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What You Need to Know about Preventing and Treating the Flu

In the winter of 2011, Sandra brought two of her four children to my private practice in Charlotte, North Carolina. It had been a difficult flu season for everyone in the family except her son Hasan, who hadn’t shown any signs of illness. Sandra’s daughter had tested positive for flu and after checking on her progress, we marveled at how Hasan had managed to escape the highly contagious virus.

What was the difference between Hasan and the rest of the family? One year prior, on my recommendation, Sandra had placed Hasan on an anti-inflammatory diet, eliminated gluten and dairy,  and incorporated some foundational supplements: a probiotic, a whole food supplement, omega-3 fats in the form of fish oil, and vitamin D (during winter). The nutrition changes plus supplements worked synergistically to decrease the body’s overall systemic inflammation.

At that time I was only recommending these nutrition changes for children on the autism spectrum, like Hasan. Research suggests a small percentage of these kids may experience an improvement in some of their symptoms autism symptoms as a result of decreasing their systemic inflammation. An additional benefit of minimal inflammation is that it allows the immune system to work optimally, which is an ideal state for the body, all year long, not just the wintertime. 

Of course, I can’t be certain whether his anti-inflammatory diet, his supplements, or something else prevented him from getting the flu that year. However, this family’s experience is why I recommend the Healthy Kids, Happy Moms Program of foundational supplements and an anti-inflammatory diet (including minimal or no dairy and gluten). The less inflammation in the body, the more easily it can mount an immune response. While Hasan dodged the flu that season, even those who are on perfect supplements and perfect nutrition can still get sick at times. However, in my experience, the illness often runs a shorter course with less severe symptoms in individuals who have minimal inflammation as compared to those with excessive inflammation.

Integrative medicine combines the best of both conventional and holistic treatments when fighting the flu. We will cover both in this blog.

Understanding the Flu

The flu is a highly contagious respiratory illness caused by influenza viruses. It spreads in tiny droplets that are released into the air when people cough, sneeze or talk, or when people touch contaminated objects or surfaces, such as phones or doorknobs.

The incubation period, or the time from when you are exposed to the virus to when you start showing symptoms, is typically one to four days. People are most contagious in the first three to four days after they become symptomatic.

The most common symptoms are fever, cough, and sore throat. Young children and babies may have higher fevers and more severe respiratory symptoms. Other symptoms include chills, headache, runny or stuffy nose, fatigue, body aches, and loss of appetite. Some children may also present with an ear infection.

While most cases of the flu are mild, some can be life-threatening and even fatal. Children younger than five are most at risk, but especially those under two. In addition to children, pregnant people, adults over 65, and those with weakened immune systems are at higher risk for getting ill.

Most people with uncomplicated illness improve gradually over about a week, although cough symptoms may linger for another week or so.

Flu tests

Many other viruses can produce some overlapping symptoms with the flu. A healthcare professional will begin the diagnosis by evaluating the patient’s symptoms and history of illness. They will also perform a physical examination, including listening to the lungs and checking for signs of infection, such as redness in the throat or swollen lymph nodes, to rule out any other conditions like strep throat.

There are two tests for the flu, RIDT (rapid influenza diagnostic test) and RT-PCR (reverse transcription-polymerase chain reaction) test. Both rely on a sample taken by swabbing either the nose or the back of the throat. Nasal swabs are most commonly taken to diagnose flu and other respiratory illnesses, such as RSV, COVID-19, or adenovirus. If strep is a concern, it will be tested by swabbing the throat.

 RIDTs can provide results within 10-15 minutes. However, they are not as accurate as other types of tests and may produce false negatives or false positives.

The RT-PCR test is highly accurate. It works by amplifying small amounts of viral RNA (genetic material) in a sample of respiratory secretions. RT-PCR tests take longer to provide results than RIDT tests, but they are generally considered the gold standard for diagnosing the flu.

The accuracy of the test may vary depending on the stage of the illness and the type of test being used. In some cases, the healthcare provider may diagnose the flu based on the symptoms a person is experiencing, even if a test is negative.

