Well, it's our "favorite" time of year again. It's the time of year when the days get shorter, the nights get longer, and BOTH get colder. But while you're gearing up for an enjoyable season of winter activities and cozy evenings, don't forget about a certain lurking hazard that is always out for opportunities to put a hamper in your day; that being the cold and flu.
Cold vs Flu:
The flu and the common cold are two different things, even though they are commonly discussed interchangeably. There tend to be seasonal outbreaks of both around this time of year. It is not clear why this happens. Some suggest that it's because the colder drier air makes the mucous membranes of our nasal cavities more susceptible to infection. Some suggest it's because people tend to crowd together indoors for warmth, facilitating the spread of germs. Some suggest that it's due to reduced Vitamin D thanks to reduced sunlight exposure. Whatever the reason, seasonal outbreaks happen, and there are things you can do to prepare.
The common cold is different from the actual Flu. Its presentation can be caused by over two hundred different viruses. The most common of these is Rhinovirus, which is responsible for 30-50% of cases. However, the Flu is caused by the Influenza virus, of which there are three subgroups; Influenza A, B, and C. None of these three subgroups is more common than another, but they do differ in their severity. Influenza A is the most virulent, being responsible for pandemics, like the outbreak of H1N1 swine flu several years ago, and is responsible for most complications and deaths from the Flu.Influenza B and C cause milder disease in the elderly and infants.
Flu season generally runs during the colder months of November to March. So, if you are getting the cardinal symptoms of Flu, and it is between November and March, then it is most likely that you have caught Influenza Type B or Type C. However, if you're getting these symptoms during April to May, or in September, it's more likely to be the common cold.
The Flu tends to have an abrupt onset, commonly involving severe headaches, body aches, fever, malaise, dry cough, chest discomfort, lack of appetite, and it often lasts up to three weeks. The flu, also less commonly, involves nasal congestion, sneezing or sore throat.
By contrast, the common cold presents with a more gradual onset, a mild or absent headache, absent or very mild fever, and mild or absent weakness of short duration. It also less commonly affects the appetite or results in body pains, and the malaise (fatigue) is mild. The common cold much MORE commonly entails nasal congestion, sneezing and sore throat.
Both the common cold and flu are spread by physical contact, like shaking hands, or through commonly touched objects like doorknobs and shopping carts and the like, as well as through air-born transmission, exacerbated by sneezing and coughing.
While relatively common, the Influenza virus is not necessarily something to be taken lightly. Complications can be life-threatening in some cases. The most vulnerable populations are the very young and the very old.
Here are some of the warning signs of a Flu emergency for young children:
Fast or labored breathing.
- Bluish skin color (cyanosis). Another sign of laboured breathing.
- Lack of thirst, resulting in not drinking enough fluids, and thus dehydration.
- Not waking up or not interacting with caregivers.
- Irritable to the point that the child does not want to be held. Usually mom or dad will realize that something is wrong.
- Flu-like symptoms improve, but then return with fever and a worse cough.
- Fever with a rash.
These are the symptoms you should watch for, indicating that more aggressive medical intervention may be needed.
In adults, emergency signs may be:
- Difficulty breathing/shortness of breath. This may be a sign of a lung infection, or pneumonia.
- Pain or pressure in the chest or abdomen.
- Sudden dizziness.
- Severe or persistent vomiting.
Prevention and Treatment:
Regarding some of the conventional treatments and prevention strategies, firstly there is the influenza vaccine. It comes under different trade names, such as Fluvirin, Fluzone, and Flumist. There are also antiviral drugs, such as Tamiflu, Relenza and Flumadine.
Then you have your antihistamines, such as Benedryl and Claritin. These don't fight the virus, but simply provide some relief from symptoms. The same goes for decongestants such as Neocytrin and Sudafed, Dayquill, Nyquill, Tylenol cold and flu, as well as for anti-inflammatories such as Ibuprofen, Naproxen, and Celebrex.
Flu Vaccine Recommendations:
Per the Centers for Disease Control and Prevention,
*Everyone over 6 months of age, except for those with contraindications, should be vaccinated against influenza
*Flu shot is a must for high risk groups:
- adults over 65
- pregnant women in 2nd or 3rd trimester during flu season
- residents of long-term care facilities
- patients with disorders like asthma, heart disease, diabetes, Cystic fibrosis, COPD, kidney disease, and immunocompromised.
- children aged 6 months - 19 years who are on long-term aspirin therapy
- health care workers
Effectiveness of Flu Vaccine:
This to me is a contentious topic. Patients will often come to me looking for a straight answer on whether the Flu shot is effective and worth getting every year. I feel I must follow the research. I try to be unbiased on the matter, and I honestly find that that evidence is mixed.
Firstly, each year the exact viral strain used for the vaccine is an educated guess by the US and Canadian Public Health Advisory committee. Basically, they look at the viral strains used for vaccines of previous seasons and how effective they were, and use that data to determine which strains should be used for that year's flu vaccine. They predict which viruses are likely to cause the flu for the upcoming flu season, and that prediction is made some 6-9 months in advance of the flu season, to allow production time for the vaccines. A faulty prediction can result in a vaccine which doesn't fully protect against that season's prevalent flu strains. This is a common problem.
Some Systematic Reviews:
- Studies on healthy children -A review of more than 51 studies involving more than 294,000 children found there was no evidence that injecting children 6-24 months of age with a flu shot was any more effective than placebo.This comes from the Cochrane Database in 2008.
