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  1. #1
    novastepp's Avatar
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    Mega Dosing

    Today in my 4th year pharmacology class, it was stated that there is proof that vitamin C is a viable "drug" to combat the onset of a cold/virus. It was said that by 2011 it might even be a medical regiment. This is just some info for those of you/us that mega dose when we're feeling down, or on a regular basis. I know I take about 12g everyday. "Mega dose" that was given was only 10g over a 24 hour period, dosed accordingly.

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    yup, i take 500 mg ed... which is well over the normal daily percentage but 10g, that's a lot. are there any adverse effects to mega dosing VC or do you just piss it out?

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    i might have to try dosing it when it gets closer to flu season around here

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    I always take 3-5g daily........ If im not mistaken-I read somewhere that (maybe some europe guys could chime in here)Docs in some european countries recommend 3x the amount of vitamins they recommend here in the states.... anyone know?

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    when i get a cold/sore throat i take 5g a day. definitely helps the immune system attack quicker.

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    Vitamin C is the corner stone of vitamins I use to kick a cold out of me.I find it's best at the first indication of a cold.

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    when im feelin sick i take at least 10g a day

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    1-2g'sED for me.

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    Quote Originally Posted by novastepp View Post
    Today in my 4th year pharmacology class, it was stated that there is proof that vitamin C is a viable "drug" to combat the onset of a cold/virus. It was said that by 2011 it might even be a medical regiment. This is just some info for those of you/us that mega dose when we're feeling down, or on a regular basis. I know I take about 12g everyday. "Mega dose" that was given was only 10g over a 24 hour period, dosed accordingly.
    you should run a search on thie subject nova,i think you will find that Johan/Kärnfysikern has posted numerouse writings and facts ect on this subject..................
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    Quote Originally Posted by dedic8ed1 View Post
    Vitamin C is the corner stone of vitamins I use to kick a cold out of me.I find it's best at the first indication of a cold.
    me 2

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    Quote Originally Posted by qualityclrk1 View Post
    me 2
    Yeh, whenever I get sick I take an Emergen-C (or however it's spelled) 3 times daily and it goes away within a day or two.

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    12 grams everyday!!!!! Holy crap!!! I'm not quite sure what material you are covering in class right now, but I don't believe there are any current peer reviewed articles (U.S) that are indicative of those doses being safe or even effective. I take 1-2 grams a day and if you take into account the other doses you ingest via food, drink, etc., it adds up to more than 3-4 grams daily. But 12.....I am surprised that you don't suffer some significant stomach distress or discomfort with that range.

    Doc M

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    Quote Originally Posted by Doc M View Post
    12 grams everyday!!!!! Holy crap!!! I'm not quite sure what material you are covering in class right now, but I don't believe there are any current peer reviewed articles (U.S) that are indicative of those doses being safe or even effective. I take 1-2 grams a day and if you take into account the other doses you ingest via food, drink, etc., it adds up to more than 3-4 grams daily. But 12.....I am surprised that you don't suffer some significant stomach distress or discomfort with that range.

    Doc M
    Sodium Ascorbate is usually taken when mega dosing so that shouldnt be a problem

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    Quote Originally Posted by l2elapse View Post
    Sodium Ascorbate is usually taken when mega dosing so that shouldnt be a problem
    I don't see any reference in any of the above posts to suggest he was referring to "sodium ascorbate" as opposed to ascorbic acid tablets. Anything in high doses, especially anyting that has excipients or binders in it can cause stomach distress.

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    Quote Originally Posted by Doc M View Post
    I don't see any reference in any of the above posts to suggest he was referring to "sodium ascorbate" as opposed to ascorbic acid tablets. Anything in high doses, especially anyting that has excipients or binders in it can cause stomach distress.
    Sodium Ascorbate is Vitamin C

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    Quote Originally Posted by l2elapse View Post
    Sodium Ascorbate is Vitamin C
    And your point is what exactly? Sodium Ascorbate is a form of Vitamin C.

    What point are you trying to make exactly besides trying to pick an argument?? Or are you the world renowned vitamin expert and an internet MD..if so, I do apologize and don't dare challenge your vast knowledge...

    Oh, and thanks for pointing out that sodium ascorbate is vitamin c. I never would have figured that one out.

    Doc M

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    My Grandmas 95 and she takes 10 grams. She said she hasnt had a cold in 30 years. If I take that much I have trouble though...

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    Quote Originally Posted by Booz View Post
    you should run a search on thie subject nova,i think you will find that Johan/Kärnfysikern has posted numerouse writings and facts ect on this subject..................
    http://forums.steroid.com/showthread...dosing+vitamin

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    Quote Originally Posted by Doc M View Post
    And your point is what exactly? Sodium Ascorbate is a form of Vitamin C.

    What point are you trying to make exactly besides trying to pick an argument?? Or are you the world renowned vitamin expert and an internet MD degree.

    Oh, and thanks for pointing out that sodium ascorbate is vitamin c. I never would have figured that one out.

    Doc M
    I miss you.

    Muscle Asylum Project Athlete

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    Quote Originally Posted by Carlos_E View Post
    I miss you.

    Hahaha..What can I say, as you know I am a sensitive person!!

