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When 45-year-old Emma, a nurse, anticipates the onset of winter, there is one must-have product on her shopping list.
Despite a career steeped in medical science, her fail-safe remedy is a herbal one. It's Comvita's Olive Leaf Extract, and she swears by it. It is packed full of antioxidants. Her three children and husband are also dosed up at the first sign of a runny nose. During the past two years they have used four bottles - a cost of $180 all up is not to be sniffed at.
What makes Emma's dedication interesting is that there is currently no hard scientific evidence that this preparation works. Despite this, Emma is convinced that the olive-leaf preparation shortens the duration of her family's colds and helps them avoid the next level of treatment: antibiotics.
Emma and thousands of well- educated, middle-aged New Zealanders like her spend staggering sums on unproven herbal preparations. Many of these natural health products can help, but equally others have no value at all.
Young children succumb to about 12 colds a year. This statistic improves with age as our immunity increases and by adulthood the incidence has dropped to about three a year.
The common cold is a leading cause of visits to the doctor and absenteeism from school and work, with significant cost to the individual and our economy.
Olive leaf products, such as the one Emma uses, have captured 7 per cent of the New Zealand cold and flu market in the past year. Sales have overtaken garlic and echinacea products.
Blackmore's brand marketing manager, Lisa Munroe, indicates we are increasingly seeking remedies to banish the winter snuffles.
Total sales of natural cold and flu remedies are growing at an average of 5 per cent a year in New Zealand and statistics are similar in Australia.
But is it really possible to prevent colds? Can we actually reduce the severity of the symptoms or the amount of time we will be lying on the couch cuddling a box of tissues?
We know that traditional medicine is of limited use, except for the flu injection, which is highly effective at preventing influenza.
We also know that consumers are bombarded with advertisements promising "scientifically proven" remedies and "immune support", many of which have been shown to be ineffective.
So what are the safe options that will actually do what they promise on the packet?
ZINC
Last year, a systematic meta-analysis of studies (the "gold-standard" in scientific research) conducted by the independent Cochrane Collaboration found that zinc lozenges definitively reduce the duration and severity of cold symptoms. The research found that when administered within 24 hours of the onset of symptoms, zinc lozenges reduce the duration and severity of symptoms. The lozenges were taken two to three hourly when awake and were of varying strengths (minimum 13mg). Zinc can also be used as a preventer for five months continuously but this clearly requires some degree of commitment. Used in this way, zinc significantly reduced the number of colds a year, the number of days off school and the amount of antibiotics prescribed to children. Many of the products available over the counter use sub-therapeutic doses that won't provide enough zinc to be effective. This is more likely if you are buying a product that combines zinc, for example, with several vitamins. However, pure zinc lozenges aren't readily available in New Zealand, so other options include a combination lozenge such as Pro-Life's Cold-Ez or a pure zinc tablet, such as Thompson's OptiZinc. Data about potential side-effects and interactions is encouraging, so for me it is a good winter choice.
ECHINACEA
Again, a meta-analysis of studies has shown that echinacea, a popular herbal preparation, taken at a dose of 700mg three times daily, is effective at preventing and treating colds. Echinacea will reduce the likelihood of getting a cold by almost two-thirds and will reduce the duration of symptoms by an average of 1.5 days. Hataitai pharmacist Kelvin Lim says that, despite these impressive statistics, sales of echinacea products have dropped during the past few years. Whether this is because of the emergence of newer products, such as olive leaf, or the rather unpalatable taste of echinacea drops, he is not sure. It is worth noting that the dose used in this study is significantly higher than the dose in most combination products containing echinacea. Buy pure or strong echinacea, such as Blackmore's Echinacea forte, for the best effect. There have been some concerns raised about using echinacea as a preventer during winter. In a few people, continuous use for months at a time has been shown to lead to hepatotoxicity or liver damage. Consider using it for a few days at a time only and check with your pharmacist before taking it, especially if you are on other medications or have a history of liver problems.
VITAMIN C
The news isn't as good for people who swear by vitamin C. According to Victoria University's Professor Shaun Holt, for most of us, taking daily vitamin C tablets is unlikely to reduce the number of colds. In his book, Natural Remedies that Really Work, he acknowledges that vitamin C may work in certain circumstances, such as during periods of intense exercise or very cold weather. The doses used in the studies are high (2000mg daily) and there are some concerns over the safety of vitamin C at this level, especially if you are on other medications. The studies also look at how effective vitamin C is at reducing the duration of cold symptoms. If started before symptoms appear, there is a mere 14 per cent reduction. Despite this, vitamin C products still capture more than 50 per cent of the cold and flu market.
