Chapter 1: Conquering Colds and Vanquishing Viral Infections 1 Conquering Colds and Vanquishing Viral Infections Everyone is familiar with the common cold: runny or stuffy nose, sore throat, coughing, sneezing, perhaps a low-grade fever, and generally feeling bleh. These symptoms result from a viral infection of the upper respiratory tract. Of all the places you can witness the human body's incredible recovery mechanisms, this may be the most discernible. Your body knows exactly how to vanquish a virus, and integrative medicine can speed up the process. Colds can be caused by more than two hundred different types of viruses,1 with rhinovirus the most common. As any parent or teacher will know, colds are highly contagious, spreading easily through infected droplets in the air when someone coughs or sneezes, or through contact with contaminated surfaces or an infected person's hands. The average adult comes down with two to three colds each year.2 While they are less severe than many other conditions in this book--most colds usually resolve within a week--they are unpleasant and disruptive, leading to seventy million missed work days annually and costing the U.S. economy some $40 billion.3 Western medicine does not offer any medications that speed a cold along, but there are many integrative strategies at your disposal that can. They work by supporting your rapid recovery reflex, both preventing colds and accelerating your return to feeling well again. For example, my thirty-five-year-old patient Lydia is a kindergarten teacher who complained of constantly catching whatever cold was circulating around her classroom; she effectively had one long cold from November through April. "What can I do to give my immune system a boost?" she asked me. I recommended that she chop a clove of fresh garlic every morning and spread it on her toast. (Garlic has potent antiviral and antibacterial qualities, but only when cut or pressed.) I also recommended a mixed-mushroom supplement and a daily Emergen-C supplement in conjunction with frequent handwashing. Lydia was delighted to report in a follow-up visit three months later that she had not had a cold since instituting her antiviral regimen. The flu, which I will also discuss in this chapter, is a much more severe illness caused by the influenza virus that infects up to forty-one million Americans each year.4 It comes on suddenly and can present with fever, body aches, cough, a sore throat, fatigue, and headaches.5 While fever and body aches are uncomfortable, they signal that the body is amping up its recovery systems to fight the infection. Having a fever means your white blood cells are activating to kill harmful bacteria; the fever also activates other cellular defense mechanisms, including macrophages, natural killer cells, and dendritic cells.6 Indeed, fever is a key component of your recovery reflex, so it is worth skipping the Tylenol or Advil if you are able! Western medicine includes vaccines to prevent the flu and medications to treat symptoms and shorten its duration; integrative medicine delivers further armaments with herbs and supplements that shorten the flu's duration. With a few simple strategies, you may ensure your recovery reflex functions optimally, thwarting viral symptoms and speeding your recovery from the cold, flu, and herpes. (In the chapter "Overcoming Long Covid," I will cover the viral illness that has captured so much of our attention in recent years: Covid-19.) Cold and Flu For as long as humans have existed, we have sought remedies for the common cold. In medieval Europe, it was believed that stuffing onions in sleeping socks could ward off illness.7 (The strong smell likely only succeeded in warding off other people!) From the "Gogol Mogul" (a Russian beverage combining egg yolk with sugar, milk, and butter) to traditional Chinese lizard soup, every culture has a cold remedy.8 The flu is a more serious illness. Consider the 1918 Spanish Flu, which infected a staggering one-third of the world's population and claimed twice the number of lives as World War I.9 A robust integrative approach can help reduce the severity and duration of both cold and flu symptoms. Here is what I recommend. Nutrition A balanced diet can help strengthen your immune system, reduce the severity and duration of symptoms, and support overall health. Here is what to put on your plate. Vegetables and Fruit: Women who consume more vegetables and fruits reduce the risk of respiratory infections, as demonstrated in one study of more than one thousand pregnant North American women.10 But even without a specific supportive study, I recommend everyone eat them! Vegetables and