Flu Update September 2009

Jacob Schor, ND FABNO
September 4, 2009

Last Summer New Scientist magazine contacted sixty flu experts, and asked if the H1N1 influenza strain might become more virulent this winter.    Only about 8% of those surveyed thought it “likely to happen.”         About 23% gave it a “fifty–fifty chance” to happen; most thought it “less likely” but still possible.        The experts weren’t that worried. 

Those survey results appeared just five months since H1N1 emerged in Mexico.  The flu had already spread to 168 countries and caused 160,000 confirmed infections. As of August 16, there were 556 (593 as of 9/4/09) confirmed deaths in the US.    As 30 to 50,000 people die yearly in the US from the flu, this is not striking.

In the 1918 pandemic, the virus became more virulent over time.  No one knows if this will happen again.  The worry is that the Swine Flu, which spreads very quickly, may combine with Bird Flu, which is much more lethal and kills a third of those infected.  A fast spreading lethal virus would be reason to worry.

About a third of those experts surveyed had stocked up on Tamiflu, the flu drug just in case.  This may have been false security.

A study in the British Medical Journal, August 10 issue, concluded that treating children under 12 with antivirals provided little benefit; it shortened the duration of disease by just a day or so and decreased the odds of an infected child spreading the disease to others by only 8%.  

There are other options to consider.  Some are may prevent infection or taken before getting ill reduce symptom intensity.  Others may be useful to take if you do get ill.

Vitamin D:
Flu is generally a seasonal disease, outbreaks increase in the late winter as vitamin D levels in decline; outbreaks decrease in the summer as vitamin D levels rise.  British epidemiologist Edgar Hope-Simpson was the first to notice a relationship between sunlight and flu.  He theorized in 1981 that ultraviolet light had a protective effect against infection.  A quarter century later, John Cannell suggested vitamin D was the missing piece in Hope-Simpson’s theory:  exposure to ultraviolet rays from sun light triggers vitamin D production in the skin and this in turn protects against flu infection. People make vitamin D in the summer and use it up during the winter.  By late winter many people are deficient.   Cannell argues that’s why infections increase.
We are encouraging our patients to boost their Vitamin D levels in preparation for flu season.       We suggest they test their levels and then take oral vitamin D-3 supplements throughout the winter to keep their levels optimal, a 25(OH) D-3 level above 50 ng/ml.
Vitamin D was once thought to be toxic in high doses.  Current research says not true, these worries were unfounded.   The RDA for vitamin D is 400 IU/day, but doses as high as 10,000 IU per day are now considered safe.   The Canadian Cancer Society recommends 1,000 IU/day during the fall and winter to reduce risk of cancer.       Health Canada is researching whether vitamin D is protective against Swine Flu but data has not reached publication.  
In 2008, Cannell reported that high dose vitamin D, 2,000 IU/kilogram body weight, should be taken for three days at the first onset of upper respiratory disease.    For someone weighing 100 pounds (about 50 kilograms) that would be 100,000 IU per day!  Supposedly this is useful at fighting off bronchitis, pneumonia and the flu.  We are unaware of published research confirming benefit of this high dose technique.
Lower vitamin D levels are correlated with increased risk of upper respiratory tract infections.     Vitamin D does appear to prevent and treat infectious disease.  A review article in July examined, “randomized controlled clinical trials that studied vitamin D for treatment or prevention of infectious diseases in humans.” The authors identified thirteen trials conducted from 1948 to present, ten of which were conducted using rigorous double blind design meeting modern criteria:  “…the strongest evidence supports …. adjunctive vitamin D therapy for tuberculosis, influenza, and viral upper respiratory tract illnesses.”
Although not definitive studies, these are promising and as there is little risk in taking vitamin D, we are encouraging all of our patients to do so.

