Daily Nutrients in the Treatment of Asthma – Part 2

Part I described the properties of Vitamins A, C, D and E and the research based conclusions as to in their use in the treatment of asthma. This installment reviews the other dietary nutrients.

Magnesium1-5

  • is essential for health and life
  • is an anti-inflammatory
  • regulates release of histamine
  • regulates immune responses
  • is essential for T lymphocyte development
  • relaxes smooth muscle
  • causes bronchoconstriction at low levels
  • is for intravenous use in emergency room for FEV1 < 50% predicted

Research-based conclusion: Beneficial. Patients with acute asthma tend to have lower serum levels of magnesium than individuals without asthma. While intravenous magnesium is recommended in acute exacerbations, it has been found to improve lung function slightly in adults and significantly in children.6 Research supports the use of nebulized magnesium at a “dose of 151 mg given three times in the first hour of treatment as an adjuvant to standard treatment when a child presents with an acute episode of severe asthma.” 7 A placebo-controlled trial of the use of oral magnesium supplements, at a dose of 170 mg twice a day, showed improvement to both objective and subjective measure of pulmonary function as well as quality of life.8

Selenium9-11

  • is toxic at very high levels
  • may be fatal at low levels
  • is an essential micro nutrient
  • is a potent antioxidant
  • activates, proliferates and differentiates cells
  • is active in immunity and immunoregulation
  • is required for optimal immune cell functioning
  • is essential in trace amounts

Research-based conclusion: There are concerns about safety in long-term use. A recent study involving children with asthma and healthy controls found that nutritional supplements of vitamin E and selenium improved plasma levels in asthmatics – (particularly FeNO levels) but not controls.12 The second study on murine mast cells showed that selenium in the form of sodium selenite had a beneficial effect in reducing mediator release.13 Current available evidence does not provide adequate information as to the dosage of selenium that could be beneficial in both asthma and allergy. At the moment, selenium supplementation is not recommended.

Sodium Chloride14-18

  • increases airway reactivity and resistance
  • increases BHR
  • in a high-salt diet, exacerbates post- exercise pulmonary function, while low-salt diet improves post pulmonary function in individuals with Exercise Induced Asthma (EIA)
  • in a low sodium diet, decreases bronchoconstriction in EIA
  • in a low sodium diet, may improve lung function in adults with asthma

Research-based conclusion: There is a weak association between intake of salt and increased airway responsiveness.19 A Cochrane data base review did not find any evidence that a reduction in dietary sodium chloride significantly improved asthma control, though the study did reiterate that salt reduction in EIA was beneficial.20

Zinc21-25

  • is an essential bio-element and micro nutrient
  • helps regulate immune responses to antigens
  • deficiency of zinc promotes cancer and airway inflammation
  • is a potent antioxidant
  • is essential for cellular function in immune response
  • has immune modulating effect
  • is anti-inflammatory
  • levels are lower in individuals with asthma
  • levels correspond with asthma severity but not control
  • deficiency promotes proliferation of Th2 cells at the expense of Th1

Research-based conclusion: Beneficial. A randomized, double-blind, placebo-controlled clinical trial involving 144 children with asthma and 140 controls found that the addition of a zinc supplement resulted in significant improvements in pulmonary function measures as well as clinical symptoms.26

Saturated fats27-29

  • lowest intake gives 10-fold protection against BHR
  • increased intake associated with increased risk of asthma
  • high intake level activates immune response

Research-based conclusion: Lower intake is beneficial.

N-3 fatty acids30-33

  • reduces production of inflammatory mediators
  • is an anti-inflammatory
  • influences inflammatory cells responses
  • helps maintain membrane function
  • plays a role in immunity

Research-based conclusion: Supplements may be beneficial.

Omega 3 polyunsaturated fatty acids33-36

  • is an essential nutrient
  • is obtained only from diet
  • has an anti-inflammatory effect
  • has a protective effect
  • are beneficial as dietary supplements provided in a controlled environment with a controlled diet

Research-based conclusion: Supplements may be beneficial.

