Tag Archives: flu prevention

To Flu Vaccine, or Not Flu Vaccine – 2018 Edition

Toronto Naturopathic Doctor

The flu vaccine is “released” annually in October, and with it, begins our season of answering the question: “Should I get the flu vaccine?”.

As naturopathic doctors, prescribing the flu vaccine, or advising against it lies outside out scope of practice.

We can however help you to make an informed decision by helping you understand what the most current research demonstrates with regards to flu vaccination decision factors.

We wrote a blog post on this a couple off years ago, but the research has been updated with the findings of more recent flu seasons, and here’s the what we know about the usefulness of the flu vaccine to date, and other relevant statistics, to date.

Statistically, your risk of contracting the flu is approximately 0.06% (but likely higher).

There are 23’000 laboratory confirmed cases of flu in Canada yearly1. The actual number of flu cases is likely higher, as many who contact the flu seek healthcare.

Assuming there are 36.95 million people in Canada, that’s simple math.

In the opinion of researchers, the flu vaccine isn’t particularly effective, but you be the judge.

These numbers are the most recent I could find, were from Cochrane’s 2018 February review of flu vaccine research.

Cochrane is a highly-respected organization that conducts research reviews (essentially gathering all the research available on a topic, removing biased or poor-quality studies, and using sophisticated mathematical tools to distil all the research findings into a “final word”).

According to the Cochrane review of research, to prevent one case of flu:

  • 71 healthy adults need to be vaccinated2
  • 7 healthy children need to be vaccinated with a live attenuated vaccine3
  • 5 healthy children need to be vaccinated with an inactivated vaccine3
  • 30 older adults need to be vaccinated4

Flu vaccination reduces rates of hospitalization and absenteeism modestly.

  • Healthy adults who have received the flu vaccine are hospitalized 0.6% less often than those who have not2
  • Having the vaccine reduced missed work days by 0.042 (assuming a work day is eight hours, this works out to your working an extra 19.2 minutes each winter)

The flu vaccine may have risks that are not well understood.

We can’t make this decision for you, but are fairly comfortable advising that if you are concerned about contracting the flu, you need to do more than only flu vaccination.

Jonah Lusis, ND


  1. Ministry of Health and Long-Term Care. 2018/2019 Universal Influenza Immunization Program: Health Care Provider Q & A: General information [Internet]. [Cited 2018 Nov 1]. Available at: http://www.health.gov.on.ca/en/pro/programs/publichealth/flu/uiip/docs/flu_uiip_HCP_QA_2018-19.pdf.

  2. Demicheli V, Jefferson T, Ferroni E, Rivetti A, Di Pietrantonj C.

    Vaccines for preventing influenza in healthy adults. Cochrane Database of Systematic Reviews [Internet]. 2018 Feb 1 [cited 2018 Nov 1]. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001269.pub6/abstract.

  3. Jefferson T, Rivetti A, Di Pietrantonj C, Demicheli V.

    Vaccines for preventing influenza in healthy children. Cochrane Database of Systematic Reviews [Internet]. 2018 Feb 1 [cited 2018 Nov 1]. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001269.pub6/abstract.

  4. Demicheli V, Jefferson T, Di Pietrantonj C, Ferroni E, Thorning S, Thomas RE, Rivetti A. Vaccines for preventing influenza in the elderly. Cochrane Database of Systematic Reviews [Internet]. 2018 Feb 1 [cited 2018 Nov 1]. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001269.pub6/abstract.
  5. Cunningham AS. Official doubletalk hides serious problems with flu shot safety and effectiveness [Internet]. BMJ. 2018 Jan 9 [cited 2018 Nov 1]. Available at: https://www.bmj.com/content/360/bmj.k15/rapid-responses.


Posted: 2018 November 1

Vitamin C – More than you care to know about it!

Toronto naturopathic doctors

Recently, a patient asked me about a specific vitamin C product, basically whether it was worth paying a premium for.

In order to offer them the most accurate answer I could, I decided to confirm a few facts before replying, and ended up going down bit of a rabbit hole.

Vitamin C (ascorbic acid) is a an often over-looked (probably owing to it’s ubiquitous nature), but very valuable nutrient, protecting against heart disease and cancer; and supporting immune system activity and eye health, but where we use it most is in recovery from tissue healing (e.g., disc injury, sports injuries, etc.).

