|In this issue of HEALTHbeat:
• Think twice about cold remedies
• Does having ridged and split fingernails mean I’m unhealthy?
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|January 22, 2008|
Dear HEALTHbeat subscriber,
When Ben Franklin observed that death and taxes are the only certainties in life, he seems to have left out one other thing: the common cold. No matter how hard we try to avoid picking up germs, most of us get a cold at some point during the year, complete with sneezing, a runny nose, sore throat, congestion, and coughing. There’s no cure for the common cold yet, but this issue of HEALTHbeat evaluates the available remedies to help you choose what might help you most. Also in this issue, Dr. Celeste Robb-Nicholson, editor in chief of the Harvard Women’s Health Watch, discusses what causes ridged and split fingernails and what might help protect them.
Wishing you good health,
|Think twice about cold remedies|
The cold season has arrived, a cure hasn’t, and even efforts at treating the symptoms seem like a dubious proposition these days.
Over-the-counter cold remedies have come under harsh scrutiny lately. In October 2007, an FDA advisory panel recommended a ban on cold medicines for children under six, and in anticipation of that vote, several drug makers pulled their infant cold medicines off the shelves. Medicines for adults weren’t affected, but they don’t have a track record that inspires great confidence. A drug called phenylpropanolamine was used as a nasal decongestant in many products until researchers linked it to hemorrhagic strokes in women. Guidelines from the American College of Chest Physicians in 2006 cast doubt on the effectiveness of cough expectorants and suppressants included in many over-the-counter products.
Little wonder, then, that people have sought out alternatives like vitamin C and zinc. But for the most part, the evidence for them is pretty shaky.
Here’s a rundown on cold treatment and prevention:
Over-the-counter medicines. Colds, of course, have a variety of symptoms, so cold medicines have a variety of ingredients: almost always some kind of pain and fever reducer, usually acetaminophen; a cough suppressant, often dextromethorphan; a nasal decongestant, usually phenylephrine; and sometimes an antihistamine, often chlorpheniramine.
The combination of uncertain benefit and possible harm cast a shadow over the infant and children’s cold formulations. Do these concerns apply to the adult medicines? Efficacy is certainly an issue. The American chest physicians aren’t alone in their skepticism about the anti-cough ingredients. British researchers reviewed 15 trials of cough medicines and concluded that “there’s no good evidence of their effectiveness.” Their damning assessment included antihistamines. The first-generation antihistamines like doxylamine and chlorpheniramine have a sedating effect, so they’re often ingredients in the medicines that brag about nighttime relief.
If taken at the recommended dose, the OTC medicines are reasonably safe for adults. Still, that’s a sizable if. Most of the complications from the infant and children’s formulations have come from accidental overdoses, which can be a problem for adults, too. People don’t necessarily read the fine print and may not realize, for example, that a tablespoon of Nyquil contains 500 milligrams (mg) of acetaminophen. If they are taking lots of Tylenol — which is acetaminophen — at the same time, they can get into trouble that, in the worst case, may end in liver failure.
The possibility of anticholinergic effects from antihistamines is also something to keep an eye on. Particularly in older people, anticholinergic drugs can cause confusion, constipation, urinary retention, and other problems.
Pseudoephedrine, the active ingredient in stand-alone nasal decongestant products like Sudafed, is a powerful medicine that needs to be taken with care. It works by constricting nasal blood vessels, but that effect isn’t limited to the nose. Pseudoephedrine can cause hypertension and, rarely, cardiac arrhythmias and strokes, as well as urinary retention in men with an enlarged prostate gland. It’s unclear whether phenylephrine, the nasal decongestant that has replaced pseudoephedrine in many of the multisymptom cold medicines, poses the same risk.
Vitamin C. Linus Pauling’s book, Vitamin C and the Common Cold, was published in 1970. The Nobel laureate believed that most people should take 1,000 to 2,000 mg of vitamin C daily, advised people to carry a 500-mg tablet at all times to take at the first sign of a cold, and envisioned eradicating colds from certain parts of the world within a decade or two. In 2007, a review of 30 trials that included a total of over 11,000 people found that taking the vitamin to prevent colds had little, if any, effect. Exceptions might be people who engage in heavy-duty exercise like marathon running or who are exposed to extreme cold. Such experiences cause temporary dips in immune function that vitamin C may offset. Whether megadoses might help treat a cold once it’s started will require more research, the review concluded.
