Posts Tagged ‘general health’

Conception is a complex process that depends on everything working properly at a number of stages. Firstly, your hormone balance must be correct so that the egg develops normally. Secondly, you must be ovulating so that the egg is released. Thirdly, you must have sex at the right time in your cycle (there may be only two or three days a month when you are fertile). In addition, your partner must have a good sperm count and possess healthy sperm, which are capable of penetrating your cervical mucus to reach the egg. Then the egg has to be captured by the fallopian tube and be fertilised. Finally, once the egg has been fertilised, the embryo has to implant securely in the lining of the womb, which needs the right levels of the hormone progesterone to maintain the pregnancy. No wonder they talk about the miracle of life!
It’s daunting to think about the number of things that can go wrong. But, as we have seen, there are many simple ways in which you can dramatically improve your chances of getting pregnant.
In this section of the book I outline all the different factors that can undermine your fertility.The list may seem long but it is important to identify the particular combination of factors that may be undermining your and your partner’s health and wellbeing.
You may have been given the impression that there is no medical reason – and therefore no Solution – for your problem. But when you read this section you will realise that nothing could be further from the truth.

Nutrition
You are what you eat. Or, to put it another way, if you put poor-quality petrol in a high-performance car, like a Rolls-Royce or a Porsche, it may run for a while but eventually it will become less productive and less efficient. It is exactly the same with the human body.You need top-grade `fuel’ to function properly, and to produce healthy eggs or sperm. To a very large extent, your fertility depends on what you eat.
Food Isn’t What it Used to Be
One of the problems is that nowadays we eat a lot of convenience and refined foods that have been stripped of essential nutrients during manufacturing. For example, 80 per cent of zinc is removed from wheat during the milling process to ensure that a loaf of bread has a longer shelf life.’
The soil our food is grown on is so lacking in nutrients due to overuse and commercial farming methods, that even what we regard as ‘healthy’ foods — vegetables, for instance — may not contain the amounts of minerals we expect to get from them. If you have been dieting for a number of years (either restricting your food intake or trying different diet drinks or pills), you could well be deficient in a number of vitamins and minerals.
The well-balanced diet is a myth. We simply do not get all the nutrients we need from our food. This was confirmed by a National Food Survey conducted in 1995 which found that the average person in Britain was grossly deficient in six out of the eight vitamins and minerals surveyed. Fewer than one in ten people received the RDA (Recommended Daily Allowance) for zinc, which is the most important mineral for both male and female fertility.

Put this lack of nutrients together with all the additives, preservatives and pesticides (see Chapters 4 and 5) in your food and you can see that your fertility may well be compromised on a daily basis. Chemicals like pesticides are known to affect fertility, others will affect your general health, and this in turn can reduce your ability to conceive. Scientists may know the toxic effects of one particular chemical but what they don’t and can’t know for certain is the effect of being exposed to a cocktail of these substances.
Balancing the Scales
Your weight is crucial for your fertility. Being very underweight or very overweight can make conception difficult or impossible. So it’s important that your weight is within a certain range in order to give you the best chance of conceiving.
Nature gave women proportionately more body fat for a specific purpose, in order to reproduce and then feed our young. That is why fat accounts for 27 per cent of an average woman’s body weight, while it is only 15 per cent for a man.
Fat is essential to fertility and it is necessary in order to ovulate.Young girls do not begin to menstruate until their bodies are composed of at least 17 per cent fat.
Underweight
If a woman’s body fat drops too low, then her periods can stop. This low level of body fat may be caused by excessive exercise, as sometimes happens with ballet dancers or athletes who have very tough physical regimes.’
Infertility can also be caused by excessive dieting. When a woman is anorexic, for instance, her periods stop.’ With so much publicity about anorexia and an increasing number of young women falling victim to the ,slimmer’s disease’, the long-term damage to fertility caused by drastic weight loss is well-known. But not so many people realise that being overweight can also affect fertility.
Overweight
If a woman is overweight it can stop her ovulating. Studies have shown that just losing a small amount of weight, 10 per cent, for instance, can be enough to increase fertility by stimulating ovulation, improving hormone balance and making periods more regular.”‘
In another study, on women who previously did not ovulate, 11 out of 12 conceived naturally after exercising and dieting over a period of six months to get their weight down.”
Fortunately your dietary intake is fully within your control, and eating the right food may be the single most important thing you can do to achieve a successful pregnancy. Later (in Chapter 7) I will explain how the right  fertility. -Ig it nutrition can give you and your partner optinitini health and fertility.

Alcohol, Smoking and Drugs
Most of us know that smoking and drinking alcohol when pregnant can be very harmful to the baby. But what most couples don’t realise is that smoking and alcohol could actually be stopping them conceiving a baby because it reduces their fertility. The good news is that the negative effects are not permanent and simply stopping will dramatically improve your chances.
Alcohol
Research has shown that drinking alcohol causes a decrease in sperm count, an increase in abnormal sperm and a lower proportion of motile
sperm.12
Alcohol also affects a man’s fertility by changing his hormone levels because it can alter the way testosterone is produced and then released.” Because alcohol affects the liver (the organ which normally clears out any excess hormones), a man who drinks alcohol may accumulate small amounts of female hormones (men produce `female’ hormones, just as women produce testosterone). These female hormones can lower sperm production and potency.
