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Program AS Asthma Breakfast ½ c soy plain yogurt, ¼ cup sliced almonds, 1 cup blackberries, 1/8 c ground flax seeds * ½ c oatmeal cereal, ½ c blueberries, 1/8 c chopped walnuts, 1/8 c ground flax seeds * ½ of a medium cantaloupe, 2 poached eggs, ½ cup flax cereal * 6 oz. grapefruit juice, 1 cup soy plain yogurt, 1 Tbsp. ground flaxseeds * ½ cup flax cereal, 1 Tbsp. ground flax seeds, 6 oz. tofu scrambled with ½ cup spinach Lunch and Dinner 3 oz. buffalo burger, 1 slice brown rice hamburger bun, spinach salad with soybeans and fresh tomato slices, 1 tsp. of flax oil and olive oil each for dressing mix * 4 oz. sole/flounder, 1 cup steamed cauliflower, 1 small baked potato, 1 apple * 3 oz. chicken breast mixed in a spinach salad with ½ cup kidney beans, 1 cup potato cubes, tomato slices and other vegetables, 1 tsp. olive oil and 1 tsp. of flax oil for dressing mix * 4 oz. Salmon baked/broiled, 1 cup steamed brussel sprouts, ½ cup brown rice * 4 oz. turkey breast, 2 cups broccoli, 1 cup lima beans, 1 tsp. of olive oil and 1 tsp. of flax oil for vegetables * 3 oz. filet mignon, 1 sweet potato, and 2 broiled tomato halves, 1 tsp. flax oil * 2 pieces of lentil loaf, 2 cups of cauliflower, and mixed greens, 1 tsp. olive oil for dressing mix * 4 oz. beef burger, 1 slice of brown rice hamburger bun, ½ cup carrots and ½ cup celery and other vegetables over mixed greens, 1 tsp. flax oil * 4 oz. chicken breast with rosemary, 1 cup black eyed peas, roasted onions or garlic, spinach salad with 1 tsp. canola oil for dressing mix * 4 oz. flounder, 2 cups sautéed spinach, 2 cups broiled parsnips, 2 tsp. canola oil 1 Program AS Asthma Snacks Roasted garlic or almond butter on rice cake or celery, protein shakes with freshly ground flaxseeds added, handful of raw almonds, hazelnuts, walnuts, or sesame seeds, an organic apple, pear, or grapes, rice cakes with nut butter Beverages Fresh mixed vegetable juice, green drinks: Green Magma, Kyogreen, or Green Kamut (1 tsp. 1-3x day in water). Teas: licorice, chamomile, lemon balm, green tea, iced herbal teas Avoid Aspirin (which can worsen attacks), hydrogenated oils, sugar, allergenic foods, safflower, sunflower, corn oils, exposure to airborne allergens, food additives, alcohol, smoking, stress. Suggestions and Goals Try doing an elimination diet to identify food allergens. Check for presence of Candida. Include plenty of quality fats found in mackerel, sardines, salmon, and herring. Supplements EPA/DHA Vitamin C Magnesium B6 B12/Folate Selenium Carotenoids Mycel A Vitamin E Zinc Beneficial Bacteria Curcumin Quercetin Taurine NAC Grape Seed Extract Boswellia Extract Gingko Biloba 500-2,000 Mg 1-5 Grams 400-600 mg (and/or Epsom salt baths) 200 mg with B complex at different time of day 1,000 mcg of each, with B12 doses as high as 10 mg 200-400 mcg 50-200,000 IUs (Natural Mixed Carotenoids) 1 dropper once per week (not near pregnancy) 400-800 IUs/Liquid E 1-3 Tsp./day (Twinlab) 25 mg or as per ZTT 1-3 capsules to 1-3 Tablespoons 100-1,000 mg 300-900 mg 1-3 grams 1-2 grams 50-300 mg 300 mg 3x per day 80-240 mg of standardized extract 2 Program AS Asthma Research Review A considerable body of evidence suggests that oxidant stress results in inflammation and tissue damage in the respiratory system, and later in immune damage, and that individuals with lowered cellular reducing capacity are at increased risk to develop asthma. Dietary selenium deficiency lowers red cell glutathione peroxidase activity and is associated with an increased risk for asthma, and low dietary intakes of vitamins C and E also appear to increase asthma risk. High body iron stores increase free radical production and may also elevate asthma risk. Environmental lead exposure depresses cellular reducing capacity. Simple dietary and environmental interventions may significantly reduce oxidant stress and prevent or minimize the development of asthmatic symptoms and should prove to be a cost effective approach to asthma management in addition to current pharmacological strategies.1 Oxidant Stress (Smoking, nutrient deficiency, heavy metals, n-6/n-3 imbalance, frequent colds) Inflammation Tissue Damage Asthma Asthma prevalence and morbidity have increased in the past 10 years in the face of improved knowledge about pathophysiology and treatment. Diet is a newly recognized potential risk factor for asthma occurrence. Four types of dietary constituents are considered: breast feeding and food avoidance in infancy; antioxidant vitamins, specifically vitamin C; dietary cations, specifically sodium and magnesium; and N3-N6 fatty acids. Data are strongest for vitamin C, which is associated with protective effects of airway responsiveness, lung function and asthma symptoms.2 Asthma and Insulin Clinical asthma appears to be less severe when diabetes mellitus is superimposed. To examine whether insulin influences the development of