Medical advice over the centuries seems to swing between feeding a fever and starving a cold and back again. Today, even our definition of a fever has evolved. So what to do?
These days, a fever is a unit of measurement and a leading indicator for physicians to include in forming their diagnosis. In the early days before medicine, a fever was the diagnosis.
To understand the state of the contemporary debate on whether to feed or starve a fever or cold, we first need to be clear about what a fever and a cold actually is.
Introducing: A Fever
The accepted oral temperature range for contemporary adult humans is 36.8ºC plus or minus 0.4ºC. However, this temperature also varies in a circadian pattern. Normal temperatures also vary with where in the body we take the measurement. Rectal measurement is the most accurate, but unsurprisingly, the least popular! Taking a temperature via the ear is also an acceptable measurement point in children.
Fever in children is a common health worry for parents and generates the most visits to the GPO or Hospital Emergency Departments. Most parents see fevers as serious and are concerned about the possible causes of childhood fever such as infections.
Introducing: A Cold
Typical cold like symptoms include a running nose, sore throat, headaches, sneezing and coughs, low lung oxygen concentration. On average colds linger for seven to ten days with peak symptoms spiking over two to three days. However, patients may experience some symptoms or three weeks or longer.
A veritable battery of viruses can cause colds. Rhinovirus (30–50%) and corona virus (10–15%) are the most common viruses causing cold-like symptoms, while influenza is the third most common (5–15%) cause. Most colds are caused to exposure to air born secretions.
The effects are felt more acutely in children compared to adults.
Current Thinking On Fevers
Some 2–4 percent of children under 5-years of age with colds will experience convulsions. However, these are rarely linked to neurological or other problems. Fevers are rarely reliable indicators of a serious illness compared to the diagnostic panel used by practitioners to diagnose a patient’s condition. Fever frequently triggers a response in the immune system and stimulates its activity, actually helping patients recover from infection.
More On Feeding And Starving On Fever And Its Immune Response
Early practitioners under Hippocrates first adopted starving a fever. His teaching remained part of a physician’s standard procedure until the early nineteenth century when the eminent physician Dr Robert Graves transformed care by introducing the idea of ‘feeding a fever’.
The origin of his thinking probably lay in his suspicion that the increased metabolic rate created by the fever, required food to sustain energy and retain body mass. For every 1ºC increase in temperature, the body’s metabolic rate rises by 10 percent.
Starving a fever lowers our core body temperature, which promotes immunity towards bacterial infection but is not effective against viruses. Fasting and dehydration may increase our immunity against bacterial infections but it undermines our body’s antiviral immune response.
Feeding a fever sparks our immune responses by promoting interferon production, helping fight off viral infections, the most common cause of fever. In contrast, starving a fever only assists anti-bacterial immune response, a significantly less common source of infection.
Current Thinking On Feeding and Starving A Cold
There is little hard evidence on the effectiveness either way in support of the case for feeding or starving a cold. One Cochrane review flags potential issues with the build up of excess fluids, while another randomised study found no effect from feeding a milk-rich diet to people with colds on either the severity of the illness or the amelioration of other symptoms such as mucous secretion and cough. Generally, the results of studies into common cold treatments are inconsistent and ultimately inconclusive.
Is Medicating Fevers Effective?
Following the logic that a fever is the body’s way of fighting off infection, therefore it comes as no surprise to discover that there is no proven link between attempts to cool the body and improved survival rates. In fact it may even result in greater mortality risks in certain circumstances.
The most common justification for actively treating fever is to improve patient comfort and to prevent seizures. Unfortunately, the most common types of medication, paracetamol, aspirin or ibuprofen do not prevent seizures. Indeed these medications can actually have the opposite effect, increasing the spread of infection and prolonging influenza, chicken pox and common colds.
The optimal treatment for the common cold it seems remains with bed rest and mild analgesia, which will relieve aches and pains.
Feeding A Fever May Prove The Most Effective
Providing excess fluid build up is avoided, it seems feeding a fever is the preferred option in most situations. There is no independent evidence to suggest dosing with paracetamol, aspirin or ibuprofen is beneficial in treating colds. As always, care and common sense should be exercised and medical advice should be sought if the condition persists.