fruits are our major source of antioxidants, including vitamin C, which can help boost the immune system, shorten the duration of cold symptoms, and support the production of infection-fighting white blood cells. Garlic: When my children were sick, one of my favorite remedies was to press a clove of garlic and mix it into a bit of cream cheese, then spread it on a bagel. To this day, my kids swear by raw garlic! When garlic is chopped, crushed, or pressed, it produces allicin, a sulfur-containing compound.11 Allicin is known for its antibacterial, antiviral, and antifungal properties, which help the immune system combat infections. While it may be yummy roasted or cooked, only raw garlic is an effective antimicrobial. Garlic has been shown to help prevent colds from reoccurring. In one double-blind study,12 146 people were randomized to receive either a garlic supplement or a placebo. After twelve weeks, sixty-five members of the placebo group had colds, compared with just twenty-four in the garlic group. You can easily add garlic to your morning toast, stir it into your salad dressing, or throw it in a stir-fry right before serving; I recommend consuming fresh, pressed garlic over taking supplements. Honey: Honey has a thick, viscous consistency that coats the throat, providing a soothing effect while reducing irritation and discomfort. It was found by Oxford University researchers to be superior to usual care (such as cough syrup and acetaminophen) for improving symptoms of upper respiratory tract infections.13 Honey is also a yummy and effective cough suppressant.14 Add it to your tea or simply lick it off the spoon before you go to bed. (Just be sure to brush your teeth afterward!) Chicken Soup: No, your bubbie was not the first person to realize chicken soup is an excellent cold remedy. During the Middle Ages, the Jewish physician and philosopher-scientist Maimonides prescribed chicken soup as a cure for everything from colds to asthma, to weight gain and leprosy.15 While chicken soup may not be quite the panacea Maimonides claimed, its benefits for colds are substantial. The broth keeps you hydrated, helping to thin mucus and keep your throat moist, while adding spices like garlic and pepper can open nasal passages.16 If you are a vegetarian, a hot vegetable soup can provide immune-enhancing vitamins and minerals. While it has not been formally studied, the broth likely helps thin mucus as well. I recommend adding chopped astragalus root to either chicken or vegetable soup early in the onset of the viral infection for an immune boost.17 Medicinal Mushrooms: Mushrooms have been recognized for their medicinal properties for centuries. Many contain polysaccharides, particularly beta-glucans, which enhance the function of the immune system. Reishi, shiitake, maitake, turkey tail, and cordyceps mushrooms are all associated with immune-boosting benefits.18 You can add them to soups, stews, and stir-fries, or brew them into teas. Another easy way to take mushrooms is as an extract or capsule. Herbal Medicines An internet search will reveal a plethora of herbal remedies for cold and flu symptoms. Here I will focus on those with the strongest scientific evidence. Echinacea: A flowering plant in the daisy family, echinacea is also commonly known as coneflower. It has been used as a cold remedy for centuries, particularly by Native Americans.19 Echinacea is believed to inhibit the replication of viruses while stimulating the activity of immune cells, including macrophages, natural killer cells, and T-cells; as a side benefit, it even reduces anxiety. While it is still unclear whether echinacea reduces the overall severity of cold symptoms, one review of fourteen clinical trials found that echinacea reduced the chance of developing a cold by 58 percent and lessened the cold duration by as many as four days.20 There are many ways to consume echinacea, and the dose depends on the particular plant variety. This can be confusing. To keep things clear, when you are at the store, I recommend you purchase one of the following: A 1:5 tincture (> 60 percent alcohol) of E. angustifolia root. Take 9 to 15 ml per day. E. angustifolia dried root. Take 1 to 3 gm daily. E. angustifolia root powder. Take 900 mg daily. E. angustifolia root extract (sold under the name Echinaforce). Take 290 mg (or 6 tablets) daily. The herbalists I work with recommend the following mixture: Steep an echinacea tea bag for 10 minutes along with a bag of black tea. Add lemon juice (to help with swelling in your throat), 1 pressed garlic clove, honey, and a pinch of cayenne pepper. While this may sound like an intense beverage to drink, it is surprisingly