Unfortunately one of my very dear friends is seriously unwell, so I started writing this from the 9th floor of St Thomas’s hospital.  There are hand wash points all over the place in a bid to prevent the spread of infection.  Any hint of a sniffle and I would not be allowed to set foot onto the ward.  So, I am doing my very best to keep my immune system strong! 

In the past I have written about the prevention and treatment of colds and coughs and generally about the immune system and how to keep it strong.  It is the time of year when the cold and flu virus sis rife and people are very interested in how they can escape the infections that seem to be surrounding them.  Earlier this week I was made aware of the potential benefits of Black Elderberry extract (brand name Sambucol®) for the prevention and alleviation of the influenza virus.  I wanted to delve into the scientific research to discover if there is fact behind the hype.

Black Elderberry (sambucus nigra), a member of the honeysuckle family, is a tree-like shrub.  Traditionally various parts of the plant, including the leaves, bark, flowers and berries, have been used in medicine.  The health giving properties have been documented as far back as the 5th century.  Currently much of the interest and research has focussed on extract from the berries.  Research(1) suggests that elderberry has antiviral properties, especially against the influenza virus, and also seems to activate and boost the immune system as well as acting as an antioxidant.

The berries contain various bioactive plant compounds, known as flavonoids, as well as certain vitamins (C, A and various B vitamins), that appear to be responsible for the positive effects on the immune system and our health.

Sambucol® is a supplement that contains 38% standardised extract of black elderberry.  Research(2,3) suggests that elderberry extract appears to boost and activate the immune system in individuals who are healthy as well as those who are already suffering from a viral infection.

Two small well planned studies (randomised, placebo-controlled, double-blind studies 4,5) found that Sambucol® effectively inhibited the influenza A and B virus strains when given orally to patients in the first 48 hours of flu symptoms developing.  The earlier preliminary study (4) was very small, involving only 27 patients, but demonstrated the ability of elderberry (4 tablespoons of Sambucol® syrup per day) to reduce influenza symptoms in 20% of influenza patients within 24 hours and to reduce influenza symptoms in 75% of patients within 48 hours.  After three days of elderberry use, 90% of influenza patients experienced a total alleviation of symptoms. 

The most recent study (5) involved 60 patients aged 18-54 years who had just began (48 hours or less) to suffer from flu-like symptoms.  Participants received 15 ml of elderberry or placebo syrup four times a day for 5 days, and recorded their symptoms using a special scale.  In the participants receiving the elderberry syrup the symptoms were relieved, on average, 4 days earlier and use of rescue medication was significantly less compared those receiving placebo.  The study was small but very encouraging, the findings need to be confirmed in a larger study.

The underlying mechanism (1) for elderberry’s effectiveness in the treatment of influenza virus was discovered by an Isreili virologist, Dr Mumcuoglu.  The berry seems to be able to prevent and inhibit the replication of the influenza virus.  The active compounds within the elderberry seem to ‘coat’ or neutralise the spike-like projections that are found on the surface of several viruses, including the influenza viruses.  When these spikes are deactivated the virus is prevented from piercing the human cells, so the virus does not enter our cells and is prevented from replicating.  Unlike bacteria, a virus cannot replicate on its own, it must attack living cells in order to survive.  If the virus is prevented from entering our cells it will be unable to survive and cause us to suffer health problems.

I mentioned earlier that elderberries also possess antioxidant properties.  Antioxidants protect our cells from the damaging effects of highly reactive molecules called free radicals, which cause oxidative stress in the body.  There is mounting evidence that these destructive molecules, together with lowered antioxidant defences, play a significant role in the development and aggravation of many diseases (including cardiovascular disease and cancer to name but a few).  The body does produce its own antioxidants but also relies on vitamins, mineral and phytochemicals (bioactive plant chemical) from the diet, especially from colourful vegetables and fruits, for additional valuable supplies.

The elderberry extract, Sambucol®, is widely available in the UK as a liquid or lozenge.  The products can be taken as a preventative or at the first signs of cold or flu-like symptoms.  A healthy diet (rich in fruit and vegetables) is obviously the most important way to keep the immune system strong, healthy and effective.  However, if you are surrounded by people with colds, or worried about the ‘flu-season’ taking an elderberry extract may well give your immune system an extra boost and help you to fight off invading infections. 

(1) Sambucus nigra - monograph.  2005.  Altern Med Rev.  10(1):51-54.
(2) Barak V et al.  2001.  The effect of Sambucol® , a black elderberry-based, natural product, on the production of human cytokines:I.  Inflammatory cytokines.  Eur Cytokine Netw.  12:290-296
(3) Barak V et al.  2002.  The effect of herbal remedies on the production of human inflammatory and anti-inflammatory cytokines.  Isr Med Assoc J.  4:S919-S922
(4) Zakay-Rones Z et al.  1995.  Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra) during an outbreak of influenza in Panama.  Journal of Alternative and Complementary Medicine.  1(4):361-369.
(5) Zakay-Rones, Z et al.  2004.  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.  32(2):132-140.

