Richard G. Petty, MD

Asthma, Air and Allergies

After a couple of weeks away I was distressed to see that I was going to be returning to a city which has just been rated as the most challenging place in America for people with asthma.

This is the list according to the Asthma and Allergy Foundation of America:

1. Atlanta
2. Philadelphia
3. Raleigh, North Carolina
4. Knoxville, Tennessee
5. Harrisburg, Pennsylvania
6. Grand Rapids, Michigan
7. Milwaukee
8. Greensboro, North Carolina
9. Scranton, Pennsylvania
10. Little Rock, Arkansas

I am pleased to say that I do not have asthma, though I have a strong family history of it. If you live in one of these cities, or any other with a high rate of pollution, there is nothing much to be done apart from:

Staying indoors when the weather is bad

Using an air purifier

Keep to a diet designed to reduce your risk of inflammation

Use homeopathy and tapping therapies to help when necessary.

And sadly, for some people, medicines are the only option. But I always try the other approaches as well.

Self-hypnosis and Hay Fever

I first learned to do hypnosis in 1980, and I have always found it a useful adjunctive treatment for some people, though in recent years I have spent far more tie teaching people to use self-hypnosis.

The research data on hypnosis has also been growing, to the extent that nearly two years ago an article in the Mayo Clinic Proceedings, a fairly conservative journal, suggested that the time had come for an expanded role for hypnosis in general medicine as well as a study of different techniques that are in use.

Hypnosis and self-hypnosis may affect an illness directly, or it might reduce a trigger to the illness, say if anxiety triggers an asthma attack, we could use hypnotherapy to treat the anxiety. Hypnosis may improve a person’s subjective responses to the illness. It might also be useful to help counteract side effects in people who just have to be treated with conventional medications.

Many case reports of apparent cures with hypnosis have found their way into the popular press.  I have mentioned that over a period of five years I spent one to two days a week going through and checking most of these reports in all the languages that I can read. Sadly some of them turned out not to hold much water.

But now the quality of the research has improved enormously. I have been particularly impressed with some of the studies on allergy: it is very remrakable to think that we can make specific suggestions that produce demonstrable effects on the immune system. I particularly liked a study from Switzerland that was published in the journal Psychotherapy and Psychosomatics.

A team from Basel University taught 66 people with hay fever how to do self-hypnosis and found that it helped them to alleviate symptoms such as runny nose.

The volunteers also took their regular hay fever medicines, but the effect of hypnosis appeared to be additive so that they could reduce the doses that they needed to take.

The study took place over two years and included two hay fever seasons. During the first year, one group of the volunteers with hay fever were taught and asked to regularly practice hypnosis as well as take their usual allergy medicine. The training consisted of one two-hour session with an experienced trainer. The remaining volunteers had no other treatment apart from their normal allergy medication.

After a year, the researchers found the volunteers who had been using self-hypnosis had reported fewer symptoms related to hay-fever than their fellow volunteers.

During the second year, the researchers taught the remaining "untrained" volunteers how to use hypnosis. By the end of this year, these volunteers also reported improvement in their hay-fever symptoms.

Although the improvement in symptoms was not statistically significant the researchers also found that the volunteers had cut down on the amount of hay fever medication they used after learning self-hypnosis.

There is another interesting piece of research on this topic. You will probably have experienced a histamine reaction: the typical wheal, flare and swelling that can occur after, say, an insect bite. Researchers form Denmark used hypnosis to induce emotions of sadness, anger, and happiness, to see whether these emotions would have any effect on the skin’s response to histamine. Not only did mood have an effect on the skin reactions, but also people who were more susceptible to hypnosis were more reactive to histamine.

Hypnosis is being used with many clinical conditions, from asthma to migraine and irritable bowel syndrome. It is not a panacea, but it can be a very useful tool. And it tells us a lot about the power of the mind to influence virtually every system of the body.

