Sarah, a high-school senior, was gasping for air and could hardly get a breath. The vital airways that bring life-giving oxygen to the lungs were being cut off by a severe asthma attack. Her blonde hair stuck to her forehead and her face grew very pale. There was desperation in her green eyes; she had suffered asthma attacks before and was gripped by fear. She needed medical care and needed it fast.
Her parents drove her in the dark to the hospital at breakneck speed, the car swerving around corners and barreling down the straightaways, Sarah wheezing loudly in the backseat. It was six miles to the hospital downtown, but it felt like forever. Driving up to the big hospital, they scanned the building for the Emergency sign. They got Sarah out of the backseat and rushed her inside, their eyes momentarily blinded by the bright fluorescent lights. A crowd of people of all ages, some in their pajamas, waited for care.
A scene like this takes place two million times a year in U.S. emergency rooms.
The villains we met in Chapter 2, “How Did We Get So Sick?”, and Chapter 5, “Mission Detoxable”—air pollution, tobacco smoke, and toxic chemicals—return here with a vengeance, ready to wreak havoc on our airways. These villains are powered by a vast industrial machine that never rests. Their menace spans the globe, making us sick with allergies, asthma, and innumerable other diseases. Who is lined up on the other side? The individual trying to protect her or his health. This is David versus Goliath.
The Asthma Epidemic
More than 300 million people worldwide suffer from asthma, reports a study from Tulane University and Oregon Health Sciences University. The National Center for Health Statistics, part of the Centers for Disease Control and Prevention, reports that 25 million people have asthma in the United States. Asthma in the U.S. population has been increasing steadily and is now at its highest level ever: one person out of ten will experience asthma at some time in his or her life. The New England Journal of Medicine article “The Asthma Epidemic” highlighted the scope of the problem. There are more than two million visits to emergency rooms for asthma each year in the U.S. and about 4,500 asthma deaths.1 These lives could be saved.
Asthma is a complex and heterogeneous disease. The main symptoms of acute asthma—wheezing, shortness of breath, chest tightness, and cough—are caused by two principal events: 1) the cells that line the bronchial tubes produce excess mucus and promote inflammation, and 2) the muscles that line the walls of the bronchial tubes constrict. Both these events together produce a critical but reversible narrowing of the airways.
Between 50 and 80 percent of asthma cases are the result of allergies.2 Asthma is the most complicated allergic disorder of all, because there are so many types of asthmatic reactions. Both Type 1 and Type 4 allergy may cause asthma. The two types may operate together or separately, and the nature of the reaction is influenced by a multitude of factors including, but not limited to, the level of pollution in the air you’re breathing, whether or not you’re overweight or subject to esophageal reflux, and whether you have sinusitis or nasal polyps. Both late-phase and delayed allergic reactions can scar the delicate architecture of your lungs through a process called airway remodeling.
Environmental stimuli like dust, mites, animal dander, mold, and pollens are the most common allergic triggers in asthma. In addition, food allergies occur in 10 to 50 percent of asthmatics.3 Food allergies can play a critical role in aggravating asthmatic reactions, and the presence of asthma increases the risk that a food-allergic person may suffer a fatal reaction from food allergen exposure. People with asthma must not follow the Re-entry Food Challenge described in Chapter 7: asthmatics must avoid foods to which they may be allergic.
Conventional asthma treatment is based on the use of steroids to control inflammation and bronchodilators to prevent narrowing of the bronchial tubes. About 10 percent of people with asthma develop severe chronic disease that does not respond to steroids or bronchodilators.
What Is Asthma Control?
Control of asthma has been defined as not having any restriction in activities, not waking at night with asthma, not needing bronchodilator therapy to relieve symptoms more than three times per week, not missing school or work because of asthma, and not having severe acute asthmatic reactions. Data from several studies has shown that only between one in three and one in four people with asthma enjoy that level of control.4 Clearly, much more needs to be done.
In this chapter I’ll discuss the nutritional factors that scientific research and human clinical trials have found to be most helpful for reversing or controlling asthma. The takeaways from these studies are:
While these factors have been found to be effective in numerous studies, there is growing recognition that the immune amplification mechanisms in asthmatics are not the same for everyone, so an individualized approach to treatment is essential.5 The complex and multifaceted nature of asthma underscores the need to work with your doctor on any treatment plan.
