Friday, October 28, 2011

Preventing and Treating the Common Cold and the Flu

The rhinovirus, microscopic view and magnified
plushy view.
Cold season is in full swing here in the United States, so I wanted to discuss what we can do to prevent and treat this annoying and sometimes dangerous illness. Since the common cold (the rhinovirus), is the single most infectious disease on the planet, it is not easy to avoid. The reason this particular virus is so infectious is because it can mutate quickly, often allowing dozens of variants to develop and co-exist at the same time. The influenza virus (the flu) also mutates and this is the reason that there is a different flu vaccine every year. Vaccine manufacturers are basically trying to guess which influenza variants are most likely to strike this year. Unfortunately, the common cold mutates so often and there are so many different strains that vaccinating against a cold is essentially useless.

So what else can you do to fight off a cold or the flu?

First: Diagnosis - what are the signs of a cold?

We are all familiar with the beginning stages of a cold. Scratchy throat, runny or stuffed nose, sneezing and feeling chilled are some of the typical early symptoms of a cold, but could they also be symptoms allergies or even the flu... and how do you tell the difference?

With so many overlapping symptoms between them, it is often difficult to immediately know exactly what is making you feel sick. Symptoms like congestion, runny nose, sneezing, or sore throat could be because of a cold, but also simple allergies or a more serious viral infection, such as influenza (the flu). Not all people experience the same symptoms, and even two different strains of the same virus can cause different symptoms in people.

While they share many symptoms, there are some differences that can help you to figure out which of these is making you feel ill. In general, if you have a fever and muscle pain, then it’s more likely to be the flu. Distinguishing between a cold and allergies is slightly more difficult, as more of their symptoms overlap. However, a sore throat is rare with allergies, but quite common with a cold. In addition, itchy eyes are generally a symptom of allergies, but usually not of a cold.

The chart below is a good guideline as to what symptoms are associated with each:

Aches and Pains
Itchy Eyes
Sore Throat
Runny Nose
Vomiting / Diarrhea
very rare
yes (children usually)

How do you catch a cold?

The rhinovirus is incredibly infectious. The virus adheres to the walls of your airways and within 15 minutes of exposure it can start replicating. From the time you get infected to the time you show symptoms (the incubation time) is usually about two days. Unfortunately, you may not know you are infected because people around you may all seem fine. The rhinovirus is infectious before people actually show symptoms because the virus can shed (be spread) even before any symptoms are present.

The rhinovirus needs dry, cool conditions in order to multiply. It multiplies best at 32°C (89°F) which is why it tends to grow so well in our upper respiratory system; breathing cools and dries your airway enough for the virus to multiply. Humidified air can help to keep your airways moist, preventing the virus from reproducing there. Anything that keeps your nose and airways warm after exposure will also limit the virus growing, and thus reduce your chances of getting sick. Furthermore, if you warm up your nose and airways at the first sign of a cold, you may be able to fight off the virus immediately preventing full blown symptoms.

Chinese medicine believes that there are points at the back of your neck that should be kept an even temperature. Changes in temperature on these points are believed to increase what Chinese medicine physicians call “wind”. Wind is purported to increase your likelihood of catching a cold. Our grandmothers were probably right when they told us to bundle up with a hat and scarf to prevent a cold.

So how do you prevent it from spreading?

The rhinovirus (as well as most upper respiratory infections like the flu) are spread by tiny droplets, sprayed out by sneezing or coughing. Most of us understand that someone sneezing in our face greatly increases our chances of getting sick, but what most people don’t realize is that these droplets also settle everywhere around anyone who has a cold. These viral packed droplets end up on surfaces like counters, desks, computer keyboards, children’s toys, and even towels. The virus also remains infectious on these surfaces for a lot longer than we might expect (sometimes days).

You may not even have been in the room when these surfaces were infected by viral droplets and yet it will be infectious if you touch it. But how does it get from these surfaces into your body to make you sick? Your hands pick up and spread the virus and, since we all tend to touch our faces, the virus has a direct trip to your mucus membranes (nose, throat, or even eyes) when you touch them; after all, they don’t call it “catching” a cold for nothing.

Clean Hands Are Healthy Hands

Washing your hands often and thoroughly can help
prevent the spread of the rhinovirus and prevent illness.
If you suspect someone around you might be sick, washing your hands often is essential in order to protect yourself from “catching” their cold. Proper hand washing with normal soap (no need for antibacterial soap, antibacterial gels, or “hand sanitizer”) both kills and removes the viruses and bacteria from your hands. Normal soap is just as effective as antibacterial soap at killing microbes, but without the side effects of hormone disruption or antibacterial resistance.

The World Health Organization website has a guide to properly wash your hands in a convenient poster format. While this is a skill we all learn at a young age, most people don’t wash their hands using proper technique, potentially leaving behind bacteria and viruses. It’s probably a good idea to check it out and brush up on this important skill.

