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Letter
from Dr. Janson
Managing Asthma
Ask Dr. J.
In the Health News
Recipe of the Month: A Healthy
Pizza
References
Dear Friends,
I usually spend time researching and defending
the scientific basis for nutrition, dietary
supplements, and other alternative treatments,
and noting that conventional medicine is not
better documented than many alternatives. However,
science has limits in human understanding, and
devoting so much to it neglects the rest of
the art of medicine. This has to do with the
art of life—with communication, inspiration,
motivation, and compassion.
Doctors have an obligation and an opportunity
to instill in a patient a positive attitude
and a burning desire to get well and stay well,
and give them the knowledge and motivation to
change the habits that often contribute to degenerative
disease.
In an Email discussion, a friend pointed out
that in addition to the physical senses of taste,
hearing, vision, smell, and touch, human beings
also have non-physical senses that allow us
to live life to the fullest. They are not scientific,
and they are not often considered in the realm
of medicine, but they are essential for a rewarding
and fulfilling life. Doctors are in a special
position that allows them to help a patient
cultivate these senses. We must take advantage
of our position to enhance the healing process
through these senses that promote the patient’s
power to enjoy life.
The sense of adventure allows us to step out
of our daily environment and experience the
pleasures of different cultures, new foods,
unexpected architecture and scenery, unusual
plants and animals, and different perspectives
on life. It also lets us enjoy new and challenging
physical experiences that are part of our animal
nature.
The sense of beauty provides an appreciation
of art, music, crafts, scenery, and human features.
It lifts us to a higher existence. The sense
of joy enriches everyday experiences of relationships,
rewarding work, and play, and allows us to fill
ourselves with good feelings.
The sense of wonder leads us to learn new things,
and enjoy both new and old experiences as a
child does, with a feeling of awe and appreciation
of the moment. And finally, a sense of humor
keeps everything in perspective, so we don’t
take ourselves and our lives too seriously,
and it gives us the healing and restorative
power of laughter. It lets us defuse threatening
situations, and learn to cope with physical
and emotional trauma, while being able to laugh
and play together enhances the bonding in human
relationships.
Appreciation of these senses takes us out of
the realm of simple existence to live life to
its fullest. As one of my favorite poets, e.e.
cummings, says, “existing’s tricky,
but to live’s a gift.” To be fully
alive means making the most of our gifts. Physicians
also benefit from these senses of joy, beauty,
wonder, adventure, and humor, and when we help
our patients enjoy life, we enhance our own
lives.
Recent research shows that a high dietary intake
of apples, the trace mineral selenium, and red
wine reduces the risk and severity of asthma,
possibly because of antioxidant and anti-inflammatory
effects of the mineral and the flavonoids found
in fruit and red grapes. As people with asthma
sometimes feel powerless to control their symptoms
without drugs, this article and others provide
some hope that they may be able to take charge
of their health and control their condition.
Asthma is a condition of the tracheobronchial
airways with spasms restricting air flow in
and out of the lungs. The symptoms are difficulty
breathing, cough, and wheezing. It most often
starts early, 50 percent of the time by the
age of 10, and over 80 percent by the age of
forty.
Asthma is very common, affecting now about
ten percent of the population, and the incidence
is increasing. It may be triggered by allergies,
drug reactions, chemical and toxic metal exposures,
exercise, and stress, as well as by infection.
Asthma is increasing from about one in
20 people 15 years ago to about one in 10 now,
perhaps due to air pollution (ozone, sulfur
or nitrogen dioxide), drugs and chemicals such
as aspirin, NSAIDS, and artificial colors, food
allergies, fast foods with hydrogenated oils,
sulfites used to prevent browning of vegetables
and dried fruits, and poor nutrition. Work or
leisure exposure to metal salts, wood and vegetable
dusts, farm and garden chemicals, and plastics
may play a role.
Infections also trigger asthma attacks, and
sometimes a seemingly minor respiratory virus
may lead to a severe asthma attack. This might
be the result of inflammation leading to increased
sensitivity of the airways to particular triggers.
Exercise, especially in the cold, can precipitate
asthma attacks, and sometimes this is the only
trigger when someone first develops symptoms.
This frequently changes much later into asthma
unrelated to exercise. It is also well known
that psychological factors can initiate asthma
attacks or help relieve or prevent them.
When looking at the lungs of asthmatics, pathologists
find extensive secretions plugging the airways,
swelling of the bronchial lining, thickening
of the muscles, and collections of both allergy-related
cells called eosinophils and inflammatory cells
in the bronchial walls. The end result of all
these physiologic changes is a marked narrowing
of the air passages. With changes in messenger
substances (histamine, leukotrienes, prostaglandins,
and others), and cells related to inflammation,
it appears that asthma is a chronic inflammatory
disease.
