By Anne Marie Mingiardi
The elderly, and residents of care homes should consider supplementing their diet with Vitamin D and Vitamin C because of the absence of sun exposure and poor nutritional status in this population. In addition, it is recommended that healthcare providers and hospital staff, who have increased risk of exposure to SARS-CoV-2, be provided with nutritional supplements to enhance their resistance to infection and inflammation.
Many people are looking for guidance on maintaining health and good nutrition. We could start with the fundamentals, like hand-washing, an extremely effective way to lower your chances of getting sick – from almost any infectious disease. But it is likely most readers have already incorporated the Public Health advice that has been widely publicized. During my medical career, I discovered the benefits of incorporating nutrition science into my approach with patients. More recently I joined a group of doctors who support the practice, education, and research of a healing and prevention-based healthcare system. The Canadian Integrative Medicine Association (CIMA) recently published suggestions on staying healthy during the current pandemic. (www.cimadoctors.ca).
A look at three seniors
Here I profile 3 people who are all in their late 80’s and living in the community as examples. I hope to demonstrate that there are practical ways to support the immune system that you will actually undertake.
Patient A is someone who grew up on a farm and has always had a love of good food. “A” eats a variety of vegetables and cooks in a Mediterranean “slow food” style. This is in line with Health Canada’s suggestions for healthy eating during the pandemic. Eating fewer processed foods and avoiding fried foods also helps to limit the ingestion of toxic chemicals. I would advise checking the Environmental Working Group (EWG) website for the Dirty Dozen list (grocery produce that has been tested for the highest pesticide residue). If possible, choose organic options as opposed to conventionally grown foods from this list. “A” walks regularly, which is good for the immune system, but he does so indoors. My next suggestion for him is to get short amounts of mid-day sun and take supplemental Vitamin D, which cannot be adequately supplied
by foods. Advances in basic science from the last 20 years reveal that Vitamin D is not just for bone health. Many immune system cells have receptors for this “pro-hormone,” and it is involved in hundreds of different immune functions.
In contrast to Health Canada’s position that “most Canadians have adequate vitamin D status,” CIMA collected evidence from surveys where Vitamin D status was assessed with a blood test. People with more pigmented skin, those who spend most of their time indoors, people with obesity and seniors are at higher risk for Vitamin D deficiency or insufficiency. In Canada, we don’t get as much sun as we need to produce adequate vitamin D. Furthermore, the skin’s ability to make vitamin D decreases as we age. There are very few food sources of vitamin D, (cod liver oil, sockeye salmon and mackerel are best), therefore Osteoporosis Canada recommends routine vitamin D supplementation for Canadian adults year-round.
Patient B is another independently living senior. She has less interest in cooking and often favours processed foods. She maintains a socially vibrant life with a good network of friends. Recently a neighbour told her about a group making blankets for children in the hospital, so she dusted off her knitting skills. Social interaction induces the brain to produce endorphins which latch onto our immune cells making them better at fighting bacteria and viruses. Volunteering and giving is good for your mental health and immune system health! “B” is interested in taking natural supplements and has added Vitamin C and D supplements to her regimen. Other essentials for the immune system are zinc, selenium and magnesium. Foods rich in zinc include oysters, seafood, red meat, poultry, yogurt, wheat bran, wheat germ, whole grains and enriched breakfast cereals. Living alone, B’s diet lacks variety, so my suggestion for B is to consider a multivitamin and mineral supplement that specifically includes “trace minerals.”
Patient C is also an independently living senior. She has little appetite and is not interested in cooking, but she does start the day with yogurt, muesli with nuts and heaps of berries and other fruits. In the afternoon, she will either make a smoothie with fruit or supplement with a commercially available nutritional drink. There is always some trail mix on the table for snacking. In the evening she may warm up prepared frozen foods. “C” is getting many good polyphenols from the berries and probiotic from the yogurt, although kefir has higher levels of beneficial bacteria. If she has Brazil nuts, she benefits from 96 mcg of selenium that is in a single Brazil nut. You’ll also find selenium in tuna, halibut, salmon, turkey, chicken, beef, pork, whole-wheat bread, sunflower seeds and eggs. However, breakfast cereals and trail mixes often contain raisins, which have recently been found to be the #1 food that is laden with pesticides. Here is a time when choosing organic is important. Unfortunately, the exercise group that was offered at C’s apartment was cancelled, and that led to more sedentary time. Exercise will help the immune system as well as improve sleep. Spending time in nature has even more benefits.
Consider mental health
There is no doubt that the measures taken to combat the pandemic have taken a toll on our mental health. It is important to seek counselling if you or a loved one has symptoms of depression or anxiety.
I mentioned trace minerals earlier. Randomized controlled trials done in New Zealand at the time of the earthquakes of 2010 and 2011 showed that giving micronutrient supplements reduced the risk of developing long term post-traumatic stress disorder (PTSD). Although the evidence is not sufficient to make widespread recommendations, it would be a reasonable personal choice to take a supplement that mentions micronutrients and trace minerals in the ingredients as a complement to other mental health supports.
Along with CIMA, I encourage integrative medicine approaches and consultation with integrative medicine physicians and other healthcare professionals. This is particularly relevant when there are limited conventional therapies that can be recommended to patients. The good news is that you can always look for wellness improvements at any stage and situation.
Optimizing Your Immunity
CIMA’s recommendations for optimizing immune function for all Canadians, with modifications for children. For adults, these recommendations are:
- A minimum of Vitamin C 500-1000 mg 1-3 times daily. This dose can be increased to bowel tolerance* to optimize prevention and support treatment of active infection.
- Vitamin D3 4000 IU daily from October to May, with serum 25-hydroxyvitamin D testing to ensure a level of 100–150 nmol/L.
- Canadians should continue vitamin D3 supplementation year-round if they have inadequate sunshine exposure in the summer months. This is likely to occur in office workers, the elderly, and skin cancer patients (who are avoiding sun exposure).
- Zinc 20 mg daily. This is often contained in a good-quality multivitamin.
- Magnesium: Start with 50-100 mg daily and increase to bowel tolerance* (preferably magnesium bisglycinate). Caution: If you have any kidney disease, consult your healthcare provider before starting Mg.
- Selenium 100 mcg daily.
[*bowel tolerance: increase dose until loose stools, then reduce dose slightly to maximize intestinal absorption.]Source: CIMA
Disclaimer: Always seek the advice of your physician or other qualified healthcare provider with any questions you have regarding a medical condition and before undertaking any diet, dietary supplement, exercise, or other health program.
Anne Marie Mingiardi is a family doctor and member of the Canadian Integrative Medicine Association.