Doctor's orders: Top medics on how to stay well this winter

What should we do and avoid in order to get through the dark months in good health? Helen O’Callaghan asks four leading doctors for their advice

WINTER – the time of year that takes the biggest toll on our health. The weather’s bad, the days short, bugs abound – yet right when we instinctively want to draw in and conserve energy, we’re expected to gear up for the big festive blow-out. Little wonder we’re beset by various health bugbears.

We ask four top doctors how to stay fit and healthy in the run-up to Christmas.

Dr Harry Barry, GP and author of the Flag series. His latest book is Anxiety and Panic – how to reshape your anxious mind and brain.

Problem: Tired all the time.

“As a doctor, fatigue’s the commonest presenting symptom, across both physical and mental health. It’s a core element of many illnesses – just Google ‘fatigue’ and count the number linked with it.

“If you’re got persistent fatigue, start with a full physical work-up – significant errors can be made if everyone just assumes stress. Blood tests should check for clear signs of ill-health – anaemia, weight loss, bleeding from back passage, very heavy periods, diabetes, thyroid, excess or lack of iron, lack of B12. Check liver and kidney function.

“If these are clear, look at sleep. The cardinal thing to watch out for is sleep apnoea – waking up continually through the night gasping for air. You’re not sleeping properly and your brain’s exhausted. Then look at stress. Do you have toxic stress? Are you tired but wired, constantly on edge but exhausted? Perhaps you’ve got mouth ulcers, cold sores or increased infections?

“Absolute exhaustion’s a key depression symptom – dragging yourself out of bed, struggling to get through the day. Your mood’s low, you’ve no interest in food or life and you have negative thoughts.

“General anxiety disorder is more subtle but also causes fatigue. The key sign is spending most of your time in constant foreboding that something terrible’s going to happen – worrying when no danger exists. You might be having nightmares, teeth grinding and irritable bowel symptoms.”

What over-the-counter treatments do you recommend?

“If tiredness is caused by stress, I recommend B complex vitamins and fish oils. Depression may require drugs, talk therapy or both.”

Do you recommend vitamin supplements?

“Apart from the above, the only vitamin I’d recommend is pure Vitamin D if you’re someone who doesn’t get much sunlight.”

What simple precautions can you take?

“Eat a balanced diet with plenty of fruit and vegetables, some meat and fish. I strongly recommend avoiding fad diets – they can be very destructive because you miss out on key nutrients. And if you’re not getting seven to eight hours a sleep a night, work out why. What’s causing the problem? Always re-assess your life to make sure you’re getting your priorities right. If there are stressful areas in your life, ensure you sort it out.”

When should you see a doctor?

“If the fatigue persists, if it’s there for a week to 10 days though you’re exercising, eating properly and getting enough sleep.”

Do you have strong views on antibiotics?

“Bacteria are becoming increasingly smarter at outwitting antibiotics. Lots of ordinary coughs and colds don’t require anything beyond Paracetamol. If a person’s running a very high temperature and has a septic throat, go to the GP to see if there are clinical indications for using antibiotics.”

What’s your top tip?

My number one top tip is to exercise every day. If you’re stressed, have general anxiety disorder or are depressed, you must do 30 minutes exercise every day, preferably something like a brisk walk. Exercise treats and prevents – it’ll go a long way towards preventing toxic stress and bouts of depression.

“When we’re stressed, exercise burns off stress hormones (cortisol). It boosts endorphins and the dopamine and serotonin systems. It’s good for the brain’s neurochemistry.”

Dr Phil Kieran of RTÉ One series You Should Really See a Doctor and GP based on Washington Street, Cork.

Problem: coughs and colds.

What’s the latest research?

“They’re looking for a universal vaccine – if discovered, it’d take a lot of the sick burden out of people’s lives. There’s always research too into what sorts of treatments are beneficial.

“Recent studies of probiotics and vitamins in relation to prevention and treatment suggest there isn’t huge benefit. Some big review trials for high-dose vitamin C found it might benefit people under high stress – soldiers training in Arctic conditions or people training for a marathon. Outside these two extremes, there’s no benefit to taking high-dose vitamin C, or even garlic supplements, ginger and echinacea.

“It’s difficult for a doctor to say something doesn’t work without putting something in its place, but these supplements can end up quite expensive.”

What over-the-counter treatments do you recommend?

“I often recommend a teaspoon of honey in warm milk, particularly at night going to bed. It’s been shown to be as effective as most cough medicines, but a lot cheaper and natural.

“Warm water with honey, lemon and ginger before bed can help soothe a cough too. Many problems at night are to do with dripping nose – you lie down and you’re coughing. A saline nasal spray helps dry out the inside of the nose and has very few side-effects – do it an hour before bed.

“I recommend rest, Paracetamol, fluids and maybe ibuprofen.”

Do you recommend vitamin supplements?

“I recommend many of my patients take vitamin D during winter. But if you have a balanced diet with plenty of fruit and vegetables, there should be no reason for taking vitamins.”

What simple precautions can you take?

“It’s nearly impossible to guarantee you’ll avoid getting coughs and colds. They’re spread through droplets in the air. The mantra is ‘catch it, bin it, kill it’. Have tissues to catch the cough or sneeze. Then bin and wash your hands. If you’re out and about, bring a small tube of alcohol gel with you. It helps reduce spread of colds, flu and winter vomiting bug.”

At what point should you see a doctor?

“If it’s worse after three days – if something changes, where your cough was bringing up clear, slightly yellow phlegm and suddenly it’s green and copious, go see a doctor. If you had no temperature up to day three and then you get one, check that out.”

