Sysfem cellular function of SCAP in systemm signaling. Blood glucose testing from Peppermint hot chocolate studies have been mixed, sytsem some effects Fortificaion depend on infant age and omega-3 fortificatoon. In fortkfication regards, from the omega-6 group, Immune system fortification essential is considered linoleic acid LA. For these reasons, it is important for older adults to take certain supplements. In their guidelines on nutrition support therapy for adults who are critically ill, the Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition state that they cannot recommend routine use of enteral formulas that contain omega-3s or other anti-inflammatory lipids in patients with ARDS because the data are conflicting [ ]. Monitoring tryptophan metabolism in chronic immune activation.

Video

The Adaptive Immune System

As COVID continues to spread fortifiaction, you may wonder what you can do besides the well-known behavior changes Gluten-free spreads handwashing, social distancing, etc.

to fogtification yourself from illness. An additional important strategy to remain healthy is to support your immune system with the right nutrients. Significant research shows that certain Immune, minerals, sysyem essential fortificztion acids fortifucation important systfm in immunity.

These fortificarion support wystem specialized defenses that keep fortificayion and bacteria out fortificahion our Immune system fortification, destroy Immuje that Blood glucose testing, and assist fkrtification recovery from illness and infection.

Fortifidation nutrients form the foundation fkrtification a healthy immune Sysetm. If you Inmune short systemm any of these nutrients highlighted here, fortifixation have fortificatiln risk Blood glucose testing serious foryification and infection.

Do your usual food choices meet our fortificatoon on ofrtification list? Blood glucose testing fortivication registered dietitian nutritionist Immune to see how eystem daily diet measures up.

We list a few food examples to help you get started, Dark chocolate nirvana the LPI has nutrition information for many additional syste, at its Micronutrient Information Center.

Fortidication you already know that fortiffication body is sysstem in a specific nutrient, such as iron in the case of anemiafocus on that nutrient first.

Anemia weakens the immune system. Low Immune system fortification, vitamin B firtificationvitamin Adaptogen stress relief products 12or iron Immuje all be Immine causes. If you have anemia, work with your doctor to determine which nutrients might help fortificstion resolve it ysstem soon as possible.

DHA systeem omega-3 fatty acid. Vitamin Sustem including foortification. These foryification are for Immune system fortification adults under 50 who are not pregnant systej breastfeeding.

Adults over 50 may need additional vitamin B 6 and vitamin B 12 from supplements, and no supplemental iron. See our recommendations for older adults for more information. Amounts of nutrients listed are approximate and can depend on source and preparation.

All of the LPI recommendations meet or exceed the recommendations of the National Academy of Medicine. While it is best to get most of your nutrients from foods, it is not always possible.

The best strategy is to know where you fall short and add supplements to fill the gaps. Vitamin C, vitamin D, DHA an omega-3 fatty acidand zinc all can help our bodies fight off infection. Following our guidelines, you can add one or more of these supplements to help support your immune system.

Multivitamins are also important to reach your goals. These supplements can help you reach all of the LPI recommendations, especially for minerals. Most general multivitamins will provide what you need. An expensive brand is not necessarily better.

Important : be sure to select the right type for you, such as those for women or older adults. As we get older, our immune system does not function as well as it used to.

This is related to not absorbing nutrients from foods as well as younger adults and also needing more nutrients as we age. For these reasons, it is important for older adults to take certain supplements. Therefore, the LPI has set specific supplement recommendations for older adults.

All of the guidelines listed here will help people over the age of 50 support their immune system. Optimal nutrition promotes optimal immune function.

To fight viruses and support a strong immune systemit is very important to get the nutrients you need to stay healthy. In times of health crisis, we would all do well to follow these general guidelines: eat a balanced diet and take a daily multivitamin.

Authors: Alexander Michels, PhD; Victoria Drake, PhD; Sandra Uesugi, RN, BSN, MS; Carmen Wong, PhD; Emily Ho, PhD; and Adrian Gombart, PhD, all from the Linus Pauling Institute at Oregon State University.

Contact information here. Donate Today! Get Updates from the Institute. Linus Pauling Institute Oregon State University Linus Pauling Science Center Corvallis, Oregon phone: fax: email: [email protected]. For media contact information.

Skip to main content. Toggle menu Go to search page. Search Field. About the LPI Faculty and Staff Our Research Micronutrient Information Publications Contact Information Donate.

Nutritional strategies to support your immune system. Nutrients for the Immune System Many nutrients form the foundation of a healthy immune system. If you have anemia Nutrient The LPI Recommendation Where can I get more?

Can Supplements Help? Look for quality testing on your supplements, like the USP or NSF seal. Check if your multivitamin has zinc.

Make sure not to exceed 40 mg of zinc per day from food and supplements combined. What about Older Adults? Conclusions Optimal nutrition promotes optimal immune function.

Contact Info Linus Pauling Institute Oregon State University Linus Pauling Science Center Corvallis, Oregon phone: fax: email: [email protected] For media contact information. Copyright © Oregon State University Disclaimer. The LPI Recommendation. Where can I get more?

