It’s that time of year. As days get shorter, doctor’s offices all over the country fill up with people who have colds and flu. Some say this is because we are indoors and are more likely to spread viruses and others believe this is because serum vitamin D levels are lower in the winter. (1)
This year we have H1N1 influenza in addition to the usual seasonal influenza and viral URI’s. The CDC is recommending Tamiflu only for high risk individuals with classic influenza symptoms. If one follows these guidelines, it can seem as if there is little to offer patients beyond simple supportive care for influenza. And there is no cure for the common cold. However, there are several helpful herbal remedies and dietary supplements that are safe and may alleviate symptoms or shorten their course. (2)
Andrographis has intriguing evidence for use with URI’s. There are reports of antimicrobial, anti-inflammatory and immunomodulatory activity in the chemical constituents of andrographis. (3,4) Small trials show evidence that it decreases subjective symptoms and the duration of uncomplicated viral URI’s. Most commonly Andrographis is dosed at 400 mg three times a day. There are no published drug interactions and because safety has not been tested precaution for use with pregnant women and children is prudent. More research is warranted, but given its relative safety, it seems reasonable to recommend its use for adults.
Controversy exists about the evidence for echinacea. The majority of published results have shown positive effects. However, two recent and higher quality trials have shown no better efficacy than placebo. Echinacea is safe with no published side effects or drug interactions other than allergic reactions. (3,5) Taking all this into account, it seems that one could safely recommend its use for non-pregnant adults especially with patients who have had a positive effect with echinacea in the past.
Other herbal remedies that have been for many generations with some symptomatic relief including chamomile and peppermint tea. These are particularly tasty with honey and lemon. Lemon provides vitamin C and honey soothes a sore throat. Both chamomile and peppermint have been used for calming an upset stomach and peppermint contains constituents helpful in relieving congestion. Chicken soup with garlic has been shown to have antimicrobial benefits with no obvious contraindications.
Goldenseal is a top-selling herbal supplement. It has been recommended for treating everything from viral infections to feminine hygiene. At this time, no randomized controlled trials have supported its use. Goldenseal overuse has been associated with cardiac arrythmias and death. Given its risk benefit profile, it does not seem prudent to recommend its use.
Nasal saline washes have long been used in other cultures and more recently been introduced in the West. Even though the evidence in controlled trials is mixed, there is significant anecdotal evidence for efficacy. The cost is low and no significant risks are evident, and there are possible benefits. It can be recommended for all people with viral symptoms. One can advise patients to lean over a sink with the head horizontal and one ear downward to gently pour saline into the higher nostril. The fluid should run through the upper nostril to the lower nostril. Blow the nose gently and repeat with other side.
Increasing vitamin C intake for the prevention and treatment of viral infections has been promulgated since the 1960’s when Linus Pauling advocated its use. Data from the research into efficacy of vitamin C is mixed but there is a preponderance of modest preventive and treatment effect. There are few side effects, especially for short term use and possible benefits. So, one can reasonably recommend vitamin C at doses of 250-500 mg 3-4 times daily for URI symptoms. Given the overall benefit of eating fruits and vegetables, one can enthusiastically recommend their consumption as a way of obtaining vitamin C. (3)
Low serum vitamin D levels have been implicated in seasonal flu epidemics. Vitamin D has been shown to have immunomodulation effects and there is some interesting epidemiologic data showing increased influenza prevalence when serum vitamin D levels are low. (1) This combined with the increased interest in vitamin D for the prevention of cancers, coronary artery disease and osteoporosis and the relatively few side effects, make it appropriate to recommend increased vitamin D consumption. 1000- 2000 IU of vitamin D daily may be of benefit. The forthcoming research on vitamin D will be interesting to follow.
Zinc has been a popular over the counter remedy for viral prophylaxis and treatment for a number of years. Nasal installation of zinc preparations has been studied and has shown modest effects. This mode of administration has been associated with nasal irritation and loss of smell. For these reasons, nasal preparations are to be avoided. Oral preparations of zinc containing zinc gluconate, have some modest benefit. Therefore, their use can be justified in those who desire zinc supplementation or in those who have had a positive benefit in the past
By far, the most efficacious way to address colds and flu is prevention. Much has been written about hand washing and the importance of hygiene can’t be overemphasized. Both acute and chronic stress have been shown to increase the risk of viral infection. Decreasing stress through meditation, yoga, prayer or other mind-body interventions may help to decrease the onset and duration of viral illnesses.
Overview: A healthy diet including plenty of fruits and vegetables, vitamins C and D supplementation, adequate rest, exercise, stress reduction and good hygiene measures is the best offense against common viral URI illnesses. If infection occurs, initiating andrographis, increasing fluids and rest and other comfort measures such as chamomile or peppermint tea with lemon and honey or chicken soup may help to ameliorate symptoms or decrease the overall time course of the illness.
- Vitamin D review article
- 1000 cures
- Rakel URI chapter
- Poolsup, N. et al: Adrographis paniculata in the symptomatic treatment of uncomplicated upper respiratory tract infection: Systematic review of randomized controlled trials. J Clin Pharmacol Ther 29:37-45, 2004
- Huntley et al: The safety of herbal medicinal products derived from echinacea species: A systematic review. Drug Safety 28:387-400, 2005.