By Natural Health Resources, Inc. James B. LaValle R.Ph., D.H.M., D.H.Ph., CCN Ross Pelton R.Ph., Ph.D., C.C.N. Ernest Hawkins R.Ph., M.S.  Nutritional Supplements According to a study conducted by the National Center for Health Statistics, the common cold causes 35.6 acute illnesses per 100 persons annually in the United States, accounting for about one-third of all visits to physicians.[1] The common cold is an acute (short-term), highly contagious inflammation of the upper respiratory tract caused by infection with a virus. Colds result in symptoms that include sinus congestion, low-grade fever and chills, body aches and headache. Even though the common cold does not cause death, its economic consequences are enormous, because it is the greatest cause of absenteeism in schools and industry throughout the United States. People are searching for natural agents that will strengthen their defenses during cold and flu season, because many people cannot tolerate traditional OTC cold and flu products, or these products are contraindicated for their condition, Additionally, natural agents may be used as a first line of defense or adjunctively along with traditional OTC medications. VITAMIN C  Vitamin C, although somewhat controversial, is claimed to be useful in the prevention and treatment of the common cold. The 1970 publication of Dr. Linus Pauling’s book, Vitamin C and the Common Cold and the Flu, brought vitamin C to the attention of the general public.[2] A meta-analysis of sixteen controlled studies evaluating the effects of vitamin C and the common cold provided the following results:In five studies in which people ingested from 70 to 200mg of vitamin C daily, there was an average 31 percent decrease in the symptoms and severity of the cold. In the other eleven studies in which people ingested 1,000mg or more of vitamin C daily, there was an overall 40 percent reduction in the symptoms and severity of colds.[3] A more recent meta-analysis of 21 placebo-controlled studies from 1971 to 1993 reported similar results. Although there was no reduction in incidence, individuals ingesting 1,000mg or more of vitamin C daily reduced the duration of episodes and the severity of symptoms of the common cold by an average of 23 percent.[4] There is a great deal of evidence indicating that vitamin C is necessary for efficient functioning of the immune system. For example, various types of antibodies (also called immunoglobulins) are large protein molecules that are an important part of our immune system. It has been reported that regular ingestion of 1 gram of vitamin C daily for 75 days resulted in a significant increase in levels of immunoglobulins IgA, IgM, and IgG.[5] Lymphocytes, white blood cells that play a critical role in our immune systems, are dependent on vitamin C. Volunteers who were given 5 grams of vitamin C daily for 3 consecutive days nearly doubled their production of new lymphocytes within a few days. Volunteers who took 10 grams of vitamin C daily for 3 days tripled their production of new lymphocytes. A follow-up test revealed that the elevated production of lymphocytes in these volunteers remained high for an additional week.[6] This study established that higher doses of vitamin C enhance the ability of the immune system to fight infectious diseases. Interferons are proteins with antiviral activity that are made by cells that have been infected by viruses. Research has reported that ingestion of high doses of vitamin C increases the body’s production of interferon. The authors concluded that vitamin C is an excellent natural antiviral agent.[7,8] In another study, cultures of human cells were incubated for two days with vitamin C at a level equivalent to the serum concentration of a person taking from 6 to 10 grams of vitamin C daily. The cultures were then impregnated with the common cold virus (rhinovirus). Forty-eight hours after the cultures were infected with the cold virus, the amount of virus collected from the untreated control cells was 40 times greater than the amount of virus produced in the vitamin C-treated cells.[9] This implies that elevated doses of vitamin C have the ability to inhibit the replication of the common cold virus. Dr. Pauling and a number of other researchers have stressed that vitamin C will be more effective in suppressing a cold if high dose vitamin C therapy is begun immediately at the first sign of the onset of cold symptoms. ZINC  Zinc lozenges have become highly promoted in the treatment of the common cold. In a meta-analysis of seven randomized controlled trials, it was determined that zinc gluconate lozenges have a therapeutic effect in treating the common cold. The author reported that sucking on zinc gluconate lozenges every two hours while awake, beginning within 24 to 48 hours of the onset of cold symptoms, significantly reduces the duration and severity of the cold.[10] The minimum effective dose was determined to be 13.3mg of elemental zinc per lozenge.In a meta-analysis of eight double blind placebo-controlled trials, four found zinc lozenges to be effective, while the other four studies reported ineffective results.