Treating Asthma with Plants vs. Supplements?

Treating Asthma with Plants vs. Supplements?
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Whole fruits and vegetables were compared to both antioxidant pills, as well as supplements containing fruits and vegetable extracts, for their ability to treat seasonal allergies, improve lung function, and control asthma.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

This landmark study on “Manipulating antioxidant intake in asthma” found that just a few extra servings of fruits and veggies a day can powerfully reduce asthma exacerbation rates. If it’s the antioxidants doing it, why can’t we instead just take some antioxidant pills?

Because they don’t seem to work. Studies using antioxidant supplements “on respiratory or allergic diseases…have mostly shown no beneficial effect[s]… This discrepancy between [studies] relating to fruit and vegetable intake compared with [those] using antioxidant supplements may indicate the importance of the whole food,…rather than individual [components].”

For example, in the Harvard Nurses Health Study, women who got the most vitamin E from diet appeared to be at half the risk for asthma, which may help explain why nut consumption is associated with significantly lower rates of wheezing, but vitamin E supplements did not appear to help.

Men who eat a lot of apples appear to have superior lung function. Same with kids who eat fresh fruit every day, as measured by FEV1, which is basically how much air you can forcibly blow out in one second. The more fruit, salad, and green vegetables kids ate, the greater their lung function appeared. Why no data points for “more than once daily” consumption of salad and veggies? Because so few kids made the cut.

They were “cautious [about] concluding” which nutrient might be responsible. Yes, there’s vitamin C in all three, but there’s lots of other antioxidants—for example, so-called vitamin P, polyphenol phytonutrients found in grapes, and flax seeds, and beans, berries, broccoli, apples, citrus, herbs, tea, and soy. Turns out they can directly bind to allergenic proteins, and “render them hypoallergenic” to slip under our body’s radar. And, if that first line of defense fails, they can inhibit the activation of the allergic response, and prevent the ensuing inflammation—and so, may not only work for prevention, but for treatment as well.

Most of the available evidence is “weak,” though, in terms of using supplements containing isolated phytonutrients to treat allergic diseases. You could just give people fruits and vegetables to eat, but then, you can’t do a double-blind study to see if they work better than placebo. So, researchers decided to try to use pills containing plant food extracts. It’s kind of a middle ground: better than isolated plant chemicals, but not as complete as whole foods. But, you can stick them in a capsule, for experimental purposes, so you can compare them to sugar pill-placebo capsules.

The first trial involved giving people extracts of apple skins. I’ve talked about the big problem they have in Japan with cedar allergies. So, apple extract pills were given every day for a few months, starting right before pollen season started. The results were pretty disappointing—maybe a little less sneezing, but didn’t seem to help their stuffy noses or itchy eyes.

What about a tomato extract? A “randomized, double-blind, placebo-controlled,” eight-week trial for perennial allergic rhinitis. This time, not for seasonal pollen, but for year-round allergies to things like dust mites. There’s lots of drugs out there, but you may have to take them every day year-round. So, how about some tomato pills instead? Significant improvement of total nasal symptom scores, combined sneezing, runny nose, and nasal obstruction were all observed after oral administration of tomato extract for eight weeks with “no [apparent] adverse effects.”

Would whole tomatoes work even better? If only researchers would design an experiment directly comparing phytonutrient supplements to actual fruits and vegetables, head-to-head against asthma—but such a study had never been done, until now.

Same amazing study that compared the seven fruit-and-vegetables-a-day diet to three fruits-and-vegetables “then commenced a parallel, randomized, controlled supplementation trial” with capsules of tomato extract, which boasts, “The power of five tomatoes in one little pill,” and the study subjects were given three pills a day.

So, who did better—the group that ate seven servings of actual fruits and vegetables a day, or the group that ate three servings a day, but also took 15 supposed serving equivalents in pill form? The pills didn’t help at all. “Improvements [in lung function and asthma control] were evident only after increased fruit and vegetable intake, which suggests that [the] whole-food interventions are most effective.”

“Both [the] supplements and increased fruit and vegetable intake were effective methods for increasing carotenoid concentrations” in the bloodstream, but who cares? The “clinical improvements”—the getting better from disease—was “evident only as a result of an increase…” in produce intake, not pill intake. “The results provide further evidence that whole-food approaches should be used to achieve maximum efficacy of antioxidant interventions.”

And if this what just a few more plants can do, what might a whole diet composed of plants accomplish? I’ll cover that, next.

