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January 2002

Letter from Dr. Janson
Managing Asthma
Ask Dr. J.
In the Health News
Recipe of the Month: A Healthy Pizza
References

Letter from Dr. Janson
Dear Friends,
I usually spend time researching and defending the scientific basis for nutrition, dietary supplements, and other alternative treatments, and noting that conventional medicine is not better documented than many alternatives. However, science has limits in human understanding, and devoting so much to it neglects the rest of the art of medicine. This has to do with the art of life—with communication, inspiration, motivation, and compassion.

Doctors have an obligation and an opportunity to instill in a patient a positive attitude and a burning desire to get well and stay well, and give them the knowledge and motivation to change the habits that often contribute to degenerative disease.

In an Email discussion, a friend pointed out that in addition to the physical senses of taste, hearing, vision, smell, and touch, human beings also have non-physical senses that allow us to live life to the fullest. They are not scientific, and they are not often considered in the realm of medicine, but they are essential for a rewarding and fulfilling life. Doctors are in a special position that allows them to help a patient cultivate these senses. We must take advantage of our position to enhance the healing process through these senses that promote the patient’s power to enjoy life.

The sense of adventure allows us to step out of our daily environment and experience the pleasures of different cultures, new foods, unexpected architecture and scenery, unusual plants and animals, and different perspectives on life. It also lets us enjoy new and challenging physical experiences that are part of our animal nature.

The sense of beauty provides an appreciation of art, music, crafts, scenery, and human features. It lifts us to a higher existence. The sense of joy enriches everyday experiences of relationships, rewarding work, and play, and allows us to fill ourselves with good feelings.

The sense of wonder leads us to learn new things, and enjoy both new and old experiences as a child does, with a feeling of awe and appreciation of the moment. And finally, a sense of humor keeps everything in perspective, so we don’t take ourselves and our lives too seriously, and it gives us the healing and restorative power of laughter. It lets us defuse threatening situations, and learn to cope with physical and emotional trauma, while being able to laugh and play together enhances the bonding in human relationships.

Appreciation of these senses takes us out of the realm of simple existence to live life to its fullest. As one of my favorite poets, e.e. cummings, says, “existing’s tricky, but to live’s a gift.” To be fully alive means making the most of our gifts. Physicians also benefit from these senses of joy, beauty, wonder, adventure, and humor, and when we help our patients enjoy life, we enhance our own lives.

Managing Asthma
Recent research shows that a high dietary intake of apples, the trace mineral selenium, and red wine reduces the risk and severity of asthma, possibly because of antioxidant and anti-inflammatory effects of the mineral and the flavonoids found in fruit and red grapes. As people with asthma sometimes feel powerless to control their symptoms without drugs, this article and others provide some hope that they may be able to take charge of their health and control their condition.

Asthma is a condition of the tracheobronchial airways with spasms restricting air flow in and out of the lungs. The symptoms are difficulty breathing, cough, and wheezing. It most often starts early, 50 percent of the time by the age of 10, and over 80 percent by the age of forty.

Asthma is very common, affecting now about ten percent of the population, and the incidence is increasing. It may be triggered by allergies, drug reactions, chemical and toxic metal exposures, exercise, and stress, as well as by infection.

Why is Asthma Increasing?
Asthma is increasing from about one in 20 people 15 years ago to about one in 10 now, perhaps due to air pollution (ozone, sulfur or nitrogen dioxide), drugs and chemicals such as aspirin, NSAIDS, and artificial colors, food allergies, fast foods with hydrogenated oils, sulfites used to prevent browning of vegetables and dried fruits, and poor nutrition. Work or leisure exposure to metal salts, wood and vegetable dusts, farm and garden chemicals, and plastics may play a role.

Infections also trigger asthma attacks, and sometimes a seemingly minor respiratory virus may lead to a severe asthma attack. This might be the result of inflammation leading to increased sensitivity of the airways to particular triggers.

Exercise, especially in the cold, can precipitate asthma attacks, and sometimes this is the only trigger when someone first develops symptoms. This frequently changes much later into asthma unrelated to exercise. It is also well known that psychological factors can initiate asthma attacks or help relieve or prevent them.

When looking at the lungs of asthmatics, pathologists find extensive secretions plugging the airways, swelling of the bronchial lining, thickening of the muscles, and collections of both allergy-related cells called eosinophils and inflammatory cells in the bronchial walls. The end result of all these physiologic changes is a marked narrowing of the air passages. With changes in messenger substances (histamine, leukotrienes, prostaglandins, and others), and cells related to inflammation, it appears that asthma is a chronic inflammatory disease.

Natural Asthma Treatments
In addition to recommending environmental controls, physicians prescribe many drugs for asthma, including bronchodilators, steroids, and allergy medications. In severe acute asthma, it is important to take immediate measures, including drug therapy, but injections of magnesium can be extremely helpful in stopping such an attack. Other than in emergency situations, it is best to do whatever you can to avoid drugs while still controlling symptoms.

