Should You Get The Flu Vaccine or Flu Meds?
In the fall, one of the most common questions I get asked by my clients is: “Should I get the flu shot?” They know I’m an evidence-based practitioner, which means I’m going to give advice according to the scientific literature. Doctors are told by their boards to recommend the vaccine, and if you’re sick with the flu, then also a prescription treatment. But what does the research actually say about the effectiveness and safety?
*If short on time, skip ahead to the mid-article conlusion and the checklist at the end.*
What Is A Flu Vaccine?
A vaccine is a liquid that gets injected into the muscle that contains dead proteins of the virus. The proteins stimulate your immune system to create antibodies to protect you against it. Flu vaccines contain 3 or 4 strains, and often have mercury, egg proteins, and for those over 65, aluminum. (1) Because the predominant strains causing infection constantly changes, the composition of the vaccine generally changes each year as well..
On average, about 10% of adults get the flu each year. The reason it seems like the number would be higher is because 85-90% of flu-like illness is actually caused by 200 other bugs (bacterial or viral) not related to influenza. (2) This is why the vaccine contains multiple strains.
Is A Flu Vaccine Worth It?
Being that rates of infection with influenza are relatively low, studies have evaluated whether it’s cost-effective to advocate for most adults to get vaccinated. A multi-year study showed that even when the vaccine protected against the predominant strain and therefore reduced sick days and doctor’s visits, it was still a net cost (and not savings). (3)
The fact that the predominant strain causing the flu changes each year complicates the effectiveness of vaccination. Sometimes, the strains in the vaccine don’t match the one most affecting people that season. When this happens, there is no statistically significant difference in illness rates in those who get the vaccine. (3) When they are well matched, though, the vaccine can reduce illness and workplace absenteeism by 30-40%.
In addition to strain differences, timing can greatly impact the reduction in risk. 4 months after getting vaccinated, protection against the flu reduces by more than 50%. (2) Overall, large studies of tens of thousands of individuals over the 14 years since 2004 show that the average effectiveness of the flu vaccine was 41%. Most other commonly used vaccines have a rate over 90%. (4) Even though it’s a net cost to society and has relatively low effectiveness, it may be worth it if it’s completely harmless. Let’s look to see if that’s the case.
If you do decide to get the vaccine, be careful if you’re someone who is sensitive to eggs. Drug manufacturers usually grow vaccines in egg cells. This may stimulate a negative immune response in those who react to eggs. To see which vaccines have egg protein, and mercury, go here. (5)
The most common flu shot protects against 4 strains, known as quadrivalant. The report provided by the company that produces it lists mercury, formaldehyde, and Octylphenol ethoxylate as ingredients. (6) The amounts of these toxins allowed are very limited, so they shouldn’t be enough to cause problems.
However, this hasn’t been thoroughly tested, and some people may be more sensitive than others because of their genes or pre-existing conditions. In their testing, the most common side effects that occurred systemically (not just at the place where the shot was inserted) are muscle pain (24%), headache (16%), and general illness (11%). These numbers are even higher in children.
Symptoms that arise after testing are part of post-market surveillance. Because this comes from consumer reporting and not a defined number of participants, the exact rate at which they occur is unknown. Here’s a list of rare side effects correlated with the flu shot from the medication’s brochure:
- Low blood platelets
- Swollen and tender lymph nodes
- Facial nerve dysfunction: Guillain-Barré syndrome (GBS) and Bell’s palsy
- Autoimmune spinal inflammation
- Pain and inflammation in the optic (eye) nerve
- General nerve pain, which can last greater than 6 months after vaccination (7)
In conclusion, you need to weigh the pros and cons when making a decision. The flu shot can help about half of the people who get it, and it’s fairly safe. On the other hand, it’s significantly less effective than most vaccines, carries a small risk of side effects (some very serious), and is an economic burden.
Flu Vaccine Alternatives
If not vaccinating, what else can we do to prevent and reduce the burden of the flu? Workplaces can make it easier to take days off to stop those who are experiencing symptoms from coming to work (called presenteeism). Reducing presenteeism by just 2% has the same effect on decreasing the flu as mandatory vaccination. (4) Furthermore, 3 nutrients show promise in reducing the rate and severity of infection. The great thing about using nutrients? You get tons of side benefits instead of side effects.
N-acetylcysteine (NAC) is a special form of a naturally occurring protein. It has many amazing effects, and is one of my favorite supplements! It’s been used at high doses for years at a time in trials and shown to have an excellent safety profile. One of its many uses is in reducing symptoms of the flu and improving the immune system, especially in elderly high-risk individuals. (8)
One study of 262 participants showed that 600mg twice daily led to a 43% reduction in flu symptoms over the winter. In those who were confirmed to have influenza, there was a 68% reduction in subjects showing symptoms in the NAC group. Furthermore, three times as many subjects in the placebo group reported severe symptoms compared to the NAC group. (9)
Vitamin D Supplementation
This simple, easy vitamin provides a double whammy of improving the fighting power of immune cells while also preventing them from releasing excessive amounts of inflammatory compounds. For this reason, researchers recommend keeping levels where they would be naturally during the summer with healthy sun exposure, which is around 50. (10)
A 2020 review of the evidence for Vitamin D found that the typical recommended blood level of 30 might be causing harm for being too low. (11) For example, one of the trials in the review examined 198 healthy adults in the fall and winter. The trial showed that those with Vitamin D levels below 38 were 2.5 times more likely to get an acute respiratory infection compared to those with levels above 38. Therefore, the authors recommended that
people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly raise 25(OH)D concentrations, followed by 5000 IU/d. The goal should be to raise 25(OH)D concentrations above 40-60.
