What is immunonutrition?

Immunonutrition is the science that is responsible for studying the relationship between nutrients and immunity in our body, with all that this means. That is, the objectives of immunonutrition are, among others, to know and study the immunological markers associated with nutritional status, to understand how different compounds present in food influence the immune response that the body develops against viruses, bacteria, allergens, toxins. , malignant cells, etc. And, in general terms, study the factors related to nutrition that influence the immune system.

Let's talk about immunity

It is a complex system that works together with other systems, exercising many different functions, always in order to protect our body against possible attacks. In this sense, we can speak of physical, chemical and biological barriers that the organism interposes against the contact of the “outside world” and that act as a wall and filter to limit the entry of external substances and potentially harmful to us. These barriers are the skin, the mucosa, (mucosa of the digestive system, stomach, intestine ..., mucosa of the respiratory system, nasal mucosa, bronchial ..., mucosa of the reproductive system) and also their secretions (stomach secretion, sweat, mucus ...), as well as the native of each of these areas. When pathogens or foreign substances manage to cross these first obstacles offered by the immune system and reach the interior of our body, it is when other mechanisms of the immune system must act, which can be of two types:

• Innate or nonspecific immune responses.
• Specific, acquired or adaptive immune responses. They are those that the body develops as it comes into contact with certain substances or microorganisms as a defense mechanism.

In both cases, leukocytes, antibodies, cytokines, etc. come into action. The cells of the immune system originate in the bone marrow and the lymphatic system and are distributed through the bloodstream to reach the areas where their action is necessary.

Immunity and nutrition: immunonutrition

So that the immune system function properly it is essential that the nutritional intake is correct. A poor nutritional state is considered a cause of immune decline, since, for example, the first defensive barriers such as the skin and mucous membranes can be affected in malnourished patients, reducing their functionality and effectiveness.

In addition, there are those that have an especially relevant role within the immune system and / or the entire set of defense mechanisms of the body. On the other hand, certain nutrients that are not considered essential in a healthy person and that have functions at the immune level can become essential in people who suffer from certain health problems.

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Immunostimulatory nutrients

They are substances that are usually used in a clinical setting to supplement the diet of patients subjected to a high degree of physique due to the diseases they suffer and / or the treatment to which they are subjected. Are these:

• Glutamine Glutamine is a non-essential amino acid that is very present in our body. It plays a protective and even restorative role in the digestive tract, as it helps to moderate the atrophy of the intestinal mucosa that occurs due to certain health problems and treatments (chemotherapy or radiotherapy) or the administration of While in normal conditions it is a non-essential nutrient, in the process of critical illness it has been observed how glutamine serum values ​​decrease and it temporarily becomes an essential nutrient, that is, we must incorporate it into our diet to cover the needs of the body, because endogenous synthesis, or what is the same, the manufacture of this substance by our body, is not enough. Glutamine supplementation in doses equal to or greater than 0.2 g / Kg weight / day has been shown to have positive effects on the intestinal mucosa in patients with parenteral nutrition, significantly reducing morbidity and length of hospital stay in bone marrow transplant patients and other patients undergoing different types of surgery, and prevents bacteremia and mortality in burn patients.
• Omega-3 fatty acids The fatty acids that we take in our diet, in addition to representing an energy source, are part of cell membranes and regulate the synthesis of eicosanoids (molecules that act as mediators of the central nervous system and the immune response). Omega 3 fatty acids They have an anti-inflammatory effect, which limits the pro-inflammatory effect of omega 6 (that is why there must be a balance between both essential fatty acids) and their use in nutrition formulas has shown positive effects at different levels, including a better immune response.
• Arginine In stress processes the production of nitric oxide increases, and arginine limits its activity. In addition, among other functions, it stimulates the secretion of hormones such as insulin, prolactin and glucagon and improves cellular immune function and wound healing. When we are subjected to stressful situations, arginine synthesis is insufficient and therefore its supplementation is valued. It should be taken into account that in the West around 5.4% of the protein ingested in the diet is arginine. Supplementation has been assessed with contributions of up to 30 g per day, causing mild side effects such as diarrhea, although in some types of patients it can have more negative effects, such as increasing the inflammatory response. Therefore, more studies are needed to determine its effectiveness.
• Nucleotides Nucleotides have functions at the immune level, and it seems clear that an adequate intake through diet is necessary to maintain correct immune function. However, supplementing the diet has not been shown to be beneficial.
• Vitamins and minerals Immune level benefits have been found in the administration of vitamins A, C, E, iron, zinc and selenium, in highly variable doses, between five to twenty-five times the daily requirements of each of these nutrients, in surgical patients and patients affected by trauma and sepsis. Important benefits have also been seen in critically ill patients, but it has not been possible to establish the adequate dosage of these types of elements, so more studies are required on the effect of these nutrients.
• Protein It has been observed that the amount and nature of the proteins that are ingested in the diet influence the immune response.

Evidence

It is important to highlight that the clinical complexity of the cases in which these supplements are studied, the interpersonal diversity between patients and the use of combined formulas (mixtures of glutamine, omega 3, arginine ...) make it difficult to study the effectiveness and suitability of each substance to each type of patient, in order to also establish the time, duration and dosage of the treatment. On many occasions, the use of these formulas has managed to shorten the length of hospital stay, reduce the incidence of infections and thereby increase the speed of recovery and reduce healthcare costs. In any case, as has already been commented, positive effects have not always been achieved and a further study is needed on the intervention with each of these elements and specifically for each type of situation.