integrative approach to asthma. asthma prevalence is rising worldwide better diagnosis air pollution...
TRANSCRIPT
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Integrative Approach to Asthma
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Asthma prevalence is rising worldwide
better diagnosisair pollutionallergiesdietary factorshygiene hypothesisobesityantibiotics in 1st year
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Asthma prevalence in Canada 1978-1996
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Asthma morbidity and mortalityAsthma prevalence: 8.4% of persons >12 years >12% of children ages 0-9
Millions of office visits>50,000 hospital admissions/year >500 deaths in Canada/yearSignificant costs: Quality of life Medications Health care system
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Key features of asthma
Variable air flow obstruction
Airway hyper-responsiveness
Cellular inflammation
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Asthma is a
heterogenous condition
exercise allergens infections
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Integrative approach begins with good conventional care
Education
Recognize triggers
Clear treatment plan
Optimize asthma control
Minimize visits to ER,
life threatening episodes
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Integrative therapy for asthma
Prevention
Diet
Botanical medicines
Mind/body therapies
TCM
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Asthma Prevention: dietary fatsThe kinds of dietary fats consumed during pregnancy may have a significant impact on childhood asthma riskAn increase in omega 3 fat consumption from oily fish has been found to be beneficial Fried fish sticks (high in trans fats) have been found to increase riskConsumption of fatty fish > once per week in childhood may also be protective
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Asthma prevention: breast feeding
Exclusive breast feeding has been found to childhood asthma by 30-50%
A 50% reduction has been found in high risk children
Encourage exclusive breast feeding x 6 months
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Modifying the severity of exercise induced asthma (EIA)
Low salt diet
omega 3 fatty acids
omega 6 fatty acids
Increase dietary antioxidant vitamins, especially vitamin C
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Low salt diet
Higher salt intakes in a population are proportional to the prevalence & severity of asthma
Several RCT’s have shown: Low salt diet improved lung function High salt diet worsened lung function
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Sodium
Recommended sodium intake is 1500mg/day (or definitely < 2400mg/day)
1 teaspoon of salt = 2358mg
Average North American diet contains over 3900mg/day
75% of sodium in our diet comes directly from foods: tinned soups, snacks, processed meats, restaurant meals
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Essential fatty acids
There are two main groups of essential fatty acids: omega 6 and omega 3
North American diets are generally overloaded with omega 6 fats and deficient in omega 3 fats (ratio n-6:n-3 12-40:1)
The ideal ratio of n-6 to n-3 fats is thought to be ~ 1-2:1
Diets high in omega 6 fats can promote inflammation
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Fish oil (EPA+DHA) reduces inflammation
1997 AJCN: >40% of the asthmatic ‘responders’ showed a complete resolution of airway hyper-responsiveness. The others showed no change.
2003 AJRCCM: Elite athletes with exercise induced asthma who supplemented with 3.2g/day EPA and 2.2g/day DHA showed a marked improvement in post exercise pulmonary function
Omega 3 fatty acids in EIA
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Linoleic acid (LA)
Gamma-linolenic acid
(GLA)
Arachidonic acid
(AA)
Alpha-linolenic acid(LNA)
Eicosapentanoic acid (EPA)
Docosahexanoic acid (DHA)
Omega 6 pathwayOmega 6 pathway Omega 3 pathwayOmega 3 pathway
Delta-6 desaturase
Elongase
PG1
PG2
PG3
Safflower, sunflower, corn, peanut oils
Flax, walnuts, hemp, canola
Salmon, halibut sardines, herring
Evening primrose oil
Meat, butter
Salmon, halibut, sardines, herring
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Cell membrane composition after
omega 3 fatty acid supplementation
Study EPA DHA (as % total neutrophil FA content)*Arm, et al.10 wk3.2 EPA+2.2 DHA 0.2 2.2
2.6** 2.6
*Lee, et al. 6 wk 3.2 EPA+2.2 DHA <0.1 1.7 1.5** 2.0
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Antioxidants & EIA
Ascorbic acid is the major airway antioxidant useful in EIA: 50-80% response also effectiveness of bronchodilators (500mg
vitamin C 1.5 hrs prior to exercise)
-carotene (found in dark green and dark orange vegetables): benefit seen in ~50%
Lycopene (best source is cooked tomatoes): 45% in FEV₁
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‘Anti-inflammatory diet’
Abundant fruits and vegetables
Healthy fats: olive oil, nuts, fatty cold water fish, fish oil
Low glycemic index/load carbohydrates
Green tea, turmeric, ginger
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Boswellia serrataAyurvedic medicine- gum resin and bark usedBoswellic acids inhibit leukotriene synthesis (anti-inflammatory effect)This herb has been used for arthritis, inflammatory bowel disease and asthmaIn a 6 week study of 40 asthmatics, 70% showed improved lung function Usual dose is 400-800mg tidMore studies are needed to assess long term safety
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Butterbur (Petasites hybridus)Rhizome (root) is usedSpasmolytic and anti-inflammatoryUsed for: migraine prophylaxis, hayfever & asthmaIn a study of 80 people, butterbur decreased asthma symptoms by 47- 65% Important: Butterbur may contain hepatotoxic pyrrolizidine alkaloids. Use clinically tested product such as Petadolex (free of PA’s)Usual adult dose is 50mg 3 times per day
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Ginkgo biloba
Leaf is used (seed used in TCM)
Ginkgolides: anti-inflammatory, neuroprotective, anti-oxidantKEY FACT: Reduces airway hyper-responsiveness and bronchospasm
An 8 week study showed a 15% improvement in lung function
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Ephedra (Ma huang)
Traditional TCM: stems are used medicinally KEY FACT: Has been misused for weight loss and as stimulant (“herbal ecstasy”)Alpha and beta adrenergic effects: can increase heart rate and also cause bronchodilationContraindicated in heart disease, hypertension, glaucomaShould only be used by an experienced practitioner of traditional Chinese Medicine
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Licorice (Glycyrrhiza glabra) Often used in TCM in combination
with other herbsRoot is used medicinallyAnti-inflammatory, anti-tussive, expectorantLicorice can reduce the need for steroids (Steroid sparing effect)Safe dose is 1-1.5 gm crude licorice/dayUse only under the supervision of an experienced health care provider
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Marijuana (Cannabis sativa)
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Marijuana (Cannabis sativa)
Leaves and flower buds are dried and smoked
Contains delta 9- tetrahydrocannabinol (THC)
Marijuana was used as a bronchodilator in the mid 1800’s
Inhaled marijuana has been found to have bronchodilator activity greater than an inhaled beta-agonist
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Mind/body therapy
Hypnosis: 50% of children with asthma have shown improvement after 1 or 2 short hypnosis sessions
Journaling: improved FEV₁ for 4 months
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Journaling results
JAMA April 14, 1999 Vol 281, No 14
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Relaxation & breathing exercises
Identify stress
Teach relaxation
Yoga/meditation
Osteopathy
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Traditional Chinese medicine
Treatment is individualized and usually involves: dietary advice, a botanical formula, chi gong, acupuncture
IKPA (invigorating kidney for preventing asthma) tablets: significant improved lung function in asthma
Wenyang Tonglulo mixture also found effective
Acupuncture: studies show mixed results
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Integrative asthma therapy
Anti-inflammatory diet
Fish oil
Low salt diet
Vitamin C
May consider the use of Boswellia or Butterbur
Mind/body therapy: hypnosis/journaling
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Mind body CD’s or MP3’s
Guided imagery: Belleruth Naparstek www.healthjourneys.com
Self hypnosis: Steve Gurgevich www.tranceformation.com