GARLIC
For centuries, garlic has been a popular home cure for colds. It may even be the basis for all those chicken-soup theories (the soup usually contains garlic). However, a 2012 report in the Cochrane database, which collated all previous studies on the use of garlic, concludes that "there is insufficient clinical trial evidence regarding the effects of garlic in preventing or treating the common cold". Possible side-effects at high doses include dizziness, sweating, headaches, fever and chills. It can also interact with other medications, most notably warfarin and aspirin, and should be avoided before any surgery because of the risk of bleeding. Given these concerns, it is not a convincing option for winter until further research has been carried out.
GINSENG
Although popular, especially in combination form, there are concerns about its safety at high doses and its effectiveness. It can interact with medications in a similar way to garlic. Perhaps it shouldn't be top of the list at present.
VITAMIN D
The jury is out on vitamin D for colds and flu but it is being researched globally so the next few years will bring some answers. Its use in protecting against bone loss, or osteoporosis, is not disputed and it is likely to have other health benefits. One large study shows that people with higher levels of vitamin D are far less likely to get cold and flu bugs. But it doesn't necessarily follow that taking a vitamin D supplement will have the same effect. The results of the study are even more pronounced in people with asthma. Watch this space.
SYMPTOM RELIEF
So if you haven't successfully prevented a cold, is there anything you can do to feel better? The good news is that standard home-brand honey is probably going to give as much relief as anything else, especially if your child has a tickly night-time cough. Good studies have shown this to be more effective (and a lot cheaper and safer) than cough syrups containing the common ingredient dextromethorphan. Paracetamol or ibuprofen can be safely used in most people to reduce fever, inflammation and general achiness. Keep hydrated and seek medical help if your symptoms worsen rather than improve.
And if you're not a believer in natural health products, don't despair.
An American study published in 2006 proved once again that exercise is so often the key to well-being. Regular exercise can support a healthy immune system and aid in fighting infections. The research found that a group of women who exercised five times a week were three times less likely to catch colds or flu in winter.
Diet is similarly important. A well- balanced diet, incorporating fresh fruit, vegetables, fish, iron and other essential foods will help your general physical health and reduce your risk of succumbing to any bugs doing the rounds. Talk to your doctor or pharmacist if you are concerned about your diet. They may suggest a daily multivitamin supplement or omega fish oil.
So are there any pitfalls to consider when buying these products, other than the damage to our wallets?
The main concerns around "natural health products" revolve around safety. Just because a product is "natural" doesn't necessarily mean it is safe. There are possibilities of interactions with other medications, side effects and toxicity.
The Government's proposed Natural Health Products Bill, under review at the moment, will tighten the rules and regulations around all over-the-counter medications, ensuring that products are clearly and accurately labelled.
Following these basic tips should help avoid these pitfalls:
* Read the label. Know exactly what is in the product and at what dosages. If you are taking a scientific approach, you need to know the dose is going to be adequate for your purposes. Go for a single active ingredient rather than a combination, or you may end up with an expensive, but ineffective, cocktail. If a product isn't clearly labelled, be wary of what it may, or may not, contain.
* Don't believe the advertising. Ask an unbiased professional with a scientific background. Most doctors or pharmacists should be able to find out the information you require. Good websites to visit for more information include altmedicine.about.com and naturalhealthreview.org.
* Ask about interactions, especially if you are on any other medications or about to have surgery.
* Ensure it is safe for children. They are not simply smaller versions of adults and it is never safe to assume a product will be safe for a child if it is only recommended in adults.
* Use the doses that have been shown to work and stick to the suggested timings. Using less than this will likely be under-dosing and you may miss out on all the beneficial effects.
* Use a product that contains predominantly the active ingredient that you want. Combinations often lead to dilution of not only the active substances but also the effect they may have.
* Always buy locally made products. Although there may be cheaper options available on-line, products manufactured outside Australasia are not subject to the same regulations. They may have variable levels of the active ingredient in them and will often contain other substances that aren't listed on the packet. Stick to reputable brands.
* Don't listen to your friends, unless you are sharing recipes or discussing matters of the heart. When it comes to talking natural therapies you are likely to get a wide range of diverse, and sometimes heated, opinions. Your friends or family may well have wonderful stories of the amazing remedy they took last year and how remarkable it was that they never got sick. There is a high likelihood they were going to have a cold-free winter that year anyway and that the natural product they chose had nothing to do with it. Different products don't necessarily suit us all, so make a choice with all the unbiased information you can find out about what will best suit you and your situation.
* Finally, don't rely on any product if you are becoming more unwell. Always seek medical advice if symptoms aren't improving as expected.
So, what will be sitting on Professor Holt's kitchen bench this winter?
"A packet or two of zinc lozenges to be taken at the first sign of a runny nose."
I'm heading down the road to buy mine now and will be storing them between the honey and the fruit bowl, next to my walking shoes and the paracetamol tablets.
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