Colds are the “bread and butter” of a general medical practice. I remember when the clangor of school bells and the cadence of marching drums signaled not only the start of a new school year but a surge in office visits that would continue through fall, winter and well into spring. When patients presented with cold symptoms in October or November I knew the odds were great that I would be seeing them on several more occasions before the seasonal viruses retreated and the summer respite began.

The cold and flu business was so good, in fact, that I had a closed practice for many years. My calendar was filled with repeat customers and had no room for newcomers. At one point, however, I made a financially devastating mistake – I began teaching people how to stay well. Suddenly I found myself seeing individuals not three or four times each cold and flu season, but once or not at all. My busy practice sputtered and was never closed again.

The common cold is, indeed, common. It is estimated that over 500,000,000 cold episodes occur in the United States each year. That averages out to 2.5 colds for each person. The economic impact is enormous.

A University of Michigan study published in February, 2003, reported that cold viruses cost the U.S. economy $40 billion annually. Cold sufferers spend nearly $3 billion on over-the-counter cold remedies and another $1.5 billion for antibiotics and other prescription drugs to ease their symptoms.  The study also reported that 189 million school days and 126 million work days are missed each year due to colds. The impact of this lost productivity is estimated at $20 billion.

As impressive as these cold statistics are, they probably represent only the tip of the iceberg of cold-related illnesses. A substantial number of colds lead to secondary illnesses including ear infections, sinus infections, bronchial infections, and pneumonias. Clearly, decreasing the frequency and duration of colds can have a dramatic impact not only in the lives of individuals, but in society at large.

The impact of cold viruses in our society is not an indication of their great potency. It simply demonstrates that people who make poor dietary choices, lack physical activity, and are profoundly deficient in basic nutrients are unable to withstand even the most trivial health challenges.

Decreasing cold frequency and severity is not a difficult task. A wide number of strategies are available. It is not necessary to apply all of them; implementing a few of them can provide significant protection from viral infections. The success in my medical practice was achieved simply by suggesting that a multivitamin, vitamin A, and vitamin C be supplemented on a daily basis and that Echinacea be added if cold symptoms appeared.

Regular water intake is an excellent starting point in preventing colds and other infections. The best way to maintain good hydration is to drink enough water to keep the urine pale. Cells and tissues that are well hydrated are able to function more efficiently. This is particularly true of the mucus membranes that line the nose and throat, which are the first line of defense against cold viruses.

Drinking an adequate amount of water supports the integrity of mucus membranes, but several other measures appear helpful in this regard. One is the use of a cool mist humidifier to restore moisture to heated air. When air is heated, much of its moisture content is lost. It is not uncommon for indoor winter air to be drier than hot summer air in Death Valley. As the dry air moves along mucus membranes they lose moisture and become more susceptible to viral invasion. Studies have shown that irrigating the nose with saline can significantly reduce the number of colds. Commercial sprays may be purchased or a saline solution can be made at home by adding one-half teaspoon of pickling (non-iodized) salt to eight ounces of warm water. It is best to use water purified by reverse osmosis or distilled water rather than chlorinated tap water to avoid irritating the sensitive lining of the nose. Irrigating once daily appears to be adequate, but the saline can be used whenever the lining of the nose begins to feel dry.

Gargling is a popular in Japan as a means of preventing colds. In 1996 Japanese researchers reported significantly fewer colds, a lower absentee rate, and less medication usage in a group of auto workers who were encouraged to gargle with water three times daily. A second Japanese study, released this month, found that the incidence of colds was reduced by one-third in a group of individuals who gargled with plain water at least three times daily compared to a control group that did not gargle and a third group that used a wash that contained iodine. The study also showed that bronchial symptoms, such as cough, were less common in the gargling group when a cold did appear. The reason for the decrease in colds with water, but not with an iodine solution is not clear, but it is likely that the water had a hydrating effect while the iodine tended to dry and irritate the tissue.

Not surprisingly, Aaron Glatt, M.D., spokesman for the Infectious Diseases Society of America, was quick to criticize the study’s findings, pointing out that it was not “blinded” – meaning that the people who were gargling knew that they were doing so and the people who were not gargling knew that they weren’t. Double-blinded studies, in which neither the researcher nor the subject knows who is in the treatment group and who is in the control group work well in drug studies where capsules or substantial tablets that look alike can be administered, but they can rarely be done in other instances. Nevertheless, physicians use the “unblinded” nature of non-drug studies to discount any positive results. Of course, given the substantial risks and tremendous cost of gargling with water, it would be wise to await further studies before engaging in the practice.

