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Wellness Foods & Supplements 1/2021

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Micronutrients Photo © : AdobeStock/arloo Immunonutrition: Reinforcing the immune system against COVID-19 with nutritional supplements Philipp Gebhardt Nutritional supplements can be used to enrich the food with health-promoting substances if these cannot be supplied in sufficient or optimal quantities. Various nutrients are also of crucial importance for the functioning of the immune system. Since the beginning of the COVID-19 pandemic, numerous studies have been published that show a clear connection between the supply of micronutrients and the likelihood of infection and the severity and duration of an illness. As natural substances, micronutrients are particularly suitable for prevention and (complementary) therapy, as they can strengthen the immune system without causing undesirable side effects. The respiratory disease COVID-19 caused by the SARS-CoV-2 corona virus was first observed in December 2019 in the Chinese city of Wuhan. The virus is transmitted by droplets and aerosols and quickly spread into a pandemic. The disease often causes only mild symptoms or no symptoms at all. Sometimes and especially in older people, severe respiratory symptoms occur, so that those affected have to be treated in intensive care and possibly ventilated. 85 % of those who died of COVID-19 in Germany were 70 years or older. (1) In many patients who die of COVID-19, the reaction of their own immune system plays a decisive role in the course of the disease. An excessive immune reaction can occur, in which immune cells release disproportionate amounts of pro-inflammatory cytokines. The messenger substances stimulate other immune cells to release cytokines, so that a self-reinforcing state of crisis arises (so-called cytokine storm), in which, in addition to diseased cells, healthy lung tissue is also destroyed. For a controlled immune response to occur, certain tissue levels of micronutrients are required. An undersupply of appropriate nutrients is particularly widespread among older people. The connection between micronutrients status and immune function is the subject of current scientific research. Vitamin D In addition to its importance for bone health, vitamin D plays a crucial role in the function of the immune system. The sun's rays can produce vitamin D in the skin. Contrary to an often published opinion, in the latitudes 6 No. 1 April/May 2021

Micronutrients of Germany, vitamin D formation through UV exposure of the skin is not possible from October to March, since the solar radiation hits the earth's surface too flat and the relevant UV-B component is absorbed by the atmosphere (Fig. 1). (2) Low vitamin D serum values are also associated with a significantly increased susceptibility to bacterial pathogens, which can occur in the context of a secondary infection as a complication of COVID-19 disease. The analysis of the data from 2,135 hospitalized patients showed that the risk of suffering sepsis doubles at 25 (OH) vitamin D levels of < 10 ng/ml, compared to levels of > 30 ng/ml (7). Fig. 1: In latitudes of around 50 degrees north or higher, solar radiation falls too flat on the earth in winter. Due to the longer path through the atmosphere, the part of the UVB radiation relevant for vitamin D formation is almost completely absorbed. Vitamin D formation through sun exposure of the skin is therefore only possible from April to September. With our modern way of life, in which most of us spend the majority of the day indoors, we contribute to the fact that vitamin D deficiency is widespread (fig. 2). An insufficient vitamin D status weakens our immune system against pathogens and promotes the development of autoimmune diseases. (3) A vitamin D deficiency is particularly common and pronounced in the elderly, as the formation of the vitamin in the skin through solar radiation decreases with increasing age. It could be shown that with the same UV exposure, only about 30 % of the amount of vitamin D is formed in the skin in 62-yearolds and older, compared to 30-year-olds and younger people. (5) When the vitamin D levels of 1,578 patients at a geriatric rehabilitation clinic in Trier were measured, dangerously low values of < 10 ng/ml were found in two thirds of the study participants. (6) In this age group in particular, COVID-19 claims the most deaths. (1) After evaluating 6,405 patient data, a similar study showed that with a vitamin D status of < 20 ng/ml there is almost twice the risk of contracting an infection with multi-resistant Staphylococcus aureus bacteria (MRSA) compared to a status of > 20 ng/ml (8). 600 500 400 300 200 Number of Persons 88% 12% Optimal: 31 - 60 ng/ml Insufficient: 21 - 30 ng/ml Deficient: 11 - 20 ng/ml Severely deficient: ≤ 10 ng/ml 100 Vitamin D-Status [ng/ml] 0 0 10 20 30 40 50 60 70 Fig. 2: In the course of the study on adult health in Germany (DEGS1), the Robert Koch Institute published the analysis of the data of almost 7,000 participants. Nearly 90 % of the study participants showed an insufficient or deficient vitamin D status of < 30 ng/ml. (4) No. 1 April/May 2021 7

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