Immune Support Part I: Introduction Autumn is a beautiful time of year, filled with excitement (or trepidation) for students and teachers alike. For most, fall also marks the end of vacation or summer hours, and the onset of a more rigorous work schedule. The combination of these various stressors, in addition to cooler weather fluctuations, also makes for the beginning of the dreaded cold-and-flu season. First, a child comes home with a sniffle, or a colleague down the hall has a dry cough before you know it, the bug has gone through your entire household. This month, we discuss some key natural strategies to keep your immune system healthy throughout the fall-winter, and help you continue to function at your best. Before we get into the interesting stuff, the role of hygiene deserves an honorable mention. Proper hand-washing entails lathering with soap for at least 20 seconds, and is recommended before, during, and after preparing food, before eating food, before and after caring for someone who is sick, after using the bathroom, and after blowing your nose, coughing, or sneezing, as well as other exposures such as animals or garbage. [1] Hand sanitizers are not considered as effective as soap and water. [1] Adopting good hand-sanitization procedures alone has been shown to reduce the number of absentee days in school children. [2] From a diet and supplement perspective, it is fundamental to boost the intake of plant-based flavonoids and vitamin C, and to avoid or limit refined sugar. For instance, supplementing with a juice powder concentrate extracted from fruits and vegetables for six months has been shown to reduce the number of days with moderate-tosevere cold symptoms by almost two days compared to a placebo drink. [3] Similarly, supplementing with 500 1000 mg vitamin C, with or without low-dose zinc, throughout the cold season has been shown to reduce the frequency of the cold, duration of runny
nose symptoms by up to 27%, and speed up recovery time. [4, 5, 6] Limiting your intake of refined sugar is important, because sugar and other refined carbohydrates have been shown to suppress the antibacterial (and presumably antiviral too) activity of immune cells such as neutrophils for up to five hours after consumption! [7] In part II, we will discuss the role of some tier 2 natural supplements, including green tea, probiotics, and vitamin D. 1. Centers for Disease Control. Wash Your Hands. Updated March 25, 2013. URL: http://www.cdc.gov/features/handwashing/ Accessed 12 August 2013. 2. Lau, C.H., et al. Hand hygiene instruction decreases illness-related absenteeism in elementary schools: a prospective cohort study. BMC Pediatrics Vol. 12 (2012): 52. 3. Roll, S., M. Nocon, and S.N. Willich. Reduction of common cold symptoms by encapsulated juice powder concentrate of fruits and vegetables: a randomised, double-blind, placebo-controlled trial. The British Journal of Nutrition Vol. 105, No. 1 (2011): 118 122. 4. Sasazuki, S., et al. Effect of vitamin C on common cold: randomized controlled trial. European Journal of Clinical Nutrition Vol. 60, No. 1 (2006): 9 17. 5. Maggini, S., S. Beveridge, and M. Suter. A combination of high-dose vitamin C plus zinc for the common cold. The Journal of International Medical Research Vol. 40, No. 1 (2012): 28 42. 6. Van Straten, M. and P. Josling. Preventing the common cold with a vitamin C supplement: a double-blind, placebo-controlled survey. Advances in Therapy Vol. 19, No. 3 (2002): 151 159. 7. Sanchez, A., et al. Role of sugars in human neutrophilic phagocytosis. The American Journal of Clinical Nutrition Vol. 26, No. 11 (1973): 1180 1184. Immune Support Part II: Supplements and Immune Health; Green Tea, Vitamin D, Probiotics In part I, we discussed the role of hygiene and dietary habits in preventing and controlling cold and flu symptoms. These provide the foundation to which select nutritional or herbal supplements can be added for even greater immune benefits. Some key agents are green tea, good-quality probiotics, and vitamin D. Green tea is an emerging natural agent with antiviral effects. [1] Green tea, consumed either as an extract in tablet form (equal to about 400 mg green tea catechins), has been shown to reduce the incidence of the flu among health-care workers by 75%. [2] In another study, green tea extract was shown to reduce the total number of illnesses lasting
