How to Address the Root Cause of Your Asthma

In this episode, we discuss:

• Why the root cause of asthma is immune dysregulation
• Four potential triggers for your asthma
• How to balance your immune system

Show notes:

• “RHR: What You Should Know about Histamine Intolerance,” by Chris Kresser
• “Got Allergies? Your Microbes Could Be Responsible,” by Chris Kresser
• The Paleo Cure, by Chris Kresser
• “RHR: Low-Dose Naltrexone (LDN) as a Treatment for Autoimmune Disease,” by Chris Kresser

Chris Kresser:  Hey, everybody. Chris Kresser here. Welcome to another episode of Revolution Health Radio. This week we’re going to answer a question from a listener.

Jenny:  Hi, Chris, this is Jenny. I have a question for the podcast. I have asthma. It’s not severe, but I’ve been on an inhaler for many, many years. I take the Flovent inhaler. It’s the only medication that I take. I am a regular athlete. I do a lot of exercise and do some running races, and I’ve done some triathlons, shorter distances as well. So it’s not exercise-induced, but it’s something that when I try to get off the medication, it’s very difficult.

So I just wanted to see if you had any information on how to get rid of it. I am experimenting with the low-dose allergy LDA treatments right now with my Functional Medicine doctor. But I just wanted to see if you had any other thoughts on asthma. I know a lot of people out there have asthma and if you have anything that you suggest to be done. I have celiac disease, so I obviously don’t eat any gluten, and I don’t believe that I’m eating anything that is triggering the asthma. If anything, I think it’s triggered by environmental like grass and things like that. That would be my guess. However, I’m not really 100 percent sure.

So if you have any suggestions, I’d appreciate it. Thanks a lot for all the information you provide.

Why the Root Cause of Asthma Is Immune Dysregulation

Chris Kresser:  Thanks so much, Jenny, for sending in your question. Asthma is a huge problem. It affects about 8 percent of the U.S. population, which is about 25 million Americans, including many children. And it is increasing every day in the U.S.

Functional Medicine is always oriented toward addressing the root cause of disease, and with asthma that root cause is immune dysregulation. So we can think of immune dysregulation in three broad categories. One would be weakened immunity, so getting frequent colds and flu and other conditions. A second would be autoimmunity, where the body is attacking itself, and the third would be hyperactivity or hyperreactivity.

Do you dream of getting rid of your asthma and ditching your inhaler altogether? It might be possible—if you can address the root cause of the problem. Check out this episode of RHR to learn how to identify the triggers for your asthma and balance out your immune system.

Hyperreactivity could be against environmental antigens like dust or pollen or even mold or food antigens like gluten or dairy or chemicals like herbicides and pesticides. I think asthma probably falls into the third category of hyperreactivity, and that reactivity in the case of asthma is often directed at environmental antigens and toxins including molds, food, microbes in the gastrointestinal tract, proteins inappropriately getting into the bloodstream by a leaky gut, chemicals like dyes and preservatives in foods, pesticides and herbicides, as I mentioned. But from a Functional Medicine perspective, the issue is not really with these substances per se, it’s with the immune system’s reaction to them. So that isn’t to say that these substances aren’t harmful in their own right. Given enough exposure to them, many of them are, of course. But not everybody will have asthma in response to exposure to low levels of these substances. And that’s why it’s important to consider asthma as a condition that’s characterized by immune dysfunction or a dysregulation.

Four Potential Triggers for Your Asthma

In Functional Medicine, we can break down the approach to asthma in two broad steps:

• The first would be to identify and address potential triggers of immune dysfunction, and
• The second would be to take specific steps to balance and regulate the immune system.

Unfortunately, this can be quite an involved process because there are many potential triggers to consider. But let’s just talk about some of the main ones.

1. Food Intolerances

So diet of course, is one of the biggest triggers not only for asthma but for many other conditions. Food intolerances are very common in people with asthma, especially to gluten and dairy. And these are not often tested for in conventional medical settings, and when they are tested for, the type of testing that is done is inadequate. So, for example, the typical test for gluten intolerance might include alpha-gliadin and then possibly tissue transglutaminase. And those are common markers that would be elevated in gluten intolerance, but there are many, many people who have gluten intolerance who are reacting to different proteins and different epitopes of the proteins in gluten. And those will be missed if only those two markers are measured.

So that can be a big problem and it can lead people astray. They can be led to believe that they are not gluten intolerant even when they are. And then dairy proteins are also a common issue with people with asthma. And again, the testing for this is not very good in the conventional setting, when it’s done at all. So the best way still for most people to determine this is a strict elimination diet where you remove gluten and dairy from your diet for 30, 60 days. Sixty is better, and then you add them back in and you see what happens. And if the asthma improves significantly when you’re not eating gluten and/or dairy, that’s really the only test you need in terms of figuring this out. And if it gets worse when you add them back in, that’s even more conclusive.

