Influenza: Causes, Risks & Prevention | Dr. Roger Seheult & Dr. Andrew Huberman

00:00:00.000 | - Obviously the flu can be deadly in some circumstances,

00:00:05.000 | but for most people that are healthy, generally healthy,

00:00:08.980 | first of all, how concerning is flu?

00:00:13.100 | Like, should I really be concerned about flu

00:00:15.440 | this winter season, even though I feel robust?

00:00:18.680 | And then the second question is,

00:00:20.280 | do you personally get the quote unquote flu shot?

00:00:23.060 | I said on a previous podcast that I don't get it,

00:00:25.580 | and I took a lot of heat for that.

00:00:29.520 | I understand that the flu shot does protect

00:00:32.380 | against certain forms of flu, not all of them.

00:00:34.860 | That statement was kind of pushed out there

00:00:39.000 | by folks saying that I was going against CDC guidelines.

00:00:41.200 | I'm not going against CDC guidelines.

00:00:42.640 | People should do as they choose.

00:00:43.720 | They should just know what they're doing.

00:00:45.080 | I've never gotten a flu shot.

00:00:47.560 | I don't know if I've ever gotten the flu,

00:00:50.140 | but that's my personal choice,

00:00:51.560 | and it's not based on any specific fear of the flu shot.

00:00:54.920 | It's because it's never been an issue for me,

00:00:57.840 | and I'm okay with getting a cold or a flu

00:01:01.840 | every couple of years,

00:01:03.000 | feeling miserable for a week or two, and bouncing back.

00:01:06.440 | I feel like that's good to develop my own antibodies,

00:01:08.400 | but maybe I'm thinking about this completely irrationally.

00:01:11.240 | So do you get the flu shot?

00:01:14.000 | Do you recommend the flu shot for healthy people?

00:01:16.280 | Do you recommend the flu shot

00:01:17.440 | for people that are metabolically challenged?

00:01:20.480 | - Yeah, it's a good question.

00:01:21.840 | I think it's, and the approach that I take

00:01:23.920 | is the approach that I take

00:01:25.360 | with any intervention in medicine.

00:01:27.120 | Every intervention in medicine has a benefit,

00:01:29.200 | and every intervention has a risk, no matter what it is.

00:01:32.640 | So for me, because I work in an intensive care unit

00:01:35.760 | around sick patients all the time,

00:01:37.440 | I'm exposed to a lot of flu.

00:01:39.600 | I mean, you literally walk in, and the next day they say,

00:01:42.000 | "Oh, by the way, that guy, yeah, he had the flu."

00:01:44.160 | So you find out after the fact.

00:01:46.220 | So for me, I've always, since I've been a physician,

00:01:48.480 | I've always gotten the flu shot every single year.

00:01:50.580 | - Do you get it multiple times per season?

00:01:52.520 | - No, just once.

00:01:53.360 | - Okay, so at the beginning of the flu season,

00:01:54.600 | when they say, "Flu shot available now."

00:01:56.360 | So it's a mix of antibodies

00:01:58.080 | against known strains of the flu.

00:02:01.400 | - Yeah, interesting.

00:02:02.680 | The way that they try to figure out or guess the way it is,

00:02:06.000 | because that's what it is, it's a guess,

00:02:07.400 | is they look six months earlier

00:02:08.800 | to see what happened in the Southern hemisphere,

00:02:11.040 | and they see what was circulating there,

00:02:12.360 | and then they believe that's what's gonna be circulating

00:02:14.560 | in the Northern hemisphere.

00:02:15.400 | And they do the same in the South.

00:02:16.960 | They look and see what's circulating up here,

00:02:18.240 | and they try to figure out what is gonna be there.

00:02:20.120 | So there's usually about three or four different ones

00:02:23.040 | that they try to put in there.

00:02:24.840 | Ever since 2009, they've tried to put one in there

00:02:27.160 | about 2009, because that was a really bad year.

00:02:29.240 | We mentioned that in terms of that study on sunlight,

00:02:32.360 | but in terms of the side effects as a result of that,

00:02:36.920 | it's been pretty bad.

