It might start with a sniffle, sneeze, headache or scratchy throat. There
might be body pains, soreness, nausea, or difficulty breathing or swallowing. At
best, getting sick is discomforting. At worst, it is dangerous to long-term
health. It can affect your ability to work, exercise and socialize, not mention
the impact on your wallet. Beyond contagious microbial infection seasons,
environmental pollution is taking its toll on immune systems year-round.
Luckily, the immune system offers a complexity of defenses, the green movement
is picking up steam, and the natural products marketplace offers a diverse
inventory of potent remedies.
Some boost, some modulate and some fill in the holes of key nutrient
deficiencies that influence immunity. Overall, natural immune health products
strive to help you immune system efficiently identify and neutralize any health
threats.
While the benefits of these helpful natural remedies are often claimed in
general descriptions, the research on how various compounds can help the immune
system are quite specific. Thus, it is important to learn the immune system's
parts and functions, in order to understand how natural products can help.
There are two main stages of immunity, passive (innate) and active
(adaptive). Elements of passive immunity include the skin and mucosal surfaces
of the nose, intestines, throat and lungs. These linings are home to immune
cells, such as macrophage and neutrophils, which help initially identify
compounds as antigens (foreign substance) and whether these compounds are
harmful or innocuous. Among the immune responses triggered by this innate team
is inflammation, which helps isolate antigens and pathogen (disease-causing
substance) for neutralization.
The innate response also triggers the adaptive response, which helps
eliminate pathogens. The defining tools of the adaptive response are recognition
and recall. In simple terms, this phase of immunity identifies the pathogen,
generates a specific response to the pathogen and remembers the pathogen and the
specific antibody produced to eliminate it. Immune cells involved in this
response include the lymphocytes T cells and B cells—which both come from stem
cells—as well as natural killer (NK) cells. B cells produce antibodies (immunoglobulins),
which target both bacteria and viruses. T helper cells stimulate cytotoxic T
cells to destroy pathogens and also stimulate production of the cytokines
interferon, which interferes with aspects of viral infections and interleukin
(immune communication cells).
Im-moo-nity
David Bergsma, president of Health Technology Resources, said five main
factors can interfere with immune health: stress, poor nutrition, toxins,
infection and trauma. "The primary consequence we experience as a result of
interference by these factors manifests as a reduction in immune system
communication, which reduces the immune system's effectiveness," he explained.
"This reduction in communication is represented physically in the body by a
reduction in the number and variability of immune communication cells available
to carry out the imperatives."
Bergsma noted immune-boosting ingredients generally “stimulate” immune cells
already present toward a higher level of activity. He suggested stimulation
cannot reach immune communication cells that have been compromised or eliminated
by the five factors of interference. On the other hand, he said "modulation"
suggests more of a regulatory effect.
"[Recognizing and remembering] are dependent upon the presence of a highly
variable array of immune communication cells and are activities of what is known
as adaptive immunity," he explained. "If the array is compromised, the immune
system will struggle and innovate to create optional solutions that may or may
not be successful. This struggle reduces immune capability and introduces the
potential for undesirable outcomes."
One dietary supplement that addresses adaptive immunity is bovine colostrum,
mother's milk for calves. Lab tests reveal colostrum can modulate cytokine
production stimulating the release of IFN-gamma, IL-10 and IL-2.1
Clinically, immunomodulatory results from bovine colostrum supplementation in
adults have included increased production of IL-12 and an antigenic-dependent
impact on IFN-gamma production—enhanced IFN-gamma in response to weak
stimulation and inhibited IFN-gamma after strong stimulation.2
Additional study on trained male cyclists undergoing a 40-km time trial
showed 10 g/d bovine colostrum for five weeks suppressed post-exercise decreases
in cytotoxic T cells and immunoglobulin-G (IgG) concentrations.3
Researchers also noted a trend toward reduced incidence of upper respiratory
illness in subjects taking colostrum.
