ALTERNATIVE STRATEGY FOR THE FLU PANDEMIC

Stephen Holt, MD, PhD, DSc, LLD DNM, ChB, FRCP (C), MRCP (UK), FACP, FACG, FACN, FACAM, KSJ, Distinguished Professor of Medicine (Emerite), Scientific Advisor to www.naturalclinician.com.

Introduction

Amid mounting public anxiety, several nations are bracing for the further spread of “swine flu” (type A H1N1 virus).¹ On Monday, August 24, 2009, the US President’s Council of Advisors on Science and Technology opined on the consequences of widespread infection with H1N1 virus in the US. Predictable recommendations of this working group include intensive case monitoring, flu prevention with vaccination programs or treatment with anti-viral medications (Tamiflu®, oseltamivir, etc.). “Common-sense” preventive techniques have been advocated with hand sanitization, quarantine, mask-wearing, diversionary – coughing etc, but the efficacy of these efforts is debatable.^2,3 Noticeably absent from many proposed preventive tactics is the idea of enhancing the body’s defense system against flu, by promoting nutritional and lifestyle supports for immune function.

The notion of “seed and soil” as regulators of growth is a fundamental tenet in the practice of infectious disease. Plant a vital seed (H1N1 virus) in good soil (a debilitated or vulnerable individual) and growth is inevitable. Alter the soil in a manner that does not accommodate the seed (improve immune function) and growth or spread (of the virus) is attenuated or absent. All microbiologists subscribe to these notions.

It is clear that individuals with a compromised immunity (infants, children, the elderly or those with chronic disease) are at special risk of death or serious clinical complications from acute viral infections.³

Observations on the Prevalence and Consequence of H1N1

At the time of writing, the prevalence of H1N1 infections is changing rapidly. On August 28, 2009, the WHO announced that H1N1 virus had established itself on a global basis as the most common flu strain. The first case of swine flu was detected in Mexico in March 2008 and it has spread to almost every country worldwide. Current estimates by the World Health Organization and others imply that between 15 and 45% of the world’s population may become infected, amounting to between one and three billion people^{. 2,3}

Different types (strains) of flu virus may target different age groups. Unlike seasonal flu, swine flu (H1N1) appears to show a predilection for children and young adults. Countries that have already experienced hundreds of deaths from H1N1include Mexico, USA, UK, Argentina and Thailand, but these circumstances are dynamic, on a global basis.

Flu outbreaks tend to emerge in winter and they appear coincidental with children or teenagers going back to school.^2,3 In locations in the southern hemisphere, between April and August (winter), more than a doubling of deaths from H1N1 infection occurred (337 versus 165 deaths) in a two week period, prior to August 5, 2009. On Friday, august 28, 2009, the Public Health Ministry of Thailand reported that one million Thai residents had been infected by H1N1 virus in the preceding four months. In England over the summer months (2009), there were several outbreaks of H1N1 with few fatalities, but treatment resources in the British National Health Service were swamped for several weeks with patients in states of panic. Similar episodes of public panic have been documented in India, when initial fatalities from H1N1 were reported. Under these circumstances, many patients request “testing” for the viral disease of H1N1in a manner that may serve little practical purpose.

Vaccine Promises

Many epidemiologists and physicians are relying on the efficacy of vaccination programs for H1N1, in the absence of the availability of such vaccines, at the time of writing (August 31, 2009). However, at the time of submission of the article (October 6, 2009) some states had received initial shipments of nasal vaccine sprays for H1N1. While the US government is attempting to procure a couple of hundred million dosages of H1N1, it is estimated that only 50 million dosages will be available in the middle of October, 2009, or thereabouts. These matters are evolving.

In Thailand, one of the hardest hit countries with swine flu, it has been reported (27^th August, 2009) that the first 1270 doses of a clinical nasal spray vaccine against the type A (H1N1) flu virus are being tested in animals, but production problems and other issues are delaying vaccine research and development. Similar problems are being encountered by the US vaccine makers with a possibility of significant delays in vaccine availability.

