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Chronic granulomatous disease

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Related Terms
  • Bacterial infections, bone marrow, fatal granulomatosis of childhood, fungal infections, gene therapy, genetic disorder, granulomas, granulomatosis, granulomatous disease of childhood, immunoglobulins, immune system, infection, inflammatory tissues, leukocytes, NBT, neutrophils, nitroblue tetrazolium test, phagocytic, phagocytes, progressive septic granulomatosis, X chromosome, X-linked chromosome, white blood cells.

Background
  • Chronic granulomatous disease (CGD) is a rare, inherited abnormality of certain cells of the immune system, known as phagocytic cells. The phagocytes do not function properly and are unable to kill harmful bacteria and fungi in CGD patients. Consequently, CGD patients suffer from repeated bacterial and fungal infections. Another common characteristic of the disease is granulomata (tumor-like masses of inflammatory tissue), which develop in many organs in response to chronic inflammation.
  • This disease was first discovered in 1959, and it was called "a fatal granulomatosis of childhood."
  • The exact number of CGD cases in the United States is unknown. However, the data from a recently established national registry suggest that the incidence of CGD in the United States is about one case per 200,000-250,000 people. Up to 20 patients are born with CGD each year, and there does not appear to be a racial or ethnic predilection.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Immune Deficiency Foundation. Chronic Granulomatous Disease. . Accessed May 12, 2009.
  2. Maryland Pao, M.D. et al. Cognitive Function in Patients With Chronic Granulomatous Disease: A Preliminary Report. 45 (June 2004): 230-4.
  3. MedlinePlus. Chronic Granulomatous Disease. . Accessed May 12, 2009.
  4. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed May 12, 2009.
  5. Ott M, Schmidt M, Schwarzwaelder K, et al. Correction of X-linked chronic granulomatous disease by gene therapy, augmented by insertional activation of MDS1-EVI1, PRDM16 or SETBP1. 12 (4): 401-9.
  6. The Children's Hospital at Westmead. Chronic Granulomatous Disease. . Accessed May 12, 2009.
  7. Weening R, Kabel P, Pijman P, et al. Continuous therapy with sulfamethoxazole-trimethoprim in patients with chronic granulomatous disease. 103 (1): 127-30.

Causes
  • CGD is a genetic disorder of phagocytic cells. It is transmitted in 50-60% of the cases as a recessive sex-linked trait. Therefore, CGD is more likely to affect males than females because the mutated gene is on the X chromosome. It is estimated that four out of five CGD patients are male. Since females carry two X chromosomes, they will not be affected by one defective chromosome if the second chromosome is normal. Therefore, a female can only develop CGD if she inherits the mutated gene from both parents.
  • The disease can also be transmitted by inherited autosomal recessive genes. In this case, both parents must be carriers of the recessive trait in order for the child to have CGD. If both parents are carriers, there is a 25% chance that the child will have the disorder.

Symptoms
  • Most individuals with CGD are born healthy and develop symptoms within the first months or years of life. Some individuals with CGD may not develop symptoms until as late as adolescence. The severity of the disease varies among individuals, and children with less severe CGD may have a normal life expectancy, according to researchers.
  • The early symptoms associated with CGD include, lymphadenopathy, hepatosplenomegaly, growth deficiency and chronic skin infections. However, these symptoms are less common today because most patients are identified and treated in early infancy or childhood.
  • The most common symptom of CGD is the early onset of severe recurrent bacterial and fungal infections. Recurrent pneumonia is especially common and can cause serious health problems.
  • Other symptoms of the disease include: fever, skin rashes, persistent cough, boils, gum disease, swollen glands, swollen lymph nodes, enlarged liver, enlarged spleen, skin abscesses, hypergammaglobulinemia (high levels of immunoglobulins in the blood), anemia, pneumonia and bone infections.
  • Another common characteristic of CGD are granulomas (tumor-like masses of inflammatory tissue) in the skin, gastrointestinal tract, and genitourinary tract. They form in response to persistent, chronic infection. Granulomas block the gastrointestinal or urinary tracts. Nearly two thirds of patients experience granulomas in the skin. Other symptoms of granulomas include dysphagia, nausea, vomiting and abdominal pain.
  • In general, carriers of CGD show no symptoms.

Diagnosis
  • CGD is often diagnosed in the first years of life. Milder forms may appear during adolescence or even adulthood.
  • Amniocentesis: Amniocentesis is used at about 15-18 weeks gestation to determine whether the fetus has any genetic abnormalities. During the procedure a long, thin needle is inserted into the abdominal wall to the uterus, and a small amount of fluid is removed from the sac surrounding the fetus. There is a slight risk of infection or injury to the fetus, and an even smaller chance of miscarriage.
  • CBC: A complete blood count (CBC) may be performed to determine how many and what types of cells are in the blood. This test may help diagnose the condition.
  • Chorionic villus sampling: During chronionic villus sampling (CVS), a small piece of tissue (chorionic villi) is removed from the uterus during early pregnancy to screen the fetus for genetic defects. Depending on where the placenta is located, CVS can be performed through the cervix (transcervical) or through the abdomen (transabdominal). The risk of infection or fetal damage is slightly higher than the risks of amniocentesis. Fetal loss occurs about two percent of the time.
  • ESR: ESR (erythrocyte sedimentation rate) is a nonspecific test for various diseases. This one-hour test measures the distance (in millimeters) that red blood cells settle in un-clotted blood toward the bottom of a specially designed test tube.
  • Nitroblue tetrazolium test: Nitroblue tetrazolium test (NBT) may be conducted to confirm the disease and determine whether the mother is a carrier. A sample of blood is taken from the patient. Then a colorless chemical, nitroblue tetrazolium (NBT), is added to white blood cells in the laboratory. The neutrophils (white blood cells in the immune system) normally produce a chemical that kills the bacteria. In chronic granulomatous disease (CGD), this chemical is absent. If the chemical is absent when NBT is added to the sample, it will not change color, and the patient is has CGD.
  • Physical examination: A physical examination may detect an enlarged liver or spleen, as well as swollen lymph nodes throughout the body. In addition, signs of osteomyelitis (inflammation of the bone and bone marrow) may appear. A chest x-ray, bone scan or liver scan may help diagnose a patient suspected of having CGD.