Several products derived from colostrum have achieved similar results. AiE10,
a refined lacteal complex based on colostrum, can increase immune surveillance
and transfer immunological information among cell groups.4 The
ingredient was designed to supply immunoactive compounds that are often depleted
by prolonged stress, poor diet and other immune-compromising factors.
Unpublished trials have shown AiE10 supplementation in healthy adults and
those with chronic illness can increase NK cell activity significantly, while
increasing general well-being. In one trial, 200 mg of Ai/E10 t.i.d. for 15 days
generated a clear “modulated” immune response in adults, elevating key immune
markers occurring in concert with each other, which is consistent with
observations of the immune system’s ability to recognize and respond.
Basic Immune Nutrition
Mother's milk provides babies their first nutrition outside the womb. Getting
the essentials is one of the most important factors in maintaining good immune
health. This is where basic vitamins and minerals take the limelight, as many of
these micronutrients can address some of the same adaptive immune cells.
In 2008, Bayer researchers reported, "Micronutrient deficiency suppresses
immunity by affecting innate, T cell mediated and adaptive antibody responses."5
Their previous study showed vitamin C helps preserve cellular integrity and
improve the activities of NK cells and other lymphocytes.6 Vitamin E
supplementation can produce similar results, as a Spanish study found it could
enhance neutrophil, lymphocyte and NK functions in elderly adults.7
Fat-soluble vitamin A, and its active metabolite retinoid acid (RA), can also
augment adaptive immune function, according to research linking supplementation
to increased antibody response and regulated T/B cell populations, as well as
cellular differentiation.8,9 On the other hand, the increased
attention on vitamin D is due to its reported ability to stimulate innate
immunity, including an impact on signaling within macrophages and keratinocytes
in the epidermis, which aids responsiveness to barrier protection.10,11
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As for essential minerals, zinc and selenium have garnered most of the immune
research. A Wayne State University, Detroit, review noted zinc deficiency
adversely impacts production of T helper cells, which can reduce the activity of
NK and T cytotoxic cells, and lead to greater production of pro-inflammatory
cytokines and oxidative stress.12 Research on zinc has been less
about mechanism and more about performance results. A Tufts University, Boston,
study found elderly adults who had normal serum zinc concentrations had a
significantly reduced chance of contracting pneumonia compared to those with low
zinc levels.13 And another Wayne State study on healthy adults
receiving zinc gluconate (45 mg/d elemental zinc) or placebo for 12 months found
a significant reduction in incidence of infections as well as oxidative stress
levels.14 Similarly, selenium has shown the ability to enhance
lymphocyte function and reduce viral loads.15,16
From the mineral world comes an interesting supplement with reported immune
activities: silver. Keith Moeller, director at American Biotech Labs, said the
government does not consider silver an essential mineral, "but our experience
with the long-term use of the products would seem to differ." Silver was used as
the primary antimicrobial until antibiotics were developed. However, antibiotic
resistance has turned many eyes back toward silver.
Focused on the problem of antibiotic resistance, researchers from Penn State
University, State College, tested antibiotics and a silver solution (silver
nanoparticles dispersed in water, from American Biotech Labs) on seven bacterial
strains, including methicillin-resistant Staphylococcus aureus (MRSA) and
multiple drug-resistant (MDR) strains (Escherichia coli, Pseudomonas
aeruginosa).17 The researchers found the silver solution had a
significant additive effect on clearing the bacteria and would be a powerful
partner with antibiotics in the fight against resistant strains.
Concerns about the use of silver have focused on argyria, a condition in
which the skin and eyes can become blue or grey in appearance. However, Moeller
assures metallic silver cannot cause argyria. "Only ionic forms of silver can
cause the problem, according to a number of scientific sources," he said.
While not a micronutrient, but macronutrient (fat), conjugated linoleic acid
(CLA) may exert beneficial effects on the adaptive immune system. In a double
blind study, healthy adults given Safflorin (1.7 g/d) for 12 weeks showed
increased in IgA and IgM antibodies for up to 12 weeks after treatment ended.18
This proprietary CLA supplement has also demonstrated benefits to people
receiving various antiviral vaccines, as well as those facing rhinovirus
infection.
