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Dr. Richard Firshein
Chapter 7. HOW HEALING BEGINS
It began when I was nine years old," Kris, the young woman in my office, said. "My family was on a ski vacation in Colorado, and we kept running from ski slopes into the hot tub. Suddenly I couldn't breathe, and I had to go to the hospital. Since then, I've been hospitalized almost every year, and I feel like I'm addicted to my medications."
Kris is twenty-four years old, a model by profession, waifishly slender and elegant, but when she first came to see me, she had not been able to work in six months.
"Last January I was running around from five in the morning to seven at night doing print modeling, and then one night, I woke up and couldn't breathe, and my inhaler just didn't work," she told me. "I kept taking puffs and I still couldn't breathe. It was terrifying. I was hospitalized for five days.
"The doctor said he couldn't believe I let myself get that sick, but I hate doctors and hospitals. When they give you a shot of adrenaline, you feel horrible, like you're speeding and yet you're a million miles away. There's this roar of nurses and doctors around you, but you're so disoriented you can't understand what they're saying. And then they pump you up with antibiotics and steroids. The steroids make you feel so out of control, like hyperactive.
"I've been in and out of emergency rooms and each time they just send me home with a handful of medications. I feel completely frustrated. I have to think about my asthma all the time. I can't even laugh without coughing. I don't go to parties anymore, because people smoke and I just can't deal with not breathing for the next few days."
Kris's story is not unusual. Asthma calls into play the intricacies of the immune and nervous systems, which are profoundly linked by a vast web of chemical messengers. That's one reason asthma can be triggered by so many factors- from foods to pollutants, changes in temperature, stress, allergens, and unsuspected toxins anywhere from the bedroom to the boardroom. All these stresses strain the body, leading to nutritional deficiencies and cellular damage.
In Kris's case, nutritional supplements were crucial to regaining her health. Her diet had been poor for years. She ate on the fly- slices of pizza, hamburger, and Diet Cokes. She took no vitamin supplements, and her tests showed that she was deficient in magnesium as well as most B vitamins.
"It worked so quickly, I was amazed," she said, referring to her nutritional supplementation. "At first I felt kind of strange because I was taking loads of vitamins, but within two weeks I felt great, I had more energy, I didn't have trouble breathing, I could even walk down the street and go up and down steps without feeling out of breath. I have to go to lots of appointments all day long, so feeling better made a world of difference. Now I'm sleeping well, not always waking up at night. My overall health has been so much better, and I'm more even-keeled emotionally, too. I used to get sick and feel sorry for myself, then get better and party, then get sick again. Now I'm off that merry-go-round."
Nutritional deficiencies are an important key to beginning to heal asthma. Nutrient supplementation targets asthma at a cellular level, where I believe things first go wrong.
How do you work at the cellular level? you study what happens to cells in the lung during an asthma attack. What inflammatory chemicals are released? What damage is caused to the body? What nutrients are required by the body to repair that damage?
During an asthma attack, an allergen or toxin causes an inflammatory response in the lungs. That response actually triggers a whole avalanche of inflammatory chemicals that attack not only the invader but also the tissue at the site of the invasion, attempting through inflammation to confine it and then kill it. As I've explained, perhaps the most damaging by-products of inflammation are free radicals, highly reactive, highly charged particles that can wreak havoc and cause cell damage.
Unless you have a rich supply of antioxidants that can quench those free radicals, you will be unable to prevent tissue damage. Over the long term, that damage can lead to a lung that is scarred, fibrotic, and perpetually inflamed.
THE NUTRACEUTICAL REVOLUTION
Nutrition is not the only answer to asthma, but it is a cornerstone, perhaps the most important one. A few supplements will not miraculously banish your asthma, but supplementation can make all the difference when applied in the context of a complete program. In fact, I don't believe asthmatics can get truly well without nutrient replenishment, either through diet or supplementation.
I have found that nutritional therapy can have a powerful impact on the course of asthma. Research backs me up. The nutrients that work in real life asthmatics have been proven in the laboratory to alter inflammation at a cellular level and help the body to repair itself. I treat asthma with supplements designed to accomplish two goals: to slow and dampen inflammation and to help the body repair itself.
There is a gathering mountain of evidence that nutrients can improve overall health. Nevertheless - and this is an extremely important point - they cannot undo the damage of an unhealthy lifestyle. A recent study of 29,000 Finnish men aged fifty to sixty-nine who were heavy smokers with a high-fat diet showed no benefit from taking the nutrients beta-carotene and vitamin E for six years. Those who quit smoking did show benefit. The study raised questions: Do healthy foods rich in nutrients provide unknown nutritional cofactors that prevent disease? Are higher amounts of nutrients, taken for a longer period of time, necessary to improve healthy in an individual leading a toxic lifestyle?
