Colds and Flu: How to Get Rid of a Head Cold and Herbs for Colds

Introduction:

The common cold is medically referred to as a viral upper respiratory tract infection. It is a contagious illness that can be caused by about 100 different types of known viruses with the most common being the rhinovirus, but others include adenovirus, influenza virus, parainfluenza virus, respiratory syncytial virus, and many others. The only way how to get rid of a head cold is for the body’s immune system to send out T- and B-lymphocytes against the virus. These special white blood cells produce antibodies to bind the virus and prevent it from replicating. These cells also tag viruses for other white blood cells to attack them. Because many different viruses can cause a cold and because new cold viruses constantly develop, the body never builds up immunity to all of them. For this reason, colds are a frequent and recurring household and societal problem.

The Centers of Disease Control states that prevention of the flu starts with vaccination for anyone 6 months and older at the start of each flu season in October. Symptoms of the common cold may include cough, sore throat, nasal congestion, runny nose, and sneezing but influenza infections are generally more severe with body aches, high fever and possible viral pneumonia which can lead to bacterial super—infection resulting in bacterial pneumonia. Over-the-counter cold and cough medicines may help ease symptoms in adults and older children, but do not reduce the duration of the illness. Evidence-based methods natural treatments, and herbal agents may prevent viral transmission, reduce the symptoms of the cold, and decrease the duration of an upper respiratory infection. Review the herbs for colds and many ways below on how to get rid of a head cold by preventing it in the first place or supporting the body’s immune system.

If there is any suspicion of the common cold or flu, prevent the spread to others by washing hands after touching the face nose or eyes and use hand sanitizer when hand washing is not available. To help prevent colds and flu whether others are known to be sick or not, wash hands frequently, and avoid touching ones face, nose, eyes, or mouth and use hand sanitizer when hand washing is not available. When using doors, a paper towel may be used to open and close doors. Reaching up high ont odoors to open and close them where others infrequently touch may also reduce risk. Cough should be contained into a tissue or into the sleeve at the elbow since viruses may be transmitted by air droplet exposure. Do not share utensils and drinking cups. A surgical mask or any simple mask which covers the mouth and nose will help prevent exposure to others. Spreading the flu virus to others is of greatest concern in patients younger than age 2 or over 65 years old, patients in a nursing home, pregnancy, or those with chronic diseases of the lungs, heart, kidneys, cancer patients (especially those on chemotherapy), and patients with diabetes.

Within 24 hours of onset of symptoms, the physician may prescribe anti-viral medication which may reduce the duration of the illness but in mild cases it is not needed. Researchers found that individuals who reported sleeping less than 7 hours a night were 2.94 times more likely to develop a cold than those who slept 8 hours or more, and those who had sleep efficiency of 92% or less were 5.5 times more likely to develop a common cold than those with an efficiency of 98% or better (24). Exercise during colds is not recommended until symptoms begin to taper off, otherwise recovery from a cold may be prolonged. It is important to stay hydrated by consuming adequate amounts of fluids. Many over the counter medications for the common cold increase blood pressure and heart rate. By taking measures to prevent the common cold, in turn bronchitis and even pneumonia may also be prevented since it often occurs as progression of viral infection or secondary bacterial infection after viral illness. It is important to stay hydrated by consuming adequate fluids. Please see the section on acute bronchitis.

An observational study by Pockett, RD et al (37) calculated odds ratios on use of the flu vaccine in the UK. They found that high risk patients had a lower probability of practitioner visits, lower risk of becoming hospitalized, and a lower mortality rate in those 65 or over that have been vaccinated.

According to the CDC, the fall 2014 vaccine included H1N1, H3N2, and influenza B. Unfortunately the H3N2 strain in the 2014 vaccine is only protecting vaccinated individuals from about one third of H3N2 viruses. However, even if the strains are not matched well to the current active circulating viruses, protection from the influenza infection by the vaccine can still be as high as 60%in healthy adults, but as low as 48% in those with a high-risk medical condition (38). The vaccine was more protective for the H1N1 and influenza B viruses in the 2014 vaccine. We are awaiting the fall 2015 vaccine update from the CDC.

A flu vaccine is needed every year because immunity declines over that time period and because the strains contained in the vaccine are updated each year. The vaccine can start working in about 2 weeks when antibodies start to form. Healthcare providers have a duty to protect their patients and help prevent hospitalizations.

The CDC has expressed that this vaccine should be avoided by those with life threatening allergy to eggs, allergy to components in the vaccine, history of paralyzing illness like Guillain-Barré Syndrome, and those who are acutely ill. There is an egg-free vaccine available in case one is allergic to eggs. The live attenuated vaccine (Flu Mist) was found to be more effective for preventing flu in children (as high as 80-90%), and the trivalent inactivated vaccine was found in research to be more effective than the live attenuated vaccine for the college age group and older. According to the CDC, research has found a 34% reduction in total respiratory illnesses and a 55% reduction in pneumonia during one two-week peak of influenza.

