Asthma and AllergiesTotal Health ClinicCnr Sauvignon Pde, Brygon Creek DriveUpper Coomera

Asthma and AllergiesCauses and prevention

Amanda Franzi Health Coach

• Respiratory Health an Important Health care issue

• Allergic Diseases are now epidemic

• Causes of allergy

• Allergy as an immune response

• The gut connection

• How to avoid triggers and attacks

• Asthma what is it and how to avoid it.

• Natural treatments for the prevention of allergies and asthma

Topics Covered

Respiratory Health is an Important healthcare issueChronic respiratory diseases are very prevalent in Australia – an estimated 5.8 million Australian had at least one long term respiratory condition 2001. Respiratory diseases are major causes of illness and mortality in Australia. They place great stresses on the health care system and are a significant financial burden for the individual and the community disrupting the daily life and productivity of many individuals

(Australian institute of health and welfare, Chronic respiratory diseases in Australia. Their prevalence, consequences and prevention. August 2008

Allergic Diseases are now Epidemic• Over the last 50 years the prevalence of diseases such as hay

fever, atopic dermatitis, and allergic asthma has increased significantly in the developed world.

• Allergic diseases are now epidemic in the most westernized societies, affecting approximately 20%-30% of their populations, and ranking first among the causes of chronic disease in children.

• 1 in 6 now suffer allergies.• Grammatikos Ap. The genetic and environmental basis of

atopic disease. Ann Med. 2008,4(07)482-95

Causes of Allergy

Genetic FactorsPresence of specific HLA alleles

Genetic Polymorphisms

Environmental FactorsAllergen sensitivitiesHaving few siblingsExcessive hygiene

Receipt of antibiotics in the first two years of life

Vaccination and prevention of disease

Defects in Target OrgansBronchial epithelium Skin

Gut

TriggersViral infections

Exposure to allergensTobacco smoke

Indoor and outdoor pollutants

Atopy

Th2 mediated allergic inflammation.

Signs and symptoms of allergies

Symptoms of food allergy include •wheezing•stomach upsets and •skin rashes•Bloating•Gastrointestinal pain and gas•Mood and behavioural disturbances

Symptoms of food intolerance are similar to food allergy, but can be associated with conditions including •asthma, •chronic fatigue syndrome and •irritable bowel syndrome (IBS). •ADD/ADHD

Some food allergens include nuts, gluten and wheat, casein, shellfish, milk, egg and soy products.

The Hygiene Hypothesis• The prevalence of atopic diseases has increased abruptly in

recent years in most Westernized societies

• The best paradigm available to day to explain this steep rise, the ‘Hygiene hypotheses’ , supports that it is the excess cleanliness of out environments that has led to the decline in the number of infectious stimuli that are necessary for the proper development of out immune system.

Grammatikos Ap. The genetic and environmental basis of atopic disease. Ann Med. 2008,4(07)482-95

Allergies

Weak Immune System

Causes

Allergy as an immunological disorder• It is defined as a disease that follows an immune system

response towards an otherwise innocuous antigen (AG) and is usually equated by the type of hypersensitivity reaction.

• Key Points• The presence of particular gene variations modifies an individuals

likelihood to develop allergic diseases.• Exposure to infections during the maturation of a child's immune

response may be crucial to reduce reactivity to innocuous environmental particles

• More than any specific infection, it is the overall microbial burden early in life that seems to protect against development of allergies.

Immune Imbalances contribute to Allergy• Children are born THelper 2 dominant

• Viral Bacterial and Parasitic infections protective against allergy, although helmiths induce Th2 response, and virus and bacteria skew towards Th1 response, the high overall infection burden seems to be an instrumental factor in the development of the anti-inflammatory regulatory network. Instead of the Th1-Th2 dichotomy, a pro-versus anti-inflammatory T-Cell regulatory axis may be central to the outcome.

• Meaning that in order to have immune balance we must be exposed to bacteria and pathogens in order to activate immune TH1 response. Otherwise over activation of Th2 is present resulting in allergy response.

Technology

VS

Environment

What Causes a Weak Immune System?

Environment

Pollution

Obesity Over Cleanliness

The gut connectionThe gut connection

Digestive Enzymes• What are enzymes?These are protein like substances, formed in animal and plant cells, that act as catalysts to

initiate or speed up specific chemical reactions and breakdown of proteins within the cells. We have trillions of enzymes, and as they complete their function they die. Enzymes are in every cell of our body, performing vital functions every mili-second.