Glucan Gladiators
Beta-glucans, a type of polysaccharide, are featured in a great number of
research trials on numerous aspects of immune health. Used as traditional
medicines, mushrooms are loaded with certain beta-glucans and have become quite
a group of immunomodulating natural products, supported by a wealth of research.
Eight mushroom strains were tested in a Dutch study for their
immunomodulating capabilities, and the extracts of Ganoderma lucidum (reishi)
and Volvariella volvacea were found to act directly on monocytes to
modulate T cell activation.19 Further studies on reishi suggest its
polysaccharides prompt splenic B cell activation and enhance antibody secretion,
specifically stimulating TNF-alpha and IL-6 production, and IFN-gamma release.20,21
One of the most popular mushroom extracts is Grifola frondosa or
maitake. A proprietary extract of maitake—D-Fraction, from Maitake
Products—appears to activate immune cells including macrophages, dendritic cells
(immune cells that process antigens) and T cells, in addition to supporting the
cytotoxicity of NK cells.22,23,24 In vitro tests on a hot water
extract of maitake mycelia showed strong cytokine activity and enhanced
up-regulation of certain neutrophils in a dose-dependent manner.25
John Seleen, president of JHS Natural Products/Mushroom Science, stressed the
importance of hot water extraction for mushroom beta-glucans. "Hot water
extraction allows you to concentrate active compounds to a level many times
higher than what you find in non-extracted mushroom product," he explained,
noting most extracts in traditional Chinese medicine (TCM) are at least 4:1
(kilos of dry herb to kilos of finished extract) with hot water extracts as high
as 20:1 polysaccharide content. "Alcohol can penetrate the cellulose fibers of
other plants and draw out actives, but it can't penetrate the mushroom cell
walls, which are made from chitin—the same material comprising lobster shells.”
In his book, "The Health Benefits of Medicinal Mushrooms," Mark Stengler,
N.D., wrote: "The majority of published scientific literature that I was able to
locate on the clinical effects and health benefits of using medicinal mushrooms
used supplements prepared with hot-water extraction. This is also consistent
with the references on traditional use by East Asian herbalists."
According to Seleen, Coriolus versicolor is one of the most researched
mushrooms in immune health. In fact, Japanese researchers reported protein-bound
polysaccharide-K (PSK) found in this species has both cellular and humoral
immunomodulatory effects, including enhanced IgM production and B cell activity,
as well as antibody production.26 This mushroom has also been shown
to activate CD4+ T cell response in the lymph nodes and modulate T cell
receptor-induced IL-2 production.27
Another popular mushroom for immune support is Agaricus blazeii Murill,
which is attributed with strong immunomodulating properties.28
Research has found this species can increase IgG and T cell counts in the
spleen, in addition to elevating both phagocytic capability and the body’s
resistance to bacterial infection.29 In cancer patients, A. blazeii
administration has increased NK cell activity and improved
chemotherapy-associated side effects.30
Combining mycelia (vegetative structure of fungi) from several medicinal
mushrooms, Active Hexose Correlated Compound (AHCC®, manufactured by Amino Up
Chemical Co., U.S. distribution by Maypro Industries), has been shown to
modulate immunity and increase survival in response to acute infection and has
been tested against a variety of infectious agents.31 According to
animal studies, AHCC can regulate adaptive and innate immune response, enhancing
the body’s tumor surveillance and increasing its response rate to pathogenic
infection.32,33 A recent Japanese trial found healthy adults taking
AHCC for four weeks had increased dendritic cell levels and differentiation.34
A similar trial revealed 60 days of AHCC supplementation could increase levels
of the cytokines INF-gamma and TNF-alpha, enhancing the T cell immune response.35
Polysaccharide beta-glucans also can be found and sourced in certain yeasts.
