MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

The spread of misinformation has accompanied the coronavirus pandemic, including topics such as immune boosting to prevent COVID-19. This study explores how immune boosting is portrayed on the internet during the COVID-19 pandemic. The researchers compiled a dataset of 227 webpages from Google searches in Canada and the USA using the phrase ‘boost immunity’ AND ‘coronavirus’ on 1 April 2020. They coded webpages for typology and portrayal of immune boosting and supplements. They recorded mentions of microbiome, whether the webpage was selling or advertising an immune boosting product or service, and suggested strategies for boosting immunity.

No significant differences were found between webpages that appeared in the searches in Canada and the USA. The most common types of webpages were from:

  • news (40.5%),
  • commercial (24.7%) websites.

The concept of immune boosting was portrayed as beneficial for avoiding COVID-19 in 85.5% of webpages and supplements were portrayed as beneficial in 40% of the webpages, but commercial sites were more likely to have these portrayals. The top immune boosting strategies were:

  • vitamin C (34.8%),
  • diet (34.4%),
  • sleep (34.4%),
  • exercise (30.8%),
  • zinc (26.9%).

Less than 10% of the webpages provide any critique of the concept of immune boosting.

The authors concluded that pairing evidence-based advice for maintaining one’s health (eg, healthy diet, exercise, sleep) with the phrase immune boosting and strategies lacking in evidence may inadvertently help to legitimise the concept, making it a powerful marketing tool. Results demonstrate how the spread of misinformation is complex and often more subtle than blatant fraudulent claims.

The authors did not search for evidence to check whether any of the named interventions have any influence on the immune system. As reported previously, this review did just that. Its authors aimed to evaluate evidence from clinical trials that studied nutrition-based interventions for viral diseases (with special emphasis on respiratory infections). Studies were considered eligible if they were controlled trials in humans, measuring immunological parameters, on viral and respiratory infections. Clinical trials on vitamins, minerals, nutraceuticals and probiotics were included.

A total 43 studies met the inclusion criteria:

  • vitamins: 13;
  • minerals: 8;
  • nutraceuticals: 18
  • probiotics: 4

Among vitamins, A and D showed a potential benefit, especially in deficient populations. Among trace elements, selenium and zinc have also shown favourable immune-modulatory effects in viral respiratory infections. Several nutraceuticals and probiotics may also have some role in enhancing immune functions. Micronutrients may be beneficial in nutritionally depleted elderly population.

There were 15 studies with a high score for methodological quality. Here is what their results showed:

  1. No significant difference in incidence of winter-time upper respiratory tract infection in children with high versus low dose vitamin D.
  2. Significantly less acute respiratory infections in elderly individuals with vitamin D versus placebo.
  3. Higher TGFbeta plasma level in response to influenza vaccination but no improved antibody response in elderly, vitamin D-deficient individuals with vitamin D versus placebo.
  4. No effect on lower respiratory tract infections; however, a protective effect was noted on upper respiratory tract infections in elderly individuals with vitamin E versus placebo.
  5. Neither daily multivitamin + mineral supplementation at physiological dose nor 200 mg of vitamin E showed a favourable effect on incidence and severity of acute respiratory tract infections in well-nourished, non- institutionalized elderly individuals.
  6. Better improvement in the clinical status, respiratory rate and oxygen saturation in children suffering from pneumonia with zinc sulphate versus placebo.
  7. Selenium-yeast increased Tctx-antibody-dependent cellular cytotoxicity cell counts in blood before flu vaccination + dose-dependent increase in T cell proliferation, IL-8 and IL-10 secretion after in vivo flu challenge in healthy volunteers.
  8. Frequency and duration of acute respiratory infections during the first two months was unaffected in healthy elderly with ginseng versus placebo.
  9. Broccoli sprout homogenate favourably affected immunological variables in healthy volunteers.
  10. The incidence of illness was not reduced, however significantly fewer symptoms were reported and the proliferation index of gd-T cells in culture was almost five times higher after 10 weeks of cranberry polyphenol supplements versus placebo.
  11. Higher antibody titres against all 3 strains contained in the seasonal influenza virus vaccine than the placebo in healthy elderly individuals with a sea-weed extract versus placebo.
  12. Non-inferiority was demonstrated for Echinacea compared to oseltamivir in early treatment of clinically diagnosed and virologically confirmed influenza virus infections.
  13. Significant reduction of cold duration and severity in air travellers with elderberry supplement versus placebo.
  14. Increased NK cell activity with probiotics versus placebo in tube-fed elderly patients.
  15. Titres against the influenza B strain increased significantly more with probiotics compared to placebo in healthy elderly individuals.

