An Integrated Approach to Swine Flu and H1N1 Symptoms
A Health Writer Gets Ready for Swine Flu Season 
By Jonathan Galland               September 30, 2009

With the H1N1 pandemic already begun, every time you hear a sneeze or cough you wonder—is that an allergy, a cold, or symptoms of H1N1 influenza? 

The media focuses on predicting how bad the flu season—which has already begun—is going to be, and the level of concern the public should have about H1N1 symptoms. In an article on H1N1 influenza, Time magazine asks if we are overreacting or underreacting to the pandemic. 

But as a health writer I am more interested in finding out about both conventional and alternative approaches to H1N1 symptoms.  A pandemic has begun so I want to find out how to build up my immunity and stay healthy.  Here is what I have learned about H1N1 influenza and its symptoms, with resource links for more information below.

Emerging from Mexico and then spreading rapidly to countries around the world, the H1N1 influenza is a new strain of the influenza A virus.  In June, the World Health Organization (WHO) declared H1N1 to be a pandemic, due to its contagious nature, rapid spread within populations and ability to easily jump across borders.  By July, over 100 countries reported cases of H1N1 influenza, and further spread to other countries was deemed “unstoppable”.

Dr. Margaret Chan, Director-General of the WHO stated in July: “Influenza pandemics are remarkable events because they spread throughout a world population that is either largely or entirely susceptible to infection. They tend to hit a given area in the epidemiological equivalent of a tidal wave.”

Experts worry that the current H1N1influeza could repeat the infection pattern of the 1918 flu pandemic: mild in the spring, as this one was, but back with a vengeance in colder months.  

What are the symptoms of H1N1?

According to the U.S.  Centers for Disease Control and Prevention (CDC):

“The symptoms of 2009 H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting. Severe illnesses and death has occurred as a result of illness associated with this virus.”

As flu season starts, news articles remind us to wash our hands frequently, sneeze into our elbows, stay home when sick, etc. and just wait for the H1N1 influenza vaccine, which “might be ready” in early October. 

From the CDC here are some recommended steps for prevention of H1N1 symptoms:

    Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

    Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.

    Avoid touching your eyes, nose or mouth. Germs spread this way.

    Try to avoid close contact with sick people.

Reasonable enough advice, and if washing my hands all the time can help me avoid H1N1 symptoms, that’s great.

But there has been very little in the news about what to do to build the body’s resistance to swine flu.

There is research about building up immune system defenses that just isn’t on the mainstream medical radar and – as a health writer – I want to know more about the nutritional aspect of flu prevention and protection.

Below is published research on three supplements that might give me an edge in fighting the flu, or help in reducing symptoms of H1N1.  

American Ginseng

American ginseng (Panax cinquefolium) is an herb with immune stimulating effects. Research done at the Eastern Virginia Medical School found that taking an extract of American ginseng during the winter helped to reduce the incidence of acute respiratory illness (ARI).   Seniors participated in two randomized, placebo-controlled trials conducted during the influenza seasons. 90% of the participants had received influenza vaccine. They received 200 mg. of a proprietary ginseng extract twice a day or a placebo.  Of the 101 participants receiving the placebo, 7 developed influenza.  In contrast, of the 97 participants taking the ginseng extract, only one developed influenza.

Published in the Journal of the American Geriatric Society, the research notes that this represents “an overall 89% relative risk reduction of ARI in the CVT-E002 (American Ginseng) group. The paper concludes by saying that ginseng extract “was shown to be safe, well tolerated, and potentially effective for preventing ARI due to influenza.”

NAC

An amino acid called NAC (N-acetlycysteine) was examined in an Italian study for its ability to help to prevent symptoms of H1N1 flu.  The study was published in the European Respiratory Journal in 1997, and therefore had an earlier strain of the H1N1 influenza, and not the current version. NAC is presently sold as a nutritional supplement, but has been used for over 40 years to loosen mucus in patients with chronic bronchitis.

Researchers from the University of Genoa and the University of Pavia conducted a randomized, double blind trial in 20 Health Centers across Italy during flu season.  262 subjects of both sexes received either placebo or NAC tablets (600 mg) twice daily for 6 months.  The study reported: “NAC treatment was well tolerated and resulted in a significant decrease in the frequency of influenza-like episodes, severity, and length of time confined to bed.”

While both the placebo and NAC groups got the flu at similar rates of infection, “only 25% of virus-infected subjects under NAC treatment developed a symptomatic form, versus 79% in the placebo group.”

The study adds that “Prevention by NAC of influenza-like symptomatic episodes was particularly evident during the winter season.” 

