Category Archives: Caring for the Ill

Pandemics and Preparedness

This is not my sciencey viral intervention post.  That one is going to take me a few days to fact check and I am honestly dreadfully dreary of reading scientific journals and sitting through WHO modules. We have the first three confirmed cases of this blasted virus in our town and not surprisingly all contracted it on a cruise ship.  I am reminded of a story I heard once about the cnotan na gall – the “strangers’ cold” that came in on a vessel from a far away land.

I needed a break from it.    So I decided to write a history post  because I felt the need to connect with my roots a little . My maternal grandmother was born in 1907. Which means that when the flu of 1918 hit, she was an eleven year old helping her mom care for her siblings.   As I’ve mentioned before her dad died during that flu and her mother had a premature baby because of it, so you can imagine life lessons came early for  her.

It seems that when Grandma was little the lives of poor, rural people were pretty similar on both sides of the pond. When I came across first-hand accounts of the 1918 pandemic in the NFCSC material, they sounded familiar.  These stories in the collection were gathered about 18-20 years after the pandemic swept Ireland, so they were fresh in their minds. I picked a couple to share.

Mr. Patsy Corrigan of Co. Cavan the told young Breda Callaghan,

“In the year nineteen hundred and eighteen an epidemic of influenza spread over the country. It was one of the most fatal diseases in history. It sent more people to the grave than were killed in the great war. Owing to the war there was a scarcity of foodstuffs and beverages which if plentiful would hinder the spread of the disease. This disease which started as a germ in the air spread from Europe to the United Kingdom. It was an uncommon sight on an Irish country – side to see coffin after coffin being borne to the grave-yard.

Very few houses escaped its ravages. This was the first time that influenza became known as a fatal disease. No year has passed since, without it claiming some victims.  The influenza of nineteen hundred and eighteen ranks in the hearts of the people as the greatest disease in living memory.  It carried away hundreds of victims, including priests, nuns, doctors, and nurses.”[1]

In Co. Westmeath the teacher Sister Ní Chonaire wrote:

“An epidemic of influenza broke out in Ireland in the year 1918 and it lasted for about three months. There were a lot of people stricken down with it and many of them died from the effects of it. It was different from the usual influenza cold, as very often people were nearly better of it, but got pneumonia and died.

In some houses all the inhabitants were sick together, and as the neighbors were frightened of the dread disease they did not like to go near them, so they suffered great hardship as they had nobody to nurse them. The Doctor was kept so busy that he had not time to visit all his patients every day. The shops in the villages were closed and a gloom was cast over the place. When people died their coffins were not brought to the Church fearing the germs of the disease would be spread, when crowds congregated for the funeral.”[2]

It gave me a moment’s pause reflecting on what it would be like to live during a pandemic like that when there was no PPE, no antibiotics, and no oxygen therapy.  I hurts my heart because I know many people in our society wouldn’t have access to those things today. (I sometimes feel foolish making recommendations about herbal adjuncts they don’t have access to either.  This is why the affordable apothecary project is my first priority this year.  I don’t have enough to share widely right now in case of an outbreak, and I want that to change.)

So what I wanted to do was to look at these two first hand accounts and maybe draw some conclusions about how people weathered these events in the past.

It certainly seems that social interactions were curbed considerably. I don’t think that’s particularly surprising.  I think that Mr. Corrigan’s observation about the fact that the war had left them short on healthy foods and beverages bears thinking about.

Back in those days it was typical for women of all classes in the UK (or their servants) to put up a good number of jams, jellies, cordials, liqueurs made from a variety of fruits and vegetables.  The variety of phenolic compounds in their diet was probably triple that of the standard American diet (SAD).  I don’t have any good proof of that other than knowing that mine was growing up.

My grandmothers and mother gleaned fruit from all over the countryside and put a huge variety of juices, jams and jellies up for the winter along with their garden produce.  I loved it when Mom made jelly because she sealed the jars with paraffin, and I liked to dip my fingers in it and play with the wax.  I followed suit as best as I could growing up in town.

