0020 - What to do when you have the flu?

In the US and in Europe, the flu season typically starts in October, peaks in February and finishes in May. For us, in Australia, this is when it starts, to finish in October, with a peak in August. So, whilst we are enjoying summer here, the topic is very timely in the Northern hemisphere.

The influenza A and B viruses cause seasonal epidemics and can affect up to 10% of adults and 30% of children every year. That's 1 billion people! 4 pandemics (an epidemic of worldwide proportion) also occurred in the past century, the last one in 2009.

This article is for educational purposes only. It is not a substitute for professional medical advice and is not intended to diagnose, treat, cure, heal or prevent any disease or medical condition. See full Disclaimer here. I encourage you to do your own research and to discuss with a qualified healthcare practitioner the options that could work the best for your specific circumstances.

What is the difference between the flu and a cold?

Colds are much more common than the flu. They start gradually and usually don't cause any serious harm. The flu, on the other hand, strikes quickly and causes more severe symptoms. Colds affect primarily the airways (runny nose, sore throat, cough) whereas the flu affects the entire body, with also muscle and joint pain, severe fatigue, stronger headaches, fever between 38°C and 40°C (about 100-104°F) or higher, and sometimes gastrointestinal symptoms. The cold and the flu both last for about 7 to 10 days, although the cough can linger longer.

In theory, when we are infected with a virus, we are then immune to that virus once we have recovered. Unfortunately, there are more than 200 viruses responsible for the cold, and different strains of flu that are always mutating. This is why we can still catch colds or the flu every year. The most effective ways to prevent these viruses from spreading are to wash our hands frequently, to stay away from people coughing or sneezing (viruses can travel up to 2m / 6ft and survive for 48 hours) and to stay at home when we are sick. We can still be contagious for up to a week after the symptoms have disappeared, which is a reasonable excuse to work from home when possible.

In people with a weakened immune system, the flu can lead to complications like pneumonia and can become life-threatening. Up to 650,000 people die of respiratory diseases linked to the flu each year.

Should you get the flu shot?

A flu vaccination can offer some protection from flu viruses. The WHO recommends an annual vaccination for the people at risk of developing sever complications: the elderly, kids under 5 years of age (but not infant under 6 months), pregnant women and people with chronic medical conditions. Unfortunately, this is also the group for which the vaccines are the least effective.

Whether or not you want to get a flu shot is a personal choice. The efficacy ranges from 10 to 60% depending on the year, as it is difficult to predict which strain variation will circulate during the following season. Also, the flu vaccine can have side effects, such as fever, headache and respiratory symptoms. Last, there is some controversy about the potential toxicity of certain ingredients contained in vaccines (formaldehyde, aluminium salts, mercury), although the US CDC declared them safe, apart from a few contraindications (allergies or severe immunodeficiency).

What about antiviral medication?

Antiviral medication is available with a prescription, but it has to be taken within 48 hours of the first symptoms. Studies have shown that it only reduces the duration of the flu by 0.7 day on average in healthy adults and that it can cause nausea and vomiting. Only one trial observed better results for young kids, with a reduction of 3.5 days when the drug was administered within 24h of the first symptoms. It is also unclear whether antiviral medication helps prevent complications.

Some people think that antibiotics can treat the flu, but they are only effective against bacteria, not viruses. Unless there are signs of bacterial infection, taking antibiotics is useless and it can also be bad for the gut flora and increase germs resistance: not a good idea!

The cool benefit of fever

Before reviewing the other treatment options, let's talk about fever. It is normal to get a fever of 38 to 40°C (100.4 to 104°F) or even a bit higher during the flu. Whilst this is not enjoyable, it is not dangerous either for otherwise healthy adults. Medical articles indicate that a fever becomes a medical emergency when it exceeds 40 to 41°C (104 to 105.8°F) in adults, less for children.

Research shows that letting a fever run its course may reduce the length and severity of the flu and colds. The fever is a natural response from our immune system to fight the virus (it is harder for the virus to survive at a higher temperature) and also to help more T lymphocytes (a type of white blood cells) move to the infected area to destroy virus-infected cells. In other words, fever helps you heal.