Read further below to review the best cold and flu…

• Prevention methods
• Herbs for colds and flu compared to placebo
• Reducing the duration of a cold and flu
• What natural remedies work well and which do not
• Does research support taking vitamin C, zinc, Echinacea, cocoa, garlic, elderberry, and many others for colds and flu?

Prevention of upper respiratory infection in children:

Researchers conducted a three-group study in 130 children age 4 to 11 years old comparing Echinacea purpurea (L.), Andrographis paniculata (kan jang), and standard treatment. Children were assigned to either standard treatment (n=39), standard treatment plus A. paniculata (n=53), or standard treatment plus Echinacea (Immunal was used) (n=41) treatment. The A. paniculata was administered as two tablets three times daily for 10 days (30 mg of andrographolide and deoxyandrographolide per day). An equivalent would be Andrographis capsule, 50 mg standardized to 10% andrographolides with 2 capsules taken 3 times per day or a 100 mg capsule standardized to 10% andrographolides taken 3 times daily. The echinacea group received 10 drops three times daily for 10 days. Standard treatment for the control group (n=39) consisted of warm drinks, throat gargles with matricaria (chamomile) infusion, antiseptic nose drops of silver nitrate colloid p.r.n., and acetaminophen (pain-killer) 500 mg three times daily if fever or severe headache was present. An improvement in upper respiratory tract infection symptoms by days 2−3 was reported in all groups but authors reported a faster improvement in symptoms in the A. paniculata group and a decrease in nasal secretions in the AP and echinacea groups. AP treatment was well tolerated with not reported side-effects.  (1)

Herbs for Colds: Symptoms were significantly improved by and herbal extract :

Extract of Andrographis paniculata (kan jang) was shown to significantly improve treatment of uncomplicated upper-respiratory tract infections in two randomized double-blind, placebo-controlled parallel group clinical trials (a pilot study [n=46] and a phase III study [n=179]). A standardized extract (SHA-10) of A. paniculata was given 3 times a day for 3 to 8 days in the pilot study and for 3 days in the phase III study. In both studies measures such as pain in the muscle, cough, throat symptoms, lymph glands-tonsils, headache, nasal symptoms and eye symptoms were significantly improved in the treatment group compared to placebo group. Throat symptoms showed the most improvement in both studies. (2)

Upper respiratory infection symptoms severity and duration:

Andrographis paniculata SHA-10 extract (Kan Jang) was found to decrease severity and duration of upper respiratory tract infections in a 5-day double blind, placebo-controlled, parallel-group clinical study. Headache, nose and throat symptoms, and body weakness or discomfort improved significantly in the A. paniculata group. Cough and eye symptoms however were not significantly different between the groups. (3)

Upper respiratory infection treated by herbal agent superior to placebo:

A meta-analysis found 7 double-blind, controlled efficacy trials, enrolling a total of 896 participants, evaluating the use of a proprietary oral andrographis extract (AP) for the treatment upper respiratory tract infection (URTI). The combined results indicate that AP is more effective than placebo for reducing symptoms. The studies included in this review used standardized AP alone or in combination with Eleutherococcus senticosus, except for one study. Herbal supplements were compared to either placebo or paracetamol also known as acetaminophen or Tylenol. The daily dose of AP ranged from 48 to 360 mg/day in the efficacy review and from 11 mg/day to 10 mg/kg per day for 14 studies (n=1,235) included in the safety review. Significant differences in outcomes suggested that A. paniculata is superior to placebo in alleviating subjective symptoms of URTI. One study in HIV-positive patients and healthy volunteers, which used a high dose of AP (5 mg/kg and 10 mg/kg increasing every 3 weeks) was terminated early because of a large number of adverse events such as allergic reaction, fatigue, headache, pruritis/rash, diarrhoea, nausea, metallic taste, bitter taste, decreased/no taste, dry tongue, decreased sex drive, eyes sensitive to light, decreased short term memory, dizziness, heartburn, tender lymph nodes, lymphadenopathy. Side effects reported in other studies include unpleasant sensations in the chest, headache, urticarial, nausea, vomiting, abdominal discomfort, dizziness, drowsiness and malaise, increased nasal discharge and epigastric pain, blocked nose. However, AP was well tolerated among most participants. (4)

Common cold duration reduced by herbal treatment:

Taking 1200 mg/d of dried extract Andrographis paniculata (kan jang) significantly reduced the length of a common cold in this placebo-controlled double-blind study. Sixty-one participants were assigned to either 1200 mg A. paniculata (n=33) or placebo (n=28). On day 4 of treatment, the A. paniculata group showed significiant reductions in clinical symptoms compared to placebo. (5)

