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As we enter the 21st century the incidence of asthma is spiraling out of control throughout the world. It is an epidemic
(44 ). Asthma is the fastest growing chronic disease in America (
44
), affecting more than 15 million Americans ( see Science or Progress? ) and this is expected to increase to 29 million in 2020 (
44
). Between 1980 and 1994 the number of Americans with asthma increased by 75%
while the figure for those under four years of age was an astonishing 160%
( 44
). All the "breakthroughs" and wonderful new drug treatments, and the much
heralded asthma "management plans" which we are constantly reminded about by
modern medicine, have been unable to prevent this continuing epidemic. It has
been predicted that one generation from now an American child will be twice as
likely to develop asthma as a child born today (44 ).
In both Britain ( 45
) and Australia ( 47 ) also, the incidence of asthma has doubled in the past 20 years while during this same period the rate of smoking
in Britain has declined by 50%
(45 ). In the decade from 1980-1990 prescriptions of inhaled steroids for asthma treatment increased by 600% (
45 ).
As has occurred with heart disease, cancer, diabetes, and other chronic diseases ( see
Health Trends ), the drug oriented symptomatic approach of orthodox medicine to disease "management" during the 20th century has correlated with an ever increasing incidence of these diseases.
Science reveals quite clearly that the more drugs that have been developed
for asthma treatment, the more the incidence of asthma has accelerated. The question which never seems to be asked
( let alone answered ) by modern medical science is: what happens to the underlying cause of a chronic disease if the symptoms are continually concealed or "managed" by prescription
drugs? Especially in regard to genetically transmitted diseases, would it not be expected that the disease will become more rampant in the next
generation? How could we expect otherwise when nothing has been done about the cause?
In comparing drug treatments and nutritional treatments the point must be made most emphatically that
any nutritional supplement which is used to correct a deficiency condition will have a curative
effect, unlike drugs which merely conceal symptoms (see Symptom
Suppression, The Current Medical
Paradigm). There is absolutely no evidence that nutritional supplements have any symptom suppressing potential whatsoever. Their positive effects therefore, must be cause based and curative.
It is not surprising that conventional symptomatic drug treatments for
asthma have a long history of tragic results. From the 1960's when the
introduction of asthma "puffers" saw a sudden dramatic increase
in asthma mortality ( 66,
67
), these problems are still continuing, even with more modern puffers ( 65,
66,
67,
68, 69,
70,
71
), as drug companies continue to search for the magic drug. Recently a
trial of salmeterol (Serevent) had to be terminated because of the dangers
of this product (71,
72).
Adrenal Insufficiency and the
Causes of Asthma
Traditionally asthma has been commonly regarded by medical science as a psychological or emotional disorder ( 48 ). The hypersensitive asthmatic child was considered to be suffering from "nerves". Asthma was a psychosomatic disease
(49 ) which was considered to be (
55 )
"purely psychogenic in origin" and therefore was "commonly
referred to as asthma nervosa" ( 55
). Psychiatrists regarded asthmatic children as having an
"allergy to life" ( 48 ) which perhaps was the result of the mother's personality ( 48 ). According to this belief
"something in the mother's personality sets off the child's hidden fears and
anxieties" ( 48 ) and this in turn "produces allergic reactions in the child which constrict the bronchial
tubes" ( 48 ). Because of this scientific evidence certain mothers were described as being asthma causing or "asthmatogenic" ( 48 ). The asthmatogenic mother was described thus ( 48 ):
"on the whole clinicians tend to agree that the asthmatogenic mother is concerned with her own adequacy, self defensive, protective of others, sensitive to demands, in need of reassurance from others, irritable, and tends to feel
guilty." The removal of asthmatic children from their parents as part of their treatment was described by Peshkin (
52 ) as "parentectomy".
While it may seem that the above views are the result of superstitious
beliefs taken straight out of the middle ages, this could not be further
from the truth. In fact they represent the prevailing views of orthodox
medicine when medicine was at the height of its scientific approach
to health care in the mid 20th century. Astonishingly, only 30-40 years
ago many doctors continued to cling to these strange beliefs. I wonder if
today's beliefs will seem equally ridiculous 50 years from now.
