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FOR IMMEDIATE RELEASE
Fever: Friend, Foe or Both?
by Ralph K. Campbell, MD, with Robert G. Smith, PhD
(OMNS Feb 2, 2018) As a young parent, even though I had just finished filling my head full of medical facts, I felt alarm when my infant daughter ran a fever. The first thing I had to do was to measure her temperature. Grandmas' method of touching the baby's forehead against her own was an OK way of measuring a moderate to high fever but certainly did not meet the standard of accuracy demanded by this young doctor. The current method of sticking the end of an electronic gadget in her ear, instead of using a conventional thermometer, didn't exist. So horrors, all we had for infants was the rectal thermometer. The end would be coated with Vaseline, then gently inserted and held in place for what seemed like forever. In a bit of foresight, the rectal thermometer had a much more bulbous end than the oral thermometer, which would prevent breakage and damage to the rectum. It wasn't until the late '70s and '80s that mercury, making its way through the atmosphere and ocean to our shores, from coal burned throughout the world (as methyl mercury, the organic form) was found to poison fish in the Great Lakes. This became a real environmental concern which also got the American Academy of Pediatrics concerned about the possibility of the rectal thermometer breaking and poisoning an infant. Broken glass in the rectum would not be good, and elemental mercury can be toxic, but nothing like the extent of damage from methyl mercury. Since our little ones can't express what is causing their distress, we feel a greater sense of urgency. Thus the modern infrared thermometer ameliorates a real safety concern besides allowing a quick decision on fever.
Fever is usually helpful
On the friendly side, fever generated in response to infection turns on several biological mechanisms that help to fight the cause of infection: mobilize leukocytes and phagocytes, decrease the effects of endotoxins, and increase proliferation of T-cells. In more understandable terms---leukocytes are white blood cells, and phagocytes are more specialized cells that gobble up bacteria. An endotoxin is produced by certain bacteria and can cause muscle aches or headache. Fever is elevated in response to the endotoxin and attenuates its harmful effects. The more T-cells the better as they are the real killers of the bad guys, whether bacteria or viruses. Long before we had this knowledge, medical professionals knew from personal experience with influenza that one feels much better in the cooler recovery stage after the fever breaks than during the febrile stage.
"Give me the power to create a fever, and I shall cure any disease."
Harm from fever can vary
There is much individual variation in what degree of fever should push the decision from don't treat to treat. Nowadays there is even question of what temperature should be regarded as normal. The old standard was 98.6 degrees F oral, and one degree higher for a rectal temperature. More importantly, the doctor tries to assess what symptoms and signs are resulting from this fever or are associated with whatever illness is causing the fever and whether they are severe enough to warrant further attention. Is our patient irritable (or the opposite, listless), unwilling to eat or drink? Currently there is a wide range for Normal temperature. The lows are very low. When the skin begins to feel warmer than the hand that touches it, keep an eye out for how high the fever will go. When it rises rapidly, in order to more rapidly get to the set point determined by the illness, there can be sweating, even combined with a shaking, since muscle contractions increase body heat. In spite of the individual variation of the fever temperature, most infants or children show some of these signs with a temperature of 103℉ or above. A child with a temperature of 105℉ may even be delirious, but will generally not suffer permanent brain damage. When a temperature is high but not higher than 105℉, many parents might consider the fever a foe, but even though a child might be a bit goofy, we can be assured those symptoms are the worst to expect from the fever. However, it's important to remember that fever is often part of many severe illnesses such as meningitis that need immediate medical attention. Putting fever aside, the doctor must evaluate how sick the patient is and take action if needed.
Lowering the fever
To lower the fever, the first line of treatment is to let heat escape from the skin surface. Dress lightly, and cover only with a light weight sheet. Next, if needed, uncover the large skin surface of the back, and with the little one face down, apply a cloth wrung out in cool water to it. Periodically, wring out the cloth in more cool water. If "cool" proves to be too uncomfortable, go to lukewarm sponging. The object is to get as much difference in temperature between the warm skin and the sponge cloth as can be tolerated. If not too successful and the little one seems quite miserable, an antipyretic (drug to lower fever) can be used: pediatric Ibuprofen or acetaminophen, both of which are over-the-counter drugs. Ibuprofen is preferable because it is anti-inflammatory in addition to being antipyretic. Either one should be used sparingly to avoid toxicity; therefore its use might be reserved for at nighttime to enable good sleep. Remember that a fever is most often the body's attempt to fight an infection or other sickness. Such over-the-counter drugs taken to lower fever cannot directly prevent the sickness from getting worse.
