Posted tagged ‘colds’

Can vitamin D supplements prevent colds?

February 20, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

Linus Pauling was a brilliant scientist. He won the Nobel Prize in Chemistry in 1954 (and, later, a Nobel Peace Prize for his work towards nuclear disarmament.) In the later part of his career, he became convinced that megadoses of vitamins, especially vitamin C, could ward off upper respiratory infections and other ills. Studies have never supported those claims. But maybe he was only off by one letter of the alphabet.

A recent, large study from the BMJ provides solid support for the use of vitamin D – not C, but D – supplementation to prevent ordinary colds and other respiratory infections.

There’s been some inkling that this might be the case. We know that vitamin D, separate from its role in calcium metabolism, has an important part to play in our immune response to infections. It supports the production of built-in antiviral and antibacterial peptides, and helps immune cells make germ-destroying oxygen and nitrogen compounds. Population studies that have shown an increased susceptibility to colds among people who are immune deficient.

What we haven’t had, until now, is a convincing study from an experimental perspective. If we give vitamin D, does that really prevent colds?

What these authors did was impressive. They collected the raw, patient-by-patient data from 25 previous clinical trials of vitamin D, and combined all of that into one mega-study with about 11,000 participants. All of the patients had to have been randomized to either vitamin D or placebo, and rates of respiratory infections tracked going forward. Most of them had blood tests to assess their levels of vitamin D before the trials began.

The bottom line: vitamin D supplementation decreased the risk of a cold by about 12%. That doesn’t sound very high, but on a population level, we’re talking about a lot of infections. And: among those that had low vitamin D levels, the effect size was much larger, about 40%. Vitamin D supplementation was more effective in preventing colds with a daily dose rather than just bolus dosing once in a while.

Who’s low in vitamin D? Based on my experience looking and blood tests from children and teenagers, all of our children are low. Seriously. The only time I see blood tests reflecting a normal or high vitamin D level, it’s in someone already taking a supplement. Our children (us, too) aren’t spending enough time outside to make the vitamin D we need.

The study also found no downsides to ordinary supplements. There were no significant side effects or problems. We’re talking, here, about ordinary doses of probably 400-2,000 IU each day. There’s really no reason to take any more than that, unless there’s a problem with vitamin absorption or some other unique medical issue.

Vitamin C, Airborne, zinc, echinacea – none of these have held up to scrutiny. None of those help prevent people from getting respiratory infections. If you want you and your children to get fewer colds, there are only a few strategies that genuinely work. Stay away from sick people, keep infants out of group care, wash hands frequently, and immunize against influenza and other respiratory pathogens. And, maybe, enjoy a little more time in the sun, or take a vitamin D supplement every day.

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Homeopathy as good as antibiotics? No.

November 9, 2015

The Pediatric Insider

© 2015 Roy Benaroch, MD

An August, 2015 study in Multidisciplinary Respiratory Medicine is being touted as evidence that homeopathy is as affective as antibiotics for respiratory infections in children. It doesn’t show that at all—in fact, it doesn’t show anything, except that crappy studies in crappy journals can nonetheless be used to manipulate opinion. Beware.

First, the study itself. Researchers in Italy looked at about 90 children with ordinary colds. All of them were given a homeopathic product that the authors claimed had already been shown to be effective for cough (that’s not actually true, but let’s let it slide for now.) All of the children did improve, as expected—colds go away, as we all know.

The “study” part was randomizing the children into two groups. One half of the study subjects only got the homeopathic product, the other half got both the homeopathic syrup PLUS amoxicillin-clavulanate, an antibiotic. You Insiders are already thinking—what, wait, what? You know that antibiotics have no role at all in the treatment of the common cold. Colds are caused by viruses, and antibiotics won’t make any difference. In fact, they’re very likely to cause harm, causing allergic reactions and gut problems and maybe triggering c diff colitis. It was entirely unethical for them to even give these antibiotics to the children, with not even an inkling of a reason to think they were a valid medical therapy. But they did it anyway.

The results are exactly what you’d expect. Both groups of children (the ones on homeopathy, and the ones on homeopathy plus antibiotics) did the same—their symptoms all improved over the weeks of the study. No surprise at all.

But the authors claimed “Our data confirm that the homeopathic treatment in question has potential benefits for cough in children…” The study didn’t show that all. They didn’t even look for that kind of effect—if they wanted to, they could have, by randomizing one group to receive homeopathy, and the other group to not receive homeopathy. But that kind of study wouldn’t show what they wanted it to show, so they didn’t do it.

You’re wondering, maybe, why did Multidisciplinary Respiratory Medicine even print this unethical, worthless study? The answer is here:

How much does it cost to publish?

