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Naturopathic Prevention and Treatment of Swine Flu H1N1

The 2009 swine flu outbreak is the spread of a new strain of H1N1 influenza virus that was first detected by public health agencies in March 2009.Localized outbreaks of influenza-like illness (ILI) were detected in three areas initially in Mexico and soon after in the United States and Canada. Following the discovery of the new strain in the United States, its presence was quickly suspected on most continents, with over 1,600 candidate cases by April 27. Because it is not possible to confirm every one of such cases as being caused by an influenza virus, the World Health Organization (WHO) refers to them collectively as influenza-like illnesses (ILI).

The new strain is derived in part from human influenzavirus A (subtype H1N1), and in part from two strains of swine influenza as well as an avian influenza.[1] In April both the WHO and the United States Centres for Disease Control and Prevention (CDC) expressed serious concerns about this novel strain, because it apparently transmits from human to human, has had a relatively high mortality rate in Mexico, and because it has the potential to become a flu pandemic.[2]

On April 25, 2009, the WHO determined the situation to be a formal "public health emergency of international concern", with knowledge lacking in regard to "the clinical features, epidemiology, and virology of reported cases and the appropriate responses".[3] Government health agencies around the world also expressed concerns over the outbreak and are monitoring the situation closely.

[1] Deadly new flu virus in US and Mexico may go pandemic. New Scientist. 2009-04-24.

[2] CDC Press Briefing Transcripts April 24, 2009. Centers for Disease Control and Prevention. 2009-04-24.

[3] Chan, Margaret (2009-04-25). Statement by WHO Director-General, Dr Margaret Chan: Swine influenza. World Health Organization.

Pandemic concern

The U.S. Centres for Disease Control (CDC) and the World Health Organization (WHO) are concerned that this outbreak may become a pandemic, for the following reasons.[1]

New strain

The virus is a new strain of influenza, from which human populations have not been vaccinated or naturally immunized[2]

Human transmission

The virus appeared to infect by human-to-human transmission. Investigations of infected patients indicated no direct contact with swine, such as at a farm or agricultural fair. [3] The strain was later confirmed to have been transmitted between humans.[4] However, at least one other strain of swine flu has previously been transmitted between humans without wider community infection.[5] In contrast, for example, disease transmission in the last severe human outbreak of influenza, the bird flu that peaked in 2006, was determined to be almost entirely from direct contact between humans and birds.[6]

Virulence

The virus has produced severe disease in Mexico, and some deaths. Furthermore, in Mexico (but not in the United States) the illness has primarily struck young, healthy adults, much like the deadly Spanish Flu of 1918. Most other influenza strains produce the worst symptoms in young children, elderly adults, and others with weaker immune systems.[7] [8]

Geography

The virus has been detected in multiple areas, indicating that containment is unlikely.[9] [10] This is exacerbated by the incubation and infectious periods of influenza.

Lack of data

That other factors are still somewhat unknown, such as transmission rates and patterns and effectiveness of current influenza treatments, combined with the unpredictability of influenza strains, means that reliable forecasts cannot be made.[11]

Current phase of alert in the WHO global influenza preparedness plan

In the 2009 revision of the phase descriptions, WHO has retained the use of a six-phased approach for easy incorporation of new recommendations and approaches into existing national preparedness and response plans. The grouping and description of pandemic phases have been revised to make them easier to understand, more precise, and based upon observable phenomena. Phases 1-3 correlate with preparedness, including capacity development and response planning activities, while Phases 4-6 clearly signal the need for response and mitigation efforts. Furthermore, periods after the first pandemic wave are elaborated to facilitate post pandemic recovery activities.

The current WHO phase of pandemic alert is 5.

In nature, influenza viruses circulate continuously among animals, especially birds. Even though such viruses might theoretically develop into pandemic viruses, in Phase 1 no viruses circulating among animals have been reported to cause infections in humans.

In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat.

In Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver. However, limited transmission under such restricted circumstances does not indicate that the virus has gained the level of transmissibility among humans necessary to cause a pandemic.

Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause "community-level outbreaks." The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.

Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

Phase 6, the pandemic phase, is characterised by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

During the post-peak period, pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed levels. The post-peak period signifies that pandemic activity appears to be decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave.

Previous pandemics have been characterized by waves of activity spread over months. Once the level of disease activity drops, a critical communications task will be to balance this information with the possibility of another wave. Pandemic waves can be separated by months and an immediate "at-ease" signal may be premature.

In the post-pandemic period, influenza disease activity will have returned to levels normally seen for seasonal influenza. It is expected that the pandemic virus will behave as a seasonal influenza A virus. At this stage, it is important to maintain surveillance and update pandemic preparedness and response plans accordingly. An intensive phase of recovery and evaluation may be required. [12]

Prevention and treatment

Recommendations to prevent infection by the virus consist of the standard personal precautions against influenza. This includes frequent washing of hands with soap and water or with alcohol-based hand sanitizers, especially after being out in-public. People should avoid touching their mouth, nose or eyes with their hands unless they've washed their hands. If people do cough, they should either cough into a tissue and throw it in the garbage immediately or, if they cough in their hand, they should wash their hands immediately.[13]

The previously recommended influenza vaccines for the southern and northern hemispheres, including that for the 2009/2010 flu season, are ineffective against the new strain.[14] Current development, large-scale manufacturing, distribution and delivery of a new vaccine takes several months.[15]

US based medical product company Baxter International has requested a virus sample from the WHO in order to begin development of a new vaccine.[16] Baxter has patented a cell-based technology that may allow the company to develop a vaccine in half the time it usually takes, possibly cutting development time from six months to three.[17]

Of the available antiviral treatments for influenza, the WHO stated that the viruses obtained from the human cases with swine influenza in the United States were sensitive to oseltamivir (Tamiflu)[18] and zanamivir (Relenza) but resistant to amantadine and remantadine.[19]

Tamiflu and Relenza also have a preventative effect against Influenzavirus A.[20] Roche and the US government have extended the shelf-life of stock-piled Tamiflu from the original five years to seven years because studies indicated that the medication continues to maintain its effectiveness.[21]

Some physicians in the US are recommending the use of masks when in public.[22] The purpose of a facemask is to effectively cover a person's mouth and nose so that if a person is around someone who is infected, there is a decreased likelihood of transmission. Recommendations to protect against the avian flu indicated that using a facemask with a rating of N99, N100 or P100 in the United States or a rating of FFP3 in Europe should be effective in protecting against transmission.[23] While facemasks with these ratings provide 99% or greater efficiency in protecting against flu transmission, N95 or FFP2 facemasks provide about 94% efficiency.[24] N95 and FFP2 rated facemasks may therefore also be effective.