[11] Criticisms of the failed trials included: too low of a dose of zinc was used; poor formulation of the lozenges; and inadequate placebo controls, indicating that there were some plausible explanations for the studies that had negative outcomes. Zinc’s mechanism of action against the human rhinovirus is thought to be as follows: It appears that free ionic zinc (Zn+2) complexes with proteins of critical nerve endings and surface proteins of the human rhinovirus (HRV). These complexes interrupt nerve impulses and also block the ability of the rhinovirus to attach to the intercellular adhesion molecule-1 (ICAM-1). This action reportedly interrupts the human rhinovirus infection and reduces the inflammatory process.[12] This is why people taking zinc gluconate lozenges for the common cold experience a rapid reduction in their inflammatory symptoms associated with their cold. Another study reported in a more general way that zinc helps regulate the immune system. This study reported that young children with frequent upper respiratory tract infections had significantly lower zinc levels as shown by a hair analysis.[13] One particular population, patient with diabetes, tends to have low zinc utilization, as well as poor insulin regulation during bouts with colds and flu. So, improving zinc status may provide additional stimulus to the immune system and support normalization of blood sugar during colds and flu for patients with diabetes and impaired glucose tolerance individuals. Both vitamin C and zinc are claimed to act in support of the immune response instead of simply controlling the symptoms of colds and flu. As a pharmacist, you can recommend vitamin C and zinc supplementation as an adjunct to traditional OTC care, or as a primary recommendation for “at risk” groups who may not tolerate OTC medications, or when OTC medicines may be contraindicated. Herbal Remedies ECHINACEA  Currently, echinacea, or purple coneflower, is one of the most popular herbs in the world. As pharmacists, we need to know about the quality, dosages and potential benefits and risks in recommending echinacea. The echinacea that is used medicinally consists of two species, Echinacea purpurea and Echinacea angustifolia. The bio-active constituents in echinacea include polysaccharides (immunomodulation, anti-inflammatory), flavonoids (antioxidants), essential oil (antibacterial), allylamides (antibacterial, immune enhancing, tumor inhibiting) and others.[14,15] Echinacea has significant non-specific stimulatory effects on the immune system,[16] and there have been literally hundreds of studies reporting echinacea's value to the immune system. Research has reported that echinacea stimulates the alternate and complementary pathway, activating white blood cells to scavenge for bacteria and cellular debris.[17] It has been used to improve wound healing[18] and to help in the treatment of colds and flu.[19] Echinacea is claimed to have a wide variety of antimicrobial activities on bacteria, fungi and viruses.[20] It has been used externally as a wound wash and for eczema, burns, herpes, canker sores and abscesses.[21] Echinacea purpurea fresh expressed succus (plant juice) is currently used routinely in Germany by physicians in the support and treatment of colds and influenza. German physicians generally prescribe echinacea products on a 3 day on, 3 day off cycle. However, these are usually injectable products and may not apply to oral use. One study reported that continuous oral doses of echinacea resulted in greater immune reactivity after 10 weeks than after 2 weeks, and both were higher than before therapy.[22] It is generally accepted therapy to give individuals echinacea products for more than 5-10 days on, 2 days off, during infection, and 3 weeks on, 1 week off, during bouts of colds and flu. It is up to the health care professional as to how long to supplement individuals with echinacea. Dosage In acute phases of colds and flu, 2-250mg capsules, 3 times a day for 1 day, then 250mg, 4 times a day are recommended until cold or flu subsides. For dietary support in prevention of colds and flu during cold season, the recommended dosage is 250-500mg daily, 3 weeks on and 1 week off. Ideally, echinacea products should be standardized to contain 4 percent echinacosides (angustifolia) or 4 percent sesquiterpene esters (purpurea) per dose, but there are other active constituents in echinacea as well. There are minor differences in species, with Echinacea purpurea tops showing more antiviral activity than Echinacea angustifolia. Echinacea angustifolia root preparations are generally preferred for the prevention and on supportive treatments of colds and flu. All echinacea extracts should be tested for pesticide and heavy metal content prior to marketing. Fresh Plant Juice The recommended dose of Echinacea purpurea (freshly expressed plant juice) to support a healthy immune system is 40 drops three times a day with food. In acute infections, the recommended dose is 60 drops three times a day with food for 1 day, then 40 drops three times a day with food for up to 10 days. Echinacea fresh expressed plant juice should be standardized to contain not less than 2.4 percent soluble beta-1,2 D-5 fructofuranosides per dose. Toxicities, Cautions and Contraindications There has been no observed toxicity with echinacea and side effects are very rare.