Cold and Flu Resources: The Immune System and What You Can Do to Stay Healthy.

By Sarah Piestrup, RN, EAMP, FNP student, Graceland University.

Introduction

Your immune system is amazing! It can fight off invaders from the outside, like viruses or bacteria that get inside you through your skin, mouth or nose. It can also fight off internal invaders that, when not cleaned up, could cause overgrowth, destruction and cancer. There is not one simple answer about how to not get sick; it is going to depend on an integrated dance within your body and cells that is largely dependent on your overall health and well being. Even though as of today, November 6th, 2011, the Centers for Disease Control (CDC) reports no flu activity in WA state, other states are affected and many locals in Leavenworth have been falling ill over the last week or two so we had better know what to do to keep our selves well protected (CDC, 2011).

Your immune system is complex and interrelated with many different large and small cells that all communicate with one another to create your own personal internal army. Our little army is teeming with tricks and cells ready to combat any invader. It turns out this is mostly (60%) going on in the gut, which makes sense, considering the surface that comes in contact with the external world (via ingestion) is about the size of a football field (Wikipedia, 2011). It also turns out we have a neural system lining our guts that contains 100 million neurons, more than the spine or peripheral nervous system. Filled with important neurotransmitters, this brain in our belly sends 90% of its information to the brain in our head, and has a large influence on our emotions (Hadazy, 2010). Stress also affects our immunity as we release stress hormones for the short burst of fight of flight where energy and blood flow are designated to critical areas like the brain for sharpened cognition and away from places like the gut or areas of maintenance and rebuilding (Sapolsky, 2004). In long term stressful situations glucocorticoids linger, extending these effects and suppressing immunity by affecting the proteins that turn on the genes of immunity (Marx, 1995; Sapolsky, 2004).

Obviously, it is important to WASH YOUR HANDS and keep your fingers that just touched the door handle or railing off your mucus membranes (don\’t pick your nose or rub your eyes or eat until after you have washed your hands).

The Army, your defense system

On a cellular level, the cellular army of the immune system is keeping in close conversation with all the parts of the army, the chemokines, cytokines, complement enzymes, co-stimulatory molecules and dendritic cells all working together to help regulate action against invaders. These messenger proteins, enzymes, molecules and cells interact with immune cells to help determine their movement, proliferation, method of action, activation, and many other specifics of the immune response dance. We now know that even the innate and adaptive immune systems are connected by a plasma protein (LPS-binding protein) & toll like receptor proteins that signal the initiation of adaptive immune responses (Haynes, et al., 2008). In fact the discovery of the connection of innate and adaptive immunity, specifically the toll like receptor\’s roll in innate immunity and the dendritic cells that bring pathogens to the attention of T cells won Bruce Beutler & Ralf Steinman the Nobel prize this year (Seppa, 2011). This is all very important because it means that what you do to support the whole system, including innate immunity is of vital importance, something that often gets left behind when we feel protected from a previous exposure in life or in a vial.

But I got the flu shot!

Your body will need more than just a flu shot. Unfortunately the flu shot is not as effective as we would like. While it is an important aspect of care for some patient populations and recommendedby the CDC for almost everyone over 6 months of age and especially for those at high risk, often the flu shot is for a strain that does not affect you because it is out dated by the time it comes out or because you simply ended up catching a different bug not contained in this years shot.  This is not surprising since the viruses in the shot were determined across the world many months before you got sick, \”at best\” they are effective against influenza A and B (10% of those viruses that make you sick) and now they have less chance of survival because more people are immune to them because they got the shot (Jefferson, et al., 2010 p 2). There are at least 200 viruses that cause influenza or influenza like symptoms (Jefferson, et al., 2010). Last year the flu shot was similar to the 2,494 influenza viruses reported (CDC, 2011).  In a recent review of 59 studies that contained 70,000 participants it was determined that in the \”relatively uncommon circumstance of vaccine matching the viral circulating strain and high circulation\” there was a 3% risk difference (Jefferson, et al., 2010). This equates to a 50-70% effectiveness estimate which was shown to be more like 59% in a more rigorous meta analysis (Jefferson, et al., 2010; Osterholm, et al., 2011). Even under the best circumstances (when there was viral matching) the shot had no effect on complications, hospitalizations or if you contracted a virus (transmission), and had only a modest effect on time lost from work, which may have shown due to pervasive scientific bias as most studies were run by vaccine manufacturers. In the elderly the risk of death has been reduced by vaccination.  Flu shots are also more effective in children (Jefferson, et al., 2010). An even more recent meta-analysis that looked at 5707 studies and selected 31 due to strict criteria (including testing for actual influenza) showed that evidence for the elderly was lacking, that the benefit was moderate at times but greatly reduced or absent in some seasons (Osterholm, et al., 2011).