Parents might not know whether the signs of sickness are due to the underlying illness or just the fever. If the results are poor and the infant or child remains noticeably uncomfortable, an underlying illness is more likely to blame, creating a need for medical attention. Fever, in itself, can be a foe when the body temperature climbs too high and too fast. When shivering is noted, the body temperature is likely rapidly rising. For temperatures above a certain point (again, with much individual variation) neurological signs may appear---terribly irritable or the opposite---listless and unwilling to eat or drink, and even more frightening, being goofy or having a convulsion. In my experience, most often the threshold for these more serious problems in children is around 105℉ . Current literature assures us that fevers below 107.6℉ will not cause permanent brain damage. So don't worry, just take action. Telling someone not to worry under these worrisome circumstances, is like telling a toddler, "Don't you dare do that", which is exactly what he is going to do. Worry a bit, but don't let it interfere with devising an action plan.
A state of truly good health derived from a healthy lifestyle and diet greatly reduces the chance of acquiring one of these fever associated illnesses.[1-8] Vitamin C is the king pin of vitamins because it is necessary to maintain health of the blood and all the organs of the body and helps the immune system prevent infection. [2-8] The pioneers of Orthomolecular Medicine realized its value and the importance of adequate doses. Linus Pauling's original recommendations  were widely disbelieved because at that time (the 1970s) many medical professionals believed that a deficiency of vitamin C could only cause scurvy (a recognized medical as well as nutritional deficiency disease), and that a small dose (100 mg/day) was sufficient. Later, Dr. Abram Hoffer suggested, "If you are going to build a house, be sure to have enough bricks". We now know that "enough" should be based on the body's daily need for vitamin C when under various sorts of stress. Pauling advocated and we now know that vitamin C is normally required in much larger doses.[2,3] The required dose varies with the individual's biochemistry, lifestyle, diet, and level of stress both mental and physical. Under normal circumstances an adequate dose for most adults is 1,000 to 3,000 mg taken in divided doses throughout the day, for example, 1,000 mg per meal.[3-7] However, when under severe stress such as recovering from major surgery or when ill with a bad case of influenza or other viral or bacterial infections, much higher doses may be required to keep the vitamin C level high enough for the body to effectively fight the illness. [3-7] The high dose is necessary because the illness depletes vitamin C and the body can normally only get more from the diet. An IV treatment of buffered vitamin C is very effective in preventing mortality from septic shock (organ failure) or severe influenza.[4-9]
Pediatric vitamin C doses
Many studies confirm that in high doses, vitamin C has bactericidal and virucidal effects. Appropriate doses are 250-500 mg for an infant and 1,000-2,000 mg (1/4 level tsp) for a child of 45 pounds which can be found in liquid or chew tab form. For a bad case of flu these doses can be given several times per day. An easy way to give correct doses is to mix vitamin C crystals (500 mg: 1/8 level tsp; 1,000 mg: 1/4 level tsp) with juice. Capsules containing 500 mg or 1,000 mg of vitamin C crystals can be opened and divided into portions. Or, tablets of 250 mg or 500 mg vitamin C can be broken into 2 or 4 pieces and given with a glass of water. The indication that the dose is too high is measured by bowel tolerance. If the dose is too much for that individual, it will attract water into the gut, causing a laxative effect -- the bowels will become loose, meaning back off a bit for the next dose, then make note of this individual's bowel tolerance. The amount of vitamin C that is absorbed is an indication of how much is required by the body to fight off the illness. For a bad viral infection in an infant or toddler, give doses of 250-500mg more often, for example, every hour. At the first sniffle or sign of a scratchy sore throat, pour it on, giving a big dose (500mg) right away, followed by regular doses while the child's symptoms continue. Since vitamin C is normally only partially absorbed by the gut, give it in divided doses. It is absorbed best when given 15 minutes before meal times.
