Q. I have read that the H1N1 flu may return in the fall and cause more severe illness than the spring epidemic. What can I do to prevent it?

A. Many of us, professionals and lay people alike, are concerned about the second wave of H1N1 flu. People at risk will most likely receive a specific H1N1 vaccine; for the rest of the community, health experts recommend washing hands frequently, wearing masks if concerned about exposure, and staying home when sick.

There are other effective strategies we can use to strengthen our immune system, and prevent or minimize the effects of the flu. Use of a full spectrum of natural noninvasive approaches can greatly enhance your ability to prevent and recover from illness.

At the Department of Complementary and Alternative Medicine clinic at the John A. Burns School of Medicine, we blend the best of all worlds to provide a whole-person approach to ailments.

My area of interest and experience is Ayurvedic medicine, the ancient tradition of India, as effective today as it was 5,000 years ago. Ayurveda holds that incomplete and ineffective digestion leads to accumulation of toxins, decreasing the strength of the immune system and rendering the individual more prone to infections. Therefore proper diet is crucial to maintaining health and preventing illness.

General lifestyle recommendations to strengthen the immune system and prevent the flu:

• Drink plenty of warm fluids.

• Get enough rest and sleep.

• Wash hands frequently and vigorously for at least 20 seconds.

• When in cold or rain, keep warm — particularly your head, neck and feet.

• Gargle with salt water to prevent sore throat.

Diet recommendations:

• Warm soups, such as chicken-with-herbs soup. Your grandmother was right: Chicken soup is effective in minimizing symptoms of the flu. Recent research at the University of Nebraska confirmed that homemade or readymade chicken soup is effective in decreasing symptoms and speeding recovery by decreasing congestion and inflammation in the respiratory tract.

• Fresh fruits, vegetables, and grains, as they contain antioxidants, which boost the immune system.

• Garlic has long been used as a natural antibiotic antiviral agent.

Get your vitamins:

• Vitamin C. The human body does not produce this vitamin, present in many fruits and vegetables. The Cochrane review, the most respected evidence-based database, reported that research results regarding the role of vitamin C in preventing colds and flu are inconclusive, however there is evidence for its benefit in decreasing the length and severity of illness.

• Multivitamins, including A, B-complex and E. Recently there has been growing evidence of the important role of vitamin D in regulating the immune system and decreasing inflammation.

Herbs:

• Chinese herbs: ginseng-astragalus combination.

• Ayurvedic herbs: guduchi (Tinospora cordifolia), chyavanprash (an herbal formulation), ashwaganda (Withania somnifera, sometimes called "Indian ginseng"), amlaki (Emblica officinalis), tulsi (Ocicum sanctum) and others.

• Yin chiao, a safe herbal flu remedy, has been used in China for hundreds of years. Take when the first symptoms appear and continue up to four days if necessary.

• Echinacea, a Western herb, is used extensively to minimize symptoms of colds and flu. It's best to use early, as soon as symptoms appear. The Cochrane report graded the evidence for its use as inconclusive.

Additional recommendations:

• Ginger tea, in combination with other spices.

• Avoid dairy products, as they tend to promote mucus production, except for yogurt, and lassi (yogurt diluted with water), which enhances immunity.

• Acupuncture or specific Ayurvedic breathing techniques may be helpful.

Dr. Tamar Hoffmann, assistant clinical professor, Department of Complementary and Alternative Medicine, John A. Burns School of Medicine, University of Hawai'i, is board-certified in internal medicine and a certified Ayurvedic practitioner. This column is for information only. Consult your health practitioner for medical advice.