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quote:Zinc is an essential mineral that is a component of more than 300 enzymes needed to repair wounds, maintain fertility in adults and growth in children, synthesize protein, help cells reproduce, preserve vision, boost immunity, and protect against free radicals, among other functions.In double-blind trials, zinc lozenges have reduced the duration of colds in adults,1 2 3 but have been ineffective in children.4 The ability of zinc to shorten colds may be due to a direct, localized anti-viral action in the throat. For the alleviation of cold symptoms, lozenges providing 13–25 mg of zinc, in the form of zinc gluconate, zinc gluconate-glycine, or zinc acetate, are used, typically every two hours while awake, but only for several days. The best effect is obtained when lozenges are used at the first sign of a cold.Lozenges containing zinc gluconate, zinc gluconate-glycine, or zinc acetate have been effective, whereas most other forms of zinc and lozenges flavored with citric acid,5 tartaric acid, sorbitol, or mannitol, have been ineffective.6 Trials using forms other than zinc gluconate, zinc gluconate-glycine, or zinc acetate have failed, as have trials that use insufficient amounts of zinc.7 Therefore, until more is known, people should only use zinc gluconate, zinc gluconate-glycine, or zinc acetate.Zinc reduces the body’s ability to utilize the essential mineral copper. (For healthy people, this interference is circumvented by supplementing with copper, along with zinc.) The ability to interfere with copper makes zinc an important therapeutic tool for people with Wilson’s disease—a genetic condition that causes copper overload.Zinc supplementation in children in developing countries is associated with improvements in stunted growth, increased weight gain in underweight children, and substantial reductions in the rates of diarrhea and pneumonia, the two leading causes of death in these settings.8 9 10 Whether such supplementation would help people in better nourished populations remains unclear.A small, preliminary trial has found zinc sulfate to be effective for contact dermatitis (a skin rash caused by contact with an allergen or irritant).11 Participants with active skin rashes took approximately 23 mg of zinc (in the form of zinc sulfate) three times daily, for one month. 73% of those taking the zinc sulfate had complete resolution of their skin rashes, while the remaining participants had a 50–75% improvement. Further trials are needed to confirm these preliminary findings, however.
quote:What are the symptoms of cold sores?Cold sores may appear with colds, fevers, exposure to excessive sunlight, or menstrual periods, as well as during periods of stress or illness. The sores usually disappear within two weeks. Initially, there may be tingling or prickling at the site of the cold sores even before they are visible (called the prodrome); afterward, the blisters often weep a clear fluid and form a scab. If the infection is transmitted to the eyes, it may lead to blindness.Medical treatmentsThe over the counter topical agents docosanol (Abreva®) and allantoin (Herpecin-L®), as well as camphor and phenol combinations (Campho-Phenique®), help relieve pain and might promote healing of cold sores. Analgesics, such as aspirin (Bayer®, Ecotrin®, Bufferin®), ibuprofen (Motrin®, Advil®), and acetaminophen (Tylenol®), might provide some pain relief.Antiviral prescription medications such as topical acyclovir (Zovirax®), topical penciclovir (Denavir®), or oral acyclovir (Zovirax®) might reduce the duration of the sores.Dietary changes that may be helpfulThe herpes simplex virus has a high requirement for the amino acid, arginine. On the other hand, the amino acid, lysine, inhibits viral replication.1 Therefore, a diet that is low in arginine and high in lysine may help prevent or treat herpes outbreaks. Several studies have shown that increasing lysine intake can reduce the recurrence rate of cold sores.2 Although people with herpes simplex reportedly consume about the same amount of arginine and lysine in their diet as do people without cold sores,3 it is conceivable that adjusting the intake of these amino acids may be beneficial. For that reason, many doctors advise people with cold sores to avoid foods with high arginine-to-lysine ratios, such as nuts, peanuts, and chocolate. Nonfat yogurt and other nonfat dairy can be a healthful way to increase lysine intake.Nutritional supplements that may be helpfulThe amino acid, lysine, has been reported to reduce the recurrence rate of herpes simplex infections in both preliminary4 5 and double-blind trials.6 7 The amount used in these studies was usually 1 to 3 grams per day, although some people received as little as 312 mg per day. In one double-blind trial, lysine supplementation (1,200 mg per day) failed to prevent recurrences better than placebo.8 However, the results of that study may have been skewed by a large number of dropouts in the placebo group who fared poorly but were not included in the analysis.When lysine has been used for acute outbreaks, the results have been mixed. In a preliminary study, 390 mg of lysine taken at the first sign of a herpes outbreak resulted in rapid resolution of the cold sores in all cases.9 However, in a double-blind study, supplementing with 1 gram of lysine per day for five days did not increase the healing rate of the cold sores.10Vitamin C has been shown to inactivate herpes viruses in the test tube.11 In one study, people with herpes infections received either a placebo or 200 mg of vitamin C plus 200 mg of flavonoids, each taken three to five times per day. Compared with the placebo, vitamin C and flavonoids reduced the duration of symptoms by 57%.12Zinc preparations have been shown to inhibit the replication of herpes simplex in the test tube.13 In one study, people with recurrent herpes simplex infections applied a zinc sulfate solution daily to the sores. After healing occurred, the frequency of applications was reduced to once a week for a month, then to twice a month. During an observation period of 16 to 23 months, none of these people experienced a recurrence of their cold sores.14Zinc oxide, the only commercially available form of zinc for topical application, is probably ineffective as a treatment for herpes simplex.15 Other forms of topical zinc can be obtained by prescription, through a compounding pharmacist. However, because an excessive concentration of zinc may cause skin irritation, topical zinc should be used only with the supervision of a doctor knowledgeable in its use.In