  • Tissue biopsy: A tissue biopsy may detect granulomas (tumor-like masses of inflammatory tissue).

Treatment
  • Currently, there is no known cure for the disease. However, some researchers believe that gene therapy could potentially cure CGD in the future. Many believe CGD is well suited for gene therapy because is the result of a single mutated gene, which only affects one body system. In 2006, two human patients with X-linked chronic granulomatous disease were successfully treated with gene therapy, as well as blood cell precursor stem cell transplantation to their bone marrow. Both patients recovered from the disease. However, long-term complications of this therapy remain unknown.
  • Acute infections caused by CGD should be treated aggressively with antibiotics.
  • Preventive antibiotics, like trimethoprim-sulfamethoxazole, may be prescribed to prevent bacterial infections. Fungal infections have been prevented with antibiotics such as itraconazole. These are taken on a daily basis to try to decrease the frequency of infection.
  • Interferon-gamma may also be helpful in reducing the number of severe infections. Interferon gamma-1b (Actimmune®) has been used as a prophylactic (preventative) treatment for CGD.
  • Oral corticosteroids like prednisone have been used to treat gastrointestinal and genitourinary tract infections and appear to be safe and effective. Individuals should not undergo steroid treatment if any underlying or concomitant infections exist.
  • Patients are likely to live longer and healthier if they are diagnosed at a young age and begin therapeutic intervention soon after diagnosis. As treatment options continue to increase, the life span for CGD patients is also expected to increase.

Integrative therapies
  • Note: Currently, there is insufficient evidence available on the safety and effectiveness of integrative therapies for the prevention or treatment of chronic granulomatous disease (CGD). The integrative therapies listed below have been studied for effects on the immune system, bacterial infections, and fungal infections, should be used only under the supervision of a qualified healthcare provider, and should not be used in replacement of other proven therapies.
  • Strong scientific evidence:
  • Iodine: Iodine is commonly used in topical disinfectant preparations for cleaning wounds, sterilizing skin before surgical/invasive procedures, or sterilizing catheter entry sites. Betadine solution, for example, contains povidone-iodine. Other topical disinfectants include alcohol and antibiotics and iodine is sometimes used in combination with these as a skin disinfectant. Commercially prepared iodine products are recommended in order to assure appropriate concentrations.
  • There have been reports of severe and even fatal reactions to iodine. Avoid iodine-based products if allergic to iodine. Do not use for more than 14 days. Avoid lugol solution and the saturated solution of potassium iodide (SSKI, PIMA) with high amounts of potassium in the blood, fluid in the lungs, bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate or burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is considered to be safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
  • Probiotics: Probiotics are beneficial bacteria and are sometimes called friendly germs. They help maintain a healthy intestine by keeping harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products. Probiotics can be taken as capsules, tablets, beverages, powders, yogurts, and other foods. An increasing number of studies support the use of probiotics as a supplement to antibiotic therapy. Probiotic supplementation during a course of antibiotics has been studied for reducing adverse effects of antibiotics in the intestinal environment. This includes reducing growth of Clostridium difficile bacteria, which can lead to colitis, a common complication of antibiotics, especially in the elderly. Some probiotics may also help prevent the development of antibiotic resistance. In acutely ill children, synbiotics have been linked to greater weight gain and fewer bacterial illnesses after antibiotics are ended. The evidence consistently supports supplementation of antibiotics with probiotics.
  • Probiotics are generally considered to be safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Good scientific evidence:
  • Ginseng: For more than 2,000 years, the roots of ginseng have been valued in Chinese medicine. Several studies suggest that ginseng may be an effective agent for immune system enhancement. Additional high quality research is needed before a conclusion be made.
  • Avoid with known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.
  • Probiotics: Probiotics are beneficial bacteria that are sometimes called friendly germs. They help maintain a healthy intestine and help the body digest foods. They also help keep harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products. Research suggests that probiotics, especially those in milk or food, may be an effective agent for immune system enhancement. However, commercially produced yogurt may not be as effective. More studies are needed, particularly with yogurt, to give recommendations.
  • Limited evidence with day care children suggests supplementation with Lactobacillus GG may reduce number of sick days, frequency of respiratory tract infections, and frequency of related antibiotic treatments. Fermented milk (with yogurt cultures and L. casei DN-114001) may reduce the duration of gastrointestinal and respiratory infections in elderly people. More research is needed to make a firm conclusion.
  • Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Zinc: Zinc formulations have been used since ancient Egyptian times to enhance wound healing. Zinc appears to be an essential trace element for the immune system, but research on the effect of zinc supplementation on immune function is scant and mostly focuses on patients with specific diseases. Zinc gluconate appears to exert beneficial effects on immune cells, improving CD3 and CD4 counts and increasing CD4/CD8 ratios in children. There are relatively few studies that examine zinc levels and the effects of zinc supplementation on the health of the elderly population. Further research is needed before a recommendation can be made.
  • Evidence from human trials suggests that zinc pyrithione shampoo may be an effective treatment for tinea versicolor fungal infections of the scalp. Side effects were not noted. Additional research is needed before a strong recommendation can be made.
  • Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
  • Unclear or conflicting scientific evidence:
  • Amaranth oil: Amaranth is grown in Asia and the Americas and harvested primarily for its grain, which is used as a food source for bread, pasta, and infant food. Limited evidence suggests that amaranth may stimulate the immune system when combined with a heart-healthy diet in patients with heart disease and high cholesterol. However, additional studies of amaranth alone are needed to determine if it is effective for immunomodulation.
  • Amaranth is generally considered safe. Avoid if allergic or sensitive to amaranth. Use cautiously with diabetes, low blood sugar, low blood pressure, immune system disorders, or kidney disorders. Use cautiously if pregnant or breastfeeding.
  • Arabinogalactan: Arabinogalactans belong to a group of carbohydrates called polysaccharides. When consumed in the diet, arabinogalactan comes from the wood of the larch tree (Larix species) and is approved for use as a dietary fiber by the U.S. Food and Drug Administration (FDA). Early research has suggested that arabinogalactan may cause immune stimulation; however, its effect on immunity in healthy volunteers is not clear. More evidence is needed.
