What supplements are recommended for immunomodulation?

Recommended Supplements for Immunomodulation

Based on current evidence, omega-3 fatty acids, arginine, glutamine, zinc, vitamin D, and soluble fiber are the most supported supplements for immunomodulation, with specific applications depending on clinical context. 1

Key Immunomodulatory Supplements and Their Applications

Omega-3 Fatty Acids

• Recommended for surgical patients, particularly those undergoing major abdominal cancer surgery, where they can reduce postoperative morbidity and length of hospital stay 1
• Can be administered parenterally in surgical patients who cannot be adequately fed enterally, showing advantages regarding postoperative infection rates and hospital length of stay 1
• May modulate inflammation through alteration of the gut microbiota and immune cell function 1

Arginine

• Beneficial as part of immunomodulating formulas for surgical patients, especially those undergoing gastrointestinal cancer surgery 1
• Should be avoided in patients with severe sepsis, where it may be harmful 1
• May be particularly beneficial for undernourished patients undergoing surgery 1

Glutamine

• Strongly recommended for burn patients and trauma patients as an addition to standard enteral formulas 1
• Shown to improve wound healing and reduce length of hospital stay in burn patients 1
• Has demonstrated significantly lower rates of bacteremia, pneumonia, and sepsis in trauma patients 1

Zinc

• Recommended for patients with Hurley stage I or II hidradenitis suppurativa as a modulator of innate immunity 1
• Retrospective studies show improvement in quality of life scores when administered at 90 mg daily with topical triclosan 1
• Should be supplemented in higher than standard doses for burn patients 1

Vitamin D

• May benefit vitamin D-deficient patients with hidradenitis suppurativa, with studies showing a 20% decrease in inflammatory nodules after supplementation 1
• Influences immune function and may be reduced in patients with obesity 1
• Works synergistically with other micronutrients to support immune function 2

Soluble Fiber

• Recommended for routine use in all hemodynamically stable ICU patients on standard enteral formulation 1
• Modulates the gut microbiome, which is integral to immune system development and function 1
• Examples include fructooligosaccharides (FOS) and inulin 1

Clinical Context Considerations

Surgical Patients

• Pre- or perioperative intake of oral nutritional supplements enriched with immune-modulating substrates (arginine, omega-3 fatty acids, and nucleotides) for 5-7 days is recommended for major abdominal cancer surgery 1
• Immunonutrition should be integrated into Enhanced Recovery After Surgery (ERAS) protocols 1
• Undernourished patients appear to benefit more significantly from immunomodulating formulas 1

Critical Illness and Sepsis

• Immune-modulating formulas containing arginine should NOT be used in patients with severe sepsis, as they may increase mortality 1
• Patients with less severe sepsis (APACHE II score <15) may benefit from immune-modulating nutrition 1
• For critically ill patients with obesity, a tailored approach with fewer calories and more protein is recommended, with potential benefits from immunonutrition still under investigation 1

Burn and Trauma Patients

• Glutamine supplementation is strongly recommended for both burn and trauma patients 1
• Trace elements (Cu, Se, and Zn) should be supplemented in higher than standard doses for burn patients 1

HIV and Infectious Diseases

• Nutritional counseling with or without oral nutritional supplements is equally effective for preserving nutritional status in HIV-infected patients 1
• Immune-modulating formulas enhanced with arginine, glutamine, omega-3 fatty acids, and antioxidative vitamins have not shown significant benefits over standard supplements in asymptomatic HIV-infected patients 1

Practical Implementation

Dosing Considerations

• Zinc: 90 mg daily has shown benefits in hidradenitis suppurativa patients 1
• Omega-3 fatty acids: Most effective when administered for 5-7 days perioperatively 1
• Glutamine: Should be added to standard enteral formulas for burn and trauma patients 1

Potential Risks and Contraindications

• Immune-modulating formulas containing arginine may increase mortality in patients with severe sepsis 1
• Overfeeding should be avoided, particularly in critically ill patients with obesity 1
• Supplementation should be targeted rather than indiscriminate to avoid potential adverse effects 3

Monitoring

• Regular assessment of nutritional status and immune function is essential when using immunomodulatory supplements 4
• In critically ill patients, monitor for electrolyte imbalances, particularly challenging in dialysis patients 4

Evidence Quality and Limitations

• Many studies on immunonutrition report divergent results due to various factors including trial design, population characteristics, intervention doses, and outcome measurements 5
• The strongest evidence exists for vitamins C and D and zinc for immune support 2
• For many supplements, the evidence remains weak, and avoiding nutritional deficiencies through a balanced diet may be the most pragmatic recommendation 3
• Newer concepts of immunonutrition are emerging that take more comprehensive approaches to influence the intestinal microbiome and modulate macronutrient composition 6