The Science Behind "Man Flu"
abstract
This abstract is available on the publisher's site.
Access this abstract nowMan flu” is a term so ubiquitous that it has been included in the Oxford and Cambridge dictionaries. Oxford defines it as “a cold or similar minor ailment as experienced by a man who is regarded as exaggerating the severity of the symptoms.” Since about half of the world’s population is male, deeming male viral respiratory symptoms as “exaggerated” without rigorous scientific evidence, could have important implications for men, including insufficient provision of care.
Despite the universally high incidence and prevalence of viral respiratory illnesses, no scientific review has examined whether the term “man flu” is appropriately defined or just an ingrained pejorative term with no scientific basis. Tired of being accused of over-reacting, I searched the available evidence (box) to determine whether men really experience worse symptoms and whether this could have any evolutionary basis.
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The Science Behind "Man Flu"
BMJ 2017 Dec 11;359(xx)j5560, K SueFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The Man-Flu – Finally Fully Justified
This article is very timely as we enter the winter season when the emergence of the Man-Flu becomes commonplace. Women around the world have rolled their eyes as the men worldwide whimper and ask for help with even the most basic activities. Well, this article looks into the potential causes of the Man-Flu as the author digs for some justification of the whimpering and “laying on the couch.”
This article reviews past suggestions that the immune response is different between the two genders. Some of the research results were from observational studies about influenza outbreaks in which men did have higher rates of hospitalization and death. Many of the other references were from murine data showing that estrogen elicits a stronger immune response. The patchwork of studies stitched together by this author basically say that estrogen seems to boost the immune system while testosterone seems to suppress it. Hence, a well-“virilized” man has a weaker immune response and hence any viral infection will wreak more havoc in a male versus a female. Women tend to also recover faster, and, in animal models, if the effects of estrogen are blocked, these beneficial effects are not seen.
So, perhaps it is not that men are weak but more that women are stronger. That makes it sound so much better than the “Man-Flu.”
Now, the article also attempts to explain the evolutionary benefits of this difference. This is even more entertaining. Males were typically the hunters; so, if they are infected, they needed to be shut down in order to prevent them from going out hunting when they are not in perfect condition. This way, they would not be killed by all the predators that they would face in their weakened condition. Hence, the males who survived to make offspring presumably were the ones who did not go out into the jungle when they were sick. Hence, a natural selection for the males who got wiped out and stayed at home.
On the other hand, the females had to look after the camp and offspring, so their duties could not go un-done, and, hence, the females who were selected were the ones who could continue to function and bounce back quickly. This way their offspring would have a better chance to survive to adulthood and then mate. So, in a very strange way, this explanation makes both sexes feel good about themselves. Man-Flu allowed males to survive and procreate and tough women allowed their offspring to be able grow up and procreate. See, in the end, both adaptations were good and necessary.
In all seriousness, this line of thinking is of great interest. The immune system is now the cornerstone of all of our scientific inquiry. It is essential, not only in infectious diseases, but also in understanding autoimmune diseases, HIV, and oncology. For example, boys and girls have equal asthma rates up until puberty, then males have less asthma. It turns out that they have less immune response in their lungs and, hence, they have less of an allergic response and therefore less asthma. Pregnant women, with changes in their hormonal levels, have more infection but their autoimmunity diseases get better. Cancer cells are allowed to grow perhaps because the immune system does not recognize that they are a threat, and we are now trying to give immunotherapies to target the cancer cells that the patient’s own immune system cannot recognize.
Perhaps the Man-Flu justifies why I like to lay round and complain and ask for my servant. But perhaps once the eye-rolling stops, we may be able to understand how our immune system is modulated and just maybe the lazy Man-Flu might help us find treatments for autoimmune diseases and even cancer. So, long live the whimpering man on the couch because he might be the portal to many future discoveries. Now, just to be clear, there is no research connecting laziness and your immune system—that one does deserve the eye-rolls.