Elderberry Fruit Extract

Elderberry fruit is high in antioxidants and has been used in traditional European healing practices.  In research published in the journal Phytochemistry in July 2009, extracts of the elderberry fruit were found to help prevent H1N1 infection. Tests done in vitro found that flavonoids from the elderberry extract blocked the ability of H1N1 to infect host cells. The study concluded that “The H1N1 inhibition activities of the elderberry flavonoids compare favorably to the known anti-influenza activities of Oseltamivir and Amantadine,” (two drugs used to treat flu).

In another study, conducted during flu season in Norway, researchers gave 15ml. of elderberry syrup four times a day to people suffering from influenza-like symptoms. The results were published in The Journal of International Medical Research, finding that “Symptoms were relieved on average 4 days earlier and use of rescue medication was significantly less in those receiving elderberry extract compared with placebo. Elderberry extract seems to offer an efficient, safe and cost-effective treatment for influenza. These findings need to be confirmed in a larger study.”

Of course none of these supplements are guaranteed to prevent swine flu or any other illness. They are not drugs or vaccines for H1N1 influenza or its symptoms.

In terms of conventional treatment for H1N1, the CDC says:

    CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with 2009 H1N1 flu virus. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications.

Please see the CDC website link below for more information.

I am not a doctor, but as someone very interested in health, I feel better taking a proactive approach toward preventing H1N1 symptoms.  I began taking NAC a few weeks ago, and have started taking elderberry extract and American ginseng.  For me, that beats waiting and worrying any day.

Resources:

WHO Pandemic (H1N1) 2009 Webpage:

http://www.who.int/csr/disease/swineflu/en/

CDC 2009 H1N1Flu (Swine Flu) Webpage:

http://www.cdc.gov/H1N1FLU/

References

The following are abstracts, or summaries, of the research articles.

American Ginseng

Journal of the American Geriatric Society 2004 Jan; 52(1):13-9.

    A placebo-controlled trial of a proprietary extract of North American ginseng (CVT-E002) to prevent acute respiratory illness in institutionalized older adults.

    McElhaney JE, Gravenstein S, Cole SK, Davidson E, O’Neill D, Petitjean S, Rumble B, Shan JJ.

    Eastern Virginia Medical School, Norfolk, Virginia, USA.

    OBJECTIVES: To compare a proprietary extract of American ginseng, CVT-E002, with placebo in preventing acute respiratory illness (ARI) in an institutional setting during the influenza season. DESIGN: Two randomized, double-blind, placebo-controlled trials conducted late in the 2000 (8 week) and 2000-2001 (12 week) influenza seasons. SETTING: Long-term care setting that included nursing home and assisted living at three sites. PARTICIPANTS: Eighty-nine (2000) and 109 (2000-2001) enrolled subjects, average age 81 and 83.5, respectively; 74% women. Approximately 90% had received influenza vaccine in each of the 2 years. INTERVENTION: Oral twice-daily administration of a proprietary ginseng extract, CVT-E002, 200 mg or placebo. MEASUREMENTS: ARI was defined as two new respiratory symptoms or one with a constitutional symptom. Confirmation of viral ARI was by culture (influenza or respiratory syncytial virus (RSV)) or serology for influenza. Laboratory safety monitoring was done at 0, 4, and 8 or 12 weeks. RESULTS: An intent-to-treat analysis of pooled data corrected for drug exposure time showed that the incidence of laboratory-confirmed influenza illness (LCII) was greater in placebo- (7 cases/101 subjects) than CVT-E002-treated (1/97) groups (odds ratio (OR)=7.73, P=.033). Combined data for LCII and RSV illness were also greater in placebo- (9/101) than CVT-E002-treated (1/97) groups (OR=10.50, P=.009), for an overall 89% relative risk reduction of ARI in the CVT-E002 group. CONCLUSION: CVT-E002 was shown to be safe, well tolerated, and potentially effective for preventing ARI due to influenza and RSV.

NAC

European Respiratory Journal 1997 Jul;10(7):1535-41

    Attenuation of influenza-like symptomatology and improvement of cell-mediated immunity with long-term N-acetylcysteine treatment.

    De Flora S, Grassi C, Carati L.

    Institute of Hygiene and Preventive Medicine, University of Genoa, Italy.