Here is the plain language summary of the Cochrane Review (Jefferson, et al. 2010 p 2):

\”Authors of this review assessed all trials that compared vaccinated people with unvaccinated people. The combined results of these trials showed that under ideal conditions (vaccine completely matching circulating viral configuration) 33 healthy adults need to be vaccinated to avoid one set of influenza symptoms. In average conditions (partially matching vaccine) 100 people need to be vaccinated to avoid one set of influenza symptoms. Vaccine use did not affect the number of people hospitalized or working days lost but caused one case of Guillian-Barré syndrome (a major neurological condition leading to paralysis) for every one million vaccinations. Fifteen of the 36 trials were funded by vaccine companies and four had no funding declaration. Our results may be an optimistic estimate because company-sponsored influenza vaccines trials tend to produce results favorable to their products and some of the evidence comes from trials carried out in ideal viral circulation and matching conditions and because the harms evidence base is limited.\” 

So should you get the shot? That is entirely up to you, and something you should consult your provider about. Reported adverse effects are very rare so it\’s likely not to cause you any harm. However, before you go weighing the risks and benefits from this research I would like you to look carefully at the recent Institute of Medicine report on vaccines (Stratton, et al., 2011). The media buried very important aspects of this study which carefully laid out the possible mechanisms of harm from vaccines that are currently under investigation. Jefferson, et al. (2010) called the reporting of harm in the literature \”limited\” because the studies even looking at those details are few. The recording of adverse events is also usually only for immediate effects because there really is no way to prove long term effects unless we look at the mechanisms behind those effects, or they are so pervasive that they show up in a correlational study. The media did amply share that vaccines are unlikely to cause Autism, a conclusion based on one study looking at one vaccine in isolation, a conclusion that did not take mechanism into account (Stratton, et al., 2011). Stratton, et al. (2011) presented the mostly preliminary research on mechanisms that look at the contaminants in vaccines from unattenuated accidental viruses (live and not the one they meant to have in the vial) to mycotoxins not to mention the known neurotoxic agents and list of unfriendly ingredients in there from formaldehyde to mercury. There are studies presented that show how even just the over stimulation of the immune system and molecular mimicry could be responsible for long term debilitating diseases such as rheumatoid arthritis, lupus, diabetes mellitus, hashimotos thyroiditis or other auto immune conditions. Cytokine imbalance and inflammation are also associated with vaccines.

My point is that your immune system will definitely need more than just a vaccine to keep you from being ill this winter (and to help the vaccine help you).

Immune Building Blocks

The fuel

Mitochondria are the energy producers in your cell that make ATP but they also help the immune system with apoptosis, or programed cell death (cells are sacrificed due to disease or deformity). They are involved in making new cells (cellular proliferation regulation), cellular metabolism regulation and signaling (Wikipedia, 2011). Basically the mitochondria will help determine your health and vitality so having healthy and prolific mitochondria is very beneficial. This can be accomplished with exercise and a diet filled with a variety of vegetables in a variety of colors.  Try to get 7-9 servings of fruits and vegetables in all 7 colors of the rainbow every day.

Protein

Proteins make up much of the immune system, as well as many other structural and functional components in your body necessary for life and daily functioning. You will need plenty of amino acid building blocks coming into your body for this purpose. It is also important to note that protein ingestion at every meal also helps regulate the glucose brought in through the gut keeping the blood sugar in balance which helps prevent blood sugar crashes that can stimulate a stress response that temporarily wipes out immunity.

Zinc

Zinc is an essential building block of many pieces of the immune system.  It is necessary for the function of over 300 enzymes and plays a role in a large number of biological processes.   Zinc has been used for centuries to help wound healing and has been said to have antiviral qualities (Natural Standard, 2011). A recent Cochrane review on zinc and the common cold looked at 13 trials with a total of 966 participants which showed a significant effect on both duration and severity of illness and reduced the incidence of illness, school days lost, and antibiotics used in children.  Specifically zinc helped reduce the severity and duration of illness when given within 24 hours of symptom onset, and zinc prevented illness when given over a 5 month period (Meenu & Rashmi, 2011).   Because zinc is a metal, more is not better.   You should only be taking what your body needs and consult with a professional if you are unsure (there is a simple test we have at Cascade Wellness that is free and helpful to determine how low you are on zinc).  15 mg a day is usually a good dose but you may need significantly more at times of healing, illness or stress.

