Which Supplements Help Prevent and Treat Infections?

I don't know anyone who wants to get sick, so most of us try our best to avoid illnesses. We do this by washing our hands and encouraging our kids to cover their coughs. We avoid sick people as much as possible (though we don't always stay home when we should). We should routinely get enough sleep (most Americans fail in this regard) and eat more fruits and vegetables (again, most of us fail to get the minimum recommended amounts of plants in our diets).

All of these measures can help, but can we get more help from nutritional supplements or other natural remedies? What will boost our immune system?

I'm often asked if vitamin C, zinc, or essential oils will help various ailments or boost our immune system. I know that many people try natural products that are promoted to boost or support the immune system. They're hopeful that stimulating immune system activity will help the body fight off a virus. But research doesn't show that our immune system works that way. A virus can cause illness even in healthy people. If you want to read an in-depth summary of how our immune system works, the Skeptical Raptor has done a nice job discussing the complexities and why it's not as easy as eating healthy and taking supplements. Not to mention the fact that we don't necessarily want an overactive immune system, which is associated with allergies and autoimmune diseases.

One thing we need to remember first and foremost in the discussion of supplements is that this is an under-regulated industry. The FDA is not authorized to review dietary supplement products for safety and effectiveness before they are marketed. For this reason I hesitate to recommend supplements at all. Even though I do recommend Vitamin D supplements because studies support the need for additional Vitamin D in most people, I cannot endorse one particular product. Over the years many supplements, homeopathic products and herbs have been reported to have significant variances in amounts of product and unnamed contaminants, including lead and other hazards.

Summaries of supplement and other "natural treatment" effectiveness:

• Probiotics may actually help prevent the number of infections. There are many, many types of probiotics, so further studies are needed on how to choose the best strain.
• Zinc has been shown to help prevent upper respiratory tract infections in children and teens and to decrease the duration of the common cold symptoms. It is best given as a lozenge to help with absorption. Intranasal zinc has been linked to a permanent loss of smell and should not be used. High doses can cause significant side effects, so talk to your doctor and pharmacist before supplementing.
• Nasal saline rinses show benefit in treating symptoms of upper respiratory tract infections. Learn how to do these correctly before trying it though. I often recommend Nasopure products as an unpaid endorsement. They're a local company with a very helpful website. Use their library to learn how to properly use nasal rinses in kids as young as 2 years of age.
• Honey may reduce the frequency of cough and improve the quality of sleep for children with the common cold. Honey should never be used in children younger than 1 year of age because of the risk of botulism.
• Echinacea has consistently been shown to be ineffective in many studies. I know that many people have heard of its benefits, so if you aren't convinced that you shouldn't waste money on it, see the NCCIH's Echinacea page.
• Garlic shows overall low evidence of benefit.
• Vitamin C can shorten the duration of illness mildly with daily supplementation. 
• Chinese herbal medicines do not have high quality studies so effectiveness is unknown.
• Geranium extract (Pelargonium sidoides) has insufficient evidence of benefit for cold and cough symptoms.
• Turmeric's supposed anti-inflammatory properties have not been shown to be effective by research.
• Essential oils have the potential for beneficial effects – but they also have the potential for adverse reactions. Although they are touted as a cure for many ailments, published studies regarding the uses of aromatherapy have generally focused on its psychological effects on stress and anxiety or its use as a topical treatment for skin conditions. Both Young Living and dōTERRA have received warning letters from the FDA about improper marketing and unsubstantiated claims for uses of their oils. While many people think essential oils are safe, they can lead to significant problems. Some people suffer from allergic reactions to oils. They can increase sensitivity to the sun when applied topically. Tea tree oil and lavender have estrogen-like effects and caution should be used with these. Some of these substances can even lead to seizures, liver damage, and death if used improperly. Ingestion of the oils is a growing concern - as more households have them, more children are ingesting them.

