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Ding dong merrily on health

As the festive season approaches, pharmacy staff are in the right place to help customers deal with the effects of seasonal ailments and overindulgence.

The end of the year can herald a whole host of winter health hurdles. From the usual winter ailments to the stress and overindulgence of the festive season, this year we also have the post-celebration (or commiseration) hangovers that are bound to accompany the 2022 Football World Cup.

As the year draws to a close, pharmacy teams can be on hand to help customers with self care support as well as product advice for all of these eventualities.

Feel the burn 

Digestive health problems are often related to lifestyle choices and health issues. Indigestion – or dyspepsia – occurs when stomach acid breaks down the protective lining of the digestive system due to incomplete digestion or delayed emptying of the stomach, causing irritation and swelling.

It is one of the most common results of dietary overindulgence, but other factors that can contribute include being overweight, smoking, eating too fast or too late in the day, or taking certain medications.

Most cases of indigestion and heartburn can be treated with lifestyle changes and over-the-counter (OTC) medicines. Cutting down on rich, fatty foods, alcohol and caffeinated or fizzy drinks is a good place to start. Being overweight or a smoker is also something to address, and pharmacies running weight management or smoking cessation services can tactfully signpost customers to these.

Pharmacies are also well stocked with OTC products that can help. Simple antacids work to neutralise excess stomach acid following short periods of overindulgence, but customers experiencing more persistent indigestion may benefit from a referral to the pharmacist or their GP, as many of the medicines used to tackle this need a prescription.

Customers should also talk to the pharmacist if they want to use indigestion remedies but have liver or kidney problems, are pregnant or breastfeeding, are on a low salt diet or are lactose intolerant.

Sick with it

There are plenty of reasons why people can feel – or be – sick, so it might take a bit of investigation to find out what’s at the root of a customer’s nausea.

For example:

  • Diarrhoea or vomiting could be caused by norovirus or food poisoning
  • Headache and a high temperature could be caused by an infection such as flu
  • Heartburn or bloating after eating could be caused by acid reflux
  • Headache and sensitivity to light or sound could be caused by migraine.

Other reasons for feeling sick include pregnancy (morning sickness), motion sickness, anxiety, alcohol, medicines or even recent surgery. 

The good news is that nausea is common and usually goes away on its own, and there are plenty of ways that pharmacy teams can advise customers to ease their sickness. 

Eating foods and drinks containing ginger is a very popular way of tackling nausea and is also said to help with flatulence and cramps, with some people preferring peppermint tea for the same reason. 

Choosing smaller meals of bland foods until the nausea passes can also help. People who are vomiting may become dehydrated, so pharmacy staff should advise them to sip water little and often. 

These tips should resolve nausea and vomiting within a few days, but customers should call 111 or see their GP if it continues, and pharmacy staff should advise anyone who suddenly feels sick and has chest pain that feels tight or heavy; pain that spreads to their arms, back, neck or jaw, and shortness of breath to call 999 immediately, as these can be signs of a heart attack.

Tipsy tips

Alcohol education charity Drinkaware claims that almost two thirds (61 per cent) of drinkers in the UK overindulge in alcohol over the festive season, while one in five (18 per cent) say they typically suffer more hangovers during this period. 

Its top tips for avoiding a festive hangover include choosing a smaller glass size and alternating alcoholic drinks with soft ones. If a hangover does hit, rehydration can help ease symptoms, alongside paracetamol to help reduce headaches, and antacid to settle an upset stomach.

All blocked up

Constipation is where the passage of waste through the bowels is slow, hard to expel and sometimes painful. Signs and symptoms of constipation include not emptying the bowels at least three times a week, abdominal discomfort, bloating, nausea, straining and a sensation that the bowels are never completely emptied.

“Including fresh food components and sources of dietary fibre such as fruits, vegetables and wholegrains can help to manage the symptoms of constipation,” says A.Vogel nutritionist Emma Thornton. “Other tips such as drinking enough water, moving more and going to the loo as soon as you feel the urge are also important habits to encourage more regular toilet habits.”

While the occasional bout is quite normal, if customers are experiencing frequent or persistent constipation, they should see their GP for options such as stimulant laxatives, suppositories and enemas, or further investigation. Pharmacy staff should also immediately refer people who mention any other warning signs such as bleeding, alternating constipation and diarrhoea, mucus or blockage.

Stuck in a gut

Good gut health also has an effect on immune health, so keeping a healthy ‘gut microbiome’ – known as ‘gut flora’ – is especially important in the winter months. 

Adrienne Benjamin, nutritionist at ProVen Probiotics, says: “Restoring the balance of bacteria in the gut can be achieved by introducing good bacteria such as Lactobacillus and Bifidobacteria through a probiotic supplement. Prebiotic foods can also help to feed the population of good bacteria to help restore balance. You can also repair the gut by eating an unprocessed diet and including nutrients such as omega-3 fatty acids, L-glutamine and antioxidants – vitamins A, C and E, zinc and selenium.”

Adrienne also advises people to give their digestive system a rest, adding: “Allow four hours between meals if possible. Taking time between meals to allow your gut to fully digest and absorb one meal before moving on to the next can make a significant difference in how you feel.” 

Echinacea update

Customers looking to add an extra layer of self-care protection into their winter health toolkit may be interested in recent research which has shown that fresh extract of Echinacea purpurea reduced the incidence of respiratory tract infections (RTIs) and aided recovery from the symptoms of RTIs including Covid-19 (SARS-CoV-2) and its subsequent variants in non-vaccinated and vaccinated adults.

The randomised, controlled clinical study – published in Frontiers in Pharmacology – was conducted over a six-month period (November 2020 to May 2021) in Bulgaria, where there was a low uptake of Covid-19 vaccination. From the 120 healthy participants aged between 18-75, individuals were randomly assigned to the group for treatment with Echinacea purpurea or to the control group. Only five people in the treatment group and seven in the control group had been fully vaccinated by the end of the study.

The study showed that adults treated with Echinacea purpurea had a 25 per cent reduced RTI risk, a 48 per cent reduced coronavirus risk, and a 63 per cent reduced SARS-CoV-2 risk, as well as a reduced virus load of at least 99 per cent during acute RTIs. Viral clearance time was reduced by 4.8 days.

Chair of the British Herbal Medicines Association, Dr Chris Etheridge, says: “This study supports the hypothesis that a fresh extract of Echinacea purpurea, a regulated common cold and influenza herbal medicine that is readily available over the counter, has the potential to play a role in supporting the immune system by not only helping to reduce viral load on infection, but also lessen the severity of symptoms experienced and aid recovery; all factors that may also help to reduce hospitalisation rates.”

Sore point

A sore throat is usually caused by a viral or bacterial infection. The Epstein-Barr virus, which causes glandular fever, is responsible for up to one in 10 cases, and people suffering from bacterial tonsillitis may see whitish pus on their tonsils, have painful glands in their neck, and a fever but no cough. 

Around half of the British population will have at least one sore throat a year, according to the Selfcare Forum, with a fifth of these people going to see their GP – offering community pharmacy teams a great opportunity to step in and help.

Most throat infections clear up by themselves after a week or so with no need for antibiotics, but in the meantime, there is plenty that pharmacy staff can recommend that might help relived the symptoms:

  • Home remedies – eat cool, soft food and drink cool or warm drinks and suck ice lollies. Adults can try sucking lozenges, ice cubes or hard sweets and gargling with warm, salty water, which may help to reduce swelling and pain
  • Smoking – avoid smoking and smoky environments as much as possible. Customers can be signposted to smoking cessation services if they identify as smokers looking to quit
  • Fluids – adults should drink at least six to eight glasses of fluid (preferably water) every day, particularly if they also have a fever
  • Painkillers – paracetamol and ibuprofen can help to relieve symptoms of sore throat, fever, and headaches in adults. Paracetamol is not suitable for children under two months. Do not give ibuprofen to a child under three months or under 5kg, or to children with asthma. Aspirin is not suitable for children under 16
  • Other OTC products – pharmacies stock a wide range of throat lozenges, sprays and gargling remedies that many people find helpful in tackling sore throat symptoms. Some customers may prefer traditional herbal remedies such as echinacea or pelargonium products, so pharmacy teams must ensure they are confident on advising about these as well.

With end-of-year festivities meant to be a time of good cheer, having the right advice and products to tackle all of these conditions will help customers have a happy holiday and keep them in good shape for the year to come.

Ease Covid concerns 

With cases of coronavirus rising and a worse than normal flu season predicted, the NHS is gearing up to respond to the most challenging winter on record. 

Peter Openshaw, professor of experimental medicine at Imperial College London and honorary physician at Imperial College Healthcare NHS Trust, says: “Due to the Covid-19 pandemic and measures to stop the spread of the virus, cases of flu have been very low over the last two winters. As a result, we’re expecting this crisis to be even bigger than it would normally be, because no one has got that much background immunity this time.”

There has been a big resurgence of flu in the southern hemisphere, with Australia experiencing its most severe flu season in five years – an indication of how serious flu cases could be in the UK this winter.

For those who are eligible and suitable, one way they can choose to protect themselves against flu and Covid is by keeping up to date with their booster injections.

“It is vital that everyone eligible gets their [Covid] boosters and flu vaccines so that they can protect themselves and those around them,” says Dr Layla McCay, director of policy at the NHS Confederation. “Hitting the target of 30 million people will require everyone eligible to continue to come forward to take up this offer and so it is vital to keep this message alive over the coming weeks and months.” 

Chill out

Chilblains are small, itchy swellings that occur on fingers and toes when blood vessels near the surface of the skin contract in reaction to cold and then expand too quickly when exposed to heat. 

While it can be tempting to try to warm up cold feet quickly, the Institute of Chiropodists and Podiatrists advises against this, saying: “Do not put cold feet in hot water, near an open fire or use a heat pad. Instead, soak them in warm water to allow them to gradually return to their normal temperature. Be careful not to let the water get hot, dry them thoroughly and repeat the process if necessary.”

Most chilblains get better on their own after a few weeks, but keeping warm and active can prevent them as this helps maintain healthy circulation. For the same reason, giving up smoking can also help.

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