Asthma in the White House: Theodore Roosevelt
Before he was a student at Harvard, a boxer, a legendary hunter, a cowboy in North Dakota, the author of more than a dozen books, a Rough Rider in Cuba, or the governor of New York State, before he was Secretary of the Navy, before he served as Vice President and then President of the United States, and before he won the Nobel Peace Prize, Theodore Roosevelt was a little boy with asthma.
Born in 1858 on East 20th Street in Manhattan, he was plagued by illness as a child. “I was a sickly, delicate boy, suffered much from asthma, and frequently had to be taken away on trips to find a place where I could breathe,” he wrote in his autobiography.
When the attacks came, they were terrifying, making him feel as if he were going to die. He gasped for breath and had the sensation that he was being strangled. He overheard his parents saying that he wasn’t expected to live very long. He found himself afraid to leave the house, gripped by a terrible fear and in need of a way to cope with that fear.
His father told him that to overcome the terrible affliction of asthma, he would need to “make his body.” Teddy’s mission became strengthening himself in body and mind. On the outdoor balcony of the family home he undertook a rigorous training program, spending hour after hour on gymnastics. Boxing lessons followed, and then hunting, hiking, horseback riding, swimming, the long jump, running, rowing, and wrestling. He developed a lifelong love of the outdoors and believed in the restorative power of time spent in nature.
He read books constantly, eventually devouring an estimated 20,000 titles. He was without a doubt a man on a mission to build himself up. Teddy Roosevelt strove to get as much done as quickly as possible, with his illness teaching him that life itself was precious. His mottoes became “Get Action!” and “Do Things.”
As governor of New York State, he bucked the entrenched political establishment and sought to use his power to solve problems for people. He backed progressive legislation that limited working hours for women and children, taxed corporations, and protected land in the Catskill and Adirondack Mountains.
When hostilities broke out with Spain, he insisted on participating personally, by joining the U.S. Army, and famously led his Rough Riders up San Juan Hill in Cuba. His exploits catapulted him to national fame, and he became a hero to millions of Americans who felt he embodied the vigorous ideals of the young country. Living at a breakneck pace, he became the youngest president of the United States at 42 years of age.
During a time of rapid industrial development, when entire forests were being cut down for lumber and huge areas were being destroyed by coal mining and drilling for oil, Roosevelt recognized that natural resources were finite, that even on a continent as big as North America nature needed protection and needed it right away. Although he was a voracious hunter, his experience taught him that nature had its limits, that even the teeming wildlife of the American plains could eventually be pushed to extinction. Ultimately, this led him to champion the establishment of the National Park System, so that vital wilderness could be forever protected against development.
Roosevelt’s example is that you can improve your condition if you take an active role in your care and your health. As the most famous case of asthma in American history, he taught that weakness of the body can be overcome. Everything else you wish to accomplish will be enabled or greatly enhanced by taking excellent care of your health.6
Oxidative Stress, Allergy, and Asthma
One thing that the lungs of all asthmatics have in common is a condition called oxidative stress, which increases with the severity of asthma.7
Your body uses oxygen to burn fuel for energy and to destroy dangerous bacteria. The process, called oxidation, is like a well-controlled fire, similar in concept to a combustion engine. Your body also has an antioxidant defense system, which controls the fire and keeps it from damaging your own cells.
Oxidative stress results from an imbalance between these two essential activities, oxidation and antioxidation. Because all the oxygen in your tissues enters your body through the respiratory system, your lungs are especially prone to oxidative stress, and nothing aggravates that tendency more than inflammation.
