The Science

Integrative Medicine. Backed by science.

IMUNI Vital D3

IMUNI Vital D3 helps prevent dietary vitamin D deficiency and supports healthy immune system function.

How common is vitamin D deficiency?

How common is vitamin D deficiency?

Vitamin D deficiency has been recognised as a global public health concern with nearly a third of Australians over the age of 25 shown to have low levels of vitamin D. This finding was demonstrated in a large population-based study conducted in 2012 which assessed vitamin D levels in more than 11,000 Australians. Vitamin D deficiency was found to affect 31% of Australians, with the highest incidence in women (39% were deficient in vitamin D overall). Even more astounding was the finding that nearly sixty percent of women were found to be deficient in vitamin D over the period of winter to spring. The study also found that 73% of Australians had vitamin D levels less than 75 nmol/L - the level classified as ‘vitamin D insufficiency’.1

Why is vitamin D deficiency so common?

Why is vitamin D deficiency so common?

There are many plausible reasons to explain why such large proportions of the population are afflicted by suboptimal vitamin D status including:

  • Greater amount of time spent indoors at work and home.
  • Increased adherence to sun protection. For example: SPF 15+ sunscreen blocks 99% of vitamin D synthesis in the skin.
  • Higher proportion of people adhering to plant-based diets (vitamin D levels are higher in animal products overall).
  • Lower levels of vitamin D in conventional diets (mushrooms for example are typically grown in dark growing rooms precluding exposure to sunlight which is essential for vitamin D synthesis).
  • A growing elderly and institutionalised population with lower exposure to sunlight.

Rising rates of obesity are also likely to be partially responsible for suboptimal vitamin D status. Given that vitamin D is soluble in fat, people tend to store vitamin D in adipose tissue (body fat). Historically this vitamin D would be released over winter as our hunter-gatherer ancestors were starved of high-density caloric diets over the winter period. Nowadays, people tend to maintain their belly fat over winter, preventing release of vitamin D from their fat stores. In addition, people tend to spend more time indoors over winter. The reduced exposure to sunlight combined with a lower UVB index over winter contributes further to vitamin D insufficiency.2-4

What is the link between vitamin D and immunity?

What is the link between vitamin D and immunity?

Vitamin D plays an important role in the immune response as an immune modulator. The role of vitamin D in regulating immune function has been described in various literature reports. Vitamin D receptors have been identified on various immune cells including macrophages, monocytes, dendritic cells, and T and B lymphocytes. These cells are vital to enable direct killing of bacteria and viruses along with the development of long-standing immunity through production of antibodies.5

How common is acute respiratory infection (cold and flu) in Australia?

How common is acute respiratory infection (cold and flu) in Australia?

In 2008 to 2009 an Australian National Survey was conducted to extrapolate the prevalence of acute respiratory infection (ARI) by season and state, and to estimate the incidence of ARI in the Australian community. 19.9% of respondents reported ARI defined as cold or flu symptoms in the previous 4 weeks including symptoms such as cough, fever, runny nose or sore throat. Extrapolation of these data suggests an incidence of 68.9 million cases of acute respiratory infection occurring in Australia each year.6

What evidence is there to support vitamin D supplementation for the prevention of acute respiratory infection?

What evidence is there to support vitamin D supplementation for the prevention of acute respiratory infection?

Routine vitamin D3 supplementation has been shown to be safe and effective in preventing acute respiratory tract infection. A large meta-analysis of 25 high quality, double-blind randomised control trials involving 10,933 individuals showed that daily and weekly vitamin D supplementation was safe and effective in reducing the incidence of respiratory infection in all participants, including those with 'adequate' levels of vitamin D. The study also demonstrated a profound effect in those who were vitamin D deficient. Those with vitamin D levels less than 25 nmol/L who received daily or weekly supplementation with vitamin D experienced a 70% reduction in incidence of cold and flu. It is important to know that daily and weekly supplementation is effective, but larger infrequent doses (e.g. once a month) are not effective. The body of evidence contributing to this meta-analysis was considered to be of high quality, meaning the randomised trials were well designed, therefore increasing the power of these results.7

Another meta-analysis published in 'The Lancet' in May 2021 also found that vitamin D supplementation was associated with a lower risk of acquiring acute respiratory infection, further backing up findings from the 2017 study. This meta-analysis included 43 randomised controlled trials and analysed results from more than 48,000 participants. The meta-analysis found that a significantly lower proportion of participants supplemented with vitamin D had 1 or more respiratory infections. In particular, there was a pronounced effect of vitamin D supplementation in children aged 1 to 16 years taking doses of 400 to 1000 IU vitamin D3 on a daily basis. This level of supplementation resulted in a 44% reduction in risk of experiencing at least 1 respiratory tract infection over the study period.8

Definitions of vitamin D status (based on blood test results) are as follows:

Definitions of vitamin D status (based on blood test results) are as follows:

  • Vitamin D deficiency = blood level less than 50 nmol/L* (<20ng/mL)#
  • Vitamin D insufficiency = 50 to 75 nmol/L (20 to 30 ng/mL)
  • Vitamin D sufficiency = greater than 75 nmol/L (30 ng/mL)
  • Multiple studies cite optimal levels at more than 100 nmol/L (40 ng/mL) 2,3,9

*nmol/L = nanomoles per litre (this measurement unit is commonly used in Australia)
#ng/mL = nanograms per millilitre (this measurement unit is commonly used in USA)

How much vitamin D do you need?

How much vitamin D do you need?

Attaining optimal levels of vitamin D has been shown to optimise immune function and neuromuscular function; optimise intestinal calcium absorption; improve breast milk vitamin D concentration for infant health; and reduce chronic musculoskeletal pain. The suggested general target for optimal beneficial effects of vitamin D is greater than 100 nmol/L on serum blood test. This is twice the level that defines vitamin D deficiency (50 nmol/L).

The following table featured in a review article published in the Australian Journal of General Practice (formerly Australian Family Physician) in 2008. It describes the minimum levels of vitamin D that should be achieved to optimise health benefits.

In Australia, vitamin D deficiency refers to levels lower than 50 nmol/L, with levels greater than 100 nmol/L considered optimal. The total daily requirement of vitamin D (from sunlight and diet) is around 4000 IU to maintain levels above 100 nmol/L. Evidence suggests that exposure to the sun to obtain these levels may increase skin cancer risk, and therefore dietary supplementation is largely considered a safer option. An Australian study of 11,247 individuals found that 73% had vitamin D levels less than 75 nmol/L. In the United States of America, it is estimated that only 10% of the US population has vitamin D levels greater than 100 nmol/L.

Daily vitamin D3 doses of 1000 IU (25 mcg) per day can maintain people in the healthy range provided they are not already deficient in vitamin D. There is some evidence that the dosing requirement to achieve optimal vitamin D levels in the range of 100 to 150 nmol/L may require daily dosing of 4000 to 6000 IU per day. Toxicity from excessive oral intake of vitamin D is possible, however, no evidence of vitamin D toxicity has been shown with doses of up to 4000IU per day. The tolerable upper limit of daily vitamin D is debated, but may be as high as 10,000IU daily. In Australia, the maximum daily dose of vitamin D recommended for general use is 1000IU per day unless advised otherwise by your doctor. The safest way to optimise your vitamin D level is to consider seeing your GP for a blood test and to supplement accordingly to attain levels of at least 100 nmol/L.2,3,5,10,11

Is it safe to get vitamin D from sunlight?

Is it safe to get vitamin D from sunlight?

It’s common knowledge now that sunlight plays an important role in vitamin D synthesis. It does this by facilitating the synthesis of vitamin D in the skin. However, apart from being an important source of vitamin D, UV radiation from the sun also causes skin cancer.

The Cancer Council of Australia recommends people limit their sun exposure to reduce skin cancer risk. As the skin can only absorb a limited amount of sunlight, excessive exposure to sunlight does not help boost vitamin D levels and only increases skin cancer risk. In some parts of Australia, sunburn can occur in as little as eight minutes. Regular sunburn increases the risk of skin cancer. Sun exposure guidelines exist for various parts of Australia, and generally recommend limiting exposure of the upper limbs and face to no more than 2 to 10 minutes per day for most areas of Australia over summer while taking extreme care to avoid reddening of the skin. For some parts of Australia, exposure to the sun for more than 5 minutes per day might be putting people at higher risk. For this reason, dietary supplementation might be considered a safer option if taken at appropriate doses.2,12,13

Can vitamin D be obtained from dietary sources?

Can vitamin D be obtained from dietary sources?

Sunlight remains the most important natural source of vitamin D, but smaller amounts can be obtained from select food sources. Animal foods are higher in vitamin D content compared to plants with oily fish like salmon and trout containing around 600 IU of vitamin D per serve. Foods other than fish and mushrooms are generally scarce in vitamin D content, containing less than 200 IU per serve.4

Mushrooms are the richest natural plant source of vitamin D. In fact, they are the only non-animal food product that contains a considerable amount of bioavailable vitamin D, making them the primary source of dietary vitamin D for vegans and vegetarians. However, if mushrooms are grown indoors and not exposed to the sun or UV light they will not contain any vitamin D. Most fresh mushrooms sold in grocery stores in Australia, New Zealand, North America and the UK are grown in atmospherically controlled growing rooms in complete darkness leaving them with little to no vitamin D.4,10

 

Are vitamin D supplements suitable for vegans or those who prefer plant-sourced products?

Are vitamin D supplements suitable for vegans or those who prefer plant-sourced products?

Select vitamin D3 supplements are available for those who prefer plant-based products, but many forms of vitamin D3 are obtained from animal sources. Vitamin D3 is more effective at boosting blood vitamin D levels than the usual plant sources of vitamin D known as ergocalciferol or Vitamin D2.14

Most consumers and prescribers are unaware that vitamin D3 commonly found in health supplements and marketed as 'vegetarian' is typically derived from lanolin, which is obtained from sheep’s wool. Other forms of vitamin D may rely on farming fish for the relatively high vitamin D content that is found in fish oil.10

What type of vitamin D is used in IMUNI VITAL D3?

