Dealing with cold and flu season

Dealing with cold and flu season

(pictured above Ligusticum canbyi) 

Well, it’s that time of year, and people are dropping like flies. Why is it that almost everyone succumbs to sickness during that fall, and how can we prevent it?

From the perspective of medical science, a cold or flu is caused by one of over 200 different viruses, most commonly one of the rhinoviruses, coronaviruses, influenza viruses or the adenoviruses. Typical symptoms include cough, sore throat, runny nose, sneezing, and fever, and while most people get better in about seven to ten days, some symptoms can last up to three weeks or longer.

While the science isn’t clear, it is generally thought that susceptibility to viral infection occurs during this time due to factors such as decreased humidity, which increases viral transmission rates by allowing tiny viral droplets to disperse farther and stay in the air longer, as well as the fact that most of use spend more time indoors, which enhances viral transmission. But apart from that, medical science doesn’t have too much to say, and when it comes to treatment and prevention, there are few options, including the flu vaccine that researchers say provides only a modest benefit at best, with a small risk of certain diseases including Guillain-Barré Syndrome. Thankfully, we have other options. But before we review these, let’s look at why we get sick.

Is the common cold caused by cold?

For almost a hundred years now doctors have dismissed the idea as an “old wive’s tale”, that it is exposure to cold weather that causes the common cold. Given my healthy respect for “grandma wisdom”, I have always railed against such an attitude, not only because it easily dismisses this kind of non-technical assessment, but also because it denies the very experience of getting a cold, which itself FEELS cold! Thus, despite the non-technical use of the term “cold”, it is a term that defines not only the experience but the basic pathology, which relates to a down-regulation of the bodily heat, and the diminishment of the immune response which relies upon this heat to function. I think it is important to honour the language of disease, because even simple words like “cold” not only tell us about the experience itself, but provide clues for treatment. Likewise are our use of idioms such as “venting the spleen”, which allows to connect emotions like anger and frustration to the health of the visceral organs. After all, when you feel frustrated and angry, where do you feel it? In some discrete part of your cerebral cortex, or in your belly? In this way, simple terms like catching a “cold” provide us with more information than we might immediately be aware of.

Dispelling the cold

It is no co-incidence that we catch colds more frequently during the fall and winter. In the classical system of medicine of India, called Ayurveda, the period from the summer solstice to the winter solstice is called the “dakshinayana”, when the north pole tips away from the sun and the northern hemisphere is plunged into increasing darkness. It is said that during the dakshinayana the empowering influence of the sun diminishes, and in response all life hunkers down to wait out the season of death and dissolution. Thus during the dakshinayana the dominant quality is one of coldness, and thus it should be no surprise that archetypal diseases such as “cold” become more dominant. Part of this relates to our growing inability to synthesize vitamin D3 from sunlight, and with diminished vitamin D3 production immune function begins to weaken.

Here in Vancouver, we stop producing vitamin D around mid-September, when the shadow cast by your shadow at mid-day (when the sun is highest in the sky) is now longer than your height. The low angle of the sunlight means that too much ultraviolet B light is filtered out by the atmosphere, and without sufficient UVB, the body cannot produce vitamin D3. Thus traditional fall/winter foods such as marrow broth, little oily fish (e.g. smelts and herring), liver and blood pudding are relied upon to help boost vitamin D levels, although because many people don’t eat these foods regularly, they don’t get their full benefit. This is why for most people supplementing with vitamin D3 is a good idea, and to this end I recommend liquid vitamin D3 drops that contain 1000 IU per drop, usually in the neighbourhood of around 3-5 drops per day (3000-5000 IU).

