Sunday, April 19, 2020

Cold remedies: Old wives' tales... or legitimate science?

By Jessica Brown3rd December 2018
From orange juice to zinc lozenges, chicken soup to garlic capsules, there are plenty of home remedies for the common cold. But is there any evidence that they work?
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As many countries urge populations to stay at home, many of us are paying more attention to our diets and how the food we eat can support our health. To help sort out the fact from the fiction, BBC Future is updating some of our most popular nutrition stories from our archive.
Our colleagues at BBC Good Food are focusing on practical solutions for ingredient swaps, nutritious storecupboard recipes and all aspects of cooking and eating during lockdown.
There are few experiences as universal as catching a cold. And while there are around 200 viruses that cause it, there seem to be almost as many home remedies to combat it.
But do any of them work?
At the core of any home remedy is the idea that it bolsters our immune system. When a virus enters our bodies, it comes up against two systems of defence: the innate immune system tries to flush invading cells out, while the adaptive system targets specific pathogens that the body already has had contact with and creates memory cells of new ones, so the body can fight them off if they return. This is why we tend to get chicken pox only once, whereas the common cold – which changes its appearance as it passes from one person to the next, confusing our memory cells – is something we can experience dozens of times.
It’s well-known that both lifestyle habits and diet affect the strength of our immune systems.
We know that our diet affects our immune system (Credit: Getty)
But because the immune system is only impaired in otherwise healthy people when we have a vitamin or mineral deficiency, supplementing our diets with so-called cold-busting foods will make little difference if we already have a relatively good diet, says Charles Bangham, head of the Division of Infectious Diseases at Imperial College London.
“Only if you’re short of a vital nutrient, such as vitamin, zinc or iron, will supplementing that particular item be very helpful. But if you eat a balanced diet, adding more of these things doesn’t make the immune system any more efficient,” he says.
It should also be pointed out that many of the same remedies we're told can cure the common cold are also being circulated on social media with the promise that they can keep us safe during the current virus pandemic.
Supplement solution
Studies looking into cures for the common cold have found that they can make a difference.
The vast majority of these studies concentrate on supplements, rather than food – in fact, no reliable research has been done on whether a popular cure like chicken soup actually makes a difference.
But one supplement that may help is popular home remedy garlic. In one small study, 146 healthy adults were given either a placebo or a daily garlic supplement for 12 weeks over winter. The placebo group contracted 65 colds, resulting in 366 days of sickness – whereas those who had garlic supplements only contracted 24 colds, with 111 days of sickness between them.
One small study found that, compared to a placebo, a garlic supplement led to fewer colds (Credit: Getty)

One review on vitamin C supplements didn’t find that supplements greatly reduce the risk of getting colds

Another supplement many people reach for when they feel cold symptoms is vitamin C. Some research suggests it too can help – though not as much as you might think. One review analysing 29 studies on vitamin C supplements didn’t find that supplements greatly reduce the risk of getting colds, or that they alleviate symptoms. But it did find that children saw a 14% reduction in the length of their colds; in adults, the reduction was 8%. Researchers concluded that since the supplements are low-risk, it may be worthwhile trying them to see if they can help.
Orange juice may be less useful: there is no robust evidence that orange juice helps prevent colds, alleviate symptoms or reduce a cold’s length. This is because it doesn’t contain high enough doses of vitamin C to have the same impact as daily supplements, says Harri Hemilä, a public health researcher at the University of Helsinki and author of the vitamin C supplements review. A standard small bottle of fresh orange juice has around 72mg of vitamin C, according to the US Department of Agriculture – that’s more than the recommended daily minimum of 40mg, but still less than many supplements.
Orange juice is unlikely to make a difference in preventing or alleviating a cold (Credit: Getty)
Then there’s zinc. One review examining the effectiveness of daily zinc acetate lozenges on the common cold found that they shortened the duration of runny and blocked noses by around a third, plus led to 22% less sneezing and almost half as much coughing.
The study concluded that if started within 24 hours of the first symptoms, 80mg daily zinc acetate lozenges may help treat the common cold.