This particular study does not negate the fact that many epidemiological studies demonstrate a strong link between nutrients and health although they do not prove a cause-and-effect relationship. Two important epidemiological studies of nearly 120,000 people found a significant reduction in hear disease among men and women who took daily supplements of vitamin E. A study of 22,000 male doctors found protective benefit from taking 50 milligrams of beta-carotene every other day for a decade. Another study showed that 9 out of 10 doctors approve the use of antioxidants for chronic heart disease. There are over fifteen studies to date showing that individuals with a diet rich in carotene reduce their risk of lung cancer. Carotenoids have also been linked to protection against heart disease and strokes. One molecule of beta-carotene has been shown to regulate nearly 16 billion free-radical reactions.
Nutrients with antioxidant properties are an equally rich and exciting source of promising studies. Studies done at universities in Texas and California found that vitamins C and E can prevent the oxidation of "bad" LDL cholesterol. A study of 3,000 Swiss men found that the risk of death from cancer was significantly higher among men with low levels of carotene and vitamin C in their blood. Other studies have shown that women with precancerous changes of the cervix had low levels of the same two vitamins.
Given the avalanche of studies about nutrients and health, it's not surprising that a special term has been coined for this burgeoning new field of nutritional medicine, Nutraceutical - nutrients that may fight and prevent illness- has become a buzzword of late. Articles on healing nutrients, from vitamins to phytochemicals (plant chemicals), have appeared in the last few years on the covers of magazine like Time and Newsweek and in articles in The New York Times. Even a publication like American Druggist ran a cover story on plant remedies in May 1992.
Research on the capacity of plant substances to prevent tumors is a hot new field that makes headlines in national media and is now considered a viable topic for publication in top medical journals. This is an intriguing new field that is providing fresh insight into new treatments for illness.
The American public seems to be taking to heart the new research. in 1993 alone, sales of vitamin E supplements soured by 39 percent (to $123 million); beta-carotene sales jumped 31 percent (to $22 million); and vitamin C sales rose 10 percent (to $117 million).
As a nutritionally oriented physician, I feel that one of the most important medical advances of this century is our new understanding that nutrients can have profound benefits for our health. But perhaps the most important news we have is that nature's healing capacities are both complex and subtle. Foods contain far more than vitamins, minerals, protein, carbohydrates, and fats.
IT'S TIME TO CHANGE OUR SIMPLISTIC THINKING
The very concept of vitamins and minerals now turns out to be a simplistic one. Vitamin was originally coined from the Latin vita ("life") and the amine (a scientific term that means "containing amino acids"). Vitamins do not, however, contain amino acids, which are the building blocks of protein. The loose definition of a vitamin is an organic substance present in foods and essential to nutrition in man.
Minerals, in turn, are considered inorganic substances obtained by mining, and the word was coined from the Latin minerale ("ore"). Minerals are important as cofactors in most reactions in our bodies. Hormones, another classic concept, originally meant substances secreted into the blood and regulating organ systems and tissues.
It turns out that none of these substances can be easily classified. They are staggeringly complex.
Consider hormones. Plants are known to contain substances that act like hormones in our body, filling up the same receptor sites. In addition, some hormones can be created in the blood, kidneys, lungs, and other tissues. Some vitamins, such as vitamin E, function as regulators of hormones, and vitamin E can combat excess levels of estrogen in women. Vitamin B6, in turn, has been shown in some cases to help potentiate progesterone in women deficient in that hormone. Vitamin D is transformed by the body into vitamin D3, a hormone-like substance that is crucial in the formation of bone. Most vitamins and minerals play a wide variety of roles in the body, assisting virtually every action and reaction, working as cofactors in enzyme reactions, as building blocks for new tissue and bone, as antioxidants that clean up free-radical damage.
There are countless other substances that also improve health. Some are amino acids, such as carnitine, glutamine and cysteine, to name a few. They can have profound beneficial effects on health. Sulforaphane, a substance discovered in cruciferous vegetables like broccoli and kale, has been shown to dramatically protect laboratory animals from cancer. Certain fatty acids present in fish and flaxseed protect against inflammation.
Nutraceuticals need to be looked at for precisely what they can do in the body. Let's set aside the classic divisions and definitions and examine how these nutrients can help us now, today.
MY APPROACH TO NUTRITION
Study after study shows that disease is clearly linked to low levels of nutrients. These low levels may be due to improper or deficient diets. They may also be due to the stress of fighting off illness, stress that requires greater than normal stores of important vitamins and minerals. We don't have all the answers yet.
