Yannick Foing : People with lower incomes often cannot afford nutritious food and are at higher risk of malnutrition that can negatively impact immune health. This is a significant challenge for vulnerable groups such as school children, workers and pregnant women. Micronutrient deficiencies are, however, not only prevalent in low-income population groups, but across income brackets.

The public and private sectors have a responsibility to come together and ensure that affordable and aspirational nutritional solutions are accessible by everyone, everywhere. Maaike Bruins : Women and children are particularly vulnerable to micronutrient deficiencies and poor immune health.

In many societies, women are caregivers and make up a large proportion of front-line health care workers, meaning that they need a strong, healthy immune system in times of crisis. Addressing malnutrition in women and children must therefore be a central pillar in the global COVID response strategy.

Yannick Foing : Fortification is one of the most effective, safe and cost-efficient ways to tackle deficiencies population-wide. It can enhance the nutritional value of staple foods such as rice, wheat flour and maize by adding or replacing essential vitamins and minerals that may have been lost during processing — without changing the taste, cooking requirements or consumer diets and preferences.

A long-term investment with all stakeholders, large scale staple food fortification programs can help to combat malnutrition and improve the immune health of large population groups. These interventions can also be targeted at specific demographics via workforce nutrition or school feeding programs.

Most catered meals for workers in low- and middle-income countries consist largely of staple foods that lack essential vitamins and minerals. Meanwhile, school feeding programs can supply fortified meals to children at school, and point-of-use fortification like micronutrient powders MNPs can also help combat malnutrition in children.

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.

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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. In addition, evidence that the authors deemed to have high certainty showed that zinc supplementation reduces the duration of diarrhea in children with signs of malnutrition by about a day.

In children younger than 6 months, however, zinc supplementation did not affect mean duration of diarrhea or persistence of diarrhea for 7 days. A systematic review and meta-analysis had similar findings. It examined the use of zinc alone or in combination with other treatments for acute diarrhea and gastroenteritis in studies in 32, children, mostly from low- and middle-income countries [ ].

Analyses showed that zinc alone or in combination reduced the duration of diarrhea by about ¾ to 1½ days. The authors concluded that zinc was one of the most effective interventions of those examined, especially when it was combined with Saccharomyces boulardii a probiotic or smectite a natural clay that contains minerals , for reducing the duration of acute diarrhea and gastroenteritis in children.

The WHO and UNICEF recommend supplementation with 20 mg zinc per day, or 10 mg for infants younger than 6 months, for 10 to 14 days to treat acute childhood diarrhea [ ]. However, most trials of zinc supplementation for diarrhea have been conducted in low-income countries [ ].

In well-nourished children, zinc supplements might have only a marginal effect on diarrhea duration. HIV infection reduces the absorption and metabolism of zinc from foods [ ].

In addition, people with HIV often have diarrhea, which can result in excessive losses of zinc. For these reasons, people with HIV often have low plasma or serum zinc levels. Several clinical trials have found some beneficial effects of zinc supplementation to manage the morbidity and mortality associated with HIV infection.

However, findings were less positive in two Cochrane Reviews and another trial not included in either Cochrane Review that assessed the potential benefits of supplementation with micronutrients, including zinc, or placebo in various populations with HIV.

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.

Addressing malnutrition in women and children must therefore be a central pillar in the global COVID response strategy. Yannick Foing : Fortification is one of the most effective, safe and cost-efficient ways to tackle deficiencies population-wide. It can enhance the nutritional value of staple foods such as rice, wheat flour and maize by adding or replacing essential vitamins and minerals that may have been lost during processing — without changing the taste, cooking requirements or consumer diets and preferences.

A long-term investment with all stakeholders, large scale staple food fortification programs can help to combat malnutrition and improve the immune health of large population groups. These interventions can also be targeted at specific demographics via workforce nutrition or school feeding programs.

Most catered meals for workers in low- and middle-income countries consist largely of staple foods that lack essential vitamins and minerals.

Meanwhile, school feeding programs can supply fortified meals to children at school, and point-of-use fortification like micronutrient powders MNPs can also help combat malnutrition in children. 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.

Rachel Reid Source: © RSSL Rachel is the functional ingredients leader at RSSL. Source: © Shutterstock Packaging and storage conditions influence stability.

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Help Contact Privacy Cookies Terms of use Accessibility Permissions. Royal Society of Chemistry Our mission News and events Campaigns Awards and funding Global challenges Support our work © Royal Society of Chemistry Registered charity number: A healthy immune system protects your body by creating a barrier to stop those outside invaders and keep them from entering the body.

If one slips by, your immune system begins producing white blood cells and other proteins and chemicals that destroy these foreign substances. It does this by trying the find the intruder and getting rid of it before it can reproduce.

If it fails at that task, it then kicks into high gear and works harder to destroy the invaders as they multiply. Therefore, building a healthy and hearty immune system is essential in helping your body do this job.

Your immune system is everything to you, and it needs smart, conscious choices to be fortified and ready to do its magic! Here are 10 tips to help fortify your immune system starting today:.

Feeding your body certain foods may help keep your immune system strong. It is recommended that you eat organic, plant-based foods , roots, leaves, stems, grains, beans, nuts, seeds, etc.

Land and sea vegetables are acceptable, as is wild fish. 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.