But my point here is that my people weren’t putting up closets full of herbal tinctures,  they were putting up vegetables, fruit, and condiments full of the herbs and culinary spices we should be eating every day. The fact that people don’t eat a wide variety of antioxidants anymore is already contributing to an epidemic of chronic diseases and I don’t think it’s a coincidence that people with those same diseases seem more susceptible to this virus.  So eat your fruits and vegetables.

That’s why that the only thing I bought compulsively was a big box of apples and a bag of oranges, while everyone else is stockpiling hand sanitizer and toilet paper.
I want  to point out to city folk that there is nothing wrong with being prepared.  I am by nature, a prepared person.  Part of that comes from growing up country poor.  We had to put enough food away in the fall to get through winter.  If we didn’t we ate mealy potato soup for weeks. I still don’t love potatoes and I will probably never get over the fear of running out of food before the garden comes in or the next paycheck.

When I was young we also never knew when a snowstorm was going to keep us snowed in for a week or even more, or when we might lose power for that long.  These days I never know when my RA is going to flare up and I am going to be unable to get around while Steve is out-of-town on a business trip, and so those skills I have learned as a kid have served me well.  This brings me to another thing these stories brought up for me.

Sr. Ní Chonaire felt like it was their neighbors fear of going in and taking care people like they would have normally done that led to so many people passing on.  I think that’s worth thinking about. I mean today in many places neighbours don’t do that at all.

I am not suggesting we all put ourselves in harm’s way, though I am obstinate enough I probably will.  But  I am suggesting that we need to pull our heads together and plan to do something.

I had a friend drop off ice when we had the flu earlier in the season and I was so grateful. I think in the 15 years I have lived here, that’s the only time someone has done something like that for me. The kind of preparedness I advocate for is being prepared to help yourself and your neighbors like that regardless of what comes along- be it a  pandemic or just general hard times.

This weekend I  made up a roaster full of broth heavy on the garlic, thyme, and pepper  so that I can make  some “sorry you are sick” soup and drop it off on people’s doorstep. We are making  the brew pot full of ham and bean soup, because we have some meal train meals to deliver this week, too.

I thought I would give you a few recipes for other things you could include in a care basket to comfort people when they are ill that contain ingredients that you could pick up here at the store and not have to order online. And you know me I love to trace things back to my roots,  so I included some historical references just for fun.

Black Currant Tea
Judging by the folklore commission accounts, black currant tea was probably the most common cold remedy taken at the turn of the 20th century in the Ireland.  They also called them Quinsy berries.  Quinsy is a complication of tonsillitis that we call a peritonsillar abscess, these days. The tried-and-true great-grandma’s way of making the tea is explained here by Mrs. Quinn of Co. Dublin:

“This is a cure for a bad cold.  Before going to bed at night make a good mug of black currant drink. But only put a tea spoon-ful of black currant jam in the mug. Then fill it up with hot water and let it cool off. Do that for two or three nights and your cold will be gone in three days.”[3]

There is a good deal of modern clinical research to support the idea that it’s a good adjunct.[4]  If you can’t find black currants, that’s okay. You can tuck a nice jar of blackberry jam or bilberry jam in a basket with directions how to use it. This is one of the things I make with my bramble berry syrup, and I think a teaspoon is a little stingy. I use a good tablespoon or so, but maybe my mugs are bigger or my tea spoons are smaller?  ( I promise to get to the bramble berry thing before Beltaine.)

Blackberry Brandy
Modern herbalists often write about taking blackberry root infusions for diarrhea (the leaves work just as well), but the anthocyanins in the juice are what you want during cold and flu season. Kiva told me the other day that Michael Moore taught that, too.   Most of the old-timers simply stewed the berries and strain ed the juice through a jelly bag.  Some people preserved the juice by making it into wine.  Kate Donegan of Co. Westmeath simply wrote:

Blackberry Wine. Stew the blackberries with sugar. This cures colds.”[5]

I don’t have any blackberry wine made and we drank up the cranberry wine, but I am thinking I will make up some blackberry liqueur to have on hand. I have this quick recipe for making it:

Highland Bitters
This bitters recipe is very simple. I’ve adapted from one of my favorite books  A Hundred Years in the Highlands in which the author noted of his uncle “On the sideboard there always stood before breakfast a bottle of whisky, smuggled of course, with plenty of camomile flowers, bitter orange-peel, and juniper berries in it — ‘ bitters ‘ we called it — and of this he had a wee glass always before we sat down to breakfast, as a fine stomachic.[6]

Ingredients
1 cup chamomile flowers (you can use the tea bags you buy at the store)
¼ cup bitter orange peel or mixed peel
¼ cup juniper berries
1 bottle of whiskey

First of all local accessibility:  they sell juniper berries in the spice section at HyVee and you can use chamomile from tea bags.  If you can’t afford juniper berries steal some cedar needles or pine needles off a tree at the park.  Grind the ingredients and put them in a jar with an airtight lid and pour the whiskey over top.  Close the lid and shake every couple of days.  Then strain and bottle it.

You can drink it like Sir Mackenzie up there did or you can put just a few drops in some sparkling water.  Bitters have been shown to improve digestion and assimilation of nutrients. There are more recipes on this post. 


Heat is a wonderful adjunct.  It can relieve aches and pains by causing muscles to relax which in turn helps people rest.  It can ward off the chills that often accompany an illness. People who know me know that I have a long love affair with my hottie, so it made me smile to come across this recommendation from Ellen Evans of Co. Wicklow:

“Yarrow is one of the most valuable herbs that grows in the district. It is great for curing colds influenza and all classes of fevers. If you have a cold, influenza or fever, go to bed between two blankets, have a hot-water bottle placed to your feet and drink a cup of hot yarrow-tea.”[7]

I will have more to say about a yarrow in my more serious post about viral interventions but what I want you to think about here is tucking in the other things in a care basket, that could provide people comfort like a hot water bottle with a wool cover.

You could also share reusable ice bag and a big bag of ice.  I find that tucking an ice bag under the base of my neck helps with a headache.  Migraine sufferers should try my favorite trick which is ice under the neck and a hot water bottle at the feet.  I like actual ice because it puts some pressure on my neck but you can also sew up hot/cold rice packs .

[1] NFC: The Schools’ Collection Volume 1000, Page 337-338
[2] NFC: The Schools’ Collection, Volume 0734, Page 402
[3] NFC: The Schools’ Collection Volume 0798, Page 103
[4] Ikuta, Kazufumi, Koichi Hashimoto, Hisatoshi Kaneko, Shuichi Mori, Kazutaka Ohashi, and Tatsuo Suzutani. ‘Anti-Viral and Anti-Bacterial Activities of an Extract of Blackcurrants ( Ribes Nigrum L. ): Anti-Microbial Activity of Blackcurrants’. Microbiology and Immunology 56, no. 12 (December 2012): 805–9. https://doi.org/10.1111/j.1348-0421.2012.00510.x.
[5] NFC: The Schools’ Collection Volume 0740, Page 101
[6] MacKenzie, Osgood Hanbury. A Hundred Years in the Highlands. London, England: Arnold, 1921. http://archive.org/details/hundredyearsinhi00mack
[7] NFC: The Schools’ Collection Volume 0915, Page 165

Targets of Viral Interventions

Wow, I really want to answer all the emails I received individually, but I  have paying gigs to try to keep up with, so this is what I have time to do. I am going to cover this in two posts so to keep your interest in this one, I will integrate the information about SARS-CoV-2 released yesterday.

But first I want to address the many emails I got about the history thing.  My other (much neglected) blog focuses completely on historical herbalism.  I teach history classes at conferences and I have a lot of history articles on this blog.

That’s kind of my area of expertise.  I only dabble in the science stuff enough to be able to support my use of traditional remedies.  Sending emails  calling me out for being a “young  person who doesn’t know anything about tradition” are a little foolish.  It made my eight-year-old granddaughter laugh when I read that to her.