What type of vitamin D is used in IMUNI VITAL D3?

IMUNI VITAL D3 contains the specialised ingredient Vitamin D3V® a high quality 100% vegan-friendly, plant-sourced vitamin D3 that is biologically identical to vitamin D3 obtained from animal sources. Unlike most forms of vitamin D3 commonly obtained from lanolin, vitamin D3V® is sourced from an eco-sustainable, non-GMO form of algae.15

References:

References:

  1. Daly R et al. 2012. Prevalence of vitamin D deficiency and its determinants in Australian adults aged 25 years and older: a national, population-based study. Clinical Endocrinology [Internet]. 77(1):26-35. Available from: https://pubmed.ncbi.nlm.nih.gov/22168576/
  2. Vitamin D deficiency in adults [Internet]. NPS Medicinewise. 2010 [cited 4 December 2020]. Available from: https://www.nps.org.au/australian-prescriber/articles/vitamin-d-deficiency-in-adults-1
  3. Nowson C & Mason R. 2013. Vitamin D and health in adults in Australia and New Zealand. Medical Journal of Australia. 199(6): 394-394. Available from: https://www.mja.com.au/journal/2012/196/11/vitamin-d-and-health-adults-australia-and-new-zealand-position-statement
  4. Cardwell et al. 2018. A review of mushrooms as a potential source of vitamin D. Nutrients [internet]. 10(10): 1498. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213178/
  5. Charoenngam N & Holick M. 2020. Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients [internet]. 12(7):2097. Available from: https://www.mdpi.com/2072-6643/12/7/2097/htm
  6. Chen Y & Kirk M. 2014. Incidence of acute respiratory infections in Australia. Epidemiology & Infection [internet]. 142(7): 1355-1361. Available from: https://pubmed.ncbi.nlm.nih.gov/24103382/
  7. Martineau A et al. 2017. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ [internet]. Article ID i6583. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310969/
  8. Jolliffe D. 2021. Vitamin D supplementation to prevent acute respiratory infections: a systematic review and meta-analysis of aggregate data from randomised controlled trials. The Lancet: Diabetes & Endocrinology [internet]. 9(5): 276-292. Available from: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00051-6/fulltext
  9. RCPA - Vitamin D [Internet]. The Royal College of Pathologists of Australasia. 2020 [cited 4 December 2020]. Available from: https://www.rcpa.edu.au/Manuals/RCPA-Manual/Pathology-Tests/V/Vitamin-D
  10. Office of Dietary Supplements - Vitamin D [Internet]. Ods.od.nih.gov. 2021 [cited 14 Dec 2021]. Available from: https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
  11. Stroud et al. 2008. Vitamin D: a review. Australian Family Physician. Vol 37, No. 12. Available from: https://www.racgp.org.au/afpbackissues/2008/200812/200812stroud.pdf
  12. Cancer Council NSW. Sun exposure and vitamin D. Available from: https://www.cancercouncil.com.au/melanoma/after-cancer-treatment/sun-exposure-and-vitamin-d/
  13. Samanek A et al. 2006. Estimates of beneficial and harmful sun exposure times during the year for major Australian population centres. Medical Journal of Australia. Available from: https://pubmed.ncbi.nlm.nih.gov/16584368/
  14. Tripkovic L et al. 2012. Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis. American Journal of Clinical Nutrition. 95(6): 1357-1364. Available from: https://pubmed.ncbi.nlm.nih.gov/22552031/
  15. Vitamin D3V [internet, cited 14 Dec 2021]. Available from: https://www.vitamind3v.com/about/

IMUNI Vegan Complete

Important nutrients for plant-based diets

Plant-based and vegetarian diets have grown in popularity over the last decade with Vegan Australia estimating 400 to 500 thousand Australians following a strict plant-based lifestyle. Plant-based eating patterns are associated with several beneficial health outcomes. In particular, emerging evidence continues to favour a plant-based diet in conferring multiple health benefits including reduction in heart disease, diabetes, obesity and some cancers including colon cancer. However, despite several health benefits of going meat-free, a purely plant-based diet is far more likely to leave people deficient in important nutrients like zinc, vitamin D, B12 and iron which are more readily available in fish, poultry, red meat and dairy foods.1

Vitamin B12 in particular is almost exclusively sourced from meat, which also contains more readily bioavailable iron in the form of haem iron. Levels of iron in the blood, as well as iron stores (in the form of ferritin) have been shown to be lower in vegetarians and vegans, than in people who consume meat. This is in part due to the absorption characteristics of iron derived from haem being significantly more efficient than the non-haem iron found in plant foods. Complementing iron intake from non-animal sources with vitamin C can help overcome its poor absorption characteristics. This is why it is important to take vitamin C in conjunction with dietary iron supplements. Similar to iron, absorption of zinc is not as effective from plant sources as it is from animal sources.1,2

Supplementation with these nutrients may assist vegans and vegetarians to attain healthy intakes of these essential vitamins and minerals, while making the most of the health benefits conferred by a predominantly plant-based diet. The team at IMUNI Health has reviewed the literature to unveil which nutrients are most at risk of insufficient intake when following a plant-based diet. For individuals who don’t meet dietary intake requirements, supplementation with the following nutrients, vitamins and minerals is likely to be beneficial for human health.

Ingredients:

Selenium

Selenium

Selenium is a nutritionally essential mineral for humans that plays critical roles in thyroid hormone metabolism, reproduction, DNA synthesis and protection from oxidative damage and infection. Selenium plays a role in immune system regulation and is a co-factor for glutathione peroxidase, an important antioxidant enzyme within the immune system. Both animal studies and human trials have demonstrated its ability to improve activation and proliferation of white blood cells such as B and T lymphocytes and Natural Killer cells.

Besides Brazil nuts which are relatively rich in selenium, the major sources of dietary selenium include seafood and meat, especially organ meats. In general, plant-based foods tend to have lower levels of selenium compared to animal products, and the amount of selenium contained in plant sources tends to vary widely depending on the selenium content of the soil the plants are grown in. Several other factors affect the selenium concentrations in plant-based foods, including soil pH, whether the form of selenium in the soil is amenable to plant uptake, and the amount of organic matter contained in the soil.

Research suggests that people at highest risk of deficiency are vegetarians who consume their diets in regions with selenium deficient soil. For instance, the lowest selenium intakes in the world exist in certain regions of China, where large proportions of the population consume primarily vegetarian diets and selenium content of soil is very low. In addition, average selenium intakes are low in some European countries, especially among those consuming vegan diets. Historically, New Zealand had relatively low intakes of selenium, until the country increased importation of foreign wheat with higher levels of selenium.

In terms of bioavailability, studies have demonstrated that selenomethionine tends to have the best absorption characteristics with more than 90% selenomethionine absorbed by the human body, compared to only 50% selenium absorbed from selenite.3

Chromium

Chromium

Australian foods have been found to contain lower levels of this mineral, suggesting that the average Australian diet is likely to be lower than the minimum suggested adequate daily intake for chromium of 50 mcg/day.

One study assessed the chromium content in Australian foods from 150 different foods selected from across the five main food groups and found that most fruits and vegetables, fats and oils, and refined grains contained low amounts of chromium.

Chromium has been shown to play an important role in glycaemic control and regulation of blood glucose levels as well as having secondary benefits for antioxidant systems. Chromium deficiency may be a precursor to the development of insulin resistance, and thus is associated with hyperglycaemia (high blood sugar), hypoglycaemia (low blood sugar), and obesity. For this reason, numerous randomised controlled trials have been conducted, some of which have demonstrated improvements in blood glucose metabolism with supplementation.

One of the most commonly cited intervention studies was a randomised controlled trial conducted in 1997, which examined the effects of chromium supplementation in 180 adults aged 35 to 65 years old with type 2 diabetes. The study participants were given 100mcg or 500mcg of chromium (as sodium picolinate) twice daily for four months, or placebo. The study found that subjects supplemented with chromium had improved fasting glucose concentrations, as well as improved HbA1c after 4 months, compared to placebo. HbA1c is a robust measure of blood glucose control because it reflects long-term blood glucose levels.

While it is difficult to say what effect chromium supplementation might have in healthy individuals, most evidence seems to support its role in regulating blood glucose and insulin. Importantly, given the lower levels of chromium found in many plant-based foods, there might be a role in supplementing the diet with chromium in people who follow plant-based diets, especially given that dietary supplements tend to have similar bioavailability to food-sources of chromium, making them similarly effective at replenishing chromium levels.4-6

Coenzyme Q10 (aka. ubidecarenone or ‘CoQ10’) and the importance of B vitamins

Coenzyme Q10 (aka. ubidecarenone or ‘CoQ10’) and the importance of B vitamins

Coenzyme Q10 or ‘CoQ10’ is a vitamin-like compound that acts as a cofactor in many critical metabolic pathways, including the production of adenosine triphosphate (ATP) in oxidative respiration, which is responsible for the production of 95% of the body’s energy. It also serves important roles as an antioxidant and cell membrane stabiliser. As the body is capable of synthesising coenzyme Q10, it is not technically considered a vitamin, despite functioning in a similar way to typical vitamins obtained from dietary sources.