N-6 fatty acid and trans-fatty acids37,38

  • are potentially harmful
  • consumption associated with chronic diseases
  • may be associated with development of asthma and allergies in children

Research-based conclusion: Not beneficial

Conclusion

  • Currently, there is no data that recommends nutritional supplements for the treatment of asthma.39
  • The Second National Health and Nutrition Examination Survey (NHANES II) noted that while the data suggested that various dietary constituents may “influence the occurrence of respiratory symptoms in adults”, there was insufficient evidence for the use of vitamin A and C supplements in the treatment of asthma and exercise-induced bronchoconstriction.40
  • A recent Cochrane Data Base Review had similar findings.41
  • Further, none of the vitamins or nutrients such as folate, omega-3 and omega-6, or polyunsaturated fatty acids have been shown to be consistently related to either atopy or asthma.42

Until such time as research can advocate through clinical studies that provide clear evidence for the use of specific nutrients to help control asthma, the best advice to be given to patients with asthma is that they should follow the Mediterranean diet – one that is rich in fruits and vegetables, whole grains, legumes and nuts and low in animal fat.

References

 

  1. Baker JC, Tunnicliffe WS, et al. Dietary antioxidants and magnesium in type 1 brittle asthma: a case control study. Thorax. 1999; 54: 115-118. PMC1745426
  2. Smit HA. Chronic obstructive pumonary disease, asthma and protective effects of food intake: from hypothesis to evidence? Respir Res 2001; 2(5):261-4. Doi:  10.1186/rr65
  3. Baker JC, Ayres JG. Diet and asthma. Respir Med. 2000; 94:925-934 DOI: http://dx.doi.org/ 10.1053/rmed.2000.0873
  4. de Baaij JH, Hoenderop JG, Bindels RJ. Magnesium in man: implications for health and disease. Physiol Rev. 2015; 95(1):1-46. Doi: 10.1152/physrev.00012.2014
  5. Liang RY, Wu W, et al. Magnesium affects the cytokine secretion of CD4T lymphocytes in acute asthma. J Asthma. 2012 Dec;49(10):1012-5. doi: 10.3109/02770903.2012.739240.
  6. Powell C, Dwan K et al. Inhaled magnesium sulfate in the treatment of acute asthma. Cochrane Database Syst Rev. 2012 Dec 12;12:CD003898. doi: 10.1002/14651858.CD003898.pub5.
  7. Powell C, Kolamunnage-Dona R, et al. MAGNEsium Trial In Children (MAGNETIC): a randomised, placebo-controlled trial and economic evaluation of nebulised magnesium sulphate in acute severe asthma in children.  Health Technol Assess 17: 1–216, 2013. doi: 10.3310/hta17450.
  8. Kazaks AG, Uriu-Adams JY, et al. Effect of oral magnesium supplementation on measures of airway resistance and subjective assessment of asthma control and quality of life in men and women with mild to moderate asthma: a randomized placebo controlled trial. J Asthma. 2010 Feb;47(1):83-92. doi: 10.3109/02770900903331127.
  9. Shaheen SO, Sterne JA, et al. Dietary antioxidants and asthma in adults.  A Population-based case-control study. Am J Repir Crit Care Med 2001; 164: 1823-8. Doi: 10.1164/ ajrccm.164.10.2104061
  10. Huang Z, Rose AH, Hoffmann PR. The role of selenium in inflammation and immunity: from molecular mechanisms to therapeutic opportunities. Antioxid Redox Signal. 2012 Apr 1;16(7):705-43. doi: 10.1089/ars.2011.4145.
  11. Norton RL, Hoffmann PR. Selenium and asthma. Mol Aspects Med. 2012 Feb;33(1):98-106. doi: 10.1016/j.mam.2011.10.003.
  12. Fabian E, Pölöskey P et al. Nutritional supplements and plasma antioxidants in childhood asthma.  Wien Klin Wochenschr. 2013 Jun;125(11-12):309-15. doi: 10.1007/s00508-013-0359-6. Abstract.
  13. Safaralizadeh R, Nourizadeh M et al. Influence of selenium on mast cell mediator release. Biol Trace Elem Res. 2013 Aug;154(2):299-303. doi: 10.1007/s12011-013-9712-x. Abstract.
