Sunday, April 22, 2018

Hay Fever Treatment Alternatives, The What, How and Why – Part III

Diet & Supplements
In part I and II we discussed how both the local inflammation in the upper respiratory tract as well as whole body inflammation adds to a hay fever sufferer’s burden. Decreasing inflammation through lifestyle and dietary measures is of prime importance. In this chapter of the series, we will examine diet and supplements in more detail.

Dietary Measures in General

In general a focus on whole, fresh organic foods is the foundation of a healthy diet. In most cases, raw foods should be a part of every meal. A focus on a variety of brightly colored vegetables along with fresh fruits helps promote vitality. Healthy fat is important. Butter should be from grass fed, organic animals.  Focus should be on fats high in essential fatty acids. Omega 3 fatty acids are especially important and are low in the western diet. An excellent source can be found in cold water fish.  Other sources of healthy fats come from extra virgin, organic coconut oil and extra virgin, organic olive oil, as well as fresh nuts and seeds as well as free range, grass fed animals and animal derived products. Some individuals with hay fever react to milk and milk products, in which case they should abstain from them. Other sources of protein include organic, whole grains and legumes. They are also a source of fiber. Some individuals with hay fever react to grains, in which case they should abstain from them also.

Specific Dietary Measures

Hydration
We will start with hydration. The first thing to remember is to stay adequately hydrated. Respiratory tract mucous membranes depend on being hydrated and they can not function well without adequate water. Most individuals need about 8 glasses of water every day. Some people have different needs and may need more or less due to a medical condition, exercise or the environment they live in.

Resting the Digestive Tract
Letting your digestive system rest is helpful. Try to let your digestion rest for at least 12 hours between dinner and breakfast. Longer is even better. This of course can change from person to person. It may not work for some lifestyles or health issues.

Bright Colored Organic Vegetable and Fruits
Eat a diet high in fresh organic fruits and vegetables which will provide numerous healthy anti-inflammatory substances and fiber. Raw fruits and/or vegetables should be a part of the diet at each meal. Eat a great quantity of vegetables and as great a variety as possible. Diversity of colors in your vegetables and fruits represents a vast range of anti-inflammatory substances.

Leave the refined sugars, all additives and other chemicals out of the diet.

High Nutrient Foods

Focus on foods that are high in vitamin C, E, carotenoids flavonoids, B vitamins, healhty fats, healthy proteins and minerals. 


Antioxidants such as carotenoids will decrease inflammation and support upper respiratory tract function. These can be found in bright colored vegetables and fruits where you find alpha-carotene, beta-carotene, lycopene, lutein/zeaxanthin, canthaxanthin and cryptoxanthin. Eat them all day long. This includes dark leafy greens such as kale and collards, carrots, sweet potatoes, and fruits such as tomatoes, plums and apricots. If histamine is a concern, eat low histamine foods high in carotenoids and minerals. See hay fever part II for more information on histamine and diet.

Foods high in flavonoids are able to assist in decreasing mast cell activation and reduce histamine in the body. These flavonoids include quercetin and catechin which are found in herbs such as Green tea, Chamomile, Hawthorne and Gingko. Quercetin is found in many foods and some good food choices for quercetin content are garlic, onions, capers, fruits with dark red or blue colors such as blueberries and cranberries.  Elderberries are high in quercetin as well as Lovage and kale. Quercetin’s anti-inflammatory activity appears to be due to its antioxidant effects and inhibition of cyclooxygenase and lipoxygenase, which in turn regulate the inflammatory mediators leukotrienes and prostaglandins. Quercetin also stabilizes mast cells, which inhibits release of histamine.

Fish high in omega-3 fatty acids are helpful in alleviating hay fever symptoms in some scientific studies. Many people find this to be true in their daily lives. Certainly all the epithelial cells that line the respiratory tract depend on these fatty acids to to build new, stable, healthy cell membranes on a daily basis. Cold water fish are high in omega 3 fatty acids. Salmon is one of my favorites. 



Alcohol
Alcohol causes the release of histamine and some wines, especially red wines have a high concentration of histamine themselves. Additionally alcohol consumption inhibits diamine oxidase (DAO), one of the enzymes that metabolizes histamine. It appears people who drink alcohol have double the risk of allergic symptoms even in people without prior allergies. Beer also contains histamine. In research that examined Canadian beer, porter contained the highest amount of histamine, followed by malt liquor, ale, lager, and low-alcohol beer, in descending order. Apparently, the higher the malt, the more histamine is formed.  Unusually high amounts of histamine were found in some bacteria-infected beers. Therefore, I would expect the sour lambic beers to have more histamine in them. Besides the histamine, most wine contains sulfites which can also cause reactions in people without an adequate amount of the enzyme sulfite oxidase which is necessary to change the sulfite into sulfate. Additionally, there is the issue with dehydration caused by alcohol which is not at all helpful to maintaining healthy upper respiratory tract mucus membranes. So, drinking alcohol is not a great idea for someone with hay fever.



Supplement the Diet With Nutrients

There have been a lot of different supplements used with hay fever. I am going to give you some ideas of useful nutritional supplements that have shown benefit in research and clinical settings.

Vitamin C
Mixed results have been seen in research with vit C and vit E. However, many hay fever sufferers have found larger doses of vitamin C up to bowel tolerance can be of use.  2 – 5 grams per day have been helpful. Vitamin C is maintained in phagocytes and lymphocytes at 100 times greater concentration than the plasma and inhibits histamine secretion by blood cells. As plasma ascorbic acid levels decrease, histamine levels increase significantly. Oral dosing of vitamin C has been shown to lower blood histamine levels.

Seaweed & Mineral Supplementation
A study in Japanese pregnant females showed an inverse relationship with hay fever and the dietary intake of seaweed, calcium, magnesium and phosphorus.  This is not surprising as it is my belief that most people are lacking enough minerals in this day and age and minerals are absolutely necessary to prevent all disease including hay fever. 


In looking through the research and integrating it with what works clinically, zinc, vitamin C, P-5-P (active B6) and magnesium appear to be the most useful in supporting the respiratory system in hay fever. Magnesium dietary intake has been shown to be inversely related to asthma also. Since some hay fever suffers can have a hay fever attack turn into an asthma attack, magnesium is especially important in this subset of individuals. Many people are found to have low mag levels in general. I find most individuals are missing magnesium in their diet or simply not absorbing it. Magnesium can be taken with food and can be used up to bowel tolerance (when it causes loose stools) and then back off. I usually suggest a vitamin B complex with P-5-P in it as well as pantothenic acid and other B vitamins, rather than P-5-P by itself.  Zinc can be taken up to 50 mg per day short term. No more than a few months. If a situation necessitates zinc be taken longer, it has to be taken with copper in an 8:1 ratio. As mentioned before, Vitamin C can be taken up to bowel tolerance same as magnesium. Most folks use 2-5 grams per day during hay fever season. These can all be taken with meals. To know which nutrients an individual might be missing, they should see a local naturopath or a functional medicine practitioner. Make sure there is pantothenic acid in the b-complex as it helps decrease histamine and supports the adrenals. People need varied amounts of pantothenic acid. More is not necessarily better. It is hard to find a low dose B vitamin on the market, but Bio-B 100, made by Biotics Research has low dose tablets. This low dose option is helpful for many folks rather than the high dose B vitamins generally found on the market.

Myer’s cocktail
There is an intravenous infusion given by some naturopathic physicians called the Myer’s cocktail. This intravenous mix of nutrients was created by John Myers, MD, for the treatment of a wide range of clinical conditions. The modified “Myers’ cocktail,” which consists of magnesium, calcium, B vitamins, and vitamin C, has been found to be effective against hay fever symptoms.

Omega 3 fatty acids (EPA, DHA)
If an individual has inadequate omega 3 fatty acids in their diet, this can be taken as cod liver/fish oil. Make sure the mercury has been removed and it is refrigerated. It should not smell rancid. Omega 3s are found in cod liver oil, sardines, wild salmon, herring, mackerel and anchovies.