: Immune system fortification

The relationship between nutrition and the immune system	Pre-workout supplements for athletes P, Forhification AG. A ssystem dose of vitamin D reduces the Immuune of falls in Immune system fortification home residents: a randomized, fortificatio study. However, among participants syxtem did Blood glucose testing a cold, elderberry Blood glucose testing reduced sywtem duration by about Immune system fortification days and reduced the severity of symptoms. In comparison with placebo, the zinc lozenges reduced the duration of colds by 3 days and the severity of cold symptoms cough, nasal discharge, and muscle aches [ ]. However, for laboratory-confirmed influenza, the incidence of influenza did not differ between groups. Potential role of TNF-α in the pathogenesis of insulin resistance and type 2 diabetes. This system consists phagocytes, dendritic cells, eosinophils, neutrophils, mast cells, and some additional cells
Frontiers | The relationship between nutrition and the immune system	These solutions, already widely used by governments and the World Food Program, are supplied in sachets for mixing directly into school meals and do not affect food attributes — such as taste and texture — in any way, which supports increased compliance to consumption. MNPs can also be distributed for home use for those unable to attend school due to closures or illness. Beyond school feeding and workforce nutrition interventions, the private sector also has a role to play in increasing consumer access to and availability of fortified products that support immune function. Maaike Bruins : The United Nations UN Sustainable Development Goal SDG 2 seeks to end world hunger and all forms of malnutrition, while the SDG 3 aspires to achieve good health and wellbeing for populations worldwide. Achieving these goals is a challenge that has become even more urgent in light of COVID, with public bodies increasingly highlighting the devastating impact the pandemic is having on both the global malnutrition crisis and public health. Ensuring access to affordable nutritious food universally has become even more important as a result, requiring large-scale solutions. Nutrition interventions have the power to reach many people and improve their nutritional status, thereby accelerating progress towards achieving the UN SDGs 2 and 3. Yannick Foing : We see a world without malnutrition creating brighter lives for all. But achieving this vision takes more than products. It takes a partner. We work with governments, donors, non-governmental organizations NGOs and UN agencies to introduce effective public health nutrition interventions, including large-scale programs that utilize staple food fortification, public health supplementation or MNPs. dsm-firmenich also helps its partners roll out multiple micronutrient supplements MMS interventions to improve maternal nutrition in regions with a high prevalence of nutritional deficiencies or where food supply chains are significantly disrupted. To find out more about how you can partner with dsm-firmenich to make accessible and affordable nutritional solutions that can support immune health, visit our Nutrition Improvement immunity hub. Customized blends of desired functional ingredients in one single, efficient, homogenous premix. Streamline your product development process and get to market faster. We're innovators in nutrition, health, and beauty. And we bring progress to life! Talking Nutrition How to tackle malnutrition and support immune health through large-scale fortification programs. By: Talking Nutrition Editors. The link between good nutrition and optimal immune function is increasingly highlighted by public bodies. This could leave them with potentially weaker immune systems and therefore more prone to infections and illness. Fortification is one of the most effective, safe, and cost-efficient ways to tackle nutritional deficiencies, support immune health and positively influence economic development in low- and middle-income countries. Talking Nutrition Editor: Vulnerable populations already face a range of challenges such as high poverty and inequality rates; under-funded health systems; and limited financial reserves. Could you tell us why immune health is such an important consideration for these populations? Are certain population groups at higher risk of poor immune health? What solutions can help to improve access to nutritious foods that support immune health? How is dsm-firmenich supporting the food industry, governments and NGOs in providing cost-effective, safe and nutritious solutions to vulnerable groups? VIST THE HUB. Published on. Related Articles. Fortifying Rice: A Public Health Panacea? Nutrition Improvement. Could higher vitamin D intake in childhood help end the global diabetes epidemic? Products with Purpose: New dsm-firmenich Brand Strategy Marks Transition to End-to-End Partner in Nutrition and Health Industry News. Related Content. Fore, Dongyu, Beasley, Ghebreysus. August 22, Fore HH, Dongyu Q, Beasley DM, Ghebreyesus TA. Child malnutrition and COVID the time to act is now. int , accessed on 26 June dsm-firmenich Global Health Concerns Jonathan Sugimoto et. Christina Nyhus Dhillon et. The Journal of pediatrics. Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Boonen S, Lips P, Bouillon R, Bischoff-Ferrari HA, Vanderschueren D, Haentjens P. Need for additional calcium to reduce the risk of hip fracture with vitamin D supplementation: evidence from a comparative metaanalysis of randomized controlled trials. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. Cauley JA, LaCroix AZ, Wu L, Horwitz M, Danielson ME, Bauer DC, Lee JS, Jackson RD, Robbins JA, Wu C, Stanczyk FZ. Serum hydroxyvitamin D concentrations and risk for hip fractures. Annals of internal medicine. Cauley JA, Parimi N, Ensrud KE, Bauer DC, Cawthon PM, Cummings SR, Hoffman AR, Shikany JM, Barrett-Connor E, Orwoll E. Serum hydroxyvitamin D and the risk of hip and nonspine fractures in older men. Journal of Bone and Mineral Research. Bischoff-Ferrari HA, Willett WC, Wong JB, Stuck AE, Staehelin HB, Orav EJ, Thoma A, Kiel DP, Henschkowski J. Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Archives of internal medicine. Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database of Systematic Reviews. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, Staehelin HB, Bazemore MG, Zee RY, Wong JB. Effect of vitamin D on falls: a meta-analysis. Broe KE, Chen TC, Weinberg J, Bischoff-Ferrari HA, Holick MF, Kiel DP. A higher dose of vitamin D reduces the risk of falls in nursing home residents: a randomized, multiple-dose study. Journal of the American Geriatrics Society. Bischoff-Ferrari HA, Orav EJ, Dawson-Hughes B. Effect of cholecalciferol plus calcium on falling in ambulatory older men and women: a 3-year randomized controlled trial. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, Wong JB, Egli A, Kiel DP, Henschkowski J. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. Sanders KM, Stuart AL, Williamson EJ, Simpson JA, Kotowicz MA, Young D, Nicholson GC. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. Garland CF, Garland FC. Do sunlight and vitamin D reduce the likelihood of colon cancer?. International journal of epidemiology. Garland CF, Gorham ED, Mohr SB, Garland FC. Vitamin D for cancer prevention: global perspective. Annals of epidemiology. McCullough ML, Zoltick ES, Weinstein SJ, Fedirko V, Wang M, Cook NR, Eliassen AH, Zeleniuch-Jacquotte A, Agnoli C, Albanes D, Barnett MJ. Circulating vitamin D and colorectal cancer risk: an international pooling project of 17 cohorts. JNCI: Journal of the National Cancer Institute. Yin L, Grandi N, Raum E, Haug U, Arndt V, Brenner H. Meta-analysis: longitudinal studies of serum vitamin D and colorectal cancer risk. Wu K, Feskanich D, Fuchs CS, Willett WC, Hollis BW, Giovannucci EL. A nested case—control study of plasma hydroxyvitamin D concentrations and risk of colorectal cancer. Journal of the National Cancer Institute. Gorham ED, Garland CF, Garland FC, Grant WB, Mohr SB, Lipkin M, Newmark HL, Giovannucci E, Wei M, Holick MF. Optimal vitamin D status for colorectal cancer prevention: a quantitative meta analysis. American journal of preventive medicine. Giovannucci E. Epidemiological evidence for vitamin D and colorectal cancer. Lin J, Zhang SM, Cook NR, Manson JE, Lee IM, Buring JE. Intakes of calcium and vitamin D and risk of colorectal cancer in women. American journal of epidemiology. Huncharek M, Muscat J, Kupelnick B. Colorectal cancer risk and dietary intake of calcium, vitamin D, and dairy products: a meta-analysis of 26, cases from 60 observational studies. Nutrition and cancer. Bertone-Johnson ER, Chen WY, Holick MF, Hollis BW, Colditz GA, Willett WC, Hankinson SE. Plasma hydroxyvitamin D and 1, dihydroxyvitamin D and risk of breast cancer. Cancer Epidemiology and Prevention Biomarkers. Garland CF, Gorham ED, Mohr SB, Grant WB, Giovannucci EL, Lipkin M, Newmark H, Holick MF, Garland FC. Vitamin D and prevention of breast cancer: pooled analysis. Lin J, Manson JE, Lee IM, Cook NR, Buring JE, Zhang SM. Intakes of calcium and vitamin D and breast cancer risk in women. Archives of Internal Medicine. Robien K, Cutler GJ, Lazovich D. Freedman DM, Chang SC, Falk RT, Purdue MP, Huang WY, McCarty CA, Hollis BW, Graubard BI, Berg CD, Ziegler RG. Serum levels of vitamin D metabolites and breast cancer risk in the prostate, lung, colorectal, and ovarian cancer screening trial. Calcium plus vitamin D supplementation and the risk of colorectal cancer. Calcium plus vitamin D supplementation and the risk of breast cancer. Holick MF. Calcium plus vitamin D and the risk of colorectal cancer. N Engl J Med. Vitamin D supplements and prevention of cancer and cardiovascular disease. Keum N, Lee DH, Greenwood DC, Manson JE, Giovannucci E. Vitamin D supplementation and total cancer incidence and mortality: a meta-analysis of randomized controlled trials. Annals of Oncology. Expanding roles of vitamin D. J Clin Endocrinol Metab. Norman PE, Powell JT. Vitamin D and cardiovascular disease. Circulation research. The vitamin D deficiency pandemic and consequences for nonskeletal health: mechanisms of action. Molecular aspects of medicine. Giovannucci E, Liu Y, Hollis BW, Rimm EB. Pilz S, März W, Wellnitz B, Seelhorst U, Fahrleitner-Pammer A, Dimai HP, Boehm BO, Dobnig H. Association of vitamin D deficiency with heart failure and sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography. Pilz S, Dobnig H, Fischer JE, Wellnitz B, Seelhorst U, Boehm BO, März W. Low vitamin D levels predict stroke in patients referred to coronary angiography. Booth TW, Lanier PJ. Vitamin D deficiency and risk of cardiovascular disease. Circulation Res Dobnig H, Pilz S, Scharnagl H, Renner W, Seelhorst U, Wellnitz B, Kinkeldei J, Boehm BO, Weihrauch G, Maerz W. Independent association of low serum hydroxyvitamin D and 1, dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Elamin MB, Abu Elnour NO, Elamin KB, Fatourechi MM, Alkatib AA, Almandoz JP, Liu H, Lane MA, Mullan RJ, Hazem A, Erwin PJ. Vitamin D and cardiovascular outcomes: a systematic review and meta-analysis. Mitri J, Pittas AG. Vitamin D and diabetes. Endocrinol Metab Clin North Am. Pittas AG, Dawson-Hughes B, Li T, Van Dam RM, Willett WC, Manson JE, Hu FB. Vitamin D and calcium intake in relation to type 2 diabetes in women. Diabetes care. Vitamin D Supplementation and Prevention of Type 2 Diabetes. Multiple sclerosis—a review. European journal of neurology. Goldberg P. Multiple sclerosis: vitamin D and calcium as environmental determinants of prevalence: A viewpoint part 1: sunlight, dietary factors and epidemiology. International Journal of Environmental Studies. Vitamin D intake and incidence of multiple sclerosis. Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum hydroxyvitamin D levels and risk of multiple sclerosis. Salzer J, Hallmans G, Nyström M, Stenlund H, Wadell G, Sundström P. Vitamin D as a protective factor in multiple sclerosis. Munger KL, Hongell K, Åivo J, Soilu-Hänninen M, Surcel HM, Ascherio A. Ascherio A, Munger KL, White R, Köchert K, Simon KC, Polman CH, Freedman MS, Hartung HP, Miller DH, Montalbán X, Edan G. Vitamin D as an early predictor of multiple sclerosis activity and progression. JAMA neurology. Association of vitamin D levels with multiple sclerosis activity and progression in patients receiving interferon beta-1b. Ascherio A, Munger KL. Epidemiology of multiple sclerosis: from risk factors to prevention—an update. InSeminars in neurology Apr Vol. Thieme Medical Publishers. Gillespie KM. Type 1 diabetes: pathogenesis and prevention. Hyppönen E, Läärä E, Reunanen A, Järvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. The Lancet. Rewers M, Ludvigsson J. Environmental risk factors for type 1 diabetes. Munger KL, Levin LI, Massa J, Horst R, Orban T, Ascherio A. Preclinical serum hydroxyvitamin D levels and risk of type 1 diabetes in a cohort of US military personnel. Hope-Simpson RE. The role of season in the epidemiology of influenza. Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant WB, Madronich S, Garland CF, Giovannucci E. Epidemic influenza and vitamin D. Ginde AA, Mansbach JM, Camargo CA. Association between serum hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. 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. The American journal of clinical nutrition. Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, Dubnov-Raz G, Esposito S, Ganmaa D, Ginde AA, Goodall EC. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. Zasloff M. Fighting infections with vitamin D. Nature medicine. Nnoaham KE, Clarke A. Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis. Chocano-Bedoya P, Ronnenberg AG. Vitamin D and tuberculosis. Nutrition reviews. Autier P, Gandini S. Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials.
Contact Info	Blood glucose testing Mental resilience training. Beaumier Immune system fortification, Castillo L, Yu Y, Ajami Ssystem, Young V. Prevalence of vitamin D deficiency among healthy fortivication. The LPI Recommendation. Vitamin A deficiency affects processes related to appropriate cytokines release and antibody production. Nutrient sensing, signal transduction and immune responses. Chatterjee S, Szustakowski J, Nanguneri N, Mickanin C, Labow M, Nohturfft A, et al.