CoQ10 is ingested in small amounts in dietary sources – most notably meat and seafood, with lower amounts consumed from fruits and vegetables. Absorption of coenzyme Q10 from food sources appears to be equivalent to absorption of coenzyme Q10 from supplements. However, the majority of the body’s daily CoQ10 requirement is normally derived via biosynthesis within the body. The biosynthesis of CoQ10 is dependent on a 17-step process involving a myriad of vitamins and trace elements, including vitamins B2 (riboflavin), B3 (niacinamide), B5 (pantothenic acid), B6 (pyridoxine), B9 (folate), B12 (cobalamin) and vitamin C. Because its biosynthesis is dependent on these nutrients, it is important that sufficient quantities are consumed in the human diet, as deficiencies in any of these cofactors can result in suboptimal CoQ10 biosynthesis.7,8

Vitamin B12 in particular is almost exclusively sourced from animal food products, and B12 deficiency is therefore more common in those who consume strict plant-based diets without adequate supplementation. Some vegetarians and vegans are at risk of other B vitamin deficiencies. For example, vegetarian athletes are more susceptible to vitamin B2 (riboflavin) deficiency due to increased demands and insufficient intake due to avoidance of B2-rich animal sources. B vitamin deficiencies uncommonly occur in isolation, with B12 deficiency for example often associated with deficiencies in other B vitamins including vitamin B6.9-12

Due to plant-based diets having lower quantities of CoQ10 than animal products, and its biosynthesis being dependent on several cofactors which are more prevalent in animal foods, we have incorporated a significant dose of CoQ10 in IMUNI Vegan Complete, to ensure adequate intake of this important energy-producing powerhouse and antioxidant.

Vitamin B12

Vitamin B12

Humans obtain almost all of their daily vitamin B12 requirement from animal foods, which can leave vegans and vegetarians particularly vulnerable to vitamin B12 deficiency. Adequate B12 intake is vital for red blood cell production and normal neurological function. It is required for synthesising the fatty acids in myelin which is an important component of normal nerve conduction. In conjunction with folate, it is also necessary for DNA synthesis.

Symptoms of vitamin B12 deficiency generally include symptoms relating to anaemia and altered neurological function, including low energy, reduced exercise tolerance, fatigue, shortness of breath, cognitive dysfunction, weakness, and sensory alterations such as paraesthesia (pins and needles or reduced sensation). Symptoms may be absent or subtle and not all symptoms may be experienced.

The recommended dietary intake (RDI) for vitamin B12 is surprisingly low, at only 2.4 micrograms per day for adults. However, higher doses might be required for people who are severely deficient or have issues with absorption or low stomach acidity. Some randomised controlled trials have demonstrated that high dose oral B12 might have similar efficacy to intramuscular injection.9-12

IMUNI Vegan Complete contains co-methylcobalamin which is one of the active forms of vitamin B12. Interestingly, the bioavailability of vitamin B12 obtained from dietary supplements is about 50% higher than that obtained via food sources.

Iron and Vitamin C

Iron and Vitamin C

Almost two-thirds of the body’s iron is found in haemoglobin - the oxygen carrying component of the red blood cell. The synthesis of haemoglobin is dependent on adequate intake of dietary iron from food. The Recommended Dietary Intake (RDI) ranges from 8mg for men, to 18mg for menstruating females (due to increased blood loss from regular menstruation). Higher amounts may be required during pregnancy. Dietary sources of iron come in one of two forms: haem iron, and non-haem iron. Haem iron is exclusively sourced from animal products such as meat, fish and poultry, and is more highly bioavailable than non-haem iron obtained from plants. Due to the poorer absorption characteristics of non-haem iron, iron deficiency occurs more commonly in vegetarians and vegans, than in omnivores.13-15 Taking vitamin C alongside iron supplements is important, as vitamin C has been shown to assist in optimising absorption of non-haem iron.13-15

Zinc

Zinc

The RDI for zinc ranges from 8 to 14mg per day for adult women and men, respectively. However, strict vegetarians and vegans may require intakes 50% higher than the RDI, corresponding to 12mg per day for women, and 21mg per day for men. This is because zinc absorption is largely dependent on dietary intake of animal protein and bioavailability of zinc from animal sources is therefore superior to zinc derived from plant sources. Implementation of effective dietary planning can assist vegans and vegetarians in obtaining sufficient intake of zinc from plant sources. Supplementation is beneficial when dietary planning is inadequate.1,16

Iodine (potassium iodide)

Iodine (potassium iodide)

Iodine was one of the first trace elements recognised as being essential for human health. Iodine plays an integral role in the synthesis of thyroid hormone which is required for normal human growth and metabolism. According to the Australian Bureau of Statistics, an Australian Health Survey conducted in 2011-2012 assessed the iodine status of Australians and found that 15% of Australian adults aged 35 to 54 years old had results consistent with moderate clinical iodine deficiency (urinary iodine concentration less than 50mcg/L). This is despite introduction of a national fortification program in 2009 mandating the fortification of bread with iodine. Certain groups are at higher risk of iodine deficiency, including those who avoid the food groups with highest levels of iodine (bread, eggs, milk, fish and iodised salt). As eggs, milk, and fish make up a substantial portion of dietary intake, strict vegetarians may require more careful dietary planning to achieve adequate consumption of iodine-rich foods. Adequate dietary planning incorporating iodine-rich foods such as seaweed can help to ensure vegans and vegetarians meet their dietary requirements. However, supplementation can be beneficial if dietary planning is inadequate.1,17-19

Vitamin D3

Vitamin D3

Mushrooms are the richest natural plant source of vitamin D. In fact, they are the only non-animal food product that contains a considerable amount of bioavailable vitamin D, making them the primary source of dietary vitamin D for vegans and vegetarians. However, if mushrooms are grown indoors and not exposed to the sun or UV light they will not contain any vitamin D. Most fresh mushrooms sold in grocery stores in Australia, New Zealand, North America and the UK are grown in atmospherically controlled growing rooms in complete darkness leaving them with little to no vitamin D.20

Despite Australia’s sunny climate vitamin D insufficiency remains highly prevalent. In an Australian study of 11,247 individuals, it was found that 73% had suboptimal vitamin D levels consistent with vitamin D insufficiency (<75nmol/L). The same study also found that 31% of Australian participants had vitamin D levels below 50nmol/L consistent with vitamin D deficiency, and nearly 60% of women were vitamin D deficient by the end of winter.21

Many factors contribute to vitamin D insufficiency, including:22-24

  • Inadequate dietary intake and plant-based diets
  • Advancing age - efficiency of vitamin D synthesis in the skin declines with age
  • Darker skin – higher melanin content of skin reduces vitamin D synthesis
  • More time spent working indoors
  • Improved adherence to sun protection measures – SPF15+ sunscreen blocks >99% of vitamin D synthesis
  • Obesity – vitamin D retained in fat is not bioavailable

Due to the lack of vitamin D in most vegetarian foods, sunlight remains the primary source of vitamin D for vegans and vegetarians. However, too much sunlight exposure can increase the risk of skin cancer and several factors (including those described above) can limit vitamin D availability from sunlight alone. In these circumstances where sunlight exposure is insufficient to meet vitamin D requirement supplementation with vitamin D might be beneficial.

References:

References:

  1. Dynan N. 2018. Helping to meet the nutritional needs of patients. News GP: Royal Australian College of General Practitioners (RACGP). Available from: https://www1.racgp.org.au/newsgp/clinical/helping-to-meet-the-nutritional-needs-of-patients 
  2. Sakkas H. 2020. Nutritional Status and the Influence of the Vegan diet on the Gut Microbiota and Human Health. Medicina. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073751/
  3. Selenium. National Institutes of Health. Office of dietary supplements. [cited 23 Nov 2021). Available from: https://www.nrv.gov.au/nutrients/selenium
  4. Braun, L., & Cohen, M. (2015). Chromium. In Herbs & Natural Chromium Australian adequate Supplements. An evidence-based guide (4th ed., pp. 180-189). Chatswood, NSW: Elsevier Australia.
  5. Ashton et al. 2003. The chromium content of some Australian foods. Food Australia. 55. 201-204. Available from: https://www.researchgate.net/publication/290185338_The_chromium_content_of_some_Australian_foods
  6. Chromium. National Institutes of Health. Office of dietary supplements. [cited 23 Nov 2021). Available from: https://ods.od.nih.gov/factsheets/Chromium-HealthProfessional/#en39
  7. Mantle & Dybring. 2020. Bioavailability of Coenzyme Q10: an overview of the absorption process and subsequent metabolism. Antioxidants. 9 (5): 386. [cited 24 Nov 2021]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278738/
  8. Coenzyme Q10. TRC natural medicines database. [cited 24 Nov 2021]. Available from: https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=938
  9. Vitamin B12. Fact Sheet for Health Professionals. National Institutes of Health. Office of Dietary Supplements. [cited 24 Nov 2021]. Available from: https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
  10. Riboflavin. Fact Sheet for Health Professionals. National Institutes of Health. Office of Dietary Supplements. [cited 24 Nov 2021]. Available from: https://ods.od.nih.gov/factsheets/Riboflavin-HealthProfessional/
  11. Vitamin B6. Fact Sheet for Health Professionals. National Institutes of Health. Office of Dietary Supplements. [cited 24 Nov 2021]. Available from:   https://ods.od.nih.gov/factsheets/VitaminB6-HealthProfessional/
  12. Vitamin B12. Nutrient Reference Values for Australia and New Zealand. National health and medical research council (NHMRC). [cited 24 Nov 2021]. Available from: https://www.nrv.gov.au/nutrients/vitamin-b12
  13. Iron. Nutrient Reference Values for Australia and New Zealand. National health and medical research council (NHMRC). [cited 06 Dec 2021]. Available from: https://www.nrv.gov.au/nutrients/iron
  14. Pawlak R et al. 2016. Iron Status of Vegetarian Adults: A Review of Literature. American journal of lifestyle medicine. 12(6): 486–498. Available from: https://doi.org/10.1177/1559827616682933
  15. Wilson A and Ball M. 1999. Nutrient intake and iron status of Australian male vegetarians. Eur J Clin Nutr. 53(3): 189-94. Available from: https://pubmed.ncbi.nlm.nih.gov/10201799/
  16. Zinc. Nutrient Reference Values for Australia and New Zealand. National health and medical research council (NHMRC). [cited 06 Dec 2021]. Available from: https://www.nrv.gov.au/nutrients/zinc
  17. Iodine. Nutrient Reference Values for Australia and New Zealand. National health and medical research council (NHMRC). [cited 06 Dec 2021]. Available from: https://www.nrv.gov.au/nutrients/iodine
  18. Iodine. Fact Sheet for Health Professionals. National Institutes of Health. Office of Dietary Supplements. [cited 06 Dec 2021]. Available from:   https://ods.od.nih.gov/factsheets/Iodine-HealthProfessional/
  19. Iodine [Internet]. Australian Bureau of Statistics. 2021 [cited 06 Dec 2021]. Available from: https://www.abs.gov.au/articles/iodine
  20. Cardwell et al. 2018. A review of mushrooms as a potential source of dietary vitamin D. Nutrients. 10(10): 1498. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213178/
  21. Daly R, Gagnon C, Lu Z, Magliano D, Dunstan D, Sikaris K et al. Prevalence of vitamin D deficiency and its determinants in Australian adults aged 25 years and older: a national, population-based study. Clinical Endocrinology [Internet]. 2012;77(1):26-35. Available from: https://pubmed.ncbi.nlm.nih.gov/22168576/
  22. Vitamin D. Fact Sheet for Health Professionals. National Institutes of Health. Office of Dietary Supplements. [cited 06 Dec 2021]. Available from:   https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
  23. Vitamin D. Nutrient Reference Values for Australia and New Zealand. National health and medical research council (NHMRC). [cited 06 Dec 2021]. Available from: https://www.nrv.gov.au/nutrients/vitamin-d
  24. Wortsman J et al. 2003. Decreased bioavailability of vitamin D in obesity. The American Journal of Clinical Nutrition. 72(3): 690-693. Available from: https://academic.oup.com/ajcn/article/72/3/690/4729361

