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Effects of a modified yeast supplement on cold/flu symptoms

  • Embria Health Sciences

Abstract and Figures

A yeast-based product (EpiCor, a dried Saccharomyces cerevisiae fermentate) was compared to placebo to determine effects on the incidence and duration of cold and flu-like symptoms in healthy subjects recently vaccinated for seasonal influenza. In a 12-week, randomized, double-blind, placebo-controlled clinical trial, 116 participants received daily supplementation with 500 mg of EpiCor or placebo for 12 weeks. Data collected included periodic in-clinic examinations and serologic evaluations at baseline, 6- and 12-weeks. Subjects also utilized a standardized self-report symptom diary during the study. Participants receiving the yeast-based product had significantly fewer symptoms and significantly shorter duration of symptoms when compared with subjects taking a placebo.
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A yeast-based product (EpiCor
, a dried
Saccharomyces cerevisiae
fermentate) was compared to placebo to determine effects on the
incidence and duration of cold and flu-like symptoms in healthy sub-
jects recently vaccinated for seasonal influenza. In a 12-week, ran-
domized, double-blind, placebo-controlled clinical trial, 116 partici-
pants received daily supplementation with 500 mg of EpiCor or place-
bo for 12 weeks. Data collected included periodic in-clinic examina-
tions and serologic evaluations at baseline, 6- and 12-weeks.
Subjects also utilized a standardized self-report symptom diary dur-
ing the study. Participants receiving the yeast-based product had sig-
nificantly fewer symptoms and significantly shorter duration of
symptoms when compared with subjects taking a placebo.
Key Words: Influenza,
Saccharomyces cerevisiae
, yeast, EpiCor,
common cold, flu, dietary supplement.
50 UROLOGIC NURSING / February 2008 / Volume 28 Number 1
mmune modulation that
includes suppression or
enhancement of immune
function has become either a
primary or potential form of
adjuvant preventive medical
treatment, and is an ongoing
focus of research (Ault, 2007;
Chiarella, Massi, DeRobertis,
Signon, & Fazio, 2007). For
example, immune suppression is
utilized for more complex dis-
eases, such as rheumatic arthri-
tis, asthma, and inflammatory
bowel disease (Leath, Singla, &
Peters, 2005; Williams, Paleolog,
& Feldmann, 2007). Other condi-
tions, such as allergic reactions,
also require down-regulation of
immune function, usually with
less intensity, and numerous
over-the-counter treatments are
Effects of a Modified Yeast
Supplement on Cold/Flu Symptoms
Mark A. Moyad
Larry E. Robinson
Edward T. Zawada, Jr.
Julie M. Kittelsrud
Ding-Geng Chen
Stuart G. Reeves
Susan E. Weaver
Mark A. Moyad, MD, MPH, is the
Jenkins/Pokempner Director, Preventive and
Alternative Medicine, University of Michigan
Medical Center, Department of Urology, Ann
Arbor, MI.
Larry E. Robinson, PhD, is Vice President,
Scientific Affairs, Embria Health Sciences
Ankeny, IA.
Edward T. Zawada, Jr., MD, is Medical
Director, Avera North Central Kidney
Institute, Sioux Falls, SD.
Julie M. Kittelsrud, MSN, RN, CNP, is a
Nurse Practitioner, Avera Research Institute,
Sioux Falls, SD.
Ding-Geng Chen, PhD, is a Professor,
Department of Mathematics and Statistics,
South Dakota State University, Brookings,
Stuart G. Reeves, PhD, is Director of
Research and Development, Embria Health
Sciences, Ankeny, IA.
Susan E.Weaver, MSN, RN, CNP, is a Nurse
Practitioner, Avera Research Institute, Sioux
Falls, SD
Many over-the-counter products
claim to reduce symptoms associated
with cold and flu. This is the largest
randomized trial to date to examine
the impact of a daily modified yeast-
based product (EpiCor
, a dried
Saccharomyces cerevisiae
tate) compared to placebo on the inci-
dence and duration of cold and flu-like
symptoms in healthy subjects recently
vaccinated for seasonal influenza.
To determine if a modified yeast-
based dietary supplement (EpiCor)
taken daily reduces the incidence and
duration of colds or flu-like sympto-
matic features in a group of healthy
individuals recently vaccinated against
seasonal flu (influenza).
Design and Method
A 12-week experimental, double-
blind, placebo-controlled study of 116
randomized, healthy participants with
up-to-date vaccination histories
received daily supplementation with
500 mg of EpiCor or placebo for 12
weeks. Clinical outcome measure-
ments included periodic in-clinic
examinations at baseline, 6- and 12-
weeks; participants also utilized a
standardized self-report symptom
diary during the entire study. Com-
prehensive laboratory serologic analy-
sis was performed during each clinic
Subjects receiving EpiCor experi-
enced a statistically significant reduc-
tion in the incidence (
= 0.01) and
duration (
= 0.03) of colds or flu com-
pared with participants receiving
placebo. Additionally, subjects in the
EpiCor group experienced a non-sig-
nificant (
= 0.23) reduction in adverse
events compared to placebo.
Daily nutritional supplementation
with 500 mg of EpiCor may be an
effective adjuvant preventive treatment
in patients recently vaccinated for sea-
sonal influenza. This yeast-based
intervention also demonstrated a safe-
ty profile similar to a placebo. Future
studies should focus on the use of this
product as a potential single agent to
reduce cold and flu-like symptoms in
healthy individuals.
Level of Evidence – Level II
Do Not Reprint
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UROLOGIC NURSING / February 2008 / Volume 28 Number 1 51
now available (Finegold, 2007).
Enhancement of immune func-
tion also is being investigated
currently as a potential primary
form of medical treatment for
certain types of invasive dis-
eases, such as cancer (Cranmer &
Hersh, 2007; Moyad, 2007a;
O’Neill & Bhardwaj, 2007).