00:02:38.040 | I mean, to give you an example,

00:02:39.480 | I had a patient recently in the intensive care unit.

00:02:42.160 | This patient came in, very poorly controlled diabetes,

00:02:45.400 | hemoglobin A1C of like 16, 17, it was very bad.

00:02:49.000 | And she developed, she got the flu,

00:02:51.200 | and her immune system was not well.

00:02:53.540 | She actually also got a very bad fungal infection

00:02:56.700 | that was near fatal.

00:02:58.380 | And so that's the typical patient that we're gonna see

00:03:02.640 | who's gonna have that type of a bad reaction to the flu.

00:03:05.840 | People who are immunocompromised,

00:03:07.960 | people who are not metabolically healthy,

00:03:10.560 | these are the ones that are wide open.

00:03:11.880 | And so a flu virus is going to do a lot of damage there.

00:03:16.880 | So what does the flu vaccine do?

00:03:18.880 | It gives the immune system an advanced notice

00:03:23.440 | of what this antigen is.

00:03:24.980 | And that has two effects.

00:03:26.640 | What a lot of people believe is that it's gonna protect you

00:03:30.420 | from ever getting infected.

00:03:32.300 | That's not the case.

00:03:33.420 | You can still get infected,

00:03:34.940 | but what happens is that the symptomatology

00:03:37.740 | or the side effects of that infection

00:03:40.220 | will be greatly diminished.

00:03:42.040 | So instead of you being hospitalized, perhaps,

00:03:44.140 | maybe you're only coming down with the flu

00:03:46.700 | and you stay at home.

00:03:47.780 | A lot of people would say, "I got the flu shot

00:03:49.560 | and it didn't help, I got the flu anyway."

00:03:51.480 | What we don't know is how severe that infection

00:03:54.380 | would have been in the first place.

00:03:56.040 | So that's why, for people who are immunocompromised,

00:03:58.640 | I generally recommend it to get the flu shot.

00:04:01.040 | - Or people that are exposed to a lot of flu,

00:04:02.800 | because like you, you work in the ICU.

00:04:05.240 | But, and if I may, do your kids get the flu shot?

00:04:10.240 | - Yeah, we give them the flu shot as well.

00:04:14.080 | It's more because they're the kids of doctors

00:04:16.120 | who might bring home the flu more than anything else.

00:04:19.840 | But there was a point where we were not doing it.

00:04:22.960 | When they're in their teenage years,

00:04:24.160 | that's when we start actually giving them the flu shot.

00:04:26.200 | That was just a personal opinion,

00:04:27.280 | even though I know it's approved

00:04:29.200 | down to six months of age, I believe.

00:04:31.240 | - So you started your kids

00:04:32.280 | once they were in their teen years?

00:04:33.560 | - Yeah, yeah.

00:04:34.840 | I remember one year, our son, Ryan,

00:04:37.960 | he got some virus, I don't know what it was,

00:04:41.480 | but he had very bad diarrhea.

00:04:43.360 | And we had to take him to the emergency room

00:04:46.520 | to actually get an IV and get fluids into him.

00:04:48.120 | He was very dehydrated.

00:04:49.960 | I don't know what that was.

00:04:51.080 | I don't know if it was rotavirus,

00:04:52.400 | but something was going around that year.

00:04:54.080 | So, and he's perfectly healthy.

00:04:55.920 | So this is something that can happen.

00:04:57.580 | And you just have to look at the risks and benefits.

00:05:00.800 | - So if, well, I am telling you

00:05:03.080 | that I've never gotten a flu shot.

00:05:04.920 | Am I being irresponsible as a citizen?

00:05:07.280 | I don't tend, I mean, I go places, I go to restaurants,

00:05:10.400 | I go to the gym, I've remained healthy for the most part.

00:05:15.200 | I'm in an occasional sniffle here and there.

00:05:16.640 | Every couple of years, I'll get,

00:05:18.080 | it's been a long time actually, now that I think about it.