Not everyone gets the full benefit of an oral dose, however, particularly if you suffer from chronic diseases of the digestive tract and liver, including malabsorption issues. Thus I frequently recommend topical administration, either as a transdermal cream, or the judicious use of sun-beds. While the latter might raise some eyebrows, there is a growing body of evidence that a non-erythemal dose, i.e. not allowing the skin to even become slightly pink, is an excellent way to boost vitamin D3 status. There is further evidence that UV light not only promotes vitamin D synthesis, but is an independent factor in supporting immune function generally. Thus there should be little surprise that judicious UVB exposure may be helpful in autoimmune diseases such as Crohn’s disease.

The exposure of our bodies to UVB light is exactly the way we evolved to manufacture vitamin D3, and when we do, we provide many more sites for vitamin D synthesis and metabolism than a simple oral dose, including the involvement of other tissues such as the prostate, colon, skin and osteoblasts. Besides which, the judicious use of sunbeds provides very clear psychological benefits in Seasonal Affective Disorder, and guess what – it WARMS you up. Since I have been visiting a solarium once a week, from Oct-March, I haven’t had a cold in 10 years. The key issue, however, is NOT TO TAN, as this defeats the purpose by increasing melanin production, which inhibits your ability to absorb UVB light and blunts its benefit in the body. Over the long term, however, it is probably better to rely upon the sun for vitamin D synthesis (e.g. tropical vacation), and find a balance of other options that suits your individual needs.

Preventing ama

In Ayurveda, the underlying pathogenesis for the common cold relates to poor digestion, and the production of a waste product called “ama”, which literally means undigested food. Viewed as a kind of detritus that interferes with digestion, ama can mobilize from the digestive tract into circulation, where it interferes with the proper nourishment of cells and the elimination of cellular and lymphatic wastes. According to Ayurveda, ama is associated with the qualities of heavy, cold, greasy, sticky and slow, and it is easy to see how these qualities could impair both digestion and metabolism.

The primary cause for the accumulation of ama is weakness of digestion, and/or eating foods which increase the qualities of heavy, cold, greasy, sticky and slow in the body. These qualities promote symptoms such as lassitude and inertia, coldness, poor circulation, mucus congestion, poor appetite and indigestion, all of which are prominent symptoms with a cold or flu. Thus the best way to prevent as well as treat the common cold, is to stop the accumulation of ama, which includes avoiding all the foods that promote the qualities of heavy, cold, greasy, sticky and slow. This means avoiding excessively greasy and fatty foods unless your digestion is very strong, as well as congesting foods such as flour products, dairy and sweets.

In particular, watch for minor symptoms of congestion, such as increase in mucus, and take appropriate measures in hand to prevent the accumulation of ama. In Ayurveda, this includes not only avoiding those heavy and congesting foods, but actively eating foods and beverages to warm and stimulate the body, such as ginger tea, Mulligatawny soup and a spicy Kitchari.

Destressing

Immune function is influenced by the health of our nervous system, and when we’re stressed and tired, our immune system begins to suffer. Energy is energy is energy, and if you are using up all your vital energy rushing from hither to thither, trying to keep up with work load, commitments and family, you shouldn’t be too surprised if you get sick. It is said in Ayurveda that the dakshinayana takes “energy away from the people”, and so we need to respect the fact that we are simply more susceptible to illness and disease in the fall. Partly this relates to the dynamics of doshas in Ayurveda, and the natural increase of vata during the autumn. This period is marked by dissolution and deficiency, and we need to take active measures to protect our vital energy. According to the ancient Indian physician Charaka, the most important way to do this is to avoid stress and worry, which perhaps sounds easier than it is, but it is a recommendation by Charaka to take some time to go within and destress the mind. Options include activities such as yoga, meditation, and tai qi, as well as fun ways to release stored anxiety in a creative way, through activities such as dance, art, singing, poetry, and music. In this way, the dakshinayana is a time to go within, and recharge the emotional batteries.

