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Winter Remedies
poor health are generally lower again). The Sufficient range for Vitamin D is generally agreed as 75 – 125 nmol/L. Molloy’s Pharmacy Group in the West helped me run a trial of Vitamin D testing in summer in Galway some years back. Despite 2 months of good weather, working people tended to be low. To have sufficient levels you needed to be a healthy and active retiree. I’ve also found that it takes about a fortnight’s holiday in the sun (in the Med rather than Bundoran) to have levels around 120nmol/L. For this winter, if we assume most are starting at or below 40nmol/L a D3 dose of around 3000IU per day should be fine till Spring. But levels should be checked at some stage. Children: COVID will be an ever-present fear this winter, both for children and any relatives they meet. Parents will also worry than the first signs of a cold could lead to children being sent home, or for testing. Based on the no-harm principle, what can we offer parents for their children as “tonics” and to boost immunity? We have some very decent multivitamin brands. As with most micronutrients, I advocate them as top-up courses rather than for daily ongoing use. Stressful times (e.g. the Christmas excesses, exams or illness) are situations where they should be considered. When looking to boost the immune system, paediatric Echinacea is no more (but is, thankfully for adults). But we do have the likes of extracts of elderberry as sambucus nigra (e.g. Sambucol). Research showed it could prevent attachment and replication of coronaviruses that are closely related to the agent triggering COVID-19. As a result, sambucus has been advocated as a preventative, but – since it increases cytokine release – not for treatment. Dr Dílis Clare, a GP and herbalist based in Galway, has been
producing Kinderkind Syrup (Dr Clare’s Apothecary) for some years. It can be used from one year of age and contains Mallow leaf, Sambucus Berries, Limeflower, Elderflowers, Rosehips, Chamomile, Icelandic Moss, and Hyssop Herb, a mix of active botanicals for winter infections. Moving towards the grown-ups, there has been a lot of discussion of the role of intracellular zinc in immune modulation and potential prevention and attenuation of COVID-19 infections. Zinc also plays a massive role in enzyme systems involved in repair, glucose metabolism and growth. Regular supplementation over months might affect absorption of other micronutrients (e.g. copper, manganese). However, short term use is fine. If taking zinc lozenges, the anecdotal naturopathic advice has been that if they leave a long-lasting metallic taste, your levels are already high. A diet high in meats and vegetables will generally provide decent levels of zinc. It’s also in lentils and beans. Organ meats like liver are particularly strong and there’s even some in porridge. Quercetin, also found in onions and apples, helps push zinc into cells and this is considered important for COVID resistance. Earlier in the year, I’d written about therapeutic use of Vitamin C in infections. I’d mentioned liposomal (e.g. Porebski, Altrient C and other brands) forms as boosting Vitamin C levels beyond the usual. I was hoping there would be published results of high dose Vitamin C trials (usually injected) in COVID-19 by now, but they are still ongoing. There are anecdotal case report reviews (i.e. no control group) suggesting safety and reduced severity of disease. Ailments aggravated by cold: Chilblains are one of those awkward conditions that present in pharmacy, usually in elderly patients. Products like Pickle’s Chilblain Ointment tended to
come and go over the years and we never really had a good range of therapeutic options. Most products for chilblains contained a heater-upper like methyl salicylate or other essential oil, along with some moisturizing and anti-friction ingredients. My newfound interest is due to recent publications about patients presenting with chilblains as a primary symptom of COVID-19, especially younger patients. So we’ll take a look at chilblains and some related symptoms that are aggravated by cold weather. Chilblains typically afflict extremities, hands, feet, ears and nose and arise in response to exposure to cold. They are caused by inflamed blood vessels and present as itch, pain and red-purple swelling (see picture). They sometimes blister. As with Raynaud’s (see below), standard treatment involves avoiding the