Two years ago I wrote an article for Running Journal titled, “Breathe Better: Understanding Asthma.” That article, as with all my writings, talked about getting to the root of asthmatic symptoms and how certain medications provide clues to the cause of any asthma. What I soon realized after that article was written was that there is very little information regarding asthma, (and EIA), other than how to get by with a prescription drug. The lack of information is something that I am continuously reminded of as I still receive [weekly] emails from every continent other than Antarctica, just from that one article. So after a long hiatus from contributing to RJ, here is my comeback article, with a revisit to the non-information, (if that is even a word), and mis-information regarding asthma and EIA. (For simplicity, I will use the word asthma rather than distinguish between EIA and asthma.) Take a puff of that inhaler and read on.
The number one reason for asthma is an adrenal related issue. This is because the majority of bronchodilators are adrenergic and/or steroid medications. Asthma is most commonly a classic case of a lung symptom resulting from a hormonal problem. Like most things treated today, this is similar to putting a muzzle on a barking dog so you can continue to step on his tail. The common names for adrenergic medications are albuterol, (Proventil, Ventolin, Volmax, Airet), levalbuterol, terbutaline, Maxair, and Foradil. These drugs stimulate the adrenal medulla, which is where adrenalin and noradrenalin are made. Therefore, if one of these medications “work” for you, then investigating what is driving (or actually not driving) the adrenal glands to do this themselves is something to look at. Additionally, many times there is something irritating the lungs and the adrenal glands simply cannot muster up the strength to deal with the irritation on their own. Common irritants to the lungs are poor air quality, other medications, food and environmental allergies, and chemical intolerances and sensitivities – such as MSG, Aspartame (Nutrasweet), and chemicals called aldehydes. Aldehydes are the main chemicals in perfumes, carpets, paints, and other similar items which many people are sensitive to.
The adrenal corticosteroids are another popular group of meds. These drugs include Aerobid, Flovent, Azmacort, Pulmicort, Qvar, and others. These affect the adrenal cortex which is where hormones such as cortisol and aldosterone are made. Cortisol is your major hormone secreted as a result of stress. It is an anti-inflammatory hormone and it is partly responsible for blood sugar control. Aldosterone is the major hormone that helps regulate your electrolytes, primarily sodium and potassium. When aldosterone levels are low you’ll lose a lot of sodium in your sweat and urine leaving you dehydrated and fatigued. Many people have an adrenal cortex problem. Saliva tests available today are extremely accurate in measuring the circadian rhythm of cortisol to pinpoint any potential problem, and during an applied kinesiology examination the physician will look for certain muscle imbalances that are a result of adrenal gland dysfunction. Often these muscle imbalances result in foot pain, low back pain, and knee pain – so you can see the link between physical ailments (joint pain) and chemical-hormonal problems (asthma). Plantar fasciitis, shin splints, and ITB frictional syndrome are three very common injuries that almost always have an adrenal component to them. It is not just a coincidence that an injury like that pops in a person who also has an asthma problem, or EIA occurs after an injury. You can read more about these injuries under the Athlete Section.
The adrenal glands and the pancreas work together to maintain a balanced blood sugar. So if the adrenal glands are not working well, then blood sugar is a problem too. Signs of an intolerance to carbohydrates, termed insulin resistance, include symptoms such as craving sugar, getting sleepy after eating, headaches, loss of concentraion, and irritability, just to name a few.
So when an adrenal based medication helps your asthma think about your adrenal glands, not your lungs. Evaluate (or see a doctor who can) what may be causing your adrenal glands to not function properly. Are you training too hard – (overtrained)? Is your diet bad – containing excess sugars, caffeine, and hydrogenated fats, MSG? Are you under too much stress?
Other medications combat allergic reactions and inflammation. Mast cells in the body secrete histamine in response to an allergy. Mast cell histamine blocker medications are Omalizumab (Xolair), Intal (cromolyn), Tilade, and Accolate, Singulair, and Zyflo are the common leukotriene modifiers. These do two things: they act as an antihistamine and they block leukotrienes, which are inflammatory hormones. So if any of these meds work for you then you need to figure out why you are making histamine and/or leukotrienes; that’s what makes sense to me.
Histamines are produced in response to, most commonly, an allergy, though they can be a result of injury and infection too. Although the allergy can be environmental such as pollen, grasses, or weeds, I can safely say from clinical experience that there is almost never someone who has an environmental allergy that does not have a food allergy. They usually just don’t know about the food allergy. Some estimates are that over 55% of people are allergic to something, and a vast majority of those individuals are allergic to a food that they don’t know is bothering them. This is because the majority (80%) of food allergies are of a slow onset type, not the anaphylactic type most are aware of where you flare up with a rash from eating a peanut or shellfish. The most common food allergens with respect to asthma are [cow’s] dairy (casein), wheat (gluten & gliadin), soy, corn, egg, and nightshades (tomato, potato, eggplant, pepper, paprika, tobacco, and Goji berries). So if histamine levels are already high and when an extra stressor such as pollen comes around, it’s too much for the person’s immune system to handle. These are the same people who need to take Claritin, Zyrtec, Allegra, or any other antihistamine to get through the change of season.