Respiratory infections are
also part of an intense focus on
better preventive therapies. In-
fluenza is now responsible for
more than 200,000 hospitaliza-
tions and approximately 36,000
deaths per year in the U.S. alone
(Lynch & Walsh, 2007; Roxas
& Jurenka, 2007; Zimmerman,
2005), and it is one of the top 10
causes of mortality in men and
However, the incidence and
impact of this ever-changing viral
infection is increasing, which is
potentially due to the current
and ongoing increase in the aging
population. The seasonal vaccine
itself has kept this disease from
becoming a more primary cause
of morbidity and mortality, and
health education concerning the
importance of this vaccine has
been a critical component to
effective preventive medicine.
Concerns about vaccine resist-
ance, waiting periods for novel
annual vaccines, and patient
access issues (regardless of finan-
cial background or insurance sta-
tus) limit its use in many geo-
graphical areas and among differ-
ent population groups.
The common cold is less of a
medical concern; yet, virulent
variants of the common cold are
becoming more common. The
lack of preventive treatment is
perhaps one of the many reasons
this class of virus is responsible
for millions of dollars a year in the
lack of productivity due to conva-
lescence (Roxas & Jurenka, 2007).
Identifying effective adjuvant
preventive therapies synergistic
or complementary to convention-
al treatments may be beneficial
in decreasing the symptoms and
duration of influenza and colds.
A simplistic or complex reason-
ably priced method that en-
hances general immune function
and may reduce a variety of
infections or symptoms, includ-
ing those of the common cold or
influenza, seems to be a reason-
able and ethical option to im-
prove overall health outcomes,
productivity, and general well
To date, many over-the-
counter options claim signifi-
cance as a potential adjuvant
therapy or sole treatment for
colds and flu-like symptoms, but
few dietary supplements, apart
from vitamin C, have had ade-
quate numbers of clinical trials
conducted (Moyad & Combs,
2007). For example, meta-analy-
ses exist of randomized trials of
vitamin C and its impact on
pneumonia (Hemila & Louhiala,
2007) or the common cold
(Douglas, Hemila, Chalker, &
Treacy, 2007). More over-the-
counter products should be sub-
jected to rigorous double-blind
randomized trials.
Saccharomyces cerevisiae,
better known as baker’s or brew-
er’s yeast, has a long history of
providing some form of immune
protection or health promotion
beyond its commercial applica-
tions (Moyad, 2007b). Modified
forms of this species of yeast
have been shown to be safe in
moderate dosages but may pro-
vide enhanced immune benefits
beyond what is typically capable
in its original form. For example,
one of the largest randomized tri-
als of cancer prevention that
showed benefits seemed to
enhance selenium supplementa-
tion awareness, but the actual
trial utilized a modified yeast
form that included 200 mcg of
selenium, as opposed to seleni-
um by itself (Clark et al., 1996).
Decades-old research shows that
this same principle has already
been applied to other forms of
yeast, but the lack of randomized
trials that included a placebo is
one potential major limitation to
determining whether or not
yeast-based technology has a
future in preventive medicine
(Moyad, 2007b). Therefore, this
research group decided to pro-
vide more clarity on this issue.
This randomized trial is the
largest to date that has examined
the impact of a yeast-based
dietary supplement on the inci-
dence of cold and flu-like symp-
toms, and more specifically, on
the symptoms associated with
these conditions in subjects with
a recent history of seasonal
influenza vaccination.
The primary objective of the
study was to determine if a once-
daily dose of the modified yeast
product would reduce the inci-
dence and duration of the com-
mon cold or influenza-like symp-
toms in healthy human subjects
that had recently received the
influenza vaccine. A second end-
point measured in the study was
the severity of these symptoms if
illness occurred.
Sample and setting. Individ-
uals were recruited via print
advertisements, local television,
and e-mail. Age range was 18 to
76 years (M = 44, SD = 11) and
included subjects living in a met-
ropolitan area of the rural Mid-
west. The number of participants
at the start of the study totaled
130. There were a total of 14
dropouts during the study,
including 10 in the supplement
group and 4 in the placebo group.
The final analyses were carried
out on the results from 116 par-
Inclusion criteria. Selected
individuals were healthy, with a
Charlson comorbidity of 0 or 1
(Charlson, Szatrowski, Peterson,
& Gold, 1994), based on basic
physical examination by clinical
and research staff and via self-
report. All had recently received
the seasonal influenza vaccine.
Exclusion criteria. Exclusion
criteria are listed in Table 1.
Power Analysis
Power analysis was conduct-
ed prior to the study for the pro-
posed sample size and signifi-
cance level (0.05). Based on the
proposed sample size with
approximately a similar number
of control subjects compared to
the intervention group, the com-
puted power is 0.886. This com-
Do Not Reprint
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52 UROLOGIC NURSING / February 2008 / Volume 28 Number 1
putation results in an 88.6%
probability of identifying a statis-
tically significant difference
between incidence rates for the
control versus the intervention
group, with a 0.05 significance, if
a true difference exists. Final sta-
tistical analysis on the outcomes
utilized a two-way analysis of
variance (ANOVA), with EpiCor
and placebo as treatment factor,
and all symptoms as another fac-
tor. Ninety-five percent confi-
dence intervals (95% CI) were
calculated around each mean
value to determine the appropri-
ate range of accuracy within each
separate clinical outcome.
Protection of human sub-
jects. The clinical study was con-
ducted in accordance with Good
Clinical Practice (GCP) and all
applicable regulatory require-
ments, and was approved by the
Institutional Review Board (IRB)
by the Avera Institutional Review
Board (IRB) for Avera Health
(Sioux Falls, SD).
This 12-week, randomized,
double-blind, placebo-controlled
trial was conducted during the
acute period of the year for cold
and flu seasonal symptoms
(December 2006 to March 2007).
