This article was originally published in Maclean's Magazine on February 24, 1997
New, Natural Common Cold "Cures"
Gloria Gribling swears it is the best way to beat a cold. At the first hint of a sneeze, a sniffle or a scratchy throat, the 48-year-old Vancouver art-school employee pops a zinc lozenge and lets the tangy, metallic-tasting mineral dissolve slowly in her mouth. "It does make a difference," says Gribling. "I used to have a lot of colds and they would hang on for weeks. Now, I have one a year - if that."
The difference between Gribling and thousands of other Canadians now trying alternative cold remedies is that she was an early convert. She began experimenting with zinc lozenges more than a decade ago, when only a handful of herbalists and health food fanatics used them. "In the '80s, it was considered off-the-wall," recalls Gribling, whose anti-cold arsenal also includes vitamin C and echinacea - a popular herb touted as a cold preventive. "I would ask for zinc lozenges at a drugstore and people would say, 'What's that?' Now, they are mainstream - you can buy them at a chain store."
Zinc lozenges are catching on faster than the flu in February. "People are starting to buy them like crazy," says Sam Ibrahim, owner of the Nutrition Plus Pharmacy in Edmonton. At the same time, health-conscious consumers continue to stock their medicine cabinets with echinacea - one of the best-selling medicinal herbs in North America, with estimated yearly sales in the tens of millions. "It is amazing," remarks Paula Prociuk, a spokesman for Windsor, Ont.-based Jamieson Laboratories, one of four Canadian manufacturers working overtime to meet the growing demand for natural cold and flu remedies. "Last year, sales of echinacea tripled over 1995 and, so far this year, sales of zinc have tripled over last year."
The shot-in-the-arm to the profitability - and credibility - of once-suspect zinc lozenges was administered, surprisingly enough, by conventional medicine. Last summer, researchers at the Cleveland Clinic Foundation in Ohio published a study in the respected Annals of Internal Medicine suggesting that zinc lozenges - taken within 24 hours of the onset of symptoms - may cut the duration of a cold in half. "It works," confirms pediatrician Michael Macknin, who led the study. "It's not what I'd call a cure, but cold symptoms do go away more rapidly."
But many Canadians appear willing to experiment with natural cold remedies even without a medical seal of approval. "I don't know if it's just horseshoes or if it really works," says Leslie Ashton, a Toronto mother who takes echinacea and gives it to her three-year-old girl during the winter cold season. "But my daughter seems healthier - she may get a runny nose, but it doesn't become a full-blown thing."
Like Ashton, many hope that echinacea and zinc will reduce their susceptibility to colds - an understandable goal given that the average adult suffers three or four colds a year, each one lasting about a week. Children - less resistant to the 200 or so viruses that cause the common cold - endure twice as many. "There is also a growing frustration with modern medicine," says immunologist Tim Lee, head of a study on echinacea at Dalhousie University in Halifax. "There is no cure for a common cold, so people are going back to traditional remedies which have been around for millennia. If they've been around that long, there very well might be something there."
For thousands of years, several North American native societies, including the Sioux and the Blackfoot, relied on echinacea to treat an astonishing number of injuries and ailments, from snake bites to diphtheria. Native healers would apply the root - the most potent part of the plant - directly to an aching tooth, sore throat or infected wound. Popularly known as the purple coneflower, echinacea grows wild on the Prairies and in the woodlands across the continent. Now, the pungent herb, produced by commercial growers, is cropping up on drugstore shelves in an ever-increasing variety of preparations, from liquid extracts to capsules, chewable tablets, tea bags and a new lemon-flavored drink mix called Citrinacea.
Herbalists continue to debate the merits of E. purpurea compared with E. angustifolia and E. pallida - the three varieties used medicinally - and whether echinacea is more effective in liquid or dried form. But all of them tout its ability to fight colds and flu by strengthening the immune system. "The Health Protection Branch [of Health Canada] recognizes it for sore throats," notes Ibrahim, who studied herbal healing for two years in Germany and now owns Nutravite Pharmaceuticals, a manufacturer of echinacea. "It's not a fad, it's not snake oil. It's science."
But Dalhousie's Lee, like many mainstream scientists, remains unconvinced. "Echinacea definitely stimulates the immune system," says the immunologist, citing a recent German study in which laboratory mice were infected with a deadly bacteria. Half received large doses of echinacea and survived, while the untreated mice died. "We know it works by injection," states Lee. "The question is - if you take it orally, does it work? The answer to that is - nobody knows." Although many of the hundreds of studies on echinacea have produced encouraging results, he reports that there is still "no solid clinical trial where oral echinacea has been shown to work."