What we do know - and what I see in my practice every day - is that when patients flood their bodies with properly monitored levels of special nutrients targeted to treat asthma, they regain their health. The nutrients I recommend fall into the following general categories:
- Nutrients that treat underlying inflammation
- Nutrients that encourage bronchodilation
- Nutrients that serve as antihistamines
- Nutrients that help the body clean up and repair damaged tissue
Some nutrients are so useful in treating asthma that they seem to have more than one effect. Others are targeted to one of the four groups above.
What follows is a thumbnail sketch of the nutrients that I find most useful in treating asthma. No patient takes every single one of these nutrients: a protocol is tailored to specific symptoms. A patient with seasonal allergies, like Rita, a thirty-two-year-old illustrator and mother of two, needs an herb called stinging nettles every spring and summer. Another patient, like Joseph, a thirty-nine-year-old stock broker, with diabetes and food allergies, needs nutrients like glutamine and omega-3 fatty acids to calm inflammation in the digestive tract.
What I offer first, then, is a basic nutrient protocol that can be used by any asthmatic. In order to devise a complete, full-range nutrient program, you must work with a physician who is skilled and knowledgeable about nutrition. You can use your CAP (Comprehensive Asthma Prevention) questionnaire (Chapter 2) and personal history to determine where your problem areas might be, but I recommend that you then work with your doctor in hand-tailoring a nutrient protocol.
THE BASIC ASTHMA PROTOCOL
Magnesium. If I had to recommend one nutrient to asthmatics, it would be magnesium. Over half a century ago, scientist reported that magnesium sulphate worked as a natural bronchodilator, one that opened constricted bronchial tubes without side effects. Though magnesium alone cannot cure a severe attack, intravenous magnesium sulfate is now used at many hospitals along with drugs to treat attacks. Magnesium helps relax smooth muscle, rapidly opens the bronchial tubes, and as at least one report has shown, can prevent intubation (a painful procedure in which a tube is forced down the throat to help a patient breathe).
Magnesium works at a cellular level, most likely by displacing calcium. Calcium stimulates one of the primary allergic cells in the body - the mast cell - to burst and release a flood of histamine. It is also necessary for muscle contraction. Magnesium, in contrast, helps stabilize the mast cell and relax muscles, so it functions as both an anti-inflammatory nutrient and as a bronchodilator.
Only a hospital or a trained physician can administer intravenous magnesium. I find that intravenous magnesium, along with other nutrients such as vitamin C and the B vitamins, can be extraordinarily helpful to my patients. Intravenous infusions of nutrients at levels shown to be safe can go straight into the cell in a matter of minutes. An oral supplement must be broken down and digested before it can be absorbed, and that process can be derailed by faulty enzymes or low levels of hydrochloric acid in the stomach. Therefore, oral supplements are not always sufficient, especially in patients who suffer from digestive problems.
One forty-year-old male executive who came to me was extremely skeptical about IVs. He felt so much better the day after his first IV that he returned religiously for a treatment every week for the next ten weeks. Now he is on a maintenance regimen of one IV every two months.
I find intravenous infusions to be most helpful at the beginning of a treatment program, when I want to replenish long-depleted levels of nutrients. Finally, intravenous magnesium is useful for acute attacks of asthma.
Supplements of oral magnesium can be useful over the long term. I recommend daily oral supplementation to all asthmatics. My preference is a combination of magnesium aspartate, orotate, and glycinate, in a dose of 500 milligrams a day. (As mentioned in chapter 4, accurate magnesium levels can only be obtained through an RBC magnesium test. Standard blood tests only tell you how much free magnesium is floating in the blood, and studies have shown that blood levels can be normal while cells themselves are deficient.) A note of caution: excess oral magnesium can cause diarrhea and lead to hypermagnesemia.
Anti-inflammatories
Omega-3 fatty acids. Another star in the nutritional arsenal, omega-3 fatty acids are found in flaxseed and fish oils and are particularly high in fatty,deep-water fish like salmon, tuna, and mackerel. Actually incorporating itself into the fatty membrane that surrounds a cell, fish oil works as a natural anti-inflammatory substance that inhibits a powerful, hormone-like substance known as prostaglandin E2.
In general, oils such as omega-3 fatty acids are beneficial for the body. Other oils, such as omega-6 fatty acids, are important but can lead to inflammation when taken in excess. Omega-6 fatty acids have been linked to cancer in studies at the Strang Institute in New York City. They do not necessarily cause cancer, but they increase the activity of carcinogenic end-products of estrogen.