Washing your hands regularly, even if you don’t touch anything you think might be contaminated, is very important. Also, you should wash any surfaces (desks, counters, etc.) that might get exposed to the virus laden droplets regularly with soap. You can use vinegar and water or a very dilute mixture of bleach and water to clean these surfaces, as long as it won’t damage the particular surface you need to clean (vinegar and bleach just don’t belong on wood or antiques for example).

Washing and disinfecting these types of surfaces is particularly important for high traffic areas where a lot of people usually gather (offices, day care centers, schools, etc.). Small children especially love to touch things, put them in their mouths, and then touch their faces. Teaching children to regularly wash their hands properly is very important to keep them from getting sick. Finally, make sure to wash your hands before you eat and be careful about how much you touch your face during cold season, especially if you recently touched surfaces in public places.

Some of the most contaminated surfaces are in public places, especially things that nobody ever really cleans or disinfects. Any kind of buttons usually top the list. The most contaminated items include:

  • Elevator Buttons
  • Gas Pump Handles
  • Doorknobs / Handles
  • Vending Machine Buttons
  • ATM Buttons
  • Escalator Handrails
  • Parking Meters
  • Communal Pens

How else can I decrease my chances of catching a cold or the flu?

Simple, help your body become more resilient to infection by providing your body with the ingredients to health. Eat a diet of real food (organic, non-GMO, not packaged, not processed or otherwise adulterated) that provides lots of healthy nutrients. Avoid toxins (e.g. pesticides, formaldehyde, MSG, BPA, etc.) that stress your body and your immune system. Find an experienced natural medicine physician with expertise and experience with nutrition and herbal medicine. Ask them to help you by optimizing your nutrition, decreasing your toxic load, and providing you with supplements, herbal preparations, or homeopathic remedies to take at the first sign of a cold. Get adequate rest, exercise, and make time for your emotional and spiritual well being. Simple? Well maybe not so easy or simple for most of us!

The problem with viral infections:

Viral infections, like the cold or flu are difficult to treat because viruses are harder to kill in our bodies than most bacteria. There is no easy “one pill anti-viral cure all” for the common cold or the flu. Even flu vaccines are just the manufacturers best guess of what strain of flu will be around in any particular year, which is hardly reassuring. Anti-viral therapy is a very complex and difficult field and advancements in developing these potential therapies are slow and frustrating. Ultimately, It may take a completely new technology like the previously mentioned DRACO Virus to easily kill the rhinovirus or influenza viruses in a really effective way. Unfortunately, it may take many years until DRACO passes FDA trials and is approved for human use.

Different approaches to treating a cold or flu -- Allopathic (Western) Medicine vs. Integrative and Holistic Medicine or Complementary and Alternative Medicine (CAM):

Most Allopathic physicians try to help their patients reduce the symptoms they experience during a cold. Unfortunately, treating symptoms alone does not help to treat the underlying viral illness. On the other hand, Allopathic medicine become essential if serious complications arise from a cold or the flu. From antibiotics to emergency medical care in a hospital, Allopathic medicine becomes essential and indispensable when simple infections become life threatening.

Integrative and Holistic Medicine physicians look at things differently. We generally try to fight the virus more directly from the start. We try to do this by either boosting your body’s own immune system to assist you in fighting off the virus yourself or by recommending remedies that have natural anti-viral properties. Some of these remedies may also ease some of the symptoms of a cold, but that is generally not the primary purpose of recommending them.

CAM practitioners suggest herbal
supplements with anti-microbial
properties to help you battle a cold.
The remedies suggested by Integrative Medicine physicians may include supplements, homeopathic remedies, and herbs or plant extracts. Herbal medicine is the oldest medicine on the planet and has a history that goes back hundreds and even thousands of years. Unfortunately, while many CAM remedies may be very helpful in the prevention and early treatment of a cold or the flu, they may not fare as well when it comes to treating serious, life threatening complications.

So let’s look at the way Allopathic Medicine and CAM treats the common cold.

Allopathic Medicine - Antibiotics

My physician prescribed antibiotics for my cold, do I need them? Unfortunately, many doctors still mistakenly prescribe antibiotics for a simple uncomplicated cold, usually because a patient asks for them. This is not only not helpful, but actually harmful. What are the problems with using antibiotics on a cold virus?

First and foremost, antibiotics do not kill viruses and are, therefore, useless as an initial treatment for a cold or any other viral infection. Why would you pay for a treatment or medication that simply doesn’t do anything to cure your illness and may have serious side effects?

Antibiotics are far from harmless. They indiscriminately kill off bacteria, including the healthy and beneficial bacteria which live in symbiosis with us and that we very much need to stay well. Research clearly demonstrates that we need these good bacteria in order for our bodies to function properly. Taking antibiotics indiscriminately kills these good bacteria. Furthermore, these beneficial bacteria have a hard time growing back as harmful bacteria and other microbes (fungi, viruses, etc.) take their place. Harmful micro-organisms are usually kept in check by these good bacteria and so killing these “good” bacteria for no reason is just foolish.