IMUNI Sleep + Mind Balance

IMUNI Sleep + Mind Balance is a specialised blend of herbal supplements that assists in relieving mild stress and anxiety, improving mood, and promoting restful sleep. Each of the ingredients contained in this formulation have been carefully selected based on comprehensive review of scientific literature to identify the most important and evidence-based herbal supplements available.

This formulation helps maintain emotional wellbeing and supports healthy mood balance. Lemon balm, Lavender oil and passionflower are traditionally used in Western herbal medicine to relieve symptoms of mild anxiety and stress; support healthy sleeping patterns; relieve sleeplessness and reduce time to fall asleep.

Please note that the following information is intended to be informative and educational. It is not intended to infer that this supplement is effective at treating medically diagnosed major depression, anxiety or sleep disorders. IMUNI Sleep + Mind Balance is indicated for mild anxiety and stress, and the promotion of healthy mood balance and restful sleep. More severe mental health conditions should only be managed by qualified clinical psychologists and registered medical practitioners.

Ingredients:

Withania somnifera (Ashwagandha) 

Withania somnifera (Ashwagandha)

Ashwagandha is often used in traditional medicine as an ‘adaptogenic herb’. Adaptogens are theorised to help the body resist physiological and psychological stress. Emerging scientific evidence suggests a specific form of Ashwagandha known as KSM-66® might be effective at relieving mild anxiety and stress.

In adults with chronic stress, clinical research suggests that KSM-66® ashwagandha taken at a dose of 300mg twice daily for 60 days reduces perceived stress levels by 30% to 44% and decreases cortisol levels by 22% to 28% when compared with baseline levels. These changes remain statistically significant when compared to placebo.1

In one prospective, randomized, double-blind, placebo-controlled study, the stress-relieving effect of Ashwagandha root extract was investigated in 60 stressed healthy adults. Study participants took KSM-66® capsules at doses of 125mg or 300mg twice per day for eight weeks, or placebo. The study found that KSM-66® taken at a total daily dose of 250mg or 600mg resulted in statistically significant improvements in sleep quality, reductions in perceived stress scores, and lower cortisol levels. The authors concluded that KSM-66® is effective at alleviating stress and anxiety.2

Another 60-day, randomised, double-blind, placebo-controlled trial conducted in India tested the effects of a 240mg capsule of Ashwagandha (standardised to 35% or 84mg withanolide content) in relieving stress amongst 60 healthy adults. Compared to baseline, a daily dose of Ashwagandha resulted in a 41% reduction in Hamilton Anxiety Scale score (P = 0.001*), compared to a 24% reduction in the placebo group suggesting superior effectiveness over placebo. In the same study, it was also observed that Ashwagandha supplementation resulted in a 23% reduction in cortisol, while only a slight change was observed in the placebo group.3

A further randomised, double-blind, placebo-controlled study evaluated the safety and efficacy of KSM-66® in reducing stress and anxiety in 64 stressed adults. The study found that KSM-66® taken at a dose of 300mg twice per day for 60 days resulted in a significant reduction in stress levels (P < 0.0001) on all stress assessment scales, relative to placebo. Adverse events were mild, and no serious adverse events were reported.4

*NB: p value less than 0.05 suggests that the likelihood of these results being due to chance alone is very unlikely

Crocus sativus (Saffron) 

Crocus sativus (Saffron)

Saffron is the most expensive spice in the world and has been used as a medicinal supplement for at least 3000 years. In addition to its longstanding legacy of traditional use in herbal medicine, emerging scientific evidence continues to demonstrate its positive effects on improving sleep, mental wellbeing and mood balance. A standardised saffron extract known as Safr’Inside™ is now backed by more than 10 clinical studies.

The results of a randomised, double-blind, placebo-controlled trial were recently published by Pachikian et al in April 2021. The trial was designed to assess the effects of Safr’Inside™ on sleep quality with subjects receiving either placebo or Safr’Inside™ at a dose of 15.5mg daily administered to 64 healthy adults with mild to moderate sleep disturbance over a period of 6 weeks. Compared to baseline, supplementation with Safr’Inside™ resulted in improvements in sleep quality (p = 0.014), sleep latency (p = 0.032) and sleep duration (p = 0.013). Saffron was found to be well-tolerated with no serious adverse events.5 Another randomised, double-blind, placebo-controlled trial conducted by Lopresti et al in 2020 assessed 63 healthy Australian adults with self-reported sleep problems and demonstrated that taking a saffron extract at a dose of 14mg twice per day resulted in significant improvement in sleep quality, with the bulk of the improvements occurring within 1 week of commencing saffron supplementation.6

Another randomised, double-blind, placebo-controlled trial published by Jackson et al in 2021 assessed the effect of Safr’Inside™ on mood, well-being and response to stress. 56 healthy adults were randomised to receive either placebo or 15mg Safr’Inside™ twice per day for 8 weeks. At the start of the study, participants reported feelings of low mood and mild anxiety and/or stress. The results showed that saffron supplementation resulted in several beneficial effects on mood with improvement in the POMS depression scale score compared to placebo (p = 0.05).7

A randomised double-blind, placebo-controlled trial conducted by Kell et al published in 2017 assessed the effect of placebo vs saffron supplementation in 128 healthy Australian adults over 4 weeks. The trial showed that supplementation with saffron at a dose of 28mg per day resulted in statistically significant improvements in mood (p = 0.001) and stress (p = 0.010) across several standardised assessment scales, with superiority over placebo.8

Other clinical studies have demonstrated comparable effects of saffron supplementation when compared to commonly used anti-depressant medications such as fluoxetine, citalopram and imipramine. However, supplementation or treatment with saffron is not recommended for use in those suffering from clinically diagnosed depression or anxiety due to insufficient evidence for use in more severe mood and anxiety disorders.9

*NB: p value less than 0.05 suggests that the likelihood of these results being due to chance alone is very unlikely

Lavandula angustifolia (Lavender oil)

Lavandula angustifolia (Lavender oil)

Lavender has a long history of traditional use for a range of medical conditions often attributed to proposed relaxing and sedative properties. Current scientific evidence for oral use of lavender oil in capsule form is positive, supporting its use for alleviating anxiety and stress and assisting to promote restful sleep.

Several clinical trials demonstrate that taking lavender oil capsules at a dose of 80mg per day is effective at alleviating symptoms of anxiety and stress and improving sleep. A randomised, double-blind, placebo-controlled clinical trial conducted by Kasper et al in 2010 compared taking 80mg lavender oil per day with placebo in 216 adults with anxiety over a period of 10 weeks. The study found that lavender oil supplementation resulted in meaningful improvement in anxiety and anxiety-related sleep disturbance, without unwanted sedative effects.10

Another clinical trial conducted by Woelk et al also assessed lavender oil supplementation at a dose of 80mg per day in 77 adults with anxiety in comparison with a 0.5mg dose of lorazepam, a benzodiazepine often used to treat anxiety. The study found that both lorazepam and lavender oil were similarly effective at improving symptoms of anxiety, worry and sleep disturbance. The study also indicated that lavender oil was superior to lorazepam after 6 weeks of treatment in terms of global improvement and efficacy.11

A meta-analysis conducted by Moller et al in 2019 assessed the effect of lavender oil at a dose of 80mg per day from results of three double-blind, randomised, placebo-controlled clinical trials involving patients with subthreshold anxiety. The results of the meta-analysis revealed that lavender oil was significantly superior to placebo in alleviating anxiety (p = 0.003) and more effective than placebo in improving sleep latency (i.e. time taken to fall asleep, p = 0.001) and sleep disturbances (p = 0.014). In all three RCTs, supplementation with lavender oil was found to be well tolerated, with adverse event rates similar to those observed for placebo.12

*NB: p value less than 0.05 suggests that the likelihood of these results being due to chance alone is very unlikely

Passiflora incarnata (Passionflower) 

Passiflora incarnata (Passionflower) 

Spanish conquerors first learned of passionflower from the Aztecs of Mexico who used it as a medicinal herb to treat insomnia and nervousness. The plant was subsequently taken to Europe where it was cultivated and introduced into European medicine. Today, passionflower is often used to treat insomnia and anxiety. Scientific data suggests that passionflower may potentiate the effects of GABA, an inhibitory neurotransmitter that plays an important role in neurological function and cognition.13