Individuals meeting the inclu-
sion criteria and giving informed
consent were screened for a max-
imum of 14 days to determine
baseline standardized laboratory
values, including complete blood
count (CBC), complete metabolic
profile, and other general health
serologic parameters.
All forms of medications
ingested by subjects during
screening or the 12-week study
period were recorded, and any
changes in medications or
dosages were also noted in the
patient chart. Subjects were
encouraged throughout the study
to continue unaltered with their
specific dietary regime, exercise,
alcohol consumption, and all
other behavioral patterns, includ-
ing smoking, throughout the
study period.
Subjects were randomized to
one of two groups. Both groups
demonstrated statistical equiva-
lence at baseline for body mass
index, medication usage, and
smoking status. The following
mean baseline characteristics for
the EpiCor and placebo group
were: age (43 [SD = 10] and 45 [SD
= 13] years, p = 0. 265), BMI (27.8
[SD = 6.6] and 26.7 [SD = 4.7], p =
0.283), and current smoking status
(14% and 20%); 57% of the partic-
ipants were female. There was no
statistical significance between
baseline characteristics of either
group. The experimental group (n
= 52) received daily doses of 500
mg modified yeast-based product
intervention (EpiCor); the control
group (n = 64) received a placebo.
EpiCor is a dietary supple-
ment, as defined by the Dietary
Supplement and Health Edu-
cation Act (DSHEA) of 1994 (U.S.
Food & Drug Administration,
2007) and was developed by
Embria Health Sciences, LLC., of
Ankeny, IA. It consists of a fer-
mented medium of Saccharo-
myces cerevisiae, which when
proliferating under stress secretes
multiple bioactive metabolites.
Over the last 60 years, a feed addi-
tive product for commercial ani-
mals based on this proprietary
technology has been utilized to
enhance immune function and to
prevent disease. Recently, the
human-modified version of this
product (EpiCor) has been subject
to multiple laboratory safety, sta-
bility, and efficacy investigations.
For example, EpiCor has demon-
strated anti-inflammatory proper-
ties with the stimulation of B lym-
phocytes and natural killer (NK)
cells (Jensen, Hart, & Schauss,
The placebo capsule was of a
similar appearance, weight, and
non-odor as the active interven-
tion. Subjects were instructed to
ingest medications with breakfast.
Participants attended the research
institute clinic at weeks 0 (base-
line), 6, and 12, and in addition to
examination, were required to
record cold and flu-like symptoms
at home in a modified standard-
Table 1.
Exclusion Criteria Utilized Before Determination of Randomization
in the Cold and Flu Study of the Modified Yeast-Based Product
Compared to Placebo
Diagnosed or treated immune abnormality
Current use of any immunosuppressive medication (such as azathioprine,
cyclosporine, and steroids)
Current use of any antiviral medication (including amantadine, oseltamivir,
rimantadine, and zanamivir)
HIV positive
ALT, AST, BUN, and/or creatinine laboratory values greater than 2 times the
upper limit of normal
Females who are pregnant or breastfeeding, or who are planning to become
pregnant during the study period
History of substance abuse
Severe co-morbidity or concomitant disease or condition
Allergies to yeast or to yeast-derived products
Environmental allergies requiring medication or allergy-based injection therapy
Vitamin deficiency that requires supplementation
Herbal or supplemental preparation use such as echinacea, vitamin C, or zinc
Received seasonal influenza vaccination for 2006 to 2007 period, and more
than 60 days have elapsed between vaccination and the randomization
Unable or unwilling to comply with the study protocol (including ingesting the
study supplement or placebo, regular blood sampling, and completing the
study diary)
Current participation in another clinical research investigation of any kind
Do Not Reprint
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UROLOGIC NURSING / February 2008 / Volume 28 Number 1 53
ized diary (McDowell, 2006) pro-
vided by the research group.
Blood samples, basic physical
examination, vital signs (blood
pressure, heart rate, temperature,
and weight), medication, health
summaries (including an on-site
completed Short Form 36 [SF-36])
(Patel, Donegan, & Albert, 2007;
Ware, & Sherbourne, 1992), and
summarized diary information
were preformed and collected at
each clinic visit.
The diagnosis of common
cold or influenza-like symptoms
was primarily based on the pro-
vided self-report diaries (see
Figure 1). Common cold was
clinically defined as an upper
respiratory tract infection of viral
etiology consisting of one or
more of the following symptoms:
cough, generalized malaise,
headache, hoarseness, low-grade
fever, nasal drainage, nasal stuffi-
ness, and sore throat (Centers for
Disease Control and Prevention,
Influenza-like symptoms were
clinically defined as a respiratory
tract infection of viral etiology
and acute onset, more severe
than the common cold, and con-
sisting of one or more of the fol-
lowing symptoms: chest discom-
fort, fever of 102 to 105 degrees
Fahrenheit, myalgia, nonproduc-
tive cough, prominent headache,
rhinitis, and sore throat (Centers
for Disease Control and
Prevention, 2007). Cold and flu-
like symptoms could clinically
overlap or occur simultaneously.
The incidence of cold or flu-
like symptoms was defined as the
number of clinical occurrences
reported during the entire 12-
week study period. Duration of
symptoms was defined as the
number of consecutive illness
days, and severity was also
recorded on a scale from 0 to 10
as described by the diary.
Adverse events (AE) were
defined as any clinically unfa-
vorable and unintended sign or
laboratory finding, symptom, or
new or exacerbated disease cor-
related with the utilization of the
interventional supplement or
placebo. A serious adverse event
(SAE) was defined as any med-
ical occurrence that included at
least one of the following condi-
tions: life-threatening, requiring
hospitalization, or resulting in
disability, incapacity, or death
during the time of the entire 12-
week trial period. Study medical
staff analyzed each participant’s
past and current health and ill-
ness history to determine if any
incident or prevalent AE was
attributed to a pre-existing condi-
tion or a current illness unrelated
or associated to the study med-
ications. An overview of the
diversity of the symptoms pro-
vided in this diary to evaluate
cold and flu symptoms is provid-
ed in Figure 1.