So, talk to your medical practitioner to see whether addressing the other symptoms of the flu without stopping the fever can be a good option.

Strengthen your immune system

The best treatment against the flu and the colds is not to catch them in the first place! There is a lot you can do to boost your immune system: a healthy nutrition, good sleeping habits and stress management skills will go a long way to help you avoid seasonal viruses.

Lack of sleep causes all sorts of issues, including stress, fatigue and lowered immune function. A study showed that those who sleep less than 7 hours a night are 3 times more likely to develop a cold than those who get more than 8 hours. Similar results were observed for those who have interrupted sleep. You may have noticed that you get sick more often when you are tired. People who are sleep deprived are also much more likely to develop the flu. Also, do not schedule a flu shot when you are tired, as you will produce a lot less antibodies. See my 10 tips to improve your sleep.

The same goes with chronic stress that suppresses the immune system by inhibiting the inflammation and the production of killer cells and antibodies. More stress means more chances of getting the flu or a cold (from 27% to 47% according to a study) after being exposed to the virus, as well as more time needed to recover.

And nutrition - of course - has a very significant impact on our immune system. Nutrient-rich foods will strengthen your immune response, whereas sugary and processed foods will compromise it.

Other treatments for the flu and the colds

Research has shown that Non-Steroidal Anti-Inflammatory Drugs (such as aspirin and ibuprofen) and paracetamol can relieve pain and fever in people with colds or upper respiratory tract infection but not other symptoms (sore throat, cough, nasal congestion...). On the other hand, many natural treatments have be found effective to help prevent or relieve these symptoms and might be worth considering, either stand-alone or in addition to standard medication.

• Zinc - Many studies have observed the efficacy of zinc supplementation to reduce the duration (-33% on average) and the severity of colds, although the results vary significantly depending on the study and the individuals. Taken preventively, zinc can also reduce the number of colds per year in children (-43% on average). The most common treatments studied were 80 to 207mg/day of zinc gluconate or acetate lozenges, taken within 24 hours of the onset of a cold. Zinc works by stimulating the generation of natural killer and cytolytic T cells that kill viruses. It is also a powerful anti-inflammatory that helps relieve the pain of sore ears and throat and nasal congestion. Many people are deficient in zinc and could benefit from supplementation to strengthen their immune system.

• Vitamin C - the research recommends regular supplementation of 1 to 2 g/day to slightly reduce the duration (-8% in adults, -14% in children) and the severity of the colds. Some studies (but not all) also showed that vitamin C could work as prevention. Other studies and medical experts recommend a much higher dosage (up to bowel tolerance) to reduce the length and severity of the colds and flu: 1g, 4 times a day resulted in a 85% reduction of symptoms in one study. Overall, the benefits vary quite a bit depending on the trial. Nevertheless, considering the low cost, safety and additional benefits from vitamin C supplementation, it might be a good option for those who feel tired, stressed or who catch more than their share of viruses. Alternatively, eat plenty of vitamin C-rich foods such as citrus fruits (the whole fruit rather than sugary juices!), capsicums, kiwis, berries and green leafy vegetables.

• Echinacea extracts have been used traditionally in North America to control the symptoms of the flu, colds and other infections. Many studies have evaluated the efficacy of these extracts with different results, probably due to the differences in the species and parts of plant that were used. Whilst some studies found no benefits, others did observed a significant reduction of the flu or cold symptoms. A few studies even found that echinacea extracts were as efficient as standard flu or antiviral medication to prevent and treat the flu and without the side effects (nausea and vomiting). Certain species of echinacea (not all of them) contain antimicrobial, antiviral and anti-inflammatory compounds that support our immune system and can even increase the efficacy of the flu vaccine. These compounds interfere with the entry of the virus into the cells, which can stop its replication and dissemination and they can also reduce the incidence of secondary infections by preventing virus-induced bacterial adhesion.