two days or more by over 22%, reduce the total number of days with symptoms by over 35%, and increase the amount of antibody produced by immune cells. [1] Another study found that consumption of green tea as a beverage, between 1 and 5 cups per day, reduced the incidence of the flu by between 40 and 50% in schoolaged children. [3] Information on probiotics has exploded in the last few years. It is becoming wellrecognized that probiotics can effectively reduce the incidence of upper respiratory tract infections. [4] A review paper found that probiotic supplementation was able to significantly reduce the number of upper respiratory tract infections as well as reduce antibiotic prescription rates. [4] Probiotics are thought to interact with immune cells that live in the gut, stimulating the production of secretory IgA which neutralizes viruses and bacteria in the gut, [5] and also affects immune-cell function systemically throughout the body. [6] Vitamin D is an important nutrient for modulating immune function. A randomized study found that vitamin D supplementation (1200 IU) to school-aged children during the winter months resulted in a greater than 40% reduction in the incidence of influenza A. [7] This was accompanied by a significant reduction in asthma attacks among children with a previous history of asthma. [7] Vitamin D is especially important for Canadians, since the prevalence of borderline and even frank deficiency is high in Canada. [8] To determine the most appropriate dose of vitamin D for you, a blood test costing about $40 can be done through your family doctor or naturopathic doctor. Part III will discuss the use of echinacea. Is echinacea effective after all? 1. Rowe, C.A., et al. Specific formulation of Camellia sinensis prevents cold and flu symptoms and enhances gamma, delta T cell function: a randomized, double-blind, placebo-controlled study. Journal of the American College of Nutrition Vol. 26, No. 5 (2007): 445 452. 2. Matsumoto, K., et al. Effects of green tea catechins and theanine on preventing influenza infection among healthcare workers: a randomized controlled trial. BMC Complementary and Alternative Medicine Vol. 11 (2011): 15. 3. Park, M., et al. Green tea consumption is inversely associated with the incidence of influenza infection among schoolchildren in a tea plantation area of Japan. The Journal of Nutrition Vol. 141, No. 10 (2011): 1862 1870. 4. Hao, Q., et al. Probiotics for preventing acute upper respiratory tract infections. The Cochrane Database of Systematic Reviews No. 9 (2011): CD006895. 5. Perdigon, G., et al. Immune system stimulation by probiotics. Journal of Dairy Science Vol. 78, No. 7 (1995): 1597 1606.
6. Hatakka, K. and M. Saxelin. Probiotics in intestinal and non-intestinal infectious diseases clinical evidence. Current Pharmaceutical Design Vol. 14, No. 14 (2008): 1351-67. 7. Urashima, M., et al. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. The American Journal of Clinical Nutrition Vol. 91, No. 5 (2010): 1255-60. 