In Thailand, clinical studies of H1N1 vaccine in human volunteers have been compromised because specific pathogen free eggs have produced a low yield of the new flu vaccine. Furthermore, vaccine production facilities in Thailand require urgent expansion, if the government can obtain the 20 million dosages of vaccine that it has requested.

Several countries may be engaged in “wishful thinking” as they plan widespread vaccination programs for H1N1. Dr. Margaret Chan (Head of the World Health Organization) has commented that only 900 million unit dosages of vaccine can be made against H1N1. Dr. Chan and others indicate that this volume of vaccines will not meet the needs of the world population (about 6.8 billion people) or even come close to dealing with the up to “3 billion individuals” who may become infected.^2,3

Even in cases of plentiful supply of flu vaccine, less than one half of the population may go for a flu shot. Perhaps, the imminent panic of the flu pandemic may change this circumstance in several countries. If vaccines against H1N1 are made available by the target date of mid-October 2009, most vaccinations would involve the giving of two flu shots, separated by a period of one month. However, some experts predict the efficacy of “one flu shot” of certain vaccines (wishful thinking?). Following the second shot of most H1N1 vaccines adequate immunity may not be conferred for a further couple of weeks. This means that immunity may not be present in many people who received a timely vaccine until December, 2009 or later. If an early spike occurs in the prevalence of H1N1, as anticipated in children returning to school, the vaccine program could be “too little, too late.”

A residual, deep-seated concern is the mutation of the H1N1 virus into a more virulent pathogenic or “antigenic strain” that is not countered by the immunity induced by H1N1 vaccination. Vaccine producers are basing their products on the virus responsible for the original Mexican outbreak and human clinical vaccination trials have been underway for a couple of months (at the time of writing). One hopes that the virulence of H1N1 undergoes down regulation (an unlikely event) or the virus, at least, stays the same. It is not long ago that the threat of H5N1 (bird flu) was in the media. If H1N1 and H5N1 “kiss and comingle,” a more lethal circumstance could emerge?

At the time of writing, there were hints in the lay-press that there was an increase in the reporting of “more severe” forms of H1N1. These forms appear to cause a direct pneumonitis, respiratory failure, and severe systemic symptoms. Severe attacks of H1N1 require hospital admission and 15% or more of those who are hospitalized often require acute intensive medical care. While poor standards of living and chronic disease (e.g. diabetes and asthma) may increase the severity and adverse consequences of H1N1 by factors up to several-fold, the WHO has made a puzzling conclusion that established AIDS does not appears to increase risks.

Opinions about ideal vaccine components for the H1N1 pandemic may change following the reports of the dominance of this strain among flu viruses. Old vaccines may become obsolete in this circumstance and a greater range of viral antigenic components may be required for adequate prevention of flu.

Anti Viral Drugs

The old adage that there is “no cure for the common cold” applies generally to swine flu. Antiviral drugs, such as Tamiflu® (oseltamivir), do not result in consistent treatment benefits and they are not a specific flu preventives. For example, by August 2009, the Thai Ministry of Health had distributed about 6.7 million dosages of oseltamivir, but the benefits of this intervention are not clear, as spread of swine flu occurs among farmers and members of the work force. Tamiflu® inhibits the neuraminidase enzyme that assists in cellular reproduction and breakout of the virus. The major effects of Tamiflu are to lessen the severity and length of influenza symptoms,² if this drug is given early in the course of the disease.

Tamiflu® cannot be administered for long periods of time or used in children under 14 years of age. And about 20% of all flu viruses are resistant to this drug.² Substantially similar drugs such as Relenza ® are not to be used in babies (<1 yr.) or the elderly (>65 yrs.) Many deaths occurring with the flu are caused by secondary bacterial infections (e.g. bacterial pneumonia) and routine antibiotic administration is advisable in moderate or severe flu symptomatology.

