It’s pretty easy to be paranoid about every cough, sneeze and ache these days—it’s officially flu season, after all. You may need to be especially alert this year, as some experts believe the 2019–2020 flu vaccine may not be effective against two of the four strains of flu virus likely to be circulating. But it is still important to get vaccinated. The vaccine is not perfect, but it does prevent flu for many people…and for those who do get sick, it makes the illness much less severe.

Here’s help: In case you or a member of your family has the flu, or you suspect it, we sought advice on what to do from two of the country’s top experts—infectious disease specialist William Schaffner, MD, professor of preventive medicine and infectious diseases at Vanderbilt University School of Medicine in Nashville…and Andrew Rubman, ND, a naturopathic physician, medical director of the Southbury Clinic for Traditional Medicines in Southbury, Connecticut, and author of Bottom Line’s “Nature Doc’s Patient Diary” blog. Together, Drs. Schaffner and Rubman will help get you through the flu with confidence—confidence in your ability to spot the signs, seek the right treatment and feel your best when the flu strikes you or a member of your family. Here’s what they had to say…


While symptoms can vary from mild to severe, there are a few key differences between a nasty cold and the flu.

Dr. Schaffner: If all of your symptoms are above the neck—sore throat, stuffy or runny nose, headache and a little degree of fever—that’s likely to be a cold. If you have these symptoms plus symptoms below the neck including persistent dry cough, body aches, chills, feeling tired and/or a fever over 101°F— that’s likely the flu. Because the flu varies from mild to severe, it’s hard to make black and white distinctions. You don’t need all symptoms, but having a few is cause for concern.

Unlike the common cold, flu symptoms often come on quickly and can quickly lead to severe, dangerous infection or dangerous flu-related complications such as pneumonia. This is especially true if you’re over age 65, pregnant or have an underlying chronic condition such as asthma, lung disease, heart disease or diabetes—but flu can be dangerous for anyone.


Dr. Schaffner: If you think you have the flu and you’re in a high-risk category, don’t wait to tough it out. Call your doctor as soon as you feel sick. Many health-care professionals will prescribe an antiviral medication such as oseltamivir (Tamiflu) or zanamivir (Relenza) without even seeing you. This also prevents you from exposing other people in the doctor’s office to the flu. If you can’t reach your doctor, going to a walk-in “urgent care” or other type of clinic is an option.

Baloxavir marboxil (Xofluza) is an antiviral that works similar to Tamiflu. The difference? You only need one dose of Xofluza for it to work—Tamiflu needs to be taken every 12 hours for five days to treat flu symptoms (once a day for 10 days to prevent flu symptoms). Xofluza is best if taken within 48 hours of symptom onset and can shave off about one day from a typical seven-to-10-day bout of the flu. Some people do experience mild side effects from the drug, including nausea, abdominal cramps and diarrhea. Important: If you have a chronic illness or compromised immune system, an antiviral can help prevent complications. It also makes it less likely that you’ll pass the virus to someone in your family.

Relatively healthy individuals may be asked to take a while-you-wait diagnostic test at a doctor’s office or clinic to check for influenza infection. Here’s the tricky part: If this quick test comes back negative, you can still have the flu. That’s why your doctor may treat you for flu based on your symptoms and his/her clinical judgment, not just on the test, during flu season—and why you should directly ask your doctor about an antiviral or other treatment if he/she seems reluctant to treat you.


Dr. Schaffner: Once you are diagnosed, mild over-the-counter pain relievers and fever reducers such as acetaminophen or ibuprofen can help ease muscle aches and high temperatures. You’ll likely spend the next few days zonked out in bed, but it’s important that you wake yourself up periodically to stay hydrated. If you let yourself get dehydrated, it predisposes you to pneumonia. Set an alarm for every hour or so to remind yourself to sip water. Note: Alcohol and caffeinated beverages like coffee or tea are dehydrating, so avoid them while you are ill.

During your fluid breaks, get up and walk a little, even if just to the bathroom and back. As you gain more strength, you even can head down your driveway and eventually around the block (weather permitting). This type of gentle exercise can give you a more positive outlook. Just be sure to listen to your body and stop before you feel totally exhausted.

Important: Being vertical is better for your body than being horizontal. Lying flat causes your muscles to weaken more, and because you’re lying flat, you’re not taking breaths as deeply, and that predisposes you to pneumonia. When you’re in bed, prop yourself up with pillows. When you’re not asleep (or trying to sleep), sit up in a chair or on the sofa as much as possible throughout the day.