Studies on fish oil have produced uneven results, mainly because the length of the studies has varied enormously, from ten weeks to a year. Most studies have shown a significant response at the cellular level within ten weeks, so that key inflammatory cells (called neutrophils) quiet down and fire significantly fewer red-alert messages.
More important, fish oils moderate the late-phase reaction. Asthma involves both an acute inflammatory response and a secondary, late-phase reaction that can occur up to twenty-four hours later and last for weeks. That late-phase response is now believed to be the cause of chronic asthma and tissue damage, and it is halted by fish oils. A dramatic clinical response, however, can take as long as six to nine months. Remember, unlike drugs, fish oils offer a gentle treatment that slowly, over time, helps the body repair tissue damage.
One caveat: studies have shown that for asthmatics who are sensitive to aspirin fish oils may actually intensify asthma. About 10 percent of asthmatics who are aspirin sensitive did not respond to fish oil or found that the nutrient intensified their asthma. Aspirin sensitivity is most often found in patients who suffer from asthma and nasal polyps. In addition, high levels of fish oils can thin the blood. This can be beneficial for those at risk for heart disease. It can also be a problem for asthmatics at risk for strokes. Before you take fish oils, check with your doctor to be sure that your circulatory and cardiac systems are in good shape.
For those who cannot eat fish - either because they are vegetarians, do not like the taste of fish, or are allergic to fish - another option is flaxseed oil, which contains omega-3 fatty acids. I treated one nine-year-old asthmatic who couldn't stand the fish oil capsules because she belched up a fish taste after swallowing them. Flaxseed was a reasonable substitute for her.
Fish oils can be the key nutrient for some asthmatics. One patient of mine, a forty-nine-year-old mother, went in for cosmetic surgery recently. She has been taking fish oils for a year and had been off cortisone during that time. Because fish oils can thin the blood and increase bleeding, she went off them before surgery and did not take them during the eight weeks required for total healing to the head, neck, and face. She began to notice her symptoms returning for a month before she felt fine again.
I generally recommend 6 grams (6 capsules) of fish oil a day to patients who regularly eat fish, and up to 12 capsules a day for those who are not fish eaters. For strict vegetarians, enough omega-3 fatty acids can be obtained from 3 tablespoons of flaxseed oils a day. Both magnesium and fish oils help slow the inflammatory process.
Borage oil and Evening primrose oil. Both these oils, obtained from plants and seeds, provide vegetable sources of GLA, gamma linoleic acid. Borage oil has about four times as much GLA as does primrose oil. GLA is an important fatty acid that some of us have a hard time making because we lack sufficient enzymes.
Another important function of GLA is that the body can transform it into omega-3 fatty acids, although we need sufficient enzymes in our body to do so. The enzyme that is used to transform GLA into omega-3 is also necessary to create inflammatory chemicals from other plant oils. Therefore, by supplementing GLA, you can use up the enzyme in creating "Good" oils and reduce inflammation. Our bodies prefer omega-3 oils to all other oils, and our cells absorb them rapidly. There are a few supplements available that offer both omega-3's from fish oils, and GLA from plant oils. That, in my opinion, is an excellent combination. I recommend 3 grams of borage or primrose oil a day, in three divided doses.
Feverfew. Known officially as tanacetum parthenium, feverfew first became famous for its proven ability to treat migraines. It is rich in two powerful plant chemicals known as parthenolide and sesquiterpenes. A double-blind study published in a prominent British medical journal found that 50 milligrams daily of freeze-dried feverfew significantly reduced migraine headaches in seventeen patients. Another double-blind study of sixty migraine patients confirmed these results. Feverfew seems to inhibit inflammatory chemicals known as prostaglandins as well as histamine. It has also been shown to inhibit bacteria and yeasts. I recommend 750 milligrams a day in two divided doses.
PAF inhibitors. Platelet-activating-factor inhibitors are an exciting new avenue of treatment. Platelets are blood cells that perform a wide variety. They cause blood to clot. They are also part of the inflammatory cascade. (Both inflammation and clotting are important for wound healing.) However, because PAF is part of the inflammatory cascade, it can be a potent trigger of allergies. By dampening levels of PAF, allergies and asthma may be eased. Used in conjunction with fish oils, PAF fighters can help down-regulate the inflammatory arm of the immune system. (Feverfew, for instance, contains one ingredient, parthenolide, that inhibits PAF.) I currently use two other PAF fighters, ginkgo and alkylglycerols.