Protect yourself with natural antiviral remedies

Antiviral Herbs

The following is a list of natural herbal anti-virals. Although the drugs are said to be effective and authorities are currently looking at developing a vaccine, it is known that viruses have an ability to mutate and drug resistance can develop. While not meaning to be a scaremonger, as a naturopath I would strongly advise being self prepared in the event of a global pandemic. The following remedies are readily available and can be added to the home first aid kit and can be taken to improve natural immunity to prevent infection. Of course, these have not been tested directly on the swine flu however, evidence is strong of the nature of their anti-viral and anti-microbial activity therefore making them appropriate to treat and prevent viral infections. Natural medicine is designed to empower people with the ability to prevent disease and act proactively rather than reactively. The anti-microbial activity relates to the anti-biotic effects that the herbs have and are particularly useful to treat secondary pneumonias associated with swine flu.

Goldenseal Hydrastis canadensis

Golden seal contains a high content of isoquinoline alkaloids, of which berberine is the most widely studied. Although not as potent as some prescription antibiotics, berberine exhibits a broad spectrum of antibiotic activity. It has also shown activity against protozoa and fungi.[25] [26] [27] In relation to Golden seals's anti-viral activity, the anti-human cyto megalus virus activity of berberine was compared to the anti-viral drug, ganciclovir (GCV). The mechanism of action by which 1 inhibits the replication of HCMV is presumed to be different from that of GCV; being that berberine compounds interfere with intracellular events after virus penetration into the host cells and before viral DNA synthesis.[28] Antimicrobial activity increases with pH in all organisms studied. There for a [29] Alkalinisation will improve its clinical efficacy particularly in the treatment of urinary tract infections. Berberine has also been shown to activate macrophages.[30] Usual dose is 250-500 mg/day (8-12% alkaloid content). Berberine is generally non-toxic at recommended doses, but it is not recommended for use during pregnancy, and it can decrease B vitamin absorption. It may interfere with H-2 antagonists, proton pump inhibitors, antihypertensives, barbiturates and sedatives, and heparin.[31] [32]

Echinacea Echinacea angustifolia or purpurea

Echinacea may boost the immune defenses in various ways. It contains three compounds with specific antiviral activity: caffeic acid, chicoric acid, and echinacin. It strengthens the body's local defences by use of a substance, echinacein, that deactivates germs' tissue-dissolving enzyme. This prevents germs from spreading and infecting other body tissues. In one study, echinacea stimulated production of white blood cells and phagocytes, and increased macrophage germ-killing activity. A University of Munich study demonstrated that echinacea boosted production of infection-fighting T-lymphocytes up to 30% more than standard immune-supportive drugs.[33] In Germany echinacea is used to treat flu, colds, bronchitis, tonsillitis, ear infections and whooping cough. Root extracts of echinacea are believed to boost interferon levels, vital to the body's defences.

Echinacea has been the subject of over 200 scientific studies.[34] [35]Echinacea is the most widely recommended herb for infectious conditions despite the fact that the direct activity of Echinacea as an antibacterial is quite mild. Its main effect appears to be immunostimulatory; activating the alternative complement pathway, promoting chemotaxis of neutrophils, monocytes, and eosinophils, enhancing macrophage phagocytosis and stimulation of production of TNF, interferon, and interleukin-1.[36] [37] [38] TNF is our bodies own natural anti-viral. The herb also possesses antiviral activity due to inhibition of hyaluronidases.[39] hyaluronidase lowers the viscosity of hyaluronic acid, a major constituent of the interstitial barrier, thereby increasing tissue permeability. It is, therefore, used in medicine in conjunction with other drugs in order to speed their dispersion and delivery. It has been shown to decrease symptoms and length of sickness in patients experiencing the common cold.[40] Echinacea has also been shown to accentuate the topical antimycotic agent (econazol nitrate) decreasing recurrence of C. albicans from 60.5% to 5-16.7%.[41]

The usual dose is 900 mg/day of 3.5% echinacoside. Caution is indicated in patients with HIV because of potential stimulation of viral replication. The literature on Echinacea has been reviewed by the Cochrane Collaboration. The reviewers concluded that the majority of available studies report positive results.[42]

St. John's Wort Hypericum perforatum

St John's wort has received national attention as an herbal anti-depressant. Surprisingly, it is most effective as an anti-vial and anti-bacterial. In vitro studies have shown that the two major compounds (hypericin and pseudohypericin) exhibit strong antiviral activity against HSV I and II as well as influenza types A and B, vesicular stomatitis virus and remarkable antiviral activity against Epstein-Barr virus.[43] [44] St. John's Wort also have broad spectrum antimicrobial activity against both Gram-positive and Gram-negative bacteria including Staphylococcus aureus, Streptococcus mutans, Proteus vulgaris, E. coli, and Pseudomonas aeruginosa.[45] Research suggests that Hypericum may be a useful adjunctive treatment for herpes simplex, mononucleosis, and influenza, and because of its antidepressant and anti-EBV activity, a promising treatment for fibromyalgia and chronic fatigue. Several studies show effectiveness of Hypericum against HIV.[46] [47] [48] While hypericin has been shown to be effective in inactivating enveloped viruses, such as hepatitis B and C, and cytomegalovirus, it has not been effective against non-enveloped viruses, such as hepatitis A, or parvovirus B-19.

St. John's Wort has a historical use as an topical aid to wound healing. Research has demonstrated antibacterial and wound healing activity.[49] The usual oral dose of Hypericum standardized to 0.3% hypericin is 300 mg three times a day. There are many potential drug interactions, including: sedative-hypnotics, 5-HT antagonists, cyclosporine, digoxin, nefazodone, NNRTI's, tricyclic antidepressants, photosensitizing drugs, protease inhibitors, theophylline, and coumadin. Hypericum is metabolized by the cytochrome P-450 system and caution should be used with any drugs using the same metabolic pathway.

