Joseph F. McCaffrey MD, FACS


Preventing Colds and Flu


Every year as we enter the so-called "cold and flu season" people feel vulnerable, as if the bugs are out there waiting to attack them at the first opportunity. At the same the barrage of advice to get their flu shots suggests that that’s all they can do to protect themselves.


cold and flu season newspaper headlineI won't get into the debate over the effectiveness of getting a flu shot but I do want to describe steps everyone can take to reduce their chance of getting a cold or coming down with the flu. We aren’t all that vulnerable. The steps I’ll outline here will help you stay healthy. I believe they are even more important than getting immunized.


Let's begin with a quick review of what colds and the flu are all about. To begin, viruses cause both of these illnesses. Colds are more common; the flu tends to be more severe. Because these illnesses are caused by viruses, antibiotics (which only affect bacteria) have no role in either prevention or treatment.


An even more important point is that exposure to a disease-causing virus does not by any stretch mean that you will become ill. In fact, the vast majority of the time we’re exposed to a pathogen (a disease causing virus or bacteria) our powerful immune system does a neat job of eliminating it before it can cause any problems.


This means that whether or not we become sick depends on the interaction between our immune system and the microorganisms we are exposed to. If our immune system is strong it’s much more able to protect us. If we’re run-down and stressed, our weakend immune system makes us more susceptible to illness.


On the other side of the equation, some viruses are more likely to cause disease than others. Microbiologists often refer to these as "virulent strains". It's more difficult for our immune systems to deal with these organisms.


The degree of exposure also affects the chance of developing problems. If we are never exposed to cold virus we’re never going to catch a cold. If we are only exposed to a small number of viruses it's easier for our immune system to deal with them than if the exposure is extreme.


This introduction suggests that we can take a two-pronged attack to avoid catching a cold or flu: maintain a strong immune system and avoid or minimize our exposure to disease causing viruses.


The flu shot is intended to strengthen our immune system. The weakness of the flu shot is that it only produces antibodies to a select few strains of viruses. These are often not the ones we get exposed to. Strengthening our immune system generally is likely to be more effective. Here are some ways to do just that.


tired man in bedA major way is to improve our sleeping patterns. I know this is easier said than done, but getting adequate sleep supports our health at multiple levels, including a strong immune system. The unfortunate fact is that a majority of Americans do not get adequate sleep on a regular basis. This increases their vulnerability to all kinds of illness.


In addition to being well rested it's also important to find a way of managing stress well. I don't think I need to tell you that stress is a frequent occurrence in today's world. This is not all bad. Stress that is within our ability to cope adds excitement to life and can make us more productive. You can think of it as excitement.


There is also such a thing as good stress and bad stress. Most of us would consider losing your job as bad stress and getting a promotion entailing increased responsibilities as good stress. While one form of stress is obviously more desirable than the other, our biology responds in a way that can adversely affect our immune system if the stress becomes chronic and exceeds our ability to successfully cope.


A study relating directly to the topic at hand demonstrates this nicely. Researchers surveyed volunteers to document their current level of both good stress and bad stress. They then exposed them equally to a cold virus. In line with what I said in the introduction, not everyone got sick. Also, among those who did get sick the symptoms were worse in some than others.


The researchers found that the higher the level of stress, either good or bad, at the time of exposure the more likely a person was to get sick. Not only that, if they did get sick the higher their stress levels the more severe the symptoms were likely to be.


This highlights the interplay between the organism and the host. (As an aside, microbiologists have debated the relative importance of each since the days of Pasteur). It also raises the question of just what can we do about stress? The short answer is that we each have to find our own way. I find meditation, HeartMath, and EFT helpful. Exercise, hobbies and other activities that we find rejuvenating can all be effective. To a large extent, it's a personal choice


I remember discussing this with a patient once. She'd asked what she could do about stress. She was dealing with her own health issues while her husband had problems that were even more serious. At the same time, her two young grandchildren were living with her and she was their primary caregiver (her rather irresponsible adult child was in and out of the picture). Clearly, she had some stress in her life


As we were talking about strategies she might try, she lit up as she said "I used to do ceramics. I really liked that. And needlepoint! I found that very peaceful and relaxing." She already knew what worked for her. She just needed to remember to make the time to do it. It's probably the same for you.


A healthy diet also supports the immune system. I won't belabor the point. Emphasize fruits, vegetables, lean meats and healthy fats. Avoid sugars and highly refined and processed foods. They really are deadly.


So the lifestyle strategy to improve your immune system is to eat well, get enough sleep and balance the stress in your life with appropriate downtime. That's obviously a good strategy for living life well in general.


In addition to a healthy diet, there's one supplement that I think is particularly crucial to maintaining optimum immune function. That supplement is vitamin D.


We used to think that the main purpose of vitamin D had to do with bone metabolism. We now recognize that its role extends far beyond that. Specifically, it's crucial for proper immune function at several levels.