Elderberry is not a flu remedy in my tradition.  It just isn’t.  In my spare time, I am a volunteer transcriptionist for  Meitheal Dúchas and in all of their primary sources I found two (there are only 29 total) mentioning elderberry for colds and I think they were still speaking to the flower or scraping the inner bark of the tree.  That is in stark contrast with the hundreds of entries about blackberries and black currants.  (Remind me to talk to you someday about how they used black currant jam to make a tea for colds.)  Even in Darina Allen’s Traditional Irish cookbook she goes straight from elderflower recipes to black currant recipes with nary a mention of the berries.

I don’t know when it became such a thing.  I wasn’t really paying attention until people started charging $20 for a cup of the syrup.   A lot of my colleagues I talk to on a regular basis still don’t use it for influenza. I looked at Kiva’s Herbs for Winter Ailments chart she shared in 2010 and only elderflower is mentioned as a relaxing diaphoretic, so it’s been pretty recently.  The thing is, I really don’t care, either.

Let’s just put  to rest the idea that I am flying in the face of tradition to rest and talk about viruses.

Herbal Viral Interventions
To begin with, let us agree that the goal of herbal viral interventions is to help to reduce the duration and severity.  We certainly cannot cure or treat anything. I mean physicians can’t even really do anything about a virus.

I absolutely believe that you must address  winter illnesses on a case-by-case basis. My clients and students learn all about the different ways respiratory complaints can present and how to best balance each presentation. I can’t really distill that down to a blog post.  I do have several old posts on caring for the ill on this blog and there’s a link to a newsletter I sent out a couple of years ago. I encourage you to look through those.

When it comes to limiting duration, that’s where we get into our herbal adjuncts.  Despite what people are telling you on the Internet,  I really don’t believe anything is broadly antiviral.  I can’t help that in the world of subpar Internet herbalism many articles of that nature will be shared.

The reason that there are so many pharmaceutical antivirals is that each of them is tailored to target a specific stage of specific pathogen’s life cycle, and herbal interventions work a lot the same way.

So we can about specific therapeutic targets of herbal interventions. Before I can do that though, I have to talk to you a little bit more about viruses and their lifecycle which is where we encounter our intervention targets.  This is really basic.  It’s about as simple as my brain will let me make it.

Learning this has been very useful to me.  I have used it to developing protocols for different viral  strains  and it has helped me to improve outcomes for my clients.  It also increases their confidence in my recommendations, which as many of you know is its own special kind of magic.

What is a Virus?

Viruses are obligate intracellular parasites that hijack a host cell to create energy and translate their genome (genetic code) into new virions.   They don’t have the capacity to create their own energy or replicate.

Virion is the term used for an extracellular virus particle used to spread the virus between cells and organisms. The virion includes an inner core of nucleic acid surrounded by an outer protein shell called a capsid. The capsid is formed due to weak covalent bonds between its protein subunits.  So some interventions  (like household cleaners and aromatic vinegars) target these extracellular virions by weakening these bonds further, breaking up the capsid, and destroying the virus.

An enveloped virion has a biological membrane consisting of lipids and proteins surrounding the protein shell.  This is not necessarily an advantage for the virion. An enveloped virion is less likely to survive strongly acid environment of the GI tract and they are even more susceptible to environmental factors such as humidity and temperature.  One advantage of an envelope to the virion is that it is comprised of materials from the host cell and so the host’s immune system is less likely to recognize the virus as a non-self pathogen.

The Viral Life Cycle

Adsorption (Attachment)
The first thing a virion must do to survive is to attach itself to its host cell. The surface of the virion is covered with attachment proteins called spikes. The spike for SARS-CoV-2 aka COVID-2019 was identified back in February.[i]  These spikes have what they call specificity which means that they will only bond with one type of receptor.

Examples:
Hemagglutinin is a surface protein of the influenza A virus which binds with sialic acid containing receptors. Antibodies that bind near the head of this protein prevent attachment while those that bind on the stem prevent membrane fusion which I will discuss below.

Herpes simplex virus 1 (HSV-1)  glycoprotein B targets  heparan sulfate proteoglycans (HSPGs).  Lemon balm  inhibits this interaction.

