I spend a lot of time wrestling with false binaries, but the one that is particularly annoying during cold and flu season is the idea that natural health modalities and conventional modern medicine are on opposite ends of the spectrum. The two modalities can and should be working together to create the best outcomes for people.
I really don’t know what fuels this divide? I mean some of it is undoubtedly marketing competition and some of it is probably ego-driven dogma and a lot of other nonsense. None of that is in the best interests of the people I serve.
Maybe that will change, soon? Research scientists are hard at work digging up herbal adjuncts to conventional treatments and alternatives to antibiotics. Hopefully 10 years from now (okay maybe 20 in Iowa) when today’s biomedical research filters down to actual clinical practice [1] herbal adjunct care will get more attention.
But here’s a hard truth people in the profession have to address. You have to earn respect and the shoddy excuse for herbalism that proliferates on the Internet isn’t going to do that for us. We need to do better.
I’ve done a good deal of family health support and have been using herbal remedies to address acute illness for most of my life. I think one of my superpowers is working with herbal interventions to make people more comfortable during an illness and ward off secondary infections. Neither of my younger kids (19 and 16) has ever needed antibiotics.
(Note: I said “needed.” If I even suspected they had a secondary infection, I would take them to a doctor immediately. There’s no reason a child should suffer due to a parent’s irrational opposition to conventional medicine. )
This is a summary of my integrative view of the stages of acute illness including a look into the emotional needs that a person might experience during each stage based on experience and classwork in college.
This primarily applies to acute illnesses but certain aspects such as sickness behavior present with chronic illness as well. I am including a few quite simple comfort measures you can take during some stages, I will be writing more on this later.
Exposure (Incubation Period)
If you live around children or leave your house regularly, you are going to be exposed to pathogens. Once you are exposed to an infectious agent, viral or bacterial particles begin replicating in your system. With influenza, this stage lasts until you begin to experience prodrome symptoms within 24 – 72 hours. Foodborne bacteria may cause symptoms within 6-24 hours.
Onset (Prodromal Period)
During this stage, you begin to experience prodrome symptoms. These are generalized signs and symptoms that indicate the immune system is responding to a pathogen as opposed to the characteristic symptoms caused by a specific pathogen.
One of the body’s defense mechanisms is to elevate your body temperature. Normal fevers between 38° – 40° C (100.4° and 104° F) are a healthy expression of the immune system and do not need to be treated.[2] Fever is often accompanied by chills, and it’s nice to provide comfort measures like a hot water bottle at the feet and warm beverages.
You also might notice swollen lymph glands. You may experience inflamed mucosal tissue and mucus drainage, and for many that leads to a sinus headache. You may feel generalized body aches or pain.
This is a time to begin pumping liquids into people in the form of warm beverages and broths, to keep them well-hydrated. You can use conventional pain relief like ibuprofen, or an herbal alternative. Some people start frontloading supplements like zinc or Vitamin C. I am not a fan of this approach.
Sometimes a good strong immune response fights off the invading pathogens and you never experience strain-specific signs and symptoms. If you have ever experienced running a fever for a day or so without any other symptoms, this may be what has happened.
The neurobehavioral characteristics of illness are called “sickness behavior.” Emotionally you might begin to feel “off” or disinterested in activities you usually enjoy. You might lose your appetite or become excessively fatigued. Some people may even become anxious or fearful as they begin to experience signs and symptoms.
You might find yourself asking questions like “Do I feel feverish to you?” or “Is it cold in here?” Some people begin to consult with other people in their social circle to find out what illnesses have been in circulation and what symptoms to expect. Many people are just looking for confirmation that their symptoms are not specific to them. They might find comfort in being reassured that other people have been recovering quickly without expensive medical care.
Active Phase (Periods of Illness and Decline)
The active phase of the illness is when the pathogen count in your body climbs to its highest point, strain-specific signs and symptoms are most severe, and you are the most contagious. This stage peaks and declines as the number of pathogenic particles starts to decrease. It is during a viral period of decline that you are particularly susceptible to secondary bacterial infections.
Self-medication during this active phase accounts for a huge share of healthcare dollars expended in the United States. People might self-medicate with over-the-counter (OTC) medicine such as decongestants or NSAIDs. The predominant market for botanical therapeutics is replacing these OTC medications with herbal alternatives. In my home, we use an aromatic chest rub, and herbal steams.
Obviously, any time that you feel overwhelmed by an illness, you should seek medical care. When people do seek out professional help they are looking for validation, explanation of symptoms in simple terms, and preparations that might lessen the intensity and duration of symptoms.
That’s why they get so frustrated by doctors who tell them to go home and drink fluids when they have a virus. Some people really want that pill and really push physicians to prescribe it.