Cold symptoms significantly improved by herbal extract: A double-blind, placebo-controlled study of 158 adults with colds found that treatment with Andrographis paniculata SHA-10 extract for 4 days significantly reduced cold symptoms. Participants were given either placebo or 1200 mg daily of A. paniculata extract. The results showed that by day 2 of treatment individuals who were given the actual treatment experienced significant improvements in symptoms (tiredness, sleepiness, sore throat, and nasal secretion) compared to participants in the placebo group. These benefits were even better at day 4. The greatest response was seen in earache (odds ratio [OR] = 3.11), sore throat (OR=3.59), and nasal drainage (OR=3.27). (6)

Cold prevention by herbal agent successful:

According to one double-blind, placebo-controlled study, Andrographis paniculata (kan jang) may increase resistance to colds. In this 3-month-long trial 54 of the participants took two 100-mg tablets standardized A. paniculata daily. The other 53 students were given placebo tablets. Then, once a week throughout the study, a clinician evaluated all the participants for cold symptoms. No significant differences between the groups were observed after 1 month. By the end of the trial however, only 16 people or 30% in the group using A. paniculata had experienced colds, compared to 33 of the placebo-group participants or 62%. This difference was statistically significant, indicating that A. paniculata reduces the risk of catching a cold by a factor of two as compared to placebo. (7)

Acute bronchitis, and an evidence-based herbal agent:

Because a lower respiratory tract infection may sometimes accompany an upper respiratory tract infection, this agent is included here. For further information see the section on acute bronchitis. By taking measures to prevent the common cold, bronchitis and pneumonia may be prevented since it often occurs as progression of viral infection or secondary bacterial infection after viral illness.

A randomized, double-blind, placebo-controlled trial enrolled 124 adults with acute bronchitis present for 48 hours or less, with symptoms greater than 5 points on the Bronchitis Severity Score (BSS: cough, sputum, rales/rhonchi, chest pain at cough, dyspnea). Participants received Pelargonium sidoides (30 drops [1.5 mL]) (n=64) or placebo (n=60) 3 times daily for 7 days. From baseline to day 7, decrease in the BSS in the treatment group was 7.2 points versus 4.9 points for placebo. In the treatment group, at day four onset of treatment effect was reported for 68.8% versus 33.3% for placebo. Patients on pelargonium reported a greater improvement in quality of life status. No serious side effects were reported. (8)

Acute bronchitis treated in adults and children by an herbal agent: Pelargonium sidoides (EPs 7630) was reported to benefit both adults and children with acute bronchitis. A total of 2099 patients aged 0-93 years were included in this study. Participants received EPs 7630 for 14 days at a dose determined by a participant’s age. During treatment, the average Bronchitis Severity Score (BSS: cough, sputum, rales/rhonchi, chest pain at cough, dyspnoea) of all patients decreased from 7.1 points at baseline to 1.0 points at last visit. For children, average BSS decreased from 6.3 points to 0.9 points. For children aged 3 years or less,  average mean BSS decresed from 5.2 points to 1.2 points. No serious side-effects were reported. (9)

Methods used to avoid influenza infection:

When caring for an individual with the flu (influenza), practicing personal hygiene, wearing face masks, and using air filters is beneficial in reducing the risk of the care giver or other individuals from also getting the flu. (10)

Prevention of influenza spread by an intervention: Researchers conducted a study of the effect of intensive hand hygiene on school absentees due to influenza-like illness (ILI), diarrhea, conjunctivitis, and laboratory-confirmed influenza in children from 60 different elementary schools in Egypt. Children in the treatment group washed their hands twice a day and received health message reminders. At the end of the study, compared with results for the control group, the intervention group reported a reduction in absences caused by ILI, diarrhea, conjunctivitis, and laboratory-confirmed influenza of 40%, 30%, 67%, and 50%, respectively. (11)

Risk reduction of influenza: Students (n=1178) living in college dorms reduced their risk of influenza-like illness (ILI) during flu season by wearing surgical masks a few hours a day and practicing good hand hygiene. The researchers used a cluster randomized design in which individuals were randomly assigned to one of three arms of this 6-week trial: face masks and hand hygiene, face masks only, or control. Compared to the control group, in the last 3 weeks participants in the treatment arms had lower rates of ILI, with a maximum reduction of 75% observed in week 6. The drawback of the study was that the results did not reach statistical significance. (12)

Common cold and a well-known herbal agent:

Common cold duration may be reduced by a well-known herbal agent’s ability to stimulate the immune system. Echinacea purpurea is a flowering herb found in North America. It is generally given at 2000-3000 mg of crude extract, or 6-9 mL in juice form, or 0.75-1.5 mL of alcoholic extract.

