The McDougall Newsletter
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From Nov/Dec '98

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SURVING THE COLD SEASON

 Acute upper respiratory viral infections are among the most common of human diseases. In the United States the incidence is 3 to 6 episodes per person per yeear on average. Children under 6 have the highest rates because of their frequent exposure to many viruses and lack of immunity acquired from previous infections. More than 200 different viruses are known to cause these infections

Treat these viral infections with the most advanced medications known to modern medical science and they will last 2 weeks, but if you do nothing you will be better in 14 days. In other words, there is no cure for the common cold or flu. However, there are treatments that may shorten the duration of illness and definitely improve the symptoms associated with an upper respiratory infection.

Is it a cold or a flu?

A common cold is a virus infection involving the upper respiratory chacterized by congestion of the mucosa, watery nasal discharge, and general malaise lasting 4 to 9 days. Influenza, commonly known as the flu, is similar but with more intense symptoms including headaches, muscle aches, fevers, chills, and cough, lasting 2 to 6 weeks.

Prevention

Hand Washing:

These viral infections are spread by passing the virus between people. The commonest close contact people have is by their hands which touch other people and objects with viruses. From the hands the virus is transferred to the mucous membranes of the mouth and nose, where it infects these tissues. The viruses can survie on surfaces for several hours. Hand washing is an effective means of preventing the spread of the virus. In one study of 3 to 5 year-old children taught handwashing the risk of colds and flu was significantly reduced during cold and flu season (J Pediatr Health Care 1997 Jan-Feb;11(1):26-31). Disinfection agents may halt the spread of infection from objects contaminated with viruses. In one study dried virus was exposed to Lysol spray or bleach and virus infectivity was reduced by > 99.99% after a contact of 10 min (Appl Environ Microbiol 1993 May;59(5):1579-85).

Vaccinations:

The major public health measure to prevent influenza has been the use of inactivated vaccines. These vaccines are derived from previous influenza A and B viruses which circulated during the previous flu season. Each year's vaccine should contain three virus strains representing the influenza viruses that are likely to circulate in the upcoming winter. Influenza vaccination has been shown to reduced mortality by 41% for all subjects, and by 75% for those who had also been vaccinated previously (Lancet 1995 Sep 2;346(8975):591-5)..

Currently available vaccines have been highly purified and therefore cause few adverse reactions. Up to 5% of people experience fever and mild symptoms. Up to one-third may have tenderness at the site of vaccination. Since the vaccine is produced in eggs, people who are egge allergic should avoid vaccination or be desensitized. Vaccination is particularily important for those people who have other serious diseases, such as asthma, heart disease, and the elderly. Early autumn, before flu season, is the best time to be vaccinated.

My experience with influenza vaccines was negatively colored during my early years in practice. I had 2 patients who became parapalegic (paralyzed from the waist down) as a result of immunization for the swine flu in 1976. However, since then the vaccines have not caused such serious adverse reactions. Because of a bad bout with the flu several years ago I have personally been getting my flu shots annually.

Diet:

Many of my patients claim they get fewer colds and flu after they have changed to a diet high in fruits and vegetables. There is considerable scientific research that says a healthy diet results in a healthy immune sytem that is better able to resist and over come viral infections. Fats, animal protein and cholesterol are known to suppress the immune system and anti oxidants found in plant foods enhance the disease fightening capabilities of our bodies (Annu Rev Nutr 1998;18:93-116)

Herbs:

Some herbs, such as Ginseng and Echinacea, are believed to help prevent colds and flu. In a multicentre, two-arm, randomized, placebo-controlled, double-blind investigation a total of 227 volunteers received daily oral capsule doses of either placebo or 100 mg of standardized ginseng extract Ginsana G 115 for a period of 12 weeks within which they also received an anti-influenza polyvalent vaccination at week 4 Drugs Exp Clin Res 1996;22(2):65-72. The result were 42 cases of colds or flu in the placebo group, but only 15 cases in the G115 group. Antibody titres against the flu virus by week 8 rose to an average of 171 units in the placebo group, they rose to an average of 272 units in the G115 group. Natural killer (NK) activity levels at weeks 8 and 12 were nearly twice as high in the G115 group as compared to the placebo group.

Echinacea purpurea, a plant originally used by native Americans to treat respiratory infections, has been found to stimulate the production of antiviral factors by human white blood cells (Int J Immunopharmacol 1997 Jul;19(7):371-9). Even very small doses (0.012 microgram/ml) had this effect. These results are consistent with the proposed preventive effects of Echinacea on colds and flu. Unfortunately, to date not enough proper research has benn done to say how effective these hebal preparations might be for preventing viral infections. My personal approach is that I take my Echinacea and my vitamin C with the firts hint I might have come in contact with a virus or the first symptom of a cold or flu. I figure I have done no harm--an maybe some good.

Shortening the duration:

Zinc:

Eight controlled trials on the use of zinc to treat the common cold have been published. Four of these show benefits and the other four did not (Ann Pharmacother 32:63, 1999; Ann Intern Med 125:81, 1996). Different results may be due to variation in formulations and dosages. Zinc gluconate lozenges may be more effective than those made with citric acid or tartaric acid, which bind zinc. The exact mechanism of action is unknown, however zinc may act by preventing the virus from binding to the cells of the respiratory tract, thus preventing them from enetering the cells. The benefit appears to be maximal if the lozenges are started immediately after the onset of symptoms. Common adverse effects include unpleasant taste, mouth irritation, and nausea.