• Where do they come from?All living cells contain enzymes - they are the "spark of life" in the cells. We are born with a

"bank of enzymes". Although, to some degree, we can replenish enzymes by manufacturing metabolic enzymes in the liver and digestive enzymes in the pancreas (primarily for protein digestion), the number of enzymes each cell can produce is limited. Most of the enzymes needed for digestion should come from food.

• What do enzymes do and why are they so important?These tiny substances are vital to all cellular activity in our bodies. Your heart, lungs, liver,

eyes, skin, glands, immune system - every organ, tissue and cell in your body are dependent upon enzymes for every process and function. Enzymes help prevent degenerative disease, keep us youthful, increase our energy. Digestive enzymes break down food and insure complete digestion and assimilation of nutrients. When our enzyme bank is depleted, we die, so we want to be sure they are not wasted.

Where do we get them from?• Protease,helps digest proteins. Un-digested proteins wind up in circulatory system and other parts of your body.Food Sources: Broccoli, Figs, Guava, Ginger root, Green plants, Kiwi, Mushrooms, Papaya, Pineapple,

Romaine lettuce, Spinach, Soy bean, Wheat, Kidney beans

• Amylase,helps digest carbohydrates. Incomplete digestion can cause blood sugar imbalances, allergies, and asthmaFood sources: Banana, Beets (roots, leaves and stems), Cabbage, Reishi mushrooms, Sweet potatoEgg, Maple sap, Milk, Honey, Sugar-cane, Barley, Corn, Oats, Rice, Wheat, Kidney beans

• Lipase,helps digest fat. Incomplete digestion can lead to clogged arteries causing blood pressure and heart

problems.Food Sources: Avocado, Coconuts, Corn, Flaxseeds, Raw red meats, Romaine Lettuce, Spinach, Wheat

germ ,Rice, Soybeans, Rape seeds

• Cellulase,Helps break down cellulose (soluble fiber). Helps bind heavy metal and toxins to be expelled out of bodyFood Sources. Avocado, Peas, Reishi mushrooms, Oat sprouts,

continued• Maltase,Helps convert complex sugar found in malt and grain products into glucoseFood Sources: Banana, Beet leaves, Green plants, Brewers' yeast, Mushroom, Sugar-cane, Rice,

• Lactase,Helps digest lactose found in dairy productsFood Sources. Almonds, Apples, Peaches, Persimmons, Tomatoes, Milk.

• Sucrase,Helps digest sucrose including table sugarFood Sources. Cucumbers, Potato, Romaine Lettuce, Spinach, Sugar-cane

• Alpha Galatosidase,Hydrolyzes sugars in beans that ferment and cause gas. This enzyme is in the Bean-o ,Helps prevent gas. Food Sources: Cucumbers, Sprouted legumes (soy beans, cowpeas)

• Phytase,Helps digest Phytic acid (Phytate) found in Grains and Seeds releasing phosphorus, calcium and other nutrients

Digestive Enzymes and their influence on allergies• Different research ex periments that were performed by Dr. Willstatter as far back as 1929 proved

that white blood cells contain eight different types of amylase, protease, and lipase. He states that "white blood cells provide transportation for enzymes throughout the body". Antigens, bacteria, yeast, and other toxins enter the body through the digestive tract. They leech onto food substances we ingest and then multiply prolifi cally within the body of the immune system if it is not strong and healthy enough to destroy them.

• Al lergens (substances causing an allergy) can also en ter the body simply through the air that we breathe. Most antigens, bacteria, viruses, and yeasts are proteins. Often the toxins causing allergies and in fections are secreted by bacteria that also contain protein substances.

• At this point it should be understood that the body needs a tremendous supply of protease (protein di gestive enzymes) to counteract the constant bom bardment of these proteins to digest and eliminate them. This digestion of protein is done by enzymes, not only in the digestive tract, but in the bloodstream itself. Undigested proteins are often found in the bloodstream. If digestion is not properly accom plished, undigested substances can be absorbed through the digestive tract.

• Antigens that cause allergies attach themselves to these proteins in the blood (antigen complex), deposit in the walls of tiny capillaries and secrete sub stances that cause inflammations which result in swellings, sneezing, hayfever, hives, asthma, etc. In order for the body to rid itself of the allergen, it must be separated from the protein molecule. This is ac complished by enzymes that digest the protein and release the allergen so the body can eliminate it via the lymphatic system

Digestive Enzymes• How can enzymes be wasted?When we eat foods that don't contain digestive enzymes, our body must

use its limited supply of metabolic enzymes to digest our food, for digestion is the body's main priority

• Digestive enzymes are supposed to come from food. Our bodies cannot make up for the amount of enzymes needed to digest the average meal.