    Maybe he's just misunderstood...or maybe he was trying to spawn an argument..Either way, it's all good. Great pic by the way..You just seem to get bigger and more cut every time you post a pic. It pisses me off!! lol

    Doc M

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    Quote Originally Posted by Doc M View Post
    And your point is what exactly? Sodium Ascorbate is a form of Vitamin C.

    What point are you trying to make exactly besides trying to pick an argument?? Or are you the world renowned vitamin expert and an internet MD..if so, I do apologize and don't dare challenge your vast knowledge...

    Oh, and thanks for pointing out that sodium ascorbate is vitamin c. I never would have figured that one out.

    Doc M
    "Sodium Ascorbate is buffered (non-acidic) and will not contribute to gastric irritation in acid-sensitive persons. Sodium Ascorbate is synthesized from a combination of Sodium Bicarbonate and Ascorbic Acid to form Sodium Ascorbate."

    yawn

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    Quote Originally Posted by l2elapse View Post
    "Sodium Ascorbate is buffered (non-acidic) and will not contribute to gastric irritation in acid-sensitive persons. Sodium Ascorbate is synthesized from a combination of Sodium Bicarbonate and Ascorbic Acid to form Sodium Ascorbate."

    yawn
    Well, you have certainly shown you can copy and paste from an online medical resource. At least you gave the courtesy of putting it in quotes.

    And I'm still looking where he mentioned or indicated he was dosing with Sodium Ascorbate, but hey, who am I to argue with you. You are obviously light years ahead of the rest.

    Doc M

    Yawn...that's funny...

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    Quote Originally Posted by Doc M View Post
    Well, you have certainly shown you can copy and paste from an online medical resource. At least you gave the courtesy of putting it in quotes.

    And I'm still looking where he mentioned or indicated he was dosing with Sodium Ascorbate, but hey, who am I to argue with you. You are obviously light years ahead of the rest.

    Doc M

    Yawn...that's funny...
    whats funny is all i did quote your section on stomach distress and i said Sodium ascorbate for that and you proceeded to "pick a fight" as you would say

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    Wait, I am sensing a Pharm student who feels constantly compelled to try and show others he is intelligent. Just no tact or respect with a lot of the new members here, you obviously fall into that category. Feel free to post all of the smart ass responses you feel necessary, I have better things to do. A little word of advice though, you could choose how you respond and the tone in which it is delivered a little more closely. Good luck in school.

    Or....maybe it is just a misunderstanding?

    Doc M

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    ...Move along. Nothing to see here.



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    Quote Originally Posted by Carlos_E View Post
    ...Move along. Nothing to see here.



    Well timed humor!!!! Maybe I was just being an ass...If so, I apologize...I'm really not...

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    maybe we had miscommunication, and no im just a sophmore in college. I was just saying sodium ascorbate is available for people sensitive to stomach distress. No biggy

  28. #28
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    I'm not prepared to take a position on either side of the argument at this point, until I do some further reading and research...For now I'd rather just post a full text article to get the conversation going...Ill put in bold or red what I think is important...I'd like to find some research that shows or can indicate HOW Vitamin C is affecting the virus...

    __________________________________________________ __________________________________________________ _____________________________

    Treatment of the Common Cold

    MADELINE SIMASEK, M.D., and DAVID A. BLANDINO, M.D.
    University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

    Patient information: A handout on the common cold, written by the authors of this article, is provided on page 522.
    A PDF version of this document is available. Download PDF now (6 pages /160 KB).

    The common cold is a viral illness that affects persons of all ages, prompting frequent use of over-the-counter and prescription medications and alternative remedies. Treatment focuses on relieving symptoms (e.g., cough, nasal congestion, rhinorrhea). Dextromethorphan may be beneficial in adults with cough, but its effectiveness has not been demonstrated in children and adolescents. Codeine has not been shown to effectively treat cough caused by the common cold. Although hydrocodone is widely used and has been shown to effectively treat cough caused by other conditions, the drug has not been studied in patients with colds. Topical (intranasal) and oral nasal decongestants have been shown to relieve nasal symptoms and can be used in adolescents and adults for up to three days. Antihistamines and combination antihistamine/decongestant therapies can modestly improve symptoms in adults; however, the benefits must be weighed against potential side effects. Newer nonsedating antihistamines are ineffective against cough. Topical ipratropium, a prescription anticholinergic, relieves nasal symptoms in older children and adults. Antibiotics have not been shown to improve symptoms or shorten illness duration. Complementary and alternative therapies (i.e., Echinacea, vitamin C, and zinc) are not recommended for treating common cold symptoms; however, humidified air and fluid intake may be useful without adverse side effects. Vitamin C prophylaxis may modestly reduce the duration and severity of the common cold in the general population and may reduce the incidence of the illness in persons exposed to physical and environmental stresses. (Am Fam Physician 2007;75:515-20, 522. Copyright © 2007 American Academy of Family Physicians.)