 Vitamin C:

In 1970 Linus Pauling claimed that vitamin C prevents and alleviates the episodes of the common cold. Over the past three decades numerous studies have been done to assess the benefits of vitamin C in preventing and treating the common cold. Although the subject is controversial, a recent analysis of the published literature suggested a significant decrease in the duration of illness and severity of disease by 23% (J Am Coll Nutr 14:116, 1995). The potential benefits from supplementation might be most in people with low dietary vitamin C intake--which would be most Americans who eat too few fruits and vegetables. There is no vitamin C in meat, poutry, dairy or any other anomal product, and refined foods have had much of the vitamin C removed. The best dose for supplementation has not been determined, but is probably greater than 1 gram a day. (Br J Nutr 1997 Jan;77(1):59-72)

Raising Body Temperature

One of the body’s natural responses to infection is a raise in body temperature commonly know as a fever. Beyond drawing attention to an illness fever plays a role in killing infectious organisms such as cold and flu viruses. In the past fever therapy has been used treat neurosyphlis and forms of chronic arthritis. Many other factors, in addition to a raised body temperature play a role in fighting an infection. However, simply raising the body’s core temperature may agument the immune response. Therfore raising the body’s temperature has recently been tried as a treatment for AIDS (ASAIO J. 1997 Sep-Oct;43(5):M830-8).

A warm bath and dry and steam saunas have been recommended for centuries to benefit cold and flu suffers. Therefore one of the treatments I recommend is to soak in a bath or better yet a hot tub at 108 degrees in order to raise your core body temperature--possibly as high as 102 degrees (normally being 98.6 degrees). How long should you bathe at this temperature? An hour would be ideal. However, for most people this treatment is too uncomfortable for that prolonged treatment. People with heart or other debilitating diseases should not raise their body temperatures.

Symptomatic Treatments:

Nasal Congestion:

Pseudoephedrine (Sudafed)

Pseudoephedrine is a decogestant for relief of stuffy nose and head due to colds and allergies. Side effects include nervousness, dizziness, and sleepiness.

Antihistamines

The nasal symptoms of a cold--runny nose, sneezing, itching, nasal secreations associated with a cold are effectively reduced by antihistamines. A common side effect is sleepiness which can be a drawback impairing driving and work related activities, but can also help you sleep when taken at bed time. Common over the counter antihistamine products include Actifed, Comtrex. Contact, Dimetapp, and Tavist. Many other products are sold with antihistamines as one ingredient in a cold prepartaion.

Sodium cromoglycate (Nasalcrom)

Nasalcrom is inhaled through the nose and relieve stuffy and runny nose by stabilizing cells that line the respiratory tract preventing the release secretions.

Cough Suppressants:

Dextromethorphan, often labels as DM on the bottle, is similar to codiene, a powerful doctor-prescribed cough suppressant. The drug acts on the brain to elevate the threshold for coughing. It is almost as effective as codiene, but does not produce drowsiness or constipation commonly seen with codiene.

Pain and Fever Relief:

Tylenol, aspirin, and nonsteroidal antiinflammatory drugs (NSAID), like Advil and Motrin, can be taken to relieve some of the head and body aches and to reduce an uncomfortable fever. Although aspirin and NSAID are usually more effective they have more side effects, especially irritation of the stomach. Two adult aspirins dissolved in a glass of water and gargled, then swallowed, provide excellent relief from a sore throat.

Your Doctor and Prescription Drugs:

There is very little more your doctor can do for you when you get a cold or flu than you can do for yourself with the above recommendations. For high risk individuals--those with other serious dieseases--who did not get immunized, there are drugs (amantadine and rimantadine) that can be given throughout an influenza outbreak that can prevent infection. If your illness progresses with complications, such as pneumonia, your doctor can be of great help to you by administering antibiotics.

However, with an uncomplicated upper respiratory infection antibiotics should not be used. But that’s not the way medicine is practiced. In a recent survey 21% of all antibiotic prescriptions for adults wrere for colds and flus (JAMA 278:901, 1997) Another study found 60% of patients seen in primary care for the common cold recieved antibiotics (J Fam Pract 42:357, 1996). Howver, antibiotics are ineffective against viruses.

A proper indication for the use of an antibiotic would be treatment of a superimposed bacterial infection. An indication for this kind of bacterial infection may be the presence of green and/or yellow mucus from the nasal pasages or the sputum from a cough. Clear drainage would suggest no such bacterial infection has occurred and therfore antibiotics would be useless at best. The side effects of antibiotics are many and sometime sever. The use of an antibiotic for a common cold or flu may add the unpleasantness of a vaginal yeast infection to a woman’s suffering.

So What Does Dr McDougall Do?

I wash my hand frequently through the year, but even more vigorously when there is an outbreak of colds or flu, or if I touch someone who is sick. I get an annual flu shot. I take my vitamin C and Echinacea during cold and flu season or if I feel like I’m starting to come down with anything. After I have passed the point of prevention and am sick I use my hot tube every evening to raise my body temperature. To treat my cough with a syrup containing dextromethorphan, I gaggle aspirin for a sorethroat, and occassionally I take aspirin for bodyaches. Do any of my efforts prevent a cold or flu or help me get over them faster? I don’t know, but I feel better and believe that I have at least taken some action to help myself.


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From Nov/Dec '98

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