Galen's Watch

CAM Studies for the Flu and Cold Season: Prevention and Length Reduction

The hype around the flu seems to be at a all time high right now. I have not checked the flu-tracker or asked around much because does it really matter. I take care of myself and my family, we try to eat well most of the time, get enough sleep  and practice a healthy lifestyle. If we do get the flu then I will work on supporting our health through it and relieving the symptoms. There are no guarantees. 

 

I looked backed through the Galen's Watch issues and scanned for studies that either helped shorten the duration of acute illness or helped lower it's incidence. 

 

• Safety and Efficacy Profile of Echinacea purpurea to Prevent Common Cold Episodes
• Vitamin D Supplementation in School-aged Children Reduces Incidence of Influenza A
• Probiotics Reduce Number of Missed School Days in Children
• Intake of Lactobacillus plantarum and Lactobacillus paracasei Reduce the Risk of Acquiring the Common Cold
• Whey Supplementation Stimulates Immune Response
• Fermented Dairy Product (Lactobacillus casei DN-114001) Decreases Common Infectious Diseases in the Elderly
• DHA Supplementation During Pregnancy Influenced Colds in Children at 1,3 and 6 Months

 

Safety and Efficacy Profile of Echinacea purpurea to Prevent Common Cold Episodes

Seven hundred and fifty-five healthy subjects were allocated to receive either an alcohol extract from freshly harvested E. purpurea* (95% herba and 5% root) or placebo. Participants swallowed 3 × 0.9mL per day for illness prevention. This corresponded to 2400mg of extract per day. During acute stages of colds, the participants were instructed to increase the dose to 5 × 0.9mL per day; this totaled a daily dose of 4000mg of extract. Each single dose was diluted in water and retained in the mouth for 10s. A total of 293 adverse events occurred with Echinacea and 306 with placebo treatment. Echinacea reduced the total number of cold episodes, cumulated episode days within the group, and pain-killer medicated episodes. Echinacea inhibited virally confirmed colds and especially prevented enveloped virus infections. Echinacea showed maximal effects on recurrent infections, and preventive effects increased with therapy compliance and adherence to the protocol. 

 *Echinacea product was the commercially available Echinaforce drops produced by A. Vogel Bioforce AG, Switzerland. Echinaforce was prepared by alcoholic (57.3% m/m) extraction from freshly harvested E. purpurea with a combination of 95% herba (DER = 1:12) and 5% roots (DER = 1:11).

Evid Based Complement Alternat Med. 2012;2012:841315. Epub 2012 Sep 16. Safety and Efficacy Profile of Echinacea purpurea to Prevent Common Cold Episodes: A Randomized, Double-Blind, Placebo-Controlled Trial.

 

Vitamin D Supplementation in School-aged Children Reduces Incidence of Influenza A

The study randomized 334 school-aged children to either receive vitamin D(3) supplements (1200 IU/day) or placebo for December through March. Influenza A occurred in 10.8% of children in the D3 group and 18.6% of the placebo group. The reduction in influenza A was more predominant in children who had not been taking other vitamin D supplements and who started nursery school after age 3. In children with a previous diagnosis of asthma, two children in the D3 group had asthma attacks compared to 12 in the placebo group. 

Am J Clin Nutr. 2010 May;91(5):1255-60. Epub 2010 Mar 10. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren.

 

Probiotics Reduce Number of Missed School Days in Children

This double-blind, placebo-controlled study randomly assigned 326 children (3-5 years of age) to receive placebo, Lactobacillus acidophilus NCFM, or L acidophilus NCFM in combination with Bifidobacterium animalis subsp lactis Bi-07 twice a day for 6 months. With single and combination probiotics, but not placebo, reduced fever incidence, coughing incidence and rhinorrhea incidence were observed. Overall, fever, coughing, and rhinorrhea duration was decreased significantly, relative to placebo, by 32% (single strain) and 48% (combination). Antibiotic use and absentee days were also reduced. Results were better for the combination probiotics group than the single strain probiotics group. The researchers concluded that daily dietary probiotic supplementation for 6 months was a safe, effective way to reduce fever, rhinorrhea, and cough incidence, 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. In a 2008 study, it was found that that a regular, long-term intake of various synbiotics may improve health by reducing the incidence and severity of respiratory diseases during the cold season. That 3-stage prospective, randomized, double blind, placebo-controlled study was carried out over a 3-year period with several synbiotic preparations containing 3-5 strains of Lactobacillus plantarum, Lactobacillus rhamnosus, and Bifidobacterium lactis, lactoferrin and prebiotics such as either FOS (short-chain fructooligosaccharides) or GOS (galactooligosaccharides). 