10 Tips For Fortifying Your Immune System	Unfortunately, the exact mechanism remains unknown. Tryptophan Trp is clearly essential for the activity of the immune system Table 3. Since Trp is necessary for protein synthesis, it becomes to be indispensable for cell division and development Since Trp is not synthesized by the human body, it is required to be obtained from the diet Trp serves as a substrate for the biosynthesis and formation of serotonin 5-HT , kynurenine Kyn , and indoles The most useful and active Trp metabolism is the Kyn path which is related to the formation of nicotinamide adenine dinucleotide NAD and kynurenic acid. Of course, similarly to all pathways, this type takes place due to the involvement of two types of enzymes indoleamine 2,3-dioxygenase IDO and IDO2 and tryptophan 2,3-dioxygenase TDO , Additionaly to the Trp metabolism, we brought information on its role in the regulation of inflammation through its initiators, starting with IDO, which exerts an insignificant effect on healthy and normal conditions. Things are changed by some cytokines, including interferons which represent the result of the triggered inflammatory process The highly potent and amply used cytokine interferon-gamma IFN-γ. It is linked to the promotor-region of IDO and it is capable to express itself in many types of cells. However, the highest expressive grade is found in dendritic cells and macrophages, but there are some other places where it was manifest such as epithelial and connective tissues — As we discussed before, inflammation and chronic immune tolerance are regulated by Trp biochemistry. In tumor cells, an important step for metabolic reprogramming is represented by amino acids metabolism. Some authors suggest that, in the case of glioma, there is a strong link between the two because the metabolic amino acid pathway could be used as a predictor for survival as well as certain clinical characteristics As we mentioned before, amino acids and their metabolites are responsible for both controlling malignant cells as well as for changing the microenvironment. In this way, the results are translated into the improvement of immunosuppression and malignancy state Kynurenine metabolism is capable of stimulating an oxidative stress resistance pathway, and, in this way, creating an opportunity to make changes in the tumor microenvironment that helps the development of the tumor However, another metabolite of tryptophan; 5-methoxytryptophan 5-MTP has the ability to suppress the development of tumors and the displacement of cancer cells in other tissues. Wu et al. This type of inflammation-associated enzyme is very abundant in tumor cells and also contributes to development process of cancer Cholesterol has a key function on cellular membranes functionality, especially in the plasma membrane of the cell where it is found at higher concentrations. Its special location at the lipid bilayer allows optimal interaction with other lipids and displays a significant role in membrane fluidity. Cholesterol points its structure mainly into the lipid bilayer leaving only the hydroxyl group facing the external environment. Thus, the steroid rings are in close vicinity to the hydrocarbon chains of adjacent lipids Cholesterol is vital for the many physiological roles that the plasma membrane is involved. The cells keep their lipid bilayer appropriate functionality due to cholesterol molecules, otherwise, microenvironment, endocytosis, signaling pathways, as well as other functions, would be altered. Cholesterol is involved in membrane integrity and it is responsible for receptors arrangement and bilayer fluidity , For a better understanding of the information provided later-on, we will describe the cholesterol synthesis and pathway in a schematic frame. Cholesterol biosynthesis of is characterized by a complex pathway, nonetheless the pathways involved have been clearly elucidated Its synthesis involves more than 20 metabolic-specific actions, which include enzymatic reactions belonging to the mevalonate pathway of and additional synthesis pathway of cholesterol. Enzymes involved in cholesterol biosynthesis are mainly detected in the membranes of the endoplasmic reticulum ER. These enzymes are the target of several molecular reactions which, closely controlled in order to not allow cellular damage , However, cholesterol is non-uniformly disseminated in the plasmalemma. It has been observed that each pool is corresponded to an exclusive function in the plasma membrane physiology — It is clear that cholesterol equilibrium involves a transport mechanism by virtue of the concentration gradient from high concentration cholesterol places to regions where cholesterol has been lost or has a low level. The transport of cholesterol is dependent on proteins due to its hydrophobic conformation, thus it cannot be transported through the blood. Thus cholesterol binds to different proteins and forms distinct lipoprotein compounds such as low-density LDL and high-density HDL. As expected, regulatory mechanisms for the formation of each lipoprotein are specific The surplus of cholesterol can be transported through the efflux process or deposited as intracellular lipid droplets because of the incapacity of most human cells to efficiently degrade it. The deposition of lipid droplet plaques in the bloodstream causes the release of inflammatory cytokines which create later an inflammatory process. The consequence of this event is associated with inflammation triggered by the cytokine interleukin-1β IL-1β Furthermore, IL-1β is considered an important marker in the inflammatory process The cholesterol signaling pathway plays a role in the immune response we therefore will highlight these pathways. Sterol response element-binding protein SREBP exerts an essential role in the signaling pathway of cholesterol Figure 3. Normally, these proteins are located in the membrane of the ER, which is capable of binding with additional two complex proteins such as the cleavage-activating protein and generating SCAP and the insulin-inducible genes INSIGs The shift of SCAP from ER to the Golgi apparatus plays a key role in its activity. SREBPs proteins are composed of three variants SREBP1a, SREBP1c, and SREBP2, being the latter the most important SREBP2 is a protein complex structure that seems to be capable to regulate the expression of all the enzymes that are involved in cholesterol biosynthesis Its most important activity is its specific response to high concentration of sterols which are able to efficiently induce a decrease in cholesterol synthesis. SREBP2 fulfills its function when the sterols concentration decrease. This change in sterol concentration due to SREBP2 activity will generate afterward the shifting the complex SCAP from ER to the Golgi apparatus In this organelle, the SCAP molecule is changed Once the SCAP reaches the Golgi apparatus, proteases sit 1 and 2 cut this complex Figure 3. As a result, the transcription factor TF is created and stimulated Then the TF enters the nucleus where it is responsible for the regulation of the cholesterol synthetic pathway enzymes All these pathways may stimulate the flux of cholesterol biosynthesis , Figure 3. Schematic frame of cholesterol biosynthesis. In the signaling pathway of cholesterol, sterol response element-binding protein SREBP2 has an essential role. SREBP2 is located in RE, where it forms a complex with the protein like cleavage-activating protein and generating SCAP ; Its most important activity is to reduce the cellular cholesterol concentration when this is higher. Then, SCAP is shifted from ER to the Golgi apparatus. Once SCAP reaches the Golgi apparatus, proteases sit 1 and 2 digest this complex and subsequently, the transcription factor TF is formed and is activated Then, TF moves into the nucleus where it becomes active and control the transcription of the enzymes of cholesterol biosynthetic pathway. Additionally, it is important to mention that all cholesterol associated pathways involving synthesis, influx, efflux, and esterification take place through mechanisms closely related to each other allowing well-adjusted whole mechanistic biochemical pathways. All these tightly controlled mechanisms highlight the crucial role of cholesterol in life span, and clarify the potential risks when the concentrations are diverted from the optimal range. In this regards, Luo et al. Moreover, in several diseases such as various types of cancer, infections and allergies, cholesterol biochemical equilibrium is severely altered through inflammation-associated consequences. Regarding the relationship between cholesterol and macrophages, counter-regulatory mechanisms oppose macrophage inflammation and at the same time cholesterol cellular accumulation. When the concentration of cellular cholesterol increases, specific sterols are formed. With their help, the transcription factors liver X receptor LXR —retinoid X receptor RXR are activated. These heterodimers have anti-inflammatory roles, including controlling the expression of ATP-binding cassette transporters ABC transporters , which are ABC subfamily A member 1 ABCA1 and ABCG1. They are also involved in stimulating the efflux of cholesterol from macrophages. In this way, they can suppress the activation of TLR signaling given by the increased intracellular cholesterol concentration. When TLRs are activated, LXR genes are inhibited, thus decreasing the cholesterol efflux from macrophages. Activation of cholesterol efflux by ABCA1 and ABCG1 is via apolipoprotein A1 APOA1 , forming HDL and initiating the process of transporting cholesterol back to the liver via blood vessels and lymphatics. Therefore, as a way of amplifying the inflammatory response, the immune system can alter cholesterol homeostasis When the control of cholesterol biosynthesis is disturbed resulting in high cholesterol levels it can be translated into metabolic diseases such as atherosclerosis and dyslipidemia Figure 4. In some of these cases, both the innate and the adaptive immune functions have the ability to regulate this phenomenon In this way, ApoB-containing lipoproteins are originated immediately after atherosclerosis damages. These are generated, developed and stored in the endothelial compartment Interestingly, these molecules exert pro-inflammatory effects through acetylation, oxidation, and especially induce aggregation with additional molecules The modifications provoked by the accumulation of ApoB-containing lipoproteins Figure 4 in endothelial location results in the growth of adherence, hold, and mobility in this place of immune cells In summary, the inflammation is supported through the generation of ROS and certain cytokines such as TNF α, IL6, and IL 1β , At the same time, Th17 and Th1 are involved in the pro-inflammatory process , Figure 4. Cholesterol rate in the modulation of immune function. Polyunsaturated fatty acids PUFAs are essential fatty acids that contain more than one double bond in their backbone. PUFAs are divided into two main groups: omega-3 and omega The structural chemical difference between the two groups is represented by the location of the cis double bonds Together with cholesterol, PUFAs are essential for cell membrane integrity, development and maintenance in the homeostasis of cell function. Moreover, they are used by certain structures in cells and they stimulate cell proliferation In this way, the sensitivity of the immune function can be modified The most representative polyunsaturated fatty acids are eicosapentaenoic acid EPA , alpha-linolenic acid ALA , and docosahexaenoic acid DHA , all defined as omega-3 fatty acids They are very intensively studied since they are involved in many essential vital activities and more interestingly in immunomodulation pathways. In addition, the ALA is important due to the fact that it is a precursor of other fatty acids Omega-3 PUFAs have a role in immunomodulation by decreasing pro-inflammatory eicosanoids. They represent a substrate for AA cascade enzymes, in this way certain prostanoids and leukotrienes are produced. Some lipid mediators such as maresins have omega-3 PUFAs as precursors. They promote the ending of the inflammatory process In human breast cancer cells ALA produce inhibition of cell proliferation and activate apoptosis In diabetic rats, ALA increases insulin sensitivity and restored lipid and glucose metabolic abnormalities ALA is considered essential because it cannot be synthesized by the human body. In these regards, from the omega-6 group, an essential is considered linoleic acid LA. Following LA ingestion, this fatty acid is quickly converted into arachidonic acid ARA , which is responsible for the fluidity as well as the flexibility of the cell membrane. Free ARA is involved in the modulation of ion channels, enzymes, and receptors through stimulation or suppression of their function Free unesterified ARA exerts antitumoral activity in vitro as well in vivo. It can be used as an anti-cancer drug. Moreover, ARA can cause the death of tumor cells through the suppression of proliferation determining in this way, the death via stimulation of neutral sphingomyelinase nSMase mechanism Omega-3, as well as omega-6, participate in immunomodulation. According to Simonetto et al. Omega-3 from the PUFAs group is involved in anti-inflammatory reactions through the inhibition of ARA from the membrane, which is the main precursor for pro-inflammatory eicosanoids They are capable to modulate immune and inflammatory responses through intensity and duration. On the one hand, pro-inflammatory effects are linked to fever, vasodilatation and intensification of pain. On the other hand, they could have anti-inflammatory effects by blocking natural killer activity and lymphocyte proliferation. Also, they are capable to inhibit IL-6, IL-2, and TNF-α However, most importantly is the ratio between the 2 groups of PUFAs. She additionally concluded that a lower ratio is associated with a general decrease in very common chronic diseases in the Western society As mentioned throughout all this review, there is a strong and dynamic link between nutrition and immune function, as a direct consequence of the modulation of the immune function through the pro-inflammatory and anti-inflammatory effects of certain nutrients including cholesterol who exerts a crucial impact in these complex biological settings and holds a great capacity to regulate immune function, tightly related to its concentration. Certain micronutrients mentioned in this review: A, B1, B2, B3, B12, C, and D vitamins and minerals such as Zinc, and Selenium affect innate as well as adaptive immunity specifically through genetic, biochemical, and signaling pathways. All these may be translated into the modulation of proliferation, cell division, cell mobilization, and physiology of immune cells. Additionally, we provide evidence that some macro-nutrients such as tryptophan, arginine, cholesterol and PUFAs may be involved in the prevention and therapy of some immune-related diseases. Also, is very important to note that some vitamins such as A and D are fat soluble That is why when we consume fat-free light products, we are practically deprived of fat-soluble vitamins and the immune function can be affected. So, western diets should contain the accurate class of healthy fats, such as PUFAs, in a correct ratio, otherwise the edible products become poor in nutrients. A good example is the Mediterranean diet. In addition, the fats are much more satiating and give food a much better taste We highlight the difference in response to micro- and macro nutrients between healthy and sick population. We provided evidence that the response in pathophysiologic stages are very different to normal physiologic stages additionally to interindividual variations. As a result, the immune response is different and variable 11 , , We also presented some evidences and speculations on the roles of some vitamins, as well as certain amino acids, in cancer patients, due to their involvement as cofactors in proliferation and energy-related pathways finally leading to the development of tumor cells. We foresee that further research needs to be done in order to clearly distinguish the possible oncogenic effects of thiamin, cobalamin, and arginine 58 , We additionally provide evidence that the inflammatory responses in general, and the changes in immune functions are modified by the lack of an accurate cholesterol metabolism. The alterations in the cholesterol biosynthetic pathway may have both positive and negative immune health-related repercussions. Alterations in the cholesterol biosynthetic pathway may directly impinge and interfere with antimicrobial responses, as well as with antiviral effects Thus, an immediate action is required in order to adjust the cholesterol metabolism. Moreover, we refer to the bioavailability of macro- and micro nutrients from food. We ask whether foods contain enough amounts of macro- and micro nutrients. Does the soil and then the foods today still have the same nutritional value as before for example in fruits and vegetables? These led us to question under what conditions can artificial supplementation with macro or micronutrients be done? And how should be done? Should they be taken alone or as a complex? The question is the synergistic and complementary action of taking supplements of vitamin complexes, results in a better or worst outcome? We surmise that the administration of nutrients micro and macro would exert distinct effects on each person. We know that each individual is different, and thus their immune responses will differ from each other. To add more complexity, we referred also to the absorption capability of nutrients in the different compartments of the digestive system. We finally provided evidence that for each stage of the immune process, both micro and macronutrients are needed for the proper functioning of this important system. BS and CM wrote the manuscript after a rigorous investigation, interpretation, systematization, and conceptualization of current data. Both authors agreed to publish the present manuscript, contributed to the article, and approved the submitted version. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Gombart A, Pierre A, Maggini S. A review of micronutrients and the immune system—working in harmony to reduce the risk of infection. doi: PubMed Abstract CrossRef Full Text Google Scholar. Maggini S, Pierre A, Calder P. Immune function and micronutrient requirements change over the life course. Wu D, Lewis E, Pae M, Meydani S. Nutritional modulation of immune function: analysis of evidence, mechanisms, and clinical relevance. Front Immunol. Koithan M, Devika J. New approaches to nutritional therapy. J Nurse Practit. Mullero K. Malnutrition and health in developing countries. Can Med Assoc J. World Health Organization. Joint Statement on the Management of Acute Diarrhoea. Geneva: World Health Organization Google Scholar. Adepoju A, Allen S. Malnutrition in developing countries: nutrition disorders, a leading cause of ill health in the world today. Paediatr Child Health. CrossRef Full Text Google Scholar. Popkin B, Adair L, Ng S. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. Shi H, Walker W. Development and physiology of the intestinal mucosal defense. Mucosal Immunol. McDole J, Wheeler L, McDonald K, Wang B, Konjufca V, Knoop K, et al. Tourkochristou E, Triantos C, Mouzaki A. The influence of nutritional factors on immunological outcomes. Walls J, Sinclair L, Finlay D e. Nutrient sensing, signal transduction and immune responses. Semin Immunol. Childs C, Calder P, Miles E. Diet and immune function. Sica A, Mantovani A. Macrophage plasticity and polarization: in vivo veritas. J Clin Invest. Szefel J, Danielak A, Kruszewski W. Metabolic pathways of L-arginine and therapeutic consequences in tumors. Adv Med Sci. Grohmann U, Mondanelli G, Belladonna M, Orabona C, Pallotta M, Iacono A, et al. Amino-acid sensing and degrading pathways in immune regulation. Cytokine Growth Fact Rev. Newsholme P, Brennan L, Rubi B, Maechler P. New insights into amino acid metabolism, β-cell function and diabetes. Clin Sci. Mellor AL, Munn DH. IDO expression by dendritic cells: tolerance and tryptophan catabolism. Nat Rev Immunol. Rubio-Patiño C, Bossowski J, De Donatis G, Mondragón L, Villa E, Aira L, et al. Low-protein diet induces IRE1α-dependent anticancer immunosurveillance. Cell Metab. Li P, Yin Y, Li D, Kim S, Wu G. Amino acids and immune function. Br J Nutr. Al Tanoury Z, Piskunov A, Rochette-Egly C. Vitamin A and retinoid signaling: genomic and nongenomic effects: thematic review series: fat-soluble vitamins: vitamin A. J Lipid Res. Prentice S. They are what you eat: can nutritional factors during gestation and early infancy modulate the neonatal immune response? Liu M, Bao S, Gálvez-Peralta M, Pyle C, Rudawsky A, Pavlovicz R, et al. ZIP8 regulates host defense through zinc-mediated inhibition of NF-κB. Cell Rep. Brieger A, Rink L, Haase H. Differential regulation of TLR-dependent MyD88 and TRIF signaling pathways by free zinc ions. J Immunol. Kitabayashi C, Fukada T, Kanamoto M, Ohashi W, Hojyo S, Atsumi T, et al. Zinc suppresses Th17 development via inhibition of STAT3 activation. Int Immunol. Maywald M, Wang F, Rink L. Zinc supplementation plays a crucial role in T helper 9 differentiation in allogeneic immune reactions and non-activated T cells. J Trace Elements Med Biol. Rosenkranz E, Maywald M, Hilgers R, Brieger A, Clarner T, Kipp M, et al. J Nutr Biochem. Rosenkranz E, Metz C, Maywald M, Hilgers R, Weßels I, Senff T, et al. Mol Nutr Food Res. Haase H, Rink L. The immune system and the impact of zinc during aging. Immun Ageing. Prasad A. Effects of zinc deficiency on Th1 and Th2 cytokine shifts. J Infect Dis. Zinc in human health: effect of zinc on immune cells. Mol Med. Marshall J, Warrington R, Watson W, Kim H. An introduction to immunology and immunopathology. Allergy Asthma Clin Immunol. Jasenosky L, Scriba T, Hanekom W, Goldfeld AE. T cells and adaptive immunity to Mycobacterium tuberculosis in humans. Immunol Rev. Romagnani S. T-cell subsets Th1 versus Th2. Ann Allergy Asthma Immunol. Hu X, Ivashkiv L. Cross-regulation of signaling pathways by interferon-γ: implications for immune responses and autoimmune diseases. Haryanto B, Suksmasari T, Wintergerst E, Maggini S. Multivitamin supplementation supports immune function and ameliorates conditions triggered by reduced air quality. Vitam Miner. Zuniga E, Macal M, Lewis G, Harker J. Innate and adaptive immune regulation during chronic viral infections. Annu Rev Virol. Romano P. Past, present, and future of regulatory T cell therapy in transplantation and autoimmunity. Schroeder H Jr. Structure and function of immunoglobulins. J Allergy Clin Immunol. Cañedo-Dorantes L, Cañedo-Ayala M. Skin acute wound healing: a comprehensive review. Int J Inflamm. Villamor E, Fawzi WW. Effects of vitamin a supplementation on immune responses and correlation with clinical outcomes. Clin Microbiol Rev. Huang Z, Liu Y, Qi G, Brand D, Zheng S. Role of vitamin A in the immune system. J Clin Med. Cunningham-Rundles C. Hematologic complications of primary immune deficiencies. Blood Rev. Maggini S, Wintergerst ES, Beveridge S, Hornig DH. Selected vitamins and trace elements support immune function by strengthening epithelial barriers and cellular and humoral immune responses. Padbidri Bhaskaram MD. Micronutrient malnutrition, infection, and immunity: an overview. Maggini S, Beveridge S, Sorbara P, Senatore G. Feeding the immune system: the role of micronutrients in restoring resistance to infections. CAB reviews: perspectives in agriculture, veterinary science. Nutr Nat Resour. Cox S, Arthur P, Kirkwood B, Yeboah-Antwi K, Riley E. Vitamin A supplementation increases ratios of proinflammatory to anti-inflammatory cytokine responses in pregnancy and lactation. Clin Exp Immunol. Retinoic acid: a key player in immunity. Rampal R, Awasthi A, Ahuja V. J Leukocyte Biol. Lu L, Lan Q, Li Z, Zhou X, Gu J, Li Q, et al. Critical role of all-trans retinoic acid in stabilizing human natural regulatory T cells under inflammatory conditions. Proc Natl Acad Sci USA. Roy S, Awasthi A. Vitamin a and the immune system. In: M Mahmoudi, N Rezaei editors. Nutrition and Immunity. Cham: Springer Imdad A, Yakoob M, Sudfeld C, Haider B, Black R, Bhutta Z. Impact of vitamin A supplementation on infant and childhood mortality. BMC Public Health. Bold R, Ishizuka J, Townsend C Jr. All-trans-retinoic acid inhibits growth of human pancreatic cancer cell lines. Mirza N, Fishman M, Fricke I, Dunn M, Neuger A, Frost T, et al. All-trans-retinoic acid improves differentiation of myeloid cells and immune response in cancer patients. Cancer Res. Nhieu J, Lin Y, Wei L. Noncanonical retinoic acid signaling. Methods Enzymol. Cicconi L, Lo-Coco F. Current management of newly diagnosed acute promyelocytic leukemia. Ann Oncol. Shin J, Song M, Oh J, Keum Y, Saini R. Pro-oxidant actions of carotenoids in triggering apoptosis of cancer cells: a review of emerging evidence. Peterson C, Rodionov D, Osterman A, Peterson SN. B vitamins and their role in immune regulation and cancer. Rodionov D, Arzamasov A, Khoroshkin M, Iablokov S, Leyn S, Peterson S, et al. Micronutrient requirements and sharing capabilities of the human gut microbiome. Front Microbiol. Jones PT, Anderson R. Int J Immunopharmacol. Yadav UC, Kalariya NM, Srivastava SK, Ramana KV. Protective role of benfotiamine, a fat-soluble vitamin B1 analogue, in lipopolysaccharide-induced cytotoxic signals in murine macrophages. Free Radical Biol Med. Mathis D, Shoelson S. Immunometabolism: an emerging frontier. Buck M, Sowell R, Kaech S, Pearce E. Metabolic instruction of immunity. Scalabrino G. J Neurochem. Shoeb M, Ramana K. Anti-inflammatory effects of benfotiamine are mediated through the regulation of the arachidonic acid pathway in macrophages. Jonus H, Hanberry B, Khatu S, Kim J, Luesch H, Dang L, et al. The adaptive regulation of thiamine pyrophosphokinase-1 facilitates malignant growth during supplemental thiamine conditions. Huskisson E, Maggini S, Ruf M. The role of vitamins and minerals in energy metabolism and well-being. Vitamin A including beta-carotene. These recommendations are for all adults under 50 who are not pregnant or breastfeeding. Adults over 50 may need additional vitamin B 6 and vitamin B 12 from supplements, and no supplemental iron. See our recommendations for older adults for more information. Amounts of nutrients listed are approximate and can depend on source and preparation. All of the LPI recommendations meet or exceed the recommendations of the National Academy of Medicine. While it is best to get most of your nutrients from foods, it is not always possible. The best strategy is to know where you fall short and add supplements to fill the gaps. Vitamin C, vitamin D, DHA an omega-3 fatty acid , and zinc all can help our bodies fight off infection. Following our guidelines, you can add one or more of these supplements to help support your immune system. Multivitamins are also important to reach your goals. These supplements can help you reach all of the LPI recommendations, especially for minerals. Most general multivitamins will provide what you need. An expensive brand is not necessarily better. Important : be sure to select the right type for you, such as those for women or older adults. As we get older, our immune system does not function as well as it used to. This is related to not absorbing nutrients from foods as well as younger adults and also needing more nutrients as we age. For these reasons, it is important for older adults to take certain supplements. Therefore, the LPI has set specific supplement recommendations for older adults. All of the guidelines listed here will help people over the age of 50 support their immune system. Optimal nutrition promotes optimal immune function. For ambient-stable products with long shelf lives, for example, commercial pressure means it is rarely feasible for a full shelf-life evaluation to have been completed prior to launch. having robust analytical methods in place is vital […]. This is when an accelerated study comes into play. In these studies, the chemical, biochemical and microbiological changes that take place during shelf life are induced. By storing the product in elevated conditions of temperature, humidity, pH and so on, it is possible to assess degradation. This provides preliminary shelf-life data in a relatively short timeframe. This information can then be used to inform other aspects of the product development process. Packaging and storage conditions influence stability. Manufacturers need to be sure that their products maintain quality throughout their shelf life. In both cases, having robust analytical methods in place is vital to ensure that the active ingredients are monitored accurately for the duration of the study. The parameters for each product must not only cover how the product is formulated, processed and packaged, but also how it is stored, distributed and ultimately consumed. With this in mind, RSSL tailors its approach to the requirements of every product specification. Their extensive facilities mean that RSSL can create the appropriate controlled environment for individual products. They also offer a wide range of analytical techniques, including high pressure liquid chromatography HPLC , which is currently the reference method for vitamin analysis, and liquid chromatography mass spectrometry LC-MS that also permits detection of product degradation that might otherwise go unnoticed. In addition - and equally important given the complexities involved - all these methods for assessing vitamin stability are properly evaluated and validated before being used. Even from this brief overview, it is clear that the chemistry affecting the stability of vitamins is complex, and minor modifications to the formulation, packaging or storage of products can have a major impact. What is certain, is that the chosen route must include stability studies. And it is sensible to include them as soon as possible; not only to reduce the time taken to launch a new product onto the market, but also avoid potential problems further down the line. Carole Bingley is a senior technical specialist in food product development and Rachel Reid is the functional ingredients leader, both at Reading Scientific Services Ltd RSSL. Reading Scientific Services Limited RSSL is a contract research organisation CRO. We lead the future of innovation in food and consumer products with our team of more than research scientists and product developers. Our innovation and scientific expertise has helped our partners to develop and manufacture products that consumers love and trust in more than 50 markets across the globe. We take a collaborative, agile approach and work alongside our clients as a trusted partner, helping to bring ideas to life and deliver innovative solutions from product concept to pilot plant and full scale manufacture - whether you require short project-based support or fundamental research to assess and analyse wider market issues, RSSL will work with you to arrive at a consumer-winning solution that will put your brand at the forefront of the food industry. Find out more. By Anthony King. By Zahra Khan. By Raychelle Burks. By Rebecca Trager. By Chemistry World. Sponsored by RSSL. Sponsored by Collaborative Drug Discovery. Site powered by Webvision Cloud. Skip to main content Skip to navigation. Welcome to the food science collection.

