Unscientific 'immunity boosters' may do more harm than good

About two months ago, NITI Aayog member (Health) Dr V K Paul stressed the need to take immunity boosters like chyawanprash twice a day. The advice, irrespective of pre-existing conditions, came at a press conference, where he went on citing anecdotal statements on their benefits.

Quite contradictorily, the Ministry of Health and Family Welfare issued guidelines to diabetics to monitor their blood sugar levels amid the pandemic, indirectly implying that chyawanprash — which has sugar in it — needs to be avoided. But that is the fine print. It could be overlooked by the layperson, who might go by what is trending, which might cause more harm than good.

There is no denial that our markets and social media platforms are flooded with so-called immunity boosters and their advertisements. Facebook, Twitter and WhatsApp forwards offer a lot of information about ‘immunity-boosting’ products that claim to help keep the virus at bay.

According to a report by the India Brand Equity Foundation, an initiative of the Ministry of Commerce & Industry, scores of new products have been launched ever since the outbreak of the pandemic. It also reports that Dabur saw a 400 per cent increase in demand for its flagship product Dabur Chyawanprash, and saw almost an 80 per cent rise in demand for Dabur Honey. Consequently, many companies in this space are introducing more products to strengthen their immunity-boosting portfolio.

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“The idea of general immunity boosters is misleading, especially so during a pandemic. It is one thing to talk of overall general healthy behaviour, healthy food and eating at home, but the current fad for such products is purely being driven by commercial interests. For me, this is not about Ayurveda at all, this is about what we call the commercial determinants of health. Companies see the pandemic as a business opportunity,” says Dr N S Prashanth, a physician and public health researcher with the Institute of Public Health.

“Secondly, there is no basis to think that these boosters have any demonstrable medical impact on illness progression or its prevention. In fact, they feed a naive complacency among people who blindly and uncritically rely on them as they begin to think they have better protection, which is untrue. This is especially true with excessive and irrational use of vitamins and minerals like zinc, most of which is very likely excreted by our kidneys and liver, which bear a huge burden of processing these,” cautions Prashanth.

Earlier this year, Patanjali Ayurved, co-founded by Ram Kishan Yadav aka Baba Ramdev, claimed their product Coronil has been approved by the World Health Organisation (WHO). Soon after, WHO clarified through a tweet, saying ‘it has not reviewed or certified the effectiveness of any traditional medicine for the treatment of Covid-19’. Patanjali is now claiming it to be an immunity booster, scaling down their claims of curing Covid-19.

Worse, people have started self-medicating by taking zinc or other multivitamins.

“We may soon turn into Tin men,” says Dr Krishna Mohan, a physician from Moodabidri in Dakshina Kannada, as he cautions against the amount of zinc people are consuming to prevent Covid-19. He notes that zinc, in recommended doses, is helpful in fighting the infection, but long-term supplementation can cause copper deficiency.

The use of zinc supplementation for durations as short as 10 months has been associated with copper deficiency. Copper is a micronutrient essential for the smooth functioning of the nervous and immune systems in humans. While the lack of copper causes disorders related to the blood and the nervous system, excess amounts of copper could be toxic, resulting in conditions like Alzheimer’s disease and inflammatory disorders.

In addition, oral zinc can decrease the absorption of medications that bind with polyvalent cations. As zinc has not been shown to have any clinical benefit against Covid-19 and may be harmful, its consumption higher than the daily allowance is not recommended.

So, what are immunity boosters? Perhaps, we should take a step back and understand the immune system first.

Know your immune system

The immune system is a set of biological processes that protects an organism from diseases. Its function is pretty much like a security system that detects and responds to a host of intruders like harmful viruses and bacteria. Almost all organisms have some immune system. Even bacteria have an immune system in the form of enzymes that protect them against infections. Primarily, the immune systems are of two types: innate immune system and adaptive immune system.

The innate immune system is the dominant and older evolutionary defence system found in plants, fungi, insects and primitive multicellular organisms. This system provides certain standard responses to a wide range of known situations and stimuli. On the contrary, the adaptive immune system provides a custom response to each stimulus by learning to recognise molecules it has previously encountered.

The adaptive immune system, also called the acquired immune system, establishes an immunological memory resulting in an enhanced response to subsequent encounters with those same harmful bacteria or viruses (pathogen). The mechanism of acquired immunity is the basis of vaccination.

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Antibodies play a critical part in the adaptive immune system. They are specialised Y-shaped proteins used by the system to identify and neutralise harmful bacteria and viruses. Antibodies can recognise and bind to certain unique molecules of the pathogens, which are called antigens. Antigen is essentially a molecule or molecular structure present outside pathogens (viruses, bacteria and even pollens). The presence of antigens due to a viral or bacterial infection in the body typically triggers an immune response. Antigens are the preferred “targets” by antibodies.

In case of any infection by a pathogen, antibodies are produced in the blood. As the infection recedes, these antibody-producing cells die and consequently, the blood antibody levels come down. However, some portion of these antibody-producing cells, also known as long-lived plasma cells, move to the bone marrow. While being there, they continuously secrete low levels of antibodies into the bloodstream to prevent further reinfection by the pathogen.

Adaptive or acquired immunity can provide long-lasting protection — that is the reason why one takes a vaccination against known infections. Such acquired immunity can remain during the entire lifetime of an individual. Thus, if one gets infected by measles and recovers, they are protected for their lifetime. But for certain infectious diseases, they would need vaccinations.

SARS-CoV-2 and immunity

The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has unique “spikes” on its outer coat. Some antibodies bind to and recognise these spike proteins. Even during a SARS-CoV-2 virus infection, antibodies are produced and circulated in the blood. The extent of this virus infection and the host body’s condition can determine if the antibodies can fight them or not. As has been evident, there are both symptomatic and asymptomatic cases causing the spread of the virus. Even in asymptomatic cases, they can still be the host and spread the virus. And for those with comorbidities, it has been worse, leading to greater fatality rates. However, there have been instances where one has recovered from the infection, in which case the body’s immune system has acted well or has generated sufficient antibodies to counter the infection.

A recent study has shown that SARS-CoV-2 infection induces a robust antigen-specific, long-lived humoral immune response in humans. Although antibodies show decay in some parts of the body, they are known to reside in bone marrow plasma cells. Some studies have also pointed out they may die off over time, causing a risk of reinfection, perhaps after a year. So, if you have been infected earlier, you don’t need to get vaccinated at least over the next six months, say studies.

In any case, the key to fighting pathogens are our antibodies. And the vaccination against SARS-CoV-2 is intended to provide acquired immunity against the coronavirus. Studies haven’t yet proved that products marketed as immunity boosters are any good to provide acquired immunity against the disease.

It is thus imperative that everyone above 18 years take the vaccine, which is the only way to prevent the spread of the virus. We are safe only when everyone is vaccinated.

(H S Sudhira is with Gubbi Labs, a private research collective)

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