From Infants to Top-Notch Athletes to the Critically Ill, this “First Milk” Provides Immune and Gastrointestinal Benefits
What’s the nutritional superfood that almost all of us have had at some time in our lives, and that new mothers, dairy farmers, and OB/GYNs know best? It is colostrum, the first milk that comes at birth. It actually comes in a bit before birth, and in various settings that increase the health risk for the newborn, mothers-to-be are being taught to collect the colostrum prior to birth, so it can rapidly be available for supplemental feeding immediately after delivery.[1]
Colostrum is particularly important for a newborn infant because they lack a fully developed immune system.
Colostrum provides important immunological factors such as immunoglobulins, lactoferrin, oligosaccharides, and cytokines, as well as many growth factors to support the developing infant’s digestive tract and beyond.[2],[3]
These factors also interact with the intestinal microbiome and promote the population of healthy bacteria.[4]
Perhaps needless to say, when colostrum is consumed as a supplement, it is not derived from a human host; rather, it is a product of the dairy industry. Differences exist between human and bovine colostrum (BC): BC has high levels of immunoglobulin G (IgG), while in human colostrum levels of immunoglobulin A (IgA) are the highest.[5],[6] High levels of IgG in BC are important because the offspring of hooved mammals do not develop passive immunity prenatally—it must be provided after birth.[7] Because of colostrum’s critical importance for the development of the calf, the process of collecting it for our use of its healing components occurs after the necessary amount has been fed to the calf to provide this passive immunisation. [8]
Numerous studies have shown that consumption of BC may increase our immunity to infection in a similar manner. Interesting research has considered the use of colostrum immunoglobulins from cows that have been vaccinated against common diseases such as rotavirus to protect humans from infection as well as serve as a treatment for infection.[9],[10],[11] Hyperimmune BC has also been successfully used in this manner for the treatment and/or prevention of human disease caused by Cryptosporidium sp., Shigella sp., enterotoxigenic Escherichia coli, and Clostridium difficile infection.[12]
The protection hyperimmune BC may provide is not limited to enteric infections—data strongly suggests it also may protect against highly virulent forms of the influenza virus in a similar fashion.[13]
BC is not just protective against infection: the many factors found in it also may help protect against allergies and asthma. Perhaps this is not surprising, as many may be familiar with the epidemiological studies showing a lower incidence of allergic disease in breastfed infants.[14],[15],[16] Of the many active components, transforming growth factor (TGF)-β, found in both human and bovine colostrum,[17],[18] plays an important role in regulating inflammation and the development of oral tolerance.[19] In mice, administration of BC has been shown to promote a Th1 response, reducing levels of the cytokine interleukin (IL)-4, which is associated with Th2 (allergic) immune response.[20]
Finally, colostrum plays an important role in the maturation of the gut and other tissues. One factor in colostrum that may play an important role in this is epidermal growth factor (EGF).[21] EGF promotes normal development of the gut, lungs, and skin, protecting infants from necrotizing enterocolitis, chronic lung disease, and respiratory distress syndrome.[22],[23],[24] Insulin-like growth factor (IGF) is found at high levels in BC and also plays a role in tissue development and growth.[25] Studies suggest IGF may also be a factor that helps protect the intestinal barrier and promote repair.[26],[27]
Herein, we take a deeper look at the clinical data backing the use of BC for the treatment and prevention of infection, for the support of healthy gut permeability, as well as an agent to help ameliorate exercise-associated gut and immune dysfunction.
Influenza
In addition to the many studies investigating the use of hyperimmune BC as a treatment and a preventative for common gastrointestinal infections, BC has also been investigated in high-risk cardiovascular disease patients as an alternative or adjunctive to influenza vaccination.[28] One of the challenges with influenza vaccination is, of course, viral mutation or the emergence of new viral strains. Because the typical influenza vaccine is based on projections from common viral strains the previous year, these selections may be inaccurate. A good example is the seasonal flu vaccine in 2018 to 2019, which was reported by the Centers for Disease Control to only be 29% effective.[29] BC has been proposed as an alternative because it provides a broad spectrum of immunoglobulins against common pathogens.[30]
In this two-stage study,28 the first stage included healthy individuals divided into four arms: group A received only the flu vaccine, group B received the flu vaccine + 400 mg of freeze-dried BC daily, group C received only 400 mg of BC/day, and group D had no prophylaxis. The period of oral supplementation was eight weeks, and vaccinations were within two weeks before the initiation of the study. Assessment at three months showed no significant differences between groups B and C (both receiving BC); however, group A (receiving only the vaccine) had approximately four times more episodes of the flu and three times the number of days with disease. These parameters in the vaccine group were only slightly better than the group receiving no prophylaxis. The number of days with malaise was highest in the vaccine group, even considerably higher than the control group, suggesting the vaccine itself also had this adverse effect.
