February 4, 2018

It’s flu season, and hospitals and doctors’ offices like mine are being swamped with patients with influenza. This week alone the CDC reported 16 more deaths in kids from the flu nationwide, bringing the total to 53 pediatric deaths for the season. Along with two strains of influenza B, there are two strains of influenza A. The first, H1N1, known as the “swine flu”, made a grand appearance in 2009 and still seems to be a player. But the really bad actor this year is a strain of influenza A known as H3N2, which has been particularly severe in children and the elderly.

Those of you who know me, know that I am a big proponent of food as medicine. So given the reality of this harsh flu season, I believe bolstering your immune system with the right foods is more important than ever. As a pediatrician, my line of work puts me at particular risk so I’m careful about what I eat and how I take care of myself each winter. Here is some of the information I have used to shape how I take care of myself during the flu season.

First, my favorite nutrition guru Dr. Michael Greger at nutritionfacts.org summarizes some of the studies that link fruit and vegetable intake to immune function. Even adding one fruit or a glass of tomato juice a day has been shown to boost immune function. When it comes to which veggies boost that function the most, it appears that cruciferous vegetables like broccoli, cauliflower, and cabbage are the winners. One study shows decreasing fruit and vegetable intake is associated with increased hospitalizations due to influenza. So for me, handfuls of berries and pomegranate arils (both high in antioxidants), lots of green leafy veggies like kale, and TONS of roasted cruciferous vegetables are part of my flu-season diet.

Turmeric is a smoky flavored bright yellow spice used in many curry dishes. The active component, curcumin, has been studied for its anti-cancer, anti-inflammatory and antimicrobial properties. A 2014 review of these studies shows this spice has been particularly well studied for its activity against viruses like the influenza virus. With so many easy ways to use turmeric, it’s hard not to find a reason to use it every day. A pinch in soups, a sprinkle over roasted veggies or in curries, or even stirred into turmeric tea, (like Doctor Yum’s Sore Throat Sipper) is part of my winter routine, especially at the first sign of a sore throat. You can even find it in supplement form in most pharmacies.

Next, green tea is also a great way to boost immune function as Dr. Greger also summarizes on nutritonfacts.org. Green tea has been shown to increase the function of gamma delta T cells that serve as a first line of defense for viral illness and has even been shown to dramatically reduce warts caused by human papillomavirus when applied topically. Drinking green tea daily or even just gargling with it each night has been shown to significantly decrease the incidence of influenza in children and the elderly. So, after working out in the morning I make sure to have iced green tea and lemon ready to sip on my way to work.

Lastly, Elderberry syrup is a traditional remedy for the cold and flu, cited for it’s potent antioxidant effects. This year, I’ve been hearing a lot of my physician colleagues in social media groups talking about giving it a try, so with other studies citing it’s safety, I added this to my winter regimen. In one study in 2014, researchers found elderberry juice had a favorable effect on the control of the influenza virus infection in mice. While I’m not a mouse, I’m willing to add a natural syrup to my diet if it may give me a chance against H3N2. After work I may add a little bit of this to a cup of warm fruit tea.

In summary here are the things I have been doing to help decrease my chances of getting the flu.

  1. Lots of raw and roasted veggies, especially cauliflower, cabbage, brussel sprouts, and broccoli
  2. Berries and Pomegranate arils with every meal possible
  3. Turmeric in veggie heavy soups or as a soothing drink like our “Sore Throat Sipper”
  4. Green Tea every morning
  5. Elderberry Syrup each day

These steps above are a great way to boost the immune system, but by no means provide a guarantee against the flu. So, now onto the most effective way to make sure the flu does not take you DOWN. I know this may be met with controversy in certain circles, but here it is: The flu shot is the best way to prevent serious complications and death from influenza.

So first, let me make something clear. The flu shot, much to everyone’s dismay, is never a guarantee against contracting the flu. Influenza is an ever changing virus and sometimes those changes happen so fast the predicted strains of the flu covered in the vaccine end up looking different than the strains actually circulating. But PLEASE do not let this dissuade you from getting a flu shot. Every couple of years despite getting the flu shot, I will get the flu. However, instead of being in bed for 5-7 days with a 104 temperature, I’m usually sick for 1 day with a low grade fever. This is a huge difference for a mom and physician like me who needs to get back to taking care of my kids and patients as soon as possible.

So here is the way I see it. The real reason to get the flu shot is so you don’t die of the flu.