A note on Zicam.   Just in case you still have some of the nasal spray around that has since been taken off the market, do NOT use it.   It has caused permanent damage to people\’s ability to smell.

Vitamin D

Vitamin D is a hormone you make when direct sunlight (during the summer months, unobstructed by buildings trees, widows or sun screen) uses the cholesterol under your skin to create about 20 different chemicals including D3, the active form of D we use in our body (Holick, 2007).   Vitamin D has wide spread effects on our cells (cellular differentiation and proliferation).  It has effects on immune responses and central nervous system function and has the ability to influence (or modulate) our gene expression, or how our genetics are used to make what our cells become (Sundar & Rahman, 2011). 1,25(OH) D is vital to respiratory health because it decreases inflammation, promotes immunity, slows the cell cycle, reduces hyperplasia and enhances the effects of exogenous steroids (Igbal & Freishtat, 2011). Vitamin D and vitamin D receptors are involved in gene regulation of several genes involved in inflammation, immunity, cellular proliferation, differentiation, and apoptosis (Sundar & Rahman, 2011).   Higher vitamin D levels were associated with less incidence of influenza (Ginde, et al., 2009).   It is possible because these levels were based off of sun exposure and not supplementation that this information would not be as relevant to supplementation.  Get your D levels checked to make sure you are in the range of health.   Visit our vitamin D resource page for more information on vitamin D.

Vitamin C

Vitamin C has been shown to stimulate the production and function of white blood cells (especially neutrophils, lymphocytes and phagocytes) and has a protective quality on those cells (Higdon, 2009).   It supports many processes in the body, including synthesis of collagen that is used in blood vessels, bones, tendons, and ligaments.  It also plays an important role in making the neurotransmitter norepinephrine.   It is required for the synthesis of carnitine, which brings fat into the mitochondria to make energy.

There is mixed evidence on vitamin C overall for cold prevention especially in small doses. However, in subgroups such as people who exercise in the cold, the reduction rate was as high as 50%.   It is also important to understand that vitamin C is absorbed very quickly so if you take it frequently at high doses the effects are thought to be of much greater value where most studies looked at low dose and almost all looked at once daily dosing (Roxas & Jurenka, 2007).

N-Acetylcysteine

A potent antioxidant that has been used for decades to treat lung conditions like bronchitis due to its expectorant and mucolytic qualities.   Roxas and Jurenka (2007) present studies that show decreased infection severity in bronchitis as well as great reduction in the incidence and severity of influenza in the elderly.

DHEA

In the elderly a DHEA reduction my account for decreased immunity.   Studies show that metabolites of DHEA have potent immune-enhancing and antiviral effects (Roxas & Jurenka, 2007).

It starts with the gut

Remember all that much of the immune system is in the gut.  This means that if you are using your immune system up in this area it will have an impact on the total load your body has to deal with.  Certain foods can stimulate an immune response in some people.  These foods often cause inflammation and symptoms that can range from rash to malaise, joint pain and many other symptoms that can often be identified through an elimination diet with careful follow through.  Using the medical symptoms questionnaire, and a specific elimination diet protocol you can determine what foods affect you so you can reduce your immune system burden.  It also helps to reduce stress, and to reduce stimulants such as coffee and sugar (Sapolsky, 2004).  It has been recently discovered in mice that intracellular lymphocytes are increased with green vegetable consumption (Li, et al., 2011).  So it may also help humans to have a daily intake of green vegetables such as broccoli, bok choi, collards, kale, chard and similar items.  We also know that these foods are high in sulforphane and can help us keep our total toxic load down by assisting with glutathione synthesis (see our toxin resources page for more information).

Herbal prevention and treatment

Echinacea

This is an herb used mostly to prevent an illness, it has immune stimulating qualities that have shown statistically significant results in reduction of illness and length of illness (Shah, 2007). There is controversy in the scientific community due to conflicting results. It is possible these results are due to different strains, extraction methods and overall quality of the echinacea used (Shah, 2007). Dosing should be about 300 mg equivalent of angustifola root taken three times a day for 5-7 days of a product known for it\’s potency and effectiveness (this part is difficult as sources vary). This herb can be taken as prevention or at early stages to help treatment (Natural Standard, 2011).

