Oct. 27--Whether you get vaccinated this fall or not, there are lots of other things you can do to protect yourself from flu and colds.

To stay healthy, experts recommend many things we've heard before, such as frequent hand-washing and covering your coughs.

But physicians who incorporate alternative medicine and natural healing also suggest other immune-system boosters.

"There are a lot of herbs and supplements that are sometimes recommended during flu season," said Dr. Evangeline Lausier of Duke Integrative Medicine in Durham.

They include traditional Chinese medicines, such as astragulus, echinacea and yin chiao.

"Anything that gives the immune system a little bit of a goose at this time of year is not a bad idea," said Dr. Russell Greenfield, who practices integrative medicine in Charlotte. "It's got to be part of an overall approach to staying well."

That overall approach includes common-sense hygiene and good eating, sleeping and exercise habits. (See list at right.)

But it also includes suggestions that might surprise you.

"The most important thing people could do is to get their vitamin D levels up," said Dr. Neal Speight, a family doctor who practices integrative medicine in Matthews.

Besides building strong bones, as we've always heard, the "sunshine vitamin" appears to protect against everything from cancer to depression -- and even the flu. And most of us are deficient because we don't get enough sun.

"If we don't have enough, our body doesn't mount an immune response," added Michael Smith, a Matthews naturopathic physician.

To find out whether they're deficient, patients should get their "25 hydroxy vitamin D" levels checked. Normal range is 20 to 100 nanograms per milliliter. The optimal level is 45 to 60 ng/ml.

For people with very low levels, aggressive supplementation may be necessary, under monitoring by a physician.

But for most adults, these experts said, 2,000 international units of vitamin D3 daily would be helpful. African Americans may need as much as 3,000 IUs a day because their skin is less able to synthesize vitamin D from the sun.

This is several times the amount of vitamin D supplied by a typical multivitamin. To get enough, you'd have to take separate vitamin D3 supplements.

The potential connection between vitamin D and flu is getting a lot of attention. Researchers theorize that lack of sunshine may be one reason flu circulates more widely in the winter.

Studies indicate ultraviolet light from the sun reduces the incidence of influenza, probably because it increases vitamin D levels, Speight said.

He cited one study of 200 patients that showed the incidence of flu went from 25 percent to nearly zero when patients took 2,000 IUs of vitamin D daily.

A more recent study involving 19,000 people found that those with low levels of vitamin D were 40 percent more likely to have had a recent respiratory infection.

Vitamin D "stimulates the body's own anti-microbes, or antibiotics, if you will," Speight said. "When you have adequate amounts of vitamin D, you can stop viral replication... You have your innate immune system working for you."

Duke's Lausier said she's "not sure the evidence is really there" to support the use of vitamin D to prevent the flu. But she said it "does have a clear-cut role in immune support."

"It's pretty hard to have too much vitamin D," Lausier said. But she said people who have sarcoidosis or hyperparathyroidism could be harmed by taking extra vitamin D.

Other things to try

Here are other suggestions:

Probiotics: These "good" bacteria help the digestive tract and the immune system so that "when we do get sick, we are able to respond better," Smith said.

A recent study in the journal Pediatrics showed that 3- to 5-year-olds who took daily probiotic supplements had less fever and coughs, reduced use of antibiotics and fewer missed school days due to flu-like illnesses and colds.

Astragulus: This parsleylike herb is found in Chinese chicken soup, and it's used in traditional Chinese medicine to increase resistance to illness. It's recommended by Lausier and Greenfield, who both trained at Dr. Andrew Weil's integrative medicine program at the University of Arizona.

The immune-boosting action of astragulus has been shown to help with colds and seasonal flu, Greenfield said. But he said the H1N1 virus is so new, there is no research to show if it will specifically affect the so-called swine flu. He added that people with autoimmune disorders should not take immune-boosting agents because an overactive immune system can be harmful.

Echinacea: Many practitioners suggest this herb to boost immunity. Unlike astragulus, which can be taken daily to prevent viral infections, echinacea should be taken at the first sign of illness, to shorten its duration, Lausier said. "Herbalists really blast themselves for the first few days with a fairly high dose."

Yin chiao: "The Chinese have been using this for millennia," Lausier said. Like echinacea, you take it at the first sign of a cold and only for a few days.

Mushroom extract: Weil takes a daily mushroom extract called Host Defense to fortify his immune system. Greenfield recommends it too, as part of "an entire program of staying well."

Finally, don't panic. While some children and pregnant women are getting very ill and even dying from H1N1 flu, the majority of cases are mild.

People who are under stress or feeling anxious are more susceptible to illness, the experts agreed.

Smith's advice: "Take time to breathe, to de-stress, to pray, get a massage, watch a funny movie."

Karen Garloch: 704-358-5078.

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