In addition, alcohol stops absorption of nutrients like zinc which is one of the most important minerals for male fertility. Zinc is found in high concentrations in the sperm. Adequate levels of zinc are needed to make the outer layer and tail and are therefore essential for healthy sperm. If you reduce the amount of zinc in a man’s diet, his sperm count goes down.”
Finally, alcoliol reduces fertility in nianirrials, and studies show that women who drink heavily may stop ovulating and menstruating, and take longer to conceive.”

How Much is Too Much?
A study of 430 women demonstrated that drinking more than 5 units of alcohol (equal to five glasses of wine) a week could stop women conceiving. Researchers discovered that the women in the survey who drank less than 5 units a week were twice as likely to get pregnant within six months compared with those who drank more. A study published in the British !Medical Journal concluded that women should be ‘warned to avoid alcohol when trying to conceive’.”
The fact is that drinking any alcohol can reduce your fertility by half— and the more you drink, the worse the impact on your chances of conception.”
Studies have also shown a strong relationship between alcohol and miscarriages. Women who have a drink every day have a much higher risk of miscarriage (2.5 times more) than non-drinkers.” The same study found that if the woman was a drinker and a smoker her chance of a miscarriage was four times higher.
Smoking
There is so much information available nowadays about the risks of lung cancer, emphysema and other life-threatening conditions and most people are aware of the detrimental effects of smoking when pregnant. I know how shocked many of us feel when we see a heavily pregnant woman standing with a cigarette in her hand.Yet most people are not aware of the impact smoking can have on a couple’s fertility. It’s not surprising that tobacco has such an effect — it contains more than 4,000 compounds, including carbon monoxide, oxide of nitrogen, ammonia, aromatic hydrocarbons, hydrogen cyanide, vinylchloride, nicotine, lead and cadmium.
Although many women smokers resolve to give up when they get pregnant, they don’t realise that by smoking they are reducing their chances of getting pregnant in the first place. Not only that but you don’t usually know that you are pregnant for the first couple of weeks and the baby will be taking in all that tobacco smoke in the meantime.
The man’s fertility is also affected by smoking — it decreases his sperm Count, makes his sperm more sluggish, increases the number of abnormal sperm and reduces his testosterone levels.
In addition, smoking reduces the level of vitamin C in the bloodstream. Lack of vitamin C encourages sperm to clump together (a process known Alcohol, Smoking and Dru
as agglutination) instead of moving forward to fertilise the egg. One study showed how male fertility was improved by giving men 500mg of vitamin C twice a day.”
Smoking has definitely been linked with infertility in women.” It can even bring on an early menopause, which is an especially important consideration for older women trying to conceive who may be racing against time.” If you are a smoker, you should ask yourself why you are taking something into your body that is bringing you nearer to the menopause
—and infertility?
Recreational Drugs
The use of marijuana and cocaine has increased steadily over the years to the point where, for some people, it is part of everyday life. Although still illegal, recreational drug use is increasingly socially acceptable. That does not mean it is healthy or safe. The fact is that these drugs can compromise both your and your partner’s fertility. But, as with alcohol and tobacco, you can stop using recreational drugs and negate the damage to your fertility in a relatively short space of time.
If you continue to use them during a pregnancy, of course, it can have disastrous effects on your developing baby.
The Effects of Some Common Recreational Drugs
•    Marijuana can lower a man’s levels of FSH and LH, two hormones needed to produce sperm. It can also lower his libido.” For the woman, marijuana can lead to irregular periods, reducing fertility and sometimes even stopping ovulation.”
•    Cocaine users will have a lower sperm count, poorly moving sperm and a high rate of abnormal sperm.21
•    Heroin can cause a decrease in testosterone levels.2`
•    Cocaine and heroin, taken together, will make it harder for a woman to conceive and she is more likely to have a miscarriage, a stillbirth or a baby born with a malformation.21

Medicines
If you or your partner are taking medication while you are trying to conceive you should speak to your doctor about which drugs are medically essential and which are not. Some drugs have a direct effect on fertility and you do need to discuss this with your GR
Many drugs can affect not only the man’s sperm but also his ejaculatory function and libido. Some medicines may even cause impotence. These drugs can include sulphasalazine (used to treat irritable bowel), nitrofti•antoln, tetracyclines, cimetidine, ketoconazole, tricyclic antidepressants, monoamine oxidase inhibitors and propranol.”
In addition, medication given for conditions like gout or high blood
pressur can interfere with fertility. And non-steroidal anti-infianiniatory drugs (often used for arthritis) can stop ovulation.”

Over the last two decades, there has been a significant rise in the number of couples experiencing fertility problems:
•    Sperm counts have dropped by 50 per cent in the last ten years.’
•    Men are showing an increasing number of sperm abnormalities.
•    A quarter of all couples planning a baby have trouble conceiving.
•    It is not uncommon for a couple without any fertility problems to take two to three years to conceive.
•    One in four women miscarry. Some experience repeated miscarriages – as often as ten times.
•    More and more couples are turning to fertility treatments to enable them to have a family.
•    Of the couples who seek medical help, 30 per cent are told they have ‘unexplained infertility’ for which the doctors can offer no treatment.
