The Internist 1998 (Sept); 5 (3): 14–16 ~ FULL TEXT
by Mitchell Chavez, BS CN
Thanks to the ACA's Council On Family Practice for their permission to reprint this article exclusively at Chiro.Org
Asthma affects approximately 10 million people in the U.S.A.
The most common populace is children under the age of
This disease has had an increased occurrence of over 29% within
the last twelve years.
United States mortality rates have also increased by a staggering
31%, with blacks requiring hospitalization twice as often as
The pathophysiology of asthma generally includes, but is not
(1) bronchial spasm and/or constriction of smooth muscle tissue
due to a reduced production of cyclic adenosine monophosphate
(cAMP) resulting in a reduction of airways diameter;
(2) inflammation, via edema, of bronchial mucosa;
(3) increased mucus production (this is a precursing symptom to
bacterial infection, often resulting in bronchitis or bacteria
(4) cellular allergic factors such as eosinophilia, results in
inflammation of airways. This allergic mechanism is almost
always mediated by platelet activating factor (PAF) and histamine
(to a lesser extent) and will often result in bronchial
At Last, An Alternative's Alternative
The compounds in this "alternative protocol" apply to the four
major aspects of the disease as described above; without the
side-effects of orthodox treatments.
Other alternative treatments often implement and/or advocate the
usage of botanical compounds such as ma huang (Ephedra
sinensis and its subspecies), cola nut (also known as bissy
nut), and green tea. These botanicals are rich sources of
sympathetic amines such as ephedrine, and methylxanthines such as
caffeine and theophylline. Side-effects such as
hyperactivity, hypertension, reduction in peripheral circulation,
diuresis, and tachycardia have all been demonstrated by these
indigenous plant constituents.
The efficacy of magnesium, pyridoxine, cobalamin, Coleus
forskholii, and Ginkgo biloba have all been
established and validated many times over, by multiple studies
via peer-reviewed journals. These anti-asthmatic
compounds are completely free of any hidden source of potentially
stimulating alkaloids such as: caffeine, theophylline and
Magnesium: An Unsung Hero
Magnesium is extremely effective in the relaxation of bronchial
smooth muscle tissue, resulting in a reduction of bronchospasm
and increased airways diameter. Magnesium is a critical
cofactor in cellular biochemistry areas such as production of
adenosine triphosphate (ATP) and cyclic adenosine monophosphate
(cAMP) are mediated by magnesium status. By competitive
inhibition of ionized calcium (which induces smooth muscle tissue
constriction via the elevation of cyclic guanine monophosphate),
magnesium has been shown to relax bronchial smooth muscle tissue.
Magnesium has also been demonstrated to reduce the histamine
response. Patients who suffer from allergy related asthma
often show excessive eosinophilic and basophilic histamine
release which ultimately results in bronchoconstriction.
The "dulling" of magnesium to the histamine response might be due
to a correction and/or increase in tryptophan metabolism, via the
Various nutritional and lifestyle practices have been shown to
have a negative effect on cellular magnesium levels.
Factors include: chronic caffeine and alcohol consumption,
dieting, and prescription diuretics such as hydrochlorothiazide,
furosemide, and bumetanide. Ironically, studies have
shown asthma medications such as theophylline and the beta
agonists (such as albuterol and metaproterenol) can cause
magnesium wasting. This may result in exacerbation of the overall
Vitamin B6: The Critical Catalyst
Pyridoxine, commonly refered to as vitamin B6, is a critical
co-enzyme in human biochemistry, areas such as production of
adenosine triphosphate (ATP) and cyclic adenosine monophosphate
(cAMP) are mediated by cellular pyridoxal and magnesium status.
ATP and cAMP have been shown to promote relaxation of
bronchial smooth muscle tissue, resulting in an increase of
airways diameter. Vitamin B6 also plays a critical role
in the utilization of various amino-acids such as L-tryptophan
and L-tyrosine and is therefore the key co-enzyme in the
synthesis of neurotransmitters such as: serotonin, adrenaline,
Unfortunately, most medications commonly prescribed have been
demonstrated to potentially induce pyridoxine deficiency, again
exacerbating the asthma. Some of these pharmaceutical
agents include: theophylline (an oral methylxanthine), albuterol
(an inhaled beta-adrenergic agonist) and prednisone (an oral
steriod form of cortisone).
In one study, patients were given 50 mg of vitamin B6 twice daily
and reported a dramatic decrease in frequency and severity of
Vitamin B-12: The Anti-Sulfite Agent
In several clinical trials, supplementation with cobalamin
(vitamin B12) has been demonstrated to improve the overall asthma
condition by reducing its severity and frequency.
This is especially true with pediatric asthma, which is often a
result of sulfite-sensitivity. Jonathan V. Wright, MD of
Kent, Washington, believes "B12 therapy is the mainstay in
Vitamin B12 has been shown to induce the production of a
sulfite-cobalamin complex, which blocks the allergic effects of
sulfites. It has also been proposed that the oxidative
action of vitamin B12 is able to block the sulfite-induced
bronchospasm associated with chronic allergy related
Coleus Forskholii: Bronchodilation Ayurvedic Style
As an Ayurvedic herb used for centuries, Coleus forskholii
has been traditionally used for respiratory disorders, painful
urination, and various heart conditions. This botanical
medicine has been scientifically demonstrated to be a rich source
of biologically active compounds including a diterpene molecule
known as forskolin.
Forskolin has been demonstrated by many studies to potentiate and
activate the enzyme adenyl cyclase. This enzyme is the
critical catalyst in the production and conversion of magnesium
mediated adenosine triphosphate (ATP) to cyclic adenosine
monophosphate (cAMP) and is also antagonistic to the production
of guanyl cyclase.