This condition, in which unhealthy microbes grow relatively unchecked in our intestines, is called dysbiosis. Dysbiosis can pose many long term health problems. For example, dysbiosis may prevent us from absorbing the essential nutrients we need because these beneficial bacteria live in our intestines and help us digest our food. Dysbiosis may also cause long term allergic and immunological problems that can lead to chronic illness (Irritable Bowel Syndrome, Ulcerative Colitis, etc.).

Another huge problem with misusing antibiotics when you are suffering from a viral infection is that antibiotic resistant strains of all kinds of bacteria begin to develop in your body. In fact, any time you take antibiotics, resistance starts to develop, whether you are sick or not. This may becomes a real problem if you later get a serious or life threatening bacterial infection; suddenly, you discover that the bacteria in your body are now resistant to all currently available antibiotics. As our supply of working antibiotics continues to dwindle from increasing anti-microbial resistance, this becomes more dangerous for all of us. Some day, the antibiotic you need to save your life may no longer work. Sadly, this problem already exists has become an all too real tragedy!

As I discussed above, antiviral medications are the only kind of anti-microbial that may be helpful if you get a cold or the flu because these drugs are specifically designed to fight viral infections. You may be familiar with anti-viral treatments like Tamiflu from the news. This anti-viral medication can be quite effective if taken in the first couple of days of a cold or the flu. However, Tamiflu is not something you should be taking with every cold. Just like with antibiotics, viruses can become resistant to anti-viral medications. Since there are so few anti-viral medications available, they should be saved for serious infections, such as a severe life threatening flu, in those who are most at risk (young children and the elderly).

The moral here is don’t ask your physician for antibiotics or anti-viral medications for a simple, uncomplicated infection like the common cold. Furthermore, if your doctor suggests them, inquire as to why he believes they are necessary at this time for your treatment. Is it to help the symptoms of a cold or is it for a serious secondary bacterial infection?

With so many choices, it's important
to know what will actually help.
Allopathic Medicine: over the counter (OTC) medications:

Decongestants, such as pseudo-ephedrine, can relieve some of the symptoms of a cold. A single dose of decongestants can help to relieve congestion in your nose and sinuses. Repeated doses seem to continue to help but with decreasing effectiveness. As far as your cold is concerned, problems can arise from decongestants as they increase the dryness in tissues that you need to stay moist, like the airways to your lungs. If you need to cough up mucus from your lungs, then decongestants can dry out your mucus and make it harder to clear  it by coughing. Also, decongestants have many concerning side effects including hypertension. Decongestants are also very stimulating and may interfere with your sleep. If you want to take decongestants for an upper respiratory infection, make sure to check with your doctor to make sure that they are safe for you.

Decongestants may be taken by mouth (e.g. Sudafed) or as a nasal spray (e.g. Neo-Synephrine). If your doctor tells you a decongestant is safe for you then make sure you take oral preparations early in the morning (for long acting preparations that last 12 hours) and before approximately 3 PM  for short acting preparations (that last about 4-6 hours). Nasal decongestants in spray form are a more targeted, local option that may be helpful in the evening or overnight. They may still make it difficult to sleep but it is less of a concern as your entire body is not getting the medication.

Finally, don’t take decongestants for too many days in a row. Our bodies get used to the decongestant medication and starts to adapt. Before you know it (after about 3-5 days), you may start to experience “rebound” congestion when you stop taking them. It is not uncommon for patients to develop what you might call an “addiction” to decongestants because they think that they still have a cold or are still stuffy and that they can’t do without them. In fact, the only solution to rebound congestion is to stop the decongestants completely in order to allow your mucus membranes to return to its normal state.

Antihistamines can help treat the symptoms of congestion and runny nose, however, research has demonstrated that antihistamines can make a cold last longer if you take them for more than 3 days. Because anti-histamines are very drying, they will dry out your airways at exactly the time that you want them to stay moist. While it may initially make you feel less congested, these medications can actually help the cold virus to reproduce, leaving you suffering longer with your cold. Unfortunately, older anti-histamines are mixed into almost every over the counter (OTC) cold preparation. The one benefit that these older anti-histamines have is that they can make you drowsy. Getting a good nights sleep while you are ill is always important, but anti-histamines are not a good way to go. Ask your pharmacist or doctor to recommend a mild and safe sedative for sleep that doesn’t include anti-histamines. There are also natural alternatives (e.g. Valerian) that your natural care practitioner may recommend for you.

Dextromethorphan (DM) is able to help decrease your cough during a cold. Dextromethorphan can be very useful when you take it for an annoying dry, or mostly dry, cough that is not producing a lot of mucus. On the other hand, using DM if you have a very productive and wet cough may not be advisable. In this case you actually want to cough up the mucus that is in your throat and lungs. Taking a medicine that reduces your cough in this case could increase your chances of a secondary bacterial infection, as the mucus acts as a breeding ground for bacteria.