One randomised, double-blind, placebo-controlled trial assessed the effect of a passionflower extract at a dose of 60mg per day versus placebo sleep study parameters in 110 adults with insomnia. The study found that after 2 weeks, passionflower supplementation resulted in statistically significant improvement in total sleep time (p = 0.049), compared with placebo. Sleep efficiency and waking after sleep onset also significantly improved after 2 weeks, however there was no significant difference compared to placebo for these particular parameters.14

Another double-blind, placebo-controlled trial published by Ngan et al in 2011 assessed the effects of passionflower herbal tea on subjective sleep quality. This small study assessed 41 adults and found that taking passionflower tea daily for 7 days resulted in improved subjective ratings of sleep quality (p < 0.01).15

Another randomised, double-blind clinical trial compared passionflower and oxazepam for treatment of anxiety in 36 patients randomised to each intervention group for a duration of 4 weeks. The results showed that both treatments were similarly effective in treating anxiety, with significantly more problems relating to impairment of job performance due to side effects in the oxazepam group.16

*NB: p value less than 0.05 suggests that the likelihood of these results being due to chance alone is very unlikely

Melissa officinalis (Lemon Balm) 

Melissa officinalis (Lemon Balm)

Lemon balm is a lemon-scented herb that belongs to the mint family of plants and is also known by its scientific name Melissa officinalis. It has a long history of traditional use in Western herbal medicine to relieve symptoms of mild anxiety and stress, as well as digestive discomfort, indigestion, abdominal cramping, bloating and distension. It is now well established that stress and anxiety can aggravate symptoms of IBS and a comprehensive biopsychosocial approach to treating IBS should therefore focus largely on addressing and alleviating symptoms of psychological distress. The unique formula in IMUNI Specialised Probiotics+ includes Lemon balm due to Traditional and empirical evidence indicating it may play a role in addressing symptoms of both IBS and stress.17

A small randomised, double-blind, placebo-controlled trial involving 18 healthy volunteers assessed the efficacy of Lemon balm in attenuating laboratory-induced stress. The results of the trial suggest that a single dose of Lemon balm might be effective in moderating feelings of stress without adversely affecting cognitive performance.18 The results of this study back up findings from previous small-scale studies demonstrating beneficial effects of Lemon balm on both mood and cognitive performance.19,20

References:

References:

  1. Therapeutic Research Centre. 2020. Ashwagandha. Retrieved from Natural Medicines website. Available from: https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=953
  2. Salve J et al. 2019. Adaptogenic and anxiolytic effects of ashwagandha root extract in healthy adults: a double-blind, randomized, placebo-controlled clinical study. Cereus. 11(12): e6466. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979308/
  3. Lopresti A et al. 2019. An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomised, double-blind, placebo-controlled study. Medicine. 98:37. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750292/
  4. Chandrasekhar K et al. 2012. A Prospective, Randomized Double-Blind, Placebo-Controlled Study of Safety and Efficacy of a High-Concentration Full-Spectrum Extract of Ashwagandha Root in Reducing Stress and Anxiety in Adults. Indian Journal of Psychological Medicine. 34(3): 255-262. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573577/
  5. Pachikian B et al. 2021. Effects of saffron extract on sleep quality: a randomised double-blind controlled clinical trial. Nutrients. 13(5): 1473. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8145009/
  6. Lopresti et al. 2020. Effects of saffron on sleep quality in healthy adults with self-reported poor sleep: a randomised, double-blind, placebo-controlled trial. Journal of Clinical Sleep Medicine. 15;16(6): 937-947. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849671/
  7. Jackson et al. 2021. Effects of saffron extract supplementation on mood, well-being, and response to a psychosocial stressor in healthy adults: a randomised, double-blind, parallel group, clinical trial. Frontiers in Nutrition. 7, 606124. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882499/
  8. Kell et al. 2017. Affron® a novel saffron extract (Crocus sativus) improves mood in healthy adults over 4 weeks in a double-blind, parallel, randomised, placebo-controlled clinical trial. Complementary Therapies in Medicine. 33: 58-64. Available from: https://pubmed.ncbi.nlm.nih.gov/28735826/
  9. Therapeutic Research Centre. 2020. Saffron. Retrieved from Natural Medicines website. Available from: https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=844#effectiveness
  10. Kasper et al. 2010. Silexan, an orally administered Lavandula oil preparation, is effective in the treatment of ‘subsyndromal’ anxiety disorder: a randomized, double-blind, placebo controlled trial. International Clinical Psychopharmacology. 25: 277-287. Available from: https://pubmed.ncbi.nlm.nih.gov/20512042/
  11. Woelk et al. 2010. A multi-center, double-blind, randomised study of the lavender oil preparation Silexan in comparison to lorazepam for generalised anxiety disorder. Phytomedicine. 17(2): 94-99. Available from: https://pubmed.ncbi.nlm.nih.gov/19962288/
  12. Moller et al. 2019. Efficacy of Silexan in subthreshold anxiety: a meta-analysis of randomised, placebo-controlled trials. European Archives of Psychiatry and Clinical Neuroscience. 269: 183-193. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6726711/
  13. Therapeutic Research Centre. 2020. Passion flower. Retrieved from Natural Medicines website. Available from: https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=871
  14. Lee et al. 2019. Effects of Passiflora incarnata Linnaeus on polysomnographic sleep parameters in subjects with insomnia disorder: a double-blind randomized placebo-controlled study. International Clinical Psychopharmacology. 35: 29-35. Available from: https://pubmed.ncbi.nlm.nih.gov/31714321/
  15. Ngan A and Conduit R. 2011. A double-blind, placebo-controlled investigation of the effects of Passiflora incarnata (Passionflower) herbal tea on subjective sleep quality. Phytotherapy Research. 25: 1153-1159. Available from: https://pubmed.ncbi.nlm.nih.gov/21294203/
  16. Akhondzadeh S et al. 2001. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. Journal of Clinical Pharmacy and Therapeutics. 26: 363-367. Available from: https://pubmed.ncbi.nlm.nih.gov/11679026/
  17. Lemon Balm. Therapeutic Research Centre. TRC natural medicines database. [cited 06 Dec 2021]. Available from: https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=437
  18. Scholey, A. 2004. Attenuation of Laboratory-Induced Stress in Humans After Acute Administration of Melissa officinalis. Psychosomatic Medicine, 66(4), 607-613. Available from: https://pubmed.ncbi.nlm.nih.gov/15272110/
  19. Kennedy et al. 2002. Modulation of mood and cognitive performance following acute administration of Melissa officinalis (Lemon balm). Pharmacol Biochem Behav. 72: 953-954. Available from: https://pubmed.ncbi.nlm.nih.gov/12062586/
  20. Kennedy et al. 2003. Modulation of mood and cognitive performance following administration of single doses of Melissa officinalis (Lemon balm) with human CNS nicotinic and muscarinic receptor binding properties. Neuropsychopharmacology. 28: 1871-1881. Available from: https://pubmed.ncbi.nlm.nih.gov/12888775/

IMUNI Immune Defence

IMUNI Immune Defence is a unique formulation designed to maintain healthy immune system function and support the immune system to fight illness. Contains antioxidants that help reduce free radical damage to body cells. Helps maintain optimal Vitamin D and Zinc levels in the body.

Ingredients:

Quercetin

Quercetin - an antioxidant with antiviral activity

Quercetin is a well-known antioxidant and an abundant flavonoid found in several foods derived from plants. Robust scientific evidence has demonstrated Quercetin’s physiological properties including anti-inflammatory, antioxidant, anti-pathogenic and immunomodulatory effects. Having been previously identified as playing an important role in the protection of plants from bacterial and fungal infection; in vitro (i.e. laboratory-based) and animal studies have also demonstrated Quercetin’s antiviral and antibacterial properties.6,7

While research to establish the role of Quercetin in the treatment of viral disease in humans is still in its infancy, preliminary data suggest that Quercetin may be beneficial in the prevention of upper respiratory tract infections. Research has shown that Quercetin can reduce the incidence of viral upper respiratory tract infection in the immediate post-exercise period following intensive exercise and in individuals suffering from high mental stress, conditions in which it is known that immune function is decreased and the incidence of viral infections is higher.8-11

Zinc

The Role of Zinc in Respiratory Infection and Immunity

Zinc is an essential micronutrient which plays a role in the regulation of immune function. A substantial amount of scientific literature has documented the beneficial role of zinc in fighting respiratory tract infections such as common cold and flu. This review is intended to summarise available research on the role of zinc in immunity and respiratory infection.

In 2017, a large meta-analysis was conducted reviewing seven randomised, double-blind, placebo-controlled clinical trials of robust methodological quality including 575 participants with naturally acquired common cold. The seven clinical trials were conducted by six different research groups over three decades and all seven clinical trials concluded that supplementation with oral zinc lozenges decreased common cold duration by at least 33%.12

In 2012, a systematic review and meta-analysis of 17 trials involving a total of 2121 participants found moderate quality evidence to suggest that orally administered zinc reduced the duration of symptoms of the common cold compared to placebo.13

A similar systematic review conducted by Singh & Das in 2013 included 16 therapeutic trials (randomised, double-blind and placebo-controlled trials) and found that zinc administered within 24 hours of symptom onset reduced the duration of common cold symptoms in healthy people, regardless of the type of preparation used (lozenges, syrup or tablets), and concluded that tablet forms of zinc were better tolerated than lozenges. It should be noted that the majority of research to date has been conducted using high dose zinc lozenges (greater than 75mg elemental zinc per day) and further clinical trials are needed to further evaluate the benefits of zinc tablets. In 2009, a clinical trial to assess the efficacy of zinc tablets in the treatment and prevention of common cold in 200 primary school children showed that regular supplementation with zinc tablets (equivalent to 10mg elemental zinc) reduced the frequency and severity of common colds and resulted in less missed school days and less antibiotic use when compared to children taking placebo.14,15

Furthermore, zinc deficiency is common. The World Health Organisation (WHO) estimates that up to one third of the world’s population is deficient in zinc and an Australian study of 497 Tasmanian adults showed that zinc deficiency was present in 18% of men over the age of 50 and 30% of men over the age of 70.16

A number of clinical trials have documented effects of zinc supplementation in improving cell-mediated immunity and reducing respiratory infection in elderly populations. A clinical trial conducted in 2015 involving more than a hundred nursing home residents in Italy demonstrated that 25mg elemental zinc (as zinc sulfate) improved cell-mediated immune response by increasing the number of T helper cells and cytotoxic T cells. Another study showed that supplementation with 45mg elemental zinc per day (as zinc gluconate) significantly reduced the occurrence of infections in older people, including respiratory infection, over a 12 month period.17,18

Given the prevalence of zinc deficiency in the general community; the clear association between zinc deficiency and the incidence of respiratory infection; and the benefits of zinc supplementation in reducing infectious disease, assessment of zinc status and appropriate supplementation with zinc should be considered an issue of public health concern.