Licorice root Glychrrhiza glabra Licorice has, as its major active component a triterpenoid saponin, glycyrrhizic acid. Intestinal flora hydrolyzes glycyrrhizin yielding the aglycone molecule (glycyrrhentinic acid) and a sugar moiety, resulting in absorption of both.[50] Both glycyrrhizin and glycyrrhentinic acid have been shown to induce interferon, a natural anti-viral[51] This leads to significant antiviral activity. Licorice root has been shown to directly inhibit the growth of several DNA and RNA viruses in cell cultures (vaccinia, herpes simplex, Newcastle disease, vesicular stomatitis virus) and to irreversibly inactivate HSV I.[52] The herb also shows antimicrobial activity in vitro against Staphylococcus aureus, Streptococcus mutans, Mycobacterium, and Candida albicans.[53] Licorice compounds are showing promise in the treatment of HIV related diseases and chronic Hepatitis B (40% of patients will have complete resolution).[54] [55]

Topical preparations have been shown to reduce the healing time and pain associated with cold sores, apthous ulcers, and genital herpes.[56] [57]

Caution is recommended when used with drugs that can deplete potassium, stimulant laxatives, and herbs with anticoagulant/antiplatelet properties, including: aspirin and other NSAID's, corticosteroids, cardiac glycosides, loop diuretics, hormones (estrogen-like), insulin, MAOI's and interferon. The use of deglycyrrhizinated licorice (DGL) is recommended because of comparable efficacy but reduced side-effects. Usual dose of standardized 4% extract is 250-500 mg/day.

Other herbs exist which show definite but more limited antimicrobial activity. One such example is Uva ursi (bearberry, upland cranberry), which is especially active against E. coli and can be used in the acute treatment and prevention of recurrent cystitis. It is also active against C. albicans and S. aureus. The usual dose of extract standardized to 10% arbutin is 250-500 mg/day.[58]

Garlic Alium sativa

Garlic has long been considered as a natural remedy against a range of humanillnesses, including various bacterial, viral and fungal infections. This kind of antibiotic activity of garlic has mostly been associated with the thiosulfinate allicin. Even so, recent studies have pointed towards a significant biological activity of trisulfides and tetrasulfides found in various Allium species, including a wide range of antibiotic properties and the ability of polysulfides to cause the death of certain cancer cells. The chemistry underlying the biological activity of these polysulfides is currently emerging. It seems to include a combination of several distinct transformations, such as oxidation reactions, superoxide radical and peroxide generation, decomposition with release of highly electrophilic S(x) species, inhibition of metalloenzymes, disturbance of metal homeostasis and membrane integrity and interference with different cellular signalling pathways. Further research in this area is required to provide a better understanding of polysulfide reactions within a biochemical context. This knowledge may ultimately form the basis for the development of 'green' antibiotics, fungicides and possibly anticancer agents with dramatically reduced side effects in humans.[59]

Allicin, one of the active principles of freshly crushed garlic homogenates, has a variety of antimicrobial activities. Allicin in its pure form was found to exhibit i) antibacterial activity against a wide range of Gram-negative and Gram-positive bacteria, including multidrug-resistant enterotoxicogenic strains of Escherichia coli; ii) antifungal activity, particularly against Candida albicans; iii) antiparasitic activity, including some major human intestinal protozoan parasites such as Entamoeba histolytica and Giardia lamblia; and iv) antiviral activity. The main antimicrobial effect of allicin is due to its chemical reaction with thiol groups of various enzymes, e.g. alcohol dehydrogenase, thioredoxin reductase, and RNA polymerase, which can affect essential metabolism of cysteine proteinase activity involved in the virulence of E. histolytica.[60]

Andrographus Andrographis paniculata

The leaves of Andrographis paniculata, an annual herb, have been used widely as part of Indian folk medicine and Ayurveda for centuries. The Chinese and Thai herbal medicine systems have also incorporated this herb, valued mostly for its "bitter" properties as a treatment for digestive problems and a variety of febrile illnesses. More recently, this herb, in its standardized extract form, has become popular in Scandinavia as a remedy for upper respiratory infection (URI) and influenza. For example, a 300 milligram Kan Jang tablet containing 4% andrographolides has been recommended to be taken four times daily for cold treatment (for a total daily dose of 48 milligrams andrographolides). Lower doses have been evaluated for respiratory infection prevention; for example, a single 200-300 milligram standardized tablet taken daily. Use appears to be safe for up to two weeks. Higher doses may be unsafe, leading to significant side effects. Kulichenko et al. carried out two randomized parallel-group trials of the SHA-10 extract of andrographis (Kan Jang, Swedish Herbal Institute) in adults diagnosed with influenza. Both studies found significant improvements in reduction of duration of influenza symptoms (1-2.5 days sooner, depending on particular symptom, p< 0.01). Although the study suffers from a poorly described randomization procedure and a lack of a standardized outcome measure for symptoms, it does seem to provide preliminary evidence that andrographis extract may be effective not only for standard URI treatment but also specifically for influenza treatment.

Astragalus Astragalus membranosis

Astragalus is an extremely versatile herb which may act as an immune strengthener. It is a commonly used herb in traditional Chinese medicine and is used as a component of many immune-supporting formulas, whether prepared as a sliced and boiled herb in food preparations, in extracts, or in capsules. The IL-2 inducing activity of the triterpene saponins found in astragalus might be the mechanism involved in the immunomodulatory and anticancer effects of astragalus species.

Elderberry Sambucus nigra

Elderberry has been used has been used as a remedy for flu, cough, colds, and upper respiratory infections for over 2500 years. Recent studies demonstrate black elderberry's effectiveness against all strains of influenza virus. A constituent present in black elderberry (with actions similar to neuraminidase inhibitors oseltamivir and zanamivir) prevents the spread of virions from infected cells to new cells.

Forsythia Forsythia suspensa

Forsythia is a traditional Chinese herb used for treating colds, flu, and other viruses. It is often mixed with honeysuckle and sometimes lemon balm and/or ginger as a tea.

Honeysuckle Lonicera japonica

Often used in China to treat bacterial and viral conditions. It is taken as a liquid from flower extracts or as a tea.