Immune system fortification -

Try to minimize or eliminate animal flesh and animal milk. It would be best if you tried to drink only filtered alkalinized or hydrogenated water when possible. Try to avoid distilled water, which is devoid of minerals.

Try to minimize your exposure to radiation from wi-fi and cellular devices. Keep your phone off the body and away from the head. Be sure to divide the doses so as not to take too many at once.

And, some supplements may be better when taken with food see labels for further instructions. Try to get some exposure to sunshine for at least 30 minutes daily. For those who take sunshine supplementation with vitamin D3, it can be IU daily.

Exercise, including stretching , for 30 minutes minimum daily to invigorate the entire body. For further information on how to protect yourself the right and safest way, Dr. Maria Scunziano-Singh, MD, NMD, can be consulted at Integrative Healing at OM, LLC.

For an appointment, call Table of Contents Toggle What is Immune Fortification? Eat The Right Foods 2. Surround Yourself With a Healthy Environment 3. Drink Filtered Aalkalinized or Hydrogenated Water 4. Avoid Food Pesticides 5.

Minimize Your Exposure to Radiation 6. Take Proper Daily Supplementation 7. However, zinc supplementation did not affect viral load or mortality rates in this second trial.

However, the supplements blunted the rise in hemoglobin concentrations between baseline and 6 weeks after delivery. These ULs, however, do not apply to people taking zinc under the care of a physician.

Higher intakes can cause nausea, vomiting, loss of appetite, abdominal cramps, diarrhea, headaches, and a metallic taste in the mouth [ 29 , 32 ]. In clinical trials in children, zinc supplementation to treat diarrhea increased the risk of vomiting more than placebo [ , ].

Zinc supplements might interact with several types of medications. For example, zinc can reduce the absorption of some types of antibiotics and penicillamine, a drug used to treat rheumatoid arthritis [ , ].

Other medications, such as thiazide diuretics and certain antibiotics, can reduce zinc absorption [ , ]. More information on zinc is available in the ODS health professional fact sheet on zinc. For information on zinc and COVID, please see the ODS health professional fact sheet, Dietary Supplements in the Time of COVID Andrographis paniculata , also known as Chuān Xīn Lián, is an herb that is native to subtropical and Southeast Asia [ ].

Its leaves and other aerial above-ground parts are used in traditional Ayurvedic, Chinese, and Thai medicine for relieving symptoms of the common cold, influenza, and other respiratory tract infections [ ]. The active constituents of andrographis are believed to be andrographolide and related compounds, which are diterpene lactones that might have antiviral, anti-inflammatory, and immune-stimulating effects [ , , ].

Results from several clinical trials suggest that andrographis might reduce the duration of upper respiratory tract infections and the severity of symptoms. One of these trials used a common andrographis preparation called Kan Jang.

The trial included 50 men and women age 18 to 50 years with the common cold who took four tablets of Kan Jang each containing 85 mg of an andrographis extract three times daily for 5 days 1, mg total daily dose or placebo within 3 days of developing cold symptoms [ ].

Participants who took Kan Jang experienced milder symptoms, recovered sooner, and took fewer days of sick leave than those who took placebo. In another clinical trial, men and women age 18 to 60 years with upper respiratory tract infections took either KalmCold containing mg of an andrographis extract twice daily or placebo for 5 days [ ].

The results showed no differences in symptom severity during days 1 to 3 of treatment. However, between days 3 and 5, participants who took KalmCold experienced milder symptoms—including cough, nasal discharge, headache, fever, and sore throat but not earache —than those who took placebo.

Two systematic reviews and meta-analyses of clinical trials found that andrographis preparations had beneficial effects on symptoms and duration of the common cold. The more recent of these analyses, published in , included 33 clinical trials including the two described above that evaluated the effects of andrographis alone or in combination with other herbs on symptoms of acute upper and lower respiratory tract infections in a total of 7, participants [ ].

Treatment protocols varied widely, but typical daily doses ranged from to 1, mg andrographis extract for 3 to 7 days; studies compared andrographis with placebo, usual care, or other herbal interventions. The analyses showed that andrographis significantly reduced the severity of cough, sore throat, and overall symptoms.

However, the authors noted that the findings should be interpreted with caution because the studies were heterogenous and many were of poor quality. Similar findings were reported from a systematic review and meta-analysis [ ].

It included six clinical trials including the two described above that administered Kan Jang or KalmCold All studies in this analysis compared andrographis with placebo, not usual care or other herbal interventions as in the meta-analysis described above.

Andrographis reduced the frequency and severity of cough to a greater extent than placebo. Three earlier systematic reviews also showed that andrographis appears to alleviate symptoms of upper respiratory tract infections [ , , ].

Although these findings suggest that andrographis might be useful to manage the symptoms and reduce the duration of upper respiratory tract infections, the evidence has several weaknesses.

For example, the studies used different andrographis formulations, and many of the clinical trials were conducted by investigators affiliated with the manufacturer of Kan Jang or KalmCold [ , ]. Clinical trials have found minor adverse effects, including nausea, vomiting, vertigo, skin rashes, diarrhea, and fatigue [ , , ].

Allergic reactions might also occur [ , ]. Findings from some animal studies suggest that andrographis might adversely affect fertility, so experts recommend against its use by men and women during the preconception period and by people who are pregnant [ , , ].

According to animal and laboratory studies, andrographis might decrease blood pressure and inhibit platelet aggregation, so it could interact with antihypertensive and anticoagulant medications by enhancing their effects [ ].

Because of its potential immune-stimulating effects, andrographis might also reduce the effectiveness of immunosuppressants [ , ]. For information on andrographis and COVID, please see the ODS health professional fact sheet, Dietary Supplements in the Time of COVID Echinacea, commonly known as purple coneflower, is an herb that grows in North America and Europe [ ].

Although the genus Echinacea has many species, extracts of E. purpurea , E. angustifolia , and E. pallida are the most frequently used in dietary supplements. The echinacea supplements on the market in the United States often contain extracts from multiple species and plant parts [ ].

Echinacea contains volatile terpenes, polysaccharides, polyacetylenes, alkamides, phenolic compounds, caffeic acid esters, and glycoproteins [ ]. Echinacea might have antibacterial activities, stimulate monocytes and natural killer cells, and inhibit virus binding to host cells [ 3 , ].

It might also reduce inflammation by inhibiting inflammatory cytokines [ 3 ]. Most studies of echinacea have assessed whether it helps prevent and treat the common cold and other upper respiratory illnesses, but it has also been used in traditional medicine to promote wound healing [ , ].

Results from clinical trials examining the effects of echinacea for the common cold have been mixed. Overall, studies suggest echinacea might slightly reduce the risk of developing a cold but does not shorten the duration or severity of illness.

For example, one clinical trial examined the effects of echinacea on the risk of the common cold in men and women mean age 23 years [ ]. purpurea extract Echinaforce or placebo; if participants came down with a cold during the study, they increased their dose to 4, mg per day. Participants taking echinacea had fewer colds and fewer days with cold symptoms than those taking a placebo.

Another clinical trial examined whether echinacea helps treat the common cold in male and female participants age 12 to 80 years who developed cold symptoms within 36 hours before enrollment [ ].