 

Multidisciplinary Respiratory Medicine is what’s called a “predatory journal”, which charges high fees — $1,940 — to publish articles. These types of journals exist only to make money—there is minimal or no editorial oversight, and the whole point is to publish whatever someone will pay them to publish. The authors get their publication, and journalists and the public are fooled into thinking real science has occurred.

Another highlight – I’m not an investigative journalist, but looking at the full text of the article, I see under footnotes “The authors declare they have no competing interests.” Yet under acknowledgements, it also says “We thank Boiron SA, Messimy, France for a non-binding financial contribution.” Boiron is a huge producer and marketer of homeopathic products. And: when I Googled the lead author’s name + the word “Boiron,” I found this page, which features a video of him on Boiron’s site. No competing interests?

So, an unethical study comparing the wrong things claiming to show something it didn’t, published in a pay-to-play journal, paid for by a homeopathy company, written by a guy who is featured on said homeopathy company’s website. You still shouldn’t use antibiotics to treat a cold. And this study, like so many other homeopathy studies, shows only that homeopathy is a scam.

How long should coughs and runny noses last?

December 23, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

Many sick visits to primary care docs, like me, are driven by just a handful of complaints, all typically caused by viral upper respiratory infections (URIs): cough, congestion, and runny noses. How long should parents expect ordinary cold symptoms to last?

Longer than you’d think.

The British Medical Journal this month published a wonderful article, titled “Duration of symptoms of respiratory tract infections in children: systematic review.  They found 48 studies of the symptoms of URIs which included systematic tracking of system duration. Only placebos or over-the-counter remedies were included—they did not include any patients treated with antibiotics. From pooling the information from all of these studies, they found that:

  • Cough usually lasted at least 10 days (that is, 50% of kids with cough were still coughing after day 10). Cough resolved in 90% of patients by day 25—meaning that 1 in 10 children were still coughing at day 26, almost 4 weeks after the start of the cold.
  • Common cold nasal symptoms resolved by day 10 in 50% of children. 90% were better by day 15.

So: ordinary colds, just ordinary viruses we all get, cause symptoms that typically last a couple of weeks, with the cough often lingering even longer. The old joke ought to be rewritten: without this prescription, your cold will last two weeks. With it, it’ll only last 14 days.

If you or your child has an icky cold, you might be tempted to see your doctor after a few days or a week. It’s probably better to wait longer—save yourself a visit, and you’ll be less likely to end up on an antibiotic that won’t do you any good anyway.

Preventing colds: Kids show us how it’s done

August 28, 2011

The Pediatric Insider

© 2011 Roy Benaroch, MD

Want to get fewer colds, skip the flu, and avoid using the toilet face-first? One of the most effective ways to prevent infectious diseases is to stay away from mucus. Other people’s mucus, that is—the infectious toxic goo that sick people can’t seem to avoid spreading all over the place.

Two recent studies illustrate that it really is possible to stay healthier thru goo avoidance. But the kids seem to be better at it than we are.

I wrote earlier about the first study, where adults were observed during, let’s say, events of mucus production. Surprise! The vast majority of adults did nothing to limit the spread of their sneezes, and even helped further spread their germs by wiping their snot-covered hands on doorknobs and other surfaces. Look around you. If you see adults, they’re trying to make you sick.

Compare that to a more recent study of children, summarized here. Danish schoolchildren underwent special training in hand washing, and were required to follow good hand hygiene while in school. Over the following months, compared with kids in other schools without the special training, the children in the handwashing groups had about 25% fewer illnesses and missed days of school. Even better—the following year, when the special training and requirements were dropped, those same children still continued to wash their hands, and continued to have a reduced rate of illnesses. The kids learned, and it worked, and it stuck! Take a lesson from these kids: good hand hygiene is a habit that we can learn, and a habit that really can keep us healthier.

If it makes you sick, it probably likes mucus. Try to keep your mucus to yourself, especially when you’re ill. When you’re sick, sneeze into your elbow and wash your hands! If you don’t want to become ill, wash your hands before eating or especially before touching your own face. In fact, you might be able to prevent many infections by developing a new habit: don’t touch your eyes, your nose, or your mouth without first washing your own hands. The germs on your skin won’t make you ill until you rub them in your eyes or up your nose. With the kids back in school and winter approaching, now’s a good time to work on those anti-mucus, staying-healthy habits. Let’s all keep our snot and germs to ourselves.

Too many colds

April 18, 2010

The Pediatric Insider

© 2010 Roy Benaroch, MD

Claire wanted to know why her kids get sick so much. So many colds, so much snot. Is there any way to stop this?