Patients with a cold who were given zinc lozenges recovered three times faster

However, Hemilä argues it’s more accurate to study recovering from a cold fully, rather than measuring symptom duration – which avoids data being affected by people dropping out of the study before fully recovering from their cold, and to avoid those with extended colds skewing the findings. His study of 199 common cold patients found that those with a cold who were given zinc lozenges recovered three times faster.
Often, scientists say that vitamins and minerals are best consumed through foods, rather than supplements – though they point out that, as with vitamin C, it’s often easier to get high doses of a vitamin through supplements.
Zinc lozenges may help curtail the pain of a cold – if they’re started within 24 hours of having symptoms (Credit: Getty)
For zinc, however, the opposite is true. In order to be effective against colds, zinc must come from lozenges and not from ordinary zinc tablets or zinc-rich foods, Hemilä says.
“Zinc lozenges are slowly dissolved in the throat region and the effect of zinc is local,” he says. “We don’t know what the biochemical mechanism of this effect is. But studies finding zinc lozenges to be effective used large lozenges that have dissolved for up to 30 minutes in the mouth.”
Cold comfort
Still, one complication is that researchers haven’t tended to look at whether people were deficient in something like vitamin C or zinc before they started a regimen. So, any cold-fighting benefit might be down to the fact that by taking a supplement, some participants were correcting a deficiency, rather than the supplement making a difference for already healthy people.
If studies of vitamin C show it’s helpful in fighting a cold, it may be because participants were previously deficient (Credit: Getty)
Another complication is the power of placebo. Of course, many studies, like that on garlic supplements, do control with a placebo-only group – so the effect for those isn’t down to placebo alone.
But if we swear that something for which there’s limited or no scientific evidence, like chicken soup or orange juice, really cures us, it may be down to placebo. Placebos have been found to be effective in alleviating many symptoms, from pain to irritable bowel syndrome, although the reasons why aren’t yet fully understood. And whether for vitamin C or chicken soup, the placebo effect alone could help us get over a cold.

People who believed in the alleged cold-fighting properties of echinacea experienced milder and shorter colds when taking daily doses, compared to than those who didn’t believe in it

One study found that people who believed in the alleged cold-fighting properties of herbal remedy echinacea experienced milder and shorter colds when taking daily doses, compared to than those who didn’t believe in it. Previous studies in which participants weren't aware they were getting echinacea weren't shown to improve cold symptoms.
It works the other way, too. Milk has long been thought to worsen mucus production when we have a cold, although this has now been debunked. But one study found that people who believed that milk causes mucus reported more respiratory symptoms after drinking it. (Find out more in our BBC Future story Should you avoid dairy when you have a cold?).
While placebos are usually administered by doctors in clinical trials, the placebo power of home remedies can come from our everyday lives, says Felicity Bishop, associate professor of health psychology at the University of Southampton.
“Studies show the power of the placebo pill comes from a trusted relationship between patients and healthcare professionals, someone who is caring and can offer treatments with confidence,” she says. “And this is kind of what parents do when we’re young. It’s the nature of the relationship is important, rather than who that person is.”
If we learn from our families that chicken soup helps with a cold from our families, then it really can help us, thanks to the power of placebo (Credit: Getty)
As well as trusted friends and family, the placebo effect could also be strengthened by how foods are marketed, Bishop adds.
The good news? Knowing that home remedies are placebos won’t necessarily stop them from alleviating our symptoms. “Open-label placebos, when a doctor tells the patient something is a placebo but that it’s helped some people, can still make patients better,” she says.
Another effect could be the comfort induced by such foods. Dietician Sarah Schenker says the comfort of having chicken soup, for example, could help someone with a cold to feel slightly better.
Rather than how much vitamin C we stock up on, the chances of being able to stave off bugs in winter depends largely on the individual – including how much we believe in placebos, but also because of our genes.

