While the mortality rate for the now prevalent late-2009 season novel H1N1 flu strain is far lower than seasonal-flu death rates in prior years, needless death is always regrettable. According to published medical reports, most Americans dying of flu-related illness need to be immediately tested for nutritional deficiencies upon hospitalization or physician examination as they are likely to exhibit shortages of vitamins and trace minerals.

Despite strong evidence that nutrient adequacy is important in producing antibodies following vaccination and in favorably controlling the immune response, it is not yet common practice in American hospitals or doctors' offices to test for nutrient deficiencies.

The Centers for Disease Control reports 29% of patients who succumbed to the flu developed secondary infections in their lungs resulting in pneumonia. [Morbidity & Mortality Weekly Reports September 29, 2009/58(Early Release); 1–4]

Public health authorities are calling for more vaccines, in this case, pneumococcal vaccine (Prevnar®), while ignoring published data showing life-threatening influenza is likely triggered by nutritional deficiencies, particularly vitamin E, vitamin D and the trace mineral selenium.

More recently researchers at the Department of Preventive Medicine and Community Health, University of Medicine and Dentistry–New Jersey Medical School, Newark, said "undernutrition or malnutrition adversely affects host defenses against many invading microorganisms, thereby increasing the severity of infection." These researchers call attention to adequate levels of selenium and vitamin E in reducing the severity of infectious disease as well as inhibiting human-to-human transmission. [Clinical Infectious Disease 2007 Aug 15; 45(4):470–4]

Over reliance upon vaccines, antibiotics, anti-viral drugs

It goes unexplained why health authorities, in an age of antibiotic, vaccine and anti-viral drug resistance, continue to ignore what University of North Carolina researchers call the "the neglected virulence factor: host nutritional status." The nutritional status of the individual not only controls immunity but also the genetic makeup of the attacking virus, say these researchers, who wrote in 2004 that "the nutritional status of the host, until recently, has not been considered a contributing factor to the emergence of infectious disease." [Trends Microbiology 2004 Sep; 12(9):417–23]

Spanish flu deaths reexamined

A review conducted by Dr. Anthony Fauci, chief of the National Institute of Allergy and Infectious Diseases, examined autopsy records, lung tissue sections and bacteriologic data from subjects who succumbed to the Spanish flu of 1918–19 and conclude that they largely died of bacterial pneumonia. [Journal Infectious Disease 2008 Oct 1; 198(7):962–70] While modern medicine does have access to antibiotics, their overuse could imperil the world. Widespread use of antibiotics during a flu pandemic would certainly spark an increase in germ resistance. Modern medicine is walking out on the end of a limb here.

The 1918 Spanish flu occurred prior to the discovery of the first penicillin, the first antibiotic. Flu outbreaks since the availability of antibiotics have not been so deadly. But it also needs to be said the Spanish flu occurred before the 1930s, the decade when most vitamins were discovered, and this may explain why, with widespread food fortification, there has never been another flu epidemic in America quite so deadly.

While antibiotics like erythromycin and chloramphenicol do suppress the growth of bacteria like Escherichia coli and Staphylococcus aureus, which are known to secondarily result in flu-related pneumonia, these antibiotics diminish the production of natural antimicrobial peptides such a cathelicidin, a molecule dependent upon vitamin D for synthesis. [FASEB J. 2007 Apr; 21(4):1107–16] Natural immunity is suppressed when antibiotics are used.

Making flu vaccines work

The call this year for the public to require two rather than just one flu shot is admission that adequate immunity was never achieved in prior vaccination campaigns.

Not only does nutritional supplementation help avert flu-related death, but it also improves antibody production following vaccination. Inoculation against the flu is typically not very effective in generating antibodies among senior adult populations, the greatest at-risk group to develop flu-related pneumonia and to die. Flu vaccination among retirees is only about 20–35% effective in producing adequate antibody response. Well-made multivitamins that include vitamins C, E and E, folic acid and selenium are likely to serve well here. [J Gerontology A Biol Sci Med Sci. 2002 Sep; 57(9):M563–6; Vaccine. 2005 Feb 10; 23(12):1457–63; J Parenteral Enteral Nutrition 2004 Sep–Oct; 28(5):348–54]

Calming an over-responsive immune system

Old animals subjected to infectious diseases develop more pronounced inflammation (as evidenced by increased markers of inflammation – COX-2 and TNF-alpha). Vitamin E calms an over-responsive immune reaction. [J Leukocyte Biology 2008 Oct; 84(4):900–14] This is important because the arrival of armies of white blood cells at the site of infection, such as the lungs, can induce inflammation and result in the lungs rapidly filling up with fluid, literally drowning the patient. One experiment shows that vitamin E enhances protective T-cells (white blood cells made in the thymus gland) and inhibits inflammation that results from an over-responsive immune system. [Immunology Review 2005 Jun; 205:269–84]

