Holistic/Integrative Nutrition

8 Ways to Support Immunity

During this trying time of concern over COVID-19, commonly referred to as coronavirus, recommendations from the Centers for Disease Control and Prevention and other state and federal organizations have centered around washing hands, avoiding touching your face, and staying home.

However, not much press has been given to a key concept that dietitians know plenty about when it comes to staying well: tapping into the power of diet (and supplements) to fortify the body’s immune function. RDs have an incredible opportunity to leverage their knowledge and experience and potentially play a vital role in helping to reduce the spread and severity of COVID-19.

As dietitians know, there are numerous dietary and supplemental strategies that can offer support for a more resilient immune system. No matter your place of work, you can offer the following helpful advice to clients.

1. Consume immune-protective herbs and spices. Ginger, garlic, onions, oregano, rosemary, and thyme all have properties that help fight off viruses and harmful bacteria and give the body’s defenses a natural boost. Suggest clients whip up garlicky hummus, sip raw ginger tea, and throw oregano and rosemary into salads and roasted vegetable dishes or even a chickpea/tuna salad. Or go for an all-in-one elixir with my flu buster.

2. Munch on more orange foods. Carrots, sweet potatoes, and winter squashes all are rich in beta-carotene, which has been shown to protect lung function and act as a strong defender against less favorable bugs. Beta-carotene also gets converted to vitamin A, which is critical for immune function. Bright-colored fruits and veggies in general offer all kinds of antioxidant protection and bolster the body’s infection-fighting mechanisms.

3. Eat vitamin C–rich foods. Citrus, red peppers, broccoli, and kiwi all are great sources of vitamin C. Suggest clients start their day with a grapefruit or an orange or throw sliced peppers on their sandwich. Studies show that consuming vitamin C can help prevent illness. As extra insurance for those who may be immunocompromised or are feeling susceptible to getting sick during flu and cold season, I suggest a supplement of 250 to 500 mg/day. Recommend clients read supplement labels to look for accompanying flavonoids, which help improve absorption and utilization of this important nutrient.

4. Zap it with zinc. Zinc is key for immune function, and it tends to be lower in those who are older, who take antacids, and in some vegetarians and vegans. Clients can find high amounts of zinc in meat and seafood and in moderate amounts in sunflower and pumpkin seeds. A low-dose supplement of 15-25 mg/day (taken with food) can offer clients an additional immune-system boost. Remind clients that supplement quality matters, and suggest they look for zinc supplements in the form of zinc picolinate, which has been shown to be best absorbed.

5. Pop a fortifying supplement. There is some emerging evidence on the benefits of elderberry syrups and tinctures. Research shows elderberry can protect against flu and fortify the immune system as well as be an effective treatment for upper respiratory infections. This supplement can be found in natural food stores and even in some drugstores. Trusted brands clients can look for include Sambucol, Gaia, or Garden of Life.

6. Get your vitamin D. At this time of year and for those living in more northern locations, serum levels of this critical vitamin can decline. Vitamin D is essential for optimal immune function and has been shown to help address respiratory infections. Supplementing is an easy way to get 1,000 IU/day, a safe amount for most people and one shown to raise low serum vitamin D levels (ie, those below 30 ng/mL). Vitamin D also can be found in mushrooms, fatty fish, and eggs.

7. Give the magic of mushrooms a try. These fungal gems can offer an excellent boost to the immune system and provide some food (in the form of beta glucans) for beneficial gut bacteria, which help fend off infection. Suggest clients toss them into salads, stir-frys, and soups or, if mushroom ain’t their thang, there’s a supplement for that. My personal fave: MyCommunity, a collection of different mushrooms for immune support in a simple capsule.

8. Minimize alcohol, sugar, and processed foods. Not only can the consumption of these foods increase the risk of suppressing the immune system, but eating them often means that healthful and supportive nutrients are displaced. Getting clients and patients to focus on a whole foods diet instead of heavily processed foods and try a seltzer with a splash of juice or a few drops of bitters instead of a cocktail can be helpful advice.

Think dietitians can’t also be superheroes in the COVID-19 outbreak? Just watch us!

Please note that this blog is not meant to substitute for medical advice. If you or your clients suspect that you or they may have been infected by the novel coronavirus, please contact your health care provider.

— Mary Purdy, MS, RDN, serves as adjunct faculty at Bastyr University where she earned her master’s degree. She has provided clinical nutrition counseling for the past 12 years, hosts the podcast Mary’s Nutrition Show, and speaks regularly at a variety of conferences.

11 Comment

  1. So glad to see elderberry and the compelling evidence for its use in the discussion here! Thanks for the thoughtful article with specific examples, great to share.

  2. I’m sorry, this doesn’t belong on this site. Elderberry syrup is not evidence based. RDs need to be evidence based. Please remove this

    1. Thanks for your comment, Annie. Actually, good news! A 2019 meta analysis came out that states ” Supplementation with elderberry was found to substantially reduce upper respiratory symptoms.” and concludes “These findings present an alternative to antibiotic misuse for upper respiratory symptoms due to viral infections, and a potentially safer alternative to prescription drugs for routine cases of the common cold and influenza.” You can find that study here: https://www.ncbi.nlm.nih.gov/pubmed/30670267

      Additionally, there was an RCT in 2016 that showed a reduced duration of colds in travelers. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848651/

      Elderberries are also rich in anthocyanin, a flavonoid that was featured in this TD article in 2014. https://www.todaysdietitian.com/newarchives/030314p20.shtml More research has continued to emerge on this protective phytochemical over the past 5 years as well. https://lpi.oregonstate.edu/mic/dietary-factors/phytochemicals/flavonoids.

