Cold and Flu: Echinacea – Is It All It’s Cracked Up to Be?

By: Dr. Isadore Rosenfeld

Thousands of consumers around the world believe that echinacea mobilizes infection-fighting white blood cells in the body and strengthens immune defenses, and therefore helps prevent the common cold and relieve its symptoms. Sales of echinacea account for 10 percent of the billions of dollars spent on herbal supplements in this country. We even keep echinacea in our home medicine cabinet, even though I am not convinced that it really works. But my wife is, so who am I to argue?

Here's What's New

Two research reports on echinacea about 3 months apart cast doubt on its effectiveness. Let me tell you about them so you can decide for yourself whether this herb is worth taking.

In the first study, reported in the Annals of Internal Medicine, doctors at the University of Wisconsin evaluated the effect of echinacea on 148 students who came down with the common cold. In this controlled study, half the students received the herb and the rest were given a placebo. Neither the doctors nor the patients knew who was receiving what. When the results were analyzed, there was no real difference between the treated and placebo groups in terms of the severity of the cold and its duration. In fact, cold symptoms actually lasted a little longer in those receiving the herb. Proponents of echinacea say that these results don't mean much because the researchers used only one type of echinacea (Echinacea angustifolia) and their findings may not necessarily apply to other types.

The second paper raises even more doubts as to the wisdom of spending your hard-earned money on echinacea. It looked into the manufacturing process of this herb, given the fact that the FDA doesn't routinely monitor supplements, as it does prescription drugs. Doctors at Presbyterian St. Luke's Hospital in Denver analyzed the contents of echinacea-labeled products sold in retail stores in the Denver area. Among the 59 preparations sampled (21 of which claimed to be standardized, meaning that there is no variation from bottle to bottle), 52 percent contained the ingredients as labeled. A full 10 percent contained no echinacea at all! What's more, among those claiming to be standardized, only 43 percent actually were. All in all, a rather poor showing.

The Bottom Line

If you take echinacea to treat (or prevent) your common cold and you think it works for you, by all means continue to use it, especially if it agrees with you. So what if the benefit you perceive is all in your head? You feel better, don't you? But if you've never been convinced that the herb works for you, yet you continue to spend money on it because everyone (including your wife) tells you it works, use this as the justification for trying something else, such as chicken soup.

Here's an afterthought suggested by my echinacea-hooked wife. She asks, "What if the echinacea preparation that was tested in this study and found to be ineffective was among the 10 percent that didn't contain the active ingredient? In that case, concluding that echinacea doesn't work isn't really justified, is it?" That's a far-fetched possibility, but who ever would have thought of it -- other than my wife?

Flu Treatments -- New and Old

Here are two basic facts you need to know about the flu virus: (1) Almost everybody should get the flu vaccine. (2) The flu is not caused by a bacterium, so antibiotics won't make you better.

Years ago the flu vaccine was recommended only for the elderly and the chronically sick. However, most doctors now feel that everyone should be protected against its ravages, even if it is not life-threatening to them.

Unfortunately, recent observations indicate that, although older people should be vaccinated against the flu, the vaccine may not protect them as effectively as it does younger people. If you are a senior citizen and were vaccinated, don't dismiss the possibility of flu if you develop its typical signs and symptoms. See your doctor and get treated as early as possible because flu is a major killer of the elderly.

Flu treatment has always consisted basically of reducing the severity of its signs and symptoms -- fever, cough, aches, and pains. We take Tylenol (acetaminophen) or Advil (ibuprofen), cough suppressants, and lots of fluids. And don't forget bed rest.

Several anti-flu medications, aimed both at prevention and treatment, were introduced a few years ago. The older ones are Symmetrol (amantadine) and its newer, preferred derivative Flumadine (rimantadine). These pills typically are taken at the earliest onset of symptoms.

Also, if for some reason you can't or won't have the vaccine and have been exposed to the flu, the amantadine family of drugs helps reduce your risk of becoming infected. (They only work against type A flu, not type B.)

