If the H1N1 virus were a human serial killer, it would not take much for a clever detective to put together the common denominator among its victims: the young, the elderly, the pregnant, and those with an underlying illness. This detective would have easily figured out that a compromised immune system is what makes each of these groups vulnerable.
The immune system is immature in the young, waning in the elderly, suppressed by hypothyroidism in the pregnant, and compromised for a variety of reasons in those with underlying disease. Administering nutrients that normally gird immune function and act as antimicrobials—things like vitamins A, C, and D, the minerals selenium and iodine, along with proper thyroid replacement, would prevent most of the deaths. This has been the main focus of my flu prevention efforts.
The take-home message about H1N1 is not really about H1N1—there’s nothing especially unique about this virus—but about influenza viruses in general, and innate immune system competence or lack thereof.
Chinks in the Armor
Influenza viruses are opportunistic infections that exploit compromises in the innate immune complex (skin, respiratory cilia, cough reflex, mucous production, hormone status, immune cell function, production of gastric HCl, etc). They can only make someone sick if they get “in,” and they only get in where immune defense is weak.
The principle site of vulnerability to flu viruses is the respiratory epithelium. Viral infectivity is inversely related to cell membrane integrity. Viral glycochemistry, specifically the alpha-2 glycan receptor ligands, and the hemagglutinin moiety on the virus, also plays a role, as does the efficacy of the viral RNA polymerase. From the viral viewpoint, having access to the respiratory epithelial cell glycan receptor is key. This is the combination lock to the safe. The more barriers there are to this “lock” the less successful an intruder will be.
One barrier is the production of decoy sugars to which the virus can attach, instead of the glycan receptor. These glycoaminoglycans (“snot” or mucous are the lay terms) are produced by healthy immune cells if they have adequate thyroid hormone. Other "barriers" are maintained by “vitamones” D3 and A (remember, they are hormone-like in their effects), iodine, selenium, steroid hormones such as testosterone and cortisol, and other factors that gird the innate immune complex.
An Incompetent Virus
The current H1N1 strain is fairly incompetent as far as viruses go. You have to leave your keys in the car or you doors unlocked in order to become a victim. The RNA polymerase enzyme that controls viral replication is weak in this virus. Its ability to attach to the alpha-2 glycan receptor of respiratory epithelium is also weak. So, there's no way that a truly healthy person succumbs to H1N1.
A person must be hypothyroid, low in vitamone D3, low in vitamone A, adrenally insufficient, androgen deficient, or have some deficit in innate immunity that leaves them compromised.
Very young children have immature thyroid function and their developing immune systems are not fully competent. This is why children are known to "grow out of" some diseases. The opposite happens with age: as immune and thyroid function wane and adults develop acne, allergies and all sorts of illnesses they never had in their youth. Around age 65, immune function is compromised enough to render most people highly vulnerable to for opportunistic viral infections.
In pregnant women, elevated estrogen levels cause an elevation in thyroid- binding globulin. This protein will bind to thyroid hormone, rendering it incapable of moving into cells to effect DNA transcription of proteins requisite for competent immune function. You'd think obstetricians would figure this out.
A Fungal-Viral Synergy?
Flu viruses like H1N1 may have inside help in getting past immune system defenses. I recently had an interesting conversation with David Woodward Ph.D., President and Director of the Trudeau Institute, one of the nation’s oldest infectious disease & immune system research centers. We talked at length about the dromedarian architecture of the graph of the annual flu incidence.
It is a constant every year since records have been kept, that there is a small hump in the Spring, followed by a larger hump in the Winter. The Springtime hump pretty much rules out cold as the cause of flu, as temperatures are warming in the Spring. It also dampens the low vitamin D hypothesis, as the days are getting longer in Spring and presumably, mean sun-generated vitamin D synthesis would be on the rise.
The common denominator, however, is the transition of ambient temperatures through a window that is highly conducive to fungal growth. Dr. Woodward studies viruses. I'm a fun guy (get it?). We related to each other how viruses and fungi each have their own ways of compromising the immune system. We concluded that at the very least, the mechanisms and players are in place for synergy between fungi, particularly Candida albicans, and viruses. Fungi reproduce best in temperatures seen in the Spring and Fall in temperate regions.
