Nutritional supplements that may be helpful
Most,31 32 but not all,33 double-blind studies have shown
that elderly people have better immune function and reduced infection rates when taking a multiple vitamin-mineral formula. In one double-blind
trial, supplements of 100 mcg per day of selenium and 20 mg
per day of zinc, with or without additional vitamin C, vitamin E, and beta-carotene, reduced infections in elderly people,
though vitamins without minerals had no effect.34 Burn victims have also
experienced fewer infections after receiving trace mineral supplements in double-blind
research.35 These studies suggest that trace minerals may be the most important
micronutrients for enhancing immunity and preventing infections in the elderly.
Vitamin E enhances some measures of immune-cell activity in the elderly.36 This
effect is more pronounced with 200 IU per day compared to either lower (60 IU per day) or
higher (800 IU per day) amounts, according to double-blind research.37 Intakes
under 200 IU per day have not boosted immune function in some reports.38
Beta-carotene and other carotenoids have increased
immune cell numbers and activity in animal and human research, an effect that appears to be
separate from their role as precursors to vitamin A.39 40
Placebo-controlled research has shown positive benefits of beta-carotene supplements in
increasing numbers of some white blood cells and enhancing cancer-fighting immune functions in
healthy people at 25,000–100,000 IU per day.41 42
In double-blind trials in the elderly, supplementation with 40,000–150,000 IU per day
of beta-carotene has increased natural killer (NK)
cell activity,43 but not several other measures of immunity.44
Controlled research has found that 50,000 IU per day of beta-carotene boosted immunity in
people with colon cancer but in not those with
precancerous conditions in the colon.45 Beta-carotene has also prevented immune
suppression from ultraviolet light exposure.46 Effects on immunodefiency in HIV-positive people have been inconsistent using
beta-carotene.47 48
Vitamin C stimulates the immune system by both
elevating interferon levels49 and enhancing the activity of certain immune
cells.50 51 Two studies came to opposite conclusions about the ability
of vitamin C to improve immune function in the elderly,52 53 and two
other studies did not agree on whether vitamin C could protect people from hepatitis.54 55 However, a review of 20
double-blind studies concluded that while several grams of vitamin C per day has only a small
effect in preventingcolds, when taken at the
onset of a cold, it does significantly reduce the duration of a cold.56 In
controlled reports studying people doing heavy exercise, cold frequency was reduced an average
of 50% with vitamin C supplements ranging from 600 to 1,000 mg per day.57 Thus, the
overall effect of vitamin C on immune function is unclear, and its usefulness may vary
according to the situation.
Vitamin A plays an important role in immune system
function and helps mucous membranes, including those in the lungs, resist invasion by
microorganisms.58 However, most research shows that while vitamin A supplementation
helps people prevent or treat infections in developing countries where deficiencies are
common,59 little to no positive effect, and even slight adverse effects,
have resulted from giving vitamin A supplements to people in countries where most people
consume adequate amounts of vitamin A.60 61 62 63
64 65 66 Moreover, vitamin A supplementation during
infections appears beneficial only in certain diseases. An analysis of trials revealed that
vitamin A reduces mortality from measles and diarrhea,
but not from pneumonia, in children living in developing countries.67 A
double-blind trial of vitamin A supplementation in Tanzanian children with pneumonia confirmed
its lack of effectiveness for this condition.68 In general, parents in the
developed world should not give vitamin A supplements to children unless there is a
reason to believe vitamin A deficiency is likely, such as the presence of a condition causing
malabsorption (e.g., celiac disease). However, the American Academy of
Pediatrics recommends that all children with measles be given short-term supplementation with
high-dose vitamin A in cases of hospitalization, malnutrition, and other special circumstances
determined by a doctor.69
A combination of antioxidants vitamin A, vitamin C, and vitamin E
significantly improved immune cell number and activity compared with placebo in a group of
hospitalized elderly people.70 Daily intake of a 1,000 mg vitamin C plus 200 IU
vitamin E for four months improved several measures of immune function in a preliminary
study.71 To what extent immune-boosting combinations of antioxidants actually
reduce the risk of infection remains unknown.