Some people’s genes make them particularly susceptible to certain diseases – Sarah Schenker

“Some people’s genes make them particularly susceptible to certain diseases. It’s much more important to realise we all differ genetically from one another – when some people have the flu, they don’t realise they’ve got it, while others get a very serious disease. This is partly determined by your genes, which have much more of an impact.”
For the majority of us with healthy immune systems, we can do little more than rely on the power of placebos to get over winter bugs… though popping some zinc or garlic supplements might help too.
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By Jessica Brown6th April 2020
Spices have been eaten for millennia. Turmeric and chilli, in particular, have been researched extensively in recent decades. And while consuming them is correlated with some health benefits, those benefits – and the reasons for them – are not what you might think.
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Spices have been a part of our diets for thousands of years – it’s second nature to sprinkle our chips with pepper, sip on ginger tea and add chillies to our meals. But recently, some spices have been unofficially promoted from everyday culinary staples to all-healing superfoods.
Hillary Clinton reportedly ate one chilli pepper a day while on the campaign trail in an attempt to ward off illness. Turmeric, which has been used in Asia for millennia, recently has found its way into coffee shops around the world in the form of “golden lattes” – and, most recently, into viral messages that claim it can “boost your immune system” and protect you from getting sick. Meanwhile, cayenne pepper still hasn’t recovered since the ill-advised “Beyoncé diet” back in 2013, which suggested consuming a concoction of cayenne pepper, maple syrup, lemon and water to lose weight.
But do spices really add any health benefits to our food, or help us ward off illness? And can any of them actually do us harm?  
Hot trend
One of the most well known and widely used spices are chilli peppers. Many studies have examined their potential effects on our health – but have found both beneficial and adverse results.
Many studies have looked at how chilli peppers can affect our health, but results are mixed (Credit: Getty Images)
Capsaicin is the main active ingredient in chillies. When we eat chillies, capsaicin molecules interact with the temperature receptors in our bodies, sending signals to the brain to create the feeling of heat.
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Some studies point to the idea that capsaicin may help you live longer.
In 2019, an Italian study found that people who ate food seasoned with chilli peppers four times a week had a lower risk of death compared to those who never ate chillies. (Researchers controlled for lifestyle factors including smoking, exercise and overall diet quality.) And in 2015, researchers in China, who examined the chilli consumption and health of nearly 500,000 Chinese adults, found that eating chillies was associated with lower risk of death. Those who consumed spicy foods almost every day had a 14% lower risk of death than those who ate spicy foods less than once a week.
One study found that those who consumed chillies almost every day had a lower risk of death (Credit: Getty Images)
“The major findings were that higher intake of spicy foods is related to a lower risk of mortality, particularly deaths due to cancer, heart disease, and respiratory diseases,” says researcher Lu Qi, professor of nutrition at Harvard's school of public health.
This does not, however, mean that starting to eat large quantities of chilli peppers will protect your health – or protect you from respiratory illness – in the short-term.
It’s important to remember that the China study followed people for a median time of seven years each. So even if chillies had a protective effect on participants’ health, rather than the people who ate chillies happening to be healthier to begin with, the effect likely built up over time – not within weeks or months.
Qi tried to separate the effects of chilli consumption from everything else by controlling for age, sex, education level, marital status, diet and lifestyle factors including alcohol intake, smoking and physical activity. He says the lower risk of disease relating to eating chillies may be partly due to capsaicin.
“Certain ingredients in spicy foods, such as capsaicin, have been found to improve metabolic status, such as lipid profiles” – cholesterol in the blood – “and inflammation, and these may partly account for the observations in our study.”
Capsaicin, the main active ingredient in chillies, may improve blood cholesterol levels and inflammation (Credit: Getty Images)
A number of studies also have shown that capsaicin can increase the amount of energy we burn and can decrease our appetites.
Zumin Shi, associate professor at Qatar University's human nutrition department, has found that chilli consumption is associated with lower risk of obesity and is beneficial for high blood pressure. So when she studied the effects of chilli pepper consumption on cognitive function, she expected a hat trick.  