Guaifenesin is often added to cough syrups as an “expectorant”, to make coughing up the nasty stuff in your throat and lungs easier. Guaifenesin can help improve the symptoms of a cold because it changes mucus to a more watery form. This makes it easier to blow out or cough up the mucus that develops during a cold. Guaifenesin is available in virtually all over the counter (OTC) cold preparations, but I believe it is safer to buy and take guaifenesin separately. Guaifenesin is one of the safest medications available with few if any side effects. Preparations that mix guaifenesin with anti-histamines, decongestants, or dextromethorphan are not nearly as safe. There are many preparations of guaifenesin available, both long acting and short acting. These can be purchased on the Internet inexpensively or as Mucinex from your local drugstore. I prefer to buy dye free guaifenesin online because Mucinex is so expensive and has coloring agents added to it.

Vicks Vaporub helps to provide relief from congestion. It contains menthol (the minty eucalyptus smell), which helps to break up congestion and clear your airways. However, excessive use can also dry out your throat, potentially making your cold worse. I prefer to use diffusers or steaming with Organic Eucalyptus Oil instead (see below for more details).

Fever, aches, and pains - I need Tylenol don’t I?

Drugs like acetaminophen (Tylenol) do relieve some of the symptoms of a cold including fever. However, our body creates a fever for a reason - in order to assist us in killing the cold virus. Acetominophen is used in many medications to reduce fevers, but since the rhinovirus needs cooler temperatures to multiply itself (around 89°F), taking Tylenol might be producing the ideal conditions in your body for the rhinovirus to actually replicate.

Simply masking your symptoms may give you short term relief you but it may make your cold last longer. The longer your cold lasts the more likely you are to develop secondary bacterial complications. Secondary complications include problems like sinus infections, middle ear infections, bronchitis, or pneumonia. So be careful about using drugs that simply mask your symptoms, as you may not be helping yourself at all.

Finally, a note about mixed OTC preparations for a cold. I recommend that you do not use them. Over the counter (OTC) cold remedies in your local pharmacy almost all have some combination of acetaminophen (Tylenol), decongestants, dextromethorphan, and anti-histamines in various combinations. So be aware and read the ingredients to know exactly what you are actually buying. If you have any doubts about the complicated names in the ingredients, ask you pharmacist to clarify which class of drugs they belong to and then you will have the opportunity to chose exactly what you want and need.

Fight the virus, not the symptoms

When treating a cold, it is a good idea to play to the rhinovirus’ weaknesses, namely heat and moisture. You won’t typically generate a fever when you get a cold, but you can take steps to fake one. You can use a hot water bottle on your nose and neck to discourage the bacteria nd viruses there from reproducing. In addition, you can also use a humidifier to keep your throat and airways moist and inhospitable to the virus.

The human body reacts to a cold by producing mucus to push out the virus from your airways. This is what you experience as a runny nose or sneezing. When your airways get cold, the mechanism for pushing out mucus shuts down and suddenly your throat becomes an ideal place for the virus to multiply. Keeping your throat warm keeps your body pushing out the mucus.

When your body tries to expel the virus using mucus, especially for long periods of time, it can cause you to become dehydrated as well. Staying hydrated is extremely important, not only to maintain your body’s defenses, but also to help prevent the virus from spreading to other parts of your body.

A word of caution: nose blowing and neti-pots

Congestion or a runny nose can be quite unpleasant. Our first reaction is to blow our nose and clear out our airways. This is generally a good idea, because you want to clear out the mucus (which contains bacteria and viruses) and be better able to breathe. However, the way most of us are taught to blow our noses is potentially damaging to our ears.

Most people are taught to blow out one nostril at a time while holding the other. The goal is to force more air through a smaller opening, resulting in greater pressure and airspeed to “blow” out the mucus. The problem is that with this increased pressure, you risk blowing mucus (and viruses or bacteria) into your ears.

Simple diagram of a
Eustachian tube.
You may never have heard of a Eustachian tube, but we are all familiar with the feelings associated with them. When you feel your ears “pop” after climbing or dropping in altitude (airplanes, car rides in the mountains, etc.), that is your Eustachian tubes equalizing the pressure of your middle ear to the outside air. Essentially, these tubes have a couple of functions: equalizing air pressure in the middle ear and draining mucus and other fluids out of your ears.

When the Eustachian tubes can’t drain mucus or moisture due to inflammation (either from illness or irritation), the risk of an ear infection skyrockets. In infants and small children, the tubes are more horizontal and the opening has somewhat of a flap, making it harder for them to drain anything our of their ears. This is why babies are considerably more prone to ear infections.