General Precautions

The effectiveness of general precautionary measures for the spread of the flu virus remains in question. Such measures possess disadvantages or limitations. Institutions or aggregates of people in specific locations are “breeding grounds” for the flu. Schools pose special problems where outbreaks are inevitable. Spikes in the occurrence of H1N1 have been associated with school attendance, despite widespread recommendations for sanitization programs, limited quarantine, “defensive” coughing or sneezing and prompt release of students to the confines of their homes.

In mid 2009, the US Center for Disease Control (CDC) issued some confusing revised guidelines on school or institutional closures that discourage this practice, except in the presence of large members of high risk individuals (a circumstance that defies accurate definition). Detecting rises in body temperature is a crude screening technique which has been abused in some “detection” programs. One may travel to China and receive a thermographic image that results in a high false positive detection rate for H1N1 infection. To add to the diagnostic inefficiency of “temperature screening” is the knowledge that the problem, H1N1 infection does not always cause a fever.

The Virulence of H1N1

According to the CDC, swine flu in the US has resulted in 522 deaths and approximately eight thousand hospital admissions (August 2009).² The H1N1 virus has shown clinical and laboratory evidence of greater virulence than seasonal flu. That said, swine flu does not inevitably cause severe disease in otherwise healthy people.

It has been proposed, arguably, that H1N1 infection may not be worse than seasonal flu except in vulnerable (at risk) groups such as pregnant women, infants and individuals with chronic diseases (e.g. diabetes mellitus and respiratory disease).^2,3

The possibility that H1N1 virus may evolve into a more virulent organism has resulted in a “stepping-up” of surveillance programs. Surveillance programs are perceived to be of importance in managing the H1N1 pandemic.^4,5 While these programs (when implemented effectively) may detect changes in patterns of spread and severity of disease, the changing management policies is unlikely to keep pace with putative onerous disease evolution.

The World Health Organization proposes that H1N1 infection is more contagious than seasonal flu; and it occurs often in healthy young individuals.³ There is a tendency for the clinical outcome of H1N1 infection to be more severe in urban minority-group children (African American and Hispanic), compared with Caucasian children. The reasons for this circumstance are not clear, but they may involve a higher prevalence of co-existing disease, poor nutrition and lack of social support at home, especially among these minority groups. Per capita death rates from H1N1 infection are likely to be higher in third world countries than industrialized communities.^2,3

It appears that obesity may be a risk factor for poor outcome of H1N1 infection. Obesity is often associated with Metabolic Syndrome X, which, in turn, is associated with impairments of immune function. Several nutritional deficiencies (e.g. vitamin A, B series, C and E or zinc, iron and selenium) are associated with disorders of immune function and the nutritional problems are more common in the under privilege sectors of society. We have learned that economic underprivileged is a strong predictor of obesity. Eulerian logic applies to these circumstances.

Boosting Biodefenses: Nutrition

Malnutrition or several isolated deficiencies of vital nutrients are associated with impairments of immune function (Table 1)

• Atrophy or impairment of the thymus gland

• Decreased cell mediated immunity

• Impaired antibody production, including decreased antibody responses to vaccination

• Reductions in lymphocyte proliferation

• Poor phagocyte function

• Altered cytokine patterns, e.g. IL-1

• Decreased T helper and increase in T suppressor cells

Table 1. Disordered immune function associated with protein, calorie or nutrient deficiencies. An incomplete list of nutrient-related immune deficiencies.

Many studies have linked specific vitamin or mineral deficiencies to the abnormalities listed in Table 1. Examples of the consequences of nutrient deficiencies and the benefits of nutrient administration on immune function are provided in Table 2.

Table 2 Nutrients and immune function>

The wide ranging benefits of nutritional status on immune function make it prudent to provide basic nutritional insurance to individuals who wish to optimize immune function. This “nutritional boost” is best applied by giving full RDI of vitamins with minerals and phytonutrient co-factors that are found in powders berries, fruit, vegetables and greens (www.naturalclinician.com). The use of adjunctive omega 3 fatty acids, delivered in enteric coated format for better compliance and absorption, is a valuable versatile nutritional intervention.

