Are Screening Mammograms Safe and Effective?

Introduction

In 2009, I reviewed the issue of screening mammograms and supported the US Preventative Services Task Force (USPSTF) recommendation that women of average risk should start mammograms at age 50 and continue mammography every 2 years until age 75.  I have recommended mammograms with the caveat that as new information is available, I would reassess the best strategy.  New information casts further doubt as to the safety and effectiveness of mammography as a screen for breast cancer.

Let me start off by saying the obvious, we all want to reduce the rate of breast cancer.  If cancer cannot be avoided, we want to improve the outcome through earlier detection. 

Objectively thinking through the issue of breast cancer screening with mammograms is no easy task.  Screening mammograms have been promoted far more than any other diagnostic test.  Particularly in the United States, breast cancer screening is an emotionally, politically and economically charged issue.  Powerful forces are in place which put pressure on physicians and women to promote mammography but are we helping women?

The findings and conclusions of numerous studies are not at all intuitive or obvious. To digest this information, you will want to set aside what seems to be “obviously” correct and consider the facts carefully. 

What Makes For a Good Screening Test?

To understand the issue of screening mammograms, it is helpful to back up and look at what makes for a good screening test.  Screening should meet several criteria:

·       The procedure should allow early detection of cancers destined to cause death.  By diagnosing the cancers earlier - screening should be associated with better outcomes.

·       The procedure should have a high safety profile.

An effective screening approach should show early disease rates go up in an amount equal to the decline in late disease.  Effective screening tools such as Pap smears for cervical cancer and colonoscopies for colon cancer demonstrate the expected increase in early disease with a corresponding drop in late disease.  We will see this is not the case with screening mammograms.

Landmark Study

The November 22, 2012 New England Journal of Medicine landmark article “Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence” by Archie Bleyer, M.D., and H. Gilbert Welch, M.D., M.P.H. looked at an enormous amount of federal data on screening mammography compiled from the mid-1970s through 2008. 

Key Study Findings

·       The rate of diagnosing breast cancer in early stages increased by 200% with screening mammography.

·       However, the rate of late stage cancer did not drop significantly in the screened group.  Metastatic disease was completely unchanged – screening did not prevent this.

This thorough review confirmed what numerous other studies have pointed to: screening mammograms do not make much of a difference in preventing late stage cancer.  They are not achieving their main goal which is to prevent cancer deaths.

Overdiagnosis of “harmless” cancer cells

You may be thinking that any chance of improvement would justify doing a mammogram.  This would be true if there were no downside to screening. While the breast cancer “overdiagnosis” problem has been discussed in the medical articles for over a decade, this issue is rarely understood and discussed even among physicians. 

While it seems obvious that it is a good thing to find cancer cells and get rid of them, the studies show this is not always so.  Our bodies often contain cancer cells that would have never effected out lives.  When we go looking for the early cancers, we often find what I am going to call harmless cancers – cancer which would never have caused disease.  We also find some of the bad cancers - destined to cause disease and potential death. 

The problem is that mammograms appear much better at diagnosing harmless cancers than early bad cancers.  Furthermore, at this time, once cancer is diagnosed there is no way to tell whether it is likely to cause disease or not.  As a result of screening mammograms, the overdiagnosis of cancer cells were found and treated in more than 1.3 million women over the past 3 decades.   In 2008, 70,000 women were overdiagnosed with breast cancer. This amounts to almost 1/3 of breast cancers diagnosed in women 40 years of age and older.  

Overdiagnosis is not benign:  These women overdiagnosed with breast cancer gained nothing by their treatment.  They would have enjoyed living their lives never being affected by breast cancer. The cancer would have never materialized as a diagnosis or health concern. 

Overdiagnosis causes overtreatment with the attendant emotional stress of the cancer diagnosis, unnecessary treatment such as surgery, radiation & chemotherapy and all the potential complications.   While treatment of early stage cancer is safer than treatment of late stage cancer, this overtreatment can sometimes cause serious complications and even death. 

Conclusions

The data shows 2 important problems with screening mammography:

·       Screening mammograms fail the most important criteria for screening: they fail to substantially reduce late stage disease. In fact, from 1975 to 2008 the rate of metastatic breast cancer was unchanged.

·       Screening mammography causes many women to become cancer patients who would not have been had they not been screened.