[23] Individuals highly allergic to plants in the daisy family (including ragweed) should not take echinacea. Individuals with kidney disease or disorders should not take echinacea for longer than 10 days at a time due to potential mineral imbalance through excretion. Individuals with compromised immunity should not take echinacea for extended periods of time. Any woman who is pregnant or nursing, should consult a physician before using echinacea. Do not use echinacea in children under 2 years of age unless recommended by a physician. GARLIC  Garlic has been used throughout history for treating a wide variety of conditions. Sanskrit record documents the use of garlic remedies for conditions such as runny nose and other symptoms of colds approximately 5000 years ago, while the Chinese have been using it for at least 3000 years. Although garlic has been used “historically” to “ward off vampires,” its more modern applications include cardiovascular support for conditions such as hypercholesterolemia and hypertension, and as an agent to reduce the symptoms of various infectious conditions such as colds and flu. Garlic is claimed to have a broad-spectrum antimicrobial activity against many bacteria, viruses, parasites and fungi.[24] In studies, the antimicrobial effects of garlic were reported to be comparable to many antibiotics including penicillin, erythromycin, streptomycin, chloramphenicol and tetracyclines.[25,26] The bacteria inhibited in the studies included Staph aureus, alpha- and beta-hemolytic streptococcus, E. coli, Proteus vulgaris, Salmonella enteritidis, Citrobacter sp., Klebsiella pneumoniae and Mycobacteria. In addition to confirming garlic’s well-known antimicrobial effects, the studies cited efficacy in inhibiting the growth of some bacteria that had become resistant to one or more of the antibiotics. There are several important constituents that would attribute to antimicrobial properties of garlic. The sulfur-containing compounds in garlic (allicin and alliin) are alleged to be effective against bacteria and fungi.[27,28] Dosage Range For nutritional support during colds and flu, the recommended dose is 400mg of standardized extract, equivalent to 1200mg of fresh garlic or 10mg of alliin guaranteed to provide 4000mcg of total allicin potential (TAP). One of the biggest concerns about garlic is whether it has TAP by the time it gets to the shelf for purchase. It is important to select a garlic product that guarantees potency on the shelf. Raw garlic is more potent than cooked garlic, because heat inactivates the enzyme, allinase. Allinase gives garlic its wonderful smell and stimulates the formation of allicin. There are odorless garlic preparations that provide alliin, a precursor to allicin. Alliin is converted to allicin in the body and allows for therapeutic activity without the characteristic scent that trails individuals after garlic ingestion. Some experts feel that odorless garlic preparations may not have garlic’s therapeutic activity. Toxicities, Cautions and Contraindications No toxicity with garlic has been reported.[29] However, some individuals may experience GI distress or irritation when beginning to use garlic. It should be used only under physician supervision by individuals on anticoagulant medications because garlic has been reported to be a platelet activating factor (PAF) inhibitor. There are some individuals who may not metabolize sulfur compounds. Ingesting large doses of garlic over a long period of time is not recommended. However, in recommended doses, garlic is considered to be safe. Pregnant or nursing women should consult a physician before using garlic. Garlic should not be used in children under 2 years of age unless recommended by a physician. Special Note on Garlic: A recent study reported that garlic oil had no cholesterol-lowering effect.[30,31] However, garlic oil is not the form of garlic that has traditionally been studied. There has been supportive research on the benefits of other forms of garlic in lowering blood cholesterol. Homeopathic Medicines ANAS BARBARIAE HEPATIS The number one treatment for colds and flu in Europe is a homeopathic remedy called Anas barbariae hepatis. European studies have shown that this homeopathic medicine is effective in reducing the symptoms of colds and flu.[32,33,34,35] In summary, during the seasonal “war” against colds and flu, nature has provided us with herbal and nutritional weapons – echinacea, garlic, vitamin C and zinc. Along with proper diet and exercise, supplementing with these agents may be beneficial in preventing and treating the symptoms of the common cold and flu.
