The immune system faces so many viruses, bacteria and other environmental
threats throughout the year that it is getting more difficult to point to one
season as needing the most attention. However, fall still showers its gold and
red leaves on communities teeming with cold and flu viruses, as children return
to school (read: infection incubators) and empty work offices return to full
capacity with vacations mostly over. Consumers looking to bolster their defenses
in early fall, in hopeful preparation for the coming cold and flu months, will
turn to their trusty health products retailers for the latest offerings
well-researched for immune benefits, especially relative to the dreaded cold
season.
Whether in defense of the common cold, the flu or other challenges,
empowering the immune system means increasing the production and strength of its
white blood cells, such as T cells, macrophages and B cells. These cells
coordinate a team effort to identify and destroy potentially dangerous invaders
like influenza viruses and the collection of more than 200 rhinoviruses that can
manifest as the common cold.
Outright prevention of these types of illnesses is considered an endless
pursuit, scientifically, but a strong immune system heading into the typical
cold and flu season could be the difference between getting one short, mild cold
versus a couple lingering colds, or having insufferable symptoms from a cold or
flu versus having few, if any, uncomfortable symptoms.
With a common cold, the most people generally hope for is to fight it off
quickly and minimize the discomfort. In this case, consumers turn to dietary
intervention—most often via supplements—to help fight infection before it
happens, as opposed to over-the-counter (OTC) medications that don't apply until
after infection and symptoms rear their ugly heads. Advantage: supplements.
In the case of the flu, public health officials try to gauge which of the few
influenza strains will be most prevalent in a given year and tailor the flu
vaccine to this estimation. Some years this strategy works pretty well, but
other times the guesses are wrong. In fact, the Centers for Disease Control and
Prevention (CDC) reported this year’s flu vaccine was only about 44-percent
effective, contributing to an elevated flu season. Barry Ritz, Ph.D., a
nutritional immunologist at Drexel University, Philadelphia, tracks such data,
in addition to his activities in the field of immune research. He noted on
average, influenza virus infects 5 to 20 percent of the U.S. population
annually, contributing to approximately 200,000 hospitalizations and 36,000
deaths, mostly among the elderly. Fortunately, nutritional immunology has
generated positive results to counter such negative statistics. "My own research
demonstrates that dietary interventions can have dramatic effects on the immune
response to influenza infection," he said.
In his study of how dietary supplements may affect the innate immune response
to influenza infection, Ritz has focused on how bovine colostrum can
potentially help stave off or manage flu infection.
Ritz explained colostrum provides antibodies that are important for
establishing passive immunity in newborns; colostrum also contains numerous
other compounds, such as bioactive peptides, that appear to enhance immunity
even later in life. On specific research, he reported oral administration of
bovine colostrum to neonatal and adult mice has been demonstrated to affect
local intestinal immunity, including an increase in macrophage function and
natural killer cells.1,2
"In my own research, in collaboration with La Belle Inc., I am working to
determine if bovine colostrum supplementation may also result in systemic
effects on innate immunity and increased resistance to influenza infection,"
Ritz said.
It appears to be a good direction, as Italian researchers reported in 2007
that bovine colostrum, with its concoction of antibodies, vitamins, growth
factors and other nutrients, represents an inexpensive therapeutic tool in
prevention and treatment of several human microbial infections, including
influenza.3
According to Ritz, consumers need to know that science supports bovine
colostrum as an immune and intestinal health support supplement. In purchasing
colostrum, he advised retailers and consumers to choose colostrum products that
are produced in the United States, to assure the highest quality standards.
"Depending on special needs, consider colostrum concentrates that are lactose-
or casein-free," he added.
An emerging immune force, colostrum has been studied alongside probiotics,4
which have a longer appearance in immune research and are beginning to take hold
in the minds of educated consumers, thanks in large part to the growth of
functional foods.
"More consumers are becoming aware that they help GI health," confirmed Lia
Peterson-Love, director of marketing for Sedona Labs and Nutri-Health
Supplements. "I don’t think many people know that probiotics help support a
healthy immune response." She emphasized there is great science being done on
probiotics, adding the immunomodulatory actions of probiotics are at the
forefront of research.
In fact, Sedona Labs based its iFlora® Nasal Health multi-probiotic formula
on 2003 clinical research in Switzerland that showed probiotics, taken orally,
support a healthy immune response in the nasal mucus.5 The
researchers concluded, “the ingestion of probiotics may enhance the immune
barrier of the upper respiratory tract and therefore constitute a clinically
preventive therapy.” The iFlora formula includes N-acetyl cysteine (NAC), a
natural amino acid antioxidant that helps break up stagnant mucus, helping to
support nasal and upper respiratory health.
