Category Archives: Supplements

Combating the Common Cold: What Herbals Work?

Isn’t it humbling that we have no cure for the world’s most common illness? Yes, the common cold, globally the #1 cause of sick days and doctor visits, still stampedes across the world, blissfully immune to any Eastern or Western prescriptions. As a family doctor, I’m always a bit frustrated that I can’t offer much to these patients, at least in terms of Western allopathic medicines. So, I decided to scour the literature again to see if any new research has shown benefits from herbals and supplements. And the good news is yes: there may actually be a couple of supplements which can help you get better, quicker. Here’s my advice below. (Please note that this research is for treating, and not preventing, colds and flu.)

Evidence-Based Literature Search

When it comes to supplements and natural therapies, I use only a tiny handful of resources that I consider trustworthy. All are certified by the Health on the Net Foundation as sources of trustworthy medical information. All these sites would review only the best, most unbiased research, which usually means the gold standard of all research: placebo-controlled, randomized controlled trials. I strongly recommend that everyone use HONCode’s search engine anytime you’re looking for medical advice, especially regarding supplements. For example, you’ll never see the anti-vaccine snake-oil salesman Dr. Mercola on their list. Here are my favorite medical resources, and their evaluations of therapies for the common cold:

Cold_symptoms_cdc
A graphical image and time line for cold symptoms. Note how the cough is always the last to improve…

 

Let’s break it down into the supplements that have the most evidence:

  • Zinc: This seems to have the most support, especially higher doses (>75 mg daily) of lozenges containing zinc gluconate or zinc acetate. Some good studies show reduction in cough, runny nose, headache, sore throat and overall time of illness. But side effects are common, especially nausea and a bad taste in the mouth. Also, definitely do not do the zinc nasal sprays, which have clear evidence to permanently cause loss of smell. The data suggests you should stick with lozenges and not pills. I see a few brands of logenzes up to 23 mg each, which at three times a day would help. The test results from ConsumerLab show 23 mg in Nature’s Way Zinc lozenges, and 13.8 mg in Cold-Eeze Cold Remedy Lozenges (but much more expensive). I see a few popular brands with only 5 mg zinc each, which seems far too low to work. I wouldn’t advise using these for children.
  • echinaceaEchinacea: This is probably the one you’ve heard about, and the evidence is encouraging — but not totally clear. Some “double-blind, placebo-controlled studies have found that various forms and species of echinacea can reduce the symptoms and duration of a common cold, at least in adults. The best evidence is for products that include the above-ground portion of E. purpurea rather than the root.” But it’s very difficult for me to recommend a proper dose, as studies have used multiple regimens via drops, pills and teas, also using many types of echinacea, as well as different combinations of root and plant. Here’s a useful list of test results from ConsumerLab showing which brands in the USA have proper amounts of the herb.
  • andrographisAndrographis peniculata: An Indian herb very popular in Ayurvedic medicine and now in Europe, I think this actually has some good evidence.  A handful of double-blind, placebo-controlled have shown benefit in reducing the duration and severity of cold symptoms, especially cough. An excellent meta-analysis of herbals from Germany showed significant improvement in severity and duration of a cough, especially via liquid formulation. The usual dose seems to be 48-500mg of the andrographolide aerial parts, usually divided three times a day. You can find a good list of andrographis brands on iherb.com. I keep reading about a Swedish patented combination with eleutherococcus and sambucus (Kan Jang Plus), but I don’t see it sold anywhere in the USA.
  • pelargonium-409238_960_720.jpgPelargonium sidoides (Umckaloabo): This is an interesting herbal, very popular in Europe and perhaps should be more popular here in the USA. That same German meta-analysis I mentioned above found strong evidence that it helped with cough, fevers, and sore throat — including for children as young as one year old, although the German independent Institute for Quality and Efficiency in Health Care says it shouldn’t be used for children under six years. The Cochrane Library also reviewed this herb and concluded, “P. sidoides may be effective in alleviating symptoms of acute rhinosinusitis and the common cold in adults, but doubt exists.” As with andrographis, the liquids and syrups were better than tablets. I see on iHerb a series of pelargonium products called Umcka with good reviews.
  • Probiotics: Probiotics actually have pretty good evidence that taking them for months, especially over the winter, can markedly improve both the frequency and the severity of colds — for kids and for adults (as does vitamin D). That’s great news! But for symptom relief during a cold, the evidence is much more scant. I couldn’t find one good study for this; none of the groups above recommend probiotics as treatment.
  • Vitamin C: Here’s another super popular supplement, which many people swear by. But again the evidence isn’t conclusive, and the few studies that do show a benefit show only mild improvement. Still, at least it seems safe for adults and children, and evidence is even stronger as a preventive during the cold seasons.

