Gill Stannard

Monday, June 22, 2009

Why we get dry skin in winter

Xerosis, the medical term for dry skin, is a common part of winter for many people.

The skin is our largest organ in the body. While most of us think of it merely as wrapping, like all organs the skin plays a vital role in our wellbeing. It is especially important in helping us adapt to our physical environment. Whether the temperature is below zero or in the searing 40’s, humid or so dry the moisture is sucked from our breath, our skin buffers the forces of nature as best it can.

The problem with winter is not so much the cool outdoors but the dry heat inside our buildings. The skin must not just adapt to two very different microclimates but also the shock of going from one extreme to another in a matter of seconds. This what not really the job it signed up for!

Indoor heating tends to be dry rather than moist, further taxing the hydration of our skin. Yet a long soak in a hot bubble bath, as wet and warm as that may be, can further strip some of the protective lipids from our skin. So too the detergent shampoo lather that runs over our body, from scalp to feet, when we wash our hair in the shower.

With the change in environment from cold to over warm, our skin needs to sweat a little more to cool us down. In winter many people decrease their water intake, sometimes thinking they don’t need so much in winter, or replace a refreshing glass of H2O with a hot caffeinated drink that can further dehydrate us.

As we age, the skin tends to become drier. Other than environmental factors such as dry, over-heated homes and dehydration, vitamin D deficiency and a host of other factors common to care facilities, with aging the lipid (fat) component of the skin changes.

Other common causes of dry skin

Eczema and dermatitis are atopic allergies – usually an inherited disposition that may be triggered by foods, chemicals, stress and contact with certain irritants. The skin can be generally dry but usually has red itchy patches that when aggravated may become painful and weep. Other atopic allergies include hayfever and asthma.

Psoriasis – is a scaly skin condition caused by the body making too many skin cells in one area. Foods and substances that cause the body to make arachidonic acid (red meat, dairy, alcohol, caffeine and smoking) tend to make this condition worse. Some people may only get psoriasis under a finger or toe nail or a patch in the scalp.

Vitamin A deficiency – is a common underlying cause of non-specific dry skin. It may also cause rough skin in patches, such as small raised bands of lumps at the top of the arms.

Some drugs such as statins (prescribed to lower cholesterol) are a common cause of dry skin.

Dry skin can be a symptom of more serious conditions such as an under-active thyroid and diabetes.

Some ways to avoid dry skin in winter

Treat any underlying eczema/dermatitis: if you are prone to this or had eczema as a baby – try removing dairy products from the diet through winter, don’t wear wool next to the skin and follow all the other suggestions below.

Have a break from soap: as most soaps can dry the skin out even more try an oat bag (a clean cloth with a handful of rolled oats) or sorbalene to clean your body instead.

Wash hair over a basin: to stop the oil-stripping shampoo running over your body.

Rehydrate: remember to drink water and caffeine-free herbal teas, potassium rich vegetable soups and juices.

Drink less caffeine and alcohol: as it just dries you out further.

Turn heating down: to lessen the temperature difference between outside and in. Keep the heating to 18 c.

Use a humidifier: as an alternative to a heater or if you have heating vents in the floor place a bowl of water beside them.

Wear layers: of breathable fabrics but be careful of wool if you have eczema.

Eat more orange vegetables and fruits: and red ones too like beetroot, as these a good natural source of vitamin A.

Choose oily fish: and replace a meat meal with it for extra omega 3’s.

If you want to take a supplement consider vitamin A and omega 3 fatty acids - ideally fish oils, or for vegetarians a GLA (gamma-linolenic acid) rich source such as flaxseed/linseed, borage, black currant or evening primrose oil plus a good multivitamin for the necessary co-factors.


Topical treatment

The temptation with dry skin is often to concentrate only on what we are putting on the outside, rather than treating the underlying causes of our skin to dry out. Adding extra oil directly to the skin can provide temporary relief but it is always short term.

Many beauty products have a long list of mysterious chemicals that the skin really does not need. Added fragrances or colours may further irritate it as well.

A simple remedy is straight Vitamin E oil from a liquid E supplement or a by piercing a capsule of the oil. It is safe for most people to use on delicate skin, like the face. Apply before bed to let the oil hydrate and soothe your skin as your sleep.

If your skin is itchy try a herbal cream, gel or ointment with the chickweed.

Thicker preparations such as paw paw creams can be useful to create an extra barrier for the skin but also soothe it at the same time.