Today, although the cause of asthma remains unknown (47,
49,
50 ), asthma is generally considered to be an allergic disease characterised by inflammation and hypersensitivity of the airways (40, 41, 42,
49,
50,
51 ). Asthma, like hay fever, is an atopic disease. The point must be emphasised however, that allergies are merely triggering factors (
47,
50, 51 ), they are not the cause of asthma. According to popular thought today, if an "allergy" is discovered in a patient it is considered to be the "cause" of numerous maladies, including asthma. The true cause of course is the cause of the allergy, the underlying physiological weakness or inability to cope with substances ( or circumstances ) which are harmless to most people. I recall when I was young, before I discovered the connection between vitamins and asthma, how severely "allergic" I was to pasteurised or heat treated milk. Once I commenced vitamins however, this allergy disappeared. Interestingly, no amount of prescribed antihistamines alleviated my allergies to dust and pollens etc..
Since the asthmatic person fails to cope normally with so many diverse triggering factors it would seem that the true cause of asthma lies at a rather deeper physiological level. This is further confirmed by the fact that
"the international pattern of prevalence cannot be completely explained by our current knowledge of recognised risk factors for the development of
asthma" ( 47 ). According to Wright and co-workers (
55
), "traditional environmental risk
factors" do not explain the "rising trends in the prevalence and severity of asthma observed
worldwide." Since emotions or stress may also trigger asthma attacks ( 42,
49,
51, 55
) there is clearly a more fundamental physiological weakness or predisposition in asthmatic persons. In this respect reports of adrenal insufficiency in asthmatics are indeed interesting
( 28, 29, 30, 53,
55
). As I have discussed elsewhere, adrenal insufficiency may cause general hypersensitivity with a reduced ability to cope with a diverse range of stressors including infections, allergies, chemicals, toxins and emotional stress ( see
CFS page, Western Glandular System
). Ironically, conventional asthma "preventer" treatments
such as Flixotide and Seretide may even cause adrenal insufficiency (
59, 65,73,74
).
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It has been confirmed
again recently that atopic
or allergic disorders, including asthma and atopic dermatitis, are characterised by a significant loss of adrenal reserve capacity (
54,
56, 63
). Such patients have a significantly blunted cortisol output in response
to stress (see graph ). |
|
Cortisol Responses to Stress in Allergic Children
Angelika Buske-Kirschbaum, S. Jobst, D. Psych, A.
Wustmans, C. Kirschbaum, W. Rauh, D. Hellhammer, Psychosomatic
Medicine, 1997
Graph courtesy U.S.
National Library of Medicine
|
The presence of adrenal insufficiency in asthma,
particularly diminished adrenal reserve capacity, has been
known since Robson and Kilborn ( 28 ) reported that 67% of continuous
asthmatics had diminished adrenal reserves almost 40 years ago. Given this
loss of adrenal reserve capacity it is interesting to note a recent
report that asthmatics are genetically protected from diabetes ( 64
). This is of enormous importance for it may have considerable
implications regarding the cause of both diabetes and asthma. Since
adrenal insufficiency causes hypoglycemia, the exact opposite of diabetes
( see Body Types ), while diseases which produce
adrenal hyperfunction are associated with hyperglycemia or diabetes ( see
Body Types ), it would seem that diabetics and asthmatics may
represent constitutional opposites
( see Body Types ). If asthmatics suffer from genetically
reduced adrenal capacity then their immunity from diabetes would not be
unexpected.
When the occurrence of adrenal insufficiency in asthma is considered
it is hardly surprising that other constitutional symptoms of adrenal
weakness, such as anxiety and other mood disorders, are also common in
asthmatics (75,76,77,78,79,80,81,82).
Since excessive anxiety is known to be a feature of "sensitive" constitutional
types (see Hypophobia page), it seems modern
medicine is completing a circle and returning to its former belief that
asthmatics are fundamentally hypersensitive in nature. This contrasts
sharply with the more simplistic reductionist belief that asthma is simply
a disease of the airways. Reductionists would probably suggest
that asthmatics are excessively anxious simply because of worry about
their disease or perhaps because of the side effect of medications. The
possibility of a common constitutional cause would of course be much less
popular.