It's common knowledge that colds and flu's are more common during the winter months in the north. The question is why.


We used to postulate that was because people were cooped up indoors with the windows closed during the winter which made viral transmission more likely. Since the advent of air conditioning most people spend most of their day in buildings with the windows closed year-round. That postulate doesn't hold up well anymore.


What seems more likely is that the shorter winter days, as well as the bundled up clothing that cold weather demands, mean people living in the north get little to no sun exposure during the winter. Skin produces vitamin D in response to sunlight. Without some degree of sun exposure we are prone to deficiency.


Vitamin D deficiency is, in fact, endemic in northern latitudes. I've seen studies suggesting that 85% of people living north of Philadelphia are vitamin D deficient.


The best way to know how you stand with regard to vitamin D is to get blood work done to measure it. Until you get that done, it's safe to assume you are most likely deficient and take vitamin D3 as a supplement.


The RDA of vitamin D was recently raised to 600 units per day for most adults. While it's an improvement, I don't think it will be adequate for most people. I recommend 1000 to 2000 units per day. Even that may not be enough. Last winter I had to take 7000 units per day to maintain a healthy level.


While vitamin D levels above 20 are typically considered normal, I believe a level between 40 and 80 is more optimal.


Another food I've added to my diet recently is coconut oil. This has been a complete turnaround for me. The generally accepted dogma in medicine is that because coconut oil is a saturated fat it carries the same risk of cardiac disease that saturated animal fat does. That's what I was taught in medical school and I accepted it as true without questioning. There were a couple of problems with that: a) there is no supporting evidence, and b) it was wrong.


While coconut oil is indeed a saturated fat, the fatty acids it's composed of are entirely different than the fatty acids in animal fats. This means that it's metabolized quite differently in the body and doesn't have the same health consequences as other saturated fats. In fact, in traditional cultures where coconut fat has made up a major portion of the daily caloric intake and heart disease rates are extremely low.


Aside from its lack of adverse cardiac effects, coconut oil has specific benefits with regards to infectious disease. When it's metabolized it releases certain acids that have both an anti-bacterial and antiviral effect. This effect is so pronounced that a study from the Philippines demonstrated decreased viral loads in patients with AIDS using no treatment other than coconut oil.


Coconut oil tolerates heat better than olive oil so I tend to use it for any sautéing I do and reserve olive oil for salads and marinades. To minimize caloric intake, use coconut oil to replace other oils in your diet rather than as an additional oil. 1 to 3 tablespoons of coconut oil a day is reasonable maintenance dose.


Those are some simple ideas to improve your resistance to coming down with a cold or flu. Now let's look at the other side of the equation. Here's what you can do to reduce your exposure.


little girl sneezingMost cold and flu viruses are spread through direct contact. If someone with a cold sneezes, aerosolized droplets containing the virus spread over quite a distance. They'll contaminate any surface they settle on. If you later touch that surface and then touch your nose or eyes you risk infecting yourself.


Again, if the viral load is light and your immune system is strong (especially if you've had a previous exposure to the same virus) then chances are your body can eliminate the virus without you ever becoming sick.


On the other hand, it also helps if you're never exposed to the virus at all.


One obvious way is to avoid contact with people who are actively sick. Wish your friend a speedy recovery over the phone without necessarily going to visit them. Support a workplace culture that encourages people to stay home when they're sick rather than tough it out and come in.


However, avoiding sick people isn't always practical. Clearly that's the case for me. As a physician, it's my chosen career to see and care for people who are actively sick. Other health care workers are obviously in the same boat. Even with this exposure, we usually don't get sick. There are measures we take to minimize viral load even in the presence of very sick people.


Hand washing is key among these. Washing your hands 15 to 20 seconds with plain soap is enough to very effectively eliminate superficial contamination. I'm not a big fan of the antimicrobial soaps that manufacturers are pushing now. There is absolutely no evidence that they're any more effective than plain soap and they add chemicals to the environment.


People rarely cough or sneeze directly into my face (although that does happen). The risk of exposure is predominantly from hand contact. If someone wipes their nose with a tissue and doesn't wash their hands immediately afterwards, their hand is probably contaminated with the virus. When I shake hands with them I risk becoming contaminated myself.


Some of my colleagues avoid shaking hands with patients for just this reason. For me, the physical contact of a handshake while looking a person in the eye is part of the establishment of rapport and the therapeutic relationship. It's part of the way I practice and I’m not inclined to change it.


Rather, I've developed a habit of keeping my hands away from my face when I'm seeing patients. Having the virus on your hands doesn’t make you ill, but carrying it to your face can. I wash my hands before I see a patient for their benefit. I wash them after for my benefit.


By the same token, keeping environmental surfaces (doorknobs, countertops, etc.) clean also reduces exposure risks.


These measures will go a long ways toward assuring that you will glide through the winter months without any difficulties.


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