Herbs for colds and flu

According to Charaka, another way to preserve the vital energy is to take herbs that protect the heart and promote circulation. In Ayurveda, however, this means something a little bit different, as the heart isn’t viewed simply as a mechanical pump, but also as the seat of the mind and emotions. Thus herbs to calm the mind and enhance vitality are definitely indicated during cold/flu season to stay healthy. In my clinic, I often give patients my “Immune formula” to stay healthy, which includes an assortment of herbs used in both Ayurveda and Chinese medicine to boost immune function and calm the mind. Some of the herbs in this formula include Reishi mushroom, Astragalus root, Schizandra berry, Siberian Ginseng root, Ashwagandha Myrrh resin, and Licorice root. And while I don’t use this formula to treat colds/flu, some of the herbs may be very helpful. For example, during the SARS outbreak of 2002-2003, one of the more effective remedies to inhibit the cytokine explosion that was killing otherwise healthy patients was a component of Licorice root.

My favourite go-to remedies for cold and flu are all those which are warming, opening and clearing in action. Remember, we are dealing with a COLD, and so most of our remedies need to be spicy and warming. Examples include Bayberry bark, Ginger root, Prickly Ash bark, Cinnamon bark, Black Pepper fruit and Peppermint leaf. These are all good remedies for nascent symptoms, when you just start to feel yourself getting sick. But if it progresses further, then you may need to kick it up a notch, and add in some stronger antiviral remedies such as Lomatium root, St. John’s Wort flower, Canby’s Lovage root (pictured at the top), and Echinacea (angustifolia) root. Usually this will take care of the major symptoms, but if you just can’t beat it and it descends into your chest, causing a cough, then we need to alter our strategy, adding in expectorants and cough remedies such as Mullein leaf, Wild Cherry bark, and Elecampane root, and if the cough gets real bad, herbs such as Cottonwood bud, Gumweed leaf/flowers or Lobelia leaf. For kids up at night with a chronic cough, a little bit of Lobelia, or even Ephedra (Ma Huang, in small doses) mixed with a herb like Licorice can help to ease cough and promote a restful sleep.

In addition to these measures, I am really big on inhalant therapies, using essential oils such as Fir, Pine, Cedar, Spruce Cajeput, and Eucalyptus. These can be used with a hot pot of water and a towel, or, you can use a bed-side warm-mist humidifier that has a medicated well, using about 1/2-1 tsp of the oils per session. Similarly aromatic topical therapies are also helpful, not least the old-fashioned “mustard plaster”, prepared by grinding up mustard seeds and mixing with a little water, and then applying this to the chest and back, over top a piece of wax paper. The powerful essential oils in the mustard seed will pass through the paper and migrate into the lung tissue, where they exert both a strong antimicrobial effect, as well as ease coughing. Remove the plaster after 10-20 minutes, or when the area underneath becomes reddened.

While this is by no means an exhaustive review of the treatment of cold and flu, hopefully you’ve learned some valuable tips to stay healthy this season. For more information, please check out my page on Cold, Flu and Fever.

The FODMAPS diet

The FODMAPS diet

Over the past couple years I have heard practitioners and patients refer to the FODMAP diet as a way to resolve chronic gut issues like irritable bowel syndrome (IBS). In a nut shell, the FODMAP diet refers to the reduction or elimination of foods that contain various long-chain sugars found in foods such as cereals, pulses, root vegetables, and fruits (see this list). Specifically, the term FODMAP is an acronym devised by researchers at Monash University in Australia, referring to foods that contain “Fermentable Oligo-saccharides, Disaccharides, Mono-saccharides and Polyols”.  According to proponents of the FODMAP restriction diet, as well as similar diets such as the Specific Carbohydrate and GAPS diet, many of these sugars aren’t properly digested. As a result, they are utilized instead by some of the bacteria that naturally inhabit our intestines, leading to their enhanced growth and fermentation, causing symptoms such as gas, bloating, colic, and diarrhea. Many people following a FODMAP or Specific Carbohydrate diet do indeed find that their symptoms diminish after some time. The problem, however, is that patients quickly find that the diversity and variety of foods in their diet begins to decline dramatically. With these and other restrictions, some may feel that they have painted themselves into a corner, finding that their intolerances and sensitivities actually worsen over time, or that they experience difficult problems such as chronic constipation.