Dietary choices play an important role in determining susceptibility to infections. Refined sugar has a paralyzing effect upon the body’s immune system. Seventy five to one hundred grams of sugar, the amount found in 1 ½ to 2 twelve ounce cans of soda, has been shown to cause a 40 to 50 % reduction in the ability of white blood cells to engulf invaders. The effect is noted within 30 minutes of ingestion, peaks in 2 hours and lasts for up to 5 hours.

In contrast, eating fruits and vegetables increases the body’s resistance to infection by providing needed nutrients. Shifting from carbonated beverages to water and from sugar-based snacks and deserts to fresh fruit is an excellent strategy for cold avoidance.

Grains should also be included in the winter diet. Oatmeal improves resistance to colds. It contains a substance, beta-glucan, that stimulates the white blood cells that engulf and identify viruses. Ground flax seeds are a rich source of lignans, which have been shown to have anti-viral properties. Lignans contain anti-bacterial and anti-fungal attributes as well. Onions and garlic also contain substances with anti-infective activity.

Milk and similar dairy products should be limited or avoided because of their tendency to thicken nasal secretions. While some argue that this phenomenon is unproven, I have seen many infants and toddlers whose frequent colds and ear infections subsided with this single dietary restriction.

Alcohol consumption also interferes with the ability to ward off infections. The susceptibility of alcoholics to infections is well-documented, but non-alcoholics may also be at risk. A 2004 study at the University of Massachusetts demonstrated that a single occasion consumption of 2 ml/kg (Approximately 4 ounces for a 150 pound person) adversely affected the ability of white blood cells to recognize invaders and carry them to immune centers to initiate antibody production.

Sleep plays a major role in regulating the body’s immune system. Therefore, getting regular and adequate rest is vitally important in warding off infections. Adequate sleep is defined as the ability to awake without the use of an alarm clock. Sleep appears to be particularly important in supporting the ability of cells to produce cytokines, substances that block the spread of viral infections between cells.

Exercise also has an effect upon the body’s resistance to disease. Intense activity, such as running to the point of exhaustion tends to increase the incidence of colds and other infections. On the other hand, moderate activity, such as a brisk twenty to thirty minute walk, stimulates the immune system and decreases susceptibility to cold viruses. In one controlled study people who walked briskly for 45 minutes five times a week had reported only one-half of the number of days with cold symptoms experienced by a sedentary group of individuals. Another study found a 20 to 30 percent reduction in risk of developing a cold in people who performed moderate activity compared to a non-exercising control group.

Hand sanitation can be highly effective as well. Simple hand-washing has been shown to decrease the incidence of gastrointestinal viruses (stomach flu) in schools and daycare centers by up to a third. Studies have failed to show a significant decrease in colds with hand-washing, however. Over the past several years a number of studies have compared the use of disinfecting hand gels with hand-washing in elementary schools, homes and colleges. A sanitizing regimen typically consists of using the gel upon entering a classroom, before eating, and after using the restroom. The results have been remarkable. Groups using disinfectant gels have achieved up to a 50 percent reduction in number of colds and number of days absent due to illness.

The importance of nutritional supplementation in the prevention of colds cannot be overemphasized. While vitamin C and zinc have become popular cold remedies, a symphony of nutrients is needed to effectively ward off infections. I advocate the use of comprehensive, optimum-level supplements, such as Lifetime on an ongoing basis, and anyone doing so is well-equipped to weather the cold season without difficulty. Those who do not optimally support their bodies’ needs should at least supplement a multivitamin, A, and C. The multivitamin, while not providing optimum levels of nutrients, will provide a nominal amount of the most critical vitamins and minerals, such as selenium and zinc.

Vitamin C is critical to effective functioning of the body’s immune system. While foods such as citrus fruits, tomatoes, and bell peppers are high in vitamin C, it is not possible to obtain optimum amounts from the diet alone, nor will they be found in a typical multivitamin. Amounts of 1000 mg. to 2000 mg. daily are needed by adults. Children should be given 10 mg. per pound of body weight daily. Many studies have documented the effectiveness of vitamin C supplementation in supporting the activity of white blood cells and in boosting the production of interferon, a substance that helps cells avoid viral invasion. For example, researchers from the University of Texas found that the number of NK cells, which are important in fighting viruses, increased significantly after two week’s supplementation with 1000 mg. of vitamin C daily. They also observed that T cells, which produce anti-viral substances, became more active.

