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When taking a dietary approach tomanaging asthma, it’s best to recallwhat your mother may have told youas a child: Eat your vegetables, drinkyour milk, and, if you want a snack,have an apple.

Experts haven’t arrived at any firm conclusions as towhether eating or drinking specific foods can preventasthma or lessen its severity, but the findings of a fewlimited studies suggest that healthy eating habits may behelpful. Let’s look at some of the foods that may actuallyhelp prevent the onset of asthma or ease its symptoms.

A Fish StorySeveral studies have shown that the consumption of

oily fish or fish oil supplements may prevent the onset ofasthma or ease asthma symptoms. The findings of astudy recently published in the journal Thorax (2003;58:231-6) indicate that a child’s risk of cough and wheezingmay be reduced if he or she eats fish at least once amonth.

University of Indiana researcher TimothyMickleborough, MD, found that fish oil supplementsmay help control exercise-induced asthma (EIA). In hisstudy published in the Journal of Respiratory and CriticalCare Medicine (2003;168:1181-9), athletes with EIAexperienced a decrease in the severity of postexercisesymptoms after taking fish oil capsules daily for 3 weeks.This may have been a result of the anti-inflammatoryeffects of fish oil.

Marianne Frieri, MD, PhD, director of allergy andimmunology at Nassau University Medical Center,agrees that omega-3 fatty acids (found in certain oilyfish) may play a role in improving asthma because oftheir anti-inflammatory effects. She advises her patientsto increase their intake of oily fish to help ease asthmasymptoms.

New Reasonsto Eat Right

Advice for Peoplewith Asthma

Christine Halvorson

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The authors of a study publishedin the American Journal of ClinicalNutrition (1997;65:1011-7) suggest-ed that a dietary fish oil supplementmight be beneficial for asthma. Someof the patients given the supplementswere more resistant to the develop-ment of asthma symptoms during amethacholine-challenge breathingtest. (In this test, symptoms areintentionally provoked by havingthe patient inhale an irritatingsubstance.)

In 1996, researchers at theUniversity of Sydney associated theconsumption of oily fish with areduced risk of asthma development(Med J Austr 1996;164:137-40). Thestudy comprised 574 children ages 8through 11 whose parents completeda questionnaire about their children’seating habits over a 1-year period.The children were evaluated for cur-rent asthma. The researchers foundthat those children who regularlyconsumed fresh oily fish (eg, mullet,orange roughy, Atlantic salmon, andrainbow trout, each of which containmore than 2% fat) had a likelihoodof having asthma 4 times lower thanthat of children who rarely or neverate oily fish. The consumption ofcanned fish or nonoily fish had noeffect on the development of asthma.

The Fruits of BetterBreathing

The findings of a study publishedin the journal Thorax (2003;58:231-6) suggest that children who do noteat much fruit have a higher inci-dence of coughing. Researchers con-cluded that a diet rich in fruit mayimprove lung health in childrenbecause the fruit’s vitamin, mineral,and fiber components exert antioxi-dant and antiviral effects.

Fruits high in vitamin C wereshown to be beneficial in a differentstudy, conducted by Italianresearchers and also published inThorax (2000;55:283-8).Theseinvestigators indicated that citrusfruits—kiwifruit in particular—eatenat least once or twice a week wereprotective against wheezing, short-ness of breath with wheezing, noc-turnal cough, and chronic cough.Dr. Frieri notes, however, that asth-ma patients who also have allergiesneed to know their triggers andavoid fruits that provoke a reaction.Kiwifruit may be a trigger for peoplewith allergic rhinitis, she says.

The authors of a study publishedin the American Journal of ClinicalNutrition (2003;78:414-21) exam-ined the eating patterns and healthof 1601 young adults. They showed

that young adults who regularlyconsumed whole milk or fruits suchas apples and pears were significant-ly less likely to have asthma orbronchial hyperreactivity (measuredwith the use of a methacholine-challenge test).