Alice Callahan's “Immune-Boosting” Supplements Won’t Protect You from Back-to-School Germs is a great review of many of the supplements touted to prevent or treat illnesses. Her background in nutrition provides a solid base for reviewing claims that many of us don't understand completely. 

Generally supplements are not recommended, but if you choose to use them, use them cautiously.

• Supplements contain a wide variety of ingredients - including vitamins, minerals, amino acids, and herbs. Research has confirmed health benefits of some dietary supplements but not others. The woo can be strong in this area, so be cautious where you get your information. 
• Supplements have been known to include unlisted ingredients and to have inconsistent levels of product. When they are recalled, there is no mechanism in place to identify and notify people who have purchased affected products. 
• Find a reliable source to evaluate effectiveness and risks. Some reports have shown that people who take supplements have higher risks of cancer, liver damage, birth defects, bleeding, and other health problems. When looking for information, use noncommercial sites (National Institutes of Health, Food and Drug Administration, US Department of Agriculture, National Center for Complementary Health) rather than depending on information from sellers.
• Natural does not mean safe. I've always said that I wouldn't give my picky eater marijuana to stimulate his appetite and encourage him to eat. Not even if it was organic. That usually gets the point across. You need to know the risks of a product, even if it's natural. 
• If supplements will be taken, talk to your doctor and pharmacist about drug interactions. Sometimes it's difficult to know the risks because not all ingredients are included on the label and not all ingredients have been well studied, especially in combination with other supplements and medications. 
• Most dietary supplements have not been tested in pregnant women, nursing mothers, or children. Remember just because something's natural doesn't mean it's safe. Arsenic is natural but I wouldn't advise taking it in high doses.
• If something sounds too good to be true, it probably is. There are no miracle cures. Avoid being manipulated by advertising. It's easy to fall prey because we all want to feel better quickly and parents want their kids to be healthy. But if it claims to be 100% effective or to have no side effects, it's probably false advertising. Personal accounts of something working are as likely to be based on bias or coincidence as to be from real benefit. Rely on large clinical studies that have been reproduced by other researchers. Dr. Chad Hayes has a very long, but wonderful post on how many of the integrative medicines are not simply not beneficial but potentially dangerous - Citations Needed: The curious “science” of integrative medicineMy experience at "Get Your Life Back NOW!"

This post isn't about antibiotics, but they don't work against viral illnesses any better than supplements. They don't prevent the development of ear infections or pneumonia, so even if your child seems to always develop these complications, your doctor should not prescribe them preventatively. Don't use antibiotics for routine upper respiratory infections, stomach bugs, and other viral illnesses. 

Do you know what really boosts your immune system?

Vaccines

Complimentary and Alternative Medicine

Complimentary and Alternative Medicine (CAM) means many things to many people, but the truth is  that many people use it to try to help a broad range of ailments without much guidance from their physicians.

Why?  Reasons vary.  Some feel that "natural is better."  Others feel that mainstream medicine is not working.  Many people see CAM as a lifestyle choice.  Some don't have access to (or money for) a doctor visit, and CAM is readily available at many locations.  There are many other reasons that people use CAM.

Is it safe? Is it reliable?  Depends on the CAM.

What is CAM?

CAM includes any form of medical treatment that is not a part of mainstream medicine.  It has gained popularity because it is holistic, and people like the idea of treating the whole person and not simply one condition.  It includes many categories of treatments, including natural products (vitamin supplements, herbal medicines, minerals, and probiotics), homeopathy (diluted substances that would typically cause symptoms used to treat those symptoms), acupuncture and manipulative treatments, Oriental medicine (energy fields), and mind-body medicine.

What are potential problems with CAM?

• Homeopathic medicines and natural products are not regulated by the FDA.

• Some therapies have been shown to be contaminated with heavy metals (such as lead)
• Products have been shown to be inconsistent in the amount of active ingredient from bottle to bottle
• Studies to show the appropriate dose have not been done in most instances 

•  Studies to show effectiveness have not been done in many cases

• Many don't share CAM use with their physicians.  Why?

