OMG – Cold Season Is Here!

What Is A Cold?

A cold is an upper respiratory tract infection that is usually caused by a virus. The upper respiratory tract is the nose to the upper back of the throat, the back of the throat you can see when you say “AHHH”, and everything down where the pipe splits for your gut and your lungs.

Because these are viruses, we really have to just let our immune system do the dirty work. They won’t respond to antibiotics, which kill bacteria only. Antivirals would take 7-10 days to even start working and most colds resolve well before then. This means we must tough it out.

Cold bugs are spread when droplets – small to microscopic beads of fluids and cold bug funk are transferred from one person to another. You cough onto your hand and touch a door – boom droplets. You talk with someone in close quarters and droplets are flying back and forth. Gross, right? Cold viruses in these droplets attach to the upper respiratory tract and set up camp. Get exposed to enough of them and they can overpower the local defenses and cause an infection. They start to “dig in” which causes some pain – the scratchy, sore throat. Then your immune system goes nuts.

Everything we do in cold management is trying to blunt or minimize the overreaction from the immune system while our bodies fight off the infection. Sometimes we can slow the growth and prevent the virus from gaining any traction.

There are a few questions I get asked that I want to present first in ‘lightning round’ answer style:

“Should I go to the doctor/urgent care?”

No. Unless you’ve got severe symptoms – fever over 102 in adults, symptoms persisting more than 10 days (meaning they’re getting worse), difficulty breathing, changing color, growing a shell – you’ve got a cold and need to tough it out.

“Do I have a fever? Should I check for my temperature?”

My usual advice is “who cares?” My bedside manner is atrocious – I don’t know why you people trust me. A fever is a normal part of an infection; your body is trying to cook off the invaders. Obviously, if the fever isn’t breaking or is high, that matters, but measuring your temperature obsessively is mostly unnecessary.

“Is this a flu?”

Heck no. Just because you’re sick in the wintertime doesn’t mean you have the flu. If I put $200 cash on your bedroom door and you are too sick to get up and get it, that’s a flu. And a sign you have to change the locks of your house.

Immune Boosting – Before the Cold

If you missed last week’s episode, we ranted on Boosting the Immune System. Here’s a quick synopsis:

  • The best things to improve immune function are diet, sleep, stress management, and exercise.
  • Vaccines are the only things that behave as true immune boosters – something you take that makes your immune system better than it was without the risk of dying from the disease.
  • People who claim to have immune boosting products are often the ones who don’t understand how the immune system works.

That being said, there are SOME options to give you a slight edge in the immune system arms race:

  • Probiotics – your normal flora is a VITAL part of your immune system, so ensuring your gut health is optimal is a great idea.
  • Immune Support from Nutriplex Formulas – a concentrate of foods rich in nutrients used by the immune system.

The big lesson from that article is that there is a lot we can do to prevent illness, but it doesn’t involve taking a supplement. Handwashing is crucial, as is not exposing yourself to disease (aka stay away from children). Stay home when you are sick. All of these “old-fashioned” things which are “not fun” and “don’t make people millions of dollars by misinforming consumers who just want to be healthy.”

Part of our wrap with the Wellness Pyramid is that people first jump to what they can take instead of asking what they can do. Lifestyle changes will have the most profound impact on so many health concerns that it just can’t be ignored.

Neal’s Recommendations – BEFORE A COLD:

  • Use universal precautions. Assume everything you come in contact with is infected heavily. Wash your hands all day every day.
  • Take your probiotic, get lots of rest, exercise regularly, eat well, stay hydrated.
  • DON’T waste your money on ineffective immune building supplements, especially Vitamin C.

The Start of A Cold – Trouble is Brewing

The first 24-48 hours of a cold is the make or break period for you. Typically you start to feel a little unusually tired. Your throat starts to get a little scratchy or sore. You might feel your nose start to run or a little stuffy behind your eyes. Action you take during this crucial stage will determine how bad you get sick, if at all.

The recommendations of rest, fluids, and proper diet should be a big part of each stage of this journey. I’ll try not to mention it each time 🙂

Zinc Lozenges To understand how zinc lozenges work for helping fight colds, we have to remember that colds are upper respiratory tract infections caused by a virus that is literally trying to build a gated community on the back of your throat. If only we could toilet paper their houses, they may decide they don’t like the neighborhood…

That’s a cool analogy, but are you ready for another awesome Neal analogy? I hope you are! Here goes:

Think of the cold bug like a soccer ball. If your zinc lozenge was a hose and the zinc was the water, we’re trying to spray down each of the soccer balls to get them completely wet. We’re using zinc lozenges to cover cold bugs with zinc. The zinc makes them less likely to adhere to the surface, meaning they slide off into the sarlac pit that is your gut, instead of sticking and reproducing tearing up the back of your throat.

We have to keep at spraying down the soccer balls of destruction. Zinc lozenges are normally used 6 times a day for the first 2 days following the onset of a cold. Don’t eat or drink anything for a half hour after, since you don’t wash away any zinc before it gets a chance to do its thing.

Oral zinc does not have the same impact on colds. While your immune system eats up lots of zinc when it’s running, supplying your body with zinc won’t make the immune system “boosted” or work any better than it does. Zinc lozenges work because of the topical effect – it’s attaching itself directly to the cold bugs.

Quick Defense Every year another report shows echinacea doesn’t do anything for a cold. We agree – most products get it wrong. Quick Defense, however, is a special echinacea product created by Gaia that actually does something. It’s a high dose taken early in a cold to rapidly reduce inflammation and symptoms of a cold. Take 2 capsules 5 times a day for 2 days within the first 72 hours of a cold.

Teas In the spirit of staying hydrated, warm teas with a little ginger and honey can go along way in making you feel good. Ginger gives you a zip, honey gives you a bippity. The warm liquid dilates blood vessels in the upper respiratory tract, helping reduce swelling a bit. The fluids help you flush out the gross stuff. Here are a few good teas to use – individually or in any combo:

  • White Tea
  • Lemongrass teas
  • Ginger
  • Elderflower, elderberry

Neal’s Recommendations – The First 24-72 Hours:

  • Zinc Lozenges – 1 lozenge 6 times daily for the first 48 hours. Keep this stuff in your house like you do a first aid kit.
  • Quick Defense – if the zinc didn’t do it for you after the second day, add the Quick Defense for a 1-2 punch.
  • Drink lots of warm teas, especially with ginger and honey.

We Lost – Symptom Management

If our early interventions didn’t stop the cold dead in its tracks, we move on to the next phase of cold care – symptom management. The infection has set up camp and is multiplying its numbers. Our immune system goes overboard to get this under control. It will take some time to tip the war in our favor, and until then, how we feel is the collateral damage.

An important point to remember. It may seem that we are acting against our immune system when we use agents that suppress cough, reduce inflammation, or kill bacteria or viruses. This is not true. Our immune response is dramatic – almost extreme. Using these agents sort of reduces the drama from yo momma. Blunts the response a bit so you aren’t so symptomatic. Gives you a competitive advantage. The immune system still works and is gaining the memory to fight the infectious buggers.

Whether with traditional or natural options, treating a cold is all about symptom management. Targeted treatments for the symptoms that are bothering you the most. Let’s talk through some of those symptoms and discuss possible treatments.

Sore Throat

The first thing we notice with most colds is a mild to mean sore throat. It’s the freakin’ worst. I will know that I’ve died and put rightfully in Hell if I wake up back in college classes with a bad sore throat.

Upper respiratory tract infections normally do some physical damage, causing a raw or painful sensation.

Besides the zinc lozenges when a sore throat first shows its head, it may be wise to employ some traditional over-the-counter pain meds like acetaminophen or ibuprofen. Not only will they help with the pain, but as we’ll see next, they’ll help with aches and fever as well.

There are other topical sore throat management options. Gargling with warm salt water is old school and gross, but an option. There are a billion different lozenges, including things like Chloraseptic, which is a numbing agent.