cold-1974481_960_720

My Bottom Line

For immune boosting,  don’t forget the most important advice: get a good’s night sleep; eat a lot of anti-oxidant foods; and stay well hydrated.

In terms of supplements, I think it’s appropriate for adults (not kids) to try some of the above supplements — and the sooner, the better, within 24 hours of your symptoms starting.

For what it’s worth, here’s my plan for myself and my wife the next time we get a cold: we’re going to continue our usual vitamin C + zinc bursts, usually using Airborne effervescent tablets, three times a day. Emergen-C and Wellness Formula also are similar, all three with a ton of vitamin C, some zinc and an assortment of herbals, many of which are mentioned above. I’m also adding andrographis 400mg twice a day and also pelargonium; and I’ll continue doubling up on my probiotic supplement, despite the lack of evidence. (One small note: last week my wife tried andrographis for the first time and had a horribly itchy rash for days. I was fine.)

In general, for children, I’m still hesitant about using any of these herbals for children under 6 years old, and I remain cautious about what I use with my own kids, both under 4 years of age. I still like probiotics during a cold, and I’m a big fan of honey for cough for all ages above one year, which studies show works better than any OTC syrup. I’m encouraged with the European studies using pelargonium and also ivy/primrose/thyme syrups, some of which are partially included in American brands like Zarbees. For more age-specific advice, please look at the recommendations in my previous article about curing a cough.

What herbals and supplements have you used? Please leave comments below.

 

Multivitamins: Again, Studies Show They Are Useless For Most of Us

I’ve blogged a couple of times about this, and now a trio of studies seriously underscores what I previously mentioned: a multivitamin is a waste of money for the vast majority of people taking them. Including myself.

I actually had stopped taking them a couple of years ago but recently restarted — not for any particularly good reason, I admit. But now we have three very strong, enormous research studies involving over 450,000 persons which may indeed warrant the blunt editorial title: Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements.

To recap these studies, published in the new issue of the Annals of Internal Medicine:

  • A large literature search aimed to find out if long-term use of a multivitamin helped to prevent deaths from heart disease or cancers. They analyzed data from over 400,000 persons and concluded that “limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or cardiovascular disease. Two trials found a small, borderline-significant benefit from multivitamin supplements on cancer in men only and no effect on cardiovascular disease.” This last comment refers to the tiny decrease in cancers in older men, when used for over 10 years. But this relative risk of 0.93 is debatably insignificant — and how does it make sense for men only, and not women?
  • The second study tested multivitamins in people who had recently suffered from a heart attack, following them for over five years and measuring how many died or had more heart attacks or other cardiovascular problems. This study showed no statistically significant improvement, but so many people stopped taking the multivitamins (46%) that it’s difficult to be truly definitive here.
  • The third study tested over 5,000 doctors for more than 12 years, assessing whether the group taking a daily multivitamin had less problems with age-related memory loss and cognitive decline than the placebo group. Again, there was no difference in mental ability between these two groups.

I have to admit that these studies, especially the first study, are quite conclusive, and now I think I’ll just stop taking my daily pill (again). There really isn’t any reason why any reasonably healthy person, eating basically normal food, in any developed country, should take a daily multivitamin. But does this new evidence convince you at all? A huge and growing percentage of people all over the world are taking daily multivitamins, despite all of these increasingly broadcast studies. Why? Why are so many of us simply ignoring science? Read their final statement:

“The message is simple: Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided. This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and in other countries.”

Are you really not going to change your habits?

Diabetes and Natural Supplements: Which Work? Which Don't?

What natural supplements and medicines work to prevent or lessen diabetes? We know that the Western-prescribed medicines such as insulin injections and metformin pills are extremely effective, but wouldn’t it be great, and much healthier for us, if we could focus on more natural therapies? Fortunately, with diabetes, there are quite a few healthy approaches for everyone, from healthy people to pre-diabetics and diabetics.

So, What Works?

There’s a good free review from Cardiovascular Therapeutics from last year, titled “Nutraceuticals in Diabetes and Metabolic Syndrome“. Also, my favorite natural medicine website, the Natural Medicines Database, yet again has a wonderful, free article on natural medicines for treating diabetes. This group provides an essential service for docs and consumers: they review all the best research and offer evidence-based advice on natural medicines — what works and what doesn’t work. At the bottom of their article is a nice summary graph, and here is a snippet:

Natural Medicines For Diabetes
Natural Medicines For Diabetes

There Is No Wonder-Supplement

First, the graph implies that there is as yet no officially “Effective” and “Likely Safe” natural medicine. In fact, nothing reviewed is assessed to be either “effective” or “likely effective.” The best they can state — at least,  in terms of evidence-based research — is a series of therapies that are “Possibly Effective” and “Likely Safe”. This includes psyllium (fiber), guar gum, magnesium, oat bran, and soy. Antioxidants in general such as vitamin C or E do not have strong evidence that they help with diabetes, although alpha-lipoic acid may help, especially with diabetic neuropathy. And a bunch of popular supplements are still in the “Insufficient Evidence” columns — including coenzyme Q10.

The neutraceutical review above also mentions that vitamin D and calcium may also lower risk for diabetes. I already recommend vitamin D for other reasons, so people can consider this as an added benefit.

Selenium: Do Not Use!

One surprising finding that may people don’t know is that selenium, which previously was considered good for diabetes, actually is now considered bad. Not only is it not effective, but it actually can make your diabetes worse. This latest data definitely has not made the rounds of consumer products, as almost all “diabetes” combination-herbs products such as Nature’s Bounty “Diabetes Support Pack” (available in China) still include selenium. So, if you use those expensive herbal pills, the benefits of the cinnamon and chromium may be offset from the harms of selenium — thus not helping you at all. It’s hard to say this conclusively, since all of these formulations are different, but it’s something you should consider before purchasing such combo pills.

My Bottom Line

I think those of you who are diabetic, or pre-diabetic, before considering spending your hard-earned money on any supplements, should first take care of what I mentioned last week are the most effective natural ways to help diabetes — weight loss, exercise and diet. Do not waste your money on multi-pill-pack diabetes supplements if you’re not aggressively getting your weight down 5-10%, or exercising. If you are doing these far more important steps but still have problems, it’s not a terrible idea to try the most effective natural methods:

  • Fiber in all forms, including as oat bran, has the strongest evidence to lower your sugar load ~14-20% each meal
  • Chromium (and cinnamon) have some evidence of effectiveness — you could consider trying for 3 months and stopping if you see no improvement
  • Magnesium may help, but diet forms are much more effective than in a pill
  • Vitamin D and calcium supplements may help lower your risk — I previously mentioned doses here
  • Vinegar with meals also lowers your sugar load ~20%
  • The popular Chinese vegetable bitter melon (kugua) can lower that meal’s blood sugar load
  • Soy may help a bit — and in general, soy milk is healthier than cow’s milk, so why not switch? Better yet, make your own soy milk
  • Antioxidants don’t seem to help much with diabetes, but are still a powerful concept — but you should get these from a good diet, not pills
  • Selenium does not work!

Other Resources

I already mentioned that the Natural Medicines Comprehensive Database is a great start for those of you looking for evidence-based, trustworthy reviews on natural medicines. You can also use the U.S. National Library of Medicine’s PubMed Dietary Supplement Subset, a search engine focused on top research regarding natural medicines — including Chinese medicines.