Make efforts to reduce exposures to precipitants, such as airborne allergens, trigger foods, chemicals, and drugs, and to enhance immune function to reduce infections. Avoid even second-hand smoke. An air filter (such as Austin Air Systems) can help to clean up both particulate and chemical contaminants. Do your best to eliminate house and garden chemicals from your environment. In most cases, natural alternatives are available.

A whole, natural, mostly vegetarian diet with few additives is an essential part of any health program. Avoid sulfites, not only in commercial salad bars (to prevent foods from turning brown), but also in wine. Milk is a common food allergen, as are peanuts, eggs, shellfish and some cereal grains. Hydrogenated oils interfere with normal fat metabolism and prostaglandin function.

Supplements are also important in treating asthma. Vitamin C (2000 to 4000 mg daily) is an antioxidant, anti-inflammatory nutrient that also reduces allergic symptoms. Although studies are not consistent, there is a strong suggestion that supplements might help asthma, especially if exercise induced.

In children and adults, 100 to 200 mg of vitamin B6 can markedly reduce asthma symptoms. Serum markers of B6 activity tend to be low in asthmatics. The flavonoid quercetin (800 to 1200 mg daily) reduces allergies by stabilizing the cells that release histamine. It also inhibits the action of lipoxygenase, an inflammatory enzyme involved with prostaglandin metabolism. Anti-inflammatory herbs, such as curcumin (1000 to 2000 mg) and ginger (250 to 1000 mg) help control the chronic inflammation and bronchospasm seen with asthma.

Several studies with ginkgo extracts show benefits for asthmatic patients. Ginkgo interferes with the effects of platelet activating factor, known to promote inflammation. Patients challenged with allergens after taking ginkgo extract had much less bronchoconstriction than controls. The usual dose is 120 to 240 mg daily.

Essential fatty acids are prostaglandin precursors. Prostaglandins derived from gamma-linolenic acid (GLA, 240 mg from borage or primrose oil) and flaxseed or fish oil have anti-inflammatory effects, help reduce allergic symptoms, and they relax bronchial muscles. Although there are few specific clinical studies on asthma, I have found these oils helpful in practice.

Magnesium is a smooth muscle relaxant, and helps to relieve bronchospasm when taken by mouth, as well as when administered intravenously for acute asthma attacks. The usual oral dose is about 400 to 1000 mg daily.

N-acetyl cysteine (NAC, 1000 to 2000 mg) helps to loosen
bronchial secretions, and makes it easier to clear the
airways. It is usually administered as an inhalant, however,
the oral dose is just as effective but without side effects.

In many cases, these nutrients and lifestyle changes with stress management, combined with immune support and environmental controls have helped patients reduce or eliminate their asthma medications, and live a healthier life.

Ask Dr. J
Q. I’m in serious need of an herbal solution for hot flashes! They are strong, frequent, day & night! Good rest at night is difficult. M.C., New Mexico

A. Menopausal hot flashes, or vasomotor flushing, are the result of complex hormonal changes at the time of menopause or after surgery that removes the ovaries. They can be quite uncomfortable, and even though they normally go away within a few years after menopause, or can be suppressed with hormonal therapy, sometimes a good nutrition program and dietary supplements can make a big difference in controlling them.

I recommend supplements of soy isoflavones, 500 mg daily, standardized at 40 percent isoflavones. These have natural weak estrogenic effects, and have been shown to control hot flashes up to 50 percent. Bioflavonoids (2000 mg) are plant pigments that were shown to reduce hot flashes almost 40 years ago.

Black cohosh (standardized, 40 to 120 mg) is probably the most commonly known herb that is used for menopausal symptoms. A number of double-blind studies support its use. Another herb that might help is dong quai (Angelica sinensis, standardized, 200 to 600 mg).

Other helpful supplements: vitamin E (800 to 1200 IU), shown decades ago to be helpful, although recent studies show only a small effect (perhaps because they did not give it for long enough); gamma linolenic acid ( GLA, 240 mg).

I would not discount using natural hormones, such as progesterone and estrogens modified from soybeans to mimic the same hormones found in humans. These can be quite helpful, and are not the same as synthetic progesterone analogs or horse estrogens that are commonly prescribed.

In the Health News
•I am intrigued by an article that came out in July extolling the virtues of coenzyme Q10 (Tran MT, et al., Role of coenzyme Q10 in chronic heart failure, angina, and hypertension. Pharmacotherapy 2001 Jul;21(7):797-806). The authors say that coQ10 helps with congestive heart failure, angina, and hypertension based on an extensive search of the past 25 years of research. They point out that coQ10 supplements improve ejection fraction (heart muscle function), cardiac output, and exercise tolerance, meaning that every measure of heart function is helped. They note that it is safe and well tolerated. Then, incredibly, their conclusion says that “CoQ10 should not be recommended as monotherapy or first-line therapy in any disease state.” WHY NOT? Maybe because this article comes from a school of pharmacy!