From a natural standpoint, we love Gaia’s Throat Shield spray and lozenges or our Throat-Ease. Gaia’s product uses sage and aloe. I’m not saying Gaia’s is better than our own brand, but… yes I am, it’s better.

Neal’s Recommendations – Sore Throat:

  • Acetaminophen or ibuprofen. Get the proper dosage at the pharmacy. Use it! If you take it around the clock while you are sick, you may keep the icky-feelings at bay. It’s not like you get a day off from work if you are sick like in civilized society, right?
  • Gaia Herbs Throat Shield Spray or Lozenges
  • Our Throat-Ease

Fever & Aches

Feeling achy or having a low-grade fever are common with any infection. This is due to a combination of the toxins released by the virus and our immune response. Our body wants to quite literally turn the heat up on the invaders, making the environment one that prohibits their growth.

From a treatment standpoint, there really isn’t anything better than over the counter options like acetaminophen (Tylenol) and ibuprofen (Advil or Motrin). They are effective at reducing the aches, pains, and fever. As long as you follow the directions of your pharmacist or doctor, the dose will be low and the duration short, so any concerns of long-term harm should go out the window.

We don’t like to recommend aspirin for anything but “blood thinning.” Aspirin can increase the risk of Reye’s syndrome, a liver-damaging complication, especially in children with viral infections. That being said, some people only want natural options. I’m just trying to keep it real, so I’ll say they won’t be as effective OR they’ll be aspirin-like. Here are two herbal products that support fever control and aches:

Neal’s Recommendations – Fevers & Aches:

  • Acetaminophen or ibuprofen. Get the proper dosage at the pharmacy. Use it! If you take it around the clock while you are sick, you may keep the icky-feelings at bay. It’s not like you get a day off from work if you are sick like in civilized society, right?
  • DON’T use aspirin.
  • If you HAVE to use a natural product, look to yarrow or willow bark.


One of our first responses to foreign invaders is to dilate blood vessels and make them “leakier.” This allows immune cells to move in and out of an infected space quickly. Fluid leaks out of our blood vessels and into the surrounding spaces. When this happens in your upper respiratory tract, the fluid leaks into the sinuses.

We know what congestion feels like. Stuffy noses are a rite of passage. A pearl of wisdom for you loyal readers: you can have no stuffy nose and still have sinus congestion. Behind our nose is a big sinus (sinus means cavity), but it is just one 4 major sinuses in our head. These areas can fill up but NOT our maxillary – the one behind our nose. This means you can be congested and not have a stuffy nose. This congestion pushes on your eustachian tubes (connects to your ear) causing pressure there, or it can start to leak down the back of your throat causing a cough. Picture vs 1,000 words, coming up:

Therapeutic agents that reduce that congestion will normally constrict those blood vessels, making them a bit less leaky, albeit temporarily. From a traditional standpoint, that’s pseudoephedrine or phenylephrine (Sudafed). The problem with vasoconstrictors is that they work everywhere – elevating blood pressure and heart rate. Not something everyone should want to have happen. If your heart can stand it, these traditional decongestants are great.

We do have an excellent option that isn’t a direct stimulant. Instead, it relies on vapors from aromatic foods to open airways. Sinus Blaster is a combination of horseradish, garlic, peppermint oil, cayenne, and other herbs. It has a distinct taste; we used to say that people get better so they don’t have to take it anymore. It is our #1 cough and cold seller and many people love it. Fair warning, it can be a bit stimulating so it should be used with caution if you have any cardiovascular issues.

Neal’s Recommendations – Fevers & Aches:

  • Sinus Blaster liquid – Take 1 dropperful by mouth 3-6 times a day as needed. Don’t put this up your nose. Please. Someone has and it hurts.
  • Pseudoephedrine or phenylephrine if you’re healthy enough and the congestion is really bad.


The worst part of a cold for many isn’t the sore throat that I whine about, but the cough. It’s irritating at times. You can pull muscles. It takes lots of energy to do. It keeps you up at night. Did I say it is irritating?

Problem is, cough is a very crucial protective reflex our body uses.

