Gill Stannard

Showing posts with label allergies. Show all posts
Showing posts with label allergies. Show all posts

Monday, April 28, 2008

asthma

What is asthma?

With over 2 million Australians being diagnosed with asthma, including up to 1:4 children, we are living in one of the most allergy prone countries in the world.

Asthma is an inflammatory condition of the airways in the lungs. It may feel like a persistent, irritated cough, a tightness in the chest or a distinctive wheezing sound when trying to breathe. This may be caused by a change in air temperature, exercise, dust, pollens, cigarette smoke, a respiratory infection or a wide range of allergens. When triggered, this causes swelling, constriction and the production of thick, sticky mucus that makes breathing, especially exhaling air, very difficult. Most asthma attacks are well managed with preventative (eg: steroids) or acute (eg: Ventolin) drugs but sometimes an asthma attack can be fatal. Because of this, all practitioners take a diagnosis of asthma very seriously.

Can you treat asthma without drugs?

Firstly it is important to actually make sure that someone actually has asthma. This may sound strange but asthma is misdiagnosed in both children and adults at an alarming rate. In kids there has been a tendency to classify most prolonged coughs as asthma.
Associate Professor Colin Robertson from the Royal Children's Hospital Melbourne is also a spokesman for the National Asthma Council of Australia. He says he's spent more time undiagnosing asthma than diagnosing it over the past decade. “Throughout the quarter of last century, there was an amazing awareness campaign for improving the diagnosis of asthma, which has been incredibly effective, and perhaps a bit too effective, so that children with a wide range of respiratory symptoms are having the diagnosis of asthma and not all of them have it.” ABC ’7.30 Report’, 8.4.03


In adults as well as children, common conditions such as 'silent reflux’ (gastrointestinal oesophageal reflux or GORD/GERD) which often triggers coughing after food, coffee, exercising or lying down - may be more likely to be a culprit in a person with no past history or allergies. The cough does not significantly improve on asthma medication, nor develop into serious breathing problems.

With a clear diagnosis of asthma, it would be unusual for a naturopath to tell a client to cease their pharmaceutical drugs. Treatment is generally centred around – decreasing triggers, reducing mucus, improving breathing, increasing immunity and trying to decrease the incidence of respiratory infections.

Can foods cause asthma?

Asthma is typically seen initially in children with a family history of atopic allergies eg: eczema, asthma, hayfever, hives. Often they have a history of eczema or other skin rashes before developing respiratory problems. This may go away when they use topical steroid creams but later it is not unusual for some of these children to present with asthma. Some naturopaths believe that the eczema is the body’s way of trying to get the person to avoid an allergen and when this is dampened down or ‘cured’ with drugs it can express itself in a different way such as asthma or persistent rhinitis. While there is much debate as to whether foods like dairy products or wheat “cause” asthma or produce mucus in the respiratory system, in practice an appropriate low allergy diet does tend to provide good results.

In my experience, when all dairy foods (including ‘hidden’ dairy in some processed foods) are removed from the diet long term, it can improve most allergic respiratory conditions. While other triggers still abound – such as pollens and changes in air temperature, food is the one thing we can control most of all.

Other things we can’t always control that have been linked to developing asthma and other allergies include: caesarean birth, antibiotics in the first 6 months of life, being bottle rather than breast fed, air pollution, passive smoking or being overweight.

Nutrients for asthma

A number of studies have shown a connection between low nutrition, especially antioxidants such as Vitamins E, A and C and asthma. These nutrients tend to have anti-inflammatory actions, so too does fish oil. There is some evidence that magnesium may be implicated in asthma.

Try to avoid polyunsaturated vegetable oils, margarine, vegetable shortening, all partially hydrogenated oils that might contain trans-fatty acids and deep-fried foods, due to their ability to provoke inflammation. Use anti-inflammatory herbs like ginger and turmeric.

Typically, a low allergy diet for asthma is a good starting place. This is one without wheat, dairy, soy, corn (including high fructose corn syrup), eggs, nuts and all additives. Include alternative sources of calcium such as seeds (eg tahini), beans, and edible fish bones (eg: in canned salmon and sardines, also high in good oils). Ideally most food is cooked from scratch, as processed food even when it doesn’t contain suspected allergens, is low in nutrition. Increase the amounts of seasonal fruits and vegetables, grains such as quinoa, brown rice, oats and barley and other wholefoods like beans and lentils.