a preliminary trial, a piece of cotton saturated with vitamin E oil was applied to newly erupted cold sores and held in place for 15 minutes. The first application was performed in the dentist’s office. Participants were instructed to repeat the procedure every three hours for the rest of that day, and then three times daily for two more days. In nearly all cases, pain disappeared in less than eight hours. Application of vitamin E oil appeared to accelerate healing of the cold sores.16 Similar results were reported in another study.17Application of an ointment containing propolis, the resin collected by bees from trees, has been shown to relieve genital herpes more effectively than topical acyclovir.18 It is likely that this treatment might also benefit people with cold sores, although this has not been tested. Propolis ointment should be applied four times per day.Boric acid has antiviral activity. In a double-blind trial, topical application of an ointment containing boric acid (in the form of sodium borate) shortened the duration of cold sores by about one-third.19 However, concerns about potential toxicity have led some doctors to avoid the use of boric acid for this purpose.A preliminary study found that people with recurrent cold sores have lower iron stores than healthy people.20 This may mean that correcting an iron deficiency might help prevent herpes outbreaks, but more research is necessary. Most people should not take iron supplements unless they have an iron deficiency, confirmed by a blood test.Are there any side effects or interactions?Refer to the individual supplement for information about any side effects or interactions.Herbs that may be helpfulLemon balm has antiviral properties. A cream containing an extract of lemon balm has been shown in double-blind trials to speed the healing of cold sores.21 In one double-blind trial, topical application of a 1% 70:1 extract of lemon-balm leaf cream, four times daily for five days, led to significantly fewer symptoms and fewer blisters than experienced by those using a placebo cream.22 In most studies, the lemon-balm cream was applied two to four times per day for five to ten days.The proanthocyanidins in witch hazel have been shown to exert significant antiviral activity against herpes simplex 1 in the test tube.23 In a double-blind trial, people with acute cold sore outbreaks applied a topical cream containing 2% witch hazel bark extract or placebo six times a day for three to eight days.24 By the end of the eighth day, those using the witch-hazel cream had a pronounced and statistically significant reduction in the size and spread of the inflammation when compared to the placebo group.Licorice in the form of a cream or gel may be applied directly to herpes sores three to four times per day. Licorice extracts containing glycyrrhizin or glycyrrhetinic acid should be used, as these are the constituents in licorice most likely to provide activity against the herpes simplex virus. There are no controlled trials demonstrating the effectiveness of this treatment, but a cream containing a synthetic version of glycyrrhetinic acid (carbenoxolone) was reported to speed healing time and reduce pain in people with herpes simplex.25In traditional herbal medicine, tinctures of various herbs, including chaparral, St. John’s wort, goldenseal, myrrh, and echinacea, have been applied topically to herpes outbreaks in order to promote healing.An extract from elderberry leaves, combined with St. John’s wort and soapwort (Saponaria officinalis), has been found to inhibit the herpes simplex virus in the test tube.26 However, the effect of these herbs on cold sores has not been studied.Are there any side effects or interactions?Refer to the individual herb for information about any side effects or interactions.
quote:What is it?Lysine is an essential amino acid needed for growth and to help maintain nitrogen balance in the body. (Essential amino acids cannot be made in the body and must be supplied by the diet or supplements.)Lysine appears to help the body absorb and conserve calcium.1 Lysine has many functions in the body because it is incorporated into many proteins, which are used by the body for a variety of purposes. Lysine interferes with replication of herpes viruses and is therefore often prescribed by doctors to people with cold sores or genital herpes. A review of the research trials investigating the effects of lysine on people with cold sores shows that most, though not all, trials support the use of lysine.2Where is it found?Brewer’s yeast, legumes, dairy, fish, and meat all contain significant amounts of lysine.Lysine has been used in connection with the following conditions :Cold sores (recurrence prevention)Genital HerpesShinglesWho is likely to be deficient?Most people, including vegans (vegetarians who also avoid dairy and eggs), consume adequate amounts of lysine. However, vegans whose diets contain large amounts of grains and only minimal amounts of beans could become deficient in lysine. Athletes involved in frequent vigorous exercise have increased need for essential amino acids, although most diets meet these increased needs. The essential amino acid requirements of burn patients may exceed the amount of lysine in the diet.How much is usually taken?Most people do not require lysine supplementation. Doctors often suggest that people with recurrent herpes simplex infections take 1,000–3,000 mg of lysine per day.Are there any side effects or interactions?In animals, high amounts of lysine have been linked to increased risk of gallstones3 and elevated cholesterol.4 At supplemental amounts, no consistent problems have been reported in humans, though abdominal cramps and transient diarrhea have occasionally been reported at very high (15–40 grams per day) intakes.5Lysine supplementation increases the absorption of calcium and may reduce its excretion.6 As a result, some researchers believe that lysine may eventually be shown to have a role in the prevention and treatment of osteoporosis.7Lysine works with other essential amino acids to maintain growth, lean body mass, and the body’s store of nitrogen.At the time of writing, there were no well-known drug interactions with lysine.
quote:Antiviral drugs will stop the herpes simplex virus multiplying once it reaches the skin or mucous membranes but cannot eradicate the virus from its resting stage within the nerve cells. They can therefore shorten and prevent attacks but a single course cannot prevent future attacks. Repeated courses may be prescribed or the medication may be taken continuously to prevent frequent attacks.