Dr. Rubman: There’s a good reason people say the flu “knocks you out.” To help your lungs, muscles and mental health, try two exercises that come from yoga and that can invigorate you and ease the physical malaise of the flu…

  • Pranayama breathing: When you are battling the flu, this deep “intentional” breathing helps to move mucus and enhance calm. Do it several times each hour. Start with empty lungs, then breath in through your nostrils (or your mouth if your nose is too stuffed up), allowing your diaphragm to “sit” on your abdomen and press the belly out. Then, like sand filling a sack, let the air fill the lungs from the bottom up. Feel your rib cage expanding. At the end of the inhalation, your shoulders should swing back slightly as the peaks of your lungs finally fill. Then exhale from the shoulders downward, as though you were reversing a video of the inhalation.
  • Sun Salutation pose: This is a series of slow, gentle moves that are just what’s needed to keep you from being too sedentary while your immune system fights off the flu.

Do the right thing: No one wants to be a dreaded spreader, and spreading flu germs is a lot easier than you might think. A University of Maryland-led study found that you don’t have to sneeze or cough on someone to spread the flu to that person—just breathing on someone can do it. Meanwhile, when an infected person sneezes, coughs or talks the germs can reach up to six feet away…and if a healthy person touches a surface contaminated with the virus and then touches the eyes, nose or mouth, he/she can also be contaminated. So when you have the flu, hunker down and try to separate yourself from family, friends and coworkers. It’s best to avoid work, gym and religious services for at least 24 hours after your fever is down without the use of fever-reducing medication. The CDC advises that people are contagious for five to seven days after getting flu symptoms.


Dr. Rubman: While eating is the last thing you may feel like doing when you have the flu, proper nutrition is vital for recovery. The right diet will help your immune system go after the infected cells and shorten the course of the infection—so lay off the junk food, sugary stuff and processed food, and when you eat, make it count by eating lots of fruits and vegetables. Best: Choose brightly colored, ripe-smelling produce. Top picks include grapefruit and berries. 

Something special to try: “Chinese penicillin”—aka egg drop soup, which you can get from just about any Chinese restaurant. This is a marvelous food for people with the flu because it hydrates…replaces sodium and the protein albumin lost to diarrhea…and helps stimulate healthy mucus. The egg also supplies dietary cholesterol, which helps the body produce cortisone to fight inflammation. If you’re not a fan of egg drop soup, crack an egg in chicken soup as you’re heating it on the stove for the same benefits.

Quick tip: Chewing thoroughly will help you better absorb key nutrients in the foods you eat. And the benefit of eating more slowly is another reason to opt for whole foods over processed foods—just think about how quickly you can eat a cookie versus a fresh apple.

Also consider juicing. It can be a great way to load up on immune-boosting fresh fruits and vegetables when you don’t have the stomach for solids.


Dr. Rubman: Giving your natural virus-fighting machinery a boost with certain natural supplements can help you recover. People’s nutritional needs vary, so ask your doctor how much you should take of the following nutrients…

  • Vitamins A, C, and E and the mineral zinc are the four horsemen of the immune system. Best: Take them close to when you eat brightly colored fruits and vegetables because nutrients in these foods will help them be better absorbed by the body.
  • Vitamin D is a potent flu fighter, and when you are sick with the flu, you almost certainly won’t be getting enough D from exposure to sunlight.
  • Selenium is a trace mineral used by the body to form a compound that helps to improve immune function.
  • Larix (arabinogalactan) powder (mixed into water) is a supplement made from the bark of the Western larch tree that helps the cells that line the digestive tract resist the flu and can help shorten the course and intensity of the virus. To get the most immune-boosting benefits, take it with a meal containing beans. And skip the Beano—believe it or not, raffinose, the novel carbohydrate in beans responsible for intestinal gas, amplifies the immune benefit.
  • N-acetylcysteine(NAC) is an amino acid that can help clear inflammatory substances so the body can better reduce the buildup of mucus and congestion and flush out the virus.


Dr. Schaffner: The following symptoms may indicate that your flu took a turn for the worse and, especially if you’ve been sick for several days, should prompt an immediate call to your doctor…

  • You have a fever of 103°F or higher.
  • You have more difficulty breathing.
  • You cough up green or gray sputum (saliva and mucus from the respiratory tract) or sputum streaked with blood.

Any of these symptoms could simply mean that your illness is going to be tougher than hoped before your body fights it off…but they might indicate that your case is spiraling toward pneumonia or a more widespread and serious infection, and either could be life-threatening. That’s why you must call your doctor immediately.


Dr. Rubman: Most people will be exposed to the flu virus this season, but whether you fall sick largely depends on your immune system. Most people don’t realize that the gut is the immune system headquarters for your whole body—it’s home to 70% to 80% of our immune cells. A healthy bacterial environment in the gut will support a healthy defense against the flu.

So, get your flu shot, eat well, get a healthy dose of rest and exercise, manage stress in a positive fashion and you’re more likely to stay healthy. Of course, a whole lot of disinfectant and hand washing can’t hurt either!

To keep you on the path of recovery, here are more ideas from Bottom Line for taming the flu…

Dr. Mark Stengler on homeopathic treatments

Dr. Schaffner on preventing pneumonia

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