Basic Nutrient Support for Proper Immune Function

Published in: ALTERNATIVE & COMPLEMENTARY THERAPIES—FEBRUARY 1999
By: Chris D. Meletis, N.D.

An ever increasing number of patients are presenting to primary care practitioners with immune dysfunctions and various common infec­tions. Of course, the challenge for a prac­titioner who is faced with such a patient is to intervene acutely while addressing the underlying cause of the illness to pre­vent a chronic pattern from developing. Proper nutrition is truly the best approach to preventing illness and sup­porting the immune system in order to protect the body maximally.

Indeed, foods can be "the best medicine," if the right foods are con­sumed. Ingesting the proper balance of macronutrients, proteins, fats, and carbo­hydrates is the first step toward more optimal immune functioning. The basic dietary rule is moderation and diversifi­cation: If your patients are eating whole foods, that have had a minimum of pro­cessing, from each of the basic food groups, these patients will have a head start when it comes to fortifying their bodies against immune challenges.

Marginal deficiencies are by far the most prevalent dietary problems seen in the United States. These problems can take the form of protein or caloric defi­ciencies. However, the largest problem is that most patients consume a relatively limited diet that is high in repetition and is all too often lacking in whole foods, such as fresh fruit, vegetables, and unre­fined grains.

America's fascination with sugar also contributes largely to immunosuppres­sion. The average person consumes 500 calories (125 g) directly from sucrose and an additional 200 calories (50 g) from other refined sugar sources. Research has documented that con­sumption of 100 g (less than the aver­age daily intake) of sugar leads to reduced immune function. Within 30 minutes of consuming 100 g of carbohy­drate, white-blood-cell activity become depressed; this lasts for approximately 5 hours. During the course of this car­bohydrate-triggered immunosuppres­sion, there is commonly a 50 percent decrease in white-blood-cell function-ing.1'2

Even when patients consume relative­ly healthy diets, augmentation of such diets can prove to be helpful when patients are suffering from acute or chronic illnesses. Health-oriented patients often choose to engage in pre­ventive supplementation. However, when it comes to immune modulating, nutrient selection should take into account whole-body health and not merely perceived needs. When the right nutrients are selected, not only can immune support be offered, but patients' other health conditions may also be addressed. Many nutrients fre­quently support multiple biochemical pathways and assist in correcting physi­ologic imbalances.

 Carnitine

Carnitine is particularly indicated for patients who have weakened immune systems associated with fatigue, cardio­vascular problems, or muscular weak­ness. Among the research materials that support the therapeutic use of carnitine are numerous reports indicating that patients with AIDS have reduced carni­tine levels. Even when serum levels are not depleted, white-blood-cell levels are low.3 Preliminary studies suggest that supplementation with 6 g of carnitine per day increased mononuclear cell prolifera­tion, and decreased tumor necrosis factor.4 Carnitine supplementation has also been shown to help overcome the deleterious effects that elevated choles­terol and triglycerides have on immune function.5 There are many other nutrients that are specific to immune function and cancer. This article, however, is intended to provide general information about nutrients that are useful for healthful immune function.

Coenzyme Q10

Numerous studies have demonstrated the ability of coenzyme Q10 (CoQIO, ubiquinone) to enhance immune func­tion.6 CoQIO provides critical energy for proper immune functioning, while conferring antioxidant protection. Elderly patients, in particular, can bene­fit from supplementation especially, because CoQIO also plays a vital role in maintaining a healthy cardiovascular system. 

Germanium supplementation can increase y-interferon production that promotes natural-killer-cell activity and macrophage activation.

 Summary of Commonly Prescribed Nutrients

 

NUTRIENT DOSAGE
Carnitine  1500-6000 mg per day (divided doses between meals)
Coenzyme Q10  50-300 mg per day
Essential Fatty Acids  1-2 tbsp per day (high-lignan flaxseed oil)
Germanium  50-200+ meg per day (doses vary greatly)
Lipoic Acid  50—450 mg per day (divided doses)
Molybdenum  200-600 ug per day (higher doses should be monitored)
Selenium  50-200 ug per day
Vitamin A/carotenoids  5,000-10,000 IUa per day (dosing beyond this range should be monitored)
Vitamin B6 50-250 mg per day (patient may need to take with food to prevent nausea) Vitamin C 1-10+ g per day (at high end of range, diarrhea can occur)
Vitamin E 400-1,600 IU per day (use cautiously in patients who  tend to bleed)
Zinc 15-60 mg per day (should be taken with food to prevent nausea; use at high end of range for long period should be accompanied with use of copper)

aIU, International units.
Essential Fatty Acids
It has been estimated that at least 3 out of every 4 Americans consume inadequate amounts of essential fatty acids (EFAs). This dietary deficit mani­fests via a myriad of signs and symp­toms, the most appreciable in the clinical setting frequently being dry skin, hair, and mucous membranes; aching joints; cracked nails; and consti­pation. Numerous other symptoms, including immune suppression, are often present, yet are more difficult to observe readily. Among immune conditions that may be ameliorated by prop­er physiologic essential acid balancing are AIDS, autoimmune disorders, can­cer, Escherichiacoliinfection, immune dysfunction, leukemia, and sepsis.
 