**I would want to make sure all readers recognize that all breast masses should be carefully evaluated.  The above negative findings are for screening mammograms– not diagnostic mammograms used to evaluate lumps/masses. If a woman has a breast lump/mass – it definitely should be evaluated with mammograms, ultrasound and when indicated, biopsy**

The NEJM article prompted a discussion over which of the following strategies doctors should recommend:

Option 1: Recommend Screening Mammography Starting at the Age of 40

Option 2: Recommend Screening Mammography Starting at the Age of 50

Option 3: Do Not Recommend Screening Mammography

The fact that option 3 is on the table speaks volumes.  The pressure to do screening mammograms is very intense.  For a prestigious journal to discuss this as a reasonable option reflects a large body of evidence that screening mammography has very limited benefit and significant problems.

The preponderance of the evidence we have gathered in many different countries and by many different groups show disappointing results with screening mammograms.  While the exact findings vary, women need to be aware that screening breast mammography is poor at picking up important cancers and clearly results in a great deal of overdiagnosis and overtreatment. As much as we all want a good tool to reduce breast cancer death, screening mammograms do not fill this role well. 

Should I have screening mammograms?

Since screening mammograms are not very effective or accurate, missing most important cancers and diagnosing many unimportant ones, I lean toward option 3 of not recommending mammography.  I encourage you to consider the best statistics we have and make a decision based on your assessment of the benefit versus risk:

·       We are weighing a low benefit of 0-10% in the reduction in late stage cancers

                        versus

   

·       A significant risk of overdiagnosis.  The harm of overdiagnosis includes:

·            emotional stress

·            pain and potential complications from testing

·            complications of the cancer treatments (surgery, chemotherapy, hormonal blockers,  radiation) ranging from mild issues to severe impairment and death

·       The pain involved with screening mammograms

·       The stress of screening mammograms, waiting for the results, needing additional studies and biopsies.

·       Possible x-ray induced cancer.  X-rays involved in mammograms have a small but definite risk of causing cancers – especially when you start early and have yearly studies

This is a personal decision but the case for the often stated “screening breast mammography save lives” is much weaker than most realize.  You may choose to get screening mammograms but please do so knowing there is clear evidence that screening is associated with significant harm coming from the many cases which involve finding cancerous cells that would have never affected your life.

The Cochrane Review as a tool to make your decision

When I did medical missions overseas in Central Asia, I worked in the area of medical development with consultants with the World Health Organization (WHO) to make recommendations.  We were trying to focus on what really mattered, what really made a difference.  It was not uncommon to discuss the findings of the Cochrane Reviews. The Cochrane Review is internationally recognized as a leading source of quality evidence-based health assessments.  Because the Cochrane Review is international, it is not easily influenced by political and local economic factors.  I would urge you to consider the Cochrane Reviews’ stance on screening mammograms:

Cochrane Review 2008

·       Initially in 2008, their summary was that since mammography had both benefits and harms, either way – having it done or not having it done was reasonable.

·       At the time they estimated that if 2000 women were screened regularly for 10 years, one will benefit from the screening by avoiding dying from breast cancer.

·       At the same time, 10 healthy women would unnecessarily become cancer patients and will be treated unnecessarily. These women will have either a part of their breast or the whole breast removed and often receive radiation therapy and sometimes chemotherapy.

·       Furthermore, about 200 healthy women will experience a false alarm. The psychological strain women experience from false alarms can be severe.

Cochrane Review Revised Position

·       Since the trials used to accumulate the above statistic were performed, treatment of breast cancer has improved considerably.  When improved treatment of breast cancer is factored in, it indicates mammography screening may no longer be effective in reducing the risk of dying from breast cancer.

·       Screening produces patients with breast cancer from among healthy women who would never have developed symptoms of breast cancer. Treatment of these healthy women increases their risk of dying, e.g. from heart disease and cancer.

·       It no longer seems reasonable to recommend mammograms for breast cancer screening. In fact, by avoiding going to screening, a woman will lower her risk of getting a breast cancer diagnosis.

·       However, despite this, some women might still wish to go to screening. But women should know that screening produces patients with breast cancer from among healthy women who would never have developed symptoms of breast cancer. Treatment of these healthy women increases their risk of dying, e.g. from heart disease and cancer.

Source: Cochrane review: Screening for breast cancer with mammography             http://www.cochrane.dk/screening/index-en.htm

Better Approaches

To continue to do the same thing over and over again, expecting different results, is one definition of insanity.  Moving forward, we need better tools.  Deadly cancers are routinely missed with mammograms and mammograms pick up too many unimportant cancers. 

