]

Most research for GV has been done on diabetics, aiming for a glucose standard deviation of <30. In non-diabetics, the SD should be <20.[12],[13]  Ideally, the SD for a healthy person with a healthy immune system should be <14.

My results using the CGM from NutriSense were impressive. I used the device for two continuous weeks. The SD of my glycemic variability over those two weeks was 10, which is excellent! Let me remind you that I have an incurable form of bone marrow cancer called IgA Kappa Light Chain Multiple Myeloma with severe bone lytic lesions.

During the entire experiment and at the end of the two weeks, I had frequent contact by email and Zoom chats with Carlee, one of the dietitians at NutriSense. She is extremely knowledgeable and helpful.


Bottom Line

Theoretically, I should have a significantly compromised immune system because my cancer is a malignancy of plasma cells. Plasma cells are bone marrow cells and are part of the adaptive immune system. These cells secrete large quantities of proteins called antibodies, which are created to remove specific antigens associated with specific infections and toxins invading the body. My malignant plasma cells are producing nonfunctional antibodies.

I have gone to great lengths to strengthen my overall immune system using my Unconventional Cancer Protocols. And this biomarker suggests that I have done a good job.

So, by monitoring my glucose fluctuations, I have another vital biomarker to identify the robust level of my immune system. If my glucose fluctuations demonstrated a high standard deviation, I would know that I needed to tweak my diet or other cancer protocols to reduce my GV. However, with a SD of 10, I am well-within the normal range for a healthy immune system based on this biomarker. And as I stated at the outset, a robust immune system is an important factor enhancing my body to heal naturally.


[1] https://diabetes.diabetesjournals.org/content/67/Supplement_1/1542-P

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6154439/

[3] https://jeccr.biomedcentral.com/articles/10.1186/s13046-019-1309-6

[4] https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(19)31097-6/fulltext

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250017/

[6]  https://pubmed.ncbi.nlm.nih.gov/26897277/

[7] https://onlinelibrary.wiley.com/doi/abs/10.1002/jcp.29228

[8] https://care.diabetesjournals.org/content/38/7/1356

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4543190/

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743360/?report=reader

[11] https://mbio.asm.org/content/11/2/e02841-19

[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455369/#!po=34.6154

[13] https://diabetes.diabetesjournals.org/content/67/Supplement_1/1542-P


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