Asthma, Allergies and Joint Pain
September 12, 2019 | 18 Comments | SAFM Team
(This is another rich, sample entry from our Q&A Treasure chest, a database with hundreds of entries to support students with their patient and client work. Unlimited access is included as part of our Core 101 Semester program.)
Tracy, I have a 51 y/o client who has been seeing a naturopathic doctor for Asthma, Allergies, and Joint pain she has had for 17+ years. She’s been using a steroid inhaler for her regular asthma for many years. However, none of what she’s added in this year with the naturopath has helped either the asthma or joint pain – at all. I know I need to do a deeper dive into upstream root causes (e.g. toxicity, mold), but what would be helpful here for rapid relief? What am I missing? What about a food sensitivity test? Thanks!
This client has been doing…
- No grains.
- No dairy foods.
- No processed food.
- Increase animal fats (but only grass fed, etc.) to ~70% of diet.
- Throwing out cheap grapeseed oil and soy margarine (to reduce pro-inflammatory Omega-6 fats).
- Increase intake of fermented foods e.g. sauerkraut (but he did not put her on a probiotic)
- Take omega-3 oils EPA and DHA ProOmega fish oil (Nordic Naturals) – 1 tsp/day
- Take all the Fat soluble vitamins A, E, D, and K
- Take Biotics’ “Bio-D-Mulsion Forte” (liquid form of Vitamin D3 – 2,000 IUs) a day with breakfast.
- Blue Ice Fermented Cod Liver Oil (from Green Pasture) – 1 tsp/day (which yields ~10,000 IUs of naturally occurring vitamin A)
- Increase Vitamin K2 via plenty of butter intake
Okay, now *before* you read on, take a moment to consider: how would You respond?
What interconnectedness do you see?
What would likely help this individual to get some rapid relief as you kick-off your work together?
Asthma is a chronic inflammatory disorder of the respiratory system. In the bronchioles of the lungs, we find inflammation (swollen walls, increased mucus, tightened muscles), and histamine is a major mediator. Since inflammation is generated by the immune system, asthma very often occurs hand-in-hand with other immune-mediated dis-ease in the body, especially when they have been sustained for a long time, such as environmental allergies, food sensitivity/allergy, eczema, acid reflux, arthritis, and chronic sinusitis. Many common triggers for asthma are allergies, including food sensitivities. To your point, there can be a different set of underlying root causes for the asthmatic state (e.g. toxicity, environmental allergies) vs. common triggers for a bout of asthma (e.g. specific foods, stress).
Anyone looking at the list of recommendations your client is dutifully pursuing would agree that those are all theoretically healthy activities. Who could argue with any of those, right? Well, in this case, it pays to get up close….armed with an understanding of disease-specific interconnectedness. This is a journal article on the specific connections between histamine and asthma.. Here are some specific recommendations which might be helpful:
- There is an attempt to eliminate dairy foods, yet there is encouraged high intake of butter? I understand the desire to take in more Vitamin K2, but I would not recommend butter intake for this client at all until there has been dramatic rapid relief and an opportunity to begin to work on the root causes. In my experience 100% of chronic asthma patients have a food sensitivity to dairy foods. While the dairy protein content of butter is low, it is not zero, and I have seen this be in the way of relief in a few asthmatic clients in the past.
- For rapid relief, we need lower intake of histamine overall. Asthma is a histamine-mediated inflammatory dynamic, yet there is a recommended high intake of fermented foods (which contain high levels of histamine themselves!). I recommend fully avoiding all fermented foods for now until the histamine intolerance can be explored and reversed, including the fermented cod liver oil.
- I agree with eliminating refined seed oils. However, there is a recommended high intake of animal fats (which can promote high histamine release), especially arachidonic acid and especially in chicken eggs. For a person with appropriate balance between histamine intake/production and degradation, this is not typically a concern. We simply produce more DAO (diamine oxidase) in the gut to breakdown the histamine that is produced. But if DAO is limited (e.g. post-antibiotics or with dysbiosis or toxicity) or is not appropriately responsive to demand for more, this creates histamine overload. In this case, a more moderate fat intake that focuses on medium chain fatty acids (e.g. coconut oil) and oleic acid (e.g. extra virgin olive oil) will likely be a better interim balance. For now, I would also eliminate eggs.
- Ongoing use of steroid inhalers commonly creates yeast overgrowth, perhaps even thrush, in the upper respiratory and/or GI tract. Over time (especially given the duration of this client’s suffering) this dynamic can create a food sensitivity to yeast. This is also a way in which chronic use of conventional medication for asthma can continue to promote immune imbalance. Because these foods also contain high levels of histamine, I would eliminate all yeast/fungus-containing or -cultured foods e.g. beer, wine, vinegar, cured meats, kombucha, miso, tempeh). I would also consider doing a 10-15-day round of antifungal support in order to counter what has very likely built up in her GI tract (e.g. Renew Life’s “CandiSmart”); this will not address the issue long-term but will likely provide some relief to help establish a new normal with a lower histamine burden.