Please consider volunteering to help out on the site.

Images thanks to Chatirygirl and “The owner” via flickr, and Brian Arthur via Wikimedia

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

This landmark study on “Manipulating antioxidant intake in asthma” found that just a few extra servings of fruits and veggies a day can powerfully reduce asthma exacerbation rates. If it’s the antioxidants doing it, why can’t we instead just take some antioxidant pills?

Because they don’t seem to work. Studies using antioxidant supplements “on respiratory or allergic diseases…have mostly shown no beneficial effect[s]… This discrepancy between [studies] relating to fruit and vegetable intake compared with [those] using antioxidant supplements may indicate the importance of the whole food,…rather than individual [components].”

For example, in the Harvard Nurses Health Study, women who got the most vitamin E from diet appeared to be at half the risk for asthma, which may help explain why nut consumption is associated with significantly lower rates of wheezing, but vitamin E supplements did not appear to help.

Men who eat a lot of apples appear to have superior lung function. Same with kids who eat fresh fruit every day, as measured by FEV1, which is basically how much air you can forcibly blow out in one second. The more fruit, salad, and green vegetables kids ate, the greater their lung function appeared. Why no data points for “more than once daily” consumption of salad and veggies? Because so few kids made the cut.

They were “cautious [about] concluding” which nutrient might be responsible. Yes, there’s vitamin C in all three, but there’s lots of other antioxidants—for example, so-called vitamin P, polyphenol phytonutrients found in grapes, and flax seeds, and beans, berries, broccoli, apples, citrus, herbs, tea, and soy. Turns out they can directly bind to allergenic proteins, and “render them hypoallergenic” to slip under our body’s radar. And, if that first line of defense fails, they can inhibit the activation of the allergic response, and prevent the ensuing inflammation—and so, may not only work for prevention, but for treatment as well.

Most of the available evidence is “weak,” though, in terms of using supplements containing isolated phytonutrients to treat allergic diseases. You could just give people fruits and vegetables to eat, but then, you can’t do a double-blind study to see if they work better than placebo. So, researchers decided to try to use pills containing plant food extracts. It’s kind of a middle ground: better than isolated plant chemicals, but not as complete as whole foods. But, you can stick them in a capsule, for experimental purposes, so you can compare them to sugar pill-placebo capsules.

The first trial involved giving people extracts of apple skins. I’ve talked about the big problem they have in Japan with cedar allergies. So, apple extract pills were given every day for a few months, starting right before pollen season started. The results were pretty disappointing—maybe a little less sneezing, but didn’t seem to help their stuffy noses or itchy eyes.

What about a tomato extract? A “randomized, double-blind, placebo-controlled,” eight-week trial for perennial allergic rhinitis. This time, not for seasonal pollen, but for year-round allergies to things like dust mites. There’s lots of drugs out there, but you may have to take them every day year-round. So, how about some tomato pills instead? Significant improvement of total nasal symptom scores, combined sneezing, runny nose, and nasal obstruction were all observed after oral administration of tomato extract for eight weeks with “no [apparent] adverse effects.”

Would whole tomatoes work even better? If only researchers would design an experiment directly comparing phytonutrient supplements to actual fruits and vegetables, head-to-head against asthma—but such a study had never been done, until now.

Same amazing study that compared the seven fruit-and-vegetables-a-day diet to three fruits-and-vegetables “then commenced a parallel, randomized, controlled supplementation trial” with capsules of tomato extract, which boasts, “The power of five tomatoes in one little pill,” and the study subjects were given three pills a day.

So, who did better—the group that ate seven servings of actual fruits and vegetables a day, or the group that ate three servings a day, but also took 15 supposed serving equivalents in pill form? The pills didn’t help at all. “Improvements [in lung function and asthma control] were evident only after increased fruit and vegetable intake, which suggests that [the] whole-food interventions are most effective.”

“Both [the] supplements and increased fruit and vegetable intake were effective methods for increasing carotenoid concentrations” in the bloodstream, but who cares? The “clinical improvements”—the getting better from disease—was “evident only as a result of an increase…” in produce intake, not pill intake. “The results provide further evidence that whole-food approaches should be used to achieve maximum efficacy of antioxidant interventions.”

And if this what just a few more plants can do, what might a whole diet composed of plants accomplish? I’ll cover that, next.

Please consider volunteering to help out on the site.