 Pediatrics. 2009 Aug;124(2):e172-9. Epub 2009 Jul 27. Probiotic effects on cold and influenza-like symptom incidence and duration in children.

J Clin Gastroenterol. 2008 Sep;42 Suppl 3 Pt 2:S224-33.A new chance of preventing winter diseases by the administration of symbiotic formulations.

 

Intake of Lactobacillus plantarum and Lactobacillus paracasei Reduce the Risk of Acquiring the Common Cold

Two hundred and seventy-two subjects were randomly assigned to receive either 109 cfu (colony forming units) of Lactobacillus plantarum HEAL 9 (DSM 15312) and Lactobacillus paracasei 8700:2 (DSM 13434) or placebo for 12 weeks. The probiotics group had a 55% reduction in common cold episodes versus 67% for placebo. The number of days with the common cold were also reduced in the probiotic group to 6.2 days compared to 8.6 days in the placebo group. The symptom score was reduced from 44.4 to 33.6 in the probiotic group. The proliferation of B lymphocytes was significantly counteracted in the probiotic group compared to the control group. 

Eur J Nutr. 2010 Aug 28. [Epub ahead of print] Randomised, double-blind and placebo-controlled study using new probiotic lactobacilli for strengthening the body immune defence against viral infections.

 

Whey Supplementation Stimulates Immune Response

Seventeen senior citizens were randomly assigned to receive whey (treatment group) or soy (control group) protein for 8 weeks. Four weeks into the study, the participants received a vaccine and antibody levels were measured against 14 pneumococcal types, and a detailed food questionnaire was administered. The serum response was higher in the whey group in 12/14 bacterial types. Whey supplementation led to a higher response in four of the more virulent strains. Calorie and protein intake in the whey group suggested better nutritional status. 

Ann N Y Acad Sci. 2010 Mar;1190(1):97-103. Dairy proteins and the response to pneumovax in senior citizens: a randomized, double-blind, placebo-controlled pilot study.

 

Fermented Dairy Product (Lactobacillus casei DN-114001) Decreases Common Infectious Diseases in the Elderly

This double-blind, controlled trial enrolled 1072 individuals (mean age 76 years) and randomly assigned them to eat either 200 g/day of fermented or non-fermented dairy product for 3 months. The fermented dairy product was Lactobacillus casei DN-114001 (Danone Research). Common Infectious diseases (CID) of the gastrointestinal and respiratory tracts were recorded for frequency. The fermented dairy product significantly reduced all CID with an average duration per episode of 6.5 days (versus 8 days for the control group) and the cumulative duration of CID was 7 days (versus 8 days for the control). There was also a significant positive change for all respiratory tract infections and rhinopharyngitis. There was an increase in L. casei species throughout the fermented dairy product consumption. There was no difference between groups in CID severity, fever, medication, immune blood parameters, or quality of life.

Br J Nutr. 2010 Jan;103(1):58-68. Epub 2009 Sep 14. Consumption of a fermented dairy product containing the probiotic Lactobacillus casei DN-114001 reduces the duration of respiratory infections in the elderly in a randomised controlled trial.

DHA Supplementation During Pregnancy Influenced Colds in Children at 1,3 and 6 Months

Pregnant women received 400 mg of DHA or placebo from 18-22 weeks gestation through parturition. Data from over 800 infants was collected at 1,3 and 6 months. At one month the DHA group experienced 26% shorter duration of cough, 15% less phlegm and 30% shorter wheezing. There was a 22% longer duration of rash in the DHA group. At 3 months the DHA infants spent 14% less time ill. At 6 months the DHA group experienced 20%, 13%, 54%, 23%, and 25% shorter duration of fever, nasal secretion, difficulty breathing, rash, and "other illness," respectively, but 74% longer duration of vomiting. 