Vitamin D

The Role of Vitamin D in Respiratory Infection and Immunity

Vitamin D deficiency has been recognised as a global public health concern with nearly a third of Australians over the age of 25 shown to have low levels of vitamin D. This finding was demonstrated in a large population-based study conducted in 2012 which assessed vitamin D levels in more than 11,000 Australians. Vitamin D deficiency was found to affect 31% of Australians, with the highest incidence in women (39% were deficient in vitamin D overall). Even more astonishing was the finding that nearly sixty percent of women were shown to be deficient in vitamin D over the period of winter to spring.¹ So what is the link between vitamin D and immunity? And could all this deficiency be putting people at risk?

The role of vitamin D in regulating immune function has been described in various literature reports. Vitamin D receptors have been identified on various immune cells including macrophages, monocytes, dendritic cells, and T and B lymphocytes, all of which are vital to enable direct killing of pathogens and development of long standing immunity through production of antibodies.²

Routine vitamin D3 supplementation has also been shown to be safe and effective in preventing acute respiratory tract infection. This was concluded from a large meta-analysis of 25 high quality randomised, double-blind placebo-controlled trials including 10,933 subjects. Vitamin D supplementation reduced the incidence of respiratory infection in all participants, including those with ‘adequate’ levels of vitamin D. It also had a profound effect in those who were vitamin D deficient. It is important to know that daily and weekly supplementation is effective, but larger infrequent doses (e.g. once a month) are not effective.³

How much vitamin D do you need?

The bottom line is that the only way to know if you are deficient in vitamin D is to see your doctor and get a simple blood test which will help determine the dose of vitamin D required to maintain healthy levels. In Australia, vitamin D deficiency refers to levels lower than 50nmol/L (or 20ng/mL for those readers in the USA) with levels greater than 75nmol/L considered optimal. Daily vitamin D3 doses of 1000IU (25mcg) per day can maintain people in the healthy range provided they are not already deficient in vitamin D. However, there is some evidence that optimal health benefits of vitamin D may be obtained in the range of 100-150 nmol/L which may require daily dosing of 4000-6000IU per day. Toxicity from excessive oral intake of vitamin D is possible, however, no evidence of vitamin D toxicity has been shown with doses of up to 4000IU per day. In Australia, the maximum daily dose of vitamin D recommended for general use is 1000IU per day unless advised otherwise by your doctor.4,5

Ultimately, the decision to take vitamin D supplements or not rests with you. If you’d like to know more about your vitamin D status and dose requirements, we recommend talking to your doctor.

Vitamin C

Vitamin C and the Common Cold - a review of the evidence

The case for taking vitamin C supplements has long been a topic of debate among doctors and scientists and yet, vitamin C supplements remain widely used in the general community. Here, we review the evidence on the benefits of vitamin C supplementation and debunk some myths about this commonly used vitamin.

Vitamin C gained great public interest in the 1970s after Nobel prize winner Linus Pauling released a book titled ‘Vitamin C and the Common Cold’.19 Following this, a number of clinical trials were conducted which produced conflicting results and some confusion regarding the benefits of vitamin C supplementation in treating the common cold.

Nevertheless, dozens of studies have demonstrated the immunomodulating and antiviral effects of vitamin C as well as its potential role as a physiological antioxidant, protecting against oxidative stress in the event of infection. As such, the mechanism by which vitamin C may provide a protective effect during infection remains highly physiologically plausible, but what proven clinical effect (if any) has been demonstrated in humans?

In 2013, a large systematic review was conducted to determine whether vitamin C supplementation (at a dose of 200mg per day or greater) reduced the severity, duration or incidence of common cold. In this review, an analysis of 29 placebo-controlled clinical trials involving 11,306 participants revealed that regular vitamin C supplementation on a daily basis did not significantly reduce the incidence of common cold in the general population (i.e. it did not change how often people caught colds). However, regular supplementation was shown to significantly reduce the duration of common cold symptoms by 14% in children and by 8% in adults. Regular supplementation also assisted in reducing the severity of common cold symptoms. Of particular significance was the benefit observed in clinical studies which assessed participants exposed to short periods of extreme physical stress (e.g. marathon runners, skiers and soldiers) in which an analysis of 598 participants taking regular vitamin C had a greater than 50% reduction in the incidence of common cold. That is, the risk of acquiring common cold in these circumstances was halved overall compared to those taking placebo.20

The authors of this study went on to conclude that vitamin C supplementation may be beneficial for short term use for people who engage in severe physical exercise to help prevent the occurrence of common cold. They also suggested that it may be worthwhile for patients with acquired common cold to test the benefits of vitamin C in reducing the duration and severity of their symptoms given the consistency of improvement in severity and duration of common cold symptoms with regular supplementation.

References:

References:

  1. Daly R et al. Prevalence of vitamin D deficiency and its determinants in Australian adults aged 25 years and older: a national, population-based study. Clinical Endocrinology [Internet]. 77(1): 26-35. Available from: https://pubmed.ncbi.nlm.nih.gov/22168576/
  2. Charoenngam N, Holick M. 2020. Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients [Internet]. 12(7): 2097. Available from: https://www.mdpi.com/2072-6643/12/7/2097/htm
  3. Martineau A et al. 2017. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ [Internet]. Article ID i6583. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310969/
  4. RCPA - Vitamin D [Internet]. Rcpa.edu.au. 2020 [cited 4 December 2020]. Available from: https://www.rcpa.edu.au/Manuals/RCPA-Manual/Pathology-Tests/V/Vitamin-D
  5. Vitamin D deficiency in adults [Internet]. NPS Medicinewise. 2010 [cited 4 December 2020]. Available from: https://www.nps.org.au/australian-prescriber/articles/vitamin-d-deficiency-in-adults-1
  6. Patrick R. FoundMyFitness Topic - Quercetin [Internet]. FoundMyFitness. 2020. Available from: https://www.foundmyfitness.com/topics/quercetin#quercetin-bioavailability-and-safety-profile
  7. Kinker B. 2014. Quercetin: A Promising Treatment for the Common Cold. Journal of Ancient Diseases & Preventive Remedies [Internet]. 2(2). Available from: https://www.longdom.org/open-access/quercetin-a-promising-treatment-for-the-common-cold-2329-8731.1000111.pdf
  8. Heinz S et al. 2010. Quercetin supplementation and upper respiratory tract infection: A randomized community clinical trial. Pharmacological Research [Internet].62(3): 237-242. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7128946/
  9. Li Y et al. 2016. Quercetin, Inflammation and Immunity. Nutrients [Internet]. 8(3): 167. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808895/
  10. Nieman D et al. 2007. Quercetin Reduces Illness but Not Immune Perturbations after Intensive Exercise. Medicine & Science in Sports & Exercise [Internet]. 39(9): 1561-1569. Available from: https://journals.lww.com/acsm-msse/Fulltext/2007/09000/Quercetin_Reduces_Illness_but_Not_Immune.18.aspx
  11. Nieman D et al. 2009. Effects of Quercetin and EGCG on Mitochondrial Biogenesis and Immunity. Medicine & Science in Sports & Exercise [Internet]. 41(7): 1467-1475. Available from: https://journals.lww.com/acsm-msse/Fulltext/2009/07000/Effects_of_Quercetin_and_EGCG_on_Mitochondrial.15.aspx
  12. Hemilä H. 2017. Zinc lozenges and the common cold: a meta-analysis comparing zinc acetate and zinc gluconate, and the role of zinc dosage. JRSM Open [Internet]. 8(5). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418896/
  13. Science M et al. 2012. Zinc for the treatment of the common cold: a systematic review and meta-analysis of randomized controlled trials. Canadian Medical Association Journal [Internet]. 184(10): 551-561. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394849/
  14. Singh M, Das R. 2013. Zinc for the common cold. Cochrane Database of Systematic Reviews [Internet]. Available from: https://pubmed.ncbi.nlm.nih.gov/23775705/
  15. Vakili R et al. 2009. Effects of zinc supplementation in occurrence and duration of common cold in school aged children during cold season: a double-blind placebo-controlled trial. Iranian Journal of Paediatrics [Internet]. 19(4): 376-380. Available from: https://www.sid.ir/en/journal/ViewPaper.aspx?ID=164643
  16. Beckett J, Ball M. Zinc status of northern Tasmanian adults. Journal of Nutritional Science [Internet]. 2015;4. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463943/
  17. Fortes C et al. 1998. The Effect of Zinc and Vitamin A Supplementation on Immune Response in an Older Population. Journal of the American Geriatrics Society [Internet]. 46(1): 19-26. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1532-5415.1998.tb01008.x
  18. Prasad A et al. 2007. Zinc supplementation decreases incidence of infections in the elderly: effect of zinc on generation of cytokines and oxidative stress. The American Journal of Clinical Nutrition [Internet]. 85(3): 837-844. Available from: https://pubmed.ncbi.nlm.nih.gov/17344507/
  19. Pauling L. Vitamin C and the common cold. San Francisco: Freeman; 1970.
  20. Hemilä H, Chalker E. 2013. Vitamin C for preventing and treating the common cold. Cochrane Database of Systematic Reviews [Internet]. Available from: https://pubmed.ncbi.nlm.nih.gov/23440782

IMUNI Specialised Probiotics+

Probiotics are defined as live microorganisms that are capable of promoting positive health outcomes when consumed in sufficient amounts, generally by improving or restoring intestinal flora. The term intestinal flora refers to the ‘good bacteria’ that naturally reside in the gut, the composition of which is commonly called the gut microbiome. The gut microbiome is often considered a virtual organ with incredible diversity that exhibits numerous important health functions.