Leukotrienes are often made in response to a fatty acid imbalance problem. They can also occur from taking NSAIDs. Yes, those very same medications such as ibuprofen, aspirin, Aleve Advil, Mobic, etc…, or other anti-inflammatory drugs, can really be messing things up. A diet that contains hydrogenated fats is also a big culprit to this problem. Considering the fact that the half-life of a hydrogenated “trans” fat is 51 days, eating a food with this stuff in it as little as once a week can be enough to cause problems. A diet too high in saturated fats such as red meat (non-grass fed beef and pork), dairy, and shellfish can also cause this chemical reaction. Nutrients such as magnesium, vitamin B6, zinc, and the powerful bioflavonoids like grape seed, turmeric, and quercetin tend to help with leukotriene and histamine problems.
Atrovent, Apovent, Aerovent, are in the anticholinergic category. This has to do with a sympathetic/parasympathetic imbalance which basically means that the nervous system is out of whack. Most commonly, the nervous system is too stressed – too “hyped-up”. Correlating symptoms include sleep problems, sensitivities to light and noise, and a short temper. Interestingly, most multi-vitamins and B-complex supplements contain choline in them, many times in high quantities. Taking choline at the same time as taking Atrovent, (in this instance), would not be a wise idea.
So what does this all mean? It means that there is a reason for asthma – it just doesn’t pop up one day. Some people are born with sub-optimal lung function from an underdevelopment during fetal life. In the third trimester of pregnancy a mother who is too stressed literally robs her baby’s adrenal gland hormones. She feels a lot better, but the baby suffers, and once born the mother may suffer from post-partnum depression while the baby has immune system or asthma issues. For many people unresolved stress and an overload of the nervous and hormonal systems leads to asthma. If you “need” a medication, or should I say, “do better with a medication”, then take a step back and ask yourself why. If a physician tells you to take a certain drug, ask him or her why it will benefit you and what is the medication trying to accomplish. Remember, the inhalers and other meds don’t fix anything; they just get you by. Staying on an asthma med often results in health problems becoming worse since the cause goes unaddressed, there are side-effects to the meds, and the medications can alter and deplete the respective areas they are effecting. So resolving the asthma will not only take a load off your chest (haha) but your overall health will improve and that will mean improved performance – in fitness and life.
Very helpful. Wonderful, simple outline that explains my allergies, asthma and adrenal fatigue. Thank you.
Brilliant and so different from anything anyone in a white coat has ever told me about my life-long athsma.
Quick question – Is there a way to build my adrenal function naturally ?
Thanks so much
Sure, check out the 4-part Adrenal Series starting here: https://drgangemi.com/2013/11/adrenal_glands/
I’ve had asthma all my life and your article made so much sense to me. I can’t believe I’ve never ask myself any of these questions and just go along with the meds the doctor gives me. I wish I could read more on this topic that you have written.
Thank You for pointing me in a new directions.
Dr. G, I truly enjoy your work and I spend hours on your website. But asthma has me in such a bad way that I did end up taking QVAR and boy, does it help. I am a 36 yo female with no history of asthma, ever. I didn’t even know that was what I had, I thought feeling like a Mack truck was on my chest and audibly wheezing every night was just allergies. I do however, have a history of adrenal issues. From being a drug/alcohol addict in my teens and 20s (got clean 10 years ago) to some major overtraining of the steady state cardio variety, my adrenal fatigue manifested as me passing out every time I stood up. I went to a practitioner who did NRT and I spent thousands of dollars on supplements and about a year, mostly taking various standard process supplements for my adrenals. I stopped, because of $ (and, honestly, I was not completely bought in to NRT), but still take magnesium, B vitamins, milk thistle, etc. I also cut out steady state except for one run a week and i lift heavy 4 days. So why now would I develop asthma? My dr said it is imperative that I take the inhaler or I will end up in the hospital, which seems just about right since I can barely breathe in an attack. Is it possible to continue to work on adrenals while taking QVAR to keep the asthma at bay? I tried to treat it the natural way and I definitely feel frustrated….
It really depends on the person and situation Kate. The Qvar could be impairing adrenal function and you might need to adjust or switch medications to help the adrenal. Or you might be able to stay on it until your adrenals get stronger via whatever means necessary and then you can, with the help of your prescribing physician, work your way off of it.
