Letter from the Publisher

A Cure for Asthma?

This provocative question is the title of a book by David Hahn, MD.¹ Unlike some other health books that beckon with titillating headlines, Hahn’s book is solid with clinical studies and case histories. Hahn is not a huckster pandering his own-patented formula, nor recommending an expensive wonder drug. Truthfully, I cannot see that he will profit much from this book and his self-funded research, except for the satisfaction that he will offer relief to thousands of adult and children asthma sufferers. The problem is really twofold: First, most physicians cannot accept the fact that asthma’s primary cause is not allergy or inflammation; rather, it is infection. Second, without accepting an infection etiology, doctors are disinclined to prescribe an antibiotic, much less a long-term antibiotic. Hahn is infuriated with this collegial resistance to consider an infective element to asthma. Patients are informed that asthma is a lifelong illness, manageable with bronchodilators and inhalers, subject to episodes of exacerbation, even critical events. To have a simple antibiotic, routinely prescribed by most physicians for bronchitis and pneumonia, be ignored when it could play such an important role in arresting and reversing the asthma process, is the basis for Hahn’s book.

Hahn is a Stanford Medical School graduate who opted to become a family medicine practitioner rather than a super-specialist or lab bench researcher. Still, he remained very academically inclined and liked the idea of conducting research. Hahn’s investigations, however, were clinically based in the community. He liked to study treatment outcomes with patients who are sick but not needing specialist care. Primary care research is different from lab bench research: translational research looks at the efficacy of treatment in a tissue culture, rodent population, or tertiary care population of the hospital; primary care research looks at the effectiveness of treatment with a community-based population. Unfortunately, primary care research is not well funded and does not get the resources available to academic researchers. Still, Hahn has been involved in a number of primary care studies. One of his earliest published studies was published in JAMA in 1991, when he made the observation that asthma was observed in patients experiencing bronchitis or pneumonia caused by Chlamydia pneumoniae.²

Hahn’s group had been examining patients who were having persistent cough and upper respiratory infection. Many of these patients were found to have abnormal IgG and IgM antibodies to C. pneumoniae. The serendipitous finding was that among those patients who had positive Chlamydia antibodies but no history of asthma, many developed wheezing and frank asthma. The intriguing observation for Hahn was that simple antibiotic therapy eliminated asthma symptoms and need for chronic treatment.

Hahn’s book offers extensive accounts of a number of adult and children patients who were suffering with protracted asthma. Of course, case reports are considered weak scientific evidence. However, one patient, “Jim Quinlan,” who had on at least one occasion required emergency resuscitation for status asthmaticus as documented in his local newspaper, ultimately was treated by Hahn; and following 4 months of antibiotic treatment, his asthma symptoms markedly improved and went into continued remission. He did not require any further asthma treatment, and the local newspaper reported his mountain-hiking trip with his family 3 years later. Quinlan was so impressed with Hahn’s treatment that he posted his story on line and ran a blog for other asthma patients to post their story and share with families (see www.asthmastory.com).

Hahn is not looking to be a primary referral for asthma patients. He would prefer that physicians would treat their asthma patients with antibiotic therapy. Although physicians can order testing to determine if their patient has Chlamydia, he thinks that even if the antibody testing is normal, the patient deserves a trial of antibiotic therapy. The antibiotic is pulsed, given in weekly oral doses; Hahn does not see the need to treat the patient daily. He argues that a limited regime of weekly antibiotic treatment will not create communitywide antibiotic resistance. Still, he would like to see the asthma research community do an appropriate randomized clinical trial to demonstrate the effectiveness of antibiotic therapy. Admittedly the antibiotic might not be just anti-infective, it could be anti-inflammatory as well. The point is that medicine has little justification to delay conducting a study.

Chikungunya: Coming Soon by Mosquito Bite to a Town Near You

Chikungunya, pronounced “chic-kun-gun-yah,” sounds as if it may have something to do with chickens, but there is no relationship. It is a virus like the one that brings on dengue fever, except chikungunya’s course of febrile illness is complicated by longstanding arthritis and arthralgia. The name comes from the Makonde language; it was originally discovered in southern Africa in 1952, in the region between Mozambique and Tanzania. Chikungunya translates to “drying up” and “become contorted” and refers to the deformity that “bends up.” While it was discovered in Africa, the virus carried by the ubiquitous mosquito Aedes aegypti has spread chikungunya through Africa, Asia, and more recently South America. If the mosquito name sounds familiar, that would be because it is now mentioned frequently when discussing the new viral disease Zika. In fact, some cases of chikungunya may be a coinfection of Zika virus acquired though a bite from the daytime-feeding mosquitoes.

