Conversation with My Doctor

This is good - thanks for sharing this, you have the right doctor for the topic.  I tried talking to my mom's CP, and basically had to harrass him for her meds.  She has an exposed nerve in her brain (pass out pain) and I wasn't going to leave there without a script.  Although he said he could only give her a 3 month supply, he gave her a 9 months supply....hmmmmm. 

I've heard sourkraut is supposed to be a good way to fight this off if you get it.  I've got that.  I'll buy some Lauricidin also.

Fla-Medic...thanks again!!!  If it seems not many people read this thread, this would be a good repost with a different title to catch attention.  Too much news out there to keep up!!!

More detailed info on Samboucol / Elderberry

Elderberry is a hemaggluttin inhibator.
Description: Elderberry (Sambucus nigra) is commonly used as a food product for wine, pie, and jelly. Its leaves were traditionally used for pain relief and applied to wounds to promote healing. Other traditional uses include treatment of infections, skin conditions, and coughing.
Elderberry contains many flavonoids, including Quercetin. Its therapeutic effects are found both in its berries and flowers.
Elderberry, taken several times daily, appears to cause flu patients to recover more rapidly.1 It may also be effective against herpes simplex (cold sores).2
The elderberry flowers may also be effective as an anti-inflammatory.3
Useful in treatment of: cold sores, influenza.

Recommended Dosage: 5 to 10 ml twice daily.

Contraindications: None.

Additional studies that demonstrated the effectiveness of Sambucol include:

Inhibition of Several Strains of Influenza Virus in Vitro and Reduction of Symptoms by an Elderberry Extract (Sambucus Nigra L.) During an Outbreak of Influenza B Panama

Zichria Zachay-Rones, Ph.D., Noemi Varsano, M.Sc., Moshe Zlotnik, M.D., Orly Manor, Ph.D., Liora Regev, Miriam Schlesinger and Madeleine Mumcuoglu, Ph.D. Department of Virology, Hebrew University-Hadassah Medical School, Jerusalem, Israel; Central Virology Laboratory, Public Health Laboratories, Chaim Sheba Medical Center, Tel Hashomer, Israel; Ben Gurion University, Soroka Medical Center, Beer Sheva, Israel; Brown School of Public Health and Community Medicine, Hebrew University-Hadassah Medical School, Jerusalem, Israel.

The Journal of Alternative and Complementary Medicine, 1995: 1, 361-369

Standardized Elderberry Syrup Shortens the Severity and Duration of Influenza in Adults
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HerbalGram. 2004;63:16-17 © American Botanical Council (Buy This Issue)


by Donald J. Brown, N.D.

Reviewed: Zakay-Rones Z, Thom E, Wollan T, et al. Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. J International Med Res. 2004;32:132–140.