Images thanks to Chatirygirl and “The owner” via flickr, and Brian Arthur via Wikimedia

Doctor's Note

If you missed my last video about the fruit-and-vegetable treatment study, you can watch it here: Treating Asthma with Fruits & Vegetables. Prior to that, I dealt with preventing asthma in the first place; see Preventing Asthma with Fruits & Vegetables. I’ll close out this series with a video about the efficacy of vegetarian and vegan diets for the treatment of allergic diseases in Treating Asthma & Eczema with Plant-Based Diets.

The video I referenced about the cedar allergies in Japan was Alkylphenol Endocrine Disruptors & Allergies.

The theme of whole foods being more efficacious than supplements seems to come up over and over again. See, for example:

More on “vitamin P” in How to Slow Brain Aging by Two Years.

The anti-inflammatory effects of nuts may explain the Harvard Nurse’s Health Study finding; see Fighting Inflammation in a Nut Shell.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

26 responses to “Treating Asthma with Plants vs. Supplements?

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  1. You sure are milking out these asthma videos!

    Thanks for all your hard work!

    As a medical student I am trying to wrap my head around what evidence based medicine really means. You hit on the idea in this video that without a double blind placebo controlled study, people are hesitant to trust the power of fruit and veg.

    It seems like this is a pattern in Medicine. Researchers only study what we can study easily, get funding to research, and get published. So our body of evidence doesn’t include the possibly powerful interventions that aren’t easily researched.




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    1. You point out a significant issue. T. Colin Campbell discusses this problem in his book Whole.

      While RCTs are considered the “gold standard” of medical research, they really are not appropriate for all medical interventions. Surgery would be a good example. This is why large scale cohort studies, case-control studies and cross sectional studies are important and are often more suitable for studying diet and health.

      I teach a graduate level course in Epidemiology and a large portion of the course is focused on Evidence Based Medicine. I use the following Youtube video to introduce my students to the topic. It’s a bit long (55 min.) but if you’re interested in the subject I recommend watching it. If the link does not work, search Youtube for Teaching Evidence Based Medicine: Should We Be Teaching Information Mastery Instead.

      https://www.youtube.com/watch?v=w60YNt3deW4




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      1. “large scale cohort studies, case-control studies and cross sectional studies are important and are often more suitable for studying diet and health.”

        Yes but we do have some high quality RCTs with hard endpoints such as PREDIMED and the Lyon Diet Heart Study, the Ornish Lifestyle Heart Trial, etc., so there is really no excuse (except perhaps for fundability). One of the largest nutritional RCTs was the WHI low fat diet trial, with more than 40,000 women followed for a number of years. The problem is that the various levels of evidence are not well understood by the public or even most practitioners, particularly the problem of lack of controls, lack of temporal associations in cross-sectional studies, treatment selection bias and hidden confounding, systematic measurement errors in dietary variables, etc.

        The problem is that very complex interventions are often not even subjected to RCTs, because people do not believe they are fundable or feasible. Large diet trials on record refute this notion.




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      2. matt: That talk is SO powerful and SO well done. Thank you for posting that link!

        As much as I loved the talk and got a lot out of it, I was often nagged/concerned that not once did I hear the speaker mention the importance of the patient in the process–from the perspective of the importance of the patient’s ability to get the various information (in addition to the doctor), the ability for the patient to get into the details when the doctor is too busy/only has a minute, and the importance of the doctor recognizing that he/she is just participating in Team Patient. When desired, the patient must be allowed to be part of the weighing/applying of the information (speaker called it “wisdom”). I’m not wording it very well, but it seems to me that the speaker is missing a giant piece of the issue.

        But I didn’t actually disagree with anything he said. I sure hope that topic gets some more traction. Thanks again for posting the link.




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      3. Wow thanks for posting this!

        I will have to take a look at that book, and your lecture. I got to ten minutes!

        I am a medical student in Missouri. In Medical School everyone is so focused on getting that “High Yield” information to get a good score on the board examination. Sometimes it is hard to get us to take the time to wrap our heads around untestable concepts.




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  2. Understand that you don’t promote or endorse products – but there IS a product that is WHOLE FOOD (Not Extracts) in a capsule or chewable with 31 clinical studies – most double-blind, placebo-controlled – showing that these whole food capsules (I am carefully NOT mentioning the name) absolutely have health-giving effects, showing cellular change. Perhaps Dr. Greger, you could talk about the difference between products that have a NUTRITION label (meaning it is food) and products that have a SUPPLEMENT label – meaning…. who knows what’s in it? – as you recently pointed out.