Common cold prevention was investigated by Jawad, M et al in a study using a well-known herbal agent vs. placebo. A total of 755 healthy individuals were randomized to receive an extract of Echinacea purpurea (95% herba and 5% root)—a flowering plant found in North America, believed to have immune-boosting properties)—or a placebo for a period of 4 months. The Echinacea administered was a commercially available product called “Echinaforce drops”, supplied and extracted using alcohol by A. Vogel Bioforce AG, Switzerland (batch 027643) and study standardized to contain 5 mg/100 g of dodecatetraenoic acid isobutylamide. The sample was microbiologically tested and proven to be free of endotoxins. Participants took three doses of 0.9ml of the drops each day for four months in an attempt to prevent colds (corresponding to 2,400mg of Echinacea extract per day). During a cold (cold episode), participants were instructed to increase the dose to five doses of 0.9ml per day (4,000mg per day). Each dose was diluted in water and held in the mouth for 10 seconds. The authors report that the placebo group had 188 cold episodes, lasting 850 episode days, compared to the Echinacea group which had a total of 149 episodes, lasting 672 episode days. A 59% reduction in recurring cold infections in the Echinacea group compared with placebo was reported. Additionally, significantly more people (52% more) in the placebo group used painkillers to treat their cold while in the study, than in the Echinacea group. There were no significant differences in the number of adverse events reported in the Echinacea group compared to the placebo group (293 adverse events vs 306, respectively). This study appears to show that giving healthy adults Echinacea every day for four months may result in an average 20% reduction in the combined number and duration of cold episodes compared to placebo over the same period. (13)

A review of the treatment of cold symptoms in 6 trials including 764 healthy adults using Echinacea purpurea found that cold symptom duration was significantly reduced in 3 separate studies by 1.5, 3, and 4 days. Symptom severity was also reduced in 4 of the 6 trials. However, 1 study showed no benefit for either severity or duration. Furthermore, there was no standardized formulation or dosing. A review of 2 prevention trials revealed no benefit. (14)

Echinacea adverse reactions and interactions are discussed below.

• Adverse events reported in a group taking Echinacea group compared to the placebo group was similar (13).
• Side effects according to Nehas, R include upset stomach, bowel problems, headache, rash, and the author also states that pregnancy and long-term use safety has not been tested (14).
• Tongue numbness with echinacea has been reported (29).
• Echinacea caused an increase in clearance of plasma midazolam levels (30).
• Echinacea has been found to have a significant negative impact on the effectiveness of HIV medications. Further drug interaction studies are needed (31).
• An increase in liver damage was reported to occur when acetaminophen was combined with echinacea and kava (32).
• In a systematic review by Izzo, AA et al, echinacea was reported to possibly change the clearance of caffeine (a CYP1A2 probe) and midazolam (a CYP3A4 probe) (33).

Evidence-based cold prevention by a household food:

Josling P et al found that 146 volunteers who took either a garlic supplement with 180 mg of allicin for 12 weeks had significantly fewer colds (24 vs 65), less reported sick days (111 days vs 366 days), and recovered faster when infected (4.63 days versus 5.63 days) compared to placebo but one drawback was that colds were reported by subjects instead of using a clinician reporter (15). Lissiman, E et al tried to locate additional trials relevant to the use of garlic for the common cold but did not locate further adequate clinical trials to support the findings by Josling P and concluded that more trials are needed to validate the findings (16).

A fruit extract for treatment of influenza:

A fruit extract has anti-viral activity: In a study performed on influenza infected mice, elderberry extract was found to suppress viral replication and increase antibodies directed toward the influenza virus. Elderberry was determined to have immunostimulant properties and antiviral activity. (26)

Influenza infection symptoms and symptom duration with a fruit extract: Zakay-Rones, Z, et al a performed a randomized, double-blind, placebo-controlled study in Norway during the flu season to evaluate the anti-viral activity of elderberry on influenza A and B infection. 60 patients 18-54 years old with flu-like symptoms for under 48 hours were treated with 15 ml of elderberry extract daily for 5 days or placebo. The elderberry group was found to have symptoms about an average of 4 days less and used less additional medication for flu symptoms compared to placebo group. The author believed a larger study is warranted to confirm results. (27)

Influenza infection and a fruit extract: A pilot randomized clinical study divided a group of patients with 3 or more typical flu symptoms into an elderberry group and a placebo group. The elderberry group took a slow dissolve lozenge with 175 mg of elderberry extract 4 times per day for 2 days. 28% of subjects in the elderberry group were symptom free within 48 hours, and 60% had only one or two mild symptoms by that time. In the placebo group, no subjects had complete recovery within 48 hours, and only 16% had improvement in 1-2 symptoms by that time. (28)

Zinc and the common cold:

Zinc for reducing the duration of cold symptoms: A systematic review and meta-analysis of 17 randomized, controlled trials that involved 2,121 participants suggests that oral zinc supplementation may shorten the duration of cold symptoms.  The team observed that zinc shortened the duration of cold symptoms by an average of 1.65 days in a total of 934 adults in 8 different studies, but no significant effect was seen among children.  The researchers observed that a reduction in the duration of cold symptoms was greater with high doses (≥75 mg versus <75 mg) of ionic zinc daily.  In addition, the researchers reported more common instances of side effects– most notably bad taste and nausea, in the zinc group (as compared to placebo group). (17)