A proprietary 1,3/1,6 glucan (Wellmune WGP®, from Biothera) derived from the
cell walls of the yeast Saccharomyces cerevisiae has undergone many
studies on its immune-enhancing effects. A single blind, crossover study on the
effects of Wellmune WGP® on upper respiratory tract infections (URTIs) in
firefighters—the stress of their job can depress immunity—reduced incidence of
infections after a 14-day intervention period.36 These results on
respiratory infection were duplicated in studies on other subjects under stress,
including marathon runners (exercise saps the immune system).X Similarly, a
trial in healthy adults found those taking Wellmune WGP for 90 days had shorter
and less severe colds than the placebo group.37
Another proprietary Saccharomyces cerevisiae ingredient is EpiCor®,
from Embria Health Sciences, a dried, complex fermentation product from the
yeast and its medium, yielding a high-metabolite immunogen. In two trials
conducted in early 2007, active intervention with 500 mg/d EpiCor in adults who
received flu vaccination significantly reduced the incidence of URTIs and the
duration of symptoms in subjects who did get URTIs.
Additional research has shown 500 mg/d of EpiCor can also increase levels of
secretory immunoglobin A (sIgA) and modulate levels of IgE. In a recent trial
conducted by NIS Labs for Embria, 500 mg/d of EpiCor or placebo for five weeks
in healthy adults resulted in increased levels of hematocrit and sIgA, as well
as decreases in serum IgE and IL-10. The researchers concluded EpiCor supported
the health of red blood cells and mucosal immune protection and may exert
beneficial anti-inflammatory effects in situations of chronic inflammation or
allergies.
Defensive Herbs
The botanical medicine chest is brimming with plants that can support immune
function. Perhaps the most popular of the bunch is Echinacea, which has many
different species—such as purpurea, angustifolia and pallida.
In vitro studies have shown E. purpurea extract upregulates dendritic cell
activity and modulates macrophage immune response.38 An Iowa State
University, Ames, study examined the impact of E. angustifolia, E. pallida and
E. purpurea extracts on immune parameters in mice, finding all three species
helped increase antibody response and altered cytokine production, in addition
to increasing INF-alpha and inhibiting the release of TNF-gamma and IL-1beta.39
Further, E. angustifolia and E. pallida exerted higher T cell proliferation and
increased production of IL-4 and IL-10, suggesting these species have more
anti-inflammatory activity.
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Dave Bunting, staff herbalist for Herb Pharm, said liquid extracts of
Echinacea have many advantages. "The naturally occurring plant constituents are
pulled out or extracted from the cellulose and other structural materials of the
plant into a stable liquid form," he said, noting the liquid form of Echinacea
extract is easy to dose and assimilate. "Unlike tablets and capsules, Echinacea
liquid extract does not require a break down in the digestive system. Liquids
are easy to swallow and available for immediate assimilation by the body."
