Your Mother Was Right- you really should eat your brussel sprouts… How nutrition affects your Immune System Victoria Dimitriades, MD Clinical Assistant

Your Mother Was Your Mother Was Right- Right-

you really you really shouldshould eat your brussel eat your brussel sprouts…sprouts…

How nutrition affects your Immune SystemHow nutrition affects your Immune System

Victoria Dimitriades, MD

Clinical Assistant Professor of Pediatrics

Divisions of Allergy/Immunology and Rheumatology

Louisiana State University Health Sciences Center

DisclosuresDisclosuresI have nothing to disclose, other

than my expertise in eating.

B cell Immunity

T cell Immunity

Complement System Phagocyte

s

Mucous Membrane

s

Immune Function

Nutrition-Immunity linkNutrition-Immunity link

Macronutrient deficiency◦ Protein, Calories ◦ Malnutrition is the most common cause of

immune deficiency world-wide

Micronutrient deficiency◦ Elements, Vitamins

Overnutrition◦ Excess of macronutrients

Protein-energy Protein-energy malnutritionmalnutrition

Causes Limited food access Chronic disease Chronic Pain Dental/Feeding issues Medications Severe dieting

HAS Clinical Guidelines 2007

Protein-energy Protein-energy malnutritionmalnutrition Innate Immunity

Impaired phagocyte function

Adaptive Immunity T cells

Decreased numbers and function Increased susceptibility to opportunistic

infections

IronZincCopperSeleniumVitamins

MicronutrientsMicronutrients

Aids in T cell developmentGenerates some “reactive

oxygen species” to kill pathogens

Micronutrients- IronMicronutrients- Iron

Deficiency associated with: Anemia, paleness, fatigue Infections

Immune issues Reduced phagocyte activity Impaired T cell response

Risk of parasite and Candida infections Reduced immunoglobulin levels


Supplementation Recommended: 7-18mg/day


Micronutrients- ZincMicronutrients- Zinc Stimulates T cell production and subtype switching Stimulates complement system Stimulates phagocytes

Reduction in risk of pneumonia Reduction in common cold symptoms Reduction in infectious diarrhea

(world-wide) Antioxidant/Inflammatory Control

Deficiency associated with: Skin lesions, hair loss Loss of taste and smell, diarrhea Infections, poor wound healing

Immune issues Increased susceptibility to infections

(skin and GI system) Impaired phagocytosis Impaired NK cell activity Low T and B cells

Micronutrients- ZincMicronutrients- Zinc

Supplementation Recommended daily

dose: 3-11 mg/day of elemental zinc

Micronutrients- ZincMicronutrients- Zinc

Promotes T and B cell responses◦IL-2 production

Promotes phagocyte function

Micronutrients- CopperMicronutrients- Copper

Deficiency associated with: Neutropenia, anemia Neurologic issues

Immune issues Low white blood cells Reduced T cell responses Reduced phagocyte responses

Neutropenia


Supplementation Recommended: 350-900 mcg/day


Antioxidant effectsPromotes production of limited

reactive oxygen species (ROS) to fight infections

Stimulates general immune responsivenessT and B cell activationCytokine release

Micronutrients- SeleniumMicronutrients- Selenium

Deficiency associated with: More severe effects of viral

infections Muscle aches

Immune issues Loss of antioxidant host defense Decreased white blood cell and NK

cell function


Supplementation Recommended daily: 20-55 g/day


Supports structure and function of mucosal cells of eyes, lungs, gastrointestinal tract

Promotes response to bacterial infections

Affects growth and function of B cells

Affects activation of T cells

Vitamin AVitamin A

Deficiency associated with: Dry eyes, night blindness Diarrhea Respiratory infections Fat malabsorption

Vitamin AVitamin A

Immune issues: Loss of structure/function of cells on

mucosal surfaces Impaired resistance to infections,

especially gastrointestinal Diminished function of innate

immunity Impaired B and T cell responses

Vitamin AVitamin A

Supplementation Recommended: 1000-3000 IU/day

Vitamin AVitamin A

Vitamin BVitamin BB1- thiaminB2- riboflavinB3- niacinB5- pantothenic acidB6- pyridoxineB7- biotinB9- folic acidB12- cyanocobalmin