EpiCor significantly reduced
the incidence and duration of the
common cold or flu-like symp-
toms compared to placebo.
Incidence was significantly (p =
0.011) reduced from a mean of
1.42 (95% CI 1.32 to 15.3) to 1.26
Figure 1.
The Standardized Diary to Evaluate Incidence, Duration, and Severity of Cold and Flu-like Symptoms
As soon as you start noticing any symptoms of cold or influenza, please fill in the diary.
Please assess all symptoms. Circle the number from 0-10
according to how you would rate your symptoms.
0= no symptoms, 10= most severe symptoms.
HEADACHE 0 1 2 3 4 5 6 7 8 9 10
GENERAL ACHES/PAINS 0 1 2 3 4 5 6 7 8 9 10
FATIGUE 0 1 2 3 4 5 6 7 8 9 10
WEAKNESS 0 1 2 3 4 5 6 7 8 9 10
NASAL STUFFINESS 0 1 2 3 4 5 6 7 8 9 10
NASAL DRAINAGE 0 1 2 3 4 5 6 7 8 9 10
SORE THROAT 0 1 2 3 4 5 6 7 8 9 10
COUGH 0 1 2 3 4 5 6 7 8 9 10
HOARSENESS 0 1 2 3 4 5 6 7 8 9 10
CHEST DISCOMFORT 0 1 2 3 4 5 6 7 8 9 10
CHILLS 0 1 2 3 4 5 6 7 8 9 10
FEVER ____________________°F
(please list)
0 1 2 3 4 5 6 7 8 9 10
Most severe
Do Not Reprint
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54 UROLOGIC NURSING / February 2008 / Volume 28 Number 1
(95% CI 1.18 to 1.33) clinical
occurrences, and this result
remained significant regardless
of baseline status, including age
(p = 0.54) or gender (p = 0.94).
Duration was also significantly
(p = 0.028) reduced from 5.01 to
4.16 symptom days (95% CI 3.66
to 4.66) compared to a placebo
mean of 5.01 with placebo (95%
CI 4.40 to 5.62), and this result
also remained significant regard-
less of baseline status including
age (p = 0.63) or gender (p=0.34).
Severity increased significantly
(p = 0.002) from 3.17 (95% CI
2.98 to 3.37) to 3.84 (95% CI 3.58
to 4.11). EpiCor in particular had
a significantly greater reducing
impact on several specific symp-
toms compared to placebo,
including incidence of hoarse-
ness (p = 0.008), incidence of
nasal stuffiness (p = 0.008), and
duration in weakness (p = 0.008).
No abnormalities were found
with any of the laboratory serolog-
ic parameters when comparing
EpiCor at baseline to EpiCor at 12
weeks, or when comparing EpiCor
to placebo.
The rate of reporting AEs was
30.8% for EpiCor and 39.1% for
the placebo group, which is a non-
significant difference (p = 0.232).
No serious AEs were reported for
subjects receiving the interven-
tional dietary supplement. How-
ever, two serious AEs were report-
ed in the placebo group: one hos-
pitalization for pneumonia and
one hospitalization for bowel
obstruction in a subject with a past
history of this condition. Both sub-
jects recovered without incident
and both were withdrawn from
the study upon the advice of their
primary care physicians.
The results of this, the largest
randomized trial of a modified
yeast-based product, at least ini-
tially espouses the previous obser-
vations and data surrounding the
background information on this
Saccharomyces cerevisiae prod-
uct. Both incidence and duration
of cold and flu-like symptoms
were significantly reduced,
including almost a full day of
duration reduction when harbor-
ing cold and flu-like symptoms.
The accuracy and pertinence of
these significant clinical findings
are further enhanced when the
95% CIs were evaluated because
of the narrow range in the mean of
each of these findings. However,
the small but significant difference
in severity seemed less clinically
relevant because this clinical fea-
ture is more difficult to capture
based on the inherent subjectivity
of severity as an endpoint in a
variety of infectious diseases
(Ioachimescu, Ioachimescu, &
Iannini, 2004).
The strengths of this study,
especially for a dietary supple-
ment, are not only numerous but
impressive. The large number of
participants, randomization of
group assignment, maintenance of
the double-blind, and the use of
placebo as a control are features
that set a novel standard, which is
not commonly observed in over-
the-counter product studies. In
addition, the strict exclusion and
inclusion criteria, and the real-
world setting of utilizing a product
in an adjuvant setting further
establish the integrity of the obser-
vations. Finally, the enormous
financial cost (approximately a
quarter of a million dollars) to con-
duct such a clinically robust trial
is further testimony to the inves-
tigative team and the manufactur-
er of this product and hopefully
continues to establish a new para-
digm in the dietary supplement
The limitations of this study
should also be emphasized. More
frequent clinical visits, albeit cost-
ly, would have allowed for closer
follow up and more precise sero-
logic observations. The standard-
ized diary is an imperfect system
of measure but was reviewed with
each visit. Additional immunolog-
ic plasma, serum, urine, and imag-
ing studies could have further
enhanced the accuracy of the trial,
including the duration and severi-
ty data. However, it should be reit-
erated that the monitoring of
primary symptoms in the case of
colds and flu-like symptoms
remains the gold standard for pri-
mary outcome measures utilized
in conventional medical prescrip-
tion drug and vaccine trials
(Eccles, 2005). Thus, the research
team subsequently decided to
mimic these outcome measure-
ments to not only determine con-
ventional effectiveness but also to
further enhance the integrity of
this study.