  • Avoid if allergic or sensitive to arabinogalactan or larch. People who are exposed to arabinogalactan or larch dust may have irritation of the eyes, lungs, or skin. Use cautiously in people with diabetes, digestive problems, or immune system disorders, and in people who consume diets high in fiber or low in galactose. Arabinogalactan should not be used during pregnancy or breastfeeding.
  • Arginine (L-arginine): L-arginine helps maintain the body's fluid balance (urea, creatinine), and aids in wound healing, hair growth, sperm production (spermatogenesis), blood vessel relaxation (vasodilation), and fights infection. Preliminary study results suggest that arginine may cause immunomodulation. More studies are needed to confirm these results.
  • Avoid if allergic to arginine or with a history of stroke or liver or kidney disease. Avoid if pregnant or breastfeeding. Use cautiously if taking blood-thinning drugs (like warfarin or Coumadin®) or blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
  • Astragalus: In traditional Chinese medicine (TCM), astragalus is commonly found in mixtures with other herbs. Western herbalists began using astragalus in the 1800s as an ingredient in various tonics. Astragalus has been suggested as an immune system stimulant in preliminary laboratory and animal research, and in traditional accounts. Reliable human studies are lacking. High quality human research is necessary before a firm conclusion can be drawn.
  • Limited available clinical study suggests the potential for benefit of astragalus in patients with tuberculosis. Further well-designed clinical trials are required before recommendations can be made.
  • Avoid if allergic to astragalus, peas, or any related plants or with a history of Quillaja bark-induced asthma. Avoid with aspirin or aspirin products or herbs or supplements with similar effects. Avoid with inflammation or fever, stroke, transplant, or autoimmune diseases. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with a risk of bleeding. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders, or kidney disorders. Use cautiously with blood-thinners, blood sugar drugs, or diuretics or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding.
  • Berberine: Berberine is a bitter-tasting, yellow, plant alkaloid with a long history of medicinal use in Chinese and Ayurvedic medicine. Berberine has been found to possess antimicrobial properties, and there is limited evidence of anti-inflammatory properties as well. Preliminary evidence suggests that berberine eye preparations may be beneficial for trachoma. However, the safety and efficacy of berberine for this indication remains unclear.
  • Avoid if allergic or hypersensitive to berberine, to plants that contain berberine (Hydrastis canadensis (goldenseal), Coptis chinensis (coptis or goldenthread), Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), and Berberis aristata (tree turmeric), or to members of the Berberidaceae family. Avoid in newborns due to the potential for an increase in free bilirubin, jaundice, and development of kernicterus. Use cautiously with cardiovascular disease, gastrointestinal disorders, hematologic disorders, leukopenia, kidney disease, liver disease, respiratory disorders, cancer, hypertyraminemia, diabetes, or low blood pressure. Use cautiously in children due to a lack of safety information. Use cautiously in individuals with high exposure to sunlight or artificial light. Use cautiously for longer than eight weeks due to theoretical changes in bacterial gut flora. Use cautiously if taking anticoagulants, antihypertensives, sedatives, anti-inflammatories, medications metabolized by CYP P450 3A4 including cyclosporin, or any prescription medications. Avoid if pregnant or breastfeeding.
  • Beta-carotene: Beta-carotene is a member of the carotenoids, which are very colorful (red, orange, yellow), fat-soluble compounds. They are naturally found in many fruits, grains, oil, and vegetables, including green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers. Preliminary research of beta-carotene for immune system enhancement shows mixed results. Further research is needed before a conclusion can be drawn.
  • Avoid if sensitive to beta-carotene, vitamin A or any other ingredients in beta-carotene products.
  • Beta sitosterol: Beta-sitosterol is found in plant-based foods, such as fruits, vegetables, soybeans, breads, peanuts, and peanut products. It is also found in bourbon and oils (such as olive oil, flaxseed, and tuna). Due to data that suggest immune modulating effects of beta-sitosterol and beta-sitosterol glucoside, these sterols have been studied for the adjunct treatment of tuberculosis with antituberculosis regimens. Clinical study is currently limited in this area, and larger populations of patients with tuberculosis should be evaluated.
  • Avoid if allergic or hypersensitive to beta-sitosterol, beta-sitosterol glucoside, or pine. Use cautiously with asthma or breathing disorders, diabetes, primary biliary cirrhosis (destruction of the small bile duct in the liver), ileostomy, neurodegenerative disorders (like Parkinson's disease or Alzheimer's disease), diverticular disease (bulging of the colon), short bowel syndrome, celiac disease, and sitosterolemia. Use cautiously with a history of gallstones. Avoid if pregnant or breastfeeding.
  • Bishop's weed: Limited available human study used 8-methoxypsoralen (8-MOP), a photoreactive plant compound from bishopsweed, for the treatment of tinea versicolor. Clinical studies are needed before a conclusion can be made.
  • Use cautiously in patients with photosensitivity as bishop's weed may be photoreactive, and cause phototoxic skin damage, phototoxic dermatitis, and pigmentary retinopathy. Use cautiously in patients with bleeding disorders or taking anticoagulants, NSAIDs/anti-platelet agents, or herbs or supplements that increase risk of bleeding because bishop's weed may have additive effects and increase the risk of bleeding. Use cautiously in patients taking drugs or herbs or supplements metabolized by cytochrome P450 as bishop's weed may increase the effects of these agents. Use cautiously in patients with eye disorders, as bishop's weed may cause ocular toxicity. Avoid in patients with known allergy/hypersensitivity to bishop's weed, its constituents, or members of the Apiaceae family.
  • Bitter orange: Limited available human study found promising results using the oil of bitter orange for treatment of fungal infections. However, due to methodological weakness of this research, further evidence is needed to confirm these results.
  • Avoid if allergic or hypersensitive to bitter orange or any members of the Rutaceae family. Avoid with heart disease, narrow-angel glaucoma, intestinal colic, or long QT interval syndrome. Avoid if taking anti-adrenergic agents, beta-blockers, QT-interval prolonging drugs, monoamine oxidase inhibitors (MAOIs), stimulants, or honey. Use cautiously with headache, hyperthyroidism (overactive thyroid), or if fair-skinned. Avoid if pregnant or breastfeeding.
