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lowers the incidence of recurring viral respiratory infection. They found that women who were randomly
infections. Vitamin and mineral content of the diet may assigned to receive multivitamin supplementation were
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play an important role in reducing the risk to hepatitis C less likely to have progression to advanced stages of HIV
viral infection. Plant foods that contain phytochemicals disease. These women were found to have better
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such as flavonoids have been found to improve immune preservation of CD4+ T cell counts and lower viral loads.
resistance to viral infection. Finally, probiotics that help They also had lower HIV-associated illness and mortality.
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support a healthy intestinal microbiome have been Interestingly, it was found that vitamin A appeared to
reported to enhance the antiviral effects of vaccination in reduce the effect of the other multivitamins, and vitamin
elderly patients, which demonstrates the important role A alone had some negative outcomes. In a companion
the microbiome has in immune function. editorial commenting on the study, Barbara Marston, MD
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A deeper look at individual nutrients is revealing. and Kevin M De Cock, MD stated the following: “Although
Numerous studies spanning 30 years have demonstrated definitive policy recommendations concerning
the anti-viral influence of vitamin C and its importance in multivitamin supplementation must await the appropriate
reducing the risk and severity of infections. 13,14 Significantly, evidence (ideally from a large, simple trial in a population
the resistance to viral infections that is linked to vitamin C with access to antiretroviral drugs), individual treatment
has been demonstrated in children as well adults. Vitamin programs and clinicians would be justified in routinely
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C use that exceeds dietary intake has also been shown to prescribing this nutritional support, since it may provide a
be valuable in improving immune response to viral benefit and does no harm.”
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infection. 16 In the context of the many studies demonstrating that
It is well established that vitamin A also has a very lifestyle, dietary, and environmental factors play important
important role in promoting proper immune function in roles in improving immune defense capability, do we give
response to viral exposure. Supplemental vitamin A use these variables enough consideration when analyzing why
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needs to be monitored because excessive, long-term intake some people contract a viral illness when exposed while
of this nutrient, which is stored in the liver, can cause others do not? COVID-19 is certainly not the last
damage. Zinc is an important mineral that works alongside pandemic the world will face. In truth, it represents a
vitamin A in influencing immune function. There are unique opportunity for us to seriously examine modifiable
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numerous studies demonstrating a synergistic relationship factors that may influence both the infectivity and
between zinc and vitamin A. Daily intakes that support pathogenicity of viral infections. To do this we must
immune function are 10-30 mg of zinc along with 2500 IU expand our thinking beyond the traditional public health
of vitamin A. Another nutritional trace mineral of model for the prevention of viral infection. A more
importance in supporting immune function is selenium. panoramic view would include personally modifiable
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Daily intake of selenium in the range of 50-100 mcg is biological factors that decrease the susceptibility to viral
considered important, but—like vitamin A—it should not infections and the reduction in their virulence by the
be consumed in high amounts due to potential toxicity. improvement in immune response, and a greater emergent
Lastly, vitamin D has also been identified to be a very understanding of immune mechanisms by these variables
important nutrient for the support of immune function. to help reduce the number of serious cases of infection. In
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Vitamin D is often called the “sun vitamin” because it can turn, the burden on the disease care system, which can be
be synthesized in the skin upon exposure to full spectrum strained to capacity during a pandemic event, would be
sunlight. With cold and flu more prevalent during winter reduced. Active application of the principles that underlie
months, it has been suggested that this may be due to a personalized lifestyle health care, as described in an article
lower level of sun exposure at that time of year, and I authored with my colleague Deanna Minich, PhD, in
therefore reduced vitamin D production. Daily intake of 2013, and a focus on the modifiable biological factors
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vitamin D in the range of 800-2000 IU is considered safe associated with immune defense to viral infection creates
and supports many functions, including bone formation a significant opportunity to reduce both morbidity and
as well as immune function. mortality associated with viral crises. This was a lesson
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In 2005, the Institute for Functional Medicine was we learned in the 1980s with HIV/AIDS, and this is an
privileged to host a presentation by Wafaie W Fawzi, PhD, important lesson to relearn as the battle to contain and
MB, BS, from the Department of Nutrition, Harvard School mitigate COVID-19 approaches new levels of global
of Public Health. Dr. Fawzi and his research group had uncertainty and concern.
published a landmark paper in the July 7, 2004 issue of the
New England Journal of Medicine that was titled “A References
Randomized Trial of Multivitamin Supplements and HIV 1. Fauci AS, Morens DM. The perpetual challenge of infectious diseases. N Engl
J Med. 2012 Feb 2;366(5):454-61.
Disease Progression and Mortality.” For this study, the 2. Practice Paper of the American Academy of Nutrition and Dietectics:
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investigators compared supplementation consisting of Nutrition Intervention and Human Immunodeficiency Virus Infection. J
Acad Nutr Diet. 2018 March; 118(3):486-98.
multivitamins alone, vitamin A alone, or both with 3. Young JS. HIV and Medical Nutrition Therapy. J Am Diet Assoc. 1997
placebo in women in Tanzania, Africa who had HIV October; 97 (10 Suppl 2):S161-66.

10 Integrative Medicine • Vol. 19, No. 2 • April 2020 Bland—Creating Synthesis