Ginkgo One of the most famous Chinese herbs, ginkgo is taken from a tree fabled to ensure long life and has long been prescribed for allergies in traditional Chinese medicine. It is now being studied in America for use in Alzheimer's disease, because it increases circulation (including blood flow to the brain). Ginkgo contains potent chemicals such as flavonglycosides, proanthocyanadins, and terpenes. most important, animal studies show that ginkgo reduces circulating PAF and may help prevent allergic asthma.
Ginkgo should be taken as a standardized extract of 24 percent, at 40 milligrams a tablet or capsule. I recommend 3 tablets a day, in three divided doses.
Alkylglycerol. An extract of shark oil, this supplement contains alcohol ethers by that name. These fats are present in high concentrations in bone marrow, the spleen, and the liver, and have been shown to stimulate the immune system and inhibit tumor growth. These alcohol ethers dampen the PAF response. I recommend 1 or 2 capsules three times a day.
Bronchodilators In addition to magnesium, there are a few potent herbs that can open up bronchial tubes. However, I recommend that you take these herbs only under the supervision of a knowledgeable physician and/or herbalist who is working with your physician. Simply taking herbs randomly can be dangerous. A recent patient of mine was suffering from toxic levels of theophylline because of Chinese herbal formula that had been mixed up for her by an herbalist. She was taking the herbal formula every hour, and because the formula contained high doses of theophylline, she was actually suffering from toxic blood levels. You can imagine her surprise, for she had turned to herbs in order to avoid "drugs"!
It isn't often that I see a case like that, but it does indicate a need for caution and supervision. I recommend herbs because, in general, they are gentler than drugs and often contain many active ingredients that work synergistically to improve health.
Ma huang This herb is cultivated in China and has been used for centuries as an herbal remedy. It contains ephedrine, the chemical used in much greater amounts in asthma medications like Tedral. Ephedrine is a nervous system stimulant. Ma huang can reduce swelling in the mucous lining of nasal passages and sinuses. It is a potent bronchodilator. I like to use it for cough associated with asthma because of the soothing effect of the warm tea as it is swallowed and because the ephedra can go right into the mucous membranes. This herb can be found in most health food stores and in herbal tea formulas for asthma. This should not be used by individuals with high blood pressure or heart disease.
Cayenne. Capsicum, or red pepper, stimulates secretion of saliva and thins mucus plugs. It is a stimulant that warms the body, and its active ingredient, capsaicin, has been shown to desensitize the airways of rats to irritants. It reduces the edema and permeability caused by respiratory irritants. This should be used with caution by individuals with peptic ulcer disease.
As you will see, I recommend liberal use of cayenne in cooking. Some patients do well on cayenne, but patients in an acute state of illness may find that it aggravates their intestinal tract. For those who enjoy the taste and warmth of cayenne, I recommend up to 1,000 milligrams a day in three divided doses and/or liberal use in foods.
Coleus forskholii. This herb has been used for centuries in Indian Ayurvedic medicine. It is a rich source of biologically active compounds. The active ingredient, forskolin, helps increase compounds in the body that relax bronchial muscle. Several double-blind studies have shown that the herb is as effective as the drug fenoterol, without the side effects of shakiness and tremors. Standardized extracts of the herb are most effective if they contain 18 percent forskolin. I recommend 50 milligrams two or three times a day.
Turmeric and ginger. Turmeric is a perennial herb of the ginger family used in Chinese medicine as an anti-inflammatory agent. Its active ingredient is curcumin. Ginger, in turn, is native to Southeast Asia. It is known as a warming remedy in traditional Chinese medicine and so is considered useful in colds. Ginger is a potent inhibitor of prostaglandins, inflammatory chemicals. I prefer ginger in herbal tinctures and teas. Fresh ginger can be sliced, simmered for about twenty minutes in water, and sweetened with honey and milk.
Licorice. This is an extensively studied herb whose formal name is glycyrrhiza glabra. It contains anti-allergic, antibacterial, and antiinflammatory compounds. Two of its components have cortisol-like effects in the body. One ingredient in licorice can raise blood pressure, but deglycyrrhizinated commercial products eliminate this problem. Such a product, DGL, is available as a powder, tablet, or tincture. Twenty to forty drops of a tincture in very hot water can be taken as a tea, three times a day. Licorice in its pure form is the preferred treatment, however.
Antihistamines
Vitamin C. This vitamin works as a gentle antihistamine without the side effects of medications. It is also a superstar vitamin that serves as an antioxidant. I recommend 3 grams (3,000 milligrams) a day, in three divided doses.