Fundamentally, EFAs are critical to health and optimal immunity because these acids are incorporated into healthy cells throughout the body. Cells comprised of EFAs are generally more functional and resistant to exter­nal insults. The immune-specific bene­fits of EFAs can be attributed to several factors, including the presence of lignans and the modulation of prostaglandins.
Flaxseeds have been found to have 100 times higher lignan levels than most other plant sources of this sub­stance. Anticancer, antiviral, antibacte­rial, and antifungal properties have all been attributed to lignans.7
 
Germanium Sesquioxide

When used at proper dosages and puri­ty, germanium supplementation can increase y-interferon production that pro­motes natural-killer-cell (NK cell) activity and macrophage activation.8 Traditional­ly, this nutrient has been reserved for cases of cancer, chronic fatigue, and severe immunodepression. Because toxic­ity has been reported in some cases, it is necessary to dispense germanium with caution.

Lipoic Acid

The highest levels of this non-vitamin are found in food sources, such as liver and yeast. Lipoic-acid deficiency has been linked to muscle wasting, brain atrophy, and increased lactic-acid accumulation. Lower serum levels of lipoic acid are also frequently found in patients with cirrho­sis of the liver, diabetes, and heart dis­ease. In a pilot study, supplementation with 150 mg of lipoic acid 3 times a day was shown to increase plasma ascorbate, glutathione, and T-helper cells and to optimize the ratio of T-helper cells to T-suppressor cells.9 Other studies have demonstrated that lipoic acid also helps to inhibit HIV replication by decreasing the activity of reverse transcriptase. 10/11

Molybdenum

Most research on molybdenum has been linked to deficiency states, and related disease conditions. In the United States, there has been a 30 percent increased risk of esophageal cancer, which has been documented in those parts of the country that have no or low molybdenum in the drinking water.12 In China, soil low in molybdenum has also been linked to increased esophageal can­cer.13 Supplementation has been shown to inhibit chemically inducedesophageal cancer in animal studies.14 This nutrient has also been used thera­peutically to decrease sulfite sensitivity, to prevent cavities, and to treat Wilson's disease.

 Selenium

Selenium deficiency results in dimin­ished resistance to infection. Supplemen­tation with selenium stimulates leukocyte activity and thymus-gland function.15 Even in the absence of deficiency, supple­mentation of 200 ug per day can bolster immune response. In a study conducted in 1994, individuals with normal serum selenium levels received selenium supple­mentation. In the subjects who received the supplementation, there was an 118 percent increase in ability of lymphocytes to kill tumor cells and an 82.3 percent increase in NK cell activity.16 These immune-modulating effects have been attributed to selenium's ability to trigger interleukin-2 production.

Vitamin B6 deficiency has also been linked to decreased immune function.
Vitamin A/Carotenoids

The hundreds of carotenoids identi­fied are routinely compared to beta-carotene relative to their provitamin A activity. This comparison, although accurate for vitamin A activity, does not reflect the other biologic properties of the carotene family. Many carote­noids show other biologic activities that are greater than beta-carotene, especial­ly when it comes to antioxidant activi­ty-Individuals who are deficient in vita­min A and carotenoids often present with an overall increased susceptibility to infections resulting from decreased anti­body production, diminished respiratory and gastrointestinal immunity, and a decreased total number of and activity of T-helper cells.

Carotenes have the ability to enhance immune functioning independently of their ability to be converted to vitamin A.17 In a study of 126 healthy college students who were given either 25,000 international units (IU) of a placebo, in the form of a daily supplement, or the equivalent of 25,000 IU of beta-carotene from carrots. The study actually revealed that supplemental carotenes are absorbed better than those from car­rots and other vegetables.18'19

Vitamin A deficiency has been associat­ed with reduced B- and T-cell response to mitogens and antigens, impaired phago­cytosis, and a decreased antibody response.20'21'22

Vitamin B6

Pyridoxine (vitamin B6) usually comes first to the clinician's mind as a treatment for neurologic conditions. However, vita-min B6 deficiency has also been linked to decreased immune function. Individuals who are deficient in this vitamin may pre­sent with shrinkage of general lymph tis­sue and of the thymus, diminished thymic hormone activity, decreased total lymphocyte activity, and lowered anti­body activity.23'24 Clinically, patients treated with vitamin B6 for a given neuro­logic problem, such as carpal tunnel syn­drome, will report an enhanced sense of well-being and, often, a lowered tendency toward contracting illnesses.