One of the active constituents of Echinacea is arabinogalactan, which
reportedly increases interferon, tumor necrosis factor (TNF) and IL-1 production
through stimulation of macrophage activity. In fact, a study out of Southwest
College in Arizona found extracts of E. purpurea and E. angustifolia combined
with larch arabinogalactan (LAG, extracted from Larix occidentalis tree)
increased production of complement properdin, an indicator of immune system
stimulation.40
LAG is a rich source of polysaccharides, flavonoids and dietary fiber, which
can increase the production of short-chain fatty acids in the gut, while also
working to stimulate NK cell cytotoxicity.41 McGill University,
Montreal, researchers found LAG induced a range of cytokines and impact monocyte
production in mice.42
Tinospora cordifolia, an Indian botanical traditionally used as an
adaptogen, is another source of arabinogalactans and flavonoids. In vitro work
revealed an extract from the stem of the plant can modulate levels of cytokines
and nitric oxide (NO), protecting macrophages from inflammatory challenges.43
An extract of T. cordifolia (as Tinofend®, from Verdure) taken for eight weeks
by allergic rhinitis subjects was linked to significant decreases in symptoms
and decreases in neutrophil count in nasal smears.44
Fellow Indian herb Andrographis paniculata has been used traditionally
to treat infections and has been recently found to promote the secretion of IL-2
and IFN-gamma by T cells, inhibiting tumor growth and increasing life span.45
It can also enhance antibody response when administered with vaccine and inhibit
viral replication.46,47
The Chinese adaptogenic herb Astragalus membranaceous may benefit
immune function by supporting macrophage phagocytic activity and lymphocyte
response in cases of immunosuppression.48 It may also help modulate
the response of stimulated macrophages.49
A botanical from the sea is storming the beaches to protect and arm the
immune system. Spirulina is a type of filamentous cyanobacteria that seems to
affect many immune cells, especially those important to adaptive immunity. While
it may support macrophage phagocytic activity, it also stimulates cytokine and
antibody production, and activates T, B and NK cells.50 Other
research on spirulina supplementation indicates it can significantly increase
IL-2 concentrations, reduce IL-6 levels and increase plasma antioxidant status.51
In fact, a University of California, Davis, study found giving 1,000 mg/d or
2,000 mg/d of spirulina (from Earthrise Nutritionals) to patients with allergic
rhinitis for 12 weeks significantly lowered IL-4 levels, although it did not
appear to modulate Th1 cytokines.52
Selling Immunity
Immune health is a hot category. According to Business Insights, immune
health and vitality are key drivers, especially in the functional and fortified
food markets, as major companies channel resources into this area. However,
supplements still rule the immune market.
Whether stocking foods or supplements, retailers must consider a few issues
when selling products in the immune function category. The oft-discussed
obstacle to consistent sales of immune products is the seasonal nature of
consumer purchase patterns. There is the cold and flu season, which reaches out
on both sides of winter and then there is the spring allergy season. However,
people are beginning to realize their immune system is at work everyday,
fighting major and minor dangers.
Referring to his list of factors that interfere with immune health— stress,
poor nutrition, toxins, infection and trauma—Bergsma said, "If you look at the
causes of immune decline, you can see that cold and flu season is not on the
list as an immune system risk." He noted Americans are largely
symptom-conditioned and respond to their bodies more after reactively than
proactively. "Educating the public about the risks should help retailers sell
product year round to interested consumers."
Many immune product manufacturers are designing products to address
year-round immune system needs. Bunting reported Echinacea is taken both
seasonally and year-round. "Seasonally, Echinacea is used to modulate the immune
system at times of seasonal change and stress," he said, adding seasonal
stressors affecting immune health include cold and wet weather, reduction in
daylight and even increased pollen counts. "Echinacea's usefulness, however, is
far broader than this single type of immune enhancing application.
Traditionally, Echinacea has been used as an anti-inflammatory and blood and
lymphatic cleanser with a reputation in various infections, skin conditions and
insect stings. For herb-savvy customers familiar with the broader immune
implications, Echinacea is used throughout the year whenever the need arises."
One concern with taking potent immune products regularly would be safety and
dosing. Fred Zinos, Aloha Medicinals, said such a blend of mushroom
polysaccharides as in Immune Assist 24/7™ (six mushrooms) can be taken at
maintenance doses for indefinite periods of time. "Since the active compounds in
medicinal mushrooms stay in the body a relatively short time, chances of
'overdosing' are almost non-existent," he explained. "When individuals sense a
challenge to their normal state of well-being, they can either take more of the
maintenance product or move up to higher strength products."
Same goes for Bevology's immune product, Immunity, which consists of
effervescent tablets containing vitamin C, Echinacea and zinc. "Immunity is
designed to be taken every day to keep your immune system strong so you don’t
get sick," said Sierra Cooke, vice president of marketing at Bevology. "In the
event you feel a cold coming on, we suggest two tablets per day." She assured
each day the body will throw off the vitamins it doesn’t need. "The only vitamin
in our product your body tends to store is vitamin E, which we put in very low
levels."
