Jacob Schor ND FABNO
May 1, 2009
We returned from Washington, DC earlier this week and I promptly took ill. A typical spring flu similar to the ones I’ve suffered through almost yearly for a decade. Yet given the current news about Swine Flu, I admit to being a little nervous about this illness. Though the odds are like a million to one that I caught this, the worry has inspired a bit of reading on my part.
The Centers for Disease Control and Prevention has a H1N1 page that is updated regularly. I go to this page all too frequently to watch the tally of case by state. As I type this, Colorado is still has had only two confirmed cases. See:
There are reasons why we are frightened by this flu outbreak. Probably the biggest is how little we actually know about how this disease will behave. ‘“This is a rapidly evolving situation.” Said Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention. “It is a situation filled with uncertainty.”
The worse case scenario of course is that this will be a repeat of the 1918 flu pandemic. That too was an A(H1N1) strain that went pandemic killing people from the arctic to remote Pacific Islands. Current estimates suggest somewhere between 20 million to 100 million people died March, 1918 and June 1920.
The 1918 virus was called the Spanish Flu because early reports suggested it originated in Spain. More credible suggest it may have originated at an army base in Kansas. The virus that caused the 1918 pandemic has persisted in pigs until the present time but only rarely caused human infection. In rare instances it would infect individuals working in close contact with pigs but did not appear to spread person to person.
The Spanish Flu as it was called was distinct in that mortality rates were highest among the healthy. Typically the young and old are more likely to die from the flu but in 1918 more than half the victims were between 20 and 40 years old, 90% younger than 65. It is this tendency to disproportionately kill the healthy that led Mexican health officials to suspect the swine flu and identify it. Typically 10,000 people die of seasonal flu infections in Mexico each winter season. With a population of 110 million people, even those cases do not stand out. That they noticed these few standout cases and tested for the new strain is impressive.
This tendency to kill the healthy is theorized to be the result of a phenomenon called a ‘cytokine storm.’ Cytokines are inflammatory chemicals released by the immune system in its efforts to combat infection. In theory the Spanish/Swine/H1N1 flu strains do an exceptionally good job at triggering a sudden and rapid release of cytokines causing a wave of intense inflammation that overwhelm victims. The healthier a person is, the more powerful a cytokine storm that is triggered. Despite all the articles written on cytokine storms there still isn’t conclusive evidence that the Mexican fatalities have suffered from these ‘storms.’
Yet this hasn’t stopped anyone from running with the idea. Yesterday’s article on MedPage Today, working following on the rationale that if cytokines cause inflammation, any anti-inflammatory drug might be useful quotes Dr. David Fedson suggesting that, “….Statins, fibrates, and glitazones "could be used to modify the host response, [making it] more like that of the children who lived in 1918, not like that of the young adults who died." It seems that Dr. Fedson has been a long time proponent for finding generic and inexpensive flu treatments, not necessarily the prescription drugs suggested in this MedPage article. An interview with Dr. Fedson has him suggesting herbal anti inflammatories as well as those sold by Big Pharma including curcumin and resveratrol.
If indeed our current version of the Swine Flu does turn out to trigger cytokine storms, this puts an interesting color to our selection of treatments. In a typical year, like other naturopathic doctors, we treat a number of cases of the flu among our patients. Typically we employ a combination of herbal extracts, vitamin supplements and homeopathic remedies with a degree of success. If cytokine storms prove to be part of the new virus’ presentation we need to rethink some of our choices.
A colleague of mine in Ireland, Nicolas Kats raised this question this morning when he wrote, “…. I'm accustomed to treating deficient immunity systems. But how do
I understand & treat when the immunity system is overactive, killing the
robustly healthy person?...” In other words we need to discriminate in our treatments between those treatments which bolster and strengthen the immune system and those which are directly anti-viral. We want to favor the later and avoid the former.
In simpler terms, Echinacea, because it stimulates immune function, might backfire on us, while licorice, because it is directly anti-viral, may be valuable.
There remain fascinating data from the practices of homeopathic doctors during the Spanish Flu suggesting that their patients had a far lower death rate from the flu than others. Back then the homeopathic remedies apparently most useful were Bryonia and Gelsemium. These remedies are still often useful in treating seasonal flu though response appears to vary each year. As the flu season progresses we often have a hint from colleagues which homeopathic remedies are proving most useful. In recent years Eupatorium has been commonly indicated. Keep in mind that homeopathic remedies are not prescribed by specific disease but by the symptoms a patient presents with. At this point again we are in the midst of a very, ‘uncertain’ situation. Time will tell.
In his Op-Ed piece in today’s New York Times, Julio Frank, current dean of the Harvard School of Public Health writes, “…Viruses are sensitive to seasonal temperature change, and this one, like the 1918 influenza, may reappear more robustly in the fall.” Our regular readers will know that I will take exception to that statement. As I’ve written about in the past, the seasonal fluctuation in flu infection is best correlated with ultraviolet light exposure and in recent years this has been accepted to be because greater exposure to ultraviolet light in the summer increases vitamin D levels. If you want more information on this idea a good place to start are our past newsletters:
Influenza and Vitamin D, November 2006 http://denvernaturopathic.com/news/influenzaandvitD1.html
I confess that in the last few days I’ve taken nearly a quarter a million IUs of vitamin D, just to be on the safe side, and will no doubt do so again before next fall’s flu season.
At this point we are getting phone calls and emails from patients asking what to do. At this point I’m not eager to make strong suggestions aside from the basic ones of good hygiene [that means wash your hands frequently] as found on the CDC’s website. As time progresses and we understand this phenomenon better we will have more specific information to offer.
A short postscript:
We were in Washington, DC, to attend the national finals for the “We the People” competition on constitutional scholarship. Our own team from East High School, which last fall won the Colorado competition, took first place overall, beating out the top teams from every other state. A short video overview on the program can be viewed at: http://video.google.com/googleplayer.swf?docid=3837427127618238644&hl=en
Denise Grady. Flu Spreads to 12 states; uncertainty continues. New York Times May 1, 2009 pg A10
IVW: Strong Immune Response Could Be Behind Swine Flu Deaths
By Todd Neale, Staff Writer, MedPage Today
Published: April 30, 2009
Julio Frenk. Mexico’s Fast Diagnosis. New York Times May 1, 2009 page A21