      In any case, there certainly isn’t harm in adding this option in as a way to potentially offer additional support. As dietitians we can use the best evidence available combined with years of clinical practice and experience around strategies that we have found to be effective. (See the Academy’s 2019 statement on Evidenced Based Practice) Thanks!

      The Academy 2019 definition of Evidence-Based Dietetics Practice is:

      Evidence-based practice is an approach to health care wherein credentialed nutrition and dietetics practitioners use the best available evidence, to make decisions for patients/clients, customers, individuals, groups, or populations.

      1. Thanks for your article & response, Mary Purdy!! Am listening to your lecture/teaching through IFNA – Track 4, module 3 this week!!

        1. Thanks, Cindra! Appreciate your positive response and hope the IFNA module is helpful. Here’s to continuing to learn from one another.

      2. I agree with Annie. Scared desperate consumers could extrapolate for example that elderberry is good to take if they get respiratory symptoms and could then possibly delay contacting a health care professional when in reality they have contracted the novel coronavirus. There is not enough science based evidence to support this advice and saying there “certainly isn’t harm in adding this option” is in my opinion incorrect and potentially dangerous. We all know there are no miracle cures here and should be the voices of reason especially at this crucial time.

        1. Thanks for your comment, Roberta. I appreciate your thoughts. My segment on elderberry doesn’t indicate that elderberry should be seen as a treatment for COVID19. If you go back you’ll see it says “Research shows elderberry can protect against flu and fortify the immune system as well as be an effective treatment for upper respiratory infections.” In order to be super clear, I have suggested to RD Lounge that we provide a statement to this effect. Hope that helps! Thanks.

      3. So the research on elderberry isn’t great.

        The same meta-analysis that you reference above also states “there are no large scale studies” – kinda makes it hard to do a really good meta-analysis.

        You are correct in your reply above that one RCT in 2016 showed a reduction in duration of cold symptoms in travelers but in your article you say that it can “protect against the flu” and these are 2 different things. That study did NOT show that elderberry prevented infection – only that it helped with the symptoms associated with flu. A study showing shorter and less severe symptoms in folks that have a viral infection should not be interpreted as the supplement prevented the viral infection. Additionally, it appears that this study was funded by the supplement maker.

        There is no evidence that elderberry “protects you from getting the flu”. To me, evidence-based practice would be that the available evidence does NOT support the use of elderberry to protect against the flu (including COVID-19).

        The idea of “boosting your immune system” also doesn’t sit well with me. Most of these recommendations are no different from any other recommendation we would have on any given day – get enough vitamin A, vitamin C, zinc, etc. Why is this any different during a pandemic vs no pandemic? and the vast majority of us are getting enough anyway.

        And then there is the flu buster concoction of herbs and spices – no cited research???

        Sorry – I just don’t agree with this post.

        1. Thanks for your comment, Jenn. You are absolutely allowed to disagree. As health professionals, we often have different approaches and that needs to be ok. Evidence based practice is defined by the Academy as “an approach to health care wherein credentialed nutrition and dietetics practitioners use the best available evidence, to make decisions for patients/clients.”

          I make recommendations based on the “best available evidence” combined with 12 years of clinical practice working with patients and tuning into my own expertise and experience. There may not always be perfectly designed large scale human studies to guide us, so we work with what we have and what we know about human physiology and biological systems. You mention that “There is no evidence that elderberry “protects you from getting the flu”. (In general, it can be difficult to definitively prove that something can be prevented. How do we design ethical human studies for this?) However, if we ensure that immune function is optimal in a human being, there is less likelihood of someone getting sick in general as well as an improved ability to recover more quickly. (https://lpi.oregonstate.edu/mic/health-disease/immunity-in-brief) Additionally this is different from my statement that “Elderberry protects against the flu” which can mean that it has immune enhancing properties that can help protect an individual from more severe symptoms or against the effects that having a flu may cause.

          Regarding your questions as to why the recommendations would be different from normal times versus a pandemic, I can’t imagine not strongly recommending to the general population that they do all they can to ensure their nutrient needs are being met, particularly when we know many are not getting adequate amounts of these vital nutrients, and many suffer from chronic conditions and auto-immune issues that may make them more susceptible. (I don’t believe that the “vast majority” are getting enough.” See Krebs et al. Americans Do Not Meet Federal Dietary Recommendations.) My experience with my patients has borne that out as well. Offering additional support to immune function may be quite beneficial. It also feels critical to do whatever we can to help people stay well in general so as to not overwhelm our health care system.

          Lastly, regarding the references for the concoction, yes! I should have offered these up. My apologies! I’ve listed some below. There are many studies on garlic and onions and ginger having anti-inflammatory/immune supportive properties. I’m just citing a few. But there are dozens more.

          1. Immunomodulation and Anti-Inflammatory Effects of Garlic Compounds: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4417560/

          2. Anti-Oxidative and Anti-Inflammatory Effects of Ginger in Health and Physical Activity: Review of Current Evidence https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665023/

          3. Therapeutic Role of Functional Components in Alliums for Preventive Chronic Disease in Human Being: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5316450/

          Thanks for initiating this discussion. Looks like I’ve written a bit of an essay!

          Sincerely, Mary Purdy, MS, RDN

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