Respiratory Health

Respiratory Health

by Susan Colebank

The world record for holding a breath is 6 minutes, 2 seconds.However, during normal breathing, the time between breaths averages a fewseconds. In those with asthma, allergic rhinitis (hay fever) and otherrespiratory problems, breathing does not come so easily and is fought for on aday-to-day basis.

Currently, respiratory health is on the front pages ofnewspapers as Severe Acute Respiratory Syndrome (SARS)--a pneumonia linked withtroubled breathing and a high fever--continues to affect the world's population.At press time, the virus had infected 2,700 people and claimed the lives of morethan 100. For most people, the greater concern is not contracting SARS, butrather ways to live with the more common ailments of asthma and allergies.

What is the cycle of a breath? It starts with the nose andmouth, as air is sucked in and taken through the trachea and into the lungs viatwo large passageways, known as bronchi. Smaller tubes, known as thebronchioles, carry oxygen to the millions of air sacs (alveoli) that make up thelungs. Folded like tiny balloons, alveoli have very thin walls filled withblood. The thinness of the walls is so that oxygen taken in through a breath canpass through the alveoli and into the bloodstream, where the gas can then travelto the body's cells. In a healthy, functioning lung, these alveoli expand andcontract like millions of tiny balloons. Carbon dioxide, the main component in"used air" that is exhaled, is created after the alveoli use theoxygen to burn food.

Asthma, a chronic lung disease, occurs when the lining of thebronchi is inflamed and swollen, creating large amounts of mucus and cloggingthe bronchi's airways. According to the American Lung Association (ALA), theprevalence of asthma has increased in the United States over the past twodecades. Based on results from the 2001 National Health Interview Survey (NHIS),31.3 million Americans have been diagnosed with asthma, with females being10-percent more likely to be diagnosed than males. In addition, 12 millionAmericans, 4 million of whom were 18 and younger, had an asthma attack in 2001.Interestingly, those between the ages of 5 and 17 had the highest attackprevalence rates. In 2000, 4,500 people died of asthma, most of them women.

Asthma comes in various forms and subcategories. Occupationalasthma is related to workplace exposure to asthmatic triggers and affects 5percent to 10 percent of adult asthmatics. Exercise-induced asthma (EIA) isaffects 11 percent of Americans, 4 percent of whom are not otherwise asthmatic.There are also the subcategories of adult-onset and childhood (about 5 millionAmericans under the age of 18) asthma. The causes of asthma are numerous, fromenvironmental to metabolic to genetic, and the number of potential triggers isin the thousands, ranging from chemical pollutants to foods.

According to the ALA, 2002 estimates indicated asthma costs tobe $9.4 billion in direct expenses and another $4.6 billion in indirect costs(lost productivity). In fact, the association estimated that 14.5 million lostwork days and 14 million lost school days were racked up annually among asthmasufferers.

Breathing-related allergies affect approximately 40 millionAmericans, many of whom are also among those who suffer from asthma each year.In fact, allergic diseases are the sixth leading cause of chronic disease in theUnited States, according to the American Academy of Allergy, Asthma andImmunology.

Allergists have found that IgE antibodies trigger both asthmaand allergies, high levels of which characterize both conditions. IgE antibodiesattach to the immune system's mast cells, causing histamines and leukotrienes tobe released from cells--in turn causing allergies. According to Lorna R.Vanderhaeghe and Patrick J.D. Bouic, Ph.D., in their book, The Immune SystemCure (Kensington, 1999), IgE production is under the control of T-cellcytokines. In turn, the Th1-type helper T-cells secrete gamma interferon."In a normal immune response, gamma interferon is responsible for stoppingthe release of interleukin-4, thereby reducing the production of IgEantibodies," they wrote.

Having allergies or asthma is not necessarily predestined.According to respiratory health researchers from Bulgaria's National Center ofHygiene, Medical Ecology and Nutrition, "The wide variations in theprevalence of respiratory diseases and asthma in different countries areprobably due to environmental and not genetic factors."¹

How does complementary and alternative medicine (CAM) play arole in asthma, allergies and overall respiratory health? Vitamins and mineralsattack the oxidative stress that contribute to these conditions, and botanicalsand essential fatty acids (EFAs) have been found to modulate the inflammationthat accompanies respiratory distress.

