Does medical nutrition therapy help symptoms of asthma?
By: Amber Mix
MNT II
Research Paper
Introduction
The reason I choose asthma as my topic for this clinical research paper is
because I have been suffering with asthma ever since I was a child. My typical
symptoms are wheezing, itching throat, coughing, and short of breath. The use of two
different forms of medication are used to help control my asthma symptoms and
prevent asthma attacks. This topic is important because many people are suffering
from asthma just like me. According to the Centers for Disease Control, 1 in 12 people in
the United States have asthma. Just like obesity and diabetes, asthma is increasing
every year in the United States according to the CDC. I want to find out what other
alternative methods there are to help people with asthma besides prescribed
medications. The purpose of this paper is to find out what types of research has been
done in regards to specific diets or nutrients that can help control asthma symptoms or
prevent asthma attacks.
Mediterranean Diet
The first study I looked at was a short 12 week open-label randomized trial. There
were follow-up sessions half way through the study and at the end of the study. This
study had two goals. The main goal was to see how the subjects with asthma adopted
to the introduction of the Mediterranean diet (MD). The second goal of this study was to
examine the symptoms of asthma, quality of one's life, and systemic inflammation in the
body before and after adopting to the MD. There were 35 subjects that finished the
study. Subjects were divided into 3 groups. The groups were either high-intervention (HI),
low-intervention (LI), or part of the control group. The HI group was given more intensive
advice from dietitians, and got a total of 41-hr consultation sessions. They also were
encouraged to adopt to the MD diet. The LI group was given much less intensive
advice from a dietitian and got a 2-hr consultation. The control group was given one
session with a dietitian. Both the HI group and LI group were given additional written
advice, olive oil, and vouchers for the purchase of MD foods. There were different parts
to the procedure of this study. The first part is they used a food frequency questionnaire
(FFQ) at the start of the study and also at the end of the study. “Mediterranean diet
score (MDS) was calculated from FFQ using the method described by Panagiotakos et
al.”, (Sexton). The researchers also two other questionnaires, asthma-related quality of
life questionnaire (AQLQ) and asthma control questionnaire (ACQ). The second part of
procedures is that they performed spirometry at each follow-up visit. Lab measurements
were assessed. Lab measurements included interleukin-6 (IL-6), IL-10, interferon-γ (IFN-γ),
and tumor necrosis factor- α (TNF-α) in serum samples. Outcome measurements
included the final MDS after adopting to the MD, and endpoints of the various
questionnaires and spirometry. Results for clinical outcome measurements showed an
increase statistical significance in MDS for the HI group (p < .001). The HI group reported
an increase in the intake of fruits, vegetables, and fish, and a decrease in red meats,
and chicken compared to the control group (Sexton). The LI group and the control
group showed no significant changes in MDS. Also, there were no significant changes in
ACQ or AQLQ during this study. There were no significant changes either in any of the
inflammatory biomarkers examined. At the end of the study, the HI group showed a
significant decrease in total cholesterol (TC) and low-density lipoprotein (LDL). At the
end of the study, none of the measurements correlated with the MDS. There have been
a small number of studies that focus on the reduction of asthma symptoms while
adhering to the MD. This is more than likely the first interventional study of MD in asthma
to be published. This study did fulfill their first goal with the HI group and making the MD
easier to follow. The HI group increased their MDS and their TC and LDL cholesterol
levels decreased which are effects of a Mediterranean diet. The LI group did not have
a strong enough intervention for more significant results. The second goal of this study
was not fulfilled. They did not measure any statistical significant improvements in the HI
and LI groups regarding clinical benefits of MD diet. The MD may improve a person with
asthma's' life but it may not improve their asthma. I think this study could have showed
better results if the sample size was larger. Maybe the MD doesn't improve asthma
significant but maybe it helps prevent asthma from existing. Also, this study could have
had better results if the duration was longer.
Nutrition Supplement
In this study multi-nutrient supplementation on micro-nutrient status, oxidative
stress and inflammation, immune response, pulmonary function, and health-related
quality of life in patients with mild to moderate asthma. This study was open-label pilot
study. There were 60 patients that were in this study. There were two groups in this study,
the asthma group with mild to moderate asthma (n=30) and healthy patients (n=30).
Daily dietary supplement was taken for 2 months. There was no placebo in this study.
Daily dietary doses of multi-nutrient formulas were called green barley powder, oxy rich,
omega rich, prime c complex, bio shield, and healthy life. Measurements taken were
plasma concentrations of non-enzymatic antioxidants and plasma EFA's, plasma lipid
peroxidation and inflammatory markers, erythrocyte enzymatic antioxidant activities,
changes immune index and total serum IgE, asthma control test (ACT), changes in
pulmonary function, and quality-of-life scores. These measurements were assessed at
baseline, after 1 month of supplementation, and after 2 months of supplementation.