Even if the flu shot is not great at completely preventing the flu each year (as you may have heard this year the percentages are quite low), it’s still particularly great at preventing death from the flu. No shot can give 100 percent protection because some of us just don’t mount a great antibody response to vaccines. But the vast majority of the children that died this season did not get their flu shot. One of those kids struck particularly close to home for me. I am part of a social media group of physician moms. One of these physicians posted over the holidays that her previously healthy 4 year-old son died of the flu on Christmas. He had been scheduled to get the vaccine the week after Christmas but began getting sick on Christmas Eve. On Christmas day he died. Even in the height of this mother’s grief she had the presence of mind to write a post to the rest of us to urge us to convince our patients to get the flu shot. Her plea is part of the reason I’m writing this post today.

Here’s my own personal case study of how the flu shot can lesson the severity of illness. Just last week my parents returned from an overseas trip. Near the end of their trip both of them contracted the flu. My father is a physician and had a flu shot, but my mother did not get one this year. My father, on the one hand, reported being very sick for about 1-2 days with high fever, but bounced back relatively easily. My mother, on the other hand, had a high fever for several more days and suffered from dehydration and a secondary infection. She ultimately had to be treated with IV fluids and IV antibiotics in the Emergency Room. Two weeks later she is still not back to baseline.

For those of you who believe physicians just want to vaccinate their patients for their own personal gain, let me tell you that could not be further from the truth. Flu shots are expensive (with no guarantee of full reimbursement from insurance companies) and cause a lot of extra work for my staff each year. Believe me, physicians around the world will celebrate the day a universal, one-time, highly effective flu vaccine is released. It’s not that we like to give flu shots. It’s that we love our patients and we don’t want them to die of the flu.

Another quick note is about Tamiflu, an antiviral medication which is also frequently misunderstood. Antiviral medications can be quite helpful in a harsh flu season like the one we are experiencing. In the pediatric population, Tamiflu is usually recommended for those at high risk of complications of the flu like babies and children with chronic medical illnesses like asthma. Like any medication, there are potential risks and side effects, the most common being abdominal pain, vomiting, and diarrhea. Knowing the growing death toll influenza has taken this season, I have been personally a bit more liberal in prescribing it for patients presenting in the first 48 hours of their illness. This of course has to be balanced with the fact that as the flu season progresses antivirals become more scarce and should be reserved for the most high risk patients. All in all, when Tamiflu is prescribed early, it can decrease the severity and duration of illness. If you have gotten the flu and are early in the course of symptoms, talk to your doctor about the risks and benefits of Tamiflu and other antivirals.

Facing today’s harsh flu season, it is more important than ever to be mindful of your diet. Adequate sleep and regular exercise are also important to boost your immunity. Even if you have never gotten a flu shot, consider getting one this year. Typically the flu season can last well into March and sometimes beyond, so it’s not too late if you can still find one. If you are already sick with the flu, talk to your doctor about the benefits and risks of antiviral medication in preventing serious complications of the flu. Lastly, PLEASE stay home if you are sick with a fever and flu-like symptoms.  

 

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References

Greger, M. (2016, February 15). M. G. (2016, February 15). Using the Produce Aisle to Boost Immune Function. Retrieved February 03, 2018, from https://nutritionfacts.org/
Greger, M. (2017, March 20). Benefits of Green Tea for Boosting Antiviral Immune Function. Retrieved February 03, 2018, from https://nutritionfacts.org/
Moghadamtousi, S. Z., Kadir, H. A., Hassandarvish, P., Tajik, H., Abubakar, S., & Zandi, K. (2014). A Review on Antibacterial, Antiviral, and Antifungal Activity of Curcumin. BioMed Research International, 2014, 1-12. doi:10.1155/2014/186864
Kinoshita, E., Hayashi, K., Katayama, H., Hayashi, T., & Obata, A. (2012). Anti-Influenza Virus Effects of Elderberry Juice and Its Fractions. Bioscience, Biotechnology, and Biochemistry,76(9), 1633-1638. doi:10.1271/bbb.120112
Ulbricht, C., Basch, E., Cheung, L., Goldberg, H., Hammerness, P., Isaac, R., . . . Wortley, J. (2014). An Evidence-Based Systematic Review of Elderberry and Elderflower (Sambucus nigra) by the Natural Standard Research Collaboration. Journal of Dietary Supplements,11(1), 80-120. doi:10.3109/19390211.2013.859852

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