Unfortunately, when blowing your nose the traditionally taught way, you risk blowing mucus from your nose back through your Eustachian tubes and into your middle ear. Since you are already sick, the tubes are probably inflamed and less able to clear the mucus back out. The mucus that is now trapped there contains large quantities of viruses and bacteria that can now cause a rather severe ear infection on top of your cold. Another, though very rare, problem that might happen is that the pressure is so high that it can cause physical damage to the parts of the ear that allow you to hear, even causing deafness.

To minimize the risk of this happening, blow your nose carefully. You shouldn’t plug a nostril while blowing, especially if you have an upper respiratory infection. When you blow, blow with both nostrils open and try not to blow with all your might. In addition, be careful with any product that forcefully blows anything into your nose. This can include nasal sprays (don’t plug the other side of your nose when spaying) or neti pots if it has a spray bottle that forces water into your nose.

A simple neti pot for clearing mucus.
A Neti-Pot is just a way of getting a salt water mixture into your nasal airway and sinuses to help break up congestion and flush it out. These help clearing mucus and may prevent secondary infections. There are several cautions about using Neti-pots. Some versions of them include a device that forces the water into your nose, which may not be safe. I recommend that you only use the type of Neti-pot that you pour and works using gravity. Remember, any increase in pressure can force mucus back up through the Eustachian tubes and may lead to an ear infection. Also, it is essential that you only use disinfected (properly boiled) or distilled water in a Neti-Pot. There have been cases of serious infections arising from people using Neti-Pots with tap water.

What I do when I feel the onset of a cold:

When I start to notice symptoms of a cold, I immediately take steps to fight it. I really don’t enjoy having a cold, but I really hate the potential complications (sinusitis, bronchitis. etc.) even more.  

At the first sign of a cold, I immediately start a mixture of natural remedies (see below) that I find works for me. On multiple occasions, I developed the early signs of a cold only to have it stopped in it’s tracks by taking the advice of CAM practitioners I trust and respect. I’ve tried a number of preparations and some of them seem to work well, especially in combination with each other. I also take supplements (see below) to try to give my body some extra nutrients I may need during a viral infection. Furthermore, I start guaifenesin (approximately 400 - 600 mg 2-4 times per day). I try to keep all these medicines available ahead of time so that I can take them immediately and so I don’t have to waste time or energy shopping when I feel unwell. I also travel with some of these remedies so that I have them available if I start to feel sick while away from home.

To gently clear my congestion and kill the virus, I use steam with Eucalyptus oil. First, I boil two to four cups of water and put it in a large bowl. In the water, I mix a couple of drops of organic Eucalyptus globulus essential oil. Then, I lean over the bowl and cover my head with a towel, breathing in the steam from this mixture gently through my nose and into my throat. This should feel relaxing and comfortable as it breaks up congestion. Be careful to not breathe too deeply in the beginning, or the hot steam might hurt you. Not only does the steam help clear congestion, by breaking up mucus, but Eucalyptus oil has been found to be remarkably effective at actually killing the virus.

A word of caution: boiling water is dangerous so be very cautious when steaming to have the bowl in a secure location that will not spill on your or anyone else. Steaming is not recommended for children or others who may not be able to take appropriate precautions. An option to consider instead of steaming is to use a diffuser that gently sprays the Eucalyptus oil around the room. Diffusers have been found to be effective in disinfecting areas that are infected with rhinovirus and they are excellent options to use through the night.

The next thing I work on is trying to increase my temperature in order to fool my body into a fever. As soon as I can, I take a hot bath, especially if I am feeling chilled. Then, I get into bed, cover myself with several blankets, and put on thick socks (two pairs if necessary). This allows my body to warm up enough to start sweating (my fake fever). I usually try to stay this way as long as I can tolerate. It’s not the most fun thing to do, but it really can work wonders. The other thing that can help is putting a hot water bottle on your nose and throat to keep them warm. (Caution: do not use an electric heating pad for this purpose as you could fall asleep and burn yourself). Finally, I add humidification to my room air by adding a humidifier or a cold mist steamer.

For a sore throat, I gargle with warm salted water. If the water is salty enough, then it has antimicrobial properties and is also very soothing as it helps to shrink inflamed tissues.  

Tea is very helpful to keep your throat warm and can
help reduce symptoms of a cold.
When I feel the onset of a cold I change my diet to respond. I immediately start increasing my intake of warm fluids (herbal teas in the evening and possibly caffeinated teas in the morning) in order to keep my throat warm, moist, and comfortable. I also stop eating overly sweet or sugary foods and avoid milk and milk-related foods as I these increase the symptoms of congestion and mucus production, as well as increasing the length of a cold.

I like homemade chicken soup when I have a cold. The warm fluids and easy to digest nutrition from chicken soup is also helpful to your body when it is using extra energy working to fight off a viral infection. So perhaps, our mothers knew best all along. Some studies have even found that there are anti-inflammatory properties to chicken soup - so maybe mom really did know best all along!

