The Flu*The information on this website is not intended to diagnose, treat, cure or prevent any disease.
What is the Flu?
The “flu” is an abbreviated term which is short for influenza. Influenza is a viral disease which typically manifests as a respiratory infection, which can range greatly in severity. A common misconception is that influenza causes diarrhea and vomiting. This is true in children, but when it is seen in adults, it is typically due to an unrelated infection. The early signs of influenza resemble the Common Cold, and it may be difficult to distinguish the two if symptoms remain mild.
Although some cases of influenza can be quite severe, most people will recover in about 2 weeks with supportive at-home care. For the immunocompromised or people with other ongoing health conditions, however, influenza can be deadly. Occasionally, the immune system can become over-activated in case of influenza, resulting in autoimmune disease called Guillan-Barre syndrome. Sometimes, influenza can also cause severe neurologic signs which may lead to permanent damage.
Like the Common Cold, influenza tends to be a seasonal disease, hitting peak prevalence during the winter months. It is not well understood why this is the case, however it is thought to be related to people being indoors in enclosed spaces more frequently with dry air, which may impair immune defenses. There are other theories that the seasonality may correspond with fluctuations in vitamin D levels.
Influenza is a serious global disease, killing more than half a million people every year around the world and causing major economic impacts. Approximately every 30 years or so, a strain emerges that is more virulent than normal, and these are capable of killing many more people. The worst known flu pandemic in history occurred in 1917-1918, killing an estimated 50 to 100 million people around the world.
The most common symptoms of the flu are:
- Sore throat
- Runny nose
- Nasal congestion
- Loss of appetite
- Muscle aches
The most commonly ordered test for diagnosing influenza is called the “rapid influenza diagnostic test” or “rapid molecular assay.” This is a bed-side test which can be performed easily in a clinic. A swab is taken of the throat or nose and can provide results in approximately 15 minutes. In scenarios where there is a serious outbreak (>70% of the population is affected), confirmatory diagnostics are considered unnecessary prior to initiating treatment as long as the symptoms are consistent with influenza.
In addition to the rapid molecular assay, other diagnostics may be recommended depending on your particular symptoms or concern for other complications. These diagnostics may include:
- Chest x-rays
- Routine blood work
- Blood pressure measurement
- Virus isolation test
Treatment recommendations will vary depending on the severity of the infection. Mild infections can usually be managed from home with bed rest and oral fluids to avoid dehydration. More severe cases may benefit from medications, however.
Pharmaceuticals and Medical Procedures:
- Anti-Viral Medications: There are two classes of antiviral medications. The most well-known class consists of neuraminidase inhibitors. The drugs Tamiflu (oseltamivir) and Relenza (zanamivir) are members of this class. Overall, the neuraminidase inhibitors tend to provide modest benefit, but carry a number of risks which limits their use. Increasingly, viral resistance to these drugs is noted. The other class of drugs is called M2 inhibitors. These drugs target a specific protein on the virus particle. There is a great deal of viral resistance to these drugs as well.
- Acetaminophen: This is an over-the-counter medication which can be an effective fever reducer as well as pain reliever. Influenza often causes muscle pain as well as headaches.
- Non-Steroidal Anti-inflammatories: Drugs like ibuprofen and naproxen may also help relieve pain during influenza infections. Aspirin can also be used, but it should not be used in children and teenagers; it is associated with a severe liver condition called Reye’s syndrome when used during influenza infections.
- Decongestant Medications: Decongestants like phenylephrine and pseudoephedrine can help reduce the severity of nasal congestion and alleviate runny noses. These medications are usually stimulatory in nature and may increased blood pressure. There are also decongestant nasal sprays which may have fewer systemic side effects.
- Cough Suppressants and Expectorants: Cough syrups and expectorants can decrease the severity and frequency of coughs, while at the same time making the coughs more productive.
- Antibiotics: These are not typically needed for the flu itself, however secondary bacterial infections may affect the ears, sinuses, and lungs. In these scenarios, antibiotics may be required.
- Mentholated Vapor Rubs: These products do not actually relieve congestion; however, they do provide the sensation of relief and they may facilitate sleep.
- Menthol Throat Lozenges: Throat lozenges can help provide temporary topical relief by temporarily numbing the back of the throat with menthol.
There are many non-pharmaceutical options which may provide a great deal of relief to people fighting the flu.
- Vitamin C: Vitamin C may reduce the severity of symptoms by up to 85% compared to people who don’t take it during an infection. Take it early when symptoms start for maximum benefit.
- Zinc: Zinc is important for maintaining the health of the immune system. It plays a major role in T-cell function, which help eliminate infected cells.
- Tea with Honey: Warm beverages sooth the throat and the addition of honey may provide a coating texture. Honey also has antibacterial properties itself, which may be beneficial in preventing secondary infections.
- Humidifiers: Keeping the air human can help avoid further irritation to the throat and may reduce the urge to cough.
- Gargles: Salt water, tea, or apple cider vinegar-based gargles may help provide relief to a sore throat.
