Written by Dr. Tanya Wylde, Naturopathic Doctor
Cold & Flu Season is upon us and October is influenza (flu) immunization awareness month. Some people struggle with the decision of whether or not to vaccinate with the flu-vaccine. See my blog titled “To vaccinate or not to vaccinate, that is the question” for the pros and cons of vaccinating. Although seasonal flu outbreaks can circulate as early as October according to the Centers for Disease, Control and Prevention (CDC) “most of the time influenza activity peaks in January or later.” This means you still have time to start taking care of your health and supporting yours and your family’s immune systems with the goal of avoiding the viruses of the season, this includes the various 200 viruses that cause the common cold. This article will discuss some evidenced based natural medicine tips to help you work on preventing the circulating viruses from invading you and your family and treating them should the need arise this cold & flu season. It will also help educate you on when it is necessary to use antibiotics and when to treat a fever as way too often people use antibiotics for viruses which can be harmful and parents suppress fevers even when their child seems otherwise healthy.
Evidence based Natural Prevention and Treatment for Colds and Flus
With the realization that most colds & flus circulating through the season are caused by viruses it’s important to know that there really isn’t any approved anti-viral conventional medical treatments. So we have to prevent and treat naturally. We also have to limit the spread of viruses. It’s best not to go to work when you are sick so that you have a quicker recovery time and so that you don’t spread the virus to others. The common cold is among the leading reasons for visiting a doctor and for missing school or work. If you stay home for the first few days and rest at the onset of a cold or flu you are more likely to have a faster recovery time and spend less time away from work rather than waiting until all your symptoms manifest. Often we push through illness and forget the importance of something as simple as resting and end up needing a week off work rather than a couple of days at the onset of the illness. Even when you are feeling better but your symptoms are still present, you are likely carrying the virus in your mucus secretions so it’s best not to sneeze on your friends, family members, co-workers and fellow community members in general.
SEEK SOCIAL SUPPORT
I’ve always known how important my own social support network has been to me (my husband, family, employees, co-workers and friends) but recently my husband who is studying his masters of public health has taught me that greater support from our social support network (95%) has a considerably higher impact on our health compared to the more commonly considered factors such as access and use of health care services such as conventional doctor clinics and hospitals (only 5%) which often have less of an impact. Researchers have also found that your spouse’s social network quality influences your health. What does all this mean? When you reach out to others for help, support and to listen to you, your susceptibility to illness (including colds & flus) is lower. So remember to keep you’re social support network active through the colder months instead of totally hibernating since your support network of family and friends will benefit from listening and talking to you too. Something Naturopathic doctors pride in is being good listeners and part of many of our patients social support networks.
It is most important is to remember to wash your hands with regular soap and water, as this is the most effective way to reduce the number of germs on your hands. Alcohol based hand-sanitizers aren’t effective since they kill bacteria not viruses. Remember to wash your hands before you leave work and as the first thing you do when you walk into your home since many people will still show up to work sick not even knowing they are spreading a virus to others. Also, dirty hands in the mouth and on the face is one of the most effective way to transmit viruses so keep your dirty hands off your face. Don’t be insulted when your doctor doesn’t shake your hand, this is for your benefit! Always make sure your doctor washes his/her hand before making contact with you and your children as doctors’ offices and hospitals are notorious for spreading viruses and bacteria. Consider using “Benefect” to sanitize your work-stations and door handles at work and home regularly. Benefect is a natural disinfectant made from the spice “Thyme” and it kills over 99.9% of bacteria, mould, mycobacteria, HIV and other viruses when sprayed onto surfaces and the great thing about it is that it’s safe for pets and children! (For more information go to http://www.benefect.com)
