"One Flu Over the Cuckoo's Nest"

Swine Flu and Herbal Medicine

There have been a number of cases recently of what has become known as swine flu. At the time of writing there have been 14 deaths in N. Ireland since November 2010, over 50 across the UK as of this month. The general public, rightly, want to know about it. Where does it come from? What are the symptoms? What should people do if they think they have contracted it? And what about the flu jab?  are just some of the questions being asked.

Let's try to answer some of those questions but let's remind ourselves that statistically many people die of influenza-related conditions annually. There have been over 5000 deaths attributed to Swine Flu worldwide as of 2009 according to the New Scientist (1) and yet in the US some 36,000 flu-related deaths are recorded each winter. The difference is that Swine flu (or H1N1) is causing problems in younger people.

Where does it come from?

According to Dr Michael Greger, director of the Humane Society of the United States the genetic fingerprint of the strain has only recently been identified - it is "a triple hybrid mutant first found on factory farms in the United States in 1998" (2). Greger goes on to suggest the name is a slight misnomer and might correctly be identified as "Factory Farm Flu" - factory farms where animals are confined into very tight spaces creates a breeding ground for virus, he adds.

A triple mutant hybrid? Influenza is a virus that has adapted itself to various host organisms, for example the Influenza A type is the particular strain that affects birds. The Spanish flu epidemic which claimed 50-100 million lives between 1917 and 1920 has been linked with this particular strain. Researchers at  the Armed Forces Institute of Pathology, Southeast Poultry Research Laboratory and Mount Sinai School of Medicine in a collaborative effort using infected tissue samples were able to determine in 2005 that the Spanish flu virus was a variant of bird flu (H1N1) that had adapted itself to humans.

A zoonosis is an infectious disease that can be transmitted between a non-human animal and a human (and vice-versa) and according to Taylor et al (3) there are some 1415 pathogens known to affect homo sapiens and 61% of these are zoonotic! Research by the Goldstein group determined that the ancestor virus of the Spanish flu first appeared in mammals between 1882 and 1913, and between 1913 and 1915 it developed into new strains (or 'clades') one of which gave rise to the H5N1 (bird flu) virus and the other gave rise to the H1N1 (swine flu) virus (also variant subtypes H1N2, H2N3, H3N1 and H3N2). H5N1 is not transmitted from human to human (yet) but should it mutate we could see a serious pandemic.

Influenza C, on the other hand, is a specific strain that affects humans and pigs but does not affect birds. In the case of swine flu humans who work with pigs are at greater risk of getting the virus, though infected pork, if properly cooked cannot transfer the virus. In the Virology Journal 2004 Yassmine et al (4) determined that the H3N2 subtype was a triple mutant hybrid containing genes from birds, swine and human influenza strains. Dr Greger's assertion that the latest outbreak can be traced to the factory farm is not without foundation. Herbalists and naturopaths have often commented that prevention is better than cure so one area that needs wider attention is the mass production of food and particularly factory farming.

Should I get the flu-jab?

The annual flu jab (for seasonal influenza) does not offer protection against Swine Flu. (There is currently NO vaccine developed for avian flu (H5N1) either). Flu vaccines are based on predictions of which strains are likely to be the most virulent in the next  'flu season'. A separate vaccine has been developed for Swine Flu (Pandemrix & Celvapan are the 2 different brands). It takes on average about 10 days for it to take effect. Protection is thought to be permanent however because the virus mutates so easily there is no definite protection. I have not found any gold standard double blind studies that have been performed to judge the efficacy of these vaccines, and there are side-effects too. A study into the side effects of the swine flu vaccination got underway at the University of Dundee in 2009. Known side-effects in seasonal flu vaccinations include allergic reaction, fever, behavioral changes, aches, dizziness and redness.

Dr. Anthony Morris, a distinguished virologist and former Chief Vaccine Office at the U.S. Federal Drug Administration (FDA), states that “There is no evidence that any influenza vaccine thus far developed is effective in preventing or mitigating any attack of influenza” and that “The producers of these vaccines know they are worthless, but they go on selling them anyway.” The scientist who invented the flu jab is also on record as saying it is 'ineffective' and that natural infection is probably a safer way of building antibodies. (5)

There is indeed much controversy over these issues and later in this article I will return to a fundamental piece of advice, that prevention is better than cure. This is certainly not to suggest that individuals should not take flu vaccines but merely to provide information so an informed decision can be taken.

What then are the symptoms of Swine Flu?