8. Whiting, S.J., et al. The vitamin D status of Canadians relative to the 2011 Dietary Reference Intakes: an examination in children and adults with and without supplement use. The American Journal of Clinical Nutrition Vol. 94, No. 1 (2011): 128-35. Immune Support Part III: Echinacea Most people who keep up on developments in natural health and wellness will have heard of echinacea, a popular immunestimulating herb; more to the point, you may have heard of the controversy around the effectiveness of echinacea which has been ongoing over the last several years. In this section, we discuss the efficacy of echinacea, and things to be aware of when using echinacea. First of all, there is a respectable level of evidence indicating that echinacea can be effective. For instance, a 2007 study in The Lancet, a high-ranking medical journal, found that the Published evidence supports echinacea s benefit in decreasing the incidence and duration of the common cold. [1] Use of echinacea was found to decrease the risk of developing the common cold by more than 40%, and decreased the duration of the cold by 1.4 days. [1] In another study, echinacea was able to reduce the total number of cold episodes, total number of days with cold symptoms, and the need for pain-killer medications. [2] When nasal swabs taken from the participants were tested, echinacea was found to inhibit virally confirmed colds. [2] When using herbal supplements, the quality of the product is of paramount importance. Depending on the way the herb has been grown, when it has been harvested, and how processed and extracted, the end product contains vastly differing chemical constituents. It has been pointed out that when reviewing the studies of echinacea, there is in fact great variability with respect to the products used. [3] Alkamides are the active molecules
in echinacea; therefore, the effectiveness of the product depends on the quantity of these contained. [4] A tincture (liquid alcohol solution) containing alkamides will result in a peculiar tingling sensation in the mouth on tasting it, and this can be a simple taste test as to the quality of the product. If your echinacea product doesn t have this tingling effect, it may not be very effective. One review paper looked at 22 studies; 19 for the treatment of the common cold, and three for the prevention of the common cold. [3] This review found that echinacea was effective for treatment, but less so as a preventative. [3] Since this review was published, other evidence has emerged also suggesting some effectiveness for echinacea when used preventatively; [2] however, it is possible that it is most effective when used at the first signs of a cold (early treatment). Dosing also varies, with between 5 and 15 ml of a tincture commonly used for adults in studies. [3] Clearly, product quality, dosing, and timing of use are factors that make a big difference to the effectiveness of echinacea for the common cold. In part IV, we discuss the role of lifestyle hygiene! 1. Shah, S.A., et al. Evaluation of Echinacea for the prevention and treatment of the common cold: a meta-analysis. The Lancet Infectious Diseases Vol. 7, No. 7 (2007): 473 480. 2. Jawad, M., et al. Safety and efficacy profile of Echinacea purpurea to prevent common cold episodes: a randomized, double-blind, placebocontrolled trial. Evidence-Based Complementary and Alternative Medicine Vol. 2012 (2012): 841315. 3. Linde, K., et al. Echinacea for preventing and treating the common cold. The Cochrane Database of Systematic Reviews No. 1 (2006): CD000530. 4. Woelkart, K., et al. Bioavailability and pharmacokinetics of Echinacea purpurea preparations and their interaction with the immune system. International Journal of Clinical Pharmacology and Therapeutics Vol. 44, No. 9 (2006): 401 408. 5. Woelkart, K. and R. Bauer. The role of alkamides as an active principle of echinacea. Planta Medica Vol. 73, No. 7 (2007): 615 623. Immune Support Part IV: Lifestyle influences on immune health In parts II and III, we reviewed some of the key natural supplements for boosting immune function and fending off the cold/flu. Now we take a closer look at lifestyle factors, namely the impact of stress, so prevalent in modern life. Although stress is commonly recognized as suppressing healthy immune function, it is not generally known how this happens, and what can be done about it.