Stinging nettles. This herb has been utilized for decades as a medicinal agent and edible plant. However, the stinging hairs of fresh nettle leaves contain histamine as well as chemicals that actually liberate histamine when you eat the plant. We don't know why, but somehow this histamine seems to help allergic people. It sounds paradoxical, but in a double-blind study of sixty-nine individuals with allergic rhinitis, nearly 50 percent found stinging nettles as effective as their regular medications.
I use nettles for asthma patients with sinus problems or nasal allergies. Care must be taken to obtain a good brand of nettles that has been properly harvested in the spring, when the potent constituents of the stinging leaves are present. I generally recommend 2 capsules, three times a day.
Quercetin. This is a potent bioflavonoid that has been well documented for its anti-allergic and antihistamine properties. I find it very helpful for allergies and recommend 300 milligrams a day in three divided doses.
Histidine. This amino acid is actually a building block for histamine. For reasons not fully understood, supplements of histidine seem to reduce allergic symptoms. I recommend 1,500 milligrams in three divided doses daily.
Star Nutrients
Vitamins C and E and beta-carotene. This famous triumvirate of free-radical quenchers is being widely studied. In fact, the National Institutes of Health (NIH) now has over a dozen studies under way on beta-carotene and cancer. Each of these nutrients works in a special way.
Vitamin E is a fat-soluble nutrient that penetrates each cell's fatty membrane and, once there, protects the cell from damage. It is especially good at neutralizing rancid fats that have themselves been damaged by free radicals. In particular, vitamin E neutralizes the damaging effects of ozone, a major component of smog. Since studies have shown that asthma and allergies worsen in general after exposure to ozone, this is a necessary nutrient for asthmatics. I recommend 400 international units a day of vitamin E.
Vitamin C deactivates free radicals and stimulates white blood cells to fight infection. It has been proven to directly kill many bacteria and viruses, and finally, it has the ability to recycle vitamin E. After vitamin E has neutralized a free radical, it becomes inactive. In the presence of vitamin C, it can become active again. I recommend 3 grams a day, in three divided doses. Vitamin C can be obtained in a buffered or esterized form so that it does not cause diarrhea and is more easily absorbed.
Beta-carotene and other carotenoids are potent free-radical quenchers. Low carotene levels are linked with decreased white blood counts and decreased ability of the white blood cells to fight infection. Low levels have also been linked with an increased incidence of lung cancer. There are over six hundred forms of carotene found in natural sources, but only 10 percent can serve as building blocks for vitamin A. Those 10 percent, including beta-carotene, can be converted by the body into vitamin A, which is crucial for healthy lung tissue. I recommend up to 25,000 international units a day.
B vitamins All the B vitamins are crucial for energy production in the body. Vitamins B5, B6, and B12 are particularly helpful.
Vitamin B5, or pantothenic acid, is a building block for cortisone. When B5 is deficient the adrenal glands become weak and compromised. Allergies are often a sign of B5 deficiency. B5 has been shown to enhance production of adrenal hormones, sometimes in as little as twenty-four hours.
Vitamin B6, is involved in more bodily functions than any other nutrient. Studies have shown that B6 can improve asthma. Asthmatics with very low levels of B6 in its active, usable form improved dramatically when given 50 milligrams of the vitamin twice a day.
Vitamin B12 boosts energy and immunity and is especially helpful in combating fatigue associated with chronic illness.
Though individual needs for B vitamins vary widely, my basic daily recommendation for moderate to severe asthma is 50 milligrams of B2 and B3, 100 milligrams of B1, 500 milligrams of B5, 150 milligrams of B6, 1,000 micrograms of B12. These vitamins are water soluble, so excess amounts are quickly excreted in the urine. Divided doses enhance absorption.
Zinc Low levels of zinc, an important mineral for immunity, have been linked to poor wound healing and frequent infections, as well as loss of taste. Moderate zinc deficiency is associated with impaired ability to react to specific antigens, such as allergens, while severe deficiency is linked with recurrent infection. (On the other hand, excess zinc can sometimes cause problems, particularly in Alzheimer's patients.) High doses of zinc (over 100 milligrams a day) for longer than a month can displace other minerals, including copper and iron. Therefore, I recommend 50 milligrams a day. For long-term use over 3 months, I recommend 25 milligrams daily.
Vitamin A. An important element in the treatment of asthma, vitamin A ensures the health of mucus-producing epithelial tissue in the lining of the mouth, nose, and lungs. Those low in vitamin A are more susceptible to upper respiratory infections. This vitamin is fat soluble and is stored in the tissues and liver, so it needs to be given in judicious amounts. Excess vitamin A can be toxic. I do recommend supplements, however. Many people forgo vitamin A entirely, taking its precursor, beta-carotene. They do not realize that beta-carotene is useful in its original form as an antioxidant and that the body uses energy to convert beta-carotene to vitamin A. Therefore, modest supplementation with vitamin A, about 5,000 international units daily, is something I recommend. More than 5,000 international units a day can be dangerous, especially in women of childbearing years.