smooth and will soothe your sore throat. Note that echinacea is generally considered safe. However, it may inhibit an enzyme called CYP1A2. Speak to your doctor if you are taking medications that are metabolized by this enzyme, including acetaminophen, amitriptyline, diazepam, estradiol, propranolol, and warfarin. Elderberry: With only three days left before a big international trip, my patient Michael was desperate for fast relief from the flu, which had hit him hard several days earlier. It was too late for an antiviral medication, so I suggested he take elderberry syrup. Michael did, and by the time he arrived at the gate, his symptoms had dramatically improved. Elderberry has been used since ancient Egyptian times to treat fever and rheumatism.21 The berries contain compounds called anthocyanins , which have been shown to inhibit the replication of the cold and influenza viruses. One 2021 study showed that elderberries can reduce the duration of cold symptoms by an impressive two days. In another study,22 sixty adults with influenza were given either three teaspoons of elderberry syrup or a placebo four times daily for five days; those who took the elderberries recovered more quickly--by an average of four days. Finally, elderberries are also excellent for cold prevention, according to one study of 312 people flying overseas from Australia, who were given either elderberry supplements or placebo ten days before the onset of their travel.23 Among those who got sick, the elderberry users experienced a two-day shorter duration of the cold and noticeably milder symptoms. Elderberries are delicious, especially in syrup form. I recommend 3 teaspoons four times daily for cold and flu relief. Andrographis: Andrographis ( Andrographis paniculata ) is an herb traditionally used in Ayurvedic and Chinese medicine to treat respiratory infections, along with constipation, digestion, and snake bites. It has been shown in studies to stimulate the immune system by increasing the production and activity of white blood cells.24 One meta-analysis found that compared to typical care, andrographis shortened the duration of cough and sore throat symptoms while reducing the number of sick days taken.25 I recommend taking 3 to 6 grams daily of the powdered herbal extract (containing up to 500 mg of andrographolide constituents) for up to ten days. Astragalus: Astragalus is a traditional herbal medicine widely used in Chinese medicine. The root of the Astragalus membranaceus plant contains carbohydrates called polysaccharides , which stimulate the immune system by increasing the production of white blood cells.26 Astragalus is an adaptogen, meaning it helps protect the body against physical and emotional stress. It is commonly taken by cancer patients to help strengthen their immune system after chemotherapy, and I recommend it to many of my patients to prevent recurrences of upper respiratory infections. Talk to your healthcare team before taking astragalus. The typical dose is a 500 to 1,000 mg capsule twice daily; alternatively, you can chop astragalus root and add it to winter soups. Supplements A number of supplements have been shown to reduce the severity and duration of cold and flu symptoms. Here is what I recommend. Vitamin C: If you walk into your local drug store, you may see an entire shelf devoted to vitamin C supplements. But do they actually work? The evidence suggests a modest benefit. One study found that adults who take 1 to 2 grams of vitamin C per day have an 8 percent faster recovery from colds.27 While this degree of improvement is not dramatic, vitamin C supplements are inexpensive and rarely cause side effects. I recommend Emergen-C, which is added to water and has a pleasant fizzy taste; or squeeze packets like Vitamin C Max by Coromega; or use supplements by NOW Foods, Vital Nutrients, or Pure Encapsulations. Probiotics: Probiotics are live microorganisms found in foods such as yogurt, kimchi, sauerkraut, kefir, and kombucha. They support your recovery reflex and alleviate cold symptoms by stimulating the production of antibodies and boosting the activity of immune cells. One randomized trial found that compared to a placebo, people taking probiotics had 30 percent fewer cold recurrences after an infection.28 And a meta-analysis of twenty randomized controlled trials found that probiotics reduce the duration of illness among children and adults.29 Current evidence suggests that probiotic formulations containing Lactobacillus rhamnosus and Lactobacillus casei rhamnosus may be the most effective organisms, depending on the condition being treated and individual patient factors.30 You can find the most up-to-date