Dr. Frieri is convinced that foodshigh in antioxidants, such as carrots,can ease symptoms, and she recom-mends a diet rich in vitamin C. Shealso recommends vitamin supple-ments; however, she says that a well-balanced diet is the best approachand encourages patients not to getcarried away with supplements.

Dr. Monafo, an allergist withoffices in New Hampshire andMassachusetts, usually prescribes vit-amin C and selenium supplementsfor his asthma patients. He alsoadvocates increased consumption ofantioxidants and omega-3 fatty acids.Monafo says he usually recommendssupplements to his patients or tellsthem to increase their consumptionof foods containing these nutrients.He is also an advocate of flax oil(used as a salad dressing), vitamin C,and vitamin E. Dr. Monafo says healways tells his patients to exerciseand eat well overall. He is lookingforward to the day when more stud-ies are funded to examine the bene-

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fits of foods and nutrients for peoplewith asthma.

Drink MilkMilk is important for everyone,

but let’s start with the youngest kids.In a recently published Dutch study,2-year-olds who drank whole milk orate yogurt and butter experienced areduced incidence of recent asthmaby the age of 3 (Thorax 2003;58:567-72). Among the children whodrank whole milk, asthma developedin 3.4% by age 3, compared with5.6% of those who didn’t drinkwhole milk. The incidence of asthmaat age 3 among children who con-sumed butter daily was 1.5%, com-pared with 5.1% among those whodid not.

These findings do not necessarilymean that milk and other dairyproducts are directly responsible forthe inhibition of the development ofasthma. It could be that childrenwho consume these products take inless polyunsaturated fat (eg, thatfound in vegetable oil or margarine).A diet high in polyunsaturated fat issuspected of increasing a child’s riskfor the development of asthma(Thorax 2001;56:589-95).

Slim DownObesity is widely recognized as an

aggravating factor in asthma, so itstands to reason that a well-balanced,well-proportioned diet that facilitatesweight loss would help ease symp-toms in obese persons with asthma.In a small study conducted inFinland, participants who lost 14.5%of their body weight through a low-calorie, high-nutrient diet showedimprovements in lung function,symptoms, morbidity, and health sta-tus after 1 year (Br Med J 2000;320:827-32).

The effects of nutrition on asth-ma and overall lung health are notwell understood, but proper nutri-tion has shown promise in the lim-ited research that has been conduct-ed. Unfortunately, relatively fewlarge studies on the subject have

been carried out—in fact, not manystudies have been performed at all.One possible reason is that much oftoday’s medical research on asthmaand allergies is funded by pharma-ceutical companies as a means oftesting the effects of their productsin controlling asthma. Researchinto the effects of nutrition on asth-ma does not have that kind offunding source. However, the goodnews is that proper nutrition has noside effects but many benefits sepa-rate from asthma relief. So be sure

that your diet includes foods rich inthese valuable nutrients and breatheeasier with regard to your overallhealth—and perhaps your asthmaas well.

Reprint requests: Elsevier, Inc., 11830Westline Industrial Dr., St. Louis, MO 63146-3318; phone 314-453-4350.doi:10.1016/j.asthmamag.2004.06.001

Milk Helps Protect AgainstMedication Side Effects

According to Dr. Frieri, people with asthma who are using corticosteroidmedications must make doubly sure they are getting enough calcium,and they should start as young as possible. These medicationsdecrease calcium absorption and increase bone loss. Calcium is essen-tial for bone health and—along with vitamin D, which aids the absorp-tion of calcium—decreases this risk of lower bone density, which canlead to bone fractures. A balanced diet with enough vitamin D and theright amount of calcium for one’s age and sex is important. Children andadults who take corticosteroids should get 1000 to 1500 mg of calciumand 400 to 800 IU (international units) of vitamin D each day.

A person with a sensitivity to dairy products should consider drinkingmineral water with a high calcium content, along with vitamin D supple-ments. Some juices are also fortified with calcium and vitamin D.