allergic reactions in the airway mucosa antigen challenge, normal and diabetic rats sensitized against ovalbumin (OA) were used. Compared with controls, animals rendered diabetic by the injection of alloxan presented markedly decreased cell yields from bronchoalveolar lavage after OA challenge. The impaired response was not related to antibody production because enhanced IgE antibody titers of the same magnitude were found in both control and diabetic animals. Similarly, the mechanism underlying the inhibited responses could not be ascribed to hyperglycemia or intracellular glucopenia, first, because correction of blood glucose levels through fasting did not restore the decreased response, and second, because administration of 2-deoxyglucose, which blocks glucose utilization, did not affect the bronchoalveolar reaction to OA challenge in normal animals. Reversal of the impaired responses was attained by treatment of diabetic animals with insulin. There is evidence that insulin exerts proinflammatory effects. We conclude that insulin might modulate the inflammatory component of asthmatic responses.3 3 Program AS Asthma Food Allergy Food allergy (FA) induced asthma is less common than FA induced atopic dermatitis, or angioedema. The incidence reaches 8.5%. Occupational asthma due to the inhalation of various food proteins is increasingly described. Egg proteins could be peculiarly at risk. In the childhood, all the kinds of foods can be incriminated. In adults, FA are predominantly due to vegetal allergens, included in the following botanical families: rosaceae, umbelliferae, and exotic fruits. Bronchi are sensitized either by inhalation of food allergens or by inhalation of cross-reactive pneumoallergens, such as pollens, feathers, latex. The fact that FA might create a bronchial hyperreactivity is controversial. Bronchial challenges induce late-phase reactions and document the acquisition of an inflammatory state. The quantity of allergens gaining access to bronchi plays a major part in the triggering of asthma. It can be modulated by variations of intestinal permeability which are related to viral infections, aspirin, alcohol, etc. The chemical characteristics of proteins, such as hydrophobicity might interfere with the passage through the gut mucosa.4 Food and food additive triggers play an important role in approximately 5-8% of all asthma cases. Exact epidemiological data are lacking, partly because the etiological link is not always obvious, the diagnosis of food hypersensitivity is often complicated and ambiguous, food triggers usually act in concert with other trigger(s), and intraspecies and intrabotanic cross-reactivities between inhalant and nutritional allergens can make the time-course of the symptoms confusing. The participation of airway symptoms in food allergy goes up to 40%. Relevant diagnosis can only be established by the combination of procedures used for both food allergy and asthma. In the therapy avoidance measures are of great importance besides usual asthma therapy, and probably in combination with the reduction of gut permeability.5 B6: Theophylline Increases Need Plasma pyridoxal-5'-phosphate concentrations were significantly lower (p less than 0.001) in a group of 28 asthmatic women when compared to 33 controls. Theophylline was administered to a group of 17 volunteers and resulted in large reductions in plasma pyridoxal-5'-phosphate levels.6 Asthmatics Need 100-200 mg B6 Per Day Urinary xanthurenic and kynurenic acid levels were measured in five patients while they were receiving 50 mg and 100 mg of pyridoxine. The levels of tryptophan metabolite decreased progressively as the dose was increased but remained above basal levels. There was marked clinical improvement in these patients while receiving the higher dose only. The double-blind study with 76 asthmatic children followed for five months indicated significant improvement in asthma following pyridoxine therapy (200 mg daily) and reduction in dosage of bronchodilators and cortisone. The data suggest that these children with severe bronchial asthma had a metabolic block in tryptophan metabolism, which was benefited by long-term treatment with large doses of pyridoxine.7 Further research supports the partial block in the metabolism of tryptophan in children with bronchial asthma.8 B12 We have studied five children with asthma with sulfite intolerance confirmed by oral challenge testing. The challenge test with metabisulfite was repeated after premedication of all the patients with 1.5 mg of oral 4 Program AS Asthma cyanocobalamin. In four of the five patients treated with cyanocobalamin, bronchospasm did not develop in the second metabisulfite challenge. The possible mechanisms are discussed.9 Vitamin C Vitamin C intake in the general population appears to correlate with asthma, suggesting that a diet low in vitamin C is a risk factor for asthma. There is evidence that oxidants produced