Summary: In a randomized, double-blind, placebo controlled trial, 60 male and female patients (18-54 years old; mean 30 years old) were recruited from four primary care sites in Norway to study the efficacy of a standardized elderberry syrup for the treatment of influenza. Patients were screened for participation between December and February, when influenza infection is most prevalent. All volunteers selected for the study had a fever ?38.00C (100.40F) and at least one respiratory influenza symptom. Influenza type A virus was isolated from 54 patients and influenza type B from 6 patients. Patients were randomized to receive either a standardized black elder (Sambucus nigra L., Caprifoliaceae) berry syrup preparation (containing 38% elderberry extract plus small amounts of raspberry extract, glucose, citric acid, and honey; Sambucol®, Razei Bar, Jerusalem, Israel) or a placebo syrup (same as above but with no elderberry). Patients were instructed to take 15 ml of elderberry or placebo 4 times per day. Study medication was started within 48 hours (mean 27.2 hours) of the onset of the influenza-like symptoms and continued for 5 days. Patients were also allowed to take a “rescue medication” (oral paracetamol and/or a dose-metered nasal spray [Otrivin®, Novartis, Basel, Switzerland]) if necessary during the study. The primary study outcomes included visual analogue scores (VAS) for aches and pains, frequency of coughing, quality of sleep, mucus discharge in the respiratory tract, and nasal congestion. The VAS used a 10-point rating scale with 0 = no improvement and 10 = pronounced improvement. A self-evaluation score measuring overall personal well-being was also completed. Patients scored their symptoms on diary cards at baseline, four times a day during treatment, and twice daily for 5 days after the treatment had finished. Baseline VAS scores did not differ significantly between the elderberry and placebo groups. There was a significant difference (p < 0.001) between the two groups in the development of mean VAS scores. By days 3-4 of treatment, most of the VAS scores in the elderberry group were close to 10 (pronounced improvement), while the placebo group reached this level after 7-8 days. A significant difference (p < 0.001) in the global evaluation scores for the two groups was noted after a mean of 3.1 ± 1.3 days, while a similar score was obtained after 7.1 ± 2.5 days in the placebo group. Mean VAS scores for aches and pains, quality of sleep, mucus discharge in the respiratory tract, and nasal congestion were all greater than 9.0 by day 4 in the elderberry group and were ? 1.0 in the placebo group. The mean VAS score for aches and pains was 10.0 at day 5 in the elderberry group and at day 8 in the placebo group. Taking rescue medication was significantly less (p < 0.001) in the elderberry group (7 used paracetamol and 5 the nasal spray) versus the placebo group (26 and 21, respectively). Patients from both groups were fully recovered after 8 days. None of the patients reported any adverse events during the study.
Comments/Opinions: Sponsored by the makers of Sambucol, this trial demonstrates the safety and efficacy of the standardized elderberry syrup for the treatment of influenza A in otherwise healthy adults. A previous Israeli trial with both adults and children showed similar efficacy in the treatment of influenza B/Panama.1 In that trial, 27 subjects were randomized to receive Sambucol for 3 days at the onset of flu symptoms. Adults were instructed to take 4 tablespoons per day and children (under 12 years; the youngest was 5 years old) 2 tablespoons per day. A significant improvement of symptoms, including fever, was seen in 93.3% of the elderberry group within 2 days, compared to 91.7% of the placebo group not showing improvement until day 6 (p <0.001). Complete resolution (“cure&#8221 was achieved within 2 to 3 days in approximately 90% of the elderberry group and within 6 days in the placebo group (p < 0.001).

While the active constituents in this extract have not been clearly disclosed, it is thought that anthocyanins such as cyanidin 3-glucoside and cyanidin 3-sambuboside may be the key constituents in the extract.2 Both are detectable in the plasma after oral ingestion of the extract.3 Possible mechanisms of action suggested for the extract include immunomodulatory actions as well as possible inhibition of viral adhesion to cell receptors. One ex vivo study found that incubation of human monocytes with Sambucol increased cytokine production—most notably tumor necrosis factor alpha (TNF-a) but also various interleukins (IL-1?, IL-6, IL-8).4 An in vitro study found Sambucol inhibited the replication of common human and animal influenza A and B strains as well as prevention of viral adhesion to cell receptors.1

Practice Implications: The results of this clinical trial support the use of a standardized elderberry syrup extract for the treatment of symptoms associated with influenza in otherwise healthy adults. Although based on small clinical trials, the data suggests a 50% reduction in both the severity and duration of symptoms in persons (adults and children) using the extract for 3 to 5 days. Based on the cost effectiveness of elderberry extract, future trials should focus on its potential value in preventing influenza and also its safety and efficacy in high risk populations such as immunocompromised patients, young children and infants, as well as the elderly.
http://www.herbalgram.org/herbalgra...view.asp?a=2702

There are two sides to the story of using Sambucol in the fight against Bird flu. The first is that it has shown to be effective in limiting the virions ability to replicate. The second argument is based on the products ability to raise cytokines and hence possibly exacerbate a cytokine storm. Both arguments have merit.

In June of 2005 two doctors in Hong Kong published an article in the Hong Kong Journal of Medicine. They were two of the attending physicians in the first outbreaks of Avian flu in 1997. Within the article the two described the actions they had taken and why they took those actions to save their patients lives. Half of the patients died of A.R.D.S. or cytokine storms. In the conclusion they wrote the only way to limit the deaths of their patients was by somehow limiting the viral lode. Nothing else they tried worked. The doctors reached the same conclusion in their latest article. Limiting the viral lode is the only known way to better your chance of survival.
In the Oct. 6, 2005, issue of Nature, on page 794 is the Special Report on "The 1918 flu virus is resurrected" article. Dr. Taubenberger reproduced the virus that is responsible for the pandemic of 1918. Within the article they stated "The full sequence is strong evidence that the 1918 flu virus is derived wholly from an ancestor that originally infected birds. In contrast, the viruses that caused the flu pandemics of 1957 and 1968 arose when human and Avian flu viruses infected the same person at the same time, allowing their genes to mix. This explains why the pandemic of 1918 was so much more devastating than were the two subsequent pandemics.
All eight of the genome segments from the 1918 virus differ in important ways from other human flu sequences, suggesting that none of the genome came from a strain that had previously infected people. 'It is the most bird-like of all mammalian flu virus,' says Taubenberger."
They injected the reconstructed virus into mice. What happened to the mice is chilling. There were 50 times as many virus particles released from lung cells a day after infection than in a comparable strain of influenza called the Texas virus. After two days of infection of the 1918 strain the mice lost 13% of their body weight. The weight loss in the Texas flu group was only transient. After four days there were a whopping 39,000 more virus particles found in the lung tissue of the 1918 group than were found in the Texas group. And finally every mouse injected with the 1918 virus died while none of the Texas group succumbed. The mice never had a chance because the viral lode was too high.
Researchers suggest that this new flu threat acts in the same way. It both is brand new to the human race and therefore we have no defence against it, and it multiplies at a faster rate overwhelming the body.
Limiting the number of virus by stopping the replication is paramount to survival. For that reason I have chosen to use the elderberry extract which has shown both in test tubes, and in humans to disable the haemagglutonin thereby reducing it's ability to replicate.
I am concerned however about the possible boost in cytokine levels. To mitigate any possible serious inflammatory response we will be taking the curcumin/piperine combo to reduce any inflammation. In conjunction I feel they should both inhibit the viruses ability to replicate and reduce my chance of inciting a cytokine storm.
It is also of paramount importance that the extract has to be taken as soon as infection occurs. Or even better yet, prior to infection. Using the product prophylactically should prevent the flu from ever getting a foothold in the body. This would then limit the viral lode. And as all the experts agree, limiting the viral lode is the best way to survive a bout of the bird flu.

Flowerchild;

I'm right there with you. They"ll take my Godiva when they pry my dead, cold fingers from the box.

AnnE, could you please provide some info on curcumin/piperine combo? What is it? What does it do?

I read your article with great interest. It would seem to me that if you decide to take Elderberry it would be best taken before BF actually hits. But for how long? what dosage?

any add'l info would be much appreciated.

From Medowl

In order to understand Curcumin maybe we should back up and make sure we understand Cytokine Storm and TNF.  Sorry if this is a review.

Cytokine Storms and Inflammatory Cascades - General Concepts

In many diseases (including H5N1 in humans), a "cytokine storm" is triggered by the infection. Cytokines are hormones that regulate the immune sytem. When released at the right time in the proper amounts, cytokines can help fight infections and regulate processes through out the body.  But many cytokines are inflammatory and are damaging to the body if present in too high levels, or for too long.

The term cytokine storm is a common designation for the technical term hypercytokinemia (sometimes spelled hypercytokinaemia). Some people object to the use of the term cytokine storm, as it carries weather related images that may not apply to hypercytokinemia.  But whatever it is called, this phenomenon is a type of inflammatory cascade.

One type of inflammatory cascade familiar to many people is hay fever.  In hay fever, the proteins in pollen enter the body through the sinuses, lungs, or eyes.  The immune system recognizes that these proteins are not part of the self, and it turns on the defense mechanisms.  Histamine is released, nitric oxide is produced, and antibodies are produced.  The inflammation and collateral damage to the body are far greater than the threat posed by a bit of pollen.  But the immune system does not always recognize the real magnitude of the danger, and can over-react.