The Guo et al results included asthma patients with a significant higher IgE, MDA,
copper (CU), hs-CRP, and CD19 and CD4/CD8 lymphocyte ratios, and decreased
selenium (Se), zinc (Zn), B-carotene, vitamins C and E, and catalase, glutathione
peroxidase (Gpx) and glutathione reductase (GR) activities compared to healthy
controls at baseline (3). “Asthmatics had non-significantly increased pulmonary function
and a trend toward lower IgE levels, markedly reduced MDA, Cu, hs-CRP, and CD19
and CD4/CD8 ratios, and increases in levels of Se, Zn, B-carotene, vitamins C and E,
and enzymatic antioxidant activities” (3). Also, both questionnaire scores increased
significantly. In the end, nutritional supplementation may improve dysregulated
oxidative and antioxidant status, inflammation and immune responses, pulmonary
function, and health-related quality of life asthmatics (3). This study could have showed
a stronger result if the sample size was larger. I believe this sample size was too small to
get even better results. Not only did this study show an improvement in lab values but
also in a person's quality of life with asthma. These subjects were put on all the dietary
supplementation formulas. There was really no distinct supplementation. I think they
should have had a couple more groups in the study to see which formulas worked
better than the others.
Vitamin and Mineral Treatment in Asthma
There is no known cure for asthma, just medications to help with the symptoms
and prevent future asthma attacks. Also, you can avoid asthma symptoms and attacks
by staying away from possible triggers or irritants. Sometimes people might not even
know what they are allergic to or sensitive to. With that being said, the cause of asthma
is unknown. Avoiding triggers alone is a significant treatment for asthmatics. In recent
studies, the focus on diet and asthma intervention is becoming more familiar. What this
research has found is that antioxidants vitamin C, magnesium, and polyunsaturated
fatty acids have been the majority of nutrients studied to date. When you have asthma,
your air ways become inflamed and are more susceptible to oxidative damage. This is
why antioxidants are good because they may help to reduce inflammation and
asthma symptoms. The Singh et al (4) research has stated that the Murray (2001) study
concluded that high-dose vitamin C therapy of 1-2g/day appears extremely effective
based on the increasing exposure of inhaled oxidants in the respiratory system and
helps lower histamine levels. Magnesium for example, has been shown to promote
relaxation of the bronchial smooth muscles which then dilates airways and patients can
breathe easier. Magnesium is best absorbed “when bound to citrate or aspartate and
25-75mg/kg doses of intravenous magnesium sulfate have been a well proved and
clinically acceptable measure to halt acute asthma attacks and acute exacerbations
of COPD” according to Singh et al (4). Also, oral supplementation of 280mg/day can
improve bronchial airflow. Nutritional supplementation has not been well studied yet
and further research is needed but we do know that there is a possibility that diet and
nutrients may play a role is the control of asthma.
Conclusion
In conclusion, all 3 studies have shown that nutritional intervention may help
asthma symptoms but research is still inconclusive. It is important to have further
research about the effects of nutrition and asthma because many people are suffering
with asthma. It makes sense that antioxidants can help protect the body from oxidative
damage, specifically the inflammation in the airways. These studies were done with a
small sample sizes and short durations and it is hard to make a decision on what is
significant. Findings in these studies may have not been statistically significant but there
was an improvement in the control of asthma. It would be interesting to see how
children would be affected because these studies involved adults. I could apply this
information to my future patients who have asthma to help them cope with their
symptoms.
References
Sexton P, Black P, Metcalf P, Wall CR, Ley S, Wu L, Sommerville F, Brodie S, Kolbe J.
Influence of Mediterranean diet on asthma symptoms, lung function, and systemic
inflammation: A randomized control trial. Journal of Asthma. 2013; 50(1):75-81.
Centers for Disease Control and Prevention. CDC Vital Signs. Asthma in the US. 4 May
2011. Available at: http://www.cdc.gov/vitalsigns/asthma, assessed May 6 2013.
Guo C, Liu P, Lin K, Chen P. Nutritional supplement therapy improves oxidative stress,
immune response, pulmonary function, and quality of life in allergic asthma patients: An
open-label pilot study. Alternative Medicine Review. 2012; 17:42-56.
Singh A, Feuerstein L. Vitamin and Mineral Treatment in Asthma. Townsend Letter. 2013;
Feb/Mar: 70-72.