From what we are learning about vitamin D (even agreement with the medical establishment which is finding supplements of vitamin D more and more acceptable), vitamin D helps to prevent respiratory infections often caused by flu -- possibly even more than a flu shot. [10-12] Doses should be given proportional to body weight (30 IU/pound/day), so adults should take 2,000-5,000 IU/day and infants should be given 200-800 IU/day. Since vitamin D is a fat soluble vitamin, its level in the body rises and falls slowly, so rather than trying to remember to give a very small dose every day, it is easier to give an infant or toddler a larger dose (1,000-2,000 IU) once per week. To give better absorption, vitamin D should be taken with food, for example at breakfast or dinner. Magnesium (taken in the preferred chloride form at dose of 3 mg/pound/day or 50-100 mg/day for toddlers, 300-600 mg/day for adults) is synergistic with vitamin D and helps to prevent anxiety and lung conditions such as asthma, both of which may arrive with fever.
Other vitamins and essential nutrients
Other essential nutrients are also important to increase the body's resistance to fever and associated illness.[7,14] Of course, an excellent diet, with plenty of colorful vegetables and greens, along with moderate servings of fish or meat and little sugary drinks or foods is the first consideration. Since children in our modern time tend to eat cookies and other foods made with refined flour it is important for them to get a daily vitamin supplement. This can be a chewable tablet or a liquid in a dose appropriate for the age of the child. The B vitamins are best taken in proportion and a daily adult or children's multivitamin is convenient and has the right proportions. The reason a multivitamin should be taken every day is that the B vitamins are water soluble and for best health the body's level of these important nutrients needs to be refreshed daily. Vitamin E (mixed tocopherols in preference to alpha-tocopherol; infants/toddlers 50 IU/day, adults 400-1,200 IU/day, ramping from 400 IU over weeks to 1,200 IU) is also helpful in preventing damage to the body from fever induced by viruses. For small children, a vitamin E capsule containing a larger than daily dose can be taken once per week. Essential nutrients including minerals (adult doses: magnesium: 500 mg, selenium 50 mcg, zinc 25mg), omega-3 fatty acids (serve walnuts and sardines) and probiotics are also helpful in preventing viral and bacterial illness.[7,14]
Starting with good health and a well-functioning immune system goes far in preventing contracting a disease, viral or bacterial, that we consider to be associated with fever. Do your best to prevent exposure to yourself or your little one, such as get away from someone coughing. Pay attention to the fever that develops but look at it objectively as being only part of the illness. If it is causing too much mischief, treat it. At the first signs of illness - fever being only one of them - pour on the vitamin C and the other nutrients that boost immune system function.
(Ralph K. Campbell, MD, is a retired board-certified pediatrician. He is Contributing Editor for the Orthomolecular Medicine News Service. Dr. Campbell is the author of The Vitamin Cure for Children's Health Problems and The Vitamin Cure for Infant and Toddler Health Problems. Robert G. Smith, PhD, is Research Associate Professor, Department of Neuroscience, Perelman School of Medicine at the University of Pennsylvania. He is Associate Editor of OMNS, and the author of The Vitamin Cure for Eye Disease, and also The Vitamin Cure for Arthritis.)
1. Campbell R. Influenza And no, I am NOT getting a flu shot. http://orthomolecular.org/resources/omns/v14n02.shtml
2. Pauling L. Vitamin C, the Common Cold, and the Flu (1976) W H Freeman & Co. ISBN-13: 978-0716703617.
3. Pauling L. (2006) How to Live Longer And Feel Better. (2006) Oregon State University Press ISBN-13: 9780870710964
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10. Mamani M, Muceli N, Ghasemi Basir HR, et al. Association between serum concentration of 25-hydroxyvitamin D and community-acquired pneumonia: a case-control study. Int J Gen Med. 2017, 10:423-429. https://www.ncbi.nlm.nih.gov/pubmed/29180888
11. Martineau AR, Jolliffe DA, Hooper RL, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017, 356:i6583. http://www.bmj.com/content/356/bmj.i6583.long
12. Urashima M, Segawa T, Okazaki M, et al. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr. 2010, 91:1255-60. https://www.ncbi.nlm.nih.gov/pubmed/20219962
13. Dean C. (2007) The Magnesium Miracle. Ballantine Books (2017) ISBN-13: 9780399594441.
14. Hoffer A, Saul AW. Orthomolecular Medicine For Everyone: Megavitamin Therapeutics for Families and Physicians. Basic Health Pubs, (2008) ISBN-13: 9781591202264
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