recommendations at https://usprobioticguide.com. Zinc: Zinc is an essential mineral that supports the immune system and is thought to interfere with the cold virus's ability to reproduce and spread. One meta-analysis reported that patients who took zinc got over their colds about a day faster compared to those on a placebo.31 Note that the studies generally show zinc is most effective when started soon after the onset of symptoms. I recommend my patients begin sucking on low-dose 5 to 7 mg zinc lozenges at the very first hint of a cold, as often as every 2 to 3 hours while awake, until symptoms subside. Don't exceed more than 50 mg per day. I like Zand's Elderberry Zinc Lozenges and TheraZinc by Quantum Health. Nasal Decongestion When a cold or flu virus infects the nasal passages, the body's rapid recovery system responds by releasing inflammatory compounds, including histamines, cytokines, and leukotrienes, which help fight the infection. Blood flow increases in the nasal passages, delivering more immune cells to the infection site, but also causing swelling of the nasal tissues--in other words, a stuffy nose. I recommend rinsing your nasal passages with saline using either a neti pot, NeilMed Sinus Rinse, or Naväge Saline Nasal Irrigation.32 These nasal-irrigation systems will shrink the swollen nasal passages, dramatically clearing out mucus and making it easier to breath. You can purchase pre-mixed salt packets buffered with baking soda, or do it yourself by adding 1/4 teaspoon of table salt and a pinch of baking soda to a glass of room-temperature distilled water. (You can make your own distilled water by boiling tap water for up to 5 minutes and letting sit until lukewarm.) Follow the irrigation instructions on the label. After each use, wash the neti pot with soap and water and allow to air-dry. Periodically disinfect the neti pot with a solution of 1 percent sodium hypochlorite (bleach) or by microwaving it. While many of my patients are initially reluctant, they quickly become believers! In one trial involving 143 people with an acute upper-respiratory infection,33 symptoms like nasal congestion and runny nose were significantly reduced among those using a nasal saline spray when compared to usual supportive care. Other common over-the-counter nasal decongestants include oxymetazoline (Afrin) and phenylephrine (Neo-Synephrine). I typically do not recommend over-the-counter nasal decongestants as they can cause a fierce rebound congestion if used for more than one to two days. Saunas for Cold Prevention There is some evidence that regular use of a sauna can halve the incidence of colds.34 In one study of fifty participants, one group used a sauna once or twice a week for six months while a second group avoided all hyperthermic treatments. The sauna users first took a warm shower, then sat or lay down for up to twelve minutes in the 175° to 200°F sauna room; this was followed by fifteen minutes cooling off with cold water and twenty minutes of rest. This cycle was repeated two or three times, followed by a final rest period. Three months into the experiment, the frequency of colds among the sauna users dropped significantly; they had just nine colds compared to twenty-three colds among the abstainers. Tamiflu After a long flight, my patient Sandy came down with flu symptoms: fever, runny nose, congestion, and body aches. "I feel like I've been hit by a truck," she told me. Because it had been just sixteen hours since the onset of her symptoms, I prescribed Tamiflu, a neuraminidase inhibitor. Neuraminidase is an enzyme on the surface of the influenza virus that allows the virus to be released from infected cells and spread to new cells. By inhibiting this enzyme, Tamiflu prevents the virus from spreading within the body. Within twenty-four hours, Sandy was feeling significantly better. When taken within the first forty-eight hours of the onset of symptoms, Tamiflu can reduce the duration of the flu by one to two days while lessening the fever, chills, muscle aches, sore throat, and fatigue. If you come down with a bad case of the flu, I highly recommend Tamiflu; the standard dose is 75 mg twice daily for five days.35 Side effects, which may include nausea, vomiting, and headache, are generally mild and are mitigated by taking the medication with food. While you will need a prescription, your healthcare provider can likely prescribe it using a virtual appointment to prevent you from showing up to the office in person and potentially exposing others. Boosting the Potency of the Flu Vaccine Did you know you can increase the potency of your annual flu vaccine by getting it in the morning, after a good night's