David Berger, M.D West Bearss Avenue phone. Flu Update January 10, 2013

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1 3341 West Bearss Avenue phone Tampa, FL fax Flu Update January 10, 2013 Influenza is a virus that typically begins to appear in the Fall and then recedes as Spring progresses. While the flu season is certainly upon us, despite the current media frenzy, there is nothing that I see at this point that makes this more than a typical flu season. We hear reports that the flu is here earlier, however influenza usually starts to pick up during December into January, and then peaks in February. And although there have been flu deaths, there are about 30,000 flu associated deaths on average each year. Influenza is potentially a more serious disease for those with chronic respiratory illnesses and immunodeficiency, though mortality has been seen in seemingly healthy people as well. In our practice the experience of our patients seems to be much different than what I hear from my pediatric colleagues. In any flu season, I typically do not see more than a handful of kids sick enough that actually have to come into the office, and we have not had to hospitalize any patients in at least the past 5 years. So far this year we have not seen any patients in the office with the flu, though we have had a few phone calls of possible mild disease. I attribute this mostly to the fact that almost all of our patients are taking good daily doses of probiotics and vitamin D. Pediatric studies have shown that both of these supplements can reduce the effects of the flu. Emergency warning signs of the flu in children include: fast or troubled breathing, bluish skin color, dehydration, not waking up or interacting, and being very irritable. Emergency warning signs in adults include: difficulty breathing or shortness of breath, pain or pressure in the chest or abdomen, sudden dizziness, confusion, and severe or persistent vomiting. For more information about the signs of dehydration of the flu and how to prevent/treat it, please read this article: Treating Intestinal Illnesses The best way to prevent the spread of flu is through good hand washing with soap and hot water and avoiding people who have flu-like symptoms. People who have questionable or definite symptoms should avoid being out in public. Covering one s mouth during a cough can decrease how far and how much distance the virus will travel. Having a healthy diet, avoiding sugar, high fructose corn syrup, and processed food, along with adequate intake of vitamins and minerals also can be helpful. Therapies for when coming down with Flu Symptoms: 1) ELDERBERRY- An herb that appears to have direct anti-influenza viral activity. Children as young as 6 months of age can use this (although some people have used the product in younger children). There are many elderberry products on the market. In the office we carry the encapsulated liquid extract (Phyto-Caps) from Gaia/Professional Solutions.

2 The dose for older children and adults is 2 capsules 4 times a day. For younger children and people who do not swallow pills, we carry Sambucus, (by Nature s Way) which is an updated version of Sambucol. Children under 4 years of age should take 1 teaspoon 4 times a day, and older children and adults should take 2 teaspoons 4 times a day. There is a newer concentrated liquid extract fro GAIA herbs called "Black Elderberry Syrup". This product contains organic sugar, but it is also about 4-times more concentrated then the Nature's Way product, so 1/4 of the above dose would be given of this product. 2) OSCILLOCOCCINUM - A homeopathic remedy that has been shown to be effective in small studies. I have personally had success with this product, although some families are concerned about the lactose/casein content. If it really seemed like the flu was going through my community, I would strongly consider using it. Each small vial contains little sugar pellets (containing lactose) that are most effective if allowed to dissolve under the tongue. To be cost effective, it seems that using ½ of a vial works just as well as using the whole vial. Three doses a day for 2 days is the recommended amount. Small children can chew the pellets if necessary. For the youngest children, give a few at a time to make sure they can handle it. Another alternative is to dissolve the pellets in about ½ teaspoon of warm water, and then give this slowly, a few drops at a time so that it there is more contact with the oral lining. As with any homeopathic remedy, it is most effective when given away from food, herbs, or strong flavors like mint or cinnamon in toothpaste. 3) VITAMIN A - in a mycelized natural or palmitate form, (instead of one that is mostly Beta Carotene), Vitamin A seems to have strong anti-viral activity. High doses should never be used for more than 2-3 days in a row. The liver can be damaged if used for long periods of time at these doses. The dosing provided here is anecdotal, based upon my and other doctors experience. Studies have not been done to confirm them. The amount give per dose: for children 2-6 months, 10,000 IU; children 6-12 months, 15,000 IU; children months, 20,000 IU; children 2-4 years, 25,000-30,000 IU; children 5-7 years; 50,000 IU; children 7-10, 75,000 IU; children 11-14, 100,000 IU; and people 15 and older,150,000 IU. Pregnant women and lactating women of young infants, should not take more than 50,000IU per dose. These doses are to be used twice a day for 2-3 days only. These high doses may be problematic for people with clotting difficulty or liver disease. It is advisable to give/take a ½ dose when not sick to make sure it is tolerated. There are both liquid drops and capsules available. In our office we have a concentrated liquid that has 5,000IU per single drop (NOT DROPPER) as well as capsules that contain 25,000IU. 4) VITAMIN C - preferably as Ester C or Buffered C. Doses listed here are the total amount per day and should be divided in 3-4 doses. For children under 1 year of age give 100mg per month of age. For children up to age of 5, 1000mg per year of age, and as much as possible for older children and adults, as long as the stool does not become loose. Our office has capsules that are 250 and 500mg, 250mg chewable tablets, and a powder that has 1100mg per 1/4 teaspoon. 5) ZINC - this mineral should be given divided into at least 2 doses spread through the day. For children under 2-12 months old give 10-15mg a day, for children between 1 and 3 give mg daily, for older children give 50 mg a day, and adults can take mg a day.