    Acute upper respiratory infection is the second most common diagnosis in physician offices1 and the most common discharge diagnosis in emergency departments.2 A survey revealed that almost one fourth of U.S. adults had taken a cough or cold medication with or without a sedating antihistamine in the preceding week.3 Prevention of colds and influenza and "immune boosting" were among the top 10 reasons participants took vitamins and herbal supplements.3 A survey conducted by the Centers for Disease Control and Prevention showed that, in 1991, two thirds of three-year-olds had taken cough or cold medicine in the preceding 30 days.4 Because colds are common presentations in physician offices, and cough and cold remedies are used almost universally, it is important that physicians know the evidence (Table 15-9 and Table 25,6,10) that supports or refutes the use of these medications.11

    SORT: KEY RECOMMENDATIONS FOR PRACTICE

    Clinical recommendation
    Evidence rating
    References

    Antibiotics are not recommended for treatment of the common cold in children or adults.
    A
    14, 15

    Dextromethorphan (Delsym) is a treatment option for adults with cough caused by the common cold.
    B
    5, 19

    Topical (intranasal) or oral nasal decongestants, used for up to three days, is a treatment option for adolescents and adults.
    B
    7, 8, 30

    Topical ipratropium (Atrovent) is a treatment option for nasal congestion in children older than six years and in adults, although it is expensive.
    B
    9

    Codeine (Robitussin AC) and other narcotics, dextromethorphan (Delsym), antihistamines, and combination antihistamine/decongestants are not recommended to treat cough or other cold symptoms in children.
    B
    5-7, 10, 17

    Older first-generation antihistamines and combination antihistamine/decongestants are treatment options for cough and cold symptoms in adults if the benefits outweigh the adverse effects.
    B
    6

    Among available complementary treatments, vitamin C prophylaxis may decrease the severity and duration of cold symptoms; however, vitamin C, zinc, and Echinacea are not recommended for active treatment.
    B
    31-34, 36



    --------------------------------------------------------------------------------

    A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, see page 453 or http://www.aafp.org/afpsort.xml.



    Table 1

    Overview of the Evidence for Cold Therapies in Adults

    Therapy
    Study findings

    Cough (one Cochrane review [17 studies])5

    Antihistamine/decongestant combination
    Two studies: one showed benefit with unfavorable side effects; one showed no benefit

    Antihistamines
    Three studies: no benefit

    Codeine (Robitussin AC)
    Two studies: no benefit

    Dextromethorphan (Delsym)
    Three studies: two showed benefit; one showed no benefit

    Dextromethorphan plus salbutamol*
    One study: limited benefit with unfavorable side effects

    Guaifenesin (Mucinex)
    Two studies: one showed benefit; one showed no benefit

    Moguisteine*
    One study: very limited benefit

    Mucolytic (e.g., Bisolvon linctus*)
    One study: benefit

    Congestion and rhinorrhea (two Cochrane reviews [30 studies])6,7; two RCTs8,9)

    Antihistamine/decongestant combination
    Seven studies: five showed some benefit for nasal obstruction; two showed no benefit

    Six studies: five showed some benefit for rhinorrhea; one showed no benefit

    Antihistamines
    Five studies: no benefit for nasal obstruction

    Seven studies: benefit for rhinorrhea (first-generation antihistamines only)

    Intranasal ipratropium (Atrovent)
    One study: benefit

    Oral or topical decongestants (single dose)
    Four studies: benefit for nasal obstruction

    Oral decongestants (repeated doses)
    Two studies: one showed benefit for nasal obstruction; one showed no benefit


    --------------------------------------------------------------------------------

    RCT = randomized controlled trial.

    *-Not available in the United States.

    Information from references 5 through 9.


    The literature on the common cold is extensive, but it is inconsistent in its rigor. Among the numerous studies, the clinical definition often is unclear or variable, natural and experimental colds are evaluated, and age ranges are sometimes broad and variable. Furthermore, the number of participants often is small, interventions vary from individual to combination medications, compliance often is not addressed, single or multiple symptom outcomes are used, and outcomes are subjectively reported in some studies and objectively reported in others. Not surprisingly, there is great heterogeneity among the results. These limitations in the literature limit the ability to make confident and specific recommendations about treatments. For clinical purposes, the literature on traditional pharmacologic treatment is best summarized by making separate recommendations for cough alone and for congestion and rhinorrhea. For complementary and nonpharmacologic treatments, the literature addresses more global outcomes.

    Epidemiology and Clinical Presentation

    The common cold is caused by various respiratory viruses, most commonly a rhinovirus. Adults have an average of two to four episodes annually, and young children may have as many as six to eight episodes. A common cold is characterized by sore throat, malaise, and low-grade fever at onset. These symptoms resolve within a few days and are followed by nasal congestion, rhinorrhea, and cough within 24 to 48 hours after onset of the first symptoms. The second set of symptoms are what prompt most patients to see a physician for relief.1 Symptoms usually peak around day 3 or 4 and begin to resolve by day 7.12 Nasal discharge, appearing at the peak of illness, can become thick and purulent and may be misdiagnosed as a bacterial sinus infection.13

    Table 2

    Overview of the Evidence for Cold Therapies in Children

    Therapy
    Study findings

    Cough (Cochrane review [seven studies])5; one RCT10

    Antihistamines
    Two studies: no benefit

    Antihistamine/decongestant combination
    Two studies: no benefit

    Codeine plus guaifenesin (Robitussin AC)
    One study: no benefit

    Dextromethorphan (Delsym)
    Two studies: no benefit

    Dextromethorphan plus guaifenesin (Robitussin DM)
    One study: no benefit

    Dextromethorphan plus salbutamol*
    One study: no benefit

    Mucolytic (e.g., Letosteine*)
    One study: benefit

    Other combinations
    One study: no benefit

    Congestion and rhinorrhea (Cochrane reviews [four studies]6)

    Antihistamines
    Two studies (one using astemizole†): benefit

    Antihistamine/decongestant combination
    Two studies: no benefit

    Decongestants
    No studies


    --------------------------------------------------------------------------------

    RCT = randomized controlled trial.