Although clear benefit is lacking – it seems prudent to do self-breast exams as well as have your doctor perform regular breast exams.  Also, I repeat, you should definitely have a breast mass evaluated with all appropriate tools including mammograms (when done to evaluate a lump, this is called a diagnostic mammogram rather than a screening mammogram).

What might work instead of screening mammograms? Screening with ultrasound and breast thermography are promising.  However, we will only know if they really help when long term rigorous studies done on them.  Read more about breast thermography in my previous posts in the January & November 2009 blog posts. 

To your health!  

Don Ellsworth, M.D.  

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Disclaimer:  The information provided should not be construed as personal medical advice or instruction.  No action should be taken based solely on the contents of this site. Readers should consult appropriate health professionals on any matter relating to their health and well-being. The information and opinions provided here are believed to be accurate and sound, based on my best judgment and research.  I cannot assume responsibility for any possible errors or omissions.

References and further reading

Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence

Archie Bleyer, M.D., and H. Gilbert Welch, M.D., M.P.H.

N Engl J Med 2012; 367:1998-2005 November 22, 2012 http://www.nejm.org/doi/full/10.1056/NEJMoa1206809/

Roundup of some reactions to NEJM mammography overdiagnosis analysis http://www.healthnewsreview.org/2012/11/roundup-of-some-reactions-to-nejm-mammography-overdiagnosis-analysis/   

Letters to the editor “Effect of Screening Mammography on Breast Cancer Incidence”

http://www.nejm.org/doi/full/10.1056/NEJMc1215494

http://www.nejm.org/doi/full/10.1056/NEJMoa1206809/

Cochrane Review:

http://www.cochrane.dk/screening/index-en.htm/

http://summaries.cochrane.org/CD001877/screening-for-breast-cancer-with-mammography/

Overdiagnosed: Making People Sick in the Pursuit of Health by H. Gilbert Welch, Lisa Schwartz and Steve Woloshin

http://www.amazon.com/Overdiagnosed-Making-People-Pursuit-Health/dp/0807021997/

Iodine for Optimal Health

Iodine for Optimal Health

Optimal Dose of Iodine/Iodide is 12.5 milligrams a day – not 0.150 mg

Iodine is critical for our health and yet it is underused and even incorrectly feared. Former professor of obstetrics, gynecology and endocrinology at UCLA School of Medicine, Guy Abraham, M.D. began research which resulted in a series of papers which came to be known as “The Iodine Project.”   Our new understanding of iodine has some which startling implications for your health.    

The RDA (recommended daily allowance) is the minimal amount of iodine/iodide needed to prevent goiter, hypothyroidism and cretinism - mental retardation due to low thyroid activity. What has been missing from most discussions on iodine is what the optimal dose would be.  Dr. Abraham’s studies revealed that the optimal daily dose is 12.5 milligrams which is almost 100 times the RDA of iodine - 0.150 milligrams (150 micrograms).  At the Hotze Health and Wellness Center we routinely recommend the use 12.5 mg a day by taking 1 tablet of Iodoral, a combination of Iodine and Iodide.  Note: Iodide is preferred by the thyroid gland. Iodine is preferred by the breast, ovary and prostate.  Both iodide and iodine must be replaced but for the sake of simplicity I will simply use iodine to refer to both of these forms.  

A Rats’ Tale: The Origins of Iodo-phobia

Many medical experts incorrectly believe that iodine can block thyroid function and becomes toxic at doses of more than 2 mg a day.  This erroneous conclusion started with a 1948 rat study published by Drs. Wolff and Chaikoff.  If they had limited their incorrect conclusions to rats, the results would not have been too bad (I would not be too upset if rats were iodine deficient). Unfortunately, the Wolff-Chaikoff conclusions were generalized to humans and today medical textbooks repeat these conclusions as though they were based on solid evidence.  Several other studies have looked at iodine and seemed to build on the conventional wisdom that iodine is dangerous.   Later, these studies were also shown to have flaws which have led most who look at the data to conclude iodine supplementation is very safe.  In fact, as discussed below, the Japanese have an intake of 13.8 mg of iodine/iodide a day and experience significantly better health in many important areas such as thyroid function and cancer rates.

