Many readers emailed questions about my recent article, “Unhealthy Olympians—Who’s to Blame.” Several asked about asthma, and some said it appeared to be a common problem. Yes, asthma is a common condition in athletes, and one associated with reduced health.
Asthma is a chronic respiratory condition characterized by episodes or attacks of impaired breathing. Symptoms are caused by chronic inflammation and narrowing of the airways going into and out of the lungs. Shortness of breath, coughing, wheezing, and chest pain are the most common complaints of asthmatics.
Asthma is a treatable condition—but I’m not talking about using drugs to treat symptoms, but improving the overall health of the body to eliminate the problem. (Of course, proper medication may sometimes be temporarily needed for some patients, but with improving health, reduction, then elimination, of drug therapy can occur when it’s no longer necessary.)
Many environmental triggers are known to activate asthmatic symptoms, such as cold air, chlorine, food and other allergies and even working out (leading to the so-called “exercise-induced asthma” name), but these don’t cause asthma. Since it’s difficult to say what really causes the condition (it’s not genetics), we have to take a different approach in helping patients with the problem—that is to improve overall health.
In general, healthy people don’t have asthma. So improving the overall health of those who do have the condition can help eliminate it. That’s been my approach in treating many patients with asthma.
Of course, it could be said that most health conditions—from the majority of physical injuries and intestinal problems to fatigue and high blood pressure could be successfully eliminated when the individual significantly improves his or her overall health. Healthy people, athletes included, don’t have fatigue, allergies, sleep problems, blood sugar problems, or asthma. While the main focus of most athletes is fitness, improving overall health has many possible benefits—in addition to eliminating chronic conditions such as asthma, improved health can also enhance performance.
The Centers for Disease Control and Prevention (CDC) report that about eight percent of Americans have asthma. But in some sports, especially the endurance community, there is a much higher incidence of asthma.
Recent data collected by Pascale Kippelen and colleagues at Brunel University, Uxbridge, UK, and a number of other universities worldwide (British Journal of Sports Medicine. 2012; 46(7): 471–476), showed that in the past five summer and winter Olympic Games, about 8 percent of athletes had asthma, making it the most common chronic medical condition experienced by Olympians. Higher asthma appears in cross country skiers (15%), and swimmers and cyclists (17%). While lower levels are seen in downhill skiers and divers (both about 4%), triathletes had the highest rates of asthma—about 25 percent.
Most of these Olympians used inhalers (beta 2-agonists), which dilate the bronchial passageways into the lungs to improve their breathing. Athletes taking asthma medications have consistently outperformed their peers (those who were not asthmatic and taking medication).
In 2009, the World Anti-Doping Agency (WADA) started removing asthma medications from its list of unapproved drugs. First was salbutamol, then, in 2012, formoterol was taken off this list. The reason is that, despite asthmatics on medication outperforming their peers, the WADA found the laboratory research linking these prescription drugs to improved performance was not sufficiently significant.
While research has not provided useful clues as to the cause of asthma (probably because it’s so variable and individual), many clinicians have. Throughout my career, asthma was not an uncommon complaint in athletes visiting my clinic. In most cases, eliminating the condition could be accomplished in those making the appropriate changes necessary to improve their health. These included dietary, environmental, stress and other lifestyle factors.
Perhaps the three most common problems associated with asthma in these athletes included the trio of overtraining, chronic inflammation and carbohydrate intolerance. Although, in a clinical sense, as these three problems are usually interconnected, addressing only one or two health issues often did not reduce asthma symptoms. Below is a summary of these problems and their remedies. (My other articles and books describe these and other issues in more detail, helping individuals determine their specific needs.)
Overtraining is often misunderstood, and in its first stage many athletes (and coaches) either don’t recognize the problem or won’t accept that they are in this physiological impaired state. The image of an overtrained athlete is typically portrayed by an exhausted, broken down, defeated person, unable to train or perform as expected. But this appearance is more typical of the third of three stages of overtraining. Less serious injuries, illness and poor performance is common in the second stage, and often gets the attention of most athletes. But initially, the onset of overtraining is subtle, with less serious injuries, illness, and, if carefully assessed, the onset of reduced aerobic function and fat burning. Because this first stage is the start of an imbalanced, overactive sympathetic nervous system, improved performances can temporarily occur, giving the mistaken impression that training is going well.