The common occurrence of anxiety and mood disorders in asthmatics is
especially significant given the fact that such mood disorders are
considered to be adaptive diseases (see Stress and
Adaptation). Adaptive diseases result when the body, perhaps because
of genetically reduced adrenal capacity, is unable to properly adapt to
the stresses with which it is confronted (see Stress
and Adaptation). Anxiety is also considered to be an evolutionary
defensive emotion aimed at protecting the body and increasing survival
rates (see Stress and Adaptation). It is indeed
interesting that asthmatics seem to be genetically programmed to enhance
this life preserving defensive emotion.
Unless asthma treatments address any contributory adrenal
insufficiency and restore normal adrenal reserves and normal adaptive
capacity ( as distinct from simply increasing blood cortisol levels;
see CFS page, Body Types, and Traditional
Medicine page ), then an ever increasing number of drugs may be
required. From a nutritional point of view all those nutrients which are known to be essential for adrenal function
may be particularly important. Such nutrients include vitamin C, vitamin B6, zinc, magnesium, and pantothenic acid
( 41; see also, CFS page, When Changing Genes is Not
Possible, The Current Medical Paradigm ). Various other nutrients may also be necessary, particularly those which are most important for the health of the respiratory system and the immune system.
Given the fact that conventional medical treatments for asthma do not address the underlying cause, the rising incidence of asthma is hardly surprising.
Many people today are satisfied to try and eliminate each separate allergy
without concerning themselves with the underlying cause of this
hypersensitivity to normal substances. Continuing to use symptomatic treatments
while ignoring the underlying cause raises the very real possibility that there will be an increasing number of cases of
"difficult asthma" ( 57,
58
), asthma that is completely unresponsive to treatment by asthma inhalants (57 ), and steroid dependent asthma
(57,
58
). As I have mentioned elsewhere ( see
But What About Efficacy? ), in my own case, prior to commencing vitamins, asthma inhalants were totally ineffective.
The whole history of the relationship between asthma and vitamin B6 is beginning to resemble the discovery and treatment of other nutritional diseases. Although, according to Hoffer (
1 ), most medical treatments are not generally accepted until around 40 years after their initial discovery or introduction, history shows quite clearly that when it comes to nutritional treatments such as vitamin B6 therapy for asthma or thiamine treatment for beri
beri, the figure of 40 years may be extremely conservative. Just as
scientists and doctors opposed nutritional treatment of beri beri for
around 200 years ( see Nutrition
is for the Birds ), there will continue to be those who oppose nutritional
treatments, preferring instead, symptomatic drug treatments. Such persons
typically make no distinction between the potentially curative or
preventative effects
of nutrition and the symptom concealing effects of drugs ( see Symptom
Suppression ).
Deficiency of vitamin B6, which causes altered metabolism of tryptophan and serotonin and subsequent excretion of substances such as xanthurenic acid and kynurenic acid in the urine, has long been suspected in asthmatic patients because of the prevalence of these urinary changes in earlier studies of asthmatic patients (
2, 3, 43
). These studies were confirmed by later studies showing further evidence of vitamin B6 deficiency in asthmatics (
4,
5 ). Additionally, and more significantly, large doses of vitamin B6 have been shown to be remarkably effective in reducing symptoms of asthma in various patients (
4,
5,
6 ), although Kaslow
( 7 ) claims that this vitamin is only effective in children. While Hall et al (
8 ) could not confirm the presence of vitamin B6 deficiency as a result of their study of asthmatic patients, in a subsequent reanalysis of their data, Reynolds and Natta
(4 ) claimed that the B6 treatment used by Hall and co-workers caused a "possible improvement in the B6 status of the children" (
4 ). The
report by Hall et al ( 8 ) is notable in several important respects.
Firstly, it is a study of B6 status only, not an assessment of the
effectiveness of B6 supplements as a treatment for asthma. Secondly,
unlike most studies, the control subjects selected for this study were
all suffering from various illnesses. These sick children formed the
yardstick by which the B6 status of the asthmatic children was assessed.