endogenously by overactive inflammatory cells contribute to ongoing asthma. Vitamin C is the major antioxidant substance present in the airway surface liquid of the lung, where it could be important in protecting against both endogenous and exogenous oxidants.10 Magnesium In 2633 adults aged 18-70 sampled from the electoral register of an administrative area of Nottingham, UK, we measured dietary magnesium intake by semiquantitative food-frequency questionnaire, lung function as the 1-sec forced expiratory volume (FEV1), and atopy as the mean skin-prick test response to three common environmental allergens. Dietary magnesium intake is independently related to lung function and the occurrence of airway hyper-reactivity and self-reported wheezing in the general population. Low magnesium intake may therefore be involved in the etiology of asthma and chronic obstructive airways disease.11 Many asthmatic children have a slower growth rate than normal children, and a physiological delay in puberty which does not affect final adult height. Prolonged administration of oral corticosteroids retards growth. Growth should be monitored in children taking over 0.8 mg day-1 of inhaled corticosteroid, but the priority should be to treat the asthma adequately.12 Selenium Lowered selenium (Se) status has been observed in asthma patients. Se supplementation might be beneficial to patients with intrinsic asthma, who may be at risk of Se deficiency.13 EPA/DHA A questionnaire, containing questions about the frequency of eating more than 200 foods, was sent to the parents of 574 children in whom we had measured recent wheeze (by questionnaire), AHR (by exercise) and atopy (by skin prick tests) six months before this study. Children who ate fresh, oily fish (>2% fat) had a significantly reduced risk of current asthma (odds ratio, 0.26; 95% confidence interval, 0.09-0.72; P0.01). No other food groups or nutrients were significantly associated with either an increased or reduced risk of current asthma. These data suggest that consumption of oily fish may protect against asthma in childhood.14 Since airway inflammation may play a central role in the pathophysiology of asthma, we studied the effect of omega-3 essential fatty acids on bronchial responsiveness in 7 atopic patients suffering from seasonal asthma due to airborne allergens, and positive to intracutaneous skin reaction to two or more allergens. The present data strongly suggest the hypothesis that dietary supplementation with omega-3 essential fatty acids could decrease bronchial hyperreactivity in atopic patients.15 n-6/n-3 Imbalance 5 Program AS Asthma The last two decades have seen an increase in the prevalence of asthma, eczema, and allergic rhinitis in developed countries. This increase has been paralleled by a fall in the consumption of saturated fat and an increase in the amount of polyunsaturated fat in the diet. This is due to a reduction in the consumption of animal fat and an increase in the use of margarine and vegetable oils containing omega-6 polyunsaturated fatty acids (PUFAs), such as linoleic acid. There is also evidence for a decrease in the consumption of oily fish which contain omega-3 PUFAs, such as eicosapentaenoic acid. Linoleic acid is a precursor of arachidonic acid, which can be converted to prostaglandin E2 (PGE2), whereas eicosapentaenoic acid inhibits the formation of PGE2. PGE2 acts on T-lymphocytes to reduce the formation of interferon-gamma (IFNgamma) without affecting the formation of interleukin-4 (IL-4). This may lead to the development of allergic sensitization, since IL-4 promotes the synthesis of immunoglobulin E (IgE), whereas IFN-gamma has the opposite effect. Changes in the diet may explain the increase in the prevalence of asthma, eczema and allergic rhinitis.16 Approximately 55% of children use alternative therapies for asthma management.17 Herbal Therapies A comprehensive literature search was performed of relevant English-language papers and abstracts were identified through a MEDLINE search and from bibliographies of the identified papers. The results show positive effects of these herbs on bronchodilation, pulmonary function tests, and antagonism of asthma mediators such as histamine and platelet activating factor, corticosteroid levels, and clearance of mucus. Improved symptoms were also seen in patients with allergic rhinitis specifically on histamine-induced reactions, e.g., rhinorrhea, sneezing, and itching. From the review, there has been a role for some herbal medicines in the treatment of asthma and allergic rhinitis. Usage of herbal medicines has increased in recent years. Many of these medicinal plants provided relief of symptoms equal to allopathic medicines used. The amount of research on these products, especially in the United States, is limited. There is a lack of control of quantity and quality of the components in these remedies. Yet, many have fewer side effects than current therapy. Throughout the history of medicine, drugs have been developed from traditional medicine. By continuing to investigate how some of these herbal interventions work, we may be able to find additional effective medicines to treat asthma and allergies.18 Boswellia The gum resin of Boswellia serrata contains boswellic acids, which have been shown to inhibit leukotriene biosynthesis. In a double-blind, placebo- controlled study forty patients, 23 males and 17 females in the age range of 18 - 75 years having mean duration of illness, bronchial asthma, of 9.58 +/- 6.07 years were treated with a preparation of gum resin of 300 mg thrice daily for a period of 6 weeks. 