Sunday, June 21, 2009

Winter solstice reflections and updates

As those of us in the Southern hemisphere arrive at the longest night and shortest day of the year, it can be useful to take a moment and reflect on the symbolism of the winter solstice. This is the time of both darkness and revival, culminating in the joyous return of the light.

Winter historically has been a time of death, scarcity of food and the cruelness of the elements. The solstice symbolises an end of the gloom and the triumph of optimism. To me both elements are essential in understanding the meaning of the solstice. By taking the time to sit with our darkness - sadness, grief, disappointments and all those uncomfortable feelings that we try to avoid, only then can we symbolically leave them behind and move forward into a phase of positive plans and celebration.

The news last week, that a 26 yo man has likely become the first Australian to die from swine flu fills me with great sadness and shame. While an opportunistic virus may be his ultimate cause of death, the reality is the disparity between indigenous and Caucasian health in this country must shoulder the blame. The officials who have reported his death euphemistically use the term “pre-existing health conditions” to explain it. Yet in 2009, even without the latest influenza pandemic, this man could only have expected to live to his mid-50’s, two decades shorter than a white man born in the same country.

At the moment many of us feel some degree of uncertainty about our future. From influenza to the economic downturn, through to the reality of climate change – there is not a lot of good news going around. Sometimes just sitting with the enormity of the state of our world can feel immobilizing. But by acknowledging the big stuff (whether it is on a political scale or the macro level of our personal burdens) and giving thanks for what we do have, this simple ritual can help us move through the problems.

When I am overwhelmed I like to take some time to acknowledge the personal elephant in my room and even if I can’t change a problem that feels too large, choose something small to help move on through it. Giving money to my favourite charity if I am worrying about finances, cleaning one small cupboard when the whole house feels like an untidy mess or spending time with friends when the inanity of communicating in 140 characters or less gets too much. The winter solstice encourages us to focus on what we can do, rather than stay bogged down in the mire of “its all too much”.

In my own life right now small but exciting changes are afoot. But you’ll have to tune into RRR tomorrow morning at 10.30 to find out more about!

Happy Winter Solstice.

Wednesday, June 17, 2009

NPR podcast about coeliac

National Public Radio (NPR) has a great program about coeliac disease, covering symptoms, diagnosis and living with gluten intolerance from both a medical perspective and those who live with the condition. It also features an interesting aside about wheat intolerance.

There is a cameo from Gluten-Free Girl, Shauna James Ahern, as well as a teenager talking about how the diagnosis has changed their lives.

The podcast is currently available to download from NPR.

Monday, June 15, 2009

Swine flu

Over the past month the local media has been salivating in the desire to spot the first case of Swine Flu in Australia. Now the inevitable has happened, there are only so many times they can show the same picture of primary school children covering their faces to ward off the disease. You get the feeling the press is rather disappointed that everyone is pulling through so far.

Below is an updated version of an article originally published in my May E-newsletter plus more news as the situation unfolds


Having a head cold that makes you feel awful and drags on for days is not flu. When you can’t sleep from coughing and you feel thoroughly miserable it is normal to think you must be suffering something far grander than a common bug. But a cold is not influenza.

Some of the notable characteristics of flu may include a sore throat and sinus congestion like a cold but influenza will also bring a fever (over 38c), chills, body aches, severe fatigue and loss of appetite. You cannot get out of bed and you will rarely, if ever, have felt this bad before.

Swine flu will begin like any other strain of influenza. The mystery is why this virus killed so many healthy and young people in Mexico. Disease and naturopathic discussion boards are rife with theories, just google “cytokine storm” for equal parts awe and bafflement to get an inkling of how complex this virus is. Certainly what is different about this variety of flu compared to the ordinary Influenza A strain is there is no prior exposure to give partial immunity and good health is no protection. This is likely due to the fact that it is only one part human in origin, with pig and bird forms of influenza completing the puzzle.

The most famous H1N1 (the flu strain that swine flu belongs to) epidemic was the 1918 Spanish Flu which claimed 50 million lives (approximately one hundred times our current worldwide annual influenza death rate of 250,000-500,000), so there is understandable cause for concern. Like the Mexico outbreak, the Spanish Flu also claimed a large amount of supposedly healthy young men. But as it came on the tail of a major world war with horror, poor nutrition and a large amount of post-traumatic stress perhaps this was the group in society most vulnerable to an attack on their immune system?

Usual prevention strategies involve good old fashioned commonsense. Do lots of hand washing and the disease is spread by droplets, when we absentmindedly rub our eyes, nose or put our fingers in our mouth we give the virus entry to our body via our mucus membranes. Following last March’s article on staying well in autumn, I strongly suggest that we all take a daily dose of cod liver oil to strengthen mucus membranes and get a much needed dose of immune boosting Vitamin D. Low Vitamin D is emerging as a significant factor in Swine Flu as well as general health.

But most importantly, don’t soldier on! If you feel like you are coming down with something, be it a cold or influenza – stay at home, go to bed, drink lots of water, soup, herb teas and lemon and honey. If it is Swine Flu, your boss will thank you for not coming in and spreading it around the workplace.

If you don’t have a thermometer in your house, go out and buy one now. This is a cheap and effective tool to monitor any illness. Normal temperature is around 37c depending on what part of the body it is taken (sublingual - under the tongue, axillary - under the armpits or rectal – you know where that is!). The agreed normal for sublingual temperature is 36.8c, although this can vary by a full degree throughout the day. Typically your temperature is higher in the afternoon and lower in the middle of the night, so here is no cause for alarm if you temperature is under 38c.

Be aware that if you have recently eaten or drunk hot or cold substances this may give an inaccurate oral temperature reading. Infrared ear thermometers are handy as they only take a second to get a measurement but studies show they can be less accurate than a correctly used oral thermometer. Strips that take skin temperature are considered least reliable.

Wear a mask if it makes you feel better but once again it’s the droplets on our hands that is often the culprit so this may just give you a false sense of security. On packet trains, trams and buses it may be handy to have a pack of antiseptic wipes to use once you get off at your destination.

There has been a rush of anti-viral medications like Tamiflu or Relenza. While it is well indicated if you have been exposed to any kind of influenza or if you develop the virus, be cautious about taking it unnecessarily. These are serious pharmaceutical drugs with a well documented list of adverse reactions including alarming psychiatric symptoms from hallucinations through to psychosis and suicidal thoughts, especially in children.

Interestingly a successful Swine Flu vaccine was developed in 1976 but caused more deaths than the illness itself. At least 500 people who were given the vaccine developed a life-threatening neurological condition, Guillain-Barré Syndrome.

Keep in mind that if you take the Mexican Swine Flu deaths out of the tally, the death rates in the rest of the world are not nearly as alarming. The World Health Organisation has running tally that is regularly updated. At the time of writing this there have been almost twice as many reported cases of Swine Flu in the USA, than in Mexico yet their have been 12 deaths in former compared with 85 in the later. What this means is, bar a mutation to the virus, we can be less paranoid about the current pandemic.


The take home message remains that prevention from exposure is the best, if not the only, measure to prevent getting Swine Flu. Stock up on your cod liver oil capsules, make sure you have some healthy food (e.g.: whole grains, legumes as well as canned organic beans, fish and fruit) in your pantry in case you are unexpectedly quarantined, practice hand washing and stay at home if you feel at all unwell.


More Swine Flu resources

The BBC Q&A about Swine Flu is useful and up to date.

WHO alerts.

Updated 15 June 2009:
According to The Age, up to 1:3 Victorians may have swine flu. Though a spokesman for the Department of Human Services said "it was difficult to estimate Victoria's swine flu prevalence because symptoms could range from a sniffle that would not prompt someone to go to the doctor through to fever, sore throat, aches and pains and other flu-like symptoms".

Last week the WHO officially upgraded H1N1 influenza from phase 5 to phase 6 pandemic, which is the highest alert. There are now over 30,000 confirmed cases of swine flu in 74 different countries. Currently there are 1515 confirmed cases of swine flu in Australia.

Worldwide, the number of deaths is small. Each and every one of these deaths is tragic, and we have to brace ourselves to see more. However, we do not expect to see a sudden and dramatic jump in the number of severe or fatal infections.

We know that the novel H1N1 virus preferentially infects younger people. In nearly all areas with large and sustained outbreaks, the majority of cases have occurred in people under the age of 25 years.

In some of these countries, around 2% of cases have developed severe illness, often with very rapid progression to life-threatening pneumonia.

Most cases of severe and fatal infections have been in adults between the ages of 30 and 50 years.

This pattern is significantly different from that seen during epidemics of seasonal influenza, when most deaths occur in frail elderly people.

Many, though not all, severe cases have occurred in people with underlying chronic conditions. Based on limited, preliminary data, conditions most frequently seen include respiratory diseases, notably asthma, cardiovascular disease, diabetes, autoimmune disorders, and obesity.

At the same time, it is important to note that around one third to half of the severe and fatal infections are occurring in previously healthy young and middle-aged people.

Without question, pregnant women are at increased risk of complications. This heightened risk takes on added importance for a virus, like this one, that preferentially infects younger age groups.(Dr Margaret Chan, Director-General of the World Health Organization)


Updated 18 June 2009

The Australian experience of swine flu (or swine influenza A as it is currently known) has been much milder than anticipated. However, there is concern that this is just the dress rehearsal for a future, more deadly mutation of this particular virus.

In the Medical Journal of Australia’s online report this week ”Swine flu update: bringing home the bacon”, several characteristics of this virus have been observed:

- the symptoms have been milder than expected
- on average there is an incubation period of 3-4 days between exposure to the virus and onset of symptoms
- unlike most strains of influenza, the majority of people with swine flu do not experience a significant fever (in both mild and severe presentations of swine flu)
- in the US over a third of cases have diarrhoea and vomiting along with the usual symptoms such as a sore throat and malaise
- it is not as deadly - when the Mexican death rate is excluded from the statistics the mortality rate is 0.2% (including Mexico it brings it to 0.5%)
- older people may have some degree of immunity despite it being a new virus as there may be some viral similarity with a previous seasonal flu or flu vaccine, explaining why younger people have been more vulnerable to acquiring swine flu

The MJA published another piece this week, “Australia’s influenza containment plan and the swine flu epidemic in Victoria” examining the response to the Swine Flu at the epicentre of the Australian outbreak.

In reality, the severity of the 2009 swine flu outbreak has fallen well short of the worst-case scenario: instead of resulting in high mortality, swine flu has been associated with only a 1%–2% hospital admission rate and zero mortality in Australia (so far); early experience has shown that the clinical case definition (fundamental to accurate disease modelling) was not an accurate model for the swine flu epidemic…”
MJA.

The article also made an alarming reference to our faith in current antiviral medication (oseltamivir, marketed as Tamiflu) and its efficacy. Other than the drug needing to be administered within 48 hours of the onset of the disease the authors noted, “it is known that the main seasonal influenza strain in the United States in 2008 was resistant to oseltamivir. The real nightmare scenario will be if the current swine flu strain also develops resistance in the face of widespread use of oseltamivir, leaving us with few treatment options. We are currently wasting oseltamivir on a mild illness when we are likely to need it next year, when the current strain could become more aggressive.”

And on that note a sub-type of the H1N1 virus has just been identified in Brazil. It is not known yet if this mutation of swine flu is any more virulent or is resistant to medication.

Health Trip - 22 June

Feeling a little itchy? This week on Health Trip I'm looking at the foes of winter – dermatitis and eczema. As the weather cools down and we crank up the heat indoors, our skin can start complaining. Tune into Health Trip on RRR this Monday morning at 10.30 (for those outside of Melbourne check the world clock for local time) to hear about natural ways to achieve clear, calm skin.

You can call the station on +61 3 9388 1027 during the program if you'd like to ask a question. If you subscribe to the podcasts, you can email your question to The Grapevine and get it answered on the show.

Tuesday, June 09, 2009

Warming up in winter

It’s chilly outside and one of the best ways to warm up is to exercise. Here are some creative ideas to get you moving this winter.

1. Take up dancing. Whether it’s a Salsa class or a bit of belly dancing – classes can keep you motivated and can be great for your social life. If nothing else crank up the music and dance at home.

2. Rug up and go for a walk. When the sky lightens and patches of blue appear, grab the opportunity while its lasts and head out for a walk. Did you know that some new or recently renovated houses emit more toxic gasses than the city on a smog alert day? Getting out of home or work and into the fresh air is worth the effort.

3. Do something new. Winter is the perfect time to learn new skills – consider an adult swim or stroke correction class, circus skills or trampolining. Or reconnect with a childhood activity like ice skating, roller blading or skipping.

And while you have exercise on your mind, check out a recent article on exercise myths from Choice while it is available free online.

Thursday, June 04, 2009

June e-newsletter out now

The latest Health Trip newsletter is now out. If you've subscribed and it has not made it into your inbox, check your junk mail folder or resubscribe (in the welcome post above).

This issue has some great information about just how much sunlight we need to be exposed to at this time of year in Australasia to get our recommended daily dose of Vitamin D, there is a yummy recipe for my favourite fish pie and much more.

The newsletter can also be viewed online for a short while.