Iodine is Essential for Brain Development

Women of childbearing age need to pay particular attention to their intake of iodine.  Iodine deficiency is now accepted as the most common cause of preventable brain damage in the world.  The World Health Organization (WHO) estimates that over 30% of the world’s population has insufficient iodine intake.  Iodine deficiency has adverse effects in all stages of development but is most damaging to the developing brain.  In addition to regulating many aspects of growth and development, thyroid hormone is important for myelination of the central nervous system, which is most active before and shortly after birth.  Every year over 100,000 infants are born with cretinism – mental retardation due to low thyroid (hypothyroidism), a problem clearly related to low iodine intake.

School children in iodine-deficient areas show poorer school performance, lower IQs, and a higher incidence of learning disabilities than matched groups from iodine-sufficient areas. A combination of 18 studies (called a meta-analysis) concluded that iodine deficiency alone lowered mean IQ scores in children by 13.5 points.

Iodine and ADD/ADHD/Autism

Areas where iodine intake is lower has been associated with high rates of ADHD and ADD.

Children with autism have been shown to have lower levels of iodine that children without autism.

Hypothyroidism and Goiter

Iodine deficiency is a common cause of goiter in many parts of the world and may result in hypothyroidism.  Adequate iodine intake will generally reduce the size of goiters, but the reversibility of the effects of hypothyroidism depends on an individual's stage of development when treated.

Iodine and Cancer Prevention

Japanese women have the highest iodine intake in the world at 13.8 milligrams a day, mainly from seaweed.  They also have one of the lowest rates of fibrocystic breast disease, breast, ovarian and uterine cancer.  Conversely, Thailand & Mexico have low iodine intake and have high rates of breast cancer and goiter.

Iodine to Resolve Breast and Ovary Cysts
The breast and ovary concentrate iodine and iodine deficiency causes fibrocystic breast disease (FBD) with nodules, cyst enlargement, pain and scar tissue.

Iodine has been shown to resolve fibrocystic breast disease and help ovarian cysts to decrease in size.  

Iodine for Prevention of Autoimmune Disease

When iodine deficiency is present, the thyroid enzymes called peroxidases damage the thyroid gland and can cause autoimmune diseases such as Hashimoto’s thyroiditis and Graves’ Disease.  When iodine is replaced, the peroxidase injury in hyperthyroidism stops and hyperthyroidism  can return to normal. 

Iodine for Prevention of Cardiovascular Disease

Lipoprotein (a) is sticky substance in the blood which when created in excess can cause plaques in arteries. Excessive clotting and vascular disease resulting from high levels of lipoprotein (a) can be reversed by iodine treatment.

Determining if a Person is Iodine Sufficient and Treatment Dosages
If you are not taking iodine supplements or eating iodine rich foods such as kelp or seafood, you are very likely to be among the 95% of adults who are deficient.  If needed, the status of iodine can be determined by urine testing.  A loading dose of 4 – 12.5 mg Iodoral tablets are taken (50 mg of iodine/iodide) and for the next 24 hours all the urine is collected.  If less than 90% (45 mg of the iodine) is excreted, the person is considered iodine deficient (i.e. the less iodine you have in your body, the more your body will hold onto iodine instead of it passing through in the urine).  By the way, the fact that iodine is excreted when the body has enough highlights the safety of iodine, if you do not need it, it passes through you.

Iodine Use is Inhibited by Fluoride, Bromide and Chlorine
Instead of addressing the need for more iodine, we are adding iodine blocking compounds such as fluoride, bromide and chlorine.  Chlorine and fluoride are added to city water supplies and bromide is added to most baked products such as bread.  Bromides are present in many processed foods and beverages (especially Mountain Dew).           

Iodine Supplementation Allows Detoxification of Fluoride and Bromide
David Brownstein, M.D. and Jonathan V. Wright, M.D have noted that iodine helps remove toxic elements such as bromide and fluoride.  As is generally seen with detoxification, the mobilization of toxic substances can cause temporary side effects such as rash, fatigue or irritability all of which can be resolved by decreasing the dosage of iodine.

            

People are using less of our main source of iodine: Iodized Salt
Americans are getting less iodine than ever.  We have replaced iodine in bread with iodine, less iodine rich seafood and using less iodized salt.  Note that most sea salt does not contain iodine; however, iodized sea salt is available. The nutritional survey known as NHANES I and III demonstrated that the average iodine levels in the US have declined more than 50% during the 20 year period from 1971-1974 to 1988-1994.

Are You Low On Iodine?