If you are reading this book, you or your partner may have experienced problems trying to have a baby. You may have gone through fertility treatments that failed. Or you may just be worried that nothing is happening. I see hundreds of couples every year who are trying to conceive and I fully understand their unhappiness and frustration at not being able to achieve something that most of us grew up believing would happen whenever we wanted.
But, as the above statistics reveal, you are not alone. There is an epidemic of infertility and subfertility – and in many cases the doctors do not know the answers.
But, before we discuss these issues, I want to say:
Don’t lose heart
I believe that getting yourself and your partner into optimum health, usin the four-month programme outlined in this book, will give you the best possible chance of having that longed-for, healthy baby.
I don’t just believe it — I know it. By the time you have finished readin), this book, I hope I will have inspired you and your partner to take contrd of your health and fertility.
Nature is wonderfully clever. At this particular moment you may not think so, because on the most fundamental level, reproduction, it seems to have let you down. But the purpose of this book is to encourage you to restore your own and your partner’s fertility to its proper ‘natural’ state by simple lifestyle and dietary changes that eliminate toxins from your bod i and ensure that you have the level of nutrients needed for conception.
Fundamentals of Health
In the animal world, fertility is paramount for the survival of any specie However, the human race today has a number of fertility problems. Men are showing sperm abnormalities (such as sperm with two heads or sperm tha-:
are so sluggish they cannot reach the egg). Some women have a number Or menstrual cycles during which they do not ovulate; or, when fertilisation happens, the embryo does not implant in the womb.
To explain these anomalies, we have to go back to the foundations 0: health.The egg and sperm are only as healthy as the man and woman who produce them. If there are any problems with either the egg or the sperm. however subtle, nature will either try to stop fertilisation occurring or, if i does take place, a miscarriage may follow.
One reason why so many couples are diagnosed with ‘unexplained infer - tility’ is that doctors cannot put it down to a specific, observable medical cause. But I believe that infertility is a multi-factorial problem and should be investigated that way. That means looking at a variety of issues, such a, nutrition, alcohol and smoking habits, levels of lead and other toxic metals pesticides, food additives, genito-urinary infections, allergies, stress and other hazards of modern life.That means your partner taking a close look a: his health and nutrition as well (in four out of ten cases of infertility, the problems are on the male side). The fact is that our modern ‘unnatural lifestyle, combined with the nutrient depletion of much of our food, ha;
left many of us deficient in the vitamins and minerals we need for successful babymaking.
Any specialist who works in a zoo, or breeds champion dogs, cattle or racehorses, will tell you that optimum nutrition is essential. But, while the fertility clinic business is booming (with desperate couples lining up for treatment), there isn’t much incentive to look at whether simple factors, like a deficiency of zinc for instance, may be the main reason for unexplained infertility.
Learning From the Past
We should learn from the folic acid story, which really demonstrates the importance of nutrition and how a crucial deficiency identified by researchers as being responsible for birth abnormalities was ignored by doctors for years.
In 1991 the Medical Research Council (MRC) finally published a study which showed that supplementing with folic acid during preconception and pregnancy could prevent the reccurrence of spina bifida in babies.’ Yet the damaging effects of a folic acid deficiency had been recognised three decades earlier, after rats were born with malformations (including neural tube defects) and other problems (such as club foot and cleft palate) in folic acid trials.’
This knowledge, which could have prevented a great deal of heartache, had been around for over 30 years and yet women were not told to take folic acid for decades.These early findings were confirmed again in humans in 1981 trials that looked at the effects of folic acid on the prevention of spina bifida.’
Even as recently as 1993 the Daily Mail ran an article asking ‘Could this vitamin save your baby?” It said, `The fact that a supplement which can stop women having spina bifida babies remains the best kept secret of preconceptual care has now prompted sharp criticism from the medical world: ‘
Cynically, one might suppose that if folic acid had not been a simple easy-to-obtain supplement but a highly profitable pharmaceutical drug we would all have known about it years ago. You cannot patent a nutrient so there is no commercial incentive to investigate and promote it.
But the big lesson we should learn from the folic acid story is that our diet — what we eat or don’t eat — is absolutely crucial to our fertility.
How to Use This Book
Folic acid is only the tip of the iceberg. Medical and scientific literature contains a great deal of information that call help couples who are having difficulty conceiving or who have had previous problems such as miscarriages and malformations. This book presents that information in an easyto-understand form so that you call use it yourself. Having this knowledge will help you gain control of your own health and fertility.
By following the advice in this book you can increase your fertility anc reduce the possibility of miscarriage. liven if you have a condition like blocked fallopian tubes (which means that you need IVF treatment in order to have a chance of conceiving), this book will increase your chance of success. With assisted conception techniques it is still vital for the sperm anc the egg to be as healthy as possible.
As you read the recommendations, you’ll realise that the changes you make to increase your fertility are the same as those that will protect you from miscarriage and help you produce a healthy baby. They are also, quite simply, recommendations that will improve your general health. The advice
is so logical and makes such sense that you will probably wonder why nc one has told you all this before.
Finding that you can’t conceive when you want is a real shock and it is not something that many of us want to talk about even to our close friends and families. GPs and consultants are busy people and, all too often, overworked. The minute you come out of the consulting room you think of .1 dozen other things you wanted to discuss. There just isn’t time to talk in as much depth as you would like. Yet you want to find out as much as you can.This book is designed to answer your specific queries as well as present a comprehensive self-help programme that will give you and your partner the best chance of conceiving.