Vitamin B- allVitamin B- all B1- thiamin

◦ Aid in antibody responses B2- riboflavin

◦ Aid in antibody responses B3- niacin B5- pantothenic acid

◦ Aid in production and release of antibodies B6- pyridoxine

◦ Aids in T and B cell production and maturation B7- biotin B9- folic acid

◦ Aids in T cell production and maturation B12- cyanocobalamin

◦ Promotes NK cell activity, aids in T and B cell production

Vitamin B- allVitamin B- allSupplement

◦Range dependant on each vitamin

Antioxidant effects Protects cells from reactive oxygen species

(ROS) made by the body to control infections May have anti-viral activity

May aid in symptoms of common cold because of ROS function on surface of airway and lung epithelium

Improvement in both innate and adaptive immunity function

Vitamin CVitamin C

Deficiency associated with: Purpura/petechiae Poor wound healing (scurvy)

Immune issues: Impaired collagen synthesis for

barriers Impaired antioxidant performance-

increased free radical production

Vitamin CVitamin C

Supplementation Recommended: 75-90 mg/day

Vitamin CVitamin C

Necessary for phagocytic activityLimits inflammatory response

promoted by specific T cell subtypes

Promotes wound healing

Vitamin DVitamin D

Deficiency associated with: Rickets Autoimmune diseases Diabetes, type I Atopic diseases

Vitamin DVitamin D

Immune issues: B cells

◦ Decreased proliferation◦ Decreased immune globulin production

T cells- Decrease in overall proliferation ◦ TH1 cytokines decreased

◦ TH2 cytokines and T regulatory cells increased

Vitamin DVitamin D

Supplementation Sunlight (5-30 min, 2x per week) Foods- Fish, liver, fortified foods (milk, cheese, OJ) Supplementation

Vitamins Ergocalciferol (D2) or

Cholecalciferol (D3) Recommended: 600-800 IU Replenishment: 1000-4000 IU

Vitamin DVitamin D

Antioxidant◦Protects against cell damage from

free radicals◦Affects innate and adaptive

immunity

Vitamin EVitamin E

Deficiency associated with: Neurologic symptoms Atopic disease

Immune issues: Loss of phagocyte responses T and B cell dysfunction Difficulty controlling viral infections

Vitamin EVitamin E

Supplementation Recommended: 15-30 IU/day

Vitamin EVitamin E

Polyunsaturated fats (PUFA)Eicosapentaenoic acid (EPA) Docosahexaenoic acid (DHA)

Decreased production of inflammatory cytokines

Increased response by white blood cells to control inflammation

Decrease in clotting problems, cholesterol, and triglycerides

Omega-3 Fatty AcidsOmega-3 Fatty Acids

Goal is to achieve a proper ratio of of 1:4

Supplementation Fish (natural ratio)

3.5 oz piece = 1 g of 3 FA Fish oil (contains both)

1-4 g/day

Omega-3/Omega-6 RatioOmega-3/Omega-6 Ratio

GarlicGarlic

Used for both food and medicine for thousands of years

Allicin- exact function unknown ◦Anti-bacterial◦Helps control viruses◦Anti-fungal

Human studies have shown short-term, laboratory effects

Commonly promoted Commonly promoted foodsfoodsGreen tea (Camellia sinensis)Ginger (Zingiber officinale)Purple coneflower (Echinacea) Black cumin (Nigella sativa)Licorice (Glycyrrhiza glabra)St. John's wort (Hypericum

perforatum)

*research sparse in this area*

ProbioticsProbioticsLactobacilli, Bifidobacteria

species Strengthen gut barrier Stimulate production of T cells Stimulate production of antibodies Must be ingested regularly for

effectsFoods with probiotics:

fermentation

Overnutrition and ObesityOvernutrition and ObesityPromotes inflammationPromotion of immune system

stimulation causing autoimmunity

Poor wound healingIncreased susceptibility to

respiratory, gastrointestinal, and liver infections

SummarySummaryThe best way to “boost” you

immune system is to include foods naturally rich in nutrients and vitamins◦“EAT YOUR COLORS”