When I was a child I dreaded the onset of winter, because it meant a daily dose of cod liver oil. My mother was convinced that cod liver oil would keep us from catching colds. She was right. Cod liver oil is a rich source of vitamin A and is also rich in omega-3 fatty acids. Vitamin A, while not as popular as vitamin C, is equally important in preventing and managing viral illnesses. Omega-3 fatty acids have been shown to decrease the frequency of colds by approximately 30 percent, probably by providing the building blocks for anti-inflammatory compounds and by enhancing the activity of white blood cells.

Vitamin A’s primary functions in defending against viral invasion are its support of mucus membrane health and its role in the production of a substance called immunoglobulin A. Immunoglobulin A (IgA) has antibacterial and antiviral activity. It is one of the key constituents of the clear fluid that bathes the membranes of the nose, throat, and sinuses. Vitamin A is essential for the manufacture of IgA. When the lining of the respiratory tract is coated by mucus rich in IgA viruses are washed away before they can cause disease. When disease does occur, increased IgA production promotes a quick recovery. I recommend supplementing beta-carotene, which the body can use to manufacture vitamin A. The amount required for prevention is 25,000 IU daily. If an infection occurs I recommend increasing this to 50,000 units twice daily until the illness has resolved.

B-vitamins, vitamin E, selenium, and zinc are among the nutrients known to be needed to protect the body against viruses. I have not found the need to supplement them separately, however, the amounts found in multivitamins being sufficient for this purpose when combined with optimum levels of C and A.

A number of herbs are beneficial in preventing colds. Echinacea has been studied extensively and is, perhaps, the most well known. A number of compounds within Echinacea have been found to support immune function, but the most significant appears to be inulin, which increases the production of disease-fighting T-cells and NK cells. Echinacea has been shown to improve the migration of white blood cells to sites where they are needed throughout the body. It also, like vitamin C, enhances the production of interferon.

Because tolerance appears to develop to Echinacea when it is used on a continual basis I prefer to introduce it at the onset of cold symptoms. When immune function is low and colds are occurring frequently I do recommend that it be used for several months. In those instances I suggest that it be taken no more than five days a week. This seems to prevent tolerance from developing. Garlic can be eaten, but may be more socially acceptable when taken as reduced-odor capsules. It contains oils with anti-bacterial, anti-fungal, and anti-viral effects. The usual amount for cold prevention is 1000 to 2000 mg. twice daily.

Lemon Balm (Melissa), a member of the mint family, has been shown to contain substances that protect cells from viral invasion. This is significant, because viruses must enter living cells if they are to replicate and multiply. Lemon balm is most commonly taken as a tea. Two or three cups daily are typically consumed.

Constituents of elderberry also protect cells from viral invasion. Generic elderberry provides some benefit, but I recommend a brand, Sambucol, in which the active substances are concentrated. It can be taken twice daily for prevention and four times daily at the onset of cold symptoms.

Capsicum, or cayenne pepper, is another beneficial herb. It contains a substance, capsaicin, which increases mucus flow, helping to wash viral invaders harmlessly out of the nose before they can invade the body and cause infection.

Beta-glucan, the substance felt to be responsible for oatmeals effectiveness in preventing colds is available as a supplement. Taken in this concentrated form it can be a potent activator of macrophages, the cells that seek out and carry invading viruses to sites where they can be identified and effective countermeasures instituted.

One of my personal favorites for decreasing the incidence of viral infections is colostrum. Colostrum is the first fluid produced by a mammal after giving birth. It is rich in immune factors that are transferable from one species to another. Colostrum supplements come from dairy cattle. The fluid is collected, freeze-dried, and encapsulated.

Colostum is rich in immunoglobulins that are highly effective in neutralizing bacteria and viruses. It also contains PRP-3b, a substance that has a regulating effect on the immune system, boosting it when it is underactive areas and moderating it if is becomes overactive. Unlike Echinacea, colostrum can be taken daily without losing its effectiveness. Its milky flavor makes it very easy to administer to children. Capsules can be sprinkled in a small amount of yogurt, for example. One capsule is given to children once or twice daily and two capsules are taken twice daily by adults.

As I stated at the outset, it is not necessary to institute all of the above measures to significantly decrease your risk of catching a cold this winter. Select some that make sense to you and follow them faithfully.

I highly recommend that you drink optimum amounts of water, use a humidifier when needed, eat sensibly, remain physically active, get adequate rest, and take a comprehensive supplement that provides optimum nutrient levels daily. If you are stressed or have a history of frequent colds an immune system support would be a wise addition. If you attend school, work with or around more than six people each day, or have school age children investing in and using a disinfecting hand gel would be prudent.

Those measures should keep you from contributing your fair share of the nearly $25 billion price tag of this winter’s cold season. I hope you put your savings to good use!