Zinc. Taking zinc has been proposed as a way to shorten colds and perhaps reduce their severity. The mineral’s cold-fighting career got started with a 1984 report by a Texas researcher, George Eby, that zinc lozenges shortened colds by seven days. The research has meandered since, with some positive outcomes and some negative ones. Stanford researchers reported in 2007 that three of four studies that they identified as being the most reliable didn’t find a therapeutic benefit from zinc lozenges or nasal spray. The fourth, which tested a nasal gel, did. There have been several reports, though, of zinc gels causing a loss of the sense of smell. In most cases, the sense comes back, but the impairment has been known to last more than six months.
Echinacea. Gardeners know echinacea as the coneflower, a perennial that looks a little like a daisy, but has thin, droopy petals. In a meta-analysis of 14 studies, University of Connecticut researchers found that taking echinacea decreased the odds of developing a cold by 58% and the duration by 1.4 days. The results, reported in 2007 in Lancet Infectious Diseases, were a bit surprising because a number of randomized clinical trials, including two funded by the National Institutes of Health, hadn’t found any benefit from taking echinacea. Meta-analyses are a good way to get a handle on a body of evidence, but there are always questions about the quality of the underlying studies, how results are weighted, and the variety of doses used.
And once you get a cold…
Cold medicines aren’t the only OTC game in town. You can take many of the ingredients contained in these medicines separately, which allows for a targeted rather than a shotgun approach to symptoms. Aspirin or acetaminophen can ease the pain of a sore throat. Nonsteroidal anti-inflammatory drugs like naproxen (Aleve, other brands) can help with a cough.
Taking a decongestant isn’t the only way to open up nasal passages. Inhaling steam from a teakettle or in a hot shower can help. Drinking plenty of water helps unplug nasal passages by keeping mucus moist and flowing. And if you have a fever, fluids counteract the tendency to get dehydrated.
Finally, don’t overdo the nose blowing. Too much blowing can push nasal fluids laden with bacteria and viruses into the sinus cavities. The result in some cases is a secondary infection of the sinuses that needs to be treated with antibiotics.
For more information on vitamins, order our Special Health Report, Vitamins and Minerals: What you need to know, at www.health.harvard.edu/VM.
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|Does having ridged and split fingernails mean I’m unhealthy?|
Q: I’m 63, and I’ve begun to notice a decline in the quality of my fingernails. They have numerous up-and-down ridges, and at the tips, they’re always splitting. I’ve heard you can tell a lot about a person’s health from the condition of her nails. What does this say about mine?
A: Some changes in nails can be a sign of an underlying health problem, but the lengthwise nail ridging you describe is usually not one. It’s simply a common sign of normal aging. The growth of fingernails and toenails slows as we get older, and their appearance may change. Some nails become yellowed or dull and brittle, and some or all may develop tiny longitudinal ridges. Fingernails tend to become thinner and more fragile, while toenails usually become thicker and harder.
Fingernails don’t always change with age, and they don’t necessarily change at any particular age. But brittle nails are very common, occurring in 27% of women. The nails may separate at the tips in thin layers, peeling like layers of an onion, a condition called onychoschizia. If the nails are ridged and brittle, they may split lengthwise. The problem tends to increase with age, as nails lose their water content. Dehydration is a risk in cold, dry climates and with frequent washing and drying of the hands and exposure to cleaning agents and solvents like nail polish removers.
You can’t do anything about age-related nail changes, but you can reduce the risk of splitting and breaking that often accompanies them:
Evidence from a small controlled study suggests that oral supplementation of the B vitamin biotin may increase the thickness of brittle nails and reduce splitting, although it’s unclear whether it’s more effective than moisturizers. There’s no evidence that eating gelatin, calcium or other minerals, vitamins, or supplements has any effect on age-related changes in fingernails.
— Celeste Robb-Nicholson, M.D.
This Question and Answer first appeared in the January 2008 Harvard Women’s Health Watch, available at www.health.harvard.edu/women.
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