Oversupplementation can be detrimental:◦Toxicity (Vitamin A)◦Inhibition of phagocytes (zinc, iron,

copper)◦Obesity in relation to food excess

The Brussel Sprout The Brussel Sprout powerhousepowerhouse

Vitamins A, C (more than an orange!), B6, folic acid, iron, selenium

ReferencesReferences

Adams JS and Hewison M. Unexpected actions of vitamin D: new perspectives on the regulation of innate and adaptive immunity. Nature Clinical Practice: Endocrinology and Metabolism 2008. 4(2): 80-90

Bruns H et al. Anti-TNF immunotherapy reduces CD8+ T cell–mediated antimicrobial activity against Mycobacterium tuberculosis in humans . J Clin Invest 2009. 119(5): 1167–1177.

Chasapis C et al. Zinc and human health: an update. Archives of Toxicology 2011. in print

Chinen J and Shearer W. Secondary immunodeficiencies, including HIV infection. J All Clin Immunol. 125(2): S195-203

Cunningham-Rundles S, McNeeley DF, and Moon A. Mechanisms of nutrient modulation of the immune response. J All Clin Immunol 2005. 115(6): 1119-1128

Dorshkind K et al. The ageing immune system: is it ever too old to become young again? Nature Reviews: Immunology 2009. Vol 9: 57-62

Elefteriadis T et al. Basic Science and Dialysis: Disturbances of Acquired Immunity in Hemodialysis Patients. Seminars in Dialysis 2007. 20(5): 440-451

Fairweather-Tait S. Selenium in Human Health and Disease. Antioxidants and Redox signalling 2011. 14(7): 1337-1383

Geerlings S and Hoelpelman A. Immune dysfunction in patients with Diabetes Mellitus. FEMS Immunology and Medical Microbiology 1999. 26: 259-265

Gomez C et al. Innate immunity and aging. Experimental Gerontology 2008. Vol 43: 718-728

Haute Autorite de Sante. Nutritional Support Strategy in protein-energy malnutrition in the elderly. HAS Clinical guildelines 2007.

ReferencesReferences

Jawad A et al. A Prospective Study of Influenza Vaccination and a Comparison of Immunologic Parameters in Children and Adults with Chromosome 22q11.2 Deletion Syndrome (DiGeorge Syndrome/Velocardiofacial Syndrome). Journal of Clinical Immunology 2011. August e-pub

Kaufman D et al. Vitamin D deficiency impairs vaccine-ellicited gastrointestinal immunity. Journal of Immunology 2011. 187:1877-1883

Kumar V et al. Nutritional Diseases. Robbins and Cotran Pathologic Basis of Disease 2009. Le T et al. Acquired Immunodeficiencies. ACAAI Review for the Allergy and Immunology

Boards 2010. 310-318 Maggini S et al. Essential Role of Vitamin C and Zinc in Child Immunity and Health. The

Journal of International Medical Research 2010. 38:386-414 McPherson R and Pincus M. Clinical Criteria for Evaluation of Cellular Immunity:

Implications for Interpretation. Henry's Clinical Diagnosis and Management by Laboratory Methods 2006.

Mocchegiani E, Costarelli L, Giacconi R et al. Micronutrient-gene interactions related to inflammatory/immune response and antioxidant activity in ageing and inflammation. A systematic review. Mech Ageing Dev 2014. 136-137:29-49

Percival SS. Copper and immunity. Am J Clin Nutr 1998.67(5 Suppl):1064S-1068S. Siegrist CA and Aspinall R. B-cell responses to vaccination at the extremes of age. Nature

Reviews: Immunology 2009. Vol 9:185-194 Simopoulos A. Omega-3 Fatty Acids in Inflammation and Autoimmune Diseases. J Am Coll

Nutr 2002. vol. 21 no. 6 495-505 Weinberger B. Biology of Immune Responses to Vaccines in Elderly Persons. Clinical

Infectious Diseases 2008. 46:1078-84 Wu D and Meydani SN. Age-associated changes in immune and inflammatory response:

impact of Vitamin E intervention. Journal of Leukocyte Biology 2008. vol. 84 no. 4 900-914

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Your Mother Was Right- you really should eat your brussel sprouts… How nutrition affects your Immune System Victoria Dimitriades, MD Clinical Assistant