The Flu Vaccine: New Information You Should Know

Flu season is upon us, and once again you are faced with the dilemma: should you get a flu vaccine or not?   Are there other flu prevention strategies that may work just as well or better?  Well, recent studies have called  into question the effectiveness of influenza vaccination in certain age groups and populations.

According to the Center for Disease Control (CDC), 90 percent of flu deaths occur among the elderly.  However, in spite of widespread flu vaccination in adults older than 65 years old, increasing from 15 percent before 1980 to 65 percent by 2001, the
number of flu-related deaths in this group did not decline.[1]

A new study in The Lancet showed that in adults older than 65, the protection offered by the flu vaccine may weaken or disappear entirely during a season.  In contrast, the live attenuated flu vaccine, a.k.a. Flumist^®, provided the best protection to children ages 6 months to 7 years, but not beyond.[2]

If you are obese, meaning your BMI (Body Mass Index) is greater than 30, you are less likely to develop and maintain an effective immune response to flu vaccination compared to healthy weight adults.[3]  This may the reason why persons that were  overweight were more susceptible to complications from H1N1 influenza two years ago.

[Body Mass Index is a way to standardize height to weight measurements, so that they can be compared across persons of different heights and weights.  The link above will take you to a BMI calculator.  A BMI < 25 is generally considered a healthy weight; a BMI between 25 - 30 is overweight, and BMI > 30 is obese.  However, when calculating BMI's, differences in body composition are not taken into account, so males with more muscle (muscle weighing more than fat) may have a higher BMI without being overweight for their body build.  It is also helpful to look at waist circumference, where a waist > 35 inches in women, and > 40 inches in men (as measured around the umbilicus), is associated with a higher risk of disease such as cardiovascular disease and diabetes.]

With more than one in ten of the world’s population obese, that means that 700 million people worldwide do not respond well to flu vaccination.  In other words, if you are obese, you are more likely to get the flu and suffer a complication than a healthy weight adult, if you both received the flu vaccine.  Does the flu vaccine still offer protection?  Yes, but not equally to all people.

Right now, if you are in one of these groups, you are concerned.  What do you do?

Well, regardless of what group you’re in, following these Flu Prevention Guidelines will help  keep you healthy during the flu season:

1. Eat plenty of organic fruits and vegetables for their higher vitamin and anti-oxidant content
2. Avoid excess sugar in your diet
3. Make time for rest and sleep, especially when you feel run-down
4. Exercise regularly
5. If you are overweight, get on a plan to lose those excess pounds
6. Stay well-hydrated, especially as the heat kicks in
7. Do not smoke
8. Use a hand sanitizer, which can kill up to 99 percent of viruses and bacteria
9. Manage stress with positive activities

When this is not enough, certain natural remedies have a proven track record for helping stave off or shorten the duration of the flu.

Vitamin D

Vitamin D plays an important role in the body’s “immune fitness.”  Naturally, vitamin D levels drop during the winter months, especially in the northern latitudes.  Vitamin D was looked at as the possible “unknown factor” that British researcher, Dr.
Edgar Hope-Simpson, postulated was the cause for the seasonal rise in influenza cases in the winter.[4]

Adults with minimal sun exposure and in northern latitudes should get 5,000 IU daily of vitamin D3 during the winter months as a preventive.[5] [6]

Black Elderberry Extract

A number of studies have shown the effectiveness of black elderberry extract in shortening the duration of the flu.[7] [8]  For treating influenza, take 15 mL every four hours while awake until symptoms subside.

Elderberry extract, such as Sambucol^®, can also be taken daily as a preventive remedy.  Take 1 tablespoon daily to prevent the flu during flu season.

Zinc

If you are deficient in zinc, your immune system will have a diminished ability to fight off infections.[9] [10]  Zinc also offers protection from the spreading of influenza from infected cells to ones that have not been infected.[11]

Take 25mg zinc lozenges every two to four hours while awake, until symptoms improve, starting at the earliest sign
of symptoms.

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[1] Simonsen L, Reichert TA, Viboud C, et al.  Impact of influenza vaccination on seasonal mortality in the US elderly
population.  Arch Intern Med 2005;165:265-272.