"Although research showing that probiotics have an effect on the immune
system was being published in the 1990’s … it takes awhile for consumer
awareness and to catch up," said Peterson-Love. "There is still much to be
learned about probiotics and how they affect the immune system."
The Purple Rhino-saur
While nutritional immunology shines the light on some newer ingredients,
other natural cold and flu remedies have captured consumers' attention for
decades, even centuries. The purple coneflower, known in herbal science as
Echinacea, has a storied traditional medicinal past, but an up-and-down path
in recent scientific research.
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This popular immune health remedy is touted for its role in activating front
line immune cells, including macrophages, which swallow debris and pathogens
(viruses, bacteria, etc.). People take Echinacea for its reported ability to
shorten the duration and severity of colds and flus.6,7 Protection
via Echinacea supplementation appears more pronounced in people who exercise
regularly, as the herb helps limit post-workout decreases in mucosal
immunoglobulin-A (IgA) antibodies.8
Unfortunately for consumers, the mass media picked up a 2005 New England
Journal of Medicine (NEJM) report on a study that concluded no significant
benefit from Echinacea on the rate of infection or symptom severity in students
subjected to a viral rhinovirus challenge.9 However, the herbal
industry quickly debunked this slender journalism, questioning the doses and
preparation used, as well as the protocol relative to standards put in place by
the National Center for Complementary and Alternative Medicine (NCCAM). This
trial was a stark departure from hundreds of previous trials showing some
benefit from Echinacea supplementation on the severity and duration of the cold.
Likewise, the method of delivering the rhinovirus directly into the nose was
challenged, as this same method failed to produce a benefit from vitamin C
supplementation, despite the long list of research showing such a benefit from
vitamin C.
Some consumers were influenced by the media reports on the NEJM trial, but
most saw through the weak study design and seemingly malicious intent of the
accompanying editorial. "Consumers have been coming back [to Echinacea], thanks
to efforts of the industry and of manufacturers such as Bioforce AG, which has
funded and sponsored clinical trials published in peer-reviewed journals," said
Eileen Sheets, managing director for Bioforce. "Our sales of Echinaforce have
been steadily climbing during the past three years, and we expect even higher
sales for this coming cold season."
As the NEJM Echinacea debacle showed, the key for retailers and consumers is
in the quality and formulation of Echinacea products. Sheets stressed the
importance of manufacturers controlling their product from seed to shelf via
standardized process. "Bioforce has its own organic farm, using its own seeds,
its own expert gardeners and its validated manufacturing process," she
explained, noting the company even blends all the individual batches from a
given growing season into a yearly batch to even out any naturally occurring ups
and downs in constituents. "By standardizing the whole process in this manner,
we can be certain that the quality and efficacy of every bottle of Echinaforce
will be the same—a customer who uses Echinaforce effectively one time will have
the same result each time they use it." When companies have less control over
these stages of manufacturing, customers may find that a product will work one
time and not another.
Herbal Remedies to the Rescue
Many herbs have been used for hundreds of years against incidence and
symptoms of cold and flu. Some have even enjoyed positive modern research
results. Black elderberry (as Sambucol, from Nature's Way) was shown to
reduce the symptoms and shorten the duration of influenza strains A and B.10Goldenseal, oregano, myrrh and rosemary are proven
antibacterial herbs.11,12,13,14Licorice, an antiviral, has
known mucosal protective benefits that make it an ideal sore throat herb.15,16
Also antiviral is Andrographis paniculata, which has been shown to
counter the common cold, flu and other respiratory infections.17,18
One of the most popular, time-honored traditions of supplementing with
medicinal herbs during the late-year cold and flu season is to sip a brewed cup
of herbal tea. "Taking to time to nurture oneself, sipping a soothing aromatic
herb tea and relaxing into the healing process—it almost makes being sick
worthwhile," quipped David Hoffmann, medicinal herbalist for Traditional
Medicinals. The company makes a range of cold season tea products, from
Echinacea Plus to Cold Care and Throat Coat teas, which contain herbs such as
elder, yarrow, licorice, peppermint and Echinacea.
