Shoring your immunity: the roles of Vitamin D, Omega 3s, probiotics, elderberry, and turmeric

• December 17, 2020 @ 16:35 pm EST
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Many people scoff at the idea of actually strengthening your immunity – it seems in the realm of quacks. In this post, using my background in Immunology, I’ll talk about how a Vitamin D deficiency or an Omega 3 paucity in your diet could potentially affect how well your immune system does its job. We’ll discuss probiotics for adults and kids, and last, we’ll talk about whether certain commonly used supplements (turmeric and elderberry) have any potential value in fighting an infection.

First, a backstory…..

For the first 30 years of my life, I thought my immune system was pretty awesome. I would fall sick 1-2 times a year, and the infection with fever and malaise would last maybe 3-4 days. Not too shabby, right?

Then, I discovered I had a Vitamin D deficiency, and had probably had it all my life – my levels were around 16 ng/mL. On continuous supplementation to correct for this,  my blood levels have held steady at 40-50 ng/mL. Many things changed subtly. My skin improved,  I gained some badly needed weight, and interestingly,  over the next 4 years, I never got really sick. Nasty infections would come around, but at the worst, I would be under the weather for a day – there was never a three-day bout.

Then, I had a baby. Soon after her birth, I caught my first 15-day cold, the first I could ever remember having in years. With a baby at home and the sleep deprivation of the first year, I quickly realized I needed more.

Now, thanks to Linus Pauling, when people fall sick, they dive for Vitamin C, and think they have done enough. While it appears to have some usefulness (anti-oxidant, anti-inflammatory, and even anti-microbial properties), its effectiveness in reducing infection severity and length may be limited by itself. You need more than one thing to make a difference!

A multi-pronged approach to strengthing your immunity

1. Vitamin D: Vitamin D’s role in infection defense is, in part, through its requirement for making the anti-microbial peptides cathelicidin and beta-defensin-1, which form an important part of the first line of defense against infections. Overall, vitamin D is vital for optimal immune function, and children who fall ill repeatedly routinely turn out to have a Vitamin D deficiency. Ideally, one should maintain repleteness (blood levels between 30-45 ng/mL) via continuous supplementation or sunblock-free sun exposure. If looking for supplements, this is a good adult formulation, and this is a good infant/child formulation. Taking too much Vitamin D is not good either, so starting with a blood test if you suspect deficiency is the right thing to do.
2. Probiotics: Are there actually good probiotics for adults? Generally, probiotics help you if taken during a stomach infection, or when taking antibiotics. There is little cause to take most probiotics regularly, and doing so is often a waste of money. The only one I may consider taking regularly is a unique probiotic first isolated from human breast milk, BioGaia. Its novelty stems from the fact that it is one of few bacterial species that produces a broad-spectrum antibiotic, reuterin: this allows this one single bacterial species to influence the microbiome, which is a very rare thing. To put it simply, Biogaia tends to keep bad bacteria away, and may have anti-inflammatory effects as well. Secondly, of many Lactobacillus species examined, this was the only one to be found conserved across several species, suggesting it has a role in health. Overall, there is a wealth of research done on this probiotic, with some evidence suggesting that it may protect against colic in breast-milk fed infants, may protect against dental carries, protects against H. pylori colonization, and GI tract infections. There is even some data on Biogaia and cancer. What information is available has compelled me to keep giving it regularly to my daughter since infancy, and I take it myself. Given the minimal expenditure ($28 for a 2 month supply, we spend more on Netflix), it seems a good choice, if one were attempting to use probiotics to improve overall health.
   When suffering from a GI infection, alternating BioGaia with a very different probiotic, Florastor (Saccharomyces boulardii, available as Econorm in India) will be more effective. Florastor is very effective for reducing length/severity of stomach infections, and maybe a valuable adjunct to antibiotic treatment (please talk to a doctor about this, if prescribed antibiotics). 
3. Vitamin C: While getting this from food is best, supplementation on occasion, when ill, will not hurt. I’ve tried many options, and the one I like best is Emergen-C.
4. Omega 3 fatty acids: While these are mainly associated with roles in brain-building and protecting from stroke/heart attacks and reducing pain, new evidence shows that they also have a role in immune functioning; specifically, they appear to affect B cell immunity. While the understanding of Omega 3s is still fledgling, making sure your diet includes some Omega 3 intake (either through diet or supplementation) seems sensible. I really like the Nordic Naturals line of Omega 3 supplements.
5. Turmeric with black pepper:  Turmeric, which has used as folk medicine for centuries, has an eye-popping array of useful properties,  including anti-inflammatory, anti-viral, anti-microbial, and anti-cancer effects. But despite all of these benefits, turmeric, even taken in vast quantities orally, shows almost no effect because of the low solubility and very poor bioavailability of its component curcuminoids. There has been a lot of research aimed at addressing these issues. But sitting at home, what can you do? While this is by no means optimized, piperine, a component of black pepper, increases the blood levels of curcumin considerably by inhibiting its removal through the liver. There are two ways to get a good quantity of turmeric in your system:
   1. Turmeric home-brew: Add 1 tsp of turmeric + 0.25-0.5 tsp of fresh ground black peppercorns to a sufficient quantity of fat (I recommend coconut oil for lauric acid) to mix. Then add honey (Manuka is a good choice) and eat the resulting paste, or mix with milk with or without adding honey.
   2. Bioavailable turmeric supplement containing liposome-encapsulated turmeric root extract + piperine (from black pepper): I now prefer the bioavailable supplement to the turmeric home-brew as it is far more convenient, especially when ill or traveling – one should ideally take turmeric multiple times per day when trying to ward off infection.
6. Elderberry Extracts: These, like turmeric, have been medicinally used for centuries. Their anti-viral effects have been shown in the case of influenza in mice, in birds,  in vitro, and even in one very small human study. Plenty of elderberry supplements available, and there is largely no reason to recommend one over the other.

