Immune Support Dr. Heidi Fritz 26 September 2013 Immune Support - Preventing the “turn-of-season” cold By: Heidi Fritz MA, ND Bolton Naturopathic Clinic 64 King St W, Bolton, ON L7E1C7 www.boltonnaturopathic.ca firstname.lastname@example.org Jump to: Part 1 Part 2 Part 3Part 4 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” had 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 honourable 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 intake 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-to-severe cold symptoms by almost 2 days compared to a placebo drink.(3) Similarly, supplementing with 500-1000mg 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 anti- bacterial (and presumably viral too) activity of immune cells such as neutrophils for up to 5 hours after consumption!(7) Stay tuned for Part II where we will discuss the role of some “tier 2” natural supplements, including green tea, probiotics, and vitamin D. References 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 CH, Springston EE, Sohn MW, Mason I, Gadola E, Damitz M, et al. Hand hygiene instruction decreases illness-related absenteeism in elementary schools: a prospective cohort study. BMC Pediatr. 2012;12:52. 3. Roll S, Nocon M, Willich SN. Reduction of common cold symptoms by encapsulated juice powder concentrate of fruits and vegetables: a randomised, double-blind, placebo-controlled trial. Br J Nutr. 2011;105(1):118-22. 4. Sasazuki S, Sasaki S, Tsubono Y, Okubo S, Hayashi M, Tsugane S. Effect of vitamin C on common cold: randomized controlled trial. Eur J Clin Nutr. 2006;60(1):9-17. 5. Maggini S, Beveridge S, Suter M. A combination of high-dose vitamin C plus zinc for the common cold. J Int Med Res. 2012;40(1):28-42. 6. Van Straten M, Josling P. Preventing the common cold with a vitamin C supplement: a double-blind, placebo-controlled survey. Adv Ther. 2002;19(3):151-9. 7. Sanchez A, Reeser JL, Lau HS, Yahiku PY, Willard RE, McMillan PJ, et al. Role of sugars in human neutrophilic phagocytosis. Am J Clin Nutr. 1973;26(11):1180-4. Immune Support - Preventing the “turn-of-season” cold Part II: Supplements and immune health; green tea, vitamin D, probiotics By: Heidi Fritz MA, ND Bolton Naturopathic Clinic 64 King St W, Bolton, ON L7E1C7 www.boltonnaturopathic.ca email@example.com 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 anti-viral effects.(1) Green tea consumed either as an extract in tablet form (equal to about 400mg green tea catechins) has been shown to reduce the incidence of the flu among healthcare workers by 75%.(2) In another study, green tea extract was shown to reduce the total number of illnesses lasting 2 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 1-5 cups per day, reduced the incidence of the flu by between 40-50% in school-age children.(3) Information on probiotics has exploded in the last few years. It is becoming well-recognized 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. Check in next week for Part III, where we will discuss the use of Echinacea. Is Echinacea effective after all? References 1. Rowe CA, Nantz MP, Bukowski JF, Percival SS. Specific formulation of Camellia sinensis prevents cold and flu symptoms and enhances gamma,delta T cell function: a randomized, double-blind, placebo-controlled study. J Am Coll Nutr. 2007;26(5):445-52. 2. Matsumoto K, Yamada H, Takuma N, Niino H, Sagesaka YM. Effects of green tea catechins and theanine on preventing influenza infection among healthcare workers: a randomized controlled trial. BMC Complement Altern Med. 2011;11:15. 3. Park M, Yamada H, Matsushita K, Kaji S, Goto T, Okada Y, et al Green tea consumption is inversely associated with the incidence of influenza infection among schoolchildren in a tea plantation area of Japan. J Nutr. 2011;141(10):1862-70. 4. Hao Q, Lu Z, Dong BR, Huang CQ, Wu T. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Syst Rev. 2011;(9):CD006895. 5. Perdigon G, Alvarez S, Rachid M, Agüero G, Gobbato N. Immune system stimulation by probiotics. J Dairy Sci. 1995;78(7):1597-606. 