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Sunday, November 1, 2009

Preventing Swine Flu

The upper respiratory infection caused by the H1N1 influenza virus, commonly called the swine flu, has everyone on alert. Preliminary reports suggest that most cases are limited to mild illness and unless the virus mutates or combines with a more dangerous virus, an above-average incidence of death and disability are unlikely. Immunization efforts are underway but swine flu vaccines have sparked controversy and concern over questionable ingredients and inadequate safety information. My patients frequently ask me to make recommendations for alternatives to vaccination, so here I share some simple strategies to enhance immunity and prevent infection during swine flu season.

Common Sense

The swine flu is much like the regular flu. The symptoms are similar – fatigue, fever, chills, sore throat, cough, runny nose, headache, body aches – and like other influenza viruses, H1N1 is transmitted through contact with respiratory secretions of infected individuals, usually after coughing, sneezing or touching common surfaces. To prevent transmission, avoid touching your mouth, nose, or eyes and wash your hands often with hot, soapy water and lots of friction, for at least twenty seconds. Although people can become contagious before symptoms even start, use your best judgment and avoid contact with individuals who appear to be sick. If you are ill, stay home to prevent spreading the infection to others.

Good Nutrition

While a multiple vitamin-mineral supplement can provide the nutrients necessary for a healthy immune system, it is no substitute for whole foods. Eat a wide variety of fruits, vegetables, whole grains, beans, raw nuts and seeds. If you eat meat, choose pasture-raised and grass-fed animals. If you eat seafood, choose small fish that live in cold water, like anchovies, sardines, herring and wild salmon, and avoid large fish at the top of the food chain, like tuna and swordfish. Avoid processed foods, trans-fats, hydrogenated oils, refined carbohydrates like white flour and sugar, and excessive intake of alcohol. Unless you have kidney disease or your doctor has told you otherwise, drink plenty of fluids. The best choices are filtered or spring water and unsweetened herbal or green tea.

Sufficient Sleep

Getting enough sleep is important for a healthy immune system. A study published in the Archives of Internal Medicine found that healthy adults who slept at least eight hours each night had a higher resistance to upper respiratory infections. Participants reported their sleep duration and sleep efficiency (time spent in bed asleep) every night for two weeks before they were exposed to a rhinovirus known to cause the common cold. Those who reported less than seven hours of sleep per night were almost three times as likely to develop a cold than those who slept eight hours or more. Participants who reported poor sleep efficiency (less than 92 percent) were five and a half times more likely to come down with a cold compared to those who reported a high sleep efficiency (98 percent or above). Although this study focused on rhinoviruses, sufficient sleep is most likely an essential element in preventing other upper respiratory infections, like swine flu, as well.

Regular Exercise

Exercise can also impact immunity. One study, published in the American Journal of Medicine, followed 115 sedentary postmenopausal women for one year to study the effects of physical activity on resistance to upper respiratory infections. Participants were divided into two groups: one exercised for 45 minutes at a moderate intensity, five days each week, while the other attended one 45-minute stretching session, one day per week. Researchers concluded that the stretchers had a much greater risk of getting sick than the exercisers, by a factor of three in the final three months of the study. If regular exercise can increase resistance to upper respiratory infections in older women, there is a good chance it can be helpful for the prevention of swine flu in others.

Vitamin D

Studies have shown that vitamin D can stimulate the production of white blood cells responsible for identifying and destroying abnormal cells, like the H1N1 virus, and producing anti-microbial peptides that protect the respiratory system from infection. Studies have also shown that low blood levels of vitamin D are associated with an increased incidence to colds and flu. Vitamin D production is stimulated in the skin upon exposure to ultraviolet radiation and levels may be low during colder months when we spend less time in the sun. Blood levels of Vitamin D can be tested by your doctor and should ideally fall between 60 and 90 nanograms per milliliter (ng/ml). If levels are low, vitamin D can be taken in supplement form to increase immunity during cold and flu season.


Probiotics are healthy bacteria that normally live on our bodies and inside our gastrointestinal tracts. These supplements are most commonly used to treat digestive disorders but studies show that probiotics can also play an important role in respiratory tract infections. In a double-blind, placebo-controlled study published in Pediatrics, researchers followed 326 healthy children between the ages of three and five years taking a placebo or probiotic product (lactobacillus acidophilus alone or in combination with bifidobacterium) twice daily for six months. Compared to placebo, the kids who took probiotics experienced fewer cold- and influenza-like symptoms, including fever, cough and runny nose, and they recovered faster when they did get sick. They reported less illness-related school absences and required fewer prescriptions for antibiotics. If probiotic supplements can be protective against the flu, they may be useful in preventing the swine flu as well.

Botanical Medicines

Elderberry has a long tradition of use as treatment for upper respiratory infections and a recent study, published in Phytochemistry, supports its efficacy against the H1N1 virus. Researchers found that elderberry flavonoids can bind the H1N1 virus and block its ability to infect host cells. They concluded that its anti-viral activity is comparable to pharmaceuticals Oseltamivir (Tamiflu) and Amantadine.

Other herbal medicines used to prevent and treat viral upper respiratory infections include Astragalus root and medicinal mushrooms like reishi, shiitake and maitake. These botanicals have been used in traditional Chinese for thousands of years as restorative tonics, immune stimulants, and adaptogenic herbs that increase resistance to stress and illness.

Good Guidance

Like pharmaceutical medications, nutritional and herbal supplements are not appropriate for everyone. Before taking anything new, talk to a doctor trained in the use of natural medicines about contraindications, side effects, potential interactions, and the best dosage for you.


Cannell JJ et al. Epidemic influenza and vitamin D. Epidemiol Infect. 2006 Dec;134(6):1129-40.

Chubak J et al. Moderate-intensity exercise reduces the incidence of colds among postmenopausal women. Am J Med. 2006 Nov;119(11):937-42.

Cohen S et al. Sleep habits and susceptibility to the common cold. Arch Intern Med. 2009 Jan 12;169(1):62-7.

Leyer GJ et al. Probiotic effects on cold and influenza-like symptom incidence and duration in children. Pediatrics. 2009 Aug;124(2):e172-9.

Roschek B Jr et. al. Elderberry flavonoids bind to and prevent H1N1 infection in vitro. Phytochemistry. 2009 Jul;70(10):1255-61.

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