The Red Tide

There is an important report about the impact of environmental change in this month's issue of the journal Chest.

Red tide is a common name for a phenomenon known as an algal bloom, a well known event in which marine algae accumulate rapidly in the water column, or "bloom". These algae, more correctly termed phytoplankton, are microscopic, single-celled, plant-like organisms that can form dense, visible patches near the water's surface. We know that red tides have been occuring in the Gulf of Mexico for centuries, but they appear to be spreading and to be becoming more common and severe.

The main type of plankton is a species of dinoflagellate known as Karenia brevis, that is  concentrated along shorelines and produce highly potent aerosolized toxins. The new research shows that Florida red tide toxins - called brevetoxins can impact respiratory function and increase respiratory symptoms in patients with asthma.

In otherwise healthy people inhaled aerosolized red tide toxins can lead to eye irritation, runny nose,  postnasal drip, nonproductive cough, and wheezing. The symptoms usually subside after leaving beach areas. But things can be far more serious for people with asthma, who may experience respiratory problems and decreased lung function after just one hour of beach exposure to the toxins.

This was a fine piece of research funded by the National Institute of Environmental Health Sciences, and makes it clear that not only that asthma sufferers need to be aware of this potential source of trouble but that we all need to be alert to the possibility that human activities are increasing the red tide and with it, the risk of further health problems.

Handedness and Immunity

In 1982, one of my mentors, the late Norman Geschwind, and two colleagues – Al Galaburda and Peter Behan - proposed an extraordinary hypothesis. It was that the levels of testosterone to which a baby is exposed before birth influence the development of both the cerebral and immune systems. According to this theory, high levels of testosterone result in greater incidences of left-handedness, deviations from the standard distribution of cerebral functions and increased autoimmune dysfunction. If the theory is right, then male brains should mature later than female brains, and the left hemisphere should mature later than the right.

It is certainly true that if a boy gets a head injury or infection involving the brain, he is less likely to recover than would a girl, and boys are far more likely to have some types of neurodevelopmental problems like dyslexia.

For a while it seemed as if there was also a strong association between left-handedness and certain types of allergy, and also with inflammatory bowel disease. This association with immunity also seemed to be present in mice: those who had left paw preference had more reactive immune systems, and they were thought to be more likely to produce auto-antibodies, suggesting that the central nervous system was involved in the genesis of some autoimmune diseases. Over the years the data has become less clear-cut, but the idea of an association between anomalous cerebral asymmetry and autoimmune disease never completely went away.

Recent data has again found an association between inflammatory bowel disease and laterality. And left-handers really do have more autoimmune disease.

The Geschwind-Galaburda hypothesis proposes that there should be a four-way association among neurodevelopmental disorders, special talents, non-right handedness, and immune disorders. In a huge study of 11,578 children, less than 1% had all four.

So where does this leave us?

The original theory was half right:

1. There is indeed a link between testosterone and early brain development
2. People who are left-handed or have a strong tendency toward left-handedness do seem to be at slightly increased risk of several autoimmune conditions
3. People who are left-handed or have a strong tendency toward left-handedness may have a slightly increased risk of high blood pressure, asthma and migraine
4. People who are left-handed or have mixed handedness are more likely to excel in certain disciplines: creative arts, music, computer programming and mathematics. What we don’t know is whether people with these special skills are more likely to have autoimmune diseases
5. Amongst very successful tennis players,  there are far more left-handers than would be predicted by chance. This supports the idea that support the notion that left-handed people have neurological advantages in performing certain tasks, such as visuospatial visuomotor cognitive tasks.

I was reminded of the way in which Nature seems to like to balance things out a bit: with some notable and famous exceptions, many successful athletes have not done so well academically and many academics would be unlikely to survive on the plains of Africa. Only some of these differences can be explained in terms of early direction and encouragement in school or while growing up: it seems that most of us cannot hope to become the kind of superman that Nietzsche used to dream about.