Calcium has been shown to increase levels of guanine triphosphate
and cyclic guanine monophosphate (cGMP) (via guanyl cyclase),
thus resulting in smooth muscle tissue constriction.
Studies have shown that relaxation of bronchial smooth muscle
tissue is dependent on intra-cellular cAMP production.
Since forskolin is not a sympathomimetic amine or central nervous
system stimulant (e.g. ephedrine and theophylline), it's
mechanism of action is free of the side-effects (e.g.
tachycardia, hypertension, anorexia, etc.) common to sympathetic
agents generally prescribed.
Ginkgo Biloba For Intelligent Breathing
Commonly referred to as the plant kingdom's oldest living fossil,
Ginkgo biloba's existence can be traced back over 200
million years. The Ginkgo tree is planted throughout the
United States primarily as an ornament, often as city landscape
along roadsides. A single tree may easily reach the age
of one thousand years with great resistance to insects, disease,
and pollution. The traditional use of Ginkgo, in China,
has almost always been related to lung function, blood
circulation, longevity, and/or mental performance.
To date, Ginkgo biloba is the most widely prescribed
phyto-pharmaceutical in the world, with over two hundred
published studies and abstracts validating the herb's efficacy.
Clinical indications include cerebral vascular
insufficiency, Raynaud's Phenomenon, and asthma. All of these
diseases have common components: a physiological need for an
increase in micro-circulation and reduction or inhibition of
The biologically active compounds occur primarily in the leaves
of the Ginkgo tree and are classified as ginkgo-flavoneglycosides
and terpenoids. The flavonoid (ginkgo-flavoneglycoside)
class includes: the molecules kaempferol, isohamnetin, and
quercitin. The terpenoid class is further broken down
into two subclasses as ginkgolides and bilobalides. The
major ginkgolide factors are A, B, and C.
The terpenoids have been demonstrated in a multitude of research
to be potent inhibitors of PAF, resulting in increased
micro-circulation and reduction of the inflammatory response.
Other constituents such as the ginkgo-flavoneglycosides,
have been shown to improve capillary integrity and strengthen
Studies have demonstrated maximum efficacy is achieved at 120 mg.
total per day as 24% ginkgo-flavoneglycosides and 6%
Review and Conclusion
Combination therapy utilizing the compounds previously discussed
could be the best approach for the chronic asthmatic patient;
especially pediatric situations where stimulating modalities (eg.
theophylline and ephedrine) may cause a range of side-effects.
Implementing magnesium, pyridoxine, cobalamin, Coleus
forskholii, and Ginkgo biloba as long-term therapy
could not only provide prophylactic benefits, but would also
yield a multi-faceted approach.
Bronchodilation, increased production of cAMP, reduction of the
histamine response, and the blocking of sulfite sensitivity, have
all been demonstrated to minimize the frequency and severity of
asthma attacks. Magnesium, pyridoxine, cobalamin,
Coleus forskholii, and Ginkgo biloba; a novel,
unique, and non-invasive therapy for the asthma patient.
Brunner, E.H. et al.
Effect of parenteral
magnesium on pulmonary function, plasma cAMP, and histamine in
Journal of Asthma, 22:3-11,
Treatment of childhood asthma
with parenteral vitamin B12, gastric reacidification, and
attention to food allergy, magnesium and pyridoxine: Three case
reports with background, and integrated hypothesis.
Journal of Nutritional Medicine, 1:277-282, 1990.
Mathew, R. et al.
The role of magnesium in
lung diseases: Asthma and Allergy.
Magnesium and Trace Elements, 10(24):220-228,
Khilnani, G. et al.
Hypomagnesemia due to beta 2-agonist use in bronchial asthma.
Journal of the Association of Physicians of India,
Rolla, G. et al.
histamine-induced bronchoconstriction by magnesium in asthmatic
Allergy, 42(3):186-188, 1987.
Collip, P.J. et al.
Pyridoxine treatment of
Annals of Allergy, 35:93-97, 1975.
Ubbink, J.B. et al.
The relationship between
vitamin B6 metabolism and asthma.
Annals of the New York Academy of Sciences, 585:285-294,
Weir, M.R. et al.
Depression of vitamin B6
levels to theophylline.
Annals of Allergy, 65:59-62, 1990.
Vitamin B12 therapy in allergy
and chronic dermatoses.
Journal of Allergy, 2:183-185, 1951.
Anibarro, B. et al.
Asthma with sulfite
intolerance in children: A blocking study with cyanocobalamin.
Journal of Allergy and Clinical Immunology,
Kreutner, W. et al.
antiallergy activity of forskolin.
European Journal of Pharmacology, 111:1-8, 1985
Lichey, J. et al.
Effect of forskolin on
methacholine-induced bronchoconstriction in extrinsic
Lancet ii, p.167, 1984
The ginkgolides: Potent
platelet-activating factor antagonists from Ginkgo biloba.
Chemistry, pharmacology, and clinical applications.
Drugs of the Future, 12:643-699, 1987
V Klein, P. V
Study on the inhibitory activity
of Ginkgo biloba extract. PAF-induced platelet aggregation.
Therapiewoche, 38:2379-2383, 1988
V Kleijen, J. and Knipschild, P. V
Lancet, 340:1136-1139, 1992.
Return to the DISEASE Section
Return to ChiroZINE ARCHIVES
Return to the PEDIATRICS Section
Return to the GINGKO BILOBA Page
Return to the NUTRITION Archives Section
Return to the CHIROPRACTIC AND ASTHMA Page