Oxidative stress has been proven to directly stimulate bronchial muscle constriction, induce airway hyper-irritability, and increase mucus secretion.8 It also plays a key role in the well-known link between air pollution and allergic asthma. Air pollution is an important factor in both the development and the worsening of asthma; it can trigger oxidative stress in anyone, but current research reveals that people with asthma have an exaggerated inflammatory response to air pollution–induced oxidative stress.9
It is critically important that people with asthma minimize their exposure to air pollutants, cigarette smoke in particular. Cigarette smoke contains more than 4,700 chemical compounds and very high concentrations of oxidants (ten trillion molecules per puff). Some of these become trapped in the cells that line the respiratory tract and continue to cause damage for a long time after smoke exposure ends.10
Nutrition vs. Asthma: Antioxidants
Over the past decade, scientists have been carefully researching the role of antioxidants in preventing or controlling asthma. This research is exciting and holds out great possibilities. I use its findings extensively in The Allergy Solution.
Once you’ve eliminated food allergens from your diet, your next step in overcoming asthma is ensuring a high intake of antioxidants from natural foods. Here’s the science:
Fruits and Vegetables Help Asthma, Research Finds
In an article published in The American Journal of Clinical Nutrition, Australian scientists demonstrated the potential of antioxidants from vegetables and fruits in preventing asthma attacks by placing adults with asthma on two diets: a high-antioxidant diet containing five servings of vegetables and two servings of fruit a day, and a low-antioxidant diet containing no more than two servings of vegetables and one serving of fruit a day.14
After two weeks, the people in the study consuming the high-antioxidant diet showed better lung function on breathing tests than did the people on the low-antioxidant diet. After 14 weeks, those on the low-antioxidant diet not only showed poorer lung function, they also showed higher blood levels of C-reactive protein (CRP), an important marker of systemic inflammation.
The Australian scientists then demonstrated that adding tomato juice (about two glasses a day) to the low-antioxidant diet produced a decrease in lung inflammation.15 Tomatoes are an excellent dietary source of carotenoids and vitamin C. Those asthmatics who had tomato juice added to their low-antioxidant diet showed a decrease in the levels of white blood cells in mucus compared with those on the low-antioxidant diet who did not get supplemental tomato juice. Tomato juice alone, however, did not improve airflow. The whole-foods high-antioxidant diet was more effective than tomato juice for that purpose.
The Two Faces of Vitamin E
Vitamin E is probably the best-known dietary antioxidant. It’s actually not one substance but eight, each of which may have different effects on your body. Research indicates that vitamin E from food or supplements may either prevent or aggravate asthma, depending upon the form of vitamin E being consumed.
There are eight forms of vitamin E in nature, of which two predominate in human tissues: alpha-tocopherol and gamma-tocopherol. These have similar antioxidant effects in test tubes, but your cells preferentially take up alpha-tocopherol and break down gamma-tocopherol, so that the concentration of alpha-tocopherol is typically ten times higher than the concentration of gamma-tocopherol in your tissues.16
Alpha- and gamma-tocopherol also differ in the way they combat inflammation. In laboratory experiments with animals and humans, gamma-tocopherol has been shown to have unique effects that can benefit acute nonallergic inflammation caused by exposure to bacteria, smoke, or ozone.17
However, researchers at Northwestern University in Chicago demonstrated that in allergic mice, gamma-tocopherol increases bronchial hyperreactivity and increases the recruitment of inflammatory eosinophils (Eos) into lung tissue, whereas alpha-tocopherol does the opposite.18 They conclude that in chronic allergic asthma, as opposed to acute lung infection or injury, alpha-tocopherol is anti-inflammatory and blocks airway hyperactivity, whereas gamma-tocopherol is pro-inflammatory, increasing airway hyperactivity and interfering with the beneficial effects of alpha-tocopherol.19
The Northwestern researchers note that the past 40 years have witnessed an increase in gamma-tocopherol in the U.S. diet and in infant formulas, largely due to increased consumption of soybean oil, which is high in gamma-tocopherol.20 Other vegetable oils, like olive oil, in contrast, contain minimal gamma-tocopherol. Since many vitamin E supplements use soybean oil as a carrier, vitamin E supplements (even if they are labeled as alpha-tocopherol) may act as hidden sources of gamma-tocopherol.
