This is a question I get on a regular basis. Once it cools down, infections become more prevalent. Initially it was thought that the cold weather altered our immune system by dampening its defenses such as decreased ciliary movement within the respiratory tract which would decrease in the ability to get rid of fluids and infected secretions but in actuality, the reason we get more infections in the winter is we are indoors more.
You can never entirely prevent yourself from getting sick as illnesses are a common occurrence. They are a means of building resistance for more serious infections in the future. The key starts with prevention. Hygiene is the most important thing you can do. Washing your hands on a regular basis. Avoiding touching your mouth and nose with your hands whenever possible. Most importantly is when you are personally sick covering your mouth when you cough and sneeze and social distancing (not going out in public when you are considered infectious) and wearing a mask if you are sick to decrease your range of spreading the virus. I remember when COVID was with us people would want to be tested for COVID because they had a party or a family outing they had to go to and they wanted to make sure they were not infected. When they tested negative, they felt it was okay to still go out but I had to stresse to them they were still considered infectious with a different virus. On a separate note, a good rule of thumb is you are not considered infectious if you have been afebrile for more than 24 hours and you are actually feeling better.
Exercise is extremely important in preventing infection. It not only boosts your immune cell circulation. It does this by activating your neutrophils, which are your first responders to fight infection. Your natural killer cells, which attack viruses and even cancer. Cytotoxic T cells are also produced in increased amounts with regular exercise. Exercise reduces cytokine levels and therefore dampens low-grade inflammation. In short, it enhances your immune system. You shouldn’t exercise when you are actually infected as this could worsen the infection as your immune system is already compromised and ran down. But to be honest I do not see any harm in sitting in a sauna for 10-20 minutes if you have the means, because it is a way of getting the benefits of exercise without exercising as you are not stressing your muscles.
Equally important is good sleep. Sleeping greater than 7 hours but less than 9 hours is extremely important for maintaining a robust immune system. Sleeping less than 7 hours alters and decreases your immune response and sleeping more than 9 has been found to increase your risk of infection in some studies. Increased REM sleep actually protects you against infections and most of your REM sleep comes later in your sleep cycle particularly after 7 hours of regular sleep.
A healthy diet rich in fruits and vegetables helps your immune system as well. Ultra processed foods can predispose to infection and should be avoided in general. A good rule of thumb is if it has a label, it is processed and if sugar is one of the first 3 ingredients in that label it is considered dessert.
Staying hydrated is very important as well. Particularly increased intake of water. You should avoid caffeine and alcohol which can dehydrate you. When you are appropriately hydrated the secretions are cleared easier than if you were dehydrated. If you are not given your body adequate water, it will take water from wherever it can which includes mucus making it thicker and stool, making it harder. As I tell my patients, an adequate amount of water is whatever your weight is divided by 2 and convert it into ounces of water per day. For example, if you weigh 150 pounds you should be drinking at least 75 ounces of water per day. And during illness or in the summer I would increase this amount. Warm fluids are even better for you such as chicken soup or tea because the heated fluids will loosen your congestion.
So, hygiene, exercise, sleep, healthy diet and hydration are all things that need to be dealt with prior to the infection to prevent them from occurring. Once the infection sets in. It is a matter of controlling the symptoms with over-the-counter medications. In spite of what you might think > 95% of all upper respiratory infections are viruses that will not respond to an antibiotic which only addresses bacteria. I know many of you think that the “Z-Pak” can cure anything but in actuality it does not. Typically, I request that you treat the symptoms for at least 7 days and if it does not improve, then you MAY have developed a secondary bacterial infection that COULD require antibiotics. Nasal saline rinses have been found to hasten the recovery and can be used as a means of prevention as well. I tend to flush my nasal passages with nasal saline whenever I feel I may have been exposed to someone who has been sick or when I am developing symptoms. You shouldn’t do this on a daily basis. Only when you are having symptoms because doing it on a regular basis can disrupt your natural barrier and defense. There have been studies with airline travel that show the benefits of frequent nasal flushes of approximately 4 times a day to prevent infection when travelling on an aircraft. The mechanism is that it physically washes out the virus reducing the viral load and can also act as a barrier to prevent the virus from attaching. There have been studies that show nasal antihistamine such as azelastine can decrease your chances of infection as well. There are other over-the-counter agents such as Vicks First Defence which is a gel based liquid and has been found to decrease your risk of infections as well. There are many individuals who swear by the use of zinc, vitamin C and vitamin D as a prevention for infections. This was particularly popular during COVID-19. To be honest, I started zinc 50 mg, vitamin C 500 mg and vitamin D 2000 units and continue to do so. Not all of the studies show there is a significant difference compared to placebo. The bottom line is this may help and at these dosages it should not hurt anything. I would also use a humidifier at night particularly in the winter months as that heaters produce a dry air environment which can thicken your mucus.
The key to upper respiratory infections is the realization that they are typically viruses and all you can really do is treat the symptoms. You have to be patient as there is no magic bullet for the infections. And when I am reluctant to give you an antibiotic with less than a weeks’ worth of symptoms it is because I am trying to save these for the future when you will actually need the antibiotic and due to the resistance caused by frequent, inappropriate use it will not work when you actually need it which could result significant gastrointestinal issues or even an untimely death. I hope this helps. Stay healthy this season.
Doug