After 3-6 weeks, introduce a new food group, one at a time, each week and see if there is any worsening in the asthma. Record symptoms on a chart, peak flow readings and how often acute medication is needed.

Alternative treatments for asthma

Both Western and Chinese herbal medicines are frequently used for asthma. I use herbs like elecampane, hyssop and sundew to strengthen the lungs, as well as immune stimulants and nervous system tonics as required depending on the individual. Unfortunately in Australia some strong but effective herbs like lobelia and ephedra are no longer available to be prescribed by herbalists.

There are potentially issues with the contamination and adulteration of some Chinese medicines bought overseas or in Australia. These have included heavy metals or the inclusion of non-disclosed pharmaceutical drugs. This is less likely to occur if you are given raw herbs to decoct rather than pre-made tablets or powders.

Manual treatments – including osteopathy, chiropractic and remedial massage can often help if the diaphragm is tight of other musculo-skeletal problems are apparent.

Buteyko technique - has some of the most promising results for asthma management. This is a breathing technique that needs to be taught by a qualified instructor. I would thoroughly recommend every asthmatic to give it a go.

Appropriate exercise: There is a good reason why so many of our gold medal winning swimmers began their life as asthmatics. While exercise can be a trigger for asthma attacks, swimming is largely beneficial, though preferably in an outdoor, non-chlorinated pool. Yoga and chi-gong can also be useful.

Other common asthma triggers

Analgesic drugs, such as aspirin and nsaids, panadol is often a safer choice.

Cleaning products especially aerosol and spray based ones. White vinegar and bicarbonate of soda are effective cleaners and much safer for asthmatics.

Cockroaches mould and dust mites. This offers some solutions.

Cats and dogs are controversial. Though an obvious trigger for some, growing up in a home with pets, such as in this study looking at cats, can also reduce your chances of becoming an asthmatic. And here's a study in support of dogs.

Not taking your asthma seriously. While complementary therapies may reduce your need for medication, doing nothing and not having an action plan is a disaster waiting to happen.

As reminded by a caller on the show - check your heating. Gas heaters, especially those with a pilot light, can provoke asthma in some. Also clean out your ducted heating every year. It costs a little money but is worth it when you see the gunk pulled out of the ducts that you were breathing in.

Update: April 2009. "A low intake of vitamins A and C could raise the risk of asthma, a team which reviewed 40 studies carried out over the past 30 years has said.

A Nottingham University-led team found people with a low intake of vitamin C had a 12% increased risk of asthma, the Thorax journal reported.

For vitamin A the raised risk was less clear cut, the team said, but there was still a significant association." Read more

Monday, May 14, 2007

Wheat allergies, coeliac disease and gluten-free living

What is Coeliac Disease?

Coeliac Disease (CD) is an intolerance to gliadin, a protein in gluten. Gluten is what makes grains ‘stretchy’ (think of kneading bread dough and how elastic it becomes). Some people have a genetic predisposition to react to gliadin, causing the absorptive surfaces in the small intestine (villi) to flatten and not absorb food properly. CD, though an intolerance to gluten, is considered an auto-immune disease (where the body’s defence system attacks itself) and a person with CD may be more likely to have other auto-immune conditions. One small study found 51% of coeliacs had other immune diseases, the most common being type 1 diabetes. Interestingly, the same study sited only 24% had classic coeliac symptoms.

The 2 main tests for CD are a blood test that looks for antibodies to gliadin and a biopsy of the small intestine. However it is recommended you eat gluten containing foods for 6 weeks before being tested to get an accurate result. For people who have already experienced the wonders of being gluten-free and healthy again, this can be agonising.

The only treatment for CD is a totally gluten-free diet. Even traces of gluten can flatten the villi again, usually taking weeks to recover.


What are some of the symptoms of Coeliac Disease?

Keep in mind that perhaps a 1/3 of people with condition do not experience classic or even minor symptoms. The majority will experience gut pain and change in bowel habits (chronic diarrhoea, smelly stools, gas, weight loss) when they eat gluten. However as a result of the malabsorption of nutrients that occur a whole range of non-gut related symptoms can occur.