Elderberry

Elderberry\’s antiviral properties come from its ability to neutralize the activity of the hemagglutinin spike on the surface of some viruses (including influenza A and B and the Herpes virus). Without these spikes the virus can not enter the cell and replicate. Elderberry is also has immune modulating effects by enhancing cell signaling (cytokine production) which activates phagocytes and facilitates movement to the target area of inflamed tissue (Shah, 2007).

Ginseng/Astragalus

Ginseng tonifies the qi. This is helpful to keep you strong. It is not helpful if you are sick already as it will \”lock the robber in the house\” so use it if you are run down, or tired. It\’s an adaptogen so you can take it to help mediate the stress response which can help your body move it\’s energy towards rebuilding so it is ready for invaders.

Arabinogalactans

These polysaccharides derived from the wood of the Western Larch tree stimulate the immune system by activating phagocytosis and increasing the effectiveness of macrophages and monocytes.  There is potential for helping the reduction of viral illness and reduction in otitis media in children has been documented (Shah, 2007).

At first sniffle- Traditional East Asian Medicine

In traditional East Asian medicine we use a complex diagnostic process to determine the exact type and stage of illness. So just saying you have a cold or the flu does not really help determine what herbs you will need. If you can get in for a treatment and a diagnosis that is the best possible scenario to get you the best herbs for your condition at that time (after warning us so we can prepare the office to be virus free for others). You can also have herbal formulas such as gan mao ling, gui zhi tang, or ge gen tang on hand for what will most likely be your first stage of illness. If you don\’t have prepared herbs on hand try these basic remedies:

Ginger or Cinnamon

Use ginger or cinnamon if you are feeling more chilled than hot, if you have a scratchy throat that is not too sore, maybe body aches, sniffles, cough that is not to loud, and clear or white phlegm. To take ginger for a cold or flu you use the FRESH herb (dried ginger is not the same herb).  Another way to take spicy warming herbs is in a chai (not the kind that is made from powder with added sugar, the kind you make from bulk herbs with no added sugar). You can also cook with these herbs.

Mint or Chrysanthemum

Use spicy cooling herbs like mint or chrysanthemum if you feel more feverish than chilled, you have a strong sore throat, loud cough, and yellow phlegm. Use bulk herbs and make the tea strong.

More symptom relief ideas

Sore throat

Gargle with salt water.  Dissolve as much salt as you can in warm water and gargle one full 8 oz. glass, spitting between sips.  Careful not to swallow, and rinse after.  Repeat if your throat is still sore in about an hour.

Add honey and lemon in your mint tea.

Congestion

Use hot steam to help relieve congestion.  Mint is helpful and can be added to tea that you can breathe in before you drink.  To amplify the effects use a towel over your head and a bowl of hot liquid or even essential oils such as mint or pine.

Bi Yan Pian is an excellent traditional formula to relieve congestion and can be found in some herbal tea products and at some health food stores, and always at Cascade Wellness.  You should consult your provider before taking this formula and avoid it if you have any cardiac conditions.

Cough

Loquat syrup or cough drops are excellent for soothing the throat and relieving cough.  Many different loquat based formulas are available.  They are hard to find without preservatives so look carefully at your label or ask us for the best one.

Digestive symptoms

Congee is a traditional easily digested and highly nourishing traditional treatment for digestive up set.  If you have had vomiting or diarrhea it is best to eat simply, having only three ingredients on your plate (including spices, which should be mostly ginger, cinnamon, rosemary, or other warming herb).  Congee is even better.  You make it just like rice only add 10 cups water to one cup rice and add a few other ingredients like lean pork meat, chicken and maybe one vegetable and warming spices like ginger.

For late stage diarrhea after the toxins feel like they are gone from your system and you have had plenty of fresh ginger you can astringe your colon with nutmeg to help get your gut back to normal.

References

Ginde, A. A., Mansbach, J. M. & Camargo, C. A (2009). Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the third national health and nutrition examination survey. Archives of Internal Medicine, 169(4), 384-390.

Echinacea. (2011). In Natural Standard. Retrieved from http://naturalstandard.com/databases/herbssupplements/echinacea.asp

Hadhazy, A. (2010). Think twice: How the gut\’s \”second brain\” influences mood and well-being. Scientific American, 88. Retrieved from http://www.scientificamerican.com/article.cfm?id=gut-second-brain

Human gastrointestinal tract. (2011). In Wikipedia. Retrieved fromhttp://en.wikipedia.org/wiki/Human_gastrointestinal_tract

Haynes, B. F., Soderberg, K. A., Fauci, A. S. (2008). Introduction to the immune system. In Fauci, A. S., Braunwald, E., Kasper, D. L., Hauser, S. L., Longo, D. L., Jameson, J. L., & Loscalso, J. (Eds.), Harrison\’s Internal Medicine (pp. 2019-2045). New York, NY: McGraw Hill Medical.