But there are also other things in food that could be problematic. Chemicals and additives, I mentioned before. We live in a society in the U.S. where 60 percent of people’s calories come from highly processed and refined foods and these can include all kinds of chemicals and additives, dyes, and then of course sugar and industrial seed oils. And many of these are somewhat foreign to us. They have not been around for very long. We don’t have a long history of eating them and they’re more likely to cause problems for that reason.

Jenny mentioned that she had celiac disease, which of course is an autoimmune disease characterized by gluten intolerance, and that can lead to intestinal permeability, a.k.a. leaky gut. And what happens there is proteins that should stay in the gut as part of normal foods that we eat escape the gut and end up in the bloodstream. And then our immune system attacks those food proteins because it considers them to be foreign invaders, which they are. They really shouldn’t be there. And that immune attack and can lead to asthma and allergies and many other conditions that are characterized by immune dysregulation. So it’s not unusual to see people with celiac disease that also have asthma or other immune imbalances.

I mentioned dairy intolerance. A little-known fact is that about half of people, according to one study, with celiac disease are also intolerant of dairy proteins. Yet I rarely hear about conventional doctors who diagnose someone with celiac disease mention this. It may be a lack of awareness. But many people who are gluten intolerant, particularly with celiac disease, will also benefit from removing dairy products for their diet. That doesn’t mean everybody, but it does mean that if you have celiac disease, it’s worth testing that out either with proper laboratory testing or by doing an elimination protocol.

Finally, another thing to consider is histamine. As many of you know, I’ve talked about and written about histamine quite a bit. It’s a mediator of the inflammatory response, particularly when it comes to the allergic response in human beings, and histamine is also found in the diet. So if you eat foods that are high in histamine and you already have fairly high levels of histamine in the body because of an allergic reaction or allergic response or a tendency towards allergy, then eating foods that are high in histamine can push that over the edge and exacerbate symptoms. So for some people with asthma, a low-histamine diet, at least while you’re figuring out some of the underlying problems, can be helpful. Being on a really extreme low-histamine diet for an extended period of time is probably not a good idea because you’ll be removing a lot of foods that are otherwise beneficial, particularly fermented foods. But it can be helpful, especially in the short term while you’re figuring everything out.

2. Digestive Problems

The next trigger or mechanism that’s very common for asthma is G.I. issues. So this could include things like:

• SIBO, bacterial overgrowth in the small intestine
• Chronic gut infections like Helicobacter pylori, or pylori
• Fungal overgrowth
• Dysbiosis
• Intestinal permeability

I mentioned before the mechanism by which intestinal permeability can lead to asthma and allergies and other immune responses. Well, the things that lead to intestinal permeability in the gut are those that I just called out: SIBO, infections, fungal overgrowth, and a disrupted gut microbiome. The gut doesn’t just become permeable for no reason, and this is why I think focusing on leaky gut without addressing and identifying and addressing these other underlying causes is usually not a fruitful approach. You really need to look at what’s driving the leaky gut in the first place and address those things, and then the gut will usually take care of itself because the cells in the intestine regenerate every few days, and the gut has remarkable healing power once all of the other triggers are removed.

So assuming you’ve tested for and addressed SIBO, infections, fungal overgrowth, etc., with a Functional Medicine provider, then the next step would be to reestablish a healthy microbiome using probiotics and prebiotics and possibly, if necessary, things that specifically address the gut barrier function. Because the barrier system is very important in maintaining the integrity of the gut barrier. As I’ve said now a few times, it can prevent leaky gut and prevent those proteins from inappropriately getting into the bloodstream and triggering that immune reaction.

3. Environmental Toxins

The next major category of triggers is environmental. So this includes toxins that are found in home cleaning and personal care products. It could include mold and other biotoxins that are found in indoor air inside of homes and buildings. It could include particulates and other outdoor air pollution. It’s a very broad category, and unfortunately, it’s growing all the time. We’re exposed to just an almost inconceivable number of toxins in our environment now.

There’s very little regulation that governs which toxins companies can release into the environment. It’s sort of an innocent-until-proven-guilty policy, which is really ridiculous because we’re essentially allowing these companies to experiment on us and our children without our expressed permission and without any controlled monitoring of what the effects of these experiments are.