Unless you are eating a lot of seaweed, kelp, seafood or taking Iodoral or other iodine/iodide supplements, you are almost certainly low. 

Dr. Brownstein has found 95% of those tested are low in iodine

Starting Iodine

While very safe, iodine supplements like Iodoral should be done with medical supervision.  I often recommend our guests at the Hotze Health and Wellness Center start with one 12.5 mg tablet of Iodoral, available at Physicians Preference www.physicianspreference.com.  The dose should be reduced if any detoxification symptoms occur.  Detoxification symptoms include irritability, acne-like skin lesions, headache, an unpleasant metal taste or increased salivation and sneezing.

Iodoral may decrease the need for thyroid hormone supplementation. Watch for signs of too much thyroid such as feeling your heart beating hard or fast, anxiety, increased sweating, being short of breath of not tolerating heat. 

Selenium is required to use iodine/iodide, 200 mcg of selenium a day ensures adequate selenium for use of iodine.

Dr. Abraham found iodine deficiency takes a year to resolve when 12.5 mg a day is used and 3 months when 50 mg a day is used.  For this reason, those with severe deficiency issues may best respond when treated with 4 tablets a day for 3 months and then reduce to 1- 12.5 mg tablet a day.

For children who cannot swallow a tablet, some liquid preparations such as Liquid Iodine Forte from Biotics Research may be helpful.  Each drop contains 150 mcg (0.15 mg) of potassium iodide.  A drop a day would cover the RDA and would be a reasonable minimum for most children.  Use of iodized sea salt is also helpful. The optimal dose in children has not been determined but is certainly higher than the RDA for children listed below:

RDA for Children
1–3 years	90 μg/day of iodine
4–8 years	90 μg/day of iodine
RDA for Boys
9–13 years	120 μg/day of iodine
14–18 years	150 μg/day of iodine
RDA for Girls
9–13 years	120 μg/day of iodine
14–18 years	150 μg/day of iodine

Iodine Allergy?

An allergy to iodine itself is rare. A reaction to intravenous contrast dye or shellfish is not the same as an allergy to elemental iodine/iodide.   The allergy is actually to the organic molecule which includes iodine bound to something else.  An allergy to elemental iodine/iodide is extremely unlikely.  If you do not have a problem with iodized salt, you are not allergic to elemental iodine and iodine supplements.   If you are avoiding iodine supplements due to a history of a reaction to shellfish or contrast dye, you should discuss this with your doctor before starting Iodoral. 

For more information:

www.theiodineproject.webs.com

www.optimox.com/pics/Iodine/opt_Research_I.shtml

www.drbrownstein.com/bookstore_Iodine.php

Eat to Live: Sylvia’s Super Salubrious Salad Shake

Eat to Live

I recently read Dr. Fuhrman's book "Eat to Live."   It is available in audio form as well as in paperback. The website drfuhrman.com is well done. 

I was very impressed and have adopted his concept of trying to eat 2 pounds a day of nutritious green foods daily.   Sylvia has come up with a tasty way to help achieve this goal that I wanted to share with you.    

Sylvia’s Super Salubrious Salad Shake

In a powerful blender ( like a Vitamix) add the following ingredients:

-1 handful of carrots

-3 cloves garlic, pressed

- ½ jalepeno pepper

-1 tsp minced ginger

-2 T. red onion

-6 rehydrated dried tomato halves

-2 handfuls of spinach

-1 large leaf of kale (center rib removed)

-3 large leaves of romaine lettuce

- 1/2 avocado

-1 t. Bragg’s Amino Acids or Nama Shoyu or soy sauce

-1 t. sea salt

-1 T. fresh lemon or lime juice

-1 T. hempseed or flaxseed oil

-1/2 cup water

Whiz altogether until a nice smooth consistency. You will probably need to eat with a spoon, but you can add more water if you want to drink it.

How to Fight Infections Naturally

NaturalWellnessChoices.com

We all hate that feeling of coming down with something. Fortunately, we have been blessed with many powerful, natural tools which can help fight colds and flu. When started early, you may find that both the duration and severity of symptoms are significantly reduced.  Many of the products I mention can be found at www.physicianspreference.com de

Fighting & Preventing Infections begins with healthy living:

-        Good nutrition Sugars and fruit juices significantly decrease our immune defenses.  Conversely, fruits and vegetables boost immune activity.   Eating 5+ serving of fruit & vegetables can also be augmented with fruit & vegetable capsules.