Newer medications actually attack the flu virus itself and prevent it from reproducing. One medication, Relenza (zanamivir), is inhaled orally; the other, Tamiflu (oseltamivir), comes in pill form. Both shorten the duration of the infection and reduce the severity of its symptoms. Tamiflu also is approved for preventing flu types A and B in those ages 13 or older.

Here's What's New

Elderberry has been used for centuries to treat everything from respiratory tract infections to gastrointestinal symptoms to depression. In fact, it has been called the "medicine chest of the common people."

Now comes word from some credible scientists that elderberry really does work against the flu. Researchers at the University of Oslo School of Medicine in Norway have found that an extract from the black elderberry reduces the symptoms and duration of flu types A and B. Flu patients given this herbal extract recovered in about 3 days as compared to 7 days in those taking a placebo. Apparently, an ingredient in elderberry attacks the flu virus and prevents it from attaching to the body's cells and making us sick.

The specific preparation used in this study was developed by an Israeli virologist and is marketed as Sambucol. It may not yet be available in this form in the United States, but ask your health food store if they sell other elderberry preparations. It may be worth trying (along with the conventional medications) if you come down with the flu.

The Bottom Line

Although several effective medications minimize the severity and duration of the flu, there is no cure. You may want to consider taking black elderberry extract, which has recently been shown to be an effective palliative for this infection as soon as the diagnosis is confirmed. But use it along with the proven antiviral agents now available for this infection.

More Flu Shots, Less Death

It always amazes me that so many of my patients resist receiving their annual flu shots. These are the same people who clamor for MRIs, CT scans, colonoscopies, and other time-consuming, expensive, unpleasant procedures, yet balk at getting a little jab in the arm once a year. (Don't get me wrong, these other tests are important, especially the colonoscopy, but it's often easier to "sell" them than it is a flu shot.)

Some of their reasons for rejection are:

  1. "I had one last year."
  2. "No, sir, never again. I got the flu after the last shot."
  3. "Look, doc, I never get the flu."
  4. "I'll take it only if I get the flu."
  5. "I can't take it because I am allergic to eggs and chicken."

Here's how I respond to each of these excuses.

  1. Unlike other vaccinations, such as the one against pneumonia, which lasts for years and usually need not be taken again after age 65, a new formulation of flu vaccine is made annually because the specific flu virus changes from year to year. Last year's supply won't protect you.
  2. The flu vaccine contains the dead virus. It cannot cause the flu. If you come down with the infection after you were vaccinated, it's because you were already harboring the bug, and it takes about 2 weeks for the vaccine to work.
  3. Everybody is vulnerable to the flu. If you have never had it, it's probably only a matter of time until you do -- unless you get the shot.
  4. Once you come down with the symptoms, it's too late for the vaccine to work (although now some effective antiviral drugs can reduce the duration of the illness and the severity of its symptoms).
  5. Having an allergy to eggs or chicken is the only valid reason not to have the shot.

Every year, more than 100,000 people are hospitalized because of the flu, and 36,000 of them die. Most have not been vaccinated and are older than age 65. The vaccine protects 70 to 90 percent of healthy adults against the flu and prevents it from developing into pneumonia in 50 to 60 percent of the elderly and those with compromised immune systems.

Here's What's New

The Veterans Affairs Medical Center in Minneapolis, Minnesota, compiled data from 280,000 men and women 65 years and older during flu season in 1998, 1999, and 2000. Those who received a flu shot not only had a 29 to 32 percent lower incidence of pneumonia and flu but also were 19 percent less likely to be hospitalized for heart disease and had 16 to 23 percent fewer hospital admissions for stroke. Overall, a flu shot reduced the risk of dying of any cause by 48 to 50 percent. I wonder if these impressive figures will have any impact on all the naysayers in my practice.

Here's more good news. If you're between ages 5 and 49, you can now be vaccinated with a nasal spray, recently approved by the FDA. No more needles!