I might also try some raw unfiltered honey in my tea. This kind of honey has been shown to have anti-microbial properties. The best honey for this purpose is called Manuka honey which is a unique honey from New Zealand. Be sure you don’t heat this raw (unheated) honey or it will undermine it’s effectiveness. If you want to use Manuka honey in tea, then let your cup of tea cool down to a comfortable temperature and then add the honey. (Caution: raw unfiltered honey is not safe for infants under one year, so please do not give this remedy to your child).


Vitamin C:

Vitamin C is often suggested by lay people, allopathic doctors, and Integrative and Holistic Medicine physicians alike. However, studies on its benefits are somewhat inconclusive. Vitamin C shows a clear benefit if you take it daily before you get sick. When taken this way, it appears to reduce both the duration of a cold and chance of getting it in the first place by about 10%. Athletes who take vitamin C regularly during cold season show an increased benefit, as they are more likely to get a cold overall. Taking vitamin C after you get a cold doesn’t appear to do very much, so it’s probably a good idea to take it regularly during cold season. Suggested doses are in the 2000mg per day range.

Some people want to take much higher doses of vitamin C. There are some risks associated with higher doses of vitamin C, primarily because of it’s acidity. Vitamin C (ascorbic acid) is an acid and, as such, may cause side effects from increasing the acid levels in your stomach to altering the balance of acid and alkali in your bloodstream.

Buffered vitamin C is a better option for high dose therapies. It has added minerals and other ingredients that makes it pH neutral, so it won’t upset the balance of your body. Some of the best buffered vitamin C products contain additives that are a good idea to take anyway, like calcium and magnesium. If you are considering taking high doses of Vitamin C you should check with your physician to make sure that this is a safe option for you.

Cough drops containing zinc can help reduce the
duration of a cold.

In recent years, zinc has gained attention as a treatment for colds not only in alternative medicine, but also in the eyes of Allopathic physicians. Zinc is an antioxidant and essential to the proper functioning of our bodies. Though the results of studies are somewhat mixed, the general trend suggests that zinc may play a role in prevention and treatment of colds. The findings suggest that zinc is helpful when taken in the first 24 hours of a cold, but not very much if you start taking it after that window. Zinc may shorten the duration of a cold. It also appeared to help prevent colds if taken early enough in the first 24 hours. The appropriate dose is approximately 10 mg of zinc picolinate taken every 2 hours as a capsule. There are also syrups and lozenges sold OTC which are effective as well.

Zinc does have some side effects and cautions to consider. Using zinc supplements for a few days does not appear to lead to serious side effects, but it can cause minor mouth irritation, loss of taste sensation, a metallic taste, or upset stomach. These symptoms are especially pronounced in zinc nasal sprays which, incidentally, do not appear to help a cold at all.

Experts recommend that a high dose of zinc supplements should not be taken for longer than five days due to the potential side effects. Long-term, high-dose use of zinc for longer than six weeks can also lead to a copper or iron deficiency. Our bodies do naturally need zinc, but we usually get enough from our diets combined with a good multivitamin. However, supplementing extra zinc for a few days to help prevent or knock out a cold appears to help and is probably a good idea.

Herbal Medicines

Many Integrative and Holistic Medicine physicians suggest the use of herbs to help battle a cold. While scientific evidence supporting their use in colds is somewhat scarce, these medicines are known to possess antiviral, antibacterial, or immune boosting properties. The reason that the evidence for these herbal products is lacking is because western medicine rarely studies them (they are not easily patentable by pharmaceutical companies), and when it does, researchers may use incorrect dosages or otherwise not follow the protocols that CAM practitioners historically used. Many of these herbs have been used for hundreds or thousands of years to battle illness and there is probably a good reason for that, even if modern science hasn’t quite caught up with the hard research to prove it as of yet.

It is important to seek the guidance of a Integrative and Holistic Medicine physician to decide if these are right for you and to get proper dosage information. Just some of the herbs, essential oils and foods that I have found effective in the prevention and treatment of the common cold include:

  • Goldenseal
  • Echinacea
  • Elderberry
  • Melia Azadirachta
  • Lomatium
  • Astralagus Root
  • Osha Root
  • Coptis
  • Larix Occidentalis
  • Garlic
  • Ginger
  • Oil of Oregano
  • Eucalyptus Globulus Essential Oil
  • Lavender Essential Oil


While there is not a lot of research of any kind on Homeopathy, the good news is that it is extraordinarily safe and therefore certainly worth considering. If this type of treatment interests you, I would recommend seeking out the care of a licensed and experienced homeopathic practitioner. Naturopathic practitioners are trained in homeopathy. You may want to seek out a practitioner who has a particular interest in this area to create an individualized treatment plan for you.