Perhaps it’s a way of stopping us from getting too full of ourselves.

Women, Asthma and the Brain

There’s been a longstanding puzzle in medicine. Well actually there are lots of them, but here’s one that may be a puzzle no more.

For many years now, it’s been known that asthma is more common in women, and also that psychological stress can cause flare ups of asthma.

Many women experience “menstrual flaring:” a worsening of asthma around the time of their menstrual period. There is also a strange paradox: some women with asthma wheeze less if they take an oral contraceptive, while some non-asthmatic women begin to wheeze when they take it. In some women pregnancy makes asthma worse, and in others it affords months of relief of symptoms. Women who are obese are more likely to get asthma, presumably because their intra-abdominal fat stores are churning out inflammatory mediators.

Researchers from the University of Wisconsin have shed  some important light on this link between asthma and the brain. In research published in the Proceedings of the National Academy of Sciences. In the study, six patients with mild asthma were exposed to ragweed or dust-mite extracts. The subjects were shown three different categories of words: asthma-related (e.g., "wheeze"), non-asthma negative ("loneliness") or neutral ("curtains").

Using functional magnetic resonance imaging, they showed that activity in two regions, known as the anterior cingulate cortex and the insula showed increased activity when the asthma-related words were heard compared with the other types. What is more, this enhanced activity was specifically linked to physiologic signals from the ragweed and dust-mite extracts. So being exposed to asthma-relevant emotional stimuli is associated with markers of inflammation and airway obstruction in asthmatic people exposed to an asthma-producing antigen.

In people with asthma and other stress-related conditions, these brain regions may be hyper-responsive to disease-specific emotional and physiologic signals. Taken together, these could contribute to problems that worsen the asthma, such as inflammation.

And one of the ways of making these regions of the brain hyper-responsive? Bathe them in estrogen.

That still does not explain why pregnancy and the oral contraceptive makes some women’s asthma better, and does the opposite in others. But it may just have to do with the “set point” of the cells in these regions of the brain. In the same way that we might set the thermostat in out house. An already hyper-responsive brain might be normalized and an under-active one stimulated to be over-active.

We need to do some more experiments, but these are a great start.

If you ever wheeze, have a look to see if there are stressors or hormonal events that trigger you. Whether you are being treated with homeopathy, herbals or conventional therapy, knowing when to expect trouble gives you the power to adapt you treatment when you are entering a risky time in your life.

Parkinson’s Disease, Allergies and Inflammation

The symptoms of Parkinson’s disease have been reported throughout history, but it was first described in the modern era by the great Scottish neurologist James Parkinson in 1817. Even after all these years, we still do not know all that much about what causes it. There’s an interesting study in the August issue of the journal Neurology, which is the official publication of the American Academy of Neurology.

Investigators from the Mayo Clinic used what is known as a case-control design (196 cases and 196 matched controls). What they found was that people who suffered from hay fever or allergic rhinitis, are 2.9 times more likely to develop Parkinson’s disease over a 20-year period.

The researchers did not find any association with autoimmune illnesses such as lupus, rheumatoid arthritis, pernicious anemia or vitiligo. They also did not find any association with asthma.

In addition, people who developed Parkinson’s disease used anti-inflammatory agents less frequently than controls, although this result was not statistically significant. The results may support the hypothesis that there is an inflammatory component in the causation of Parkinson’s disease.

You may ask, “Why on earth would anyone even look at a link like this?” The answer is that there have been previous reports of an association between the use of non-steroidal anti-inflammatories and lower rates of Parkinson’s disease in men but not in women and Alzheimer’s diseases.

This study does not suggest that hay fever causes Parkinson’s disease: it provides evidence for an association between the two. Parkinson’s is probably a group of illnesses with different causes. However, if chronic inflammation around the upper airways could produce inflammation in the brain, we might have a whole new way of preventing a degenerative brain disease.

In a future posting I’ll talk about some natural methods for reducing the burden of inflammation in your body.