These may include:
recurrent and slow healing infections
unexplained anaemia (low iron)
bone pain
behavior changes
muscle cramps
fatigue
delayed growth
failure to thrive in infants
pain in the joints
seizures
tingling or numbness in the legs (from nerve damage)
pale sores inside the mouth,(aphthus ulcers)
painful skin rash (dermatitis herpetiformis )
tooth discoloration or loss of enamel
reproductive issues (miscarriages, infertiltiy)
missed menstrual periods (often because of excessive weight loss)

Gluten containing foods:

The grains that contain gluten
Wheat: eg most breads, noodles, pasta, couscous, cakes, biscuits, muffins, tabouli, pancakes, pastry, breadcrumbs (eg: schnitzel), bran, ingredient listed as “flour”
Spelt, semolina, durum, kamut (all varieties of wheat)
Rye: bourbon
Oats – eg: most muesli, anzac biscuits, porridge (however – oats are very low in gluten and the issue may be cross-contamination when oats are processed)
Barley – some coffee substitutes, added to soups and stews
Malt – eg: most malted milk and chocolate drinks, soy milk (except those labelled “malt free”) malt/brown vinegar (and lots of pickled foods), beer
Triticale
Seitan eg: most Chinese ‘mock’ meats

Watch out for gluten hidden in some of these products

Soy sauce (wheat)
Thickeners (in sauces, some commercial mayonnaise)
Gravy
Caramels
Some lollies and candy bars
Cocoa
Most breakfast cereals
Sausages and luncheon meats
Fried and ‘grilled’ fish (usually dredged in flour)
Some types of whisky, gin, vodka (as well as bourbon and beer)
Casseroles and other dishes where meat or fish has been rolled in flour and fried.
Baby foods, formulas and cereals
Packet soups and stocks
Baking powder
Sauces and gravies
Tinned soups
Baked beans
Some mustards and curry powders
Pickles
Some yoghurts
Some ice blocks
Ice cream cones
Semolina
“starch” or “modified food starch”
MSG (glutamic acid can be made from wheat, soy or corn but rarely is the source mentioned on the label)

Note: eating out can be hazardous. It is not unusual for meat or fish to be floured then fried in most restaurants. There is also the risk of cross-contamination. Kissing someone who has just eaten gluten can also set off the condition (think about a few crumbs hanging around after eating a sandwich, beards and mustaches can also harbour all sorts of morsels). However the good news is there is an increasing awareness about gluten intolerance and Melbourne has some dedicated allergy friendly stores and restaurants (see links below). Now most supermarkets have a range of gluten-free products in the health food aisle.

Some good alternatives

Check the health food isle at your supermarket (or a wholefoods store) for items labelled “gluten free” including flours, muesli, pasta etc.
Flours – rice, potato, soy, lentil, chickpea, buckwheat, arrowroot, cornflour/cornstarch
Rice noodles
Polenta
Millet
Quinoa
Rice
Sorghum
Beans/legumes
Rice cakes/crackers (plain)
Corn thins
Taco shells, corn chips (plain)
Tamari (instead of soy sauce)
Apple cider or balsamic vinegar

Wheat allergy versus Coeliac Disease

Food allergies are common and not everyone who reacts to wheat is gluten intolerant/coeliac. Many different food allergies and intolerances can cause similar gut symptoms such as bowel changes, bloating, colic, gas, mood changes, fatigue and trigger atopic allergies such as eczema etc.

As wheat is usually eaten as flour (ie: a highly processed form of the grain) and over eaten in the modern diet, it is not surprising that it is such a common allergy. You may be born with a (non-coeliac) sensitivity to wheat or acquire it after a gastrointestinal bug (such as giardia or “Bali belly”), a period of stress or from over exposure. Less commercially used forms of wheat such as spelt may be tolerated in small doses (such as in a rotation diet) as well as non-wheat but gluten containing whole grains. But you may find if you eat your alternative flour too frequently you may become sensitive to it, bringing back your old symptoms.

Testing for food intolerances (other than CD) is controversial. The most commonly used medical test – RAST (skin prick test) is notorious for delivering both false positive and false negative results. Kinesiology, Vega, Thera and other ‘naturopathic’ tests have also given varied responses. As an allergy (a permanent response, causing an antibody-antigen reaction) is different from an intolerance (which may also occur all the time or only in certain circumstances) even an accurate allergy test won’t prove an intolerance. However the most reliable test for a food allergy that I have found is an IgG antibody test, such as the 93 food panel test. You will need to eat the suspect foods for at least a week before doing the test. Unfortunately it is not covered by medicare and is quite expensive.