The notion that indigestible sugars can cause gas and bloating isn’t anything new. More than 20 years ago when I began my training as a herbalist, I was taught that a whole foods vegetarian diet was a healthier option than a meat-based diet, and during the first couple years of my practice I encouraged many to make this switch. One of the more common issues I observed, however, was that with the displacement of meat for vegetarian sources of protein such as beans, nuts and seeds, as well as whole grains and root vegetables, patients very often presented with an increase in gas and bloating, and sometimes even experienced diarrhea. I learned to anticipate this, and explain that it was a natural result of adding more high-fiber foods to the diet, which in turn, altered the composition of the microflora in the gut. In many cases, the symptoms of gas and bloating that accompanied these changes were temporary, and usually the symptoms would begin to diminish within a few weeks. Often I would discuss ways to improve digestibility, such proper cooking techniques, and the use of culinary herbs, such as cooking legumes with ginger and garlic. In some patients however, their digestive symptoms didn’t get better, and it was this as well as other reasons, that I soon abandoned the idea that a vegetarian diet was necessarily good or well-suited to everybody. Nonetheless, I learned a great deal about how to deal with digestive issues attributable to a high fibre diet.

It is very clear that some people do note an improvement in their digestive symptoms when they avoid FODMAP-containing foods. But before we celebrate the success of this intervention, it is important to look at some potential problems. Firstly, the FODMAP diet seeks to remove many of the high fibre foods that researchers have linked to a reduction in the risk of hypertensionstrokeelevated LDL cholesterolischemic heart diseasediabetes, and colorectal cancer. Some of the FODMAPs have also been shown to benefit chronic digestive disorders such as GERD, ulcer, and hemorrhoid, as well as promote mineral absorptionmodulate immune functionresist infection, enhance mood and memory, and promote healthy aging. In this context, the fermentable, indigestible fibres described by the FODMAP system are also called ‘prebiotics’, meaning that they provide a substrate for the growth and development of probiotic bacteria such as Lactobacillus spp., Bifidobacterium spp. and Saccharomyces boulardii. It is well-established that these and related bacterial species promote a healthy gut, which in turn, conveys a benefit to immune and metabolic function. Further, some FODMAP foods such as onion and garlic contain powerful antitumor chemicals such as diallyl disulfide, S-allylcysteine, and ajoene, and when consumed regularly, are highly associated with a significant reduction in cancer risk. Given the weight of evidence in favor of consuming prebiotic foods, is the FODMAP-restricted diet a valid and safe approach for managing chronic digestive disease?

While it may be empirically true that in some cases a FODMAP-restricted diet promotes an improvement of symptoms, we need to ask if the benefits are only attributable to an avoidance of fermentable sugars. Upon review, many of the foods listed by researchers at Monash University as being high in FODMAPs, are also high in a plethora of other molecules that are well-established to cause problems in the gut. In my book Food As Medicine, I review the issue of antinutrient factors (ANFs) in high-fiber foods, which includes constituents such as phytic acid and polyphenols, which chelate minerals and directly inhibit digestive secretions. In the case of cereals and legumes in particular, these foods also contain toxic storage proteins such as gliadin and vicilin that promote inflammation, protease inhibitors that block the function of protein-digesting enzymes, and lectins that can induce gut inflammation and provoke autoimmune diseases. Thus it seems reasonable to challenge the conclusions made by FODMAP proponents that it is just fermentable sugars that are the problem, when in actual fact, the issue is a great deal more complicated. It is also difficult to have a great deal of faith in the FODMAP recommendations, when they state that spelt flour is low FODMAP and gluten-free, when in fact spelt is just a subspecies of wheat (Triticum aestivum subsp. spelta), and most definitely contains gluten. While there is some research showing that fermentation can reduce the gliadin content in sourdough bread, the procedure may require specific strains of bacteria (e.g. Lactobacillus sanfranciscensis) and must be fermented for up to 72 hours at 37°C, and currently, there are a serious dearth of commercial bakeries I know of that ferment their dough long enough to significantly reduce gluten. In other words, if you are following a FODMAP diet but actually have a gluten sensitivity, the recommended FODMAP diet won’t provide any benefit.

