Fuelling the festivities
Colds and flu, exhaustion, hangovers, indigestion – you name it, the winter weather and Christmas partying can do their worst. So what can pharmacy teams do to help customers keep happy, healthy and full of festive spirit?
Dark nights and cold spells can play havoc with customers’ physical and mental health. For some people, the festive season is also a time of overindulgence, partying and stress, followed by an extreme health kick in the new year. The build up to the festive season is usually a slow one, over several weeks or months, and even customers who don’t celebrate Christmas in a big way – or at all – may still find it difficult to avoid the shopping mania and general buzz.
“A few weeks before Christmas, everywhere becomes more manic, which can increase stress levels,” says Mahendra Patel, member of the Royal Pharmaceutical Society (RPS) English Pharmacy Board. “If people are in a minority ethnic group, this can also apply to other festivals, such as Eid and Diwali. Customers should think about their diet and lifestyle in advance and how far they intend to overindulge. It’s particularly important to discuss this with customers with diabetes or cardiovascular disease, who may experience health problems if they have a high intake of sugar or fried foods. Many people don’t realise how much they’re consuming.”
Practising self control
Media reports suggest people can eat a staggering 6,000 calories on Christmas Day alone, which is three times the recommended daily intake for women and more than twice that of men. And, on average, people will put on half to one kilogram (one to two pounds) over the Christmas period.
While overindulgence isn’t good for people’s health, total abstinence isn’t necessarily the best solution either. Last year, behavioural psychologists at Loughborough University revealed that indulging in a little of what you fancy over the festive period may be better for people’s diets in the long term. Research shows that being overly rigid, by restricting ‘naughty’ foods, could lead to binge eating later on at times of stress or when food is freely available.
“Christmas is a time where social expectations, particularly around food, are high, and our learned behaviours, such as what we eat and when, coupled with our innate preference for sweet foods, can drive a lot of our eating behaviour, some of which can be unhealthy,” says Dr Gemma Witcomb, behavioural psychologist at Loughborough University. “But having a healthy Christmas doesn’t have to mean forgoing all of the lovely treats that we associate with this time of year. Indulgence, like anything, doesn’t have to be all or nothing. Allowing oneself some wiggle room in terms of what is and isn’t acceptable to eat over the festive period is likely to reduce what has been termed the ‘what-the-hell’ effect.”
It’s not just physical
Many people struggle with mood and mental health at this time of year – often called the winter blues. Christmas is about spending time with friends and families, but some people can experience heightened loneliness, sleep problems and depression. “During the winter months, people can often feel down and less able to cope,” says Mark Pinches, head of coaching at Westfield Health. “Not only does our physical health take a hit, due to low immune systems, but depression and mental health-related issues such as seasonal affective disorder (SAD) tend to be more common. Whilst trying to plan the ‘perfect Christmas’, it’s easy to let stress get the better of you. Being too busy can have an impact on your mental health, as there is less time to look after yourself when you might need it the most.”
Lack of exposure to sunlight lowers serotonin levels in the brain – this hormone affects mood, sleep and appetite. Sleep patterns can also be disturbed if customers are busy catching up with friends and family and partying late into the night. Laura Jones, Assured Pharmacy’s clinical lead, suggests that if customers are experiencing low mood they should make sure they get plenty of sleep. “There are OTC remedies that customers can try, such as valerian root,” she says. “These products are based on traditional use, so there is no medical evidence to back them up. However, they have been used by many people who feel they really work. If customers ever feel unable to cope or feel they are unable to enjoy the festivities due to a low mood, they should be encouraged to seek advice from a healthcare professional or talk to a group such as The Samaritans.”
Significant depression, tiredness and lethargy linked to this time of year may be signs of SAD. Symptoms of SAD can start as early as August and are at their worst from November to February, usually disappearing by April. The severity of SAD varies from person to person. According to the Royal College of Psychiatrists, around three in every 10 people will be badly enough affected by SAD that it interferes with their normal life.
“SAD arises in part due to reduced exposure to sunlight during the shorter autumn and winter days,” says Dr Abby Hyams, a MedicSpot GP in Hemel Hempstead with an interest in mental health issues. “Therefore, people with SAD should try to get as much light as possible during the day to lessen the symptoms. In addition to lifestyle measures, their GP may advise them to try light therapy. This uses a light box to simulate sunlight and make up for some of the reduced exposure to light in the winter. A GP may also recommend trying talking therapies, such as cognitive behaviour therapy or counselling, or even medication to help patients get through the winter months.”
Enjoying a tipple
Official guidelines recommend that men and women shouldn’t regularly drink more than 14 units of alcohol a week, and spreading drinks evenly throughout the week, with at least two alcohol-free days, is best. However, many people drink more alcohol than recommended on Christmas Day or at festive parties. Not only does alcohol have negative effects on the body, it is also rich in calories and can contribute to weight gain. A survey last year by preventative healthcare service Thriva, of 2,000 young professionals, found that 56 per cent of working millennials admitted they drank to excess during December, with wine and beer being the most popular tipples. One in five admitted to having a social cigarette and 10 per cent enjoyed a cigar at some point over the holidays.