How much vitamin C should I take daily?

At this writing, the recommended daily allowance (RDA) for vitamin C is 60 mg daily, an amount that can be consumed by eating a single orange.

That said, experts disagree that this an optimal daily intake. Most vitamin C supplements offer 1000 mg per dose, and in the recent past, recommendations of 5000 or 6000 mg daily were not unusual.

For optimal vitamin C levels, research demonstrates that complete plasma (“blood”) saturation (i.e., the blood is as full as it can be) of vitamin C occurs at doses of 1000 mg daily.

White blood cells (i.e., cells of the immune system) were vitamin C saturated at even lower doses of 100 mg daily.

Should I take my vitamin C all at once?

No. Much of the vitamin C taken in a 1000 mg  capsule will be excreted in the urine.

At doses of 100 mg, no vitamin C is excreted in the urine (i.e., your body “keeps”, and presumably uses, it all).

At doses of 500 mg, bioavailability (i.e., the amount that enters the blood)  begins to decline.

This suggests, in order to not “waste” your vitamin C supplement, you should separate your intake into doses of less than 500 mg.

Importantly, slow-release vitamin C, which theoretically would allow for more complete absorption of higher doses of vitamin C, resulted in 50% lower absorption of 1000 mg of vitamin C in at least one study.

Ultimately, after at least one month of supplementation, users of both slow-release and regular vitamin C had equal blood vitamin C levels, but clearly, added cost for “slow-releasing” is not warranted.

How about “buffered” vitamin C?

Persons finding they experience digestive upset when using vitamin C are often directed to use “buffered” vitamin C products – mineral salts of ascorbic acid (e.g., calcium ascorbate), which are less acidic, and therefore thought to be less” irritating”.

There is little scientific support for this assertion.

Importantly, at the 1000 mg discussed above, the common digestive side effect of diarrhea, which may be mistakenly attributed to the acidic nature of vitamin C, is unlikely to occur.

How about vitamin C products combining bioflavenoids?

Bioflavenoids are plant chemicals that act as antioxidants, and are reputed to improve absorption of vitamin C.

Although they do add value to a product that is used for the purpose of antioxidant action, the research does not support that the vitamin C absorption of that product will be increased.

Sum it up, Egghead!

Vitamin C, take:

  • 1000 mg daily
  • In doses of approximately 400 mg (although practically, 500 mg is likely the closest dose you will be able to source)
  • Theoretically, having vitamin C with food may increase bioavailability (decrease “waste”)
  • Slow-release capsules, and bioflavenoids-added formulas do not improve vitamin C absorption


Zelman KM. Benefits of vitamin C [Internet]. WebMD. [cited 2018 Sep 14]. Available at: https://www.webmd.com/diet/features/the-benefits-of-vitamin-c#1.

Vitamin C [Internet]. Government of Canada. [cited 2018 Sep 14]. Available at: https://www.canada.ca/en/health-canada/services/nutrients/vitamin-c.html.

Oranges, raw, Florida, nutrition facts and calories [Internet]. SelfNutritionData. [cited 2018 Sep 14]. Available at: https://nutritiondata.self.com/facts/fruits-and-fruit-juices/1969/2.

Levine M, Conrey-Cantilena C, Yank Y, Welch RW, Washko PW, Dhariwal KR et al. Vitamin C pharmacokinetics in healthy volunteers: evidence for a recommended dietary allowance. Proc Natl Acad Sci USA [Internet]. 1996 Apr 16 [cited 2018 Sep 14];93(8):3704–3709. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC39676/.

Oregon State University. Linus Pauling Institute [Internet]. Supplemental forms. [cited 2018 Sep 14]. Available at: https://lpi.oregonstate.edu/mic/vitamins/vitamin-C/supplemental-forms.

– Jonah Lusis, ND


Posted: 2018 Sep 14

To Flu Vaccine, Or Not Flu Vaccine: Natural Approaches to Flu Prevention

Toronto Naturopathic Clinic

This blog entry is in support of our Wellness Wednesday video of this week, and a continuation of last week’s topic of flu vaccine decision-making.

Flu vaccine prescription is outside the scope of practice of naturopathic doctors: we do not prescribe it, or dissuade people from it’s use. Our responsibility is, offering reliable information in service of making an informed decision

Last week we began to work through the four (often unconscious) factors people consider when making a health decision, in this case with respect to flu vaccination:

  1. What are the risks of not vaccinating?
  2. Is the vaccine effective?
  3. Is the vaccine safe?

Today we review:

What are my alternatives to vaccination for prevention of flu?