  • Black currant: The black currant shrub is native to Europe and parts of Asia and is particularly popular in Eastern Europe and Russia. There is currently a lack of information in humans on the effectiveness of black currant seed for immunomodulation.
  • Avoid if allergic or hypersensitive to black currant, its constituents, or plants in the Saxifragaceae family. Avoid with hemophilia or in those taking blood thinners, unless otherwise recommended by a qualified healthcare provider. Use cautiously with venous disorders or gastrointestinal disorders. Use cautiously if taking MAOIs (antidepressants) or vitamin C supplements. Avoid if pregnant or breastfeeding.
  • Black tea: Black tea is made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. In early study, inhaled tea catechin was reported as temporarily effective in the reduction of Methicillin-resistant Staphylococcus aureus (MRSA) infection and shortening of hospitalization in elderly patients with MRSA-infected sputum. Additional research is needed to further explore these results.
  • Avoid if allergic or hypersensitive to caffeine or tannins. Skin rash and hives have been reported after caffeine ingestion. Use cautiously with diabetes. Use cautiously if pregnant. Heavy caffeine intake during pregnancy may increase the risk of SIDS (sudden infant death syndrome). Very high doses of caffeine have been linked with birth defects. Caffeine is transferred into breast milk. If breastfeeding mothers consume black tea, it may lead to anemia, decreased iron metabolism, and irritability in their infants.
  • Blessed thistle: Human research of blessed thistle as a treatment for bacterial infections is currently lacking. Laboratory studies report that blessed thistle (and chemicals contained in blessed thistle, such as cnicin and polyacetylene) may have activity against several types of bacterial infections and no effects on some types. Early studies report no activity of blessed thistle against herpes viruses, influenza, or poliovirus. Further evidence is necessary in this area before a firm conclusion can be drawn.
  • Blessed thistle is generally considered to be safe when taken by mouth in recommended doses for short periods of time, with few reported side effects such as birth defects, bleeding, breathing problems, bruising, cancer of the nose or throat, increased production of stomach acid, itching, kidney disease, liver toxicity, skin rash, stomach discomfort, stomach ulcers, and vomiting. Allergic reactions to blessed thistle including rash may occur, as well as cross-sensitivity to mugwort and Echinacea. Cross-reactivity may also occur with bitter weed, blanket flower, Chrysanthemum, coltsfoot, daisy, dandelion, dwarf sunflower, goldenrod, marigold, prairie sage, ragweed or other plants in the Asteraceae/Compositae family. Avoid if pregnant or breastfeeding.
  • Bovine colostrum: Bovine colostrum is the pre-milk fluid produced from cow mammary glands during the first two to four days after birth. Bovine colostrum confers growth, nutrient, and immune factors to the offspring. Bovine colostrum contains immunoglobulins or antibodies that are released into the bloodstream in response to infections. These immunoglobulins may help improve immune function and may be effective in treating immune system deficiencies. More evidence is required before a firm conclusion can be made.
  • Avoid if allergic or hypersensitive to dairy products. Use bovine colostrum with caution. Toxic compounds, such as polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT), and dichlordiphenyldichloroethylene (DDE) have been found in human colostrum and breast milk. Thus, it is possible that these agents may be found in bovine colostrum. Avoid with, or if at risk of developing, cancer. Use cautiously with immune system disorders, atherosclerosis (hardening of the arteries) or if taking medications, such as anti-diarrheal agents (e.g. immodium), insulin, or CNS agents (amphetamines, caffeine). Avoid if pregnant or breastfeeding.
  • Cat's claw: Cat's claw is widely used in the United States and Europe, and it is one of the top herbal remedies sold despite a lack of high-quality human evidence. Preliminary research of cat's claw for immune system enhancement shows mixed results. Further research is needed before a conclusion can be drawn.
  • Avoid if allergic to Cat's claw or Uncaria plants or plants in the Rubiaceae family such as gardenia, coffee, or quinine. Avoid with a history of conditions affecting the immune system (such as AIDS, HIV, some types of cancer, multiple sclerosis, tuberculosis, rheumatoid arthritis, or lupus). Use cautiously with bleeding disorders or history of stroke, or if taking drugs that may increase the risk of bleeding. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Cat's claw may be contaminated with other Uncaria species. Reports exist of a potentially toxic, Texan grown plant, Acacia gregii being substituted for cat's claw. Avoid if pregnant, breastfeeding, or trying to become pregnant.
  • Chlorophyll: Preliminary evidence suggests that chlorophyll intake during chemotherapy treatment in patients with tuberculosis may improve immune parameters and free radical indices, such as malonic dialdehyde. Additional study is needed in this area.
  • Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes, or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressant agents or agents used to treat diabetes. Avoid if pregnant or breastfeeding.
  • Cinnamon: There is currently a lack of available evidence to support the use of cinnamon for AIDS patients with advanced oral candidiasis. More study is needed in this area.
  • Avoid if allergic or hypersensitive to cinnamon, its constituents, members of the Lauraceae family, or Balsam of Peru. Use cautiously if prone to atopic reactions or if taking cytochrome P450 metabolized agents, anticoagulants (blood thinners), insulin or blood sugar-altering medications, antibiotics, or cardiovascular agents. Avoid if pregnant or breastfeeding.
  • Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains, fruits, shellfish, avocado, beef, and animal organs, (e.g. liver and kidney). Copper is involved in the development of immune cells and immune function in the body. Severe copper deficiency appears to have adverse effects on immune function, although the exact mechanism is not clear.