Zinc, cold symptoms, and duration of the cold: A review of 13 trials looking at the link between zinc and treatment of the common cold in adults suggests zinc may be mildly effective for management of colds. The review did not find any trials which evaluated zinc in cold prevention. Compared to placebo, zinc nasal sprays were found to reduce the duration and severity of a cold in 4 trials and 2 trials, respectively. Lozenges small, medicated tablets intended to be dissolved slowly in the mouth (like a cough drop) containing at least 13mg of zinc are recommended every 2 hours during a cold episode but individuals may experience bitter taste, nausea, and impaired smell and taste while taking zinc. Zinc use should be stopped after 6-8 weeks or the individual may become copper deficient. In 5 trials lozenges were found to reduce cold symptom duration and severity. Lozenges containing 13-24 mg of zinc taken every 2 hours were associated with a reduced cold duration of 1.3-6.9 days with improved severity. According to the author, results were difficult to decipher due to dosing and formulation questions. (18)

Zicam intranasal zinc FDA warnings:

In 2009, the FDA issued a public health warning and advised consumers to stop using three Zicam zinc-containing intranasal (administered through the nose) products. A warning was also issued to the manufacturers of Zicam products, Matrixx Initiatives, that they could not market their products without FDA approval and that their label did not sufficiently warn consumers about the risks.  The Zicam intranasal products marketed for cold and allergy relief were subsequently discontinued in the US market due to the risk of damage to sense of smell. The FDA received more than 130 reports of sense of smell loss when taking the following three Zicam products: Cold Remedy Nasal Gel (15mL), Cold Remedy Swabs, and Cold Remedy Swabs, Kids Size. This loss of smell may be permanent. Consumers were advised to contact their health care professional if they had taken any zinc-containing products administered into the nose and were experiencing loss of sense of smell or other related problems. Oral zinc products and other dietary zinc products were not included and do not pose a risk. Consumers should avoid these products if still present in the household following the discontinuation of the products within the marketplace. (19)

Theobromine and cough:

Theobromine inhibits capsaicin-induced cough: In human subjects (n=10), theobromine (a bitter compound found in chocolate and closely related to caffeine) stops capsaicin-induced cough. Results showed that compared to placebo, theobromine significantly increased the amount of capsaicin needed to produce five coughs. Capsaicin is used to help relieve minor pain associated with rheumatoid arthritis or muscle sprains and strains. In clinical research, capsaicin is also used to determine the cough threshold. (20)

Glutamine and infection in athletes:

The effects of oral glutamine supplementation on marathon runners were tested in this study. In the 7 days following a marathon, runners were given a placebo or glutamine (0.1 g/kg body wt/day) freshly prepared from sachets of L-glutamine (Oxford Nutrition Ltd,Witney, UK) dissolved in 250 mL distilled water. For a 70 kg person, this would be 7 grams per day. The results also showed a significant increase in glutamine concentration after ingestion for the glutamine group.  All those included in the study were healthy volunteers who responded to a questionnaire about infections within the 7 days after exercise. They were not taking any medication. Infection rates were found to be the highest in those individuals engaging in the most strenuous exercise including marathon runners, ultra-marathon runners and rowers. It was found that numbers of white blood cells increased in the blood and glutamine levels dropped about 20% after the strenuous activity followed by a reduction in lymphocytes. Oral glutamine supplemented after exercise appeared to reduce the number of infections following exercise. There were also higher numbers of T-helper and T-suppressor cells in the subjects taking glutamine compared to placebo. An average of 80.8% of patients in the glutamine group reported no infections compared with 48.8% of subjects reported no infections in the placebo group. Therefore it may be restated that there were 32% less infections which occurred in the glutamine group. (21)

Vitamin C and the common cold:

When vitamin C was tested for treatment of colds in 7 separate studies that included 3294 cold episodes, vitamin C was no more effective than placebo at shortening the duration of cold symptoms except in one study that found patients taking 8g of vitamin C when cold symptoms started had shorter colds than those taking 4g. A review of 30 prevention trials (N=11,350) revealed that, while severity remained unchanged, when taken daily at 1g, vitamin C very slightly shortened cold duration—by 8% in adults and 18% in children. This means a shorter cold episode by 1.5 to 2 days assuming the typical cold runs 7 to 10 days. Finally, researchers found the most effect in subjects who were in extreme conditions, such as marathon runners. In this group of 642 individuals (6 trials), taking vitamin C at 200 to 2000 mg/d cut their risk of catching a cold in half. (22)

Cold medicine and its effects on heart rate, blood pressure:

Cold medicine and bronchodilators with sympathomimetic agents may increase heart rate or blood pressure during rest and exercise and will have no effect exercise capacity (23).