Vitamins & Minerals

"The contribution of free oxygen radicals in thepathogenesis of bronchial asthma is generally accepted," said researchersfrom the Institute of Preventive and Clinical Medicine in Bratislava, Slovakia.²"The modulation of antioxidative defense by supplementation withantioxidants represents an additive approach in the complex management of thedisease." Specifically, the antioxidant effects of various vitamins andminerals may be of benefit in respiratory health.

The most well-known antioxidant vitamin is vitamin E. Thealveolar surfactant (a specific complex produced by Type 2 alveolar epithelialcells) is the first area in the pulmonary system that oxidants bombard.Researchers from Berlin postulated that vitamin E could serve an important rolein protecting surfactant lipids against oxidation and subsequent lung injury.³They added that a temporary vitamin E deficiency induced a reversible change inthe expression of pro- and anti-inflammatory markers.

Other German researchers reported vitamin E in high doses wascorrelated with low IgE concentrations and a reduced prevalence for allergicreactions.⁴ They hypothesized that the vitamin's inherent antioxidantproperties suppressed interleukin-4 protein levels in T-cells. Researchers fromthe University of Nottingham, England, and Harvard had similar findings: Higherconcentrations of vitamin E intake were associated with lower serum IgEconcentrations and a lower frequency of allergen sensitization.⁵

Researchers in Cuernavaca, Mexico, reported that vitaminsupplementation may counteract the detrimental effects of pollution--a topreason for oxidative stress in the body.⁶ Asthmatic children given adaily supplement of 50 mg of vitamin E and 250 mg of vitamin C or aplacebo were followed over 1.5 years. Researchers found that there was noassociation between ozone and lung function in the supplement group, leadingthem to conclude that antioxidants may modulate the impact of ozone exposure onthe small airways of children with moderate to severe asthma.

Since ozone aggravates asthma, researchers from the Universityof Washington, Seattle, evaluated the effects of antioxidants such as vitamin E(400 IU/d) and vitamin C (500 mg/d) on ozone-induced bronchialhyper-responsiveness in adult asthmatics.⁷ Subjects on theantioxidants were seen to respond less severely to the sulfur dioxide challenge,which mimicked ozone.

High dietary intake of vitamin C, or foods rich in the vitamin,may reduce the rate of loss in lung function for adults, which may ultimatelyprevent chronic obstructive pulmonary disease.⁸ Vitamin C is abundantin the extracellular fluid lining the lung, and low status has been associatedwith pulmonary dysfunction, according to English researchers.⁹However, after conducting a meta-analysis of 65 studies, they found that, atpresent, evidence from randomized trials is insufficient to recommend vitamin Cfor asthma relief.

Vitamin A deficiency may play a hand in childhood asthma.Children with severe, persistent asthma were seen to have markedly low serumvitamin A levels; however, more trials were needed to see if vitaminsupplementation would be of benefit.¹⁰ Researchers at the Universityof Iowa reported that vitamin A and its retinoids may aid respiratory health byregulating bronchial responsiveness and maintaining a normal bronchialepithelium.¹¹ Conversely, research out of Des Moines University,Iowa, indicated that that children who have been free of infectious illness maydisturb the natural balance of vitamin A and Th1-type helper T-cells.¹²In turn, vitamin A accumulation may occur in the lungs by producing retinoidmetabolites, which could lead to an acute, localized form of retinoidintoxication, recognized as asthma.

The provitamin A precursor, beta-carotene, as well asvitamins C and E, work in tandem to promote respiratory health.¹³ Inparticular, they may help with forced expiratory volume.

Suboptimal levels of coenzyme Q10, a vitamin-likenutrient occurring naturally within the body, may lead to antioxidant imbalancein asthmatics, according to Slovakian researchers.¹⁴ Concentrationswere decreased significantly in asthmatics' plasma and whole blood.

