Thursday, November 17, 2011

Cold Remidies: What Works and What Doesn't

Cold and flu season has begun yet again. And people take a whole slew of medications, some with nasty side effects, to try and get themselves through it. What works and what doesn't? As a biologist and as a parent, I have paid close attention to this topic and want to share some of my conclusions.

First of all beware of any "natural" or "homeopathic" remedies. It isn't that none of them are helpful...but there is absolutely no regulation of them and they have no obligation to back up their claims with facts. A lot of these remedies are basically based on nothing with no facts, no evidence and often just plain made up claims to see what used to be called "snake oil": basically a quack remedy.

An example is Echinacea. This was touted some years back as a hugely effective "natural" cold cure. But when people actually studied it they found it had no more effectiveness than a sugar pill. There is no evidence that Echinacea works. Back then I tried it and found it didn't help me at all. And when the scientific evidence came out I knew didn't help me because it doesn't do anything for a cold.

But it isn't just "natural" remedies you need to be suspicious of. Many cold medicines have so-called "cough suppressants." Supposedly these calm your cough. Again I never found they worked that well, or at best inconsistently. Well, turns out actual scientific studies show these over-the-counter "cough suppressants" are about as effective as Echinacea...which means not at all. This was research published in a top scientific journal, and yet we are still being sold "cough suppressants" which are basically ineffective. PLUS they have nasty side effects. My advice is don't buy a cold medication that contains a supposed "cough suppressant."

So what does work?

Cold medication contain three basic ingredients that DO work: analgesics, decongestants and antihistamines.

Analgesics are basically pain relievers. Some can also reliever fever and inflammation. There are three basic types: aspirin, acetaminophen, and ibuprofen. All of them work. Aspirin has the side effect of irritating the stomach and so isn't used so much any more. Acetaminophen works well but has a major problem in that its effective dose is awfully close to its dangerous dose. Many people who overuse cold medication wind up overdosing on acetaminophen. This can destroy your liver. It is fine to take a medication with acetaminophen, but NEVER take more than the recommended dose. The best analgesic is ibuprofen. It is the most effective, relieves the most symptoms, and can be taken in relatively high doses. For any kind of pain relief or illness, ibuprofen should be part of your medication. Not only does it relieve pain, but it inhibits something called prostaglandins. These are chemicals your body makes that are part of the pain response and are one of the main reasons you just plain feel awful when you have a cold or flu. Taking ibuprofen won't cure your cold or flu but will make you feel much better. It also, like aspirin and acetaminophen, lowers fever. That is particularly critical in children. I remember once when my son had a fever. We had medicated him but we were out and it wore off before we could get home. He suddenly became very listless and miserable, and I felt his forehead and could tell his fever had shot up. We went right to the nearest store and bought some children's ibuprofen and gave it to him. Within an hour he was feeling much better and his fever came down. This isn't just about making him feel better either. Fevers, back before analgesics, could kill people, particularly children. In the old days, the level of fever my kid had that day would have been very dangerous. Today, with analgesics, fevers don't kill people anymore except in very rare cases.

So, ibuprofen is one of the best medications you can take when you have a cold or flu. Or, for that matter, almost any kind of pain. But you can even boost its effectiveness. If you take a regular or below recommended (NEVER above recommended) dose of acetaminophen along with a regular or even say 1 and a half dose of ibuprofen, the two do something called synergize. They work far far better together than apart. Together they relieve pain, fever and that general ill feeling amazingly well. Since most cold medicines for some reason use acetaminophen, then taking a regular dose of a cold remedy along with some ibuprofen can really help you. Just avoid the cold remedies with so-called "cough suppressants."

Decongestants are kind of a mixed blessing I feel. They basically dry you out. This means if you have a stuffy nose, that will go away for awhile. But it doesn't really clear you up permanently. It just dries you out temporarily. As long as you are still sick, that stuffiness will come back all the worse once the decongestant wears off. And while it is effective you feel dried out, which in itself can be irritating. Still, if I have something I really have to do that day, I take a decongestant. Furthermore, if you need to be awake, cold medicines with decongestants tend to make you slightly speedy and this can counteract the drowsy effects of the next medication: antihistamines.

I mentioned above prostaglandins above as one of the chemicals in your body that just plain make you feel awful. Histamines are another kind of "bad-feeling" chemical. That watery eyed, stuffy, allergic feeling is caused by histamines. Antihistamines inhibit this, making you feel better. They work well. But they also make you sleepy. This is great if you can stay home in bed. If you can, do so and take an antihistamine along with some ibuprofen and acetaminophen and go to bed. Do this for a day or two and your cold or flu will clear up MUCH faster because you are giving your body a chance to fight it off. That combination is your best bet for over the counter drugs. Check the packaging. If it has acetaminophen and an antihistamine, take it along with a separate dose of ibuprofen. By the way, for all of these go for generics. They are cheaper and just as effective. Just check the label for what the medication contains and what dose. Some generics are lower dosage, but most are the same medicine, same dosage, just cheaper than name brands.

