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Measles is in the news once again, and once again, the high impact of nutrition on measles isn’t usually mentioned. Though we are accustomed to media click-baiting with scary headlines, here’s some good news: There is indeed a high impact from nutrition on measles, and vice versa too. This means you can leverage nutrition to protect and support your family during measles exposures.

Historically, measles was regarded as a routine infection that pediatricians expected children to get, and recover fully from, by about age 5 or 6. Kids who didn’t get it were a bigger concern, since it was a tougher course for teens or adults.  By the time I was born in 1960, this was still true, as measles shots were not yet available. There was no hysteria, and you can see why in the CDC’s historical data below.

Deaths from measles in the US fell dramatically, to fewer than 2 per 100,000, by 1945 (see page 85 here), nearly twenty years before a vaccine existed. The graphs below show this timeline. On the far right, the last arrow shows introduction of measles vaccine, many years after deaths and illness from measles had flattened, thanks to improved nutrition and sanitation. The second graph illustrates same, but for measles only. For both, here is the CDC source:


We’ve had a measles vaccine since the 1963, and measles-mumps-rubella (MMR) vaccines since the 1980s. Currently, nationwide compliance with MMR shots is 93%.This is well above the level that public health experts want for herd immunity. Conventionally, it is believed that if two thirds or more of a population is immune, this benefits the herd and stops or slows spread. So where is measles coming from now?

The problem isn’t that more people should be vaccinated, but that MMR vaccines can fail. We began seeing this in the early 1980’s, with outbreaks spreading through fully immunized populations. In this case, the CDC takeaway was this: “”This outbreak demonstrates that transmission of measles can occur within a school population with a documented immunization level of 100%”. Despite this investigation being published by the CDC itself, media outlets today keep telling us that this only happens because of people who don’t vaccinate. Even Science Magazine made this gaff with a piece titled: “Measles Outbreak Traced To Vaccinated Person For First Time “. The reality is that periodic outbreaks continue in vaccinated kids. Acquiring measles from an immunization itself has also been documented – creating another possible source of spread.

My siblings and I grew up in the era when many pediatricians worried if you didn’t get measles, not the other way around. Measles, chickenpox, and mumps infections were regarded as beneficial childhood milestones that developed a vigorous, healthy immune system. Measles infection was so benign for healthy children that our lexicon created the word “measly” from it – meaning, insignificant, or “contemptibly small“. How times have changed! Pediatricians today who are under the age of 50 may never have seen a healthy child with measles in the flesh, or know how to guide you through it.

The impact of nutrition on measles means that well nourished children are more likely to be uncomfortable and sick for a week or two, with cough, fever, malaise, and rash, then recover fully. Nutrition on measles works the other way too: Underweight, depleted children will be at higher risk for a longer or more complicated course, or even for serious secondary infections, like pneumonia or encephalitis. But these are extremely rare in children who are healthy and in strong nutrition status, before exposure.

Whether your child is exposed to measles from wild type infection or from MMR shots, both make vigorous demands on the immune system, and both require the immune system to respond. Your child’s nutrition status before, during, and after these exposures determines the severity of illness or tolerance for the shot, and whether or not there are complications. In my pediatric nutrition practice of nearly 25 years, I have encountered a single unvaccinated child who got measles. This child was in the Philippines and was about two years old. The child had a mild course and recovered fully. On the other hand, I have encountered many hundreds of children whose parents reported poor tolerance of MMR doses, across several countries including the US and UK. In these cases, lasting debility ensued, for GI features, developmental features, or both.

While sick with measles, your child probably won’t feel like eating, will have a fever, and may have a cough and diarrhea. Measles exposure (natural or injected) triggers changes in gut tissue and immune function, causing children to lose protein in stool during this illness, when the immune system most needs it. Replenish your child daily with good food during this infection. If they feel too nauseous to eat, feed organic beef broth or bone broths that are not low sodium – your child needs electrolytes here. Stir a half teaspoon of ghee or grass fed butter (a vitamin A source) into the broth. Give electrolyte drinks and any protein rich foods they will accept. Lactose intolerance is a documented effect for some children exposed to measles, so if dairy foods that your child usually loves suddenly feel awful during this illness, switch to non-dairy protein sources like egg, meats, chicken, homemade broths, collagen, non-dairy milks like Kate Farms or Kiki Milk, or any tolerated legumes/beans/peas. Elemental amino acid formulas and supplements are available too.

Contact me if you need help with nutrition strategy. Here are key nutrition-measles points to keep in mind:

1 – Growth Pattern Counts – Your child’s weight relative to his height (body mass index, or BMI) should be in a healthy range. BMI should be above 10th percentile. Underweight children, especially those with a body mass index or weight-to-height ratio below the fifth percentile, are at higher risk for infection in general and for more complications from infections. Though we often hear about childhood obesity in the US, most children in my practice are struggling with gaining weight and growing – and these are kids who get sick more often, stay sick longer, and have more complications. Don’t fear feeding your kids ample portions of all macros, including carbohydrates, and traditional fats.

2 – Check on Iron  – Iron status should be robust. A good way to assess this is to check a child’s ferritin level. It should be at least 30, though reference ranges drop to 10. A functional level is 50-60. Signs of weak iron status – besides frequent infections  – include pallor, veins visible through skin, shiners at eyes, penchant for chewing ice or other non-food items (sticks, rocks, sand, pens, paperclips, fabric), fatigue, intermittent hyperactivity, depression or mood swings, or poor restless sleep. Counterintuitively, girls may have heavier menses when iron deficient. Iron is the single most commonly deficient nutrient world wide, including in US children. To learn more about when kids need iron and how to properly test it, click here.

3 – Vitamin A Is Key Against Measles –  Vitamins A should be strong in your child’s diet every day. Vitamin A in particular is specifically protective against measles virus and will be depleted by the demands made on the immune system if your child is exposed. Cod liver oil, whole milk or butter that is from grass fed cows, brightly colored vegetables and fruits are all good sources, and can add omega 3 fats also, which help modulate immune function. Use a supplement if necessary, to maintain good intake.

4 – Zinc Is An Immune WorkHorse – zinc status should be strong. Eat zinc rich foods daily – raw cashews, nut butters, pumpkin or sunflower seeds, pork, lamb, beef, mushrooms, or legumes and beans are good sources. You can also use a supplement to 15-30 mg daily for children in most cases. Picky eaters may especially need help with a supplement to maintain healthy levels – chewables and liquids are available in my FullScript platform here.

5 – Protein Status Protein status refers to good tissue function and tissue reserves of protein in the body. Give your child strong protein status with good food, so the immune system has the building blocks needed to make globulins and other immune molecules to mount a defense. Your child should be eating at least 35-60 grams protein daily depending on age, from varied sources (that is, not just milk, cheese, and yogurt – see my blog on dairy addiction if that is your kid).

The impact of nutrition on measles and lessening the impact of this infection is legendary in public health circles, and has filled volumes for decades – from vitamin A status as a predictor of measles deaths, to how fish oils modulate certain immune proteins in our bodies. Your child can have marginal status for any of these nutrition factors without your pediatrician’s notice – a scenario I routinely find in my pediatric nutrition practice. If you’d like a nutrition assessment for your child with recommendations tailored to their needs, contact me here.