In the second stage of the study,28 high-risk cardiovascular disease patients were divided into three treatment arms using the same protocol as the first stage; however, in this portion of the study, all groups received some form of treatment. Of the three treatments, both groups receiving BC had only three events of cardiopulmonary problems, while the group only having vaccination had six events, resulting in one death. The incidence of hospital admissions was also significantly higher in the group having only vaccination.
Common Paediatric Infections
Perhaps not surprisingly, BC has been considered as a therapy in many paediatric settings. Often available as a powder that can easily be mixed into other dairy products or a smoothie, this also contributes to its common use in children.
In a study of children with recurrent diarrhoea or upper respiratory tract infections, daily supplementation of colostrum significantly reduced the number of respiratory infections, episodes of diarrhoea, and hospital admissions.[31]
Additionally, even though the period of intervention was only for four weeks, the reduction in infectious events was maintained at two and six months.
A randomised, double-blind, placebo-controlled trial (RDBPCT) also evaluated the effectiveness of BC for the treatment of acute viral or bacterial diarrhea in children ranging in age from six months to two years.[32] Children were given 3 g of BC or placebo in addition to standard of care with oral rehydration solution and supplemental zinc per the World Health Organisation guidelines. At 48 hours, it was found that the children additionally receiving BC had a significantly lower frequency of vomiting, diarrhoea and Vesikari scores (composite diarrhoeal disease severity scores[33]) compared to those receiving the placebo.
A 2019 meta-analysis of randomised, controlled trials further supports the use of BC for the reduction of childhood infectious diarrhoea, concluding, “In the sensitivity analysis of studies with low risk of biases, bovine colostrum significantly reduced stool frequency, occurrence of diarrhoea and pathogen detection.”[34]
Adult Respiratory Tract Infection
Supplementation with BC has been shown to reduce the incidence of URTI symptoms in adults as well. In a RDBPCT of healthy, active males, daily supplementation of 60 g of BC for eight weeks significantly reduced the proportion of subjects reporting URTI symptoms compared to placebo.[35] In elite swimmers, daily supplementation of 25 g of BC also reduced reported URTI symptoms by week four of the intervention, with even lower reporting of symptoms during the remainder of the 10-week intervention.[36]
Intestinal Permeability
As mentioned, multiple growth factors found in colostrum also impact the health of the gut lining. In addition to animal models showing protection against the adverse gastrointestinal effects of nonsteroidal anti-inflammatory drugs (NSAIDs) and chemotherapy,[37],[38] human studies have also demonstrated that BC has positive effects in these settings.
In healthy volunteers, coadministration of BC with indomethacin prevented the medication-induced increase in intestinal permeability, which increased three-fold after five days in the control group taking a placebo along with the medication.[39] In children with newly diagnosed acute lymphocytic leukaemia, daily supplementation with BC alongside chemotherapy significantly reduced the severity of oral mucositis compared to those receiving placebo.[40] Finally, in a study of critically ill patients hospitalised in an intensive care unit (diagnosis unspecified), after 10 days of supplementation with BC, improvements were seen in intestinal permeability (assessed by plasma zonulin level), plasma endotoxin level, and the incidence of diarrhea.[41]
There are not yet human studies in the setting of inflammatory bowel disease (IBD), a condition in which we also see increased gut permeability along with inflammation that typifies the disease. However, given the positive findings from numerous animal models of IBD[42] and the high level of tolerability of BC in populations including the severely ill, we should anticipate studies in this population soon as well.
Exercise-Associated Immune and Gut Dysfunction
Although regular moderate exercise is proven to have numerous health benefits, exercise that is extremely high intensity, of prolonged duration, or under other extreme conditions can have adverse effects, including increased risk of infection as well as increased intestinal permeability.[43],[44],[45],[46],[47] Because BC has data suggesting it may ameliorate both of these issues and contains growth factors like IGF that may further enhance training, it has been investigated in numerous studies with athletes.
Clinical studies have shown that routine supplementation with BC during training attenuates aspects of exercise-associated immune dysfunction by increasing levels of secretory IgA,[48] total lymphocyte counts and CD4+:CD8+ ratio,[49] and salivary lysozyme, also enhancing neutrophil recovery.[50] Additional positive effects on training were seen with a reduction in exercise-induced muscle damage and markers of inflammation.[51]
In regard to gastrointestinal tract dysfunction, supplementation with colostrum has been shown to decrease intestinal cell damage incurred during hot-climate exercise[52] and attenuate the exercise-related increase in intestinal permeability by 80%.
In athletes already amid peak training activities, lactulose and mannitol absorption tests showed that 75% had increased intestinal permeability, which was restored to normal range and significantly lower than baseline after 20 days of BC supplementation.[53]
Clearly, colostrum is a nutritional tool with substantial evidence showing its positive impact on human health, which likely can be traced back to the origins of humankind. Its broad range of benefits for all ages and high level of tolerability even in the critically ill make it a broadly useful tool to combat infection and gastrointestinal dysfunction in nearly all populations.
References
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