Evidence Based Nutritional Strategies For Optimal Mucosal Health

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The World Health Organisation declared the first flu pandemic in 41 years on 11 June. As details of the global impact of the 2009 influenza A (H1N1) virus — and efforts to combat the threat — continues to unfold, Clinical Education provides evidence based nutritional strategies for optimising the mucosal barrier of prevention.

man sneezing

The UK has decided that it cannot contain swine flu, and has moved its health service onto a treatment footing instead.

Health minister Andy Burnham told the House of Commons that over the last week there was a “considerable rise” in H1N1 with several hundred new cases every day.

“Cases are doubling every week, and on this trend we could see more than 100,000 cases per day by the end of August—although I stress that that is only a projection,” he said. “As cases continue to rise, we have reached the next step in our management of the disease.”

Nine per cent of the workforce will be sick by the end of August, say the latest official forecasts, and up to 12 per cent in September, when the peak of the first wave of the swine flu pandemic in the UK is expected

Our review document explores the science behind the bodies natural antiviral defences and describes evidence-based nutritional strategies to optimise them.

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Antibodies (Y shaped) are part of the innate and adaptive immune response. In the first stage of exposure to a virus non specific or natural(n) nSIgA and nIgM antibodies will bind to a virus in the respiratory and gastrointestinal tract. They work to exclude the virus and also to provide identification for destruction. This immediate defence is also dependent on the presence of mucins, a collected group of glycoproteins that help to entrap the influenza virus for removal and also offer dummy binding sites (sialic acid ligands), to keep the virus away from the surface cells required for its replication. One of the proposed actions of certain probiotics is the increase of mucins in the gastrointestinal and respiratory tracts.

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How Do We Judge The Evidence For ‘Mucosal Immune Support’?

In recent years a hierarchy of the quality of evidence in medicine has been increasingly promoted, particularly for the formulation of guidelines. Hierarchies place randomised controlled trials (RCTs) at their summit, with various forms of observational studies nestling in the foothills, but information from observational studies and other foothill inhabitants (experimental investigations, analogy with similar conditions and processes, pathological, immunological, biochemical and pharmacological understanding and reasoning, and a derived assessment of risks and benefits) is also valuable.[i]

It is likely that innate host defense mechanisms play an important role in defense against novel strains associated with antigenic drift or shift. These defense mechanisms may play a greater role in more vulnerable subjects (e.g., those who are immunocompromised in other ways).

The currently available influenza anti-virals have a number of limitations. There is limited data on the use of anti-virals in vulnerable populations or in severe disease. Manufacturing of the antiviral products is complex, multiple doses are often required, and there are no licensed parenteral agents. Importantly, resistance has been observed to the licensed products.

On this basis, making use of food concentrates, probiotics, yeasts, and milk concentrates as a safe means of optimising innate antiviral defences is  low risk and potentially of significant benefit.

[i] Rawlins M (2009) De testimonio: On the evidence for decisions about the use of therapeutic interventions. Lancet 372: 2152–2161.

Additional Resources

Hygiene Recommendations

In areas with confirmed human cases of novel influenza A (H1N1) virus infection, the risk for infection can be reduced through a combination of actions. No single action will provide complete protection, but an approach combining the following steps can help decrease the likelihood of transmission. These recommended actions are:

  • Wash hands frequently with soap and water or use alcohol-based hand cleaner when soap and water are not available.
  • Cover your mouth and nose with a tissue when coughing or sneezing.
  • Avoid touching your eyes, nose and mouth
  • People who are sick with an influenza-like illness (ILI) (fever plus at least cough or sore throat and possibly other symptoms like runny nose, body aches, headaches, chills, fatigue, vomiting and diarrhoea) should stay home and minimise contact with others, including avoiding travel, for 7 days after their symptoms begin or until they have been symptom-free for 24 hours, whichever is longer.
  • Avoid close contact (i.e. being within about 6 feet) with persons with ILI.

Ill people should be placed in well ventilated areas when possible and placed in areas where at least 6 feet distance can be maintained between the ill person and other well and ill people.  Selected references:  a) Blumenfeld HL, et al.  J Clin Invest 1959;38:199-212.  b) Bridges CB, et al.  Clin Infect Dis 2003;37:1094-1101. c) Foster MG and Cookson AH.  Lancet 1918 (Nov. 2): 588-90. d) Gregg MB.  Ann NY Acad Sci 1980;353:45-53. e) WHO.  Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care.  June 2007.

Pandemic only means that a new virus is spreading across the world. It does not define its level of physical danger. That level of severity, according to The World Health Organization, is currently defined as “moderate.” And they go on to say:

“On present evidence, the overwhelming majority of patients experience mild symptoms and make a rapid and full recovery, often in the absence of any form of medical treatment.

Worldwide, the number of deaths is small. Each and every one of these deaths is tragic, and we have to brace ourselves to see more. However, we do not expect to see a sudden and dramatic jump in the number of severe or fatal infections.”

