• Cristina Montoya, RD

Should You Take Immune Boosters if You Are Immunocompromised?

Updated: May 12


I miss the time when my incredible army of immune cells protected me against infections, healed my wounds and helped me recover from a common cold. My soldiers, instead of defending me, started to attack the healthy tissues of my joints, eyes, digestive system, lungs, and other organs (otherwise called autoimmunity). A rebel army took over, causing Rheumatoid Arthritis, Sjogren’s Syndrome, and possibly Celiac Disease. I needed to defeat my own immune army by taking them down with immunosuppressants to survive with my autoimmune conditions. So, when the cold and flu season rolls around, do I really want to “boost” my immune system?

Every year we get bombarded with ads telling us how to boost our immune systems with this food or that supplement, it can be overwhelming! With the added concern of the Covid-19 pandemic this cold and flu season, you might be wondering Do these immune boosters really work?

The answer is not a simple yes or no, so I am here to clear up some of the truths and myths about boosting your immunity.

Echinacea Flower. Source: Wix.com

Echinacea

The effectiveness of echinacea in the treatment and prevention of viral infections has been overblown. A study of random control trials found that most Echinacea products have weak to no benefits over the placebo. Additionally, prolonged use of Echinacea (more than 8 weeks) may overstimulate your immune system, therefore it is not recommended for people with a suppressed immune system or autoimmune conditions. Overall, Echinacea has been proven to be safe, but you are better off saving your money.


Source: Thinkstock

Colloidal Silver

Colloidal Silver has gained a reputation for being an immune booster, but is it effective and is it safe? The Mayo Clinic has stated that there is no evidence supporting the claims that Colloidal Silver has any benefit on the immune system and because Silver is not an essential mineral, it could build up in your tissues and potentially cause irreversible health issues. Best to leave this one on the shelf!



Goldenseal. Source: Illinois Wildflowers

Goldenseal

There is little evidence showing that Goldenseal is effective in fighting off infections, and there is potential for interactions with other medications. Goldenseal can cause arrhythmia, decrease white blood cell counts, and respiratory depression. This herb can carry a high toxicity load. Speak to your healthcare provider if you are considering this supplement.


Oysters. Source: Unsplashed. Viviana Riche

Zinc

When it comes to fighting colds, Zinc gets a lot of attention, for a good reason! Your immune system relies on Zinc for optimal functioning and it may help to shorten the duration of colds if taken at the onset of symptoms. It also helps with tissue development and helps to support cartilage regeneration, both are very important for those with arthritis. Supplementation is usually not needed if you eat a varied diet that includes high protein foods such as seafood, legumes or lean meats. However, studies have shown that people with Rheumatoid Arthritis may have lower levels of zinc. Additionally, people with short bowel syndrome and inflammatory bowel disease (i.e. Crohn’s Disease) are at risk of Zinc deficiency due to malabsorption.

So how much zinc should you take?

Well, studies have suggested that healthy adults treated with >75mg/day of Zinc Acetate for the duration of cold symptoms recovered faster. Most Zinc lozenges contain 10mg per lozenge, with the recommendation of consuming up to 5/day (50mg Zinc/day). However, as those with immunocompromised conditions, I would definitely not apply these findings to our bodies.

You may have heard of the UL (aka the Tolerable Upper Intake Level), it is the highest level of a nutrient that can be ingested each day without having any adverse effects for most healthy individuals. For Zinc, that UL is 20mg a day for healthy adults, so mega-doses of Zinc over long periods of time should be avoided. Taking more than 50mg/day can not only cause toxicity, it can block the absorption of copper. Copper is an essential mineral which has anti-inflammatory effects, and low levels of it may lead to irreversible anemia. Speak to your healthcare provider to decide what dose is right for you.


Vitamin C


Fresh vegetables. Source: Wix.com

Vitamin C is important for many of your body’s functions, including the immune system. However, if you eat a diet full of colourful fruits and vegetables then you are likely getting all the vitamin C you need. Foods high in vitamin C include bell peppers, strawberries, broccoli and citrus fruits.