Boosting Biodefenses: Lifestyle Factors

Many studies link healthy immune function with positive lifestyle. The maintenance of psychological well-being, interventions to reduce stress (e.g. meditation, yoga, guided imagery, relaxation responses) and restful sleep have a positive impact on immune functions. Measurable reductions in several immune functions are noted in circumstances of sleep deprivation that may affect up to 100 million Americans. Moderate physical activity can boost immunity, especially in the elderly, where documented improvements in lymphocyte function may occur.

The reduction of dietary intake of calories from simple sugar and fat can decrease oxidative stress. These dietary adjustments benefit the individual with insulin resistance, a disorder that is associated with disordered immune function (Metabolic Syndrome X). A nutrient dense, low calorie diet has been associated with enhanced immune function and the promotion of longevity.⁶

Boosting Biodefenses: Nutraceuticals

Many herbals, botanicals and non-nutritive dietary supplements may enhance or modulate immune function (Table 3)⁷. Single dietary supplements used to “boost” immunity are limited in their effects (e.g., Moducare or MGN3 or BRM4 or AHCC alone etc). “Boosting” certain aspects of the complex series of events in some immune-related diseases may sometimes do more harm than good. The additive benefits and versatile nature of many different natural agents in a dietary supplement that can work on different aspects of immune events may help modulate or balance many different immune functions. (Table 3)

• Andrographis paniculata ● Oregon grape

• Acanthopanax senticosa ● Shitake mushroom

• Green Tea ● Echinacea purpurea

• Turmeric ● Coriolus versicolor

• Grape seed extract ● Beta glucan

• Zinc ● Aloe Vera

• Vitamin C ● Garlic

• Ashwagandha ● Astragalus

• Echinacea purpurea ● Korean ginseng

• Goldenseal ● Active Hexose Correlate

• Golden thread Compound (AHCC)

Table 1.

Nutrients, herbs and botanicals with good scientific agreement of nutritional benefits for immune function. The basis of a patent-pending formula (Holt MD Labs).

Single-agent approaches with one herb or limited nutrient contents possess disadvantages and limitations. For example, sterolins (Moducare^®) or mushroom extracts (MGN3^®,BRM4^® ) or active hexose correlated compounds (AHCC or ImmPower®), or Maitake Products^®, are immune stimulators, but they have relatively focused and limited effects on only certain aspects of immune function, eg stimulation of killer cell function. I have proposed that there is a way of producing an improved, synergistic, dietary supplement that can be used in combination to stimulate immune function, in a more global manner.^1,3

Any natural agent that exerts an antioxidant function can be potentially valuable in promoting healthy immune function. Oxidative stress (free-radical damage) to components of the immune system is a common reason for disordered immunity. In particular, the following antioxidants are of value for immune well-being: Vitamin C, zinc, green tea, turmeric, grape seed extract and other antioxidants that are found in a variety of herbs and botanicals (Table 1).¹

Botanical agents with specific immune-enhancing power include: several species of mushrooms; Coriolus versicolor, Shitake mushroom, natural components such as AHCC, plant or yeast sources of beta glucan, Echinacea, and the potent and versatile herb Andrographis paniculata (AP).¹ Recent research implies that AP may be a very powerful stimulator of immune function by its specific actions on chemical signals in certain cells; and AP has reported antiviral properties, A synergistic formula (tablet) of natural substance that in scientific studies promote immune function was found to outperform agents such as MGN3 (BRM4 and by inference AHCC alone). AHCC is merely the forerunner to BRM4 with less therapeutic value. Not only was the synergistic formula more potent in stimulating NK cell function than MGN 3 (BRM4), it induced cytokine changes that were not observed with MGN3 (BRM4).