Pediatrics. 2011 Sep;128(3):e505-12.Prenatal Docosahexaenoic Acid Supplementation and Infant Morbidity: Randomized Controlled Trial. 

Zinc Acetate Reduces the Duration of the Common Cold by 42%

The review examined the effect of zinc lozenges on the length of the common cold. Thirteen trials were included. There was no effect found in 5 trials that used a daily dose of zinc of less than 75mg. In 5 trials that used more than 75 mg zinc/day there was a 20% reduction in the duration of the cold. The highest reduction of 42% was seen 5 studies using zinc acetate in daily doses over 75 mg. 

Open Respir Med J. 2011;5:51-8. Epub 2011 Jun 23.Zinc lozenges may shorten the duration of colds: a systematic review.  

 

 

 

 

 

 

Herbal Medicine Studies, Echinacea and the Healing Crisis

I have just read the article Becoming a Stakeholder: Herbal medicine, Vampires and the Research Process by Andrew Flower. It discusses the usefulness of RCT's and herbal medicine.

Flower's asks, "should we engage (as herbalists) in RCT's?" He says, absolutely as then we have a voice in the studies. This point is made clear by him citing the study where Saint John's Wort - Hypericum perforatum (SJW) was studied on children with ADHD to the eternal head shaking and muttering of herbalists saying 'but we don't use SJW for ADHD'! Occasionally though I do see a study where a herb is used unconventionally and I think it is worth the effort as the outcome is thought provoking and possibly treatment changing. Such as the study: Maitake mushroom (Grifola frondosa) extract induces ovulation in patients with polycystic ovary syndrome: a possible monotherapy and a combination therapy after failure with first-line clomiphene citrate. This was a new use to me, for maitake.

But at the mention of the SJW and ADHD study and how ludicrous it seemed I remember a study from 2003 entitled:
Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial.

I am not going into the use of echinacea and upper respiratory  infections (URI) in this post. There is lots of good information out there on echinacea and colds and maybe in another post we we will look at that. Instead I am going to focus on the reported adverse reaction of skin rash.

The study basics:

• children were 2-11 years of age
• Dried pressed E purpurea juice of the above-ground herb harvested at flowering was used
• Children 2 to 5 years old received 7.5 mL/d (3.75 mL twice a day) during a URI, while those 6 to 11 years old took 10 mL/d (5 mL twice a day). These doses provided 50% of the manufacturer's recommended adult dose in the younger group and 67% of the adult dose in the older group.
• The study medication was begun at the start of the URI and continued until all symptoms had resolved, up to a maximum of 10 days.
• Parents were asked to call the study coordinator immediately when their child developed at least 2 symptoms of a URI, including sneezing, coughing, nasal congestion, runny nose, or temperature greater than 100.4° F (38.0° C)

Here is the part that I have always wondered about

• Rash was reported during 7.1% of URIs treated with echinacea and 2.7% of those treated with placebo
• Although we attempted to exclude children with known allergies to echinacea species or those with other atopic conditions from participation, it is possible that the increased rate of rash seen in children whose URIs were treated with echinacea was a manifestation of an allergic reaction. Severe allergic reactions to echinacea, including anaphylaxis, have been reported. It is possible that the 2 children in our study who developed croup symptoms shortly after taking a dose of echinacea may have been experiencing an allergic reaction.
• Given its lack of documented efficacy and an increased risk for the development of rash, our results do not support the use of echinacea for treatment of URIs in children 2 to 11 years old