Vitamin C supplementation in doses less than 2000mg/day does not appear to lead to adverse reactions, except in individuals with severe acute pancreatitis. Please note that mega-doses of vitamin C supplements do not improve your immunity and could cause stomach upset, diarrhea and kidney stones in people with pancreatic conditions!


Image source: Wix.com

Vitamin D

Vitamin D, the sunshine vitamin, helps to maintain your immune system but can be hard to come by in Canada during the cold and flu season. This amazing vitamin also helps to regulate autoimmune function and reduce inflammation!

For those of you with Systemic Lupus Erythematosus (SLE) or Lupus, you may be avoiding direct sunlight because it can trigger your condition, leading to lower levels of vitamin D. Also, some medications commonly taken for managing Lupus and inflammatory arthritis (Rheumatoid Arthritis and Sjögren’s Syndrome), such as corticosteroids (prednisone) and antimalarials (hydroxychloroquine and chloroquine) can also affect the metabolism of vitamin D and increase your risk of bone loss and osteoporosis. If you are taking more than 2.5mg of corticosteroids a day for longer than three months, you may be at risk of bone loss and osteoporosis.


Osteoporosis Canada recommends that those taking medications affecting vitamin D absorption should supplement with 800 – 2,000 IU daily. Make sure you are purchasing vitamin D3 (cholecalciferol) supplements in oil or oil-based capsules for optimal absorption. As always, speak to your healthcare provider for advice that fits best with you.


Image source: Wix.com

Vitamin E

An antioxidant, immune system regulator AND anti-inflammatory? Vitamin E seems to be a powerhouse supplement, but is it right for you? Probably not! Supplementation is usually unnecessary because most people get all the vitamin E they need from their diet. It can be found in a number of different foods such as canola and sunflower oil, nuts, seeds, avocados and even spinach and broccoli.


Flaxseeds. Source: Wix.com

Omega-3

Like vitamin E, Omega-3 fatty acids provide excellent support for your immune system during the cold and flu season, and it can help to reduce inflammation. Unlike vitamin E, it can sometimes be in short supply in our diets. The best dietary sources of Omega-3s are from fatty fish such as salmon, tuna and sardines or from plant sources such as walnuts, soybeans and flaxseeds. If you are concerned that you may not be consuming enough through your regular diet, speak to your healthcare provider to find out which Omega-3 supplements could be of most benefit to you.



Many of us with inflammatory forms of arthritis may be at an increased risk of infection because of certain medications or the disease itself; but fear not, there are small things you can do to avoid getting sick this season!


Get moving! Carve out at least 30 minutes a day for your favourite form of exercise.

I know, sometimes it's easier said than done. There are gentle ways to get your body moving when you are in pain or have limited mobility. Here are links to a fantastic initiative by Arthritis Consumers Experts #ArthritisAtHome with great videos to keep you active and informed during the COVID-19 pandemic:


#ArthritisAtHome Episode 2: Caring for your joints during #COVID19 with Dr. Jackie Whittaker


A special 4-part #MotivationMonday series called “15 minutes of exercise “snacks” during COVID-19 with Dr. Jasmin Ma”.


There is also a great program on YouTube lead by Colombian physiotherapists "En Forma Sin Salir De Casa" (Be Fit at Home). No need to understand Spanish, the exercises are self-explanatory and just like Zumba exercises, you could follow the visual directions. See my candid video.



  • Eat your fruits and veggies! Fruits and vegetables contain soluble fibre and many vitamins such as A, C, and B which are important for immune function.


  • Quit smoking and drink in moderation! Smoking increases your chances of contracting infections and excessive alcohol consumption can further suppress your immune system.


  • Wash your hands! Keep germs at bay by regularly washing or sanitizing your hands.


  • Get vaccinated! Make sure you are up to date on your vaccinations and get your flu shot annually.

Your best defence this cold and flu season, and particularly during the COVID-19 pandemic is to continue practicing physical distancing, frequent hand hygiene, and stay home when ill. Strive to maintain a healthy and active lifestyle as much as possible.


Don't forget to seek the advice of your healthcare professionals when you have any questions about your health.

Other Helpful Resources:



Special thanks to Cheryl Anderson, 3rd-year nutrition student at Ryerson University who assisted with the research for this post.

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