Nutrition IV - Common Ailments in Clinic - Asthma and Atopic Dermatitis

Question 1

Asthma and Atopic dermatitis (Eczema)

Answer 1

Atopic dermatitis (eczema) and asthma are hypersensitivity reactions where the immune system overreacts to an antigen
* There is often a family history of atopy and there is a strong link between having atopic dermatitis (AD) in childhood and developing asthma (and /or allergic rhinitis later) in life
* A low intake of fresh fruit and vegetables and imbalances and fatty acid ratios (omega-6: omega-3) are contributing factors
* Common allergens include pollen, dust , mites, animal dander and fungal spores
* Food allergies (e.g. eggs, peanuts) and sensitivities can also play a role

Question 2

Imbalanced immune system (Th1:Th2)

Answer 2

Imbalanced immune system (Th1:Th2):
* Central to AD and asthma is disturbance to the balance ofcertain immune system cells – the T-helper cells
* There are two subsets – T-helper 1 (Th1) and T-helper 2 (Th2)
* Th1 cells target viruses and certain bacteria that have entered body cells
* Th2 cells target allergens, toxins and parasites
* They generally work in a ‘seesaw’ fashion with neither being dominant or activated for extended periods
* In some people the activity of T-helper cells becomes imbalanced
* Th2 dominance is associated with atopic conditions – excessive Th2 promotes the release of IgE, resulting in inflammation

Question 3

Imbalanced immune system (Th1:Th2): Pregnancy

Answer 3

• In pregnancy women are tipped towards Th2 dominance to reduce the risk of miscarriage
• As a result, babies are born with Th2-biased immune systems
• The Th2 and Th1 balance is normally established during birth via the exposure to vagina bacteria and prebiotics in the breast milk
• Some babies are prevented this exposure through C-section birth, bottle-feeding or antibiotic use in the first year of life
• Genetic influences, increased antigen uptake (intestinal permeability) and dysbiosis at any age can disrupt T-helper cell balance

Question 4

Simple elimination diet

Answer 4

Simple elimination diet:
* This starting point can be helpful in addressing the Immune imbalance by identifying problematic foods
* Key triggers: cow’s milk, shellfish, eggs, soy, peanuts, wheat, rye, barley and chocolate
* Avoid the most common allergenic foods and any food containing artificial colours, flavours and preservatives for at least one week
* After the elimination period, introduce a new food every two days and monitor for recurrence of signs and symptoms

Question 5

Addressing immune imbalance

Answer 5

Addressing immune imbalance:
* Good microflora colonization promotes Th1 / Th2 to balance, whilst also supporting the GI tight junctions. Support with:
o Prebiotics (chicory root, dandelion greens, garlic, onions, asparagus, flaxseeds) – plant fibres that are fermented by bacteria, subsequently producing SCFA’s which fuel enterocytes and support the GI tight junctions
o Probiotics (kefir, sauerkraut, kimchi, kombucha, miso) – bacteria that promote healthy microflora, supporting immune health and are linked with reduced allergy risk

Question 6

Vitamin C

Answer 6

Vitamin C: 250 mg x 2 daily
* Food sources:
o Peppers
o Broccoli
o Kale
o Cauliflower
o Tomatoes
o Kiwifruit

• Functions:
  o Has antioxidants, anti-inflammatory and antihistamine properties (balances Th1 / Th2)
  o Aids collagen production – skin (dermis)
  o Asthma – 2000 mg before exercise helps protect against exercise-induced asthma

Question 7

Vitamin D

Answer 7

Vitamin D: 400 – 1000 iu / day

• Food sources:
  o Mushrooms (Sun exposed)
  o Oily fish
  o Egg yolks
• Functions:
  o Helps to regulate immunity and rebalance Th1 and Th2
  o Decreases inflammatory mediators (TNF-a, IL-6)
  o Inhibit oesinophils – cells strongly associated with asthma

Question 8

Vitamins E

Answer 8

Vitamin E: 400 – 800 iu / day

• Food sources:
  o Sunflower seeds
  o Almonds
  o Pine nuts
  o Olive oil
  o Avocado
  o Spinach
• Functions:
  o Optimises Th1 and suppresses Th2 leading to a decrease in inflammation and serum IgE
  o Reduces oxidative stress
  o AD -topically enhances skin repair

Question 9

Omega-3 fatty acids

Answer 9

Omega-3 fatty acids (3 – 6 g / day):
* Food sources:
o Coldwater fish
o Chia seeds
o Hemp and flaxseeds and oil
o Walnuts
* Functions:
o Imbalance in the ratio of omega-6 to omega-3 negativity effects Th 1 / Th2 balance
o Restores balance and reduces inflammation
o AD – improved moisture content and the skin barrier

Question 10

Quercetin

Answer 10

Quercetin (500 mg 2 x daily)

• Food sources:
  o Red onions
  o Shallots
  o Apples
  o Berries
  o Grapes
  o Broccoli
  o Kale
  N/B: Onion and shallots contain quercetin in a form that may make absorption easier
• Functions:
  o A naturally occurring flavonoid (plant pigment) found in certain foods and herbs
  o Anti-inflammatory – down regulates NF-KB and inhibits histamine release
  o Asthma – decreases airway inflammation and hyper-responsiveness
  o AD – ameliorates tissue damage and reduces development of lesions

Question 11

Vitamins B3 and B6

Answer 11

Vitamins B3 and B6 (50 -100 mg / day)

• Food sources:
  o Whole grains
  o Green leafy veg
  o Sunflower seeds
  o Legumes
• Functions:
  o B3 decreases histamine release – calms the allergic response
  o Increased intake of B6 is linked to decreased frequency and severity of asthma attacks

Question 12

Magnesium

Answer 12

Magnesium (500 – 1000 mg / day):

• Food sources:
  o Almonds
  o Seeds
  o Dark leafy greens
  o Whole grains
  o Legumes
• Functions:
  o Decreases uptake and release of calcium in bronchial smooth muscles
  o Relaxes and dilates bronchial muscles
  o Increased magnesium intake correlates with reduced airway reactivity

Question 13

Additional considerations: Asthma

Answer 13

• Ginger and turmeric are anti-inflammatory. Include healthy dietary fats and black pepper with turmeric to aid absorption.
• Include in meals, add to fresh vegetable juices, freshly grate and infuse in boiling water
• Include fresh fruit and vegetables (antioxidant, anti-inflammatory)
• Reduced meets – arachidonic acid increases inflammatory mediators that cause airway hyper responsiveness
• Avoid a table salt – excess is linked with bronchial reactivity
• Avoid additives ( especially MSG), preservatives (especially sulphites) and colourings (especially tartrazine– yellow dye)

Question 14

Additional considerations: Atopic dermatitis – Zinc

Answer 14

Zinc (25 – 60 mg / day)

• Food sources:
  o Sesame Seeds
  o Pumpkin seeds
  o Cashews
  o Lentils
  o Chickpeas
  o Oats
  o Quinoa
  o Brown rice
  o Oysters
  o Sardines
  o Salmon
• Functions:
  o Role in cellular replication and wound healing
  o Supports tight junctions (i.e. the skin barrier)
  o Supports immune function to reduce risk of bacterial infection in eczema lesions
  o A co-factor for the production of essential fatty acids (which are crucial for skin health)

Traditional AD is considered a hot condition:
* Avoid eating foods e.g. chilli, dry ginger, red meat, coffee, alcohol
* Balance with cooling food e.g. salads, green smoothies, fruit