Asthma is a chronic inflammatory disorder of the airways characterized by episodes of wheezing, shortness of breath, chest tightness, racing heart, mucus production, flared nostrils, and cough. According to the Morbidity and Mortality Weekly Report (2001) asthma is among the most common chronic diseases in the United States, affecting approximately 10.2 million adults during 1996 (7.2% of adults residing in the United States report having asthma).
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Asthma has been considered a rare disease in the elderly, but recent studies have shown that it is as common in the elderly as in the middle-aged (Quadrelli and Roncoroni 2001). Diagnosis of asthma is often overlooked in older patients and is more severe in this group.
Asthma is diagnosed using lung function tests such as spirometry and expiratory flow, as well as histamine challenge tests (histamine is the compound that causes runny nose, watery eyes, and itching). While asthma is usually fairly simple to diagnose, it is sometimes confused with chronic bronchitis and emphysema.
Asthma, like so many diseases, is simply an adaptive biological response gone bad. According to evolutionary biologists, allergic and asthmatic responses evolved initially to protect us against parasitic organisms and for the expulsion of toxins via sneezing. Most natural toxins are highly allergenic. They cause swelling, heat, constriction of the muscles of the bronchi, and the release of fluid, which expel or dilute offending toxins. The resulting dilation of blood vessels lowers blood pressure and slows the dissemination of any by-products through the body. Some research suggests that people with allergies do not get cancer in allergenic tissues because of this heightened immune sensitivity to toxins (Profet 1991).
Asthma is closely tied to the immune system. In particular, a part of the immune system called humoral, or antibody based, immunity is overactive in people with asthma, while another part, called cell-mediated immunity is sluggish. Humoral immunity is controlled by cell-signaling chemicals called cytokines (e.g., IL-4, IL-5, IL-6), which turn on and turn off the activity of various cells (antibodies) of the immune system, such as mast cells, basophils, eosinophils, and B cells. Allergic antigens bind to mast cells and basophils. When the antigen-bound mast cells and basophils come into contact with another antibody known as immunoglobulin E (IgE), a hypersensitivity response occurs leading to inflammation and the resultant bronchoconstriction (Miller 2001).
The current pharmaceutical drugs used for asthma are bronchodilators and anti-inflammatory compounds. Short-acting beta-2 agonists are used for relief of acute symptoms and prevention of exercise-induced bronchospasm (EIB). Inhaled corticosteroids (very powerful anti-inflammatory compounds) are used in long-term control of asthma, and systemic cortico-steroids are for quick control of asthma symptoms. Long-acting bronchodilators are also combined with anti-inflammatory medications for long-term control and nocturnal asthma. Sustained release theophylline is a mild bronchodilator used principally with inhaled corticosteroids for nocturnal asthma.
Leukotriene modifiers are an alternative to inhaled corticosteroids (Balachandran et al. 2001) that can cause several negative side effects. Oral glucocorticoids inhibit growth in children by blunting growth hormone (GH) secretion, decreasing insulin-like growth factor 1 activity, and inhibiting new collagen (protein) synthesis. Similarly, corticosteroids cause short-term growth suppression (Allen 2002). Corticosteroids also deplete the body of calcium, magnesium, potassium, and zinc and may lead to osteoporosis. These nutrients should be supplemented during long-term corticosteroid therapy.
New drugs with fewer side effects are being developed to treat asthma. The first selective anti-IgE therapy, a monoclonal anti-IgE antibody (omalizumab), binds with a receptor on IgE, reducing the amount of free IgE available to bind to antigen receptors on mast cells, basophils, and other cells involved in allergic responses. So far in trials, omalizumab controls allergic responses, reduces or eliminates the need for inhaled or oral corticosteroids, and has an excellent safety profile (Boushey 2001).
Hydergine is another useful drug for asthma. It works, like theophylline, by safely boosting intracellular levels of the messenger molecule cyclic adenosine monophosphate (cAMP) which can reduce bronchial constriction. The recommended dose of hydergine is 5-10 mg a day with food. (For more information about the benefits of the drug hydergine, please refer to the Age-Associated Mental Impairment protocol.)
Certain supplements can interact with asthma medications, so be cautious when combining the two. Ipriflavone can slow liver detoxification and thus raise blood levels of theophylline, giving you a longer period of stimulation than you expected. Be sure to consult with a health professional when combining supplements with asthma medications or attempting to reduce the use of pharmaceutical drugs.
Food allergies are a common cause of asthma, and effort should be made to eliminate allergenic foods from the diet. Baker and Ayres (2000) explain that the "role of food intolerance in asthma is well recognized and where food avoidance measures are instituted, considerable improvement in asthma symptoms and in reduction in drug therapy and hospital admissions can result."
Cereal grains, given their prevalence and evolutionary novelty, are among the biggest offenders. A high intake of cereals in the diet during early life causes IgE sensitization to cereals because allergens in cereals cross-react with proteins in grass pollen leading to pollen allergies (Armentia et al. 2001). Hypoallergenic, gluten-free flour suppresses gluten-caused allergic reactions. In rats fed a hypoallergenic flour after an allergen challenge, body weight remained the same, indicating no allergic reaction had occurred. (Watanabe et al. 2001). In addition, cereal grains and seeds are a major source of airborne asthma allergens including molds, fungi, insects such as mites, and insect droppings.
Other common allergenic food that can cause an asthma attack include nuts, chocolate, fish, tomatoes and other nightshade plants, cow milk, eggs, and cheese. Also be wary of food colorings, MSG, and aspirin. Hydrochloric acid and pancreatin supplements are useful if asthma attacks are related to food sensitivity. These help break down food proteins, minimizing allergic reactions.
Obesity and high intake of certain types of dietary fats are also associated with asthma. High caloric intake and the consumption of saturated fats are associated with asthma, while monounsaturated fats (such as olive oil) reduce risk of asthma (Huang and Pan 2001). People with high body mass (referred to as body mass index or BMI) are at a higher risk of asthma due to the added mass on their lungs and more active inflammatory mechanisms (von Mutius et al. 2001).
In general, asthma increases in industrialized societies due to worsening dietary habits. In one study in Saudi Arabia, people who ate at fast food restaurants and had the lowest intakes of vegetables, fiber, vitamin E, calcium, magnesium, and potassium had the highest risk of asthma (Hijazi et al. 2000). Another study in Taiwan revealed that high intake of meat (especially liver) and fat-rich foods were associated with asthma (Huang et al. 2001). Finally, another team of researchers has found that the risks of bronchial hyper-reactivity are increased seven fold among those with low intake of vitamin C, although the lowest intake of saturated fats gives a 10-fold protection. Furthermore, the risk of adult-onset asthma is increased five fold by the lowest intake of vitamin E (Seaton and Devereux 2000). All of these studies also cite urban location as a major risk factor for asthma.
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For more information on asthma, check out the Athsma & Allergy Foundation of America.