• Probiotics are another good option to help fight the flu and colds and recover faster. Many studies observed a significant reduction of their incidence (up to 73%), duration (up to 48%) and/or symptoms (fever, cough, nasal congestion). Probiotics enhance the immune system (by increasing natural killer cell activity), reduce inflammation in the respiratory tract, decrease the volume of viral particles and down-regulate the viral replication. The strains studies were Bifidobacterium, and various Lactobacilli. As echinacea, probiotics improve the immunologic response and protection obtained after getting the flu vaccine. So, start taking a daily probiotic drink (such as plain full-fat unsweetened fermented yogurt) or supplementation before the flu season starts and until the end of winter to boost your antibody levels. And if you prefer getting your probiotics from foods, the best sources include kefir, sauerkraut, tempeh, kimchi, miso, kombucha, pickles, traditional buttermilk, nato and some cheeses with active cultures.

• American ginseng has been observed to prevent the flu, colds and upper respiratory tract infections. Although not all studies found significant benefits, several studies showed that ginseng extracts (400mg per day for 8 to 16 weeks) decreased the incidence (-26 to -56%) or duration (-35 to -55%) and severity (-31% for sore throat, nasal congestion, fever, headache, earaches and cough) of the flu or colds.

• Elderberry extracts taken at the onset of a cold or flu can stop the replication of the virus and reduce the symptoms (duration -51% and severity -58%). In several studies, the flu symptoms were relieved 4 days earlier than average. A complete cure was achieved within 2 to 3 days in nearly 90% of the patients taking elderberry extracts (versus at least 6 days in the placebo group). Impressive! Extracts are available in tablet or syrup form. They contain compounds that inhibit the entry of the virus in the cells and its propagation once the cells have been infected. In addition to their antiviral properties, elderberry extracts enhance our immune system by increasing cytokine production.

• Liquorice root - Thanks to their antiviral, antibacterial and anti-inflammatory properties, the liquorice roots can prevent the flu or colds and soothe a sore throat. Glycyrrhizin (try to spell that one correctly!), the main active component of the roots, protects the cells from the flu virus in the early steps of the virus replication cycle. Treatments with glycyrrhizin led to a clear reduction in the number of the flu virus-infected cells and a reduction of the number of certain viral particles by 90%.

• Garlic is one of the best foods to prevent or fight the symptoms of the flu and colds, thanks to its tremendous antimicrobial (especially antiviral) and anti-inflammatory activity. Add garlic to your meals in winter or at the onset of any infection. Use fresh raw garlic (not garlic powder) to preserve all the active compounds. Mince it and leave it to rest for a few minutes if you find the smell or the taste too strong. Otherwise, supplementation with encapsulated aged garlic extract for 90 days has been shown to reduce the incidence of the colds (-63%) and the flu as well as their severity and duration (-70%).

• Many essential oils have antiviral, antibacterial or anti-inflammatory properties that can help prevent the spread of pathogens. The most efficient oils to fight the flu and colds and alleviate the symptoms of sore throat, headache and nasal congestion include: bergamot, cinnamon, cumin, eucalyptus, grapefruit, lime, nutmeg, peppermint, oregano, rosemary, sage, sandalwood, tea tree, thyme and wintergreen (gaultheria). Choose a few oils that you like, dilute them (at 2 to 3%) in a carrier oil such as almond or coconut oil and use the blend in a diffuser for 30 minutes, several times a day. For a more powerful effect, use 10 drops of essential oil (eucalyptus, peppermint or tea tree are great options) in hot water, lean over the bowl with a towel on your head and breathe deeply for 5 to 10 minutes, several times a day. You can also rub a little bit of the blend into your chest like you would do with a vapour rub (do not apply undiluted oils directly on your skin).

• Many others plant extracts or supplements have also be shown to help fight the flu or colds by strengthening the immune system or thanks to their antiviral or anti-inflammatory properties: maoto, antiwei, pomegranate, guava tea, Bai Shao, selenium, seaweed extract, yeast-based products, vitamin A and D (or sun exposure), ginger, EPA and DHA, curcumin, astragalus, green tea, L-thiamine, colloidal silver, blackcurrant, raspberry, oregano, yarrow, chamomile, thyme, willow bark, goldenseal, beta glucan... the list is long. Even earthing or grounding has been observed to help.

Try different options to maximise their synergistic effects. Diffuse essential oils at home, enjoy wholesome foods that are rich in vitamin C and probiotics, season your meals with garlic, herbs and spices and sip on herbal teas that contain echinacea, ginseng and elderberry.

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