Grape seed extract (GSE)

GSE is a general antimicrobial agent with specific antiviral properties. It is best known for its application against Candida albicans, an organism responsible for fungal infections. Flavonoids and related polyphenols, in addition to their cardioprotective, anti-tumor, anti-inflammatory, anti-carcinogenic and anti-allergic activities, also possess promising anti-HIV effects. Recent studies documented that the beta-chemokine receptors, CCR2b, CCR3 and CCR5, and the alpha-chemokine receptors, CXCR1, CXCR2 and CXCR4 serve as entry coreceptors for HIV-1. Although flavonoids and polyphenolic compounds elicit anti-HIV effects such as inhibition of HIV-1 expression and virus replication, the molecular mechanisms underlying these effects remain to be clearly elucidated. [61]Although not proven by scientific research, it may be effective against a long list of other microorganisms as well, including herpes simplex type 1 virus, and influenza A virus. GSE may be used in liquid concentrate form or in capsules. GSE may be taken internally, in minute doses such as 2 to 4 drops twice daily diluted in at least 4 ounces of carrot, orange, pineapple or grapefruit juice.

Green tea

Certain constituents called catechins found in green tea have been studied for their ability to inhibit influenza virus replication and their direct virucidal effects. One study evaluated polyphenolic compound catechins ((-)-epigallocatechin gallate (EGCG), (-)-epicatechin gallate (ECG) and (-)-epigallocatechin (EGC)) from green tea for their ability to inhibit influenza virus replication in cell culture and for potential direct virucidal effect. Among the test compounds, the EGCG and ECG were found to be potent inhibitors of influenza virus replication. It has been suggested that the antiviral effect of catechins on influenza virus is mediated not only by specific interaction with HA, but via alteration of the physical properties of the viral membrane.

Indigowoad Root Isatidis Isatis tinctora (Chinese: 板藍根 pinyin: bǎn lán gēn)

Indigowoad Root is a Traditional Chinese Medicine herb that comes from the roots of woad, but often incorrectly listed under the synonymic name, Isatis indigotica. It is also known as Radix isatidis. The dried root is then processed into granules, which are most commonly consumed dissolved in hot water or tea. The product, called Banlangen Keli, is very popular throughout China, and used to remove toxic heat, soothe sore throat and to treat influenza, measles, mumps, syphilis, or scarlet fever. It is also used for pharyngitis, laryngitis, erysipelas, and carbuncle, and to prevent hepatitis A, epidemic meningitis, cancer and inflammation. Possible minor side effects include allergic reactions and dizziness; only large dosages or long term usage can be toxic to the kidneys. These treatments have not generally been evaluated clinically. Banlangen was used during the SARS epidemic in China.

This herb is one of the best-known traditional Chinese medicine antiviral herbs. Isatidis may be a remedy for any virus but appears to be especially good for hepatitis, because it helps reduce both swelling and liver inflammation. Isatidis is mild and can be used in children or those who do not tolerate heat well. Isatidis may also be a good anti-bacterial agent. Recently, scientists have discovered woad might be used to prevent cancer, having more than 20 times the amount of glucobrassicin contained in broccoli.[62] Young leaves when damaged can produce more glucobrassicin, up to 65 times as much.[63]

Licorice root

Licorice root has been used to prevent and remedy infections, fevers and inflammation. It has broad antimicrobial activity against viruses, bacteria, yeast and fungi. Licorice contains at least eight antiviral and 25 antifungal substances. Licorice also possesses antiviral compounds that promote interferon release.

Olive leaf Olea europea

This herb has general antimicrobial and antiviral properties. It usually comes in powder form in capsules. Schizandra ( Schizandra chinensis ) This herb has been used in traditional Chinese medicine as an antiviral herb, specifically in cases of viral hepatitis.

Antiviral Vitamins

Vitamin A

Vitamin A stimulates several immune system activities, possibly by promoting the growth, and preventing the stress-induced shrinkage, of the thymus gland. Vitamin A is known to enhance the function of white blood cells, increase the response of antibodies to antigens, and to have anti-viral activity. In addition, retinoic acid is needed to maintain the normal structure and function of epithelial and mucosal tissues, which are found in the lungs, trachea, skin, oral cavity, and gastrointestinal tract. These tissues, when healthy and intact, serve as the first line of defense for the immune system, providing a protective barrier that disease-causing microorganisms cannot penetrate.

Vitamin A deficiency results in multiple derangements that impair the response to infection. A review focused on experimental models of specific virus infections and on cytokines and cells with cytolytic activity important to antiviral defences. Altered specific antibody responses and greater epithelial damage in vitamin A-deficient hosts are consistent findings. The cytolytic activity of natural killer cells and various cytokine responses are altered. The inflammatory response to infection may also result in derangements in the transport and metabolism of retinol. We speculate that interaction of several factors may combine to explain the greater severity of infection seen in vitamin A-deficient animals and children.

In addition to a pre-existing lack of tissue vitamin A, these factors may include reduced mobilisation and increased excretion of retinol during the acute phase response to infection, poor innate and specific immune response to virus, and delayed repair of damaged epithelia. Foci of vitamin A-deficient epithelia may be sites of penetration of bacteria and other agents, leading to secondary infections and contributing to an increased severity of infections and poor outcome in vitamin A-deficient animals and humans.[64]

Toxicity Symptoms

Vitamin A can cause side effects when taken in excessive amounts. Most causes of vitamin A toxicity are due to accidental ingestion of doses exceeding 660,000 IU (200 mg of retinol equivalents) and 330,000 IU (100 mg of retinol equivalents) by adults and children, respectively. Adverse reactions to acute ingestion are usually temporary and include loss of appetite, irritability, fatigue, weakness and vomiting. Chronic vitamin A toxicity may occur following many months of daily intake of the vitamin in amounts exceeding 14,000 IU (4.2 mg or retinol equivalents) in children and 25,000 IU in adults, and is most likely to develop in individuals taking high doses of vitamin A compounds to treat skin disorders, or in those with poor liver function. The symptoms of chronic toxicity in infants include growth retardation of the long bones (for example, the femur bone in the leg) and premature epiphyseal bone closing. In adults, vitamin A toxicity causes a variety of health conditions, including dry and itchy skin, dry and brittle fingernails, hair loss, headaches, visual changes, bone and muscle pain, fatigue, irritability, depression, schizophrenia, fever, liver damage, anemia, and/or loss of appetite. In most cases, these maladies begin to disappear as soon as vitamin A intake is decreased.