Little girl in striped pajamas with hand to forehead. Adult reading a digital thermometer in the foreground

Flu Prevention

Integrative medicine combines the best of both conventional and holistic treatments when fighting the flu. We will cover both in this blog, starting with vaccines.

Flu vaccines

The Centers for Disease Control and Prevention (CDC) advocates for the annual flu vaccine. There are three types of influenza viruses: A, B, and C, and within each type, there are many different strains (a flu strain is a specific variant of the influenza virus). Each year scientists work to match the strain in the vaccine to the flu viruses in circulation.

Vaccines that match the exact seasonal strain provide the most protection. If scientists get it right, the vaccine reduces the risk of illness by about 40% to 60%. If the vaccine doesn’t match, it will provide little protection against those viruses, but may offer protection against other circulating strains.

The protection conferred by the vaccine also depends on the health of the person receiving the vaccine, including how effectively they are able to mount an immune response. The CDC offers a table on flu vaccine guidelines on its website. Parents may use this information to discuss the risk vs benefits of the flu vaccine with their child’s doctor.

The CDC recommends the flu vaccine for everyone six months of age and older, especially those in the following categories:

  • Healthcare workers who provide direct patient care
  • Caregivers to children under six months old
  • Pregnant people
  • Children between the ages of six months and two years
  • Adults 65 years and older
  • People with asthma
  • People with heart disease
  • People with diabetes
  • Anyone with weakened immune systems, and their caregivers. Typically, people with autoimmune conditions like rheumatoid arthritis or lupus are treated with immunosuppressants. Some cancer treatments will also suppress the immune system. Ask your doctor if you are unsure about how your medication interacts with your immune system.

Support the immune system

Taking a year-round approach to overall health, in addition to vaccines, gives each of us a much larger and more effective toolbox to prevent all illnesses, not only with flu, as I outlined above in Hasan’s case.

I outline the way systemic inflammation (driven by diet and lifestyle factors, such as highly processed foods filled with sugar and carbs) prevents the immune system from working optimally in both my book, Healthy Kids Happy Moms: 7 Steps to Health and Prevent Common Childhood Illnesses, and in a comprehensive blog post, Inflammation and Recurrent Illness: A Parent’s Guide.

The following guidelines help support the immune system throughout the year, especially during flu season:

  • Maintain optimal Vitamin D levels (40 – 60 ng/mL). Research has found that those with lower Vitamin D levels have a greater susceptibility to the flu and other viral respiratory illnesses
  • Nasal saline spray or rinse for children and for adults. Using a saline rinse helps to physically remove bacteria and viruses that can cause illness. The saline keeps our mucous membranes moist, which helps increase the movement of cilia (hairlike structures that help move microbes out of the nasal passages and down into the GI tract where they are eliminated). The NeilMed Sinus Rinse comes with a refillable 4-oz plastic bottle and 60 premixed packets of pH-balanced sodium chloride and sodium bicarbonate. Use only distilled or previously boiled and cooled water to mix the packets.
  • Eat the rainbow! Colorful fruits and vegetables contain essential vitamins, minerals, and phytonutrients that keep our bodies in balance and our immune system supported. Add garlic to your meals for its antimicrobial and immune-boosting properties! A recent study from the American Gut Project showed that people who ate 30 or more different types of plants (fruits, vegetables, legumes, grains (excluding white pasta and rice), nuts and seeds, and herbs and spices) per week had a more diverse microbiome than those who ate ten or fewer. A diverse microbiome is vital for a robust immune system. Challenge yourself and see how many different plants you can eat each week!
  • Minimize added sugars. Research has shown that excessive sugar consumption may suppress the immune system for hours after eating. One study found that eating 100g of sugar significantly impaired the immune system’s ability to kill bacteria for up to five hours!
  • Sleep. During sleep, the body produces immune cells and molecules, such as T cells and cytokines, which help to fight off infections and other diseases. Lack of sleep or poor sleep quality can reduce the production of these immune cells and impair the immune system’s ability to function properly.
    • Newborns (0-3 months): 14-17 hours
    • Infants (4-11 months): 12-15 hours
    • Toddlers (1-2 years): 11-14 hours
    • Preschoolers (3-5 years): 10-13 hours
    • School-aged children (6-13 years): 9-11 hours
    • Teenagers (14-17 years): 8-10 hours

Treating the Flu

Okay so you did (or did not ) do all of the wonderful immune-boosting things listed above, and you still got the flu! Now what?