Higdon, J., Drake, V. & Frei, B. (2009). Vitamin C. Linus Pauling Institute. Retrieved fromhttp://lpi.oregonstate.edu/infocenter/vitamins/vitaminC/

Iqbal, S. F. & Freishtat, R. J. (2011). Mechanism of action of vitamin D in the asthmatic lung. Journal of investigative mechanism: The official publication of the American Federation for Clinical Research, epub [Abstract]. Retrieved fromhttp://www.ncbi.nlm.nih.gov/pubmed/21941209

Jefferson, T. Di Pietratonij, C., Rivetti, A. Bawazeer, G. A., Al-Ansary, L. A. & Ferroni, E. (2010). Vaccines for preventing influenza in healthy adults. The Cochrane Library, 7. Accession: 00075320-100000000-00049

Li, Y., Innocentin, S., Withers, D. R., Roberts, N. R., Gallagher, A. R., Grigorieva, E. F., … Veldhoen, M. (2011). Exogenous stimuli maintain intraepithelial lymphocytes via aryl hydrocarbon receptor activation. Cell, 147(3), 629-640. Retrieved from http://www.cell.com/retrieve/pii/S0092867411011366

Marx, J. (1995). Immunology: How glucocorticoids suppress immunity. Science, 270(5234), 232-233. Retrieved fromhttp://www.sciencemag.org/content/270/5234/232.summary

Meenu, S. & Rashmi, D. (2011). Zinc for the common cold. Cochrane Database of Systematic Reviews, 10. Accession: 00075320-100000000-00007

Mitochondria. (2011). In Wikipedia. Retrieved from http://en.wikipedia.org/wiki/Mitochondria

Olstrum , M. T., Kelley, N. S., Sommer, A. & Belongia, E. A. (2011). Efficacy and effectiveness of influenza vaccines: A systematic review and meta analysis. The Lancet. doi 10.1016/S1473-3099(11)70295-X Retrieved fromhttp://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70295-X/fulltext#

Roxas, M. & Jurenka, M. T. (2007). Colds and influenza: A review of diagnosis and conventional, botanical, and nutritional considerations. Alternative Medicine Review, 12(1), 25-48.

Sapolsky, R. M. (2004, September). How stress effects your health. On Talk of the Nation, National Public Radio. Retrieved from http://www.npr.org/templates/story/story.php?storyId=3911637

Seppa, N. (2011). 2011 medicine Nobel goes to immunology researchers: Medical researchers recognized for work on innate, adaptive defenses. Science News, 180(9). Retrieved fromhttp://www.sciencenews.org/view/generic/id/334887/title/2011_medicine_Nobel_goes_to_immunology_researchers

Shah, S. A., Schlesselman, L., Cios, D., Lipeika, J., Patel, A. A., Kluger, J., and White, C. M. (2007).  Effects of echinacea on electrocardiographic and blood pressure measurements. American Journal Health System Pharmacy, 64(15), 1615-1618.

Stratton, K., Ford, A., Rusch, E. & Clayton, E. W. (2011). Adverse effects of vaccines: Evidence and causality. Institute of Medicine, Washington DC The National Academes Press. Retrieved from http://books.nap.edu/openbook.php?record_id=13164

Sundar, I. K. & Rahman, I. (2011). Vitamin D ans susceptibility of chronic lung disease: Role of epigenetics. Frontiers in pharmacology. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171063/?tool=pubmed

U. S. Department of Health and Human Services, U. S. Food and Drug Administration. (2009). FDA Advises consumers not to use certain Zicam cold remedies intranasal zinc product linked to loss of sense of smell. Retrieved fromhttp://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm167065.htm

U. S. Department of Health and Human Services, U. S. Food and Drug Administration. (2009).  Weekly US map: Influenza summary update.  Retrieved from http://www.cdc.gov/flu/weekly/usmap.htm

U. S. Department of Health and Human Services, U. S. Food and Drug Administration. (2009).  Overview of influenza surveillance in the United States.  Retrieved from http://www.cdc.gov/flu/weekly/overview.htm
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