For all of the above reasons, in 2000 the National Academy of Sciences set Tolerable Upper Intake Levels (ULs) for preformed vitamin A as follows: * Children 3 years or younger, 600 micrograms (2,000 IU) per day

* Children 4-8 years, 900 micrograms (3,000 IU)

* Children 9-14 years, 1,700 micrograms (5,666 IU)

* Teenagers 14-18 years, 2,800 mcg (9,333 IU)

* Adults 19 years and older, 3,000 mcg (10,000 IU)

* Pregnant or lactating women 18 years or younger, 2,800 mcg (9,333 IU)

* Pregnant or lactating women 19 years or older, 3,000 mcg (10,000 IU) It is important to emphasize that although excessive intake of vitamin A by children and adults does not usually cause irreversible damage, vitamin A is toxic to the fetus and can cause severe birth defects, including cleft palate and spina bifida, when taken in daily doses exceeding 10,000 IU by pregnant women. It is recommended, therefore, that women who may become pregnant limit intake of supplemental vitamin A to no more than 5,000 IU per d

Drug-Nutrient Interactions

The following medications impact the absorption, utilization and/or excretion of vitamin A:

* The class of cholesterol-lowering medications known as HMG-CoA reductase inhibitors (Lipitor, Lescol, Mevacor, Provachol, Zocor) may increase blood levels of Vitamin A

* Bile acid sequestrants (Cholestyramine, Colestid) are used to reduce cholesterol levels. These drugs may interfere with the fat-soluble vitamins, including vitamin A.

* Medroxyprogesterone (Provera, Depo-Provera), a contraceptive, may increase blood levels of vitamin A

* Neomycin, an antibacterial drug, may decrease the absorption of vitamin A. Isotretinoin and tretinoin (Retin-A, Vitinoin, Vesanoid) are used in the treatment of severe acne and certain types of skin cancer. These drugs are similar in chemical structure to vitamin A.

To prevent the symptoms associated with vitamin A toxicity, individuals taking these medications should avoid taking supplemental vitamin A in doses exceeding 10,000 IU per day. [65]

Vitamin C

The immune system relies on a wide variety of mechanisms to help protect the body from infection, including white blood cells, complement proteins, and interferons; and vitamin C is especially important in the function of these immune components.

Leucocytes require Vitamin C for Effective Function

Vitamin C is required for proper leucocyte function. Leucocytes are the body's white blood cells, a vital component of the immune system. Researchers investigating leucocytes from guinea pigs, realized that the unusually fragile leucocytes were the result of Vitamin C deficiency. [66] The scorbutic (suffering from scurvy) guinea pigs' leucocytes were so depleted of Vitamin C that they could not reject tissue transplants. Upon supplementation with Vitamin C, the leucocytes functioned normally, and the guinea pigs were able to reject the skin grafts.

Lymphocytes, a phagocytic type of leucocyte, are particularly important to immune responses in cancer and only function effectively as phagocytes if concentrations of Vitamin C are high. In an experiment to test the relationship between Vitamin C and reproduction of lymphoctyes, Yonemoto at the National Cancer Institute demonstrated a direct relationship between levels of Vitamin C supplementation and the budding of new lymphocyte cells (blastogenesis). 5 grams of Vitamin C doubled the rate of lymphocyte budding - 10 g Vitamin C trebled the rate, and 18 g quadrupled the rate of lymphocyte blastogenesis.[67]

Vitamin C Modulates Antibody Levels

Antibodies are one of the immune system's most direct lines of defence against infectious foreign substances "antigens". When the body is exposed to such an organism, or compound, clones of antibodies are produced against the antigen, which attack and destroy it. There are a variety of classes of antibody molecules, with corresponding different functions within the complex immune system. Levels of three of these classes of antibody molecules - IgA, IgG and IgM - have been found to increase with increased Vitamin C levels.

In a study conducted by Vallance of British subjects isolated for a year in Antarctica, it was found that antibodies IgG and IgM increased with increased Vitamin C intake. Similarly, in a placebo-controlled study conducted by Prinz and colleagues[68] It was found that 1 gm Vitamin C per day resulted in significant increases in serum levels of IgA, IgG and IgM. Similar correlations with Vitamin C and antibody levels have also been found in guinea pigs, which, like man, cannot synthesise their own Vitamin C, and must rely upon external sources for this vital nutrient.

Antibody Function

  • IgA Concentrates in body fluids (tears, saliva, respiratory, genitourinary and gastrointestinal secretions) guarding body entrances. First line of defense against invading pathogens and food allergens. Major Ig in defense against viruses.
  • IgD Major Ig present on surface of B cells; may be involved in differentiation of these cells.
  • IgE Involved in allergic reactions. Attaches to surface of mast cell and on encountering its matching antigen, stimulates the mast cell to pour out its contents. Also fights parasites.
  • IgG Most common. Major Ig in defence against microbes. Coats micro-organisms, speeding their destruction by other immune system cells. Confers long-standing immunity.
  • IgM Major Ig produced in primary antibody response. Circulates in the blood stream where it kills bacteria. Increases during acute stage of an infection. Usually forms in star-shaped clusters.

Vitamin C Modulates Synthesis of Complement

Complement is a non-cellular immune component which is composed of a complex cascade of 20 enzymatic proteins which can modulate antibody-antigen reaction, thus affecting efficiency of phagocytosis, virus neutralization, chemotaxis and cytolysis. Vitamin C is involved in the synthesis of the C1-esterase component of complement, and levels of this compound increase with increased Vitamin C intake[69]

Vitamin C Modulates Interferon Synthesis

Interferons (there are as many as 20 different types) are proteins with antiviral activity, produced in cells which have been infected with virus, and also possibly in malignant cells. Interferon is being experimentally tested in treatment of different forms of cancer; however treatment with externally synthesized interferon rather than with the body's own naturally produced interferon, may have toxic side effects. Recent evidence confirms that increased Vitamin C intake results in increased interferon levels.[70] [71] Thus taking Vitamin C is a "natural" antiviral treatment