3 This should be divided into 2-3 doses throughout the day. We carry capsules of 20, 25 and 50mg, and a syrup that has 20mg per teaspoon and drops that are 1mg per drop. 6) LARIX/ECHINACEA - Larix is an herb derived from the bark of the Western Larch tree. The active ingredient, arabinogalactan, is the same as Echinacea, which is believed to increase production of white blood cells. Larix has been found to be much stronger than Echinacea when using similar amounts, and can be used by patients over 6 months of age. For adults and children over the age of 10, the dose is 2 tablets 3 times a day, and younger children who can swallow pills should give 1 tablet 3 times a day. There is also a powder available. Adults and children over 10 should use 1 tablespoon 3 times a day, and children under the age of 10 should use 1 teaspoon 3 times a day. For children less than 12 months of age, there are alcohol free extracts of Echinacea that can be used. For children under 6 months of age use 5 drops 4 times a day and for children 6-12 months (if wishing to use this over Larix) use 10 drops 4 times a day. Echinacea should not be used as a daily preventative. Daily supplements to strengthen the immune system against Flu These are doses of therapies that can be taken longer-term until the flu threat has been lessened: 1) Vitamin D3 (probably the most important): Vitamin D, while known for its use in calcium absorption, is also very important to help fight off infections. Quite possibly, part of the reason that the flu season occurs in the winter is because people do not spend as much time outdoors. If possible, people should get their 25-hydroxy vitamin D level checked and get the value above 50ng/ml. If not able to check a level, all adults can take 5000IU of Vitamin D3, children under 25 lbs can take 1000IU, children lbs can take 2000IU, and children over 50 lbs can take 3000IU. We have capsules of 1000, 2000 and 5000IU as well as a concentrated liquid that has 1000IU per single drop. If a person is suspected to have a vitamin D deficiency, either revealed by testing or from lack of direct sun exposure (sunscreen blocks the formation of active vitamin D), I would consider taking 5 times the dose mentioned above for 1 week only in order to build up the body s levels and then drop down to the maintenance dose. For more information about vitamin D, go to 2) Probiotics: Preferably a mixed product of lactobacillus and bifidophilus. Babies under 1 year old can get 5 billion organisms per day, children 1-5 years old can get 10 billion, and those older than 5 years old can get 20 billion per day. 3) Vitamin C: Young children (under 5) can take 250mg twice a day and older children and adults can take 500mg twice a day. 4) Zinc: Children under the age of 4 can take 5mg daily and older children and adults can take 10mg a day.