Notes

Of these, Vitamin D (if needed to avoid deficiency), the BioGaia probiotic, vitamin C via food or supplementation,  and Omega 3 fatty acids via food or supplementation *can* be taken regularly: most of these have functions that go beyond optimization of immune responses.

In contrast, elderberry and turmeric extracts should not be taken daily, ideally. There is also little reason to take a probiotic such as Florastor regularly. 

A great many people have expressed interest in taking elderberry regularly, and I would have to advise against this stratagem: elderberry is certainly not required for normal functioning, unlike Vitamin D, vitamin C, omega 3 fatty acids, and even probiotics (which may play a role in shaping the gut microbiome, which in turn has a tremendous effect on health).  Elderberry extracts actually exert their anti-viral effects in part by inhibiting ribsome functioning, which means they affect protein production, and hence in theory could affect any rapidly dividing cell in a dose-dependent manner, making them a very questionable choice for say, a pregnant woman. They may exacerbate autoimmune diseases thanks to their ability to induce inflammatory cytokine production, and their long-term safety has not been studied.

Small (non-medicinal quantities) of turmeric in combination with black pepper can be taken daily by older people: this may be a particularly good idea for individuals with or at risk for metabolic syndrome. There is a wealth of literature on this, but I will highlight this analysis, which suggests that it may be helpful in diabetics. If anybody wishes to take medicinal quantities of turmeric in a bio-available form for any number of conditions (cancer, osteoarthritis, other chronic pain conditions, metabolic syndrome, and so on), I would suggest that they do so in consultation with their doctor, as turmeric can interfere with certain medications. Medicinal amounts of turmeric in pregnancy also do not seem wise.

For anyone looking for more information, Memorial Sloan Kettering has an excellent resource page on turmeric. I should emphasize that turmeric is a potentially useful supplement for cancer patients. Its anti-viral, anti-microbial, and anti-inflammatory effects may really help protect those with immune systems weakened by chemotherapy and radiation. It could also combat some of the mechanisms by which drug resistance develops, and it also is anti-angiogeneic and can induce apoptosis of cancer cells, so it could help in the fight against cancer itself. However, for previously noted reasons, please consult your doctor before taking medicinal quantities.

I do not advise that children be given turmeric + pepper or elderberry daily, though they can be given turmeric and elderberry if okayed by their doctor, if they are showing signs of infection.

Over the many years since I have written this post, I have had multiple threatened infections, most of which were (coincidence or not) staved off within a day by taking all of these in combination. If in case there has ever been a fever, it is gone within a 24-36 hour period. I have also tried these (absolutely safe) experiments on all my family members, and they claim all of these (especially the probiotic and the turmeric-in-milk-with-pepper homebrew) have helped. All of this is done for my toddler daughter as well, and again, it really seems to help, especially the Florastor + BioGaia combination for GI infections. As she has gotten older, the bioavailable turmeric and elderberry have seemingly helped her get over her very rare infections astonishingly quickly.

More than reducing the incidence and severity of minor infections, these easy, safe, and relatively inexpensive strategies, if in play from an early point, may have a far more important role: to reduce the severity of illness following infection with the very nasty bugs, maybe reducing the risk for hospitalization, a requirement for intensive care, or worse.  

Cautionaries

None of this should be taken as a replacement for vaccination. The protection vaccines provide (including the flu vaccine, which reduces the risk for severe infection, hospitalization, or death from the flu) is tangible and very real. I vaccinate my child in addition to do all these things – we get yearly flu shots. 

Elderberry and Turmeric can be taken while keeping your doctor in the loop. Everything covered here should never continue to be the sole form of care in a severe infection that is not improving. If you do not recover quickly, see your doctor and follow their advice, although you could continue to take turmeric and elderberry with whatever they prescribe, if okayed by them.

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