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Dr. Magryta: Asthma, allergies and nutrition, part 1

Dr. Chris Magryta is a physician at Salisbury Pediatric Associates. Contact him at newsletter@salisburypediatrics.com

This article is, at points, quite technical, however the gist is to provide a roadmap to health for allergy and asthma sufferers.
• Asthma is well known to be an inflammatory disease based on the response to anti-inflammatory medications, making it a prime candidate for anti-inflammatory nutritional interventions.
• The Standard American Diet is filled with pro-inflammatory, highly refined and processed foods laden with excessive amounts of sugar and unhealthy fats that exacerbate disease.
• The inflammation is now believed to start in part in the intestinal and pulmonary microbiomes, with the loss of immune tolerance. The intestinal microbiome is highly responsive to dietary alterations.
• We will discuss in depth the food choices that lower the inflammatory burden, the asthma phenotype and the food immune reactions that exacerbate disease.
Historical medical training over the past half century has focused on asthma as an allergic disease that is predominantly only modifiable through allergic trigger avoidance and pharmaceutical medical therapy.
Physicians were never trained to focus on diet or nutrition as a tool for disease remediation. Frankly, it was scoffed at to worry about a patient’s sticky bun habit as means to modify their symptoms. However, science has created a new working understanding of asthma as a modifiable disease with the discovery of the epigenome, microbiome, metabonome and nutrigenome.
In order to understand how food affects asthma, the understanding of the root cause is critical: asthma is an inflammatory disease which starts very early in life when a person develops a disruption of immune tolerance. This disruption occurs for many reasons; however, the leading theory is the Biome Depletion Theory, which basically states that the loss of co-evolving microbes has put a strain on the ability of the immune system to develop natural tolerance to non-pathogenic protein epitopes from foods, plants, dust, animals, etc.
The prototypical study, published in 2016, looked at house dust microbial cell wall endotoxin levels in the Amish and Hutterite enclaves in the United States. The Amish lived very intimately with their animals, as the children spent much time from birth on, exposed to animals in their immediate vicinity. Contrast this with the Hutterite community where the children lived peripherally on a mechanized centralized farm. They were rarely exposed to the farm animals.
This differential exposure to the animals gave the Amish children a roughly 7 times higher microbial exposure than their Hutterite brethren. Statistically, the study showed that the Amish offspring had a 4X fold lower risk of developing asthma and allergic sensitization. They posited that the lack of microbial exposure was driving the disease in the Hutterite children.(Stein et. al. 2016)
The researchers furthered the evidence by exposing asthma-prone mice to the respective endotoxin laden house dust from both communities. What they found was remarkable. The dust exposure dictated whether a mouse developed the disease phenotype that we call asthma. The Amish dust exposed mice did not develop asthmatic disease paralleling the human data of disease risk.(Stein et. al. 2016)
Knowing that a failure of early microbial exposure is compounded by over clean home environments, cesarean section birth deliveries, antimicrobial drug use and a lack of breastfeeding, the science is now proving that the long-term effect is to develop an abnormal intestinal microbiome that allows the interface between the outside world, i.e. food and the immune system to be compromised.
Essentially, there is cross talk between the microbes of our lungs and gut and our immune cells that when disrupted, leads to abnormal recognition of food protein epitopes, leading to antibody responses, as in food allergy and food sensitivity/intolerance.
There is also a solid body of growing evidence that beyond the humoral immune system’s response, there is endotoxemia that is seen as inflammation.(Cani et. al. 2009)
This latter point is likely a major player in the inflammatory process of humans, as it is well known that highly processed foods laden with sugar and saturated fats drive the intestinal microbiome to a dysbiotic gram negative rod predominant enterotype.

The story continues next week.

Dr. M

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