Foundations for Immune Support
We all know how important and helpful natural interventions can be in supporting a healthy immune system. Many botanicals have proven antiviral, antibacterial and immune stimulating properties1, and no immune support protocol is complete without them.
My own regimen for winter health includes daily beta glucan from both yeast products and mushroom products to help keep NK cells and macrophages strong and doing what they do best: surveillance and attack. I also take a multi-strain probiotic daily, which includes Saccharomyces boulardii for its immune benefits. However, most strains of lactobacilli and bifidobacteria have direct and indirect positive effects on immunity and immune response as well.2
I supplement daily with astragalus, olive leaf and elderberry, all with antimicrobial and immune activity and all safe for daily use. What’s important to keep on hand, in addition, are Echinacea or larch arabinogalactan, which support the activation of immune complement, and berberines, which are antiviral and antibacterial.1, 3 We can use these immediately upon exposure to a virus which may circumvent infection and always upon onset of illness if we succumb, but the dosing of botanicals is most important in acute situations. If you’re not getting the expected results, it’s usually because you are not dosing high enough. Although combination formulas are popular, I use Echinacea and berberines separately and dose them differently since proper dosing is the key to effectiveness. Echinacea helps stimulate immune complement, which is the part of the immune system that enhances the ability of antibodies and phagocytes to clear microbes. It is a very mild herb with no toxicity level reported, so dosing two capsules or better, two droppersful of extract, every 2-4 hours at the onset of illness will give better results. You can reduce the dose after two days, and it doesn’t need to be taken for more than a week or two.
When berberines are dosed properly, a patient feels better, because of direct antiviral and anti-inflammatory action, which keeps sinuses clearer and reduces symptoms. Two capsules with each meal (three times a day) for one week usually works wonders. Botanicals are a “go-to” for immune support during the winter or whenever the risk of infectious illness arises. But in order for these therapies to be effective, the basic nutritional needs of the immune system must be met. Research and clinical practice has taught us a lot about the necessary nutrition foundations for supporting healthy immune response to infectious illness, which includes adequate Vitamins A, D, C and zinc. We’re very familiar with the importance of Vitamin C for immune health, and there has been a lot of recent focus on the importance of adequate Vitamin D. So let’s take a closer look at some facts about Vitamin A and zinc.
Vitamin A is so critical to healthy immune function that the World Health Organization (WHO) promotes Vitamin A supplementation as an essential child survival intervention in developing countries.4 Vitamin A alone, as a single intervention, helps reduce mortality from infection by strengthening the immune system. So what has research shown us about the relationship between Vitamin A and infection? Infection provokes an acute response, reducing the synthesis of retinol-binding protein in the liver and thereby decreasing circulating Vitamin A levels.5,6 Adding insult to injury, infection and fever increase urinary excretion of Vitamin A.7 So, infections may decrease Vitamin A status, which can in turn affect one’s immune status and ability to fight the infection, especially if Vitamin A status is poor or marginal to begin with.
You may be surprised to know that data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) reveals the average daily dietary Vitamin A intake in Americans aged two years and older is 607 mcg RAE or roughly 2000 IU of pre-formed Vitamin A. This is actually less than the RDA for teens and adults. Yes, you read that correctly.
The USDA Human Nutrition Research Center documents that approximately 46-50% of Americans do not consume enough vitamin A from their diets.8 While the WHO is promoting supplementation in “developing nations”, perhaps we should ensure the same is happening here at home. If your patient is getting beta carotene from fruits and vegetables, that is fantastic. But it can be unpredictable how much of that is converting into Vitamin A (retinol). Some of that beta carotene will be utilized as an antioxidant. And, it takes a healthy and robust digestive system and usually the consumption of enough fat at the same time to ensure absorption and conversion to Vitamin A.
If your patient has a deficient diet and is not taking a daily multivitamin or cod liver oil supplement that provides optimal levels of Vitamin A, they could be chronically deficient. When infection strikes, decreasing Vitamin A status further, there may be inadequate reserves to support a healthy immune response. Perhaps that explains the impressive clinical and research results of high-dose Vitamin A supplementation at the onset of acute infections.5 The typical naturopathic protocol for adults is 100,000 IU at the onset of illness for 3-5 days. However, high dosing of Vitamin A is not appropriate during pregnancy or for anyone with compromised liver status and should only be administered under medical supervision after proper assessment. That said, it is every practitioner’s responsibility to assess their patients’ approximate daily Vitamin A intake and suggest supplementation if appropriate for adequate immune system support.
We know zinc is critical for proper immune function, but did you also know that deficiency is quite common around the world, in our own country and among all age groups? Even marginal zinc deficiency will affect immune status, which is why repletion prior to and during illness is so important. In spite of the presence of adequate zinc in our food, dietary zinc is relatively difficult to absorb. Those most at risk for zinc deficiency are vegans, vegetarians and children (for reasons having to do with food choices), older adults and those with GI issues (for reasons of inadequate digestion and absorption). Factors interfering with zinc absorption are the fiber and phytates contained in whole grains, legumes, nuts and seeds…All those wonderful whole nutrient rich foods we love! Soaking these foods helps reduce the phytates, so encouraging patients to soak all their legumes and grains (yes even oatmeal, rice and quinoa) prior to cooking helps decrease interference with mineral absorption. Beef is the best source of zinc as it provides about 8mg of zinc in a 6oz serving. Pork, turkey and chicken weigh in at only half of that. With the minimum RDA set at 15mg for an adult and given the interference of whole grains, legumes, nuts and seeds, I’ll bet you already see a significant problem. Infection depletes zinc status, and repletion through appropriate supplementation can provide optimal support for healthy immune function.
Lisa Murray, RDN, LD
- M.Roxas, J. Jurenka. Colds and Influenza: A Review of Diagnosis and Conventional, Botanical, and Nutritiona lConsiderations. Alt.Med.Rev. Volume 12, No. 1 2007
- E.Isolauri, Y.Sütas, P.Kankaanpää, H.Arvilommi, S.Salminen. Probiotics: Effects on Immunity. Am J Clin Nutr February 2001vol. 73 no. 2 444s-450s
- Shin HB, Choi MS, Yi CM, Lee J, Kim NJ, Inn KS. Inhibition of respiratory syncytial virus replication and virus-induced p38 kinase activity by berberine. Int Immunopharmacol. 2015 Jul;27(1):65-8.
- World Health Organization Guidelines on Vitamin A Supplementation for infants and children 6-59 months of age. http://www.who.int/nutrition/publications/micronutrients/guidelines/vas_6to59_months/en/
- Gaby,Allen. Infectious Diseases. In: Nutritional Medicine. Concord, NH: Fritz Perlberg Publishing; 2011:pg 1142
- Bates,DJ. Vitamin A. lancet 1995;345;31-35
- Stephensen CB, Alvarez JO, KohatsuJ, et al. Vitamin A is excreted in the urine during acute infection. Am J Clin Nutr 1994;60:388-392
- USDA Agricultural Research Service, Human Nutrition Research Center https://www.ars.usda.gov/northeast-area/beltsville-md/beltsville-human-nutrition-research-center/docs/florida/