    *-Not available in the United States.

    †-Withdrawn from U.S. market in 1999.

    Information from references 5, 6, and 10.


    Traditional Pharmacologic Therapy

    Because there are no effective antivirals to cure the common cold and few effective measures to prevent it, treatment should focus on symptom relief. The most commonly used treatments include over-the-counter antihistamines, decongestants, cough suppressants, and expectorants. These treatments can be used alone or in combination.

    Although a cold is a viral illness, antibiotics often are inappropriately prescribed to patients, even when bacterial complications (e.g., pneumonia, bacterial sinusitis) are not present. Studies of antibiotics for the treatment of the common cold focus on cure rate, symptom persistence, prevention of secondary bacterial complications, and adverse effects. Systematic reviews have shown that antibiotics have no role in the treatment of the common cold.14,15 This is because antibiotics are ineffective at reducing symptom duration or severity and because of the risk of adverse gastrointestinal effects, cost of treatment, and increased resistance of bacteria to antibiotics.14,15

    cough

    A Cochrane review showed that there is a lack of good evidence to determine the effectiveness of any over-the-counter product at reducing the frequency or severity of cough in children or adults.5 Some authors explicitly recommend against the use of these medications.16,17 The American College of Chest Physicians guideline does not recommend centrally acting cough suppressants (e.g., codeine [Robitussin AC], dextromethorphan [Delsym]) for cough secondary to upper respiratory tract infection.18

    Despite these conclusions, two of the three studies included in the Cochrane review suggest that dextromethorphan provides a modest clinical benefit.5,19 One of these studies (a meta-analysis) showed a reduction in the frequency and severity of cough for persons 18 years or older without significant adverse effects.19 The average treatment difference was 12 to 17 percent in favor of dextromethorphan for cough bouts, cough components, and cough effort.19

    One study included in the Cochrane review showed that combination antihistamine/decongestant medications have a modest benefit but with significantly increased adverse effects. In contrast, newer-generation, nonsedating antihistamines do not effectively reduce cough.18 Because of the conflicting evidence, physicians must weigh the risks and benefits of dextromethorphan or combination antihistamine/decongestant medications (Table 311,20).

    Table 3

    Adverse Effects Associated with Cold Therapies

    Therapy
    Adverse effects

    Antihistamines
    Arrhythmia, blurred vision, dizziness, dry mouth, hallucinations, heart block, paradoxic excitability, respiratory depression, sedation, tachycardia, urinary retention

    Decongestants
    Oral: agitation, anorexia, dysrhythmia, dystonic reactions, headache, hypertension, irritability, nausea, palpitations, seizure, sleeplessness, tachycardia, vomiting

    Topical: drying of nasal membranes, nosebleeds, rebound nasal congestion

    Dextromethorphan (Delsym)
    Confusion, excitability, gastrointestinal disturbances, irritability, nervousness, sedation


    --------------------------------------------------------------------------------

    note: Adverse effects may be more significant in young children and older adults.

    Information from references 11 and 20.


    No medication available in the United States has been shown to effectively treat cough in children.5,10 Although clinical trials have reported a low incidence of minor adverse effects, anecdotal reports of serious adverse effects and dosing errors have prompted the American Academy of Pediatrics and other experts to caution against the use of these preparations in children.21-24

    There also is little evidence to support the use of codeine and its derivative hydrocodone (Hycodan) to relieve cough caused by the common cold in adults and children.5 One small study of codeine use in children25 and two small studies in adults26,27 failed to show a benefit. Hydrocodone commonly is prescribed for suppression of cold-related acute cough. There are no studies of hydrocodone use in patients with the common cold, although the drug's effectiveness has been demonstrated in patients with other conditions.28,29

    nasal congestion and rhinorrhea

    Several mechanisms can cause cold-related nasal congestion and rhinorrhea.12 Although these mechanisms differ from those that cause allergy-related symptoms, antihistamines remain a popular therapy for the common cold.

    Although some randomized controlled trials (RCTs) of older first-generation antihistamines have shown positive results for certain end points, a Cochrane review concluded that antihistamines do not alleviate cold-related sneezing or nasal symptoms to a clinically significant degree and do not affect subjective improvement in children or adults.6 Even if a slight clinical benefit exists, there are risks and adverse effects, especially with first-generation antihistamines.11 Therefore, antihistamine monotherapy is not recommended for children and should be used cautiously in adults.