Great News: Something Actually Helps Fight The Common Cold — Zinc!

zinc common coldI’ve often complained, along with the rest of the world, that there is no magic pill yet designed to cure the world’s most common illness — the common cold. But now, there is some hope! There’s an excellent meta-analysis by the well-respected Cochrane Library which now says what some docs had been touting for years — that zinc supplements, when taken within 24 hours of cold symptoms, can truly improve symptom severity and length, as well as lower risk of needing antibiotics. This is great news! I already used zinc off and on for years in my cold supplements, which are usually Airborne or Dr Thompson Coldwar pills; and I will now definitely be more aggressive with zinc during my colds. I’m convinced.

The New York Times has a nice review of this Cochrane meta-analysis, and you can download the Cochrane PDF file here and also read their original conclusions here:

The common cold is often caused by the rhinovirus. It is one of the most widespread illnesses and is a leading cause of visits to the doctor and absenteeism fromschool and work. Complications of the common cold include otitis media (middle ear infection), sinusitis and exacerbations of reactive airway diseases. There is no proven treatment for the common cold. However, a medication that is even partially effective in the treatment and prevention of the common cold could markedly reduce morbidity and economic losses due to this illness.

Zinc inhibits rhinoviral replication and has been tested in trials for treatment of the common cold. This review identified 15 randomized controlled trials, enrolling 1360 participants of all age groups, comparing zinc with placebo (no zinc). We found that zinc (lozenges or syrup) is beneficial in reducing the duration and severity of the common cold in healthy people, when taken within 24 hours of onset of symptoms. People taking zinc are also less likely to have persistence of their cold symptoms beyond seven days of treatment. Zinc supplementation for at least five months reduces incidence, school absenteeism and prescription of antibiotics for children with the common cold. People taking zinc lozenges (not syrup or tablet form) are more likely to experience adverse events, including bad taste and nausea. As there are no studies in participants in whom common cold symptoms might be troublesome (for example, those with underlying chronic illness, immunodeficiency, asthma, etc.), the use of zinc currently cannot be recommended for them. Given the variability in the populations studied (no studies from low- or middle-income countries), dose, formulation and duration of zinc used in the included studies, more research is needed to address these variabilities and determine the optimal duration of treatment as well as the dosage and formulations of zinc that will produce clinical benefits without increasing adverse effects, before making a general recommendation for zinc in treatment of the common cold.

The usual dosing is 3-4 times a day during your illness; the most common lozenges are 23-30mg, so one of these 3-4 times a day would help best. Don’t forget, it’s important to start zinc quickly and not wait a few days. As it says above, side effects are common but not severe, including bad taste and a bit of nausea.

Vitamin D — It's Trendy! Oh, Wait, Hold On A Minute…

Last year I bragged about vitamin D and the evidence showing benefits in multiple arenas, especially for fighting colds and flu. I even started taking 2,000 IU a day of vitamin D3.

But now…one wonderfully annoying thing about medicine is that one headline will say “medicine A is great for disease X”, but wait a couple years and another famous journal will contradict it — thus frustrating doctors and confusing the public.

And now, of course, we have a long-awaited publication from the highly-esteemed U.S. Institute of Medicine, which last November published their findings about vitamin D and calcium. The IOM is very official and their papers are usually considered top quality standards of care. In this case, they were not very enthusiastic about vitamin D supplements for most people, and concluded that actual vitamin D deficiency is not so common. They specifically recommended only 600 IU a day supplement for people aged 1-70 years;  over 70 years needs 800 IU a day. That’s it; no mega-doses, not even 1,000 IU, for anyone. Not only that, but anyone taking more than 4,000 IU a day is not only getting no additional benefit but they increase their risk of kidney stones and other issues (how many of you are taking 5,000 IU a day?). Here’s the table of their official recommendations:

vitamin d and calcium recommendations

This more cautious review came just a couple weeks after another well-regarded review from Canada which was much more enthusiastic about supplements and recommended 400-1,000 IU for most people, and 2,000 IU or more for “high risk” people such as people prone to osteoporosis.