Ginseng. Formally known as eleuthroccocus senticosus, ginseng root is a member of a class of herbs called adaptogens, herbs that normalize the metabolism, whether it is overactive or underactive. Ginseng has been found to help those with hypertension as well as hypotension, for instance. It is very helpful in treating fatigue and low energy. The root contains sterols, coumarins, lignans, an other compounds that seem to increase energy and the ability to tolerate stress. Ginseng extracts vary widely according to the company that manufactures them, but I recommend 800 milligrams a day in capsule form in two divided doses.
Echinacea. One of the most studied herbs in the world, echinacea (purple coneflower) is anti-infective, anti-bacterial, and anti-viral. The herb stimulates our immune system's B-cells and T-cells, as well as interferon. It aids in tissue regeneration and is excellent as a general immune booster. According to Ed Alstat, a pharmacist and founder of Eclectic Institute, it is the long-chain sugars, or mucopolysaccharides, that are responsible for echinacea's immune-boosting capacity. Those complex sugars are also present in other herbs, says Alstat, and he has extracted them in a formula known as Atomic Echinacea. In addition, notes Alstat, tinctures of echinacea often leach out these beneficial long-chain sugars. Freeze-dried herbs preserve the plant better. I recommend about 800 milligrams a day in two divided doses.
Shiitake mushrooms. Known as lentinus edodes, shiitake mushrooms - along with other mushrooms now being studied, such as reishi and maitake - are immune stimulants. They also contain complex polysaccharides that boost T-cells and interferon. Raw or cooked, mushrooms are recommended in any diet. Capsules of freeze-dried mushroom extracts can also be of benefit. I recommend 800 milligrams a day in two divided doses.
N-acetylcysteine (NAC). This amino acid is a free-radical scavenger. It potentiates the body's use of vitamin C. It is also a building block for glutathione, one of the most powerful free-radical quenchers available to the body. Glutathione helps the liver detoxify medications, histamine, and other harmful substances. Finally, NAC has been used therapeutically to reduce mucus buildup. I recommend 500 milligrams twice a day.
Selenium. One of the ten essential trace minerals, selenium is another vital building block for glutathione, and it also helps vitamin E quench free radicals. Selenium is also an antioxidant and helps maintain the integrity of cell membranes, protecting against toxins and toxic metals. I generally recommend 200 micrograms a day.
Garlic For over four thousand years, the Chinese have maintained that garlic has a wide range of benefits, from battling infection to helping prevent heart disease and cancer. Though garlic is not a cure-all, recent research has confirmed that garlic's sulfur-containing compounds do have active pharmacological activity. The amounts vary from variety to variety, and even from bulb to bulb, but garlic's saponins (steroidlike compounds) reduce blood pressure, reduce the stickiness of blood platelets better than aspirin, reduce the risk of colon and stomach cancer, and slow deterioration of the brain. In animal studies, one garlic compound, diallyl disulfide, was found to be very effective in inhibiting tumor growth. I recommend liberal use of garlic or, if you dislike the odor, odorless garlic capsules or oil. However, these may lack some of the beneficial compounds.
As this book goes to press, our knowledge of the benefits of natural therapies continues to grow. In a letter to the New York Times in June of 1996, Mark Blumenthal, executive director of the American Botanical Council, noted that "Thousands of studies are conducted each year on the chemistry, pharmacology, toxicology, and clinical use of hundreds of herbs, their individual chemical constituents and whole extracts containing numerous compounds." Another letter by David Eisenberg, M.D., director of the Center of Alternative Medicine Research at Beth Israel Hospital/Harvard Medical School, concluded, "There is a Chinese proverb: 'Real gold is not afraid of the hottest fire.' It is the responsibility of the medical establishment to ensure that these therapies do not remain untested forever."
A MAINTENANCE PROTOCOL
As I have mentioned, I don't recommend all of the above to any individual patient. The above nutrients are my basic nutritional arsenal. However, I do recommend that all asthma patients take a blend of basic vitamins and minerals. A daily maintenance program should include 1,000 milligrams of vitamin C; 10,000 international units of beta-carotene; 400 international units of vitamin E; and 500 milligrams of magnesium.