00:05:20.640 | - I think irresponsible is probably too strong of a word.

00:05:23.600 | The way I look at things

00:05:24.600 | is through what I call the Swiss cheese model.

00:05:26.760 | I don't know if you've ever heard of the Swiss cheese model.

00:05:28.520 | - I love Swiss cheese.

00:05:29.360 | - Okay, so the Swiss cheese model says this.

00:05:31.600 | Every, if I cut up a bunch of pieces of Swiss cheese,

00:05:34.480 | you'll know that every piece has a hole in it, right?

00:05:36.680 | Or maybe a couple of holes.

00:05:38.120 | And if you line up those pieces of Swiss cheese,

00:05:40.760 | those holes might be in different places.

00:05:43.080 | So if you are, let's say you're on one end of those

00:05:45.640 | multiple slices of Swiss cheese

00:05:47.400 | and little particles are coming through.

00:05:50.160 | If you have enough pieces of those Swiss cheese,

00:05:52.680 | no particles are gonna get through.

00:05:54.560 | And that's really what we look at in medicine.

00:05:56.680 | We don't just depend on one slice of Swiss cheese.

00:05:59.840 | Like in the operating room, for instance,

00:06:02.680 | we don't wanna have infections.

00:06:04.000 | So what do we do?

00:06:04.840 | We sterilize the instruments.

00:06:06.720 | But we don't just leave it there, right?

00:06:08.000 | We sterilize the skin that we're going to incise.

00:06:10.680 | We make sure that the room is the right temperature,

00:06:12.560 | the right humidity, because that has an effect.

00:06:14.360 | We make sure it's under positive pressure.

00:06:16.400 | The surgeon is wearing a mask.

00:06:17.960 | He's also wearing sterile gloves.

00:06:19.200 | So we go through, we try to do everything

00:06:21.480 | that we can possibly do so that if there is a breakdown

00:06:24.760 | in one place, we still have a bunch of other

00:06:26.720 | Swiss cheese slices in place.

00:06:28.640 | It's the same thing with the flu and new start.

00:06:31.160 | So nutrition, exercise, water, all of those things.

00:06:33.760 | And then at the end, when you've done that for yourself,

00:06:37.120 | if you wanna have extra protection,

00:06:38.640 | you wanna add on another piece of Swiss cheese,

00:06:40.480 | then you, well, you can talk to your doctor,

00:06:42.240 | see what the risks and the benefits are,

00:06:44.000 | and then make that decision

00:06:45.160 | if that's something that's right for you.

00:06:47.240 | - Are there any known risks of the so-called flu shot?

00:06:50.320 | And if so, what's the percentage risk?

00:06:53.000 | - Yeah, well, definitely there are risks

00:06:55.080 | in terms of allergies.

00:06:56.520 | So they should be asking you when you get it,

00:06:58.760 | have you ever been allergic to the flu shot before?

00:07:00.800 | I mean, you can have anaphylactic shock.

00:07:02.200 | That's one possibility.

00:07:03.480 | Of course, you can have that with anything, right?

00:07:05.960 | But specifically to the flu,

00:07:08.360 | there was actually, interestingly, one year,

00:07:11.640 | and I can't remember which year it was,

00:07:13.040 | but there was a, I think it was in Europe,

00:07:15.320 | and we actually never got it in the United States,

00:07:17.640 | but there was a rash of narcolepsy that was occurring.

00:07:21.360 | So something about the flu vaccine was causing a reaction

00:07:26.040 | that was causing an autoimmune response,

00:07:27.840 | and the antibodies, they believe,

00:07:29.240 | were acting against where hypocretin is made

00:07:35.120 | in the brain, hypothalamus.

00:07:38.120 | And so they noticed that there was an association.

00:07:41.400 | I don't know if they actually determined that it was causal,

00:07:44.040 | but they stopped that brand.

00:07:46.560 | - I would not want narcolepsy.

00:07:49.200 | I used to work in a laboratory for a summer

00:07:51.320 | that studied narcolepsy.