• Don't want to admit in case doc disagrees

• Don't think about it and aren't asked specifically 

• Don't think it will make a difference

• Many docs don't know how to advise about CAM.

• If parents ask about herbs, spinal manipulation, or other CAM treatments, physicians often don't have the answers.  
• Physicians are taught to advise based on an evidenced based platform.  If studies haven't shown a treatment to benefit, we are less likely to recommend it. For many complementary and alternative medicines studies have not been done to show safety and efficacy.  
• Studies that have been done typically were done in adults, not children.  Children handle medicines and therapies differently than adults, but research is often not done on them. 

• CAM information does not often make news in medical journals and is not typically discussed at conferences, the places at which your physicians learn. 

Do I recommend CAM?


While there are many CAM treatments that I am not comfortable recommending, I often recommend things that are CAM.

The first and foremost form of alternative medicine I recommend to everyone is healthy diet and lifestyle.  This is widely accepted among mainstream medical doctors.  Healthy diet and exercise helps prevent many health problems, treat some health problems, and even helps mental focus and overall mental health.  

I believe there is solid research supporting fish oil, probiotics, and other vitamin supplements.  The American Academy of Pediatrics recommends Vitamin D for all children. 

I think that relaxation techniques, biofeedback, yoga, prayer, and meditation can all be beneficial and I cannot see how they would be detrimental if used properly.  

In the category of manipulative medicine, I have not been trained specifically, but I refer to physical therapists and sometimes chiropractors.  Massage therapy is a growing field, and has been recommended for children with muscle tightness affecting gait and for those with sports injuries.

Other CAM therapies are difficult for me to recommend.

Herbal therapies might be beneficial, but there is also potential risk of interactions with other therapies.  They are not regulated by the FDA and have been known to be contaminated with things such as lead. There also have been reports of the strength of the supplement to vary widely from what is listed on the bottle and non-listed ingredients to be in the supplement.  This can lead to unknown interactions and consequences.

Most studies of CAM therapies have been done on adults.  Children are not little adults.  Therapies such as lifestyle changes are safe, but those with herbal or homeopathic medications might not be.  There simply is not enough scientific data to support the use of these in children.

Studies do show that about 50% of children have used complementary or alternative medicine (higher numbers if you include vitamin supplements).  Unfortunately most of the time the physician is unaware of these treatments.  Many of the kids using these therapies are those with chronic conditions for which there is no traditional medical therapy that manages the condition well.  This means that more research is needed to show if they are safe or effective.  Are they worth the cost? Is there something better? Should physicians recommend them because they do work?

Why would parents use a treatment that isn't proven? They just want to help. Many parents think "natural" is better.

My answer to that: I would never give my kids organic marijuana to stimulate their appetite.  It is natural.  Organic even.   And it does stimulate the appetite, so it might work.  But I know there are risks to marijuana.  We've all heard those because it is a well known (and unfortunately misused) substance.  Many herbs and other treatments aren't as well known.

How to improve the safety of CAM use in your children:

• Discuss any therapy you are using with your health care provider. If you have more than one provider, be sure all know each treatment you are using.
• If you use a CAM provider, be sure to check the education and training of that person.  Are they licensed to practice?  Be sure they have experience with the age group of your child.  (This actually goes for any health care provider you choose!)
• Ask your pharmacist if there are any known interactions with the supplements and medications you are giving your child.  Be sure to list all prescription, over the counter, and supplements given.
• Store all medications, supplements, and vitamins out of reach of children.
• If you notice any ill effects that might be related to CAM or other treatments, be sure to discuss with your provider!

Resources:

AAP News 2008; 29;1
PEDIATRICS Volume 120:1, July 2007
PEDIATRICS Volume 125:2, February 2010
National Center for Complementary and Alternative Medicine (NCCAM)