Certainly an adverse reaction is undesirable and uncomfortable but there is also something referred to as a 'healing crisis' in herbal medicine. In
Principles and Practice of Phytotherapy: Modern Herbal Medicine  Mills and Bone talk of this in the skin disease chapter. Skin diseases are particularly prone to exacerbation and herbal medicine has to be used gently to prevent this. Herbs that can cause these flare ups are called alteratives and guess what is categorized as a alterative by some herbalists? Echinacea. An alterative is indicated for skin diseases and thought of as a detoxifier. Bartram in Bartram's Encyclopedia of Herbal Medicine describes an alterative as  "medicines that alter the process of nutrition, restoring in some unknown way the normal functions of an organ or a system" and Matthew Wood in The Book of Herbal Wisdom: Using Plants as Medicines describes alternatives as "blood cleaners", "and such remedies act on the lymphatics and the liver to remove metabolic waste products." So maybe these children were having a healing crisis. There is no mention if they had had rashes in the past or if children with rashes were atopic (although they tried to screen out atopic children). So, now we have study that found echinacea lacks effectiveness in URI's and has a documented increased risk of rash that is reported as an adverse reaction and not seen from a broader perspective. If the echinacea had been given by a herbalist and the parents had had access to a herbalist they may have understood better what was going on and I am pretty sure they would not have been offered echinacea to start with as it is just one herb in a whole arsenal of herbs that can be used for URI's.

Stave off the common cold

I just did a guest post on Toronto Marketing Blog for my friend and business consultant Sandra Bekhor of Bekhor Managment. Bekhor Management is a full service marketing firm in Toronto, Ontario that is focused on building better business for Canadian professional practices.

Here is a peak at my my post

Add this to your grocery list and get sick less: probiotics.

No one wants to miss work because they are sick or their children are sick. We all have deadlines, meetings and plenty to do. The common cold can place a whole family on hold for days. What can you do to help assure that your family stays healthy? Add this ONE item to your grocery list!

Read more at Stave off the Common Cold

 

Sabra

 

Sabra Way MNIMH

Editor in Chief and Founder, Galen's Watch

 Galen's Watch reports on complementary and alternative medical literature that is relevant to CAM practitioners. Visit our journal watch service and see the medical journals we scan regularly.

Over the holidays a new study Echinacea for Treating the Common Cold was released. The study found that illness duration was not statistically reduced by echinacea compared to placebo. When a study like this comes out I am many others want to find out what was wrong with it. We want the finding to be the opposite of what it is. Although, there are some criticisms about the study it was mostly a good study that came to a surprising  conclusion.

Often when studies are conducted on trials that find that the herb does not have the expected effect I look to the source of the herbs. Was it the correct dose, who made the product, where were the herb/s sourced from. All these things matter. In this case the echinacea was provided by a highly reputable company and  dosed appropriately. It may have been that giving echinacea at the onset of a cold was not enough, the cold was established and had to run its course. It is a common practice in herbal treatment to increase the dosing schedule for acute illness, like the common cold. Echinacea was dosed higher in the first 24 hours  in this study but perhaps it was not dosed frequently enough. Francis Brinker makes an interesting observation on dosing (below). He also makes some other observations on the trial structure that you can find in the ABC advisory. I think that generally people do not understand that herbs are complex. How they are grown, where they are grown, when they are harvested, how they are prepared, how much is given, when they are given, how often they are given all play a role in their healing ability.

Francis Brinker, ND, a respected herbal expert and author of Herb Contraindications and Drug Interactions 4th Edition (2011), and a member of the ABC Advisory Board, wrote:

For years I have noticed that clinical studies done on echinacea that include extracts of fresh Echinacea purpureawhole plant or aerial plant, especially in liquid form, are consistently positive compared to those using dried echinacea species extracts (or powdered herbs), especially in solid forms (tablets or capsules) to treat viral URTIs [upper respiratory tract infections]. It makes eminently good sense to treat locally when possible, and contact of echinacea extracts with the oropharangeal lymphatic tissue is extremely important in acute URTI conditions. Use of solid extracts requires systemic distribution that is useful as an adjunct, but not as the sole therapeutic intervention when echinacea is concerned. Use of whole powdered echinacea parts and species should be reserved for such or as a preventive measure. I understand the preference when doing research to use a solid form, since it makes a placebo-control much easier to make and administer, but it deprives the study of utilizing a factor of known empirical efficacy (local tissue exposure) (F. Brinker, e-mail, December 21, 2010.).

There was some benefit seen from this study.