•    Section 1 outlines the different aspects of your life and health that could be causing your and your partner’s problem. This will help you identify what may be going wrong.
•    Section 2 explains how you can help improve your and your partner’s fertility, concentrating particularly on good nutrition and Supplementing your diet.This is one of the most crucial sections in the book because it could be the key to solving your infertility problem by making some simple changes that are entirely within your own control.
•    Section 3 explains what tests are available to help you identify any medical cause of infertility. It is important that your partner understands that lie must also be involved in this process.
•    Section 4 describes the different fertility treatments available in the UK and reveals some heartening evidence that you and your partner can dramatically improve your chances of having successful fertility treatment, if you should need it, by following the advice in this book.
•    Section 5 discusses the problem of miscarriage in depth and shows how you can help yourself overcome it.
•    Section 6 puts it all into practice – and shows you how to organise your self-help programme for those vital months of preparation.This is really the most essential part of the book.
•    Section 7 tells you how to care for yourself in pregnancy so as to ensure that you Krill have a healthy baby.
I believe that any couple planning to have a baby would benefit from following the kind of recommendations outlined in this book – not just Couples who have had problems conceiving.
If all this sounds too hard to stick to, just think how important it is … We plan our holidays and we train for a career so why should we expect to just have babies without any proper planning or preparation.- This preconception care period of three or four months shapes your baby’s future, both physically and mentally, so it could be the most important bit of planning you ever do in your life. My aim is to help you and your partner to optimum health to give you both the best chance of having a healthy baby. As a bonus, following these recommendations will make you both feel better, fitter and more energetic.
Self-help Strategies
Most couples who seek fertility treatment find out a great deal about sophisticated medical technologies but very little about the relatively simple measures they themselves can take to improve their chances of conceiving. These highly effective self-help strategies include easily implemented dietary and lifestyle changes. Such measures cost little or nothing, their success has been scientifically documented, and yet most of these couples will not have been told about them.Why on earth is this–
The cynical answer is that infertility has become `big business’.As Professor Robert Winston points out in his book Making Babies, there are now at least 21 IVF units in London alone. And more and more units are opening because they are ‘highly profitable in the private sector’. Couples who desperately want to have a baby are very vulnerable. Even though some IVF units have extremely low success rates, such couples are still willing to gamble a great deal of time and money in order to try to conceive.
In contrast, there are no big financial gains to be made in helping couple to look at their lifestyle or to correct their vitamin and mineral deficiencies Yet this approach makes such sense, and has been shown to give an unprecedented success rate.
Over the last 20 years, Foresight has pioneered an approach to fertility that looks at the fundamentals of health, including lifestyle, diet, pollutants, infections and environmental and occupational hazards and gives an unprecedented 80 per cent success rate. Researchers from the University of Surrey followed the progress of 367 couples over a period of three years (1990-3). The women were aged between 22 and 45, and the men were aged 25 to 59. In all, 37 per cent of the couples had a history of infertility, and 38 per cent had experienced between one and five miscarriages (others had had other problems, including still births, malformations and low birth-weight babies).
Many of the couples were older, coming to the trial as a1ast resort’.They were all asked to eliminate smoking and alcohol, and to follow the recommendations outlined in this book (such as buying organic food, having infections checked and having mineral analysis). All the couples were given personal supplement programmes and were then re-tested to make sure their levels had returned to normal.
By the end of the three-year trial, 89 per cent (327 of the couples) had given birth. Out of those couples with a previous history of infertility, 81 per cent conceived and had babies. Out of those who had experienced a previous miscarriage, 83 per cent had a baby within the three years of the Study, without experiencing another miscarriage.
Of the 327 babies born to the couples in the study, no baby was born before 36 weeks and none was lighter than 51b 2oz (2.368kg).There were no miscarriages, perinatal deaths or malformations. The national average for miscarriages is one in four so one could at least have expected 80 miscarriages, but there were none. No baby was admitted to a special care baby unit.
A number of the couples had already tried IVF – sometimes two or three times – without success.Yet 65 per cent of this group conceived naturally on the Foresight programme without needing another IVF cycle.
These results are undeniably impressive and speak for themselves. Yet sceptics maintain that they are ‘too good to be true’.To date, the results have been published in the Journal of Nutritional and Environmental Medicine but not in a standard medical journal.’ This is because, in order to be accepted by a medical journal, there must be a control group.
Ina normal double-blind placebo controlled trial, to assess the efficacy of a headache remedy, for example, volunteers are randomly assigned to either a control group (placebo) or a treatment group (headache remedy). The volunteers don’t know if they are taking the placebo or the remedy, and nor does the scientist running the trial. All the volunteers in the treated group get the same dose of headache remedy.
However, in this study each person was given an individual supplement programme according to their needs. So they were all taking different dosages and supplements, depending on how deficient or toxic they were.
This is an important point because the double-blind placebo controlled trial is the ‘gold standard’ in medicine but it cannot take into account that we are all unique and that we may need different treatments to increase our fertility. And it is this ‘individually tailored’ approach which I believe is the key to finding a natural solution to infertility. The fact is that 37 per cent of the couples in this study had an established history of fertility problems and had undergone medical investigation. They did something different – changed their dietary habits and lifestyle – and then conceived. The information contained in this book explains in detail my enhanced version of this preconception programme.
It worked for them. It could work for you.