  • Avoid if allergic/hypersensitive to copper. Avoid use of copper supplements during the early phase of recovery from diarrhea. Avoid with hypercupremia, occasionally observed in disease states, including cutaneous leishmaniasis, sickle-cell disease, unipolar depression, breast cancer, epilepsy, measles, Down syndrome, and controlled fibrocalculous pancreatic diabetes (a unique form of secondary diabetes mellitus). Avoid with genetic disorders affecting copper metabolism such as Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis. Avoid with HIV/AIDS. Use cautiously with water containing copper concentrations greater than 6mg/L. Use cautiously with anemia, arthralgias, or myalgias. Use cautiously if taking oral contraceptives. Use cautiously if at risk for selenium deficiency. The U.S. Recommended Dietary Allowance (RDA) is 1,000 micrograms for pregnant women. The U.S. RDA is 1,300 micrograms for nursing women.
  • Cranberry: Limited laboratory research has examined the antifungal and antibacterial activity of cranberry. Further research is warranted in this area.
  • Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium species. Sweetened cranberry juice may affect blood sugar levels. Use cautiously with a history of kidney stones. Pregnant and breastfeeding women should avoid cranberry in higher amounts than what is typically found in foods.
  • Echinacea: Echinacea is a perennial herb that has been used to treat a variety of medical conditions. Echinacea has been studied alone and in combination preparations for immune system stimulation. It remains unclear if there are clinically significant benefits. Additional studies are needed in this area before conclusions can be drawn regarding safety or effectiveness.
  • Avoid if allergic to echinacea, its constituents, or any members of the Asteraceae/Compositae family (ragweed, chrysanthemums, marigolds, daisies). Use cautiously in patients prone to atopic reactions and in those with hemochromatosis and diabetes. Some natural medicine experts discourage the use of echinacea by people with conditions affecting the immune system, such as HIV/AIDS, some types of cancer, multiple sclerosis, tuberculosis, and rheumatologic diseases (such as rheumatoid arthritis or lupus). Use parenteral preparations of echinacea(no longer approved for use in Germany) cautiously. Use tinctures cautiously with alcoholic patients or in patients taking disulfiram or metronidazole. Avoid using echinacea in patients presenting for anesthesia. Use cautiously if pregnant or breastfeeding.
  • Gamma linolenic acid (GLA):Gamma linolenic acid (GLA) is a dietary fatty acid that is found in many plant oil extracts. Few clinical trials have investigated the effect of GLA on immune responses in healthy human subjects. GLA, as blackcurrant seed oil, may offer some benefits. Further study is required to determine if GLA is beneficial for immune enhancement.
  • Use cautiously with drugs that increase the risk of bleeding like anticoagulants and anti-platelet drugs. Avoid if pregnant or breastfeeding.
  • Garlic: Garlic is used both medicinally and as a food spice. Preliminary research suggests that oral plus intravenous garlic may help manage symptoms of cryptococcal meningitis, a fungal infection that commonly occurs in HIV patients. Further research is needed before recommending for or against the use of garlic in the treatment of this potentially serious condition, for which other treatments are available. Several studies describe the use of garlic as a topical antifungal to treat fungal infections of the skin, including yeast infections. More research is needed in this area.
  • Use cautiously as garlic can cause severe burns and rash when applied to the skin of sensitive individuals. Avoid if allergic or hypersensitive to garlic or other members of the Lilaceae(lily) family (e.g. hyacinth, tulip, onion, leek, or chive). Avoid with a history of bleeding problems, asthma, diabetes, low blood pressure, or thyroid disorders. Stop using supplemental garlic two weeks before and immediately after dental/surgical/diagnostic procedures with bleeding risks. Avoid in supplemental doses if pregnant or breastfeeding.
  • Ginseng: In patients treated with Hochu-ekki-to, which contains ginseng and several other herbs, urinary Methicillin-resistant Staphylococcus aureus (MRSA) has been reported to decrease after 10 weeks. Further study of ginseng alone is necessary in order to draw firm conclusions.
  • Avoid with a known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.
  • Goldenseal: Goldenseal is one of the five top-selling herbal products in the United States. Goldenseal is sometimes suggested to be an immune system stimulant. However, there is little clinical evidence in this area. More research is needed before a firm conclusion can be drawn.
  • Several poorly designed human studies report benefits of berberine used in the eye to treat trachoma (Chlamydia trachomatosis eye infection). Better research is needed before a strong recommendation can be made.
  • Avoid if allergic or hypersensitive to goldenseal or any of its constituents (like berberine and hydrastine). Use cautiously with bleeding disorders, diabetes, or low blood sugar levels. Avoid if pregnant or breastfeeding.
  • Honey: Currently, there is insufficient available evidence for the use of honey in the treatment of Fournier's gangrene. Additional study is needed.
  • Avoid if allergic or hypersensitive to honey, pollen, celery or bees. Honey is generally considered to be safe in recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously in pregnant or breastfeeding women.
  • Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. These approaches have been used for the relief of various diseases and injuries, or for general well being. There is preliminary evidence that some hydrotherapy techniques may reduce skin bacteria. There may be benefits in people with skin wounds or ulcers who are at risk of infection. Evidence that infection of the skin itself (cellulitis) is improved is currently lacking. More research is needed in this area.
  • Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices, such as pacemakers, defibrillators, or liver infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, or impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and it should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physicians before starting hydrotherapy.
  • Iodine: Povidone-iodine has been suggested as a topical treatment for molluscum contagiosum. Research is limited in this area.
  • There have been reports of severe and even fatal reactions to iodine. Avoid iodine-based products if allergic to iodine. Do not use for more than 14 days. Avoid lugol solution and the saturated solution of potassium iodide (SSKI, PIMA) with high amounts of potassium in the blood, fluid in the lungs, bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate or burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is considered to be safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
  • Lavender: Early laboratory studies suggest that lavender oils may have topical antibiotic activity. However, this has not been well tested in human studies.
  • Avoid if allergic or hypersensitive to lavender. Avoid with a history of seizures, bleeding disorders, eating disorders (such as anorexia or bulimia), or anemia (low levels of iron). Avoid if pregnant or breastfeeding.
  • L-carnitine: Preliminary study suggests antibacterial activity may be increased in patients with tuberculosis given acetyl-L-carnitine. Additional research is needed to confirm these findings.
  • Avoid with known allergy or hypersensitivity to carnitine. Use cautiously with peripheral vascular disease, hypertension (high blood pressure), alcohol-induced liver cirrhosis and diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.