70% of patients showed improvement of disease as evident by disappearance of physical symptoms and signs such as dyspnoea, rhonchi, number of attacks, increase in FEV subset1, FVC and PEFR as well as decrease in eosinophilic count and ESR. In the control group of 40 patients only 27% of patients in the control group showed improvement. The data show a definite role of gum resin of Boswellia serrata in the treatment of bronchial asthma.19 Traditional Chinese Herbal Medicine 6 Program AS Asthma A multicenter, double-blind and placebo-controlled study was therefore conducted to evaluate clinical efficacy of using Traditional Chinese medicines (TCM) to treat bronchial asthma . Three hundred and three asthmatic children were classified by Chinese doctors, according to a standardized questionnaire designed on the basis of basic logic of Chinese medicine, into three groups of specific constitution (group A, B and C). Group A consisted of 32 herb A-treated patients and 34 placebo-treated; group B, 74 herb B-treated and 64 placebotreated; and group C, 55 herb C-treated and 44 placebo-treated. The study period was six months. Both treatment group and placebo group showed an improvement in all clinical parameters, thus demonstrating a placebo effect. However, the improvement was usually greater in the treatment group.20 1. Greene LS. Asthma and oxidant stress: nutritional, environmental, and genetic risk factors. J Am Coll Nutr 1995;14(4):317-24. 2. Weiss ST. Diet as a risk factor for asthma. Ciba Found Symp 1997;206:244-57. 3. Vianna EO, Garcia-Leme J. Allergen-induced airway inflammation in rats. Role of insulin. Am J Respir Crit Care Med 1995;151(3 Pt 1):809-14. 4. Moneret-Vautrin DA, Kanny G, Thevenin F. [Asthma caused by food allergy]. Rev Med Interne 1996;17(7):551-7. 5. Nekam KL. Nutritional triggers in asthma. Acta Microbiol Immunol Hung 1998;45(1):113-7. 6. Delport R, Ubbink JB, Serfontein WJ, Becker PJ, Walters L. Vitamin B6 nutritional status in asthma: the effect of theophylline therapy on plasma pyridoxal-5'-phosphate and pyridoxal levels. Int J Vitam Nutr Res 1988;58(1):67-72. 7. Collipp PJ, Goldzier Sd, Weiss N, Soleymani Y, Snyder R. Pyridoxine treatment of childhood bronchial asthma. Ann Allergy 1975;35(2):93-7. 8. Collipp PJ, Chen SY, Sharma RK, Balachandar V, Maddaiah VT. Tryptophane metabolism in bronchial asthma. Ann Allergy 1975;35(3):153-8. 9. Anibarro B, Caballero T, Garcia-Ara C, Diaz-Pena JM, Ojeda JA. Asthma with sulfite intolerance in children: a blocking study with cyanocobalamin. J Allergy Clin Immunol 1992;90(1):103-9. 10. Hatch GE. Asthma, inhaled oxidants, and dietary antioxidants. Am J Clin Nutr 1995;61(3 Suppl):625S630S. 11. Britton J, Pavord I, Richards K, et al. Dietary magnesium, lung function, wheezing, and airway hyperreactivity in a random adult population sample. Lancet 1994;344(8919):357-62. 12. Price JF. Asthma, growth and inhaled corticosteroids. Respir Med 1993;87 Suppl A:23-6. 13. Kadrabova J, Mad'aric A, Kovacikova Z, Podivinsky F, Ginter E, Gazdik F. Selenium status is decreased in patients with intrinsic asthma. Biol Trace Elem Res 1996;52(3):241-8. 14. Hodge L, Salome CM, Peat JK, Haby MM, Xuan W, Woolcock AJ. Consumption of oily fish and childhood asthma risk [see comments]. Med J Aust 1996;164(3):137-40. 15. Villani F, Comazzi R, De Maria P, Galimberti M. Effect of dietary supplementation with polyunsaturated fatty acids on bronchial hyperreactivity in subjects with seasonal asthma. Respiration 1998;65(4):265-9. 16. Black PN, Sharpe S. Dietary fat and asthma: is there a connection? Eur Respir J 1997;10(1):6-12. 17. Andrews L, Lokuge S, Sawyer M, Lillywhite L, Kennedy D, Martin J. The use of alternative therapies by children with asthma: a brief report. J Paediatr Child Health 1998;34(2):131-4. 18. Bielory L, Lupoli K. Herbal interventions in asthma and allergy. J Asthma 1999;36(1):1-65. 19. Gupta I, Gupta V, Parihar A, et al. Effects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study. Eur J Med Res 1998;3(11):511-4. 20. Hsieh KH. Evaluation of efficacy of traditional Chinese medicines in the treatment of childhood bronchial asthma: clinical trial, immunological tests and animal study. Taiwan Asthma Study Group. Pediatr Allergy Immunol 1996;7(3):130-40. 7