rest and after pumping some iron beforehand? Indeed, the flu vaccine leads to a significantly higher antibody production when injected in the morning compared to later in the day,36 reflecting the importance of circadian rhythms on immune function. Your immune response will also be stronger after a good night's sleep and if you exercise your biceps and deltoid muscles in the hours prior to injection.37 Lastly, taking probiotics has been shown to improve the uptake of the flu vaccine and may be especially beneficial in anyone who is immunocompromised or elderly.38 Herpes Perhaps it will seem odd to combine herpes in the same chapter as the common cold, but there is significant overlap when it comes to activating your recovery system. And herpes is very common, affecting some four billion people worldwide.39 There are multiple different herpes viruses, but I will focus on the most common: herpes simplex virus type 1 (HSV-1), which leads to cold sores or fever blisters around the mouth and face, and herpes simplex virus type 2 (HSV-2), which typically causes sores and blisters in the genital area. As we'll see, dealing with both is straightforward, and I hope to help you let go of any feelings of shame or stigma. My thirty-year-old patient Roberta reported monthly bouts of soreness around her vulva and pain urinating after contracting genital herpes from her husband. She was also extremely embarrassed. I acknowledged her feelings, but emphasized she had nothing to be ashamed of. What she was experiencing was common, and I reassured her there was a great deal we could do to reduce the frequency and intensity of her outbreaks. I suggested she increase her intake of lysine, an amino acid that inhibits replication of the herpes virus, by adding a supplement. We discussed the importance of managing stress, which is another common trigger. I prescribed acyclovir (an antiviral medication) to be taken as a preventive medication. Finally, I advised her to begin using propolis, a resin-like material made by bees, to help the sores heal more quickly. With time, Roberta's outbreaks became rare, and she was able to discontinue daily use of acyclovir, instead taking it only to treat the occasional outbreak. Herpes is spread primarily through direct contact with an infected person. There are two types: HSV-1, which is spread through saliva (by kissing or even sharing a utensil or glass), and HSV-2, which is contagious through sexual contact. After the initial infection, the virus can remain dormant in the body and reactivate at a later point. These reactivations are often, but not always, triggered by factors within your control. Both types are also much more common than you think: As many as 80 percent of American adults have been infected with HSV-1,40 and about one in six has HSV-2.41 People with HSV-1 generally have less than one outbreak per year, while HSV-2 can cause four or five outbreaks a year. High stress levels are strongly associated with herpes outbreaks. If you or a loved one carries the virus, I encourage you to read the chapter "Unwinding Anxiety," where we explore potential strategies to manage anxiety. Nutrition and the Herpes Virus Essential amino acids play a significant role in protein synthesis, tissue repair, and nutrient absorption. There are nine "essential" amino acids, meaning your body cannot synthesize them on its own; they must be consumed in your diet. Two are linked to HSV-1 and HSV-2 outbreaks: lysine and arginine. High-lysine foods include cheese, fish (especially cod and sardines), eggs, soybeans, legumes, beef, pork, and poultry. Arginine-rich foods include white rice and white flour, deep-fried foods, processed meats, chocolate, corn, and peanuts. Be aware that many protein powders are rich in arginine as well. Lysine and arginine compete with each other for absorption and utilization in the body. When lysine levels are high, that inhibits the uptake of arginine, and vice versa. This matters because arginine provides the raw materials the herpes virus needs to reproduce, leading to an increased risk of outbreaks. Effectively, you can reduce the odds of an outbreak by eating foods rich in lysine and low in arginine. Acyclovir Acyclovir (brand name Zovirax) is an antiviral medication used to treat oral and genital herpes by inhibiting the replication of the virus. Studies show that it can significantly shorten healing time, reduce pain, and limit the spread of the virus.42 The standard seven- to ten-day regimen is prescribed either as a five-times-daily dose of 200 mg or a three-times-daily dose of 400 mg; begin within seventy-two hours of the onset of symptoms, for best results. Acyclovir