Immune Boosting – for Adults and Children
Every winter, we are faced with influenza, Respiratory syncytial virus (RSV), and a whole host of other respiratory viruses. When I was younger, I thought, oh, these are just pesky colds, but through medical training, practice and being a mom, realized these are dangerous contagious diseases, particularly for the youth, the elderly and anyone with a chronic medical condition. Some of you who know me, have heard the story of my daughter getting RSV at age 2 and being hospitalized for a week, the most frightening experiences of my life. And now, add the Coronavirus, growing every day in China, one of the most fatal outbreaks in modern history. So we’re all a little worried about getting infections, particularly in the winter months.
So I get the question almost every day, “what can I do to help my immune system?” Some patients chose not to vaccinate against influenza, which is obviously a personal choice. I continue to vaccinate myself and my family yearly, which after reviewing all the data, believe is the right approach. But regardless, there are plenty of viruses out there including RSV and the new Coronavirus which have no effective vaccines to combat.
So what do we do? To follow is a brief practical approach to measures to take to improve your immunity, both acutely, if you exposed to viral conditions right now and over the winter months.
1. If you’re ill, avoid public places. Even avoid the doctor’s office and the hospital. Quarantine yourself. There is very little modern medicine has to offer for upper respiratory tract infections. If you think it could be the flu, it may be reasonable to take Tamiflu/oseltamivir, if you catch it early in the course or you are very ill, but short of that, there is not much your doctor or the hospital can do for you. If you are extremely ill and having problems breathing, advanced supportive care like supplemental oxygen or mechanical ventilation can be life saving until you recover from the virus. But otherwise, stay home, in your bed and keep family members at a distance.
2. Wash your hands and mask up in public places. Eye shields or glasses are helpful as well as respiratory droplets from a sneeze or cough can enter via the eyes. I use an alcohol based hand sanitizer in my office, car and bag, safe for children. (Avoid triclosan based hand sanitizers given their endocrine-disrupting properties). A regular surgical mask or trendy paper or cloth mask is fine. N-95s are more protective for “Air-borne” tiny particles like tuberculosis but are not necessary to prevent viral respiratory transmission by droplets (which are much larger particles) and are hard to breathe through for extended periods.
3. Get plenty of sleep. Sleep deprivation is a very fast way to cause immunosuppression. Sleep is important if you are ill to help recover and to maintain healthy immunity. Some natural children’s night time cough medicines have low-dose melatonin, a safe and effective way to aid in sleep while ill.
4. Avoid sugar. Sugar is an immune suppressant. Natural sugar in fruit is safe.
5. Eat real food. Avoid fast food during illness and to avoid lowering the immune system. Even one meal laden with high omega-6 oils, taste changing chemical additives and preservatives will lower immune response. Eat plenty of vegetables and fruits, where there are many benefits beyond vitamin C consumption. Some individual plants have been found to have 200 different phytonutrients good for your health, and there have been 25,000 different phytonutrients found in plant foods.
6. Get some sun. This may be easier in some parts of the country than others, weather permitting. But sun exposure has multiple benefits including vitamin D conversion, cortisol regulation, and immune boosting. If you have a UV light and it’s freezing outside, use this instead. The best theory I’ve heard about why influenza and other respiratory viruses circulate in the winter, is the vitamin D link. Our natural nadir vitamin D levels occur in January-February (in the Northern Hemisphere). More about vitamin D below.
7. Be aware of immune suppressant medications. These include corticosteroids, antihistamines (first generation like Benadrylâ, H2 blockers like Ranitidine, and second generation antihistamines like zyrtecâ or claritinâ), and antacids like proton pump inhibitors (indirectly increase risk of infections). If you’re on one of these, it may be medically necessary, but consider talking with your doctor about alternative options.
8. Avoid behaviors that suppress innate immunity: alcohol, cigarette smoke exposure (either first or second hand), vaping.
What supplements help with immunity, doses and duration? And remember, to eat your vegetables and fruit!
· Vitamin C. Acutely, to boost the immune system, 5 grams (5000mg) per day for 3-5 days can augment the immune system to stay well or help fight an active infection. (Children’s dose – 4 years or older- is 1 gram). Avoid high-dose vitamin C if you have oxalate sensitivity or history of kidney stones
· Vitamin A: 25,000 Units/day (acute) for a week. Chronic 10,000-15,000 Units/day. Children’s dose – 3,000 Units/day for up to a week. Interestingly, The World Health Organization (WHO) recommends administration of an oral dose of 200,000 IU (or 100,000 IU in infants) of vitamin A per day for two days to children with measles in areas where vitamin A deficiency may be present.
· Vitamin D: Acute immune boost: 150,000 Units daily x 3 days and stop (acute), or chronic 2000-10,000/day to target goal levels (target levels vary but experts recommend 40-60, 50-80, or 70-100 depending on underlying health conditions. Talk with your doctor about your optimal levels and have them checked at least yearly)
· Zinc 50-100mg/day (acute), 25-50mg/day (chronic). If taking high dose zinc long-term, consider having copper levels checked as can impair copper absorption.
· Probiotics
· Prebiotic in the form of Larch Arabinogalactan. This is very safe for both adults and children (Dion, C., Chappuis, E. & Ripoll, C. Does larch arabinogalactan enhance immune function? A review of mechanistic and clinical trials. Nutr Metab (Lond) 13, 28 (2016). https://doi.org/10.1186/s12986-016-0086-x)
· L-lysine 1-2 grams/day – 3-5 days (adults)
· Elderbrerry – there are both Adult and children’s versions available
· Echinacea (Origins Virid contains Echinacea, Elderberry, vitamin A, C and low dose of zinc). Avoid echinacea if you you have autoimmune disease. All the above are otherwise safe.
· Other herbs and foods that promote the T cells that fight viruses: Astragalus, garlic, ginger, mushrooms.
References:
Metz M, Doyle E, Bindslev-Jensen C, Watanabe T, Zuberbier T, Maurer M: Effects of Antihistamines on Innate Immune Responses to Severe Bacterial Infection in Mice. Int Arch Allergy Immunol 2011;155:355-360. doi: 10.1159/000321614
Sarkar M, Hennessy S, Yang YX. Proton-pump inhibitor use and the risk for community-acquired pneumonia. Ann Intern Med 2008; 149:391 – 398.
Sultan N, Nazareno J, Gregor J. Association between proton pump inhibitors and respiratory infections: a systematic review and meta-analysis of clinical trials. Can J Gastroenterol 2008; 22:761 – 766
Dion, C., Chappuis, E. & Ripoll, C. Does larch arabinogalactan enhance immune function? A review of mechanistic and clinical trials. Nutr Metab (Lond) 13, 28 (2016). https://doi.org/10.1186/s12986-016-0086-x)
Leann Silhan, MD