Daily Supplement Use by Gender
The Health & Wellness Database
The Natural Marketing Institute

Vitamins may also help those with cystic fibrosis. This geneticdisease affects approximately 30,000 U.S. children and adults, and causes thebody to produce an abnormally thick, sticky mucus that leads to a variety ofsymptoms, including persistent coughing, wheezing or pneumonia. Australianresearchers reported a high-dose supplement containing 200 mg of vitamin E, 300mg of vitamin C, 25 mg of beta-carotene and 500 mcg of vitamin A decreasedoxidative stress, a possible factor in clinical outcomes in cystic fibrosispatients.¹⁵

Vitamins are not the only nutritional helpers in respiratoryhealth--there are also minerals. For example, researchers out of Athens, Greece,reported magnesium levels in asthmatics' red blood cells were low, eventhough plasma levels remained unchanged during asthmatic episodes.¹⁶In a hospital setting, 2 g of intravenous magnesium sulfate improved pulmonaryfunction as an adjunct to standard therapy in patients with very severe, acuteasthma.¹⁷ According to the Natural Marketing Institute's (NMI) Health& Wellness Trends Database, four years of trended data from more than2,000 consumer respondents, allergy sufferers are 24-percent more likely thannon-sufferers to use a magnesium supplement.

Selenium is reported to have antioxidant benefits in thefight to breathe. Researchers in Slovakia reported selenium eliminateshydroperoxides produced at the site of respiratory inflammation and intakeincreased the mineral's presence in plasma and red blood cells.¹⁸ Inparticular, asthmatics dependent on corticosteroids were seen to have a reduceddependency on their medication during a 96-week supplementation at 200 mcg/d.

Daily Supplement Use by Asthma Sufferers vs. GP
The Health & Wellness Database
The Natural Marketing Institute

Complementary Natural Products

Vitamins and minerals have their place in respiratory health,but so do botanicals, EFAs and sulfur compounds.

On the asthma front, there are plant extracts that can make aworld of difference in the everyday process of breathing. Boswellic acidsfrom Boswellia serrata help various inflammatory diseases, includingbronchial asthma. Research out of Germany reported that compounds from the guminhibited leukotriene biosynthesis and elastase in white blood cells.¹⁹

Even though it is making the news these days in terms of weightloss and possible harmful side effects, ephedra has a long historysteeped in respiratory health. Chinese researchers have investigated the herb'sclinical uses for asthma, chronic bronchitis, pneumonia and whooping cough. Inthe oldest comprehensive material medica, Shen Nong Ben Cao Jing, ephedrais listed among the "middle class" herbs as an anti-allergy agent.²⁰

Ginkgo biloba, as Ginkgolide B, has been seen in vitro tohave inhibitory effects on peripheral blood mononuclear cells in asthmaticpatients, leading researchers from Kuwait to conclude that it may be a usefulmodality for asthma treatment.²¹

The acute effect of lycopene (as Beer-Sheva Israel-based LycoRed/Biodar'sLyc-O-Mato) on airway hyper-reactivity was assessed in patients withexercise-induced asthma by researchers out of Israel.²² In a doubleblind test using 30 mg/d of lycopene or a placebo, patients on the supplementfor a week were more protected against exercise-induced asthma, most likelythrough the supplement's antioxidant effects.

Flavonoids may also impart health benefits forasthmatics. Researchers from King's College in London reported intake of redwine--and its flavonoids--was negatively associated with asthma severity.²³

Other flavonoids, such as quercetin, also appearbeneficial for those with compromised respiratory health. In an evaluation ofdietary intakes of 10,000 men and women, researchers from the National PublicHealth Institute in Finland reported asthma incidence was lower for those in thehighest quartile of quercetin intake.²⁴ Luteolin, found infoods such as bee propolis and tea, has been indicated to inhibit the IgE-mediatedreaction by blocking histamine and cytokine release from mast cells.²⁵

Flavonoids may also be a winner in terms of general respiratoryhealth. In research out of Dublin, French maritime pine bark (asPycnogenol from Hillside, N.J.-based Natural Health Science) was investigatedregarding its antioxidant effects on histamine.²⁶ Scientistsresearched the flavonoid's effects on rat mast cells in comparison with sodiumcromoglycate, a known inhibitor of histamine release from the mast cell; theyfound Pycnogenol's inhibitory effect was on par with sodium cromoglycate's.

Plant extracts in the form of isoflavones also appearpromising in respiratory function. In animals treated with the soy isoflavonegenistein, the compound was seen to inhibit tyrosine kinase signaling, a factorin the activation of inflammatory cells.²⁷ Researchers from theNational University of Singapore reported lung tissue was protected by genistein,which may have therapeutic potential for allergic airway inflammation. Researchout of the University of Minnesota, Duluth, also reported phytoestrogens werebeneficial for asthma.²⁸ Animals consuming an isoflavone-rich dietwere protected against pulmonary challenges inflicted in the lab. Theresearchers concluded isoflavones reduced antigen-induced eosinophilia (asystemic respiratory disease) in the animal model of asthma.