  • Lime: Limited available study found that lime juice used in sauces may aid in cholera prevention. Another preliminary study suggested that using limes in the main meal may also have a protective effect; both studies were investigated by the same primary author. Additional study is needed before a firm conclusion can be made.
  • Lime is considered safe when used in amounts typically found in foods. Avoid if allergic or hypersensitive to lime or any members in the Rutaceae family. Use cautiously with drugs that are broken down by the liver. Use cautiously with drugs that cause sun sensitivity. Avoid if pregnant or breastfeeding.
  • Maitake mushroom: Maitake mushrooms (Grifola frondosa) are fungi that can be eaten. Maitake has been used both as a food and for medical conditions. Beta-glucan extracts from maitake have been studied for immune stimulation. Additional high quality research is needed to make a conclusion.
  • Maitake has not been studied thoroughly in humans, and its effects are not well known. Because it has been used historically as a food, it is thought that low doses may be safe. Avoid if allergic or hypersensitive to maitake or its constituents. Use cautiously with low blood pressure, diabetes, or low blood sugar. Use cautiously if taking blood pressure medications, antidiabetic agents, immunostimulants, immunosuppressants, or interferons. Avoid if pregnant or breastfeeding.
  • Massage: The main goal of massage is to help the body heal itself. Touch is fundamental to massage therapy and is used by therapists to locate painful or tense areas, to determine how much pressure to apply, and to establish a therapeutic relationship with clients. Preliminary evidence suggests that massage therapy may preserve immune function. Further research is needed before a firm conclusion can be made.
  • Avoid with bleeding disorders, low platelet counts, or if taking blood-thinning medications (such as heparin or warfarin/Coumadin®). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
  • Meditation: Many forms of meditation have been practiced for thousands of years throughout the world, with many techniques originating in Eastern religious practices. Preliminary research reports increased antibody response after meditation. Further study is needed to better determine if meditation affects immune function.
  • Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professionals before starting meditation and should explore how meditation may or may not fit in with their current treatment plans. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses.
  • Mistletoe: Once considered a sacred herb in Celtic tradition, mistletoe has been used for centuries for high blood pressure, epilepsy, exhaustion, anxiety, arthritis, vertigo (dizziness), and degenerative inflammation of the joints. A few small trials found mistletoe to be promising as an immunostimulant in individuals with the common cold. Further study is needed to determine if mistletoe is effective for immunomodulation.
  • Avoid if allergic or hypersensitive to mistletoe or to any of its constituents. Anaphylactic reactions (life threatening shock) have been described after injections of mistletoe. Avoid with acute, highly febrile, inflammatory disease, thyroid disorders, seizure disorders, or heart disease. Use cautiously with diabetes, glaucoma, or if taking cholinergics.
  • Peppermint: There is currently not enough available scientific evidence to support the use of peppermint for tuberculosis. More research is needed in this area.
  • Peppermint oil may be safe in small doses, although multiple adverse effects are possible. When used on the skin, peppermint oil has been associated with allergic/hypersensitivity reactions, skin rash/hives/contact dermatitis, mouth ulcers/sores, chemical burn, and eye irritation. Lung injury has occurred following an injection of peppermint oil. Peppermint oil taken by mouth may cause headache, dizziness, heartburn, anal burning, slow heart rate, or muscle tremor. Very large doses of peppermint oil taken by mouth have resulted in muscle weakness, brain damage, and seizure. Peppermint oil should be used cautiously by people with G6PD deficiency or gallbladder disease. Use in infants or children is not recommended due to potential toxicity.
  • Pomegranate: In clinical study, an extract of pomegranate was shown to be as effective as a commonly used oral gel when used topically to treat candidiasis associated with denture stomatitis (mouth sores). Additional study is needed to confirm pomegranate's antifungal effects.
  • Avoid if allergic or hypersensitive to pomegranate. Avoid with diarrhea or high or low blood pressure. Avoid taking pomegranate fruit husk with oil or fats to treat parasites. Pomegranate root/stem bark should only be used under the supervision of a qualified healthcare professional. Use cautiously with liver damage or liver disease. Pomegranate supplementation may be unsafe during pregnancy when taken by mouth. The bark, root, and fruit rind may cause menstruation or uterine contractions. Avoid if breastfeeding due to a lack of scientific data.
  • Probiotics: Early research suggests that cheese containing probiotics may help reduce the risk of a fungal mouth infection, called thrush, in the elderly. As a bacterial reservoir, the nose may harbor many varieties of potentially disease-causing bacteria. There is limited evidence that probiotic supplementation may reduce the presence of bacterial infections in the upper respiratory tract. More studies are needed to determine the effectiveness of probiotics for these indications.
  • Probiotics are generally considered to be safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Propolis: Propolis is a natural resin created by bees to make their hives. Propolis is made from the buds of conifer and poplar trees and combined with beeswax and other bee secretions. Animal and laboratory studies suggest that propolis may be a beneficial treatment for various types of bacterial and fungal infections. Initial human research reports possible benefits against oral/dental bacteria, genital herpes, urine bacteria, intestinal giardia infections or H. pylori. In humans, a commercial propolis ethanol extract from Brazil, formulated to ensure physical and chemical stability, was found to inhibit fungal infections of the mouth, such as oral candidiasis. Additional research is needed to confirm these findings.
  • Avoid if allergic or hypersensitive to propolis, black poplar (Populas nigra), poplar bud, bee stings, bee products, honey, or Balsam of Peru. Severe allergic reactions have been reported. There has been one report of kidney failure with the ingestion of propolis that improved upon discontinuing therapy and deteriorated with re-exposure. Avoid if pregnant or breastfeeding because of the high alcohol content in some products.
  • Qi gong: Qi gong is a type of traditional Chinese medicine (TCM) that is thought to be at least 4,000 years old. It is traditionally used for spiritual enlightenment, medical care, and self-defense. There is some evidence suggesting that internal Qi gong may help with treatment of immune deficiencies. However, the evidence is still unclear, and further research is needed to understand how Qi gong may potentially benefit immune function. Based on preliminary study, Chan-Chuang Qi gong therapy may be used to treat leukopenia (low white blood cell count) in breast cancer patients treated with chemotherapy. Further study is warranted.
