With the widely publicized shortage of flu vaccines in the US this year, many people want to know what alternatives exist to prevent influenza. This is not a new question for naturopathic physicians: every year, we are asked for our recommendations on flu shots and other prophylactic approaches.
The American Association of Naturopathic Physicians has a position statement on vaccination, which advocates for preventive medicine, the proper use of vaccines, informed consent about the risks of infectious diseases, the risks and benefits of vaccinations, and other options (http://www.naturopathic.org/positions/vaccinations.html).
Conventional Options
FluMist, a nasal flu vaccine, is available for healthy people ages 5–49. It is a live attenuated virus and can cause the flu if someone is immunosuppressed. It should not be given to pregnant women or individuals in close contact with immunocompromised people. The cost is over $100. Antiviral drugs (rimantadine and amantidine) can be used preventively in some cases, but carry risk of serious side effects, and must be used throughout flu season. Viral resistance can develop in about 25% to 35% of patients. Oseltamivir (Tamiflu) and zanamivir (Relenza) can be used for patients who have had flu symptoms for no more than two days. As neuramidase inhibitors, they prevent viruses from penetrating healthy cells and inhibit viral release from infected cells. They may be better tolerated than older antivirals, and resistance has not yet been seen (Couch RB. N Engl J Med. 2000; 343:1778–1787).
Natural Medicines
Echinacea has emerged as one of the most effective herbs for prevention and treatment of flu. Echinacea can inhibit influenza virus in cell cultures. Certain Echinacea components may block receptors on the cell surface, but the antiviral effects may also be due to inhibition of hyaluronidase, which is probably more important than direct antiviral activity. Echinacea does seem to enhance killing of virus-infected cells (Bauer R, Wagner H. Econ Med Plant Res. 1991; 5:25. 3–321; Wacker A and Hilbig W. Planta Medica. 1978; 33:89–102; Braunig B et al. Zeitschrift Phytother. 1992; 13:7–13).
Naturopathic physicians typically use Echinacea as a main component of formulas with other antiviral and immunomodulating herbs such as Melissa officinalis (Lemon Balm) leaf, Liguisticum porteri (Osha) root, Phytolacca americana (Poke root), Baptisia tinctioria (Wild Indigo) root, Hypericum perforatum (St. John’s Wort) flowering top, Lomatium dissectum root, Arctium lappa (Burdock) root, Fouqueria splendens (Ocotillo) bark, Larix occidentalis (Western Larch), and Allium sativum (Garlic).
Elderberry (Sambucus nigra) has recently come into more common use. Sambucol is a standardized extract from black elderberry, and studies show it has antiviral properties against ten different influenza strains. In a double-blind, placebo-controlled trial, Sambucol reduced duration of flu symptoms (e.g., fever and myalgia) to 3–4 days when 4 tablespoons were taken daily for 3 days (Zakay-Rones et al. J Altern Complement Med. 1995; 1:361–369; Barak et al. Eur Cytokine New. 2001; 12:290–296). Elderberry has both antiviral and immunomodulating effects; it seems to increase inflammatory cytokines, such as interleukins and tumor necrosis factor while preventing viral attachment to cells, similar to the neuraminidase inhibitors. Oregano oil has also been shown to strongly inhibit human influenza virus A in vitro (see Holistic Primary Care, Fall 2004).
There is some evidence that Panax ginseng might protect against colds and improve response to flu vaccine. When Panax ginseng, 100 mg per day, is started 4 weeks prior to vaccination and continued for 8 weeks thereafter, it seems to reduce cold and flu symptoms. The mechanism for this effect is unknown, but it may involve increases in NK cell activity and the antibody response to the vaccine. Limit Panax use to three months on and one month off, to avoid “ginseng abuse syndrome,” which manifests as sleeplessness, tight muscles, water retention, and high blood pressure (Scaglione F et al. Drugs Exp Clin Res. 1996; 22:65–67).
Vitamin C has long been promoted to prevent and treat colds and flu and has generated considerable controversy. It seems to increase T-lymphocyte activity, phagocyte function, leukocyte mobility, and possibly antibody and interferon production (Leibovitz B, Siegel BV. Adv Exp Med Biol. 1981; 135:1–25; Vilter RW. West J Med. 1980; 133:485–92). In one study, patients taking vitamin C, one gram, four times daily, reduced cold and flu symptoms by 85% compared to those who took only pain relievers and decongestants (Gorton H and Jarvis K. J Manip Physiol Ther. 1999; 22(8):530–3). Supplementation with zinc and selenium may improve antibody response to the flu vaccine in elderly patients with mineral deficiencies (Girodon F et al. Arch Intern Med. 1999; 1:59:748–754).
Xylitol nasal spray (Xlear) prevents the attachment of microorganisms to the nasal mucosa, unlike saline sprays that can inhibit and paralyze ciliary movement (see Holistic Primary Care, Fall 2004). Although there are no studies of Xlear in preventing flu, it has been demonstrated to prevent bacterial infections of the sinuses and ears.
Homeopathic medications such as Oscillococcinum (Boiron), Dolivaxil (Dolisos), and Hyland’s Complete Flu Care can be used to prevent or treat influenza. I have personally found Oscillococcinum reliable in preventing flu. I recommend one dose monthly during flu season. Three large randomized controlled trials have shown statistically significant results for the treatment of flu (Vickers AJ, Smith C. Cochrane Database Syst Rev. 2000; 92:CD001957). Dolivaxil is prepared annually from the viral strains likely to cause influenza, and is intended to be taken prior to flu season, once weekly for 4 weeks, 3 weeks off, and a fifth dose during the eighth week.
Lastly, do not forget simple hygiene to prevent infection. Wash hands frequently, especially when around those infected or when in public places. Avoid touching the eyes or nose to prevent self-inoculation. Alcohol-based hand gels (Purell) seem to be more effective than water for hand washing because it takes less time than a 1–2 minute soap and water scrub. There’s some evidence that alcohol-based hand gels containing 62% ethyl alcohol reduce cold-causing viruses on fingers better than water alone. Alcohol hand sanitizers are also a good option when hand washing is inconvenient (Widmer AF. Clin Infect Dis. 2000; 31:136–143).
Michael Traub, ND, is immediate past-president of the American Association of Naturopathic Physicians. He practices in Kailua-Kona, Hawaii, and is on staff at North Hawaii Community Hospital.