Sulfur
Sulfur is important in maintaining the normal properties of the mucous membranes. A person can get plenty of sulfur from the mustard family plants such as broccoli, kale, brussel sprouts etc. and the Allium family plants such as garlic and onions. However, some people have trouble transforming it into sulfate that the body uses through a process called sulfoxidation. These people have trouble converting cysteine to cysteinesulfinic acid and or from cysteinsulfinic acid to sulfite and/or finally transforming the sulfite to sulfate. If a person has too much cysteine:sulfate or sulfite:sulfate in the urine, this points to an issue in one of these areas and cysteine and/or sulfite can build up to a toxic level and be toxic to the nervous system or over-exciting. Therefore I often suggest people lower their sulfur foods/supplements and take epsom salt baths to enhance their body sulfate if they seem to be reacting to sulfur containing foods. These people will also have trouble with sulfate conjugation (Phase II biotransformation/detox process) due to a lack of adequate sulfate.  This becomes especially important if they are under toxin load that requires sulfate for conjugation of toxins. (Which is why I have them take epsom salt baths.) Besides sulfation, sulfur is also important in the conjugation pathways called glucuronidation and glutathione conjugation. If  these biotransformation pathways are not working up to par, this will add another layer of inflammation upon the body and add to the overall reactions of the person experiencing hay fever.  For science geeks the next section will help you understand this situation a little better.

More on making sulfate
- warning: this is very scientific and if you don’t like that, skip this section: Cysteine is changed into cysteinesulfinic acid, then  sulfite and finally from sulfite to sulfate. (Please realize this is just one route cysteine can take, as there are others.) This process requires cysteine dioxygenase, cysteinesulfinate decarboxylase and sulfite oxidase. These enzymes need iron, tyrosine, B6 B2 and molybdenum to undergo this process. Note that cysteine is also used to make other compounds such as glutathione or taurine. Cysteine can be consumed in the diet, made from methionine or taken as supplements. (N- acetyl cysteine or NAC). If the process does not proceed normally, excess cysteine may build up and act on NMDA gluatmate receptors and thus can have an exitotoxicity effect such as seen without enough cysteine dioxygenase or overabundance of cysteine. Researchers have noted depressed levels of sulfate in plasma, elevated fasting plasma cysteine concentrations, elevated cysteine to sulfate ratios and lower sulfation, to be associated with impaired cysteine oxidation. Cysteine toxicity reactions include gas, bloating, mental dullness and fatigue in individuals after eating sulfur containing foods. Low levels of cysteine dioxygenase (CDO) has been associated with general inflammation and specifically cytokines such as tumor necrosis factor alpha (TNF-a), transforming growth factor-beta (TGF-b) which are both seen with long term allergenic reactions. IL-1β, TNF-α and TGF-β down-regulate CDO mRNA level. Branch chain amino acids can  help protect the CDO1 gene transcription. DNA mutations coding for CDO appear to be involved. 30% of the population has been found to have lower CDO activity than the norm. Adrenal dysfunction may also decrease CDO. Low B-5 levels (panothenic acid) which is necessary to make cortisol has also been shown to up-regulate CDO.

Anyone with a CDO down-regulation may note symptoms of cysteine toxicity if they take glutathione, NAC, alpha lipoic acid or have a high intake of foods with cysteine or methionine. 


So as a recap, cysteine is converted to cysteinesulfinic acid and cysteinesulfinic acid is converted to sulfite and  sulfite is converted to sulfate. To make sulfate with sulfite oxidase, the co-factors molybdenum and vitamin B-2 (riboflavin) are needed. Without adequate functioning of sulfite oxidase, sulfites will build up in the body. These people have trouble with the sulfites used to preserve foods, but can also react to inhalation, and injection or skin contact with sulfites.  These people have sulfites in their urine when tested with sulfite strips. Normal people usually do not as it is usually sulfate that is removed in the urine. Serum levels or urinary sulfite can be checked. Molybdenum is high in beans, peas and dark leafy vegetables. Grains and nuts are also a decent source. Besides low molybenum and B-2, additional considerations associated with low sulfite oxidase are excess boron, decreased B12, excessive ingestion or inhalation of sulfites and heavy metals. Lead, mercury and tungsten all interfere with molybdenum.