Specific microorganisms that comprise the gut microbiome confer multiple health benefits. They may do this in a number of ways including:

  • Preventing growth of pathogenic or ‘disease-causing’ microorganisms
  • Improving digestion and nutrient absorption
  • Regulating immune system function
  • Enhancing gut motility and barrier function
  • Producing beneficial metabolites (including substances like lactic acid and hydrogen peroxide which inhibit growth of pathogenic organisms)
  • Producing vitamins (e.g. vitamins K, B1, B2, B6, B12)
  • Forming a ‘colonisation barrier’ by binding to the intestinal mucosa and preventing pathogens from adhering to the gut wall
  • Binding directly to viruses (e.g. rotavirus) thereby preventing some mucosa-associated viral infections1

It is important to note that not all probiotics are considered equal and specific probiotic strains may exhibit different beneficial effects. A growing body of scientific evidence continues to favour certain probiotic strains over others in terms of their ability to promote beneficial health outcomes. Below is a summary of the evidence behind specific probiotic strains selected for inclusion in the IMUNI Specialised Probiotics+ formula.

Ingredients:

Lactobacillus rhamnosus GG (‘LGG’, reference strain ATCC 53103, product strain PA-LR66)

Lactobacillus rhamnosus GG (‘LGG’, reference strain ATCC 53103, product strain PA-LR66)

Lactobacillus rhamnosus GG or ‘LGG’ is one of the most extensively studied probiotic strains in existence. Lactobacilli are able to provide nutritional benefits by inducing growth factors and increasing bioavailability of minerals, as well as producing lactic acid and hydrogen peroxide which inhibit growth of pathogenic microorganisms. Lactobacilli have also been shown to modulate both non-specific (cellular) and humoral (antibody-mediated) immunity. They are thought to do this by stimulating white blood cells including lymphocytes and macrophages, and by modulating cytokine production (cytokines are compounds which play important roles in cell signalling). LGG is one of the probiotic strains that is capable of adhering to the colonic mucosa forming a ‘colonisation barrier’ and thereby preventing pathogenic bacteria from colonising the gut.1,2

Rotavirus diarrhoea:

A meta-analysis conducted by Szajewska and colleagues in 2007 included 988 individuals in eight randomised controlled trials (RCTs) and found that supplementation of LGG resulted in a statistically significant reduction in duration of rotavirus diarrhoea by 2.1 days in children (P = 0.006) and reduced the risk of diarrhoea lasting more than seven days by 75% (P = 0.01).1,2 Another meta-analysis of 14 randomised controlled trials assessed whether probiotics including LGG administered to children younger than six years of age assisted in reducing duration of acute rotavirus diarrhoea. The trial found that amongst the trials with data on LGG administration, six clinical trials attained a statistically significant 47% overall reduction in duration of diarrhoea amongst children taking LGG (P = 0.020).3

Travellers’ diarrhoea:

One placebo-controlled RCT investigated the efficacy of LGG in a dose of 2 billion CFU per day for the prevention of travellers’ diarrhoea in 245 subjects travelling from Finland to developing nations. This study found that the risk of developing travellers’ diarrhoea in subjects taking LGG was reduced by 47% compared to placebo.2

Acute upper respiratory tract infections (URTI):

LGG is also the most well studied lactobacillus species for the prevention of upper respiratory tract infection. One meta-analysis concluded that giving LGG to infants and children reduces the risk of developing URTI by about 38%.2 One large clinical trial showed that children aged 1 to 6 drinking milk containing LGG had less frequent and less severe URTIs while attending day care centres. This randomised double-blind placebo-controlled trial assessed 281 children taking LGG at a dose of 10 billion CFU per day for 3 months. This resulted in a significant reduction in the risk of developing URTI (P = <0.001); a lower risk of URTI episodes lasting longer than 3 days (P = <0.001); and a reduced rate of absence from day care due to infection (P = <0.001). Children who received placebo had 2.88 times greater chance of developing URTI than children who received LGG (P = <0.001).4

Functional gastrointestinal disorders (including IBS) in children

Functional gastrointestinal disorders refers to a group of gastrointestinal disorders without underlying organic pathology and includes: functional dyspepsia, irritable bowel syndrome (IBS), abdominal migraine and functional abdominal pain. A systematic review conducted by Horvath et al (2011) found that giving LGG at doses of 1 to 3 billion CFU per day for 4 to 8 weeks in children under the age of 18, resulted in a significantly higher rate of children reporting no pain or reduction in pain intensity. The results of this meta-analysis demonstrated that use of LGG was particularly beneficial in reducing pain in children suffering from IBS, among which LGG was shown to reduce the frequency and intensity of abdominal pain.5 An RCT conducted in 2007 compared LGG to placebo in 104 children between 6 and 16 years of age and found that LGG administered at a dose of 3 billion CFU taken twice per day moderately increased the likelihood of children with IBS becoming pain-free compared to placebo (33% vs 5%).6

Antibiotic associated diarrhoea:

LGG is the most extensively studied strain for the prevention of antibiotic associated diarrhoea. Clinical research has demonstrated that regular use of LGG probiotics while taking antibiotics can reduce the risk of antibiotic-associated diarrhoea by about 60 to 71%. However, for this purpose it may be more effective in children than in adults.2 A meta-analysis published in 2013 concluded that taking LGG at doses of up to 10 billion CFU daily was significantly protective against antibiotic-associated diarrhoea in children with a pooled risk reduction of 74% (P = 0.002). Amongst 16 clinical trials testing LGG at doses of less than 10 billion CFU per day, the incidence of antibiotic-associated diarrhoea was 7.3%, compared to an incidence rate of 15.9% in the placebo group (P < 0.001).7

*NB: p value less than 0.05 suggests that the likelihood of these results being due to chance alone is very unlikely

Bifidobacterium animalis subsp. lactis (strain Bl-04)

Bifidobacterium animalis subsp. lactis (strain Bl-04)

This particular probiotic strain has a substantial amount of evidence supporting its effectiveness in reducing the incidence of upper respiratory tract infection (URTI) in healthy adults. An Australian study conducted in 2014 included 465 healthy Australian adults aged between 24 to 48 years old in a randomised double-blind placebo-controlled trial to assess whether Bl-04 at a dose of 2 billion CFU per day would assist in reducing incidence of URTI. The trial assessed daily use of Bl-04 over 5 months and found that it resulted in a 27% risk reduction in URTI episodes in the Bl-04 group compared to placebo (P = 0.02). On average, subjects taking placebo encountered symptoms of URTI 0.7 months earlier than those taking Bl-04. In total, there were 59 single episodes and 43 recurrent episodes of URTI in the Bl-04 group and 67 single episodes and 60 recurrent episodes in the placebo group over the 5 month study duration.8

*NB: p value less than 0.05 suggests that the likelihood of these results being due to chance alone is very unlikely

Saccharomyces cerevisiae (ibSium™ strain CNCM I-3856)

Saccharomyces cerevisiae (ibSium™ strain CNCM I-3856)

ibSium™ is a scientifically tested unique strain of probiotic yeast known as Saccharomyces cerevisae which is backed by clinical trials demonstrating its efficacy in treating symptoms of medically diagnosed Irritable Bowel Syndrome (IBS).

A randomised double-blind placebo-controlled trial conducted in 2015 assessed the efficacy of ibSium™ in alleviating IBS symptoms in 200 French adults. Participants aged between 18 and 75 years old were given ibSium™ 500mg daily for 13 weeks. A significantly higher percentage of subjects reported improvement in abdominal pain and discomfort in the treatment group compared to placebo, with almost two-thirds (62.8%) of participants reporting improvement in pain score in the group treated with ibSium™ (62.8% treatment group vs 47.3% placebo group, P = 0.04).9

Another randomised controlled trial conducted in 2020 assessed efficacy of ibSium™ as ‘add-on therapy’ in conjunction to standard IBS treatment in 100 adults randomly allocated to receive ibSium™ or placebo for 8 weeks. Participants in the treatment group (n = 52) were given ibSium™ 250mg twice per day, in addition to two weeks of ‘standard care’ including loperamide (anti-diarrhoeal medication) for IBS subjects experiencing diarrhoea, or dicyclomine (an anti-spasmodic/anti-cramping medication) for IBS subjects experiencing constipation. Participants in the placebo group (n = 48) were given standard care for 2 weeks in addition to placebo twice a day for 8 weeks. A statistically significant improvement in abdominal pain scores was observed at both 4 and 8 weeks in all subjects given ibSium™, regardless of the subtype of IBS symptoms (diarrhoea-predominant, constipation-predominant, or mixed), compared to the group given placebo. Improvements in stool consistency were also observed in the group treated with ibSium™ compared to placebo.10

*NB: p value less than 0.05 suggests that the likelihood of these results being due to chance alone is very unlikely

Lactobacillus plantarum (product strain PA-LP10)

Lactobacillus plantarum (product strain PA-LP10)

