01.10.2006

Finding Answers

In recent months, there'sbeen increasing awareness that asthma may be more thanone disease and the leading medical journal The Lancethas even called for the term to be dropped. There'sincreasing evidence that the causes, too, are varied.Dr Peter Dingle puts together some of the pieces ofthe asthma puzzle.

Asthmais one of the most common respiratory diseases. In Australia,New Zealand, the UK, US, Canada, many European countries,and now in many Asian countries, asthma is on the increaseand has reached proportions of one in four childrenand one in 10 adults.

The asthma rates in these countries have doubled inthe last two decades and fortunately they, at last,seem to be levelling off. But as other countries becomeWesternised, the rates are quickly catching up to ourlevels. Asthma is a potentially life threatening anddebilitating respiratory disease. Not only do asthmaticshave to face potentially fatal attacks, but they mayalso have to deal with headaches, depression, mood swings,hyperactivity, learning difficulties, chronic fatigueand allergy related afflictions such as allergic rhinitisand eczema.

It's unlikely that the genetics of the population hashad an influence in such a short period of time, butit is likely that a degree of genetic susceptibilityis being triggered by a combination of modern factors,perhaps the epigenetics factor I wrote about a few monthsago. The rise of modern, Western society has broughtwith it many changes. Many of these appear innocentwhen considered in isolation, but when contemplatedin combination, they present a formidable threat toour health and the health of our children.

The most probable cause of asthma and many other modernchild health problems is a combination of Diet, Environment,Attitude and Lifestyle (DEAL) factors. To wait for definitivescientific proof that may never come, is to put a growingnumber of kids at severe risk. Asthma is not just aninconvenience, it kills.

The "Westernised" diet seems to be a contributingfactor. Because asthma involves an immune response tovarious trigger substances, decreases in the averageweekly consumption of fresh fruit, green and mixed vegetablesand an increase in the amount of processed foods haveall been linked with increasing asthma rates. And nowhereis this more evident than in Asian countries where thediet is rapidly becoming Westernised. The "new"diet provides fewer antioxidants, fewer minerals suchas magnesium, selenium and zinc, and fewer vitamins,including Vitamins A, B, C and E - all of which areconsidered to be necessary co-factors in the immunefunction. The modern diet is also very low in methyldonors such as folate and vitamin B6 which may be havingan impact on how the genes for asthma are expressed.

A number of studies have shown decreased levels ofminerals such as selenium and zinc in subgroups of asthmasufferers. There is also evidence that people with reducedintake of fresh fruit and vegetables have lower ventilatoryfunctions (they take in less air with each breath) andother studies which link diets low in fruit and vegetableswith increased rates of asthma, and more severe symptoms.There's growing evidence of the benefits of vitamin,mineral and antioxidant supplements on the severityof asthmatic symptoms. For example, the essential fattyacids (EFAs), particularly an increase in Omega 3 oils,have been shown to reduce the incidence of asthma inchildren in some studies. In the old days, parents usedto feed their kids cod liver oil and kids would eathome grown vegetables and free range eggs, all of whichare a source of EFAs.

A number of studies have also shown a relationship betweenasthma and the mother's eating habits. Children bornto women who supplement with Omega 3 oils are less likelyto develop asthma. Some studies have also found reducedsymptoms and rates of asthma in children who were breast-fedfor longer as infants. The precise reason for this isunknown, but is probably due to the protective effectof breast milk and the detrimental effect of cows' milk.Apart from other essential nutrients in human milk,it's a rich source of EFAs, choline and important immunefactors. And there is growing evidence mounting overthe use of cows' milk and increasing allergies and foodintolerances.

Some of the food colourings and other food additivesthat our kids consume in relatively large quantitiesare also linked with asthma attacks. Ones that are particularlyrelevant include the colours 102, 110, 127, the sulphurpreservatives (220- 230, sulphur dioxide, sodium sulphiteand bisulphite potassium bisulphite and sodium and potassiummetabisulphite) and MSG (621). Investigations throughoutthe world confirm a link between asthma and a person'ssensitisation to indoor allergens, such as dust mites,pet fur and feathers, insects and mould. Nevertheless,these allergens have probably always been present inhouses although the quantities of allergens and degreeof exposure may have increased in many homes.