  1. Don’t be afraid to let your child have a fever!
  2. Understand the risks and benefits of fever reducers and antiviral medications
  3. Learn how to address flu symptoms naturally

The Benefits of Fever

Allowing your child to run a fever stimulates their immune response and increases the performance of germ-fighting cells. Plus, the higher temperature creates an unfavorable environment for the virus, which means having a fever can actually help your child recover faster!

Four steps to the Wet Sock Technique for reducing flu symptoms

I would reserve the wet sock method for kids at least one year and older.

What temperature qualifies as a fever?

  • Rectal, ear, or temporal artery temperature of 100.4 (38 C) or higher
  • Oral temperature of 100 F (37.8 C) or higher
  • Axillary (under the arm) temperature of 99 F (37.2 C) or higher (Mayo Clinic)

Keep in mind that by suppressing the fever, we actually shed the virus for a longer period of time. This can increase the transmission rate of the flu, leading to larger epidemics with a more severe case of the illness. Instead of reducing fever, it may be better to allow the body to use it as a tool to help fight off infection.

Oftentimes, for generally healthy children who do not have an underlying illness or history of febrile seizures, it is okay to let the fever run its course and allow their body to experience the beneficial effects. However, if you do decide to treat with a fever-reducing medication such as acetaminophen (Tylenol) or ibuprofen (Motrin and Advil), it may help them feel a little better so they can stay hydrated and sleep better during the illness. Just remember they may start to feel better while still contagious!

Please remember, your child’s behavior is more important than the number on the thermometer.

Fever reducing medications

Always check with your pediatrician before making the decision to allow the fever to remain elevated. In some cases, such as children with a history of febrile seizures, it is important to treat fevers proactively.

Proper dosing is imperative for both acetaminophen and ibuprofen. Acetaminophen can cause liver damage if it is taken in large amounts, or too frequently, over a period of time. It can also deplete the body’s stores of glutathione, our master detoxifier. 

Ibuprofen is an NSAID (non-steroidal anti-inflammatory drug) and I prefer it over acetaminophen as a fever reducer for kids over six months of age. It has a longer window of action, six to eight hours, versus four to six hours for acetaminophen. The longer timeframe can be especially helpful at night. Ibuprofen is cleared through the kidneys and can also impact the lining of the GI tract (that area we work so hard to build up using integrative and functional medicine).

If a fever reducer is needed it is important to use one, especially if your child is so uncomfortable that they don’t want to drink, are unable to sleep, or if it is recommended by your doctor.

Checklist when using a fever reducer in kids

  1. Write down the time you give each dose so there is no confusion about what medication was given and at what time, especially if more than one adult in the home is administering the medication.
    • Acetaminophen can be given every four to six hours
    • Ibuprofen can be given every six to eight hours
  2. Only give Ibuprofen if your child is well hydrated (since it is cleared through the kidneys) and ideally give them something to eat to help protect their stomach, even if it is something small like applesauce or a piece of toast.

Tamiflu antiviral medication

Tamiflu (oseltamivir) is an antiviral medication used to treat the flu. The medication is most effective at reducing the severity and duration of the flu when it is taken early in the course of the illness, which is why we recommend taking Tamiflu as soon as possible after the onset of flu symptoms—ideally within 48 hours.

While Tamiflu can reduce symptoms and shorten the course of illness, there are also several common, and rare, side effects to consider.