A similar dosing and duration of use concern confronts silver users. However,
Moeller said, "We have finished 20 safety and toxicity studies directly on our
products, so the safety of the products even at high dosage levels is well
established."
Due to its antimicrobial actions, silver products were historically used
during acute infection; however Moeller reported consumers use the products for
specific events as well as for regular immune support. "We do have more than 200
studies and test series backing the effectiveness of our products in a number of
uses, but the info is only listed to give our customers background data on the
products, not for claims for uses," he said. "In other words, we can give out
the data as background data on our products, but not for any claims for specific
drug type uses."
Law is an important area of concern in marketing and selling immune products.
FTC has promised to step up its action against immune claims, especially for
"immune booster" products.
Patrick Sai, marketing manager at La Belle, stressed while a challenged
immune system would benefit from the antimicrobials and nutritional support
offered by colostrum, the antimicrobials issue must be stated carefully. "A
claim is when we say this fights diseases or cures illness," he reminded.
"[Antimicrobials] are in there, but we don’t say it cures anything. Colostrum
supplements are for nutritional aspects only."
The restrictions on what can and cannot be said in explaining benefits and
mechanisms of action to consumers presents quite a challenge to those selling
the products. "Complicating the issue with respect to immune products is the
fact that while most people have some idea what a skeletal system or a
respiratory system is, they normally can’t identify a specific organ associated
immunity," Zinos said, noting immune support activity and expectations are
therefore less defined. That complication aside … customers buy benefits. A huge
and immediately understood benefit that does not violate regulatory constraints
is 'Supporting your immune system is one way to help you feel your best.' That
is a powerful statement."
Armed with the science behind the numerous products in the immune category,
as well as some guidance from each manufacturer on proper dosing and use of each
product, retailers will have no shortage of opportunities to effectively and
responsibly match their customers with products that can help address both
short- and long-term immune needs.
Homeopathics for Allergies
Spring has sprung, which usually means the allergy season is kicking into
high gear. Allergies occur when the immune system identifies a normally
innocuous particle as an antigen and activates the immune response, including
inflammation and mucus production.
Homeopathy can address allergy symptoms by providing a plant, mineral or
animal component that can produce the targeted allergy symptom. For instance,
runny nose or eyes can be helped by a diluted form of red onion (Allium cepa),
which produces those same symptoms.
Nancy Holt, director of marketing for VÄXA International, reported the Aller-Sine
homeopathic formula helps limit allergic reactions to pollen, dust, animal
dander, and more. Key ingredients include: Nux Vomica, to inhibit frontal
headache, watery eyes, itching in the ears and reduce stiffness or congestion;
and Sabadilla, which helps with the mucous membranes of the nose and
mouth.
Washington Homeopathic Products (WHP), the oldest full-line homeopathic
company, also uses Allium cepa and Sabadilla in a hay fever
formula. It also contains Anthoxanthum to help sooth the inflammation of
the mucous membrane in the nose caused by allergies, according to Misty
Householder, marketing manager for WHP, one of the original homeopathic
pharmacies.
Also featuring A. cepa is Pflueger USA's hay fever formula, which adds
Apis mellifica (itchy eyes), Aralia racemosa (runny nose/eyes),
Euphrasia officinalis (irritated eyes), Justicia adhatoda (acute
upper airway infection), Lycopersicum esculentum (flu), Sinapis nigra
(nasal congestion) and the hay fever remedies Linum usitatissimum and
Naturm muriaticum. Pflueger also offers Treatment Triads which combine 3
combination remedies to work together to address the complex set of symptoms.
“Utilizing a primary remedy with two complementary remedies ensures a
comprehensive approach to healing," said Michael Huelsberg, a pharmacist at
Pflueger.