Diet to Protect against Asthma
There is growing evidence that several aspects of the modern Western diet make asthma more likely to develop. Parts of this evidence are very convincing, while other findings are less conclusive as yet. Some people might argue that, until all the facts about diet and asthma are firmly established, no dietary changes should be recommended. However, all the dietary changes that might protect against asthma are also very valuable for general health.
This diet is potentially useful for:
0Atopic families who wish to reduce the chance of their chil- dren developing asthma. Other preventive measures, such as allergen avoidance and exercise (see Chapter 8), are obviously important as well.
•    Anyone who already suffers from asthma – with this diet, their symptoms may diminish.
The main elements of the anti-asthma diet are:
•    A high intake of fresh fruit. Researchers in Britain and the Netherlands have shown that people who eat more fruit have better lung function, and are less likely to develop asthma or bronchitis. Apples have a particularly good effect on the airways, according to one recent study. Many other studies show a link between Vitamin C – the major vitamin in fruit – and asthma prevention. This makes sense because Vitamin C is an antioxidant which inactivates the pro-inflammatory substances (called oxidants) that are found in cigarette smoke and other polluted air. In addition to Vitamin C, many fruits contain beta-carotene (see below) – mangoes and apricots are the richest sources.
•    Regular helpings of carrots, which contain the orange pigment beta-carotene. This is another antioxidant that can help prevent inflammation in the airways. It should be obtained from food, not supplements (see p. 207).
•    A high intake of fresh green vegetables, especially broccoli, spring greens, dark green cabbage, peas, parsley and courgettes. One Australian study has shown that children who eat fewer vegetables are more likely to wheeze. The benefits of vegetables may be partly due to the fact that they contain beta-carotene and (if eaten raw or only lightly cooked) Vitamin C. Dark green vegetables are also a good source of magnesium, and researchers find that people with a higher magnesium intake have healthier airways. Magnesium is believed to protect against asthma by helping the muscles of the airways to relax.
•    Plenty of tomatoes and tomato products, such as tomato juice, tomato sauce, ketchup and paste. The special protective effect of tomatoes is not entirely explained by their Vitamin C or beta-carotene content – another antioxidant, called lycopene, may be the crucial ingredient here. Good news for fast-food fans – the benefits of tomato paste are even seen among pizza eaters who are significantly less vulnerable to asthma.
•    Daily intake of sunflower seeds, or sunflower oil and margarine. These are by far the best natural source of Vitamin E, another antioxidant (see left) which helps to reduce the risk of becoming asthmatic. Vitamin E taken in supplements seems to have much less beneficial effect than natural Vitamin E from food.
•    A good intake of the minerals zinc, manganese and selenium, as well as magnesium (see p. 206). Shortage of any of these minerals may be linked with asthma. It is important not to eat too much wheat bran or unyeasted wholemeal bread, especially with main meals, as these block the absorption of several minerals.
Good sources of zinc include meat, shrimps, clams and oysters, with smaller amounts in cheese and egg yolks. Nuts, lentils and beans are fairly good sources of zinc, while soya protein blocks its absorption.
As well as being found in dark green vegetables, magnesium is plentiful in sardines, peanuts, hazelnuts, walnuts and lentils. Other fish, lean meat, milk, cheese and bananas contain smaller amounts.
Manganese is found in eggs and milk, and though the amounts are small, these are good sources because the mineral in them can be absorbed easily. While green leafy vegetables, whole grains and tea apparently contain more manganese – and are frequently recommended as a source of this mineral – in fact very little can be absorbed from those foods. Lentils are a moderately good source of manganese.
Selenium is most plentiful in fish and meat. It may be scarce in home-grown plant foods in areas of the world (notably Finland and parts of New Zealand) where selenium is lacking in the soil.
•    A limited intake of meat, especially red meat, plus a com-
-    plete avoidance of kidney, liver and other offal meats. An entirely vegetarian diet incurs a risk of mineral deficiencies however (see above). On balance, it is probably best to eat meat once a week or less.
•    A low intake of salt. Researchers in Kenya found that children eating a high salt diet (which equals the average salt intake in Britain and other parts of the developed world) were at greater risk of becoming asthmatic. For existing asthmatics, increasing the amount of salt eaten can make asthma worse, while reducing salt can lessen symptoms. Male asthmatics seem to be more vulnerable than females. Salt probably affects the muscles of the airways, making them more likely to contract.
The role of supplements
You should try to get all the nutrients you need from food rather than supplements. However, there are times when a supplement can be useful. Any asthmatic who has to cope with the effects of high air pollution, especially ozone and sulphur dioxide (see pp. 130-31), may find a supplement of Vitamin C beneficial. However, you should avoid very high doses of Vitamin C (e.g. I g/day) as they can cause disturbed sleep. Use natural sources for Vitamin E (see p. 206) if you can, but taking a supplement is better than nothing.
Vegans should think about taking a multi-mineral supplement, given the difficulties of ensuring an adequate intake of zinc, manganese and selenium from vegetable food (see left). Vegetarians may also benefit from a mineral supplement.
Some supplements, in certain circumstances, can do more harm than good. Omega-3 oils (also called w-3 oils, concentrated fish oils, or EPA and DHA) may make asthma worse for some people (see box on p. 221). Beta-carotene (sold alone and as part of mixed antioxidant supplements) may, according to some studies, promote cancer at the high doses used in many supplements. It should only be obtained from food.