In addition to recommending environmental
controls, physicians prescribe many drugs for
asthma, including bronchodilators, steroids,
and allergy medications. In severe acute asthma,
it is important to take immediate measures,
including drug therapy, but injections of magnesium
can be extremely helpful in stopping such an
attack. Other than in emergency situations,
it is best to do whatever you can to avoid drugs
while still controlling symptoms.
Make efforts to reduce exposures to precipitants,
such as airborne allergens, trigger foods, chemicals,
and drugs, and to enhance immune function to
reduce infections. Avoid even second-hand smoke.
An air filter (such as Austin Air Systems) can
help to clean up both particulate and chemical
contaminants. Do your best to eliminate house
and garden chemicals from your environment.
In most cases, natural alternatives are available.
A whole, natural, mostly vegetarian diet with
few additives is an essential part of any health
program. Avoid sulfites, not only in commercial
salad bars (to prevent foods from turning brown),
but also in wine. Milk is a common food allergen,
as are peanuts, eggs, shellfish and some cereal
grains. Hydrogenated oils interfere with normal
fat metabolism and prostaglandin function.
Supplements are also important in treating
asthma. Vitamin C (2000 to 4000 mg daily) is
an antioxidant, anti-inflammatory nutrient that
also reduces allergic symptoms. Although studies
are not consistent, there is a strong suggestion
that supplements might help asthma, especially
if exercise induced.
In children and adults, 100 to 200 mg of vitamin
B6 can markedly reduce asthma symptoms. Serum
markers of B6 activity tend to be low in asthmatics.
The flavonoid quercetin (800 to 1200 mg daily)
reduces allergies by stabilizing the cells that
release histamine. It also inhibits the action
of lipoxygenase, an inflammatory enzyme involved
with prostaglandin metabolism. Anti-inflammatory
herbs, such as curcumin (1000 to 2000 mg) and
ginger (250 to 1000 mg) help control the chronic
inflammation and bronchospasm seen with asthma.
Several studies with ginkgo extracts show benefits
for asthmatic patients. Ginkgo interferes with
the effects of platelet activating factor, known
to promote inflammation. Patients challenged
with allergens after taking ginkgo extract had
much less bronchoconstriction than controls.
The usual dose is 120 to 240 mg daily.
Essential fatty acids are prostaglandin precursors.
Prostaglandins derived from gamma-linolenic
acid (GLA, 240 mg from borage or primrose oil)
and flaxseed or fish oil have anti-inflammatory
effects, help reduce allergic symptoms, and
they relax bronchial muscles. Although there
are few specific clinical studies on asthma,
I have found these oils helpful in practice.
Magnesium is a smooth muscle relaxant, and
helps to relieve bronchospasm when taken by
mouth, as well as when administered intravenously
for acute asthma attacks. The usual oral dose
is about 400 to 1000 mg daily.
In many cases, these nutrients and lifestyle
changes with stress management, combined with
immune support and environmental controls have
helped patients reduce or eliminate their asthma
medications, and live a healthier life.
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Q. I’m in serious need of an herbal solution
for hot flashes! They are strong, frequent,
day & night! Good rest at night is difficult.
M.C., New Mexico
A. Menopausal hot flashes, or vasomotor flushing,
are the result of complex hormonal changes at
the time of menopause or after surgery that
removes the ovaries. They can be quite uncomfortable,
and even though they normally go away within
a few years after menopause, or can be suppressed
with hormonal therapy, sometimes a good nutrition
program and dietary supplements can make a big
difference in controlling them.
I recommend supplements of soy isoflavones,
500 mg daily, standardized at 40 percent isoflavones.
These have natural weak estrogenic effects,
and have been shown to control hot flashes up
to 50 percent. Bioflavonoids (2000 mg) are plant
pigments that were shown to reduce hot flashes
almost 40 years ago.
Black cohosh (standardized, 40 to 120 mg) is
probably the most commonly known herb that is
used for menopausal symptoms. A number of double-blind
studies support its use. Another herb that might
help is dong quai (Angelica sinensis, standardized,
200 to 600 mg).
Other helpful supplements: vitamin E (800 to
1200 IU), shown decades ago to be helpful, although
recent studies show only a small effect (perhaps
because they did not give it for long enough);
gamma linolenic acid ( GLA, 240 mg).
I would not discount using natural hormones,
such as progesterone and estrogens modified
from soybeans to mimic the same hormones found
in humans. These can be quite helpful, and are
not the same as synthetic progesterone analogs
or horse estrogens that are commonly prescribed.
•I am intrigued by an article that came
out in July extolling the virtues of coenzyme
Q10 (Tran MT, et al., Role of coenzyme Q10 in
chronic heart failure, angina, and hypertension.