6. Hatakka K, Saxelin M. Probiotics in intestinal and non-intestinal infectious diseases--clinical evidence. Curr Pharm Des. 2008;14(14):1351-67. 7. Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr. 2010;91(5):1255-60. 8. Whiting SJ, Langlois KA, Vatanparast H, Greene-Finestone LS. The vitamin D status of Canadians relative to the 2011 Dietary Reference Intakes: an examination in children and adults with and without supplement use. Am J Clin Nutr. 2011;94(1):128-35. Immune Support - Preventing the “turn-of-season” cold Part III: Echinacea By: Heidi Fritz MA, ND Bolton Naturopathic Clinic 64 King St W, Bolton, ON L7E1C7 www.boltonnaturopathic.ca firstname.lastname@example.org Most people who keep up on developments in natural health and wellness will have heard of Echinacea, a popular immune stimulating 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 3 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 5-15 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. Stay tuned for Part IV, where we discuss the role of lifestyle hygiene! References 1. Shah SA, Sander S, White CM, Rinaldi M, Coleman CI. Evaluation of Echinacea for the prevention and treatment of the common cold: a meta-analysis. Lancet Infect Dis. 2007;7(7):473-80. 2. Jawad M, Schoop R, Suter A, Klein P, Eccles R. Safety and Efficacy Profile of Echinacea purpurea to Prevent Common Cold Episodes: A Randomized, Double-Blind, Placebo-Controlled Trial. Evid Based Complement Alternat Med. 2012;2012:841315. 3. Linde K, Barrett B, Wölkart K, Bauer R, Melchart D. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2006;(1):CD000530. 4. Woelkart K, Marth E, Suter A, Schoop R, Raggam RB, Koidl C, et al. Bioavailability and pharmacokinetics of Echinacea purpurea preparations and their interaction with the immune system. Int J Clin Pharmacol Ther. 2006;44(9):401-8. 5. Woelkart K, Bauer R. The role of alkamides as an active principle of echinacea. Planta Med. 2007;73(7):615-23. Immune Support - Preventing the “turn-of-season” cold Part IV: Lifestyle influences on immune health By: Heidi Fritz MA, ND Bolton Naturopathic Clinic 64 King St W, Bolton, ON L7E1C7 www.boltonnaturopathic.ca email@example.com 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 or flight,” during which the body tried to defend itself from the immediate perceived threat. Epinephrine and cortisol are secreted by the adrenals 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 adrenals 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 flu 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 13-24%!.(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. References 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 2012; 27(4):165-76. 2. Berg AL, Rafnsson AT, Johannsson M, Hultberg B, Arnadottir M. The effects of adrenocorticotrophic hormone and cortisol on homocysteine and vitamin B concentrations. Clin Chem Lab Med. 2006;44(5):628-31. 3. Mahuren JD, Dubeski PL, Cook NJ, Schaefer AL, Coburn SP. Adrenocorticotropic hormone increases hydrolysis of B-6 vitamers in swine adrenal glands. J Nutr. 1999;129(10):1905-8. 4. Panossian A, Wikman G. Evidence-based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress-protective activity. Curr Clin Pharmacol. 2009;4(3):198-219. 5. Gaffney BT, Hügel HM, Rich PA. The effects of Eleutherococcus senticosus and Panax ginseng on steroidal hormone indices of stress and lymphocyte subset numbers in endurance athletes. Life Sci. 2001;70(4):431-42. 6. Gaffney BT, Hügel HM, Rich PA. 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. Med Hypotheses. 2001;56(5):567-72. 7. Chandrasekhar K, Kapoor J, Anishetty S. 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 J Psychol Med. 2012;34(3):255-62. 8. Panossian A, Wikman G, Sarris J. Rosenroot (Rhodiola rosea): traditional use, chemical composition, pharmacology and clinical efficacy. Phytomedicine. 2010;17(7):481-93. 9. Olsson EM, von Schéele B, Panossian AG. 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 Med. 2009;75(2):105-12.