Do you have strong views on antibiotics?

“Antibiotics do absolutely nothing for a cold. They don’t make your immune system stronger and they don’t fight anything other than bacteria. In a battlefield, antibiotics are like tanks and bacteria are like foot soldiers. But viral infections are more like airplanes – tanks aren’t much good for them.”

What’s your top tip?

“Keep yourself in good shape coming into winter. Eat enough fruit and veg to get your vitamins in. Walk or run 30 minutes a day, five days a week. Take no more than moderate alcohol. Watch your hygiene. Smoking increases two-fold your risk of catching a cold.”

Dr Ciara Kelly, GP and presenter of Lunchtime Live on Newstalk, 12-2pm.

Problem: hangovers.

What’s the latest research?

“There’s not much merit in producing R&D in this area. There aren’t any drugs that are hangover cures, though there are some that’ll help.”

What over-the-counter treatments do you recommend?

“The best over-the-counter remedy is at the bar counter – not to drink so much. That will protect more than anything. The message to avoid is vital in a country that’s awash with alcohol problems.

“Alcohol dehydrates, causing dry mouth and headaches. It causes a fall in blood sugar leading to carbohydrate cravings. When broken down by the liver it produces toxic substances, causing nausea and stomach upset. So you treat these symptoms.

“Take clear, sweet fluids: flat 7 Up, cordials like Ribena. Water’s wonderful for hydration, but get some sugar in to make you feel better. Take Paracetamol for headache, antacid for stomach acidity.”

Do you recommend vitamin supplements?

“People who drink excessively often lack B vitamins. In the main, supplements aren’t the way to go. If you’re regularly becoming hungover, you should look at sorting your drinking, rather than looking for ways to accommodate it.”

What simple precautions can you take?

“You can pre-hydrate, as well as during your night out. A clever way to slow alcohol intake is to alternate alcoholic drink with soft drink or water. This reduces volume of alcohol and keeps you better hydrated.

“Drink a pint or two of water before going to sleep. If you’re likely to wake up with headache or sick stomach, take Paracetamol and the antacid Nexium before bed.”

At what point should you see a doctor?

“People have become very unwell after a serious night’s drinking, vomiting very significantly, becoming very dehydrated and needing fluids or an anti-emetic. I’ve seen people hospitalised. Pancreatitis – very inflamed pancreas – is reasonably rare but one night’s drinking could do it. Pancreatitis kills people. If you’ve had one episode, most people are advised never to drink again.

“If you’re drunk, your blood alcohol levels have climbed to toxic levels. This has a detrimental effect on your nervous system, liver and digestive system. Anxiety and low mood are associated with hangovers. Anxiety may peak the morning or day after but low mood lasts four or five days. Binge drinkers go from one low mood episode to another.”

What’s your top tip?

“Reduce it – better still, avoid it.”

Dr Nina Byrnes, GP, TV presenter of Health of the Nation (RTÉ) and Doctor in the House (TV3) and owner of Generation Health Medical Clinics.

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Problem: flu.

What’s the latest research?

“Flu has been around a long time. It’s a particularly nasty virus and the only way to prevent it is to get the vaccine. Here, we cover ourselves for the flu virus that has been circulating in the Southern Hemisphere – they had a very bad flu season in Australia last year.

“People who should get the vaccine include over 65s, those with chronic illnesses: diabetes, cardiovascular disease, asthma, arthritis or who are on immuno-suppressant drugs – also people with BMI over 40 and all pregnant women. Pregnant women have died from flu.”

What over-the-counter treatments do you recommend?

“If someone isn’t at risk of getting really sick, I’d recommend Paracetamol, ibuprofen, fluids and rest.”

Do you recommend vitamin supplements?

“If your diet’s healthy, you shouldn’t need them. The only vitamin I recommend in winter is vitamin D because we don’t get enough sunlight. If your lifestyle’s hectic or your diet’s insufficient, there’s no harm in taking a multivitamin for a few months. But don’t spend a fortune on high-dose ones – the evidence behind them isn’t that strong.”

What simple precautions can you take?

“Flu’s an airborne virus. Basic hygiene’s important – cover your mouth/nose when you cough. Teach children to cough into their elbow. Wash hands properly with decent soap for more than just two seconds. These kinds of viruses spread fast. You’re doing no-one any favours going spluttering into the office – stay home.”

At what point should you see a doctor?

“The common cold can have you feeling fairly off, but the flu makes you feel dreadful – really sore muscle aches, high temperature, sore throat, runny nose, cough. You just have to lie on your bed. I’ve had grown men crying in front of me.

“If you’re three floors up and you spot €100 on the ground below and you’re motivated to go get it, you don’t have flu. You do have flu if you just couldn’t be bothered.

“If you take Paracetamol and ibuprofen and feel better, ok. In most cases, you don’t need to see a doctor. You should if you’re getting sicker, find it hard to breathe or can’t get your temperature below 38. If you’ve got lots of green phlegm, this suggests you have a bacterial infection on top of the virus.”

Do you have strong views on antibiotics?

“Every doctor has. Antibiotics save lives and are fantastic drugs, used correctly. They’re probably used incorrectly. As a doctor, you have a conversation every day with someone, where you say ‘you don’t need an antibiotic’ and they think you’re saying ‘you’re not sick’. That’s not what you’re saying.

“If we keep using them incorrectly, we’ll end up with bugs we can’t treat.”

What’s your top tip?

“Eating well and exercising are the best things you can do to boost your immune system.”


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