Pharmacotherapy 2001 Jul;21(7):797-806). The
authors say that coQ10 helps with congestive
heart failure, angina, and hypertension based
on an extensive search of the past 25 years
of research. They point out that coQ10 supplements
improve ejection fraction (heart muscle function),
cardiac output, and exercise tolerance, meaning
that every measure of heart function is helped.
They note that it is safe and well tolerated.
Then, incredibly, their conclusion says that
“CoQ10 should not be recommended as monotherapy
or first-line therapy in any disease state.”
WHY NOT? Maybe because this article comes from
a school of pharmacy!
•A new study shows that saw palmetto significantly
helps urinary symptoms in benign prostate enlargement
(Gerber GS, et al., Urology 2001 Dec;58(6):960-963).
In the study of 85 men, “quality of life”
also tended to improve, but it did not reach
statistical significance–perhaps because
of inadequate dosing or too few subjects. In
previous studies, saw palmetto was superior
to the drug finasteride (Proscar).
•Another study shows that eating
legumes is associated with a significant reduction
in heart disease (Bazzano LA, et al., Legume
Consumption and...Coronary Heart Disease... Arch
Intern Med 2001;161:2573-2578). The study of
nearly 10,000 people for 19 years showed a 22
percent reduction in coronary disease in those
eating beans at least 4 times a week, and a
reduction in vascular disease overall. Legumes
include kidney, black, navy, pinto, lima, and
azuki beans, and others, and soy products.
I buy a wholewheat crust or make a simple
one using my VitaMix. Lightly sauté chopped
onions, broccoli, and mushrooms with olive oil.
Spread a layer of refried beans (homemade or
canned, organic ones) on the crust. Add a layer
of tomato sauce or salsa, spread the vegetables
on top, and then a layer of fresh tomatoes.
Sprinkle with oregano, basil, and fresh ground
pepper to taste and a thin layer of grated romano
sheep-milk cheese. Put in a preheated oven at
425 degrees, and cook until the crust is crisp
and turning brown at the edges. You have your
tomato lycopene, broccoli phytochemicals, whole
grain nutrients with fiber, and beans, all of
which prevent heart disease, cancer, and prostate
problems, and preserve your vision, in one traditional,
tasty, and easy meal.
Pacor
ML, et al., Food allergy and asthma. Recenti
Prog Med 1992 Feb;83(2):64-6.
Forastiere
F, et al., Consumption of fresh fruit rich in
vitamin C and wheezing symptoms in children.
Thorax 2000 Apr;55(4):283-8.
Anah
CO, et al., High dose ascorbic acid in Nigerian
asthmatics. Trop Geogr Med 1980 Jun;32(2):132-7.
Schachter
EN, Schlesinger A, The attenuation of exercise-induced
bronchospasm by ascorbic acid. Ann Allergy 1982
Sep;49(3):146-51.
Mohsenin
V, et al., Effect of ascorbic acid on response
to methacholine challenge in asthmatic subjects.
Am Rev Respir Dis 1983 Feb;127(2):143-7.
Miric
M, Haxhiu MA, Effect of vitamin C on exercise-induced
bronchoconstriction. Plucne Bolesti 1991 Jan-Jun;43(1-2):94-7.
Collipp
PJ, et al., Pyridoxine treatment of childhood
bronchial asthma. Ann Allergy 1975 Aug;35(2):93-7.
Reynolds
RD, Natta CL, Depressed plasma pyridoxal phosphate
concentrations in adult asthmatics. Am J Clin
Nutr 1985 Apr;41(4):684-8.
Foreman
JC, Mast cells and the actions of flavonoids.
J Allergy Clin Immunol 1984 Jun;73(6):769-74.
Li
MH, et al., Effects of ginkgo leaf...in treating
asthma.
Chinese J Integrative & Western Med 1997
Apr;17(4):216-8.
Brunner
EH, et al., Effect of parenteral magnesium on
pulmonary function, plasma cAMP, and histamine
in bronchial asthma. J Asthma 1985;22(1):3-11.
Volkl
KP, Schneider B., Therapy of respiratory tract
diseases with N-acetylcysteine. An open therapeutic
observation study of 2,512 patients. Fortschr
Med 1992 Jun 30;110(18):346-50.
Upmalis DH, et al., Vasomotor symptom relief
by soy isoflavone extract.... Menopause 2000
Jul Aug;7(4):236-42.
Smith
CJ, Non-hormonal control of vaso-motor flushing
in menopausal patients. Chicago Med 1964;67:193-5.
Liske
E, Therapeutic efficacy and safety of Cimicifuga
racemosa for gynecologic disorders. Adv Ther
1998 Jan-Feb;15(1):45-53.
Barton
DL, Prospective evaluation of vitamin E for
hot flashes in breast cancer survivors. J Clin
Oncol 1998 Feb;16(2):495-500
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