Dr G – Your article was very informative! I am a 36 yr old who was recently diagnosed with asthma and have never prior to this had any such problems. It started this last November 2015 after I was sick for a month and began wheezing. The wheezing came/went but was mostly under control until recently when I’ve had episodes where there were several days in a row when I’m wheezing but I think overall it’s mild asthma. I can only feel the wheezing when I take a very deep breathe…so I assume that means it’s mild. I think I’ve only had one instance when I’ve felt my chest tight. I also have seasonal allergies which gets worse of course during the changes in the season that we see here in the DC metro area. My docs are also checking my thyroid levels so we will see if that could be a problem, and I’m going in for a follow-up to confirm again that I don’t have glaucoma (since a few months ago I had slightly elevated pressure results but one subsequent glaucoma test came back fine). I was recently switched to flovent and was wondering whether feeling very tired is a common symptom. Today, for example, I took Claritin (the regular, not the Claritin D) along with the flovent and I’m exhausted. I haven’t felt this way with Claritin before. Could it be the combination of the two? Should I switch to another allergy med? And, most importantly, should I really be taking flovent for mild asthma rather than working to identify the real/underlying issue? Beyond my general doc, I don’t know who next to see to begin figuring out what’s going on with me. Any advice? Thanks in advance.
Thank you. I’d really need to individually consul with you on this as I can’t give such specific advice on-line. Thanks for understanding.
Same question as above really, can I heal my low cortisol while taking one puff a day of Alvesco? If I don’t take it I cannot sleep at night and wake up feeling awful from poor nocturnal asthma. Are there any supplements that could help any of this?
Dr. Stephen Gangemi says
Check out the adrenal gland series on this site.
Jean Wright says
I’ve learned that Chlamydia pneumoniae causes asthma and when on antibiotics the symptoms improve. The trouble is once they stop the symptoms come back. If someone can find a cure for cpn they will also cure Alzheimer’s. See cpnhelp.org and if anyone has the answer I would be grateful if they could share it
I have been trying to get across to my dr that the plantar fasciitis and the cough variant asthma and low ferritin levels that suddenly crept up on me last year at the age of 54 had to be related. This also explains why on prednisone for a short while made me feel so great all around. After taking myself off the daily Steroid inhaler my cough and foot pain is returning. With diet and exercise and stress reduction I’m trying to address the causes, not just treat the symptoms. I’ve a long way to go and thanks for the information!
Dr. Stephen Gangemi says
:) yeah they’re often related!
I was diagnosed with asthma about 2+ yrs ago and have all the signs of Adrenal Fatigue, + foot pain, knee pain. I have to use Albuterol several times a day. I have a steroid that I use very infrequently due to hoarseness and causes shakiness. Sometimes I have to use it because I just suffer not being able to breathe. I feel like I should take it daily but the hoarseness is very annoying to me and everyone around me (constantly clearing my throat). Btw, since taking Qvar I can no longer smell anything! A skunk could walk by me. But when I use the steroid inhaler I can smell the wood in the wall or detergent in your clothes. It’s very strange. So if there’s a fire I will be in trouble. How would you deal with Adrenal Fatigue and asthma simultaneously? I cannot breathe without the Albuterol. But my adrenals are suffering!
So what does one do if they suspect sub functioning lungs becauae they were preemies? where does one begin to look for fixes for that cause of their asthma?
Dr. Stephen Gangemi says
I’d suggest you seek out a qualified natural health care physician to work with.
CJ Rowland says
Very interesting theories/article. I was diagnosed two years ago at 64 years of age with Athsma. I used to be an avid runner but with the arrival of grandchildren it has become a hit and miss event. I was diagnosed after several years of bronchitis usually in the fall/early winter. Always wondered if my change to a more sendantary life style had an affect? I’ve also put on weight. Not obese. I’m 5’4 and 140lbs. Female. Well muscled legs and arms. Weight is in my middle. Currently on Breo and singular. What would be your advice for me? Anything would help. I hate taking these meds!
Dr. Stephen Gangemi says
We’d have to set up a consult for me to help you with this one.
Shauna Davis says
Ok…I have read your article and totally agree!!!. I have just gone through menopause (62)and no longer take BioIdentical hormones and my asthma has definitely gotten worse!. I have just gone to my PC physician and she has ordered blood work so waiting on the results of that. She did say my thyroid was normal and after reading this article was convinced I may have an adrenal problem. But you do not give any suggestions nutritionally (supplements) as how to relieve or reverse asthma symptoms???
Dr. Stephen Gangemi says
Sorry I can’t give personal advice without seeing you. :)
Thank you for taking the time to write this down.
What do you suggest for people who would be in respiratory distress without their medications.
How does a person with chronic asthma get off albuterol and a steroid inhaler? I keep trying to titrate down. Every time I find myself in distress after a week or two.
Dr. Stephen Gangemi says
That would involve working with that individual to figure out what is causing their asthma trigger – so it’s very individualized past the general aspects of the article. Hopefully you can see what part of your body system(s) are affected by certain medications that may be providing symptomatic relief.