I realize this focus on sulfur is long but sulfur is very important in the body and largely ignored. This data can be an important part of assisting any allergenic person who is dealing with excess body inflammation including hay fever. Additionally if someone is not processing sulfur appropriately the reactions can look similar to a histamine reaction. I am working on adding the sulfation page to my website of biotransformation activity. When it is available you will find a link here. There will be an extensive diagram to make this easier to understand.

I mentioned the need for sulfate to transform toxins by sulfation or sulfate conjugation. Sulfation is also needed to make intestinal mucins, glycosaminoglycans, some peptides and proteins. Sulfate is most known for its activity during sulfation in which it detoxifies drugs, food additives, steroid hormones, thyroid, hormones, some neruotransmitters and toxins from intestinal bacteria. Sulfate is in the form of 3′-phosphoadenosine-5′-phosphosulfate (PAPS) when it is used for sulfation. This requires magnsium and most individuals do not have adequate levels of magnesium. PAPS also needs sulfotransferases to assist. Sulfation transforms two big classes of compounds called phenols and amines. Phenols are found in  herbicides, pesticides, plastic containers fungicides, germicides, and some essential oils contain phenols. Many plants contain polyphenols. Individuals with hay fever who also note reactions to essential oils, or other items containing phenols or amines (the amines could also be a histamine response), may have a problem making sulfate.

Bamboo salt

Bamboo salt has been shown in research to reduce inflammatory responses in hay fever. (mix of sundried sea salt and bamboo. It is higher in minerals and slightly lower in sodium than other salts. It is used in a nasal wash and on food. However, I would mention that bamboo salts may contain traces of arsenic and dioxins.

Liver & Adrenals

Besides supporting the respiratory tract, the liver and the adrenals should be supported if needed. The liver is a powerhouse when it comes to biortransformation processes and it is heavily involved in degrading histamine with the intracellular enzyme histamine-N-methyltransferase (HNMT). We discussed HNMT in part II of this “Hay Fever Series”.

Biotransformation Pathways of the Liver

When I see an individual has multiple sensitivities to things in the environment, I consider their phase I and phase II biotransformation pathways. General support of the liver will often help some of these pathways. For more details on biotransformation systems, see my website page on biotoxins. Dietary and lifestyle changes will support many of these biotransformation pathways. If you want to consider some herbs and supplements that will aid in normal function of these biotransformational systems, I would suggest the herbs Milk thistle and Turmeric. They also enhance glutathione levels as does 500 mg per day of vitamin C. Epsom salt baths, adequate protein in diet, and B vitamin complex (only folate, no folic acid in it) are also supportive of various biotransforamation pathways.

Biotransformation systems (BS) are hampered when you are under excessive onslaught of toxins. Some people have genetic reasons for their BS not working up to par. Sometimes they are both genetically deficient and have an excessive amount of toxins.  Nutrients are needed  to make the necessary substances used in phase I and phase II. If the diet lacks adequate nutrients  or lacks the protein to make enzymes for these substance to be made, this will also interfere with the BS. If the individual is around toxic substances such as living/working in a newly built building that is off-gassing or a moldy building, or working with toxic substances such as herbicides, pesticides, selling products that are off gassing, have heavy metals such as mercury from silver fillings in your mouth etc. this will add to the inflammatory load of your body. Also consider that much of the mainstream food supply has toxins from industrial farming used on it. Additionally there are GMO foods that make their own pesticide.

Saunas
Some toxins can also be removed with saunas. Saunas are often helpful for people with hay fever.  Saunas can help as far as general healthy tissue support, prevention of hay fever, diminishing hay fever response to pollen and as temporary aids to get through an acute situation.


We will examine herbs used for hay fever in our next chapter of this hay fever series. 


The Other Hay Fever Blogs
Hay Fever, The What, How and Why - part I
Hay Fever, The What, How and Why - part II
Hay Fever and Diet 
Prevention with herbs
Treating The Acute Situation 

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