- Studies on the elderly - 75 studies of various designs identified only one study of 1,438 subjects that demonstrated a positive effect against influenza and prevention of pneumonia.
- Studies on healthy adults - 40 studies testing over 70,000 people concluded that when circulating strains of that season's flu virus match the vaccine strain, 4% of unvaccinated people develop influenza and 1% of vaccinated people develop influenza. The difference is a 3% decreased risk for developing influenza when getting vaccinated, and a reduction of time off work of less than one day. It also did not change the number of people needing to go to hospital, or time taken off work. (This is the point, isn't it?)
Considering the uncertain reliability of the Flu vaccine, here are some other things to keep in mind for prevention of infection.
- Regular hand washing with soap and water. Be frequent and fastidious.
- Avoid close contact with sick people. If sick, stay home from work or school. If you need to go out in public, wear a face mask. The N95 type mask has well-established efficacy.
- Avoid sugar intake, as elevated blood sugar is known to depress the function of your white blood cells, and thus your body's capacity to fend off infection.
- Ensure balanced nutrition and regular moderate exercise. Sometimes the best prevention is health optimization.
Types of Immunity:
It needs to be understood that there are two distinct aspects to the immune response.
First, there is adaptive immunity, where the body's B cells and T cells develop specific receptors and antibodies to recognize certain infectious organisms the body has encounter before. Thus, the immune system can mount a more targeted and powerful response against those same infections. This is the principle of vaccination. However, it is difficult to develop specific immunity against the Influenza virus, as it keeps mutating each year. Therefore, the flu vaccine is recommended every year instead of just once, as with other vaccines.
But then there is innate immunity, which consists of less specialized cells, including neutrophils, natural killer (NK) cells, and macrophages, which simply detect "non-self" agents that are foreign to the body, and will destroy them. This aspect of immunity does not get more specific or more powerful with each new infection, but it can respond much more quickly than the adaptive response. You can think of innate immunity as the body's front-line first responders, and this is where many of the natural immune supports will have their effect. By supporting the body's immediate response to a new infection, it is harder for a virus to get a foothold in the body. You may not "feel" sick at all. Your body may clear the infection without any discernable symptoms. Or at least the symptoms will be less severe, and the recovery time shorter.
- Rest: If you are feeling run down, or if you have any signs or symptoms of the flu, rest and seek the assistance of your health care practitioner. Conserve your energy for your innate immune system to make use of.
- Mind set. Worry, stress and fear are known to depress the immune system. One of the best preventative treatments may simply be the belief that you are taking the appropriate steps to protect yourself. Do what you can to set aside or delegate your sources of stress as you recover.
- Moderate Exercise: This is more appropriate as a preventative to getting sick, rather than something to help recovery, which should be rest. However, moderate exercise on a regular basis supports efficient lymph flow and thus improves immune function. It has been shown that active adults who exercise regularly have a reduced incidence of Upper Respiratory Tract Infections, and show greater proliferation of Natural Killer cell activity.
Natural health products:
Influenza, and the viruses that cause the common cold, must cross mucosal membrane barriers to cause disease. The integrity and therefore, protective quality of these barriers can be enhanced using the following:
- Vitamin A - Dosed at 5000IU per day for prevention. Vitamin A supplementation should be avoided in individuals who are pregnant or trying to get pregnant. Beta-carotene (a form of vitamin A) should be avoided at doses over 10,000IU per day if you are a smoker as there is research to suggest that this can increase risk of malignancy (cancer) of the lungs.
- Vitamin C - Dosed at 2,000 to 8,000 mg per day, depending on bowel tolerance. Vitamin C also supports white blood cell function. Reduce dosage if loose stools or diarrhea occur.
Other natural medicines represent various means of directly supporting the innate immune response.
- Andrographis - Also known as "Indian Echinacea,", is thought to have immune-stimulant properties. Evidence suggests if taken for prevention, it can reduce catching a cold by 50% after 2 months of continuous use.
- Astragalus- This is a Chinese herb promoted to prevent colds and flu. There's some evidence Astragalus can stimulate white blood cell production.
- Echinacea- This is widely used to prevent upper respiratory infections including colds and flu. In vitro research suggests that Echinacea stimulates the immune system. This plant is in the same family as ragweed. Therefore, it should probably be avoided if you have a ragweed allergy.
- Elderberry- May be useful for treating the flu, rather than just preventing it. Elderberry has both antiviral and immune-modulating effects.New research shows that an elderberry fruit extract also has in vitro activity against H1N1 "swine" flu.
- Garlic - Thisis often tried for preventing colds. Garlic might have immune-stimulant activity and might also have antiviral activity. There's some evidence that taking a garlic supplement preventatively might reduce the chance of catching a cold.
- Vitamin D - The Vitamin D steroid hormone system has always had its origins in the skin, not in the mouth. Until quite recently, when dermatologists and governments began warning us about the dangers of sunlight, humans made enormous quantities of vitamin D where we have always made it, where naked skin meets the ultraviolet B radiation of sunlight. We simply cannot get adequate amounts of vitamin D from our diet. If we don't expose ourselves to ultraviolet light, we must get vitamin D from dietary supplements. A good general recommendation is for the average person to supplement with about 2000IU of Vitamin D per day during the cold and flu season, for prevention. This dose can be reduced to about 1000IU per day during the summer months.