cold, wearing warm clothes, and if that fails, sometimes Rx-nifedipine. I can’t help but think chilblains would be given more respect if referred to by the technical term - perniosis. Treatment overlaps with Raynaud’s Phenomenon or Raynaud’s Disease, an excessive vasoconstriction that happens on exposure to cold. It leads to blanching and numbing of the affected parts. It can feel like having an inanimate digit or limb and can last for hours. The sudden re-opening of microcirculation afterwards can also be very uncomfortable. Before considering Rx meds, we have a few front of shop and nutritional tools to try. Nitric Oxide is the body’s vasodilator. Arginine is one source (hence its popularity some years back as a supplement for hypertension and “poor circulation”). Nitric Oxide is also readily made from nitrates in root vegetables like beetroot. One County hurling nutritionist told me that her lads add beetroot powder to their protein shakes for the week before a big game to increase flow and oxygen supply to muscles. For conditions like Raynaud’s or chilblains it likely takes regular use to make a difference. Another intriguing option is gingko biloba. I mainly remember gingko as an aid to cognitive function. Gingko nuts were also a tasty addition to winter foods in Korea. When I worked in Seoul, gingko leaves were being exported to West Cork for extraction. For many years, the resulting gingko extract was the top prescribed drug in Germany for patients who had suffered stroke or vascular dementia. Based on its mode of action, it was also successfully
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trialled in Raynaud’s Disease (versus placebo) and the emphasis was on using it regularly to reduce the number of flare-ups. PharmaNord is now specifically marketing a Gingko supplement for this indication. A further overlapping condition is cold-induced cholinergic urticaria. There’s a well-liked pharmacist in South Dublin (let’s call him L) who often kicks lumps out of me at soccer. God’s punishment for him (I agree, it’s disproportionate) is a form of cold-induced urticaria which strikes when the temperatures fall. In the past, he’d sometimes have to leave the pitch in mid-game or avoid playing at all. Symptoms of cold urticaria can range from skin rashes (a bit like heat rash) to anaphylactoid reactions that involve circulation. As it’s largely histamine-mediated, higher doses of non-sedating antihistamines now allow L to play through the winter season. Ouch. References on request 1. Kiss B, Kis Z, Pályi B, Kellermayer M. Topography, Spike Dynamics and Nanomechanics of individual native SARSCoV-2 virions. bioRxiv [Internet]. 2020 [cited 25 September 2020];. Available from: https://doi.org/10.1101/2020.09.17.302380. 2. Zeng W, Wang X, Li J, Yang Y, Qiu X, Song P et al. Association of Daily Wear of Eyeglasses With Susceptibility to Coronavirus Disease 2019 Infection. JAMA Ophthalmology. 2020 (cited 27 September 2020); 3. Mohamed NA, Baharom N, Sulaiman WSW, Rashid ZZ et al, Viral Clearance Among Covid-19 Patients When Gargling With Povidone-Iodine and Essential Oils: A Pilot Clinical Trial. MedRxiv 2020.09.07.20180448; doi: https://doi. org/10.1101/2020.09.07.20180448 4. Khan F, Kazmi S, Iqbal N, Iqbal J, Ali S, Abbas S. A quadruple blind, randomised controlled trial of gargling agents in reducing intraoral viral load among hospitalised COVID-19 patients: A structured summary of a study protocol for a randomised controlled trial. Trials. 2020;21(1). 5. Kirk-Bayley J, Challacombe S, Sunkaraneni V, Combes J. The Use of Povidone Iodine Nasal Spray and Mouthwash During the Current COVID-19 Pandemic May Protect Healthcare Workers and Reduce Cross Infection. SSRN Electronic Journal. 2020; 6. Colunga Biancatelli R, Berrill M, Catravas J, Marik P. Quercetin and Vitamin C: An Experimental, Synergistic Therapy for the Prevention and Treatment of SARS-CoV-2 Related Disease (COVID-19). Frontiers in Immunology. 2020;11. 7. Cheng R. Can early and high intravenous dose of vitamin C prevent and treat coronavirus disease 2019 (COVID-19)?. Medicine in Drug Discovery. 2020;5:100028. 8. Hiedra R, Lo K, Elbashabsheh M, Gul F, Wright R, Albano J et al. The use of IV vitamin C for patients with COVID-19: a case series. Expert Review of Anti-infective Therapy. 2020;:1-3. 9. H Muir A, Robb R, McLaren M, Daly F, Belch J. The Use of Ginkgo biloba in Raynaud's disease: a double-blind placebocontrolled trial. Vasc Med. 2002;7(4):265-7.