Inflammatory cascades involve positive feedback - the initial change tends to magnify itself.  Like a small disturbance in a snow field that turns into an avalanche, the release of histamine or cytokines tends to trigger the release of more histamine or cytokines. Rubbing your eyes when you have allergies is another example of postive feedback in an inflammatory cascade - the initial irritation is made worse by rubbing, which leads to more release of histamine and other inflammatory compounds, more redness, and possible physical damage to sensitive tissues as the process spirals.

Many inflammatory cascades have self limiting components - the release of an inflammatory agent often leads to the production of both anti-inflammatory and inflammatory compounds.  But as microbes evolve, they sometimes begin producing a mix of toxins that interfere with the control mechanisms of the immune system.  This seems to be the case for the deadly strains of bird flu. The H5N1 virus is not only partially resistant to the cytokines that are involved in fighting viruses, but it also reduces the production of anti-inflammatory cytokines - in essence, it enhances the accelerator while impairing the brakes, and the immune system goes out of control and crashes.

The Cytokine Storm in H5N1 Infection

Not surprisingly, TNF got its name from the increased levels of this compound that were first seen in cancer patients.  TNF can be useful in fighting some cancers, but it is also secreted to fight foreign invaders like bacteria and viruses.  TNF is one of the compounds responsible for the weight loss and wasting that is seen in people with advanced stage cancers.

TNF is elevated in autoimmune diseases like rheumatoid arthritis, psoriasis, ankylosing spondylitis, and crohns disease. Excessive TNF can also lead to damage of the liver, kidneys, and other organs.

While Type A influenza strains like H1N1 or H3N2 lead to small or modest increases in cytokines, the H5N1 strain has been shown to lead to extreme elevation of inflammatory cytokines, particularly TNF. PMID: 16051807  Also important is the way that TNF is elevated by the avian flu virus; while all Type A viruses stimulate NF-KappaB (which can raise TNF), the H5N1 virus appears to be unusual by acting to strongly stimulate the MAPK pathway.  The MAPK (mitogen activated protein kinase) system, (in this case, particularly the MAPK p38 system) has been shown to be responsible for the cytokine storm in bird flu infections, while compounds that inhibit MAPK p38 lead to marked reduction in TNF release in infected cells.

Anti-TNF Therapies

 Enbrel, Remicade, & Humira

A number of pharmaceutical compounds have been developed for rheumatoid arthritis, psoriasis, ankylosing spondylitis, crohns disease, and other diseases associated with increased TNF production. Etanercept (trade name: Enbrel) is a receptor compound that binds TNF and makes it innactive.  Adalimumab (trade name: Humira) is an antibody that binds to and inactivates TNF.  Infliximab (trade name: Remicade) is also an antibody that specifically binds to TNF.

These 3 drugs hold promise in mitigating the damage caused by H5N1 infection.  Unfortunately, they are expensive (costing around $18,000 per year when adminstered for chronic inflammatory disease).  They are large molecules that must be injected, and are heat sensitive, making it difficult to rush them to remote less-developed areas where H5N1 outbreaks may first occur.

There is concern that the use of the pharmaceutical Anti-TNF drugs may increase the risks of certain cancers, although this is not completely understood yet.  While certain lymphomas seem to appear after psoriasis patients use these drugs, it is also true that psoriasis patients that never use them are at increased risk of those cancers.  I believe that the immune supression that results from the nearly complete supression of TNF may allow the tendency towards developing lymphoma to express itself, but this is an area requiring further study.  And if H5N1 was spreading in my community and I showed symptoms, I think the risk from the avian flu would be far greater than the risk of possible lymphoma. 

 Curcumin

Curcumin is the compound that gives turmeric spice its bright yellow appearance. It has been used in herbal medicine for a variety of inflammatory conditions, including fever, arthritis, and psoriasis.  Curcumin not only blocks TNF, but it is an inhibitor of the MAPK p38 system. At present, the Pubmed research database identifies 110 citations when searching for "MAPK curcumin" while the search phrase "TNF curcumin" returns 82 results.  Review of these articles makes it clear that curcumin holds great promise as an agent that may reduce the lethal effects of the avian flu cytokine storm.

