From the April 2000 Issue of Nutrition Science News
by David Wolfson, ND
Natural remedies to clear congestion
Remember the cacophonous honking sounds Felix Unger made on the television sitcom The Odd Couple? Those strange nasal vocalizations that drove his roommate Oscar crazy were poor Felix's attempts to clear his perpetually blocked sinuses. Some 35 million Americans could relatethey also suffer from the common upper respiratory condition known as sinusitis.  Hardly a laughing matter, sinusitis can cause debilitating pain and sometimes serious or life-threatening complications.
Sinuses are hollow cavities in the bones surrounding the nasal passages. There are four groups: the maxillary, frontal, ethmoid and sphenoid (see diagram). Sinusitis occurs when the mucous membranes lining these cavities become inflamed. Sinusitis is usually categorized as acute or chronic depending on its duration. Acute sinusitis lasts less than four weeks, while chronic sinusitis generally persists for longer than 12 weeks.  Both forms have similar symptoms that may include nasal discharge, post-nasal drip and pain in the area of the involved sinus(es).
Acute sinusitis is most frequently a complication of a viral upper respiratory infection (URI), such as a common cold. In most cases, acute sinusitis symptoms clear up within five to seven daysthe time it takes for most URIs to resolve. In 1 to 2 percent of cases a bacterial infection may supersede the original viral infection and cause bacterial sinusitisa much more serious condition.
Some of the blood vessels lining the sinuses lead directly to the brain. A bacterial infection of the sinuses can, in a worst-case scenario, spread to the brain via these vessels and cause a serious and potentially fatal form of meningitis. A customer who complains of fever and chills, worsened symptoms after five to seven days, or symptoms lasting beyond 10 days should be referred to a health care provider.
The therapeutic goal for acute sinusitis is to clear the URI and reestablish proper sinus drainage. Most doctors prescribe antibiotics. This practice, however, is being scrutinized because most cases of acute sinusitis are viral and therefore not responsive to antibiotics. There is also growing concern among doctors that antibiotic overuse is causing a proliferation of antibiotic-resistant bacterial strains. [2, 3]
A better strategy is to strengthen the immune system so it can counteract the underlying respiratory infection. Several nutrients can help your customers with acute sinusitis.
Vitamin A, sometimes called the anti-infective vitamin because of its vital role in immune function, reduces morbidity associated with respiratory infections. It also supports the health of epithelial tissues such as those lining the sinuses. 
Vitamin C enhances many aspects of immune function and in clinical studies reduced the duration and severity of respiratory infections. [5, 6] Vitamin C with bioflavonoids may help shrink sinus membrane swelling by decreasing vascular permeability. 
Vitamin E is concentrated in immune cells and helps them function.  Studies show that supplementing with vitamin E can help improve immune response to infection. 
Zinc is a potent immune-supporting nutrient. It inhibits growth of infectious viruses while enhancing growth and function of a variety of immune cells. [9, 10] Clinical trials show zinc effectively combats upper respiratory infections. 
Botanicals also stimulate immune function and can be taken at the first signs of infection. Here are a few to recommend.
Berberine-containing herbs, such as Oregon grape (Berberis aquifolium) and barberry (Berberis vulgaris), support immune function and have antimicrobial action. Berberine is an alkaloid that prevents bacteria from adhering to epithelial tissues.  I recommend tinctures for their concentrated strength.
Echinacea (Echinacea angustifolia, E. pallida, E. purpurea) is a popular and effective remedy against infectious diseases. Echinacea functions mainly by boosting immune cell performance, but the herb also has direct antimicrobial activity.  For a broad spectrum of echinacea activity, I recommend products with a combination of plant species and parts. Echinacea and berberine-containing herbs can be taken alone or in combination.
Chronic sinusitis usually coincides with long-standing allergies or exposure to respiratory irritants. It is marked by degenerative changes in the sinus membranes that impair proper sinus drainage. The primary therapeutic goal for chronic sinusitis is to minimize exposure to the offending allergens or irritants. Advise customers to begin by filtering the air they breathe at home and at work with a high-quality air filter. High Efficiency Particulate Air (HEPA) filters are said to be the most effective at removing pollens, dust, dander and other particulate matter.  I advise against air cleaners that generate ozone because this gas can irritate, and possibly damage, the lining of the respiratory tract. 
One of the most ubiquitous allergens that exacerbates many allergic conditions is the household dust mite. Dust mites thrive on human skin flakes and proliferate in carpets, mattresses and bedding materials. Coach customers to minimize dust mite populations by reducing household humidity, minimizing carpeted areas, covering mattresses with plastic and regularly washing sheets, pillow cases and blankets in hot water.
Removing food allergens from the diet also can be an important factor in alleviating sinusitis. According to James C. Breneman, M.D., a pioneer in food allergy study, nasal and sinus membranes readily respond to food allergens, becoming swollen and subject to frequent infections. Foods commonly cited as causing upper respiratory problems include milk, eggs, corn, wheat, chocolate and citrus fruits, particularly oranges. 
Nutrients also can be helpful in alleviating chronic sinusitis. Consider the immune-supporting nutrients mentioned for acute sinusitis at lower doses if recurrent sinus infections are part of your customer's symptom picture (see dose chart, p. 162). Antioxidants also appear to help treat chronic sinusitis. Researchers at the University Hospital Vrije Universiteit in Amsterdam, The Netherlands, examined mucosal samples from nine patients with chronic sinusitis and, compared with samples from healthy controls, found them to be lower in the antioxidants glutathione, uric acid and vitamin E. Of these, glutathione and uric acid were the most depleted. 
Glutathione, in its reduced form, plays a vital role in many antioxidant and detoxification processes. Reduced glutathione can be taken as a supplement, but because there is some controversy over its absorbability,  I recommend taking a combination of reduced glutathione, N-acetyl-cysteine (NAC, a glutathione precursor) and vitamin C. Both NAC and vitamin C raise glutathione levels. [19, 20] Plus, NAC has the added benefit of being a mucus-thinning agent, thereby interfering with bacteria's ability to adhere to mucous membranes. 
Uric acid is now recognized as an important, water-soluble antioxidant, but raising its levels may not be desirable because excess uric acid is associated with gout. However, normal uric acid metabolism is dependent upon several B vitamins and the mineral molybdenum,  so recommend a multivitamin/mineral supplement that includes these nutrients.
Herbs that reduce allergic symptoms and decongest nasal passages can help people with chronic sinusitis. Customers can benefit from a consultation with an herbalist or health care provider before self-medicating.
Ephedra (Ephedra sinica), also known as ma huang, contains ephedrine, a potent alkaloid with decongestant properties, which makes it useful for a variety of respiratory conditions. I recommend this herb when extra decongestion is needed. Ephedra should be used under the supervision of a health care provider because large doses or prolonged use can cause side effects including heart palpitations, nervousness, insomnia, hyperglycemia, headache and elevated blood pressure.  Pregnant customers and those with diabetes, cardiovascular disease or who take medication should always consult with a health care professional before using this herb.
Stinging nettle (Urtica dioi
ca) also seems to be an effective anti-allergy herb. One double-blind clinical trial conducted at the National College of Naturopathic Medicine in Portland, Ore., showed stinging nettle helped reduce allergic symptoms in a group of 69 hay fever sufferers. Participants took 300 mg of an encapsulated, freeze-dried form of the herb two to three times daily for one week. Of the subjects taking stinging nettle, 58 percent rated it moderately or highly effective compared with 37 percent of those taking placebo, a statistically significant difference. 
Sinusitis is a common problem, but one that is amenable to natural therapies. Help your customers alleviate their symptoms, and possibly avoid more serious complications, by recommending dietary and lifestyle modifications and pointing them in the direction of helpful nutritional and herbal supplements.
Enzymes to the Rescue
Squelching Sinusitis: A Daily Dose Chart
David Wolfson, N.D., is a naturopathic physician, nutrition educator and consultant to the natural products industry.
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