Beta Coronaviruses of the severe acute respiratory syndrome (SARs) family target angiotensin-converting enzyme 2 (ACE2) receptors. This is the family that includes SARS-CoV-2 aka COVID-2019.  I can say this because yesterday the paper came out confirming ACE2 as the target receptor and cellular serine protease TMPRSS2 as the priming protein.[ii]   Personally I am happy to see it because I am tired of the coronavirus cashcow.

Penetration
Next the virion needs to enter the cell or at least inject its genome into the cell. This is a simplified simulation of the most common viral entry processes.

Some enveloped viruses penetrate the host cell by fusing with the host cell membrane and releasing the capsid that contains the nucleic acids directly into the cell cytoplasm.  This sometimes requires additional priming proteases (enzyme that catalyse reactions which breakdown protein or peptides) to be present.  These proteases are another target of viral interventions, because if they can be inhibited, it prevents fusion and penetration.

It appears this is how SARS-CoV-2 enters the cell and yesterday’s paper also mentioned using the clinically approved camostat mesylate, which inhibits the protease TMPRSS2, to block SARS-CoV-2 from infecting lung cells.

It also seems that people who have antibodies built up due to exposure to SARS-CoV Cross-will have some at least some immunity to SARS-CoV-2 because those antibodies naturally inhibit viral entry.

Non-enveloped virions (NEV) such can directly penetrate the cellular membrane while most NEV and many enveloped viruses enter cells through a process called receptor mediated endocytosis.  Receptor mediated endocytosis is a process by which the virion is engulfed by the cellular membrane and pulled into the cell. Cell surfaces have small pits in their membranes coated with receptors. The cytoplasmic surface of these pits is coated with a lattice like structure made of clathrin.  So, if you see the term clathrin coated pits, this is what they are referring to.

Usually several spikes bond with several specific receptor in the same pit.  After this happens, the clathrin lattice and attached membrane encircle the virus until it is surrounded by the host cell plasma membrane. The membrane then pinches off and forms a vesicle which enters the cytoplasm.

Once this occurs, the outer clathrin lattice breaks away leaving an uncoated vesicle called a endosome. This vesicle then fuses with endocytic vesicles in the cell which along the cytoskeleton to be fused with lysosome.  It’s the lysosome’s job to breakdown cellular debris in their acidic environment and this acidity often causes physical changes in the virion allowing them to uncoat.

Uncoating
Uncoating is the term used for when the nucleic acid genome is completely released from the capsid into the cell. This process releases viral enzymes  RNA polymerase, DNA polymerase, and reverse transcriptase, which catalyse reactions in the cell. These enzymes have been therapeutic targets .  Highly active antiretroviral therapy (HAART)   uses a combination of protease inhibitors and reverse transcriptase inhibitors to treat HIV-1.

This process usually involves the acidity of the cellular environment altering the shape of the capsid proteins. In research papers they often use the term “undergoes a conformational change” to say that.  In one scenario though, the acidity of lysosome activates M2 channels in the virus that cause the inside of the virus to become acidic and dissolve the viruses outer coat. These channels are another target of viral interventions.

Genome Expression, Replication and Integration
This is the stage the virus uses host cell organelles to produce the proteins that will be used to assemble new virions and  it genome proteins which are the nucleic acids that encode all the information needed to replicate a new virus in the next host cell. This process is quite different depending on the class and family of virus and way beyond the scope of a concise explanation.

Assembly of Virions
During this stage the capsid proteins self-assemble, and the new nucleic acid genome is inserted in the capsule.

Release
Non-enveloped viruses tend escape the host cell in a way that results in lysis of the cell which is another reason that they are far more likely to attract the attention of the host immune system. Enveloped viruses are created as they move back out of the cell through the cytoplasmic membrane and in the process become covered with the lipid-protein outer layer. These new virions are once again extracellular and go on to repeat this process.

There are enzymes that facilitate this process that can be targeted.  Neuraminidase (NA) is the other surface protein associated with Influenza A which catalyzes reactions necessary for its release from the cell.