  • Qi gong is generally considered to be safe in most people when learned from a qualified instructor. Use cautiously with psychiatric disorders.
  • Reflexology: Reflexology involves the application of manual pressure to specific points or areas of the feet called "reflex points" that are believed to correspond to other parts of the body. Some research suggests that self-administered reflexology may be beneficial for immune enhancement. Additional study is needed in this area.
  • Avoid with recent or healing foot fractures, unhealed wounds, or active gout flares affecting the foot. Use cautiously and seek prior medical consultation with osteoarthritis affecting the foot or ankle or with severe vascular disease of the legs or feet. Use cautiously with diabetes, heart disease, unstable blood pressure, cancer, active infections, past episodes of fainting (syncope), mental illness, gallstones, kidney stones, or with a pacemaker. Use cautiously if pregnant or breastfeeding. Reflexology should not delay diagnosis or treatment with more proven techniques or therapies.
  • Rose hip: Rose hips are the fruits that develop from the blossoms of the wild rose plant. It is unclear if rose hips affect immune function. More studies are needed in this area.
  • Avoid if allergic to rose hips, rose pollen, their constituents, or members of the Rosaceae family. Use cautiously if taking anticoagulant or anti-platelet aggregating agents, anticancer agents, anti-HIV medications, anti-inflammatory agents, antilipemics, aluminum-containing antacids, antibiotics, salicylates or salicylate-containing herbs, or laxatives. Use cautiously in patients who are avoiding immune system stimulants.
  • Seaweed, kelp, bladderwrack: Bladderwrack (Fucus vesiculosus) is a brown seaweed found along the northern coasts of the Atlantic and Pacific oceans and North and Baltic seas. Another seaweed that grows alongside bladderwrack is Ascophyllum nodosum, andit is often combined with bladderwrack in kelp preparations. Laboratory research suggests that bladderwrack may have antifungal and antibacterial activity. However, reliable human studies to support this use are currently lacking in the available literature.
  • Avoid if allergic or hypersensitive to Fucus vesiculosus or iodine. Avoid with a history of thyroid disease, bleeding, acne, kidney disease, blood clots, nerve disorders, high blood pressure, stroke, or diabetes. Avoid if pregnant or breastfeeding.
  • Selenium: Commercially available 1% selenium sulfide shampoo has been reported as equivalent to sporicidal therapy in the adjunctive treatment of the yeast infection tinea capitis. Selenium sulfide shampoo has also been studied as a possible treatment for tinea versicolor. However, research results are inconclusive.
  • Avoid if allergic or hypersensitive to products containing selenium. Avoid with a history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
  • Shiitake: Lentinan, a constituent of shiitake, has been shown to modulate the immune system in some studies. However, there is currently a lack of reliable human evidence supporting the use of lentinan or shiitake for immunomodulation. Additional study is needed in this area.
  • Avoid if allergic or hypersensitive to shiitake mushrooms. Avoid if pregnant or breastfeeding.
  • Sorrel: There is currently not enough evidence on the proposed antibacterial effects of sorrel. More research is needed.
  • Avoid large doses of sorrel because there have been reports of toxicity and death. This may be because of the oxalate found in sorrel. Many sorrel tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. These sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl®) or disulfiram (Antabuse®). Avoid if pregnant or breastfeeding.
  • Soy: It has been suggested that soy may be beneficial for tuberculosis when taken with standard medications. According to early research, soy may improve the process of detoxification, have positive effects on the liver, reduce cell damage, and decrease inflammation. Therefore, soy supplements may allow patients to safely take higher doses of antimicrobial drugs that are used to treat tuberculosis.
  • Avoid if allergic to soy. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are unclear, and therefore, not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk that was not specifically designed for infants. People who experience intestinal irritation from cow's milk may experience intestinal damage or diarrhea from soy. It is unknown if soy or soy isoflavones share the same side effects as estrogens (e.g. increased risk of blood clots). The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast or prostate cancers. Other hormone-sensitive conditions, such as endometriosis, may also be worsened. Patients taking blood-thinning drugs (e.g. warfarin or aspirin) should check with their doctors before taking soy supplements.
  • Tai chi: Tai chi is a system of movements and positions believed to have developed in 12th Century China. Tai chi techniques aim to address the body and mind as an interconnected system and are traditionally believed to have mental and physical health benefits to improve posture, balance, flexibility, and strength. Tai chi may increase the body's immune response in older adults. For example, patients receiving varicella vaccines and who practiced tai chi showed increased immune responses. Although early study is promising, more study is needed to better determine if tai chi is effective for immune system stimulation.
  • Avoid with severe osteoporosis or joint problems, acute back pain, sprains, or fractures. Avoid during active infections, right after a meal, or when very tired. Some believe that visualization of energy flow below the waist during menstruation may increase menstrual bleeding. Straining downwards or holding low postures should be avoided during pregnancy, and by people with inguinal hernias. Some tai chi practitioners believe that practicing for too long or using too much intention may direct the flow of chi (qi) inappropriately, possibly resulting in physical or emotional illness. Tai chi should not be used as a substitute for more proven therapies for potentially serious conditions. Advancing too quickly while studying tai chi may increase the risk of injury.
  • Tea tree oil: Tea tree oil is purported to have antiseptic properties, and has been used traditionally to prevent and treat infections. Laboratory studies report that tea tree oil has activity against methicillin-resistant Staphylococcus aureus (MRSA) colonization. It has been proposed that using tea tree oil ointment in the nose and a tea tree wash on the body may treat colonization by these bacteria. However, there is currently not enough information from human studies to make recommendations for or against this use of tea tree oil. Although tea tree oil has been found to have activity against several fungus species in laboratory study, there is currently insufficient human evidence to determine if it is an effective topical treatment for onychomycosis, tinea pedis (athlete's foot), or thrush (oral Candida albicans).
  • Tea tree oil may be toxic when taken by mouth and therefore, should not be swallowed. Avoid if allergic to tea tree oil or plants of the Myrtle (Myrtaceae) family, Balsam of Peru, or benzoin. Use cautiously with a history of eczema. Avoid if pregnant or breastfeeding.