Written Ani Kowal

Continuing with the theme of child health I have decided to look at the prevention of common infections such as those of the ear, nose and throat, and tummy upsets.  Children returning to school after the long holiday break will be exposed to others who they may not have seen in weeks and also to the various ‘bugs’ that they may be carrying.  Fear not, it is not inevitable that your children will end up feeling poorly and catching every illness around them! 

A healthy, strong immune system will help to prevent various infections, or keep them short and less intense if they do occur.  Ensuring that your child is eating healthily will mean that they are getting all the vitamins, minerals and essential fatty acids they need in order to keep their immune system fighting fit.  However, I am aware that many children are not regularly getting the recommended daily 5 portions of fruit and vegetables.  This may mean that they are lacking in essential nutrients and their immune system may not be running at optimum.  Certain supplements, specially formulated for children, may be helpful in supporting a healthy diet in order to keep the immune system healthy.  However, a supplement cannot be seen as a replacement for the foundations provided by a healthy lifestyle.

Here I will be looking at some of the evidence which suggests that a multivitamin and mineral supplement taken together with a fish oil supplement (to provide essential omega 3 fatty acids) and a pre/pro-biotic supplement could be useful in helping to prevent childhood infections. 

Two papers have been published by a group of researchers who used a fish oil and multivitamin-mineral supplement in children who regularly suffered from recurrent ear(1) and sinus(2) infections.  The studies were very small and preliminary but both suggested benefit in the prevention of these common childhood conditions.  The researchers suggest that such preventative treatments could reduce the need for prescribed antibiotics.  Evidence also exists to suggest that individuals who suffer from recurrent tonsillitis infections may have a disturbed balance of various vitamins(3,4) and minerals(5), especially lowered zinc levels.

Previously I have written about zinc and vitamin C in relation to the prevention and shortening of the common cold and I would recommend you visit this post for more information. 

A few months ago I wrote about the importance of maintaining a good balance of ‘friendly’ bacteria in the digestive system in order to boost immune function and how evidence suggests that taking a daily probiotic supplement may prevent the occurrence of the common cold.  Children who have suffered from recurrent infections will normally have been exposed to frequent courses of antibiotics.  Antibiotics may indeed have been useful for fighting the bacterial infection, however they also kill many of the beneficial bacteria that would normally live in a healthy gut.  This imbalance could lead to a less efficient immune system and an increased likelihood of further infections.  One study(6) revealed that; in children with acute infections of the upper and lower respiratory tract, such as bronchitis and pneumonia, a probiotic supplement seemed helpful in regulating the immune system.  A recent review paper(7) indicated that probiotics also have immune enhancing effects in children and may prevent infections and diarrhoea. 

A daily supplement containing probiotics and prebiotics (such as FOS fructooligosaccharides) may be worth considering.  For more information on prebiotics and probiotics I would suggest visiting the post on irritable bowel syndrome which defines and explains these supplements.

When considering multi-nutrient supplements I would suggest a child-specific ‘food-state’ supplement as these will be easily absorbed by the body.  Again I would like to stress that supplements should not be seen as a substitute for a healthy, balanced diet plentiful in a variety of colourful fruits, vegetables and healthy fats. 

Best wishes to all children for an enjoyable first term back at school!

(1)Linday LA, Dolitsky JN, Shindledecker RD, Pippenger CE. 2002.  Lemon-flavored cod liver oil and a multivitamin-mineral supplement for the secondary prevention of otitis media in young children: pilot research. Ann Otol Rhinol Laryngol.  111(7 Pt 1):642-52.
(2)Linday LA, Dolitsky JN, Shindledecker RD.  2004.  Nutritional supplements as adjunctive therapy for children with chronic/recurrent sinusitis: pilot research. Int J Pediatr Otorhinolaryngol.  68(6):785-93.
(3)Aleszczyk J et al.  2001.  [Evaluation of vitamin and immune status of patients with chronic palatal tonsillitis][Polish Article].  Otolaryngol Pol.  55:65-67
(4)Shukla GK et al.  1998.  Comparative status of oxidative damage and antioxidant enzymes in chronic tonsillitis patients.  Boll Chim Farm.  137:206-209
(5)Onerci M et al.  1997.  Trace elements in children whith chronic and recurrent tonsillitis.  Int J Pediatr Otorhinolaryngol.  41:47-51
(6)Lykova EA, Vorob'ev AA, Bokovoi AG, Murashova AO.  2001.  [Impaired interferon status in children with acute respiratory infection and its correction with bifidumbacterin-forte] [Article in Russian].  Zh Mikrobiol Epidemiol Immunobiol.   Mar-Apr;(2):65-7 
(7)Nova E, Wärnberg J, Gómez-Martínez S, Díaz LE, Romeo J, Marcos A. Immunomodulatory effects of probiotics in different stages of life. Br J Nutr. 2007 Oct;98 Suppl 1:S90-5.