The stress response, also known as the General Adaptation Syndrome (GAS), consists of three stages. First is fight-orflight, during which the body tries to defend itself from the immediate perceived threat. Epinephrine and cortisol are secreted by the adrenal glands to increase alertness, increase blood sugar levels, increase breathing rate and circulation, and direct blood flow to the heart and large muscle groups. Simultaneously, bodily functions not immediately necessary for survival are inhibited, such as digestion. If the threat or stressor persists, the second stage of the GAS, the resistance stage, ensues. During this stage, the body tries to maintain elevated cortisol output in order to adapt to the continued stressor. If this continues over a long period of time, the adrenal glands are no longer able to sustain adequate cortisol production, and the third stage of the GAS occurs: this is the exhaustion stage. A popular term to describe this is also known as adrenal fatigue, and has been termed mild adrenocortical deficiency by others. [1] Individuals affected by adrenal fatigue or mild adrenocortical deficiency often suffer from lingering or recurrent respiratory tract infections. For example, this would include the cold that doesn t go away with low-grade symptoms such as fatigue, sinus congestion, or sniffly nose that lasts for weeks, or the person who gets two to three colds or flus in quick succession. Either of these scenarios are characteristic of adrenal fatigue. For individuals experiencing high levels of stress, so common in today s hectic society, use of herbs and nutrients to support adrenal-gland function can be helpful in not only improving immune function, but improving generalized fatigue and mood issues impacted by stress. Supplementation with extra B vitamins is important for supporting adrenal function, since the B vitamins are cofactors in the production of energy, and are utilized at a higher rate when the body is under stress. [2, 3] For instance, one study found that administering cortisol to healthy young men decreased blood levels of the B vitamins between 13 and 24%! [2] Herbs that help support the body s response to stress are called adaptogens, and include ashwagandha (Withania somnifera), Siberian ginseng (Eleutherococus senticosus), and rhodiola (Rhodiola rosea). [4] Adaptogens act as cortisol regulators, and have specifically been shown to increase cortisol production if low, or lower it if it
is elevated. [5, 6] On a larger scale, adaptogenic herbs help the body to handle stress by reducing the subjective perception of stress, fatigue, and anxiety, while improving mental and physical performance. [5 8] Using adaptogenic herbs is thus an important way to ensure healthy immune function for individuals suffering from high levels or long duration of stress. If you are on medications, it is recommended that you consult with a naturopathic doctor prior to taking herbal supplements. In conclusion, a combination strategy of diet, nutritional supplements such as probiotics, vitamin D, and green tea, as well as appropriate, good-quality herbs such as echinacea and adaptogens can be an effective strategy to help you reduce your risk of cold and flu this winter. 1. Prousky, J. Mild adrenocortical deficiency and its relationship to: (1) Chronic fatigue syndrome; (2) Nausea and vomiting of pregnancy and hyperemesis gravidarum; and (3) Systemic lupus erythematosus. Journal of Orthomolecular Medicine Vol. 27, No. 4 (2012): 165 176. 2. Berg, A.L., et al. The effects of adrenocorticotrophic hormone and cortisol on homocysteine and vitamin B concentrations. Clinical Chemistry and Laboratory Medicine Vol. 44, No. 5 (2006): 628 631. 3. Mahuren, J.D., et al. Adrenocorticotropic hormone increases hydrolysis of B-6 vitamers in swine adrenal glands. The Journal of Nutrition Vol. 129, No. 10 (1999): 1905 1908. 4. Panossian, A. and G. Wikman. Evidence-based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress-protective activity. Current Clinical Pharmacology Vol. 4, No. 3 (2009): 198 219. 5. Gaffney, B.T., H.M. Hügel, and P.A. Rich. The effects of Eleutherococcus senticosus and Panax ginseng on steroidal hormone indices of stress and lymphocyte subset numbers in endurance athletes. Life Sciences Vol. 70, No. 4 (2001): 431 442. 6. Gaffney, B.T., H.M. Hügel, and P.A. Rich. Panax ginseng and Eleutherococcus senticosus may exaggerate an already existing biphasic response to stress via inhibition of enzymes which limit the binding of stress hormones to their receptors. Medical Hypotheses Vol. 56, No. 5 (2001): 567 572. 7. Chandrasekhar, K., J. Kapoor, and S. Anishetty. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian Journal of Psychological Medicine. Vol. 34, No. 3 (2012): 255 262. 8. Panossian, A., G. Wikman, and J. Sarris. Rosenroot (Rhodiola rosea): traditional use, chemical composition, pharmacology and clinical efficacy. Phytomedicine Vol. 17, No. 7 (2010): 481 493. 9. Olsson, E.M, B. von Schéele, and A.G. Panossian. A randomised, double-blind, placebo-controlled, parallel-group study of the standardised extract shr-5 of the roots of Rhodiola rosea in the treatment of subjects with stress-related fatigue. Planta Medica Vol. 75, No. 2 (2009): 105 112.