4 5) Vitamin A: Children 2-24 months can take 1250IU daily, children 2-5 years old can take 2500IU daily and people over the age of 5 can take 5000IU daily. 6) Larix: Younger children (over 6 months of age) can take ¼ teaspoon of the powder once a day, and older children and adults can take ½ teaspoon or 1 tablet once a day. 7) Elderberry: Young children can take 1 teaspoon daily, and adults and older children can take 2 capsules daily. 8) Selenium: This powerful antioxidant has been shown in animal studies to decrease lung damage in mice that contracted influenza virus. Children under 1 year old can safely take around 50mcg daily, children 1-4 years old can take mcg, children over 4 years old and adults can take 200mcg daily. In our office we have capsules of 100mcg and a liquid that has 66mcg per single drop. Give it in 2 divided doses if possible. Anti-Flu Medications There are 2 anti-viral medications that appear to be effective against the flu strains that are in circulation. Tamiflu can be used in adults and children over 2 weeks old (this is a new recommendation I have never heard of a newborn actually getting Tamiflu), and Relenza is available for people over 7 years old. The effectiveness for both of these significantly declines if started after the second day of symptoms. These medications are not necessary to recover from the flu, and there are concerns about acute psychosis that has occurred following the use of Tamiflu. If a family of one of our patients suspects the flu and wants to start an anti-viral medication, they should contact our office as soon as possible. Look here for the CDC recommendations for antiviral therapies. There are several supplements (SEE BELOW) that I have found to be helpful in minimizing the effects of the flu. These therapies are most effective when started IMMEDIATELY upon the first signs or symptoms, and with the exception of the Vitamin A, should be continued for several days after symptoms subside. We have made these remedies available at Wholistic Pediatrics, and I recommend getting these products now as part of a flupreparedness kit. To have a full round of therapy, 2 bottles of Elderberry are needed for young children and 4 bottles are needed for older children and adults. 1 box of Oscillococcinum is needed per person regardless of age. The other supplements come in larger amounts and can be shared within the family. Women who are pregnant should be able to take the dose listed for young children, though safety data is not complete. Influenza vaccines As what typically happens this time of the year, I am being asked my opinion of the flu vaccine. It seems as if this year the researchers may have done a better job than in years past in properly predicting which flu strains will be predominant. However it is estimated that the vaccine will only be about 60% effective.

5 The CDC states that the vaccine is more effective in healthy young adults and less so in young children and elderly (the same group they say are at risk for more severe disease). It is thought that it takes about 2 weeks for protection to be present once getting the vaccine. There are standard recommendations for the flu vaccine, set forth by the CDC, which can be found at: The CDC also recommends that children between 6 months old and 8 years old receive 2 doses of the vaccine, 1 month apart, if they have never received a flu shot before. At this point there is no reason to suspect that the current version of the flu vaccine is any more or less safe than the one produced every year. The flu vaccine comes in both the injected and nasal spray form. Some doses of the injected form contain full doses of thimerosal (mercury), while others do not. I would not assume that a vaccine is mercury-free, and the package insert should be viewed by the consumer prior to administration of the vaccine. The nasal spray form of the vaccine (FluMist) does not contain thimerosal. The later into the flu season, the more difficult it will be to get thimerosal free or nasal spray form of the flu vaccine. If given the choice between the injected or nasal spray forms of the vaccine, unless it was contraindicated, I personally would opt for the FluMist. My justification for this is that the nasal spray exposes people to the virus in the same way that occurs in nature (i.e. through the nose/respiratory system), so the immune response in the person, in terms of the white blood cell and antibody responses, follows the pattern that occurs naturally. For anyone who is going to receive flu vaccine, I would recommend giving the same supplements listed in the Therapies for when coming down with Flu Symptoms section as follows: For Vitamin A, give the stated doses twice a day, the day before, the day of, and the day after the vaccines (yes, for 3 days total, but no more). For the vitamin C, zinc, elderberry, and Larix/Echinacea, give the stated doses from 3 days before, the day of, and for 3 days after the vaccine. I would also have on hand the oscillococcinum, but this only needs to be used if there are flu-like symptoms seen after taking the vaccine.