So I do think that toxins play a pretty significant role in all kinds of chronic diseases, including asthma. So we want to do everything we can to minimize our exposure, especially to the ones that we have control over. So that would mean switching out your home cleaning products for natural alternatives and same with personal care products. It would mean assessing your home, making sure that you don’t have a mold problem or other biotoxins in the home that are causing issues. And to the best of your ability living in a place that doesn’t have really bad air pollution and if you’re not able to move, to at least get some air filters that you can use in your home, which can be helpful for both indoor and outdoor air quality and reducing your exposure to toxins that you can inhale from the air.

So this is an area where actually a little bit of an effort can go quite a long way, and it’s a win-win scenario, no matter what. Even if these things turn out to not be a driving trigger of the asthma, it’s certainly not a bad thing to reduce your exposure to inhaled pollution, either from the outdoors or indoor. And we know that air pollution, for example, is a driver of obesity and metabolic problems and may be a bigger issue in some of the other more commonly considered factors. And there’s a growing body of evidence on this now that’s coming out. It’s really interesting. These particulates in the air pollution can cause a kind of chronic low-grade inflammatory response that can then trigger insulin resistance and weight gain and all kinds of other problems.

4. HPA Axis Dysregulation

So the fourth category of triggers is the HPA axis. We could summarize it with that term. So here we’re talking about stress, sleep deprivation, and then disruption of our circadian rhythm. So let’s talk a little bit about each of those.

The connection between stress and immune dysfunction has been known for thousands of years. It’s talked about in some of the earliest medical texts that came out of China, and it’s been a focus of virtually every system of medicine and approach to medicine for as long as we know. And stress impacts the immune system in numerous ways, and it’s widely considered to be one of the most significant triggers for autoimmune disease. There have been lots of studies that have shown that stress depletes the immune system and makes you more susceptible to colds and flu. I’m sure everyone listening to this has had their own personal experience of this. We know that students who are approaching final exams, for example, are far more likely to get sick. I’m sure all of you had an experience like that when you’ve been run down from working too much or other stuff going on in your life, stressful events, and you’ve gotten sick. Everybody knows this whether you know anything about the science or the mechanisms involved. It’s very obvious that stress impacts the immune system.

Sleep deprivation is closely related because not getting enough sleep can impact the HPA axis in similar ways that stress does and it’s really one of the epidemics of our time. I think about a third of people now are getting fewer than six hours of sleep a night. And this is up from just 2 percent in the 1960s. So pretty profound difference in a half century. And sleep deprivation leads to many of the same kinds of changes in the immune system that you see with stress. So you can see an increase in cortisol levels or eventually a decline in cortisol levels or inappropriate secretion of cortisol at the wrong times. You can see an increase in inflammatory markers, decrease in T regulatory cell function. All kinds of things that could be expected to trigger or exacerbate asthma and other immune dysfunctions.

So then lastly we have disruption of circadian rhythm. We’ve talked about this a lot and I’ve written about it in my books. But human beings have only recently been exposed to artificial light at night in the last 150 years really of our two-and-a-half-million-year evolutionary history. So a tiny blip. And only recently have we spent significant portions of our time indoors not exposed to natural light during the day. And it turns out this has a profoundly negative impact on our circadian rhythm, or circadian clock. And our circadian clock affects every cell in the body and every system of the body. All organisms on planet Earth evolved in the natural 24-hour light/dark cycle, from the most simple, single-celled organism all the way up to human beings. And that cycle governs virtually every aspect of our physiology. And so will we mess with that, with too much exposure to artificial light at night and not enough exposure during the day, and things like long-distance travel where we cross time zones, and shiftwork, all of which are very common today, that unfortunately has a profound impact on the function of our immune system.

So I would say those are the main categories: diet, gut, environmental, and HPA axis for asthma. But you also want to look at things like nutrient status, particularly magnesium and zinc have been shown to be relevant with asthma, methylation, hormones, chronic infections like tick-borne illness or reactivated viral infections, heavy metals, and other toxins.

How to Balance Your Immune System

If you’ve addressed many or all of these triggers and you’re still having symptoms, then the next step would be to do things that specifically balance and regulate the immune system. So Jenny mentioned low-dose antigen therapy, LDA. That’s one thing that can be done and some people have great success with that. You might also want to consider nutrients that support T regulatory cell function like curcumin, glutathione, vitamin D, zinc, and selenium are especially important. You might want to consider phototherapy, or photobiomodulation is another way of putting it. This is using ultraviolet light, typically sunlight or near infrared light, for example, to balance and regulate the immune system. And this is, in fact, we now understand that exposure to sunlight has direct benefits on the immune system that are not mediated by vitamin D. So some of the benefit we get from sunlight is about vitamin D production. But recent studies have shown that even if you take vitamin D out of the equation, just being exposed to sunlight and ultraviolet light has specific and powerful immune benefits. And this may be one reason why we see that autoimmune conditions in things like asthma and allergies are more common the further away from the equator that you get.