If your medical professional diagnoses you with a secondary infection they will prescribe an antibiotic unless they think it is self-limiting. Take the prescription. They are less expensive and more accessible than herbal alternatives, and they usually work faster.
If you speak to an herbal practitioner who questions your physician’s advice or tells you not to finish your prescription, that’s a red flag. Not finishing a prescription may contribute to the growth of antibiotic-resistant bacteria in your body, and it is irresponsible advice.
There are herbal adjuncts that can increase the effectiveness of your antibiotic prescription often by interfering with communication (quorum sensing) in a bacterial colony and reducing the likelihood of recurring chronic infections. [4]
There are also herbal alternatives [5] for people who are told by their physicians they have viruses or self-limiting bacterial infections. I am not going to get into specifics in this post. The measures are often strain-specific and specific to the individual’s constitution. I will not give you “one size fits all” answers.
Sickness behaviors may intensify and lead to withdrawal from activities and social interaction.[3] This innate disease-control instinct is a normal expression of the active, contagious stage of the illness. This is often complicated by the fact that this is the phase when people often are too ill to perform adequate self-care.
Check-in on your people. Don’t ask them if they need anything, just drop them off some comfort items. Because they probably don’t feel like reaching out at this stage and they certainly don’t feel like doing the mental labor of making you a list but they undoubtedly need some help.
Recovery and Convalescence
Historically the recovery time after an illness was called convalescence. This is the stage of illness during which one rests and rebuilds strength after the active stage of the illness has passed. The duration varies greatly.
Some people may experience nagging fatigue and feel otherwise depleted. Physicians call this “post-viral syndrome.” The exact etiology is largely unknown although it’s been theorized that it is due to an overactive immune system and seems to be related to a person’s allostatic load at onset. People with a lot of stressors are often hit harder.
Prevention
It’s worth mentioning that your immune system is weakened at this point, so I will end this with the same lecture about prevention my kids get all the time. Note this goes a little more in-depth than the CDC suggestions which are all tied up in red tape, but all of these measures will help you have a less eventful cold and flu season.
Unlike many herbalists, I encourage people to get their vaccinations. Some vaccinated people may get the flu and barely have any symptoms, but still be able to spread the virus to others. The flu vaccine also does not make you immune to many viruses including adenovirus, rhinovirus, coronavirus, or coxsackievirus. Basically what I am saying here is having been vaccinated is not an excuse to be an inconsiderate public health risk.
Sanitation: The flu vaccination is notoriously ineffective, so it is important to take proper preventative measures, even though I encourage you to take advantage of all the vaccinations you can. Frequent, thorough handwashing with soap and water is the most important non-pharmaceutical intervention (NPI) but that is not the only preventative measure you can take.
The World Health Organization recommends routine cleaning of frequently used surfaces and objects to reduce influenza transmission. Sterilize things everyone touches like toothbrushes, computer equipment, doorknobs, and faucet handles, once weekly during the flu season and daily when people are sick. Also wash your produce, because you don’t know who has touched it.
Isolate: Self-imposed quarantines are probably the most effective way to halt the spread of the disease. You are contagious until you are unmedicated and afebrile (without a fever). I like to wait a minimum of 24 hours after my fever breaks.
I get that we work in an inequitable society where people either don’t have sick days or are penalized for taking their sick days. Just do the best you can and try to stay away from people when you are ill.
If you must go out when you are ill, wear a surgical mask to protect other people from illness. Also, take a container of cleaning wipes with you and clean up after yourself. Think about that person who pushes the shopping cart after you who doesn’t have insurance.
It’s important to note though that masks only stop large-droplet spray. Fine aerosolized droplets still travel through the masks and remain suspended in the air for some time, so even if you are wearing a mask, cough, and sneeze into your own arm to try to contain that a little. My friend who is a surgical nurse told me I should point out that the masks are much less effective after they get damp from breathing through them so you should be switching them out daily.
Humidify: Raising the humidity in a room may reduce the mobility of these smaller droplets.[6] It’s worth noting that this is not a new discovery, however, in the past the concern about bacterial build-up in humidifiers has led hospitals to steer clear of them. While using a crockpot to simmer herbs the way I do is probably a fire hazard, at least I am thoroughly washing the crock every 48 hours.
Stay Hydrated: The mucosal tissues in your body need adequate fluid intake to maintain their integrity and to produce mucin in response to increased pathogenic presence. I recommend drinking a lot of warm herbal beverage teas during the cold winter months.