    Although a first-generation oral antihistamine and decongestant combination may have some effect on nasal obstruction, rhinorrhea, and sneezing in adolescents and adults, studies generally are of poor quality, and effects are small and may not be clinically significant. Antihistamine/decongestant treatment has not been shown to benefit young children.6

    Two systematic reviews have examined the use of nasal decongestants.7,30 The reviews included four trials that studied the short-term benefits of a single-dose topical (intranasal) or oral decongestant and one trial that studied the effects of repeated dosing. The single-dose decongestant had a moderate short-term benefit for adolescents and adults with nasal congestion. Although a repeated dose of oral pseudoephedrine (Sudafed) over five days had no benefit,7,30 another clinical trial showed that a 60-mg dose repeated four times a day over three days improved nasal airway resistance and subjective scores in adults.8 Given these findings, the use of topical or oral decongestants for a few days is reasonable and consistent with standard practice. Studies of single-ingredient decongestants have not included children younger than 12 years, and there have been anecdotal reports of serious toxicity in young children using oral decongestants.23

    Finally, a recent study supports the use of topical ipratropium (Atrovent) for rhinorrhea caused by perennial rhinitis and the common cold.9 However, it is expensive, requires a prescription, and is approved only for children older than six years.

    Complementary and Alternative Therapies

    Nontraditional complementary and alternative therapies used for the common cold include Echinacea, vitamin C, zinc, and humidified air and fluid intake.

    echinacea

    A Cochrane review concluded that, despite some studies that showed benefit, there is no solid evidence that Echinacea products effectively treat or prevent the common cold.31 The review cited concerns about publication bias (i.e., positive studies were more likely to be published), poor study quality, and variability of study results.31

    Two well-conducted studies showed no benefit from Echinacea angustifolia root32 or the aerial portion of Echinacea purpurea.33 Because three species are available for medical use, plant parts used and extraction methods differ, and some preparations contain additional ingredients, it is difficult to make specific product or dosage recommendations.

    vitamin c

    A Cochrane review showed that taking 200 mg or more of vitamin C daily does not significantly decrease symptom severity or duration when initiated after the onset of cold symptoms.34


    Data regarding prophylactic use of vitamin C are more varied. Thirty trials involving 9,676 cold episodes showed a statistically significant decrease in illness duration with vitamin C taken before onset of symptoms: an 8 percent decrease (95% confidence interval [CI], 3 to 13 percent) in adults and a 13.5 percent decrease (95% CI, 5 to 21 percent) in children.34 Likewise, 15 trials involving 7,045 cold episodes demonstrated a decrease in severity scores and in days confined to the home.34 Vitamin C did not decrease the incidence of cold in the general population. However, a subgroup of six trials involving runners, skiers, and soldiers participating in subarctic exercises demonstrated a 50 percent relative reduction in the risk of developing a cold (95% CI, 32 to 62 percent).34
    zinc

    The use of zinc has been shown to inhibit viral growth, and an RCT suggested that zinc could reduce the duration of cold symptoms.35 However, this has not been substantiated in subsequent RCTs.36 Specifically, four of eight subsequent trials showed no benefit, and the other four may have been biased by the patients' ability to recognize the adverse effects of zinc.36 Because of these inconsistent study results, zinc cannot be recommended.

    humidified air and fluid intake

    Studies of Rhinotherm (an apparatus that delivers humidified air at a controlled temperature of about 104 to 116.6°F [40 to 47°C]) have had conflicting results despite using similar equipment and methodology.37 Because of these inconsistent results and the lack of universal access to this equipment, Rhinotherm cannot be recommended. However, except for the theoretical risks associated with fluid intake,38 humidified air and fluid intake are considered benign and possibly beneficial for the relief of common cold symptoms.11

    Data sources: For this article, the authors searched the Cochrane Database of Systematic Reviews, Medline (1996 to 2005), the Cochrane Registry of Clinical Trials (2003 to 2005), BMJ's Clinical Evidence Concise, the National Guidelines Clearinghouse, the Institute for Clinical Systems Improvement, the Database of Abstracts of Reviews of Effectiveness, and EMBASE (2001 to 2005). The search was limited to English-language systematic reviews and randomized controlled trials, and recommendations were limited to products available in the United States.

    Members of various family medicine departments develop articles for "Clinical Pharmacology." This is one in a series coordinated by Allen F. Shaughnessy, Pharm.D., and Andrea E. Gordon, M.D., Tufts University Family Medicine Residency, Malden, Mass.


    --------------------------------------------------------------------------------

    The Authors

    MADELINE SIMASEK, M.D., is assistant program director of the University of Pittsburgh (Pa.) Medical Center (UPMC) and is clinical associate professor of pediatrics at the University of Pittsburgh School of Medicine. Dr. Simasek received her medical degree from Temple University, Philadelphia, Pa., and completed a pediatrics residency at Children's Hospital of Pittsburgh.

    DAVID A. BLANDINO, M.D., is chairman of the Department of Family and Community Medicine at UPMC Shadyside Hospital and is clinical associate professor of family medicine at the University of Pittsburgh School of Medicine. Dr. Blandino received his medical degree from the University of Pittsburgh School of Medicine and completed a family medicine residency at Williamsport (Pa.) Hospital and Medical Center.

    Address correspondence to David A. Blandino, M.D., 5230 Centre Ave., Pittsburgh, PA 15232. Reprints are not available from the authors.

    Author disclosure: Nothing to disclose.