A number of clinical trials have demonstrated beneficial effects of Lactobacillus plantarum in improving symptoms of irritable bowel syndrome. One of the most widely tested strains is Lactobacillus plantarum 299v, the benefits of which have been replicated in multiple clinical trials which have demonstrated its ability to improve symptoms of IBS. In one randomised, double-blind, placebo-controlled trial conducted by Ducrotté et al in 2012, L. plantarum 299v was shown to reduce symptoms of bloating as well as pain severity and frequency. 214 patients with IBS were randomised to receive either placebo or L. plantarum 299v at a dose of 1 capsule containing 10 billion CFU per day for 4 weeks. Both abdominal pain severity and frequency were significantly lower in the L. plantarum group as early as the second week of treatment. 78.1% of patients in the treatment group reported ‘good’ or ‘excellent’ improvement in symptoms, compared to only 8.1% of patients claiming a similar effect in the placebo group (p < 0.01).11

*NB: p value less than 0.05 suggests that the likelihood of these results being due to chance alone is very unlikely

Lemon balm (aka. Melissa officinalis)

Lemon balm (aka. Melissa officinalis)

Lemon balm is a lemon-scented herb that belongs to the mint family of plants and is also known by its scientific name Melissa officinalis. It has a long history of traditional use in Western herbal medicine to relieve symptoms of mild anxiety and stress, as well as digestive discomfort, indigestion, abdominal cramping, bloating and distension. It is now well established that stress and anxiety can aggravate symptoms of IBS and a comprehensive biopsychosocial approach to treating IBS should therefore focus largely on addressing and alleviating symptoms of psychological distress. The unique formula in IMUNI Specialised Probiotics+ includes Lemon balm due to Traditional and empirical evidence indicating it may play a role in addressing symptoms of both IBS and stress.12

A small randomised, double-blind, placebo-controlled trial involving 18 healthy volunteers assessed the efficacy of Lemon balm in attenuating laboratory-induced stress. The results of the trial suggest that a single dose of Lemon balm might be effective in moderating feelings of stress without adversely affecting cognitive performance.13 The results of this study back up findings from previous small-scale studies demonstrating beneficial effects of Lemon balm on both mood and cognitive performance.14,15

References:

References:

  1. Braun L & Cohen M. 2015. Probiotics. Herbs & natural supplements. An evidence-based guide. 4th Ed, pp 771-796. Chatswood, NSW.
  2. Lactobacillus. Therapeutic Research Centre. TRC natural medicines database. [cited 01 Dec 2021]. Available from:
  3. Ahmadi et al. 2015. Efficacy of probiotic use in acute rotavirus diarrhoea in children: a systematic review and meta-analysis. Caspian Journal of Internal Medicine. 6(4):187-195.
  4. Hojsak I et al. 2010. Lactobacillus GG in the prevention of gastrointestinal and respiratory tract infections in children who attend day care centres: a randomized, double-blind, placebo-controlled trial. Clinical nutrition. 29: 312 – 316.
  5. Horvath et al. 2011. Meta-analysis: Lactobacillus rhamnosus GG for abdominal pain-related functional gastrointestinal disorders in childhood. Alimentary Pharmacology & Therapeutics. 33:1302-1310.
  6. Gawronska A et al. 2007. A randomised double-blind placebo-controlled trial of Lactobacillus GG for abdominal pain disorders in children. Alimentary Pharmacology & Therapeutics. 25:177-184.
  7. McFarland L & Goh S. 2013. Preventing pediatric antibiotic-associated diarrhoea and Clostridium difficile infections with probiotics: A meta-analysis. World Journal of Meta-Analysis. 26; 1(3): 102-120.
  8. West et al. 2014. Probiotic supplementation for respiratory and gastrointestinal illness symptoms in healthy physically active individuals. Clinical Nutrition. 33(4): 581-587. Available from: https://pubmed.ncbi.nlm.nih.gov/24268677/
  9. de Chambrun et al. 2015. A randomized clinical trial of Saccharomyces cerevisiae versus placebo in the irritable bowel syndrome. Digestive and Liver Disease. 47: 119 – 124. Available from: https://pubmed.ncbi.nlm.nih.gov/25488056/
  10. Gayathri et al. 2020. Saccharomyces cerevisae CNCM I-3856 as add-on therapy for irritable bowel syndrome. International Journal of Colorectal Disease. 35: 139-145. Available from: https://pubmed.ncbi.nlm.nih.gov/31807856/
  11. Ducrotté et al. 2012. Clinical trial: Lactobacillus plantarum 299v (DSM 9843) improves symptoms of irritable bowel syndrome. World Journal of Gastroenterology. 18(30): 4012-4018. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3419998/
  12. Lemon Balm. Therapeutic Research Centre. TRC natural medicines database. [cited 06 Dec 2021]. Available from: https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=437
  13. Scholey, A. 2004. Attenuation of Laboratory-Induced Stress in Humans After Acute Administration of Melissa officinalis. Psychosomatic Medicine, 66(4), 607-613. Available from: https://pubmed.ncbi.nlm.nih.gov/15272110/
  14. Kennedy et al. 2002. Modulation of mood and cognitive performance following acute administration of Melissa officinalis (Lemon balm). Pharmacol Biochem Behav. 72: 953-954.
  15. Kennedy et al. 2003. Modulation of mood and cognitive performance following administration of single doses of Melissa officinalis (Lemon balm) with human CNS nicotinic and muscarinic receptor binding properties. Neuropsychopharmacology. 28: 1871-1881.

IMUNI Magnesium Citrate

Magnesium (Mg) is the fourth most abundant mineral in the human body, after calcium, sodium and potassium and the second most common intracellular cation after potassium. Magnesium is an important mineral that plays a role in over 300 enzymatic reactions in the body. It serves critical roles in muscle and nerve function, blood sugar control, bone health and protein synthesis. It is necessary for the transmission of nerve impulses, muscular activity, temperature regulation, detoxification reactions, and for the formation of healthy bones and teeth. Magnesium is also involved in energy production and the synthesis of DNA and RNA. When there is suboptimal intake of magnesium, it can compromise cellular activity, especially in the tissues of the heart, nerves and kidneys.1,2

Over the last 30 to 40 years, magnesium intake has declined in multiple industrialised countries due to behavioural changes in the way societies consume and prepare food. Evidence suggests that nearly two-thirds of the population in the western world is not reaching the recommended daily intakes for magnesium.2 In Australia, data from the Australian Bureau of Statistics suggests that one in three Australians over the age of two do not meet their Estimated Average Requirement (EAR) for daily intake of magnesium (37% of males and 34% of females do not meet this requirement). The same national survey also revealed that 72% of teenage girls and 61% of teenage boys (ages 14 to 18) did not meet the EAR.3 Inadequate intake of magnesium may impair biochemical processes that are specifically dependent on this important mineral.

Several factors may contribute to suboptimal magnesium intake and deficiency states:2

  • The main cause of magnesium deficiency is chronic low intake from dietary sources
  • Lower levels of magnesium are found in processed foods and some non-organic foods
  • Magnesium-deplete foods including meat, sugar and flour comprise a significant portion of conventional diets.
  • Heating processes such as cooking and boiling can result in significant decline in magnesium content
  • Vitamin D deficiency is common and may cause a reduction in the absorption of gastrointestinal magnesium
  • Certain medications, such as antibiotics, antacids and hypertensive drugs can diminish the absorption of magnesium
  • Cigarette smoking reduces plasma magnesium concentrations
  • The absorption of magnesium may decline with age by as much as 30%

What are reliable sources of magnesium?

What are reliable sources of magnesium?

Sufficient intake of magnesium can be obtained with an adequately planned diet or by using a high-quality health supplement. Foods that are rich in magnesium include green leafy vegetables, legumes, nuts, seeds and whole grains. Oral supplements may contain several different forms of magnesium and the chemical properties of the various forms will affect their efficiency in terms of absorption and bioavailability. Magnesium citrate, aspartate, lactate and chloride forms are more water-soluble and are therefore absorbed more completely with greater bioavailability than other forms such as magnesium oxide and magnesium sulfate.4,5

How much magnesium do we need?

How much magnesium do we need?

Adults: the current Estimated Average Requirement (EAR) for Australian adults is 350mg/day for men and 265mg/day for women with the Recommended Dietary Intake (RDI) faring a little higher at 420mg/day for men and 320mg/day for women. Pregnant and breastfeeding women over the age of 18 need approximately 350-360 mg a day (depending on age).

Recommended Dietary Intake (RDI) for children:

  • 1-3 years old: 80 mg
  • 4-8 years old: 130 mg
  • 9-13 years old: 240 mg
  • Boys aged 14-18 years old: 410 mg
  • Girls aged 14-18 years old: 360 mg

The National Health and Medical Research Council (NHMRC) has set the recommended upper level of intake (UL) for magnesium at 350 mg/day. Avoiding intake of supplementary magnesium above this dose will help to prevent adverse gastrointestinal side effects in most individuals. Diarrhoea is usually the first sign of excess intake.4

References:

References:

  1. Magnesium. Fact Sheet for Health Professionals. National Institutes of Health. Office of Dietary Supplements. [cited 06 Dec 2021]. Available from: https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/
  2. Schwalfenberg G & Genuis S. 2017. The importance of magnesium in clinical healthcare. Scientifica. Article ID 4179326. Available from: https://www.hindawi.com/journals/scientifica/2017/4179326/
  3. Australian Health Survey: Usual Nutrient Intakes, 2011-12 financial year [Internet]. Australian Bureau of Statistics. 2021 [cited 13 Dec 2021]. Available from: https://www.abs.gov.au/statistics/health/health-conditions-and-risks/australian-health-survey-usual-nutrient-intakes/latest-release
  4. Magnesium. Nutrient Reference Values for Australia and New Zealand. National health and medical research council (NHMRC). [cited 13 Dec 2021]. Available from: https://www.nrv.gov.au/nutrients/magnesium
  5. Kappeler D et al. 2017. Higher bioavailability of magnesium citrate as compared to magnesium oxide shown by evaluation of urinary excretion and serum levels after single-dose administration in a randomised cross-over study. BMC Nutrition. 3(7). Available from: https://bmcmutr.biomedcentral.com/articles/10.1186/s40795-016-0121-3

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