EpiCor, a modified yeast-
based (Saccharomyces cerevisiae)
dietary supplement taken daily,
appears to significantly reduce the
incidence and duration of cold
and flu-like symptoms when com-
pared to placebo in subjects vacci-
nated for seasonal influenza. This
is also the largest randomized
placebo-controlled trial to date to
demonstrate that a yeast-based
product, acting as an adjuvant
intervention to a conventional
therapy, may improve immune
surveillance and outcomes in an
otherwise healthy population. An
additional trial of EpiCor alone
compared to placebo, regardless of
vaccine status, has also been initi-
ated due to the promising out-
comes with this over-the-counter
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... Novel protein sources have emerged as an important trend in the pet food industry in response to consumer demand, sourcing constraints, and sustainability concerns. Dried whole-cell yeast (S. cerevisiae) is an alternative to traditional protein sources (i.e., animal-derived protein) that aligns with this trend and has been shown to have beneficial health effects in several animal species, including the modulation of the colonic microbiota in dogs (Moyad et al., 2008;Stercova et al., 2016;Lin et al., 2019). ...
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Global protein shortages and sustainability concerns have increased consumer demand for non-animal-derived protein. Dried whole-cell yeast (Saccharomyces cerevisiae) may be a suitable alternative to rendered protein meals in pet foods. The objective of this study was to investigate the effects of dried yeast in dog and cat foods on indicators that pet parents typically use to evaluate the suitability of a food for their pet. For this evaluation, two dog and two cat dry extruded diets were formulated. For each species, the test diet contained 10% dried yeast (Yeast) and the control diet was devoid of yeast (Control). Palatability, apparent total tract nutrient digestibility, and fecal quality of the foods were assessed in dogs and cats. Urine pH and specific gravity were measured in cats as indicators of urinary tract health. In dogs, the Yeast diet showed equivalent or better palatability compared to the Control diet based on total food consumption (P = 0.06), average daily consumption (day 1, P = 0.10; day 2, P = 0.54), and first choice preference over 2 consecutive days (P = 0.005). Cats showed a strong preference for the Yeast diet with more than double the consumption during the 2-d test period (P = 0.001). More cats showed a first-choice preference for the Yeast diet (24 vs. 16), but the difference was not statistically significant (P = 0.21). There were no significant differences in stool quality or nutrient digestibility when fed Yeast vs. Control diets to the dogs and cats (P > 0.05). All cats produced urine with pH and specific gravity values within the normal range, though specific gravity was lower in the Control group (P = 0.003). This study provides support for the acceptability and digestibility of dog and cat diets containing dried yeast as an alternative protein source.
... A fermentate generally refers to "a powdered preparation, derived from a fermented [food] product and which can contain the fermenting microorganisms, components of these microorganisms, culture supernatants, fermented substrates, and a range of metabolites and bioactive components" [163]. For example, an oral fermentation product known as EpiCor, derived from Saccharomyces cerevisiae (S. cerevisiae), showed the potential of enhancing the immune system to protect and aid in defense against cold/flu-like symptoms [164,165]. In these two 12-week randomized, double-blind, placebo-controlled trials, it was proven that this oral over-the-counter fermentate has the ability to reduce the incidence of cold and flu-like symptoms in both individuals with and without a history of influenza vaccination [165]. ...
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In recent times, the emergence of viral infections, including the SARS-CoV-2 virus, the monkeypox virus, and, most recently, the Langya virus, has highlighted the devastating effects of viral infection on human life. There has been significant progress in the development of efficacious vaccines for the prevention and control of viruses; however, the high rates of viral mutation and transmission necessitate the need for novel methods of control, management, and prevention. In recent years, there has been a shift in public awareness on health and wellbeing, with consumers making significant dietary changes to improve their immunity and overall health. This rising health awareness is driving a global increase in the consumption of functional foods. This review delves into the benefits of functional foods as potential natural means to modulate the host immune system to enhance defense against viral infections. We provide an overview of the functional food market in Europe and discuss the benefits of enhancing immune fitness in high-risk groups, including the elderly, those with obesity, and people with underlying chronic conditions. We also discuss the immunomodulatory mechanisms of key functional foods, including dairy proteins and hydrolysates, plant-based functional foods, fermentates, and foods enriched with vitamin D, zinc, and selenium. Our findings reveal four key immunity boosting mechanisms by functional foods, including inhibition of viral proliferation and binding to host cells, modulation of the innate immune response in macrophages and dendritic cells, enhancement of specific immune responses in T cells and B cells, and promotion of the intestinal barrier function. Overall, this review demonstrates that diet-derived nutrients and functional foods show immense potential to boost viral immunity in high-risk individuals and can be an important approach to improving overall immune health.
... Vitamin C and garlic reduce the duration and severity of colds while also boosting the immune system. 61,62 Yoghurt ingestion has been shown to raise the synthesis of cytokines, principally interferon γ, and enhance monocyte cytokine production. 10,16 Probiotics boost innate immunity by improving natural killer cell activity. ...
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Due to the absence of successful therapy, vaccines for protection are continuously being developed. Since vaccines must be thoroughly tested, viral respiratory tract infections (VRTIs), mainly coronaviruses, have seriously affected human health worldwide in recent years. In this review, we presented the relevant data which originated from trusted publishers regarding the practical benefits of functional foods (FFs) and their dietary sources, in addition to natural plant products, in viral respiratory and COVID-19 prevention and immune-boosting activities. As a result, FFs were confirmed to be functionally active ingredients for preventing COVID-19 and VRTIs. Furthermore, the antiviral activity and immunological effects of FFs against VRTIs and COVID-19 and their potential main mechanisms of action are also being reviewed. Therefore, to prevent COVID-19 and VRTIs, it is critical to identify controlling the activities and immune-enhancing functional food constituents as early as possible. We further aimed to summarize functional food constituents as a dietary supplement that aids in immune system boosting and may effectively reduce VRTIs and COVID-19 and promote therapeutic efficacy.
... Additionally, preparations with honey and herbal products are also used in common cold treatment [18][19][20][21]. Some of them have proven efficacy and safety, some not [18,[22][23][24][25][26][27][28][29][30][31]. All of them are available without prescription. ...