    I applaud your amazing efforts. I have donated what little I could to support your work. I ask people all the time to sign up for your emails.
    And I help people improve their health by increasing the fruits, veggies, berries and grapes in powder form in a capsule with a NUTRITION label – which is not taxed in my state because it’s food!




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    1. OK. I’ll name it. I also immediately thought of Juice Plus+ when I watched this video. In the past I had been skeptical about Juice Plus+ because it “fortifies” the food powders with antioxidant supplements like vitamins C and E, which I thought might be the “active ingredients”. I now discount that since this research shows these supplemental vitamin antioxidants are unlikely to have any clinical benefit. However, the variety issue, that is, the blend of a variety of fruits and vegetables in Juice Plus+ vs. the single food (tomato) used in this study is something I wish the study had tested.




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  3. I’d be interested in seeing some live cultured whole food probiotics (nondairy yogurt, sauerkraut, kimchi, miso, natto, kombucha, rejuvalac, etc) versus the probiotic supplements to treat allergies. They have used combinations of probiotic strains in supplements http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3784923/ and combinations are fairly regularly seen in live-cultured products, especially wild cultured sauerkraut etc.




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  4. If you would have to devise a diet especially for asthma patients based on the scientific findings so far, would it be close to Eat to Live or would you make certain modifications? Show us your optimal diet plan for one day or week based on science!




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    1. Borkent: I can’t personally answer your question about tweaking a diet for asthma, but I thought you might be interested in Dr. Greger’s “Optimal Nutrition Recommendations” based on his understanding of the science:
      http://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/

      The NutritionFacts diet is similar to Eat To Live, but I believe has some differences. For example, you will notice that Dr. Greger’s optimal recommendations do not include any animal products. Dr. Fuhrman allows as much as 10% of calories from animal products in his long term optimal diet. Also, Dr. Fuhrman has some issues with “starchy” vegetables and whole grains where as Dr. Greger does not as far as I know.

      Hope that helps.




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      1. I am certainly interested in this. I follow a combination of The Starch Solution + Eat to Live, which is a vegan nutritarian (G-BOMBS) approach supplemented with starches other than beans such as whole grains and potatoes, according to my appetite and activities. Fuhrman has lowered his upper limit of animal products to 5% in his new book The End of Dieting, btw, but I eat 0%. Fuhrman doesn’t say 5 or 10% is optimal. Lower is optimal. I do still have asthma complaints almost 3 years on this diet, it’s the reason why I asked. Thanks.




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        1. Borkent: Best of luck with your asthma issues. One thing I have noticed on NutritionFacts is that while diet does a WHOLE lot to help a whole bunch of people with a wide range of problems, it definitely is not a magic pill. Personally, while I’m committed to a whole plant food based diet free of all animal products and limiting processed food, I too have found that some of my health problems remain. But I’m convinced enough by the evidence to know that I would be in worse shape if I did anything else.

          It seems to me that you are doing really great with your diet. I’m a big fan of Dr. McDougall too and love the Start Solution. Hopefully someone else can jump in with ideas about tweaking a diet specifically for asthma issues.

          Good luck!




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  5. PolyPhenols are also closely related to salicylates in fruits and vegetables. It is well known that salicylates can play a role in ADHD symptoms and athsma/allergies as not everyone can tolerate these foods. Tomatoes are one of the big culprits… I have found through my own self study that eliminating grains during allergy season reduce my symptoms more than adding vegetables ever did… and I was eating 7+ servings a day. Seems to make sense as I’m allergic to grass/trees/weeds and grains seem to be closely related… Are there any studies that look at grain intake and allergies?




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    1. Right on. A nice lady in my house suffers from salicylate sensitivity. (took many years to find a good Dr. to figure out). I really struggle to cook up meals that don’t cause her reaction, as in patiently suffocating until the trachea decides to relax again. We found some partial lists of salicylate content. Grains always seem to be high.

      http://salicylatesensitivity.com/about/food-guide/grains/

      for most people salicylates are probably a good thing because they bring the anti-inflam properties of aspirin. But for a small segment they are misery. Of course our individual problems don’t mean others should stay away from polyphenolics…but if you are bewildered at your reactions to fruits/veg/grains/spices…consider DieselPower’s words.