IN CONCLUSION
I'd like to return for moment to the efficacy of intravenous supplements. Hospital studies have shown that IV magnesium is beneficial. I find that in acute asthma, IV vitamins including a formulation of preservative-free vitamin C, magnesium, and B vitamins, can be tremendously helpful. They drip directly into the vein and are instantly available for use by the body. Most of my patients who begin with IVs stabilize quickly, needing them later only in times of extreme stress or for a flare-up. Before and after surgery or air travel, for instance, IVs can help protect asthmatics from a relapse.
As for Kris, her health improved so rapidly after embarking on a treatment program that she took a modeling assignment in Europe. Another patient, George, was suffering so badly from allergies and asthma that his wife was ready to divorce him. He was allergic to so many substances that he was unable to concentrate at work or sleep through the night.
"If I even touched a dog or cat, I'd have a terrible reaction," George recalled. "If I petted a dog once and didn't wash my hands, my eyes were red within five seconds and I was sneezing. Everybody in the office knew me as the guy who walked around with a box of Kleenex. They joked that I must be a cocaine addict."
After a protocol of magnesium, vitamin C, B vitamins, ginseng, stinging nettles, and fish oils, he improved quickly.
"I have never had a year like this," George said. "Before, I couldn't go to bed at night without medication. After two months on your program, I can sleep through the night without drugs. But if I stop my vitamin therapy for a few weeks, my symptoms return, the asthma, bronchitis, the whole thing. I tried that in January, and I was a mess, hacking and coughing. So now I'm religious about my vitamins and my monthly IVs. I don't want to suffer again!"
A nurse who works in hospital admissions came to me after she was hospitalized for the third time in a year for acute asthma. A year later, after an intensive vitamin protocol in the context of the CAP (Comprehensive Asthma Prevention) program, she has had no severe attacks.
"I just ran my first road race," one of my patients, Trish, a thirty-four-year-old producer, recently told me. When she first came to my office, she was taking daily doses of prednisone, theophylline, and Ventolin. She was fatigued and depressed. Her "medications" now are magnesium, vitamin C, fish oils, ginkgo, and IVs once a month. She uses her Ventolin inhaler on occasion. "Last year everyone said I looked pale and tired. I didn't travel. Now I'm going to Paris next week - for the pure fun of it."
As more information about the benefits of nutrients unfolds, we will be able to refine the protocols we create to combat illness. Nutritional medicine is, I believe, the direction we will turn to in the future. We now understand that it isn't just a few nutrients, but broad family of powerful substances in our foods, that can prevent illness. Hopefully, in the coming years more research will be done in this area.
That brings me to the next piece of my program: foods themselves. Foods themselves can be your best medicine: by eliminating foods that harm, and emphasizing foods that heal, you can go a long way toward preserving health.
DOCTOR'S RECOMMENDATIONS FOR ACTION
- Nutritional deficiencies are an important cause of chronic asthma. Nutrient supplementation targets asthma at a cellular level and can be surprisingly effective. Many nutrients and herbs have been proven in studies to be helpful in treating the symptoms of chronic illnesses such as asthma.
- Think of nutrients as nutraceuticals - compounds in our foods that can be used to help heal us. Although we have created classes of nutrients, such as vitamins and minerals, that concept is actually simplistic. Vitamins, for instance, can act like hormones in some cases. Fatty acids present in fish can protect against inflammation. Compounds in broccoli can fight cancer.
- Make sure you are taking nutraceuticals that fall into all four categories needed for healing: nutrients that treat inflammation, that encourage bronchodilation, that work like anti-histamines, and that help the body repair damage tissue.
- Consider taking magnesium, orally or (if blood tests indicate it is necessary) intravenously. Studies have shown that magnesium works as a natural bronchodilator. I consider it an essential nutrient in asthma.
- Make sure your diet contains enough omega-3 fatty acids, found in flaxseed and fish oils, as well as deep-water fish like salmon, tuna, and mackerel. Fish oil works as a natural anti-inflammatory substance, and studies show that over a period of months, it can significantly reduce inflammation. Remember, it's the ratio of omega-3 oils to omega-6 oils that is important.
- If you are taking fish oil supplements, be sure to take vitamin E at the same time. Any oil can oxidize, causing free-radical damage. Vitamin E can prevent this.
- Talk to your physician about taking herbs such as feverfew and ginkgo, both of which are anti-inflammatory. Consider other supplements such as nettles, ma huang, cayenne, licorice, echinacea, or herbal asthma formulas. All can be effective in treating symptoms of allergies and asthma. Although many herbs have not been standardized, there is a mounting body of evidence to support their beneficial effects.
- At the very least, take a general asthma protocol of nutrients, which includes vitamin C, vitamin A, vitamin E, zinc, magnesium, B complex, and beta-carotene.
by Dr. Richard Firshein
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