According to the NHS(6) the symptoms are similar to other strains of flu:

If you or a member of your family has a fever or high temperature (over 38C/100.4F) and two or more of the following symptoms, you may have H1N1 flu:

• unusual tiredness 
• headache
• runny nose
• sore throat
• shortness of breath or cough
• loss of appetite 
• aching muscles
• diarrhoea or vomiting

And the best course of action is to stay at home, rest and keep warm. In most cases the condition is mild but certain people are at greater risk and if symptoms persist you should contact your doctor for advice. In the instance of hospital treatment being required antiviral drugs will be used while antibiotics may be employed if secondary infection is suspected.

The government has published a public information leaflet which can be downloaded here: http://www.direct.gov.uk/en/Swineflu/DG_177831

How is it Treated?

The recommended anti-viral drugs (which are neuraminidase inhibitors - NIs) are Tamiflu (Oseltamivir) and Relenza (Zanimivir). However these are not without controversy. The prestigious British Medical Journal, on reviewing data for the efficacy of Tamiflu in 2009 stated:

"Evidence that oseltamivir reduces complications in otherwise healthy people with pandemic influenza is now uncertain." (7)

In December 2010 the World Health Organisation reported that the H1N1 virus was "showing resistance" to Tamiflu (8). Memoli et al (9) add that this resistance is now a 'significant threat'. Previous drugs, such as Amantadine, used to treat viral conditions are no longer used for this very reason.

(From the herbalist perspective it is interesting to note that one of the ingredients of Tamiflu is an extract of the herb Star Anise (Illicium verum) used to make shikimic acid, however the drive to stockpile the resultant drug  caused a shortage of the plant in China and it is now latterly derived from fermented strains of genetically modified E. Coli (see Bradley et al).)

Jefferson et al noted:

" There is no randomised controlled trial evidence to tell us whether NI's are or are not effective against pandemic influenza." (10)

The other antiviral Zanimivir fares little better. Despite being 'more effective' than Tamiflu it can cause respiratory problems. There has been concern about birth defects in animal models. Hoffman and Kamp note in The Influenza Report (11) side effects include bronchospasm, dyspnoea, rash, urticaria and allergic type reactions, including facial and oropharyngeal oedema though go on to suggest it has a 'good safety profile'. But despite this it has not been commercially successful compared with its rival Tamiflu, and despite evidence of the virus showing considerable resistance to Tamiflu . The WDDTY (What Doctors Don't Tell You)site reveals that a review of 52 separate trials found "no credible evidence" for the effects of either Tamiflu or Zanimivir! (12).

Needless to say the sales of these two drugs are massive.

Of course the principle model of action to tackle a virus is indeed an anti-viral. With the threat of a pandemic last year, and the perennial threat of viral mutations in the future herbalists have been looking to botanical anti-virals.

Herbal Medicine

Herbalists have a number of anti-virals at their disposal including St John's Wort (Hypericum perforatum), Liquorice (Glyccyrhiza glabra), Garlic (Allium sativum), Lemon Balm (Melissa officinalis) Elder (Sambucus nigra), Boneset (Eupatorium perfoliatum ), Turmeric (Curcuma longa) , Thuja (Thuja occidentalis) and Echinacea spp among many others. Unfortunately very little research has been carried out on herbal medicine, principally because herbs cannot be patented, therefore there is no money to be made. That is a simple fact .

Zakay-Rones et al 2003 have found Elder (Sambucus niger) which contains high levels of flavonoids to be active against influenza (13). The authors also discuss an earlier double blind study from Panama in 1995 in which Sambucus affected a 'complete cure' within 2-3 days in 90% of the treated group. The authors conclude it to be an effective remedy against Influenza A and B strains. The study did not include influenza C strains however, so further research is required.

Recent research on Echinacea pupurea by Pleschka et al however validates the use of this particular plant in Swine Flu.

"Influenza virus (IV) infections are a major threat to human welfare and animal health worldwide. Anti-viral therapy includes vaccines and a few anti-viral drugs. However vaccines are not always available in time, as demonstrated by the emergence of the new 2009 H1N1-type pandemic strain of swine origin (S-OIV) in April 2009, and the acquisition of resistance to neuraminidase inhibitors such as Tamiflu (oseltamivir) is a potential problem. Therefore the prospects for the control of IV by existing anti-viral drugs are limited. As an alternative approach to the common anti-virals we studied in more detail a commercial standardized extract of the widely used herb Echinacea purpurea (Echinaforce, EF) in order to elucidate the nature of its anti-IV activity.