 

3 Responses to Misinformation and fraudulent claims about boosting immunity during the pandemic

  • Summary from a published trial:
    ABSTRACT Background: To our knowledge, no rigorously designed clinical trials have evaluated the relation between vitamin D and physician-diagnosed seasonal influenza.
    Objective: We investigated the effect of vitamin D supplements on the incidence of seasonal influenza A in schoolchildren.
    Design: From December 2008 through March 2009, we conducted a randomized, double-blind, placebo-controlled trial comparing vitamin D3 supplements (1200 IU/d) with placebo in schoolchildren.The primary outcome was the incidence of influenza A, diagnosed with influenza antigen testing with a nasopharyngeal swab specimen.
    Results: Influenza A occurred in 18 of 167 (10.8%) children in the vitamin D3 group compared with 31 of 167 (18.6%) children in the placebo group [relative risk (RR), 0.58; 95% CI: 0.34, 0.99; P=0.04]. The reduction in influenza A was more prominent in children who had not been taking other vitamin D supplements (RR: 0.36;95% CI: 0.17, 0.79; P= 0.006) and who started nursery school after age 3 y (RR: 0.36; 95% CI: 0.17, 0.78; P= 0.005). In children with a previous diagnosis of asthma, asthma attacks as a secondary out-come occurred in 2 children receiving vitamin D3 compared with 12 children receiving placebo (RR: 0.17; 95% CI: 0.04, 0.73;P= 0.006).
    CONCLUSION:
    This study suggests that vitamin D3 supplementation during the winter may reduce the incidence of influenza A, especially in specific subgroups of schoolchildren. This trial was registered at https://center.umin.ac.jp as UMIN000001373. Am J Clin Nutr doi: 10.3945/ajcn.2009.29094
    TAKE-HOME MESSAGE:
    We recommend Vitamin D3/K2-MK7 as a beneficial Liposome oral supplement – ignore some medics who warn that anything over 1,000 IU’s of D3 a day as being toxic to the body. Vitamin D as you all know is NOT a regular vitamin. It is a multi-tasking, neuroregulatory steroidal hormone that assists both the innate and adaptive immune system when the body is subjected to invading pathogens.
    If anyone has evidence that contradicts the above, I would like to know about it.

    • Mike,

      CONCLUSION:
      This study suggests that vitamin D3 supplementation during the winter may reduce the incidence of influenza A, especially in specific subgroups of schoolchildren.

      My concern here is the subgroup analysis. This is notoriously prone to generating spurious correlations, a fact which escapes a surprising number of researchers and indeed doctors.

      Vitamin D as you all know is NOT a regular vitamin. It is a multi-tasking, neuroregulatory steroidal hormone that assists both the innate and adaptive immune system when the body is subjected to invading pathogens.

      By definition this is not true. Hormones are secreted by endocrine glands (and are subject to multiple feedback systems) whereas vitamins are essential nutrients. The can be related; for instance the hormone thyroxine contains iodine and its synthesis is affected by iodine deficiency.

      Also, although the structure of vitamin D is related to the structure of steroids, it is not a steroid itself.

      The questions that we are really wanting to answer are:

      1. Is there a nutritional requirement for vitamin D over and above the level necessary for normal calcium metabolism?

      2. Does vitamin D have any pharmacological effects beyond that of being an essential nutrient?

      These are such important questions that we need proper trials, designed and conducted by researchers who have an adequate understanding of statistics.

      We recommend Vitamin D3/K2-MK7 as a beneficial Liposome oral supplement

      That sounds both expensive and rather different from any natural form of vitamin D. Have there been any trials with this psecific preparation?

      ignore some medics who warn that anything over 1,000 IU’s of D3 a day as being toxic to the body

      I think the toxic dose of vitamin D is a bit higher than that, though I don’t know how the bioavailability is affected by the liposomal preparation that you are recommending (selling?). However, excessive vitamin D is certainly toxic, and the resulting disruption of calcium metabolism can have serious consequences.

  • ABSTRACT Background: To our knowledge, no rigorously designed clinical trials have evaluated the relation between vitamin D and physician-diagnosed seasonal influenza.Objective: We investigated the effect of vitamin D supplements on the incidence of seasonal influenza A in schoolchildren.Design: From December 2008 through March 2009, we conducted a randomized, double-blind, placebo-controlled trial comparing vitamin D3 supplements (1200 IU/d) with placebo in schoolchildren.The primary outcome was the incidence of influenza A, diagnosed with influenza antigen testing with a nasopharyngeal swab specimen. Results: Influenza A occurred in 18 of 167 (10.8%) children in the vitamin D3 group compared with 31 of 167 (18.6%) children in the placebo group [relative risk (RR), 0.58; 95% CI: 0.34, 0.99; P=0.04]. The reduction in influenza A was more prominent in children who had not been taking other vitamin D supplements (RR: 0.36;95% CI: 0.17, 0.79; P= 0.006) and who started nursery school after age 3 y (RR: 0.36; 95% CI: 0.17, 0.78; P= 0.005). In children with a previous diagnosis of asthma, asthma attacks as a secondary out-come occurred in 2 children receiving vitamin D3 compared with 12 children receiving placebo (RR: 0.17; 95% CI: 0.04, 0.73;P= 0.006).Conclusion: This study suggests that vitamin D3 supplementation during the winter may reduce the incidence of influenza A, especially in specific subgroups of schoolchildren. This trial was registered at https://center.umin.ac.jp as UMIN000001373. Am JClin Nutr doi: 10.3945/ajcn.2009.29094

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