Create a routine of rinsing your nose and sinuses each night with a ceramic “neti-pot” or Neil Med squirt bottle with a sterile saline solution (salt and water) before bed to remove any viruses and inflammatory mediators in the nasal mucus and sinus cavity. Unlike nasal decongestants, nasal irrigation with saline rinses don’t lead to a rebound effect-a worsening of symptoms when the medication is discontinued-and these rinses are considered mild and safe for use in children and adults including pregnant women. A recent study found a significant reduction in respiratory infections among children using nasal irrigation as a preventive measure. I have been using the “hydrasense” nasal aspirator (aka “snot sucker”) for my 6-month-old infant and have been using it almost daily since he was a newborn. He is very used to it though so if your infant won’t allow you to use it on him or her, you can alternatively try the very fine mist saline solution or saline ampoules. (ie. NeilMed’s Nasamist). When children are older than 4 years old you can use the pediatric nasal rinse by Neil Med. And, no I don’t have any vested interest or shares in the neil med company, (this goes for all companies/product lines I recommend). I just find their products useful for my family and patients. If you are someone who gets frequent viral and bacterial throat infections I recommend gargling regularly at the end of your nasal irrigation routine with the same saline solution as a preventative treatment as well. Although nasal irrigation can shorten the duration of a viral upper-respiratory tract infection (cold) and help prevent the onset of colds and flus,, people can get infections if they use neti pots or other nasal rinsing devices improperly. It’s important to use sterile water and it’s important to properly clean your nasal rinse device well between each use. Also, don’t share your pots/rinse bottles with other family members. The U.S. Food and Drug Administration (FDA) has information on how to use them and clean them safely. Go to the following link for more information: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm316375.htm
Cold viruses thrive in dry conditions (dry air allows viruses to live longer outside the body)— another reason why colds are more common in winter. Dry air also dries the mucous membranes, causing a stuffy nose and scratchy throat. Adding eucalyptus oil to the humidifier or to a steam inhalation can be helpful to break up loose coughs and sooth irritated mucous membranes. Never take eucalyptus oil by mouth. I recommend eucalyptus oil to be added to the humidifier in infants and children’s rooms at night when sleeping and to steam for inhalation in older children and adults. Always keep eucalyptus oil bottles out of reach of infants, toddlers and children in general since it can be toxic if consumed orally!
Have you ever noticed that children always get sick around Halloween? Children are back in school, the air is getting drier and colder outside, and then add Halloween candy to the mix and you’ve got the perfect recipe for viruses to thrive. Sugar suppresses the immune system so avoid it if you can; limit it if you feel you can’t completely avoid it. Simple carbohydrates also breakdown to sugar quickly in your body so avoid/limit those too. Focus on a diet of whole foods. Root vegetables yams, beets, turnips, carrots, sweet potatoes are plentiful in the fall. Increase the intake of whole grains in their unprocessed form such as brown rice, quinoa, buckwheat, barley and millet. Consume sufficient protein in the form legumes and nuts and seeds, eggs, fish and organic lean meats (chicken, bison, turkey, duck, venison, rabbit etc.). Protein is essential to the immune system. Of course protein doesn’t have to be in the form of meat- vegetarians and vegans can still get sufficient protein from non-meat sources as well, as listed above (from legumes, nuts and seeds, dairy in the case of vegetarians and protein powders for both vegans and vegetarians). When you have the choice, always pick organic. Also consume foods high in zinc, vitamin C, iron and beta-carotene to support your immune system. Continue reading to find out which foods contain these nutrients and get daily sunshine exposure to get some Vitamin D3. Also, discuss with your naturopathic doctor when considering supplementing your diet with these nutrients as separate vitamins and minerals. If I see a patient is still getting frequent colds and flus despite following the preventative and treatment measures in this article then I highly consider ruling out other causes, such as underactive thyroid or adrenal fatigue, food and environmental allergies as a cause of their weakened immune system. Ruling out food allergies can be done by with an allergist via skin prick, food sensitivities can be ruled out through a blood test and/or elimination diet. The thyroid and adrenals can be assessed through symptom history and lab work.
If you are trying to keep your newborn and infants healthy, breastfeeding is essential. In a study where they examined the affects of breastfeeding on the size of the thymus gland they discovered that the thymus gland is considerably larger in breastfed infants than in formula-fed infants at the age of 4 months old.  This is because human breast milk contains many immune modulating factors.9 The thymus is a specialized organ of the immune system and is the largest and most active during the neonatal and pre-adolescent periods.