"The use of herbal remedies to ease the discomforts of the common cold, and
even influenza, is an ancient and worldwide phenomenon," Hoffmann said. "For
example, Echinacea was used by the Native American peoples for thousands of
years before being introduced into Europe in the early 20th century." He
explained the herbs in Gypsy Cold Care® are based on a traditional European
formulation that can be traced back to the earliest writings of Dioscorides and
Galen during the time of the Roman Empire.
The key to effective herbal supplementation in tea form is similar to herbs
in pill form: quality. However, Hoffmann suggested consumers need not be
concerned about the minutiae of manufacturing quality, as long as the product is
made from pharmacopoeial-grade herbs. "This is the grade of botanicals that is
defined in official governmental quality standards books (e.g. European
Pharmacopoeia), which require the testing, release and use of only those herbs
that meet or exceed the standards of quality, composition, identity, strength
and purity that are well-defined in the pharmacopoeial monographs," he
explained. "This certification ensures that the herbal material being used is of
the highest therapeutic quality."
Formulation is an equally important consideration. "Herbal combinations are
not combined randomly, but are based on therapeutic principles developed over
generations of herbalist in many different cultures," Hoffmann said. "Thus, to
ensure the best outcome, use combinations that have been formulated following
traditional guidelines, taking into account safety and quality concerns." He
conceded this is difficult for the customer to determine, but buying from
reputable herb company eases this challenge.
The C Scene
As noted, vitamin C has a strong research backing, although its
benefit to duration and severity of upper respiratory illnesses (URIs) is far
from definitive, scientifically. The vitamin helps maintain favorable white
blood cell counts and boost production of interferon, protein-based immune cells
that "interfere" or block invading substances. Further, Swiss researchers from
Bayer recently reported vitamin C concentrations in the plasma and leukocytes
rapidly decline during infections and stress.19 The nutrient's
antioxidant actions protect cells against oxygen generated during respiratory
bursts, which may explain why vitamin C can be especially effective against cold
duration and incidence when administered after intense exercise or exposure to
extreme cold temperatures.20
Proving nutrition research is rarely definitive, Japanese researchers noted
in 2007 that vitamin C supplementation affected the frequency of common cold
infection, but not the duration and severity of any given cold in their
randomized, five-year trial.21
Another crucial micronutrient in cold and flu season immune health is the
mineral zinc, which is important to the thymus, the organ where T-cells mature.
Zinc helps ensure optimal levels other immune cells, phagocytes (ingest
microbes) and lymphocytes (T and B cells). In research, zinc deficiency weakens
cellular mediators of innate immunity (short-term, infection defense), including
phagocytosis and NK cell activity.22
When it comes to zinc supplementation, there are different forms of
zinc, from sulfate to gluconate, and the research on each kind is mixed. In a
2007 Turkish trial, zinc sulfate in children failed to affect the duration of
cold symptoms, but successfully modulated the severity of these symptoms.23
In 2008, Wayne State University, Detroit, researchers reported zinc acetate
lozenges limited the duration and severity of cold symptoms, most likely due to
zinc's antioxidant and anti-inflammatory actions.24 A 2003 Heritage
Center, Provo, Utah, trial confirmed earlier trials showing zinc gluconate
lozenges given to school-aged children resulted in shorter cold duration and
fewer colds.25 However, a stray 2006 study concluded zinc gluconate
nasal spray and zinc orotate lozenges were not effective against the duration
and severity of colds, and while no there was no reported anosmia (loss of smell
due to olfactory receptor death), the author contended the risk of anosmia
outweighs the reported benefits that do not seem to consistently be delivered by
zinc products.26
An endless number of immune health ingredients and products vie for the
retail shelves, especially for cold and flu management sections. Research on
most such remedies is far from definitive, but a number of natural products are
churning out positive results, from the legends of vitamin C and Echinacea to
the relative rookies like colostrum and probiotics. The key to a successful cold
and flu season at the retail level is offering consumers a range of ingredients,
relying on a mixture of traditional use and scientific support of benefits,
while also paying attention to how the products you stock are sourced, produced
and formulated.
Safe Supplementation for Children
In many areas of natural health, ingredients have been tested and researched
primarily on adults. This trend breaks a bit in cold- and immune-related
investigations, as upper respiratory infection is one of those undesirable rites
of childhood.
There are hundreds of rhinoviruses that can infect a person, and adults build
up a reserve of antibodies against each kind as infections mount over the years.
Thus, children are more susceptible to a greater number of rhinovirus infections
and illnesses than are adults.
