To Your Health: Common Cold & The Flu, T’is the Season

05 Feb To Your Health: Common Cold & The Flu, T’is the Season

Dr. Alan Safdi, a world-renowned internist and gastroenterologist with encyclopedic knowledge of mind-body wellness and preventative medicine, returns to Telluride Inside… and Out with a series of posts under the banner of “To Your Health.” His blogs will feature the most current information in his field: healthy, wellness and longevity.

T’is the season when just about everyone you encounter has a viral illness. Dr. Safdi continues this week with an in-depth discussion about the common cold and the flu. Are there new homeopathic treatments that actually work? What should know about elderberry and zinc?

Some of that learning will also be showcased in three-day seminars Dr. Safdi and his partner, radiologist Dr. William Renner, are offering this winter at The Peaks Resort & Spa in Mountain Village to medical professionals, whose participation qualifies them for at least 16 hours of Category 1 CME or CEU credits. The general public is also welcome. The dates of the lectures this winter are Feb. 28  – Mar. 3, 2019; Mar. 6 – Mar. 8, 2019; Mar. 27 – Mar. 29, 2019.

Subjects under discussion at the Symposiums will answer other questions such as: What are the risks and rewards of supplements, including multivitamins? Should women be getting regular mammograms? What are the alternatives on the horizon for breast cancer screening? These and other important health-related subjects – micro-nutrients, common medical disorders and nutrition – will be addressed, revealing findings, not opinions, from evidence-based medical research.

For further information, email telluridecme@gmail.com. or go to Safdi’s Telluride Longevity Institute website. And please scroll down to find out about Dr. Safdi’s Live Longer Retreat wellness intensives planned for this coming summer. Those dates are July 21 – July 29, 2019 ; Aug. 11 – Aug. 17, 2019; and Sept. 15 – Sept. 21, 2019.

Let’s start with the basics. Let’s differentiate the common cold viruses from influenza.

The common cold is an acute, self-limiting viral infection of the upper respiratory tract, involving, to variable degrees, sneezing, nasal congestion and discharge, sore throat, cough, low grade fever, headache, and malaise. It can be caused by members of several families of viruses, the most common being the more than 100 serotypes of rhinoviruses. The common cold is the most frequently occurring human illness.

In contrast, the flu is often associated much more with body aches and a higher fever. Symptoms of influenza often come on much faster than those associated with the common cold, including chills, significant headaches and sweats. Colds tend to have a more gradual onset of symptoms often starting just with a scratchy throat. In addition, flu symptoms tend to show up below the neck as severe muscle aches, fever and terrible fatigue.

Both maladies share symptoms such as coughs, sore throat, stuffy nose, and sneezing – although those tend to be more common with the cold viruses. However, since a number of symptoms overlap, unless your doctor runs a rapid flu test — a quick check done with a cotton swab from the back of your nose or throat — it is hard to identify which of the related maladies you are facing.

Cold or flu, it is important to note that tens of thousands of Americans die of diseases that could have been prevented by vaccines—and most of those fatalities occur in the very young and in older adults. Flu and pneumonia vaccinations are especially vital because those infections are leading causes of death among older Americans. Remember there are two different pneumonia vaccines for older adults or those at a high risk, so are your vaccines up to date?

At this time of the year, flu activity is widespread throughout most of the United States. Last year’s flu season was long and brutal, the worst in four decades, with more than 80,000 flu or pneumonia-related deaths nationally. People who are very sick or at high risk of serious flu complications and get flu symptoms should be treated with antiviral drugs (like Tamiflu) as soon as possible. Antiviral drugs — oseltamivir (Tamiflu), zanamivir (Relenza), or peramivir (Rapivab) — can even prevent flu, also shorten the duration of the flu and prevent complications such as pneumonia. Ideally they are taken within the first 48 hours of getting sick for them to work.

Again, get vaccinated if you have not done so yet. There are still weeks of flu activity to come. While vaccine effectiveness can vary, recent studies show vaccine reduces the risk of flu illness by about 40% to 60% among the overall population during seasons when most circulating flu viruses are like the vaccine viruses. For people with heart conditions, vaccines can literally be a lifesaver. There is hard evidence to suggest influenza infections can lead to heart attacks, strokes, or heart failure, especially in high-risk patients. Previous studies have shown influenza vaccination can reduce acute coronary syndromes, hospitalization and death in patients with coronary heart disease and/or heart failure.

Unfortunately so far there is no cure for the common cold.

For cold and flu-like symptoms, most consumers take over-the-counter medicines. But none of these is a silver bullet. However, research has shown that elderberry syrup—a remedy as old as folklore—substantially reduces both symptom severity and symptom duration for colds and flu. Supplementation with a standardized elderberry extract proved to be significantly effective at reducing the total duration and severity of upper respiratory symptoms when compared to a placebo group.

Researchers performing in vitro studies have found that elderberry extract is active against human pathogenic bacteria, as well as influenza viruses (H1N1). In separate clinical trials in humans, investigators demonstrated that liquid elderberry extract and elderberry extract lozenges each reduced the severity and duration of cold and flu-like symptoms.

