Understand the Basics of Immune-Enhancing Supplements

Many individuals take a proactive approach to health and understand the value of promoting and maintaining well-being and a robust immune system. Although a healthy diet, regular exercise, and adequate sleep each night are fundamental components of good health, many consumers also incorporate nutritional supplements into their daily routine that are marketed for immune support and overall health.

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In a recent publication in JAMA Network Open, researchers analyzed pre–COVID-19 pandemic data from the National Health and Nutrition Examination Survey to ascertain the percentage and characteristics of consumers who reported using immune-enhancing supplements. The researchers also examined whether health care professionals’ label claims or recommendations influenced these dietary supplements’ use.¹

Results revealed that approximately 1 in 9 individuals in the US (an estimated 11% of the population) used nutritional supplements for perceived immune benefits, with usage varying by sociodemographic and health characteristics. More than 50% of the named supplements contained labels marketing immune benefits.¹

Results also revealed that among those who used supplements, 28% reported using them exclusively for perceived immune benefits. The prevalence of supplement use due to health care provider recommendations was reported to be 17%, but incidence increased among older adults and individuals with chronic conditions. Finally, the study results revealed that health maintenance was the second most common reason for using supplements besides preventing colds or boosting the immune system.¹

Impacts of the COVID-19 Pandemic

According to the National Institutes of Health (NIH) Office of Dietary Supplements, the sale of supplements marketed for immune support increased after the start of the COVID-19 pandemic, especially supplements containing vitamins C and D, zinc, ω-3, garlic, ginger, or turmeric.^2,3 However, the NIH has noted that data are currently insufficient to support the use of any vitamin, mineral, herb, fatty acid, or other supplement to prevent or treat COVID-19.²

A survey by the Council for Responsible Nutrition revealed that 43% of dietary supplement users changed their routines during the pandemic, with 91% increasing their intake for overall immune support and health benefits, 46% adding new supplements to their existing routines, 25% taking the same supplements more regularly, and 22% increasing dose(s).⁴ Supplements—including multivitamins, vitamin C, and vitamin D—were the most reported, and 83% of participants believed supplements help support health and well-being.⁴

Understanding Ingredients

Immune-boosting supplements often contain various vitamins, such as A, C, D, and E, along with trace elements such as zinc and selenium in single- or multi-ingredient formulations. Some supplements include herbal ingredients such as echinacea, garlic, and ginger, as well as others known for their immune-enhancing properties, such as turmeric. Research shows that turmeric possesses immune-boosting, anti-inflammatory, and antioxidant properties.^5,6 Abundant research has demonstrated that prebiotics and probiotics are key to balancing the gut microbiome, which is instrumental in maintaining a healthy immune system and is frequently targeted for immune support.^7-9 Some products feature colostrum, which may offer immune-modulating benefits. Elderberry is another common ingredient found in many products aimed at strengthening the immune system.¹⁰

When used as directed, immune-enhancing supplements are considered to be safe for the majority of people. In some cases, potential drug–supplement interactions can be of clinical significance depending on the patient’s medical and medication history, but often go undetected by many consumers and even health care professionals because many consumers do not report the use of supplements during office visits (Table).^9-17 As a result, a drug-supplement interaction may be a contributory factor in ineffective therapy, adverse drug effects, and augmented risk of deficiencies or toxicities, which can adversely affect a patient’s nutrition.¹¹

Conclusion

There remains significant debate about the effectiveness of supplements, as studies indicate both potential benefits and mixed outcomes, influenced by factors such as dosage, individual health status, lifestyle, and dietary factors. During counseling, pharmacists should advise patients to maintain a detailed list of all medications, including supplements; follow recommended dosages; and adhere to manufacturer instructions.

Pharmacists can also advise patients to select nutritional supplements tailored to their needs and screen for potential drug and micronutrient interactions and contraindications. Patients taking prescription medications or those with chronic comorbidities should always consult their primary health care provider before starting any supplements. Additionally, when advising on immune health supplements, pharmacists should remind patients of the importance of receiving their annual vaccines to prevent or lessen the severity of common respiratory infections such as influenza, respiratory syncytial virus, and COVID-19, depending on eligibility, and discuss their vaccine needs with their primary health care provider.