is also dosed twice daily (400 mg) to prevent outbreaks.43 Two similar antiviral prescription medications are Famciclovir (Famvir) and Valacyclovir (Valtrex). Vitamins, Minerals, Supplements, and Herbal Medicines In addition to the supplements like vitamin C and zinc described earlier in this chapter, several supplements have been proven to shorten the duration and frequency of herpes outbreaks. Here is what I recommend. Lysine: As noted earlier, eating lysine-rich foods can reduce herpes outbreaks, though a lysine supplement may be the easier route for most people. In one randomized controlled trial,44 participants who took a little over 1,200 mg of lysine daily had significantly fewer herpes outbreaks over twenty-four weeks, compared to those who took half that dose or were on a placebo. Other studies have shown that taking a lysine supplement also reduces the severity and healing time of outbreaks when they do occur.45 I recommend taking 1 gram orally three times daily. (Higher doses may cause stomach discomfort.46) Lemon Balm: Known for its antiviral properties, lemon balm has long been used to help manage herpes symptoms. It contains the compounds rosmarinic acid, caffeic acid, and eugenol, which inhibit the replication of the herpes simplex virus. In a study of sixty-six patients with recurrent oral herpes, using lemon balm within two days of an outbreak significantly reduced the severity and duration of blisters.47 Another study showed that applying lemon balm two to four times daily for ten days provided the fastest healing. I recommend Cold Sore Relief by Enzymatic Therapy, Urban ReLeaf's Lemon Balm Anti-Viral Roll-On, or Skin Food Fix's Lemon Balm Herpes Virus Oil. Propolis: As we saw earlier with Roberta, propolis has antiviral properties that can help heal herpes lesions. Propolis contains bioactive compounds like flavonoids, phenolic acids, and esters, which have been shown to inhibit the replication of herpes simplex virus.48 Propolis can be applied directly to herpes sores in the form of an ointment, cream, or lip balm. Apply it to the affected area three to four times a day. In one study of 189 people, propolis ointment was found to be more effective than Zovirax (acyclovir) ointment in healing cold sores.49 Self-Hypnosis for Herpes Outbreaks The mind-body connection can be harnessed to reduce herpes recurrences. In one study,50 people with genital herpes who practiced six weeks of self-hypnosis using an audiotape saw a 40 percent reduction in further herpes outbreaks. I recommend downloading an audio track from Hypnotic World (www.hypnoticworld.com). Your Rapid Recovery Prescription for Conquering Colds and Vanquishing Viral Infections Your rapid recovery reflex helps you bounce back from colds and viral infections, and there are things you can do to boost it. Following are ways to help speed up your recovery from a cold, the flu, and herpes viruses. People respond differently to treatments, so please experiment to find one that works best for you. For Cold and Flu Amp up your consumption of vegetables and fruits, medicinal mushrooms, raw garlic, and honey. Experiment with herbal medicines, and determine whether echinacea or andrographis is most effective for you. If you get the flu, elderberry can help shorten its duration. I also recommend astragalus. Take vitamin C, probiotics, and zinc lozenges at the very first hint of a cold or the flu--all of which can reduce the severity and duration of cold symptoms. For nasal decongestion or post-nasal drainage, rinse your nasal passages with saline using a neti pot, NeilMed Sinus Rinse, or Naväge Saline Nasal Irrigation. If you have the flu, take elderberry and talk to your doctor about whether to get a prescription for Tamiflu. Take both within the first forty-eight hours of the onset of symptoms. For Oral and Genital Herpes Consider whether stress is a trigger for you. If it is, amp up your centering practices (see the "Unwinding Anxiety" chapter). Reduce the odds of an outbreak by eating foods rich in lysine and low in arginine, or by adding a lysine supplement. Experiment with supplements that shorten the duration and frequency of herpes outbreaks, including vitamin C, zinc, lemon balm, and propolis. Take acyclovir (Zovirax) if needed to treat genital herpes. Begin taking the medication within seventy-two hours of the onset of symptoms. If you have frequent outbreaks, consider a smaller preventative dose. In conjunction with the strategies listed here, you can greatly reduce the frequency of outbreaks. Excerpted from Heal Faster: Unlock Your Body's Rapid Recovery Reflex by Victoria Maizes All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.
