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"Cold" was accepted as a cause of disease for thousands of years. The ancient Chinese master physician Zhang Zhongjing described "wind evil" and "pathogenic cold" as causes of disease nearly 1900 years ago. Ancient Greek physicians (whom we know primarily from their having written books for their Roman masters) treated "cold" to restore the natural temperature of their patients. In much of the world even today, "coldness" is understood to be a symptom of disease. It's a little like the furnace going out, only on the level of the body. In the Middle East and Africa, going to a doctor because you are "cold" would be readily understood.

In the English-speaking world, however, cold is no longer a generally accepted diagnostic term. British, Canadian, Australian, and American doctors will look at you strangely if you come in and announce "I have cold" rather than "I have a cold." That doesn't mean, however, that the effects of sudden changes in temperature are unknown to modern medical science.

Some of the best data on this topic come from Tibet, where extreme changes in temperature are common. Scientists keeping track of hospital admissions in Lhasa, the capital of Tibet, noted that emergency admissions for digestive disease increase during cold spells. The strongest effects were noted on the first day of the cold spell. If cold is going to trigger a digestive complaint, it does so right away. The effects of cold were noticed in all age groups except infants, children, and younger teens, between birth and age 15. Cold was most likely to trigger digestive complaints in men, and in both men and women over the age of 65. Every year, the greatest number of Tibetans die of from complications of gastric or duodenal ulcers or bleeding from the digestive tract during the winter months.

Why should exposure to cold trigger digestive complaints? Here are some possibilities:

  • People tend to eat more when it is cold outside, especially if they don't have good indoor heating. The digestive tract is "busier" during cold weather.
  • Cold weather causes constriction of blood vessels close to the skin. This sends blood to the core of the body. If there are lesions and ruptures in the digestive tract, bleeding will increase.
  • Sudden changes in temperature amplify these effects. The arrival of a cold front tends to trigger digestive symptoms, especially in digestive diseases that cause bleeding.
  • Differences in the severity of symptoms between men and women sometimes only reflect the fact that men are more likely to be out in the cold. There is nothing about being male or female that makes someone inherently more or less susceptible to cold.

It is not just digestive diseases that are sensitive to cold. Both high and low temperatures increase problems with cardiovascular disease. However, there may be confounding variables. In many parts of the world, air pollution is much worse during winter months. Particulate matter (such as that released by oil-fueled furnaces, wood fires, and power plants) can trigger heart symptoms. Conversely, rates of heart disease go up less during the summer in locations where most people have air conditioning.

What can you do to minimize the effects of cold?

  • If you have a gastrointestinal disease that involves bleeding, and you have to go outside, put on your hat and gloves, and wear warm socks and shoes. Keeping your extremities and your head warm keeps blood vessels from tightening and sending  blood to your core. This reduces bleeding from your digestive tract.
  • If you have cardiovascular disease, avoid sudden changes in temperature. Don't dash out into the cold, especially without bundling up. Be sure you take all of your prescribed medications, especially beta-blockers and blood thinners and/or Aspirin. You don't want sudden constriction of veins in your hands, feet, or head to send a blood clot to your heart.
  • If you have respiratory disease, do your best to avoid outdoor activities on days when there is a lot of particular matter in the atmosphere. Use an air filter (not just a mask) indoors if you can afford it. Avoid indoor fires, especially those with wood or kerosene. Clean air, even if cold, is far less dangerous than smoky air on a cold day.

The idea that exposure to cold air changes serotonin balances, incidentally, is correct. The "brown fat" cells that supply energy for shivering are activated by serotonin. Some people will get muscle cramps whenever air temperatures are low enough to make them shiver due to an unusual sensitivity to serotonin. The solution to this problem is simply to avoid the cold.

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