In view of the fact that it had previously been demonstrated by Azuma et
al ( 9
) that even 'healthy" controls are likely to be deficient in B6, the
deliberate choice of sick children effectively invalidates the reliability
of this study. In view of the results of the earlier study of Azuma et al
( 9
), the question must be asked as to precisely why Hall et al ( 8 ) chose
to use sick children for their controls.
From a practical point of view the most important aspect of all these studies is the demonstrated effectiveness of vitamin B6 supplements as a treatment for asthma
( 4,
5,
6 ). According to Reynolds and Natta in this regard ( 4 ),
"all subjects reported a dramatic decrease in frequency and severity of wheezing or asthmatic
attacks" while taking the vitamin B6 supplements. For the purposes of this study it must be emphasised that the dose of B6 which was necessary to bring about this response was around 100mg or more daily (
4,
5 ). In fact, the symptomatic and biochemical response to 50mg daily (
5 ), or 50mg twice daily (
4 ), was inferior to the response to 100mg daily (
4,
5 ). Only by using the larger dose could the vitamin B6 status of these patients be corrected. Interestingly, according to Simon and Reynolds (
10 ), even after daily supplements of 100mg of pyridoxine, plasma pyridoxal phosphate (
the active form of B6 ) levels were still 30% lower in asthmatics than in controls.
These studies confirm that these asthmatics suffered from a vitamin B6 dependency condition, that is they were unable to efficiently utilise this vitamin and were therefore dependent upon higher than normal doses. It should be
emphasized that these large doses of vitamin B6 were necessary in order to restore body stores of this vitamin to a normal level.
Scientific evidence has demonstrated that this type of increased vitamin
need is due to biochemical
individuality ( 24 ) or genetic abnormalities in nutrient utilisation
( 24; see also Genetic
Nutrition ).
In a later study by Sur and co-workers ( 11 ), 31 asthmatic patients failed to respond to B6 therapy. However, the point must be made that these workers were deliberately selective in choosing participants for the trial since they only chose patients who
were dependent upon steroids for control of their asthma. In defence of this decision Sur et al claim that pyridoxine is an
"over the counter drug with the potential for abuse" and
"in order to justify the usage of a drug that has a potential for significant toxicity, this trial was restricted to steroid requiring asthmatic patients who are more likely to be closely followed by
physicians." If these concerns are scientifically valid ( bearing in mind that Sur et al chose to use a dose of 300mg of pyridoxine, or three times the effective dose used by other workers ), then trials of prescription anti-asthma drugs, in accord with their infinitely greater toxicity, could never be justified. Perhaps this matter has been most appropriately summarised by Hoffer (
1
):
"vitamins which are safe even in large doses have not been acceptable to the profession, and their negative side effects have been consistently exaggerated and over emphasised, to the point that many of these so called toxicities have been
invented, without there being any scientific evidence that these side effects are
real."
Recently, research into the connection between vitamin B6 status and asthma has taken a different direction. It is now well known that the anti-asthma drug theophylline is a vitamin B6 antagonist and actually causes a B6 deficiency (
11,
12,
13, 14
). According to this line of thought the vitamin B6 deficiency which occurs in asthmatic patients is actually caused by the prescription drug treatment they receive, that is, theophylline (
11,
12,
13, 14 ). In other words, it is an iatrogenic deficiency. In spite of the fact that Sur et al (
11 ) reported significantly lower B6 levels in theophylline taking asthmatics, they subsequently concluded that there is "no justification for megavitamin B6 therapy for the treatment of asthma in such patients", a conclusion which must surely be rejected. In fact, their report further justifies the use of B6 supplements,
especially in theophylline taking asthmatics.
Although there is no reason to doubt the considerable volume of evidence that theophylline may cause B6 deficiency, this does not explain the dramatic effectiveness of vitamin B6 as an anti-asthma treatment. This is of fundamental importance. Neither does it explain why children who were kept off all asthma medications for two weeks before testing still had
"urinary tryptophan metabolites 5 to 30 times that of normal
controls" ( 6, 11 ). While it has been shown that theophylline is capable of causing B6 deficiency, there is no evidence to suggest that this drug is the sole cause of B6 deficiency in all asthmatic patients. Since theophylline is a dangerous drug (
15
) which may, in addition to its other adverse effects, cause a deficiency of vitamin B6, its use hardly seems warranted when alternatives are available (
16 ). Given the abovementioned scientific evidence that B6 deficiency may cause or aggravate asthmatic symptoms, the use of theophylline seems especially inappropriate. To learn more
of my personal experiences with vitamin B6 and asthma, click
here.