Vitamin C Supplementation
Think of Vitamin C as fertilizer for your white blood cells, which fight infection. It helps make them grow, and become smarter and more effective. As such, supplementation with at least 200mg per day decreases the duration and severity of upper respiratory tract infections. (12) It also significantly reduces the risk of infection in those whose bodies are under high stress. During infection, studies suggest increasing to higher levels of 1-2 grams.
In a trial of 226 individuals with the flu, only 2 patients given 300mg daily of Vitamin C got pneumonia. This is in comparison to 10 patients in the control group. That means that those who weren’t taking Vitamin C were five times more likely to get very ill! In addition, the Vitamin C group left the hospital on average 3 days earlier than the control group. (13)
Regardless of how you protect yourself from the flu, you still might end up with symptoms. In this case, should you get medical treatment, such as Tamiflu? To make the most informed decision, let’s look at what the commercials aren’t telling you and what you doctor likely doesn’t know.
The Cochrane Review is the gold standard for putting together all of the evidence and determining with the most certainty whether or not an intervention is effective. In 2014, their summary of all the data concluded: “The influenza virus-specific mechanism of action proposed by the producers does not fit the clinical evidence.” (14)
They found that the 2 main flu drugs decreased illness by less than 1 day. In addition, they had no statistically significant effect on hospitalizations or serious complications. When used preventatively, they decreased the risk of getting symptomatic flu by 3-15%. However, there was at least a 5% greater risk of having symptoms such as nausea, vomiting, headaches, and kidney issues in the group receiving medication.
In fact, the government-required label on the medication reads:
Tamiflu has not been proven to have a positive impact on the potential consequences (such as hospitalizations, mortality, or economic impact) of seasonal, avian, or pandemic influenza. (15)
What You Can Do
No matter which route you choose, it is wise to be thinking about how you nourish yourself to keep your immune system functioning optimally. I wrote about this in-depth in a blog post here. Essentially, you want to decrease your sugar, and increase your fruits and vegetables. Foods high in sugar or that act like sugar in your body are sweets, candies, juice, jelly, syrup, honey, and processed carbohydrates (bread, crackers, cereal, granola bars, and chips). To get more Vitamin C, eat more kiwi, strawberries, oranges, red bell peppers, and broccoli.
Of course, the more stressed and sleep-deprived you are, the more likely you are to get sick. Problems with both of these reduce the number and power of your immune system soldiers. If you’ve had a hard time prioritizing your sleep and need some motivation, check out my post here.
In summary, your Flu Prevention Checklist (at a minimum):
- Decrease sugar
- Increase plant-based foods
- Sleep enough and balance your stress
- Optimize Vitamin D (per labs) through sun and supplementation
- Supplement NAC and Vitamin C (if your practitioner approves)
To see which supplements I recommend based on their quality, form, price, and effectiveness, go here.
Do you have a favorite natural remedy for flu season? Share it in the comments below!
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1. Key Facts About Seasonal Flu Vaccine. 2020. https://www.cdc.gov/flu/prevent/keyfacts.htm
2. Should flu vaccination be mandatory for healthcare workers? 2013. https://www.bmj.com/bmj/section-pdf/749788?path=/bmj/347/7933/Head_to_Head.full.pdf
3. Effectiveness and Cost-Benefit of Influenza Vaccination of Healthy Working Adults. 2000. https://jamanetwork.com/journals/jama/fullarticle/193139
4. Mandatory Flu Vaccine for Healthcare Workers: Not Worthwhile. 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6468124/
5. Influenza vaccines — United States, 2020–21 influenza season. https://www.cdc.gov/flu/professionals/acip/2020-2021/acip-table.htm
6. Fluzone® Quadrivalent. https://www.fda.gov/media/119856/download
7. Paresthesia and sensory disturbances associated with 2009 pandemic vaccine receipt. 2015. https://pubmed.ncbi.nlm.nih.gov/26209839/
8. Attenuation of influenza-like symptomatology and improvement of cell-mediated immunity with long-term N-acetylcysteine treatment. 1997. https://pubmed.ncbi.nlm.nih.gov/9230243/
9. Colds and Influenza: A Review of Diagnosis and Conventional, Botanical, and Nutritional Considerations. 2007. https://pubmed.ncbi.nlm.nih.gov/17397266/
10. Epidemic influenza and vitamin D. 2006. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870528/
11. Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. 2020. https://pubmed.ncbi.nlm.nih.gov/32252338/
12. Optimal Nutritional Status for a Well-Functioning Immune System Is an Important Factor to Protect against Viral Infections. 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230749/
13. Antioxidant Therapy as a Potential Approach to Severe Influenza-Associated Complications. 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6259602/
14. Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children. 2014. https://pubmed.ncbi.nlm.nih.gov/24718923/