N-acetyl-cysteine (NAC)

N-acetyl cysteine provides the body with cysteine, the raw material needed to make glutathione internally.  Glutathione is the main antioxidant used within cells.  Increasing antioxidant activity inside cells does a surprising number of useful things.  It protects against oxidative damage, of course.  Clinically we use NAC for among other things, asthma triggered by air pollution, mercury poisoning, compulsive behavior and to thin mucous.
In a double blinded placebo controlled trial, 262 participants, 65 years or older, took 1200 mg/day of NAC for six months, during the winter. Those taking the NAC reported far fewer episodes and milder symptoms of flu that winter.     Yet when tested in the Spring, a similar proportion of the NAC group tested positive for having been infected as the group of people taking only placebo.  The NAC didn’t prevent people from catching the flu, it simply prevented them from suffering with it. 
Several studies tell us that probiotics, like NAC, also decrease flu and cold symptom intensity even if they don’t always protect people from getting sick.     The most recent was published this past August in the journal Pediatrics.    This study was published in the August issue of Pediatrics and suggests significant benefit from taking daily doses of probiotics.
The flu changes every season and the treatments that worked well in previous years may not work as well this year.  This seems especially true when seeking to treat these illnesses with either herbs or homeopathic medicines.  So although we know which treatments have worked in prior years, we are not certain what will work best this coming flu season.
Lively discussion has occurred amongst professional herbalists over the last few months on this emerging flu.  Paul Bergner of the North American Institute of Herbal Medicine in Boulder and publisher of the journal Medical Herbalist, informs me that there are a number of factors that may have made that original outbreak more severe.      The first consideration was that malnourishment was more common at that time.    White flour was a mainstay and whole wheat largely abandoned.  This ‘modern’ white flour was not yet enriched and as a result vitamin and mineral deficiencies were common.    Vitamin D deficiency was also common.  Bergner, after studying the historical record of what herbs were used with success to treat the 1918 flu suggests several herbs to consider using this winter.  They are Elderberry (Sambucus nigra), Boneset (Eupatorioum perfoliatum) and Echinacea.  All three have a long history of successful employment for reducing the symptoms and discomfort of flu both historically
and in recent years.
We often use Boneset for just what the name implies, to help fractured bones set up faster.  The keynote symptom that leads us to prescribe it for cases of the flu is bone pain, that deep ache felt.          This symptom was common in the flu cases we saw last spring. 
Elderberry also has a long history of use for flu.  Recently, about ten or fifteen years back, a proprietary extract was developed by a virologist in Israel and it became popular after studies demonstrated that it significantly shortened the duration and intensity of flu infections.   This product and other elderberry extracts are also being considered for cancer treatment because they reduce inflammatory cytokines.    Reducing inflammatory cytokines is also a goal in treating these H1N1 viral infections.   A paper published in August 2009, reported that elderberry extracts have a direct antiviral activity on the H1N1 flu virus, an effect that is comparable to the antiviral prescription drugs.  
There are several other herbs and plant extracts to consider for treating flu infections.  They include garlic (Allium sativa), ginseng (Panax quinquefolium), olive leaf, Siberian Ginseng (Eleutherococcus senticosus,), larch arabinogalactan (Larix), Astragalus  (Astragalus membranaceous), and Baptisia tinctoria.
This same wait and see attitude also applies to homeopathic medicines.        According to homeopathic lore, one does not pick the correct homeopathic medicine based on the disease but on the specific and unique symptoms of the patient.     Thus various homeopathic books may list a dozen or more medicines to choose from to treat the flu.  Picking which one is a matter of picking out the unique presenting symptoms of the individual patient.  Practitioners look at the patient’s mood, body temperature, thirst, and so on.  That being said, let me contradict myself and say that it is common to see a particular homeopathic remedy be more commonly used for a particular flu, the problem is that the particular remedy seems to vary year to year.  Dr. Paul Herscu, author of the Homeopathic Treatment of Children and founder of the New England School of Homeopathy, has been teaching about this phenomenon for several years. Dr. Herscu surveys homeopathic practitioners to see which medicines are proving most
effective each flu season.  Homeopathic phosphorous was the most common homeopathic medicine for the 2007-2008 flu, while last winter, nux-vomica won the award. 
The biggest difference in presenting symptoms is that the person who will respond to phosphorous is cheerful despite being ill while the nux-vomica patient will be quite irritable.
Websites of interest:
John Cannel: http://www.vitamindcouncil.org/
National Institute of Health Flu site: www.Flu.Gov
Center for Disease Control’s weekly flu report:  http://www.cdc.gov/flu/weekly/ 
North American Institute of Medical Herbalism http://www. naimh.com
Medical Herbalism Journal http://medherb.com
Paul Herscu, ND: http://www.hersculaboratoryflu.org/
Paul Bergner on Flu: http://naimh.com/Influenza-1918.pdf