Vitamin C

While fighting infections the immune system uses vitamin C and can actually become measurably deficient in the vita­min afterwards. Lymphocytes, in particu­lar, normally contain high levels of vitamin C 25 During periods of stress, uri­nary excretion of vitamin C increases; thus, the body's stores of the vitamin need to be replenished.26 There a large number of epidemiologic studies that indicate that sufficient vitamin C reduces the risk of contracting colon, breast, lung, cervical, pancreatic, oral, and esophageal cancers.27'28 It has also been demonstrat­ed that vitamin C increases interferon lev­els, which has been linked, in part, to the vitamin's antiviral properties 29

Supplementation with 1-3 g per day can enhance immunity.30'31 When a defi­ciency state exists in a patient, inhibition of neutrophil motility, diminished cellu­lar immunity, and decreased phagocytic activity are noted.20'32

Vitamin E

The antioxidant properties of vitamin E provide protection to the thymus gland and to white blood cells. Sufficient levels of vitamin E become particularly impor­tant during chronic illness, such as pro­longed viral infections, hepatitis, and AIDS. In one study, participants who had the lowest levels of vitamin E demonstrat­ed a 50 percent increased chance of devel­oping cancer, compared to subjects who had the highest levels of the vitamin.33'34 A patient who is deficient in vitamin E can present with a lowered immunoglob­ulin response to antigens, decreased lym­phocytic response, and overall immune function 23

 

Effects of Nutrient Deficiencies

Deficiencies of nutrients have been linked with some degree of immune impairments, as follows:

• Copper—increased potential for infections and leukopenia

• Essential fatty acids—decreased host resistance and poor wound healing

• Pantothenic acid—increased potential for infections

• Selenium—- increased potential for infections

• Vitamin A—increased potential for infections

• Vitamin B6—poor wound healing

• Vitamin E—decreased host resistance

• Zinc—increased potential for infections

 Zinc

Zinc is by far one of the most critical minerals for overall immune function­ing. Zinc's ability to optimize the immune system works directly and indi­rectly. Preventing zinc deficiency can help to ensure that the body manufac­tures adequate supplies of T cells and thymic hormones and maintains proper white-blood-cell functioning. The direct antiviral effects of this mineral have been attributed to the use of zinc lozenges, which are believed to provide sufficient zinc to prevent the replication of the viruses.35 Zinc also plays an important role in helping to reverse the lowered immune functioning associated with aging. In a study of elderly subjects who were given zinc, each patient had elevat­ed levels of thymulin.36

Conclusion

Although several nutrients have been highlighted in this article, proper total nutrition is by far the most critical factor in maintaining overall optimal immune function. When selecting a nutrient or group of nutrients to supplement patients' diets, clinical outcomes are most successful when each patient's unique nutritional status is addressed. For example, a patient presenting with small horizontal white lines on the fin­ger nails, hyperkeratosis on the back of the arms, both of which are common deficiency signs, will benefit optimally when treated with the corresponding nutrients (in this case zinc, EFAs, and vitamin A) □

 References

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2.         Ringsdorf, W., et al. Sucrose, neutrophil phagocytosis, and resistance to disease. Dent Surv 52:46-48,1976.

3.         De Simone, C, et al. Carnitine depletion in peripheral blood mononuclear cells from patients with AIDS: Effect of oral l-carnitine. AIDS8:655-660,1994.

4.         De Simone, C, et al. High dose l-carnitine improves immunologic and metabolic parame­ters in AIDS patients. Immunopharmacol Itntnunotoxicol 15:1-12,1993

5.         De Simone, C, et al. Vitamins and immunity: II. Influence of l-carnitine on the immune sys­tem. Acta Vit E4:135-140,1982.

6.         Folkers, K, et al., Increase in levels of IgG in serum of patients treated with coenzyme Q10. Res Commun Chem Pathol Pharmacol38:335, 1982.

7.         Thompson, L.U., et al. Mammalian lignan production from various foods. Nutr Cancer16:43-52,1991.

8.         Aso, H., et al. Induction of interferon and activation of NK cells and macrophages in mice by oral administration of Ge-132, an organic germanium compound. Microbiol Immunol 29(l):65-74/1985.