Chronic Widespread Pain, Fibromyalgia and Anti-inflammatory Proteins

Chronic widespread pain is a common and distressing medical condition that can be difficult to treat and is usually associated with fatigue, poor sleep and depression. One major subgroup is fibromyalgia. A connection between fibromyalgia and cytokines – small proteins that act as messengers between cells – has been suspected for some time, since some cancer patients treated with the cytokine interleukin -2 develop fibromyalgia-like symptoms. A new study from Wurzburg in Germany, published in the August 2006 issue of Arthritis and Rheumatism examined cytokine profiles in patients with chronic widespread pain and found that they had significantly lower levels of the anti-inflammatory cytokines IL-4 and IL-10.

This is an important finding: Previous research has shown that IL-10, administered as a protein or via gene transfer, reduces sensitivity to pain. Similarly, IL-4 has been shown to dull the pain response. There is also another piece to this: genetic variations in different cytokine genes are associated with distinct diseases, such as the association between IL-4 gene variations and asthma, Crohn's disease, and chronic polyarthritis.

Although low levels of anti-inflammatory cytokines could be a consequence of chronic widespread pain and its treatment, it is much more likely that these proteins actually play a role in the causation of chronic widespread pain.

This new research raises all kinds of possibilities for the physical treatment of a particularly horrible set of illnesses.

A New Way of Looking at – and Treating - Inflammation

Diseases of both large and small blood vessels are two of the biggest problem facing people with diabetes. Not only is it a huge clinical challenge, but also nature sometimes does our experiments for us. The high rates of coronary and peripheral vascular disease in diabetes can be seen as a kind of experiment of nature: a recognizable set of chemical abnormalities that might shed light on vascular diseases in general. It was those twin factors: a huge clinical problem, and an experiment of nature, that lead me to pick the topic of my research doctorate. 

When I was working on my research doctorate in the mid 1980s, I came across a lot of old research that seemed to show links between inflammatory and autoimmune conditions like systemic lupus erythematosus and rheumatic fever, and the eventual development of coronary artery disease. There was also a lot of old and largely forgotten research about the link between some viral infections and the development of coronary artery disease and acute coronary artery occlusions, because some infections can make blood more “sticky.” Inflammation evolved as one of the body’s defence mechanisms.

So I made the proposal – revolutionary at the time – that diabetes, coronary artery disease and a range of other illnesses might be inflammatory rather than degenerative. I soon found inflammatory markers in people with diabetes, that helped predict when someone was running into trouble with their eyes, kidneys or heart.  Even with stacks of data, I had to spend a lot of time defending that position, because it also implied that some illnesses thought to be irreversible might not be.

With the passage of time, it has tuned out that I was probably correct. Chronic inflammation, wherever it starts, mat have long-term effects on the body and on the mind. Chronic inflammation increases the risk of diseases of many blood vessels, as well as causing anemia, organic depression and cognitive impairment. Here is a partial list of common conditions in which inflammation is a prominent factor:
1.  Rheumatoid arthritis
2.  Systemic lupus erythematosus
3.  Fibromyalgia
4.  Chronic infections
5.  Insulin resistance or metabolic syndrome
6.  Arteriosclerosis
7.  Diabetes mellitus
8.  Hypertension
9.  Asthma
10. Inflammatory bowel disease
11. Psoriasis
12. Migraine
13. Peripheral neuropathy
14. Alzheimer’s disease
15. Autism
16. Gingivitis
17. Cystitis

The reason for raising the issue is not to say “told you so!”

It is instead that we need to think about inflammation a little differently. There is a mountain of information about the physical aspects of inflammation. We can stop at the simple description of inflammation as a condition in which part of the body becomes reddened, swollen, hot, and usually painful, or we can look below the surface: we can examine inflammation not only as a physical problem, but also as a psychological, social, subtle and spiritual problem. Why bother? Because the deeper approach allows us to understand and to treat and transcend inflammation as never before.