Several studies have found reduced levels of alpha-tocopherol in the blood of asthmatics.21 The Northwestern researchers conducted a study of 4,500 individuals and found that higher levels of gamma-tocopherol in blood were associated with poorer lung function, whereas higher levels of alpha-tocopherol were associated with improved lung function.22 They also worked out what they believe is the mechanism for the opposing effects of these two forms of vitamin E in asthmatics: The two forms have opposite effects on an enzyme called PKCa (protein kinase C alpha), which transports inflammatory cells into tissues during inflammation.23 PKCa increases inflammation in asthma and increases the airway remodeling that accompanies the late-stage asthmatic response.24 In the lungs of allergic mice, alpha inhibits and gamma enhances activity of PKCa.
Support for the Northwestern researchers’ theory comes from a study done at Vanderbilt University in Nashville in which people with allergic asthma were given a high dose of natural alpha-tocopherol, 1,500 milligrams a day for four months.25 The researchers chose the dietary form of alpha-tocopherol called d-alpha-tocopherol, derived from a natural source, rather than the synthetic form found in many supplements, which is called d,l-alpha-tocopherol. This distinction is important because only d-alpha tocopherol performs the normal functions of vitamin E. The effect of supplementation was to increase blood levels of alpha-tocopherol and decrease blood levels of gamma-tocopherol. Along with this change in vitamin E, levels of allergic mediators and oxidative stress markers in the lungs decreased. Airway reactivity to methacholine, a chemical that causes bronchial constriction, also decreased. This clinical study supports the contention of the Northwestern researchers that alpha-tocopherol may be good for asthmatics and gamma-tocopherol may actually be harmful.
Clinical trials with low-dose vitamin E (usually as alpha-tocopherol) have shown mixed results; the greatest benefits appear to occur in people who are exposed to air pollutants like ozone or sulphur dioxide. Vitamin E in that setting seems able to prevent the increase in airway inflammation produced by air pollution.26
This research has shaped the way I think about vitamin E in asthma and allergic disorders, although more research is needed, especially clinical trials. I don’t believe that vitamin E should be used as a stand-alone supplement in people with asthma. For one thing, high-dose vitamin E supplementation when used alone can have a pro-oxidant effect rather than an antioxidant effect and may increase oxidative stress over time.27 Also, vitamin E supplementation can reduce blood levels of coenzyme Q10, a nutrient that is essential for cell function. A European study demonstrated reduced coenzyme Q10 levels in the blood of people with asthma.28 When supplements of coenzyme Q10 (120 milligrams/day) were given to people who needed inhaled steroids to control their asthma, there was a significant reduction in steroid dose needed.29
The bottom line: vitamin E supplements should be carefully chosen. The best form of vitamin E for asthmatics may be natural d-alpha-tocopherol in a soy-free base. It should not be used alone but only as part of a total dietary antioxidant program, like the Immune Balance Diet, described in Chapter 8. If high-dose vitamin E supplements are taken, coenzyme Q10 in a dose of 120 milligrams a day or more may also be needed.
Nutrition vs. Asthma: Controlling NOX
One of the major sources of oxidative stress in asthmatics is an enzyme called NOX, which stands for NADPH oxidase. NOX is found in mast cells and white blood cells. It is useful for fighting infection, but there are many human diseases, including asthma, in which NOX activity causes both inflammation and oxidative stress.
Pollen grains have been shown to contain their own version of NOX, so that high pollen counts may aggravate asthma even in people who are not allergic to the specific pollen. When pollen grains are deposited in airways along with diesel exhaust, the oxidative stress is amplified in a synergistic fashion: the combined inflammatory effect is greater than the sum of either pollen grains or diesel particles alone.30
A study from the University of Lecce, in Italy, found that flavonoids in vegetables, fruits, herbs, and spices can inhibit excessive NOX activity. Omega-3 fatty acids in fish oils (EPA, or eicosapentaeonic acid, and DHA, or docosahexaenoic acid) have also shown potential for inhibiting excessive NOX activity. This may explain why numerous clinical trials have described a beneficial effect of omega-3 supplementation in people with asthma.31
Fish oils seem to be especially effective in subduing the late-phase allergic reaction in people with asthma. A long-term (20-year) study of young Americans (ages 18 to 30) supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health found that low dietary intake of omega-3s from fish more than doubled the risk of developing asthma.32
Do You Need an Oil Change?