There was a slight trend toward benefit in symptom reduction in both echinacea groups, with a reduction in duration by about 12 hours, which, although not statistically significant, the authors note may be considered clinically significant by some patients.

You can read the ABC advisory here

You can read the original study here
Ann Intern Med. 2010 Dec 21;153(12):769-77.
Echinacea for treating the common cold: a randomized trial.
Barrett B, Brown R, Rakel D, Mundt M, Bone K, Barlow S, Ewers T

 

Sabra Way MNIMH

Editor in Chief and Founder, Galen's Watch

 Galen's Watch reports on complementary and alternative medical literature that is relevant to CAM practitioners. Visit our journal watch service and see the medical journals we scan regularly.

Herbs and Honey for Colds

Dr Mercola published a piece on combating the common cold. It contains some useful home remedies like homemade cough syrup made with honey and lemon and herb teas. The idea of a few drops of 3% hydrogen peroxide in the ears was new to me and I plan on trying it next time I need to.

Recently there was a study (below) on children with coughs and natural cough suppressants. This is more peoples minds right now as many of the OTC cough products for children have been removed from the US and Canadian markets due to mis-use. This study compared honey to  dextromethorphan and diphenhydramine in children 2-5 years of age. Honey won out! My write up of the study is below. The dosage of honey used in the study was 2.5 mL (1/2 teaspoon) before bed. Honey is not recommended to children under 1 year of age. In addition to this I find rubbing the chest with a Olbas oil and a humidifier in the room are helpful.

A note on Olbas oil: I use Olbas oil but many people use Vick's Vapour rub. In any case it is not recommended for children under 2 years of age.  I dilute the Olbas oil. One to 2 drops of Olbas oil in 5 mL (1 teaspoon) of vegetable oil rubbed on the chest, back and soles of the feet. Make sure you cover the child in pyjamas and socks so they do not get it in their eyes.

In addition to honey and lemon cough syrup remedy there is another honey recipe that I often use: honey and onion. Sounds bad but it is really quite good.

1. Peel and slice the onion.
2. Put 3 to 5cm (1 to 2 inches) onion in bottom of jar.
3. Cover with 3 to 5cm (1 to 2 inches) honey.
4. Fill jar with alternating layers, pressing each layer down firmly before adding more. Cover last layer of onion with a thick layer of honey.
5. Leave overnight.
6. Strain off liquid and discard the rest
7. Bottle and label.
8. Store in cool, dark place. Keeps for about two weeks.

Dr. Mercola also recommended the following herbs: elder flower, yarrow, boneset, linden, peppermint and ginger. Unless you are a herbalist of a herbal enthusiast you probably don't have these at home. Although I would recommend buying them and keeping them on hand while for the cold season. Ginger is easy to buy at the store and a favourite cold soother at out house. Take a large piece of fresh ginger peel it and chop into chunks. There is no precise measurement but I use a root piece about the of my hand. Place the chopped ginger in a pot and add about 1 L (4 cups) water. Place a lid on the pot and bring to boil and then reduce to a gentle simmer for 10-20 minutes. Strain and drink. It is spicy but delicious with some honey added. This is not a popular remedy with my son who is small but I do make ginger syrup and then add it to carbonated water to make ginger-ale for him and he loves that. 

Ginger syrup: Make the decoction of ginger and water listed above. Remove the ginger chunks and reduce the liquid by half (500 mL). Instead of pouring out the liquid to measure it I dip a wooden chop stick in the liquid and then mark the half way point with a knife. I then keep checking the simmering liquid with the chop stick till the liquid touches the marked halfway point. Add 500 mL of honey or sugar ( I use unrefined cane sugar) and stir. Keep refrigerated. We also like to use freshly fallen snow and make snow cones with this syrup.

The other easy to find grocery store herb in Thyme. You can make a tea from it by steeping 1-3 teaspoons of thyme in 1 cup of water, straining and drinking. If you have the other herbs on hand mix equal parts of all the herbs together as your cold mix, 1-3 tsp. to 250 mL (1 cup) of water will make a good tea.