• Why don't most of our foods contain enzymes? Cooked, processed and chemical laden foods do not contain enzymes.

Even people who eat healthfully include cooked foods in their diet, for some foods must be cooked. Also, "live" foods (raw fruits, vegetables, etc.) that are not organically grown don't contain enough enzymes.

• Not only do many of our foods not contain the necessary digestive enzymes, they --especially all "junk foods" -- use up an excessive amount of your metabolic enzymes as your body attempts to digest these "foodless foods".

Digestive Enzymes what if we don’t have enough?• What happens when we don't have enough enzymes for

digestion?We experience digestive problems of all kinds, usually with gas, pain,

allergies and discomfort. Essential nutrients are not assimilated and lack of nutrients leads to disease. In addition, incomplete digestion causes toxicity from undigested food particles and toxicity also leads to disease. Perhaps the most serious result of lack of enzymes and incomplete digestion is a weakened immune system.

• Many people, who would benefit from taking digestive enzymes, are taking over-the-counter medicine for digestive disturbances and what is commonly called "heartburn". These are harmful, and in fact, until recently, some of the more powerful ones could only be obtained by prescription. These medicines block the production of hydrochloric acid, which is essential for the digestion of minerals and protein. (In addition, hydrochloric acid is our first line of defence against harmful bacteria…but that's a different presentation.)

Allergic Infants have less beneficial bacteria• Infants who develop allergy were less often colonised with

enterococci, bifidobacteria and bacteriodes in their stool cultures.

• Allergic infants had higher counts of Staphylococcus Aureus and clostridia counts.

Kim Ds, Drake-Lee AB. Infection, allergy and the hygiene hypothesis: historical perspective. J Laryngol Otol. 2003 Dec; 117(12):946-50

Bacteria, parasites and microbes• What are they?• Bacteria &Yeast • Microbes & Parasites• Intestinal Permeability (‘Leaky gut’)• Inflammation• Constipation & Diarrhoea• Food Sensitivities and Allergens

Symptoms of a microbial infection

• Headaches, “heavy head,” “heavy-feeling headaches.”• Alternated periods of mental “fuzziness” and greater

mental clarity.• Feeling “muggy-headed” or “blah” or sick in the

morning.• Transient malaise, flu-like symptoms.• Transiently increased fatigue, waxing and waning

fatigue, feeling more tired and sluggish, weakness.• Dizziness.• Irritability.• Sensation of “brain firing: bing, bong, bing, bong,”

“brain moving very fast.”• Depression, feeling overwhelmed, strong emotions.• Greater need for “healing naps.”• Swollen or painful lymph nodes.• Runny nose, low grade “sniffles,” sneezing, coughing.

• What do they do?• Support immune system, Adsorption of food and nutrients, Reduce

inflammation, inhibit growth of harmful bacteria and pathogens)

• Can they effect brain function?• Why treating with Antibiotics does not work?• Signs and symptoms of bacterial infection…

Abnormal stools, fevers that come and go, persistent nasal congestion or cough, and behaviours that are abnormal

Bacteria

Yeast infections (Candida)• What is yeast?• What are the symptoms?

Itching, rashes, eczema, abdominal bloating, increase in flatulence, constipation or diarrhoea, smelly stool; silly/giddy behavior, aggressive, stimming, chewing - on anything, low energy, cravings for bread, pasta and sweets• Why do we get it?• How do we treat it?

Yeast• Candida albicans, which lives almost everywhere in the body, is an example of such a

yeast. These yeasts live naturally in the intestinal tract and vaginal areas of animals and humans. They can take over our whole body if the immune system is weakened. It is important to realize that yeasts are also protein bodies and can be digested by enzymes if the body has a proper supply.

• Candida can change form in the human intes tines. It can remain in a yeast-fungal form and enter the circulation or develop a root structure that pen etrates the intestines, creating a large enough open ing for other bacteria, antigens, and undigested pro tein to enter. These other substances that enter are a major cause of allergies, anxiety, fatigue, digestive disturbances, vaginitis, cystitis, menstrual problems, and migraine headaches. This is the reason for the similar approach in treating both candida and aller gies.