Nutritional treatment of asthma may also involve consideration of other nutrients such as vitamin C,
vitamin B3, vitamin B12, essential fatty acids, and magnesium, all of which have been shown to benefit wheezing or asthma (
17, 37,
38, 39,
40, 41, 42, 51, 62 ). Vitamin A is also essential for the mucous membranes ( 18 )
and vitamin A deficiency in asthmatic children has been reported to vary
according to the severity of the asthma ( 46
).
Vitamin B3 has been shown to be an effective treatment in some cases of asthma (
17 ). This vitamin, which has been reported to have an antihistamine effect (
17 ), has been shown in one study to be deficient in
83% of asthmatics ( 17 ). Out of 19 patients who were given B3 treatment, 16 showed a definite reduction in attacks of asthma while two cases deteriorated (
19 ) a fact which may be related to the possibility of a simultaneous pyridoxine deficiency in these two
patients ( See B vitamins ).
The use of essential fatty acids or fish oil in asthma remains
controversial. Recent evidence has failed to confirm any benefits of fish
oil in asthmatic patients ( 60,
61
) while it seems some asthmatics may
even be adversely affected by fish oil supplements ( 60
). According to
Kemper and Lester ( 38 ) there is presently insufficient evidence to
recommend fish oil supplements for asthma. According to these workers the
most important nutritional supplements for alternative asthma treatments
are vitamin B6, vitamin C, vitamin E, and magnesium. In spite of this it
would seem sensible to ensure the diet contains an adequate amount of
omega 3 fatty acids.
Perhaps the most underrated of all the B complex vitamins is pantothenic acid. Although a deficiency of this vitamin is commonly considered impossible because of its widespread availability in foods (
20 ), this of course does not rule out the possibility of deficiencies arising from malabsorption or vitamin dependency as occurs with the other B
vitamins ( see Genetic
Nutrition , The Current Medical Paradigm
). There is also a difficulty in accurately diagnosing a pantothenic acid deficiency since reliable tests have yet to be developed (
21 ). Additionally, the precise dietary requirement also remains unknown
( 21
). Given these facts and the important metabolic role which pantothenic acid plays in the production of cortisone and coenzyme A, and its role therefore in stress resistance and normalisation of blood sugar levels, it seems both foolish and premature to glibly dismiss the possibility of pantothenic acid deficiency
occurring in humans ( see The
Current Medical Paradigm ).
In view of the general feeling that a deficiency of pantothenic acid is impossible, it is hardly
surprising that there is a shortage of clinical research regarding this vitamin as compared to the other B vitamins. However, in light of the well known importance of pantothenic acid for steroid production and adrenal function (
18, 22, 23, 25 ), and the ability of pantothenic acid supplements to increase resistance to stress (
26, 27 ), combined with the fact that asthmatics have been reported to
have reduced adrenal function (
28, 29, 30,
53
), the use of single B vitamins
in steroid dependent asthma is an oversight which warrants urgent attention. If there is an excessive need for one B vitamin in asthmatics, is there any evidence to prove that other vitamins are not involved also?
Researchers exploring the therapeutic use of B vitamins from a reductionist perspective usually seem to dismiss the combined use of vitamins for the treatment of
disease, preferring to use vitamins singly as drugs ( 11,
31 ), even though experts suggest that B vitamins especially, must be taken together in a balanced
form ( see B vitamins ). Unlike prescription drugs, which play no role in rebuilding the body and therefore may be used singly, the very essence of nutritional therapy is its ability to restore and repair the body, a fact which underlines the interdependence and teamwork nature of nutritional therapy. In the words of Roger Williams (
27 ):
"nutrients are effective because they are constructive; they enter into the makeup of enzyme systems and can function in this constructive way only when all the other building blocks are available. If only one link is conspicuously missing, then supplying this one link by itself will be effective. This is exceptional
however............... "
Evidence cited above demonstrates that conventional medical symptom based techniques for asthma "management" have correlated with asthma becoming much more severe and more prevalent. There is now clear scientific evidence implicating nutritional deficiencies
or adrenal insufficiency as underlying disease mechanisms in some asthmatics. The long held view of medical science that suppression of symptoms will somehow have a preventative effect and lower the incidence of disease has been disproved time and again. We must make a clear choice. Do we wish to continue merely concealing symptoms or do we prefer to adopt a more preventative approach? While conventional medical treatments will of course continue to be necessary for control of acute asthma attacks such treatments have been shown to be
ineffective for prevention. Even the so called "preventer" treatments have failed to arrest the ever increasing incidence of asthma.