Sterols and sterolins may attenuate the inflammatoryresponse in respiratory problems. "Sterols and sterolins stimulate therelease of Th1-type cytokines from helper T-cells and, as a result, control theallergic condition by decreasing the manufacture of IgE," Vanderhaeghe andBouic wrote. "Sterols and sterolins also reduce the synthesis ofinterleukin-6, the inflammation factor. It is known that during the late phaseof an asthma episode, interleukin-6 perpetuates the inflammatory response, whichcauses bronchial tissue damage."

In a study over a 12-week period, allergic (predominantly pollensensitive) persons were given either placebo or sterol/sterolin capsules (asEugene, Ore.-based Essential Phytosterolin Inc.'s Moducare).²⁹ Thesterol/sterolin mixture was found to reduce interleukin-4 in both allergic andcontrol groups, leading to a reduction in symptoms, including post-nasal drip.

Even a chemical found in chocolate may give rise to a naturalcough treatment. In a study presented in December 2001 at the British ThoracicSociety's (BTS) winter meeting, volunteers were given theobromine, achocolate constituent, and capsaicin, a cough stimulant. Theobromine was foundto be more effective than placebo and codeine (used in traditional coughmedicines) in treating the resulting cough. The researchers, who were from theNational Health and Lung Institute in London, said more research needed to bedone based on this promising data. "It is too early to advise peoplesuffering from coughs to treat themselves with chocolate," said JohnHarvey, M.D., chairman of the BTS Communications Committee.

EFAs are also integral for maintaining respiratoryhealth. In a published paper out of the University of Southampton, England,Philip Calder, Ph.D., reported that human inflammatory cells contain highproportions of the omega-6 polyunsaturated fatty acid arachidonic acid (AA), aprecursor to 2-series prostaglandins and 4-series leukotrienes--both of whichare highly active mediators of inflammation.³⁰ These inflammatorycells, however, also contain low levels of omega-3s. "Animal and humanstudies have shown that dietary fish oil results in suppressed production ofpro-inflammatory cytokines and can decrease adhesion molecule expression,"Calder wrote, adding that clinical studies have reported that oral fish oilsupplementation has been found to benefit asthma.

Omega-3s such as eicosapentaenoic acid (EPA) may down-regulatethe T-helper 1-type response associated with inflammatory diseases like asthma.³¹Researchers concluded fatty acids also counteract the inflammatory effects ofAA.

In a meta-analysis of asthma and fish oil studies, Australianresearchers highlighted one study that showed fish oil supplementation improvedpeak flow rate and reduced asthma medication in asthmatic children; also, therewere no adverse events associated with the supplements.³² In a studyof asthmatic children, it was found that over the course of 10 months, 84 mg/dof EPA and 36 mg/d of docosahexaenoic acid (DHA, another omega-3) decreasedasthma symptoms.³³ In a rat model, DHA (as tridocosahexaenoyl-glycerol)was also shown to reduce bronchial hyper-responsiveness.³⁴

In the area of marine nutraceuticals, green-lipped musselextract may improve lung function in asthmatics, according to researchers fromRussia.³⁵ Patients taking the extract (Hong Kong-based Pharmalink'sLyprinol) twice per day for eight weeks experienced a decrease in daytimewheezing, as well as improved peak expiratory flow rate. Scientists proposedthat the extract's eicosatetraenoic acid (ETA), a metabolite of AA, was the mainfactor in this improvement.

Methylsulfonylmethane (MSM), a naturally occurring sulfurcompound, may also be a respiratory aid. In research out of the GENESIS Centerfor Integrative Medicine in Washington state, 2,600 mg/d of MSM (as OptiMSMsupplied by Vancouver, Wash.-based Cardinal Nutrition) over 30 days was found toimprove decreased energy levels and other symptoms related to hay fever.³⁶

Daily Supplement Use by Allergy Sufferers vs. GP
The Health & Wellness Database
The Natural Marketing Institute

Whether it is magnesium for asthma or isoflavones for allergies,the respiratory landscape is rife with natural products backed by soundresearch. While taking these supplements may not be able to help people holdtheir breath for over six minutes, at least their day-to-day breathing may beimproved.

For a full list of references to this story,click here.