Human H1N1-type IV, highly pathogenic avian IV (HPAIV) of the H5- and H7-types, as well as swine origin IV (S-OIV, H1N1), were all inactivated in cell culture assays by the EF preparation at concentrations ranging from the recommended dose for oral consumption to several orders of magnitude lower. Detailed studies with the H5N1 HPAIV strain indicated that direct contact between EF and virus was required, prior to infection, in order to obtain maximum inhibition in virus replication. Hemagglutination assays showed that the extract inhibited the receptor binding activity of the virus, suggesting that the extract interferes with the viral entry into cells. In sequential passage studies under treatment in cell culture with the H5N1 virus no EF-resistant variants emerged, in contrast to Tamiflu, which produced resistant viruses upon passaging. Furthermore, the Tamiflu-resistant virus was just as susceptible to EF as the wild type virus." (14)

Some concern that Echinacea because of its immune-enhancing actions can contribute to a "cytokine storm" (a huge immune reaction which can be fatal) are possibly unfounded. Paul Bergner notes:

" Echinacea species, used a hundred years ago in the treatment of influenza, and remaining a common treatment to day may enhance immunity and also have a moderating effect on excessive inflammation (Sharma et al.; Randolph et al., Brush et al.; Zwickey et al.) One trial of the use of a combination of Echinacea and Eupatorium perfoliatum found no net inflammatory effect produced by cytokines in humans at the dose tested(Elsasser-Beile et al.) Eupatorium has been one of the frequently used herbs in the treatment of influenza in North American history (Lloyd and Lloyd).In the absence of specific evidence that herbs traditionally used in the treatment of influenza aggravate the condition by over stimulating cytokines, there appears to be on reason to avoid their use for this speculative reason." (15)

Herbalists have often argued that herbal combinations can be even more effective than single herbs. Wagner et al note that the combination of 2 anti-virals Echinacea and Licorice create a 'remarkable stimulating effect' in T-Lymphocyte count (T-cells play a key role in immunity). However much more research needs to be done.

These references indicate the potential use of some herbal medicines in the treatment of virus, including swine flu and bird flu. It is not intended as a statement that herbal medicines should replace orthodox regimes but that they are worthy of consideration . The Vogel company, manufacturers of herbal medicines, quote: " Prof. Dr. James Hudson, Department of Pathology and Laboratory Medicine at University of British Columbia, Canada said: “Especially for people unwilling to be vaccinated, there is currently a need for alternative approaches to provide protection against respiratory tract infections."

Prevention is better than cure

This is a principle of naturopathic medicine - to prevent conditions occurring in the first place. In the case of influenza, we might note that those with compromised immune systems are at greater risk of contracting the disease. It stands to reason that improving immunity is the first place to start as a preventative measure. This boils down to matters of nutrition and hygiene.

A recent article in the Guardian commenting on the effectiveness of Tamiflu and Relenza also point to Dr James Luby who carried out a randomised trial into hygiene practices in Karachi noting that children under 5 who regularly washed their hands had half as many episodes of acute respiratory symptoms, predicating that washing hands will save more lives than Tamiflu. (17)

Improving nutrition is key in immunity - having a diet which includes all of the necessary vitamins, minerals, essential fatty acids etc is key to this process. One example is Vitamin D. The American Journal of Clinical Nutrition produced a report that vitamin D can halve the chances of contracting flu, and particularly Influenza A (18). Research by the Linus Pauling institute mentions the importance of the antioxidant Vitamin E (19).

Many years ago the Naturopath Henry Lindlhar wrote that we create the 'morbid soil' for microbes in our bodies determined by our diets and lifestyles. It's certainly food for thought.

References and Further Reading:

(1) http://www.newscientist.com/article/dn18056

(2) http://www.all-creatures.org/health/whatyou.html

(3) http://www.ncbi.nlm.nih.gov/pubmed/11516376

(4) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2228287/?tool=pmcentrez

(5) http://www.globalresearch.ca/index.php?context=va&aid=15860

(6) http://www.nhs.uk/Conditions/pandemic-flu/Pages/Symptoms.aspx

(7) http://www.bmj.com/content/339/bmj.b5405.full

(8)http://www.who.int/csr/disease/influenza/2010_12_15_weekly_web_update_oseltamivir_resistance.pdf

(9) http://www.ncbi.nlm.nih.gov/pubmed/21208927

(10) http://www2.cochrane.org/reviews/en/ab001265.html

(11) http://www.influenzareport.com/ir/drugs/zanami.htm

(12) http://www.wddty.com/avian-flu.html

(13) http://www.blackelderberry.info/File/Zakay-Rones_2004_JIMR_2.pdf

(14) http://www.ncbi.nlm.nih.gov/pubmed/19912623

(15) http://naimh.com/Influenza-1918.pdf

(16) http://www.naturalhealthwelwyn.co.uk/store/product/11833/A-Vogel-Echinacea-complex-30ml/

(17) http://www.guardian.co.uk/world/2009/may/07/tamiflu-swine-flu-drugs - washing hands

(18) http://www.ajcn.org/content/early/2010/03/10/ajcn.2009.29094.abstract

(19) http://lpi.oregonstate.edu/infocenter/vitamins/vitaminE/index.html