Curcumin is quite inexpensive. At Vitacost (where I buy most of my supplements), 60 capsules of  NSI Turmeric (standardized 95% curcumin) 900 mg  cost just under $14 when I last checked - less than the typical co-pay for a prescription. 

Absorption of curcumin is modest to poor, but can be increased when co-administered with piperine (a compound found in various species of pepper, including the black pepper found in most kitchens).  PMID: 9619120   Several commercial formulations of curcumin include piperine (sometimes called bioperine). Piperine itself inhibits TNF, IL-1, IL-6 and other inflammatory cytokines. PMID: 15531295

 While it is best to store it at room temperature, it will not be completely inactivated under the un-refrigerated conditions that would destroy the potency of some expensive pharmaceutical TNF blockers.  Unlike the pharmaceutical TNF blockers, curcumin is associated with a reduced risk of many types of cancer.  In particular, lab studies have shown that curcumin induces apoptosis (programmed cell death) in several types of lymphoma.  ( citation 1, citation 2, citation 3,  citation 4 ). 

 Corticosteroids

Corticosteroids like prednisone lower TNF, but they also lower resistance to many diseases. Corticosteroids are a prime weapon against the SARS virus (another disease where over-reaction of the immune system seems to do as much damage as the virus itself). The amount of corticosteroids administered is important. Following the recent SARS outbreak, many people in China were given excessive doses of corticosteroids and later developed serious complications.  There has been little discussion on the use of these steroids to blunt the cytokine storm seen in avian flu.

Anti-Viral Infectives: Neuraminidase Inhibitors

There has been much talk about Tamiflu and the possibility that it can curb the reproduction of the H5N1 virus.  Tamiflu works by inhibiting an enzyme called neuraminidase (aka sialidase).  This enzyme is used by many virus particles to attach to cells and invade them.  When a neuraminidase inhibitor like Tamiflu is administered, it can reduce the spread of Type A influenza in the population.  It can also shorten the duration and intensity of Type A influenza if administered in the first 48 hours after symptoms appear (it typically reduces a 5-7 day influenza episode by 1 to 2 days).

The strategic use of neuraminidase inhibitors can probably help keep a lid on small outbreaks of the virus.  But if a larger epidemic occurs, supplies will probably run short.  Viruses have demonstrated the ability to mutate and become resistant to Tamiflu, which could be a problem over time.

There are natural neuramidase inhibitors found in plants: the most widely studied is a compound called 5,7,4'-trihydroxy-8-methoxyflavone, which is found in the herb Scutellaria (commonly called scullcap or skullcap).  In a study on mice cells, bathing the cell cultures in Scutellaria tea inhibited both Type A (H3N2 type) and Type B (Ibaraki/2/85 type) influenza when the flavone was administered 18 hours before the virus challenge.  It was not effective when administered five minutes before the virus.  (citation)

Many herbalists have suggested that only the Baikal variety of skullcap would be effective, but these  beliefs are not based on evidence.  Common scullcap (S. lateriflora) contains baicalin (40 mg/g) and baicalein (33 mg/g):  PMID:14692724  Baicalin and baicalein inhibit the neuraminidase/sialidase enzymes: PMID:2717686

I generally use loose skullcap herb to make tea, although there are extracts and capsules available, like these from Nature's Way.

Other hydroxy-flavones are found in plants like Passiflora incarnata (passionflower herb - but not passionflower fruit, Passiflora edulis).   It is not clear whether these flavones also inhibit neuraminidases or influenza viruses  (or the H5N1 virus in particular).  However, both scutellaria and passionflower are also mild tranquilizers (the methoxy-flavone compounds also have a gentle GABAinergic effect and are used by herbalists for anxiety).  These teas have a long history of safe use (on par with chamomile and hibiscus), so it seems logical to first prepare for a possible avian flu epidemic, and stay home and consume relaxing herbs if the epidemic does arrive.

Emodin

Thanks for the great information. Answered some questions for me.