So, what do we do now? We have two large and well-esteemed groups reviewing the same research papers and coming up with different conclusions.

What Will I Do?

I do respect the Institute of Medicine, and perhaps the Canada study is a bit too local to apply to other areas. So I would tend to stick to the IOM’s more conservative official recommendations as the new standard of care.  But I also still like those previous papers I mentioned last year about 1,200 IU of vitamin D3 helping cut down on colds and flu by 42%, so I will personally continue to take my 2,000 IU of vitamin D3. Is the dose too high? Maybe, probably — but just wait a couple years and another study may change things yet again. Plus, 2,000 IU doesn’t seem to raise the risk of kidney stones. So, for me, the possible benefits outweigh possible harms.

However, I do think there are some take-home points for the general public:

  • All children should be taking a supplement of 400 IU a day, which should also include calcium (especially for girls!), mostly for bone health
  • People taking over 5,000 IU a day are wasting their money and also increasing their risk for kidney stones
  • Many healthy people may not need it, but if a small dose of 1,000 IU cuts down on your winter colds and flu, then why not take it?
  • Blood testing for vitamin D levels can be done but still isn’t very practical, cost-effective or useful

Those of you who want to read more can read the excellent New York Times review this week about vitamin D.

Your Health in 2010: Any Major Changes? Here Are Mine…

So how was your 2010, health-wise? Do you feel more or less healthy? For me personally, it was a continuing slow improvement of my overall wellness, and I continue to be fortunate in having no major illnesses. I did make a few changes which I’d like to share with readers (and perhaps you can share your changes in the comments section under the article):

Change #1: I stopped taking a multivitamin. I took multivitamins for years, but this year I finally decided that the hard research evidence simply wasn’t there for me. I always assumed that a multivitamin may do some good and at least couldn’t hurt, but the best studies I’ve seen still don’t show much of a benefit — at least, not with already healthy people who eat well. I wrote a post earlier this year about the latest research on multivitamins. I’ve been eating much better this year and I’m convinced enough that my multivitamin isn’t doing much for me. But I’m still very much on the fence, and further studies may indeed convince me to start again.

Change #2: I started taking vitamin D. This is my one exception for vitamins this year; I started to take 2,000 IU of vitamin D daily. As I’ve mentioned in many posts this year, a lot of research shows positive benefits of vitamin D supplements — and vitamin D is one of the very few vitamins not easily available in foods (it’s mostly created by sunlight on your skin). Although most research shows few people are seriously (“clinically”) deficient in vitamin D, most health agencies are recommending this supplement. I’ve mostly been convinced by studies showing how vitamin D can cut down on winter’s colds and flu.

Change #3: I started a protein soymilk breakfast. OK, fellow Americans, let’s be honest here: after eating the typical American breakfast of pancakes, sausage, potato and eggs, your body and brain feel very sluggish and heavy. Breakfast is the #1 meal of the day, so it’s important to get proper nutrition. I love to start my day with warm, freshly-homemade soy milk. And this year, I started to add a couple tablespoons of freshly ground protein powder to this soy milk, and this protein/nutrition boost gives me a lot of positive energy for the morning. I also start my day with a small cup of warm water with juice from half a lemon; honey; and alfalfa powder. Plus, I make a big glass of a homemade smoothie, usually fruits plus spirulina powder.

Change #4: I stopped using any plastic for leftovers. How many of you still microwave your restaurant leftovers in their plastic/styrofoam containers? I previously was trying to use only “safe” plastic codes (like #5) but I finally stopped this entirely this year and switched completely to glass containers. I mentioned earlier this year that there is increasing evidence that many plastics have harmful chemicals, mostly due to chemicals such as BPA which can cause multiple endocrine and other disorders.

There are supposed to be “safe” plastics you can reuse, but I made the switch to all-glass mostly because I’m still just uncertain about using any plastics anymore. I don’t want to think #5 plastic is fine now but read some new article in a couple years saying, “uh oh, wait a second here…” And since glass is easier anyway to microwave and doesn’t stain, why not make the switch?