As a practitioner that has been studying global food traditions for 20 years, I am not overly impressed by the FODMAP diet and its conclusions. The meal plan is better than the Standard American Diet to be sure, but due to it’s myopic perspective I cannot consider it to be a sustainable diet. To be sure, some people have a very hard time digesting FODMAP foods. But is the solution one of simple avoidance? When we reach back into the history of our culinary traditions, it is very clear that humans have long worked out ways to deal with the digestive issues causes by FODMAPs, as they have been found in our staples for millennia. Beets for example, are a high FODMAP food, with high levels of fructans that can cause gas and bloating. When consumed irregularly, boiled or baked beets are helpful for occasional constipation, and have a laxative activity. When consumed as a staple however, the high levels of indigestible sugars in beets will eventually causes issues, and foment the creation of a gut filled with FODMAP-loving bacteria. Good news for the bacteria, but uncomfortable and bloaty for you.

The solution? Ferment the beets first. Make those same bacteria get the work done for you before you eat it. Surveying the majority of cookbooks, it appears to be a little known fact that a beet “borscht” was originally made with fermented beets – a tradition  kept alive by some Jewish families of Ukrainian origin as a dish called russel. Fermentation of the beets beforehand utilizes the same FODMAP-loving bacteria we don’t want to overpopulate our gut with, effectively breaking down indigestible sugars that just cooking cannot. Among poor Jewish farmers during the 20th century Ukraine, beets were very much a staple, but without fermentation it is likely that as a staple it would have resulted in severe malnutrition. Likewise, many different cultures employed fermentation to improve the nutrient bioavailability of their food, including dairy products (e.g. yogurt), cereals (e.g. idli), legumes (e.g. natto), and seeds (e.g. cacao). Perhaps the FODMAP diet should be renamed “The Fermented Food” diet, and then the confusion will cease to persist about which foods can and cannot be eaten. Then we can go back to using prebiotic foods such as garlic and apple, as well as medicinal herbs to modulate the gut, such as Astragalus and Slippery Elm. Generally, all that we need to know about them is that when given in larger doses, prebiotics tend to stimulate a colonic response by encouraging bacterial growth, helping with issues such as constipation. But when there’s gut irritation and diarrhea, indicating bacterial overgrowth, it is wise to use less prebiotics or even eliminate them altogether as a form of population control. It’s that simple. You are in charge of your bacteria by what controlling what you eat.

But what to do with the patient that has removed so many foods from their diet, that they can hardly eat anything at all? Is it a valid therapeutic goal to have someone stuck on a FODMAP diet forever? Or is there something missing? After considering the issue of food preparation, perhaps the answer is found within the process of digestion itself. Ideally, we should all be able to eat a broad variety of properly prepared, whole foods. Dietary ratios will differ for each, based on constitutional or disease factors, and for some there may always need to be a strict avoidance of a particular food – such as gluten. But humans have been consuming high fibre foods and herbs for a very long time, and there is no rational reason why we should not be able to now. Thus a blind adherence to FODMAP, Specific Carbohydrate, and GAPS, as beneficial as they might be to a patient at a certain point in time, misses the mark completely. It’s all about digestion. One major issue that needs to be accounted for, however, is the long term effect of systemic antibiotics on the human microbiome, creating ecological distortions within gut, promoting chronic inflammation and bowel dysfunction. Restoration of a healthy gut ecology is vital, and it could be that for some patients a fecal transplant from a healthy individual is the only answer (although there is some risk of autoimmune reactions). Otherwise, the focus needs to return to digestion, and how to improve it. In future blogs and webinars, I’ll explain this process further.