9.         Fuchs, J., et al. Studies on lipoate effects on blood redox state in human immunodeficiency virus infected patients. Arzneim Forsch 43:1359-1362,1993.

10.          Baur A. Alpha-lipoic acid is an effective inhibitor of human immuno-deficiency virus (HIV-1) replication. Klin Wochenschr 69:722-724,1991.

11.          Suzuki, Y.J., et al. Alpha-lipoic acid is a potent inhibitor of HF-kB activation in human T cells. Bio chem Biophys Res Comm 189:1709-1715,1992.

12.          Berg, J.W., et al. Epidemiology of gastroin­testinal cancer. Proc Natl Cancer Congr 7:459-163,1973.

13.          Yang, C.S. Research on esophageal cancer in China: A review. Cancer Res 40:2633-2644, 1980.

14.          Komada, K., et al. Effect of dietary molyb­denum on esophageal carcinogenesis in rats induced by N-methyl-N-benzylnitrosamine. Cancer Res 50:2418-2422,1990.

15.          Roy, M. Supplementation with selenium and human immune cell functions: Effect on lymphocyte proliferation and interleukin 2 receptor expression. Biol Trace Elem Res 41:115-127,1994.

16.          Kiremidjian-Schumacher, L. et al. Supple­mentation with selenium and human immune cell functions. Biol Trace Elem Res41:103—114, 1994.

17.          Bendich, A. Beta-carotene and the immune response. Proc Nutr Soc 50:263-274,1991.

18.          Brevard, P.B. Beta-carotene affects white blood cells in human peripheral blood. Nutr Rep Int 40:139-150,1989.

19.          Brown, E.D. Plasma carotenoids in normal men after a single ingestion of vegetables or purified beta-carotene. Am J Clin Nutr 49:1258-1265,1989.

20.          Chandra, R.K. Nutrition and immunity— Basic considerations, Part I. Contemp Nutr 11(11): 1986.

21.          Ongaski, M., et al. Impaired blood clearance of bacteria and phagocytic activity in vitamin A deficient rats. Proc Soc Exp Biol Med 178(2):20^-208,1985.

22.          Pasatiempo, A.M.G., et al. Vitamin A deple­tion and repletion: Effects on antibody response to capsular polysaccharide of Strepto­coccus pneumoniae. Am J Clin Nutr 49:501—510, 1989.

23.          Beisel, W., et al. Single nutrient effects of immunologic function. JAMA 245:53-58,1981.

24.          Bum, M.K., et al. Association of vitamin B6 status with parameters of immune function in early HIV infection. J AIDS 4:122-132,1991.

25.          Bendich, A. Vitamin C and immune responses. Food Technol 41:112-114,1987.

26.          Ginter, E. Optimum intake of vitamin C for the human organism. Nutr Health 1:66-77,1982.

27.          Block, G. Vitamin C and cancer prevention: The epidemiologic evidence. Am } Clin Nutr 53:270-282,1991.

28.          Block, G. Vitamin C, cancer and aging. Age Ageing 16:55-58,1993.

29.          Gerber, W.F., et al. Effect of ascorbic acid, sodium salicylate, and caffeine on the serum interferon level in response to viral infection. Pharmacology 13:228,1975.

30.          Anderson. R. The immunostimulatory, anti­inflammatory, and anti-allergic properties of ascorbate. Adv Nutr Res 6:19-45,1984.

31.          Vallance, S. Relationship between ascorbic acid and serum proteins of the immune sys­tem. Br Med 2:437-438,1977.

32.          Beisel, W.R. Role of nutrition in immune system diseases. Compr Ther 13(1):13-19, 1987.

33.          Knecht, P., et al. Vitamin E in cancer pre­vention. Am J Clin Nutr 53:283-286,1991.

34.          Watson, R.R., et al. Selenium and vitamins A, E, and C: Nutrients with cancer prevention properties. / Am Diet Assoc 86:505-10,1986.

35.          Eby, G.A. Reduction in duration of com­mon colds by zinc gluconate lozenges in a dou­ble blind study. Antimicrob Agents Chemother 25:20-24,1984.

36.          Boukaiba, N., et al. A physiological amount of zinc supplementation: Effect on nutritional, lipid, and thymic status in an elderly popula­tion. Am J Clin Nutr 57:566-572,1993.

 

 

Chris D. Meletis, N.D., serves as the dean of clinical affairs/chief medical officer, National College of Naturopathic Medicine, Portland, Oregon.

 

 

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