Boiron's Allergy Care Kit features three of the most popular medicines for
common symptoms—Apis mellifica for itchiness, Galphimia glauca for
hay fever and Histaminum hydrochloricum for general allergy symptoms. The
company also offers a six-medicine combination featuring red onion, as well as
Ambrosia artemisiaefolia for coughing, HPUS for hay fever, Euphrasia
officinalis for irritated eyes, Sabadilla for sneezing, Solidago
virgaurea for nasal discharge and Histaminum for general allergy
relief.
The homeopathic medicine chest for allergies and immune relief is quite
extensive, but retailers can help consumers decipher the ingredients and
specific benefits by utilizing brochures and charts often supplied by the
manufacturers.
1. Shing CM et al. “Bovine colostrum modulates cytokine production in human
peripheral blood mononuclear cells stimulated with lipopolysaccharide and
phytohemagglutinin.” J InterferonCytokine Res. 2009 Jan;29(1):37-44.
2. Biswas P et al. “Immunomodulatory effects of bovine colostrum in human
peripheral blood mononuclear cells.” New Microbiol. 2007
Oct;30(4):447-54.
3. Shing CM et al. “Effects of bovine colostrum supplementation on immune
variables in highly trained cyclists.” J Appl Physiol. 2007
Mar;102(3):1113-22.
5. Maggini S et al. "Selected vitamins and trace elements support immune
function by strengthening epithelial barriers and cellular and humoral immune
responses." Br J Nutr. 2007 Oct;98 Suppl 1:S29-35.
6. Wintergerst ES, Maggini S, Hornig DH. “Immune-enhancing role of vitamin C
and zinc and effect on clinical conditions.” Ann Nutr Metab.
2006;50(2):85-94.
7. De la Fuente M et al. “Vitamin E ingestion improves several immune
functions in elderly men and women.” Free Radic Res. 2008
Mar;42(3):272-80.
8. Ross AC, Chen Q, Ma Y. “Augmentation of antibody responses by retinoic
acid and costimulatory molecules.” Semin Immunol. 2009 Feb;21(1):42-50.
Epub 2008 Sep 25.
9. Pino-Lagos K, Benson MJ, Noelle RJ. “Retinoic acid in the immune system.”
Ann N Y Acad Sci. 2008 Nov;1143:170-87.
10. Maalouf NM. “The noncalciotropic actions of vitamin D: recent clinical
developments.” Curr Opin Nephrol Hypertens. 2008 Jul;17(4):408-15.
11. Bikle DD. “Vitamin D and the immune system: role in protection against
bacterial infection.” Curr Opin Nephrol Hypertens. 2008 Jul;17(4):348-52.
13. Meydani SN et al. “Serum zinc and pneumonia in nursing home elderly.”
Am J Clin Nutr. 2007 Oct;86(4):1167-73.
14. Prasad AS et al. “Zinc supplementation decreases incidence of infections
in the elderly: effect of zinc on generation of cytokines and oxidative stress.”
Am J Clin Nutr. 2007 Mar;85(3):837-44.
15. Pagmantidis V et al. “Supplementation of healthy volunteers with
nutritionally relevant amounts of selenium increases the expression of
lymphocyte protein biosynthesis genes.” Am J Clin Nutr. 2008 Jan;87(1):181-9.
16. Hurwitz BE et al. “Suppression of human immunodeficiency virus type 1
viral load with selenium supplementation: a randomized controlled trial.”
Arch Intern Med. 2007 Jan 22;167(2):148-54.
17. Mehta D et al. "Bactericidal activity of combinations of Silver–Water
Dispersion™ with 19 antibiotics against seven microbial strains." Curr Sci.
2006;91(7):926-929.
18. Albers R et al. “Effect of cis-9, trans-11 and trans-10, cis-12
conjugated linoleic acid (CLA) isomers on immune function in healthy men.”
Eur J Clin Nutr. 2003;57:595-603.
19. Jeurink PV et al. “Immunomodulatory capacity of fungal proteins on the
cytokine production of human peripheral blood mononuclear cells.” Int
Immunopharmacol. 2008 Aug;8(8):1124-33.
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