Vitamin C Modulates Prostaglandin Synthesis

The prostaglandins are a class of small lipid molecules which, acting as hormones, play a role in blood flow, heart beat regulation, cell damage by drugs and immune response. Two prostaglandins in particular, PGE2 and PGF2, are involved in tissue inflammation - swelling, pain, tenderness and heat. Vitamin C has been shown to inhibit the synthesis of PGE2 and PGF2-alpha, thus exerting an anti-inflammatory effect. The prostaglandin PGE1 modulates lymphocyte formation, thus playing a key role in immune response. Vitamin C increases the synthesis of PGE1[72], thus, in yet another way, contributing to the optimal function of the immune system. Vitamin C increases interferon our bodies own anti-viral agent. The effects of ascorbic acid on interferon production and on the antiviral effect of interferon in cultures of human cells were investigated. Ascorbic acid enhanced the interferon levels produced by human embryo skin and human embryo lung fibroblasts, induced by Newcastle disease virus and by polyinosinic-polycytidylic acid. [73]

Drug Nutrient Interactions

Categories of drugs that can diminish the body's supply of vitamin C include oral contraceptives (birth control pills), NSAIDs (non-steroidal anti-inflammatory drugs including aspirin), corticosteroids (like cortisone), sulfa drugs (often used as antibiotics or in cancer treatment), and barbituates.

Nutrient Interactions

Vitamin C has significant interactions with several key minerals in the body. Supplemental intake of vitamin C at gram-level doses can interfere with copper metabolism. Conversely, vitamin C can significantly enhance iron uptake and metabolism, even at food-level amounts.

Vitamin C also has important interactions with other vitamins. Excessive intake of vitamin A, for example, is less toxic to the body when vitamin C is readily available. Vitamin C is involved in the regeneration of vitamin E, and these two vitamins appear to work together in their antioxidant effect. [74]

 

Smoking and aging reduces Vitamin C levels In a series of 54 healthy men and 84 healthy women, plasma and leukocyte vitamin C concentration of the men was found to be significantly lower than that of the women.

For nonsmokers, there was a significant decline in the plasma vitamin C concentration with increasing age in the men and the women but the leukocyte concentration did not change with age.The cigarette smoking habit was found to lower significantly both the plasma and the leukocyte vitamin C concentration.[75]

Vitamin E

Vitamin E, or tocopherol, has been shown to exert a number of beneficial effects on influenza infection in animal studies (discussed below). A Russian study on humans showed that tocopherols lead to clinical improvement in influenza related pneumonia. [76] The low toxicity and low cost of vitamin E make a moderate supplement an attractive option for preparing for avian flu and other possible influenza infections.

In a study on mice, long term supplementation with vitamin E before infection was shown to reduce the activity of influenza A and B viruses. In particular, the vitamin lowered the amount of virus that was present in the lungs, lowered inflammatory cytokines (IL-6 and TNF) and reduced weight loss that was seen in mice not supplemented with vitamin E. Other anti-oxidants (glutathione, melatonin, strawberry extract) improved various measures of oxidation in the blood but did not reduce virus loads or signs of the disease. [77]

A second study in mice showed that Vitamin E has beneficial effects on cytokine levels during influenza infections. Vitamin E increased levels of interferon and IL-2 while decreasing levels of TNF and IL-1. The researchers suggested that vitamin E did so by reducing levels of prostaglandin E2. [78]

Previous research showed that even short term administration of vitamin E could have protective effects against influenza, although a long term administration of modest amounts (400 IU) followed by an increase if bird flu becomes active is a more logical approach.

Other research on vitamin E and influenza showed that this vitamin can improve age related declines in NK killer cells in the immune system, and that there was a significant improvement in resisting influenza in older mice and a modest improvement in younger mice given supplemental vitamin E. [79]

Drug-Nutrient Interactions

Use of the following medications can reduce the body's supply of vitamin E: Anticonvulsant drugs (like Dilantin TM) and cholesterol-lowering drugs (like probucol, cholestyramine, clofibrate, colestipol, and gemfibrozil) can significantly reduce the body's supply of vitamin E.

Long-term, regular use of mineral oil (for example, as non-prescription laxative) can also compromise the body's supply of vitamin E.

Nutrient Interactions

The recycling of vitamin E in the body is intricately connected to four other nutrients: vitamin C glutathione, selenium, and vitamin B3.

Vitamin C is required to keep vitamin E in its metabolically active form; glutathione (a very small protein molecule called a tripeptide and consisting of three amino acid building blocks) is required to keep vitamin C in its active form; and selenium (a micromineral) and vitamin B3 (in a special form called NADPH) are required to keep glutathione in its active form.

The fact that vitamin E is so heavily dependent on vitamin C, vitamin B3, selenium, and glutathione means that a diet high in vitamin E cannot have its optimal effect unless it is also rich in foods that provide these other nutrients.

At moderately high levels of 1,000 milligrams or more, vitamin E can interfere with the bodily activities of vitamin K. The potential injury to vitamin K metabolism was largely the reason why the National Academy of Sciences, in the year 2000, set a Tolerable Upper Limit (UL) of 1,000 milligrams per day for vitamin E. [80]

Safety and Dosage

Overall, Vitamin E has an excellent safety profile. A 2005 review study in the American Journal of Clinical Nutrition concluded that vitamin E is safe for the general population in a wide range of doses. This article concludes that vitamin E supplements appear safe for most adults up to 1600 IU per day, and noted that "no consistent pattern of adverse effects has occurred at any intake." [81]

There is a concern that this vitamin thins the blood slightly and large doses may be of concern if a person is on warfarin, coumadin, or other blood thinners. Many surgeons advise their patients to reduce or discontinue this vitamin if they know they will have surgery in the near future. However, a study in Japan involving a dose of 1200 IU for 28 days showed no changes in platelet aggregation, coagulation, and other clinical parameters related to blood clotting or general health. [82]

In a review of vitamin E and pregnancy in the Cochrane Systematic Database, the question was raised as to whether vitamin E could reduce the risk of eclampsia and high blood pressure in pregnant women. Although not enough data was presented to make a firm conclusion, studies alleging this beneficial effect were noted, and no health warnings were given. [83]

A 2005 study on pre-school children in the United States (in Lincoln, Nebraska) found that 91% had "less than adequate" levels of vitamin E in their diet.[84] A study on the adult population of the U.S. also determined that 90% of Americans obtained less than the recommended amount of this essential nutrient from their diet. [85]

A New Zealand study on diet and vitamin E status found that replacing many of the saturated fats with plant materials (particularly nuts and vegetables) increased tocopherols by 12 IU per day. This may be enough to lead to improvements in health over a life time, but is unlikely to have a strong antiviral effect as demonstrated in the animal studies on vitamin E and influenza. [86]

A typical vitamin E supplement for adults is in the range of 100 to 800 IU per day.

