Swine flu over the cuckoo's nest

Nearly every patient is asking me these days if I have any thoughts about the new novel H1N1 flu, also known as the swine flu. Yes, I do have some opinions. Of course, like everything else, this should not be construed as medical advice, talk to your doctor, blah blah blah.
First, let me apologize to Chicago magazine for baldly stealing the title of this article from an article they had back after the 1976 swine flu vaccination fiasco. In case you don’t remember, in 1976 there were 2 strains of a swine flu that hit the US but only resulted in one death (they were fairly limited in how much they spread). Public-health officials got alarmed (remember that the 1918 influenza that killed 10-20% of those infected (over 500,000 Americans died) was thought to be a swine flu) and recommended immunizing the entire population of the country. The vaccinations started in october and the first day three seniors died shortly after receiving the shot (though they were never proven to have died from the vaccine and there didn’t seem to be any further events like this reported) and then there were some cases of Guillain-Barré Syndrome (GBS), a few of which resulted in death. By the time the vaccination program ended, over 48 million people had been vaccinated (over 20% of the population). There were 1098 cases of GBS reported, though only half of those were linked to the vaccination, and 25 people with GBS died. This means that a little more then 1 in 100,000 people got GBS and one in twenty of them died. So, the vaccine wasn’t especially dangerous, but it was more dangerous than the swine flu that year.
Now, the swine flu this year is clearly nowhere near as deadly as the 1918 influenza. Recently, it’s been estimated that 10% of New York City has already had the flu and there no reports of large numbers of empty apartments cleared out by the flu. Also, England recently
downgraded their estimate of the number of people who will die from it to as low as 3,000 (if only 5% are infected) or more likely around 19,000, while the regular flu kills 6-8,000 each year.
So, while this novel flu is clearly more dangerous than the regular flu, it’s not the plague that was being predicted. As for the various conspiracy theories about the virus being man-made because it contains DNA common to other flu viruses, they conveniently manage to neglect the fact that this is how viruses normally adapt and rearrange themselves.
The current swine flu is susceptible to treatment with oseltamivir (Tamiflu) or zanamivir (Relenza)
according to the CDC, but they only trim 1-2 days off the duration of the illness (amantadine seems to be ineffective against it). Neither of these have ever been tested on pregnant women, Tamiflu has been tested on kids down to 1 year of age while Relenza is only approved for children 7 and over, and you may recall the report of some kids in Japan jumping off a building during a Tamiflu-induced delirium during the bird flu craze. Generally, however, the drugs are well-tolerated but will only do their trimming of 1-2 days off the total duration of the flu if the drugs are started in the first 2 days of the flu. Also the drugs should be limited to only those at high risk for complications: the ill and infirm.
The vaccine is supposedly safe and effective (at least, in so much as
any influenza vaccine is safe and effective) despite not being available yet (actually, there are reports of it just starting to become available). I’m not a fan of the regular flu vaccine and not much more of a fan of this one. Of course adding any thimerasol (ethyl mercury) containing vaccine to your body should only be done for sound benefit, realizing that the effects of the mercury may not manifest for years. While there have been some alarms sounded about squalene in the vaccine causing GBS and worse, the only official information I’ve found about squalene in the vaccine suggests that it isn’t being used now and would only be used if the vaccine supply suddenly needed to be expanded massively, however it’s listed under various names so it may be in there and people may not know it.
So, on to the big question: what can you do to prevent yourself from getting swine flu? It’s fairly elementary:
1. Wash your hands. The virus gets into you usually by contact, so keep ‘em clean.
2. Keep your fingers out of your face. It needs to get into your body and your face has the most enticing routes of entry. 2 lines of defense: a moat and a wall.
3. Take some vitamin D. A
recent article shows the clear association between season and latitude (and therefore vitamin D status back when people went outside) and 1918 influenza pandemic survival: more vitamin D led to less death. Reports by 2 physicians who keep their patients’ vitamin D up to good levels shows a profound reduction in influenza among those replete with vitamin D. If you can get your 25-OH vitamin D level checked, take enough to get it up to 50 ng/ml (it generally takes 1,000 iu daily to make it go up 10 points and can take 3 months to level off, so you could double the dose for the first week). If you can’t get your level checked, take 2,000 iu daily (you could double it the first week). Remember all these guides are for normal sized adults and vitamin D does have some toxicity at higher levels (over 150 ng/ml), so don’t go crazy with it.
4. Take some vitamin C every day. White blood cells need vitamin C to do their jobs. Give them what they need, at least 1,000 mg daily, spread it out if you can manage it.
5. Get enough sleep. I can’t say enough about the importance of sleep for the immune system.
6. If you do get sick, IV vitamin C may knock the flu back quite a bit (if not completely eliminate it). Read
dr. Klenner’s papers about his experience with using IV vitamin C for various illnesses. See also dr. Weeks’ article on using vitamin A at the onset of the flu.

Vitamin D (again) reduces cancer risk

It's starting to get tedious. In a recent article in the American Journal of Clinical Nutrition, Vitamin D (this time with calcium) reduces the risk of cancer (in a group of >55 year old Nebraskans) over a 4 year period by 76% (95% confidence interval 40-91%). At least they gave a useful amount of vitamin D3 (1100iu/day). Interestingly, even calcium (1500mg/day) alone showed a substantial lowering of risk, but it wasn't significant.
Now, the important thing to appreciate is that this study was only 4 years and that your typical cancer will have been growing for several years before it is diagnosed. So, is this a reduction in the incidence of cancers (less cancers starting), slowing of growth (thus fewer showing up over the study), or stopping the cancers that had already begun? Frankly, with such a dramatic improvement, it could be all three.

Catching up with vitamin D

A recent (June 29, 2007) article points out that even in Hawaii, 11.1 hours/week of total body skin exposure (on average) is inadequate to get 51% of the participants to have an adequate amount of vitamin D (which they define as a level of 30 ng/ml, lower than I like). As the lead author states, "This implies that the common clinical recommendation to allow sun exposure to the hands and face for 15 minutes may not ensure vitamin D sufficiency."
This echoes nicely what I've been telling patients for some time based on my own experience of having pale skin, walking to work and taking supplements with 400 iu of vitamin D3 daily and still having a level of only 23: "15 minutes of sun exposure to hands and face daily adequate? A lie. 400 iu daily adequate? A lie."
The article ends with a conservative recommendation of "treating vitamin D deficiency with vitamin D supplementation, "it seems prudent" to aim for a serum 25-hydroxyvitamin D concentration no greater than the maximum produced by natural UV exposure; i.e., approximately 60 ng/mL."
They don't mention that it commonly takes 2,000-4,000 iu daily of D3 to get anywhere near that level, a dose that will give doctors with no nutritional background fecal incontinence. This dose will not get anyone near the lowest toxicity level seen of 150.
So, this article adds to the stack of journal articles supporting higher levels of vitamin D, but will it catch on among conventional docs? Not unless there are vitamin D reps coming in with donuts and pens that say "Vitamin D3" on them. If we're lucky, however, I'm wrong and every doc will start checking vitamin D levels, then recommending adequate vitamin D supplementation (for pennies a day) and cut the rates of cancer and degenerative diseases by huge amounts (some estimates say 50% reduction in cancer with adequate vitamin D).
If you want to learn more about the benefits of vitamin D, the Vitamin D council (
.com or .org) is a good resource.