We cough because of the inflammatory immune response in the bronchioles (the tubes in our lungs) produces extra fluid. Our body is trying to cough up the gunk and keep the lungs clear, with the ultimate goal of preventing strong bacteria from setting up shop in those new “lakes” of mucus.

Sometimes our cough reflex goes a bit nuts.

There are different ways to reduce this overactive cough reflex. Products that reduce cough are called antitussives or cough suppressants. Some antitussives work in the brain and increase the “cough threshold”. Basically, our body has a cough trigger point. Once the signal from the lungs is strong enough to trigger this part of the brain, you cough. We can use certain medicines to make this trigger a bit higher, so it requires a stronger signal to get you to cough. The reflex never goes away completely, and in cases of cough and cold the nerves get a bit hypersensitive anyway and could use an attitude adjustment.

Another strategy in managing cough is to break up the gunk that is triggering coughs in the first place. These products are called expectorants, and the belief is they “thin” the mucus, making the cough more productive – more stuff comes out with each cough.

With many upper respiratory tract infections, the cough isn’t necessarily triggered by anything going on in the lungs. Instead, congestion in the sinus cavities leads to a post-nasal drip. As we said before, your nose may not be stuffy yet you may have sinus congestion. Small amounts – almost unnoticeable at times – of fluid is leaking down the back of your throat. This triggers cough reflex, sort of like how some people with reflux can cough. Medicines that have a drying effect can help out with this, or directly treating sinus congestion may reduce cough.

The strongest antitussive over-the-counter is dextromethorphan (the DM in Mucinex or Robitussin DM). There are a number of herbal products that have antitussive properties, like Wild Cherry Bark.

From an expectorant standpoint, guaifenesin is the traditional workhorse. I prefer Mucinex Extra Strength as a pharmacist. It’s a slow release, high dose of guaifenesin; you’d have to drink nearly a gallon of the liquid to get the proper dose and take it every 4 hours to equal 1 of those twice daily.

Some herbs have expectorant properties. These include anise seed, fenugreek, and yerba santa.

Neal’s Recommendations – Cough:

  • I go 50/50 for my recommendations on cough. Both our Cough Syrup or something traditional like Mucinex Extra Strength are great options.
  • If you want a lil’ pep in your step, check out Ginger Zinger Cough .
  • Most importantly, pump up the fluids. Use a vaporizer/humidifier. Prop up your mattress by putting a comforter or thick blanket between the boxspring and mattress. This little angle may be enough to keep gravity on your side and keep your cough from bothering you.
  • If post-nasal drip is a concern, a drying antihistamine like Benadryl before bed might be all you need, or an herb like Osha or Nettles may do the trick.

Other Products Used For Cough and Cold Season

There are many other products that are used for cough and colds that don’t fit into one of those categories or aren’t on the top of my recommendations.

The big one is elderberry. We definitely recommend it, there just wasn’t a good place for it.

Elderberry syrups like ours are made with mega-concentrates of the cooked elderberry fruit. It is believed that these concentrates help reduce flu symptoms. There seems to be some good data around this, so we’re on board with it.

We go pretty hard with the quality of our herbs, and we’re pretty proud of our brand of elderberry. It uses over 3 grams (that’s a lot) of organicwhole fruit. National, leading brands use about half the weight of just the fruit juice, not the whole fruit. Plus, because elderberry is a bit bitter, they put in 4g of sugar per teaspoon.

If you are DIY elderberry, the above is important to remember. The doses are HUGE. The berry can be used, but it has to be cooked. The other parts of the plant and uncooked berries can be poisonous. So, ya know, be careful.

Here’s a list of other common products that aren’t at the top of my recommendations but many people use this time of year. Use is completely fine, I just recommend you get a high-quality product because herbal quality is hard to come by.

Kids & Colds

For the sake of thoroughness, let’s discuss kids.

They are stuck and have to suffer. We did, right? We walked uphill, both ways…

Unfortunately, lots of our recommendations are for adults only. Zinc lozenges can change kid’s taste receptors. Cough medicines have not enough evidence that they work in kids and are therefore not recommended for anyone under 12.