NUTRITIONAL SUPPLEMENTS TO PREVENT AND TREAT COLDS & FLUS
The use of oral Zinc is effective for preventing colds and reducing the length and severity of the common cold in adults and children. A 2013 Cochrane database systematic review of randomized, double-blind, placebo-controlled trials using zinc for at least five consecutive days to treat, or for at least five months to prevent the common cold showed promising results on cold and flu prevention. Zinc administered within 24 hours of onset of symptoms reduces the duration of common cold symptoms in healthy people. As the zinc lozenges formulation has been widely studied and there is a significant reduction in the duration of cold at a dose of ≥ 75 mg/day, for those considering using zinc it would be best to use it at this dose throughout the cold. A common side effect of zinc is nausea so be to sure to consume with food! A 2011 systematic review of 15 clinical trials of oral zinc, involving more than 1,300 people, concluded that zinc helps to reduce the length and severity of the common cold in healthy people when taken within 24 hours after symptoms start.2 The review also concluded that zinc, taken at low doses for at least 5 months, reduced the number of colds in children.2 In my practice I often recommend a zinc supplement to treat colds and flus and longer term if a patient seems to get colds and flus frequently through the winter months. If I recommend longer term supplementation of zinc (more than one month) I make sure patients take also take additional copper to avoid a copper deficiency which can occur if zinc is taken long term on it’s own. The dose is variable depending on the size and age of the patient.
The science shows that Vitamin D is effective for reducing the frequency of colds and flus. A study in Japan, involving school aged children taking 1200 IU/day(d) vitamin D3 vs. 200 IU/d, found a 67% reduction in incidence of Type A influenza(flu virus), but no effect for Type B influenza. Type A influenza includes H1N1 varieties, which was the type involved in the 1918-19 pandemic influenza and the 2009 “swine flu” infections.11 Maintaining blood concentrations of 38 ng/ml or more in adults was associated with a significant two-fold reduction in the risk of developing acute respiratory tract infections with a marked reduction in the percentages of days ill. Although Vitamin D seems to prevent the onset of colds and flus a review of the literature doesn’t support the use of Vitamin D as a treatment for colds and flus. Theoretically, pharmacological doses of vitamin D (2,000 IU per kg per day for three days) may produce enough of the naturally occurring antimicrobial cathelicidin to cure common viral respiratory infections, such as influenza and the common cold since one of the most important genes vitamin D up-regulates is for cathelicidin, a naturally occurring broad-spectrum antibiotic and antiviral. However, such a theory awaits further science.13 In my clinical practice I recommend that adults take anywhere between 2,000iu/d and 7,000iu/d through the fall and winter depending if they are deficient or not. This can be determined by doing a blood draw for Vitamin D levels. I recommend 400iu/d for infants and 800iu /dfor children through the fall and winter months.
Vitamin C can prevent colds (in five trials in people who were exposed to extreme physical stress (marathon runners, skiers, and soldiers training in subarctic conditions), taking vitamin C cut the number of colds in half.2 It has also been shown to reduce the severity and duration of common cold symptoms. Supplementation of vitamin C improves the function of the human immune system, such as antimicrobial and natural killer cell activities and lymphocyte proliferation. A 2010 systematic review of results from 29 clinical trials involving more than 11,000 people found that taking vitamin C was associated with a reduction in the length and severity of cold symptoms.2 Vitamin C can be administered orally or by intravenous methods. In my clinical practice I find that adult patients benefit from taking a 500mg dose of buffered Vitamin C every hour to bowel tolerance (cut back if you get loose stool) for the first 12 hours of a cold and then continue taking 500mg three times daily until the cold has subsided. In children 10mg/kg of body weight can be taken three times daily safely. For adults with sensitive stomachs, the use of Intravenous Vitamin C (IV-Vit C) may be beneficial. IV-Vit C administered by a naturopathic doctor may also be used once weekly for patients who get sick frequently through cold and flu season (more than 4 colds) and have a poor recovery time (colds last more than 7 days).