Foods and drinks that bring on asthma attacks
The anti-asthma diet tackles the inflammation of the airways and the underlying tendency of the airway muscles to go into spasm – in other words, it is concerned with the long-term treatment or prevention of asthma. In addition, you should obviously avoid any foods which aggravate asthma in the short term. Various foods and drinks can bring on an asthma attack:
•    Foods and drinks containing sulphur-based preservatives tend to give off the irritant gas sulphur dioxide while being chewed or swallowed. Some asthmatics are more sensitive to sulphur dioxide than others. The foods that most commonly cause problems are dried apricots and other dried fruit (except those labelled ‘unsulphured’), shellfish, french fries, ready-made salads and fruit salads. Sulphur-based preservatives are used widely in the catering industry. On packaged food, look for ’sulphite’ and’metabisulphil or E numbers 220-227. Soft drinks, wine, beer and cider almost always contain sulphur-based preservatives.
•    Foods that cause heartburn (GER – see p.38) can aggravate asthma for some people.
•    Alcoholic drinks may make the airways contract for some asthmatics (see box on p. 160).
•    Some asthmatics need to avoid foods containing histamine (see box on p. 67).
•    A few asthmatics respond badly to the smell of food cooking. The most severely affected can suffer an asthma attack from anyfood aroma. Cromog lycate -type drugs (see p. 148) or anti -choli nerg ics (see p. 156) may block this reaction.
Needless to say, if you have a sensitivity reaction to any food listed for the anti-asthma diet you should not eat this food.

Theophylline
Theophylline-type drugs are also known as xanthines or methylxanthines. These drugs are chemically similar to caffeine. They cannot be inhaled, so are taken as tablets or syrup. They start working about 30 minutes after being taken and their effects last for 6-8 hours. Slow-release preparations take 90 minutes to start working, but they last 12-24 hours, and are therefore useful for nocturnal asthma.
In Britain, doctors generally regard theophylline-type drugs as reliever drugs (see p. 152), but rather risky ones whose use is only justified for people with severe asthma. They are given, as an additional treatment, to asthmatics who are not responding well to the usual drug programme (see p. 160). Unfortunately, fairly high doses are needed for theophylline-type drugs to act as relievers, i.e. to reverse bronchospasm. There is a very narrow margin between such a dose and one that causes major (and sometimes dangerous) side effects.
Such side effects usually occur when the doctor is still trying to work out the correct dose – this varies from one person to another, so prescribing theophylline-type drugs is no easy matter. Once you are established on a safe dose (and provided your general health and your intake of alcohol, nicotine and medicinal drugs does not vary – see p. 158) you can usually continue taking theophylline without serious side effects.
In the United States, many doctors also give theophyllinetype drugs, at much lower doses, to people with mild asthma. At these low doses they do not act as relievers, but they have a slight anti-inflammatory effect and therefore act as preventers. The risk of toxicity is much less. Taking low doses of theophylline allows people with mild asthma to reduce their use of beta-2 relievers. However, inhaled steroids are usually more effective in this role, and are the preferred treatment outside the United States.
Side effects
Typical side effects include nausea, vomiting, stomach pains, diarrhoea (sometimes with blood), headache, anxiety, restlessness, insomnia, dizziness, and a pounding heart or irregular heartbeat.
Any side effect of these drugs should be taken seriously and reported to your doctor as soon as possible. If you cannot get an appointment quickly, it may be best to stop taking the drug before seeing the doctor, as long as you have other drugs to control your asthma. Call your doctor for advice.
It is remarkably easy to overdose when taking these drugs at higher doses (see p. 157). Such overdoses can be fatal. The symptoms include repeated vomiting, shaking, feeling unusually hot, needing to urinate frequently, severe thirst, maniacal behaviour, and irregular heartbeat (palpitations). Delirium and convulsions may occur shortly afterwards, so get hospital treatment urgently if you have any of these symptoms.
Unfortunately, a serious overdose can sometimes occur in people who have taken theophylline-type drugs without trouble for many years. There may be no advance warning that anything is wrong - no mild side effects preceding the serious ones. To protect yourself against this, you need regular blood tests from your doctor.
One fundamental problem with theophylline-type drugs is that many different factors - including diet, illnesses other than asthma, and taking other drugs - can alter the way your body deals with the drug. If your liver is breaking down the drug more slowly than usual, the amount in your blood will rapidly increase, and can reach toxic levels.
These are steps that can help prevent an overdose with theophylline-type drugs:
• If you start taking a new drug of any kind, or stop taking a drug (especially the contraceptive pill), or if you change your intake of nicotine or alcohol, ask your doctor - preferably in advance - if your dose of theophylline-type drug needs to be changed.
• A great many drugs interact with theophylline-type drugs, including the new anti - leukotriene drugs. You should always be cautious with any new drug, but take particular care with two antibiotics - ciprofloxacin (brand name Ciproxin) and erythromycin (various brand names) - and with cimetidine (various brand names), used for stomach ulcers and heartburn.
• If you have flu vaccinations, or develop certain illnesses, especially viral infections, heart disease or liver disease, watch for the typical side effects of theophylline-type drugs (see above) and consult your doctor immediately if any occur. These conditions all change the effects of theophylline-type drugs.
