'Tis the time of year when change of seasons and crisp cool air bring with them the familiar dry coughs and nagging aches and pains of the flu (technically known as influenza). The flu is a viral infection that attacks the respiratory tract. Flu symptoms are usually more severe than those of the common cold, and may include fever, headache, sore throat, sneezing and runny, stuffy nose, loss of appetite, muscle soreness, general weakness, and sometimes nausea or vomiting. The flu typically lasts one to two weeks. If left untreated, the flu can lead to life-threatening complications such as pneumonia, especially among the elderly, women who are pregnant, or people with chronic illnesses. Flu epidemics cause an average of 20,000 deaths each year in the United States.

Getting a vaccine or flu shot offers the best prevention against influenza. Flu vaccines are 70%–90% effective in preventing influenza among healthy adults. Among the elderly or people with chronic conditions, the vaccine may be less effective in preventing disease, but it may prevent serious complications from happening. The best time to get a flu shot is from October through mid-November. However, shots can be taken at any time during flu season. It takes 1 to 2 weeks, after receiving the shot to develop protective antibodies. In the United States, the flu vaccine does not contain live virus so you cannot get the flu from taking the vaccine. For information on obtaining a flu shot, contact your healthcare provider or try local public health clinics or state health departments.

Is there an alternative to flu shots? Currently, the Food and Drug Administration (FDA) has approved four antiviral drugs (amantadine, rimantadine, zanamivir and oseltamivir) to treat acute, uncomplicated influenza. These drugs are not a substitute for influenza vaccine. Getting plenty of rest, taking fluids and over-the-counter medications such as aspirin, acetaminophen, ibuprofen, cough suppressants, and decongestants are traditional methods for treating flu symptoms. (Aspirin and decongestants should not be given to children under 18 years of age because of the risk of Reye's syndrome, a life-threatening disease.)

Are natural or herbal therapies effective in combating the flu? Natural remedies do play an important role in alleviating symptoms when used with the flu vaccine. Examples of herbs and vitamins that optimize the functioning of the immune system are:

Vitamin C (250 to 500 mg twice daily)

Vitamin A (25,000 IU per day for 2- 6 weeks)

Zinc (25 to 90 mg per day)

Women who are or who may become pregnant should not take high doses of vitamin A. The elderly may find vitamins C and A useful in treating their flu symptoms because of their compromised immune system. Caveat: Large doses of Vitamin C may cause excessive gas or diarrhea.

Echinacea has been used to boost the immune system and reduce fever. Currently, there's debate on whether the plant Echinacea is best used to prevent cold and flu from occurring or whether it helps one to heal faster. Caveat: Echinacea should not be taken by women who are pregnant or by individuals with autoimmune diseases such as lupus, Multiple Sclerosis or HIV.

Other herbs that may be helpful include Goldenseal (modulates the immune system), Licorice (antiviral and soothing), Yarrow (antibacterial) Elder (reduces swelling and irritation) and St. John's Wort (pain reliever). A 100 mg standardized extract of ginseng taken for 12 weeks along with a flu vaccine also helps prevent influenza by helping the body fight infection by increasing antibodies and boosting the body's natural defense system. Caveat: Those with high blood pressure should avoid ginseng. Ginger taken in the form of a tea may help relieve fever, sore throat, and headaches. Medical research indicates that garlic can kill many types of bacteria as well as some viruses and fungal infections.

Before embarking on any self-treatment plan (beyond bed rest and taking fluids), consult your doctor. He or she can perform a thorough examination and take a throat swab to identify a particular viral strain, or a chest x-ray if there is concern about pneumonia. If you have started herbal remedies or intend to do so, let your healthcare provider know before he or she recommends any medications. This will help to avoid any possible interactions between conventional medications and herbs or other remedies.

Influenza. Centers for Disease Control and Prevention. Accessed at http://www.cdc.gov/ncidod/diseases/flu/fluinfo.htm on October 2, 2001.

The Integrative Medicine Consult: Special Supplement on Influenza. Newton, Mass: Integrative Medicine Communications. December 1999.