Immune Boosting Foods – Lessons from a Dietitian on the Front Lines

Allison Pingel is a registered dietitian working with the Moffit Cancer Center to provide patients with the nutritional knowledge they need to stay healthy. As we know, COVID-19 is a severe threat to those individuals with an impaired immune system. Allison talks about building a strong immune system by eating correctly on a consistent basis.

The construction of this strong immune response does not occur overnight but occurs over time when you give your body the correct nutrients. She is quick to point out that there are no scientific studies that document or prove that vitamin supplements are a good substitute for foods which provide these building blocks naturally. “Fruits and vegetables are a more economical and nutritious way to obtain your necessary vitamins and minerals as well as other nutrients that are helpful including fiber.”

“Foods high in Vitamins A, C D, E and zinc support the immune system.” She cites broccoli, berries, garlic, ginger and spinach as products containing high amounts of these vitamins which assist the body in fighting infections. She encourages yogurt and nuts as plentiful sources of probiotics and zinc, which she considers essential for building a strong immune system. Additionally, she is a strong advocate of fruits and vegetables. One and a half cups to two cups of fruit per day, plus 2-3 cups of vegetables per day, are helpful for building a strong immune response.

While eating correctly to build your immune system is essential, so is some regular exercise and activities that are social and put you in touch with others in a safe manner. As spring descends on our country, it’s a fine time to take a walk or ride a bike and say hello to your friends and neighbors from a safe distance. Just make sure you adhere to your community’s stay-at-home restrictions.

The COVID-19 pandemic is frightening but with healthy eating, regular exercise and safe social interaction we will prevail and come out of this crisis stronger.

The Calcium – Vitamin D Supplementation Picture Gets More Confusing

As a geriatrician who believes strongly in prevention, my perspective is that the recent high volume of research on healthy aging, chronic disease and its association with Vitamin D and Calcium supplementation has done nothing but confuse the picture for us all. I have always been an advocate of healthy eating – a balanced diet that is prepared in a manner that retains and promotes the absorption of the foods nutrients. Also, I have supported the recommendations of blue ribbon panels to supplement the diets of women of child bearing age, peri-menopausal women and post menopausal women with 1200- 1500 mg of calcium per day in addition to dietary calcium to promote healthy bones.

I have read extensively about the lower measured values of Vitamin D in men and women who are ill and have many different types of acute and chronic diseases. I have not truly accepted the idea that raising their measured serum level of Vitamin D with pill supplements did anything to improve the disease state even if we did raise the measured serum Vitamin D level. I have been amazed by experts in Europe and Asia and in the World Health Organization setting a normal lower value of measured Vitamin D level at 20 while in the USA it is 28.  I am not convinced that healthy adults with healthy kidneys cannot get adequate Vitamin D levels by 10 minutes of sun exposure a few times per week in increments which will not dramatically increase the risk of lethal skin cancers.

This was made all the more confusing by the United States Preventive Services Task Force suggesting  that Vitamin D supplements reduce the risk for older people prone to falls and this month announcing that “there is no value for postmenopausal women using supplements up to 400 IU of Vitamin D and 1000 mg of calcium daily.”  This latest ruling was based on data which showed that at 400 IU of Vitamin D and 1000 mg of Calcium daily there was no effect on the incidence of osteoporotic fractures.

Much of the data used to reach this conclusion came from the Women’s Health Initiative Studies of more than 36,000 postmenopausal women.  The USPTF noted that at this dose of Vitamin D and Calcium there was a clear increase in kidney stones which they considered a harmful effect.  At the same time as this data was being discussed, the impartial Institute of Medicine (IOM) presented suggestions and data that Vitamin D at 600 IU daily plus 1200 mg of calcium per day prevented fractures in postmenopausal women.

For my postmenopausal patients I will continue to suggest they supplement their diets with 1200 mg of calcium per day as per the IOM suggestions unless they are prone to kidney stones. They will need to stay well hydrated while I ask them to take a daily 30 minute walk exposing their arms and legs to the sun for at least 10 minutes to allow their healthy kidneys to manufacture Vitamin D.

American Diabetes Association: Fish Oils Do Not Reduce Cardiovascular Event Risk

The American College of Cardiology now recommends that individuals take “fish oil” supplements in pill form to prevent coronary artery and vascular disease. The scientist who discovered that fish oils may have beneficial effects has publically come out and let it be known that he feels differently on the subject. While he once advocated eating two fleshy cold water fish meals a week to gain some degree of protection, he has most recently reduced that requirement to two meals a month. He has additionally scolded the nutritional supplement community for the promotion of fish oils in pill form when it can be safely and effectively obtained by eating a few cans of tuna fish or salmon per month.

Recently, at the annual meeting of the American Diabetes Association, Jackie Bosch, MSc, from McMaster University and Hamilton Health Sciences in Hamilton, Ontario presented data that suggested that fish oils did not reduce cardiovascular deaths or events.  The data was abstracted from the ongoing ORIGIN (Outcome Reduction with Initial Glargine Intervention) study of 12,536 patients with type 2 diabetes, impaired fasting glucose levels or impaired glucose tolerance. These study participants were composed of 65% men with a mean study age of 64 years who were followed for over six years. The study group received one gram daily of n-3-fatty acids.

The data showed that fish oils did not make a difference in the number of fatal or non-fatal heart attacks, fatal and non-fatal strokes, hospitalizations for heart failure, revascularization procedure numbers, and loss of a limb or digit due to poor circulation for any cardiovascular cause. The study additionally showed that the use of a long-acting insulin Glargine had no detrimental or beneficial effects on cardiovascular disease.  The story was covered and summarized in the online periodical of the University of Pennsylvania Medical School, MedPage.  Interestingly, the placebo group received one gram per day of olive oil.

Clearly this is another indictment against taking pills instead of acquiring nutrients in a well prepared balanced diet that includes cold water fleshy fish weekly.  Upon reading the study, I wondered if the use of olive oil by the placebo group was cardio-protective and fish oils were just no more cardio-protective than olive oil?  Once again, further research is needed. While the research is ongoing, eating cold water fleshy fish once a week as part of a nutritionally sound, well prepared diet rather than taking fish oil pills seems to make sense.