Music, pleasure, play, fun, and spending time outdoors have all been shown to have profoundly positive effects on immune function. So you can think of all these things as kind of the antidote to stress and HPA axis dysfunction. I wrote, I have chapters, actually, on all of these things in my first book, The Paleo Cure. And that’s one of the main reasons is because these things are so critical to human health. They’re as important as diet, exercise, stress, and sleep, which we tend to talk about a lot, but they really don’t get as much attention. And that’s a shame because the research is clear on how important these things are. So, for example, some studies have shown that a lack of social support is a greater predictor of early death than smoking 15 cigarettes a day. That’s almost hard to believe until you actually see the studies. And so there are all of these things that have been part of our human experience from all throughout the millions of years of our evolution that we don’t tend to make time for in today’s crazy, fast-paced world. And yet they’re like nutrients for us. They’re critical for our survival and our well-being. So making time for these kinds of activities, especially if you have an immune condition like asthma, is really, really important.

You might want to consider acupuncture. There’s not a ton of research for it for asthma. There is some, and anecdotally, I’ve definitely seen some patients get good results. I wrote a whole series on how I think acupuncture works. It’s got nothing to do with chi and energy meridians, which is the explanation that is offered through the Chinese medicine paradigm. And I don’t mean to diminish that paradigm. I studied it myself. But I just have a different understanding of how it works. And I think it works by promoting blood flow and the blood carries all of the substances that we need to heal and to be well. It also works by reducing inflammation in the central nervous system, and there is evidence that it can promote immune function. It can also improve T regulatory cell production and differentiation.

So there are some reasons to believe that acupuncture could be beneficial, especially if you get it frequently enough. So finding a community acupuncture clinic, which is a place where you can get really affordable acupuncture treatments and where the acupuncturists are all very experienced with acupuncture because they do so many treatments in their shifts, that that can really make getting treatment two, three times a week initially, which is sometimes what’s needed to kind of put the brakes on the inflammatory response possible. And then once you’ve got the inflammation calmed down and you’re in a better place, then you can titrate down and switch to a less frequent schedule, like once a week or something like that.

There are several herbs or botanicals that have been shown to be helpful for asthma or just immune regulation in general. These include:

• Turmeric
• Boswellia
• Mullein
• Parsley
• Ginkgo

You want to definitely avoid herbs that are known to stimulate the immune system, like licorice and echinacea and ginseng, because as I mentioned, asthma is really characterized by a hyper-reactive immune system already. So you wouldn’t want to do something that is going to further activate the immune system. And the tonic herbs like licorice, immune-boosting herbs like licorice, echinacea and ginseng can do that.

We have some research to support yoga and pranayama. Pranayama is a breathing practice within the yoga tradition, and that makes sense because asthma is a problem with the airways and obstruction of the airways. And we can see how certain breathing techniques might actually be helpful in that situation. And there is little evidence that it can cause harm. Yoga and pranayama also have other benefits like stress management, relaxation, improving sleep, and then the same is true for other breathing techniques and exercises. There are a number of different breathing techniques out there and progressive relaxation techniques and exercises that can be really helpful.

Probiotics, I mentioned earlier, but I want to mention them again in this different context because what we’ve come to understand about probiotics is that they’re really more than anything else, immune regulators. So we used to think that probiotics had a kind of like fill-up-the-tank-with-bacteria effect, which is, like, if you’re low on beneficial bacteria, then you dump in some probiotics and it fills up your tank with good beneficial bacteria. So it turns out that’s not really how probiotics work. In most cases probiotics do not permanently colonize the digestive tract, but they do have huge benefits while you’re taking them. And one of those benefits is to kind of tune and regulate the immune system. So I like to explain to my patients that probiotics are immune-regulating supplements as much as anything else. So that explains why they could be very helpful for asthma. And I’ve seen quite a bit of research suggesting that probiotics can be helpful in alleviating asthma.

And then if asthma is severe and none of these other things have been helpful, it may be worth considering low-dose naltrexone. This is a low dose of a medication that reduces inflammation in the central nervous system and helps balance and regulate the immune system, in part by increasing endorphin production. I’ve written and spoken about LDN before. We don’t have time to go into further detail here, but if you go to ChrisKresser.com and you search for “LDN” or you search in Google for “Chris Kresser and LDN” or “low-dose naltrexone,” you’ll find what you need.

Okay, everybody that’s it for now. Hope this was helpful. Thanks again, Jenny, for sending in your question, and everybody else, please do keep sending in your questions in to ChrisKresser.com/podcastquestion. Talk to you next time.