Asthma: Nutritional Protocol

THE BASIC ASTHMA PROTOCOL

Magnesium. If I had to recommend one nutrient to asthmatics, it would be magnesium. Over half a century ago, scientists reported that magnesium sulfate 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 antiinflammatory 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.

Antiinflammatories

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 antiinflammatory 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 endproducts 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. That seems to be how long it takes to repair longterm damage to the lungs. 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 had 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 during that period and had to resume supplements 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 oil a day. Both magnesium and fish oils help slow the inflammatory response.

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 tanaceturn 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 of functions. 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 alkylglycerol.

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 a 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 in 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 in 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 antiinflammatory 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 or milk.

Licorice. This is an extensively studied herb whose formal name is glycyrrhiza glabra. It contains antiallergic, antibacterial, and antiinflammatory compounds. Two of its components have cortisol-like effects in the body. One ingredient in licorice can raise blood pressure, but deglyc-. yrrhizinated commercial products eliminate this problem. Such a product, DGL, is available as a powder, tablet, or tincture. Twenty to 40 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.

Compound Herbal Elixir. This product, produced by Eclectic Institute, is used widely by naturopaths and physicians around the country. It is recommended for cough and asthma and contains a wide range of ingredients, including wildcrafted wild cherry, organic elecampane, red clover blossoms, lobelia, fennel, lomatium dissecturn, white pine, and essential oil of bitter orange. These ingredients work together to stimulate the immune system, treat the symptoms of asthma, and purify the lymph and bloodstream.

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 sixtynine 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 antiallergic 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.

[excerpted from the book, Reversing Asthma, by Dr. Richard Firshein, Warner Books. 369 pages. List Price: $24.95. Willner Price: $19.96, code #29284]

Dr. Richard Firshein is one of the most influential and respected asthma specialists in the country-a physician whose interest in the disease came from his own baffle With it as a patient. In this groundbreaking book, Dr. Firshein offers asthma sufferers the program he developed for his own use and has prescribed with extraordinary success to his patients-the program that challenges old ideas about asthma and dramatically cuts the use of drugs for reversing asthma...

DR. Richard N. FIRSHEIN, D.O., is a physician in private practice in New York City. A frequent guest on television and radio, he hosts his own weekly radio show, "HouseCalls." heard in six states. He is an Assistant Professor of Family Medicine at the New York College of Osteopathid Medicine and Medical Director of the Paul Sorvino Asthma Foundation, and is currently researching alternative treatments through a grant from the Karolinska Institute in Sweden. He created and edits the newsletter Dr Firshein's Healthy Living Report. A leader in the field of alternative medicine, he is the president of Nutraceutical Research, Inc., a corporation dedicated to researching alternative treatments.