Pregnancy – What to do:

conditions treated - pregnancyHuman infections with a novel influenza A (H1N1) virus that is easily transmissible among humans were first identified in April 2009. Severe illnesses among pregnant woman and infants have been reported in this outbreak although the epidemiology and spectrum of illness among pregnant woman and infants are not fully understood at this time and are under investigation.

One of the more well-studied adverse effects of influenza is its associated hyperthermia. Studies have shown that maternal hyperthermia during the first trimester doubles the risk of neural tube defects and may be associated with other birth defects and adverse outcomes. Limited data suggest that the risk for birth defects associated with fever might be mitigated by antipyretic medications and/or multivitamins that contain folic acid.

Nutrient Mucosal Support for Innate Immune Defence:

The nutrients, colostrum, laktoferrin, yeast, and probiotics described in the mucosal support programme are not contraindicated in pregnancy and may be used as described. Vit D at 5000iu per day has been recommended as a minimum dose for pregnant women as it has a number of additional proposed health benefits for the mother and foetus.

Face Mask Recommendations

Setting Recommendation
Home (when sharing common spaces with other household members) Facemask preferred, if available and tolerable, or tissue to cover cough/sneeze
Health care settings (when outside of patient room) Facemask, if tolerable
Non-health care setting Facemask preferred, if available and tolerable, or tissue to cover cough/sneeze
Breastfeeding Facemask preferred, if available and tolerable, or tissue to cover cough/sneeze
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5 Comments. Leave new

  • joanna habberley
    July 21, 2009 7:17 pm

    What shoudl I do if I don’t have any significant IgA? (This has been tested on several occasions by consultants/ labs)?

    • Serum IgA deficiency is a common immune deficiency (est: 1 in 500 [1]). Low serum IgA, however, is a useful marker of secretory IgA deficiency which almost invariably accompanies it. SIgA deficiency can also occur independent of Serum IgA deficiency.
      Improving mucosal immune health includes the optimisation of other natural antiviral mechanisms, such as defensins, collectins, mucins, sIgM and cathelicidins amongst others. The use of saccharomyces Boulardii, colostrum and Vitamin D will work synergistically to optimise these elements amongst others, even if you are unable to express additional SIgA due to a genetic mechanism error. Adults produce 3 to 4 g of secretory IgA per day. This form of IgA occurs selectively in saliva, colostrum, and other fluids. It is synthesised by plasma cells underlying mucosal surfaces and then transported across the epithelium.
      As you will know people with this genetic error are at greater risk of upper respiratory and gastrointestinal infection compared to equivalent populations with IgA, as such, supporting alternative mechanisms of mucosal defence (to SIgA) are of greater importance.

      Of note, selective IgA deficiency can complicate the diagnosis of one other condition, coeliac disease, as the deficiency masks the high levels of certain IgA antibodies usually seen in coeliac disease.

      [1] Hianson LA, Bjorkainder J, Oxelius V-A. Selective IgA deficiency. In Primary and secondary immuno-deficienicy’ disorders: Chaindria RK. cd. . Edinburgh: Churchill Livingstone, 1983: 62-84.

  • My daughter, aged 5 had one episode of vomiting and 24 hours later had multiple aches and pains (“everywhere but my feet hurt”). Her temperature was a little high and was still on the increase. She had no signs of repeated gastric disturbance or cold symptoms. I called the GP surgery where she was diagnosed with swine flu via triage nurse. She was immediately prescribed Tamiflu. The deciding factor had been her temperature rising over a 90 minute period from 36 to 39.2.

    The fact that Tamiflu hadn’t been tested on substantive numbers of children (as might be seen in a pandemic) was a really worrying aspect. I called Nutri-Link and was sent the programme for both the patient and the preventative treatment for other members of the household: the Cytolog (colostrum) spray which my daughter thought tasted nice (helpful when giving to children), Bio D Mulsion and Sacharomyces Boulardii.

    Immediately my daughter’s temperature started to normalise and she slept well throughout that night. The following day (technically day 3 although we hadn’t connected the initial vomiting), she was still taking the programme, no longer had a temperature, was using a bed as a trampoline and other than looking a little peaky and not quite up to eating normally was springing back very well. Her temperature fluctuates but at much lower variations. She is still quarantined, as are we all. We didn’t even need to use Calpol as the combination of the programme and cold flannels seemed to keep everything under control and comfortable. Now all we are waiting to see is if the preventative treatment is as good. Fingers crossed – I’m still not demonstrating any symptoms and nor is my young ‘immune compromised’ son!

    • Whilst an anecdotal report, it does present some interesting and clinically relevant experiences. The rapid resolution of the fever, and the associated recovery in terms of energy and well being are just the results anyone would like. The immune system is the victor here, we have a remarkable ability to defend against almost all pathogens and by supporting the natural innate and adaptive immune responses there is a good chance of a similarly positive outcome in other cases. Other success or failures for discussion are welcome.

  • As a final follow-up to my daughter’s swine flu experience I thought I would add that her symptoms (mainly high temperature and not eating) did continue for approx. 9 days. She acquired a cough for one week but was not serious. Overall our experience has been positive. The rest of the family did not contract swine flu and we all continue to take our spray and formula.


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