Elderberries contain many active chemicals, including anthocyanins, which have been shown to boost immune function and exhibit anti-viral effects, however, while recent study was an impressive meta-analysis, it was only conducted on 180 patients so more research is in order.

Elderberry is commonly available in most drug stores and online retailers in the form of syrup, lozenges and gummies.

Elderberry syrup can also be made at home, but it must be thoroughly heated to remove toxic compounds in the berries that could otherwise cause severe stomach upset.

Other home remedies appear to shorten the duration of a cold. Top of the list is zinc.

Zinc binds to the sites where viruses bind while entering the cells. That may prevent entry of the virus into the cells and decrease replication. In my experience the earlier this remedy is used the better, but using too much zinc can be deleterious. Do not go overboard.

There is no significant difference between zinc acetate lozenges and zinc gluconate lozenges regarding their efficacy in shortening the duration of common colds according to a meta-analysis published in Journal of the Royal Society of Medicine Open. Seven randomized trials with zinc acetate and zinc gluconate lozenges found that the duration of colds was shortened on average by 33%.

Zinc lozenges appear to influence the common cold through the release of free zinc ions into the oro–pharyngeal region. Although the binding difference between zinc acetate and zinc gluconate is a fact, it is not evident whether that causes significant differences at the clinical level for treating the common cold.

In the meta-analysis, Dr. Harri Hemilä from the University of Helsinki, Finland, collected randomized trials on zinc acetate and zinc gluconate lozenges and compared their observed the effectiveness. If an outlier trial was excluded, the difference between the three zinc acetate and the three zinc gluconate trials shrinked to just 2%, i.e., a 40% vs. 38% reduction in common cold duration. Thus, properly composed zinc gluconate lozenges may be as effective as zinc acetate lozenges. Cold EEZE and others on the market are Zinc gluconate. Zinc doses of over 100 mg per day do not seem to provide any more benefit, so more may not be better.

According to Dr. Hemilä, there is no justification for the popular phrase that “there is no cure for the common cold” because of the strong evidence that zinc lozenges can shorten common cold duration by over 30%. However, in future studies the optimal composition of zinc lozenges should be investigated. The optimum frequency of their administration also warrants further investigation. Nevertheless, Hemilä also considers that “the current evidence of efficacy for zinc lozenges is so strong that common cold patients should be encouraged to try them for treating their colds, but the patients should ascertain that the lozenges do not contain citric acid or its salt citrate.”

Most important is not to get sick in the first place, but if you do and since we have no effective vaccine for cold viruses, zinc and elderberry are intriguing alternatives.

How do I really improve my odds of staying well?

Wash your hands frequently, use disinfectant wipes on airplane arm rests and tray tables, eat a diet rich in whole fruits and vegetables, and stay away from sick people as much as possible. And get plenty of sleep, one of your most tools in avoiding viral illnesses this winter.

A fascinating fact is that shorter sleep duration measured behaviorally prior to viral exposure was associated with significantly increased susceptibility to the common cold. Specifically, those sleeping < 5 hours or sleeping between 5 to 6 hours were at greater risk of developing the cold compared to those sleeping > 7 hours per night

It is going to be the season for multiple claims about preventing viral illnesses. I just saw one on TV singing the praises of probiotics  – with no controlled studies to substantiate the claims at all. Also keep in mind there have never been any quality studies showing benefits from Vitamin A, C, D, or E supplementation in preventing upper respiratory illnesses or colds.

What about the interaction of obesity and infections? Studies have shown that people who are overweight or obese had higher susceptibility to developing post-surgical infections, H1N1 influenza and periodontal disease. More severe infections tend to be present in people with a larger BMI. People with a higher BMI have a reduced response to vaccinations and antimicrobial drugs.

There is no role for antibiotics in the absence of bacterial superinfection in treatment of the common cold. In fact when we prescribe antibiotics for the cold there is no benefit – but there is potential and significant harm.

Colonic bacteria are generally very beneficial to our overall health. When we take antibodies, the bacterial flora in our colon can take up to six months to recover and we risk an infection of the colon called C. difficile colitis.

Remember that if we look at all the DNA in a human being we are only 10 percent human. We are 90 percent bacterial.For more on why avoid unnecessary antibiotics, please listen to a podcast on the human mircrobiome by clicking here.

Antiviral therapy is not available for most of the viruses that cause the common cold although they are available and work for influenza. Over-the-counter (OTC) cough and cold medications have no proven efficacy and potential for serious adverse effects. There is no definitive evidence to indicate that treatment with Echinacea purpurea or vitamin C is beneficial in the treatment of the common cold.

Never forget the time-tested supportive interventions. Ingest enough liquids including warm liquids such as tea and soup. Inhaled steam and an ultrasonic humidifier may help loosen respiratory secretions, enhancing their removal. Also topical saline may help soothe the nasal cavity.

Working with Dr. Safdi, more: