Embracing Healthy Immunity

by Lisa Schofield | September 1, 2024

Patients are more aware of their immune system than ever before and remain wary about the upcoming colder months. Here’s how to help.

On Aug. 1, it was announced that two people in New Jersey had contracted West Nile virus—one who was older than 70 and the other only 18. The virus has been found in 286 mosquito pools, higher than average for this time of year. Interestingly, according to the CDC (Centers for Disease Control and Prevention), up to 80 percent of those who become infected with West Nile virus do not develop symptoms and are not impacted.

Media hype about nefarious illnesses always spike before the colder weather, and this fear stokes the motivation among the population to protect their immune systems—and that may be a good thing.

“The growing interest is in addressing long COVID rather than COVID-19. As we are seeing almost 15 million Americans suffering with long COVID,” reported Jacob Teitelbaum, MD, author of the new book, You Can Heal from Long COVID.

According to Dr. Teitelbaum, a 2022 study published in Clinical Microbiology and Infection found that around 82 percent of long COVID patients are women—women have more than double the risk of developing long COVID compared to men. Long COVID presents a host of symptoms including fatigue, migraines and headaches, brain fog, heart palpitations, shortness of breath, sleep insufficiency, joint and muscle aches, rashes and more.

And of course, the pandemic is over and has been. “One silver lining of the pandemic is that more people are aware of their immune function and how they can impact their overall health to promote best possible immunity, observed Amy Rothenberg, ND, Naturopathic Health Care, Northampton, MA.

Serena Goldstein, ND, of Serena Goldstein, ND LLC, Delray Beach, FL, focuses mainly on hormone imbalance and stress, and she reported that many of her patients have learned how certain imbalances and cortisol patterns can contribute to a weakened immune response. For example, this can be a lingering cold, or being unable to mount a proper response (i.e. low-grade fever) to eradicate the virus or bacteria from the body.

Similarly, as a naturopathic doctor specializing in fertility, Rosia Parrish, ND of Naturopathic Wellness Center of Boulder (CO) observed that many of her patients now understand the critical role a robust immune system plays not only in the ability to fend off colds and infections but in fertility. They have become more aware of how a nutrient-dense diet, rich in vitamins, minerals and antioxidants, supports immune function. This has led to an increased incorporation of whole foods, such as fruits, vegetables, lean proteins and healthy fats into their diets.

Other integrative approaches to protecting immune function being embraced by Dr. Parrish’s patients have been hydrotherapy, including contrast hydrotherapy with saunas, hot pools and cold plunges. “These practices help stimulate the immune system, improve circulation and reduce inflammation,” she commented. Additionally, living through the pandemic years has underscored the importance of holistic health practices. She has seen more patients turning to botanical support, homeopathy and tailored supplement approaches to support their immune systems naturally. They have also begun to engage in regular physical activity, adequate sleep and stress-management techniques like yoga or meditation, which are key for maintaining a healthy immune response.

Although patients today may be more aware and open to practices that support desirable immune response, there are factors that can conspire to reduce immune effectiveness.

Common Contributing Factors That Depress Immunity

Chronic inflammation, immune senescence and an imbalanced microbiome can negatively impact the function of the immune system in otherwise normal, healthy people.

Joe Brunner, president, Endurance Products Company (Oregon) noted that poor lifestyle habits contribute to systemic, chronic low-grade inflammation that in turn, can suppress immune function. He explained that a diet high in ultra-processed foods has been shown to shift the gut microbiome to a pro-inflammatory state.

He commented, “This is troubling since Americans are eating more ultra-processed foods than ever before with the average intake approaching a staggering 60 percent of total daily calories, according to a recent NHANES (National Health and Nutrition Examination Survey) national nutrition survey. Add the fact that the gut microbiome is one of the body’s most important first lines of immune defense, and it’s easy to see how diet alone could compromise immunity.”

And, according to Matthew Hudson, technical advisor, ADM Protexin, Somerset, U.K., you may want to explore potential leaky gut with your patient. Prolonged sedentary lifestyles tend to reduce gut motility (i.e., leaky gut), a state wherein inflammation degrades the integrity of the epithelial barrier, allowing pathogens to enter the bloodstream, inducing further inflammatory responses. Therefore, he stated, another key lifestyle factor for immune support may be the level of physical activity your patient engages in.

“The impact of exercise on the diversity of the gut microbiome diversity has been studied extensively,” he said. Research found that, through its modulation of gut motility, exercise is suggested to increase the shedding of loosely bound microbes from the gastrointestinal (GI) tract epithelium, thus allowing other commensal bacteria to colonize the gut. The resulting benefits of microbial diversity are associated with increased antioxidant capacity and reduced inflammation of the epithelial barrier, therefore reducing GI tract permeability, potentially improving immune function.