• Don’t eat meals that are very high in fats or oils. A lot of fatty food causes too much of the drug to be released at once from the slow-release preparations and increases the risk of side effects. Avoid sudden, major, changes to your diet.
• See your doctor regularly for check-ups. Simply getting older changes your reaction to these drugs: your dose may need to change over the years.
• If you are at all forgetful about tablets, keep a careful record of when you have taken your theophylline-type drugs. Be very careful never to take a second dose by mistake.
• Talk to your doctor if you are not taking a slow-release form of theophylline (see box below for brand names). There are usually fewer side effects from these than from the ordinary forms of the drug.
• Wear a Medic Alert bracelet (see box on p. 95) saying that you are taking theophylline-type drugs. If you have a severe asthma attack and are taken to hospital, it is important that medical staff know this, so that they do not give you more drugs of this type.
While pregnant or breast-feeding, it may be advisable to stop taking theophylline-type drugs: discuss this with your doctor. Although the drugs do not affect most unborn or newborn babies, there are occasional reports of toxicity. Less seriously, theophylline-type drugs go through into breast milk, and may make babies irritable and restless. This problem can be solved by always taking the drug just after a feed - this reduces the amount in the milk.
Theophylline-type drugs might produce behavioural problems and learning difficulties in young children although this is unproven. Research shows that there are no problems for children over six.
Anti-IgE drugs
For asthmatics with strong allergic reactions, who are not doing well on ordinary treatment, the new anti-IgE drugs, such as omalizumab may be very valuable (see p. 149). They are given as a depot injection under the skin.
Some common brand names
Common brand names of theophylline-type drugs include: slow-release preparations — Lasma, Nuelin SA, Phyllocontin Continus, Slo-Phyllin, Theo-Dur, Uniphyllin Continus
ordinary preparations - Aminophylline, Nuelin Ketotifen
Ketotifen (brand name Zaditen) is an antihistamine (see p. 138), although it has other effects in addition to those of ordinary antihistamines. Most significantly, it stabilises mast cells in a similar way to cromoglycate.
One advantage of ketotifen to many people is that it is taken by mouth, in capsule, tablet or syrup form. When it was first introduced, doctors hoped that it would be of particular help in asthma, but it has not lived up to expectations. However, some asthmatics do find it effective. It is worth trying because, it it works, it could permit you to reduce your dose of steroids.
Ketotifen requires up to six weeks to take effect, so continue taking your previous drugs (e.g. steroids) for at least six weeks, or you will risk losing control of your asthma.
Side effects
Minor side effects from ketotifen include nausea, headache, increased appetite and weight gain, drowsiness, dry mouth and slight dizziness. Do not drive until you are sure that ketotifen does not make you drowsy. Alcohol may pack a more powerful punch than usual, so drink very moderately at first. If drowsiness is a problem, take the drug in the late evening. The sleepy feeling may wear off after a few weeks of taking the drug.
There are no serious side effects from ketotifen, except if taken with drugs for diabetes.
Anti-leukotriene drugs
Leukotrienes are among the messenger chemicals that are produced by mast cells during an allergic reaction (see box on p. 12). They help to perpetuate the inflammatory process begun by histamine, and they amplify the reaction by attracting more immune cells into the area.
The anti - leukotriene drugs fall into two distinct groups:
• those that bind to the receptors for leukotrienes, called leu kotriene- receptor antagonists. Currently, there are two drugs in this group, montelukast (brand name Singulair) and zafirlukast (brand name Accolate). A third drug, pranlukast, is in the pipeline and currently going through its safety trials.
• those that block the production of the leukotrienes altogether, called 5-lipoxygenase inhibitors. There is only one drug in this group at present, zileuton (brand names Leutrol, Zyflo); it is not yet available in Britain.
As regards tackling inflammation, the anti - leukotriene drugs work in a completely different way from either steroids or cromoglycate. This makes them useful as an add-on treatment, supplementing the effects of existing anti-allergy drugs.
For asthmatics, anti-leukotriene drugs may be particularly good in combination with antihistamines – whereas antihistamines alone are singularly unsuccessful in asthma (see p. 138). Recent research suggests that taking antihistamines together with antileukotriene drugs is an effective way to control airway inflammation. However, there have been no large-scale trials of this treatment option yet, and it may be a while before it comes into general use.
In the airways of people with asthma, leukotrienes can directly trigger bronchospasm (contraction of the airway muscles) as well as fostering inflammation and increasing mucus production. This multiple action of leukotrienes makes anti-leukotriene drugs very valuable for asthmatics because they act as both relievers (reversing bronchospasm) and preventers (tackling inflammation). They are especially useful for exercise-induced asthma.
All the anti-leukotriene drugs are taken in tablet form. If you are trying an anti - leu kotriene drug for the first time, don’t expect any noticeable effects to occur for about three days. Once you are taking the drug regularly, each dose requires 2-4 hours to have its full effect, but goes on working for 12-24 hours in total.
Although anti - leu kotriene drugs have a reliever effect, they cannot give you immediate relief from bronchospasm. Asthmatics must therefore carry a short-acting beta-2 reliever (see pp. 152-3) as well, in case of an asthma attack.
For those who dislike inhalers, or tend to forget to use them, the fact that these drugs are taken once a day in tablet form makes them an attractive option. However, they are expensive, and at present doctors prescribe them mainly for young children who have difficulty inhaling their usual drugs.