Though not full proof, one home remedy for detecting a suspect food allergy is the pulse test. Take your resting pulse as a baseline. 10 and 20 minutes after eating the food take your pulse again. If in either of these 2 tests it is raised by more than 10 beats per minute, these foods should be considered potential allergies or intolerances.

Whenever you remove one food, or a group of foods, from your diet the key to good health is to diversify what you are able to eat. If you cut out gluten, explore cooking with quinoa, millet, rice, beans, lentils and as many vegetables as possible.


More coeliac-friendly links than you can poke a stick at!

Gluten-free in Melbourne

Silly yaks a dedicated coeliac café in Northcote (which even makes gluten-free beer!)

S.Komatsu a new gluten-free restaurant in East Melbourne (I’ve seen no reviews yet, leave your feedback in the comments if you’d like to tell us about it)

Speaking of gluten-free beer
A list of some gluten-free eateries

More eating links from the Victorian Coeliac Society

Allery Block is a store in Carlton specialising in allergy-free products. It also has online shopping.

Coping with being gluten-free

A blog documenting one woman’s journey from illness to happiness - gluten-free girl’s blog. She also has a great description of how she can spot an undiagnosed coeliac sufferer on sight.

A massive amount of gluten-free links

Monday, March 05, 2007

indigestion/reflux

Indigestion, reflux, heartburn, GERD/GORD – call it what you like but the short of if is that acid from the stomach goes in the wrong direction and irritates the oesophagus (the piece of plumbing between the mouth and stomach). There are many reasons why this may happen, often “too much stomach acid” is blamed but it must also bypass a sphincter in the lower oesophagus as well.

Some of the usual suspects in indigestion are: allergies, drug side effects (especially painkillers like NSAIDs), pregnancy hormones and pressure and stomach ulcers.

Reflux is almost as common in babies and infants as it is in adults but the symptoms of vomiting, crying, coughing, hiccoughing etc may often go undiagnosed. In 20-41% of infants diagnosed with Gastroesophageal reflux there is evidence of a cows milk allergy or intolerance. Food allergies are always suspected in babies with this condition.

In adults symptoms include – pain behind the breast bone, actual stomach acid rising in the oesophagus causing pain and irritation, a tickle at the back of the throat, persistent cough and hoarseness. The last two symptoms, when unaccompanied by an awareness of the others is sometimes termed “silent reflux” and may be misdiagnosed as asthma (though as reflux is a very common symptom, many asthmatics may have reflux as well).

Like babies’ food allergies are always likely in adults with reflux, however after a lifetime of eating an irritant food, the symptoms may appear stronger and more recalcitrant. Once you have reflux it is likely a whole host of foods will aggravate your condition – the most common are coffee (even decaf), chilli, alcohol and what I call “flour plus fat” (eg: pies, pastry, pasta, cakes, biscuits). But there are often other foods that may be your individual trigger – so a food diary is a good tool in tracking down the culprits.

Smoking is a big no-no. It severely aggravates this condition and could be a potential catalyst in upping the odds in developing cancer of the oesophagus.

And in case you skipped over it 2 paragraphs before – alcohol makes reflux really worse. If you want some relief from your symptoms, a little “detox” time makes good sense.


Reflux tips

If indigestion disturbs your sleep try raising the head of your bed to make it harder for the acid to flow back

Don’t eat for at least 2 hours before exercising

Watch your posture

Eat at a table, don’t multitask

Keep a food diary to track – food, drinks, stress, activities and symptoms

Follow the food guidelines above and consider having a break from dairy foods as well

Try good quality herbal teas: meadowsweet, liquorice, chamomile – 2-4 cups a day

Try 1-2 teaspoons of slippery elm powder mixed with water or mashed banana – before breakfast and before bed, or as required

Try a little diluted fresh cabbage and/or potato juice (strange but true)

Chew on a cell salt or tissue salt made from potassium and iron phosphate to relieve symptoms


Caveat: Long term, uncontrolled reflux can lead to permanent changes to the cells in the oesophagus, a condition known as Barrett Oesophagus. This carries a small risk factor of developing into oesophageal cancer. If you have severe reflux and wish not to take pharmaceutical drugs, you are advised to follow strict diet and lifestyle guidelines and have the appropriate diagnostic tests as recommended by your gastroenterologist.