In one study, people who ate more chillies had poorer cognitive function

But when she measured Chinese adults’ cognitive function against their chilli consumption, she found that people who ate more chillies had poorer cognitive function. This effect was strongest with memory: chilli intake above 50g per day was associated with almost double the risk of self-reported poor memory. Still, it’s worth noting that self-reported data is widely considered unreliable.
The burning sensation that comes with eating chillies has long fascinated scientists. It also gives us some insight into why chillies may be associated with cognitive decline: the sensation is the result of plants evolving to protect themselves against diseases and pests.
“While some plants have evolved to become bitter or spicy to predators, it’s better if the plant can make themselves toxic, too,” says Kirsten Brandt, senior lecturer at the Human Nutrition Research Centre Population Health Sciences Institute at the UK’s Newcastle University.
But these compounds generally have a smaller effect on us than on insects. “A little bit of toxin can be good, such as caffeine, which speeds up our metabolism so we feel more awake,” she says. “However, a lot of it is bad for you.”
On the other hand, even if a compound within a certain spice may have beneficial effects, we normally don’t consume enough of it to make any difference.
Even if a compound within a spice like chilli has beneficial effects, we normally don’t consume enough of it to make a difference (Credit: Getty Images)
Take polyphenols: the compounds found in many plants that have anti-inflammatory effects. Spices’ health benefits are partly attributed to their high levels of these polyphenols. A 2014 review of research, however, says it’s still unclear whether the limited amount of these we get when we consume spices lessens their health benefits.
Curcumin “cure”
Another popular spice that is widely regarded to have beneficial effects on human health is turmeric. This is widely attributed to curcumin. A small molecule found in turmeric, it is commonly used in alternative medicine to treat inflammation, stress and many other conditions.

Robust evidence for turmeric being beneficial is lacking

Robust evidence for turmeric being beneficial, however, is lacking.
Numerous studies have found curcumin to have anti-cancer effects in the laboratory. But a lab environment is very different to the human body. And curcumin has poor water solubility, meaning the body can't make proper use of it from the turmeric we consume.
In the Western world, this increasing interest in spices including turmeric as an alternative medicine was last seen in the Middle Ages, when spices were thought to have healing properties, says Paul Freedman, professor of history at Yale University.
In the West, the belief that spices like turmeric can help heal was last seen on a large scale in the Middle Ages (Credit: Getty images)
“Spices were used to balance the properties of food. People thought of food as having hot, cold, moist and dry qualities, and they needed balance,” says Freedman. Fish was considered cold and wet, for example, while spices were hot and dry.
The idea of using food as medicine, and of balancing out properties like hot and cold or wet and dry, also are main tenets of Ayurvedic medicine, which has been practised in India for thousands of years.

In the West, our modern fascination with spices brings us closer to a medieval outlook than 50 years ago – Paul Freedman