The two most common areas of impairment in overtrained athletes, in all stages, include the intestinal track and the immune system. Studies show that in elite athletes, reduced immune function is responsible for 30 to 40 percent of visits to healthcare professionals. Reduced immunity, which can trigger allergies, is also strongly associated with asthma. In addition, more than half of all endurance athletes complain of some type of intestinal distress.
Of course, even more common than immune and gut problems in overtrained athletes are the end result physical injuries. This leads to the popular self-treatment by anti-inflammatory drugs to control symptoms. These drugs have been shown to impair recovery, along with muscle, intestinal and immune health. Aspirin, in particular, can worsen asthma.
This common body-wide problem is not only to blame for many physical injuries, such as tendonitis, arthritis and bursitis—“itis” referring to inflammation—but in asthmatics, inflamed bronchials. While overtraining itself could drive the body’s biochemical pathways into a chronic inflammatory state, the food we eat has a significant impact. In fact, the diet can manipulate the inflammatory mechanisms in our bodies as well as, if not better, than drugs.
In particular, the balance of oils consumed can directly affect the balance of inflammatory and anti-inflammatory chemicals produced throughout the body. The two most important oils are called omega-6 and omega-3.
Too many omega-6 and or too few omega-3 oils in the diet poses the biggest problem for chronic inflammation. The most popular omega-6 foods are vegetable oils, including soy, peanut, safflower, sunflower, corn and canola. These may contribute to more inflammatory chemicals than any other single food. Because of their impact on inflammation, eliminating these oils is very important if you want to improve overall health. Replacing them with extra virgin olive oil, coconut oil, butter or ghee, is simple. But many packaged and especially restaurant foods contain high amounts of vegetable oils.
Reduced intakes of omega-3 fats are very common and another reason for high incidences of chronic inflammation. The most important oil is from fish, which contains EPA. While most people don’t eat enough fresh fish containing these oils, relying on a dietary supplement of EPA from fish oil can help significantly balance the omega-6 and -3 ratio.
Other factors influence the ability of dietary fats to control chronic inflammation. These include avoiding excess stress, and adequate nutrition best obtained from a healthy diet high in plant foods. Refined carbohydrates can also significantly contribute to chronic inflammation.
The overfat epidemic, which has expanded into the athletic community, is driven in large part by the overconsumption of refined carbohydrates. These high glycemic foods include bread, cereals, pasta, potatoes, energy bars, sports drinks and other foods and products made from refined wheat flour, and the various forms of processed sugar (from sucrose to high fructose corn syrup).
Consumption of these foods increases the release of the hormone insulin, which, in addition to increasing the body’s inflammatory chemicals, can also impair the process of fat burning and increase stored body fat.
It’s not uncommon for asthmatics to rave about how well they feel after performing the Two Week Test, with a significant reduction—or complete elimination—of symptoms. In addition, because allergic responses are common triggers in those with asthma, hidden wheat allergies appear to be a significant issue in this condition.
It’s imperative that anyone seeking optimal health significantly reduce or ideally eliminate refined carbohydrates. (The use of sugar-based products during long endurance competition is usually not a problem since insulin production is minimized in these situations.)
A Note on Choline
In addition to fish oil supplementation, choline is commonly required in higher amount in those individuals with asthma. Choline is an essential nutrient, often associated with the B vitamins (but not officially defined as such). Aside from liver, the best food source is egg yolk.
Important for brain, muscle, and liver function, choline can also help the nervous system control proper bronchial action, perhaps due to its anti-inflammatory effects.
In most asthmatics I’ve treated, a moderate to high dose of supplemental choline may be needed initially: for example, 500 mg several times daily until breathing improves and dietary choline is increased.
Improving ones overall health is the best treatment for asthma. While this is an individual issue, overtraining, chronic inflammation, and carbohydrate intolerance may be the three most common problems in athletes with asthma.