VITAMIN A (BETA-CAROTENE) AND IRON
The combination of iron and vitamin A might also be beneficial in preventing infections. A study published in “Nutrition” in October 2013 investigated the results of giving vitamin A and iron to pre-school aged children two to six. Dr. K. Chen and colleagues discovered that children who took both Vitamin A and iron supplements with both experienced fewer respiratory infections and coughs than did the groups given no vitamins or just vitamin A.  These supplements can be toxic at the wrong doses so it’s important to discuss with your naturopathic doctor first in order to determine if these are needed and how much iron and vitamin A would be good for you or your children. A good starting point would be to focus on a diet high in iron (dried apricot, watermelon, broccoli, parsley, wheatgrass juice, cooked spinach, beet greens, swiss chard, spirulina, red-leaf lettuce, kale and fortified cereals and meats if you aren’t vegetarian or vegan such as: organic beef, chicken lamb, pork, egg yolk, shrimp, clams, duck and pork) and beta-carotene, which is the form of vitamin A that we get from foods (romaine and green leaf lettuce, kale, carrots, spinach, dandelion greens, mustard greens, turnip greens, Chinese cabbage (pak choi), pumpkin, collards, swiss chard, collard greens, beet greens, parsley, sweet red peppers, sweet potato and butternut squash).16
A 2011 systematic review of 10 clinical trials involving more than 3,000 people indicated that probiotics were better than placebo in reducing the number of participants experiencing episodes of acute upper respiratory tract infections (URTIs), the rate ratio of episodes of acute URTI and reducing antibiotic use.  Probiotics are more beneficial than placebo for preventing URTIs, colds and flus in adults17, improving recovery time of the common cold in children, and may optimize the efficacy of the flu vaccine. Daily dietary probiotic supplementation for 6 months was a safe effective way to reduce fever, rhinorrhea, and cough incidence and duration and antibiotic prescription incidence, as well as the number of missed school days attributable to illness, for children 3 to 5 years of age.20
In clinical practice I always recommend a short-term higher dose of probiotics after the use of antibiotics to replenish the friendly gut bacteria that has been eliminated by the antibiotic. In general I recommend the following for probiotic usage, 20 billion Colony forming units (CFU)/day(d) for health maintenance in adults, 5 billion CFU/d for children, and between 50 and 450 billion CFU/d for chronic conditions and post antibiotic use. Strain recommendations vary depending on the issues and often I will rotate the use of different strains to ensure optimal health of the gut flora.
For my article on antibiotics and when to avoid them, click here
HERBAL MEDICINE TO TREAT COLDS AND FLUS
Echinacea’s effectiveness for colds and flus has had mixed results in many studies,,,,, The mixed results are because products studied vary widely, containing different Echinacea species, plant parts, and preparations and therefore it’s difficult to ascertain it’s effectiveness. The right part of the plant and proper dosing has to be used in order to study the use of Echinacea for colds effectively. Despite this controversy, the Lancet, one of the worlds’ best-known medical journals did a meta-analysis of 14 studies and found that Echinacea decreased the odds of developing the common cold by 58% and the duration of the cold by 1-4 days. In my practice I recommend 1ml of Echinacea root (not leaf) in tincture (liquid) form every hour at the onset of your symptoms of a cold or flu for the first 12 hours and then 1 teaspoon (5ml) three times daily diluted in a bit of water, gargled and then swallowed. Usually I combine Echinacea with other immune stimulating herbs, (and therefore anti-viral ingredients) for both adults and children.
Black elderberries (Sambucus nigra L.) are well known as supportive agents against common cold and influenza.  It is further known that bacterial super-infection during an influenza virus (IV) infection can lead to severe pneumonia.23 Standardized elderberry extract may exhibit antibacterial effects in addition to antiviral activity. These effects were seen against three Gram-positive bacteria and one Gram-negative bacterium responsible for infections of the upper respiratory tract, as well as cell culture experiments for two different strains of influenza (flu) virus and other viruses when studied in petri dishes (in-vitro) in the lab.23 Although Elderberry hasn’t been studied as well as Echinacea in addition to it having been found to be effective against the strains of viruses that cause colds and flus in-vitro.23,30 it has been shown to reduce the duration of flus and effective for fevers. We use a tincture called “Children’s cold and flu elixir” by Viriditas in office, which includes a combination of elderberry, and Echinacea. We find this to be very effective in children when used at the first onset of colds and flus and fevers.