Avoid antibiotics if you have a cold or flu. They don't do ANYTHING for cold or flu (which are caused by viruses, not bacteria) and can actually make you worse. That said, sometimes when you have a cold or flu you get what is called a "secondary infection." THESE can often be treated with antibiotics. But don't take an antibiotic UNLESS a doctor tells you specifically you have a secondary infection. One way you can tell if you have a bacterial infection (which would require an antibiotic) rather than a viral infection is if you are producing a greenish liquid. For example, an eye infection that oozes a clear or white liquid is probably viral. If the liquid is green it is probably bacterial. This has to do with what kind of white blood cells respond to the infection (a cell called a neutrophil produces the green color). In general though don't take an antibiotic unless there is evidence of a bacterial infection. It can actually make things worse. Antibiotics are way overused in America and it leads to major problems.

What else? Drink lots of water, tea, juice, etc. These mostly keep you hydrated. Your body gets dehydrated when sick because it is under so much stress and you probably aren't eating and drinking as much. So make an effort to drink these things.

What about zinc? Evidence I have seen suggests it works for colds (not flu?) if taken with the very early symptoms. It makes it harder for the virus to actually infect the next cell. Taking a medication with Zinc can help if taken at the right time.

Vitamin C? Evidence shows that taking vitamin C, particularly if you are taking it before infection, can reduce both severity and duration of a cold. It isn't a cure all, and don't take megadoses. But a regular dose of vitamin C can help you avoid and keep colds to a minimum.

I have found that the EmergenC Immune Defense packets, if I start taking one or two a day either at the FIRST sign I may be getting sick or when people around me are sick, helps to keep me from getting very sick. It has both vitamin C and Zinc and I think these are what do it...the rest of its ingredients may well be just window dressing. For example, the elderberry and hibiscus extracts in it probably do nothing at all. But it is a convenient way to not only get the vitamin C and Zinc that WILL help, but also, since it is taken in water, it can help to keep you hydrated. I am not so fond of the taste so I dilute it down a lot when I drink it, really making it a chance to hydrate. I think this combination of vitamin C, zinc and proper hydration help my body keep the cold at least partly at bay.

Another thing I think is important is controlling mold in your home. This may sound unrelated, but mold creates a constant irritation to your lungs. The combination of a cold or flu and the presence of mold in your apartment can create a situation where you get a persistent cough that won't really go away until you get away from the mold. It is like the combination of a cold or flu and mold puts your body's immune system into overdrive and it starts in a small way (sometimes large) hurting your own body. You almost become permanently sick. This is an oversimplification, but there is evidence that it is roughly true. I have experienced this personally. When my apartment was, over several years, experiencing leaks we had persistent mold problems. I considered it mostly cosmetic. But I also noticed that any time I got a cold it just would not go away completely until I visited a drier climate (which would mean less mold). Then it would go away until the next cold. By now we have dealt with all the leaks and the mold. Once those were dealt with I stopped getting the persistent coughs. It could be coincidence, but from what I have learned it probably is connected. To find out how to combat mold in your home, read my article on mold and mildew.

Colds and flu are a fact of life. They are viruses that evolve very quickly, so our immune responses grow ineffective against them. Antibiotics do nothing against them. So mostly what you are doing is relieving the symptoms of the illness so you feel better, keeping fever down because that can actually be dangerous, and giving your body a chance, through hydration, rest (that is one way antihistamines can help), vitamin C and zinc, to fight off the virus on its own.

Always remember that if a cold or flu lasts too long, or your fever gets really high, SEE A DOCTOR. When one illness hits you it can make you more susceptible to other, worse illnesses and those can be serious if not treated.

If you take nothing else away from this article always remember, NEVER take more than the recommended dose of acetaminophen, ibuprofen is the best analgesic, ibuprofen and acetaminophen taken together in modest doses work extra effectively, and don't bother ever with so-called "cough suppressants." Antibiotics don't help a cold or flu, though if the doctor finds evidence of a bacterial secondary infection, THEN it can help. Also antihistamines work well but they will put you to sleep unless also taken with a decongestant.

Also flu shots DO help. Not always, since the flu virus evolves quickly and the vaccine is designed based on the previous year's viruses, but it does help, sometimes quite a bit. I advise getting them.

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