Vitamin E is partially absorbed through the skin, and it makes an excellent topical treatment for sun burn. This transdermal method of absorption may be of value for those too sick to hold down food or absorb it through the intestines.

Natural or Synthetic?

Much of the less expensive vitamin E available today is semi-synthetic; it was produced in a laboratory using less expensive starting materials. Some concerns have been raised about the effectiveness of semi-synthetic vitamin E. In nature, all vitamin E molecules are 'right handed.' Half of the synthetic form of vitamin E is left-handed. At best, these left handed tocopherols are inactive and useless. There is some evidence that the left handed synthetic molecules may interfere with the ability of the body to use normal right handed vitamin E. I personally use only natural vitamin E, which is labeled as d-tocopherol. The synthetic form has the "dl-" designation on the ingredients.

Alpha-Tocopherol or Mixed Tocopherols

Alpha-tocopherol does have potent vitamin E activity, but it is not the only type of vitamin E. The beta, gamma, delta and other tocopherols also have significant benefits. Although the research is not unanimous, it appears that a mix of different tocopherols may be better for long-term health maintenance than a mix with only alpha-tocopherol.

Zinc

Many types of immune cells appear to depend upon zinc for optimal function. Particularly in children, researchers have studied the effects of zinc deficiency (and zinc supplementation) on immune response and number of white blood cells, including specific studies on T lymphocytes, macrophages, and B cells (all types of white blood cells). In these studies, zinc deficiency has been shown to compromise white blood cells numbers and immune response, while zinc supplementation has been shown to restore conditions to normal. Zinc is a natural anti-viral as it increases the amount of Interferon. [87]

Drug-Nutrient Interactions

What medications affect zinc?

Thiazide diuretics like Diuril TM or Enduron TM and ACE inhibitors like CapozideTM and Lotensin,TM both used to lower blood pressure, can compromise zinc status. The body's supply of zinc can also be reduced by use of antibiotics (like penicillinamine or tetracycline), ranitidine (often sold under the trade name ZantacTM and used as a stomach antacid), and oral contraceptives (birth control pills).

Nutrient Interactions

A Tolerable Upper Limit (UL) for zinc of 40 milligrams per day was set by the National Academy of Sciences in 2000 for all adults 19 years and older. The establishment of this limit was largely related to the ability of zinc - particularly supplemental zinc - to impair the status of other nutrients.

The most important of these nutrients are copper and calcium. Zinc can compromise the body's supply of copper unless foods rich in copper are also included in the diet. When few foods high in calcium are included in the diet, high levels of zinc intake (usually obtained from supplements) can also decrease absorption of calcium from the intestine into the body.

Although zinc is associated with these potential detrimental effects on copper and calcium, it is also supportive of other nutrients. The best studied of these nutrients in vitamin A, Without zinc, vitamin A cannot be effectively transported around the body, and cannot efficiently be mobilized when it is needed. [88]

See also Carahealth Immune.  Carahealth has put together a herbal mix that can be pickek up or posted. The herbs are strong organic 1:2 mixes, superior to many herbal mixes on the Irish market.

Buy also the Carahealth antiviral Vitamin Kit includingZinc 50mg, Antioxidant Mix ACE and  Vitamin C powder.

Homeopathic Remedies for Swine Flu

Homeopathy was very successful in dealing with the 1918-19 flu pandemic.

Here is a quote from the famous historian Julian Winston:

Perhaps the most recent use of homeopathy in a major epidemic was during the Influenza Pandemic of 1918. The Journal of the American Institute for Homeopathy, May, 1921, had a long article about the use of homeopathy in the flu epidemic. Dr. T A McCann, from Dayton, Ohio, reported that 24,000 cases of flu treated allopathically had a mortality rate of 28.2% while 26,000 cases of flu treated homeopathically had a mortality rate of 1.05%. This last figure was supported by Dean W.A. Pearson of Philadelphia (Hahnemann College) who collected 26,795 cases of flu treated with homeopathy with the above result.

The most common remedy used was Gelsemium, with occasional cases needing Bryonia and Eupatorium reported. Dr. Herbert A. Roberts from Derby, CT, said that 30 physicians in Connecticut responded to his request for data. They reported 6,602 cases with 55 deaths, which is less than 1%. Dr. Roberts was working as a physician on a troop ship during WWI. He had 81 cases of flu on the way over to Europe. He reported, "All recovered and were landed. Every man received homeopathic treatment. One ship lost 31 on the way."

http://www.hpathy.com/papersnew/winston-homeopathy-epidemics.asp

Homeopathic Remedies

Considering that the Swine Flu virus produces symptoms similar to the human influenza virus, the following homeopathy medicines may prove useful in cases of swine flu:

Gelsemium

This remedy corresponds to the commencement of the trouble, when the patient is weak, tired and aches throughout the body. It removes speedily the intense aching and muscular soreness. There is constant chilliness and the patient hugs the fire; the fever is less acute than that of Aconite, and the cough is hard and painful. There are paroxysms of sneezing with excoriating discharge, and great torpor and apathy. An extensive experience with this remedy in the great Epidemic of 1918 proved its usefulness. Simple cases were speedily cured. Aconite will sometimes prove the better remedy for children, but the drug will never be a prominent one in influenza. Still it may be prescribed when indicated; it will, perhaps, soothe and moderate the subsequent attack, but its action is not quick here as in simple fevers, as we have to do with a blood affection.

Baptisia

Influenza with marked gastro-intestinal symptoms may need this remedy, especially when there are present putrid diarrhoea stools. Clarke considers this remedy the nearest specific for the disease; he prefers the 30th potency. Hughes also praises it, but uses it in the 1x and 2x dilutions, which seem to have more extensive testimony as to their efficacy.