Furthermore, he continued, the composition of the gut microbiome can also be affected by signaling via the hypothalamus-pituitary-adrenal (HPA) axis, a component of the neuroendocrine system involved in regulating stress responses. During chronic psychological stress, excessive circulating cortisol can instigate inflammation, which may accelerate growth of pathogenic bacteria in the gut. Blooms of pathogenic bacteria may also exacerbate epithelial inflammation, further increasing GIT permeability (leaky gut).

Older patients may be experiencing, immune senescence, according to Hank Cheatham, vice president, Daiwa Health Development, California. “The expression succinctly defines the progression of a declining immune system over time, which leads to the aging process and anticipated decline in health that is accepted as ‘normal.’ Because of immune senescence, the elderly are vulnerable to serious infectious diseases and a poor response to vaccinations, particularly during winter months of cold and flu season.”

For example, Cheatham noted, the 2012-2013 flu vaccination was reported to have only 9 percent effectiveness against influenza A in seniors over 65 years of age, versus 52 percent in adults under 65. He commented, “Numerous reasons account for this weakened immune response, including a decline in hematopoietic stem cell activity and ability to produce B cells; a shrinking thymus, which results in lower T cell production; and telomere shortening.”

Supplements in Practice

Recommendations from fellow practitioners to patients concerned about strengthening proper immune response are rather diverse. But, according to Dr. Teitelbaum, no matter what, it is critical to start with a good multivitamin “to remember our foundations for health. Especially optimizing zinc (15 mg a day), and retinol (2,500 units a day), along with vitamin C 250 mg daily. Then we can discuss the importance of optimizing sleep as well to keep our immune systems healthy,” he said.

Dr. Goldstein likes to recommend vitamin C (5 grams), zinc (30 grams), a mushroom blend, probiotics (at least 30 billion), and some form of adrenal support (i.e. rhodiola, holy basil, ashwagandha). Dr. Rothenberg encourages patients to take vitamin D, fish oil and elderberry for immune support during cold and flu season. Dr. Parrish also likes vitamin C and zinc, as well as vitamin D, probiotics, elderberry (especially when feeling run down and on the verge of a cold), echinacea, probiotics, astragalus, curcumin, garlic and omega-3 EFAs. Additionally, she noted, patients can supplement with immune-boosting mushrooms, such as reishi, shiitake and maitake, which contain beta-glucans and other compounds that enhance immune response and improve resilience to infections.

Immune-support Supplement Suggestions

There is a diversity of immune-support supplements to recommend. HealthAid America in California offers black seed (Nigella sativa) oil. According to Slawomir Gromadzki, nutritionist, it is a rich source of omega-6 and -9 EFAs, as well as vitamins and minerals. “Our black seed oil has is packed with antioxidants, which reduces oxidative stress and inflammation, and thymoquinone, also shown to enhance immune function.

Epimune Complex from Wisconsin-based Standard Process is a vegan immune system support supplement that supports specific aspects of immune system activity and contains EpiCor as well as MaitakeGold 404 maitake and turkey tail mushrooms, described Jessica Stefanski, NMD LAc FABNE, clinical education manager.

EpiCor is a whole food fermentate comprised of proteins, fibers, polyphenols, vitamins, amino acids and beta glucans that have been clinically shown to provide significant immune health benefits. In a human study of individuals with no recent history of seasonal influenza vaccination, participants received 500 mg of EpiCor once per day or placebo for 12 weeks. Participants supplementing with EpiCor experienced a significant reduction in their incidence of cold or flu-like symptoms compared to the placebo group, she reported.

MaitakeGold 404 is shown to stimulate phagocytosis and increase the numbers of phagocytosis monocytes and macrophages. In a study, short-term consumption of MaitakeGold 404 stimulated a healthy immune reaction. These results indicate a broad-based immune system support that is part of the body’s first line of immune activity.

“Although there are many ingredients that can help support the immune system, elderberry, particularly from the European black elder, is rich in anthocyanins, which act as powerful antioxidants to reduce oxidative stress and inflammation,” described Sarah Rockoff, MS with Florida-based Designs for Health. Elderberry has been shown to support cytokine production, stimulate T-cell and B-cell activity, and inhibit viral replication. In one meta-analysis that assessed the efficacy of black elderberry in alleviating upper respiratory symptoms in 180 participants, researchers found that elderberry supplementation significantly reduced symptoms associated with colds and flu.