Colds are called “upper respiratory infections” in doctor-talk. They’re caused by one of hundreds of viruses that invade the tissues of your nose, sinuses, and throat. Typically symptoms begin with a sore throat, move into a stuffy nose, and then cause a lingering cough as a good-bye present.

Normal kids get a lot of upper respiratory infections, about twelve per year for pre-schoolers and nine per year for kindergarteners. They tend to occur more frequently once school starts in the fall, and last all through the winter. So from September through March you can expect what will seem like at least one cold a month. Since ordinary colds last at least 10 days, for the winter it seems like many kids are sick more days than they’re well.

What about those kids who really do get more than their share of colds, or the kids whose colds linger for weeks and turn into sinus infections or other problems? Think about these kids in three groups:

  1. Otherwise completely healthy kids who just get a lot of colds. They get better on their own, but seem to get “frequent colds” one after another in a string of isolated episodes. There’s no history of other infections, unusual infections, or anything else about these children that seems unhealthy.  They’re often in day care or school, and sometimes get extra exposures to cold viruses from helpful siblings. This is the largest of the three groups.
  1. Kids who “keep a cold.” These children get many colds, but don’t get better on their own. The cold symptoms linger and last “forever.” Often their colds will turn into ear infections or sinus infections, and won’t get better until an antibiotic is prescribed. Other than the lingering colds, these kids are not otherwise unwell. They don’t get lots of infections other than these respiratory problems, they’re growing well, they’re doing fine. They just have persistent snotty noses.
  1. Kids who are genuinely unwell. By far, this is the smallest of the three groups. These are children who are often not growing well, and suffer from many other frequent infections including chronic diarrhea, thrush, and other unusual or chronic, hard-to-treat infections. Kids in this group should be aggressively evaluated for an immune deficiency, and should be seen by a specialist in pediatric immunology.

Kids in group 3 are rare, but characteristic, and it’s easy to tell that these children are different. It’s sometimes tricky to separate group 1 from group 2, especially if the group 1 kids get so many colds that one just immediately follows another. The best “test” to tell if your child is in group 1 or group 2 is for parents to keep a “snot calendar.” Group 1 children, the “frequent colds,” really should get completely better, at least briefly, in between individual cold episodes. Group 2 kids, the “keep a colds,” have symptoms that get better and worse, but are never completely free of cold symptoms.

“Frequent colds” versus “keep a cold” kids are different. Though they might both benefit from strategies to prevent colds in the first place (more about that later), the children who “keep a cold” very often develop complications of viral respiratory infections: bacterial sinusitis or ear infections. Snot that stays in one place for too long is very inviting to bacteria– like a sticky, inviting swimming pool– and eventually, kids who “keep a cold” are going to be infected with bacteria. To help avoid these secondary infections, families with “keep a cold” kids need to get very aggressive about clearing out mucus. Use a humidifier, long steamy showers, and saline nose drops. Anything that physically clears out mucus will make secondary infections less likely. The children will feel better, and will need fewer antibiotics. Families who get good at mucus control might even be able to avoid a trip to the ENT for sinus surgery or ear tubes.

“Keep a cold” kids tend to run in families, probably because their parents share their same small sinuses and ear anatomy that makes clearance of mucus difficult. Some of these kids might also have allergies that trigger very similar symptoms. If your child who keeps a cold has symptoms of allergy (itchy nose, itchy eyes, sneezing) or a strong family history of allergy, further testing or treatment of possible allergies might be worthwhile.

Whether your child is in the “frequent colds” of group 1 or the “keep a cold” of group two, strategies to avoid infections are a good idea. Many, many respiratory virus exposures occur in day care. Can you move your child out of group care, at least for the winter? Children can be taught not to rub or touch their own face, which prevents viruses on their hands from invading their usual ports of entry, the nose, eyes, and mouth. Avoid playing with toys in common areas like doctor waiting rooms, and stay out of little gym classes and fast food play areas. Get into the habit of washing hands frequently or using an alcohol-based hand sanitizer to prevent not only upper respiratory infections, but common “tummy bugs” as well.

There are plenty of herbal products and supplements that claim to protect your child from colds. They’re quackery. Save your money for something else.

Some vaccines can help prevent at least some respiratory infections, and even some complications. Influenza vaccines should be given to all children each winter. Very recently, the Prevnar (pneumococcal) vaccine was improved to include several more strains of this common bacterial cause of ear infections and sinus infections. These vaccines will not prevent all or even most of these infections, but they can make an important difference.

What about medicines to treat Junior when he has a cold? Though they’re marketed very heavily, they’re not very effective. Your best bets for symptom relief during a cold are acetaminophen or ibuprofen for aches, nasal saline washes for congestion, honey for cough (over age 12 months), throat drops for sore throat, and ice cream for the child and the parents. There. Doesn’t that feel better?