Before Zika made headlines as the putative cause of the recent epidemic of microcephaly in Brazil, chikungunya was being closely watched by the CDC. The virus has been slowly making its way through the Caribbean, into the southern US, and spreading northward. While chikungunya may be limited to 2 weeks of a flulike illness, it readily enters the synovia of joint spaces. Once the virus is ensconced in the joints, it is very difficult for the immune system to remove it. Patients are faced with treating joint pain with anti-inflammatories and the potential of more disfiguring arthritis. The virus may be readily diagnosed with IgM serology, PCR, and cell culture. There is no specific treatment and no vaccine prevention. As with Zika and dengue, prevention is accomplished by wearing clothing covering the extremities, applying insect repellant, and not traveling in areas ridden with mosquitoes. Of note, chikungunya, like Zika and dengue, may be transmitted from mother to fetus and may be transmitted sexually as well.

Sugar Toxicity – A Silent Epidemic

If you have been paying attention to Dr. Gaby’s many discourses, you know that your diet should not be centered on caramelized foods. While these foods are “mighty tasty,” or “good eatin’” (in some circles), they are replete with glycation, what Dr. Gaby refers to as AGEs (advanced glycation end products). A plant-based diet, filled with vegetables and fruits, avoids AGEs, unless one caramelizes the onions. Here the emphasis is on glycation brought about by eating animal proteins that have been barbecued or seared; the higher the temperature, the more AGEs. However, Drs. Edwards and Malik, authors of this issue’s “Sugar Toxicity” article, are interested in a very different glycation process – the glycation that occurs within the body brought about by overconsumption of sugar and refined carbohydrates.

We all know about the perils of eating sugar and fructose to excess. Obesity, metabolic syndrome, and diabetes are the obvious concerns. Less obvious is how excessive sugar plays a pivotal role in progressive cardiovascular disease. Of course, in terms of basic physiology, sugar excess leads to fat deposition, abnormal hormone balance, insulin resistance, hypertension, and hypertriglyceridemia. Edwards and Malik make the case that excess sugar plays a direct role in glycation of our cellular membranes, particularly the endothelial cells of our arteries, arterioles, and capillaries. The authors describe the “glycocalyx” as a “polysaccharide sugar polymer coating that surrounds all cell membranes.” They consider it a functional biofilm that is responsible for controlling the endothelial vascular tissue. When a person consumes excess sugar, the glycocalyx is subject to major glycation modification. The disruption of the glycocalyx leads to localized fluid imbalances and edema. Inflammation brought about by glycocalyx glycation is the primary factor leading to plaque formation.

Edwards and Malik argue that it is not the large vessel arterial plaque and endothelial dysfunction that cause of major vascular events; instead it is the glycation taking place in the “microcirculation,” the capillary beds in every body tissue and organ, that eventuates in massive cardiovascular events. The authors question whether cholesterol is truly the fundamental pathology. Glycation is not only problematic for individuals who are obviously overconsuming sugar, especially in the obese, but also in thinner individuals whose sugar habit is not so obvious. Edwards and Malik advise keeping the blood glucose below 85 mg% and having a hemoglobin A1c of less than 4.6. When these numbers are high, Edwards and Malik would call for a strict reduction in sugar and carbohydrates as well as appropriate supplementation to reduce them. They would also advise the use of EDTA chelation to remove toxic element burden, but also to decrease glycation in the microcirculation.

Skin Detoxification for Kidney Disease

Dr. Jenna Henderson is a naturopathic physician who specializes in treating patients with kidney disease. I am very happy that she contributes her knowledge and experience writing articles for us. (It would be worthwhile to read her previous articles; go to www.townsendletter.com, roll over the “Article” tab, go to “Search recent indices,” and then search for Jenna Henderson.) One of the major difficulties in managing patients with chronic kidney disease is that when prescribing intravenous therapies and recommending supplementation one may aggravate the kidney pathology – after all, the damaged nephrons must remove the vitamins, minerals, amino acids, and other chemicals. Henderson has established guidelines for working with kidney patients to be able to safely support them naturopathically. The bottom line remains whether or not the BUN and creatinine worsen with treatment. Any treatment worsening those indices must be prohibited.

Henderson’s discussion of kidney skin detox is a variation of hydrotherapy. Benedict Lust and other old-timer naturopaths employed hot and cold water treatments as a mainstay of their healing therapies. As conventional medicine adopted the “new” wonder drugs early in the 20th century, allopaths reached for the prescription pads and operated on patients, abandoning dietary approaches and hydrotherapy. Still, water treatment remained a mainstay for naturopathy through much of the past 100 years until more recently, when NDs have been compelled to utilize “evidence-based” medicine.

Soaking in a bath of Epsom salts and apple cider vinegar does not seem very scientific. Yet Henderson argues that the skin is a major excretory organ, eliminating a significant amount of urea and other waste products. A lengthy bath would be very useful for the patient having chronic renal failure especially when dialysis is not available. Henderson notes that even when dialysis is available, the additional bathing would be useful for the renal patient’s quality of life. And I would imagine it would benefit most of us who do not have kidney problems as well.

Jonathan Collin, MD

Notes

1. Hahn D. A Cure for Asthma. People’s Pharmacy Press; 2013.

2. Hahn DL, Dodge R, Golubjatnikov R. Association of Chlamydia penumoniae (strain TWAR) infection with wheezing, asthmatic bronchitis and adult-onset asthma. JAMA. 1991;166:225–230.