Prevent infection altogether

Of course, the best approach is to prevent flu infection altogether. Vitamin E is particularly helpful here because it works in the most vulnerable subjects – the aged. Vitamin E has been shown to reduce viral counts in old, but no6 young animals. [Proceedings Nutrition Society 1999 Aug; 58(3):697–705] Human studies show vitamin E-sufficient nursing home patients are far more resistant to respiratory infections. [Immunology Review 2005 Jun; 205:269–84]

Sulfur compound to the rescue

Another underutilized remedy is N-acetylcysteine (NAC), available in most health food stores. NAC is a sulfur compound and precursor to glutathione, a universal antioxidant produced in all living cells. NAC has been in use for more than 50 years for its ability resolve respiratory troubles via dissolution of thick mucus in the lungs and bronchial tree.

In a study conducted at 20 centers in Italy under the direction of the Institute of Hygiene and Preventive Medicine, University of Genoa, Italy, involving 262 subjects, 78% of whom were age 65 years or older who either received 600 milligrams NAC or a placebo tablet twice a day (1200 mg NAC total per day) for 6 months, the effects of NAC were profound. Subjects given NAC experienced a significant reduction in the frequency of flu-like episodes as well as reduced severity of symptoms. While about the same percentage of subjects in both groups exhibited antibodies to the H1N1 Singapore flu strain, only 25% of those in the NAC group developed flu symptoms compared to 79% in the group that received in inactive placebo tablet. [European Respiratory J. 1997 Jul; 10(7):1535–41] NAC even exhibits strong anti-viral and anti-inflammatory properties against the dreaded H5N1 bird flu, a viral strain that is not easily transmitted to others, but has a 60% mortality rate (6 in 10 infected die). [Biochemical Pharmacology 2009 Sept 2]

Vitamin D

Long ago when medical researchers were making a connection between vitamin D deficiency and rickets (bone softening in growing children), they noticed that children with rickets also experienced a lot of infections. A study in 1981 showed that vitamin D–deficient mice exhibit sluggish white blood cells called macrophages which literally digest roaming viruses and bacteria. When given vitamin D, the macrophages vigorously pursue germs while normalizing inflammation. [Calcified Tissue International 1981; 33: 673–76] Neutrophils that comprise 70% of the white blood cells that rapidly respond to infection also are very sluggish without vitamin D. [Acta Paediatrica Scandinavia. 1976 Nov; 65(6):695–9]

A team of vitamin D researchers now claims this nutrient, made naturally in the skin upon exposure to solar ultraviolet-B radiation, "has profound effects on human immunity and in normalizing the immune response so as not to create inflammation that can fill the lungs with fluid in cases of influenza." [Epidemiology Infection 2006 Dec; 134(6):1129–40] It is no wonder now why the flu comes in winter months when vitamin D levels are low. Vitamin D would also be appropriate among individuals with pre-existing respiratory problems like chronic asthma and bronchitis. [Current Allergy Asthma Reports 2009 Jan; 9(1):81–7]

Unfortunately, the combination of outdated guidelines for vitamin D dosage in fortified foods and dietary supplements combined with misdirected advice to avoid sun exposure ensures that most adults and children in North America will exhibit less than optimal blood levels of vitamin D. [Progress Biophysics Molecular Biology 2006 Sep;92(1):26–32] When vitamin D blood levels dropped below 40 nanomole concentration among military personnel in training in Finland, they experienced more days of respiratory infection and absence from duty. [American Journal Clinical Nutrition 2007 Sep; 86(3):714–7] To learn more about vitamin D and the flu, including recommended dosage, visit www.vitamindcouncil.com.

Researchers at Winthrop University in New York did what the National Institutes of Health, with its $30 billion budget, hasn’t done. They conducted a 3-year study of 208 African-American post-menopausal women, with equal numbers being given 800 international units (IU) of vitamin D3 or an inactive placebo tablet daily. In the middle of the study vitamin D supplement was increased to 2000 IU per day. After 3 years there were 34 patients who reported cold and flu symptoms, 26 in the placebo group and only 8 in the vitamin D group (a 425% difference). Infections were almost reduced to zero during the time 2000 IU was being administered daily. [Epidemiology & Infection 2009 Oct; 137(10):1396–404] Of course, this study never made news headlines.