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Abstract Background Common cold is a frequent illness in northern hemisphere between late autumn and early spring. Patients suffering from it frequently turn to pharmacists instead of physicians in order to receive medical advice and treatment. We studied its treatment advised by pharmacists in Poland, as well as evidence for the efficacy of their recommendations by utilizing a self-developed questionnaire and a study of existing literature. Methods The data were collected by 27 pharmacists who worked in four large network community pharmacies in Lodz, Poland. The study took place from December 2019 to February 2020. Data were recorded only if the patient asked for pharmacy counselling for over-the counter (OTC) products due to common cold self-diagnosis and a product was sold. Pharmacists’ recommendations were compared with the results of a literature review of best evidence to determine appropriateness of the pharmacists’ decisions. Results In four out of five cases the pharmacists recommended products contained paracetamol. In addition, in one out of three patient encounters they advised nasal decongestant, inosines and/or OTC mucolytics. There was a significant relationship between fever and recommendation frequency of some analgesics, inosines, mucolytics and sore throat products (OR > 1, p 1, p 1, p 1, p
... However, they are proteinrich ingredients that are easily incorporated into pet diets because of their low lipid content (3,4). Yeast (Saccharomyces cerevisiae) products have shown beneficial health effects in several animal models including the modulatory effects of colonic microbiota in dogs (5)(6)(7). ...
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The popularity of plant-based protein sources has increased as consumer demand for grain-free and novel protein sources increase. Minimal research has been conducted as regards to use of legumes and yeast and their effects on acceptability and digestibility in canine diets. The objective of this study was to evaluate macronutrient apparent total tract digestibility (ATTD), gastrointestinal tolerance, and fermentative end-products in extruded, canine diets. Five diets were formulated to be isocaloric and isonitrogenous with either garbanzo beans (GBD), green lentils (GLD), peanut flour (PFD), dried yeast (DYD), or poultry by-product meal (CON) as the primary protein sources. Ten adult, intact, female beagles (mean age: 4.2 ± 1.1 yr, mean weight: 11.9 ± 1.3 kg) were used in a replicated, 5 × 5 Latin square design with 14 d periods. Each experimental period consisted of 10 d of diet adaptation, followed by 4 d of total fecal and urine collection. A fasted, 5 ml blood sample was collected at the end of each period and analyzed for serum metabolites and complete blood count. Serum metabolites were within normal ranges and all dogs remained healthy throughout the study. Fecal quality, evaluated on a 5-point scale, was considered ideal. Macronutrient ATTD was similar among dietary treatments, with diets highly digestible (>80%). Total fecal branched-chain fatty acid concentrations were highest (P < 0.05) for DYD (23.4 μmol/g) than GLD (16.1 μmol/g) and PFD (16.0 μmol/g) but not different (P > 0.05) than other treatments. The plant-based protein treatments had greater (P < 0.05) total fecal short chain fatty acid (SCFA) concentrations (average 627.6 μmol/g) compared with CON (381.1 μmol/g). Fecal butyrate concentration was highest (P < 0.05) for DYD than all other dietary treatments (103.9 μmol/g vs. average 46.2 μmol/g). Fecal microbial communities showed Firmicutes, Bacteroidetes, Fusobacteria, and Proteobacteria as abundant phyla. There was greater β-diversity for dogs fed DYD which differed from all other diets in both weighted and unweighted UNIFRAC analyses. Inclusion of these novel, plant-based, protein sources showed no detrimental effects on nutrient digestibility or fecal characteristics and represent viable protein sources in canine diets that can produce beneficial shifts in fecal metabolites.
... In accordance with our own data, in an LPS challenge model, SCFPsupplemented piglets were shown to produce enhanced quantities of serum IL-6 and TNFα compared to controls (Burdick Sanchez et al., 2018). In humans, SCFP are inclined to have an overall antiinflammatory effect, reducing the symptoms of allergic rhinitis (Moyad et al., 2009), cold/flu infection (Moyad et al., 2008;Moyad et al., 2010) and histamine-induced skin inflammation (Jensen et al., 2015); however, acute SCFP treatment results in increased activation of circulating immune cells and increased serum IFNγ concentrations (Jensen et al., 2011). Thus, the contrasting pro-and anti-inflammatory effects of SCFP treatment observed in our animal model concur with prior reports, suggesting the immunomodulatory effects of SCFP are dependent upon context. ...
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The objectives of this study were to determine the effects of oral supplementation with Saccharomyces cerevisiae fermentation products (SCFP; SmartCare and NutriTek; Diamond V, Cedar Rapids, IA) on immune function and bovine respiratory syncytial virus (BRSV) infection in preweaned dairy calves. Twenty-four Holstein x Angus, 1-2 day old calves (38.46 ± 0.91 kg initial body weight) were assigned two treatment groups: control; or SCFP treated, milk replacer with 1 g/d SCFP (SmartCare) and calf starter top-dressed with 5 g/d SCFP (NutriTek). The study consisted of one 31 d period. On d 19-21 of the supplementation period, calves were challenged via aerosol inoculation with BRSV strain 375. Calves were monitored twice daily for clinical signs, including rectal temperature, cough, nasal and ocular discharge, respiration effort and lung auscultation. Calves were euthanized on d 10 post infection (d 29-31 of the supplementation period) to evaluate gross lung pathology and pathogen load. Supplementation with SCFP did not affect body weight (P = 0.762) or average daily gain (P = 0.750), percentages of circulating white blood cells (P < 0.05), phagocytic (P = 0.427 for neutrophils and P = 0.460 for monocytes) or respiratory burst (P = 0.119 for neutrophils and P = 0.414 for monocytes) activity by circulating leukocytes either before or following BRSV infection, or serum cortisol concentrations (P = 0.321) after BRSV infection. Calves receiving SCFP had reduced clinical disease scores compared to control calves (P = 0.030); reduced airway neutrophil recruitment (P < 0.002); reduced lung pathology (P = 0.031); and a reduced incidence of secondary bacterial infection. Calves receiving SCFP shed reduced virus compared to control calves (P = 0.049) and tended towards lower viral loads in the lungs (P = 0.051). Immune cells from the peripheral blood of SCFP treated calves produced increased (P < 0.05) quantities of IL-6 and TNFα in response to toll-like receptor stimulation; while cells from the bronchoalveolar lavage (BAL) of SCFP treated calves secreted less (P < 0.05) proinflammatory cytokines in response to the same stimuli. Treatment with SCFP had no effect on virus-specific T cell responses in the blood, but resulted in reduced (P = 0.045) virus-specific IL-17 secretion by T cells in the BAL. Supplementing with SCFP modulates both systemic and mucosal immune responses and may improve the outcome of an acute respiratory viral infection in preweaned dairy calves.