Honey Is More Effective in Alleviating  Upper Respiratory Infection Coughs than Dextromethorphan
 
Children (n=139) aged between 24-60 months who had coughing for 5 days due to upper respiratory infections were randomly assigned to one of four groups. Group 1 received 2.5 mL of natural honey, group 2 2.5 mL dextromethorphan, group 3 2.5 mL of diphenhydramine and group 4 was used as a control group. The control group was allowed to use supportive measures which included saline nose drops, water vapour, cleaning a blocked nose, and acetaminophen if fever was present. The mean cough frequency score was 4.09 ± 0.72 before the intervention and 1.93 ± 0.65 after the intervention. In comparison, the control group was 4.11 ± 0.78 before the intervention and 3.11 ± 0.57 after the intervention. The honey group improved more than the dextromethorphan and diphenhydramine groups in cough frequency, cough severity, cough impact on child and parent sleep . Both dextromethorphan and diphenhydramine had a relieving effect on the cough, but the effect was less than that seen  with honey. Limitations of the study pointed out by the authors were that each patient only received one dose of honey or drugs, and that the study was not blinded.
 
J Altern Complement Med. 2010 Jul;16(7):787-93.
A comparison of the effect of honey, dextromethorphan, and diphenhydramine on nightly cough and sleep quality in children and their parents.

 

Sabra Way MNIMH

Editor in Chief and Founder, Galen's Watch

 Galen's Watch reports on complementary and alternative medical literature that is relevant to CAM practitioners. Visit our journal watch service and see the medical journals we scan regularly.

The Benefits and Cautions of Nasal Irrigation

Nasal irrigation with saline solution has become known as an effective way to clear nasal mucous. It is often reccomeneded for infants and children as a gentil way to clear the nasal passages. Many products are now available at the pharmacy for adults and children to use. Many people who have chronic sinusitis swear by this therapy.  A useful review of nasal irrigation from Medscape can be found here.

Human nature seems to bring with it the motto if a little is good, a lot is better. A recent study by the Watergate Allergy & Asthma Center in Washington shows that long term daily use of nasal irrigation can make an individual more susceptible to sinus infections. The use of nasal irrigation is effective for short term therapy of upper respiratory infections but long term use should be tempered.

If nasal irrigation is new to you or your patients then here is a brief description of the method.

Sabra Way MNIMH

Editor in Chief and Founder, Galen's Watch

 Galen's Watch reports on complementary and alternative medical literature that is relevant to CAM practitioners. Visit our journal watch service and see the medical journals we scan regularly.

 

Influenza Season: Renew your Herbal Skills for Fevers, Coughs...

A great set of articles by Paul Bergner Medical Herbalist and Clinical Nutritionist from the North American Institute of Medical Herbalism. 

Focus on Influenza:

• Rethinking the 1918 Pandemic: Excess mortality not all due to viral strain
• Influenza Prevention:
• Treatment of Febrile Illness: Focus on influenza
• Treating the Dry Cough of Influenza

    Sabra Way MNIMH

Editor in Chief and Founder, Galen's Watch

 Galen's Watch reports on complementary and alternative medical literature that is relevant to CAM practitioners. Visit our journal watch service and see the medical journals we scan regularly

It's cold and flu season!

Natural Medicines in the Clinical Management of Cold and Fluis an excellent primer for the beginning of the cold and flu season. Review the causes, pathogenesis, symptom chart, conventional and CAM medicines, and prevention.

The "common" cold is aptly named. It is something nearly everyone encounters. The U.S. population experiences nearly a billion colds annually. Children usually have about 6-10 colds per year. Adolescents and adults have about 2-4. Adults over 60 typically have less than one cold per year.

Influenza, more commonly called "the flu", is much more serious and much less common than the common cold. Each year 35-50 million people in the US get the flu. Most people recover. But the flu still causes complications which lead to 100,000 hospitalizations and more than 50,000 deaths each year.

Sabra Way MNIMH

Editor in Chief and Founder, Galen's Watch

 Galen's Watch reports on complementary and alternative medical literature that is relevant to CAM practitioners. Visit our journal watch service and see the medical journals we scan regularly