One problem, says Lee, is that researchers have been unable to identify echinacea's "active ingredient." He suspects that the plant's polysaccharides - a form of carbohydrate - may be responsible for its immune-boosting properties. If that is the case, explains Lee, "it is not at all surprising that it would not work orally because our bodies are designed to digest polysaccharides. We would break them down and they would be no damn good." Still, he hopes his research team will eventually identify echinacea's active ingredient and find a way to make it effective in an oral form. "I'm not ready to write it off," adds Lee. "In fact, there is so much in the lab, if I start getting a cold, I might give it a try."
In the meantime, sufferers can count on zinc lozenges to zap a cold, right? Well, maybe. Even Macknin, the senior investigator of the Cleveland Clinic's study of 100 patients, cautions that their encouraging results are "absolutely not" definitive. It is only one of eight studies, he points out: four concluded that zinc lozenges reduced cold symptoms, four concluded that they did not. It is unclear, adds Macknin, why the lozenges used at the Cleveland Clinic - 13.3 mg of zinc gluconate glycine, a type sold under the brand-name Cold-Eeze - produced different results than other formulations.
"The question," says Macknin, "remains, 'Why does it work?' " According to one theory, he explains, the zinc coats virus cells in the mouth and throat, preventing them from "docking" onto the body's receptor cells. Or, perhaps, the lozenge - like some mineral-rich foods - may raise the level of zinc in people deficient in the mineral, stimulating the immune-system response to the cold.
Still, Macknin says "it is reasonable" for a cold sufferer to try to reduce symptoms with zinc lozenges - "if they can tolerate the side-effects." About 20 per cent of the participants in the Cleveland study reported that the lozenges nauseated them. Others decided they would rather put up with cold symptoms than the unpalatable taste of the lozenges. "Ten per cent of the adults in our study dropped out because of the taste," says Macknin, who adds that "since then the people who make lozenges have become much better candymakers." The sweeteners may help the medicine go down, but Macknin adds a warning: ingredients added to certain brands to mask the bitter taste of zinc also reduce its effectiveness. One more caveat: zinc is an essential nutrient, plentiful in some foods, including red meat and unrefined grains, but an overload can be harmful. "If you take too much for too long," cautions Macknin, "it can actually make you more susceptible to colds."
Is it safe to take zinc and echinacea for a cold? "If it provides relief, I would not be opposed to it," says Dr. Claude Renaud, director of professional affairs with the College of Family Physicians of Canada, noting the substances - regulated by Health Canada - are safe if used as recommended. But Renaud says that he would be concerned about prolonged, unsupervised use of any alternative remedies.
"A vast majority of patients don't report it to their physicians," notes Dr. William LaValley, head of a committee studying complementary medicine issues for the Medical Society of Nova Scotia. "They are afraid of being chastised." LaValley sometimes recommends echinacea to patients with colds or sore throats. But he does not discount a possible placebo effect. And "if it is a true cold," he says, "it will often get better in five to seven days, no matter what you do."
RISKS AND BENEFITS
When Camille Collver takes echinacea, she ignores the instructions on the label. "If I feel a cold coming on," says the 43-year-old Calgary mother, "I slam it for two days - I take 15 drops 10 times a day, where the bottle may say take 15 drops three times a day." Collver believes that if she stuck to the recommended dosage, she would "still end up coming down with a cold." Whatever risk Collver may be taking, she - like many echinacea users - is only following advice offered by most herbalists and naturopaths: take a high dose for a day or two at the beginning of a cold or flu, take a low dose for about a week and then stop. "If you pussyfoot around at the beginning," says Vancouver herbalist Chancal Cabrera, "you won't get the action you are looking for."
But Tim Lee, a Dalhousie University immunologist and head of a study on echinacea, says there is not enough standardization in echinacea production to justify advice like that approach. In fact, he says, a capsule or a drop of echinacea from one company may be as much as 1,000 times stronger than another brand. "Both will appear on the shelves as 'Pure extract of echinacea,' " he notes. "So how much should I take?"
Alternative practitioners maintain that echinacea is nontoxic even in high doses. But Lee recommends moderation - and following the directions that the manufacturers have approval to put on the label. "It's a recommended dose," he explains, "because the people providing it know that it can't do any harm."
See alsoMEDICINE, HISTORY OF.
Maclean's February 24, 1997