-        Deal positively with stress, get enough sleep and exercise regularly in moderation

 

Nasal Rinsing (Neti-Pot, NeilMed Sinus Rinse, Nasopure)

This really is easy and incredibly inexpensive.  Nasal rinsing with saline or salt water helps to temporarily relieve sinus congestion and can help slow viral activity.   Devices for nasal irrigation are sold at most drug stores (see names above).  I would use nasal irrigation 3-4x/day while fighting an infection.  For more information on this, see my June 18, 09 blog post.

Vitamin C

Often you do not know when you have a runny nose whether your allergies are acting up or if you are coming down with something.  Vitamin C (as well as Andrographis - see below) work well for both conditions.

A review of 21 placebo-controlled studies found that vitamin C reduced the duration and severity of symptoms by 23%.  In these studies, 1,000-8,000 mg of vitamin C was used.  Overall, higher doses work better than low and some will need 12-15,000 mg a day to optimally fight off infection.  Vitamin C is very safe and the dose limit is primarily determined by your GI tract – too much can cause gas or diarrhea.  Dr. Cathcart found that the sicker one is, the greater the need for vitamin C.  His publication in Medical Hypothesis documented that 80% of adults can tolerate doses of 10-15 grams of vitamin C a day.  

Andrographis (Andrographis paniculata)

Andrographis is an herb which increases the production of infection fighting antibodies and improves the ability of the white cells to “eat” invaders (i.e. improves macrophage phagocytosis).   Studies have shown andrographis significantly improves symptoms of the common cold and the flu.  Generally people improve within 2 days but 4-5 days may be required for maximal effects.  The doses used have been 200 mg -6,000 mg a day.  As with most herbs, pregnant women should not use andrographis.

Elderberry

A trial from Israel published in the Winter1995 issue of the Journal of Alternative and Complementary Medicine studied the Elderberry product, Sambucol. This study was small and I would like to see it repeated but the results were rather striking: those who took Sambucol recovered completely within two to three days versus 6 days in the placebo group.   Another advantage of Elderberry is it apparently tastes good and it is easy to get children to take.  The dosage for children is two tablespoons daily, adults take four tablespoons. 

Probiotics (Bifidobacterium and Lactobacillus acidophilus) 

Children in day-care taking a probiotic blend had a 45% lower risk of experiencing fever, cough, rhinorrhea compared to placebo.  Those who did get symptoms had less sick time – 2 days shorter.  These taking probiotics were significantly less likely to need antibiotics. 

Zinc

The most studied forms of zinc for the cold are the oral lozenges and the intranasal spray.  Zinc helps decrease the duration of the common cold in adults. Lozenges should be taken every 2 hours while awake, starting within 48 hours of symptom onset.   Zinc nasal spray has also reduced the severity and duration of cold symptoms; however, some have lost their sense of smell following the use of intranasal zinc.  I would recommend avoiding intranasal zinc and but rather use the oral zinc lozenges or capsules. 

Echinacea

Echinacea increases phagocytosis and increases lymphocyte activity, possibly by promoting the release of tumor necrosis factor (TNF), interleukin-1 (IL-1), and interferon.   If taken daily for more than 8 weeks, Echinacea may lose its ability to work.  Those who find Echinacea helpful at fighting chronic infections may do best if they take it for 8 weeks and go 1 week off the Echinacea.

One issue with herbs is that the effectiveness varies with the product due to factors such as:

a)     The exact species is used

b)     Where the plant was grown

c)     Which part of the plant is used

d)     How the plant was processed

For example a recent study by Barrett (December 2010) showed that a MediHerb Echinacea product containing dried extracts of Echinacea purpurea and Echinacea angustifolia did not make a significant difference when started at the onset of cold symptoms.  Most studies on Echinacea showing a shortening and easing of cold symptoms used Echinacea purpurea. The recent media releases made it sound as if Echinacea had been wholly discredited; whereas, the reality is that we have a study showing one particular product (MediHerb Echinacea) did not work well.  When dealing with medical studies, one must look at the details to avoid being deceived and most studies show Echinacea offers modest degree of benefit.

Echinacea is in the same plant family as ragweed and might have cross-allergenicity for those who have ragweed allergies

Olive Leaf Extract

Olive leaf has infection fighting antimicrobial properties and according to the Alternative Medicine Review it appears to interact with the protein in cold and flu virus to block infection.