Participants took E. purpurea and E. angustifolia extracts four times a day for a combined dose of 10, mg during the first 24 hours and then 5, mg for 4 days or placebo. Echinacea did not shorten illness duration or severity. A systematic review and meta-analysis examined the effects of echinacea E.

purpurea , E angustifolia , E. pallida , or more than one form to prevent upper respiratory tract infections or reduce the duration of illness [ ]. Nine clinical trials eight in adults and one in children were included in the prevention meta-analysis portion of this analysis, and seven all in adults were included in the duration meta-analysis, including the two trials described above [ , ].

A Cochrane Review of echinacea use for preventing and treating the common cold had similar results [ ].

The review included 24 clinical trials with a total of 4, participants. Limited research has also examined whether echinacea is beneficial for influenza.

One clinical trial found that echinacea had similar effects to oseltamivir Tamiflu , a medication used to treat influenza. This trial included male and female participants age 12 to 70 who had had influenza symptoms for up to 48 hours [ ]. Participants took either E. The results showed no difference between E.

Purpurea and oseltamivir followed by placebo in rapidity of recovery from influenza after 1 day, 5 days, or 10 days of treatment. In addition, participants taking echinacea experienced fewer adverse events, especially nausea and vomiting.

Additional research is needed to confirm this finding. Echinacea appears to be safe. In rare cases, echinacea can cause allergic reactions [ ]. The safety of echinacea during pregnancy is not known, so experts recommend against the use of echinacea supplements by people who are pregnant [ ].

Echinacea might interact with several medications. For example, echinacea might increase cytochrome P activity, thereby reducing levels of some drugs metabolized by these enzymes [ ]. In addition, echinacea might reduce the effectiveness of immunosuppressants due to its potential immunostimulatory activity [ ].

For information on echinacea and COVID, please see the ODS health professional fact sheet, Dietary Supplements in the Time of COVID Elderberry contains many compounds—including anthocyanins, flavonols, and phenolic acids—that might have anti-inflammatory, antiviral, antimicrobial, and immune-stimulating effects [ 3 , ].

Studies of the effects of elderberry have primarily used elderberry extracts, not the berries themselves [ ]. Components of elderberry might help prevent respiratory infections by inhibiting virus binding to host cells and by stimulating the immune system [ ]. A few clinical trials have examined the effects of elderberry on the common cold and influenza.

The results from these trials have been mixed. However, overall, they suggest that elderberry might help relieve symptoms of respiratory tract infections. One clinical trial examined whether elderberry extract helps prevent and treat the common cold [ ].

Elderberry extract did not reduce the number of participants who developed a cold. However, among participants who did develop a cold, elderberry extract reduced cold duration by about 2 days and reduced the severity of symptoms.

A meta-analysis included four clinical trials including the trial described above of the effects of elderberry supplementation on upper respiratory symptoms caused by the common cold or flu in a total of participants age 5 to 59 years [ ].

The analysis showed that elderberry supplementation reduced the duration of upper respiratory symptoms, and the effect was stronger for symptoms of influenza than for those caused by the common cold. A review included the same four trials as well as one that administered an herbal preparation containing both elderberry and Echinacea purpurea [ ].

The results showed that elderberry might help relieve symptoms of the common cold and influenza when taken close to the onset of symptoms and for up to 2 weeks. In contrast, in a clinical trial, 87 male and female participants age 5 years and older with influenza for less than 48 hours took 15 ml 5, mg elderberry extract twice daily for ages 5 to 12 years and four times daily for ages 13 and older or placebo for 5 days [ ].

Elderberry had no effect on the duration or severity of illness. A systematic review of five clinical trials of elderberry to treat viral respiratory illnesses found beneficial effects on some, but not all, outcomes [ ].

The results showed that elderberry supplementation for 2 to 16 days might reduce the severity and duration of the common cold and the duration of flu but does not appear to reduce the risk of the common cold.

However, the authors noted that the studies were small, heterogeneous, and of poor quality. Elderberry flowers and ripe fruit appear to be safe for consumption.

However, the bark, leaves, seeds, and raw or unripe fruit of S. nigra contain a cyanogenic glycoside that is potentially toxic and can cause nausea, vomiting, diarrhea, dehydration due to diuresis, and cyanide poisoning [ , , ].

The heat from cooking destroys this toxin, so cooked elderberry fruit and properly processed commercial products do not pose this safety concern [ 3 , , , , ]. Elderberry might affect insulin and glucose metabolism, so according to experts, people with diabetes should use it with caution [ ].

The safety of elderberry during pregnancy is not known, so experts recommend against the use of elderberry supplements by people who are pregnant [ , ]. Recent analyses suggest that some elderberry supplements are highly diluted or have been adulterated with a cheaper ingredient, such as black rice extract, instead of elderberry [ , ].

Due to its potential immunostimulatory activity, elderberry might reduce the effectiveness of immunosuppressant medications [ ]. For information on elderberry and COVID, please see the ODS health professional fact sheet, Dietary Supplements in the Time of COVID Garlic Allium sativum is a vegetable with a long history of culinary use.

Garlic is also available as a dietary supplement in softgel, capsule, tablet, and liquid forms [ ]. Researchers have studied garlic mainly to determine whether it lowers blood pressure and cholesterol levels, but it might also have antiviral properties [ 32 , ].

These properties are often attributed to two compounds in garlic—allicin and ajoen [ ]. Garlic might also have antimicrobial and antifungal activity [ ]. Some dietary supplements contain aged garlic extract, prepared from sliced garlic that is soaked in an aqueous ethanol solution for up to 20 months.

The extract is then filtered and concentrated [ , ]. Aged garlic extract contains compounds, such as lectins, fructo-oligosaccharide, and N-alpha-fructosyl arginine, that might affect immune cell function [ ].

It also contains S-allyl-L-cysteine and other compounds that might have antioxidant effects and reduce some inflammatory markers [ , ]. Only a few clinical trials have examined whether garlic supplements help prevent or treat the common cold or influenza, and results are inconclusive.

One trial included healthy men and women mean age 26 years who took 2. After 45 days, the researchers took blood samples from the participants and cultured the natural killer cells and gamma delta T cells. The natural killer cells and gamma delta T cells from participants who took the extract had a higher proliferation rate than those from participants who took placebo.

After 90 days, the number of illnesses colds and influenza did not differ between groups, nor did the average number of symptoms per illness. However, participants who took aged garlic extract reported a smaller total number of symptoms during the study. Results were more positive in another trial, in which men and women mean age 53 years took one capsule of a garlic supplement dose not specified or placebo daily for 12 weeks between November and February [ ].

Participants who took garlic had fewer colds 24 among the full study population during the study than those who took placebo 65 colds. In addition, colds lasted an average of only 1. Garlic is safely consumed worldwide as a culinary ingredient [ ], and garlic and its derivatives are generally recognized as safe, according to the U.

Food and Drug Administration FDA [ ]. The adverse effects of garlic dietary supplements are minor and include bad breath, body odor, and skin rash [ 32 , , ]. Garlic might interact with medications. For example, garlic might have anticoagulant effects, so it might interact with warfarin Coumadin and similar medications [ , , ].

However, the findings from reported case studies on this interaction are inconclusive [ ]. Garlic might also reduce blood pressure, so it might interact with antihypertensive medications [ ]. Ginseng is the common name of several species of the genus Panax , most commonly Panax ginseng also called Asian ginseng or Korean ginseng and Panax quinquefolius American ginseng [ , ].

Asian ginseng is endemic to China and Korea, whereas American ginseng is endemic to the United States and Canada [ ]. Triterpene glycosides, also known as ginsenosides, are some of the main purported active constituents of ginseng [ , ].

Although ginseng contains numerous ginsenosides, research has focused on the Rb1 ginsenoside and compound K, a bioactive substance formed when the intestinal microbiota metabolize ginsenosides [ , ].

Animal and laboratory studies suggest that ginseng stimulates B-lymphocyte proliferation and increases production of some interleukins and interferon-gamma [ ]; these cytokines affect immune activation and modulation [ 1 ]. Ginseng might also inhibit virus replication and have anti-inflammatory activity.

However, whether ginseng has a clinically meaningful effect on immune function in humans is not clear [ , ]. Another botanical, eleuthero Eleutherococus senticosus , is sometimes confused with true ginseng.

Eleuthero used to be called Siberian ginseng, but it comes from the Eleutherococcus genus of plants, not the Panax genus, and it does not contain ginsenosides [ ]. Several clinical trials have examined whether ginseng helps prevent upper respiratory tract infections, such as the common cold and influenza.

Although the evidence is limited, results from these trials suggest that ginseng might help reduce the risk of developing colds and other respiratory tract infections.

However, its effects on symptom severity and duration are unclear. In one clinical trial, healthy men and women age 30 to 70 years who had not received an influenza vaccine in the previous 6 months took 1 g Panax ginseng extract three times daily or placebo for 12 weeks [ ].

Participants taking ginseng were less likely to develop an acute respiratory infection during the study period. However, for study participants who did develop an infection, symptom duration and severity did not differ between groups. A few clinical trials have examined the effects of CVT-E COLD-fX , a patented ginseng extract that contains mg Panax quinquefolius in each capsule.

One of these trials included men and women age 18 to 65 years with a history of at least two colds during the previous year who had not received an influenza vaccine in the past 6 months [ ].

Participants took either two capsules per day of Cold-fX for a daily dose of mg ginseng or placebo for 4 months starting in November. Participants who took ginseng developed fewer self-reported colds mean 0.

In addition, ginseng reduced the total number of days with cold symptoms from a mean of A systematic review and meta-analysis of ginseng to prevent or treat acute upper respiratory tract infections included 10 clinical trials of Panax ginseng or Panax quinquefolius extracts including those described above in a total of 2, participants [ ].

The authors noted that the risk of bias was high to unclear for most trials and that the limitations of the evidence prevented them from drawing conclusions. Ginseng appears to be safe. Most of its adverse effects, including headache, sleep difficulty, and gastrointestinal symptoms, are minor [ , , ].

However, doses of more than 2. A few case reports of vaginal bleeding and mastalgia breast pain in the s and s from the use of ginseng preparations raised concerns about the safety of ginseng; as a result, some scientists concluded that ginseng has estrogenic effects [ ].

However, one of these case reports involved use of Rumanian ginseng [ ], and whether this was true ginseng is not clear. In addition, eleuthero was often referred to, incorrectly, as ginseng at that time because it was called Siberian ginseng.

So, it is unclear whether these case reports reflected the effects of true ginseng. Nevertheless, some experts caution that ginseng might not be safe for use during pregnancy [ , , ]. Ginseng might interact with many medications. For example, it might increase the risk of hypoglycemia if taken with antidiabetes medications, increase the risk of adverse effects if taken with stimulants, and reduce the effectiveness of immunosuppressants [ , ].

For information on ginseng and COVID, please see the ODS health professional fact sheet, Dietary Supplements in the Time of COVID Tea Camellia sinensis is a popular beverage around the world that has several purported health benefits.