Parasites• What is a parasite?• Where do we get them from?• Signs and Symptoms of a parasitic infection…

Allergies, Headaches, Anxiety, Depression, Comprehension difficulty, Brain Fog, Gas and bloating, Constipation, Diarrhoea, Foul smelling stools, Chronic fatigue, low energy or

hyperactivity, Flu symptoms, fever and aches, Poor Immune function, Sleep disturbances, Grinding teeth at night, Vision problems, Anaemia, Eczema, Rashes and itchy back passage, Allergies, Weight gain or loss

Damaged Intestinal VilliDamaged Intestinal Villi

Leaky gut causes chronic inflammation

Hypochlorhydria (Low Hydrochloric acid)

• Hypochlorhydria is the lack of adequate stomach acid (hydrochloric acid) production

• Insufficient stomach acid also causes absorption of partially digested food molecules, leading to food sensitivities.

• Low stomach acid increases the overgrowth of pathogens in the lower intestine.

• Malabsorbtion of minerals vitamins and amino acids and

increases the chances of food sensitivities.

Hydrochloric Acid what impact does it have?• Hydrochloric acid helps break down proteins and also plays an

important role in signalling to the pancreas to release digestive enzymes and bicarbonate.

• HCl helps sterilize stomach contents so that bad bacteria cannot hitch a ride into the small intestine for invasive and destructive colonization.

• Plenty of folks over 40 or 50 have insufficient HCl for digestion; heartburn is often linked to low HCl levels and over-the-counter medicines only address the symptom and not the root cause and can lead to poor digestion, dysbiosis, leaky gut and allergies.

Symptoms/signs of stomach acid deficiency? Stomach aching/pain/discomfort or

bloating after meals

Feel unwell/fatigued right after meals

Food or water 'sits in stomach'

High fat foods cause nausea/stomach upset

Undigested food in stool

Reflux &/or heartburn

Poor appetite or feel overly full easily

Multiple food sensitivities

Trouble digesting red meat

Constipation

Low iron levels

Frequent nausea

Nausea/reflux after supplements (e.g. fish oil)

Burping after meals

What is Asthma ? Chronic inflammatory disorder of the medium and small airways.

These airways are hypersensitive to certain “triggers” in the environment.

Intermittent and recurrent episodes of...

Wheezing Shortness of breath Chest tightness Cough - night, early morning

Usually reversible

Asthma cannot be cured but its symptoms can be controlled with proper environmental changes and medication.

What causes an Asthma Attack ?• An allergic reaction to triggers or exposures

• Airways swell and fill with mucus and secretions

• The muscles around the airways contract and spasm

• Airways can collapse, causing classic symptoms, even death

The facts about Asthma

• Most common chronic childhood disease, affecting about 5 million children (6% of children under 18)

• 14 people die each day from asthma• Nearly 2 million emergency room visits each year• Asthma is not curable but is preventable

Histamine and Leukotrienes are key mediators of asthma• Histamine is an important protein involved in many allergic reactions.

Allergies are caused by an immune response to a normally innocuous substance (i.e. pollen, dust) that comes in contact with lymphocytes which stimulates TH2 immune response to release histamine. Histamine acts very quickly and stimulates bronchoconstriction and excess mucus production.

• Histamine, along with other chemicals, causes the contraction of smooth muscle (Schmidt et al 1999). Consequently, the muscles surrounding the airways constrict causing shortness of breath and possibly complete trachial-closure, an obviously life-threatening condition.

• If the effects of histamine during an allergic reaction are inhibited, the life of an allergic person can be eased (in the case of inflammation) or even saved by preventing or shortening asthma attacks.

• One of the best ways to reduce histamine over production is Vit C

Indoor air Triggers• Environmental tobacco smoke (ETS)• Cockroaches• Dust mites• Animal dander • Mold, mildew• Strong scented products (perfumes, scented cleaners)

Why indoor air is Important

• All of the common asthma triggers are found indoors

• We spend about 90% time indoors

• Reducing exposure to indoor allergens and irritants can reduce asthma symptoms

• Prevention is an important asthma management tool

Secondhand Smoke

• Contains more than 4,000 substances (over 40 are carcinogenic)

• Is particularly harmful to young children

• Can trigger asthma attacks and cause young children to develop asthma

Dust Mites• Found in most homes

• Live in soft bedding

• Feed on skin flakes

• Mites and mite droppings can be asthma triggers

• Most common asthma trigger in adults and kids

Pets

• Skin flakes, urine and saliva of warm blooded animals can be asthma triggers.

• Triggers can remain in the home for several months after a pet is removed, even with cleaning.

• Can be found almost anywhere.• Key to mold control is

moisture control.

