Dr Kevin McCarrollBut as the old adage in medicine goes, prevention is better than cure. So is there anything we can do to stave off winter illness or at the very least ameliorate our symptoms if we get sick?
As the winter approaches, we brace ourselves for the long dark days, the cold wet weather and the seasonal increase in colds, flus and other illnesses.
The winter spike in ill health has been recognised since Hippocratic times and is largely due to the increased incidence of viral respiratory infections. The winter period may put an increased physiological stress on our bodies and indeed the prevalence of high blood pressure, stroke, heart disease and rheumatological complaints as well as low mood is increased at this time of year. But as the old adage in medicine goes, prevention is better than cure. So is there anything we can do to stave off winter illness or at the very least ameliorate our symptoms if we get sick?
Unfortunately, the common cold has eluded a cure, being caused by hundreds of viruses that are constantly changing. However, the flu vaccine produced by the World Health Organisation (WHO) and based on viral strains identified earlier in the year is made available from September.
All adults over 65 and in particular those with respiratory or heart disease or who are immuno-compromised should be vaccinated.
Unpredictable
The peak incidence of flu is usually in the months of January and February, but early vaccination is crucial as outbreaks are unpredictable. The pneumonia vaccine which is directed against several strains of the pneumococcus (a very virulent and pathogenic bacterial cause of pneumonia) should also be given to those over 65 who are at increased risk. It is a synthetic non-live vaccine readily available at your GP that should be given no more than every five years.
In general, a healthy diet, avoidance of smoking and stress, and adequate sleep, are important factors in maintaining our immune system and our ability to fight infection. Practical measures including washing your hands and avoiding contact with others when sick are simple but highly effective ways of reducing your risk of infection.
Whilst many supplements on the market claim to boost the immune system and prevent or lessen the duration or severity of symptoms from colds and/or flus, evidence is often limited and studies conflicting. Much has been said about vitamin C. However, in the largest review of studies to date, it was found to have no effect in preventing colds, though in most people, its use did reduce the duration of symptoms by up to 36 hours.
Echinacea preparations may also bolster the immune system but studies as to its effect on the cold have been inconsistent. However, this may be in part due to differences in echinacea species and concentration used in various products. Despite this, it may reduce the length and severity of colds.
More importantly, in the largest review to date published this year, there was a consistent trend for a 10–20% reduction in the incidence of colds in those taking echinacea. In particular, echinacea purpura may be more affective than other species. Garlic is also widely touted as being beneficial and in at least one intervention study it appeared to prevent the common cold, but evidence is otherwise limited and more studies are needed.
In the winter, vitamin D deficiency is much more prevalent, especially in Ireland when levels typically drop by up to 20-30%. In fact, severe deficiency has been found in up to 30% of older Irish adults. This ‘Vitamin D winter’ is a protracted period lasting from September to March when the sun rays are too weak for cutaneous synthesis.
Apart from the negative effect on bone health with the potential to cause or exacerbate brittle bones, mounting evidence suggests a positive role for vitamin D in our immune, cardiovascular and respiratory system, as well in depression and cognitive function. For most adults, it is prudent to take vitamin D supplements during the winter months to ensure optimum status.
Supplements are inexpensive and widely available in chemists and alternative medicine shops. A daily dose of up to 1000-2000 IU is sufficient to maintain adequate levels, but make sure to check if you are taking prescribed vitamin D already.
Blues
As for winter blues, it is estimated that anywhere between 1% and 10% may suffer with seasonal affective disorder (SAD), a syndrome comprising depressive symptoms, excessive sleeping, tiredness and carbohydrate craving. It usually affects younger adults, has a female preponderance and symptoms recur each winter and disappear during the spring or early summer.
Whilst it can respond to light therapy, the cause is unclear and no role for vitamin D has been established.
If you have osteorathritris or suffer with other rheumatological complaints, studies show you are more likely to perceive greater pain in the damp, rainy and colder weather.
The reasons behind this are unclear, though lower temperatures and changes in humidity might increase joint fluid viscosity causing stiffness. Unfortunately, evidence is lacking as to the cause and there are no specific treatments proven to help.
Finally, if you do catch the cold or flu, keep warm, drink lots of fluids and eat well. Regular paracetamol and ibuprofen (as required) for pain are safe and effective.
And what about a taste of hot whiskey? Well, at least one study suggests it may modulate interferons, chemicals produced by our immune system that counteract viruses. But translating this into any real benefit is another matter. As with everything, I caution use in moderation only!
*Dr Kevin McCarroll, Consultant Physician in Geriatric Medicine, St James’s Hospital, Dublin.