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Shortening Your Cold

by Stephen Propatier

January 13, 2016

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Donate The holidays can bring joy to individuals. Unfortunately joy is not the only thing brought into your home on the holidays: getting together with family and friends isalso a big part of spreadingthe cold virus. The common coldis actually a variety of self-limiting viral infections. The most common type is the rhinovirus. Rhinovirusesalways exist in the environment and you can get them any time of year. In winter, several factors promote the spread of the common cold. In particular, peopleare mostly indoors, in dry air environments, and we tend to spend a lot of time in groups, such as children in school, parties, and holiday shopping. All of these factors tend to promote the spread of the common cold. For a variety of reasons there is no cure for the common cold. The good news is that colds are self-limiting, and only with extreme rarity can theycause a complications that lead to more serious illness.

A cold can make you feel miserable. It can also be persistent; the duration varies but is typically about sevento 10 days. A cold is really more of a group description than a specificdisease. Realistically, it is a self-limiting upper respiratory viral infection with a low complication rate. Antibiotics do not help viral infections. Most anti-viral medications are organism specific and often they have too many complications to beworthwhileas acold treatment.

The only effective medications for the common cold are symptomatic treatments such as decongestants and cough suppressants. They also carry some risks and their effectiveness varies greatly. For the most part you have to wait out a cold and give your body's defenses their best chance to defeat the invading organism. It's well known that such viral infections needhydration and rest, but are there other less conventional options for treating the common cold?

For years,vitamin C laid claim to the title of Cold Shortener. Despite mountains of research showing it has no effect on colds, people still believe that it does. In the last 10-15years thereis a new challenger to supremacy of the vitamin C attributed cold benefit. That challenger is zinc, specifically zinc gluconate, usually found on pharmacy shelves as lozenges.(Some brands use the similar supplementzinc acetate.)

This time of year you see a big upswing in useless, crank treatments for the common cold. Some promiseprevention, like the disproved supplement Airborne. This year I have noted thatthe zinc gluconate lozenge is heavily advertised. A few years ago a similar zinc product, calledZicam, was litigated and settled hundreds of lawsuits. Zicam, a nasal inhaler,introduced zinc directly into the nose and seemed to damage some users' sense of smell. This product did not work and harmedpeople, yet it can still be foundon the shelves at local pharmacies and supermarkets. Zinc gluconate lozenges use the same basic premise as the nasal product, though it does not seem to pose the same risks, as far as we know. It is stilla generally untested product. There are many versions"some are sold generically bysupplement manufacturers, some are custom formulations, some are from drug store chains like CVS. Some even have trade names, such as Cold-EEZE®. Incidentally, Cold-EEZE'sCEO "guarantees" that his product will satisfy you, making you "feel better faster." Let's take a skeptical look at thisclaim, another in thelong line of supposedly "miraculous" cold remedies.

Frankly, the evidence doesn't hold up to scrutiny. The evidence for the lozenge comes fromsmall-scale, uncontrolled, subjective, heterogeneous preliminary studies. Any time the controls improved, the benefits returned to the level of statistical noise. This meansthat the effect is so tiny that it is no better than random chance.

The oft-mentioned "best evidence"comes from two papers:a 1996 study from The Annals of Internal Medicine, and a 1992 study in The Journal of International Medical Research. These are, in fact, twosmall-scale studies, with less than 100 subjectsenrolled. The subjects were asked tokeep symptom diaries. The problems with that specificmethod are planetarysized:personal diaries are notoriously underwhelmingsince they depend upon personal diligence. People often will do them sporadically, not regularly. They tend to fill them out only when encouraged to do so and tend to do them from memory, which is unreliable in the extreme. Since the point of this research is to track improvement along a timeline results from this type of methodologyarepoorly evidenced. Even if you assume that they had 100 obsessive-compulsive enrollees who maintained diligent, time-appropriate diaries, it is still too small to draw conclusions. 50 study participants and 50 controls isjust too small a number. There are too many confounding variables with a sample size that small"far too many to be covered by that small group. Age, sleep patterns, employment, sexual activity, chronic medical problems, and medications arejust a few that would be difficult to control for with so few participants. One study was done on hospital employees, yet there was no testing to confirm whether each subject's infection was viral or bacterial, and no exam to eliminate allergy-caused symptomatically, and no lab work supporting a viral infection. Bottom line: these studies are interesting, but they're preliminary. Theymight inspire further research. Similar toalmost all sections of alternative medicine they have been treated as determinate research provingthe benefit"a common alt med failure.

In 2013, a meta-analysis, "Zinc for the Common Cold" was published in the Cochrane Review.It supported using the lozenge. Meta-analysis is a systematicreview of available research. When done well it speaks volumes about the effectiveness of a treatment. This meta-analysis showed benefit fromzinc for the common cold. Unfortunately, it was so poorly done"with obvious fabrication and data re-tuning"that it had to bewithdrawn from publication in 2014. Obviously, having to fabricate a positive meta-analysis rather than being able to produce one speaks volumes about the overall findings on the subject.

In my opinion there is no evidence that sucking on a zinc gluconate lozenge will be of any help for your cold. There are some very real concerns that it may have a deleterious effect on your sense of smell. The lozenges have been known to cause nauseaand can cause changes totaste sensation. It is advertised as homeopathic and it is not because it has an actual active ingredient. Truth be told, the best evidence says it is useless, and sucking on a sugar-free cough drop is almost certainly just assafe and just as effective.

You are an individual, a custom build. On any given day your body's biochemical environment is equally customized. And becausewe're all aging, every moment in time is unique toyour body. There is no set timeframe for you to recover from any illness. Recovery is an estimate. If you start making medical choices for a disease based on personal experiences and your recollection of priorevents you are going to make bad choices. If you have a cold, save your money, get your rest"and get checked out by a doctor if you think it is more serious. Don't take useless, over-the-counter nonsense. It won't make you feel better and, as in the case of Zicam, it may be harmful.

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You can follow me at Twitter @steveproacnpfor a daily dose of skeptical nursing.

Disclaimer: This post is my personal opinion, it is not a substitute for medical care. It is for informational purposes only. The information on Skeptoid blogis not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified healthcare professional regarding any medical questions or conditions. This postdoes not reflect the opinion of my partners, professional affiliates, or academic affiliations. I have no financial conflicts of interest to disclose.

by Stephen Propatier

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