00:07:52.920 | It was the Laboratory Emmanuel Mignon's lab

00:07:55.560 | at Stanford School of Medicine.

00:07:57.340 | He and his colleague, Seiji Nishino,

00:08:00.120 | identified the hypocretin-orexin mutation

00:08:03.920 | as the source of narcolepsy.

00:08:05.400 | And people with narcolepsy,

00:08:07.360 | people think it's just excessive daytime sleepiness,

00:08:09.440 | but anytime they have it, in the extreme examples,

00:08:13.600 | when people with narcolepsy

00:08:15.120 | have any kind of emotional activation, they fall asleep.

00:08:18.280 | And they have cataplexy too, so they can't drive.

00:08:20.820 | They become essentially paralyzed, like a sleep atonia.

00:08:25.600 | Pretty devastating disease.

00:08:26.600 | So it sounds like that particular strain of the flu shot

00:08:30.120 | in Europe was neurotoxic in some way.

00:08:33.000 | - Yeah, there was one particular strain.

00:08:34.400 | We'd never seen it before, never seen it since.

00:08:37.920 | And so yeah, there are these one-offs, right?

00:08:41.320 | But everything has risks.

00:08:43.120 | And so the example that I give is,

00:08:45.480 | look, I'm in the ICU all day,

00:08:47.080 | and I'm seeing people occasionally with head bleeds,

00:08:50.120 | and they're on a blood thinner.

00:08:52.200 | But I don't go back to my clinic in the pulmonary office

00:08:55.120 | and then take everybody off of blood thinners,

00:08:57.200 | because we know that blood thinners, epidemiologically,

00:08:59.640 | in the long run, actually save lives

00:09:01.800 | because they prevent strokes, heart attacks,

00:09:03.960 | things of that nature.

00:09:04.800 | So what we try to do is figure out

00:09:07.280 | what's the right individual for this medication,

00:09:10.040 | or what's the right medicine for this type of situation.

00:09:14.120 | And that requires training.

00:09:17.360 | And that requires, sometimes you have calculators

00:09:19.400 | that can figure out these risks.

00:09:21.640 | - In the winter months when flu levels are high,

00:09:25.240 | are you wearing a mask from the moment you walk

00:09:27.160 | into the clinic in the morning until when you leave?

00:09:29.760 | When you walk up to a new patient,

00:09:31.960 | if you know they have a flu,

00:09:33.960 | or if you know they don't have the flu, are you masked up?

00:09:38.000 | I mean, this became a big issue around the COVID discussion,

00:09:42.280 | but to what extent does wearing a conventional mask,

00:09:47.520 | or even an N95, actually protect you from flu?

00:09:50.840 | - Yeah, so the regular surgical masks

00:09:53.400 | are very good at preventing things

00:09:55.080 | from coming out of your mouth and going to other people,

00:09:58.520 | or coming onto your mouth if you happen to have one on.

00:10:00.560 | So in our clinic where we work,

00:10:02.520 | we actually look at the flu incidents.

00:10:06.120 | And then we see if it's rising,

00:10:08.120 | everybody that comes into that place,

00:10:09.720 | physicians, patients, everybody puts a mask on to reduce that.

00:10:14.240 | N95s are a little different in that

00:10:16.320 | they don't prevent viruses from coming out of somebody.

00:10:21.000 | You may notice when you put an N95 mask on,

00:10:23.240 | they may even have a valve that pops open,

00:10:25.160 | and gas can come out, respiratory air can come out,

00:10:29.160 | or comes out the sides.

00:10:30.520 | It's when you take a breath in and it seals,

00:10:33.040 | now it's filtering that air.

00:10:34.400 | So N95s are very good for people

00:10:37.200 | who don't wanna get infection

00:10:38.880 | and don't have respiratory issues,

00:10:40.640 | because you're now having to breathe air in through a filter

00:10:44.400 | that takes a little bit more work.

00:10:45.720 | If someone has COPD, which is an obstructive lung disease,

00:10:50.600 | or other lung diseases,

00:10:51.720 | that might not be the best thing to have in those situations.