But are the products used for adults safe for use in children? Questions of
appropriate dose surface, as do issues of knowing how a child's body and immune
system will react to an adult-tested ingredient, such as an herb like Echinacea.
Eileen Sheets, managing director at Bioforce, reported Echinaforce has an
excellent safety profile and has been used effectively and safely for children.
She said few adverse events have been reported, most of which were
gastrointestinal problems. However, she noted, many children do not like the
tingling or numbing of the tongue that the alkylamides, now proven to be one of
the main actives, cause. Bioforce has developed a way to encapsulate the
alkylamides and add a slightly cooling effect without sacrificing any of the
absorption. "Add to this [technology] a natural orange flavor and you have a
safe, effective Echinacea product that children find very pleasant to take," she
said. "It is the same potency as regular Echinacea tablets, but the number of
tablets taken per day is adjusted per the age of the child."
Taking herbs by way of tea may seem innocuous, but the herbs included in the
formulation can be therapeutic based on adult-focused research. The solution may
be in special formulations just for kids, as is the case with Traditional
Medicinals' Cold Care and Throat Coat teas. The kid versions feature fewer herbs
than their adult counterparts, as well as lower overdoses.
Gamma Pharmaceuticals also considered kids when formulating its Air Defense
immune products. Designed for active adults and children, the products are
available in gummy form and feature a broad array of key micronutrients, as well
as Echinacea, ginger and a few Chinese herbs. The label also includes special
dosage recommendations for various age ranges.
"Mothers are very confident in the safety and the benefit of the product
based on form and formula," assured Peter Cunningham, CEO of Gamma, adding the
children’s preference for the form and flavor boost the mother’s confidence. "We
have built in the efficacy, which shows in the wellness of the children over a
typical cold and flu season and during the rest of the year, and is evident to
the mothers."
From Airborne to Grounded
School teacher Victoria Knight-McDowell invented Airborne, a blend of
essential nutrients and recognized immune boosting herbs, to help support her
immune system. The clever packaging and marketing behind Airborne sent the
products sales growth into the stratosphere where the germ-ridden planes that
inspired the product's name routinely fly. Despite the on-the-go nature of
Airborne, the product was actually inspired by the immune challenges McDowell
faced being a teacher.
Airborne became popular with frequent flyers, office workers, teachers and
many celebrities, which contributed to the product's rise. However, Airborne's
makers faced a consumer lawsuit in 2006 after ABC News reported it had
discovered the lone clinical trial used to support Airborne's efficacy was not
conducted by a reputable pharmaceutical company, as advertised, but by a two-man
crew established just for trial—no clinic or scientists. Airborne retracted the
study. It then faced scrutiny from FTC and various state officials in 2007 over
its advertising claims. The company decided to a $23 million class-action
lawsuit settlement in 2008, agreeing to take out full-page ads in several
mainstream periodicals to tell consumers how to get refunds.
The problem with Airborne appears to be with its advertising and marketing,
not with its formulation. "The recent controversy over Airborne was caused by
Airborne [management] themselves, and they have paid for their mistake," said
Peter Cunningham, CEO of Gamma Pharmaceuticals, which manufactures a similar
formula for CVS, called Air Shield, as well as for Gamma's own line of Air
Defense gummy products. "Our positioning may be similar, but it is honest and
thorough. We do not make claims that are not supported by our research or by the
homeopathic pharmacopeia, the herbal pharmacopeias and other references, from
global sources." Most recently, Gamma launched a new immune booster formula
(product stability tests are successful), for which it has 33 supporting
research studies conducted in Unites States, Europe, Australia and Japan.
"When we formulate the products and choose the ingredients, we have personnel
who conduct literature reviews for the research, check the homeopathic
pharmacopeia, the herbal pharmacopeias and other references, from global
sources," he said. "The United States has reference standards and information
available, as do many other countries— Europe, Australia and Canada have rich
traditions in herbal and homeopathic medicine and product formulation research."
References for "Natural Solutions for Cold and Flu Season"
1. Yoshioka Y, et al. "Oral administration of bovine colostrum stimulates
intestinal intraepithelial lymphocytes to polarize Th1-type in mice." Int
Immunopharmacol 2005;5(3):581-90.
2. Perez-Cano FJ, et al. "Bovine whey protein concentrate supplementation
modulates maturation of immune system in suckling rats." Br J Nutr 2007;98:Suppl
1:S80-4.
