Anti-Inflammatory Diet

All health care starts with diet. My recommendations for a healthy diet are here:
Anti-Inflammatory Diet and Lifestyle.
There are over 190 articles on diet, inflammation and disease on this blog
(find topics using search [upper left] or index [lower right]), and
more articles by Prof. Ayers on Suite101 .

Monday, October 20, 2008

Asthma

Asthma is chronic constriction and inflammation of the airways of the lungs. Aggrevation of these symptoms can result from allergens, exercise, stress or infection. Once lungs become asthmatic the episodes of symptoms can be controlled by drugs that usually include broncodilators. But what is the cause of asthma?

Risk factors suggest the source of the disease. Exposure to smoke or inhaled pollutants, antibiotic use, formula use, obesity (metabolic syndrome), use of chlorinated swimming pools all increase the likelihood of developing asthma. The common factor in all of the risks is chronic systemic inflammation combined with some irritation of the lungs. Systemic inflammation of asthmatics is frequently the result of altered gut flora. Use of formula or antibiotics, for example, lead to a disruption of normal newborn gut bacteria, replacement with hospital strains, e.g. Clostridia spp., and inflammation. Obesity can also lead to inflammatory gut flora. Systemic inflammation combined with lung irritants, e.g. allergens, chlorinated organic compounds, infections, can lead to allergic responses and in the lung this can mean asthma.

An asthmatic attack starts with spasmodic contraction of the airway muscles, followed by inflammation. Initially, so called cholinergic receptors located in the membranes of the smooth muscles that surround the airways of the lungs, are stimulated by the binding of neurotransmitters. The result is that these receptors trigger the cleavage of phosphoinositol diglycerides to release inositol with three phosphates (IP3) and a glycerol with two lipid chains (diacylglycerol, DAG). The IP3 (which mimics heparin, by the way) binds to receptors controlling the internal stores of calcium (in the endoplasmic reticulum), causing a surge of intracellular calcium. The rise in intracelllular calcium is what causes the muscle cell actin and myosin to contract and the rings of muscle on the airways to constrict. This is ridiculously simplified to show the basic components of stimulating receptors, IP3 increase, calcium increase and muscle contraction.

Early attempts to treat asthma used plant extracts that blocked the action of the cholinergic (as in acetylcholine) receptors. These are familiar plants such as tobacco, coffee, tea and cacao. The cholinergic blockers are nicotine (pictured and in computational model below), caffeine, theophylline and theobromine. Datura stramonium, Jimson weed, also produces atropine, that is another cholinergic inhibitor. There are modern forms of the cholinergic antagonists, which are used to treat episodic constriction.

I have illustrated in the model above, how nicotine binds to the cholinergic receptor, between a tryptophan (bottom, yellow) and two tyrosines (above, orange).

The IP3-calcium constriction system can also be stimulated by allergen-based mast cell release of histamine. The histamine binds to another set of receptors and triggers IP3 release. In this context, anti-histamines are moderately effective, but the initial response is so rapid, that the histamine phase is quickly passed.

The rapid constriction phase is followed six to eight hours later by inflammatory release of leukotrienes that also cause constriction via IP3. Leukotrienes share the same precursor, omega-6 arachidonic acid, as the inflammatory prostaglandins made by the cyclooxygenase, COX 1&2, but in this case an alternative enzyme, lipoxygenase, is used. The leukotriene receptors on muscle cells act similarly to the catechol receptors and stimulate constriction.

Another approach to preventing constriction or actively relaxing airway smooth muscles is by stimulation of adrenergic receptors that have the opposite effect of cholinergic receptors. The adrenergic receptors trigger cyclic AMP production, that compromises the IP3-calcium signaling. Cholinergic receptors are activated to minimize the damage to inhaled toxins or irritants. Adrenergic receptors open the airways to increase airway capacity for flight or fight in response to adrenalin. Some of the drugs to treat asthma stimulate adrenergic receptors and open airways.

Treatment of asthma is centered on constriction episodes and not on reversal or prevention of the disease. Thus, treatment or prevention of an asthmatic episode of airway constriction can utilize drugs that block steps along the cholinergic cascade (receptor, IP3 increase, calcium increase) or by stimulation of adrenergic receptors.

These treatments do not address the cause or reversal of asthma. The inflammatory basis of most asthma risk factors suggests that lowering chronic inflammation, particularly in young children, should be a high priority in preventing asthma. The association of asthma with the use of formula and antibiotics, implicates inflammation, as well as inflammatory gut flora, as the foundations of asthma and emphasizes the essential role of diet and lifestyle in the development of asthma.

2 comments:

Athena said...

"These treatments do not address the cause or reversal of asthma."


So, Dr. Ayers, you DO think asthma can be reversed, perhaps cured?

My 7 year old son has asthma and peanut allergy as well as runny nose and swollen lymph nodes constantly. And now that I've found your blog I know why...I gave it to him by switching to formula when I put him in daycare when I returned to work when he was 8 weeks old. The pediatrician said "that's fine, he got the colostrum, use Carnation because it's hypoallergenic". I didn't know anything back then about pumping and freezing milk ahead of time, all the "professional" moms were switching to formula when they returned to work. He had his first antibiotics at 6 months for strep throat (daycares are sick wards). And as well I always made sure we ate a whole grains and low fat diet, "healthy foods". My husband developed Hashimoto disease during this time and I suffered postpartum depression for over a year. My son has been constipated his whole life since switching to formula, but that's normal for formula fed babies...and toddlers...and school kids the doctors always said because I always kept asking, "just be sure to eat whole grains and make sure he drinks plenty of water, of course and give him prune juice".

I've been pouring through your blog for about four weeks. First I just wanted to sob at what I had wrought in my son's life by passively following other people's advice. But then 21 days ago I started daily 1 teaspoon of Carlson's for Kids Cold Liver Oil, then 10 days ago I started 1000iu daily Carlson's D3 drops. I'm a bit nervous just dosing him like that. But my pediatrician's nurse said that they don't check kids for Vit D deficiency because kids don't have it as long as they drink their milk and run around on the playground every day. Happily in just this short time he has begun regular bowel habits with hardly any odors and his runny nose has stopped completely, JUST LIKE THAT. I've gotten rid of wheat (except for the husband who's apparently addicted and still has it out at lunch during the week) and am slowly working on the other grains, (rice will be the most difficult) and trying to implement the rest of your guidelines. Thank you so much for the tremendous effort you've put into your blog. I am so very thankful, I wish I could give you a big hug, really I'm just teary eyed.

I was hoping that perhaps I'd see a lot of improvement but just now reading this post today I started to wonder if the asthma and Hasimotos could actually be reversed and cured, not just controlled? Do you think it's possible?

From reading your more recent information, obviously my son is the perfect candidate for intestinal biofilms. Could I have your permission to print out some information to take to the pediatrician and ask his help in developing a protocol for biofilm removal? I know, I know, I don't anticipate much cooperation from him. However, I don't feel up to the task of embarking on that on my own, and I wouldn't want to take your information without your permission.

Again, thank you so so much. You are singlehandedly saving my family's health and lives.

rpineau_2001 said...

FYI To Athena: I read a book by Dr. Datis Kharrazian "Do you take thyroid hormones yet still suffer from symptoms?" and it deals with thyroid disorders and Hashimoto's disease. He says that you can't reverse Hashimoto's with exposures to gluten. I don't know if he wrote this, but a single gluten exposure with wreak havoc with your immune system for 2-3 months after the exposure. Based on everything I have read (which is alot), I think you're on the right path. Best of luck. Ron