•A new study shows that saw palmetto significantly helps urinary symptoms in benign prostate enlargement (Gerber GS, et al., Urology 2001 Dec;58(6):960-963). In the study of 85 men, “quality of life” also tended to improve, but it did not reach statistical significance–perhaps because of inadequate dosing or too few subjects. In previous studies, saw palmetto was superior to the drug finasteride (Proscar).

Diet and Disease
•Another study shows that eating legumes is associated with a significant reduction in heart disease (Bazzano LA, et al., Legume Consumption and...Coronary Heart Disease... Arch Intern Med 2001;161:2573-2578). The study of nearly 10,000 people for 19 years showed a 22 percent reduction in coronary disease in those eating beans at least 4 times a week, and a reduction in vascular disease overall. Legumes include kidney, black, navy, pinto, lima, and azuki beans, and others, and soy products.

Recipe of the Month: A Healthy Pizza
I buy a wholewheat crust or make a simple one using my VitaMix. Lightly sauté chopped onions, broccoli, and mushrooms with olive oil. Spread a layer of refried beans (homemade or canned, organic ones) on the crust. Add a layer of tomato sauce or salsa, spread the vegetables on top, and then a layer of fresh tomatoes. Sprinkle with oregano, basil, and fresh ground pepper to taste and a thin layer of grated romano sheep-milk cheese. Put in a preheated oven at 425 degrees, and cook until the crust is crisp and turning brown at the edges. You have your tomato lycopene, broccoli phytochemicals, whole grain nutrients with fiber, and beans, all of which prevent heart disease, cancer, and prostate problems, and preserve your vision, in one traditional, tasty, and easy meal.

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References

Managing Asthma
Pacor ML, et al., Food allergy and asthma.
Recenti Prog Med 1992 Feb;83(2):64-6.

Forastiere F, et al., Consumption of fresh fruit rich in vitamin
C and wheezing symptoms in children. Thorax 2000 Apr;55(4):283-8.

Anah CO, et al., High dose ascorbic acid in Nigerian asthmatics.
Trop Geogr Med 1980 Jun;32(2):132-7.

Schachter EN, Schlesinger A, The attenuation of exercise-induced
bronchospasm by ascorbic acid. Ann Allergy 1982 Sep;49(3):146-51.

Mohsenin V, et al., Effect of ascorbic acid on response to
methacholine challenge in asthmatic subjects.
Am Rev Respir Dis 1983 Feb;127(2):143-7.

Miric M, Haxhiu MA, Effect of vitamin C on exercise-induced
bronchoconstriction. Plucne Bolesti 1991 Jan-Jun;43(1-2):94-7.

Collipp PJ, et al., Pyridoxine treatment of childhood bronchial
asthma. Ann Allergy 1975 Aug;35(2):93-7.

Reynolds RD, Natta CL, Depressed plasma pyridoxal phosphate
concentrations in adult asthmatics.
Am J Clin Nutr 1985 Apr;41(4):684-8.

Foreman JC, Mast cells and the actions of flavonoids.
J Allergy Clin Immunol 1984 Jun;73(6):769-74.

Li MH, et al., Effects of ginkgo leaf...in treating asthma.
Chinese J Integrative & Western Med 1997 Apr;17(4):216-8.

Brunner EH, et al., Effect of parenteral magnesium on pulmonary
function, plasma cAMP, and histamine in bronchial asthma.
J Asthma 1985;22(1):3-11.

Volkl KP, Schneider B., Therapy of respiratory tract diseases
with N-acetylcysteine. An open therapeutic observation study of
2,512 patients. Fortschr Med 1992 Jun 30;110(18):346-50.

Menopausal Hot Flashes
Upmalis DH, et al., Vasomotor symptom relief by soy isoflavone
extract.... Menopause 2000 Jul-Aug;7(4):236-42.

Smith CJ, Non-hormonal control of vaso-motor flushing in
menopausal patients. Chicago Med 1964;67:193-5.

Liske E, Therapeutic efficacy and safety of Cimicifuga racemosa
for gynecologic disorders. Adv Ther 1998 Jan-Feb;15(1):45-53.

Barton DL, Prospective evaluation of vitamin E for hot flashes
in breast cancer survivors. J Clin Oncol 1998 Feb;16(2):495-500

 


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CONSULTATIONS:

From September to June, I see patients in New Smyrna Beach, Florida.
Call 386-409-7747, or send an email to to make arrangements.

In summer, I have a variable schedule, and I see patients in offices at the
Rothfeld Center for Integrative Medicine in Waltham, Massachusetts. For appointments, send an email to make arrangements, or call: 386-409-7747.

I primarily do phone consultations, as well as email and instant messaging consults.


Information herein is not medical advice or direction. All material in this newsletter is provided for information only. Its contents should not be used to provide medical advice on individual problems. Consult a health care professional for medical or health advice.

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