Sleep and prevention of the common cold:

A study included 153 healthy men and women between the ages of 21 and 55. The study tracked sleep duration and efficiency for 14 consecutive days. At the end of the fourteenth day, participants were quarantined and given a rhinovirus and monitored. Researchers found that individuals who reported sleeping less than 7 hours a night were 2.94 times more likely to develop a cold than those who slept 8 hours or more. In addition, those who had sleep efficiency of 92% or less were 5.5 times more likely to develop a common cold than those with an efficiency of 98% or better. (24)

Vitamin D and Influenza

Vitamin D and Influenza: G. Schwalfenberg published an article regarding the treatment of adult patients with vitamin D for influenza and has found that treating patients with 50 000 IU if vitamin D3 for one single dose or 10,000 IU (2 to 3 times daily for 2-3 days) has had a significantly positive anecdotal effect with improvement and resolution of influenza symptoms in 2 to 3 days. He further describes that this dose of vitamin D3 taken once has not had any toxicity in research. (36)

Summary: Common Cold, Upper Respiratory Infection, Influenza

• Preventing the spread of common cold and influenza viruses:

• • According to the Centers of Disease Control, prevention of the flu starts with vaccination for anyone 6 months and older at the start of each flu season in October (25).

• • If there is any suspicion of the common cold or flu, prevent the spread to others by washing hands after touching the face nose or eyes and use hand sanitizer when hand washing is not available.

• • To help prevent colds and flu whether others are known to be sick or not, wash hands frequently, and avoid touching ones face, nose, eyes, or mouth and use hand sanitizer when hand washing is not available. When using doors, a paper towel may be used to open and close doors. Reaching up high onto doors to open and close them where others infrequently touch may also reduce risk.

• • Cough should be contained into a tissue or into the sleeve at the elbow since viruses may be transmitted by air droplet exposure. Do not share utensils and drinking cups. A surgical mask or any simple mask which covers the mouth and nose will help prevent exposure to others.

• • Spreading the flu virus to others is of greatest concern in patients younger than age 2 or over 65 years old, patients in a nursing home, pregnancy, or those with chronic diseases of the lungs, heart, kidneys, cancer patients (especially those on chemotherapy), and patients with diabetes.

• • Within 24 hours of onset of symptoms, the physician may prescribe anti-viral medication which may reduce the duration of the illness but in mild cases it is not needed.

• • Researchers found that individuals who reported sleeping less than 7 hours a night were 2.94 times more likely to develop a cold than those who slept 8 hours or more, and those who had sleep efficiency of 92% or less were 5.5 times more likely to develop a common cold than those with an efficiency of 98% or better (24).

• • Exercise during colds is not recommended until symptoms begin to taper off, otherwise recovery from a cold may be prolonged.

• • It is important to stay hydrated by consuming adequate amounts of fluids.

• • Many over the counter medications for the common cold increase blood pressure and heart rate.

• By taking measures to prevent the common cold, in turn bronchitis and even pneumonia may also be prevented since it often occurs as progression of viral infection or secondary bacterial infection after viral illness. It is important to stay hydrated by consuming adequate fluids. Please see the section on “acute bronchitis.”

• The FDA does not provide strict regulation of supplements or herbs. There is no guarantee of strength, purity or safety of these products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Please see our disclaimer for further information.

• Natural cough suppression:

• • A small study by Usmani, OS et al with10 human subjects showed that theobromine (a bitter compound closely related to caffeine available in dark chocolate) at a dose of 1000 mg (equivalent to 11 tablespoons of cocoa, 3 squares of baking chocolate, 77 grams of baking chocolate, 1 ¼ cups of semisweet chocolate chips, or 2, 100-gram dark chocolate bars) stopped capsaicin-induced cough better than 60 mg of codeine (20).

• • According to Simons FE et al, the effect of theobromine peaked at 2 hours and lasted for 6 hours which was comparable to the duration and bronchodilation action of theophylline currently used as a pharmaceutical therapy for asthma (34).

• • The amounts of theobromine used in the study by Usmani, OS et al involve consuming a large amount of cocoa or chocolate but a patient should start with a much lower amount and increase slowly.

• • Cocoa and chocolate contains caffeine and theobromine. Caffeine intake up to 300 mg per day is generally safe for healthy adults. Each standard sized milk chocolate bar such as Hershey’s contains about 10 mg of caffeine, and each standard size dark chocolate bar contains about 31 mg of caffeine. Standard caffeine intake is generally recognized as safe by the FDA and AMA but can be dangerous with adverse effects such as high bp, stroke, and arrythmias reported. Cocoa and chocolate also contains theobromine which is known to act as a heart stimulant, vasodilator, and diuretic which may be responsible for some of the therapeutic action of cocoa (35). Theobromine in cocoa may intensify the blood pressure lowering effects of any blood pressure medications.