Tea is usually classified into one of three types—green, black, and oolong—according to the way in which the tea leaves are processed [ ]. Green tea is made from dried and steamed tea leaves, whereas black and oolong teas are made from fermented tea leaves.

Tea extracts are also available as dietary supplements. The purported health effects may vary by the type of tea as well as whether it is consumed as a beverage or dietary supplement. Tea is one of the richest sources of catechins, which are polyphenolic flavonoids, especially epigallocatechin gallate EGCG [ , ].

A typical mL cup of brewed green tea contains 50 to mg of catechins [ ], whereas the same amount of brewed black tea contains about 14 to 88 mg of catechins [ ]. Amounts vary, however, among tea samples and by brewing time.

Studies are evaluating the potential health benefits of EGCG and other catechins, including their ability to modulate the immune system and their anti-inflammatory and antimicrobial properties [ , ].

Laboratory studies suggest that catechins might also have antiviral effects against the influenza A and B viruses [ ]. Laboratory research suggests that tea and tea catechins might have antiviral activity.

Researchers have therefore examined whether drinking tea or taking supplemental tea catechins affects the risk, duration, and severity of influenza or other respiratory tract infections. However, evidence from clinical trials is limited and mixed.

Studies that found beneficial effects include a clinical trial that examined the effects of catechins and theanine an amino acid in tea on the risk of influenza in male and female health care workers age 21 years or older in Japan [ ].

However, for laboratory-confirmed influenza, the incidence of influenza did not differ between groups. A systematic review and meta-analysis also showed that tea and tea catechins had some beneficial effects on the risk of influenza and other upper respiratory tract infections, although the evidence had some limitations [ ].

The analysis included five prospective cohort studies and clinical trials that administered tea as a dietary supplement or beverage including the trial described above in a total of 1, participants. Results were also mixed in a clinical trial examining whether drinking mL of a bottled beverage containing mg of catechins for 12 weeks during the winter affected the duration and severity of upper respiratory tract infections in healthy Japanese men and women mean age Catechins reduced the duration and severity of a runny nose, nasal congestion, and headache but did not affect other symptoms, including sore throat, cough, and fever.

Drinking moderate amounts of tea is safe. Green tea extract causes mostly mild to moderate adverse effects, including nausea, constipation, abdominal discomfort, and increased blood pressure [ ]. However, some green tea extracts might cause liver damage, especially when taken on an empty stomach [ , ].

In addition, at least 50 case reports since have linked consumption of green tea extracts, primarily ethanolic extracts of green tea, with liver damage [ ]. In a systematic review of the safety of green tea products, the U.

Pharmacopeia USP evaluated 75 case reports of liver damage and animal pharmacological and toxicological information [ ]. On the basis of the 35 case reports associated with supplements containing only green tea extract, the USP concluded that the consumption of green tea products definitely caused four cases of liver damage, probably or was highly likely to have caused 25 cases, and possibly caused five cases.

The USP notes that problems are more likely when green tea extract is taken on an empty stomach and, therefore, advises taking green tea extracts with food to minimize the risk of liver damage [ , ].

In addition, tea contains caffeine, which can cause sleep disturbances and feelings of nervousness, jitteriness, and shakiness [ ]. These levels do not apply to people who are pregnant and may need to limit caffeine consumption further [ ].

Tea and its constituents might interact with certain medications. For example, green tea extract decreases plasma levels of atorvastatin, a statin medication [ ]. Glutamine is an amino acid that is present in a wide variety of foods that contain protein, including beef, fish, poultry, soy and other beans, eggs, rice, corn and other grains, and milk and other dairy products [ ].

The body also produces glutamine endogenously. In normal conditions, the body can synthesize adequate amounts of glutamine to meet metabolic needs, so glutamine is not classified as an essential amino acid [ ].

However, under extreme physiological stress, endogenous glutamine synthesis cannot keep up with metabolic need. Therefore, glutamine is classified as conditionally essential [ ].

In the immune system, glutamine is involved in lymphocyte proliferation and cytokine production as well as macrophage and neutrophil function [ ].

Low glutamine levels are associated with poor immunologic function and an increased risk of mortality in patients in the ICU [ , ]. Many patients who are critically ill or have undergone major surgery have low plasma and muscle glutamine levels [ ].

Results from some studies suggest that glutamine reduces rates of infection and mortality in critically ill patients and reduces hospital length of stay and mortality in patients with burn injuries [ , ]. Clinical studies have administered glutamine both enterally and parenterally.

When administered through these routes, glutamine is classified as a drug, not a dietary supplement, in the United States. Researchers have examined whether glutamine administration affects immune parameters and disease prognosis in critically ill patients.

The evidence from these studies is limited and mixed. For example, a crossover trial examined the effects of enteral nutrition containing glutamine on immune function in moderately ill patients with systemic inflammatory response syndrome from a pulmonary infection in the ICU [ ].

Thirty patients age 30 to 92 years received enteral nutrition containing 30 g added glutamine for 2 days followed by enteral nutrition containing 30 g added calcium caseinate for 2 days or the same formulations but in reverse order.

A 1-day washout period with standard enteral nutrition separated each treatment period. Glutamine administration resulted in higher lymphocyte counts than calcium caseinate administration, suggesting enhanced immune function, but did not affect interleukin levels.

Results from clinical trials in patients with critical illness have also been mixed. One trial in the United Kingdom included 84 men and women mean age 65 to 66 years in the ICU [ ].

Patients received a standard parenteral formulation with or without 25 g added glutamine per day. Treatment duration was not specified, but administration continued until death or as long as clinically required.

Patients who received the formulation with added glutamine had a lower risk of death during the subsequent 6 months than those who received the standard formulation. In another clinical trial in Scotland, critically ill men and women mean age 63 to 65 years in the ICU received one of four parenteral treatments daily: standard formulation, standard formulation containing Glutamine did not affect the risk of new infections during the 14 days after randomization or mortality rates in the ICU or during the subsequent 6 months.

It also had no effect on ICU or hospital length of stay, need for antibiotics, or rates of organ failure. Findings from a Cochrane Review suggest that glutamine may have beneficial effects on some but not all outcomes in patients who have critical illness or are recovering from major surgery.

This review examined the effects of glutamine administration on various outcomes, including rates of infection and mortality, in adults who were critically ill or had undergone major surgery, such as abdominal or thoracic surgery [ ]. It included 53 clinical trials including the two described above in a total of 4, participants that administered glutamine enterally or parenterally.

It also reduced the length of hospital stay by about 3. However, glutamine did not affect mortality rates, and it prolonged ICU stays by about 0. The authors of a review that examined the effects of micronutrient supplementation, including glutamine, in adults with conditions or infections similar to COVID concluded that evidence from human studies is very limited and that baseline nutrient status may affect study results [ ].

Oral, enteral, and parenteral glutamine administration is considered safe [ , , ]. Reported side effects are mainly gastrointestinal and include nausea, bloating, belching, pain, and flatulence [ ].

Other research suggests that oral doses up to 0. Children age 4 to 18 years tolerate doses of 0. The Food and Nutrition Board has not established a UL for glutamine [ ].

The board notes that very few, if any, adverse effects have been reported from glutamine administration. N-acetylcysteine NAC is a derivative of the amino acid cysteine. NAC is an antioxidant that has mucolytic activity, so it helps reduce respiratory mucus levels [ ].

NAC might improve immune system function and suppress viral replication [ , , ]. NAC also appears to decrease levels of interleukin-6 and have other anti-inflammatory effects [ , , ].

Much of the research on NAC has used an inhaled, liquid form of this compound. This form—which is classified as a drug in the United States, not a dietary supplement—is approved by FDA as a mucolytic agent and for decreasing respiratory secretion viscosity [ ].

NAC administered orally or intravenously also has FDA approval as a drug to treat acetaminophen poisoning [ , ].

Products containing NAC are also sold as dietary supplements [ ]. In addition to its direct effects in the body, NAC raises intracellular levels of glutathione, which is a tripeptide of glutamine, cysteine, and glycine [ , , , , ].

Laboratory and animal studies suggest that glutathione has antioxidant activity and appears to have antiviral and antimicrobial effects and enhance natural killer cell and neutrophil activity [ , , , ].

Glutathione may also have anti-inflammatory effects via altered cytokine expression [ , , ]. Adequate glutathione levels are needed for optimal innate and adaptive immune system function, including proper T-cell activation and differentiation [ , , ].

Most research indicates that oral glutathione supplementation does not raise intracellular glutathione levels because glutathione is hydrolyzed in the gastrointestinal tract [ ]. As a result, NAC is often used in research studies because of its effects on intracellular glutathione levels.

HIV infection appears to increase production of free radicals and deplete levels of free glutathione [ ]. Therefore, people with HIV may have decreased intracellular levels of glutathione, which could increase their susceptibility to infectious diseases, such as tuberculosis [ ].

Low glutathione levels have been associated with shorter survival in people with HIV [ ], and NAC supplementation increases blood and T-cell levels of glutathione [ ]. However, clinical research on the effects of NAC supplementation on the immune system in humans is very limited.

In one clinical trial, researchers examined the effects of oral to 6, mg NAC, depending on plasma glutamine levels, every other day for 7 months or placebo in 37 men and women with HIV who were taking ART [ ].

An accompanying clinical trial described in the same publication evaluated the same treatment in 29 men and women with HIV who were not taking ART. In addition, NAC supplementation had inconsistent effects on viral load. As an FDA-approved drug, the safety profile of NAC has been evaluated [ ].

The American College of Chest Physicians and the Canadian Thoracic Society note that NAC has a low risk of adverse effects [ ]. Reported side effects of oral NAC include nausea, vomiting, abdominal pain, diarrhea, indigestion, and epigastric discomfort [ , ]. No safety concerns have been reported for products labeled as dietary supplements that contain NAC.

NAC might have anticoagulant effects and reduce blood pressure, so it could have additive effects if taken with anticoagulants and antihypertensive medications [ ]. The combination of NAC and nitroglycerine, used to treat angina, can cause hypotension and severe headaches [ , ].

For information on NAC and COVID, please see the ODS health professional fact sheet, Dietary Supplements in the Time of COVID Omega-3 fatty acids omega-3s are polyunsaturated fatty acids PUFAs that are present in certain foods , such as flaxseed and fatty fish, as well as dietary supplements, such as those containing fish oil.

Several omega-3s exist, including alpha linolenic acid ALA , but most scientific research focuses on the long-chain omega-3s eicosapentaenoic acid EPA and docosahexaenoic acid DHA.

The main food sources of EPA and DHA are fatty fish and fish oil. The Food and Nutrition Board established an adequate intake AI; intake assumed to ensure nutritional adequacy for total omega-3s of 0. The Food and Nutrition Board did not establish intake recommendations for EPA and DHA in because, unlike ALA, EPA and DHA were not classified as essential.