The amino acid glutamine is important for immune system
function. Liquid diets high in glutamine have been reported in controlled studies to be more
helpful to critically ill people than other diets.72 73 Endurance
athletes are susceptible to upper respiratory tract infections after heavy exercise, which
depletes glutamine levels in blood.74 Although the effects of glutamine
supplementation on immune function after exercise have been inconsistent,75
76 a double-blind study giving athletes glutamine (2.5 grams after exercise and again
two hours later) reported significantly fewer infections with glutamine.77
Supplements of probiotics (friendly bacteria) such as
Lactobacillus acidophilus, or the growth factors that encourage their development in
the gastrointestinal tract may help protect the body from harmful organisms in the intestine
that cause local or systemic infection according to
published research,78 79 including controlled80 trials. The
effective amount of probiotics depends on the strain used, as well as the concentration of
viable organisms. Infectious diarrhea in children has
been successfully reduced with supplements of friendly bacteria in several trials, some of
which were double-blind.81 82
The thymus gland is responsible for many immune system functions. Preliminary studies
suggest that a thymus extract known as
Thymomodulin® may improve immune function, and double-blind trials in children and adults
with a history of recurrent respiratory-tract infections have found reduced numbers of
recurrent infections with Thymomodulin supplementation.83 84
85 86 87 Thymomodulin has also been shown in a double-blind study
to improve immune function in cases of exercise-induced immune suppression, and in preliminary
studies to improve immune function in people with
diabetes and in elderly people.88 89 90 91
Zinc supplements have been reported to increase immune
function.92 93 This effect may be especially important in the elderly
according to double-blind studies.94 95 Some doctors recommend zinc
supplements for people with recurrent infections,
suggesting 25 mg per day for adults and lower amounts for children (depending on body weight).
However, too much zinc (300 mg per day) has been reported to impair immune
function.96
While zinc lozenges have been shown to be effective for reducing the symptoms and duration
of the common cold in some controlled studies, it is
not clear whether this effect is due to an enhancement of immune function or to the direct
effect of zinc on the viruses themselves.97
Large amounts of the carotenoid lycopene have been shown
to increase the activity of NK cells in the elderly. In a controlled trial, 15 mg of lycopene
significantly increased NK cell concentration, but no other immune functions.98
A deficiency of vitamin B12 has been associated with
decreased immune function. In a controlled trial, people with vitamin B12 deficiency anemia were also found to
have markedly decreased levels of white blood cells associated with immune
function.99 Restoration of vitamin B12 stores by means of injections improved
levels of these immune cells, suggesting an important role for vitamin B12 in immune
function.
Beta-glucan is a fiber-type polysaccharide (complex
sugar) derived from the cell wall of baker’s yeast, oat and barley fiber, and many medicinal mushrooms, such as maitake. Numerous experimental studies in test tubes and animals
have shown beta-glucan to activate white blood cells.100 101
102 103 104 In fact, there have been hundreds of research papers
on beta-glucan since the 1960s.105 The research indicates that beta-1,3-glucan, in
particular, is very effective at activating white blood cells known as macrophages and
neutrophils. A beta-glucan–activated macrophage or neutrophil can recognize and kill
tumor cells, remove cellular debris resulting from oxidative damage, speed up recovery of
damaged tissue, and further activate other components of the immune system.106
107 Although the research in test tube and animal studies is promising, many
questions remain about the effectiveness of beta-glucan as an oral supplement to enhance
immune function in humans. Controlled trials are necessary to determine whether humans can
benefit from beta-glucan, and in what amounts oral beta-glucan must be taken from meaningful
effects.
The hormone DHEA effects immunity. In a controlled trial, a
group of elderly men with low DHEA levels who were given a high level of DHEA (50 mg per day)
for 20 weeks, experienced a significant activation of immune function.108
Postmenopausal women have also shown increased immune functioning in just three weeks when
given DHEA in double-blind research.109
The effects of eating fish and other dietary sources
of omega-3 fatty acids is discussed above in the
nutritional section. In terms of fish oil supplements,
except for effects in hospitalized patients, most studies have reported that additional
omega-3 intake decreases immune function.110 111 112
113 Antioxidants may correct this problem,
according to preliminary research.114
Liquid diets containing supplemental arginine, omega-3
fatty acids, and nucleotides such as ribonucleic acid (RNA) have been more effective than
other liquid diets in both maintaining immune function and reducing infections in critically
ill and post-surgical hospital patients in most,115 116 117
118 119 but not all,120 121 double-blind trials.
Typical daily intakes in these trials are 3.3 grams of omega 3 fatty acids, 12.5 grams of
arginine, and 1.2 grams of RNA. No research has studied the effects of these supplements in
people with less severe health problems.
A double-blind trial showed that 45 grams per day of
whey protein increased blood glutathione levels in a group of HIV-infected
people.122 Test tube123 124 and animal125 studies
suggest that whey protein may improve some aspects of immune function.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
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