• Andrographis paniculata

• • Andrographis paniculata was effective for symptoms of the common cold in children 4 – 11 years old in the study mentioned with improvement in upper respiratory tract infection symptoms by days 2−3 and reported no side effects. 100 mg capsule standardized to 10% andrographolides taken 3 times daily or equivalent was taken for 10 days and was somewhat more effective than a leading echinacea product. (1)

• • Andrographis paniculata is beneficial for the common cold in adults by reducing most cold symptoms and the duration of the cold. 1200 mg of the herb standardized to 10% andrographolides divided three times per day for a duration of 3–8 days has been studied and tolerated well (5,6).

• • For prevention of the common cold, Andrographis paniculata at a dose of 200 mg per day for 3 months has been studied and tolerated well but more studies are needed to confirm this benefit (7).

• • Obtain approval from a primary care physician prior to taking and provide careful attention to monitoring for adverse effects of Andrographis paniculata. Andrographis paniculata has reported as well tolerated by multiple trials, but has been found to produce several adverse reactions and interactions:

• • • Gastric irritation and nausea (8)

• • • Hypoglycemia (low blood sugar) occurred when using AP as a favorable effect for treatment of diabetes as mentioned above (8), researchers found AP at a dose of 50 mg/kg significantly reduced blood sugar by 52.9% – 61.81% (9).

• • • Relaxed uterine smooth muscle and therefore should not be taken in pregnancy (11).

• • • In males, sperm count, motility, and morphology was improved with AP (10).

• • • Testosterone levels were increased with doses of 50 to 200 mg per kilogram in male rats (10).

• • • Reduced platelet aggregation by inhibiting platelet activating factor, and this mechanism differed from the mechanism by non-steroidal anti-inflammatory drugs (12).

• • • Allergic reactions, fatigue, headache, painful lymphadenopathy, nausea, and diarrhea in doses of 20 mg per kg per day as well as stomach irritation, bloating, nausea, vomiting and diarrhea has been reported. (13)

• • • Pruritis/rash, diarrhea, nausea, metallic taste, bitter taste, decreased/no taste, dry tongue, decreased sex drive, eyes sensitivity to light, decreased short term memory, dizziness, heartburn, tender lymph nodes, lymphadenopathy (14).

• • • Unpleasant sensations in the chest, headache, urticaria, nausea, vomiting, abdominal discomfort, dizziness, drowsiness and malaise, increased nasal discharge, epigastric pain, and blocked nose. However, AP was well tolerated among most participants. (14)

• • • Do not take AP if you are pregnant or planning to be pregnant, if you are taking diabetes drugs or insulin, if you are allergic to AP, or if you are taking anticoagulants such as aspirin, warfarin, non-steroidal anti-inflammatory drugs, or ticlopidine because of the potential increased risk of bleeding.

• Pelargonium sidoides:

• • An herbal extract, Pelargonium sidoides, (also known as South African Geranium, Umckaloabo, Kaloba, Umcka, and Zucol) has been studied in both adults and children. It produced good results in several trials as a treatment for acute bronchitis. The following signs and symptoms were reported as better in the Pelargonium sidoides group over placebo: cough, sputum, rales/rhonchi, chest pain at cough, dyspnea, hoarseness, fatigue, fever, headache, and limb pain. The dose in the studies most commonly used was 30 drops or 1.5 mL, 3 times per day given before meals. Adults and children over 12 years were given a dose of 30 drops, children over 6 up to 12 years old were provided a dose of 20 drops, and children under 6 years old were given 10 drops per dose for duration of either 7 or 14 days. There were few adverse effects occurring at similar rates in both treatment and placebo groups (1-3), and another study showed that an adverse reaction of bleeding was felt unlikely (4). It is currently widely available but the use of this agent should be overseen by a physician.

• • Patients should not take Pelargonium sidoides if they have an allergy to this herbal preparation or allergy to a similar plant family.

• • For more specific information on Pelargonium sidoides, (also known as South African Geranium, Umckaloabo, Kaloba, Umcka, and Zucol) please see that section.

• Echinacea:

• • Nahas, R performed a review of Echinacea clinical trials incuding 764 healthy adults and found that a dosage range of 2000-3000 mg of crude extract, or 6-9 mL in juice form, or 0.75-1.5 mL of alcoholic extract was generally used. This author found that cold symptom duration was significantly reduced in 3 separate studies by 1.5, 3, and 4 days, symptom severity was reduced in 4 of the 6 trials, but one trial showed no benefit. The author also found that 2 prevention trials revealed no benefit, and there was no standardized formulation or dosing established. (14)

• • Jawad, M et al found that 3 doses of 0.9ml of Echinacea drops (corresponding to 2,400mg of Echinacea extract per day) held in the mouth for 10 seconds daily for 4 months appeared to prevent colds. During a cold (cold episode), participants were instructed to increase the dose to five doses of 0.9ml per day (4,000mg per day). The placebo group had 188 cold episodes or 850 episode days, compared to the Echinacea group which had 149 episodes, or 672 episode days. A 59% reduction in recurring cold infections in the Echinacea group compared with placebo was reported and 52% more subjects of the placebo group used pain medication during a cold than in the Echinacea group. (13)

• • Echinacea adverse reactions and interactions:

• • • Adverse events reported in the Echinacea group compared to the placebo group was similar (13).