- Add 300mg boswellia and 1000mg quercetin twice daily. The regimen this client is using does not include a specific anti-inflammatory agent beyond the attempt to rebalance omega-3/omega-6 fats. The goal is to minimize the need for the inhaler, so the body can begin to recover from the ongoing use of steroids. Boswellia is particularly helpful for joint pain (a good alternative to NSAIDs in this case), but it also impairs leukotriene production and has been clinically shown to reduce asthma symtoms. Quercetin impairs mast cell degranulation directly.
- A daily Lactobacilus Rhamnosus probiotic (e.g. Culturelle). While many other probiotic species are histamine-producing, L. rhamnosus is histamine-degrading. (Of note, Saccharomyces Boulardii could also be helpful in rebalancing the Th1/Th2 immune reaction that is so often skewed in these individuals; however, given the likelihood of a yeast sensitivity in this particular person given her medications, I would not use a beneficial yeast probiotic).
- An activated B-complex once daily with food. While we acquire histamine from foods, we also generate histamine internally, the degradation of which requires methylation. I would check methylation status (e.g. homocysteine, methylmalonic acid). If data is not available, I would add a daily supplement that features a P5P form of Vitamin B6 (e.g. Thorne, Pure Encapsulations). And remember we always want to add/increase a B-complex low’n’slow to allow pathways to be supported progressively.
- Assess possibility of insufficient stomach acid (which can cause both magnesium and vitamin B12 insufficiency). You don’t mention it, but there is a very common association between chronic asthma and GERD. Allergy can promote insufficient stomach acid. This hypochlorhydria can then promote GERD, and frequent use of steroid inhalers can weaken the lower esophageal sphincter, also promoting GERD. Low stomach acid promotes more immune system exposure to allergenic proteins which can then worsen allergic hypersensitivity, creating a vicious cycle. In my own practice, every single person with chronic asthma also has had hypochlorhydria. Certainly this dynamic can bounce back as you address upstream root causes (e.g. hypothyroid, steroid use), but supporting it in the short-term is often key to improve nutrient absorption and to reduce downstream allergenic response in the gut.
- Assess magnesium status. By promoting muscle tightness and/or spasm, insufficient magnesium might be at play in exacerbating these symptoms.
- I would also simplify her fat-soluble vitamin intake by using a single formula e.g. Allergy Research Group’s “Vitamin D3 Complete” which includes Vitamins A, E and K2 as well.
- Work on making the bedroom (the sleeping environment, in particular!) a non-allergenic environment. This may include an air filter, letting beloved pets sleep elsewhere, cleaning curtains/carpets, investigating sources of mold, etc..
There are many other options to consider, if necessary! For example, proteolytic enzymes taken on an empty stomach could help to break down immune complexes, especially to counter the joint pain. Or if boswellia is not enough, then curcumin might be added in combination. To counter histamine specifically, there are diamine oxidase (DAO) supplements that can be taken with meals to help the gut to break down more of what is consumed. However, in my experience, the above list is typically sufficient to bring dramatic rapid relief to this type of client profile. I will emphasize, however, what you said above that these interventions are only toward the goal of rapid relief, and the true root cause resolution remains important work! In my own practice, 100% of chronic asthma clients struggled with toxicity and benefit immensely from a few rounds of targeted detoxification support.
Yes it would be great to have food sensitivity test results. However, in this case, I would not recommend it. Any steroid medication is going to impair the accuracy of an antibody-based food sensitivity test (such as IgG). By definition, steroid medications work in the body by inhibiting the immune system – and thus reducing inflammation as well as the adaptive immune system’s function of making antibodies to identify potentially threatening agents (like food!). This can be helpful for short-term triage and relief for an overwrought immune system, but long-term use is dangerous. So yes, it is important to be off of any steroidal medications at all for 8+ weeks prior to any antibody-based testing. Otherwise, all levels will likely be suppressed. As always, we want to remember that the gold standard of food sensitivity testing is elimination and structured reintroduction.
If you know that healthcare must be transformed to be sustainable and effective, and you believe strongly that Functional Medicine is key to making that happen, we urge you to learn about our semester program.
If you haven’t done so already, sign up to receive weekly clinical tips like this via email, and you’ll also get automatic access to a free mini clinical course.
Like us on Facebook to get more great clinical tips and to get notifications of my next Facebook Live!