Hydrastis (aka Goldenseal) is well known in the naturopathic and herbalist community as the “king of the mucous membranes” since it has anti-microbial properties (anti-viral, anti-fungal, anti-parasitic and anti-bacterial) that appear to be effective (due to it’s alkaloid, berberine) against throat, lung, bladder and bowel infections (everywhere mucous membranes exist in the body essentially). I use Hydrastis in tincture form sparingly with other immune stimulating herbs such as Echinacea and elderberry at the first onset of colds and flus. Speak with your naturopathic doctor about dosing this herb, as it can be toxic in high doses. Some recent evidence has shown anti-viral properties against the standard Influenza A virus.
IMPROPER USE OF OREGANO OIL
Often my patients tell me that they use oregano oil all season to prevent colds and flus. Unfortunately this can be harmful since oregano oil is similar to an antibiotic in that it is effective against bacteria. It has also been shown to have strong anti-fungal properties. Although these properties maybe helpful when you are trying to treat yeast infections (fungus) and bacterial infections such as H. Pylori or superimposed bacterial pneumonia as a result of a complication of the flu, it is not effective against cold and flu viruses.33 I do not advise taking it all winter long since one major side effect would be to wipe out your good bacteria. Oregano oil has been studied to be effective to prevent bacteria in meats and vegetables in food storage more than it has been studied for human infections. I’d recommend taking oregano oil for bacterial infections in tandem with antibiotics to help prevent anti-bacterial resistance or for yeast infections if other anti-fungals haven’t worked.
~ Tanya Wylde, BSc, CPT, ND, Naturopathic Doctor
For Tanya’s Facebook page: Dr.TanyaWylde, Naturopathic Doctor
Originally published on: Naturally Down To Earth
Find Naturally Down to Earth on Facebook click HERE
*Also, check out Bryce’s (my bro) article titled “Bryce Wylde’s Top Flu-Fightin Techniques” in the latest Tonic Magazine, October 2013*
Sources for this article:
 National Institutes for Health. National Centre for Complementary and Alternative Medicine-The Flu The Common Cold, and Complementary Health Approaches (2013, April) Retrieved from http://nccam.nih.gov/health/flu/ataglance.htm
 World Health.net Extended Effects of a Social Support Network (2013, September 17) Retrieved from http://www.worldhealth.net/news/extended-effects-social-network/
 No authors listed. Prophylaxis of acute respiratory infections in children’s collectives: results of treatment with nasal and nasopharyngeal irrigation. Vestnik otorinolaringologii (Journal), 2012;(1): 44-6 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22678640)
 Khianey R, Oppenheimer J. Is nasal saline irrigation all it is cracked up to be? Allergy Asthma Immunol. 2012 Jul; 109(1): 20-8
 Huafei Ao, Qin Wang, Baofa Jiang, and Peter He Journal of Infectious Diseases and ImmunityVol. 3(6), pp. 96-105, June 2011
 Mayo Clinic Cold remedies: What works, what doesn’t, what can’t hurt (2012, June 7) Retrieved from http://www.mayoclinic.com/health/cold-remedies/ID00036
Hasselbalch H, Jeppesen DL, Engelmann MDM, Michaelsen KF, Nielsen MB. Decreased thymus size in formula-fed infants compared with breastfed infants. Acta Paediatr. 1996;85:1029–32
 Singh M, Das RR Zinc for the common coldCochrane Database Syst Rev. 2013 Jun 18
 Urashima, M. Segawa, T. Okazaki, M. Kurihara, M. Wada, Y. Ida, H. Randomized tiral of vitamin D supplementation to prevent seasonal influenza A in schoolchildren American Journal of Clinical Nutrition. 2010 May; 91 (5): 1255-60.
 Sabetta JR, Depetrillo P, Cipriani RJ, Smardin J, Burns LA, et al. Serum 25-hydroxyvitamin d and the incidence of acute viral respiratory tract infections in healthy adults. PLoS One 2010
 Chen K, Chen XR, Zhang L, Luo HY, Gao N, Wang J, Fu GY, Mao M. Effect of simultaneous supplementation of vitamin A and iron on diarrheal and respiratory tract infection in preschool children in Chengdu City, China. Nutrition. 2013 Oct;29(10):1197-203.