Dietary fat has a significant effect on the risk of asthma, and changing the nature of the fat you consume through food choices or supplementation can have a major impact on asthma control.
Fats are composed of components called fatty acids, which are divided into two major categories: saturated and unsaturated. These terms describe their chemical structure. Unsaturated fatty acids contain double bonds between atoms. Monounsaturates have one double bond. Polyunsaturates contain two or more double bonds. Foods that are mostly made up of saturated fatty acids tend to be solid at room temperature. Butter is a good example. Foods that are mostly made up of unsaturated fatty acids are liquid at room temperature, like vegetable oils. The more unsaturated the fat, the colder its melting point, so the more likely it will stay liquid, even when cold:
Most unsaturated fatty acids have a chemical configuration called cis, which lines up atoms on the same side of a double bond, creating a bend in the molecule. Some processed and manufactured fats have a configuration called trans, which lines atoms up on opposite sides of a double bond, creating a molecule that is straight rather than curved. Trans-fatty acids are produced when polyunsaturated cis fatty acids are subjected to a process called hydrogenation, which is the food industry’s attempt to prolong shelf life. Natural hydrogenation also occurs in the rumens of cattle, so that beef and milk contain trans-fatty acids at low levels.
I warned parents about the dangers of trans-fatty acids in my first book, Superimmunity for Kids, published in 1988. Since then, abundant research has confirmed the deleterious effects of dietary trans fats on health. A global study of half a million children, the International Study of Asthma and Allergies in Childhood (ISAAC), identified greater trans-fatty acid consumption as the most important dietary factor associated with developing asthma.33 A more modest European study found that consumption of margarine, a major source of trans-fatty acids, produced an increased risk of developing asthma among adults.34
The Essential Fatty Acids: Omega-6 and Omega-3
Your body has the ability to make saturated and monounsaturated fatty acids, but it cannot make the major polyunsaturated fatty acids. These are called essential fatty acids (EFAs), and they are divided into two families, called omega-6 and omega-3, based upon their chemical structures.
I’ve been writing and lecturing about the impact of EFAs on health and illness for most of my medical career. In 1986 I wrote a scholarly article that was published in The Journal of the American College of Nutrition. It explained that people with allergies have an increased need for EFAs because of a block in the way their cells utilize them.35 One of the fundamental principles is that you must get your EFAs from food, and both plants and animals can supply you with omega-6s or omega-3s. The difference between plant and animal sources is that EFAs found in animal foods are usually more unsaturated than those found in plants.
Omega-3s have attracted so much interest because they have effects on your body that tend to be anti-inflammatory. But the effects of omega-6s, which are the predominant category of EFA, are not so straightforward; they may either favor or inhibit inflammation. Certain omega-6 EFAs may benefit people with asthma, especially when balanced with the appropriate intake of omega-3s. In my experience, balance is the key, and more is not necessarily better.
Balancing Omegas to Help Asthma
Research I conducted in the 1980s in association with Dr. David Horrobin, an EFA pioneer, and Dr. Ross Rocklin, a professor of allergy and immunology at Tufts University, confirmed defective omega-6 metabolism in people with allergies, suggesting that some allergic individuals may require special omega-6 supplements to achieve proper balance.36 This concept has been applied with significant benefits in the clinical trials described later in this chapter.
As mentioned earlier, a study of young American adults found that the 20-year incidence of asthma was directly linked to a reduced consumption of omega-3 fats from fish; in other words, omega-3 consumption and onset of asthma were inversely related.37 As I explained in a review article I authored on diet and inflammation for the journal Nutrition in Clinical Practice, higher dietary omega-3 levels have been associated with decreased evidence of inflammation in the general population. This has also been observed in people with asthma: higher omega-3 intake from food produces less inflammation. It also produces better asthma control, whereas a high dietary omega-6 to omega-3 ratio produces poorly controlled asthma.38
I discussed the best way to balance dietary fats by eliminating trans fats, increasing omega-3s, and reducing omega-6s in my book The Fat Resistance Diet, which was written to help people lose weight with an anti-inflammatory diet. The basic principles, described in “The Allergy Solution Oil Change”, are simple and easy to implement.