There are other targets for intervention that have to do with host immune function, but I think  that’s a lot to process for one post.    I still have to do some research on specifics because I’ve only had confirmation of my suspicions about this virus for a day  now.

[i] Wrapp, Daniel, Nianshuang Wang, Kizzmekia S. Corbett, Jory A. Goldsmith, Ching-Lin Hsieh, Olubukola Abiona, Barney S. Graham, and Jason S. McLellan. ‘Cryo-EM Structure of the 2019-NCoV Spike in the Prefusion Conformation’. Science, 19 February 2020. https://doi.org/10.1126/science.abb2507.

[ii] Hoffmann, Markus, Hannah Kleine-Weber, Simon Schroeder, Nadine Krüger, Tanja Herrler, Sandra Erichsen, Tobias S. Schiergens, et al. ‘SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor’. Cell 0, no. 0 (5 March 2020). https://doi.org/10.1016/j.cell.2020.02.052.

When Not to Use Elderberry: Using a Little Discernment

(This is the second in what will be a series of posts about acute illness and herbal adjuncts.  If you haven’t read the introduction you might want to go back and do that. )

I’ve been struggling with how to start this next installment on viral illness and then I found the following statement on a website. You are just going to have to trust me on this I am not going to link to a site full of affiliate adds for supplements you don’t need, and my intention is not to start anything with the authors.

The article said, “Elderberry also upregulates IL-6, IL-8 and TNF, suggesting an indirect effect on viral immune response in the body. Interestingly, elderberry was shown to have this effect but not its major bioactive compound, cyanidin 3-glucoside.”

To begin with, I don’t consider that anthocyanin to be the major bioactive compound of this plant.  I only use elderflower for influenza, and I consider its major bioactive constituent to be pectic polysaccharides, but that’s absolutely not important to this conversation.

Honestly,  I am relieved by this statement.  I am more likely to use black currants or blackberries which contain the same anthocyanins which have the same effect on viral replication[i] without upregulating the primary proinflammatory cytokines.

[Edited 2/28/2020:  I also wanted to add that I received several messages from Chinese Herbal Medicine practitioners who shared that mulberries are a traditional flu remedy and were used prophylactically during the last SARs outbreak.  You can read about that in this article.]

To explain why I find that preferable I am going to talk about the cytokines that are specifically mentioned in that statement.

What Are Cytokines?

Cytokines are just messenger peptides that mediate the inflammation pathways by carrying messages from cell-to-cell.  Some are  proinflammatory, some are anti-inflammatory,  and some that can go either way depending on the situation.

IL 6 and TNF-alpha are some of the more active proinflammatory cytokines and IL-8 is specific kind of cytokine called a chemokine which are involved in chemotaxis or the recruitment of white blood cells to an area.  When I was in school I remembered this for tests by thinking of them as chemical taxis.

The tiny peptides traveling between these cells are cytokines.

Is Upregulating Cytokines Beneficial?

The answer to this question is not always. I will start by discussing why I wouldn’t necessarily want to upregulate IL-8 which is a chemokine involved in recruiting white blood cells to an area.

Stanford physician Catherine Blish has studied the hyperinflammatory response to severe influenza in pregnancy extensively attempting to understand why many pregnant women become extremely ill when exposed to influenza. She has stated that abnormally elevated chemokine levels common in pregnancy draw too many white blood cells to the lung. “That’s a bad thing in a lung where you need air space.” Getting the flu during pregnancy, especially pandemic strains such as those that caused the pandemics of 1918, 1957 and 2009, carries a heightened risk for pneumonia and death.”[ii]

What she’s talking about here is a cytokine storm. I have a vested interest in this story because it was this flu that killed my great-grandfather Roberts. The clinical presentation of the storms was first associated with the 1918 flu and included accounts of patients drowning because their lungs filled with fluid and blood [iii] My great-grandfather had the flu, but was then well enough to be up and working and literally dropped dead in the field. So it must have hit him fast.