Silver colloid preparations are antimicrobial in their actions.⁷ These preparations are listed among other substances that are known to kill influenza virus, according to the Center for Disease Control in the US. Other such agents kill influenza virus including: bleach or strong oxidizing agents, certain aldehydes, high concentrations of alcohol (70% and greater), quaternary ammonium compounds, extreme degrees of acidity (pH less than 2) and heat (133 degrees Centigrade or greater for 60 minutes). Claims that the FDA have approved silver preparations for flu prevention or treatment are materially misleading statements. Silver colloid preparations is best used in augmented forms (addition of tween and certain essential oils) this augmentation assists in microbial kill. While silver colloids may have synergistic benefits with antibiotics, they are not stand alone treatments for infection.⁸ It is the microbial kill of silver products that is their fundamental and most important property, despite elaborate arguments about physical or chemical differences among colloid preparations or comparisons of parts per million of silver content. The notion that silver is soluble in some products is a fairy tale. The intravenous administration of silver colloids is an illegal act of mistreatment. Topical application of silver colloid to the hands and oral application of silver colloid in parts per million may assist in the complementary prevention and management of flu and other infections.

Homeopathic medicine has been used extensively in individuals suffering from acute viral infection.⁹ The famous British homeopath, Richard Savage notes that homeopathy have four effective ways of treatment.⁹ One is an ability to generate resistance to infections and the others include reduction in the duration and severity of the disease, revitalization and correction of chronic adverse outcome of infections. One particularly effective homeopathic preparation for influenza management is Oscillococcinum. The success of this homeopathic preparation has led to it being one of the most widely applied prevention and treatment approaches in western Europe.⁹

Conspiracy Theories

Conspiracy theories are emerging in many media formats. One cannot take many of these flimsy hypotheses in a serious way. It is being suggested that covert Government agencies are placing immuno-contraceptives in vaccines for population control and that swine flu vaccination programs are a hoax. Some individuals have proposed that a virus cannot cross species unless it is manufactured in a specific manner. The idea that viruses are created by the body to cleanse itself is another absurd suggestion. In brief, there is no credible reason to accept many of these absurd and preposterous notions which are able to be access on the worldwide web.

Conclusion

“Curing” and preventing flu and the common cold has become the “holy grail” of infectious disease. The social and economic burden placed on society by flu epidemics, that result in work absenteeism and loss of productivity, is of gargantuan and incalculable proportions.^2,3 It remains to be seen what the outcome of the H1N1 pandemic will be in the next few months. This article may have been entitled “What part of the obvious do we fail to understand”.

While a “Cassandra Approach” to the H1N1 epidemic should be avoided, it seems unlikely that vaccination programs or drugs treatments will provide a satisfactory solution for this “looming epidemic.” A concerted effort to increase “biodefenses of humankind” largely by the natural promotion of immune function, seems an appealing and effective preventive option that must not be relegated in importance or overemphasized by some marketing – predators who sell dietary supplements.

REFERENCES

:

1. Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med 2009;361.

2. CDC Update: swine-origin influenza A (H1N1) virus—United States and other countries. MMWR 2009;58:421.

3. World Health Organization. Situation updates—influenza A (H1N1). Geneva, Switzerland: World Health Organization; 2009

4. Fitch WM, Leiter JMF, Li X, Palese P. Positive Darwinian evolution in human influenza A viruses. Proc Natl Acad Sci. 1991;88:4270-4272

5. Longini IM, Fine PE, Thacker SB. Predicting the global spread of new infectious agents. Am J Epidemiol. 1986; 123:383-391

6. Holt S Natural Therapeutics: Calorie Restriction Mimetics, Townsend letter, 98-101,2009

7. Holt S, A Primer of Natural Therapeutics: A Certification Program for Dietary Supplement Counselors, Little Falls, NJ Holt Institute of Medicine Press; 2008.

8. DeSouza. A., Mehta, D. Bactericidal activity of Combinations of Silver-Water Dispersion with 19 Antibiotics Against Seven Microbial Strains. Current Science, Vol 91, No.7, October 2006.

9. Ullman D, Discovering Homeopathy, North Atlantic books, Berkley, California, 1991.