The Allergy Solution Oil Change
To move from the modern Western diet to a balanced, allergy-fighting diet, consider the following choices. If you are allergic to any of the selections listed here, avoid it and make another choice.
Seeds like chia, flax, hemp, and sabja (or sweet basil). I feature chia seeds in the Immune Balance Smoothie.
English walnuts. Walnut oil makes a tasty gourmet salad dressing.
Leafy green vegetables like spinach and kale. Although they’re low in total fats, leafy greens can supply ample omega-3s if eaten regularly. The spinach leaves in the Immune Power Smoothie will provide about 300 milligrams per serving.
EFA Supplements and Asthma: The Promise of Clinical Trials
Diet is the best way to initiate an anti-asthmatic oil change, but its effects can be amplified by judicious use of omega-3 supplements. Researchers around the world have looked at how omega-3 consumption relates to symptoms, airflow, and inflammation in people with asthma. Most of these studies were done using supplements but without dietary changes. I believe that for optimal healing, supplements can be used in addition to diet, rather than as a substitute.
The studies done to date have looked at different parameters. What matters most to people are their symptoms. What matters most to doctors are changes in lung function, which is generally measured as airflow. Researchers may measure symptoms and airflow, but they also measure other endpoints. These include evidence of inflammation in respiratory secretions, as well as reactivity of the bronchial tubes to various challenges administered in a laboratory, like methacholine, a chemical that constricts bronchial tubes, or to inhaled allergens.
Laboratory measurements usually improve well before there’s a change in symptoms or in airflow measured outside the laboratory. Clinically meaningful endpoints may take time.
Omega-3s: Studies from around the World
Almost all the studies described here used a double-blind, randomized, placebo-controlled protocol. As I’ve stated before, that is considered the gold standard for clinical research.
German researchers administered a relatively low dose of omega-3s (690 milligrams a day for five weeks) to people with asthma that was caused by allergy to dust mites. They observed a decrease in measures of bronchial inflammation when the patients were challenged with an aerosol containing dust mite allergen.42
English researchers administered six grams a day of omega-3s for ten weeks and demonstrated a significant improvement in the late-phase asthmatic response when their subjects were exposed to inhaled allergens.43
What these studies suggest is that omega-3 supplementation can help diminish asthmatic responses in diverse groups of people across the world. Changes in airway hyperreactivity can occur within a few weeks, but clinically significant improvement in asthmatic symptoms may take several months.
Alternative Sources of Omega-3s
Fish oils are not the only source of omega-3s that may help people with asthma. The research team at Indiana University’s Human Performance Laboratory and another research group at Pavlov Medical University in St. Petersburg, Russia, tested omega-3s extracted from the New Zealand green-lipped mussel.
With the mussel omega-3s, the American team demonstrated a decrease in symptoms of asthma and in the use of asthma medication, along with decreased production of chemical mediators of inflammation and greater resistance to exercise-induced asthma.47
The Russian team found a significant decrease in daytime wheezing and in measures of oxidative stress and an increase in morning airflow in the mussel extract group, compared with the placebo group; the dose of omega-3s was only 100 milligrams a day.48 Research conducted at the Okayama University Medical School in Japan compared the effects of perilla seed oil, a vegetarian source of omega-3s, with the effects of corn oil, which lacks omega-3s but is rich in omega-6s.49 After two weeks, the perilla oil group showed reduced levels of asthma-provoking leukotrienes compared to the corn oil group. After four weeks, lung function was significantly better in the perilla oil group than in the corn oil group.
When Omega-3s Are Not Enough
Researchers at the University of Wyoming found a subgroup of asthmatics who actually got worse with high dose omega-3s. Unlike the good omega-3 responders, the poor responders showed no decrease in inflammatory leukotriene levels after receiving fish oils.50
One explanation for this paradoxical response to omega-3s can be found in the research I mentioned earlier that I conducted with Professors Horrobin and Rocklin in the 1980s. Some people with allergies may actually need special sources of omega-6 fats because of a block in the way their bodies utilize omega-6s. For these people, increasing omega-3 intake without addressing their omega-6 problem may make the omega-6 block even worse.