[ii] L. Pauling, Vitamin C, the Common Cold and the Flu (Berkeley, CA: Freeman & Co., 1970).
[iii] L. Pauling, How to Live Longer and Feel Better (New York: W.H. Freemen and Company, 1986) 120-21. [iv] H. Hemila, “Does Vitamin C Alleviate the Symptoms of the Common Cold? — A Review of Current Evidence,” Scand J Infect Dis 26(1) (1994) : 1-6. [v] W. Prinz, et al, “The Effect of Ascorbic Acid Supplementation of Some Parameters of the Human Immunological Defence System,” Int J Vit Nutr Res 47 (1977) : 248-56. [vi] R. H. Yonemoto, et al, “Enhanced Lymphocyte Blastogenesis by Oral Ascorbic Acid,” Proceedings of the American Association for Cancer Research 17 (1976) : 288. [vii] H. Dahl and M Degre, “The Effect of Ascorbic Acid on Production of Human Interferon and the Antiviral Activity in Vitro,” Acta Pathol Microbiol Scand [B] 84B (Oct1976) : 280-84. [viii] W. R. Thomas and P.G. Holt, “Vitamin C and Immunity: An Assessment of the Evidence,” Clin Exp Immunol 32(2) (May 1978) : 370-79.
[ix] P. R. Schwerdt and C.E. Schwerdt, “Effect of Ascorbic Acid on Rhinovirus Replication in WI-38 Cells,” Proc Soc Exp Biol Med 148(4) (Apr1975) : 1237-43. [x] S. Marshall, “Zinc Gluconate and the Common Cold. Review of Randomized Controlled Trials,” Can Fam Physician 44 (May1998) : 1037-42. [xi] M. L. Garland and K. O. Hagmeyer, “The Role of Zinc Lozenges in Treatment of the Common Cold,” Ann Pharmacother 32(1) (Jan1998) : 63-69. [xii] S. G. Novick, et al., “Zinc-Induced Suppression of Inflammation in the Respiratory Tract, Caused by Infection with Human Rhinovirus and Other Irritants,” Med Hypotheses 49(4) (Oct1997) : 347-57.