Eupatorium perfoliatum

This remedy has much soreness and aching of the entire body; hoarseness and cough, with great soreness of the larynx and upper respiratory tract. Coryza with thirst and drinking causes vomiting. The cough is a very shattering one, hurts the head and chest, and as in Drosera, the patient holds the chest with the hands. The breakbone pains are characteristic of the remedy. Add to these symptoms acute bilious derangements, and it is all the more indicated. Many physicians rely on this remedy in influenza / flu almost exclusively in the early stages.

Sabadilla

Sneezing is the great keynote of this remedy. Sneezing and lachrymation on going into the open air. The throat is swollen and the pain is worse on empty swallowing; the sneezing is excessive, shaking the whole body. Shudderings, with gooseflesh chills creeping upwards, are also prominent symptoms. Frontal headache, dryness of mouth, without thirst and cough, worse on lying down, are additional symptoms. It suits well many cases of the catarrhal form of flu; other remedies having sneezing are Cyclamen and Euphorbia.

Arsenicum

This remedy covers more phases of flu than perhaps any other remedy. Hughes believes that it will cut short an attack, especially when there is a copious flow, prostration and paroxysmal coryza. Its periodicity makes it suitable to epidemics, and it suits the early symptoms when the affection is in the upper portion of the respiratory tract. The burning dryness and copious watery excoriating secretion and the involvement of the conjunctiva are unmistakable indications. Langour and prostration are prominent symptoms.

Arsenicum iodide

Chills, flushes of heat and severe fluent coryza, discharge irritating and corrosive, sneezing and prostration. It corresponds to true influenza and is highly recommended by Hale. Sanguinaria nitrate is especially valuable when the trachea and larynx are affected. Phytolacca. Specific when the throat is inflamed and spotty, with great hardness and tenderness of the glands.

Dulcamara

This is one of our best remedies in the acute form; the eyes are suffused, the throat is sore and the cough hurts because of the muscular soreness. If brought on by damp, cold changes in the weather, so much the surer is Dulcamara indicated.

Bryonia

The trouble here is largely bronchial and going down. When a person is very grumpy and feels miserable with the flu, wanting only to lie still and be left alone, this remedy is likely to be useful. Headache, muscle aches, and cough or stomach pain may be the major symptoms. Everything feels worse from even the slightest motion. The person's mouth usually is dry, with a thirst for long cold drinks.

Phosphorus

Phosphorus may be indicated, especially when the trouble moves towards the chest. It is a very useful remedy for the debility following la grippe, as it is usually of the pure nervous type. It is the great post-influenza "tonic."

Rhus toxicodendron

Influenza, with severe aching in all the bones, sneezing and coughing. The cough is worse evenings and is caused by a tickling behind the upper part of the sternum. Especially is it useful in cases brought on by exposure to dampness. There is much prostration and depression, and the patient may have some symptoms which are suspicious as pointing towards typhoid fever, such as burning tongue, stupor and delirium. Aching pains, nightly restlessness are keynotes symptoms. Causticum, like both Rhus and Eupatorium, has a tired, sore, bruised sensation all over the body and soreness in the chest when coughing, but it has in addition involuntary urination when coughing.

Allium cepa

Profuse catarrhal coryza; the nose runs freely, there is sneezing, irritability cough, the face is swollen and looks inflamed. Camphora. This remedy is often sufficient at the outset to cut short an attack, or at least modify the severity.

Sticta

Nasal catarrh; headache, thirst, nightly expectoration, great watering of eyes,running at nose, hoarseness of voice, frontal headache and depression of whole system. Tuberculous subjects attacked by influenza. "There is no better remedy," says Dr. Fornias,"for the incessant wearing, racking cough of this class of patients." Tuberculinum is an excellent prevention of recurring attacks of influenza /flu in those who have annual attacks.

Ipecac

Adapted to cases where the gastric symptoms predominate; tongue clean or slightly coated. Nausea: with profuse saliva; vomiting of white, glairy mucus in large quantities, without relief; sleepy afterwards; worse from stooping. Low thirst. Cough: dry spasmodic, constricted, asthmatic. Difficult breathing from least exercise; violent dyspnoea, with wheezing and anxiety about the stomach. Cough, with rattling of mucus in bronchi when inspiring; threatened suffocation from mucus. Pains as if bones were all torn to pieces.

Veratrum album

Adapted to diseases with rapid sinking of the vital forces; complete prostration; collapse. Cold perspiration on the forehead (over entire body, Tab.); with nearly all complaints. Thirst: intense, unquenchable, for large quantities of very cold water and acid drinks; wants everything cold. Diarrhoea: frequent, greenish, watery, gushing: mixed with flakes: cutting colic, with cramps commencing in hands and feet and spreading all over; prostrating, after fright; < least movement; with vomiting, cold sweat on forehead during and prostration after. Vomiting: excessive with nausea and great prostration: < by drinking ( Ars. ); by least motion ( Tab. ); great weakness after.

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[84] Drewel BT, Giraud DW, Davy SR, Driskell JA., Less than adequate vitamin E status observed in a group of preschool boys and girls living in the United States Nutr Biochem. 2006 Feb;17(2):132-8. Epub 2005 Jul 28.

[85] Ahuja JK, Goldman JD, Moshfegh AJ., Current status of vitamin E nutriture.Ann N Y Acad Sci. 2004 Dec;1031:387-90.

[86] McGavin JK, Mann JI, Skeaff CM, Chisholm A. Comparison of a vitamin E-rich diet and supplemental vitamin E on measures of vitamin E status and lipoprotein profile, Eur J Clin Nutr. 2001 Jul;55(7):555-61.

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[88] http://www.whfoods.com/genpage.php?tname=nutrient&dbid=115 < Prev

Carina is available to lecture for your group or institution on this subject.

Carina Harkin BHSc.Nat.BHSc.Hom.BHSc.Acu. is a practitioner of 11 years, complementary medicine lecturer of 4 years and mother of six in Galway, Ireland who practices what she teaches.

For an appointment call Carina directly on 083 34 66 333.

All products are available through www.carahealth.ie. Remember, we are here for a good time not a long time, enjoy your food life!

Carahealth Galway, Acupuncture, Naturopathy, Homeopathy, Herbal Medicine, Nutrition, Nutritional therapy, Flower essences, Iridology, Short Courses, Cosmetic Acupuncture

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