    REFERENCES

    1. Woodwell DA, Cherry DK. National ambulatory medical care survey: 2002 summary. Adv Data 2004;346:1-44.

    2. McCaig LF, Burt CW. National hospital ambulatory medical care survey: 2002 emergency department summary. Adv Data 2004;340:1-34.

    3. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA 2002;287:337-44.

    4. Kogan MD, Pappas G, Yu SM, Kotelchuck M. Over-the-counter medication use among US preschool-age children. JAMA 1994;272:1025-30.

    5. Schroeder K, Fahey T. Over-the-counter medications for acute cough in children and adults in ambulatory settings. Cochrane Database Syst Rev 2004;(4):CD001831.

    6. Sutter AI, Lemiengre M, Campbell H, Mackinnon HF. Antihistamines for the common cold. Cochrane Database Syst Rev 2003;(3):CD001267.

    7. Taverner D, Latte J, Draper M. Nasal decongestants for the common cold. Cochrane Database Syst Rev 2004;(3):CD001953.

    8. Eccles R, Jawad MS, Jawad SS, Angello JT, Druce HM. Efficacy and safety of single and multiple doses of pseudoephedrine in the treatment of nasal congestion associated with common cold. Am J Rhinol 2005;19:25-31.

    9. Hayden FG, Diamond L, Wood PB, Korts DC, Wecker MT. Effectiveness and safety of intranasal ipratropium bromide in common colds. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 1996;125:89-97.

    10. Paul IM, Yoder KE, Crowell KR, Shaffer ML, McMillan HS, Carlson LC, et al. Effect of dextromethorphan, diphenhydramine, and placebo on nocturnal cough and sleep quality for cou***ng children and their parents. Pediatrics 2004;114:E85-90. Accessed July 25, 2006, at: http://pediatrics.aappublications.or...full/114/1/e85.

    11. Montauk SL. Appropriate use of common OTC analgesics and cough and cold medications. Leawood, Kan.: American Academy of Family Physicians, 2002. Accessed July 24, 2006, at: http://www.aafp.org/afp/otcmonograph/index.html.

    12. Heikkinen T, Jarvinen A. The common cold. Lancet 2003;361:51-9.

    13. American Academy of Pediatrics. Subcommittee on Management of Sinusitis and Committee on Quality Improvement. Clinical practice guideline: management of sinusitis [Published corrections appear in Pediatrics 2001;108:A24, Pediatrics 2002;109:40]. Pediatrics 2001; 108:798-808.

    14. Arroll B, Kenealy T. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database Syst Rev 2005;(3):CD000247.

    15. Fahey T, Stocks N, Thomas T. Systematic review of the treatment of upper respiratory tract infection. Arch Dis Child 1998;79:225-30.

    16. Schroeder K, Fahey T. Systematic review of randomised controlled trials of over the counter cough medicines for acute cough in adults. BMJ 2002;324:329-31.

    17. Schroeder K, Fahey T. Should we advise parents to administer over the counter cough medicines for acute cough? Systematic review of randomised controlled trials. Arch Dis Child 2002;86:170-5.

    18. Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, et al. American College of Chest Physicians. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest 2006;129(1 suppl);1S-23S.

    19. Pavesi L, Subburaj S, Porter-Shaw K. Application and validation of a computerized cough acquisition system for objective monitoring of acute cough: a meta-analysis. Chest 2001;120:1121-8.

    20. Kelly LF. Pediatric cough and cold preparations. Pediatr Rev 2004;25: 115-23.

    21. Gadomski A. Rational use of over-the-counter medications in young children. JAMA 1994;272:1063-4.

    22. Gadomski A, Horton L. The need for rational therapeutics in the use of cough and cold medicine in infants. Pediatrics 1992;89(4 pt 2):774-6.

    23. Gunn VL, Taha SH, Liebelt EL, Serwint JR. Toxicity of over-the-counter cough and cold medications. Pediatrics 2001;108:E52. Accessed July 25, 2006, at: http://pediatrics.aappublications.or...full/108/3/e52.

    24. American Academy of Pediatrics. Committee on Drugs. Use of codeine- and dextromethorphan-containing cough remedies in children. Pediatrics 1997;99:918-20.

    25. Taylor JA, Novack AH, Almquist JR, Rogers JE. Efficacy of cough suppressants in children. J Pediatr 1993;122(5 pt 1):799-802.

    26. Eccles R, Morris S, Jawad M. Lack of effect of codeine in the treatment of cough associated with acute upper respiratory tract infection. J Clin Pharm Ther 1992;17:175-80.

    27. Freestone C, Eccles R. Assessment of the antitussive efficacy of codeine in cough associated with common cold. J Pharm Pharmacol 1997; 49:1045-9.

    28. Homsi J, Walsh D, Nelson KA, Sarhill N, Rybicki L, Legrand SB, et al. A phase II study of hydrocodone for cough in advanced cancer. Am J Hosp Palliat Care 2002;19:49-56.

    29. Stolz D, Chhajed PN, Leuppi JD, Brutsche M, Pflimlin E, Tamm M. Cough suppression during flexible bronchoscopy using combined sedation with midazolam and hydrocodone: a randomised, double blind, placebo controlled trial. Thorax 2004;59:773-6.