In 2013 researchers examined the lung tissue of 50 victims of 2009 H1N1 who had died of cytokine storms and found they had “remarkably” elevated levels of IL-1 receptor antagonist protein,IL-6, tumor necrosis factor-alpha, IL-8, monocyte chemoattractant protein-1, macrophage inflammatory protein 1-beta, and interferon-inducing protein-10 [iv]  which undoubtedly contributed to the over recruitment of white blood cells.  People with autoimmune conditions are more susceptible to this type of immune dysregulation.

These cytokine storms trigger a type of viral induced sepsis which is an acute event involving an amped up immune system response that results in a fatal pneumonia. It is usually associated with H1N1,but coronaviruses have sparked storms, as well.  For what it’s worth the 2019-nCoV includes a risk of what some researchers are calling Wuhan Pneumonia which seems to be caused by some sort of cytokine storm.

Now let’s stop and think for a moment about what we have already read.  Three of the seven cytokines I listed up above are those the marketing article mentioned elderberry upregulating. Researchers found specifically that areas of the lungs that had high bacterial infection also had high levels of IL-6, IL-8[v], so it doesn’t seem prudent to risk exacerbating that.

SARS-CoV-2 is a virus that is associated with these storms and subjects with severe symptoms are exhibiting elevated IL-6 levels.   Detectable serum SARS-CoV-2 viral load (RNAaemia) is closely associated with drastically elevated interleukin 6 (IL-6) level in critically ill COVID-19 patients

They really don’t know why they happen.  Some researchers believe it has to do with age and the elderly are currently most susceptible, but most of the victims mentioned in that 2013 paper, were in their mid 30’s.  My great-grandfather was also a younger man with no health complications that we are aware of.

So if we know that an illness associated with these storms is circulating, we want to be cautious.  Elderberry doesn’t have a long history of use anyway.  Here is an article that speaks to herbs that were used successfully during that outbreak by Eclectic physicians.

Since the risk of cytokine storm is not common,  I am going to step back a moment to talk about IL-6 and TNF-A.  These are both what they call endogenous pyrogens in that they trigger a fever response as a defence mechanism to pathogens.  They also act on nociceptive sensory neurons in the body to initiate the sensation of pain.

So even when working with a viral disease where there is not a known association with cytokine storm, we still want to observe the type of discomfort a person is experiencing and pick our adjuncts accordingly.  There is no sense in poking a system that’s already in overdrive.

This B/Washington strain that the flu vaccination botched was a particularly hot and achy strain.   Several of my clients who normally take elderberry during a cold, told me they thought their syrup was making it worse and asked if I had other ideas.  This makes sense to me giving the fact that it elevates cytokines known for initiating those prodromal signs and symptoms.

So in the the name of making better more nuanced choices, you may want to take into account any health conditions that you don’t want to exacerbate.  Honestly I wouldn’t recommend elderberry to a client that had any autoimmune disorder, but I am a safety girl and I have enough tricks up my sleeve to work without it.

After reading the Blish interview and the associated study I am going to start recommending that pregnant women not use it during the flu season because they are also at an increased risk of hyperimmunity.[vi]

Black currants are definitely one of those tricks, but I am a big fan of getting a wide variety of anthocyanins from blackberries, blueberries, raspberries, and strawberries.

So what about taking elderberry prophylactically?

If you just  are using elderberries as tonic when there is no viral complication, is that such a big deal? There are some concerns about doing that.

We know that “excessive or persistent cytokine production results in deregulated immune activation and plays a role in both the initiation and the amplification phases of immunopathologies.”[vii]  This means it is possible  that  prolonged upregulation of these primary inflammatory cytokines could contribute to initiating or exacerbating an autoimmune disease.   I have worked with clients who believe it triggered a flare for them, although I haven’t seen that with elderberry nearly as often as I have echinacea.

TNF-α, and IL-6 are already elevated in people with rheumatoid arthritis and contribute to chronic inflammation of the synovial tissue, joint dysfunction, and consequent tissue damage in the joints.   So persistent upregulation could exacerbate their symptoms of chronic inflammation.

