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Got a cold? Eat caterpillars

Why medinical zinc is not all it's cracked up to be.

How’s this for impact? At the end of January, a research group in Manchester published a paper on the essential role of zinc in the human immune system. A week later, the price of zinc rose on the international metals markets after its longest slump in 25 years.

Amazing? Of course not. These are two entirely unrelated events. But it’s the ability to separate coincidence from causality that allows us to distinguish old wives’ tales from useful information.

Zinc has been in medical use since at least the 2nd century BC. A set of pills found in the remains of a ship wrecked off the Tuscan coast in 140BC are 75 per cent zinc. They were almost certainly used to treat eye and skin disorders, a practice documented by the Roman polymath Pliny in the 1st century AD.

Zinc is still used for this purpose. It has antiseptic and antiviral properties, which is why it is often embedded in dressings for wounds. What’s more, anecdotal evidence has long suggested that taking zinc supplements helps fight the common cold. But anecdotal evidence isn’t the most trustworthy: sometimes it sees cause and effect where there is none.

Even individual studies haven’t been enough to give us the answer; depending on how they are carried out, they can produce conflicting results. Fortunately, we’ve developed even more sophisticated techniques: dissection, analysis and pooling of the scientific studies themselves. This has allowed us to draw a firm and reliable conclusion. In the case of zinc, it’s this: take at least 75mg a day and “there is a significant reduction in the duration of cold”, according to a gold-standard Cochrane Review, which looks at primary research in health care. Ancient wisdom, in this case, has some validity.

What the ancients didn’t know is the mechanism involved. Zinc deficiency, it turns out, causes more than 3,000 types of protein in the body to function inefficiently or not at all. The body responds to this as stress, causing the immune system to leap into action. Specifically, according to researchers at Manchester University, zinc deficiency unleashes a molecule called interleukin-1-beta. This is part of the armoury of the immune system. The trouble is that, in the absence of any infection to clear, firing the immune response’s weaponry just causes damage.

The zinc deficiency, as the researchers point out, could easily be resolved using dietary supplements. And this increased medical use of zinc could have an economic impact.

Not, it has to be said, in the metals markets, where the rising price of zinc is linked to China’s construction boom. But zinc use for medical purposes could be worth about $25bn a year in the US alone. That is the estimated annual impact of common colds, in terms of lost productivity. The Cochrane Review has found that taking zinc supplements for at least five months can reduce that. It certainly reduces school absences and the prescription of antibiotics for children with the common cold.

Because colds are caused by a virus, antibiotics do nothing for sufferers, yet doctors prescribe them as a placebo to get worried parents out of their surgery. So zinc supplementation also slows the spread of antibiotic resistance. Here’s a final tip in case the price of zinc lozenges skyrockets: a daily 100g of cooked caterpillars contains all the zinc you need.

You’re welcome.
 

Michael Brooks holds a PhD in quantum physics. He writes a weekly science column for the New Statesman, and his most recent book is At the Edge of Uncertainty: 11 Discoveries Taking Science by Surprise.

This article first appeared in the 19 February 2014 issue of the New Statesman, The Space Issue

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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear