immune response, protecting the host from excessive damage by enhancing neutrophil apoptosis, clearance by macrophages and decreasing neutro-phil necrosis”. (13) The last part of the previous statement is extremely impor-tant, if neutrophils are not properly cleared, there is a persistent ongoing stimulus for further neutrophil migra-tion and death leading to tissue damage that can potentially be worse than the invading pathogen itself. Vit C is likely far more sophisticated than just expressed and has a signifi-cant role in several gene regulatory enzyme pathways. Even if Vit C does not reduce the incidence of infection, although evi-dence now supports this when there is added physical stress (14), the research shows prophylactic use reduces the risk of more serious infection such as pneu-monia. The decrease in leukocyte Vit C levels, and urinary excretion during illness, suggests a higher demand for Vit C by the body in times of immune challenge. www.Cndoctor.ca Song_about_summer / Adobe Stock Although this discussion is focused on prevention vs treatment, studies have shown using 1-3grams of oral Vit C reduced time spent in the ICU by 7.8%, and in another study it reduced the need for mechanical ventilation by 18.2%. (15) Dr. Andrew Weber, a crit-ical care specialist affiliated with Northwell Health in New York was using 1500mg of IV Vit C three to four times/day with COVID-19 patients after hearing of successes using Vit C in China. It will be interesting to see the outcome of a clinical trial at Chi-na’s Zhongnan Hospital of Wuhan University using 12g IV Vit C with COVID-19 patients. Results are ex-pected in September. Suggested dose: 1000-3000mg/day in divided dose. Mild osmotic diarrhea is possible when bowel tolerance is reached (typically exceeding >3000mg/ day) immune system (MIS). Probiotics have intimate interaction with the gut mu-cosa immune system. Probiotics have been shown to affect the innate im-mune response and offered protection in gut distant mucosa such as the bronchi and urogenital mucosa. (16) Why: A Cochrane review showed probiotics performed better than pla-cebo in reducing the number of people experiencing episodes of acute upper respiratory tract infection by about 47%. (17). Studies looking at malnutri-tion models, such as undernourish-ment and obesity, probiotics increased the intestinal and systemic immune response. (16) How: Probiotics interact with the intestinal epithelium stimulating a production of various cytokines and chemokines further stimulating the mucosal immune system, favoring the innate immune cells macrophages and dendritic cells. The MIS further acti-vates immunoglobulin IgA cells of the intestine and bronchus, and also acti-vates T cells. Probiotics enforce intestinal barrier health by increasing production of mucins, tight junction proteins, and Goblet and Paneth cell production. (16) Probiotics also offer protection to the host by inhibiting growth of path-ogens directly and through competitive inhibition for nutrients. More studies are needed to uncover further mechanisms of action and appli-cation to health in the use of probiotics. Studies have shown probiotic benefit to be strain specific. For general immune health, using a multi-strain probiotic may offer a good overall strategy. Suggested dose: Multi-strain pro-biotic (formulations that contain strains Lactobacillus (L.), Bifidobacte-rium (B.), and Streptococcus (S.) >40Billion CFU There are many other strategies that advantage immune function, this re-viewed just a few. Several of the mech-anisms discussed cross-over affecting multiple mechanisms, and most all have a link to inflammation. Removing non-purposeful inflammation culti-vates a healthier terrain resulting in improved immune function. Please visit cndoctor.ca/ healthyimmunebalance for the full article with references. June 2020 Chiropractic and Naturopathic Doctor 23 PROBIOTICS The largest area of the body hosting immune cells is the gut mucosa
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