They do not rectify nutritional deficiencies or adrenal insufficiency. There are
some modern nutrition experts and
practitioners who seek to make available to patients the full range of
treatment options for which there is supportive scientific evidence. These
treatments may be prioritised according to their risk/benefit and their
potential for prevention or cure rather than simply suppression of symptoms. Modern
experts recommend adult asthmatics should take from 50-200mg daily of
vitamin B6 ( 22, 40, 41, 42, 62 ), up to 2g daily of vitamin C ( 22, 37, 39, 40, 41,
62 ), from 100-400mg daily of magnesium ( 22, 37, 41, 42, 62 ), and 150mg of
pantothenic acid ( 22 ). According to Florence
and Setright ( 42 ) adult asthmatics should take 50-100mg daily of vitamin
B6, however, as has been pointed out by Murray and Pizzorno ( 41 ), 50 mg
is not always sufficient to restore the B6 levels of asthmatics to normal.
Quillin (62) recommends that asthmatics should take 2000mg of vitamin C,
100mg of vitamin B6, and 400mg of magnesium although somewhat smaller
doses are needed for children. As Florence and Setright ( 42 ) rightly point out
however, genetic variations in vitamin
utilisation and metabolism make it impossible to accurately predict the specific nutrient
requirements of the individual person. While the available evidence
suggests a dose of 100mg of vitamin B6 may be the optimum dose for some
asthmatics, the question of balance also needs to be considered ( see
B vitamins ). Unfortunately, as is the case with many other diseases, the attitude of mainstream
medicine to asthma treatment continues to reveal a considerable degree of anti-nutrition bias ( 32;
for more information about anti-nutrition bias refer to the Medical
Bias page ). The review by Merrill and
Henderson entitled "Diseases Associated with Defects in Vitamin B6
Metabolism or Utilisation" ( 33
) makes no reference to the well documented connection between asthma and
B6. Similarly, the review by Bender (
34 ), the aim of which was "to examine the evidence for the
efficacy of vitamin B6 supplements in treating a variety of conditions",
is notable for the fact that Bender chose to cite the negative report by
Sur et al (
96 ) and ignore the remaining scientific literature concerning
asthma and B6. Similarly, a recent review by Steurer-Stey and colleagues (83)
entitled "Complementary and alternative medicine in asthma – do
they work?", failed to make any mention whatsoever of the
scientific literature concerning asthma and vitamin B6.
Unfortunately, the poor quality of medical research ( 35
), including the "sloppy" ( 36
) or selective use of medical literature, is all too well known ( 35,
36,
32 ).
History is littered with
those who opposed the use of vitamins as well as those who became the
victims of their nutritional negligence. Sadly, many have learned nothing
from these mistakes.
Those who endorse the long term use of symptomatic treatments will need
to guarantee that their continuing neglect of nutrition will not contribute to
a further increase in the incidence or severity of asthma. They must
accept responsibility for their failures as well as their successes.
Future asthma therapies should be structured in accord with the available
evidence, should be fundamentally holistic, cause based and preventative
rather than symptomatic and reductionist, and should be untainted by bias.
If we are at all concerned about prevention and the risk/benefit of modern asthma therapies, surely,
in keeping with the available scientific evidence, nutritional therapies should receive the highest priority.
Links and References
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Hoffer, A,
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32.http://archinte.ama-assn.org/issues/v158n20/rfull/icm80223.html
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37.http://www.healthnotes.com/Consumer/library/newswire/newswire_2002
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