All these ways of treating the early stages of a cold have been very helpful for me in the past. If I do get sick, I continue to use the natural remedies, supplements, warm fluids, salt water gargles, and steaming with eucalyptus oil until I am well. I may also try nasal strips designed for colds to help me sleep. I find they work best if my congestion is not too severe. If my congestion is a real problem and I cannot sleep, then I may use a nasal decongestant spray for a couple of nights before bed to help me get through the night.

As I have described, I believe that trying a combination of Integrative and Holistic and Allopathic treatments is the best option. It is important to understand that while one remedy may only help a little (e.g. echinacea or zinc), in combination they may work much better than any one might alone. This effect is called “synergistic” and is a very well recognized phenomenon of treatment in both integrative and allopathic medicine.

What complications can occur and when should I get worried?

Fortunately, most Upper Respiratory Tract infections like a cold do not last long and pass without complications. However, serious complications can arise from a cold (or the flu) and you should watch for them carefully. The first thing to consider is the length of your cold. Most colds last from 7-10 days. If your symptoms last longer or you develop certain specific symptoms including prolonged fever, ear pain, facial pain, shortness of breath, or chest pain, you should seek medical attention. Most of the complications from a cold arise from secondary infections, usually in the upper respiratory tract.

Sinusitis occurs when the secretions from a cold (mucus) get trapped in your sinus cavities. We have several sinus cavities in our skull filled with air (they actually make our skulls lighter so we can lift our heads). When a cold inflames the opening to any of these sinus cavities then the normal drainage may be compromised. This creates the perfect environment for secondary bacterial infections to develop in the sinuses. You may have sinusitis if you develop increasingly severe pain in your cheeks or forehead as your cold progresses. This means pressure may be building up in your sinuses from a sinus blockage and bacteria are likely growing behind the blockage.

Sinusitis can be difficult to treat because it is hard to get antibiotics to the sinuses and the infection. Many physicians treat sinusitis for only a short time (5-7 days of antibiotics). This is not usually adequate. A true full blown sinusitis often requires 14 -21 days of appropriate antibiotics. A good rule of thumb is that you should continue the antibiotic for two full days after all your symptoms have completely resolved. The problem with inadequately treating sinusitis (or any bacterial infection) is that you may develop resistant bacteria that will then grow unchecked when you discontinue the antibiotics. This can lead to chronic problems with more antibiotic resistant organisms causing a potentially vicious cycle.

Middle ear infections (Otitis Media): Ear infections often develop in children as a secondary complication of a cold or the flu. While adults may occasionally develop an ear infection, children are much more susceptible because of the anatomy of their Eustachian tubes. The more vertical the Eustachian tube, the easier it is for gravity to allow drainage into the throat. Children have more horizontal Eustachian tubes than adults which prevents them from draining properly. This is why some children will have repeated ear infections. It is pretty easy to assess an ear infection in most people because your ears really hurt. In infants and young children, who cannot tell you that their ears hurt, it is important to watch out for any signs of illness or unusual discomfort. Ear pulling or fever may be the first signs in these young children. Immediately seek medical attention for children if these signs develop.

Fevers and young children: Fevers are much more complicated and risky in young children. A fever may be the only sign that a child has developed a complication like an ear infection or may be a problem on its own. While adults will rarely develop a seizure because of fever, this is not the case in children. Some children may have a seizure if their fever rises high enough during any illness. For some reason, certain children have a particular susceptibility to fever and they may have a seizure as a result.

While I have stated earlier that a fever is the natural response our bodies use to fight off a viral infection, and that it may be wise to not interfere, this is NOT the case when it comes to children. The risk of seizure or hidden complications in young children must be taken seriously. Young children’s temperatures need to be monitored carefully and often during any illness. There is no magic temperature at which a seizure may occur in susceptible children, but it is safe to assume that any fever over 102°F (39°C) requires medical attention. Any child who develops a fever above 102°F (39°C) should be watched very carefully and efforts should be started to reduce their fever. A cool water bath and acetaminophen or ibuprofen are good options.

You should seek emergency care for your child if your child has a seizure or their temperature continues to climb. Furthermore, if your child develops a fever that is rising above 102°F (39°C) and you cannot keep it under control with acetaminophen and/or cool water baths you should seek professional medical attention immediately. Fortunately, seizures that are caused by fever in children do not usually cause any long term harm. Also, children who develop seizures as young children do not typically continue to have seizures when they are older. Nonetheless, a fever in a child needs to be respected to prevent seizure or as a sign of a potentially serious complication.

[A note of caution about children: To cool down a child during a fever you should never use alcohol on their skin as a cooling agent. Children will absorb this alcohol and it can cause a serious poisoning. Also, while aspirin (acetylsalicylic acid) has the ability to reduce fever, it should never be used in children. There is a dangerous condition known as Rey’s Syndrome which can occur as a result of children being given aspirin.]