It’s just a hypothesis at this point, but it is certainly plausible that fungal proliferation can open the door for viruses by weakening a critical part of innate immunity: macrophage function. Mycotoxins (gliotoxins) released from fungi like Candida are immunotoxic to macrophages.
It is interesting that you don’t see the same patterns of influenza incidence around the Equator and in so-called “Third World” countries where the diet is not so conducive to fungal overgrowth. Maybe it should be call "affluenza".
Recommendations for Preventing Flu
If you want to prevent the flu, you’ve got to reduce susceptibility to it. This means doing things that strengthen innate immunity, while eliminating things that are detrimental. Remember, you are only as strong as the weakest part of your immune complex. Here’s what I recommend:
- Follow a diet that discourages fungal overgrowth. That means lots of purple, blue, red and green produce, high quality protein, and as little sugar, dairy, carbohydrate and grain-based foods as possible. Add spices like turmeric and oregano that are rich in antifungal components, especially sesquiterpenes. White or green tea as a daily beverage is a good idea. Hot chili peppers (and sauces derived from them), curry, and horse radish are mucolytics and also antifungal/antiviral. I recommend the book, “Food: Your Miracle Medicine” by Jean Carper, to patients as a guide on the medicinal value of various foods.
- Evaluate steroid hormones and thyroid hormone status. Test hormones in all middle-aged patients. Hormones should be supplemented when indicated. Overall immune system function is intimately linked with endocrine function.
- Test TSH levels in all pregnant patients. Do this regardless of the season, as early in pregnancy as possible. Thyroid hormone should then be titrated to keep the TSH (assuming it was "normal") at initial levels.
- Supplement with “Vitamone” A. Vitamin A’s benefit probably has more to do with it’s effect on the structural integrity of lung epithelial cell membranes likely than it’s direct effect on immune function. A 1995 paper by Vanderbilt University researchers, published in the journal, Antimicrobial Agents & Chemotherapy, gives great guidelines for use of vitamin A, in doses as high as 25,000 IU per day, in the management of viral illnesses (http://aac.asm.org/cgi/reprint/39/5/1191.pdf).
- Increase “Vitamone” D. I've been taking and prescribing "high dose" vitamone D for more years than most. My clinical experience is in line with the majority of the research. As we enter peak flu season, its a good time to check your own levels and those of your patients. Several studies show that more than 50% of children and adults in the US are deficient. I have patients from all over the world: London, Mexico City, Sidney, Costa Rica, Florida, Vancouver, you name it. Everybody is low in vitamone D if they are not supplementing.
Oregon State University researchers recently published a study showing that vitamin D’s ability to regulate anti-bactericidal proteins is so essential to immune function that is has been conserved through almost 60 million years of evolution (Gombart AF, et al. BMC Genomics. 2009 Jul 16;10:321). This vitamin D activated “cathelicidin antimicrobial peptide” plays a major role in first-line defense against bacteria, viruses and other pathogens, enabling the body to recognize something that probably doesn't belong there (like H1N1), even though the specific pathogen may never have been encountered before.
- Increase Iodine intake. This is especially important with advancing age. Iodine is the human cell's chosen halogen for antimicrobial protection. Source can be dietary (sea vegetables, fish & shellfish) or via iodine/iodide supplement. I normally recommend Iodoral, which has a combination of iodine and iodide (Lugol's solution is the liquid equivalent). Cells incorporate iodine into their cell membranes to ride shotgun and defend against microbes. The site of docking is the double bond provided by the essential fat DHA, found in fish oil. Supplementing with fish oil also makes sense as part of an immune augmentation strategy. The website www.optimox.com has more information on the benefits of iodine/iodide than you can even imagine.
- Consider HCl and Probiotics: Stomach acid is a key first-line defense against infectious pathogens. Many people under-produce HCl, though they (and their doctors) attribute all gastric symptoms to acid over-production. If there is evidence of hypochlorhydria (GERD, slow digestion, gas), give an empiric trial of hydrochloric acid. (For a more in depth explanation on the use of HCL get, "Why Stomach Acid is Good for You" by Jonathan Wright, MD). Probiotics are a good idea for patients with histories of vaginal yeast, inflammatory bowel disease, or antibiotic use.
Maintaining the functional integrity of the innate immune complex obviates the need for annual fretting over which strain of flu virus will predominate. A competent immune system will defend against them all.