In many Western countries, where such ideas are much newer, “this idea of balance is shared with modern new-age medicine,” Freedman says. “Our modern fascination with spices brings us closer to a medieval outlook than 50 years ago – when there was a wall between modern medicine like antibiotics and superstitious medicine of the past that didn’t work.”
As part of her job, Kathryn Nelson, research assistant professor at the University of Minnesota's Institute for Therapeutics Discovery and Development, looks at molecules to see if they could be a compound for new drug. She decided to study curcumin after she kept coming across the health claims associated with it.
“Researchers are able to exert effects in cells grown in test tubes by adding compounds to it and seeing what happens to the cells,” she says.
But she found that curcumin is a “terrible” drug molecule, as it isn’t bio-available – meaning the body can’t make use of it once it’s digested. It isn't easily absorbed by the small intestine, and its structure can be modified when it binds with proteins in the small and large intestines. As a result, it doesn’t actually do much.
Because curcumin isn’t easily absorbed by the small intestine, it’s unlikely to provide much benefit after it’s eaten (Credit: Getty Images)
There could be something about turmeric that’s beneficial, but it’s not curcumin, she says. Plus, if turmeric is cooked as part of a meal, she says, it’s added alongside other foods, and heated up, so its chemical components change.
“There might be something else in turmeric worth looking at, but not curcumin, and it might not be one thing. It might need to be chemically modified or added to something to be beneficial.”
She says consuming lots of turmeric isn’t harmful, but she wouldn’t advise using it as self-medication.
Correlation vs causation
Chilli and turmeric have been widely studied, but most trials have only compared data on consumption and different health outcomes, which doesn’t separate cause from effect. And research done in labs doesn’t necessarily translate to the human body.
And as is true for so many nutritional studies, it’s difficult to tease out correlation versus causation.
Take the 2019 Italian study finding that there was a lower risk of death associated with chilli consumption. It was observational, so it’s impossible to know whether eating chilli made people live longer, whether already healthy people tend to consume more chilli, or if something else is at work.
One clue could, however, lie in how chillies are consumed by Italians and other Mediterranean cultures, says the study’s author Marialaura Bonaccio, epidemiologist at Italy's Mediterranean Neurological Institute.
“Chilli is common in Mediterranean countries,” says Bonaccio. “It’s mostly eaten with pasta and legumes or vegetables.”
In the Mediterranean, chillies are often eaten with pasta and vegetables, or legumes, which may be the real reason behind any health benefit (Credit: Getty Images)
This is just one example of how spices could be indirectly beneficial – they’re eaten with legumes and vegetables.
Research also has found that adding a spice mix to burgers could potentially lead to fewer free radicals forming in a person’s body than those who ate the burger without spices, and could make the meat less carcinogenic. But these benefits could be explained simply by the preservative qualities of the spices, says Mellor, who wasn’t involved in the study.
“Putting spices into meat is a well-known technique to preserve meat,” he says. “The benefits of spices, therefore, may be more food preservation, rather than them having direct benefits to us. But either way, we could benefit as it still makes the food less harmful to us.”
Many researchers believe the health benefits of spices actually come from what we eat them with. For example, there's a tendency to use them to replace salt, says Lipi Roy. “Spices make food delicious and flavourful, and they can be a healthier alternative to salt,” she says. (Read more about how much salt we really need).
Spices are often used instead of salt, which means their health benefits could come from lowering sodium, not from the spice itself (Credit: Getty Images)
We also tend to eat chillies with vegetables – which of course benefits our health, too.
So while golden lattes won’t do us any harm, we might be better off having some vegetables seasoned with a sprinkling of spices. And we certainly shouldn’t rely on them as a way to ward off – or to fight – any kind of illness.
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By William Park 27th November 2019
Eating large meals can bring about changes that make us hungrier – but it’s not because your stomach “stretches”.
* This story is featured in BBC Future’s “Best of 2019” collection. Discover more of our picks.
I am pretty confident that I can predict how I am going to feel after Christmas dinner: snoozy, sluggish and definitely full. But by lunchtime the next day I am sure I will find room for another roast. When you think about it, it is pretty weird that the day after an enormous meal we can eat exactly the same quantity again. Did we not learn our lesson the first time?
Why do we still feel hungry after feasts like Thanksgiving or Christmas? Does overeating “stretch” your stomach, meaning you have more room for food the following day? Even thinking about it now is making me hungry.
The answer is, for most people, you don’t feel hungry in spite of the huge quantities of food you’ve recently consumed. You feel hungry precisely because of it.
But first, what is this sensation of hunger? The pang you feel that urges you to eat is the result of a number of physiological changes inside your body. (Find out how meal timings affect your wasteline.)
If we get used to eating at a particular time of day or environment, we can become conditioned to expect food when in the same situation again (Credit: Getty Images)
It is true that your stomach changes in size when hungry or full. The stomach contracts as a meal is digested to help move food towards the intestines. It rumbles as air and food move around as food is pushed down, a phenomenon called borborygmus, which is often our first cue that we might be hungry because it is audible and physical. After rumbling, the stomach then expands again in preparation for eating – this is initiated by hormones.
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But it is not really true that eating stretches the stomach. The stomach is very elastic, so will return to its resting capacity (about 1-2 litres) after a big meal. In fact, most people’s stomachs are pretty similar in capacity – neither height nor weight have an effect.
What we might not be conscious of is the release of our hunger hormones: NPY and AgRP from the hypothalamus, and ghrelin from the stomach. Ghrelin is released when the stomach is empty and stimulates the production of NPY and AgRP in our brain. These two hormones are responsible for creating the feeling of hunger and overriding the hormones that give us the sense of being satisfied.
Perhaps counter-intuitively, ghrelin levels tend to be higher in lean individuals and lower in people with obesity. You might expect that a hormone that stimulates hunger would be more present in people who eat more – but this contradiction probably reflects how complicated our endocrine system is.
While only three hormones are largely responsible for generating feelings of hunger, a dozen or so are required to make us feel sated. A couple of them, GIP and GLP-1, are responsible for stimulating the production of insulin to regulate the metabolism of carbohydrates. Several more hormones are involved in slowing down the movement of food through our stomach, to give our bodies time to digest the food. For those people with obesity who have low levels of ghrelin, it might be that high levels of insulin, needed to metabolise a high-carbohydrate diet, are inhibiting production of ghrelin.
Two are key to reducing the feeling of hunger: CKK and PYY. In patients who have a gastric band fitted, which reduces the size of the stomach, PYY is particularly high. This contributes to a loss of appetite.
Even after a big meal in the holiday period, we can easily find room for more the next day (Credit: Getty Images)
Even though your stomach has a hormonal system for telling your brain when it is empty, this is often augmented by the learned association between times of day and feeling hungry. So, even if you had a large lunch, you may well still feel hungry at dinner.
“If you repeatedly grab a piece of chocolate or crisps after dinner when you sit on the couch to watch TV, our body can start to associate sitting on the couch, TV and eating something nice, and as a result when you go to the couch you experience a craving,” says Karolien van den Akker, a researcher at Centerdata and formerly Maastricht University. “That can even occur when you are sated; when your energy stores are full.”
Overeating is not bad per se, says van den Akker. Unlike a clinical diagnosis of binge eating where very large amounts of food are consumed in a short amount of time, often associated with feelings of disgust, guilt or shame, overeating may simply be seen as a habit they would like to break. But learned food cravings can also make it very difficult to successfully stick to a diet.
When we learn to associate the rewarding properties of food, particularly high-sugar foods, with specific times, smells, sights and behaviours, the memory of that sensation is activated and you start craving. This then triggers not only psychological but physiological responses, like salivating.