Colloidal Silver is a natural antibiotic which kills many organisms which can cause disease including colds. Colloidal silver products are very safe when taken according to the recommended dosage for short periods of time.  Older preparations and home-made colloidal silvers used at higher than recommended doses have caused argyria, a condition that causes the skin to turn blue-gray.  This is not seen with a single commercially made product such as those used by naturally oriented practitioners.  Just to avoid any potential for the colloidal silver building up, I recommend you use it only to clear up an infection and always use no more than the recommended doses.  Colloidal silver should be diluted with at least 8 oz. of water and used no more than 7-10 days.    It can also be added to nasal rinses to help clear up sinus infections.

Grapefruit seed extract: Journal of Orthomolecular Medicine, Volume 5, No. 3, USA, 1990 examined the effects of GSE and compared this with 30 effective antibiotics and 18 proven fungicides.  GSE was found to perform as well as any and all of the tested agents.

Grapefruit seed extract is non-toxic. Most of my experience has been with Nutribiotic Grapefruit Seed Extract Plus, 125 mg- 90 caps. The combination of Grapefruit seed extract, vitamin C, astragalus, and the extracts of Echinacea, Reishi, Maitake, Shiitake, ginger root, goldenseal, and yarrow can be found together in Nutribiotics Defense Plus  

Garlic (Allium sativum): Garlic has antibacterial, antifungal, antiviral and immunostimulant effects

Mushroom fractions: Maitake & Shitake mushrooms are rich in immune boosting components such as beta glucans which help activate the immune systems infection fighting cells such as natural killer (NK) and lymphokine-activated killer (LAK) cells.

Colostrum is the bovine (cow) “fore-milk” or “first milk” which can enhance help in several ways: 

·       Rich with infection fighting IgG-type immunoglobulins

·       Contains lactoferrin which can fight candida.

·       Contains growth factors which may explain why athletes often notice that colostrum can enhancing performance and speed up recovery from injuries.

·       Note: Should not be used if you are allergic to dairy (though lactose-intolerant individuals may use this)

Selected References

Vitamin C  Medical Hypotheses, 7:1359-1376, 1981

Andrographis Paniculata

Puri A, Saxena R, Saxena RP, et al. Immunostimulant agents from Andrographis paniculata. J Nat Prod 1993;56:995-9.

Caceres DD, Hancke JL, Burgos RA, Wikman GK. Prevention of common colds with Andrographis Paniculata dried extract: a pilot, double-blind trial. Phytomedicine 1997;4:101-4

Caceres DD, Hancke JL, Burgos RA, et al. Use of visual analogue scale measurements (VAS) to assess the effectiveness of standardized Andrographis paniculata extract SHA-10 in reducing the symptoms of common cold. A randomized, double-blind, placebo study. Phytomedicine 1999;6:217-23.

Thamlikitkul V, Dechatiwongse T, Theerapong S, et al. Efficacy of Andrographis paniculata, Nees for pharyngotonsillitis in adults. J Med Assoc Thai 1991;74:437-42.

Caceres DD, Hancke JL, Burgos RA, Wikman GK. Prevention of common colds with Andrographis

Melchior J, Palm S, Wikman G. Controlled clinical study of standardized Andrographis paniculata in common cold- a pilot trial. Phytomedicine 1996;97;3:315-8.Paniculata dried extract: a pilot, double-blind trial. Phytomedicine 1997;4:101-4.

Elderberry 

Journal of Alternative and Complementary Medicine Winter1995  

WebMD Medical News: "The Herbal Way to Keep Flu At Bay."

WebMD Medical News: "Flu Widespread Over Nearly Half of U.S." 

Garlic

Ankri S, Mirelman D. Antimicrobial properties of allicin from garlic. Microbes Infect 1999;1:125-9.

Echinacea

B. Barrett, R. Brown, D. Rakel, M. Mundt, T. Ewers Echinacea for Treating the Common Cold A Randomized Trial Ann Intern Med December 20, 2010 vol. 153 no. 12 769-777

Brinkeborn RM, Shah DV, Degenring FH. Echinaforce and other Echinacea fresh plant preparations in the treatment of the common cold. A randomized, placebo controlled, double-blind clinical trial. Phytomedicine 1999;6:1-6.

Barrett BP, Brown RL, Locken K, et al. Treatment of the common cold with unrefined echinacea. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2002; 137:939-46.