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  6. Whole foods are the way to go, no discussion about that. But scientifically, this comparison of a supplement with a whole food is quite ridiculous. Lycomato is mainly lycopene, that’s it. A tomato is more than that. So, if lycopene is not the active substance in this study, the results just say nothing at all. If you would want to compare a whole food with an extract, you would basically first work out which compound(s) are responsible for the effect on astma, then put these chemicals (extracts or synthetics) into a capsule and do the study.




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  7. Whole food vs. supplement. Many vegans, myself included, take a vitamin B12 supplement. Given how many studies show that supplements don’t do the job that whole foods do, should I be eating dirt (reportedly an excellent source of B-12)? How effective is our B-12 supplementation? Can we conclude it works simply by blood level and lack of symptoms indicating insufficiency?




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    1. b-12 is more easily absorbed as a synthetic due to not needing intrinsic factor. a general claim of whole foods being better than supplements is not scientifically supported.




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  8. The truth and science are obvious… whole, fresh, organic, high-grade, new, and alive…….again alive foods are most healthy.

    Inside those pills are dead…DEAD and not fresh and not alive.




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  9. As someone who has asthma, thank you for these videos!!!! I have heard before that apples specifically are good for lung function! So awesome! “An apple a day”………………….. ;)




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  10. Since 1993 severe hazel pollen asthma – up to 150 ! mg oral prednisolone, than 0.2 budesonide b.i.d., vegan since 2007. 2012 I switched to polyphenol rich diet (dark colored fruits & vegetables, herbal teas). From 2013 to today all symptoms are completely gone, although I stopped budesonide in 2012.




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  11. Wow! I am so happy that some one actually is speaking up. This video is very informative. Sadly we live in a word on wish pharmaceuticals companies think they know everything. Don’t get me wrong, Pharmaceuticals do help, but they should stick to what they do best.




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  12. Salsa two ways:

    Dance the Night Away

    -3-4 ripe tomatoes, diced
    -5 cloves garlic, minced
    -½ onion, diced
    -1 tbsp Holy basil
    -black pepper

    Combine all ingredients in a bowl and stir. Let sit for 20-30 minutes in the
    refrigerator to let flavours blend.

    May I Have This Dance

    -5-6 ripe tomatoes, diced
    -½ lime, juice and pulp
    -1 small red onion, minced
    -1 clove garlic, minced
    -1 tbsp apple cider vinegar
    -½ tsp cumin
    -1 tsp cilantro
    -black pepper

    Combine all ingredients in a bowl and stir. Let sit for 20-30 minutes in the
    refrigerator to let flavours blend.

    ~complements of plant-based emporium




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  13. Have been the traditional route for asthma over a 30 year period. Getting worse and worse, gaining more and more weight, taking more and more rx drugs (9 at one point). Intubated a number of times, on a ventilator, I finally had enough about 15 years ago. Always ate well (except when I was hospitalized-worst food on the planet there), cooked from scratch, but bought into the low fat diet advice of the era. Then began studying herbal medicine, removing toxins from home (plastics, household cleaners, careful dust/mold eradication and at 59 am healthier than I have ever been in spite of Doctors, not because of them. (Forgive me Dr. Greger-I do NOT think all doctors are bad!) After finding, experimenting and then implementing some parts of ‘eclectic and specific protocols for asthma ‘ by David Winston I use plant tinctures and follow a mostly plant based diet + healthy oils like coconut, MCT and omega 3’s. . I have not been hospitalized and have not required treatment other than carrying a rescue inhaler over the last ten years. I volunteer in a classroom of first graders and have not been affected by the lovely little ‘walking petri dishes’-even through an epidemic of strep throat this winter.




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    1. i understand what you’ve been through. I’ve been hospitalized many times before age 11 even and every night waking up using machines, taking drugs, failing breathing tests miserably at doctors was a nightmare i thought would never end. My parents as well as many people(especially americans on SAD) are not aware of the importance of healthy diets. I mean i ate top roman, cocoa pebbles, and casadillas as my staples in childhood. Im proud to have educated myself and found answers on my own to cure all the suffering i was experiencing




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  14. going vegetarian and then vegan as a teenager just about cured my asthma and allergies. I suffered so much as child. I got pneumonia more than anyone I’ve ever met and i had horrible times breathing. Im now 22, vegetarian 6 years and vegan over 3 years now. I rarely suffer allergies anymore no matter the time of year and i don’t take for granted the fact i don’t wake up 3am anymore suffocating and using nebulizer machines. Plant Power!!




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