3. Biswas P et al. "Immunomodulatory effects of bovine colostrum in human
peripheral blood mononuclear cells." New Microbiol. 2007 Oct;30(4):447-54.
4. Wei H, et al. "Synergistic antidigestion effect of Lactobacillus rhamnosus
and bovine colostrums in simulated gastrointestinal tract (in vitro)." Appl
Microbiol Biotechnol 2007;75(2):427-34.
5.
6. Shah SA et al. "Evaluation of echinacea for the prevention and treatment
of the common cold: a meta-analysis." Lancet Infect Dis. 2007; 7(7):473-80.
7. Randolph RK et al. "Regulation of human immune gene expression as
influenced by a commercial blended Echinacea product: preliminary studies." Exp
Biol Med (Maywood). 2003 Oct;228(9):1051-6.
8. Hall H et al. "Echinacea purpurea and mucosal immunity." Int J Sports Med.
2007 Sep;28(9):792-7.
9. Turner RB et al. "An evaluation of Echinacea angustifolia in experimental
rhinovirus infections." N Engl J Med. 2005 Jul 28;353(4):341-8.
10. Zakay-Rones, Z et al. "Randomized study of the efficacy and safety of
oral elderberry extract in the treatment of influenza A and B virus infections."
J Int Med Res. 2004;32(2):132-40.
11. Mahady GB et al. “In vitro susceptibility of Helicobacter pylori to
isoquinoline alkaloids from Sanguinaria canadensis and Hydrastis canadensis.”
Phytother Res. 17, 3:217-21, 2003.
12. Oussalah M et al. "Mechanism of action of Spanish oregano, Chinese
cinnamon, and savory essential oils against cell membranes and walls of
Escherichia coli O157:H7 and Listeria monocytogenes." J Food Prot. 69,5:1046-55,
2006.
13. Dolara P et al. “Local anaesthetic, antibacterial and antifungal
properties of sesquiterpenes from myrrh.” Planta Med. 66, 4:356-8, 2000.
14. Del Campo J et al. "Antimicrobial effect of rosemary extracts." J Food
Prot. 63,10:1359-68, 2000.
15. Lengsfeld C et al. "Large molecules as anti-adhesive compounds against
pathogens." J Pharm Pharmacol. 2007 Jun;59(6):777-86.
16. Fiore C et al. "Antiviral effects of Glycyrrhiza species." Phytother Res.
2008 Feb;22(2):141-8.
17. Mahady G et al. "Is there clinical evidence supporting the use of
botanical dietary supplements in children?" J Pediatrics. 2005; 146(3):311-17.
18. Coon JT and Ernst E. "Andrographis paniculata in the treatment of upper
respiratory tract infections: a systematic review of safety and efficacy."
Planta Med. 2004 Apr;70(4):293-8.
19. Wintergerst ES et al. "Immune-enhancing role of vitamin C and zinc and
effect on clinical conditions." Ann Nutr Metab. 2006;50(2):85-94.
20. Douglas RM et al. "Vitamin C for preventing and treating the common
cold." Cochrane Database Syst Rev. 2007 Jul 18;(3):CD000980.
21. Sasazuki S et al. "Effect of vitamin C on common cold: randomized
controlled trial." Eur J Clin Nutr. 2006 Jan;60(1):9-17.
22. Ibs KH and Rink L. "Zinc-altered immune function." J Nutr. 2003 May;133(5
Suppl 1):1452S-6S.
23. Bayram N et al. "Effect of zinc sulfate on common cold in children:
randomized, double blind study." Pediatr Int. 2007 Dec;49(6):842-7.
24. Prasad AS et al. "Duration and severity of symptoms and levels of plasma
interleukin-1 receptor antagonist, soluble tumor necrosis factor receptor, and
adhesion molecules in patients with common cold treated with zinc acetate." J
Infect Dis. 2008 Mar 15;197(6):795-802.
25. McElroy BH and Miller SP. "An open-label, single-center, phase IV
clinical study of the effectiveness of zinc gluconate glycine lozenges (Cold-Eeze)
in reducing the duration and symptoms of the common cold in school-aged
subjects." Am J Ther. 2003 Sep-Oct;10(5):324-9.
26. Eby GA and Halcomb WW. "Ineffectiveness of zinc gluconate nasal spray and
zinc orotate lozenges in common-cold treatment: a double-blind,
placebo-controlled clinical trial." Altern Ther Health Med. 2006
Jan-Feb;12(1):34-8.
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