I am going to write some more about specific ways to address inflammation and what it means in future articles. I would also like to direct you to the book Healing, Meaning and Purpose, in which I talk about specific approaches in more detail.

But I would like to start with this.

In Ayurvedic and homeopathic medicine, inflammation is a sign of an imbalance in the vital forces of the body, and the traditional Chinese system agrees: here inflammation is usually a manifestation of an excess of Yang Qi, or a deficiency of Yin Qi. Most of our lives are seriously out of balance: Yang Qi is like a rampaging lion that has been stimulated by:
Acidic foods;
Environmental toxins;
Unwanted sexual stimulation:
Noise;
Discordant music:
Constant demands from others:
Toxic relationships;
Years spent in front of television sets and limitless multi-tasking.

It should be no surprise to learn that all of these inflammatory conditions are increasing rapidly throughout the Western world. Not because we are getting better at identifying them, or we are living longer, but genuinely increasing.

It is wrong to put all the blame on poor diets or inadequate exercise. The problem is more subtle and is a reflection of distorted Information being fed to our bodies, minds, relationships, subtle systems and spiritual relationships.

The great news is that this simple conceptual shift gives us a whole load of new tools for handling these problems, and for using them as catalysts to growth.

In the next few weeks, I am going to drill down and give you some specific guidance that ties into the material in Healing, Meaning and Purpose and the next two that are on the launch pad.

Fasten your seat belt!

Technorati tags: Inflammation Aging Alzheimer's disease Arteriosclerosis Neuropathy Autism Arthritis Systemic lupus erythrmatosus Fibromyalgia Inflammatory bowel disease Gingivitis 

Fungal Contamination of Pillows

I recently came across a study from colleagues at the University of Manchester in the United Kingdom, that was published in the journal Allergy.

Fungal contamination of bedding was first studied seventy years ago, but there have been no reports in the last seventy years. In this new study, researchers sampled ten pillows with between 1.5 and 20 years of regular use. Each pillow was found to contain a substantial fungal load, with four to 16 different species being identified per sample and even higher numbers found in synthetic pillows. One of the most worrying things was that the microscopic fungus Aspergillus fumigatus was particularly common in synthetic pillows. And fungi as diverse as bread and vine moulds and those usually found on damp walls and in showers were also found in the pillows. Aspergillus is a very common fungus, carried in the air as well as being found in cellars, household plant pots, compost, computers and ground pepper and spices. I have treated many people with invasive Aspergillosis, a sometimes nasty illness that occurs mainly in the lungs and sinuses, although it can spread to other organs including the brain. It can be very difficult to treat, and as many as 1 in 25 patients who die in modern European teaching hospitals have the disease. In France and Germany, this is one of the occasions when unorthodox medicine is often used at the same time as high doses of antibiotics: proper integrated medicine.

Aspergillosis is a particular problem in people with compromised immune systems. Hospital pillows have plastic covers and so are unlikely to cause problems, but patients being discharged home - where pillows may be old and fungus-infected - could be at risk of infection. Aspergillus can also worsen asthma, particularly in adults who have had asthma for many years, and it can cause allergic sinusitis in patients with allergic tendencies. Constant exposure to fungus in bed could be problematic.

The moral of this story is be extra aware that pillows may harbor fungi that can cause or exacerbate allergies and more serious problems in people with other illnesses. If you have allergies, it is best to use foam rather than feather pillows. If you have synthetic pillows, wash them regularly in warm water and with a non-allergenic detergent. Dip the pillow one small section at a time in the solution and squeeze through the pillow. Once the pillow is clean, rinse it out at least three times to remove all of the soap and residue. Then lie the pillow out flat to dry, and turn it frequently. To fluff the pillow, take a couple of tennis balls and put them in the dryer with the pillow and air dry for about 30 minutes.

Technorati tags: fungus, integrated medicine, allergies, asthma