- Elevate your head when sleeping: This will help encourage drainage of the nasal passages while sleeping and make it easier to breath. It can also help reduce the need to cough.
- Probiotics: Although probiotics are generally thought of as being for maintaining GI health, gut health is important for supporting the entire body’s immune system. Consider eating foods rich in probiotics like yogurt, kombucha, or kefir to help maintain your intestinal flora.
- Diet: Drink plenty of fluids. Eating soups with clear broth help maintain hydration and can help relieve the discomfort of congestion and sore throats. Eat plenty of food rich in vitamin C and polyphenols (mostly fruits and vegetables).
- Epsom Salt Baths: A warm bath in Epsom salts can be relaxing as well as provide magnesium and other minerals across the skin. This can help relax and the warm water may help relieve some congestion.
- Other Supplements:
- P73 Oregano Oil: The essential oils in oregano have antiviral and antibacterial properties. P73 Oregano oil has a high polyphenol content (73%) which may make it more effective as a remedy.
- N-Acetylcysteine: This powerful antioxidant seems to provide protection against influenza infections, making them less likely and shorter in duration. It can also help thin mucous in the airways, making it easier to expel when coughing.
- Echinacea: This is an herb that has a long history of use in respiratory infections and it may be helpful against influenza.
- Elderberries: There is abundant data showing that elderberries have anti-influenza properties. Compounds found in the berries block the virus’ ability to infect cells, neutralize the virus, and appear to activate the immune system.
- Olive Leaf Extract: Olive leaf extract boosts the immune system and has antiviral properties.
- Beta-glucan: This component of yeast and mushrooms appears to boost the immune system, helping to fight infections.
- Buckwheat Honey: Honey made from buckwheat pollen appears to be effective at reducing the severity and frequency of coughs. Take honey mixed in tea or eaten as a food
- Larch arabinogalactans: These are complex sugars from the wood of the larch tree. They are believed to stimulate the immune system during infections.
- Astralagus: An herb with antiviral and antibacterial properties.
- Hyssop: An antiviral and expectorant natural remedy.
- Ginseng: Ginseng has been used for centuries for a variety of illnesses and may be helpful against influenza as well.
- Garlic: Garlic is known for its immune-boosting properties. It can be taken as a supplement or added to food for its benefits.
- Chamomile Tea: Chamomile is well-known to have anti-inflammatory properties and can help relieve throat pain.
- Peppermint: Peppermint oils and peppermint tea contain natural menthols which may provide relief from a sore throat.
- Lomatium: This is another herb with antiviral properties and has a long history of use in upper respiratory infections.
- Oregon Grape: This is an immune-supportive supplement which antiviral and antibacterial properties.
- Capsaicin: Capsaicin is the hot compound found in many peppers such as cayenne. This is a natural pain reliever which induces the body to release its own opioids and blocking the pain response. A little goes a long way, but it can be added to teas or gargles to help relieve throat pain.
- Marshmallow Root: Marshmallow root contains a thick substance which helps coat the throat and protect the inflamed membranes.
- Slippery Elm: This is another plant with thick, mucus-like compounds in it which coat the throat. Slippery elm has a long history of use for sore throats.
- Vitamin A: This vitamin is important for maintaining immune health and the health of mucous membranes.
- Vitamin D: Vitamin D is important for overall immune function health. There is speculation that influenza tends to increase during the winter months due to relative vitamin D deficiencies caused by shorter daylight periods and people being outside less.
The flu is caused by influenza viruses, of which there are four types: A, B, C, and D. Types A and B are the ones the spread around the world every year causing epidemics. Type C viruses infect people, but they don’t appear to spread as easily and are usually much milder in nature. Influenza type D is an infection of cattle and has not been reported to cause disease in people, although there is speculation that it potentially could.
You may have heard of the flu referred to by combinations of H and N (i.e., H1N1). This is a classification scheme for influenza A viruses based on the type of proteins the virus expresses on the surface. H stands for the protein hemagglutinin and N stands for the protein neuraminidase. There are multiple types of these proteins which are numbered. Usually, the viruses which cause problems in people are H1N1 or H3N2 subtypes. Sometimes, these types are found in animals, such as birds or swine, and there is concern that they could become infective to people. If a new viral strain were to emerge which people have never been exposed to before, it may be capable of causing even more serious disease. There is ongoing concern that H5N1, a type of avian influenza, could jump to people and cause high mortality if it were to spread.
When serious disease occurs, it is often to due overactivation of the immune system. Infection with some strains can cause a “cytokine storm.” This means that a surge of pro-inflammatory substances is produced by the body, which over-mobilizes the immune system and causes massive inflammation. It is thought that highly lethal strains of influenza triggered these cytokine storms.
Clinics for Management of the Flu
Most primary care facilities will be able to diagnose and manage influenza. It is easy to become dehydrated from the flu due to high fevers and inability to drink enough fluids. Treatment may necessitate hospitalization.
Links to Articles, Research, and Other Information to Help You Heal from the Flu