Now for some bad news. It seems that the flu vaccine is not quite as effective as we used to think, especially for the elderly. Men and women older than age 80 are many more times likely to develop influenza even after being vaccinated than those 15 to 20 years younger. That's probably because their immune systems are unable to respond to the vaccine and so don't produce enough antibodies to ward off the infection. The practical implications of this observation are that if you are older and were given the vaccine but develop what appears to be the flu, see your doctor about it. Don't assume that it's only a cold simply because you were vaccinated.

The Bottom Line

The flu vaccine remains the number one safeguard against the flu. Young or old, healthy or sick, get vaccinated -- but not if you're allergic to eggs or chicken. And if you're between ages 5 and 49, you can have the vaccine as a nasal spray.

No Aspirin for Kids under Age 16

For years, doctors in the United States have been warning parents not to give their children aspirin. The reason is a rare disorder called Reye's syndrome, which for some unknown reason can develop in children (and occasionally in adults) who have taken aspirin to relieve symptoms of a recent viral infection, such as the flu, the common cold, or chickenpox. Although Reye's syndrome occurs only in one in a million cases, when it does strike, it can be fatal. It attacks the brain and liver, and unless it is diagnosed early on, it causes death within a few days. There is no cure for Reye's. Treatment typically involves reducing the elevated pressure the disease causes in the brain.

Here's What's New

Since 1986, the United Kingdom has reduced the incidence of Reye's by banning the use of aspirin for anyone younger than age 12. The U.K.'s Medicines Control Agency has now expanded the limit to age 16 because of the Reye's-related death of a 13-year-old who is thought to have taken aspirin.

The Bottom Line

Do not give aspirin to any child younger than age 16. Use Tylenol (acetaminophen) instead.

What the Doctor Ordered?

Should you bother taking cough medicine? The two medications most people ask for when they have a cold or the flu are antibiotics and cough medicine. Doctors now know better than to give you antibiotics at the drop of a hat like they once did. That's because most upper-respiratory infections are due to a virus against which antibiotics are useless. Taking them only increases your likelihood of developing antibiotic resistance, and then when you really need them in the future, they may not work.

Cough medicines are another matter. They usually contain two kinds of ingredients, one to loosen respiratory congestion (an expectorant) and the other to suppress the cough. Surely there isn't any harm in this -- or is there?

Here's What's New

Representatives of the American College of Physicians-American Society of Internal Medicine, a group that represents more than 100,000 doctors, have concluded that cough syrups are usually a waste of money. There's apparently little or no evidence that the expectorants they contain provide any benefit for upper- or lower-respiratory tract infections (despite the manufacturers' insistence to the contrary). If you need to loosen mucus, the best way to do it probably is to drink more fluids.

What about something to stop the cough? Most suppressants contain codeine or one of its derivatives, and they do stop a dry, irritating cough. The downside is their side effects, such as constipation and drowsiness. If your cough is loose, it's not a good idea to suppress it, because the cough is nature's way of getting rid of the phlegm.

The Bottom Line

There is some disagreement about these recommendations. Expectorants probably don't do much good, although everyone agrees that they can do no harm. As for suppressants, I think that if a dry, hacking cough is interfering with your sleep, you should take cough syrup. However, if the cough is already loose, a suppressant will prevent you from getting rid of mucus in your respiratory tract. First try the other time-honored alternatives, such as hot beverages and chicken soup, and keep the cough syrup handy just in case. If you weaken and do take a couple of teaspoons, don't worry about it. Just make sure you have a laxative handy and be prepared for a little drowsiness.

(Reprinted from Dr. Isadore Rosenfeld's Breakthrough Health 2004: 157 Up-to-the-Minute Medical Discoveries, Treatments, and Cures That Can Save Your Life, from America's Most Trusted Doctor! by Isadore Rosenfeld, M.D. (Rodale Inc., Paperback, $14.95/$21.95CAN; 1-57954-900-4). Permission granted by Rodale, Emmaus, PA 18098. Available wherever books are sold.)

Copyright © 2004 Isadore Rosenfeld, M.D.

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