00:10:54.200 | So, yeah, I do wear a mask.

00:10:56.920 | I was very careful.

00:10:58.040 | I know I was coming on your show this winter time,

00:10:59.960 | and I was like, "There's no way I wanna get the flu

00:11:02.320 | "and miss getting on to see you."

00:11:05.640 | So, yeah, I wore a mask.

00:11:06.480 | Well, thank you for not, for avoiding bringing flu here.

00:11:09.680 | It's wild because ever since I started this podcast,

00:11:12.040 | we put out now two episodes a week,

00:11:13.960 | full-length episodes on Mondays

00:11:15.440 | and the shorter essential episodes on Thursdays.

00:11:17.720 | So, I can't afford to get sick.

00:11:20.640 | Yeah, and I haven't been sick in years.

00:11:22.800 | I take care to not get sick,

00:11:25.280 | but I'm gonna think real carefully

00:11:27.000 | about this flu shot thing.

00:11:28.680 | What about hand-washing?

00:11:29.960 | Is that?

00:11:30.920 | So, a friend, let me give a little bit of backstory.

00:11:33.400 | The guy I worked for as a postdoc was an MD, PhD,

00:11:37.340 | and he used to joke about the fact

00:11:39.520 | that hand-washing did nothing,

00:11:40.860 | because he was, in his prior life, he was a surgeon.

00:11:44.440 | He did a, I think he did a rotation, a surgery rotation.

00:11:48.040 | He eventually became a neurologist, then a researcher.

00:11:51.640 | And I used to say, what do you mean?

00:11:53.280 | The hand-washing does nothing.

00:11:54.360 | And he's like, well, have you ever seen

00:11:55.680 | what a physician does before surgery?

00:11:57.160 | You know, they wash up to their,

00:11:58.600 | up to their, basically their shoulders.

00:12:00.640 | They've got betadine, they glove in properly.

00:12:04.120 | And, you know, that's how you prevent infection.

00:12:05.880 | Washing your hands does nothing.

00:12:07.080 | It's a formality.

00:12:07.940 | And I thought, there's no way that could be true.

00:12:10.300 | Then I started digging around in the literature about this,

00:12:12.680 | and it's kind of mixed.

00:12:14.480 | Like, so, to what extent does washing our hands

00:12:16.400 | actually help us avoid getting infection?

00:12:18.520 | I, you know, it's a good question.

00:12:19.800 | And I think it probably comes down to some of the studies

00:12:22.480 | are probably not good data or heterogeneous enough

00:12:25.120 | to do a meta-analysis.

00:12:26.980 | But what's really interesting is how many times a day,

00:12:30.800 | if you were to watch yourself, that you touch your nose,

00:12:32.840 | you touch your face.

00:12:33.680 | And these are the portals for viruses

00:12:36.160 | to come into your body. - Eyes.

00:12:37.440 | - Yeah, eyes, nose, mouth.

00:12:39.280 | That's where they come.

00:12:40.120 | And we touch them all the time.

00:12:42.140 | You touch handles.

00:12:44.320 | I mean, if you think about it, it's almost,

00:12:47.120 | I don't know, creepy.

00:12:49.200 | - And flu, it is creepy.

00:12:50.400 | And flu and cold can survive out on surfaces for how long?

00:12:54.440 | - I'd have to look up the numbers,

00:12:56.440 | but it's longer than you might think.

00:12:58.640 | I know that when we looked at COVID,

00:13:00.440 | it's that really, I know we went crazy

00:13:03.000 | at the beginning of the COVID pandemic

00:13:04.760 | about wiping things down.

00:13:05.960 | And really, that's not the way it seems to spread for COVID

00:13:10.000 | and more airborne things, but for influenza droplets,

00:13:13.800 | that is, you know, rotavirus, C. diff,

00:13:17.320 | that's clostridium difficile infection of the bowel.

00:13:20.800 | That's the primary way that it actually spreads.

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Influenza: Causes, Risks & Prevention | Dr. Roger Seheult & Dr. Andrew Huberman

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