These associations develop quickly and even with small amounts of chocolate like 1-2g – Karolien van den Akker

You might be familiar with Pavlov’s dog – an experiment in which a bell is rung at mealtimes so that a dog associates the bell with receiving food. Eventually, the dog salivates at the ringing of the bell alone. Humans are not much more sophisticated than dogs in this regard. In another experiment, people were shown simple shapes – circles and squares. When they saw the squares, they were given a piece of chocolate and thereafter began to crave chocolate whenever they were shown the squares again. Like dogs, humans can be conditioned to expect food based on simple cues.
Studies have shown time and again that people eat more when sharing a meal with a group than when by themselves (Credit: Getty Images)
“These associations develop quickly and even with small amounts of chocolate like 1-2g,” says van den Akker. “It seems quite easy to acquire these desires but it is hard to get rid of them. Your body remembers that at one specific point in time you ate chocolate. The craving can easily turn into a daily craving – even after only four days of repetition.”
Sometimes even our mood can become the trigger for conditioning. People commonly report they have less self-control if they are in a bad mood or tired. “In that case emotions can directly become associated with tasty food, so then the bad emotion could trigger the craving,” says van den Akker.
In principle, any mood, even a positive one, can become a craving trigger, as long as it is consistently followed by food. And it has been repeatedly shown that we eat more when we are in the company of friends. Even when you control for alcohol, special occasions, the length of time you spend at the table and many other factors, we eat more when we are being social. Perhaps because the pleasure of the company around us makes it harder to concentrate on portion control. Even people sat in a lab eating a bowl of plain pasta will eat more if they have a friend to talk to. (Read more about how our friends manipulate our behaviour for better – or worse – here).
The atmosphere of the festive season can condition us to expect vast quantities of food (Credit: Getty Images)
This knowledge has implications for breaking bad eating habits, too. “When we are trying to help people to eat less, we focus on “unlearning” their learned eating desires. Here, we also try to make sure they learn that eating something nice once does not mean that you have to do it on the next days, too,” says van den Akker. This is important because other studies have shown that breaking a good eating habit once can be enough to relapse into a bad habit.
Perhaps it is no surprise, then, how hungry we feel after a big meal with family and friends. We are still hungry the next day – or even later the same day – not because our stomach has stretched, but because we have grown accustomed to eating excessively on special occasions. If our brains see all the cues – the smells, the sights, the sounds – associated with a big meal the day after a feast like Christmas, then it will start getting us ready for round two.
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