CLINICAL MATTERS

One of the most common questions that I get in clinic from patients is, “Doc, what can I take to boost my immune system?” The intent of the question is to ask for supplements which can benefit the immune response and ward off illnesses. Lay people expect that, aside from their medication, doctors should also give them some sort of vitamin or mineral pill, especially those with antioxidant effects that “neutralize free radicals.” Unfortunately, most of these nutritional remedies are full of hype and very short on science. There is a reason why the Philippine Food and Drug Administration (FDA) previously required that these supplements to be labeled with the phrase: “No approved therapeutic claims.” Even this was not deemed clear enough (many people still fell for gimmicky marketing), and so the label was changed to Filipino and emphasized that supplements are not drugs: “Mahalagang paalala: Ang (Name of Product) ay hindi gamot at hindi dapat gamiting panggamot sa anumang uri ng sakit (Urgent reminder: (Name of product) is not medicine and should not be used as medicine to treat any form of illness).” The evidence for any of these supplements working is at best anecdotal and is not consistently reproducible. Otherwise, they would be approved drugs.

When I was growing up, my grandmother swore that coconut oil could cure everything. Me and my cousins were very careful not to cough when we were around her. Otherwise, she would make you lie down, take out a big bottle of smelly coconut oil (extra virgin coconut oil was not yet a thing) that she always seemed to carry with her, and she would massage your back with the greasy mess. If you continued to cough, she would take a tablespoon and make you drink some of the stuff. I still get nauseous thinking about it. It turns out that refined coconut oil does have some potentially useful antioxidants, but the amount of coconut oil you would have to consume to get clinically significant amounts of antioxidants would be offsetby the harm caused by a huge quantity of saturated fats. Coconut oil probably does help eczema because of its emollient effect, but there does not seem to be anything unique to coconut oil that you won’t get from other emollients like mineral oil. Recently, there has been a lot of interest in doing research on extra virgin coconut oil. Unfortunately, while some studies showed promise, there is not enough evidence to recommend it as something that will consistently help your immune system.

Many people still use mega doses (1000 to 2000mg per day) of vitamin C (ascorbic acid) when they are sick with a cold. Linus Pauling, one of only two double Nobel Prize winners (the other is Marie Curie), was convinced vitamin C was the best thing since sliced bread based on a small trial in school children. He recommended high doses of vitamin C as a means to prevent the common cold. More trials have been done since then and there is no good evidence that high doses of vitamin C prevent colds or any other respiratory illnesses. There is some data that it may shorten the duration of colds in some people, but this is not a consistent finding. There is also no evidence that it prevents any kind of cancer. The only clinical condition that vitamin C will treat is vitamin C deficiency, also known as scurvy. There is usually enough vitamin C in our diet to prevent scurvy so you don’t really need to take more unless you are avoiding fruits for some reason. As for high doses of vitamin C, since it is a water soluble compound, anything above what you body needs will just go out with the urine. The FDA recommends a daily dose of vitamin C taken either in the diet or as a supplement of 75mg for women and 90mg for men. The usual favorite dose of 500mg or above will not add anything. On the contrary, too much vitamin C can cause gastric disturbances and diarrhea and increase the risk of kidney stones in those who are predisposed to developing them. Nowadays, I tell people to just take the vitamin C that comes with their regular multivitamin, and not to take more than 500mg in one day. 

Aside from these two, I still get regularly deluged with questions for many other supplements, from herbal medications, extracts and even juices. My attitude towards these is the same as that of any complementary medicine. As long as it won’t harm you (that includes your pocket, some of these things are super expensive), it’s probably fine but you could spend your money elsewhere. Notice that I said complementary medicine and not alternative medicine. Medical training has evolved to be much more open to non-Western forms of medicine that have scientific evidence backing them up. These include properly done acupuncture for specific, scientifically proven indications. In that sense, we use them with Western medicine as a complement and not as a replacement for it.

At the end of the day, there is likely no harm in taking supplements which are known to be safe. Some supplements can interfere with real medication so always tell you doctor before you to start taking one. Supplements should not be treated as a panacea or as a replacement for medicine that is known to work. Taking only herbal medicines forcancer will hasten death if chemotherapy is not done, but some supplements can help alleviate the side effects of chemotherapy. 

As for people who aren’t sick but would like to be healthier, my advice is to first modify those things that we know can truly affect health. Eat a balanced diet which includes a good amount of fiber. Get enough sleep for your age. Get enough exercise. Avoid smoking and too much alcohol. See your doctor regularly for a check-up. A multivitamin a day (not mega doses of anything) can help, especially if your diet isn’t well-balanced. Doing these things can make you healthier.

As for the immune system, yes there is in fact something you can do to can boost your defenses against common infectious diseases. It is called vaccination. Vaccination is not just for children but is also adults. Adult vaccines include those that protect against Covid-19, shingles, influenza, respiratory syncytial virus, pneumococcal pneumonia, tetanus, diphtheria and pertussis. These vaccines, with the exception of influenza and Covid-19, have age indications so not everyone needs all of them. It is interesting to me why people look elsewhere especially at unproven meds when we have scientifically sound interventions right in front of us. Getting your flu shot this flu season will probably do more for your health than any number of unproven supplements out there. Talk to your doctor for guidance on how to live a healthier life, including which vaccines are right for you.