    30. Del Mar C, Glasziou P. Upper respiratory tract infection. Clin Evid 2003;10:1747-56.

    31. Linde K, Barrett B, Wölkart K, Bauer R, Melchart D. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev 2006;(1):CD000530.

    32. Turner RB, Bauer R, Woelkart K, Hulsey TC, Gangemi JD. An evaluation of Echinacea angustifolia in experimental rhinovirus infections. N Engl J Med 2005;353:341-8.

    33. Yale SH, Liu K. Echinacea purpurea therapy for the treatment of the common cold: a randomized, double-blind, placebo-controlled clinical trial. Arch Intern Med 2004;164:1237-41.

    34. Douglas RM, Hemila H, D'Souza R, Chalker EB, Treacy B. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev 2004;(4):CD000980.

    35. Eby GA, Davis DR, Halcomb WW. Reduction in duration of common colds by zinc gluconate lozenges in a double-blind study. Antimicrob Agents Chemother 1984;25:20-4.

    36. Marshall I. Zinc for the common cold. Cochrane Database Syst Rev 1999;(2):CD001364.

    37. Singh M. Heated, humidified air for the common cold. Cochrane Database Syst Rev 2004;(2):CD001728.

    38. Guppy MP, Mickan SM, Del Mar CB. "Drink plenty of fluids": a systematic review of evidence for this recommendation in acute respiratory infections. BMJ 2004;328:499-500.

  29. #29
    thegodfather's Avatar
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    I think the above article shows correlation at best, and not a causal relationship...

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    It seems there is a study that comes out practically every day with contradictory information on Vit C supplementation. I don't know what to believe anymore.

    Nice Post BTW GodFather.

  31. #31
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    Quote Originally Posted by Doc M View Post
    And your point is what exactly? Sodium Ascorbate is a form of Vitamin C.

    What point are you trying to make exactly besides trying to pick an argument?? Or are you the world renowned vitamin expert and an internet MD..if so, I do apologize and don't dare challenge your vast knowledge...

    Oh, and thanks for pointing out that sodium ascorbate is vitamin c. I never would have figured that one out.

    Doc M
    This is your first post after he says simpley that "Sodium Ascorbate is a form of Vitamin C."
    It looks like you felt like your intellegents was being challenged, so you responded an a total asinine way. You appear to be the one thats initiating confrontation.

  32. #32
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    Signs and symptoms of Vit. C excess: diarrhea, calcium oxalate/uric acid renal stones

    Not sure if any real definitive study stating benifits of mega doses of Vit C or help with colds etc.

    I'm not looking for an arguement Doc M.. lol j/k

  33. #33
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    I dont feel like wasting space and putting full-text articles up, I'm going to quote them and give credit&references, if anyone wants the full texts to examine the methodology or anything else just PM me...

    PURPOSE We undertook a study to estimate the sufficiently important difference (SID) for the common cold. The SID is the smallest benefit that an intervention would require to justify costs and risks.

    METHODS Benefit-harm tradeoff interviews (in-person and telephone) assessed SID in terms of overall severity reduction using evidence-based simple-language scenarios for 4 common cold treatments: vitamin C, the herbal medicine echinacea, zinc lozenges, and the unlicensed antiviral pleconaril.

    RESULTS Response patterns to the 4 scenarios in the telephone and in-person samples were not statistically distinguishable and were merged for most analyses. The scenario based on vitamin C led to a mean SID of 25% (95% confidence interval [CI] 0.23–0.27). For the echinacea-based scenario, mean SID was 32% (95% CI, 0.30–0.34). For the zinc-based scenario, mean SID was 47% (95% CI, 0.43–0.51). The scenario based on preliminary antiviral trials provided a mean SID of 57% (95% CI, 0.53–0.61). Multivariate analyses suggested that (1) between-scenario differences were substantive and reproducible in the 2 samples, (2) presence or severity of illness did not predict SID, and (3) SID was not influenced by age, sex, tobacco use, ethnicity, income, or education. Despite consistencies supporting the model and methods, response patterns were diverse, with wide spreads of individual SID values within and among treatment scenarios.

    CONCLUSIONS Depending on treatment specifics, people want an on-average 25% to 57% reduction in overall illness severity to justify costs and risks of popular cold treatments. Randomized trial evidence does not support benefits this large. This model and these methods should be further developed for use in other disease entities.
    I have a problem with how this study was conducted, I dont think it gives any concrete proof that any of the above listed substances are therapeautic. The study was based off of people who answered "Yes" to whether or not they had a cold. No cultures were ever taken, half of the people could have had a bacterial infection. Then they were later asked to "recall" symptoms...Im just posting this article as an example of something someone on this board might post as "concrete evidence" that Vitamin C is the wonder drug of the 21st century, when in fact upon closer examination of the actual study and how it was conducted, its far from it. You cant rely on an abstract to tell you if the research was credible, you have to look at the entire thing yourself.

    To be eligible for either arm of this study, prospective adult participants had to answer "yes" to the question, "Do you think that you have a cold or are coming down with a cold?" They also had to report at least 1 of 4 cold symptoms (sneezing, runny nose, nasal obstruction, or sore throat), and to have a total Jackson score of at least 2 points. Jackson scores13–15 are simple sums of severity ratings (1 = mild, 2 = moderate, 3 = severe) for 8 symptoms: those noted above plus cough, headache, chilliness, and malaise.