Immunitone Plus from Designs for Health is an herbal supplement formulated to protect normal immune response, and features elderberry extract with a blend of echinacea, astragalus, andrographis and mushrooms (cordyceps, shiitake, maitake and reishi). According to Rockoff, the blend aims to enhance natural killer cell activity and maintain cytokine balance.

Daiwa Health Development’s BRM4, a proprietary immune-enhancing complex featuring Rice Bran Arabinoxylan Compound (RBAC), is modified by shiitake enzyme, also enhances count and function of specific immune cells as shown by several studies, noted Cheatham. “As shown in research, RBAC can triple natural killer cell activity, increase helper T cells, and demonstrate vital antioxidant and immune balancing activity,” he said. In pre-clinical studies, RBAC was demonstrated to elevate the T cell levels up to 200 percent. The enhanced activity of helper T cells supports the proliferation of cytotoxic T and B cells. B cells stimulate production of antibodies to combat viral and bacterial infections,” he explained.

He added that the supplement will not overstimulate the immune response but instead, will bring the immune system to its optimal level. BRM4 is a true immune modulator and will not cause a “cytokine storm” or auto-immune disorder.

Washington-based Big Bold Health’s Himalayan Tartary Buckwheat is a superfood rich in protein, fiber, magnesium, potassium and zinc, and is a concentrated source of polyphenols including rutin, quercetin and luteolin, according to Austin Perlmutter, MD, managing director.

“Research on human consumption of Tartary buckwheat reveals potential benefit for immune support,” he said. Preclinical findings show benefits to boosting endogenous GLP-1 secretion, supporting a regulatory effect on immunometabolism. Most recently, consumption of the polyphenols and other phytochemicals from this plant has been shown to act on epigenetic pathways related to immune aging, with a population of participants experiencing a 47 percent reduction in aging measured using immune cells that correlated with changes in immune cell subsets. This follows the robust literature supporting a diet rich in polyphenols for immune health.

Taxifolin Complex SR from Endurance Product Company is formulated for adults who need nutritional support for antioxidant and immune defense, according to Brunner. Each sustained-release tablet provides high-potency vitamin C (500 mg), zinc (15 mg), and Lavitol dihydroquercetin (50 mg) formulated for nutrient release over five to seven hours.

“Practitioners may be less familiar with Lavitol dihydroquercetin (also known as taxifolin),” Brunner said. “This GRAS (generally recognized as safe)-affirmed bioflavonoid derived from the larch tree has been shown to exert particularly potent antioxidant and anti-inflammatory activity that supports immune function. It may also work at an epigenetic level. In one controlled clinical trial involving healthy young adults, a single dose of taxifolin (108 mg) was found to activate whole blood gene expression associated with strengthening the innate immune system.”

Ayuvedic immune solutions may be appealing to many of your patients. Washington-based Ayush Herbs “provides herbal formulations that are inspired by ayurvedic and naturopathic philosophies,” stated Brian Keenan ND, DOM, LAc, education manager.

Ayurvedic botanicals featured in Ayush Herbs’ immune-support formulas include ashwagandha, which modulates cortisol, amla, high in vitamin C, liroice, modulat es macrophages and T-cells, Indian tinospora, which increases production and activity of macrophages and neutrophils, holy basil, which helps the T-regulatory cells to limit excess inflammation, and need, a broad-spectrum herb with antimicrobial, anti-inflammatory and antioxidant properties.

Tackling immunity through the gut microbiome can be accomplished through Bio-Kult Boosted, a probiotic supplement containing 14 strains plus vitamin B12. Vitamin B12 promotes normal energy metabolism, reducing tiredness and fatigue. “During periods where the immune system is in its ‘activated’ state and energy demand is heightened as a consequence, the inclusion of vitamin B12 may allow for further support of immune function,” Hudson explained.

Lifestyle adjustments, including dietary supplements will slowly help patients strengthen their immune response and increase overall well-being. As Dr. Perlmutter pointed out, the immune system changes every day, and humans create more than 50 million immune cells every minute. “This means every minute provides 50 million chances to create a healthier immune system,” he stated.

Healthy Take Aways

• Chronic inflammation, immune senescence and an imbalanced microbiome can negatively impact the function of the immune system in otherwise normal, healthy people.
• During chronic psychological stress, excessive circulating cortisol can instigate inflammation.
• The 2012-2013 flu vaccination was reported to have only 9 percent effectiveness against influenza A in seniors over 65 years of age, versus 52 percent in adults under 65.
• Elderberry has been shown to support cytokine production, stimulate T-cell and B-cell activity, and inhibit viral replication.
• The immune system changes every day, and humans create more than 50 million immune cells every minute.