  14. Mickleborough TD, Gotshall RW, Cordain L, Lindley M. Dietary salt alters pulmonary function during exercise in exercise-induced asthmatics. J Sports Sci 2001; 19(11): 865-73
  15. Gotshall RW, Kluka EM, Miller CW, Cordain L. Dietary chloride as a possible determinant of the severity of exercise-induced asthma. Eur J Appl Physiol 2001; 85(5): 450-6
  16. Mickleborough TD, Fogarty A. Dietary sodium intake and asthma: An epidemiological and clinical review. Int J Clin Pract 2006;60:1616-24
  17. Gotshall RW, Mickleborough TD, Cordain L. Dietary salt restriction improves pulmonary function in exercise-induced asthma. Med Sci Sports Exerc. 2000 Nov;32(11):1815-9. Abstract.
  18. Wang W, Ji HL. Epithelial sodium and chloride channels and asthma. Chin Med J (Eng). Chin Med J (Engl). 2015 Aug 20;128(16):2242-9. doi: 10.4103/0366-6999.162494.
  19. Hirota SA, Janssen LJ. Sodium and asthma: Something borrowed, something new? Am J Physiol Lung Cell Mol Physiol 2007;293:L1369-73. Doi: 10.1152/ajplung.00379.2007
  20. Pogson Z1, McKeever T. Dietary sodium manipulation and asthma. Cochrane Database Syst Rev. 2011 Mar 16;(3):CD000436. doi: 10.1002/14651858.CD000436.pub3.
  21. Sprietsma JE. Modern diet and diseases: NO-zinc balance. Under Th 1, zinc and nitrogen monoxide (NO) collectively protect against viruses, AIDS, autoimmunity, diabetes, allergies, asthma, infectious diseases, atherosclerosis and cancer. Med Hypethese 1999 July; 53 (1): 6-16
  22. Razi CH, Akelma AZ, dt al. Hair zinc and selenium levels in children with recurrent wheezing. Pediatr Pulmonol. 2012 Dec;47(12):1185-91. doi: 10.1002/ppul.22628.
  23. Roscioli E, Hamon R et al. Zinc-rich inhibitor of apoptosis proteins (IAPs) as regulatory factors in the epithelium of normal and inflamed airways. Biometals. 2013 Apr;26(2):205-27. doi: 10.1007/ s10534-013-9618-2.
  24. Morgan CI, Ledford JR, et al. Zinc supplementation alters airway inflammation and airway hyper-responsiveness to a common allergen. J Inflamm (Lond). 2011 Dec 7;8:36. doi: 10.1186/1476- 9255-8-36.
  25. Khanbabaee G, Omidian A et al. Serum level of zinc in asthmatic patients: a case-control study. Allergol Immunopathol (Madr). 2014 Jan-Feb;42(1):19-21. doi: 10.1016/j.aller.2012.07.008.  Abstract.
  26. Ghaffari J, Khalilian A,et al. Effect of zinc supplementation in children with asthma: a randomized, placebo-controlled trial in northern Islamic Republic of Iran. East Mediterr Health J. 2014 Jun 18;20(6):391-6
  27. Seaton, Devereux G. Diet, infection and wheezy illness: lessons from adults. Ped Aller Immunol 2000; 11(S13):37-40
  28. Rodríguez-Rodríguez E, Perea JM, et al. Fat intake and asthma in Spanish schoolchildren. Eur J Clin Nutr. 2010 Oct;64(10):1065-71. doi: 10.1038/ejcn.2010.127.
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  32. Woods RK, Thien FC, Abramson MJ. Dietary marine fatty acids (fish oil) for asthma. Cochrane Database Syst Rev 2000; (2): CD001283
  33. Calder PC. Omega-3 fatty acids and inflammatory processes. Nutrients. 2010 Mar;2(3):355-74. doi: 10.3390/nu2030355.
  34. Nagakua T, Matsuda S, Schichijyo H, Hata K. Dietary supplementation with fish oil rich in omega-3 polyunsaturated fatty acids in children with bronchial asthma. Eur Respir J 2000; 16(5): 861-5
  35. Yates CM, Calder PC,Ed Rainger E. Pharmacology and therapeutics of omega-3 polyunsaturated fatty acids in chronic inflammatory disease. Pharmacol Ther. 2014 Mar;141(3):272-82. doi: 10.1016/ j.pharmthera.2013.10.010.
  36. Myata J, Arita M. Role of omega-3 fatty acids and their metabolites in asthma and allergic diseases. Allergol Int. 2015 Jan;64(1):27-34. doi: 10.1016/j.alit.2014.08.003.
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