We have made our buildings more airtight through changesin design, weatherproofing and the use of air conditioning.This traps allergens and chemicals inside buildings,whereas in older homes there is greater airflow. Theconstant temperature and humidity also produce idealconditions for dust mite and fungal growth. These conditionsare further exacerbated by the fact that many peoplekeep all their doors and window closed and that we spend90 per cent of our time indoors.

A number of studies have found a strong relationshipbetween house dampness, fungal growth and respiratoryillness. This is not only from obvious dampness suchas condensation on windowpanes, but also the amountof time spent in the shower and bath. Mould and mouldspores are a major problem for asthmatics. Mould canusually be controlled by increasing the ventilationin bathrooms and other wet areas. Fibre cleaning isvery effective in controlling mould and doesn't involvethe use of toxic chemicals.

Allergen avoidance, particularly for mould, dust miteallergens and pollen, has been shown to reduce boththe onset of asthma and asthmatic symptoms. This avoidanceappears to be especially important during the first12 months of life, when the immune system is maturing.Some research also suggests avoiding substances thatmay cause reactions, even though not related to immunefunction . This includes some biologically active chemicalsand some medications such as aspirin, sulphur dioxide,metabisulphate, coal tar dyes and flavour enhancers,such as MSG.

By contrast, while many pets produce problematic allergens,there's increasing evidence to show that having a petmay offer some protective effect. In fact, living ona farm and close to animals generally confers some protectionagainst asthma.

Probably of greater importance is that we have dramaticallyincreased our use of synthetic chemicals which, at higherdoses, are linked with asthma and respiratory disease.More and more studies are showing this link with evenlower levels of exposure to chemicals, such as thosefound in new or renovated homes.

Cleaning chemicals, spray cans, deodorants and perfumesare all increasingly being linked with contributingto the cause of asthma and potential asthma attacks.The evidence is also mounting that these chemicals maybe influencing our genetic expression through epigenetics.

The overuse of these chemicals may also be contributingto what is called the "hygiene hypothesis"which is that we are not being exposed to enough microorganisms and therefore not stimulating the immune systemat the right stages of growth. Unflued gas heaters (theones that don't have a flue or chimney) and other appliancesare linked with increased respiratory illness. Manycountries and some states in Australia have banned theseappliances. There are now dozens of studies showingassociated health problems. There is little doubt aboutthe effect of direct smoking and passive smoking onasthma and a litany of other diseases. While more andmore people go outside to smoke, there are others whostill expose their children to this cocktail of verytoxic substances. Many of the thousands of chemicalsfound in tobacco smoke are toxic. Even worse, parentswho smoke are showing their kids through their actionsthat smoking is okay. If you smoke you are teachingyour kids to do the same, despite what you might sayto them.

As the old adage says, "Actions speak louder thanwords". Attitude is important because not onlyis it likely to reduce the risk of illnesses, but italso determines what an individual will do to preventor reduce illness. Attitude is closely linked with education,the willingness to learn more and the desire to lookafter yourself. This does not mean ignoring the medicalsystem. In fact, it's the complete opposite. It meansworking with your doctor and asking lots of questions.

Remember asthma can be a life threatening illness,so you need to understand it and take it seriously.Our lifestyle has changed enormously over the last fourdecades. The structure of the family unit and how familiesinteract, our level of physical activity and our dependenceupon the car, television and computers have broughtdifferent pressures and demands. Many of these factorshave negative impacts on our health and our abilityto deal with asthma. Physical activity, breath controland stress management are essential for an asthmatic'sdevelopment of a healthy lifestyle. I have seen manyinstances where implementation of these has not onlyimproved how a person deals with asthma, but also reducedthe severity and frequency of symptoms. For a smallnumber of asthmatics, strenuous physical activity caninitiate an asthma attack. Be active, but also understandyour limits. Unfortunately, despite the growing scientificevidence, the medical paradigm tends to prevail in oursociety that we can't do anything about asthma becausewe don't have the definitive proof yet of the causes.Science, on the other hand, shows a different perspective,that there are probably many contributing factors thatneed to be addressed and all can help just a little.

Apart from this also being a common sense approach,it also helps with many other health issues not justasthma. So isn't it worth trying?

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