We normally don’t recommend herbs for youngsters, usually due to a lack of evidence and safety data. Their organs are developing and could possibly handle some herbs differently than developed adults.

In my kids, we usually just hit them up with acetaminophen or ibuprofen. They’re the worst when it comes to cough. They cough so hard and forcefully, they vomit. Every. Time. And there are 4 of them, so normally 2 or more of them are sick simultaneously. We have vaporizers running constantly. We’ll even use small doses of Benadryl to help dry them out. Speak to your pediatrician or pharmacist for the right dose for all of the traditional options.

We have 2 herbal blends that are formulated just for cough and cold support in kids: Kid’s Biotic and Kid’s Echinacea.

With kids though, it’s best to nurse the cold. Lots of rest, warm fluids. A teaspoon of honey here or there.

What NOT To Do For Cough and Cold

I want to touch on a few warnings around cough and cold management, then we’re done here.

Don’t Take Too Much

You can get too much of a good thing. Overdosing on cough products is a real problem. Many cough and cold products will be combinations of ingredients that people may also be getting from other products they are taking to manage their colds, or even other conditions.  

It may be helpful to double check with an expert (aka me!) or at least write out the ingredients to make sure you are not doubling up inadvertently.

Secondly, there are some products that are “day” vs “night” oriented. Daytime products normally have stimulants and nighttime products will have small amounts of alcohol and sedating ingredients. Be careful with these. Don’t take your daytime stuff with a pot of coffee. Don’t take your Nyquil with a dozen margaritas.

Don’t Bother With Vitamin C

Vitamin C doesn’t help you not get sick. Vitamin C rich foods, especially citrus ones, can make us feel better because they are super awesome – they have lots of water and naturally pep-you-uppers like sugar and essential oils.  

Don’t Bother With Airborne

“But it was developed by a teacher!”  I’d rather have an engineer develop my TV than someone who lays around watching Netflix all day. Airborne is a homeopathic product that has no pharmacologically active ingredient and has never been proven to do anything for your cold except force you to drink more fluids, which helps people feel better anyway.  /end rant

Don’t Take Antibiotics

Most colds are viruses.  Antibiotics won’t help. It’s rare that a cold will mutate into a serious bacterial infection, but it does happen.  If your symptoms persist or worsen after 7 days or so, there’s a chance you have a secondary bacterial infection.

Don’t Go To Work

Stay home.  You are sick.  Your job can wait.  (Thanks for the reminder Alan!)

You Will Survive

As we discussed in our immune system article, an active cold infection might last 3-10 days tops, but the gunky-yucky stuff may take up to 2 weeks to clear out of your system. Eventually, though, you’ll make it.

The default warnings apply here: I’m giving general advice and broad recommendations. Your mileage may vary. Get expert advice from someone who knows you best, like your doctor or your pharmacist (even if they work for the chain pharmacies, some of them are alright I guess).

For the sake of brevity, here are the best of my recommendations:

  • First signs of a cold – Zinc Lozenges 6 times a day for 2-3 days. Switch to Quick Defense if that didn’t work, 2 caps 5 times daily for 2 days.
  • Fever, aches, pains, sore throat – use those OTC pain meds. Talk to an expert about the best choice and dose for you.
  • Congestion – Sinus Blaster full stop.
  • Cough – Cough Syrup, or if you want a big pill to swallow, Mucinex Extra Strength
  • All the time: Fluids, good diet, elevate the head of your mattress, use a humidifier or vaporizer at night. And for Vitality’s sake – REST

Just trying to keep it real…

Neal Smoller, PharmD
Owner, Pharmacist, Big Mouth

Dr. Neal Smoller, Holistic Pharmacist

About Neal Smoller

Dr. Neal Smoller, PharmD, is a licensed pharmacist: and owner of Village Apothecary, an independent pharmacy in the most famous small town in America—Woodstock, NY. He’s also the host of the popular wellness podcast, The Big Mouth Pharmacist.”


The Vital 5

Nutrients you shouldn’t live without
The Vital 5 Nutrients You Shouldn't Live Without