• • • Side effects according to Nehas, R include upset stomach, bowel problems, headache, rash, and the author also states that pregnancy and long-term use safety has not been tested (14).

• • • Tongue numbness with echinacea has been reported (29).

• • • Echinacea caused an increase in clearance of plasma midazolam levels (30).

• • • Echinacea has been found to have a significant negative impact on the effectiveness of HIV medications. Further drug interaction studies are needed (31).

• • • An increase in liver damage was reported to occur when acetaminophen was combined with echinacea and kava (32).

• • • In a systematic review by Izzo, AA et al, echinacea was reported to possibly change the clearance of caffeine (a CYP1A2 probe) and midazolam (a CYP3A4 probe) (33).

• Garlic:

• • Josling P et al found that 146 volunteers who took either a garlic supplement with 180 mg of allicin for 12 weeks had significantly fewer colds (24 vs 65), less reported sick days (111 days vs 366 days), and recovered faster when infected (4.63 days versus 5.63 days) compared to placebo but one drawback was that colds were reported by subjects instead of using a clinician reporter (15).

• • Lissiman, E et al tried to locate additional trials relevant to the use of garlic for the common cold but did not locate further adequate clinical trials to support the findings by Josling P and concluded that more trials are needed to validate the findings (16).

• Elderberry extract: Elderberry should only be taken with the oversight of a physician and only cooked elderberry extracts should be used. Heating elderberry extract for 20 minutes destroys potential cyanide type toxins present in raw parts of the plant. Elderberry extracts are widely available over the counter from pharmacies and health food stores.

• • Elderberry was determined to have both immunostimulant properties and antiviral activity (26).

• • Zakay-Rones, Z, et al a performed a randomized, double-blind, placebo-controlled trial on influenza A and B starting within 48 hours treated with 15 ml of elderberry extract daily for 5 days, and symptoms lasted about 4 days less. Also the placebo group used more additional medication for flu symptoms compared to the elderberry group. The author believed a larger study is warranted to confirm results. (27)

• • Patients with the flu with 3 or more typical flu symptoms took a slow dissolve lozenge with 175 mg of elderberry extract 4 times per day for 2 days and 28% of subjects in the elderberry group were symptom free within 48 hours, and 60% had only one or two mild symptoms by that time. In the placebo group, no subjects had complete recovery within 48 hours, and only 16% had improvement in 1-2 symptoms by that time. (28)

• Zinc:

• • A review of controlled trials by Science, M et al suggested that oral zinc supplementation may shorten the duration of cold symptoms about 1.65 days and was greater with high doses (≥75 mg versus <75 mg) of ionic zinc daily but no significant effect was seen among children (17).

• • Nehas, R reviewed 5 trials including 13-24 mg zinc lozenges taken every 2 hours which were found to be associated with a reduced cold duration of 1.3-6.9 days with improved severity (18).

• • Adverse reactions and interactions of zinc supplememts:

• • • Bad taste and nausea occurred more in a zinc supplemented group compared to placebo group (17).

• • • May cause bitter taste, nausea, impaired smell, loss of taste, and should be stopped after 6-8 weeks or copper deficiency may occur (18).

• Glutamine: 7 days following a marathon, runners were given a placebo or glutamine (0.1 g/kg body weight per day-7 grams per day in 70 kg person) dissolved in 250 mL distilled water and 32% less infections occurred in the glutamine group compared to the placebo group (21).

• Vitamin C: Douglas, RM et al authored a Cochrane Database Systematic Review which determined some important points in the use of vitamin C for the common cold (22):

• • 7 separate studies that included 3294 cold episodes showed that vitamin C was no more effective than placebo at shortening the duration of cold except in one study with patients taking 8g of vitamin C daily at start of cold symptoms shortened colds more that subjects taking 4g daily.

• • 30 prevention trials with 11,350 subjects revealed that vitamin C at a dose of 1 gram per day shortened colds by 8% in adults and 18% in children which may amount to a shorter cold episode by 1.5 to 2 days assuming a more severe cold runs 7 to 10 days, but vitamin C did not decrease severity of colds.

• • After reviewing 6 trials, Douglas, RM et al found that vitamin C had the greatest benefit for colds in extreme athletes such as marathon runners, and if vitamin C was taken at 200 to 2000 mg daily by these athletes, it reduced the risk of getting the common cold in half.

• Vitamin D and Influenza: G. Schwalfenberg published an article regarding the treatment of adult patients with vitamin D for influenza and has found that treating patients with 50 000 IU if vitamin D3 for one single dose or 10,000 IU (2 to 3 times daily for 2-3 days) has had a significantly positive anecdotal effect with improvement and resolution of influenza symptoms in 2 to 3 days. He further describes that this dose of vitamin D3 taken once has not had any toxicity in research. (36)

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