The solution might be to combine omega-3s with a unique anti-inflammatory omega-6 fatty acid called gamma-linolenic acid (GLA), which is found in evening primrose oil, black currant seed oil, and borage seed oil. Breastfed infants receive GLA in their mothers’ milk. GLA can help overcome the block in omega-6 metabolism that my colleagues and I demonstrated in allergic individuals during the 1980s.
Medical research highlights:
I like to use omega-3s and sometimes GLA as part of a nutritional program such as the Immune Balance Diet, and I often add zinc, and select antioxidants as well.
Your body is like a rain forest. It teems with life. A hundred trillion microbes carpet every surface, outside and in. There are many more microbes in your body than human cells, and their presence is essential for your health. They stimulate your immune system, help regulate your hormones, and protect you from unwanted inflammation. Your relationship with them is every bit as complicated as the ecology of the Amazon Basin—and it’s in as much danger, from:
All these factors disturb the relationship that has evolved between us and our old microbial friends. Our microbes are under siege, and we are paying the price. The allergy epidemic is part of that price. Asthma is one outcome.
Research on the impact of your body’s ecology on asthma is just getting started, but there are two interesting research findings that I’d like to share with you now, because I’ve found them very important in my clinical practice.
Can Probiotics Help with Asthma?
Having a pet changes the ecology of your home and your body. Families with pets are more likely to share the same microbes, probably because everyone is cuddling the same pet. They’re likely to have a greater diversity of microbes. And having a pet will change the microbes found in house dust.
Researchers at the University of California–San Francisco exposed mice to house dust obtained from a home with a pet dog and to house dust from a home without any pets. They then attempted to provoke allergic asthma in the mice by sensitizing them to cockroaches and egg white. Mice fed dust from the home with a dog were able to resist the development of allergy. When their gut microbes were examined, they had a much greater diversity of bacteria than mice fed dust from the home with no pets. One particular species of bacteria, Lactobacillus johnsonii, was strikingly present in the allergy-resistant mice. When the scientists fed Lactobacillus johnsonii to a fresh group of mice, feeding that single probiotic protected the mice against the development of allergic asthma.56
Study results in humans depend on the probiotic used and the design of the clinical trial. Here are two interesting research studies:
Research studies suggest that probiotic supplementation with selected strains of Lactobacillus or Bifidobacteria may be a helpful adjunct in reducing inflammation and symptoms of people with allergic asthma. The greatest benefits for any kind of supplementation are likely to occur when it’s used as part of the full Allergy Solution program.
It was the full program that allowed my patient Alexa to keep her dream job.
Breathing Easy Again
Alexa was a 40-year-old reporter for a major news magazine who landed a job as bureau chief for India. This required that she spend a great deal of time in New Delhi, which is one of the most polluted cities in the world. Within weeks of starting her new job, an old childhood ailment that had been gone for decades reappeared: allergic asthma. Alexa’s symptoms—wheezing, coughing, and difficulty breathing—were worse outdoors and fluctuated in severity with the level of air pollution.
She consulted a local physician and was treated with monteleukast pills and an inhaler that consisted of a steroid combined with a long-acting bronchodilator. This controlled her symptoms until a trip to Calcutta, during which she developed a lung infection, was hospitalized, and required oral steroids for control of her asthma. Back in New Delhi, she found that she could not discontinue the steroid pills. Each time she reduced the dose, her asthma would flare.
I first met Alexa during her vacation, when she visited New York to spend time with family. Her asthma improved somewhat in New York City, but she still noticed that automotive exhaust would make her nose burn, she’d wheeze in the subways, and she’d cough much of the night. Shortness of breath still kept her from exercising. She told me she felt like she couldn’t escape the pollution and the symptoms it produced. Her case highlights the global nature of the air pollution problem.
When I examined Alexa, I could hear the wheezing in her lungs and see evidence of allergy in her nose, which had a pale and swollen lining, characteristic of people with nasal allergy. Her tongue had a heavy white coating. Culture of the coating grew out the yeast Candida albicans. High Candida growth in her mouth was undoubtedly a result of her use of steroids and had probably been aggravated by the antibiotics she’d been given in Calcutta the year before.