 Self Nutrition Data- Foods Highest in Iron (2012) Retrieved from: http://nutritiondata.self.com/foods-000119000000000000000-11.html?
 Hao Q, Lu Z, Dong BR, et al. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database of Systematic Reviews. 2011; (9)
 Kang EJ, Kim SY, Hwang IH, Ji YJ. The effect of probiotics on prevention of common cold: a meta-analysis of randomized controlled trial studies. Korean J Fam Med. 2013 Jan;34(1):2-10.
 Leyer GJ, Li S, Mubasher ME, Reifer C, Ouwehand AC. Probiotic effects on cold and influenza-like symptom incidence and duration in children. Pediatrics. 2009 Aug;124(2):172-9.
 Kumpu M, Lehtoranta L, Roivainen M, Rönkkö E, Ziegler T, Söderlund-Venermo M, Kautiainen H, Järvenpää S, Kekkonen R, Hatakka K, Korpela R, Pitkäranta A. The use of the probiotic Lactobacillus rhamnosus GG and viral findings in the nasopharynx of children attending day care. J Med Virol. 2013 Sep;85(9):1632-8
 Olivares M, Díaz-Ropero MP, Sierra S, Lara-Villoslada F, Fonollá J, Navas M, Rodríguez JM, Xaus J. Oral intake of Lactobacillus fermentum CECT5716 enhances the effects of influenza vaccination. Nutrition. 2007 Mar;23(3):254-60.
 Braunig B et al. Echinacea purpurea radix for strengthening the immune response in flu-like infections. J Z Phyother 1992; 12: 7-13
 Schoneberger D. The influence of immune-stimulating effects of pressed juice from Echinacea purpurea on the course and severity of colds. Results of a double-blind stuy. Forum Immunologie 1992; 8:2-12
 Schapowal A. Efficacy and safety of Echinaforce® in respiratory tract infections. Wien Med Wochenschr. 2013 Feb;163(3-4):102-5.
 Di Pierro F, Rapacioli G, Ferrara T, Togni S. Use of a standardized extract from Echinacea angustifolia (Polinacea) for the prevention of respiratory tract infections. Altern Med Rev. 2012 Mar;17(1):36-41.
 Jawad M, Schoop R, Suter A, Klein P, Eccles R. Safety and Efficacy Profile of Echinacea purpurea to Prevent Common cold Episodes: A Randomized, Double-Blind, Placebo-Controlled Trial. Evid Based Complement Alternat Med. 2012
 Shah SA, Sander S, White CM, Rinaldi M, Coleman CI. Evaulation of Echinacea for the prevetion and treatment of the common cold: a meta-analysis. Lancet Infect Dis. 2007 Jul;7(7):473-80.
 Krawitz C, Mraheil MA, Stein M, Imirzalioglu C, Domann E, Pleschka S, Hain T. Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses. BMC Complement Altern Med. 2011 Feb 25;11:16.
 Glatthaar-Saalmüller B, Rauchhaus U, Rode S, Haunschild J, Saalmüller A. Antiviral activity in vitro of two preparations of the herbal medicinal product Sinupret® against viruses causing respiratory infections. Phytomedicine. 2011 Dec 15;19(1):1-7.
 Zakay-Rones Z, Varsano N, Zlotnik M, Manor O, Regev L, Schlesinger M, Mumcuoglu M. Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med. 1995 Winter;1(4):361-9
 Cecil CE, Davis JM, Cech NB, Laster SM. Inhibition of H1N1 influenza A virus growth and induction of inflammatory mediators by the isoquinoline alkaloid berberine and extracts of goldenseal (Hydrastis canadensis). Int Immunopharmacol. 2011 Nov;11(11):1706-14
 Sökmen M, Serkedjieva J, Daferera D, Gulluce M, Polissiou M, Tepe B, Akpulat HA, Sahin F, Sokmen A. In vitro antioxidant, antimicrobial, and antiviral activities of the essential oil and various extracts from herbal parts and callus cultures of Origanum acutidens. J Agric Food Chem. 2004 Jun 2;52(11):3309-12