[xiii] I. Lombeck, et al., “Hair Zinc of Young Children from Rural and Urban Areas in North Rhine-Westphalia Federal Republic of Germany,” Eur J Pediatr 147(2) (1988) : 179-83. [xiv] R. Bauer, et al., “Analysis of Alkamides and Caffeic Acid Derivatives from Echinacea simulata and E. paradoxa Roots,” Planta Medica 57(5) (1991) : 447‑49. [xv] H. Wagner, et al., “Immunstimulerend Wirkende Polysaccharide (Heteroglykane) aus Hoheren Pflanzen,” Arneim‑Forsch/Drug Res 35 (1985) : 1069‑75. [xvi] J. M. Snow, “Echinacea (Moench) spp. Asteraceae,” Protocol Journal of Botanical Medicine 2(2) (1996) : 18-23. [xvii] V. T. Vomel, “The Effect of a Nonspecific Immunostimulant on the Phagocytosis of Erythrocytes and Ink by the Reticulohistiocyte System in the Isolated, Perfused Liver of Rats of Various Ages,” Arzneim‑ Forsch/Drug Res 34 (1984) : 691‑95. [xviii] W. Dorsch, “Clinical Application of Extracts of Echinacea purpurea or Echinacea pallida. Critical Evaluation of Controlled Clinical Studies,” Z Arztl Fortbild (Jena) 90(2) (1996) : 117-22. [xix] D. M. See, et al., “In Vitro Effects of Echinacea and Ginseng on Natural Killer and Antibody-dependent Cell Cytotoxicity in Healthy Subjects and Chronic Fatigue Syndrome or Acquired Immunodeficiency Syndrome Patients,” Immunopharmacology 35(3) (1997) : 229-35. [xx] M. Wichtl, in N. A. Bisset, ed., Herbal Drugs and Phytopharmaceuticals (Stuttgart: Scientific Press, 1994) 182-84. [xxi] D. Melchart, et al., “Results of Five Randomized Studies on the Immunomodulatory Activity of Preparations of Echinacea,” J Altern Complement Med 1(2) (1995) : 145-60. [xxii] E. G. Coeugniet, “Recurrent herpes labialis infections: cellular immunity and immunomodulation,” Onkologie 12 Supp 3 (Jun 1989) : 48-55. [xxiii] P. R. Bradley, ed., British Herbal Compendium, vol. 1 (Bournemouth: British Herbal Medicine Association, 1992) : 81‑83. [xxiv] M. A. Adetumbi, et al., “Allium sativum (garlic) – A Natural Antibiotic,” Med Hypothesis 12 (1983) : 227-37. [xxv] V. D. Sharma, et al., “The Antimicrobial Property of Allium Sativum Linn.: In-vitro and In-vivo studies,” Ind J Exp Biol 15 (1977) : 466-68. [xxvi] E. I. Elnima, et al., “The Antimicrobial Activity of Garlic and Onion Extracts,” Pharmazie 38 (1983) : 747-48. [xxvii] M. Adetumbi, et al., at pp. 227-37. [xxviii] S. T. Pai, et al., “Antifungal Effects of Allium sativum (Garlic) Extract Against the Aspergillus Species Involved in Otomycosis,” Lett Appl Microbiol 20(1) (1995) : 14-18. [xxix] S. Nakagawa, et al., “Acute Toxicity Test of Garlic Extract,” J Toxicol Sci 9 (1984): 155-69. [xxx] (No authors listed), “Garlic Pills Don’t Lower Cholesterol,” Health News 4(9) (Jul1998) : 5. [xxxi] H. K. Berthold, et al., “Effect of a Garlic Oil Preparation on Serum Lipoproteins and Cholesterol Metabolism: A Randomized Control Trial,” JAMA 279(23) (Jun1998) : 1900-02. [xxxii] Multi-centric Study Involving 100 Patients, Under the Direction of Prof. P. Casanova, Centre de Recherche et de Documeniation Technique, University of Marseille, France, 1983. [xxxiii] Multi-centric Study Involving 300 Patients, Under the Direction of Prof. P. Casanova and Prof. A. Gerard, University of Marseille, France, 1985. [xxxiv]J. P. Ferley, D. Zmirou, D. D’Achemar and E. Balducci, “A Controlled Evaluation of a Homeopathic Preparation in the Treatment of Influenza-like Syndromes,” Br J Clin Pharm 27 (1989) : 329-35. [xxxv] R. Papp, G. Schuback and E. Back, et al., “Oscillococcinum in Patients with Influenza-like Syndromes: A Placebo-controlled Double-blind Evaluation,” Br Homeopathic J 87 (1998) : 69-76.
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