To be clear: there are no “natural flu vaccines”.

A vaccine has a very specific mechanism of action – it “pre-raises” antibodies to a particular microbe in order that your body has a ready-made immune response to that specific microbe should you come into contact with it.

There are however other means of preventing infection – the most important example of a “natural alternative” to infection prevention, whether by the flu or any other infection, is hand-washing.

Natural Medicines for Flu Prevention

There are a range of natural medicines, primarily botanical medicines, that can be used to prevent flu infection.

Plants have over 124 confirmed pharmacological actions1, and approximately 40% of prescription medications have as their root a plant1, so it is reasonable that plant medicines can be used to protect against flu.

The primary actions to look for in an herbal medicine for prevention is plants that are:

  1. Immune- “boosting” (to increase your resistance to all infections, including the flu)
  2. Anti-viral (the flu is a virus)

A quick Google search will yield many results, here’s a more academic listing, but any product at the health store for “flu prevention” is likely to include some of the plants your Google search has turned up.

Botanical medicines however have nuance: for the initiated, they have “best ways” to be of use. To demonstrate this:

Echinacea spp. (Purple Coneflower)

Echinacea is an important “immune-modulating” plant. Immune modulating plants can be used daily through-out the season to support what-ever response your immune system is mounting (as opposed to “immune stimulating” plants that stimulate a specific action in the body determined by the plant/prescriber, rather than precisely what your body has “identified as it’s need”).

There are more than one species of Echinacea: the main one for infection prevention is one called Echinacea angustofolia. If buying a product in pill form, it should be “standardized” for chemicals called alkylamides.

Golden Seal (Hydrastis canadensis)

Golden seal is a plant that is most effective in treatment of infections at the mucous membranes – the pink skin in your nose and mouth (among other locations).

Practically, these types of infections are often experienced as runny nose, sore throat, etc. Sound familiar? Golden seal.

Garlic (Allium sativum)

Garlic is a plant that is useful in infections of the gastrointestinal tract, but has it’s strongest reputation as an herb for respiratory infection. The flu is a respiratory infection, therefore, garlic may be a better choice for flu prevention than some of the other plants that have demonstrated anti-viral activity.

Garlic, if purchased in pill form, should be standardized to a chemical called alliin, and be sold as enterically-coated capsules.

St. John’s Wort (Hypericum perforatum)

St. John’s Wort has an anti-viral action against enveloped viruses, a specific design category of virus that the flu falls into. Similarly to garlic, this may make St. John’s Wort a better choice for flu prevention than some other anti-viral plants.

Do we have specific product recommendations?

Yes we do.

We do not usually recommend products in this forum, but as the above demonstrates, purchasing herbal medicines (and natural medicines in general) is much more complex than purchasing conventional medicines (e.g., aspirin), from both a “knowledge-required” and quality control perspectives.

If you are able to find them, MediHerb™ makes very high-quality botanical medicines. They are intended to be available only by prescription by a health care practitioner, and are available via our Online Dispensary. MediHerb™ produces Echincea-, garlic- and St. John’s Wort-based botanical medicines.

Viriditas Herbal Products are only available through naturopathic doctors, but if you are a patient of a naturopathic doctor, ask them if they are able to organize purchase of a tincture called “Children and Adults Cold and Flu Elixer”, which we’ve found to be excellent for both prevention and treatment of flu.

Viriditas Herbal Products also makes a tincture called “Herbal First Defense” which is very reliable for when you sense a tickle in your throat, and may or may not wake ill tomorrow. Taken at this juncture, “Herbal First Defense” will ensure you wake hale and hearty.

Lastly, our office offers a “Flu Clinic” – a “one-off”, one-hour consultation in which we can review with you flu prevention strategies in your/your family’s lifestyle and a botanical medicine regimen to help you have a happy and healthy winter season.


  1. Fabricant DS, Farnsworth NR. The value of plants used in traditional medicine for drug discovery. Environ Health Perspect [Internet]. Mar 2001 [cited 2016 Dec 14];109(Suppl 1):69–75. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240543/pdf/ehp109s-000069.pdf.

Posted: 2016 December 14