A typical case of strep throat.
The white bands are bacteria.
Strep throat (streptococcus): the defining symptom is a really severe sore throat. Antibiotics are usually prescribed, but not for the reason you may think. Antibiotics do not actually help to reduce the sore throat. Rather, antibiotics are given to prevent a serious illness called rheumatic fever that occurs weeks to months after strep throat. The danger with rheumatic fever is that it can cause long term damage to your heart or your joints. Luckily, even if you develop strep throat, it does not have to be treated immediately. The damage to your heart or joints are a delayed problem that takes weeks to months to develop. If you get a severe sore throat, just make sure to see your doctor within 7-10 days of your symptoms (even if the sore throat completely resolves). Your physician can check for strep throat and treat you accordingly with antibiotics, if it is necessary.

Laryngitis can be caused by inflammation in the throat due to a cold. While laryngitis is not caused by a specific bacteria or virus, it can appear secondary to a cold, especially if you are talking or coughing a lot. The only real treatment is to rest your voice and throat, and stop whatever caused the irritation in the first place. Warm fluids, salt water gargles, and Manuka honey may help your throat recover.

Bronchitis can complicate the common cold. If you have an infection in your throat it is usually pretty easy to cough up phlegm (sputum) from your throat. In bronchitis there is a lot more coughing and it is more difficult  to cough up sputum. A fever may be present and you may cough up colored sputum (yellow or green). The biggest concern with bronchitis is that it can worsen into pneumonia as the virus or bacteria makes it’s way downwards into your lungs. If you think you have bronchitis you should consult with your physician for proper monitoring and care.

Pneumonia is most often caused by a bacterial infection and is a very dangerous condition that requires immediate treatment. Pneumonia is often caused by a slightly different species of the streptococcus bacteria that causes strep throat, with this version preferring to work its way down into your lungs. Once pneumonia develops in the lower part of your lungs, it causes damage to cells, even causing cell death. When the immune system responds, white blood cells cause fluid to release into your lungs to try to protect them from the pneumonia. This fluid build-up in the lungs makes it increasingly difficult to breathe. Other types of pneumonia, may have very few symptoms except a nasty, dry cough with or without a fever and yet all forms of pneumonia are dangerous and require immediate treatment.

Basically, if you get a severe cough with or without a fever, any shortness of breath or chest pain of any kind, you should immediately consult with your physician or go to your local emergency department. While complications from bacterial pneumonia are the most serious, it is important to be monitored closely with any type of pneumonia as the complications can potentially be deadly.

Treatment for pneumonia generally includes antibiotics, rest, and fluids. Antibiotics are also used in severe cases of viral pneumonia. This is because it is virtually impossible to rule out a secondary bacterial pneumonia. Most types of pneumonia, with treatment, will resolve with proper treatment in 4-6 weeks.

With any and all complications...

If you suspect that you or your child have a complication of the cold or the flu you need to seek a medical attention immediately.

A note about prescribing antibiotics: When you are prescribed an appropriate antibiotic you should start to feel better within 48-72 hours of starting them. If you’ve been taking an antibiotic for this long and are not feeling better, then you may be on an incorrect antibiotic, either due to the bacteria being resistant or a misdiagnosis. Let your physician know if you are not feeling better after 72 hours so that you can be reassessed.

When it comes to prescribing antibiotics and other antimicrobial medications, The Sanford Guide is the definitive guide used by Infectious Disease Specialized Physicians to choose antimicrobial therapies. The Sanford Guide is updated yearly and contains the current suggested treatment regimes for infectious diseases including bacterial and viral infections. This specialized guide for physicians takes into account newly developed resistances and strains of bacteria and viruses and recommends the optimal treatment protocols. If your doctor suggests an antimicrobial for your condition, then you may want to ask them what The Sanford Guide recommends as a treatment for your particular condition to ensure you are receiving the appropriate antibiotic for your condition.


The common cold is “common” for a reason, we all get it at one time or another, and often without warning. Fortunately, most of us will get well on our own without complications. I believe that being prepared and armed with the knowledge and tools to fight off a simple cold or flu may help you get better faster and prevent potential complications. I think it is also important to be able to recognize potential complications so that you can seek medical attention immediately to prevent any serious risk to your health. I hope this post will be helpful to you and good luck this winter in staying well. If you have any thoughts or experience for preventing or treating a cold or the flu, please share this with me and our readers by leaving a comment.

For more information on where to look for quality supplements for a cold or any other illness, please consult our post on supplements. All of the companies listed there make high quality supplements that are free of problematic additives. They are companies that I use and trust. With so many options available, it may be helpful to consult this list when you are looking for a particular supplement.

Researched and written by Dr. Rebecca Malamed, M.D. with assistance from Mr. Malcolm Potter.


  1. This is such an easy to read yet super informative article. Thank you Dr Rebecca! I will be sharing it with my friends.

  2. Thanks so much for the feedback. I am so happy to hear the article was helpful. Dr. Rebecca


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