[2] Osterholm, M, PhD, et al.  Efficacy and Effectiveness of Influenza Vaccines: A Systematic Review and
Meta-Analysis.  The Lancet Infectious Disease, Early Online Publication, 26 October 2011; doi: 10.1016/S1473-3099(11)70295-X

[3] Sheridan, PA, et al.  Obesity is associated with impaired immune response to influenza vaccination in
humans.  International Journal of Obesity advance online publication 25 October 2011; doi: 10.1038/ijo.2011.208

[4] Cannell,et al: Epidemic influenza and vitamin D. Review Article. Epidemiology and Infection (2006), 134 : 1129-1140. Cambridge University Press.

[5] Smith SM. Vitamin D supplementation during Antartic Winter. Am J Clin Nutr. 2009 Apr;89(4):1092-8. Epub 2009 Feb 18.

[6] Weaver CM. Vitamin D requirements: current and future. Am J Clin Nutr. 2004 Dec;80(6 Suppl):1735S-9S

[7] Zakay-Rones et al. Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med. 1995 Winter;1(4):361-9.

[8] Zakay-Rones et al. Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. J Int Med Res. 2004 Mar-Apr;32(2):132-40.

[9] Klaus-Helge Ibs & Lothar Rink. Zinc Altered Immune Function. The American Society for Nutritional Sciences J. Nutr. 33:1452S-1456S, May 2003.

[10] Shankar, A. H. & Prasad, A. S. (1998) Zinc and immune function: the biological basis of altered resistance to infections. Am. J. Clin. Nutr. 68 (suppl. 2): 447S–463S.

[11] Srivastava V, et al. Influenza A virus induced apoptosis: inhibition of DNA laddering & caspase-3 activity by zinc  supplementation in cultured HeLa cells. Indian J Med Res. 2009 May;129(5):579-86.

Rebuttal to Vitamin E Study and Increased Prostate Cancer Risk

Life Extension posted a rebuttal to the SELECT study.  I think it’s interesting to read their viewpoint, so I posted here for my readers.

Rebuttal to the Recent Study on Supplements and Mortality in Older Women

So should you take any supplements?  The answer to this question cannot be based on broad generalizations made from singular studies.  I believe this is an ongoing conversation with your doctor, who hopefully sees him or herself as a team member in your care, not the sole director of it.

A recent study brought into question the utility of supplements in enhancing health, and even questioned whether supplements increased the risk of death.  What was omitted in the spectacular headlines was the author’s own conclusion:  “It is not advisable to make a causal statement of excess risk based on these observational data…”  In other words, you cannot say that supplements lead to more deaths, simply because it was observed that the group of women taking supplements seemed to have a higher mortality rate.

In rebuttal to the study’s apparent conclusions, two interesting viewpoints have been published, for which I provide links here.

Vitamin supplements: more harm than help? by Dr. Ian Chapman

Thorne Research’s Rebuttal to the Question of Safety of Dietary Supplements.  by Alan Miller, ND and Robert Roundtree, MD

The debate is on, but we need to read through these studies with a fine-tooth comb before drawing conclusions.  The sensational title in the NY Times, “More Evidence Against Vitamin Use,” is a bit fantastical given the actual conclusions that can be made from this observational study, with a number of flaws as pointed out by the two articles above.

My patients know that I recommend different types of supplements, sometimes for brief periods and targeted uses. 

First and foremost, I recommend a balanced diet rich in nutrients we can only get from whole foods. Supplements are just that — supplements.  They are not substitutes for a poor diet, no more than lipitor should be an excuse to eat a steak every night.

An integrative, functional approach to patient care takes into account the individual circumstances of each person when designing what is right for them.  To simplify care into broad statements based solely on singular study conclusions is hubris and a mistake often made in Western medicine.

A person is not a study, no more than a study is one person.

Yes, we need our studies, but we have to analyze what types of conclusions can be drawn from them carefully.  As a doctor in clinical practice, the challenge is always to interweave what we know is the best evidence with how we know the individual patient in front of us responds to treatment.  They don’t always coincide.  And therein lies the art of medicine.

Ultimately, we are in charge of our own health with our doctors as team leaders.  You should be a co-director in your healthcare.  Your doctor should be someone you can have a conversation with about these issues, and together make a decision that makes the most sense for you and your individual circumstances.  This individual approach to healthcare makes the most sense.

Should You Take Supplements?

If you’ve read my prior posts, you know that I recommend supplements and herbs for all types of uses from keeping your bones strong, to staying healthy during the winter season.  So, I’m sure you were baffled if you read some recent reports on whether supplements are good for us or not.