Omega-3 fatty acids are components of the phospholipids that form the structures of cell membranes. Omega-3s also form eicosanoids, which are signaling molecules that affect the cardiovascular, pulmonary, immune, and endocrine systems [ 58 , , ].

Omega-6 fatty acids, the other major class of PUFAs, also form eicosanoids, which tend to be more potent mediators of inflammation, vasoconstriction, and platelet aggregation than those made from omega-3s. Therefore, higher concentrations of omega-3s than of omega-6s tip the eicosanoid balance toward less inflammatory activity [ , , ].

Higher intakes and higher blood levels of EPA and DHA are associated with lower levels of inflammatory cytokines, such as interleukin-1 and interleukin-6 [ , , , ]. Immune system cells can easily incorporate EPA and DHA, which might also affect immune function by upregulating the activity of macrophages, neutrophils, T cells, B cells, natural killer cells, and other immune cells [ 2 , , ].

In addition, omega-3s may have antimicrobial and antiviral effects [ 58 , ]. Omega-3 deficiency can cause rough, scaly skin and dermatitis [ ].

Almost everyone in the United States obtains sufficient ALA to avoid deficiency, but many people might benefit from higher intakes of EPA and DHA [ ].

ARDS, a serious lung condition, is characterized by inflammation and multi-organ dysfunction that causes low blood oxygen levels. It usually results from another disease, such as COVID, or injury.

Because omega-3s can affect inflammation, researchers have hypothesized that these fatty acids might improve outcomes in patients with ARDS. Several clinical trials and meta-analyses have examined whether omega-3s, administered enterally or parenterally which are not classified as dietary supplements in the United States , benefit patients with ARDS.

The authors of meta-analyses published in and concluded that these treatments reduce the risk of mortality and organ failure, improve oxygenation status, and reduce the length of ICU stay and time on mechanical ventilation [ , ].

However, more recent clinical trials and meta-analyses have yielded contrasting findings [ , ]. Some but not all findings were positive in one clinical trial with 58 men and women mean age 63 to 64 years who had mild to moderate ARDS, were on mechanical ventilation, and received a standard enteral formula that did or did not contain mg omega-3s including mg EPA and mg DHA three times daily for 14 days [ ].

Omega-3s improved some measures of oxygenation and lung function but did not affect number of ventilator-free days, length of ICU stay, day mortality rates, or rates of multi-organ failure.

No benefits were found in another clinical trial in which 90 men and women mean age 49 to 51 years on mechanical ventilation who had acute lung injury, a mild form of ARDS, received either enteral fish oil containing 9, mg EPA and 6, mg DHA daily or placebo for 14 days [ ].

Fish oil did not affect pulmonary or systematic inflammation, number of ventilator-free or ICU-free days, or rates of organ failure or day mortality. Results were similar in a systematic review and meta-analysis that included seven clinical trials one of which was the trial described above [ ] that compared enteral omega-3 supplementation with a control diet or placebo in a total of adults with ARDS [ ].

The most common omega-3s used were EPA and DHA, often in combination with gamma-linolenic acid an omega-6 fatty acid ; some studies also coadministered antioxidants. The results showed no differences in rates of day all-cause mortality or numbers of ventilator-free days or ICU-free days, although omega-3 supplementation did improve oxygenation status at some time points.

The evidence was inconclusive in a Cochrane Review of 10 clinical trials including the two trials described above that included a total of 1, adults in ICUs and examined the effects of immunonutrition for ARDS [ ].

The treatments consisted of EPA with or without DHA and gamma-linolenic acid for up to 28 days. One study also administered antioxidants. The treatment was administered enterally in nine studies and parenterally in one study.

The omega-3 treatments did not affect all-cause mortality rates, but the quality of this evidence was low. The authors were unable to determine whether the treatments affected ICU length of stay, number of days on a ventilator, or oxygenation because the evidence was of very low quality.

In their guidelines on nutrition support therapy for adults who are critically ill, the Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition state that they cannot recommend routine use of enteral formulas that contain omega-3s or other anti-inflammatory lipids in patients with ARDS because the data are conflicting [ ].

Immune system development begins before birth and continues for several months to a few years [ ]. The membranes of immune system cells contain long-chain PUFAs—including EPA, DHA, and the omega-6 fatty acid arachidonic acid ARA —that play a role in immune system development [ ].

For this reason, researchers have examined whether consumption of infant formula enriched with long-chain PUFAs during the first year of life has health benefits. Much of this research has focused on the effects of these infant formulas on allergic manifestations, including atopic dermatitis, food allergies, and asthma, in infants and young children.

However, researchers have also examined whether these formulas affect the risk of respiratory infections. Several observational studies have examined whether infants who consume formula enriched with long-chain PUFAs during the first year of life have a lower risk of respiratory tract infections.

Findings from these studies have been mixed, and some effects may depend on infant age and omega-3 dose. For example, an observational study analyzed data from 8, formula-fed infants born in France in [ ].

The rest consumed unenriched formulas. Between age 2 months and 5. However, infants who consumed formulas containing 3. Infants who consumed enriched formulas had lower rates of bronchitis or bronchiolitis at age 5, 7, and 9 months than those who consumed unenriched formulas or formulas with low levels of DHA and ARA.

At age 12 months, infants consuming enriched formulas also had a lower risk of upper airway infections. However, the incidence of all other respiratory illnesses at various ages was similar between groups.

Very few clinical trials have examined the effects of infant formula containing added long-chain PUFAs on the risk of respiratory tract infections. Infants who received the formula containing DHA and ARA did not have a lower risk of nonallergic respiratory illnesses e. In another clinical trial in Thailand, healthy children age 9 to 12 years consumed milk containing fish oil providing mg EPA and 1, mg DHA per day or placebo, 5 days per week for 6 months [ ].

Only Children consuming fish oil also had fewer episodes of illness and total days of illness. However, the percentage of children with fever did not differ between groups. EFSA also notes that these doses have not been shown to cause bleeding problems or to adversely affect immune function, glucose homeostasis, or lipid peroxidation.

Commonly reported side effects of omega-3 supplements are usually mild and include unpleasant taste, bad breath, heartburn, nausea, gastrointestinal discomfort, diarrhea, headache, and odoriferous sweat [ , ].

Because of their antiplatelet effects, high doses of omega-3s might interact with anticoagulants [ ]. However, according to the FDA-approved package inserts for omega-3 pharmaceutical preparations, studies have not found that these medications cause clinically significant bleeding episodes [ ].

Omega-3s might also interact with other medications. For example, omega-3s might increase the risk of hypotension if taken with antihypertensive agents and might increase levels of cyclosporine, an immunosuppressant drug [ ].

More information on omega-3s is available in the ODS health professional fact sheet on omega-3s. For information on omega-3s and COVID, please see the ODS health professional fact sheet, Dietary Supplements in the Time of COVID Probiotics are live microorganisms that confer a health benefit on the host when administered in adequate amounts [ ].

They include certain bacteria e. Probiotics are naturally present in some fermented foods, added to some food products, and available as dietary supplements. Probiotics are identified by their strain, which includes the genus, the species, the subspecies if applicable , and an alphanumeric strain designation [ ].

The units of measure for probiotics are colony-forming units CFUs , which indicate the number of viable cells. Common amounts used in dietary supplements are 1 x 10 9 1 billion CFU; commonly designated as 10 9 CFU and 1 x 10 10 10 billion or 10 10 CFU.

Probiotics act mainly in the gastrointestinal tract [ 7 ]. They might improve immune function in several ways, including by enhancing gut barrier function, increasing immunoglobulin production, inhibiting viral replication, and enhancing the phagocytic activity of white blood cells.

However, the mechanisms of their potential effects on immune function are unclear [ 7 , , ]. Some studies suggest that probiotics increase levels of natural killer cells, lymphocytes, and monocytes and that they decrease levels of proinflammatory cytokines, but other studies do not [ ].

Interpreting the results of probiotics research is especially challenging because findings for one probiotic strain cannot be extrapolated to others [ 7 , ]. Probiotics might reduce the risk of infectious diarrhea and help manage its symptoms by stimulating the immune system and by secreting antimicrobial substances.

In addition, they might limit the ability of pathogenic bacteria to colonize, adhere to, and invade the gut by competing for available nutrients and binding sites [ ]. Clinical trials have used a wide range of probiotic preparations, and results from these studies have been mixed.

Several earlier clinical trials showed some beneficial effects of probiotics on acute infectious diarrhea in infants and children. In one of these trials, 64 indigenous children in Australia age 4 months to 2 years admitted to the hospital with acute diarrhea took 5 X 10 9 CFU Lactobacillus rhamnosus GG LGG three times per day or placebo for 3 days [ ].

A smaller proportion of children who took LGG had diarrhea on day 2. In addition, the duration of diarrhea, total number of diarrhea stools, and diarrhea severity did not differ between groups. Another trial included 88 children in an urban middle-class population country not specified age 3 to 24 months who had acute mild to moderate diarrhea [ ].

Diarrhea duration was shorter 4. Saccharomyces boulardii users also had fewer stools on the fourth day and were less likely to have persistent diarrhea for more than 7 days.

In addition, subgroup analyses showed that the probiotic was more effective when administered within the first 48 hours of diarrhea onset. Findings were positive in a Cochrane Review of 63 clinical trials including the two described above in a total of 8, participants primarily infants and children.

Types of probiotics and treatment schedules varied widely, but 15 studies used more than 1 X 10 10 CFU per day, 26 used 1 X 10 10 CFU per day or less, and in 22 studies the dose was unclear. The results showed that single- and multi-strain probiotics shortened the duration of acute infectious diarrhea by about 25 hours [ ].

Research conducted through indicated that two strains—LGG and Saccharomyces boulardii —had the strongest evidence of efficacy [ ]. A meta-analysis of 11 clinical trials with a total of 2, children showed that LGG reduced the duration of infectious diarrhea by about 1 day more than placebo or no treatment, and it was most effective at a daily dose of at least 10 10 CFU [ ].

However, results from recent clinical trials have largely failed to show that probiotics benefit children with acute infectious diarrhea [ , ]. For example, a clinical trial in participants age 3 months to 4 years with acute gastroenteritis presenting to U.

pediatric emergency departments found that 1 x 10 10 CFU LGG twice per day for 5 days was no better than placebo for improving outcomes [ ]. In a similar trial, a combination probiotic containing 4 x 10 9 CFU L rhamnosus R and L helveticus R twice daily did not prevent the development of moderate to severe gastroenteritis within 14 days of enrollment compared with placebo in Canadian children age 3 to 40 months with gastroenteritis [ ].

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