The most common side effects of Tamiflu are nausea, vomiting, diarrhea, and stomach pain. These side effects are usually mild and go away on their own after a few days. Other possible side effects of Tamiflu include dizziness, headache, fatigue, fever, and cough. However, in rare cases, it has been associated with more serious neurological side effects, particularly in children. These side effects include hallucinations, seizures, and behavior changes, such as self-injury and delirium.

If you or your child experience any of these serious side effects while taking Tamiflu, stop taking the medication and see a healthcare provider immediately. These neurological side effects usually have an abrupt onset when taking Tamiflu and resolve rapidly once the medication is stopped.

Relieving Flu Symptoms without Medications

Wet Sock Treatment. Cold therapy is an old European remedy for symptomatic relief of cough congestion. Cooling off any area of the body temporarily constricts the blood vessels. The body reflexively increases blood flow to that area, increasing our overall circulation. Increased blood flow throughout the body (muscles included) seems to help decrease head and nasal congestion, allowing a better night’s sleep. Theoretically, the increase in circulation would also help activate the immune cells.

Step by step:

  • Get two pairs of socks, one light cotton, and the other a little thicker wool pair. 
  • Wet the thin pair in cold water and ring them out thoroughly. 
  • Place them on the child’s feet at bedtime.
  • Next put the dry, thicker socks over the top of the thin ones and kiss the little one goodnight.

I would reserve the wet sock method for kids at least one year and older.

Reduce congestion and thin out secretions:

  • Use a saline nasal spray for kids up to three years old

  • Use a bulb syringe or NoseFrida the “snotsucker” to suction your child’s nose

  • Supplement with PureZyme, an enzyme that helps to thin mucus secretions and lower inflammation
  • Keep your child hydrated. Offer water frequently, and do not worry about food if they don’t want to eat To increase water intake, add an electrolyte replenisher such as Ultima (for kids 1 year and older).

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Cold Therapy for Adults. The “Wim Hof Method” of breathing, meditation, and full-body cold water immersion has some extremely compelling research on its immune-boosting and anti-inflammatory impacts. One study took two groups of adults. One group was trained for ten days on the Wim Hof technique and the control group was not. Then they were all injected with E. coli endotoxin. The group trained had lower inflammatory markers and fewer flu-like symptoms. This is one of my favorite ways to stay healthy and feel vibrant and focused all day! I do three rounds of 30 breaths, followed by meditation and then two minutes of cold immersion.

NOTE: Cold Therapy studies have only been done on adults. I do NOT recommend the full-body cold immersion for kids because it may be too difficult for their bodies to tolerate and recover quickly from the extreme temperature differential.

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Thank you, Chloe Pinner, CPNP, for your help in researching and writing this post. Chloe is the pediatric nurse practitioner at Dr. Kilbane’s private practice in Charlotte, North Carolina.

References:

https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm

https://www.cdc.gov/flu/symptoms/testing.htm

https://doi.org/10.1093/ajcn/26.11.1180

https://www.mayoclinic.org/first-aid/first-aid-fever/basics/art-20056685

https://www.mayoclinic.org/drugs-supplements/oseltamivir-oral-route/side-effects/drg-20067586?p=1

https://www.nature.com/articles/s41422-020-0332-7 (microbiome & immune system)

https://pubmed.ncbi.nlm.nih.gov/24799686/  (cold therapy)

https://news.harvard.edu/gazette/story/2017/02/study-confirms-vitamin-d-protects-against-cold-and-flu/

https://academic.oup.com/ajcn/article/91/5/1255/4597253?login=false (flu and vitamin D in school children – Japan)

https://www.frontiersin.org/articles/10.3389/fnut.2021.799709/full

https://royalsocietypublishing.org/doi/10.1098/rspb.2013.2570 (suppressing fever)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4417560/ (garlic)

https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2768627 (nasal saline flush)

https://www.scirp.org/pdf/OJI20110200003_20641104.pdf (sugar and the immune system)

https://www.sleepfoundation.org/how-sleep-works/how-much-sleep-do-we-really-need

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