NMT250 - nut

Nutrition: Asthma

• The lecture is presented by Dr. Adam Gratton, MSc ND on February 12, 2024, for NMT250.

Lecture Competencies

• Articulate a comprehensive understanding of dietary factors influencing asthma.
• Identify and compare nutritional interventions and strategies for the effective management of asthma.
• Construct personalized dietary plans and education materials to support managing patients with asthma.
• Articulate nutrients and their potential mechanisms in asthma.
• Articulate the result of a food sensitivity test to a patient.

General Pattern and Structure

• Amino acids are the structural units of proteins.
• Every amino acid is built around a basic structure with an amino group, carboxyl group, a central carbon, and a side chain (R group).
• Twenty different amino acids are based on these different R groups.
• Amino acids are amphoteric and can carry a positive or negative charge, depending on the pH of the solution.
• The presence of nitrogen differentiates amino acids from the atomic composition of fats and carbohydrates.

Protein Balance

• Body protein reserves are limited, unlike fat reserves, which are typically more substantial.
• Labile protein reserves are easily broken down to meet immediate needs.
• Labile protein makes up approximately 1% of total body protein (glycogen).
• Labile protein reserves serve for emergency use
• Skeletal muscle is broken down to provide amino acids if intake is insufficient to meet body needs over a prolonged period.
• Overall protein balance is the balance between protein anabolism and catabolism.
• Periods of growth result from increased anabolism.
• Catabolism accelerates during critical illness, infections, caloric restriction/starvation, extensive burns, or surgery

Nitrogen Balance

• Involves all nitrogen in the body.
• Includes protein nitrogen, urea, uric acid, and ammonia.
• Nitrogen is generally lost through urine, feces, sweat, shedding of skin cells, and the lining of the gastrointestinal tract.
• Negative nitrogen balance occurs when body nitrogen loss exceeds intake.
• Positive nitrogen balance occurs during growth, pregnancy, or strength training; more nitrogen is retained than is lost.
• Nitrogen equilibrium occurs in healthy individuals; nitrogen intake and loss are approximately equal on a daily basis.

Essential Amino Acids

• Histidine
• Isoleucine
• Leucine
• Lysine
• Methionine
• Phenylalanine
• Threonine
• Tryptophan
• Valine

Conditionally Essential Amino Acids

• Arginine
• Cysteine
• Glutamine
• Glycine
• Proline
• Tyrosine

Nonessential Amino Acids

• Alanine
• Aspartic acid (Aspartate)
• Asparagine
• Glutamic acid (Glutamate)
• Serine

Protein Quality

• Partly determined by a protein source's ability to provide essential and conditionally essential amino acids.
• Also partly determined by the digestibility of the protein source and ability of the amino acids to be liberated from its protein structure to be absorbed.

Protein Quality Table

• Egg: Amino Acid Score 100, Digestibility 100
• Cow's milk: Amino Acid Score 95, Digestibility 95
• Beef: Amino Acid Score 89, Digestibility 95
• Peanuts: Amino Acid Score 65, Digestibility 94
• Rice: Amino Acid Score 57, Digestibility 89
• Soy flour: Amino Acid Score 47, Digestibility 86
• Sesame seeds: Amino Acid Score 42, Digestibility 90
• Peas: Amino Acid Score 37, Digestibility 88

Food Amino Acid Content

• Plant and animal foods differ in their essential amino acid content.
• A food source that provides all essential amino acids is referred to as a complete protein
• Food sources that are complete proteins include eggs, milk, cheese, meat, poultry, and fish.
• Vegan food sources that are complete proteins include tofu, tempeh, edamame, quinoa, and buckwheat.
• Incomplete proteins either supply too little of essential amino acids or are missing an essential amino acid.
• Combining incomplete proteins can make a complete protein, such as rice and beans.
• Rice is low in lysine but high in methionine, while beans are high in lysine but low in methionine.

Therapeutics: Nutritional Options for Premenstrual Syndrome

• The following information outlines nutritional options for premenstrual syndrome

Evidence Review

• A Systematic Review and Meta-Analysis of Premenstrual Syndrome with Special Emphasis on Herbal Medicine and Nutritional Supplements: https://doi.org/10.3390/ph15111371
• The purpose was to determine the safety and efficacy of herbs and nutritional supplements on premenstrual somatic and psycho-behavioural symptoms.
• Inclusion criteria were participants of reproductive age reporting regular menstrual cycles (21–35 days) who demonstrate premenstrual somatic and psycho-behavioural symptoms
• Two cycles of intervention were given to participants
• While many interventions were reviewed, most were botanical.
• Vitamin B1 and vitamin D3 were rare non-botanical interventions.

Vitamin B1 (Thiamin) Evidence

• Placebo-controlled trials have been conducted using Thiamin for PMS symptoms
• Two 100 mg vitamin B1 pills were given twice daily for a total dose of 400 mg
• This lead to a significant reduction in mean mental (35.08%) and physical (21.2%) symptoms

Vitamin D Evidence

• The Association Between Vitamin D and Premenstrual Syndrome: A Systematic Review and Meta-Analysis of Current Literature, can be found at https://doi.org/10.1080/07315724.2019.1566036
• Seven studies with 1344 participants examined the association between serum 25(OH)D and PMS among subjects both with and without PMS.
• Vitamin D status does not appear to be correlated with PMS.
• Vitamin D appears to significantly decrease symptom severity when used as an intervention.
• Studies often combine vitamin D intake with calcium
• Doses range from 200 IU a day to 50 000 IU per week
• A placebo-controlled trial gave participants 50 0000 IU of vitamin D3 every two weeks
• The trial resulted in a reduction in symptom severity that was measured by daily symptom rating

Additional Therapeutics

• Vitamin C has anti-inflammatory and antioxidant properties thought to potentially alleviate PMS symptoms.
• Products that combine vitamin C with flavonoids also have anti-inflammatory and antioxidant properties thought to benefit those with PMS.
• Symptoms associated with PMS are thought to be related to estrogen levels as they rise before menstruation.
• Phytoestrogens (like soy isoflavones) have mild estrogenic effects.
• Phytoestrogens partially compete with endogenous estrogen for estrogen receptors.
• This can reduce estrogenic activity and possibly alleviate symptoms of PMS.

New Information on Asthma

Introduction

• Asthma, particularly in childhood, is often an atopic disease where allergy is a primary mechanism.
• Non-atopic or non-allergic asthma exists but commonly develops later in life.
• Asthma is the most common lung disease in childhood.
• Potential asthma triggers include: tobacco smoke, air pollution, allergens, pets, mold, viral infections, cold air, physical exercise, and fragrances.
• Early exposure to microbial products may protect against asthma later in life which is known as the hygiene hypothesis.
• Asthma is known to have a strong genetic component.
• Poor asthma control during pregnancy is strongly associated with childhood asthma in the offspring.
• Dietary antioxidants such as vitamins C and E, carotenoids, selenium, and polyphenols, and polyunsaturated fatty acids, as well as vitamin D, may be protective, but not in supplemental forms.
• Increased serum vitamin and 25-OH vitamin D3 levels are correlated with good pulmonary function and quality of life in children with stable asthma.
• Obese children are at an increased risk of developing asthma.
• Elevated BMI might lead to less effective therapy from inhaled corticosteroids.

Therapeutics: Nutritional Options for Asthma

• Nutritional options for asthma include: promoting healthy body weight via appropriate caloric intake and weight loss, incorporating physical activity when tolerated, enhance dietary intake of protective nutritional factors, identifying and controlling allergenic factors, encouraging exclusive breastfeeding for infants at birth, and encouraging solid food introduction before 6 months of age

Nutrients and Their Potential Mechanisms of Effect

• Carotenoids, Vitamin C, Vitamin E: Act as antioxidants to protect against endogenous/exogenous oxidant inflammation.
• Vitamin C: Prostagladin inhibition
• Vitamin D: Modulation of T-cell responses
• Vitamin E: Membrane stabilization; inhibition of IgE production
• Flavones, flavonoids: Acts as antioxidants and helps with mast cell stabilization
• Magnesium: Smooth muscle relaxation; mast cell stabilization.
• Selenium: functions as Antioxidant cofactor in glutathione peroxidase
• Copper, Zinc: Functions as Antioxidant cofactors in superoxide dismutase, zinc also modulates T-cell responses
• Omega-3 fatty acids: Supports Leukotriene substitution and stabilization of inflammatory cell membranes, PUFAs modulate T-cell response.
• Omega-6 PUFAs and trans fatty acids: Increase eicosanoid production which leads to increased inflammation and worsening respiratory function.
• Sodium: Increased smooth muscle contraction; reduced intake may increase airway responsiveness.

Dietary Methylxanthines

• Caffeine can relax smooth muscles and open airways.
• Consuming 2-3 cups of black coffee daily can be helpful.
• Theobromine in cocoa can reduce coughing.

Dietary Flavonoids

• Quercetin is often discussed within the context of allergic diseases.
• Encourage the consumption of 5 or more servings per week of high quercetin foods.
• Good Food sources include apples, pears, onions, oranges, and berries..

Salicylate-Free Diet

• Only helpful for those who have a medically documented reaction to salicylates like acetylsalicylic acid.
• Foods high in salicylates include almonds, peanuts, pickled vegetables, dried fruits, avocados, mushrooms, cauliflower, coffee, pine nuts, curry, peppers/pepper-derived spices, tomato, honey, and many other fruits.

Sulphite Sensitivity

• Approximately 5-10% of people with asthma have a sulphite sensitivity.
• Symptoms include flushing, tachycardia, wheezing, hives, dizziness, upset stomach, diarrhea, tingling, difficulty swallowing, and fainting.
• Dietary sources of sulphite causing foods: dried fruit, bottled citrus juices, wine, molasses, and fermented foods.

IgG Food Sensitivity Tests

• The following information is provided by a laboratory test service provider and is not a review of the evidence associated with the use of IgG food sensitivity tests in practice.
• They are thought to relate to IgG type 3 delayed hypersensitivity reactions.
• IgG-antigen complexes activate the complement pathway and release inflammatory mediators.
• IgG-antigen complexes are typically cleared by macrophages, but in the presence of excess antigen, clearing capacity may be saturated, which causes deposition in tissue
• Deposition causes inflammation and tissue damage, which may contribute to specific health issues.

IgG Food Reactions vs Allergies

• IgG food reactions differ significantly from classic IgE food allergies.
• IgE food allergies are immediate reactions happening within minutes or hours of consuming food.
• IgE food allergies may include reactions like hives, problematic breathing, and anaphylaxis.
• IgG food sensitivity is a delayed reaction that occurs hours to days after food consumption, or symptoms may not appear for days or months.
• Elevated IgG to a specific food is not diagnostic of IgE food allergy.

Possible Complications from IgG testing

• Questions arise on how to interpret the results.
• Patient is reactive to one or more food antigens not consumed regularly caused by cross-reactions when the allergenic protein is similar across different food sources.
• Patient is not reactive to any food on the list, but this does not mean that the patient does not react to certain foods.
• Patient has elevated reactivity to most foods on the list which could represent significant cross-reactivity to multiple allergens.
• Results are generally invalid in this case of IgG elevated reactivity to most foods.

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