• Clean up the mold and get rid of excess water or moisture, this also helps reduce other triggers, such as dust mites and cockroaches.

Molds

• Droppings or body parts can be asthma triggers.

• Cockroaches likely contribute significantly to asthma problems in inner city area.

• Asthmatic children allergic to cockroaches are three times more likely to be hospitalized if exposed in the home.

Cockroaches and other Pests

Outdoor air Triggers• Ozone

• Particulate matter

• Sulfur dioxide

• Nitrogen dioxide - vehicle exhaust

• Outdoor pollens and mold

Additional Triggers• Viral upper respiratory

infections• Exercise• Dietary sensitivities• Aggravating conditions -

gastric reflux, sinusitis, rhinitis

• Diet, medication• Cold air• Changes in weather• Menstrual cycle, pregnancy

Management of Asthma

Asthma is one condition that, when treated

with timely and effective regular outpatient care,

prevents hospitalization and ED visits.

Managing AsthmaConsult with a physician or alternative health

practitioner to develop an asthma management plan, which includes:• Medication• Education: identification of asthma triggers &

ways to reduce/avoid exposure to your asthma triggers• Peak flow monitoring• Emergency plan

Goals of asthma Management

• Control chronic asthma symptoms and asthma attacks during the day and night• no sleep disruption due to asthma• no missed school or work because of asthma• no or minimal need for emergency care or hospitalizations

• Avoid attacks or exacerbations• Maintaining normal activity levels, including exercise and other

daily activities• Having normal or near-normal lung function• Avoid side-effects of medications• Prevent asthma mortality

Avoiding secondhand Smoke

Choose not to smoke in your home or car and do not allow

others to do so either.

Avoiding dust Mites• Wash sheets and blankets once a week in hot water

• Choose washable stuffed toys-- keep stuffed toys off beds

• Cover mattresses and pillows

• Vacuum often (when asthmatic is not present)

• Maintain low indoor humidity, ideally between 30-50%

Avoiding pet Triggers

• Consider keeping pets outdoors or even finding a new home for your pets, if necessary.

• Keep pets out of the bedroom at all times.• Keep pets away from fabric-covered furniture, carpets, and

stuffed toys.

Avoiding mold Triggers

• Wash mold off hard surfaces and dry completely, absorbent materials (ceiling tiles and carpet) may need to be replaced.• Use exhaust fans or open windows in kitchens and

bathrooms when showering, cooking, or using the dishwasher.• Maintain low indoor humidity (between 30-50% relative

humidity).• Fix leaky plumbing or other sources of water.• Keep drip pans in your air conditioner, refrigerator, and

dehumidifier clean and dry• Clean bathrooms frequently with non caustic products

Pest Avoidance

Free your home of places for pests to hide and sources of food and water

Regular, careful cleaning - kitchenDaily trash removalStore food in airtight containersExtermination - baits, gels (not sprays)

Peak expiratory flow (PEF) Meters

Allows the Allows the patient to patient to assess the assess the status of his status of his or her or her asthmaasthma

Peak flow ChartPeople with moderate People with moderate or severe asthma or severe asthma should take readingsshould take readings—— Every morning Every morning and and eveningevening After an After an exacerbationexacerbation Before inhaling Before inhaling certain certain medicationsmedications

Source: “What You and Your Family Can Do About Asthma” by the Global Initiative For Asthma Source: “What You and Your Family Can Do About Asthma” by the Global Initiative For Asthma Created and funded by NIH/NHLBICreated and funded by NIH/NHLBI

Nutritional deficiencies common in asthma• Magnesium deficiency is a common electrolyte

disorder in patients with acute asthma. There are some data suggestion lower levels of Mg2+ in asthmatic patients compared to non-asthmatics.

• Fish oils reduce airway inflammation and the severity of exercise induced bronchoconstriction with a concomitant decrease in bronchodilator use.

• Vit D is an immune modulator, immune induced asthma has been shown to decrease with the use of Vit D in children suffering from Low Vit D.

Conclusions• Asthma affects 5-10% of the population and the prevalence is

rising in developed countries.

• Allergies often play a key role in asthma and act as triggers for asthma symptoms.

• The gut and its function plays a key role in allergies that may affect asthma

• Deficiencies in specific enzymes may also play a key role in the development of allergies and asthma related effects.

• Asthma can not be cured but can usually be well controlled in most people.

• Controlling asthma involves patient education, lung function monitoring, avoidance of triggers, and in many, medications and dietary correction.

Thank you - Any Questions?

Amanda Franzi