Two recent studies have cast doubts over the usefulness of dietary supplements.  One study looked at the use of vitamin and mineral supplements in 38,772 older women in the Iowa Women’s Health Study, concluding that increased use was associated with a 2.4% higher risk of mortality when compared to those that did not take supplements.[1]  Another study, The Selenium and Vitamin E Cancer Prevention Trial, found that the use of vitamin E and selenium supplements in 35,000 men slightly increased the risk of prostate cancer in the men taking vitamin E alone, and slightly increased the risk of diabetes in men taking selenium alone, but neither group’s results were statistically significant.[2]

When headlines like these hit the newsstands, the details are in the fine print.  In the women’s study, the only supplement that seemed to help reduce the risk of death was calcium.  Others, like Vitamin A and D, had no effect.

When looking more in depth into the studies above, we need to consider such variables as the population studied and the supplements used.  For example, the Iowa Women’s Health Study only looked at older white women, so we have to be careful to apply such conclusions to the general population.

In the men’s study, the vitamin E supplement that was used contained solely alpha-tocopherol, one of only multiple types of vitamin E produced in nature.  So, can we really say that taking a synthetic, non-representative of nature vitamin E supplement would have the same effect on health as a mixed-tocopherol supplement?  We have to be careful about making blanket statements on a vitamin without understanding the type that was used.  In addition, the results not being statistically significant means that we really can’t draw the conclusion, and more studies need to be done.

In contrast to these reports, prior research has clearly shown scientific benefit for certain supplements.[3] 

Multiple studies have shown the following:

1. Calcium and Vitamin D help prevent osteoporosis.
2. Folic acid helps prevent birth defects.
3. Omega-3 fatty acids help improve cellular communication, prevent cardiac arrhythmias, reduce inflammation, and lower cholesterol and blood pressure.
4. Lutein and zeaxanthin help prevent age-related blindness, known as macular degeneration.

To this list, I will add vitamin B12 for vegetarians and vegans, who may not be getting enough in their diets, and patients chronically taking either a proton pump inhibitor, an acid reducer used for acid reflux, or metformin, a drug used to treat diabetes, which also causes B12 malabsorption.  Patients with celiac disease may have trouble absorbing vitamins from their food, in addition to persons with malabsorption syndromes from other causes such as food intolerances and leaky gut syndrome.  The elderly and alcoholics are also at higher risk for vitamin deficiencies, and will benefit from vitamin supplementation.  If you feel a cold or flu coming on, research has shown that zinc can help reduce the duration of your illness.[4]

The US Department of Health and Human Services has studied the American diet, and found that it does not always provide all the vitamins and nutrients we need.  In fact, a study that analyzed seventy diets found that all subjects tested, including athletes and sedentary individuals, were short of the minimum recommended by the RDA for at least one or more key micronutrients.[5]

So how do we sum up the parts?  My recommendations are:

1. Take a high-quality whole-food based multivitamin, multi-mineral formula.
2. For bone health, women should take Calcium citrate 600mg twice a day.
3. For its multiple health benefits, take Vitamin D3 2,000 IU daily.  However, you may need up to 5,000 IU daily during the winter months if you live above the 35 degree latitude, approximately Raleigh, N.C.
4. Take an EPA- and DHA-containing Omega-3, 1,000 – 2,000 mg daily for cardiovascular health.
5. Discuss your special circumstances with your doctor to choose a supplement plan that best suits your individual needs.  For example, if you are vegetarian or vegan, you may need extra vitamin B12.
6. Finally, don’t forget, the most important first step is to eat whole, organic, non-GMO foods, preferably locally-produced, and not in excess.

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[1] Jaako Mursu, PhD, et al.  Dietary Supplements and Mortality Rate in Older Women, The Iowa Women’s Health Study.  Arch Intern Med. 2011;171(18):1625-1633.

[2] Lippman, Scott M., MD, et al.  Effect of Selenium and Vitamin E on Prostate Cancer and Other Cancers.  JAMA, 2009; 301(1):39-51.

[3] The Lewin Group. (2006). An evidence-based study of the role of dietary supplements in helping seniors maintain their independence. Prepared for: The Dietary Supplement Education Alliance.

[4] Shanker, A. H. & Prasad, A. S. (1998) Zinc and immune function: the biological basis of altered resistance to infections. Am. J. Clin. Nutr. 68 (suppl. 2): 447S–463S.

[5] Misner, Bill.  Food Alone May Not Provide Sufficient Micronutrients for Preventing Deficiency.  J Int Soc Sports Nutr. 2006; 3(1): 51–55.