Cold or Flu: What's the Difference?

At this time of year, many conversations begin with "I have the flu," "I have a cold," or some variation on that theme. Concerned prying often leads to a conversation about whether the symptoms actually indicate a cold or a flu. And as adamant as the undiagnosed sufferer may be, the essential fact is this: Almost no one can tell the difference between a cold and a flu.

Even the U.S. Centers for Disease Control (CDC) warns that "it can be difficult to tell the difference between them based on symptoms alone."

Testing can be done to distinguish one from the other. But, according to Michael Alderman, M.D., most doctors and hospitals don’t do the tests because "it’s hard to grow viruses and therefore identify the cause" and because "there’s no treatment" for a virus.

Alderman is a professor of epidemiology and population health at Albert Einstein College of Medicine in New York City. He also has a practice in internal medicine in the Bronx and is on the board of directors of Sickness Prevention Achieved through Regional Collaboration (SPARC) in Salisbury.The Culprit: Viruses

Whether you have a flu or a cold, you have a virus. The flu is brought on by one or another of the strains of the influenza virus. A cold, according to Alderman, is more of a description than a disease.

"What we describe as a cold or a flu is a bunch of symptoms, usually a headache and stuffed nose and coughing," he explained. "The question is whether there is a specific underlying cause, and usually that’s some sort of virus. And among that family of viruses is the influenza virus. There are many other viruses that cause the same kind of symptoms."

"When people talk about colds, they’re talking about a collection of symptoms."

Sometimes the upper respiratory symptoms that people refer to as a cold or flu can actually be brought on by allergies, Alderman added.

Richard Malik, N.D., a naturopathic doctor with a practice in Lakeville and a monthly column in The Lakeville Journal, said that when people talk about colds and flus they are generally referring to upper respiratory tract infections with symptoms such as "runny nose, sore throat, coughing, hoarseness, things like that."

Flus are more likely to bring with them fever, chills, headaches and muscle aches.

"When you get sick and feel really bad all over," he said, "that’s usually what I associate with the flu. But when you’re sick with a cough or a runny nose but you’re not laid out in bed, I associate that with another type of infection. About 80 percent of upper respiratory tract infections are caused by a virus, but they can also be bacterial."

What’s the difference?

"Bacteria are one-celled organisms," Malik explained. "They can either live in your body cavities or inside another cell, although that’s rare.

"A virus is really some DNA or some RNA in a protein capsule or envelope that invades a cell in our body and kind of causes a coup. It causes our cells to serve its purpose instead of our purpose, so a mucous membrane cell, instead of producing mucous, produces virus. And then that cell bursts, and those viruses spread out and infect other cells."

There are many different kinds of viruses, but it doesn’t necessarily matter which one has invaded the body because, according to Alderman, "there really isn’t any treatment for a virus. Most of us have colds and are sick for a few days and then we get over it. There is no specific antiviral treatment. By the time you determined what the specific virus was, you’d probably be better."

Part of the problem, he said, is that different viruses will cause the same reactions in the human body.

"There are only a small number of ways that the parts of the body can respond," he pointed out. "If it’s in your nose, you get a stuffed nose. There aren’t that many things your nose can do."Antibiotics Not the Answer

Bacterial infections are different, and require treatment with antibiotics. However, Malik and Alderman (along with Centers for Disease Control and other national health agencies) are adamant that antibiotics should be used very sparingly.

"Everyone in the medical community wants to discourage the development of antiobotic-resistant bacteria," Malik explained. "The more a bacteria, or a class of family of bacteria, are exposed to a particular antibiotic, the more likely they are to evolve and become resistant. Now we’re seeing cases of antibiotic-resistant tuberculosis. You have to keep coming up with new antibiotics, it’s just evolution."

The Centers for Disease Control has a whole ad campaign geared toward teaching the public not to take antibiotics for colds and flus. They should only be prescribed for secondary infections such as pneumonia or ear infections. Of course, it’s ultimately up to doctors themselves to limit the use of antibiotics.

But, said Malik (who does not prescribe any antibiotics), doctors want to make their patients happy and help to ease their suffering and discomfort. So the temptation to prescribe powerful medications is a strong one.

Even when, as is the case with flu viruses and other upper respiratory infections, the medicines may not cure the cause of the problem.Rest and Fluids

The best ways to shorten the duration and misery of an upper respiratory infection are the old-fashioned ones, according to Malik and Alderman, who both advise that patients get plenty of rest and drink lots of fluids.

"When your immune system is fighting a virus," Malik said, "it consumes a lot of energy. Resting allows your body to conserve its energy and focus on eradicating the infection."

Drinking lots of liquids helps keep the body from becoming dehydrated, a condition that can lead to further complications.

"Most body processes are dependent on water, so you want to make sure the body has what it needs," Malik said.

He recommends against sugared beverages.

"There are studies that show that the ability of the cells of the immune system to do their job can be reduced by as much as 50 percent after the ingestion of refined carbohydrates," he said. White sugar is the worst offender but even honey and maple syrup can do damage.

Anyone with an upper respiratory infection should stay home from work or school, not only so they can rest but also so that other people don’t pick up the infection. Flu viruses are spread mainly through coughing and sneezing, according to the CDC, and they can be spread from one day before the sufferer feels any symptoms up to five days after the symptoms appear.

To shorten the duration of an illness, "optimize the function of the immune system by consuming good foods that are nutrient dense and don’t have too much sugar," Malik said.

To decrease decongestion, he recommends steam inhalations (adding thyme essential oil can coat the lungs with the herb, which has antibacterial and antiviral properties).

For sore throats, try breaking open a capsule of zinc or vitamin C and gargling with it. Malik said that powdered packets of EmergenC work well, too.

Ultimately, though, "the important thing for people to realize for their own peace of mind is that these infections fall into the category of self-limiting infections. To get well, you don’t really have to do anything. Getting sick is something that occurs, and in the vast majority of cases you get well within seven to 10 days."

Alderman recommends avoiding flu infections altogether by taking the flu vaccine. The vaccine was late in arriving this year, and many people didn’t bother to get their shot once the serum was available. Although it takes about six weeks for the flu shot to reach its peak power, Alderman suggests getting one anyway.

"The only way to deal with viruses is through prevention," he said. "There are still plenty of viruses around in February and March. If you haven’t got your shot, get it."