Stay Warm: While this advice used to be written off as an old wives’ tail, there is evidence that cold exposure suppresses immune function by lowering the innate immune response, especially to rhinovirus.[7] Exposure to cold also constricts the respiratory tract slowing mucociliary clearance of pathogens trapped in mucus which may contribute to developing secondary respiratory infections.[8]
Manage Stress: I know this is a lot easier said than done. I hate having to suggest it to people who are struggling to stay afloat in an inequitable, unjust society, but stress does suppress immune function. Even if you can’t change your life situation you can make lifestyle adjustments and learn coping mechanisms that reduce the impact that stress has on your body.
Exercise: There’s a school of thought out there that vigorous exercise suppresses immune function, but that’s been dismissed by a lot of researchers. Exercise probably improves immunity by directing lymphocytes to the peripheral tissue.[9]
Herbal Preparations: There are some immunomodulators that prime your immune system to work more efficiently when you are exposed to a pathogen. If you struggle with becoming ill frequently during cold and flu season I would suggest you talk to an herbal professional about your particular situation, but not all herbalists are created equal. Feel free to email me at stephany@domestic-medicine.com for a referral in your area
References:
[1] 1. Balas EA, Elkin PL. Technology Transfer From Biomedical Research to Clinical Practice. Evaluation & the Health Professions. 2013;36(4):505–517. doi:10.1177/0163278713508135. [2] Seattle Children’s Hospital. ‘Fever - Myths Versus Facts’. Accessed 2 February 2020. https://www.seattlechildrens.org/conditions/a-z/fever-myths-versus-facts/. [3] Kelley, Keith W., Rose-Marie Bluthé, Robert Dantzer, Jian-Hua Zhou, Wen-Hong Shen, Rodney W. Johnson, and Suzanne R. Broussard. ‘Cytokine-Induced Sickness Behavior’. Brain, Behavior, and Immunity, Biological Mechanisms of Psychosocial Effects on Disease: Implications for Cancer Control, 17, no. 1, Supplement (15 February 2003): 112–18. https://doi.org/10.1016/S0889-1591(02)00077-6. [4]Vasudevan, Sahana, Shogan Sugumar Swamy, Gurmeet Kaur, S. Adline Princy, and P. Balamurugan. ‘Synergism Between Quorum Sensing Inhibitors and Antibiotics: Combating the Antibiotic Resistance Crisis’. In Biotechnological Applications of Quorum Sensing Inhibitors, edited by Vipin Chandra Kalia, 209–25. Singapore: Springer Singapore, 2018. https://doi.org/10.1007/978-981-10-9026-4_10. and Moore et al. Microbiological safety of spices and their interaction with antibiotics: implications for antimicrobial resistance and their role as potential antibiotic adjuncts. Food Quality and Safety. 2019;3(2):93–97. doi:10.1093/fqsafe/fyz008. [5] Humpherys, Brayden, and David D Busath. ‘Anti-Influenza Nutraceuticals: Antiviral and Anti-Inflammatory Effects’ 4, no. 3 (2019): 15. and Akram, Muhammad, et al. ‘Antiviral Potential of Medicinal Plants against HIV, HSV, Influenza, Hepatitis, and Coxsackievirus: A Systematic Review’. Phytotherapy Research 32, no. 5 (May 2018): 811–22. https://doi.org/10.1002/ptr.6024. and Lee, Ju-Young, et al. ‘Herbal Medicines with Antiviral Activity Against the Influenza Virus, a Systematic Review’. The American Journal of Chinese Medicine 46, no. 08 (January 2018): 1663–1700. https://doi.org/10.1142/S0192415X18500854. [6] Binder, Leah. ‘This Inexpensive Action Lowers Hospital Infections And Protects Against Flu Season’. Forbes, 17 October 2019. https://www.forbes.com/sites/leahbinder/2019/10/17/harvard-researcher-says-this-inexpensive-action-will-lower-hospital-infection-rates-and-protect-us-for-the-flu-season/#7417a72a1824. [7] Foxman EF, Storer JA, Fitzgerald ME, et al. Temperature-dependent innate defense against the common cold virus limits viral replication at warm temperature ... Proceedings of the National Academy of Sciences. 2015;112(3):827–832. doi:10.1073/pnas.1411030112. [8] Mourtzoukou, E. G., and M. E. Falagas. ‘Exposure to Cold and Respiratory Tract Infections’. The International Journal of Tuberculosis and Lung Disease 11, no. 9 (2007): 938–943. [9] Campbell, John P., and James E. Turner. ‘Debunking the Myth of Exercise-Induced Immune Suppression: Redefining the Impact of Exercise on Immunological Health Across the Lifespan’. Frontiers in Immunology 9 (2018). https://doi.org/10.3389/fimmu.2018.00648.
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