Written by Ani Kowal

Whilst writing my last post about zinc and the common cold I came across some interesting research and evidence about probiotics and how they may be useful in enhancing the function of our immune system.  Probiotics are supplements containing ‘beneficial’ or friendly bacteria which inhabit the intestines.  These friendly bacteria produce various substances in our bodies, such as acetic acid, lactic acid and hydrogen peroxide, which  may help to counteract detrimental bacterial and viral infections in all parts of the body (not just in our digestive systems). 

Two studies (1,2) have looked specifically at how taking probiotics daily can prevent us from catching colds and how they may affect the duration and severity of cold symptoms if we do succumb.  Results suggest that taking probiotic supplements for at least three months had a positive effect on the cells of the immune system, shortened common cold episodes by almost 2 days and reduced the severity of symptoms!

Evidence for the various health benefits of taking daily probiotic and/or prebiotic supplements is growing each year.  Probiotics work by supplying 'beneficial/friendly' bacteria to the digestive system and Prebiotics, often called FOS or fructooligosaccharides, work by promoting the continued growth of friendly bacteria present in the intestines.  FOS act as a food source that only the beneficial bacteria can use to grow.  Personally I have taken prebiotics for many years now.  One of my professors at university, Prof Glen Gibson, has published several scientific papers and studies concerning the benefits of prebiotics and probiotics to health and he spurred me into taking a daily supplement. 

Many products are available that combine Probiotics and Prebiotics together.  After a month of taking the combined supplement you may wish to switch and use a prebiotic/FOS supplement only.  This will help to maintain high levels of the beneficial bacteria in the digestive system.
 
References
(1) de Vrese M et al.  2005.  Effect of Lactobacillus gasseri PA 16/8, Bifidobacterium longum SP 07/3, B. bifidum MF 20/5 on common cold episodes:  a double blind, randomized, controlled trial.  Clinical Nutrition.  24(4):481-491
(2) Tubelius, P et al.  2005.  Increasing work-place healthiness with the probiotic Lactobacillus reuteri:  a randomised, double-blind placebo-controlled study.  Environ Health.  4(1):25

Written by Ani Kowal

Recently my mum came back from a trip with a heavy springtime cold, a member of her travelling party had kindly passed on the infection and poor mum was suffering with the typical symptoms of a tickly throat, headache and runny nose.  Colds are caused by viruses and our susceptibility to these infections is largely dictated by the efficiency of our immune system.  A healthy diet providing our bodies with optimal nutrition may help to keep our immune systems strong and protect us from infection.

The symptoms of a common cold tend to last from a few days to a couple of weeks but most cases are over within one week (fortunately my mum is fit and healthy and her cold only lasted a few days!).   There is mixed evidence with regards prevention and treatment of colds with complementary health methods but I am always one to try ‘beating the bug’ naturally!

One of the nutrients that is essential for the efficient functioning of our immune system is zinc and last month a study published in the Journal of Infectious Diseases (1) found that using lozenges containing zinc at the first sign of a cold (within 24 hours of developing symptoms) was associated with reduced duration and severity of cold symptoms.  This study adds weight to previous research indicating that zinc lozenges, sucked in the mouth and not swallowed whole, seem to help prevent infection from the common cold and also accelerate recovery once infected. 

This most recent study involved 50 volunteers who had suffered cold symptoms, such as a cough, runny nose and muscle aches, for less than 24 hours. Half of the participants were given zinc lozenges, containing about 13mg of zinc, and half were given inactive ‘placebo’ lozenges (the two groups were not aware of which lozenges they had been assigned).  They then took one lozenge every 2 to 3 hours while awake.  The group taking the zinc lozenges had cold symptoms for an average of 3 days less than those taking the placebo.  Every cell in our body needs zinc and the investigators believe that beneficial clinical effects seen in the zinc group were due to the antioxidant and anti-inflammatory effects that this nutrient has in the body.

Lozenges and dissolvable tablets and drinks often contain vitamin C, another nutrient which some studies suggest (2) may be useful in reducing the severity and duration of cold symptoms.  If you feel a cold coming on it may be useful to try sucking on a lozenge every three hours or so while symptoms persist.  

References:
(1) Prasad AS, Beck FW, Bao B, Snell D, Fitzgerald JT.  2008.  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.  Mar 15;197(6):795-802
(2) Van Straten et al.  2002.  Preventing the common cold with a vitamin C supplement: a double-blind, placebo-controlled survey.   Adv Ther.  19(3):151-159

Written by Ani Kowal