There are no human studies that have shown long-term use is safe.  There is one study that I can find where the subjects took it for three weeks, but they were looking at diabetes markers as the end result and did not assess final C-reactive protein levels or any other marker of inflammation. Because I know from experience that autoimmune diseases are really no fun, I don’t feel comfortable recommending it without knowing for sure that I am doing no harm.

 

What really frustrates me to me is that there are plenty of herbs out there that interfere with viral replication. Research in this area is off the charts, right now.  We don’t NEED elderberry. So why is the elderberry craze persisting?  Call me cynical, but I think the answer to that has something to do with marketing.

I am not saying that everyone who tries to sell you elderberry knows this stuff. It takes a long time to understand the interaction between herbs and cytokines and I still consider myself a novice.   Some people out there have just latched on to the idea that just because something is natural it is safe, and they don’t necessarily have the education and experience to know better.

None of this is meant to say you should never use elderberry. I am just using it as an example to illustrate some of the questions you should be asking yourself about every herbal adjunct you use.  How does it work, when shouldn’t a person use it, and are their safer alternatives?

Basically what I have decided concerning the use of elderberry is that while I can’t  prove that any of these things will be a problem, I can’t prove that they won’t  be.   That should be a deciding factor of any  risk-benefit analysis.

Edited 02 Feb. 2020

I am editing this post to share my friend Thomas Easley’s  feedback that this article “maybe even underemphasizes the potential consequences of IL6 in promoting th17 and suppressing Treg differentiation. If you want to burn an infection out with your immune system use elderberry – but beware the risk of catching everything on fire!”   He shared this information about IL6 as a regulator of Treg/Th17 balance. 

I wanted to share this article, but I have also had a lot of messages about where to study this sort of information about herbs.  If you take my local consultation class I teach the basics you need to be an informed consumer. If you want to learn clinical application, I strongly suggest checking out Thomas’ program.  He will put you on the right path.

References:

[i] Ehrhardt, Christina, et al. ‘A Plant Extract of Ribes Nigrum Folium Possesses Anti-Influenza Virus Activity In Vitro and In Vivo by Preventing Virus Entry to Host Cells’. PLoS ONE 8, no. 5 (23 May 2013). https://doi.org/10.1371/journal.pone.0063657. and Ikuta, Kazufumi, Koichi Hashimoto, Hisatoshi Kaneko, Shuichi Mori, Kazutaka Ohashi, and Tatsuo Suzutani. ‘Anti-Viral and Anti-Bacterial Activities of an Extract of Blackcurrants ( Ribes Nigrum L. ): Anti-Microbial Activity of Blackcurrants’. Microbiology and Immunology 56, no. 12 (December 2012): 805–9. https://doi.org/10.1111/j.1348-0421.2012.00510.x.

[ii] Digitale, Erin. ‘Immune Response Turned up High by Flu during Pregnancy, Stanford/Packard Study Finds’. Stanford Medicine News Center (blog), 22 September 2014. http://med.stanford.edu/news/all-news/2014/09/immune-response-turned-up--not-down--by-flu-during-pregnancy--st.html.

[iii] Kobasa D, Jones SM, Shinya K, et al. Aberrant innate immune response in lethal infection of macaques with the 1918 influenza virus. Nature. 2007;445(7125):319–323. doi:10.1038/nature05495.

[iv] Gao R, Bhatnagar J, Blau DM, et al. Cytokine and Chemokine Profiles in Lung Tissues from Fatal Cases of 2009 Pandemic Influenza A (H1N1). The American Journal of Pathology. 2013;183(4):1258–1268. doi:10.1016/j.ajpath.2013.06.023.

[v] Ibid.

[vi] Kay AW, Fukuyama J, Aziz N, et al. Enhanced natural killer-cell and T-cell responses to influenza A virus during pregnancy. Proceedings of the National Academy of Sciences. 2014;111(40):14506–14511. doi:10.1073/pnas.1416569111.

[vii] Salvi V, Gianello V, Tiberio L, Sozzani S, Bosisio D. Cytokine Targeting by miRNAs in Autoimmune Diseases. Frontiers in Immunology. 2019;10. doi:10.3389/fimmu.2019.00015.