  • Thyme: Thyme has been used medicinally for thousands of years. Beyond its common culinary application, it has been recommended for many indications based on proposed antimicrobial, antitussive, spasmolytic, and antioxidant activity. Thyme essential oil and thymol have been shown to have antifungal effects. Topical thymol has been used traditionally to treat paronychia (skin infection around a finger or toenail) and onycholysis (fungal nail infection). Currently, there is insufficient reliable human evidence to recommend for or against the use of thyme or thymol as a treatment for fungal infections.
  • Avoid if allergic or hypersensitive to thyme, members of the Lamiaceae (mint) family, any component of thyme, or rosemary (Rosmarinus officinalis). Avoid oral ingestion or non-diluted topical application of thyme oil due to potential toxicity. Avoid topical preparations in areas of skin breakdown or injury or in atopic patients due to multiple reports of contact dermatitis. Use cautiously with gastrointestinal irritation or peptic ulcer disease due to anecdotal reports of gastrointestinal irritation. Use cautiously with thyroid disorders due to observed anti-thyrotropic effects in animal research of the related species Thymus serpyllum. Avoid if pregnant or breastfeeding.
  • Thymus extract: Thymus extracts for nutritional supplements are usually derived from young calves (bovine). Preliminary evidence suggests that thymus extract increases white blood cell counts. Additional study is needed to determine if thymus extract is effective for immune system stimulation.
  • Although inconclusive, preliminary evidence suggests that thymus extract may improve effectiveness of antibacterial therapy in patients with tuberculosis. Well-designed clinical trials are required before recommendations can be made.
  • Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to the potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid with thymic tumors, myasthenia gravis (neuromuscular disorder), or untreated hypothyroidism. Avoid if taking hormonal therapy or immunosuppressants. Avoid if pregnant or breastfeeding; thymic extract increases human sperm motility and progression.
  • Vitamin A: Vitamin A is a fat-soluble vitamin. Vitamin A deficiency may compromise immunity, but there is no clear evidence that additional vitamin A supplementation is beneficial for immune function in patients who are not vitamin A deficient.
  • Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity may occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses; however, vitamin A excess, as well as deficiency, has been associated with birth defects. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
  • Vitamin B6: Major sources of vitamin B6 include: cereal grains, legumes (beans), vegetables (like carrots, spinach, peas), potatoes, milk, cheese, eggs, fish, liver, meat, and flour. Vitamin B6 has been shown to be important for immune system function in older individuals. One study found that the amount of vitamin B6 required to reverse immune system impairments in elderly people was more than the current recommended dietary allowance (RDA). Well-designed clinical trials on vitamin B6 supplementation for this indication are needed before a conclusion can be made.
  • Vitamin B6 is likely safe when used orally in doses not exceeding the recommended dietary allowance (RDA). Avoid if sensitive or allergic to any vitamin B6 product ingredients. Some individuals seem to be particularly sensitive to vitamin B6 and may have problems at lower doses. Avoid excessive dosing. Use cautiously if pregnant or breastfeeding.
  • Vitamin D: Vitamin D is found in many foods, including fish, eggs, fortified milk, and cod liver oil. The sun also helps the body produce vitamin D. Preliminary human evidence suggests that vitamin D and its analogues, such as alfacalcidol, may act as immunomodulatory agents. High quality clinical studies are needed to better understand the effects of vitamin D on immunomodulation.
  • Avoid if allergic or hypersensitive to vitamin D or any of its components. Vitamin D is generally well-tolerated in recommended doses; doses higher than recommended may cause toxic effects. Use cautiously with hyperparathyroidism (overactive thyroid), kidney disease, sarcoidosis, tuberculosis, and histoplasmosis. Vitamin D is safe in pregnant and breastfeeding women when taken in recommended doses.
  • Vitamin E: Vitamin E exists in eight different forms ("isomers"): alpha, beta, gamma and delta tocopherol; and alpha, beta, gamma, and delta tocotrienol. Alpha-tocopherol is the most active form in humans. Studies of the effects of vitamin E supplementation on immune system function have yielded mixed results. Further research is needed before a clear conclusion can be drawn.
  • Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders or if taking blood thinners. Avoid doses greater than the recommended daily level in pregnant women and breastfeeding women.
  • Fair negative scientific evidence:
  • DHEA: DHEA (dehydroepiandrosterone) is a hormone that is produced by the adrenal glands. It is suggested by some textbooks and review articles that DHEA may be effective for immune system stimulation. However, current scientific evidence does not support this claim.
  • Avoid if allergic to DHEA. Avoid with a history of seizures. Use cautiously with adrenal or thyroid disorders or if taking anticoagulants or drugs, herbs, or supplements for diabetes, heart disease, seizure, or stroke. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.
  • Lycopene: Lycopene is a carotenoid found in human serum, and skin, liver, adrenal, lung, prostate, and colon tissue. It has been proposed that lycopene and other carotenoids, such as beta-carotene, may stimulate the immune system. However, several studies of lycopene supplements and tomato juice intake in humans do not report effectiveness for immune stimulation.
  • Avoid if allergic to tomatoes or to lycopene. Due to a lack of conclusive data, avoid if pregnant or breastfeeding.
  • Macrobiotic diet: A macrobiotic diet has been advocated to preserve intestinal health. However, it apparently does not reduce the incidence of antibiotic resistant bacteria, nor infections caused by resistant strains in the gastrointestinal tract, compared to a diet with animal products.
  • Use cautiously with cancer or other medical conditions without expert planning or supplementation. Avoid in children or adolescents without professional guidance or appropriate supplementation. Avoid in pregnant or lactating women due to potential deficiencies, unless properly supplemented.
  • Probiotics: Bacterial infection translocation, the passage of bacteria from the gut to other areas of the body where they can cause disease, is of special concern in surgery. Limited evidence suggests that supplementation with probiotics may not reduce this problem.
  • Probiotics are generally considered to be safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.

Prevention
  • Individuals with a family history of CGD should consider genetic counseling. Advances in genetic screening and the increasing use of chorionic villus sampling (testing uterus tissue for genetic defects in the fetus), have made early detection and prevention of CGD possible.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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