The respiratory system, like the gut, harbors a vast variety of microorganisms which include bacteria, viruses and fungi. The advent of next generation sequencing and multi-omic approaches has revealed the diversity and functional significances of microorganisms in the respiratory health. It has been identified that there has been a co-evolution of indigenous respiratory microbiota and the human immune system. However, an immune response is usually generated when the homeostasis of the microbiota is disturbed. The respiratory microbiome has been identified to be important in shaping the respiratory immunity. Gut microbiota and oral microbiota are also known to be pivotal in shaping the immune system of the respiratory tract and influence its microbial dynamics. Proteobacteria, Firmicutes, and Bacteroidetes have been identified to be predominant in the respiratory system. While, Streptococcus, Prevotella, Fusobacteria, and Veillonella forms the major part, potential pathogens, such as Haemophilus and Neisseria, also form a small fraction of the healthy lung microbiome. Dysbiosis of respiratory microbiome can lead to increased colonization of opportunistic pathogens that can lead to respiratory infections such as pneumonia. This chapter describes the microbial diversity of respiratory system and the role of respiratory microbiome during respiratory infections like pneumonia. The chapter also discusses few strategies that have been proved effective in preventing pneumonia.
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Explains basics of Nutrition and Immunity in Covid-19
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Background and aims Balanced nutrition which can help in maintaining immunity is essential for prevention and management of viral infections. While data regarding nutrition in coronavirus infection (COVID-19) are not available, in this review, we aimed to evaluated evidence from previous clinical trials that evaluated nutrition-based interventions for viral diseases (with special emphasis on respiratory infections), and summaries our observations. Methods A systematic search strategy was employed using keywords to search the literature in 3 key medical databases: PubMed®, Web of Science® and SciVerse Scopus®. Studies were considered eligible if they were controlled trials in humans, measuring immunological parameters, on viral and respiratory infections. Clinical trials on vitamins, minerals, nutraceuticals and probiotics were included. Results total of 640 records were identified initially and 22 studies were included from other sources. After excluding duplicates and articles that did not meet the inclusion criteria, 43 studies were obtained (vitamins: 13; minerals: 8; nutraceuticals: 18 and probiotics: 4). Among vitamins, A and D showed a potential benefit, especially in deficient populations. Among trace elements, selenium and zinc have also shown favourable immune-modulatory effects in viral respiratory infections. Several nutraceuticals and probiotics may have some role in enhancing immune functions. Micronutrients may be beneficial in nutritionally depleted elderly population. Conclusions We summaries possible benefits of some vitamins, trace elements, nutraceuticals and and probiotics. Nutrition principles based on these data could be useful in possible prevention and management of COVID-19
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The aim of this study was to evaluate the immunomodulating effects of a consumable yeast-based immunogen, EpiCor, on human leukocytes in vitro. The selection of antiinflammatory and lymphocyte activation assays was based on initial evidence for immunomodulating effects of EpiCor from an unusually low incidence of influenza among employees in a factory manufacturing EpiCor, along with a high oxygen radical absorbance capacity value. In the present study, EpiCor significantly reduced the production of reactive oxygen species by neutrophils (P < .005). EpiCor treatment of peripheral blood mononuclear cells (PBMCs) caused induction of the activation markers CD80 and CD86 on B lymphocytes, and CD69 and CD25 on CD3−CD56+ natural killer cells. This induction was also seen on enriched populations of natural killer and B lymphocytes, suggesting a direct effect not dependent on bystander cells. Coculturing of PBMC with EpiCor and phytohemagglutinin resulted in inhibition of phytohemagglutinin-induced T-cell proliferation and reduction of interferon gamma production. Fucoidan, a ligand for the homing molecule l-selectin (CD62L), is known to induce rapid up-regulation of several chemokine receptors on lymphocytes. EpiCor caused strong inhibition of Fucoidan-mediated expression of the chemokine receptors CXCR4 and CCR9 on PBMC. This suggested rapid altering of signal transduction pathways, or a direct competition for cell surface receptors, with an end result being an altered sensitivity to chemotactic signals from tissue. We conclude that EpiCor possesses significant antiinflammatory activity and induces direct activation and increased chemotactic awareness of lymphocyte subsets in vitro. This suggests further study of effects of EpiCor consumption on antiviral defense mechanisms and antibody production.
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The common cold is the leading cause of doctor visits in the United States and annually results in 189 million lost school days. In the course of one year the U.S. population contracts approximately 1 billion colds. Influenza infection is still a leading cause of morbidity and mortality, accounting for 20-25 million doctor visits and 36,000 deaths per year in the United States. Conventional therapies for colds and flu focus primarily on temporary symptom relief and include over-the-counter antipyretics, anti-inflammatories, and decongestants. Treatment for influenza also includes prescription antiviral agents and vaccines for prevention. This article reviews the common cold and influenza viruses, presents the conventional treatment options, and highlights select botanicals (Echinacea spp., Sambucus nigra, larch arabinogalactan, Astragalus membranaceous, Baptisia tinctoria, Allium sativa, Panax quinquefolium, Eleutherococcus senticosus, Andrographis paniculata, olive leaf extract, and Isatis tinctoria) and nutritional considerations (vitamins A and C, zinc, high lactoferrin whey protein, N-acetylcysteine, and DHEA) that may help in the prevention and treatment of these conditions.