    From May 6, 2003, when the study began until August 22, 2005, when data collection ended, 983 people contacted our research team, and 253 enrolled in 1 of the 2 groups reported here. Of the 730 not enrolled in this study, 217 joined another study, 201 did not meet inclusion criteria, 128 declined to participate, and 43 were simply calling for information. Some 141 could not be categorized meaningfully. Of those excluded, 55 were thought to have allergy or an illness other than a cold, 35 had symptoms for more than 7 days, 25 were younger than 18 years, 19 were considered unreliable after the screening interview, and 67 were excluded for a variety of other reasons. (Our screening protocol allowed people to be excluded for more than one reason.)
    Im going to add this last part in, and it should totally discredit this article from even being included in an argument such as this-

    Next, the participant was presented with 1 of the following scenarios:

    A 10-cent vitamin pill must be taken 3 times daily for the first 3 days of your cold. There are no significant risks or side effects to this treatment. It is unlikely that the length of your cold would be reduced significantly. Severity of symptoms might be reduced by as much as 30%.

    A 20-cent lozenge must be dissolved in the mouth every 2 to 3 hours while awake for the first 3 days of your cold. Side effects may include bad taste, and, very occasionally, nausea. It is possible that the length of the cold could be reduced slightly. Severity of symptoms might be reduced by as much as 30%.

    A 50-cent dropperful of an herbal extract must be taken 3 times each day for the first 3 days of your cold. Side effects are limited to bad taste. It is possible that the length of the cold could be reduced slightly. Severity of symptoms might be reduced by as much as 30%.

    A $2 prescription-only pill must be taken 3 times daily for the first 3 days of the cold. Side effects are unknown. Preliminary data suggests an average 24-hour reduction in the length of your cold. Severity of symptoms might be reduced by as much as 30%.

    The scenarios were presented in varied order, so that each scenario had an approximately equal chance of being considered first, second, third, or last. After each scenario was presented, participants were asked, "Would you take this treatment?" and then, "Why?" or "Why not?" Brief notes were taken regarding the answers to these qualitative questions. Next, participants who had answered "yes" to the original question were asked: "Would you take this [treatment] if it were able to reduce severity by 20%?" If the answer was still "yes," the hypothetical severity reduction was lowered to "10%," then if still "yes," it was lowered to "5%," and, finally, "any?" If the original answer was "no," severity reduction benefit was increased to "40%," then if still "no," it was increased to "50%," then "75%." Severity reduction SID was defined as the smallest severity reduction that justified the treatment scenario for that participant.

    Woops...meant to add this in-

    Sufficiently Important Difference for Common Cold: Severity Reduction
    Bruce Barrett, MD, PhD1, Brian Harahan, BA1,2, David Brown, PhD3, Zhengjun Zhang, PhD1 and Roger Brown, PhD1
    1 Department of Family Medicine, University of Wisconsin, Madison, Wisc
    2 School of Medicine, University of Wisconsin, Madison Wisc
    3 Provincial Health Services Authority, and Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada

    CORRESPONDING AUTHOR: Bruce Barrett, MD, PhD, Department of Family Medicine, University of Wisconsin, 777 South Mills, WI 53715, [email protected]
    Last edited by thegodfather; 11-13-2007 at 05:35 PM.

  34. #34
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    yada yada yada yada pointless play nice and share your toys.............
    thanks for the link Horse............
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    Source checks and Ugl's to be kept to PM's
    dont ask for source checks unless you have 100 posts/and 45 days minimum as a participating member.........

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    sorry but absolutely no sources will be checked at this present time....

  35. #35
    I_Want_Abs is offline Senior Member
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    God damn there was some hostility in this thread, who would have thought people would get so worked up over Vit C hahaha

    I take 5-10 grams daily (sodium ascorbate powder), depends on how i feel. eg: if im starting to feel sick i pump it up a bit

  36. #36
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    I eat oranges....
    I also play nice



    I try "mega dosing" before around 7grams. All I noticed was some nasty gas problems. And it was right around the time when I got a kidney stone, if that has any effect..idk

  37. #37
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    Despite all the stupid bickering in this thread, it's too bad your precious Vitamin C will no longer be obtainable without a doctor's perscription soon if Congress and the FDA get their way and classify Vitamin C and most other supplements as 'drugs'....

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    Quote Originally Posted by Atomini View Post
    Despite all the stupid bickering in this thread, it's too bad your precious Vitamin C will no longer be obtainable without a doctor's perscription soon if Congress and the FDA get their way and classify Vitamin C and most other supplements as 'drugs'....
    Yeah, I hear Cutler mega dosed Vit C. That, and MuscleTech.
    So be ready for Vit C being banned soon

  39. #39
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    MuscleTech should just be banned for being shitty.

  40. #40
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    Quote Originally Posted by xlxBigSexyxlx View Post
    Yeah, I hear Cutler mega dosed Vit C. That, and MuscleTech.
    So be ready for Vit C being banned soon
    Think i'm joking? The EU already did this back in 2005. For Vit C, for example, you can't buy over 60mg without a doc's perscription.

    http://www.rense.com/general24/drgs.htm

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