Side effects
The side effects noted in safety trials of these drugs were all minor ones:
• zafirlukast – headache, nausea, diarrhoea, pain
• montelukast – headache, diarrhoea, abdominal pain, cough, and flu-like symptoms
• zileuton – upset stomach
As with all new drugs, you should report any unusual symptoms to your doctor, just in case these represent a rare or longterm side effect of the drug (see p. 137).
Very occasionally montelukast provokes allergic reactions, with symptoms such as itchiness, widespread nettle rash (urticaria) or swelling (angioedema).
Zafirlukast and zileuton can both cause liver damage, but this is rare. Your liver function should be closely monitored by the doctor, by means of regular blood tests, and the drug withdrawn at the first sign of trouble. Montelukast can also affect the liver, but this is extremely rare.
The most worrying development noticed to date is the appearance, in a very few people taking zafirlukast or montelukast, of a disorder called Churg-Strauss Syndrome. The symptoms may include a blotchy purplish rash (due to vasculitis – see lower box on p. 73), a flu-like illness, worsening asthma, and numbness or tingling in the limbs. The heart, lungs and nerves are all affected, because eosinophils (see p. 19) are present in large numbers and cause damaging inflammation.
A study of the cases reported so far suggests that this syndrome may not be due to the anti-leukotriene drugs themselves but to other causes – usually (though not always) a reduction in the dose of steroids. Other patients who are not taking antileukotriene drugs, but are reducing or stopping steroids, may also (again, very rarely) develop Churg-Strauss Syndrome. Doctors now suspect that all these patients were already suffering from an underlying eosinophilic disease, which first showed itself simply as asthma, and was quelled by the steroid treatment prescribed for the asthma. The disease was thoroughly masked as long as the patient was using steroids, but when steroids were withdrawn, the underlying disease flared up, producing a wide range of symptoms. In most cases, reintroducing steroids brings these symptoms under control again.
Putting it all together
What is the ideal combination of all these asthma drugs? That is something your doctor can only work out slowly, because it varies from one individual to another.
The conventional approach to asthma treatment is to start patients on a short-acting beta-2 reliever and then, if the symptoms are not controlled, to add other drugs. This approach is called ’stepping up’. The standard steps, or stages, are as follows:
1. Use a short-acting beta-2 reliever only.
2. Add cromoglycate or low-dose inhaled steroids.
3. Try a higher dose of inhaled steroid or a long-acting beta-2 reliever.
4. Try out each of the following in turn: theophylline, anticholinergic drugs, cromoglycate and higher doses of beta-2 relievers (either inhaled or as tablets/syrup).
5. If there is still no success in controlling symptoms, add regular steroid tablets.
Short courses of steroid tablets may be used at any stage, for the control of sudden, severe, attacks.
Over the last ten years, there has been a change of strategy, and very few people are now kept on Stage 1. Inhaled steroids are now given to most asthmatics, even those with relatively mild asthma. Research from Sweden, where widespread use of
inhaled steroids first became general policy, shows considerable benefits to this approach.
If you have gone beyond Stage 2, ’stepping up’ is usually followed by ’stepping down’. In other words, when the symptoms have been well controlled for 3-6 months, doses of some drugs are reduced, or certain drugs stopped altogether. If the asthma flares up again, the dose is increased or the drug reinstated. If there are no problems, and symptoms remain stable for a month or two, another reduction is tried.
An entirely different approach to asthma management is now being tried with some patients – starting off with moderate to high doses of inhaled steroids (equivalent to Stage 3) and then ’stepping down’. The idea is to get the inflammation under control promptly and fully at the outset. This often seems to be the best strategy.
A few asthmatics don’t get much benefit from steroids. If your dose of steroid needs to be raised repeatedly, or you still need to use your reliever daily in spite of taking steroids, you may have steroid-resistant asthma. There are other drugs that can help, including anti-leukotriene drugs and the more powerful anti-allergy drugs (see p. 149).
Alcohol, caffeine and asthma
Some asthmatics experience bronchodilation (opening up of the airways) when they drink alcohol, while others experience
bronchospasm (tightening of the airways). For those whose airways open up, there is probably no harm in sometimes having a drink to relieve your asthma symptoms, assuming these are fairly mild. Clearly, it would not be a good idea to make a daily habit of this.
If your airways tighten up with alcohol, you will probably be pleased to hear that it may not be the alcohol itself. Alcoholic drinks contain a great variety of other ingredients, either derived from the original ingredients or generated during the fermentation process. Called ‘congeners’, these vary from one type of alcoholic drink to another, and they are often the culprits in asthma. So you may well find that, while one kind of alcoholic drink has a bad effect, another is fine.
Caffeine has a far more uniform effect — for most asthmatics it opens up the airways. However, the amount needed to relieve an asthma attack will also produce unpleasant side effects, such as a pounding heart or shaky hands. There are also long-term problems with such high doses of caffeine, including insomnia, headaches, nervousness and ‘restless legs’. It is much better to use your reliever inhaler to control an attack: the drug in the inhaler has been chemically tailored to give the maximum therapeutic benefit with the minimum of side effects. Anyone who consumes tea or coffee excessively can make themselves seriously ill, either physically or mentally, and it is not always obvious that caffeine is the cause (see p. 235).