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A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
The use of patient-derived, objective outcome measures has expanded substantially within the orthopaedic literature. Quality-of-life instruments are categorized as general health or as condition-specific questionnaires. The Medical Outcomes Study 36-Item Short Form (SF-36) is a general health-based survey of quality of life. it has been validated, is used widely across medical disciplines, and can be self-administered by the patient with reliability. The SF-36 has been implemented to define disease conditions, to determine the effect of treatment, to differentiate the effect of different treatments, and to compare orthopaedic conditions with other medical conditions. However, a bias of lower over upper extremity function has been demonstrated with the SF-36, as have limitations in assessment of certain physical activities of daily living as well as upper and lower limits on the detection of certain changes in quality-of-life status. Nevertheless, with an adequate knowledge of its effectiveness and limitations, the SF-36 can be a useful tool in many branches of orthopaedic surgery.
One effect of rising health care costs has been to raise the profile of studies that evaluate care and create a systematic evidence base for therapies and, by extension, for health policies. All clinical trials and evaluative studies require instruments to monitor the outcomes of care in terms of quality of life, disability, pain, mental health, or general well-being. Many measurement tools have been developed, and choosing among them is difficult. This book provides comparative reviews of the quality of leading health measurement instruments and a technical and historical introduction to the field of health measurement, and discusses future directions in the field. This edition reviews over 100 scales, presented in chapters covering physical disability, psychological well-being, anxiety, depression, mental status testing, social health, pain measurement, and quality of life. An introductory chapter describes the theoretical and methodological development of health measures, while a final chapter reviews the current status of the field, indicating areas in which further development is required. Each chapter includes a tabular comparison of the quality of the instruments reviewed, followed by a detailed description of each instrument, covering its purpose and conceptual basis, its reliability and validity, alternative versions and, where possible, a copy of the scale itself. To ensure accuracy, each review has been approved by the original author of each instrument or by an acknowledged expert.
Dendritic cells (DC) are important antigen-presenting cells (APC) that can prime naive T-cells and control lymphocyte-mediated adaptive immune responses with respect to magnitude, memory, and self-tolerance. Understanding the biology of these cells is central to the development of new generation immunotherapies for cancer and chronic infection. This chapter presents a brief overview of DC biology and the preparation and use of DC-based vaccines. Key WordsDendritic cells–antigen presentation–cancer vaccine–apoptotic cells–cyto-toxic T-lymphocytes
The basic objective of this paper is to evaluate an age-comorbidity index in a cohort of patients who were originally enrolled in a prospective study to identify risk factors for peri-operative complications. Two-hundred and twenty-six patients were enrolled in the study. The participants were patients with hypertension or diabetes who underwent elective surgery between 1982 and 1985 and who survived to discharge. Two-hundred and eighteen patients survived until discharge. These patients were followed for at least five years post-operatively. The estimated relative risk of death for each comorbidity rank was 1.4 and for each decade of age was 1.4. When age and comorbidity were modelled as a combined age-comorbidity score, the estimated relative risk for each combined age-comorbidity unit was 1.45. Thus, the estimated relative risk of death from an increase of one in the comorbidity score proved approximately equal to that from an additional decade of age. The combined age-comorbidity score may be useful in some longitudinal studies to estimate relative risk of death from prognostic clinical covariates.
To determine whether a nutritional supplement of selenium will decrease the incidence of cancer. A multicenter, double-blind, randomized, placebo-controlled cancer prevention trial. Seven dermatology clinics in the eastern United States. A total of 1312 patients (mean age, 63 years; range, 18-80 years) with a history of basal cell or squamous cell carcinomas of the skin were randomized from 1983 through 1991. Patients were treated for a mean (SD) of 4.5 (2.8) years and had a total follow-up of 6.4 (2.0) years. Oral administration of 200 microg of selenium per day or placebo. The primary end points for the trial were the incidences of basal and squamous cell carcinomas of the skin. The secondary end points, established in 1990, were all-cause mortality and total cancer mortality, total cancer incidence, and the incidences of lung, prostate, and colorectal cancers. After a total follow-up of 8271 person-years, selenium treatment did not significantly affect the incidence of basal cell or squamous cell skin cancer. There were 377 new cases of basal cell skin cancer among patients in the selenium group and 350 cases among the control group (relative risk [RR], 1.10; 95% confidence interval [CI], 0.95-1.28), and 218 new squamous cell skin cancers in the selenium group and 190 cases among the controls (RR, 1.14; 95% CI, 0.93-1.39). Analysis of secondary end points revealed that, compared with controls, patients treated with selenium had a nonsignificant reduction in all-cause mortality (108 deaths in the selenium group and 129 deaths in the control group [RR; 0.83; 95% CI, 0.63-1.08]) and significant reductions in total cancer mortality (29 deaths in the selenium treatment group and 57 deaths in controls [RR, 0.50; 95% CI, 0.31-0.80]), total cancer incidence (77 cancers in the selenium group and 119 in controls [RR, 0.63; 95% CI, 0.47-0.85]), and incidences of lung, colorectal, and prostate cancers. Primarily because of the apparent reductions in total cancer mortality and total cancer incidence in the selenium group, the blinded phase of the trial was stopped early. No cases of selenium toxicity occurred. Selenium treatment did not protect against development of basal or squamous cell carcinomas of the skin. However, results from secondary end-point analyses support the hypothesis that supplemental selenium may reduce the incidence of, and mortality from, carcinomas of several sites. These effects of selenium require confirmation in an independent trial of appropriate design before new public health recommendations regarding selenium supplementation can be made