He explicitly cites him at the end!
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Karma: 20
Oh. I can’t hover, makes sense
Also what’s going on here? The evidentiary standard and level of evidence is much lower for pro zinc evidence—this (very incorrect) speculation that could’ve been corrected by reading more than two paragraphs of that article, for whatever reason, was much better received than mine. Several times you guys have clearly referenced studies without reading them, and your post got 10 to 1 vs mine that actually read the papers!
… what? Read the study. It mentions the potential interaction with citric acid, and avoids it;
The zinc lozenge was a commercially available zinc acetate lozenge with 13 mg elemental zinc per lozenge (University Pharmacy, Helsinki, Finland). The lozenge weighed 0.9 g and had a diameter of 13mm. The lozenges contained isomaltulose, sorbitol, magnesium stearate, orange and peppermint flavours and sucralose. The instruction of the commercial package for patients with common cold is to dissolve slowly six lozenges per day in the mouth, which
Now, this study does use mannitol. And mannitol is one of the things mentioned by some studies as blocking zinc’s action. So maybe we’re out of the water! But wait—four of the eight studies in the meta analysis have acidic flavoring—“lemon and lime oils”, “peppermint oil”, “tannic acid”, etc. even worse, glycine is also mentioned as a zinc binder that hurts its action—yet many of the studies it cited use glycine!
Also, one study this meta analysis cites concludes that “zinc gluconate should not be used to treat cough due to high side effects”.
That said, it’s not clear at all. Maybe a particular combination of excipients did randomly manage to make some trials fail and others succeed! But that’s what you’d expect to happen in a case of no effect but publication bias and excuses. Which seems more likely?
Wouldn’t it wash off much faster than six hours though?
uh.
google scholar? you just search the word? preregistered.
Cochrane reviews in particular are actually, like, literally, the gold standard for medical reviews. They are notorious for finding that “there is weak or no evidence”. So them finding positive is not “well calibrated for not very”, which is why I was genuinely shocked to read that, and correctly found it wasn’t.
Is there some material I can read on the case for zinc? On this site?
N95s are, at a rough guess, significantly more effective, and have the massive benefit of not being something you put in your body, which can go wrong a lot of ways (the claimed loss of taste side effect, or just general mild dysfunction)
It’s not just personal, in general taking medical advice from reviews in areas you’re not expert in, especially when you haven’t read the review, is probably not great, and as described elsewhere this really doesn’t feel like the sort of thing that would work (compare to magnesium for headache / low energy, which definitely biologically seems somewhat reasonable, although I’m still somewhat iffy on it). That together with personal anecdotes being the sort of thing that Chinese traditional medicine and energy therapy has by bucketloads, and my experience with meta analyses like that regularly falling apart (5-httlpr had a stronger meta analysis with p=0.0001 and four hundred studies, most of which were positive, and then just got executed by a large well done study, https://slatestarcodex.com/2019/05/07/5-httlpr-a-pointed-review/) and priming, with thousands of studies and meta analyses that was also fake and I don’t mean this insultingly because I’ve done this in the past too … a lot … smh … but if you didn’t look closely at the study, it’s probably one of the tens of thousands of bad studies and bad meta analyses that get published so much because so many people want to do them). So I’m pretty confident that the current evidence base for zinc shouldn’t be enough to conclude anything,. And neutral on if it works. But it probably doesn’t because most treatments don’t.
I looked for preregistered trials and found this in 2020 - https://bmjopen.bmj.com/content/10/1/e031662.abstract—preregistration massively helps with both publication bias, post analysis bias, study design, and many other tricks one can do. It found
Results There was no difference in the recovery rate between zinc and placebo participants during the 10-day follow-up (rate ratio for zinc vs placebo=0.68, 95% CI 0.42 to 1.08; p=0.10). The recovery rate for the two groups was similar during the 5-day intervention, but for 2 days after the end of zinc/placebo use, the zinc participants recovered significantly slower compared with the placebo participants (p=0.003). In the zinc group, 37% did not report adverse effects, the corresponding proportion being 69% in the placebo group.
Conclusions A commercially available zinc acetate lozenge was not effective in treating the common cold when instructed to be used for 5 days after the first symptoms. Taste has been a common problem in previous zinc lozenge trials, but a third of zinc participants did not complain of any adverse effects. More research is needed to evaluate the characteristics of zinc lozenges that may be clinically efficacious before zinc lozenges can be widely promoted for common cold treatment.
Which I find much, much more persuasive. Also note the side effect rate and the (admittedly, subgroup, so it is probably meaningless) lower rate of recovery for takers.
edited to add
(I can’t see the starch or cellulose in pill binders mixed with zinc “physically coating” the throat, because solid matter tends to go down it)
I’m reading “coat” to mean “water with dissolved zinc will reach the side of your throat, and then the concentration of the ions does something or another”. A bit iffy on that, tbh. Do any other drugs of atomic ions work like that? It doesn’t exclude it, biochemistry can get weird, but...
Also wouldn’t the constant swallowing and cycling of mucus make any coating wash off?
I don’t think it is worth listening to “a podcast host” on medicine in any circumstance, tbh.
Elaborating, I thought that wouldn’t even be controversial—“I heard it on a podcast” fairly universally precedes advice and ideas that range from questionable to outright false, and maybe out of a dew dozen pieces of scientific or medical knowledge I’ve received anecdotally from heardonapodcast none of them have checked out when I looked.
And that advice in particular really doesn’t mesh with any sort of biochemistry I know of—it’s the exact kind of folk medical advice that wouldn’t work.
That’s not a Cochrane review? It’s a review in a different journal. The author apparently wrote a paper criticizing a cochrane review on this topic, which was then withdrawn. That’s weird.
I’m not sold on the meta analysis tbh. Publication bias can happen, lots of things can happen, and it’s well within the realm of “aggregate 15 studies of 80 people each” that have not replicated in the past. Especially given the high doses of zinc.
Shouldn’t this be a rec for a N95 instead? Those will probably reduce respiratory viruses much more than 33%
I looked for orange flavor online, especially in bulk on alibaba and flavor supply, as well as smaller consumer packages, and it seemed to in basically every case mean orange essential oils, which I don’t think have citric acid as it is hydrophilic (https://en.m.wikipedia.org/wiki/Orange_oil). If said oil did give citric acid, so would the lemon oil. No clue exactly though.
You didn’t look closely, correct. The literature does engage with the “mannitol, sorbitol, citric acid, glycine, and many others may cause past studies to not find an effect”. At least five of the eight studies referenced in the meta analysis, the meta analysis itself, the other paper, and many other studies make statements to that effect and are designed to avoid it. It’s still a mess though.
As for testing yourself—unless you do a blinded, well done, long term, controlled self experiment a la Gwern, it’s so easy to make a mistake that it probably is meaningless. I have over the internet seen hundreds of “this worked for me!” with many different methods of confirmation and levels of confidence—most of them ended up being very wrong. Here, Gwern takes magnesium—sees a benefit or signs of benefit—then does several detailed and careful self experiments and finds it causes significant harm. https://www.gwern.net/nootropics/Magnesium There are so many other examples.