“Pharmacists may need to give advice to customers about smoking, alcohol and drug use over the festive season,” says Mahendra. “It’s important to highlight that alcohol can interact with medicines that customers are already taking, so should make sure they’re fully informed. Be aware of sexual health issues as well, and highlight appropriate pharmacy products and services.”
According to the alcohol education charity Drinkaware, the risks of short-term harms like accidents or injuries increase between two and five times if people drink five to seven units of alcohol in one session. This is equivalent to two to three pints of beer. “Advice about drinking and driving is really important,” says Laura Jones, Assured Pharmacy’s clinical lead. “Most people are now aware that they shouldn’t drive home from the pub after a night out. However, they must remember that the liver can only process a small drink per hour so if they have [drunk] a lot this may not all be out of their system in the morning.”
The best way to manage a hangover (dizziness, headaches and sickness) is to rehydrate the body by drinking plenty of water-based fluids, including thin vegetable-based soups. “If customers feel they need to take some painkillers to get rid of the headache, these can be very effective,” says Laura. “However, take care with which one they choose. Ibuprofen is the best for a hangover and paracetamol should be avoided if possible. If they want to take paracetamol, they need to wait until most of the alcohol is out of their system as it can interfere with liver function, which can be dangerous.”
Indigestion and heartburn often occur over the festive season – even in people who have never experienced these symptoms before – and they are usually caused by a change in lifestyle habits. “This is usually nothing to worry about,” says Laura. “It can be caused by eating too much – or too quickly – high fat foods, smoking and alcohol.”
Customers may be able to ease their symptoms if they avoid common indigestion and heartburn triggers, as well as reduce their stress levels, sit more upright during and after meals and raise the head end of their bed at night. If these lifestyle changes don’t work, they may ask about over-the-counter remedies. “The treatment will depend on the symptoms and how long people have had them,” says Mahendra. “It’s important to check there’s no underlying cause, such as a stomach ulcer. If someone has experienced indigestion and heartburn over the festive period, they could try an antacid, depending on the medication they’re on, then a proton pump inhibitor before a referral to their GP.”
Many people are less hydrated over the festive season, less active and eat less fibre from fruit and vegetables. This can slow down their bowel, leading to constipation. If a change in lifestyle doesn’t help, customers can try a laxative for a few days, but these shouldn’t be used in the long term. Poorly cooked food (especially the Christmas staple of turkey) and poorly stored leftovers can breed bacteria, increasing the risk of diarrhoea and sickness from food poisoning. Oral replacement therapy is the best treatment for gastroenteritis, especially in babies and older people, but if adult customers can’t wait for diarrhoea to pass (e.g. before a party) they can try loperamide to slow down movement of the gut.
Colds and flu are rife in the winter months, but pharmacy customers may be even more prone to respiratory infections when they’re busy rushing around and getting ready for Christmas. “If customers are at risk of flu complications, such as those with asthma or diabetes, they should have a flu jab,” says Mahendra. “Customers can be prepared for minor ailments by keeping suitable products at home, such as simple cold and flu remedies and painkillers, but obviously they can’t buy everything in advance.”
Slouching in front of the TV over the festive season can make posture worse, leading to back, neck and shoulder pain. With fewer people taking regular exercise, customers may also be more prone to joint problems. “People who suffer from arthritis may experience increased pain and stiffness during colder months,” says consultant rheumatologist Dr Rod Hughes. “This may be because low barometric pressure has a physical impact on the joints or that it encourages inflammation, making joint movement more painful. In addition, during cold weather, the body focuses on circulating blood around the core and major organs and away from muscles and joints. As a result, the joints may seem less flexible.”
Laura says that while allergies are often seen as a summer problem, some may flare up in the winter too. “Sufferers of dust allergies or pet allergies may find their symptoms get worse. Because of the cold, miserable weather, we tend to spend more time indoors with the windows closed. We turn the heating up and keep the pets inside more often. Mould can also be a problem with the damp air and the heating on; if Christmas trees are damp, they can be a hiding place for mould. Although food allergies are present all year round, the festive season can be a temptation for trying new foods and from lots of different places. Customers should be reminded to always check the allergen information before eating anything they haven’t prepared themselves and, if they have an adrenaline pen, make sure they always have it with them.”
If customers take regular medication, they should make sure they have enough to last them over the festive season and until after the new year. “Pharmacies and GP surgeries are always busy at this time of year, so customers should be reminded to do this in advance,” says Laura. “The logistics of the festive season can make taking medications challenging. There are often changes in routine or if customers are travelling abroad there may be changes in time zones. It may be worth setting reminders over this period to make sure they don’t forget when each of their tablets should be taken. There will be a pharmacy open every day in every area, including Christmas Day, so it could be worth finding out where they are and pass on the details.”
Having a healthy Christmas doesn’t have to mean forgoing all of the lovely treats that we associate with this time of year