The Stomach Flu - Handling Gastroenteritis
by: Philip Rouchotas, MSc, ND
Bolton Naturopathic Clinic
64 King St W, Bolton, ON, L7E 1C7
The “stomach flu” or a “stomach bug” are the common names for what is officially known in medicine as gastroenteritis. Gastroenteritis essentially means “inflammation of the gastrointestinal tract”; it usually involves the stomach and the intestines. It causes a set of highly unpleasant symptoms: usually a combination of diarrhea, vomiting, abdominal pain, and abdominal cramping. There can also be other symptoms such as nausea, lack of appetite, and signs of dehydration if it gets more severe. The most common type is viral gastroenteritis, caused by a few different viruses. Norovirus is common among school-aged children, as well as in hospitals and on cruise ships. Rotavirus is the leading cause of severe gastroenteritis in children (and there are vaccines available for Rotavirus). Finally, there are other less common viruses called Astrovirus and enteric adenovirus. Those who have the highest risk of severe gastroenteritis are those who are immunocompromised (or have weakened immune systems for any reason), including the very young and the very old.
The easiest way to diagnose gastroenteritis is by allowing your health-care provider or naturopathic doctor to take a thorough history, by asking a series of questions. He or she will ask about signs that might indicate you are dehydrated, including a dry mouth or low urine output. Physical exams may include taking blood pressure; if you are dehydrated, you may have low blood pressure. Aside from the diarrhea and nausea, symptoms that occur if you have the stomach flu may include chills, fever, stiffness, muscle pain, and weight loss; your health-care practitioner will likely inquire about these. If you’ve come into contact with contaminated food or someone who’s been ill, this is usually all that is required to confirm the diagnosis and move forward with treatment suggestions. In terms of lab testing, stool samples may be used to identify the virus that is causing the illness. The majority of the time these types of tests are not needed, but if the illness lasts longer than a couple of days, it may be worthwhile doing a stool culture to see if the problem is instead being caused by a bacteria. This will help ensure that you are obtaining the most appropriate type of treatment.
The stomach flu can usually be prevented through good sanitation habits; for example, ensuring that you have uncontaminated water available is extremely important, and usually more of a problematic issue in less-developed countries — take precautions if you are travelling. Breast-feeding is another common recommendation, especially in places with poor hygiene. Breast milk appears to reduce the frequency and intensity of infections. Finally, the World Health Organization recommends that the Rotavirus vaccine be offered to all children globally; the first vaccine is usually given to infants between 6 and 15 weeks of age and is generally quite effective.
Antibiotics are not effective against viruses. Be cautious with medications and try to use the smallest amounts possible if you do choose to proceed with medications. Many can worsen the symptoms of gastroenteritis. For children, avoid pain killers and use them very sparingly. Some can cause toxicity, and aspirin is dangerous because it can cause a condition known as Reye’s syndrome. Medications that prevent diarrhea may make it harder for your body to eliminate the virus, so it may be best to seek the advice of your doctor prior to using these as well.
The best treatment for the stomach flu is rest; whether that be sleeping, lying down, or simply taking it easy — it’s important to decrease your activity level. Resting allows your body and your immune system to fight the virus and repair any damage that’s been done. Also if you are dehydrated, the illness may make you weaker than normal, so you certainly don’t want to push it.
During your recovery, it’s extremely important to make sure you don’t get dehydrated, so drink plenty of fluids. Electrolytes, such as salt and minerals, are lost through diarrhea or vomiting, so it is even more important that they are replaced. You may get some of these through drinking water, but if you’re not getting enough, you may want to have electrolyte solutions or what’s called “oral rehydration solutions”; these are normally available at drug stores. Some sports drinks have electrolytes, but they are not usually the best option, as they often contain colouring and other additives, as well as copious amounts of sugar. If you are finding it difficult to drink, try sucking on ice or taking small sips at a time. You could also try drinking clear soda or broths.
In terms of diet, you may find it difficult to eat, or you may find you have a lack of appetite; this is normal while experiencing the stomach flu. You may also find that when you do eat, you experience abdominal cramping or pain; this should pass. To help with this, try eating small amounts of food frequently. Try eating foods like cereals, bread, potatoes, lean meats, bananas, and vegetables. Gradually begin eating bland foods. You can also consider items such as rice and chicken. If you find you are too nauseous, decrease the quantities of food, or increase the time increments in between consumption. You may also want to avoid certain foods such as sugary foods, as these can make diarrhea worse.
There are a variety of vitamins and herbal supplements that can be quite helpful in treating gastroenteritis. Some supplements are specifically used because they can help boost the activity of the immune system. For instance, one good way to fight infections is to maintain adequate vitamin D levels, so if you’re living in Canada, it’s probably worthwhile supplementing for the majority of the year. Vitamin C is another option; it is essential to proper immune function, and supplementation may have antimicrobial properties. If you find it is upsetting your stomach, it may not be the best choice for you.
In terms of herbal approaches, Andrographis and Echinacea both have antiviral properties. They can be taken in tincture form (alcohol-extracts), or in dried form (as capsules, or taken as teas). Typically these herbs are both suggested in tincture or tablet form. It is recommended that they be taken a number of times per day, until the infection is cleared. With herbs, it is always important to make sure you are obtaining them from a good supplier (high quality, no adulteration), and at the right dose. This is usually where a health-care practitioner or naturopathic doctor can be of particular help. A naturopathic doctor can ensure that the prescription is correct and appropriate for you, and — perhaps most importantly — make sure that it is safe.
Another herb that is used with success is garlic, in the form of allicin (or garlic extract). This form of garlic works as an extremely potent antimicrobial, essentially wiping out all harmful microbes. It is so powerful that it may also inadvertently kill healthy bacteria as well! For this reason, it is advised that you take probiotics (at least 10 billion colony forming units, with meals), while using powerful antimicrobials. The probiotics themselves may also help independently to regulate bowels and help ameliorate gastrointestinal symptoms; they may also help fight off the virus. In severe circumstances, intravenous therapy may also be necessary for some people after being infected. It can provide rehydration to the body, and depending on the practitioner you are seeing, they may be able to add specific vitamins and minerals to help fight off the infection.
The stomach flu or viral gastroenteritis can be extremely uncomfortable and debilitating; for some populations, it can be deadly. It is contagious, and symptoms appear a couple of days after exposure to the virus. You can remain contagious for two weeks or longer. For this reason, there are many lifestyle habits we have recommended, such as maintaining good hygiene. Wash your hands frequently, and do not share food or drinks with anyone who’s been infected. Rest and sleep as much as possible, as this will give your body a chance to fight off the infection and avoid further stress. Most importantly, maintain a consistent intake of fluids and electrolytes. If you’re feeling too nauseous, take small sips at frequent intervals. The same goes with foods; try bland foods in small quantities. Even if you experience stomach cramps after eating, they should pass relatively quickly.
Antibiotics are not effective for viral infections, and so are unlikely to be of any benefit for the stomach flu. Other medications (pain killers, antidiarrhea medications) can possibly cause an upset stomach, and can be dangerous in kids. Instead, natural supplements offer lots of possible reward with very limited risks. Vitamin C and vitamin D can help boost the immune system. Herbs such as Andrographis and garlic can have antiviral activity. However you choose to proceed, take it easy, and if you do not feel better within a day or two, it is strongly advised that you check in with your naturopathic doctor to get further advice and suggestions. More testing may be warranted.