    N-acetylcysteine (NAC), an analogue and precursor of reduced glutathione, has been in clinical use for more than 30 yrs as a mucolytic drug. It has also been proposed for and/or used in the therapy and/or prevention of several respiratory diseases and of diseases involving an oxidative stress, in general. The objective of the present study was to evaluate the effect of long-term treatment with NAC on influenza and influenza-like episodes. A total of 262 subjects of both sexes (78% > or = 65 yrs, and 62% suffering from nonrespiratory chronic degenerative diseases) were enrolled in a randomized, double-blind trial involving 20 Italian Centres. They were randomized to receive either placebo or NAC tablets (600 mg) twice daily for 6 months. Patients suffering from chronic respiratory diseases were not eligible, to avoid possible confounding by an effect of NAC on respiratory symptoms. NAC treatment was well tolerated and resulted in a significant decrease in the frequency of influenza-like episodes, severity, and length of time confined to bed. Both local and systemic symptoms were sharply and significantly reduced in the NAC group. Frequency of seroconversion towards A/H1N1 Singapore 6/86 influenza virus was similar in the two groups, but only 25% of virus-infected subjects under NAC treatment developed a symptomatic form, versus 79% in the placebo group. Evaluation of cell-mediated immunity showed a progressive, significant shift from anergy to normoergy following NAC treatment. Administration of N-acetylcysteine during the winter, thus, appears to provide a significant attenuation of influenza and influenza-like episodes, especially in elderly high-risk individuals. N-acetylcysteine did not prevent A/H1N1 virus influenza infection but significantly reduced the incidence of clinically apparent disease.

Elderberry

Phytochemistry. 2009 Jul;70(10):1255-61.

    Elderberry flavonoids bind to and prevent H1N1 infection in vitro.

    Roschek B Jr., Fink RC, McMicheal MD, Li D, Alberte RS

    A ionization technique in mass spectrometry called Direct Analysis in Real Time Mass Spectrometry (DART TOF-MS) coupled with a Direct Binding Assay was used to identify and characterize anti-viral components of an elderberry fruit (Sambucus nigra L.) extract without either derivatization or separation by standard chromatographic techniques. The elderberry extract inhibited Human Influenza A (H1N1) infection in vitro with an IC(50) value of 252+/-34 microg/mL. The Direct Binding Assay established that flavonoids from the elderberry extract bind to H1N1 virions and, when bound, block the ability of the viruses to infect host cells. Two compounds were identified, 5,7,3',4'-tetra-O-methylquercetin (1) and 5,7-dihydroxy-4-oxo-2-(3,4,5-trihydroxyphenyl)chroman-3-yl-3,4,5-trihydroxycyclohexanecarboxylate (2), as H1N1-bound chemical species. Compound 1 and dihydromyricetin (3), the corresponding 3-hydroxyflavonone of 2, were synthesized and shown to inhibit H1N1 infection in vitro by binding to H1N1 virions, blocking host cell entry and/or recognition. Compound 1 gave an IC(50) of 0.13 microg/mL (0.36 microM) for H1N1 infection inhibition, while dihydromyricetin (3) achieved an IC(50) of 2.8 microg/mL (8.7 microM). The H1N1 inhibition activities of the elderberry flavonoids compare favorably to the known anti-influenza activities of Oseltamivir (Tamiflu; 0.32 microM) and Amantadine (27 microM).

The Journal of International Medical Research, 2004 Mar-Apr;32(2):132-40.

    Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections.

    Zakay-Rones Z, Thom E, Wollan T, Wadstein J.

    Department of Virology, Hebrew University-Hadassah Medical School, Jerusalem, Israel.

    Elderberry has been used in folk medicine for centuries to treat influenza, colds and sinusitis, and has been reported to have antiviral activity against influenza and herpes simplex. We investigated the efficacy and safety of oral elderberry syrup for treating influenza A and B infections. Sixty patients (aged 18-54 years) suffering from influenza-like symptoms for 48 h or less were enrolled in this randomized, double-blind, placebo-controlled study during the influenza season of 1999-2000 in Norway. Patients received 15 ml of elderberry or placebo syrup four times a day for 5 days, and recorded their symptoms using a visual analogue scale. Symptoms were relieved on average 4 days earlier and use of rescue medication was significantly less in those receiving elderberry extract compared with placebo. Elderberry extract seems to offer an efficient, safe and cost-effective treatment for influenza. These findings need to be confirmed in a larger study. 

These statements have not been evaluated by the U.S. Food and Drug administration. The product is not intended to diagnose, treat, cure, or prevent any disease. It should not be substituted for conventional therapy. 
 
This article is provided for general educational purposes only and is not intended to constitute (i) medical advice or counseling, (ii) the practice of medicine or the provision of health care diagnosis or treatment, (iii) the creation of a physician--patient relationship, or (iv) an endorsement, recommendation or sponsorship of any third party product or service by the sender or the sender's affiliates, agents, employees, or service providers. If you have or suspect that you have a medical problem, contact your doctor promptly.  


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