Week 5 DB

A 22 year old female complained of chronic asthma. She has had minimal improvement with albuterol and Advair. This is something she has only experienced the past year and never had symptoms prior. She does not have acid reflux and does not drink alcohol. She does cardiovascular exercise 3-4 times a week. She experiences a consistent dry cough which is frequent throughout the day and she is not sure what the trigger(s) is. She is looking for a natural, alternative approach to her health.

Interpret the attached labs and make dietary and/or nutritional supplement recommendations (include dosing and length of initial support) for this client based upon that interpretation as well as any additional support for this client's condition. In addition, is there any additional testing you would like to order and what is your rationale?

Case is of a 22 year old female with chronic asthma, now reports poor control associated with dry cough over last year, refractory to inhalers.

Labs include a Fatty Acid profile and shows:

• 2nd Q Mead Acid
• Elevated ALA to EPA, DHA
• Low Omega 6
• Middle to high Monounsatured
• Variable Saturated fats
• High Odd change fats
• Low trans fat
• Ratios: low EPA / DGLA, High AA/EPA, Middle T/T

Advair contains a steroid that will modulate inflammatory response. This is interesting as many of life stressor and deprivations cause a stress response that increases cortisol.

In the class presentation on asthma, it was pointed out that mast cells may be related to development of asthma.  I found this interesting as serotonin, released from neuroendocrine cells in the intestinal cells in emergency situations, is correlated with asthma (1, 2). Serotonin is carried to the lungs by mast cells and platelets to be cleared from the body, however with excessive production free serotonin may be present in blood stream and overwhelm the lung capacity. Serotonin has been found to increase Prostaglandin E2 (PGE2) and Nitric Oxide (NO) in the lungs associated with asthma symptoms (2). PGE2 is produced by Arachadonic Acid (3).

Given the above paragraph, an elevated AA/EPA ratio would be helpful to correct and Lord recommends Fish Oil treatment 1- 3 g / day (3, class lecture) which would help to normalize the O3:O6 ratio. An elimination diet may be of use in that food sensitivities lead to intestinal distress and release of serotonin. As in my 4b discussion, hypometabolism leads to intestinal digestive issues and serotonin release, so increasing metabolic rate by correcting thyroid dysfunction important, so Selenium 200 mcg daily and B6 50-100 mg a day (especially if Hcy high) may be helpful. Antioxidants including vitamin E are useful as antioxidants. Magnesium helps with metabolism and is a bronchodilator (class lecture).

Sources:
(1) Pretorius, E. "The role of serotonin and cholesterol in asthma." Progress in Neuro-Psychopharmacology & Biological Psychiatry 33.5 (2009): 910-911.
(2) Ménard, G., V. Turmel, and E. Y. Bissonnette. “Serotonin Modulates the Cytokine Network in the Lung: Involvement of Prostaglandin E2: Serotonin Modulates the Cytokine Network.” Clinical & Experimental Immunology 150, no. 2 (September 5, 2007): 340–48. https://doi.org/10.1111/j.1365-2249.2007.03492.x.

(3) Lord - Laboratory Evaluations.