A skin test revealed that she was allergic to Candida, a finding that occurs in about a third of people with severe asthma.59 Inhalation of Candida fragments from yeast growing in the mouth can provoke asthmatic symptoms in asthmatics with yeast allergy.60 I’ve found this to be an important aggravating factor for many asthmatics over the course of my medical career.
In Alexa’s case, I didn’t think that Candida allergy was the primary trigger for her asthma. It was a secondary factor that resulted from the effects of medication, but it had to be addressed, because it was part of the vicious cycle of inflammation and dysbiosis that made it impossible for her to discontinue steroids.
I had four weeks to help Alexa restore her health so that she could return to work. We needed to enhance her ability to detoxify, build up her antioxidant defenses, and correct the dysbiosis that had resulted from her treatment with steroids and antibiotics.
I prescribed an antifungal medication to clear up the yeast overgrowth in her mouth. A single dose increased her wheezing, a sign of how severely allergic she was to the yeast growing in her body. As the organisms began to die, they released allergens that aggravated her asthma. That reaction let me know that Candida allergy was a critical trigger for Alexa.
I decided that antifungal medication would have to wait. We’d have to gently reduce her burden of yeast with herbs. I chose berberine, a very thoroughly studied compound that is a component of several widely used herbs. Not only can berberine kill yeast, it has antioxidant and anti-inflammatory effects and can suppress allergic responses in the blood cells of patients with food allergy.61 Berberine was effective for Alexa, and after two weeks she was able to use the antifungal drug I’d originally prescribed.
As the month went on, she began tapering down her dose of steroids and discontinued monteleukast. I began to focus on building up her levels of the antioxidant glutathione, using methods I will explain in the next chapter. Alexa was not allergic to milk products and found that plain yogurt improved her breathing.
By the end of her vacation, Alexa was no longer taking steroids. She had no symptoms of asthma and her lung function was normal. She was following the Immune Balance Diet, and I explained to her how to continue this diet in India. Anti-inflammatory vegetables and spices are abundant there. Sabja seeds could replace chia seeds in the Smoothie. Yogurt is an Indian staple, so she might not even need a probiotic supplement.
She left for India and I held my breath. A month later she called to give me the good news: no cough, no wheezing, no shortness of breath. On the bad air days, she’d stay indoors, just to be safe. She left New Delhi shortly after, and her condition remained improved.
Alexa’s view of her illness went like this:
$190 Million for Research into Inner-City Asthma
Asthma prevalence is disproportionately high in the big cities. In the United States, you are more likely to have asthma if you:
Live in an inner city
Are part of a minority group
Are economically disadvantaged
Suffer from high levels of stress
Now a small ray of hope is headed to places that are being hit hard by the asthma epidemic. Funding to the tune of $190 million is coming from the National Institute of Allergy and Infectious Diseases to support the Inner-City Asthma Consortium.62 This consortium is a multicenter effort to understand the causes of the asthma epidemic in urban centers and to develop treatments for prevention and control. The research is being led by scientists at the University of Wisconsin. Clinical centers participating include Johns Hopkins University, Columbia University, University of California–San Francisco, the University of Texas, and many others. They will explore:
Sarah’s asthma attack and trip to the emergency room opened this chapter. Two million such visits to the hospital for asthma occur each year in the United States. Studies confirm that only a fraction of asthma cases are considered well controlled.
I presented highlights of the research on nutrition in managing asthma, then explored the role of oxidative stress; this led to a discussion of the potential of antioxidants from food to help reduce oxidative stress. I described a fascinating Australian study that showed how antioxidants from vegetables and fruits may help asthma. Next I shared the science on omega-3s and asthma, which suggests that many people could use an oil change.
I also looked at the relationship between the microbiome and asthma. Finally, the problem of air pollution and asthma was highlighted by the case of Alexa, a reporter whose asthma returned when she was confronted by air pollution.
Asthma requires the care of a health care professional, so I encourage you to bring this book with you when you see your doctor.